BACKGROUND: Some research viewed that effective dietary therapy was enough to control proper blood glucose level, but in the most patient, dietary therapy was not practiced and the most difficult part of managing their diabetes. The purpose of this research study was to investigate dietary practice adherence and perceived barriers among the elderly diabetes. METHODS: The survey was mailed to 852 persons with diabetes member via diabetic educator of 156 hospitals or clinics and 24 health centers. Questionnaire had background information of patients, meal regularity, food intake as a dietary practice adherence, barriers of 36 items which have 3 areas such as motive/attitude, knowledge, authority/resource. We asked the person with diabetes to rate barrier to dietary practice adherence. 432 questionnaire were returned the response. we selected 69 persons who were over 65 year old. RESULTS: 1) meal regularity was more satisfactory than food intake. 2) deficit of meal regularity were evening snack and resonable spacing between evening meal and evening snack. 3) deficit of food intake was serving of milk. 4) main barrier to dietary practice adherence was that of knowledge. CONCLUSION: For practice effectively dietary therapy to elderly diabetes, individual consultation or small group education must be pursued and more easily educational skills should be required.
Aged* ; Blood Glucose ; Eating ; Education ; Humans ; Meals ; Milk ; Postal Service ; Surveys and Questionnaires ; Snacks

Individuals at ultra-high-risk (UHR) for psychosis have become a major focus for research designed to explore markers for early detection of and clinical intervention in schizophrenia. In particular, structural magnetic resonance imaging studies in UHR individuals have provided important insight into the neurobiological basis of psychosis and have shown the brain changes associated with clinical risk factors. In this review, we describe the structural brain abnormalities in magnetic resonance images in UHR individuals. The current accumulated data demonstrate that abnormalities in the prefrontal and temporal cortex and anterior cingulate cortex occur before illness onset. These regions are compatible with the regions of structural deficits found in schizophrenia and first-episode patients. In addition, the burgeoning evidence suggests that such structural abnormalities are potential markers for the transition to psychosis. However, most findings to date are limited because they are from cross-sectional rather than longitudinal studies. Recently, researchers have emphasized neurodevelopmental considerations with respect to brain structural alterations in UHR individuals. Future studies should be conducted to characterize the differences in the brain developmental trajectory between UHR individuals and healthy controls using a longitudinal design. These new studies should contribute to early detection and management as well as provide more predictive markers of later psychosis.
Brain/abnormalities/*pathology ; Gyrus Cinguli/pathology ; Humans ; Longitudinal Studies ; *Magnetic Resonance Imaging ; Predictive Value of Tests ; Psychotic Disorders/diagnosis/*pathology ; Risk Factors ; Temporal Lobe/pathology

OBJECTIVE: High cholesterol level is a risk factor for coronary artery disease, and coronary artery disease is a major risk factor for out-of-hospital cardiac arrest (OHCA). However, the effect of cholesterol level on outcomes of OHCA has been poorly studied. This study aimed to determine the effect of cholesterol level on outcomes of OHCA.METHODS: This cross-sectional study used the CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance) project database in Korea. Multivariable conditional logistic regression analysis was performed to estimate the effect of cholesterol level on outcomes in OHCA.RESULTS: In all, 584 cases of OHCA were analyzed; those with cholesterol levels <120 mg/dL were classified as having low total cholesterol (TC) (n=197), those with levels ranging from 120–199 mg/dL as middle TC (n=322), and those with ≥200 mg/dL as high TC (n=65). Compared to low TC, more patients with middle TC and high TC survived to discharge (9.1% vs. 22.0% and 26.2%, respectively, P=0.001). The good cerebral performance category also increased in that order (4.1 % vs. 14.6% and 23.1%, respectively, P≤0.001). Comparing middle TC and high TC with low TC, adjusted odds ratios (95% confidence intervals) were 1.97 (1.06 to 3.64) and 2.53 (1.08 to 5.92) for survival to discharge, respectively, and 2.53 (1.07 to 5.98) and 4.73 (1.63 to 13.71) for good neurological recovery, respectively.CONCLUSION: Higher cholesterol is associated with better outcomes in OHCA; cholesterol level is a good predictor of outcomes of OHCA.
Cholesterol ; Coronary Artery Disease ; Cross-Sectional Studies ; Heart Arrest ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Out-of-Hospital Cardiac Arrest ; Risk Factors

OBJECTIVES: The purpose of this study was to examine structural abnormalities of brain in patients with pathological gambling(PG) using voxel-based morphometry. METHODS: We compared gray matter(GM) volumes between 10 patients with PG and 14 age- and IQmatched healthy controls and examined the relationship of GM volumes with clinical variables in patients with PG. RESULTS: We found significant increase of GM volume in the superior, middle, and inferior frontal gyri, the midbrain, the middle temporal gyrus, the precuneus, and the fusiform gyrus of patients with PG. A significant decrease of GM volume was observed in the parahippocampal gyrus and the lingual gyrus of the patient group. In addition, GM volumes in some of these regions were positively associated with South Oaks Gambling Screen score and negatively with age of onset in patients with PG. CONCLUSION: Current findings indicate that structural abnormalities in the fronto-temporal cortex, the midbrain, and the precuneus might be involved in the pathophysiology of PG, and contribute to some of the behavioral changes observed in patients with PG.
Age of Onset ; Brain ; Gambling ; Humans ; Mesencephalon ; Parahippocampal Gyrus

Sarcomatoid carcinomas are rare neoplasms that have been described using various terms, pseudosarcoma, carcinosarcoma or spindle cell carcinoma. Sarcomatoid carcinomas are epithelial tumors with sarcomatoid components and characterized by the presence of cytokeratin in pleomorphic spindle cells. These tumors of gallbladder rarely have been reported predominantly in older women with associated gallstones and their prognosis was very poor. However, the clinical and histological data are very limited. We report a case of sarcomatoid carcinoma in gallbladder confirmed by light microscopy and immunohistochemistry.
Carcinosarcoma ; Female ; Gallbladder* ; Gallstones ; Humans ; Immunohistochemistry ; Keratins ; Microscopy ; Prognosis

OBJECTIVE: Genetic imaging is used to investigate the mechanism by which genetic variants influence brain structure. In a previous study, a structural change of the dorsolateral prefrontal cortex was associated with symptom modulation in post-traumatic stress disorder patients. This study examined the effect of a polymorphism in the gene encoding brain-derived neurotrophic factor (BDNF) on regional gray matter (GM) volumes and the correlations between the dorsolateral prefrontal GM volume and the stress level in healthy volunteers. METHODS: Sixty-one volunteers underwent genotyping for the BDNF Val66Met single nucleotide polymorphism (SNP) and completed the Stress Response Inventory (SRI). Magnetic resonance images were also acquired, and the effect of each subject's BDNF genotype and SRI subscore on his or her dorsolateral prefrontal GM volume was evaluated. RESULTS: The Val/Val homozygotes had significantly larger GM volumes in the prefrontal cortex and the precuneus, the uncus, and the superior temporal and occipital cortices than Met carriers. The Met homozygotes demonstrated a higher stress response in depression domain than Val/Val and Val/Met groups. A negative correlation between the middle frontal cortex GM volume and the SRI depression subscore was found. CONCLUSION: These findings indicate an interaction between genes and brain structure, and they suggest that differences in dorsolateral prefrontal GM volume related to the BDNF Val66Met SNP are associated with resilience to stressful life events, particularly in the dimension of emotion.
Brain ; Brain-Derived Neurotrophic Factor ; Depression ; Genotype ; Homozygote ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prefrontal Cortex ; Stress Disorders, Post-Traumatic

BACKGROUND: Atrial fibrillation(AF) is the common and importand arrhythmia in the eldery. Because the distribution of cardiovascular disease changes according to age group and era, the distribution of underlying diseases in patients with AF also tends to change. The purpose of this study is to identify the difference between the eldery(> or = 65yr) and the young adult(<65yr) patients with AF in distribution of underlying disease. METHODS: 218 patients with AF diagnosed by routine EKG and Holter minitoring from Jan. 1996 to Dec 1998 in National Medical Center was evaluated. Their medical records were reviewed retrospectively in aspect of age, sex, developmental form & underlying disease of AF. In detail. last two subjects were investigated in two separate age group and at the same time, relation between them studied. RESULTS: The majority of age group with AF was 65~74yr(40.4%) and the eldery patient was 59.7%. Acute paroxysmal form and chronic persistent form was 21.1% and 78.9% respectively. There was no significant difference in development form of AF between the eldery and young adult group(chi2=1.45, p=0.227) The common underlying disease were hypertension(33.4%), congestive heart failure(32.1%), rheumatic valvular heart diseas(20.2%). ischemic heart disease(14.2%), hyperthyroidism(6.9%), COPD(4.1%), and lone AF(10.1%). In the eldery patients. hypertension is the most common underlying disease(42.3%) and congestive heart failure, ischemic heart disease, rheumatic valvular heart disease, and COPD were 36.2%, 21.5%, 10.8%, 6.9% respectively. In the young adult group-, rheumatic valvular heart disease was the most common(34%), and congestive heart failure, hypertension, ischemic heart disease, and hyperthyroidism were 26.1%, 20,5%, 3.4%, 10.2% respectively(chi2 = 62.71, p = 0.000). wheares ischemic heart disease, COPD, hyperthyroidism, stress, trauma, acute alcohol intoxication and lone AF were more common in acute paroxysmal AF, but hypertension, congestive heart failure, reumatic valvular heart disease were more common in chronic persistent AF(chi2 = 93.75, p = 0.000). CONCLUSION: Among underlying disease of AF. hypertension, congestive heart failure, ischemic heart disease were markedly increased and rheumatic valvular heart disease was decreased than previous reports in Korea. Hypertension, congestive heart failure, ischemic heart disease, COPD were more common in the eldely and as to rheumatic valvular heart disease, hyperthyroidism, and lone AF were in the young adult. Thus it showed significant difference in underlying desease between the eldery & the young adult as well as acute paroxysmal & chronic persistent form.
Aged* ; Arrhythmias, Cardiac ; Cardiovascular Diseases ; Electrocardiography ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Heart Valve Diseases ; Humans ; Hypertension ; Hyperthyroidism ; Korea ; Medical Records ; Myocardial Ischemia ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Young Adult

OBJECTIVE: The functional strategic mechanisms in the brain during performing visuospatial working memory tasks, especially tasks with heavy load, are controversial. We conducted the functional magnetic resonance imaging (fMRI) while sixteen subjects were performing face- and location-matching n-back tasks to examine causal relations within the frontoparietal networks. METHODS: We applied a sophisticated method, the structural equation modeling (SEM), to the fMRI data. The imaging data were analyzed by extracting the task-related eigenseries using the principal component analysis (PCA) and then by applying a form of data-driven model called the automated search method. RESULTS: The SEM analyses revealed a functional shift of network connectivity from the right to the left hemisphere with increasing load in the face-matching n-back tasks while the location-matching tasks required bilateral activation. In the locating matching n-back tasks, a pattern of parallel processing was observed in the left phonological loop and the right inferior parietal regions. Furthermore, object working memory-related activities in the left hemisphere reliably contributed to performance of both the face- and location-matching 2-back tasks. CONCLUSION: Our results are consistent with previous reports in terms of demonstrating parallel and distributed information processing during performing working memory tasks with heavy loads. Our results additionally suggest a dynamic shift between the fast imagery circuit (right hemisphere) and the stable verbal circuit (left hemisphere), depending on task load.
Automatic Data Processing ; Brain ; Magnetic Resonance Imaging ; Memory, Short-Term ; Principal Component Analysis

BACKGROUND/AIMS: In patients with occlusive colorectal cancers, a complete preoperative evaluation of the colon proximal to the obstruction is often impossible. We aimed to evaluate the feasibility of preoperative colonoscopy after stent placement and to determine whether the success rate of colonoscopy differs between covered and uncovered stents. METHODS: Seventy-three patients with malignant colorectal obstruction were enrolled prospectively. In patients with a resectable cancer, a preoperative colonoscopy was performed after insertion of a self-expandable metal stent (SEMS). The success rate of complete preoperative colonoscopy was compared between covered and uncovered stents. RESULTS: Forty-five of 73 patients who underwent stent placement had a resectable cancer (61.6%). A complete preoperative colonoscopy was possible in 40 of 45 patients (88.9%). The success rate of complete preoperative colonoscopy was significantly lower in the covered-stent group when the obstructing mass lesion was located in the sigmoid colon (p=0.024). Synchronous cancer was detected in one patient (2.2%). Stent migration was observed in four patients with a covered stent. CONCLUSIONS: A preoperative complete colonoscopy after SEMS placement was feasible and safe in most patients with malignant colorectal obstruction. Uncovered stents seem to have more advantages than covered stents in preoperative colonoscopy proximal to the obstruction.
Colon ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Neoplasms, Multiple Primary ; Prospective Studies ; Stents

OBJECTIVE: Executive dysfunction might be an important determinant for response to pharmacotherapy in obsessive-compulsive disorder (OCD), and could be sustained independently of symptom relief. The anterior cingulate cortex (ACC) has been indicated as a potential neural correlate of executive functioning in OCD. The present study examined the brain-executive function relationships in OCD from the ACC-based resting state functional connectivity networks (rs-FCNs), which reflect information processing mechanisms during task performance. METHODS: For a total of 58 subjects [OCD, n=24; healthy controls (HCs), n=34], four subdomains of executive functioning were measured using the Rey-Osterrieth Complex Figure Test (RCFT), the Stroop Color-Word Test (SCWT), the Wisconsin Card Sorting Test (WCST), and the Trail Making Test part B (TMT-B). To probe for differential patterns of the brain-cognition relationship in OCD compared to HC, the ACC-centered rs-FCN were calculated using five seed regions systemically placed throughout the ACC. RESULTS: Significant differences between the OCD group and the HCs with respect to the WCST perseverative errors, SCWT interference scores, and TMT-B reaction times (p<0.05) were observed. Moreover, significant interactions between diagnosis×dorsal ACC [S3]-based rs-FCN strength in the right dorsolateral prefrontal cortex for RCFT organization summary scores as well as between diagnosis×perigenual ACC [S7]-based rs-FCN strength in the left frontal eye field for SCWT color-word interference scores were unveiled. CONCLUSION: These network-based neural foundations for executive dysfunction in OCD could become a potential target of future treatment, which could improve global domains of functioning broader than symptomatic relief.
Automatic Data Processing ; Drug Therapy ; Executive Function ; Foundations ; Frontal Lobe ; Gyrus Cinguli ; Obsessive-Compulsive Disorder* ; Prefrontal Cortex ; Reaction Time ; Task Performance and Analysis ; Trail Making Test ; Wisconsin