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

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

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

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

Recent studies have reported that cognitive inflexibility associated with impairments in a frontal-striatal circuit and parietal region is a core cognitive deficit of obsessive-compulsive disorder (OCD). However, few studies have examined progressive changes in these regions following clinical improvement in obsessive-compulsive symptoms. To determine if treatment changes the aberrant activation pattern associated with task switching in OCD, we examined the activation patterns in brain areas after treatment. The study was conducted on 10 unmedicated OCD patients and 20 matched controls using event-related functional magnetic resonance imaging. Treatment improved the clinical symptoms measured by the Yale-Brown Obsessive Compulsive Scale and behavioral flexibility indicated by the switching cost. At baseline, OCD showed significantly less activation in the dorsal and ventral frontal-striatal circuit and parietal regions under the task-switch minus task-repeat condition compared with controls. After treatment, the neural responses in the ventral frontal-striatal circuit in OCD were partially normalized, whereas the activation deficit in dorsal frontoparietal regions that mediate shifting attention or behavioral flexibility persisted. It is suggested that altered brain activation in ventral frontal-striatal regions in OCD patients is associated with their cognitive flexibility and changes in these regions may underlie the pathophysiology of OCD.
Adult ; Basal Ganglia/*metabolism ; Behavioral Symptoms/drug therapy ; Female ; Frontal Lobe/*drug effects/physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Obsessive-Compulsive Disorder/*drug therapy/physiopathology ; Parietal Lobe/*drug effects/physiopathology

Self expandable metal stent can be used both as palliative treatment for malignant colorectal obstruction and as a bridge to surgery in patients with potentially resectable colorectal cancer. Here, we report a case of successful relief of malignant stomal obstruction using a metal stent. A 56-year-old man underwent loop ileostomy and was given palliative chemotherapy for ascending colon cancer with peritoneal carcinomatosis. Eight months after the surgery, he complained of abdominal pain and decreased fecal output. Computed tomography and endoscopy revealed malignant stomal obstruction. Due to his poor clinical condition, we inserted the stent at the stomal orifice, instead of additional surgery, and his obstructive symptoms were successfully relieved. Stent insertion is thought to be a good alternative treatment for malignant stomal obstruction, instead of surgery.
Abdominal Pain ; Carcinoma ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colorectal Neoplasms ; Endoscopy ; Humans ; Ileostomy ; Middle Aged ; Palliative Care ; Stents

BACKGROUND: Hypoglycemia is the most common therapeutic complication of diabetes mellitus and especially in elderly diabetic patients with diminished cardiac and cerebral circulation can cause serious tissue damage. Though many studies have attempted to evaluate hypoglycemia in IDDM or adult diabetic patients, few studies in the elderly. We have compared clinical characteristics of severe hypoglycemia in elderly diabetes with adult diabetes. METHODS: This study include 56 severe hypoglycemic patients who have admitted to emergency department of National Medical Center from march 1, 1992 to december 31, 1997. they are divided two group (adult group; 21, elderly group; 35) and authors investigate the cause, the symptom, the time of severe hypoglycemia, degree of education, treatment method in each group. RESULTS: 1) DM education was not well done in severe hypoglycemic patients. 2) The frequency of severe hypoglycemia in the elderly was more than adult (adult: 21 (38%), elderly 35 (62%)). 3) In both population, the most common symptom of severe hypoglycemia was neuroglycopenic symptom, especially in the elderly (adult: 57%, elderly: 77%). 4) Decreased food intake (49%) in the elderly and overdose of insulin (38%) in the adult were the most common cause of severe hypoglycemia. 5) Severe hypoglycemia occurred more often between midnight and 6 AM in the adult, between noon and 6 PM in the elderly. 6) The treatment of diabetes mellitus is insulin (71%) and oral hypoglycemic agent (29%) in the adult, oral hypoglycemic agent (51%) and insulin (49%) in the elderly. CONCLUSION: For prevention of severe hypoglycemia, we should emphasize the importance of DM education and especially elderly diabetic patients should be educated about the symptoms of hypoglycemia, the self-management of hypoglycemia, the need for a regular carbohydrate intake and more easy and effective diet program is require in elderly diabetes.
Adult ; Aged* ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diet ; Eating ; Education ; Emergency Service, Hospital ; Humans ; Hypoglycemia* ; Insulin ; Self Care

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