Objectives: Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%–70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods: The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results: Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRSrelated conditions.

Chondrolipoma is a benign tumor composed of mature adipose tissue and mature chondrocytes, and very rarely found. The patient, a 36-year-old woman, presented with a firm, walnut sized, mild tender mass at her left knee. There had been dull pain after long walking. There were no limitation of motion in physical examination. On plane lateral radiograph, radioopaque calcific densities were seen in elliptical soft tissue shadow below inferior pole of the patella. Magnetic resonance image demonstrated well defined mass of mixed signal intensity consistent with fat tissue and cartilaginous tissue. Gross specimen showed that the tumor appeared to be a round, encapsulated and firm nodule with milky whitish yellow cut surface. Microscopically the tumor consisted of nodular cartilage and mature fat tissue. The cartilage cells did not show mitotic figure and were often arranged in small clusters. But there were no cytologic features of malignancy. Thus the authors diagnosed this tumor as chondrolipoma, and report it with the literature review.
Adipose Tissue ; Adult ; Cartilage ; Chondrocytes ; Female ; Humans ; Juglans ; Knee* ; Patella ; Physical Examination ; Walking

BACKGROUND: Shift work disturbs workers' biological clocks and this condition can cause various health problems including cardiovascular disease. The elevated albuminuria level has been significantly associated with the risk of the cardiovascular disease even within a normal reference range. Therefore, this study aimed to investigate the association between shift work and microalbuminuria. METHODS: Workers aged over 20 years from the fifth and sixth Korea National Health and Nutrition Examination Survey(KNHANES 2012–2014; n = 3000) were included in this analysis. The multiple logistic regression analysis was performed to determine the association between shift work and microalbuminuria stratified by gender. RESULTS: The prevalence of microalbuminuria in male subjects was higher among day workers, but the difference was not significant. However, the prevalence of microalbuminuria among females was higher in shift workers with statistical significance. For female, the Odds ratio of microalbuminuria in shift workers was significantly higher with 1.86 (95% CI 1.02–3.39) compared with day workers. After dividing into 5 subgroups of the shift work pattern, the odds ratio of microalbuminuria for fixed night shift was significantly higher at 4.68 (95% CI 1.29–17.00) compared with day workers. CONCLUSIONS: This study showed that shift work was associated with microalbuminuria in female workers. Especially we found out the association between fixed night shift and microalbuminuria in female workers.
Albuminuria ; Biological Clocks ; Cardiovascular Diseases ; Female ; Humans ; Korea ; Logistic Models ; Male ; Odds Ratio ; Prevalence ; Reference Values

BACKGROUND: Cleanroom air is extremely dry, as it is maintained within 1 % of relative humidity. Few studies have assessed the dermatologic life quality of workers in ultralow-humidity environments. Therefore, we aimed to evaluate the dermatologic life quality of cleanroom workers using the Skindex-29, compared to those of non-cleanroom workers. METHODS: Study participants were 501 cleanroom workers and 157 non-cleanroom workers from a secondary battery factory, who underwent an employee health examination at a single university hospital from September 2014 to September 2015. Results of the self-administered Skindex-29, and McMonnies questionnaire were analyzed. Other information and disease history were also collected during physician's medical examination. Descriptive and multivariate logistic regression analysis were performed. RESULTS: The Skindex-29 score was significantly higher in cleanroom workers than in non-cleanroom workers for all domains, Symptom (16.0 ± 15.9 vs. 6.3 ± 10.2, p < 0.001), Emotion (11.3 ± 17.4 vs. 2.5 ± 7.4, p < 0.001), Function (5.2 ± 11.1 vs. 1.6 ± 4.0, p < 0.001), and Overall (10.8 ± 13.4 vs. 3.5 ± 6.2, p < 0.001). The Skindex-29 score of cleanroom workers was similar to that of patients with skin diseases such as psoriasis, other dermatitis, corns, alopecia etc. Among the cleanroom workers, 37 workers had one or more skin diseases. Among the risk factors, ‘working at cleanroom’, ‘possessing skin disease’ and ‘McMonnies score’ had significant strong correlations with Skindex-29 score, meanwhile age, sex, smoking, drinking and exercise had weak correlations with it.‘Working at cleanroom’ and ‘possessing skin disease’ had highest odds ratios with overall 14.0 (C.I.: 5.9–33.1) and 13.4 (C.I.: 4.5–29.2), and the lowest odds ratios with function domain 3.5(C.I.: 1.7–7.1) and 4.5(C.I.: 2.1–9.5), respectively. The McMonnies score had the highest odds ratio with overall, 6.9(C.I.: 4.5–10.8) and lowest odd ratio with emotion domain 4.2 (C.I.: 2.7–6.4). CONCLUSIONS: Dermatologic life quality among cleanroom workers in the secondary battery factory is shown to be lower than that among non-cleanroom workers in this study. The study suggests that the Skindex-29 may provide helpful information on the dermatologic life quality of cleanroom workers. Therefore, regarding evaluation of dermatologic life quality using Skindex-29, preventive care is necessary for cleanroom workers in ultralow humidity environment.
Alopecia ; Callosities ; Dermatitis ; Drinking ; Humans ; Humidity ; Logistic Models ; Occupational Health ; Odds Ratio ; Psoriasis ; Quality of Life* ; Risk Factors ; Skin ; Skin Diseases ; Smoke ; Smoking ; Zea mays

BACKGROUND: Lead and cadmium have been identified as risk factors for hearing loss in animal studies, but large-scale studies targeting the general human population are rare. This study was conducted to investigate the link between heavy metal concentrations in blood and hearing impairment, using a national population-based survey. METHODS: The study participants comprised 6409 Koreans aged 20 or older, who were included in the Fifth and Sixth Korea National Health and Nutrition Examination Surveys (KNHANES 2010–2013). Hearing impairment was categorized into two types, low- and high-frequency hearing impairment, using pure tone audiometry. Low-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 0.5, 1, and 2 kHz exceeding 25 dB, and high-frequency hearing impairment was defined as having a binaural average of hearing thresholds for 3, 4, and 6 kHz exceeding 25 dB. The blood levels of heavy metals (lead and cadmium) were classified into quartiles. Cross-sectional association between hearing impairment and the level of heavy metals (lead and cadmium) was examined in both sexes. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Among men, the prevalence of low- and high- frequency hearing impairment was 13.9% and 46.7%, respectively, which was higher than the prevalence among women (11.8% and 27.0%, respectively). Regarding lead, the adjusted OR of high-frequency hearing impairment for the highest blood level group versus the lowest group was significant in both men (OR = 1.629, 95% CI = 1.161–2.287) and women (OR = 1.502, 95% CI = 1.027–2.196), after adjusting for age, body mass index, education, smoking, alcohol consumption, exercise, diagnosis of diabetes mellitus, hypertension, and noise exposure (occupational, loud, firearm noises). No links were found between blood lead levels and low-frequency hearing impairment, or between blood cadmium levels and low- or high-frequency hearing impairment in either sex. CONCLUSIONS: The present study findings suggest that even exposure to low-level lead is a risk factor for high-frequency hearing loss. A prospective epidemiologic study should be conducted to identify the causal relationship between human health and exposure to heavy metals, and efforts to reduce heavy metal exposure in the general population should continue.
Alcohol Drinking ; Animals ; Audiometry ; Body Mass Index ; Cadmium ; Diabetes Mellitus ; Diagnosis ; Education ; Environmental Exposure ; Epidemiologic Studies ; Female ; Hearing Loss ; Hearing Loss, High-Frequency ; Hearing ; Humans ; Hypertension ; Korea ; Logistic Models ; Male ; Metals, Heavy ; Noise ; Nutrition Surveys ; Odds Ratio ; Prevalence ; Prospective Studies ; Risk Factors ; Smoke ; Smoking

Objective: Tracheal intubation is an essential procedure in many emergencies. Direct laryngoscopy is the best method of intubation, but its success is not assured in a difficult airway. This study was designed to compare the performance of two intubation-assisted maneuvers that can help an unskilled person to perform a successful intubation. Methods: A randomized crossover trial for intubation was conducted in three airway scenarios: normal airway, tongue edema (TE) and cervical immobilization (CI). Sixty paramedic students performed intubation on a manikin using single operator intubation (SM), external laryngeal manipulation (ELM), and colleague assisted laryngoscopic maneuver (CALM). The degree of the visual field, intubation success rate, time to ventilation (TTV), tooth fracture, and difficulty of intubation were measured. Results: There was no statistically significant difference in success rates between the three intubation methods, except in CI, where CALM had a significantly higher success rate (91.7%) as compared to ELM (78.3%) and SM (71.7%). There was no significant difference in TTV between the three intubation methods in all scenarios. However, with an improvement in the degree of visual field with ELM and CALM, evaluated using the Cormack-Lehane classification system, there was a statistically significant improvement in both TE and CI. Tooth fractures were lowest when CALM was used. The degree of difficulty felt by operators during intubation also tended to be lower in CALM than other methods, particularly, in CI. Conclusion For a novice, intubation using CALM was on par or better than ELM in the manikin study. And CALM was a more effective assistive method, specifically in CI cases.

Objective: Tracheal intubation is an essential procedure in many emergencies. Direct laryngoscopy is the best method of intubation, but its success is not assured in a difficult airway. This study was designed to compare the performance of two intubation-assisted maneuvers that can help an unskilled person to perform a successful intubation. Methods: A randomized crossover trial for intubation was conducted in three airway scenarios: normal airway, tongue edema (TE) and cervical immobilization (CI). Sixty paramedic students performed intubation on a manikin using single operator intubation (SM), external laryngeal manipulation (ELM), and colleague assisted laryngoscopic maneuver (CALM). The degree of the visual field, intubation success rate, time to ventilation (TTV), tooth fracture, and difficulty of intubation were measured. Results: There was no statistically significant difference in success rates between the three intubation methods, except in CI, where CALM had a significantly higher success rate (91.7%) as compared to ELM (78.3%) and SM (71.7%). There was no significant difference in TTV between the three intubation methods in all scenarios. However, with an improvement in the degree of visual field with ELM and CALM, evaluated using the Cormack-Lehane classification system, there was a statistically significant improvement in both TE and CI. Tooth fractures were lowest when CALM was used. The degree of difficulty felt by operators during intubation also tended to be lower in CALM than other methods, particularly, in CI. Conclusion For a novice, intubation using CALM was on par or better than ELM in the manikin study. And CALM was a more effective assistive method, specifically in CI cases.

PURPOSE: This study aimed to elucidate whether stone removal by extracorporeal shock wave lithotripsy (ESWL) is associated with delayed chronic kidney disease (CKD) progression. MATERIALS AND METHODS: We conducted a retrospective analysis of 131 nephrolithiasis patients with stage 3 and 4 CKD. We collected baseline clinical and laboratory data, kidney stone characteristics, and history of receiving ESWL. We classified study patients into two groups according to whether they underwent ESWL or not (Non-ESWL group vs. ESWL group). We initially compared annual estimated glomerular filtration rate (eGFR) changes of Non-ESWL group with those of ESWL group before undergoing ESWL. In the next step, we sought to compare annual eGFR changes in the same patients before and after ESWL. Finally, we compared annual eGFR changes between success and failure groups among patients undergoing ESWL. RESULTS: The mean age of the patients was 62 years and 72.5% were male. The mean observation period was 3.2 years. Non-ESWL group and ESWL group before undergoing ESWL showed similar annual eGFR changes (-1.75+/-6.5 vs. -1.63+/-7.2 mL/min/1.73 m2/year, p=0.425). However, eGFR declined slower after undergoing ESWL than before ESWL (annual eGFR changes, -0.29+/-6.1 vs. -1.63+/-7.2 mL/min/1.73 m2/year, p<0.05). In addition, among patients in ESWL group, eGFR declined faster in the failure group than in the success group (annual eGFR change, -1.01+/-4.7 vs. -0.05+/-5.2 mL/min/1.73 m2/year, p<0.05). CONCLUSION: Our results suggest that stone removal by ESWL is associated with delayed deterioration of renal function in CKD patients with nephrolithiasis.
Adult ; Aged ; Aged, 80 and over ; Chronic Disease/*prevention & control ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Kidney Calculi/*therapy ; Kidney Diseases/*prevention & control ; Lithotripsy/*methods ; Male ; Middle Aged ; Retrospective Studies

We evaluated on the calculation accuracy of treatment planning system (TPS) with phantom having convex and concave surface. The TPS is Eclipse (Varian, USA) using both algorithms AAA and PBC for photon dose calculations. PBC algorithms have three corrections of Batho, modified Batho (M-Batho), and equivalent TAR (E-TAR). The field sizes were 10x10 cm2 and 20x20 cm2, and MLC-shaped fields for these fields. We measured doses at three depths 5, 10 and 15 cm in phantom of SSD=90 cm in the condition of inserted farmer chamber. For given conditions, we have calculated dose with these algorithms and compared them with measured doses. In AAA the calculated doses (dose/MU) were agreed to measured doses within +/-1% in flat and convex surface and were under estimated with -1.9% maximum in concave surface. In PBC the calculated doses were over estimated with +1.7% and +4.1% respectively in flat and convex surface and the differences were from -3.1% to +2.1% in concave surface. In comparison of criteria from AAPM and IAEA reports, and statistical analysis for these results, it is found that the AAA's results are in good agreement with measured values and the M-Batho's results are generally good agreed with measured values among PBC algorithms.
Water

PURPOSE: In patients with diabetic end stage renal disease (ESRD), glycated albumin (GA) reflects recent glycemic control more accurately than glycated hemoglobin (HbA1c). We evaluated the relationship between GA and average blood glucose (AG) level and developed an estimating equation for translating GA values into easier-to-understand AG levels. MATERIALS AND METHODS: A total of 185 ESRD patients, including 154 diabetic and 31 non-diabetic participants, were enrolled (108 hemodialysis, 77 peritoneal dialysis). Patients were asked to perform four-point daily self-monitoring of capillary blood glucose (SMBG) at least three consecutive days each week for four weeks. Serum levels of GA, HbA1c and other biochemical parameters were checked at baseline, as well as at 4 and 8 weeks. RESULTS: Approximately 74.3+/-7.0 SMBG readings were obtained from each participant and mean AG was 169.1+/-48.2 mg/dL. The correlation coefficient between serum GA and AG levels (r=0.70, p<0.001) was higher than that of HbA1c and AG (r=0.54, p<0.001). Linear regression analysis yielded the following equation: estimated AG (eAG) (mg/dL)=4.71xGA%+73.35, and with this formula, serum GA levels could be easily translated to eAG levels. Multivariate analysis revealed significant contributions of postprandial hyperglycemia (beta=0.25, p=0.03) and serum albumin (beta=0.17, p=0.04) in determining serum GA level, independent to other clinical parameters. CONCLUSION: Compared to HbA1c, serum GA levels were better correlated with AG levels. Using the estimating equation, an average blood glucose level of 155-160 mg/dL could be matched to a GA value of 18-19% in patients with ESRD.
Adolescent ; Adult ; Aged ; Blood Glucose/*metabolism ; Female ; Humans ; Kidney Failure, Chronic/*blood/metabolism ; Male ; Middle Aged ; Prospective Studies ; Serum Albumin/*metabolism ; Young Adult