OBJECTIVES: Early intensive interventions are very important for children with autism spectrum disorder. We examined the actual conditions of hospital-based early intensive interventions for autism spectrum disorder in Seoul, in order to help develop and implement an evidence-based early intensive intervention model for use in Korea. METHODS: Nine hospital-based institutes running an early intensive intervention program for children with autism spectrum disorder responded to a questionnaire in September 2014. They provided a brief introduction to their program, explained its theoretical bases, and reported the number of children, their age, intervention time, duration and so on. RESULTS: In the majority of the institutions, the intervention was provided for over 20 hours every week, and the theoretical bases included various applied behavioral analysis (ABA) methods and other therapies (language and occupational therapy). The therapist-child ratio ranged from 1:1 to 5:3. Various types of therapists were involved, including behavioral analysts, special education teachers and (or) language pathologists. There was only one clinic where the behavioral analyst was the main therapist. Usually, the intervention was terminated just before the child entered elementary school. The main merit of the hospital-based intervention in our survey was the effectiveness of the multi-disciplinary intervention plan and its other merits were the accuracy of the diagnosis, its ability to be combined with medicine, and so on. CONCLUSION: The current hospital-based early intensive intervention programs provide interventions for over 20 hours per week and employ multidisciplinary approaches. However, there are very few institutes for children with autism and very few intervention specialists and specialist education courses in the country. We need more educational programs for intervention therapists and have to try to develop policies which encourage the implementation of an evidence-based early intensive intervention program nationwide.
Academies and Institutes ; Autism Spectrum Disorder* ; Autistic Disorder* ; Child ; Diagnosis ; Education ; Education, Special ; Humans ; Korea* ; Running ; Seoul ; Specialization

BACKGROUND AND OBJECTIVES: Compared to other target cells examined for gene therapy, vascular smooth muscle cells (VSMCs) have the unique advantages including proximity to blood stream and relative abundance in vasculature. With an ultimate goal of developing VSMC-based therapies for cardiovascular disorders, we explored the utility of VSMC as a target cell for ex vivo gene therapy using a set of retroviral vectors. MATERIALS AND METHODS: Cultured VSMCs were transduced with replication-defective recombinant retroviruses harboring LacZ, nlsLacZ, mVEGF, mGM-CSF or bacterial CAT reporter. The VSMCs were examined for G418-selection, transduction efficiency, the level of transgene expression, and longevity of gene expression. ResultsVSMCs were readily transduced with different kinds of retroviral vectors. The bacterial neo r gene-transduced VSMCs were successfully selected with G418. The G418-selected VSMCs could express the transduced genes at a level comparable to NIH3T3. The level of transgene expression did not appear to be affected by the increasing number of passages. CONCLUSION: The results demonstrate an efficient transduction of VSMCs by retroviral vectors in vitro and an sustained expression of retrovirally transduced genes in VSMCs. VSMCs could be one of the ideal target cells for ex vivo cardiovascular gene therapy employing retroviral vector.
Animals ; Cats ; Gene Expression ; Genetic Therapy* ; Longevity ; Muscle, Smooth, Vascular* ; Retroviridae ; Rivers ; Transgenes ; Zidovudine

Nephrotic syndrome is associated with proteinuria, hypoalbuminemia, edema, hyperlipidemia, and thromboembolic complications. Thromboembolic complications of nephrotic syndrome are common, especially in the renal vein, while cerebral venous thrombosis is a less frequent complication of minimal change nephrotic syndrome. The pathophysiology remains unclear, but various changes in coagulant and anticoagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with nephrotic syndrome. A 19-year-old man was admitted with a headache and nausea. Cerebral thrombosis was diagnosed on brain computed tomography and magnetic resonance imaging. He recovered gradually after treatment with anticoagulants and achieved control of the nephrotic syndrome. A discussion of this case, coupled with a review of the literature, emphasizes that an early diagnosis is essential for anticoagulation therapy and a successful outcome.
Anticoagulants ; Brain ; Early Diagnosis ; Edema ; Headache ; Humans ; Hyperlipidemias ; Hypoalbuminemia ; Intracranial Thrombosis ; Magnetic Resonance Imaging ; Nausea ; Nephrosis, Lipoid ; Nephrotic Syndrome ; Proteinuria ; Renal Veins ; Thrombosis ; Venous Thrombosis ; Young Adult

BACKGROUND: It has been suggested that all components of the renin-angiotensin-aldosterone system (RAAS) are present in the vascular wall and that the vascular RAAS modulates vascular tone and vascular hypertrophy. One of the catalytic step in the RAAS cascade is the local conversion of angiotensin I to angiotensin II (Ang II) by angiotensin converting enzyme (ACE). One of the major sources of ACE in the vasculature is vascular smooth muscle cells (VSMC). Here, we provide insight into the intrinsic mechanisms by which the components of RAAS regulate gene expression of ACE in cultured smooth muscle cells of the rat and we also investigated the effects of cytokines on ACE mRNA. METHODS: RNA was extracted from the primary cultured VSMCs. We analyzed the expression levels of ACE by competitive reverse transcription-PCR using recombinant RNA as an internal standard. RESULTS: 1) ACE mRNA level was increased markedly by aldosterone in a dose- and time-dependent manner, indicating that there exists positive feedback mechanism within RAAS. 2) The induction of ACE mRNA by aldosterone was inhibited by spironolactone. 3) Aldosterone-stimulated expression of ACE was also inhibited by Ang II, which shows that Ang II acts as a negative regulator of the expression of ACE in RAAS cascade. 4) Interleukin-1beta or TNF-alpha did not induce ACE mRNA expression. 5) However, mixture of interleukin-1betaand TNF-alpha(CytoMix) significantly increased the expression of ACE. It was also shown that CytoMix increased aldosterone-stimulated ACE mRNA expression in an additative manner. CONCLUSION: These results indicate that the expression of ACE in smooth muscle cells is modulated by the components of RAAS and cytokines. The intrinsic positive and negative feedback controls of RAAS would play an important role in the pathogenesis of vascular diseases.
Aldosterone* ; Angiotensin I ; Angiotensin II ; Angiotensins* ; Animals ; Cytokines* ; Gene Expression ; Hypertrophy ; Interleukin-1beta ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Peptidyl-Dipeptidase A* ; Rats ; Renin-Angiotensin System ; RNA ; RNA, Messenger ; Spironolactone ; Tumor Necrosis Factor-alpha* ; Vascular Diseases

Acute renal failure caused by rifampin typically occurs on intermittent administration or reintroduction of the drug. However, acute kidney injury (AKI) due to rifampin has been rarely reported to occur in patients receiving a continuous rifampin therapy. We have experienced a case of acute interstitial nephritis during the first course of standard anti-tuberculous therapy, including continuous rifampin therapy in daily dose. Forty-five-year-old male, who had been being treated with anti-tuberculous medication including rifampin (600 mg/day), was admitted to our hospital because of generalized edema and dyspnea by acute renal failure. His past medical history was unremarkable. Since the creatinine level was still elevated in 10 days after cessation of rifampin, we performed renal biopsy. The renal pathologic findings revealed acute interstitial nephritis. After that, the patient symptom was relieved and serum creatinine level was decreased without specific therapy. The renal function was recovered at 1 month after withdrawal of rifampin. We report a case of acute interstitial nephritis complicated with the first daily rifampin therapy, along with the review of literature.
Acute Kidney Injury ; Biopsy ; Creatinine ; Dyspnea ; Edema ; Humans ; Male ; Nephritis, Interstitial ; Renal Insufficiency ; Rifampin

OBJECTIVES: The aim of this study was to investigate the relationship between metabolic syndrome and cognitive functions among chronic schizophrenia patients. METHODS: The survey participants were 105(40 metabolic syndrome and 65 non-metabolic syndrome) chronic schizophrenia patients at Yang-san Hospital. Each score of cognitive test(A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, stroop test), Positive and Negative Syndrome Scale, Hamilton rating scale for Depression were assessed. Statistical analysis of the relationship between various tests of A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet and metabolic syndrome were performed using ANCOVA and logistic regression. RESULTS: Schizophrenia patients with lower score on construction praxia were likely to be included in Metabolic syndrome group. However, there were no significant relationships in other tests between the two groups. CONCLUSION: This study found metabolic syndrome caused cognitive decline in chronic schizophrenia patients, especially Construction praxia. This study could be a basis to show metabolic syndrome has to be treated appropriately in schizophrenia patients and suggests the necessity of following longitudinal designed study.
Alzheimer Disease ; Depression ; Humans ; Logistic Models ; Schizophrenia*

PURPOSE: To evaluate the prevalence of bladder neck contracture (BNC) and its risk factors in patients undergoing radical prostatectomy in Korea. MATERIALS AND METHODS: We analyzed data from 488 patients with prostatic cancer who underwent radical prostatectomy performed by seven surgeons in seven hospitals, including 365 open radical prostatectomies (ORPs), 99 laparoscopic radical prostatectomies (LRPs), and 24 robot-assisted laparoscopic radical prostatectomies (RARPs). Patients with BNCs were compared with those without BNCs to identify the risk factors for BNC occurrence. RESULTS: Overall, BNCs occurred in 21 of 488 patients (4.3%): 17 patients (4.7%) who underwent ORP, 4 patients (4%) who underwent LRP, and no patients who underwent RARP. In the univariate analysis, men with BNCs had a longer length of time before drain removal (12 days vs. 6.8 days, p<0.001), which reflected urinary leakage through the vesicourethral anastomosis. In the multivariate analysis, the length of time before drain removal was the only predictor of BNC (odds ratio, 1.12; p=0.001). Intraoperative blood loss was higher in patients with BNC, but the difference was not statistically significant. CONCLUSIONS: The most significant factor related to BNC occurrence after radical prostatectomy in our study was the length of time before drain removal, which reflects urinary leakage from the vesicourethral anastomosis. The proper formation of a watertight anastomosis to decrease urinary leakage may help to reduce the occurrence of BNC.
Contracture ; Humans ; Male ; Multivariate Analysis ; Neck ; Prevalence ; Prostatectomy ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder ; Urinary Bladder Neck Obstruction

Prostate cancer is the most common type of male cancer worldwide. Although radical prostatectomy (RP) is advised for prostate cancer in patients with a life expectancy of more than 10 years by various guidelines, most elderly men still do not undergo the procedure regardless of increasing life expectancy. This study aimed to determine whether RP is suitable for patients with prostate cancer aged 75 years or older. A retrospective study of patients who underwent RP at 6 institutions between 2005 and 2012 was conducted. Patients were divided into 2 groups at the time of surgery: 65-69 years (younger group) and 75 years or older (older group). We compared clinical characteristics, pathological results, complication rates, and recurrence-free survival between the two groups. Compared with the younger group, the older group had significantly higher preoperative serum prostate-specific antigen level, pre- and postoperative Eastern Cooperative Oncology Group (ECOG) performance status grade, hypertension prevalence, and Gleason score at biopsy and RP. However, except urinary incontinence, there were no statistically significant differences in the peri- and post-operative complications. After median follow-up periods of 36 months (younger group) and 40 months (older group), the biochemical recurrence-free survival rates were not significantly different (P = 0.581). Although the urinary incontinence rate was higher in the older group, RP was a suitable option for selected Korean men aged 75 years or older with limited complication rates and excellent outcomes similar to those for patients aged 65-69 years.
Age Factors ; Aged ; Biopsy ; Disease-Free Survival ; Humans ; Hypertension/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/mortality/pathology/*surgery ; Republic of Korea ; Retrospective Studies

BACKGROUND: Although a significant number of studies were done on focal segmental glomerulosclerosis(FSGS), its pathogenesis has not been sufficiently established yet. Recent studies suggested certain types of circulating factor(s) played an important role in development and recurrence after renal transplantation of FSGS by modifying the glomerular permeability of albumin. The purpose of this study performed on animals and through molecular-biological experiments is to certify the role of circulating factor (s), which cause proteinuria, by manipulating plasma of a FSGS patient who showed massive of proteinuria and wide effacement of glomerular epithelial foot processes in histologic examination after renal transplantation. also, whose massive proteinuria decreased significantly after plasma exchange. METHODS: The patient's plasma prior to(plasma A) or post to(plasma B) plasma exchange were injected into tail veins of two groups of male Sprague-Dawley rats, six in each. The ratio of 24 hour urine protein and urine creatinine(Uprt/Ucr) was calculated for each case. The 2D gel electrophoresis was performed in plasma A and plasma B. The pattern of 2D gel electrophoresis of plasma A was compared to those of plasma B and healthy human serum. RESULTS: Compared to control group, there was no significant differences in 24-hour Uprt/Ucr afer injecting 1, 2, 3, 5 mL of plasma A(p>0.05). There was no significant difference in 24-hour Uprt/Ucr between the injecting groups of plasma A and plasma B(p>0.05). We were not able to observe any new protein which did not appear in plasma B or healthy human serum in 2D gel electrophoresis. CONCLUSION: These results suggest that the proteinuria developed in a few hours after renal transplantation and is related to wide effacement of glomerular epithelial foot processes, and that it may be induced by a certain factor which is eliminated by the plasma exchange or restrained by the immunosuppressive agents. However, we were not able to find certain circulating factor(s) which rapidly changes albumin permeability in the patient's plasma with FSGS.
Animals ; Electrophoresis, Gel, Two-Dimensional ; Foot ; Glomerulosclerosis, Focal Segmental* ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Male ; Permeability ; Plasma ; Plasma Exchange ; Proteinuria ; Rats, Sprague-Dawley ; Recurrence ; Veins

OBJECTIVE: It is well known that treatment with quetiapine can easily cause somnolence and daytime sleepiness in patients with bipolar disorder. Such sedation may be the discomfort to the drug in terms of patient's perspectives and results in drug noncompliance. This study was aimed to investigate the effect of 6-week quetiapine monotherapy on subjective aspects of sleep in patients with acute bipolar disorder. METHODS: In a Korean multi-center, open-label, 6-week study, patients with a DSM-IV diagnosis of bipolar I disorder (manic or mixed episodes) were included to treatment with quetiapine. The dose of quetiapine initially started at 200 mg/day and rapid titrated up to 800 mg/day within day 7 according to the clinical judgements. Clinical improvement was evaluated using Young Mania Rating Scale (YMRS) and Clinical Global Impression-Bipolar version (CGI-BP). Extrapyramidal side effects were measured by Simpson-Angus Rating Scale (SARS) and Barnes Akathisia Rating Scale (BARS). The overall subjectively reported adverse events were gathered during the study period. Subjective sleep questionnaire modified from Leeds Sleep Evaluation Questionnaire (LSEQ) was used to assess the subjective measures of sleep, which included the aspects covering the ease of getting to sleep (GTS), quality of sleep (QOS) and hangover behavior next day (HOV). All assessments were done at baseline and days 7, 14, 21 and 42 after treatment with quetiapine. Analyses were focused to compare the differences between pre-drug baseline and post-treatment with quetiapine. RESULTS: Total 78 (male=30, female=48) patients were included and most of them were inpatients (N=59, 74.7%). Fifty-nine (75.9%) patients were completed the study. Mean changes of YMRS from baseline were significant at days 7, 14, 21 and 42. There were no significant differences from baseline in SARS and BARS at any assessment points. The common subjectively reported adverse events were somnolence, dizziness and dry mouth. While mean changes of 5 items measuring nighttime sleep (GTS and QOS) from baseline were significantly improved at days 7, 14, 21 and 42, those of HOV were not differed between baseline and post-treatment assessments. CONCLUSION: Data showed that quetiapine monotherapy had favorable effect on acute manic symptoms and well tolerated. Also this result suggests that quetiapine monotherapy may improve the self-perceived quality of sleep without any daytime impairment following sleep in acute manic patients.
Bipolar Disorder ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dizziness ; Humans ; Inpatients ; Mouth ; Psychomotor Agitation ; Surveys and Questionnaires ; Quetiapine Fumarate