OBJECTIVES: This study investigated whether long-acting injectable (LAI) paliperidone is different from its oral form in terms of the effect on cognitive function in schizophrenia spectrum and other psychotic disorders. METHODS: We reviewed the medical records of patients in Seoul National University Bundang Hospital who were diagnosed as having schizophrenia and/or other psychotic disorders based on DSM-5 from 2016 to 2017. Seven patients were treated with oral paliperidone and 11 were treated with paliperidone palmitate. All patients underwent clinical and neuropsychological assessment, including the Korean version of the MATRICS Consensus Cognitive Battery (MCCB) at their first visit or within one month of their initial treatment. MCCB was repeated within three to 12 months after the initial assessment. RESULTS: There was no significant difference between the two groups in most cognitive domains including speed of processing, attention and vigilance, working memory, verbal learning, visual learning and reasoning and problem solving domain. However, patients treated with paliperidone palmitate showed better improvement in social cognition domain than those taking oral paliperidone. The standardized values of social cognition domain scores had significantly improved over time in patients under paliperidone palmitate, demonstrating a significant time-by-group interaction. CONCLUSION: Our results show that long-acting injectable paliperidone could be helpful in some aspects of improving cognitive function in schizophrenia spectrum and other psychotic disorders. Further studies with other antipsychotics are necessary to generalize the results.
Antipsychotic Agents ; Cognition ; Consensus ; Humans ; Learning ; Medical Records ; Memory, Short-Term ; Paliperidone Palmitate ; Pilot Projects ; Problem Solving ; Psychotic Disorders ; Schizophrenia ; Schizophrenia Spectrum and Other Psychotic Disorders ; Seoul ; Verbal Learning

Ixeris dentata var. albiflora Nakai, a herbal plant, is often used to make a strong stomach as an antiphlogistic used when dyspepsia and to improve appetite in Korea and China. And also it is used for adult diseases such as diabetes and liver diseases as Korean traditional medicine. In this study, the composition and DPPH radical scavenging activities of the root of Ixeris dentata var. albiflora Nakai and its effects on cell viability on vero and chang cells were investigated. Moisture, crude ash, crude protein and crude lipid were 79.14, 2.49, 8.28 and 2.56 g/100 g respectively. The highest mineral content was K. The major free sugars were glucose, fructose and sucrose. Major fatty acid are linoleic acid, palmic acid and linolenic acid. Major amino acids were glutamic acid, arginine and aspartic acid and the total contents of amino acids were 28.12 mg/g. The methanol extracts were further fractionated with n-hexane, chloroform, ethylacetate, butanol and water to get an active fraction. In addition, cell viabilities in each fraction were determined. Methanol extract, butanol, and aqueous fraction showed strong survival rates in vero cell and chang cell viability test, and hexane, chloroform, and ethylacetate fraction were examined for toxin in a cell. The root of Ixeris dentata var. albiflora Nakai had scavenging activities against DPPH radicals in a dose-dependent assay. Ethylacetate fraction's SC50 was 6.8 microgram/mL, very strong DPPH radical scavenging activities, but water fraction did not show any activity.
Adult ; alpha-Linolenic Acid ; Amino Acids ; Appetite ; Arginine ; Aspartic Acid ; Asteraceae ; Carbohydrates ; Cell Survival ; China ; Chloroform ; Dyspepsia ; Fructose ; Glucose ; Glutamic Acid ; Hexanes ; Humans ; Korea ; Linoleic Acid ; Liver Diseases ; Medicine, Korean Traditional ; Methanol ; Plants ; Stomach ; Sucrose ; Survival Rate ; Vero Cells ; Water

Hirayama disease is a slowly progressing benign motor neuron disease that affects the distal upper limb. A 29-year-old man visited the hospital with a 1-year history of weakened left proximal upper limb. He was diagnosed with Hirayama disease 9 years ago, while there was no further progression of the muscle weakness afterward. Atrophy and weakness was detected in proximal upper limb muscles. Magnetic resonance imaging and somatosensory evoked potentials were normal. Needle electromyography showed abnormal findings in proximal upper limb muscles. Our patient had Hirayama disease involving the proximal portion through secondary progression. Clinical manifestation and accurate electromyography may be useful for diagnosis. Rare cases with progression patterns as described here are helpful and have clinical meaning for clinicians.
Adult ; Atrophy ; Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; Humans ; Magnetic Resonance Imaging ; Motor Neuron Disease ; Muscle Weakness ; Muscles ; Needles ; Upper Extremity

BACKGROUND: The blood level of alanine aminotransferase (ALT) is associated with increased coronary heart disease (CHD) risk. However, its use as an independent factor for CHD risk prediction remains unclear in Asian populations. The purpose of this study was to examine the association between serum ALT levels and CHD risk in Koreans. METHODS: This was a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (V-1, 2010 and V-2, 2011). The ALT levels of 3,215 individuals were analyzed. The Framingham Risk Score (FRS) modified by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) was used to compute the 10-year CHD risk prediction. RESULTS: Positive correlations were established between log-transformed ALT concentration and FRS (r=0.433, P<0.001). After adjusting for body mass index, low-density lipoprotein cholesterol, the amount of alcohol intake, and gamma-glutamyl transferase, the odds ratio (95% confidence interval) for intermediate or greater risk of 10- year CHD prediction (10-year risk ≥10%) for the lowest quartile of participants was 2.242 (1.405–3.577) for the second quartile, 2.879 (1.772–4.679) for the third quartile, and 3.041 (1.789–5.170) for the highest quartile. CONCLUSION: In Koreans, a higher serum ALT concentration was significantly correlated with 10-year CHD risk prediction according to NCEP ATP III guidelines.
Adenosine Triphosphate ; Adult ; Alanine Transaminase ; Alanine ; Asian Continental Ancestry Group ; Body Mass Index ; Cholesterol ; Coronary Disease ; Cross-Sectional Studies ; Education ; Humans ; Korea ; Lipoproteins ; Nutrition Surveys ; Odds Ratio ; Risk Factors ; Transferases

Purpose: To investigate the baseline characteristics in patients with diabetic macular edema (DME) during 7 years according to the need for additional treatments after intravitreal ranibizumab (RBZ) loading injections. Methods: The medical records of 32 patients treated with intravitreal RBZ loading for DME during 7 years were reviewed. After three-consecutive monthly RBZ injections, additional treatment was decided according to the patient’s response to RBZ loading. Based on whether the patients received treatment with or without additional injections, including intravitreal antivascular endothelial factor or steroid injection, they were divided into the “no add (NA)” or “add” groups, respectively. The baseline best-corrected visual acuity (BCVA), macular volume (MV), central subfoveal thickness, and other clinical factors were analyzed, and their 7-year changes were compared between the two groups. Results: The BCVA of the NA group was better than that of the add group at 2, 3, 5, and 7 years (year 2, 3, and 5; p < 0.01, respectively). Baseline MV was significantly smaller in the NA group than in the add group (10.72 ± 0.88 μm vs. 11.98 ± 1.64 μm, p = 0.008). The DME duration before treatment in the NA group was significantly shorter than in the add group (1.03 ± 0.98 years vs. 1.91 ± 1.33 years, p = 0.042). The proportion of patients with serous retinal detachment or cystic macular edema was significantly lower in the NA group than in the add group (35.3% vs. 73.3%, p = 0.042). The NA group had smaller MV until 2 years than the add group (year 1, p = 0.002; year 2, p = 0.006). Conclusions The DME patients without additional treatments during 7 years after the initial loading treatment had shorter duration of DME and diffuse retinal thickening morphologic type with lower MV at baseline, and better long-term visual prognosis.

PURPOSE: This study was designed to investigate the effects of information sharing between students on results of clinical performance examination (CPX). METHODS: 143 third-year students, who completed their core clinical clerkship, were randomly assigned to one day of a 3-day, 6 station CPX. Station checklists, scored by the SP(s), consisted of history taking, physical examination, information sharing, clinical courtesy and patient-physician interaction. We compared the CPX station scores, CPX domain scores, self assessment scores and GPA of the three groups tested on different days with ANOVA, and analyzed the differences in CPX scores, after controlling for GPA, with ANCOVA. The correlations among the CPX total and domain scores, self assessment and the GPA of the 3rd year students were calculated. Data regarding information sharing between students and self-assessment were obtained through student questionnaires. RESULTS: CPX total scores, self assessment scores and GPA of 3rd year students from day-2 were significantly higher than scores from day-1 or day-3. Checklist analysis showed that PE, CC and PPI scores were significantly higher on day-2, but Hx and IS scores were not significantly different. Results from questionnaires showed that 43% of students shared evaluation information. And CPX total scores had little correlation with self assessment scores. GPA of 3rd year students showed a similar pattern with the CPX totalscore. CONCLUSION: There is information sharing occurring between students during clinical performance examinations. Although there are significant differences in CPXscores for the treatment group, it seemed that CPX scores are not affected by information sharing between students. Reliability of information sharing from other students is low. The generalization of this study should be interpreted carefully.
Checklist ; Clinical Clerkship ; Generalization (Psychology) ; Humans ; Information Dissemination* ; Physical Examination ; Self-Assessment ; Surveys and Questionnaires

Purpose: To report a case of Vogt-Koyanagi-Harada-like syndrome that occurred during immunotherapy (pembrolizumab) in a patient with non-small-cell lung cancer (NSCLC).Case summary: A 64-year-old female visited our clinic complaining of decreased visual acuity in both eyes. The patient had NSCLC and had been prescribed immunotherapy (pembrolizumab) by the Department of Pulmonology. Fundus examination and optical coherence tomography revealed multiple intraretinal cysts and subretinal fluid in both eyes. After evaluation using fluorescein and indocyanine green angiography, Vogt-Koyanagi-Harada (VKH) disease was diagnosed in both eyes and oral prednisolone 40 mg/day was prescribed for 2 weeks. At an outpatient visit at that time, the symptoms had improved, and fundus examination and optical coherence tomography revealed decreases in the number of intraretinal cysts and the subretinal fluid level. Oral prednisolone was reduced to 20 mg/day for 2 weeks. At an outpatient visit at that time, the symptoms had further improved; no cysts or subretinal fluid were apparent on fundus examination or optical coherence tomography, and only a small amount of subretinal fluid was present near the macula of the right eye. Conclusions VKH disease may develop during immunotherapy (pembrolizumab) but can be rapidly diagnosed and treated with oral steroids.

When treating trauma patients with severe hemorrhage, massive transfusions are often needed. Damage control resuscitation strategies can be used for such patients, but an adequate fresh frozen plasma: packed red blood cell (FFP:PRBC) administration ratio must be established. We retrospectively reviewed the medical records of 100 trauma patients treated with massive transfusions from March 2010 to October 2012. We divided the patients into 2 groups according to the FFP:PRBC ratio: a high-ratio (> or =0.5) and a low-ratio group (<0.5). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. There were 68 patients in the high-ratio and 32 in the low-ratio group. There were statistically significant differences between groups in the quantities of FFP, FFP:PRBC, platelets, and crystalloids administered, as well as the initial diastolic blood pressure. Bloodstream infections were noted only in the high-ratio group, and the difference was statistically significant (P=0.028). Kaplan-Meier plots revealed that the 24-hr survival rate was significantly higher in the high-ratio group (71.9% vs. 97.1%, P<0.001). In severe hemorrhagic trauma, raising the FFP:PRBC ratio to 0.5 or higher may increase the chances of survival. Efforts to minimize bloodstream infections during the resuscitation must be increased.
Acute Lung Injury/epidemiology/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/epidemiology ; *Blood Transfusion/adverse effects ; *Erythrocyte Transfusion/adverse effects ; Female ; Hemorrhage/etiology/*prevention & control ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Patients ; Respiratory Distress Syndrome, Adult/epidemiology/etiology ; Resuscitation ; Retrospective Studies ; Wounds and Injuries/complications/mortality/*therapy ; Young Adult

Gemellae is a gram positive cocci that forms part of the oropharyngeal microflora in humans and is anaerobic to aerotolerant. Unlike the other members of the same genus, G. morbillorum rarely causes human infections. Recently, we experienced a case of tubo-ovarian abscess caused by G. morbillorum which was initially suspected to be actinomycosis associated with intrauterine device. This is the first case in the world on tubo-ovarian abscess with G. morbillorum as the culprit.
Abscess ; Actinomycosis ; Gemella ; Gram-Positive Cocci ; Humans ; Intrauterine Devices

Gemellae is a gram positive cocci that forms part of the oropharyngeal microflora in humans and is anaerobic to aerotolerant. Unlike the other members of the same genus, G. morbillorum rarely causes human infections. Recently, we experienced a case of tubo-ovarian abscess caused by G. morbillorum which was initially suspected to be actinomycosis associated with intrauterine device. This is the first case in the world on tubo-ovarian abscess with G. morbillorum as the culprit.
Abscess ; Actinomycosis ; Gemella ; Gram-Positive Cocci ; Humans ; Intrauterine Devices