OBJECTIVES: Psychiatry in North Korea is believed to seem very different from psychiatry in South Korea. However, there is nearly no information regarding psychiatry in North Korea until now. Our study aimed to get information about North Korean psychiatry. METHODS: Three North Korean defectors in South Korea, whose clinical experience as medical doctors in North Korea was over 10 years, were recruited. They underwent the semi-structured interview, content of which included the clinical experience with psychiatric patients, the details of psychiatry, the treatment of psychiatric patients, the stigma of mental illness, and the suicide, in North Korea. RESULTS: In North Korea, psychiatric department was called as 49th(pronounced as Sahsip-gu-ho in Korean). Only patients with vivid psychotic symptoms came to psychiatric department. Non-psychotic depression or anxiety disorders usually were not dealt in psychiatry. The etiology of mental illness seemed to be confined to biological factors including genetic predisposition. Psychosocial or psychodynamic factors as etiology of mental illness appeared to be ignored. Psychiatry was apparently separated from political or ideological issues. The mainstay of psychiatric treatment is the inpatient admission and out-of-date therapy such as insulin coma therapy. Stigma over mental illness was common in North Korea. Suicide is considered as a betrayal to his/her nation, and has been reported to be very rare. CONCLUSION: The situation of psychiatry in North Korea is largely different from that of South Korea. Although some aspects of North Korean psychiatry are similar to psychiatry in former socialist countries, North Korean psychiatry is considered to have also its unique characteristics.
Anxiety Disorders ; Biological Factors ; Convulsive Therapy ; Democratic People's Republic of Korea ; Depression ; Genetic Predisposition to Disease ; Humans ; Inpatients ; Porphyrins ; Republic of Korea ; Suicide

To evaluate the degree of competitive exclusion against Salmonella gallinarum(S. gallinarum) of Salmonella enteritidis(S. enteritidis) infected chickens, fifty-six, 4-week old Hyline layer suspected of S. enteritidis infection were challenged with S. gallinarum. All chickens were tested for S. enteritidis isolation using cloacal swabs and serum plate agglutination test using S. enteritidis Ag. before challenge and classified into four groups(SE isolated, SE nonisolated, SE seropositive and SE seronegative). None of the SE isolated and the SE seropositive groups died after challenge and the average weight gains were 245.5g and 254.6g, respectively. But in the SE nonisolated and the SE seronegative groups, mortality was 18.2% and 20.6% and the average weight gains were 150.1g and 111.2g. The incidence of reisolation of S. gallinarum of the SE isolated and the SE seropositive groups were 41.7% and 47.6% from liver, 33.3% and 47.6% from spleen and 8.3% and 14.3% from cecum, respectively, and the SE nonisolated and the SE seronegative group were 63.6% and 64.7% from liver, 84.1% and 88.2% from spleen and 47.7% and 52.9% from cecum. The serological response of the SE isolated and the SE seropositive groups hardly changed from 75.0 and 81.8% before challenge to 75.0 and 85.7% after. But, the other two groups were found to be significantly higher after challenge and increased from 0 and 18.2% to 100%. Consequently, S. enteritidis preinfected chickens were found to be significant different in terms of mortality, weight gain, reisolation of S. gallinarum and serological response compared to noninfected chickens. Moreover, our study shows that S. enteritidis infected chickens appear strong competitive exclusion against the colonization of S. gallinarum.
Animals ; Chickens ; Disease Outbreaks/veterinary ; Korea/epidemiology ; Oviposition ; Poultry Diseases/*microbiology ; Salmonella/*classification/*isolation & purification ; Salmonella Infections, Animal/*microbiology ; Salmonella enteritidis/*classification/*isolation & purification ; Serotyping ; Weight Gain

Background: Post-operative pain is unpleasant for patients and may worsen surgical recovery.Peri-operative multimodal analgesia has been used for many years; however,its efficacy still needs improvement.In the present study,a thorough peri-operative pain counseling and stratified management program based on risk assessment was implemented,with the goal of improving post-operative analgesia and patient satisfaction.Methods: This prospective,controlled,pilot study included 361 patients who underwent elective surgery.Of these 361 patients,187 received peri-operative pain risk assessment and stratified analgesia and counseling(stratified analgesia group),while 174 received conventional multimodal analgesia(conventional group).The two groups were compared regarding the post-operative pain intensity,rescue analgesia administration,post-operative quality of recovery as assessed via the quality of recovery 40 questionnaire,total dosage of peri-operative opioids,analgesic satisfaction,and analgesic costs.Results: Compared with the conventional group,the stratified analgesia group reported decreased pain intensity during motion at 24 h post-operatively and required lower dosages of rescue analgesia(P = 0.03).The total quality of recovery 40 questionnaire score and the scores for physical wellbeing and pain were significantly better in the stratified analgesia group than the conventional group(P = 0.04); the stratified analgesia group also reported better scores for analgesic satisfaction(P = 0.03)and received lower dosages of opioids(P = 0.03).Analgesic costs were lower in the stratified analgesia group than the conventional group; the cost-effective ratio was 109 in the conventional group and 62 in the stratified analgesia group.Conclusions: The analgesic efficacy was improved by the implementation of stratified analgesia based on surgical pain risk assessment and counseling.This stratified analgesia protocol increased the patients' analgesic satisfaction and improved the quality of recovery without increasing healthcare costs.The present findings may help improve the efficacy of peri-operative multimodal analgesia in clinical practice.

BACKGROUND: After peripheral nerve injury in human, a syndrome of events (spontaneous pain, allodynia and hyperalgesia) may be observed that includes no response of morphine and dependency of this pain state on intact sympathetic function. Spinally delivered 2-adrenoceptor agonist and cholinergic agonist or cholinesterase inhibitors have been shown to have actions attenuating the hyperalgesia in rat models of nerve injury-induced pain. Using a fixed-dose analysis and an isobolographic paradigm, the spinal interaction between the 2-adrenoreceptor agonist, clonidine and cholinergic agonist, carbachol is characterized in rat model of nerve injury-induced tactile hyperalgesia. METHODS: Male Sprague Dawely rats were anesthetized with halothane, and the left L5 and L6 spinal nerve were ligated (Chung model). After recovery, a polyethylene tubing catheter was implanted into lumbar intrathecal space. After recovery from catheter implantation, intrathecal dose-response curves were established for the antiallodynic effect of carbachol (0.1, 0.3, 1.0, 3.0 microgram) and clonidine (0.3, 1.0, 3.0, 10 microgram) alone to obtain the ED50 for each agent. ED50 fractions (1/2, 1/4, 1/8, 1/16) of drug combinations of carbachol-clonidine were administered and thresholds for left hind limb paw withdrawal to von Frey hair application were assessed. The ED50 of carbachol-clonidine combination was established and isobolographic analysis of the drug interactions was carried out.c RESULTS: Intrathecal carbachol and clonidine alone produced dose-dependent reductions of tactile allodynia: ED50 of 66 ng (12~367 ng) and 39 ng (1~1452 ng), respectively. With the fixed dose analysis, the log dose-response curves showed a left shift that considerably exceeds the theoretical curves made by a simple sum of the effects of carbachol alone and clonidine. With the isobolographic analysis, ED50 of mixture was found to be statistically less than the theoretical additive ED50 of mixture. CONCLUSION: The experiments suggest that intrathecal carbachol and clonidine alone produce a dose dependent antagonism on touch evoked allodynia and intrathecal carbachol is synergistic when combined with intrathecal clonidine.
Animals ; Carbachol* ; Catheters ; Cholinergic Agonists ; Cholinesterase Inhibitors ; Clonidine* ; Drug Combinations ; Drug Interactions* ; Extremities ; Hair ; Halothane ; Humans ; Hyperalgesia ; Male ; Models, Animal ; Morphine ; Neuralgia* ; Peripheral Nerve Injuries ; Polyethylene ; Rats* ; Spinal Nerves

Natural killer/T-cell lymphoma (NKTL) usually involves the nasal cavity or paranasal sinuses during the initial stage, and may invade the orbit or brain in the advanced phase. Thus, most patients with NKTL present with nasal symptoms. We report a case of NKTL that presented with ophthalmoplegia. MRI revealed pansinusitis and a mass lesion in the right maxillary sinus. An endoscopic biopsy revealed NKTL. NKTL should be included in the differential diagnosis of ophthalmoplegia.
Biopsy ; Brain ; Diagnosis, Differential ; Humans ; Lymphoma ; Maxillary Sinus ; Nasal Cavity ; Natural Killer T-Cells ; Ophthalmoplegia ; Orbit ; Paranasal Sinuses

No abstract available.
Neuromyelitis Optica ; Postpartum Period ; Recurrence ; Remission, Spontaneous

BACKGROUND: A pathogenesis of skin-homing lymphoid cells in primary cutaneous T-eell lymphoma(CTCL) has not been elucidated, CLA(cutaneous lymphocyte-associated antigen) defined by HECA-452 monoclonal anfibody has been proposed as the novel skin-homing receptors of infiltrative lymphocytes in atopic dermatitis and graft-versus-host disease. Accordingly, CLA may be a determinant explaining about the skin-homing properties of lymphoid tumor cells in CTCL. OBJECTIVE: This study was conducted to investigate the immunohistochemical expression of CLA in the lesional tissue specimens of cutaneous lymphomas. METHODS: Immunohistochemicslly, we examined the expression of CLA, E-selectin, ICAM-1 and LFA-1 antigens in the tissue specimens taken from the skin lesions and lymph nodes of the 22 patients with cutaneous lymphomas and the 20 control subjects with non-cutaneous lymphomas. Results : 1. The expression rate of CLA was 40.9% in the skin specimens of cutaneous lymphomas. We could not fad any expression of CLA in non-cutaneous lymphomas. 2. CTCL showed a more frequent expression of CLA(80%) than cutaneous B-cell lymphomas (CBCL)(8.3%). We found more frequently CLA+ high endothelial venules in non-cutaneous lymphomas(40%) than in cutaneous lymphomas(9.1%). 3. CLA and E-selectin were more frequently expressed in primary CTCL(100%, 83.3%) than in secondary CTCL(50%, 0%). 4. The positivity to ICAM-1 and LFA-1 antigens was higher in primary cutaneous lymphomas (72.7%, 81.8%) than in secondary forms(9.1%, 9.1%). Conclusion : CLA and E-selectin may represent the pivotal skin-homing receptor of infiltrative tumor cells and vascular counter-receptor in primary CTCL, respectively. Also, ICAM-1 and LFA-1 may have a role in the primary cutaneous infiltration of lymphoma cells as the additional cofactors.
Dermatitis, Atopic ; E-Selectin ; Flavin-Adenine Dinucleotide ; Graft vs Host Disease ; Humans ; Intercellular Adhesion Molecule-1 ; Lymph Nodes ; Lymphocyte Function-Associated Antigen-1 ; Lymphocytes ; Lymphoma* ; Lymphoma, B-Cell ; Skin ; Venules

Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.
Biological Therapy ; Capitalism ; Democratic People's Republic of Korea ; Hospitals, Psychiatric ; Humans ; Korea ; Mental Health ; Neurotic Disorders ; Psychotherapy, Psychodynamic ; Psychotic Disorders ; Social Stigma ; Socialism ; Suicide

OBJECTIVETo investigate the clinical manifestations, pathological characteristics, and treatments of urothelial-type mucinous adenocarcinoma of the prostate (UMAP).

METHODSWe reported a case of UMAP, reviewed relevant literature, and analyzed the clinicopaothological features, diagnosis, treatment, and prognosis of the disease.

RESULTSThe patient was a 60-year-old male and underwent transurethral resection of the prostate for dysuria. Postoperative pathology indicated mucinous adenocarcinoma and sigmoidoscopy revealed no primary colon cancer. Immunohistochemical staining showed the negative expressions of PSA and P504s and positive expressions of CK7, CK34 β E12, CK20, and CDX2. Thus UMAP was confirmed and treated by intensity-modulated radiotherapy. Then the patient was followed up for 30 months, which showed desirable therapeutic result, with neither local progression nor distant metastasis.

CONCLUSIONUMAP has a bad prognosis and its diagnosis depends on pathological and immunohistocchemical examinations. It responds well to radical prostatectomy but is not sensitive to endocrine therapy. Radiotherapy can be considered for those who are not fit to receive radical prostatectomy.

Adenocarcinoma, Mucinous ; metabolism ; pathology ; therapy ; Humans ; Keratins ; metabolism ; Male ; Middle Aged ; Neoplasm Proteins ; metabolism ; Prognosis ; Prostatectomy ; Prostatic Neoplasms ; metabolism ; pathology ; therapy ; Racemases and Epimerases ; metabolism

Purpose: This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. Methods: This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. Results: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. Conclusion The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.