Generalized anxiety disorder (GAD) is highly prevalent psychiatric disorder in primary care population and is a source of major morbidity. However, the underawareness and undertreatment of GAD, which is due to insufficient knowledge about the disorder, often hinder the proper management of this chronic condition. Other characteristic features such as chronic course of GAD, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria should be fully discussed. First of all, proper and accurate diagnosis is crucial for an appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD and counseling about treatment alternatives and coping strategies is an important first step. The most effective treatment of GAD is combined psychotherapeutic and pharmacotherapeutic approach. The major psychotherapeutic approaches to GAD are cognitive-behavioral therapy with relaxation techniques. Pharmacological treatment for GAD includes benzodiazepine, buspirone, and antidepressants. In this review, these combined treatment at the view point of primary practitioners was described.
Antidepressive Agents ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Buspirone ; Comorbidity ; Counseling ; Depressive Disorder ; Diagnosis* ; Education ; Primary Health Care ; Relaxation Therapy

OBJECTIVES: Transcranial magnetic stimulation (TMS) is a novel, noninvasive method of brain stimulation. As the knowledge of the neuroanatomical abnormalities of posttraumatic stress disorder (PTSD) has been increased, therapeutic application of TMS has been suggested in patients with PTSD. Thus we reviewed the literatures to look into the effectiveness of TMS for the treatment of PTSD. METHODS: We described the published clinical studies of TMS in patients with PTSD using literature review and our preliminary results of clinical trial for integrating the future direction of TMS research in the treatment of PTSD. RESULTS: Although the previous studies for the treatment of PTSD were scanty, TMS might be an tolerable and safe option for the intervention of PTSD. Several studies suggested that repeated rhythmic TMS (rTMS) to right prefrontal cortex might be useful for the treatment of PTSD. The accurate mechanism of rTMS has not been known yet. However, it is supposed that rTMS may have the ability to normalize brain metabolism, improve neuronal functional connectivity and modulate the neuronal circuitry in patients with PTSD. This capability has raised the possibility of the use of rTMS as a novel therapeutic tool for PTSD. CONCLUSION: In order to optimize rTMS for therapeutic use in PTSD, it is necessary to determine rTMS treatment parameters, such as frequency, intensity, pulse duration and stimulation site, pulse width, intertrain interval, coil type, numbers of sessions, and interval between sessions. rTMS would be a relatively new and noninvasive method for exploring the regional brain circuitry of PTSD.
Brain ; Humans ; Metabolism ; Neurons ; Prefrontal Cortex ; Stress Disorders, Post-Traumatic* ; Transcranial Magnetic Stimulation*

BACKGROUND: Common and effective treatments for calcific tendinitis involve needling procedures. However, it has been widespread practice to refer patients with calcific tendinitis, which is a predominantly orthopedic condition, to radiology department. The purpose of this study was to compare clinical and radiological outcomes after ultrasound-guided needling for calcific tendinitis between the orthopedics and radiology department. METHODS: Seventy-seven shoulders (Group 1) and 38 shoulders (Group 2) treated in the radiology and orthopedic department, respectively. A fellowship-trained orthopedic surgeon and a musculoskeletal radiologist each performed the procedure of ultrasound-guided needle decompression with subacromial steroid injection. Clinical outcomes was evaluated using the visual analogue scale for pain (pVAS) and the American Shoulder and Elbow Surgeons (ASES) shoulder score before treatment and at each follow-up. The pre- and post-needling size and shape of the calcific deposits were compared between the two groups. RESULTS: We analyzed a total of 56 shoulders for Group 1 and 32 shoulders for Group 2. The mean age and sex ratio of the patients no significantly different. We found that the mean decrease in the diameter of calcification between pre- and post-needling was 9.0 mm for Group 1 and 13.1 mm for Group 2; the difference was significantly larger in Group 2 than in Group 1. Both groups showed improved pVAS and ASES scores after needling but the extent of these improvements did not differ with the type of operator. CONCLUSIONS: Needling decompression performed by orthopedic surgeons could a viable option for the treatment of calcific tendinitis.

Cancer tissues are characterized by increased glucose uptake. 18F-fluorodeoxyglucose(FDG), a glucose analogue is used for the diagnosis of cancer in PET studies. This study was aimed to compare the glucose uptake and glucose transporter l(GLUT1) expression in various human colon cancer cells. We measured FDG uptake by cell retention study and expression of GLUTI using Western blotting. Human colon cancer cells, SNU-C2A, SNU-C4 and SNU-C5, were used. The cells were incubated with 1micro Ci/ml of FDG in HEPES-buffered saline for one hour. The FDG uptake of SNU-C2A,SNU-C4 and SNU-C5 were 16.8+/-1.36, 12.3+/-5.55 and 61.0+/-2.17cpm/microgram of protein, respectively. Dose-response and time-course studies represent that FDG uptake of cancer cells were dose dependent and time dependent. The rate of FDG uptake of SNU-C2A, SNU-C4 and SNU-C5 were 0.29+/-0.03, 0.21+/-0.09 and 1.07+/-0.07cpm/min/microgram of protein, respectively. Western blot analysis showed that the GLUT1 expression of SNU-C5 was significantly higher than those of SNU-C2A and SNU-C4. These results represent that FDG uptake into human colon cancer cells are different from each other. In addition, FDG uptake and expression of CLUT1 are closely related in human colon cancer cells.
Blotting, Western ; Colon* ; Colonic Neoplasms* ; Diagnosis ; Glucose ; Glucose Transport Proteins, Facilitative ; Humans*

Purpose: The purpose of this study was to provide evidence for future research by analyzing the contents, delivery methods, and educational effects of educational programs for hemodialysis patients. Methods: A literature review was conducted in the following order: problem identification, literature search and data collection, data evaluation, data analysis, and data presentation. In total, 936 documents were retrieved from the search, and 24 documents were finally included in this study. Results: The contents of the educational programs were comprehensive hemodialysis-related knowledge education in seven studies, exercise-related education in 10 studies, diet-related education in four studies, drug-related education in one study, and complex education in two studies. The delivery methods were pamphlets in six studies, audio-visual materials in four studies, direct guidance by researchers in six studies, and multiple methods in seven studies. The effects of the educational program were divided into physical indicators, emotional indicators, and knowledge and performance related to hemodialysis. Sixteen out of 20 articles using physical indicators showed significant outcomes, and 10 out of 12 articles using emotional indicators derived positive results. Hemodialysis-related knowledge and performance were measured in eight and 10 studies, respectively, and meaningful results were found in six studies for knowledge and seven studies for performance. Conclusion Future research will require the development of a systematic and standardized educational program with comprehensive content that can be provided to all hemodialysis patients, as well as a highly accessible education delivery method to enhance the effectiveness of education.

Purpose: The purpose of this study was to examine the effects of smart-phone app-based walking exercise programs for taxi drivers on self-efficacy and outcome expectations for exercise, health-related quality of life, walking as an exercise, and physiological indexes. Methods: A nonequivalent control group with a pre-post-test design was used. The subjects were recruited in G metropolitan city. Subjects were assigned to the experimental (n=31) or control groups (n=30). The smart phone app-based walking exercise program consisted of educations via the app, twelve short message services, and one individual telephone counseling session, which was spread over 12 weeks. Results: Self-efficacy, outcome expectations, and health-related quality of life had significantly higher pre-post test differences in scores in the experimental group. Additionally, blood pressure, body mass index, and waist circumference had significantly decreased prepost- test difference levels in the experimental group. Walking as an exercise (which consisted of days walked, number of steps walked, and amount of time walked) had significantly increased in the experimental group after 7~12 weeks in the period following the intervention program rather than 1~6 weeks after the program. Conclusion The smart phone app-based walking exercise program based on the self-efficacy theory demonstrates a significant effect on improving self-efficacy, outcome expectations physical activities, and health-related quality of life for taxi drivers. Therefore, it is recommended to actively use the program as a tool to promote self-efficacy, physical activities, and health behaviors in taxi drivers.

BACKGROUND: To investigate the role of alpha-adrenergic receptors in the development of delayed afterdepolarization, the effect of alpha-adrenoceptor stimulation and blockade on ouabain induced delayed afterdepolarization(DDAD) was examined in rabbit heart Purkinje fibers. METHODS: Purkinje fibers, taken from adult rabbit(1.8 - 2.0kg) heart anesthetized with penobarbital, were mounted in a Luicite chamber and superfused with Tyrode's solution. The transmembrane potentials were measured by the conventional microelectrode technique while the fibers were being stimulated with rectangular pulses of 50% above threshold voltage. The delayed afterdepolarizations were induced by overdrive excitation in the presence of ouabain. RESULTS: Delayed afterdepolarizations were not observed during superfusion of the control Tyrode's solution containing propranolol(5x10(-7)M). However, the addition of ouabain in the presence of propranolol elicited DADs which were dose-, time- and drive cycle length- dependent. Phenylephrine(PE ; 10(-7)M), and alpha-adrenoceptor agonist, potentiated the ouabain-induced DAD during the initial superfusion(for 10 or 20 min) of the test Tyrode's solution. However, it was followed by attenuating-effects after a superfusion time of 50 to 60 min. Both effects showed ouabain dose-dependence. Ouabain(2x10(-7)M), in the presence of propranolol, depolarized the maximum diastolic potential and shortened the action potential duration, and the addition of PE(10(-7)M) did not affect the characteristics of action potential except a decrease in velocity of phase 0 depolarization. Prazosin, an alpha1-adrenoceptor antagonist, inhibited the PE's enhancing effects of ouabaininduced DDAD at 20 min superfusion, but did not affect the attenuating-effects of PE at 60 min superfusion. On the other hand, yohimbine, an alpha2-adrenoceptor antagonist, did not affect the PE's DAD potentiating-effects at 20 min superfusion, but inhibited the attenunating-effects of PE at 60 min superfusion. CONCLUSION: It is inferred that alpha-adrenergic stimulation induce delayed afterdepolarization and triggered activity in the rabbits, being responsible for the arrhythmia development, and the effects are mainly due to the action of alpha1-subtpe adrenoceptor stimulation.
Action Potentials ; Adult ; Arrhythmias, Cardiac ; Hand ; Heart ; Humans ; Membrane Potentials ; Microelectrodes ; Ouabain ; Prazosin ; Propranolol ; Purkinje Fibers ; Rabbits ; Receptors, Adrenergic, alpha* ; Yohimbine

OBJECTIVES: The neural substrate of fear is thought to be highly conserved among species including human. The purpose of this review was to address the neural substrates of fear based on recent findings obtained from animal and human studies. METHODS: Recent studies on brain regions related to fear, particularly fear conditioning in rodents and humans, were extensively reviewed. RESULTS: This paper suggests high consistency in anatomical structure and physiological mechanisms for fear perception, response, learning and modulation in animals and humans. CONCLUSIONS: Fear is manifested and modulated by well conserved neural circuits among species interconnected with the amygdala, such as the hippocampus and the ventromedial prefrontal cortex. Further research is required to incorporate findings from animal studies into a better understanding of neural circuitry of fear in human in a translational approach.
Amygdala ; Animals ; Brain ; Hippocampus ; Humans ; Learning ; Neuroanatomy ; Prefrontal Cortex ; Rodentia

STATEMENT OF PROBLEM: With increasing demand of the implant-supported prosthesis, it is advantageous to use the different platform width of the fixture according to bone quantity and quality of the patients. PURPOSE: The purpose of this study was to assess the loading distributing characteristics of two implant designs according to each platform width of fixture, under vertical and inclined loading using finite element analysis. Material and method : The two kinds of finite element models were designed according to each platform width of fixture (4.1mm restorative component x 11.5mm length, 5.0mm wide-diameter restorative component x 11.5mm length). The crown for mandibular first molar was made using UCLA abutment. Each three-dimensional finite element model was created with the physical properties of the implant and surrounding bone. This study simulated loads of 200N at the central fossa in a vertical direction, 200N at the outside point of the central fossa with resin filling into screw hole in a vertical direction and 200N at the buccal cusp in a 300 transverse direction individually. Von Mises stresses were recorded and compared in the supporting bone, fixture, and abutment screw. RESULTS: The stresses were concentrated mainly at the cortex in both vertical and oblique loading but the stresses in the cancellous bone were low in both vertical and oblique loading. Bending moments resulting from non-axial loading of dental implants caused stress concentrations on cortical bone. The magnitude of the stress was greater with the oblique loading. Increasing the platform width of the implant fixture decreased the stress in the supporting bone, fixture and abutment screw. Increased the platform width of fixture decreased the stress in the crown and platform. CONCLUSION: Conclusively, this investigation provides evidence that the platform width of the implant fixture directly affects periimplant stress. By increasing the platform width of the implant fixture, it showed tendency to decreased the supporting bone, fixture and screw. But, further clinical studies are necessary to determine the ideal protocol for the successful placement of wide platform implants.
Crowns ; Dental Implants ; Finite Element Analysis ; Humans ; Molar ; Prostheses and Implants*

The analysis of heart rate variability is a useful tool to investigate the physiologic phenomena related with autonomic functions. At first, it was developed to evaluate the relation between cardiovascular disease and autonomic balance. Nowadays, the application of it's use has been considered in psychiatric practice. And its convenient usage and non-invasiveness gathered more interest of clinicians and investigators. However, no systematic review of the studies on the heart rate variability in psychiatric field is tound. Thus we reviewed the literatures on the usage and it's limitations of the heart rate variability in terms of the spplication in psychiaric practice and research. Interviews with experts on autonomic functions were also included to supplement the review. Studies found that patients with schizophrenia showed reduced heart rate variability while taking clozapine, and severely depressed patients showed more reduced heart rate variability than normal control. Patients with various anxiety disorders including panic disorder and posttraumatic stress disorder showed eleated sympathetic autonomic tone compared with normal control subjects. However these findings remained controversial because of many confounding factors including drug effects and individual and situational factors affecting heart rate variability. With further studies after successful control of confounding variables, the analysis of heart rate variability would be a useful physiologic parameter of asessing psychiatric patients in clinical practice and research.
Anxiety Disorders ; Cardiovascular Diseases ; Clozapine ; Confounding Factors (Epidemiology) ; Heart Rate* ; Heart* ; Humans ; Panic Disorder ; Research Personnel ; Schizophrenia ; Stress Disorders, Post-Traumatic