BACKGROUND: Incontinence and muscle loss are important senior health issues. Nevertheless, there are no available domestic or international studies on the association between urinary incontinence and muscle loss. The aim of this study was to investigate the association between muscle loss and urinary incontinence in elderly Korean woman. METHODS: Korean women (1,313) > or =65 years of age whose complete body composition data were collected using dual X-ray absorptiometry were analyzed from the Fourth Korean National Health and Nutritional Examination Surveys. Class I and II losses of the appendicular, truncal, and total muscle mass were defined using adjustments for weight and height. Each participant's incontinence status was collected using constructed questionnaires. Multiple logistic regression was performed to examine the association between muscle loss and incontinence. RESULTS: On the basis of physician-diagnosed incontinence, weight- and height-adjusted muscle loss showed no association with urinary incontinence (weight-adjusted muscle loss: class I adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.34 to 1.73; class II aOR, 1.37; 95% CI, 0.59 to 3.18; height-adjusted muscle loss: class I aOR, 0.51; 95% CI, 0.18 to 1.51; class II aOR, 1.86; 95% CI, 0.22 to 15.79). Similar results were observed for truncal muscle and total muscle mass as well as self-reported urinary incontinence. CONCLUSION: Our study found no association between urinary incontinence and appendicular, truncal, and total muscle loss in elderly Korean women.
Absorptiometry, Photon ; Aged* ; Body Composition ; Female ; Humans ; Logistic Models ; Muscle, Skeletal ; Muscular Atrophy ; Odds Ratio ; Surveys and Questionnaires ; Urinary Incontinence*

PURPOSE: Borage oil (BO) and safflower oil (SO) are efficacious in reversing epidermal hyperproliferation, which is caused by the disruption of epidermal barrier. In this study, we compared the antiproliferative effect of dietary BO and SO. Altered metabolism of ceramide (Cer), the major lipid of epidermal barrier, was further determined by measurement of epidermal levels of individual Cer, glucosylceramide (GlcCer), and sphingomyelin (SM) species, and protein expression of Cer metabolizing enzymes. METHODS: Epidermal hyperproliferation was induced in guinea pigs by a hydrogenated coconut diet (HCO) for 8 weeks. Subsequently, animals were fed diets of either BO (group HCO + BO) or SO (group HCO + SO) for 2 weeks. As controls, animals were fed BO (group BO) or HCO (group HCO) diets for 10 weeks. RESULTS: Epidermal hyperproliferation was reversed in groups HCO + BO (67.6% of group HCO) and HCO + SO (84.5% of group HCO). Epidermal levels of Cer1/2, GlcCer-A/B, and beta-glucocerebrosidase (GCase), an enzyme of GlcCer hydrolysis for Cer generation, were higher in group HCO + BO than in group HCO, and increased to levels similar to those of group BO. In addition, epidermal levels of SM1, serine palmitoyltransferase (SPT), and acidic sphingomyelinase (aSMase), enzymes of de novo Cer synthesis and SM hydrolysis for Cer generation, but not of Cer3-7, were higher in group HCO + BO than in group HCO. Despite an increase of SPT and aSMase in group HCO + SO to levels higher than in group HCO, epidermal levels of Cer1-7, GlcCer-A/B, and GCase were similar in these two groups. Notably, acidic ceramidase, an enzyme of Cer degradation, was highly expressed in group HCO + SO. Epidermal levels of GlcCer-C/D and SM-2/3 did not differ among groups. CONCLUSION: Dietary BO was more prominent for reversing epidermal hyperproliferation by enhancing Cer metabolism with increased levels of Cer1/2, GlcCer-A/B, and SM1 species, and of GCase proteins.
Animals ; Borago* ; Carthamus tinctorius* ; Ceramidases ; Cocos ; Diet ; Epidermis* ; Glucosylceramidase ; Guinea Pigs* ; Guinea* ; Hydrogen ; Hydrolysis ; Metabolism* ; Safflower Oil* ; Serine C-Palmitoyltransferase ; Sphingomyelin Phosphodiesterase

PURPOSE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract, and account for 1% of all GI malignancies. GISTs have a highly variable clinical course, and recurrent disease sometimes develops despite curative treatment. Although there are several known risk factors for recurrence, there are few adequate treatment strategies. This study evaluated the clinical behavior and clinicopathological characteristics, and examined correlation between recurrence and the prognostic factors. METHODS: From March 1999 to December 2005, 41 patients, with GISTs confirmed by a pathologic examination after a surgical resection, were enrolled. The patients were evaluated by immunohistochemical staining for CD117, CD34 and smooth muscle actin, and were classified according to the NIH criteria. RESULTS: The mean age was 58.9 years and the GISTs were mainly located in the stomach (56%) and small bowel (32%). With a median follow-up of 17.4 months, recurrence of the disease occurred in nine (22%) patients, with the liver being the main organ involved. According to the NIH criteria, there were 2 very low risk tumors, 11 low risk, 16 intermediate, and 12 high risk diagnosed. Gender was found to have predictive value for a recurrence (P=0.05). CONCLUSION: The primary site and gender have predictive value for a recurrence. Identifying the risk factors for recurrent disease may be useful for planning follow-up schedules. Further study involving more cases and a long-term follow-up will be needed. In addition, pathologic and immunohistoche-mical studies will be required to reduce the recurrence rate after a resection and to improve the patients' outcome.
Actins ; Appointments and Schedules ; Follow-Up Studies ; Gastrointestinal Stromal Tumors* ; Humans ; Liver ; Muscle, Smooth ; Recurrence* ; Risk Factors ; Stomach

PURPOSE: The screening test for colorectal polyp is important for the early detection and prevention of colorectal cancer. The aims of this study were to evaluate the characteristic findings and the anatomical distribution of colorectal polyps observed during colonoscopy and to determine proper screening candidates to undergo colonoscopy for colorectal cancer. METHODS: From March 1999 to February 2004, 3,454 asymptomatic individuals underwent total colonoscopy. The number, the location, and the histology of polyps were evaluated retrospectively in 634 patients who had colorectal polyps (453 males and 181 females). The relations among age, location, and histology were analyzed. RESULTS: The mean age was 60 years (range, 15 to 95). Four hundred and twenty-two patients (67%) had a single polyp, and 212 (33%) had two or more polyps. Left-sided polyps were observed in 422 patients (67%), right-sided polyps in 134 patients (21%), and synchronous both-sided polyps in 78 patients (12%). Adenomas were present in 387 patients (61%), and adenocarcinomas were detected in 47 patients (7.4%). There was no definite correlation between location and histology. However the prevalence of right-sided polyps increased with age (P<0.01). CONCLUSIONS: More than 30% of the polyps were located proximal to the splenic flexure. Thus, in the absence of left-sided lesions, an examination of the colon that is limited to the splenic flexure might miss 21% of such lesions. The increasing prevalence of right-sided polyps with age suggests that evaluation of the proximal colon is particularly important in the elderly, especially in those older than 60 years.
Adenocarcinoma ; Adenoma ; Aged ; Colon ; Colon, Transverse ; Colonoscopy* ; Colorectal Neoplasms ; Humans ; Male ; Mass Screening ; Polyps* ; Prevalence ; Retrospective Studies

PURPOSE: The epidermal growth factor receptor (EGFR) is a one of the transmembrane receptor proteins that play an important role in initiating tumor cell signaling and growth and is regarded as a promising target for cancer therapy. The EGFR expression rate has been reported to vary according to the detection method. The aims of this study were to evaluate the EGFR expression rate of a colorectal carcinoma by using immunohistochemical staining (IHC) and semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) and to analyze the correlation between these methods. METHODS: EGFR expression was investigated in tissue sections from 33 patients with a colorectal adenocarcinoma by using IHC and semiquantitative RT-PCR. IHC was performed with antibodies in a 1:40 dilution and a 1:80 dilution. The results of the three detection methods were compared with one another. RESULTS: The mean age of the patients was 61.9+/-12.2 years, and the male-to-female ratio was 1.2:1. The EGFR expression rates were 93.9% (31/33) in IHC with a 1:40 dilution, 87.9% (29/33) in IHC with a 1:80 dilution, and 66.7% (22/33) in RT-PCR. The result of IHC with a 1:40 dilution significantly correlated with the result of IHC with a 1:80 dilution (Pearson correlation 0.684, P<0.01). There was no correlation between semiquantitative RT-PCR and IHC (1:40 dilution, 1:80 dilution). CONCLUSIONS: The EGFR expression obtained by using IHC was consistent with different antibody dilutions. The expression rate obtained by using RT-PCR was significantly lower than that obtained by using IHC, and there was no statistical correlation between the expressions of EGFR obtained by using RT-PCR and IHC. A standardization for EGFR detection methods is needed to draw any conclusion concerning their activity in colorectal cancer.
Adenocarcinoma ; Antibodies ; Colorectal Neoplasms* ; Humans ; Immunohistochemistry ; Receptor, Epidermal Growth Factor

Purpose: Breast cancer diagnosis and treatment often produce stress in patients. Anxiety is one of the most prevalent psychological symptoms perceived by breast cancer patients. This study aims to evaluate the temporal patterns of anxiety and find factors associated with persistent anxiety during breast cancer treatment. Methods: This is prospective cohort study. Between July 2010 and July 2011, we recruited patients with nonmetastatic breast cancer who were expected to receive adjuvant chemotherapy (n = 411) from 2 cancer hospitals in Seoul, Korea. Anxiety was measured using the Hospital Anxiety and Depression Scale. Results: The mean age of the participants was 46.4 ± 7.9 years. Preoperatively, 44.5% (183 of 411) of the patients showed abnormal anxiety. The proportion of the abnormal anxiety group significantly decreased after surgery (P < 0.01) and this phenomenon continued until the 12-month follow-up point. Patients experienced renewed anxiety at 12 months when the main adjuvant therapies were finished. Socioeconomic factors were not associated with persistent anxiety. Pain, breast, and arm symptoms were significantly higher in the persistently abnormal group, especially at postoperative months 6 and 12. Conclusion Surgery was a major relieving factor of anxiety, and patients who finished their main adjuvant treatment experienced renewed anxiety. Surgeons should be the main detectors and care-givers with respect to psychological distress in breast cancer patients. To reduce persistent anxiety, caring for the patient’s physical symptoms is important.

Although central catheter-related complications are frequently reported and are inevitable in the neonatal care unit, the incidence of pericardiac tamponade is low but may be fatal. Index of suspicion, prompt diagnosis, and urgent pericardiocentesis are crucial for lifesaving. We encountered two premature cases of central venous catheter-related pericardial tamponade. The first case was a 4-day-old male premature infant (gestational age [GA], 33(+5) weeks; birth weight [BW], 1,864 g), and the second case was a 4-day-old female premature infant (GA, 28(+6) week; BW, 1,050 g). Each infant had an indwelling central venous catheter since birth and at the third day of hospitalization. The conditions of the babies suddenly deteriorated, but both babies were successfully resuscitated with urgent echocardiography and prompt pericardiocentesis.
Birth Weight ; Cardiac Tamponade* ; Central Venous Catheters ; Diagnosis ; Echocardiography ; Female ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Male ; Parturition ; Pericardiocentesis

BACKGROUND: Fatigue is one of the most common presenting symptoms in primary care in Korea. In this study, we aimed to determine the effect of exercise intervention on the severity of fatigue of unknown medical cause during a period of follow-up. METHODS: We used the data collected from an outpatient fatigue clinic in Seoul National University Bundang Hospital. The study was conducted from March 3, 2010 to May 31, 2014. We measured the body mass index of each patient and evaluated variables including lifestyle factors (smoking, alcohol consumption, and regular exercise), quality of sleep, anxiety, depression, stress severity, and fatigue severity using questionnaires. A total of 152 participants who completed questionnaires to determine changes in fatigue severity and the effect of exercise for each period were evaluated. We used univariate analysis to verify possible factors related to fatigue and then conducted multivariate analysis using these factors and the literature. RESULTS: Of 130 patients with the complaint of chronic fatigue for over 6 months, over 90 percent reported moderate or severe fatigue on the Fatigue Severity Scale and Brief Fatigue Inventory questionnaires. The fatigue severity scores decreased and fatigue improved over time. The amount of exercise was increased in the first month, but decreased afterwards. CONCLUSION: There was no significant relationship between changes in the amount of exercise and fatigue severity in each follow-up period. Randomized controlled trials and a cohort study with a more detailed exercise protocol in an outpatient setting are needed in the future.
Alcohol Drinking ; Anxiety ; Body Mass Index ; Cohort Studies ; Depression ; Fatigue* ; Follow-Up Studies* ; Humans ; Korea ; Life Style ; Metabolic Equivalent ; Motor Activity ; Multivariate Analysis ; Outpatients ; Primary Health Care ; Seoul

BACKGROUND AND OBJECTIVES: MLH1 and MSH2, which are DNA mismatched repair genes, used to be studied in HNPCC (hereditary nonpolyposis colon cancer). Now, the defects in MLH1 and MSH2 are known to be related with malignant transformations of other tumor. Mismatched repair proteins are widely dispersed in the adnexal structures. According to studies, if mismatched repair proteins were stained, as melanocytic nevi progresses into melanocytic dysplastic nevi and cutaneous malignant melanoma, positive immunoreactivity decreases. The purpose of the study is to find out the appearance pattern of DNA mismatched repair proteins, and MLH1 and MSH2 known to be associated with microsatellite instability and carcinogenesis. MATERIALS AND METHODS: Of 19 patients who had been diagnosed with malignant melanoma by pathological study in Asan medical center between June, 1989 and January, 2002, 11 patients had mucosal malignant melanoma while 8 patients had malignant melanoma on the skin. There were 9 males and 10 females, with the average age of 55 (32-77). We investigated the nuclear positivity of MLH1 and MSH2 by immunochemical staining of paraffin tissue method. RESULTS: The nuclear positivity of MLH1 and MSH2 were 27.3% (3/11) and 36.8% (7/11), respectively, indicating that there were no significant differences. Three cases of 4 metastatic mucosal malignant melanoma cases showed negative MLH1 response and MSH2 had 2 positive and 2 negative responses. Biopsy after metastasis represented negative conversion of nuclear activity in MLH1 in only on case, and this indicated a loss of activity as the disease progressed. Four except one of the metastatic cutaneous malignant melanoma cases showed negative staining of MLH1 and MSH2. CONCLUSION: We found decreased nuclear activity in MLH1 and MSH2 in the cutaneous malignant melanoma and mucosal malignant melanoma. This information can be applied for diagnosis or follow-up methods of malignancy in the future.
Biopsy ; Carcinogenesis ; Chungcheongnam-do ; Colon ; Diagnosis ; DNA ; DNA Repair ; Dysplastic Nevus Syndrome ; Female ; Follow-Up Studies ; Humans ; Male ; Melanoma* ; Microsatellite Instability ; Microsatellite Repeats ; Negative Staining ; Neoplasm Metastasis ; Nevus, Pigmented ; Paraffin ; Skin

OBJECTIVE: In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field. METHODS: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically. RESULTS: AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically. CONCLUSION: The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
Adult ; Aged ; Antipsychotic Agents ; Biological Therapy ; Consensus ; Depression ; Depression, Postpartum ; Depressive Disorder ; Depressive Disorder, Major ; Drug Therapy ; Electroconvulsive Therapy ; Female ; Humans ; Mood Disorders ; Pregnant Women ; Premenstrual Dysphoric Disorder ; Transcranial Magnetic Stimulation