No abstract available.
Humans ; Infant, Newborn* ; Streptococcus pneumoniae* ; Streptococcus*

PURPOSE: Accurate diagnosis of group A streptococcal(GAS) pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae and to reduce the improper use of antibiotics. Because the clinical presentation of pharyngitis does not reliably predict the etiologic agent, when GAS infection is suspected, diagnosis should be based on the result of a throat swab culture or antigen-detection test with culture back-up. METHODS: We reviewed retrospectively the medical records of children diagnosed as GAS pharyngitis by throat swab culture from Jan. 1995 to Jul. 2000. Since Nov. 1998, specimens were also tested with the Abbott's Testpack+plus Strep A Kit. RESULTS: 121 patients were confirmed as GAS pharyngitis by throat culture. GAS pharyngitis predominantly occurred from 3 to 7 years of age with the peak incidence at 4 and 5 years of age. The disease was more frequent in late fall, winter and spring. Clinical manifestations were as follows; fever(89.9%), abnormal pharynx(94.3%), of which exudate in 33.6%, sore throat(85.3%), headache(78.1%), cervical lymphadenopathy(67.5%), abdominal pain(64.3%), and nausea or vomiting (55.0%). The sensitivity and specificity of rapid antigen test compared to throat culture were 96.4% and 95%, respectively. CONCLUSION: GAS pharyngitis occurred every year, and more frequently in late fall, winter and spring. It occurred with the greatest frequency in preschool children. The rapid antigen test can be a basis for clinicians to decide how to treat their patients before the culture results are proven, and can be helpful to judicious use of antibiotics as well.
Anti-Bacterial Agents ; Child ; Child, Preschool ; Diagnosis ; Exudates and Transudates ; Humans ; Incidence ; Medical Records ; Nausea ; Pharyngitis ; Pharynx ; Retrospective Studies ; Sensitivity and Specificity ; Vomiting

OBJECTIVES: This study determined the work schedules of public project workers who work an irregular shift and assessed the effect of these schedules on depression. METHODS: Study subjects were 2934 laborers who are members of seven labor unions. Each was given a questionnaire requesting basic personal information, habits, socioeconomic status, and work schedules. Information gathered on work schedules included daytime, nighttime, and weekend work hours. Depression was evaluated using the Beck Depression Inventory (BDI), with Laborers who checked "not depressed" and "slightly depressive" categorized to a low-risk group, whereas laborers who checked "depressed" and "severely depressed" were categorized to a high-risk group. We used the Chi-square test and multivariate logistic regression to examine associations between work schedules and depression. RESULTS: Laborers on an irregular work schedule averaged 47.8 hours/week and laborers who working over 48 hours/week comprised over half (54.5%) of the total population. Laborers performing night work, Sunday work, and Saturday work more than once in a month made up 25.7%, 30.8% and 33.5% of the examined population, respectively. A high-risk for depression was identified in 10.4% of laborers. Using logistic regression, depression was statistically associated with working : over 10 hours a day (OR=1.63, 95% CI 1.10~2.43), night work (OR=2.20, 95% CI 1.46~3.32), Sunday work (OR=1.81, 95% CI 1.15~2.85) and Saturday work (OR=1.82 95% CI 1.18~2.82). CONCLUSION: A significant number of laborers with irregular working shifts work long hours and on weekends. Depression was significantly associated with this type of work schedule.
Appointments and Schedules ; Depression ; Humans ; Labor Unions ; Logistic Models ; Public Sector ; Questionnaires ; Social Class

PURPOSE: Planning target volume (PTV) for tumors in abdomen or thorax includes enough margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of PTV margin extends from 10 mm to 30 mm, which increases substantial volume of the irradiated normal tissue hence, resulting in increase of normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce PTV margins in patients with liver tumors, respiratory motion reduction device (RRD). MATERIALS AND METHODS: For 10 liver cancer patients, the data of internal organ motion were obtained by examining the diaphragm motion under fluoroscope. It was tested for both supine and prone position. A RRD was made using MeV-Green and Styrofoam panels and then applied to the patients. By analyzing the diaphragm movement from patients with RRD, the magnitude of PTV margin was determined and dose volume histogram (DVH) was computed using AcQ-Plan, a treatment planning software. Dose to normal tissue between patients with RRD and without RRD was analyzed by comparing the fraction of the normal liver receiving to 50% of the isocenter dose. DVH and NTCP for normal liver and adjacent organs were also evaluated. RESULTS: When patients breathed freely, average movement of diaphragm was 12+/-1.9 mm in prone position in contrast to 16+/-1.9 mm in supine position. In prone position, difference in diaphragm movement with and without RRD was 3+/-0.9 mm and 12 mm, respectively, showing that PTV margins could be reduced to as much as 9 mm. With RRD, volume of the irradiated normal liver reduced up to 22.7% in DVH analysis. CONCLUSION: Internal organ motion due to breathing can be reduced using RRD, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.
Abdomen ; Carcinoma, Hepatocellular* ; Diaphragm ; Humans ; Liver ; Liver Neoplasms ; Prone Position ; Respiration ; Supine Position ; Thorax

To evaluate the induction of preneoplastic hepatic foci in relation to natural killer cell (NK) activity, we sequentially analyzed glutathione S-transferase placental form positive (GST-P+) hepatocytes and NK activity during diethylnitrosamine (DEN) and phenobarbital (PB)-induced hepatocarcinogenesis in Sprague-Dawley rats. Previous studies have shown that NK activity can modulate the carcinogenic process induced by chemical carcinogens. Newborn females were initially given a single intraperitoneal injection of 15 mg DEN/kg and three weeks later, they were treated with 500 ppm phenobarbital (PB). From week 3, PB was administered in drinking water for 9 weeks. Interim and terminal sacrifices were performed at weeks 12, 15 and 30. GST-P+ hepatocytes increased with age in DEN-treated rats, especially in the population of more than two GST-P+ hepatocytes. The NK activity of DEN-treated rats did not significantly differ from that of control rats until week 12, but it progressively decreased from week 15 to 30. These results indicate that changes of NK activity inversely correlated with the induction of preneoplastic hepatic foci. This strong correlation of decreased NK activity with enhanced induction of GST-P+ foci suggests that NK activity is important in the early progression of hepatocarcinogenesis in rats.
Animal ; Body Weight ; Carcinogens/pharmacology* ; Diethylnitrosamine/pharmacology* ; Female ; Glutathione Transferase/metabolism* ; Killer Cells, Natural/immunology* ; Liver/enzymology* ; Liver/cytology ; Liver Neoplasms/physiopathology* ; Organ Weight ; Placenta ; Rats ; Rats, Sprague-Dawley

Background: Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population. Methods: From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve. Results: Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III. Conclusion The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

Background: Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population. Methods: From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve. Results: Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III. Conclusion The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

BACKGROUND: Large amounts of antigen may produce false low values on immunoradiometric assays due to the so-called high-dose hook effect. The physicians' awareness of the possibility of the "high-dose hook effect" will prevent preoperative misdiagnosis. The study was designed to identify the frequency and clinical features of patients with pituitary macroadenomas in whom a high-dose PRL hook effect was documented. METHODS: Our retrospective study involved 42 patients with non-functioning pituitary adenomas (tumor diameter >30mm) who underwent transsphenoidal microsurgery from between Jan 1999 to Aug 2004, and 6 patients with non-functioning pituitary adenoma(tumor diameter>30mm) were selected for prospective study from Sep 2003 to Feb 2004. Our retrospective study also involved 13 patients with macroprolactinoma for the comparison of the clinical features. RESULTS: 1) The presence of a high-dose hook effect was retrospectively suggested when the PRL levels increased in 4 out of the 42 patients with non- functioning adenomas(tumor diameter >30mm) after surgery. Post-operative immunohistochemical staining of their pituitary specimens revealed the tumors to be prolactinoma. 2) Prospectively, dilution testing of the specimens obtained before surgery was done in the 6 patients, and one patient presented with a case of the hook effect. The patient's prolactin level was measured at 53.1ng/mL before dilution and this was increased up to 22,600ng/mL upon the 1:1000 dilution. 3) Conclusively, the hook effect was seen in 5 of the 48 patients(10.4%) with non-functioning pituitary adenoma(tumor diameter >30mm) 4) Compared with other 2 patient groups(the macroprolactinoma(N=13) group, and the non-functioning pituitary tumor(N=43) group), the high-dose PRL hook effect is more likely to be observed in male patients with large pituitary tumors. CONCLUSION: In order to avoid the high-dose hook effect, PRL should be assayed at 1:100~1:200 or even higher dilutions of serum from all patients(and especially the male patients) with large pituitary tumors
Diagnostic Errors ; Humans ; Immunoradiometric Assay ; Male ; Microsurgery ; Pituitary Neoplasms ; Prolactin ; Prolactinoma* ; Prospective Studies ; Retrospective Studies

BACKGROUND: Olmesartan medoxomil is an angiotensin II receptor blocker commonly used in hypertension. First objective of this study was to evaluate the bioequivalence of two olmesartan formulations, Olmesartan 20 mg and 40 mg tablet (Yuhan, Pharmaceutical Corp. Seoul, Korea) as test drugs and Olmetec(R) 20 mg and 40 mg tablet (Daewoong, Pharmaceutical Corp. Seoul, Korea) as reference drugs. Second objective of this study was to evaluate the dose-proportionality of two formulations. METHODS: Two studies (20 mg, 40 mg) were conducted as a randomized, open-label, 2-period, crossover design. Each subject received one 20 mg or 40 mg tablet of the reference or test formulation of olmesartan medoxomil in each study. Blood samples were obtained during the 48-hour period after the dose in each treatment period. Wash-out period was 1 week in each study. Concentrations of olmesartan medoxomil in plasma were analyzed using a liquid chromatography system with tandem mass-spectrometric detection (LC/MS/MS). The primary pharmacokinetic parameters were Cmax (maximum concentration) and AUCt (area under the concentration-time curve from time 0 to the last sampling time). RESULTS: A total number of 40 healthy male volunteers participated in the study and 37 volunteers completed both treatment periods in 20 mg trial. All 40 participants completed both treatment periods in 40 mg trial. The 90 % CIs for the geometric mean ratios of the pharmacokinetic parameters (test:reference drug) were 0.93 ~ 1.04 for AUCt and 0.97 ~ 1.08 for Cmax in 20 mg trial. The 90 CIs were 0.94 ~ 1.02 for AUCt and 1.00 ~ 1.11 for Cmax in 40 mg trial. All parameters of two studies satisfy the range of bioequivalence criterion. CONCLUSION: The obtained results indicated that pharmacokinetic exposure to Olmesartan 20 mg and 40 mg tablet was bioequivalent to that of Olmetec(R) 20 mg and 40 mg tablet, respectively.
Chromatography, Liquid ; Cross-Over Studies ; Humans ; Hypertension ; Imidazoles ; Male ; Plasma ; Receptors, Angiotensin ; Tetrazoles ; Therapeutic Equivalency

BACKGROUND: Increased body fat, abdominal obesity and insulin resistance are important clinical features in hypogonadal men. Several studies have demonstrated that a low testosterone concentration in men is associated with coronary heart disease, visceral obesity and insulin resistance. In this study, the effects of testosterone replacement therapy on the abdominal visceral fat and cardiovascular risk factors in hypogonadal men were investigated. METHODS: We selected 26 men with secondary hypogonadism (mean serum testosterone+/-SD 0.39+/- 0.57ng/mL), who were then treated with testosterone for 12 months. We measured the body composition, including the abdominal visceral fat area by abdominal CT at the L4 level, both before and 12 months after treatment, and the lipid profile, fasting plasma insulin, HOMA-IR and the serum homocysteine, CRP and IL-6 before and 6, 12 months after treatment. RESULTS: With respect to the body composition, the lean body mass had significantly increased 12 months after treatment(P= 0.002), but there were no significant changes in the body fat mass and abdominal visceral fat area. There was a trend toward a decreased fasting plasma insulin and HOMA-IR, but this did not reach statistical significance. The total cholesterol had decreased significantly at 12 months(P=0.04) and the HDL cholesterol decreased significantly over the course of study(P=0.02). There were no significant changes in the serum homocysteine, CRP and IL-6 after treatment. CONCLUSIONS: After 12 months testosterone replacement therapy in the 26 men with hypogonadism, the lean body mass had increased significantly, but there was no significant change on the abdominal visceral fat during the treatment period. Testosterone replacement had deleterious effect on HDL cholesterol, but not significant effects on insulin resistance and the serum homocysteine, CRP and IL-6. These results suggest that testosterone replacement therapy may have a few adverse effects on cardiovascular diseases in hypogonadal men. However, it will be necessary to examine the long-term effects of testosterone replacement on the incidence of cardiovascular events as well as the cardiovascular risk factors in men with hypogonadism
Adipose Tissue ; Body Composition ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Coronary Disease ; Fasting ; Homocysteine ; Humans ; Hypogonadism ; Incidence ; Insulin ; Insulin Resistance ; Interleukin-6 ; Intra-Abdominal Fat* ; Male ; Multiple Endocrine Neoplasia Type 1 ; Obesity, Abdominal ; Plasma ; Risk Factors* ; Testosterone* ; Tomography, X-Ray Computed