objectives: ：The aim of this study was to identify the factors affecting ideas of persecution in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods: ：We retrospectively reviewed 116 patients who underwent CAPS and MMPI 2 between May 2013 and April 2020 at Veteran Health Service Medical Center. Based on the CAPS score, the patients were divided into the PTSD group (n=63, age: 58.16±17.84) and the trauma exposed without PTSD group (n=53, age: 67.34± 12.05). After checking the correlation between Ideas of persecution, CAPS, and MMPI-2 scales, linear regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results: ：The PTSD group showed significant differences in Schizophrenia, Ideas of persecution, Dysfunc-tional negative emotions, Aberrant Experiences, Psychoticism, Negative Emotionality/Neuroticism, Anxiety, Depression, and Anger scales compared to the trauma-exposed without PTSD group. When analyzing the correlation between Idea of persecution, CAPS and MMPI-2 scales, there was a strong association with most of the scales in MMPI-2 and Idea of persecution except Disconstraint. Multiple linear regression analysis performed in PTSDgroup identified that risk factors for Idea of persecution were Dysfunctional negative emotions and Anger scale. Conclusions ：The PTSD group had increased idea of persecution compared to the trauma exposed without PTSD group. Dysfunctional negative emotions and anger may be risk factors for idea of persecution in trauma exposed population.

BACKGROUND: Despite of the first coronary wallstent implantation ushered in the new era in interventional cardiology with the purpose of circumventing the two major limitation of coronary balloon angioplasty, early acute occlusion and late restenosis, however, previous investigators suggested the high rate of subacute occlusion after original wallstent implantation. Recently the low incidence of the subacute closure and restenosis rate with the newely modified less shortening coronary wallstent in native coronary artery and in aortocoronary vein grafts were reported. In this study we report the acute and 6 months follow up results with less shortening coronary wall stent in 32 patients. METHODS: Thirty two patients were enrolled from March 1996 through February 1997 at the Yonsei cardiovascular center of Yonsei University. The specific angiographic criteria for enrollment included at least 70% stenosis and a lesion that was 20mm or more in length and a vessel diameter of at least 2.5mm. Enteric coated aspirin(100mg daily) and ticlopidine(500mg daily) at least 3 days before the procedure and received continuous infusion of 24,000U of heparin for 1day after the procedure. Angiography was performed in two orthogonal views at pre, post procedure and 6months later. Quantitative analysis was performed with the use of the electronic caliper comparing to the empty catheter. All continuous variables were expressed as mean SD and analyzed with the t-test. Differences between groups were analyzed with Chi-square analysis and Fishers Exact test where appropriate. RESULTS: The newly modified Coronary Less Shortening Wallstents were successfully implanted in all the 35 diffuse coronary lesions(more than 20mm in length) of the 32 patients, including 15 pts of acute myocardial infarction, 14 pts of unstable angina, and 3 pts of stable angina. Average 6 months follow up angiography was performed in 26 patients. Immediate angiographic results with Less Shortening Wallstent comparing with 6 months follow up were 3.0+/-0.4mm and 1.7+/-0.9mm in minimal luminal diameter(MLD), 5.1+/-9.1% and 46.8+/-25.8% in diameter stenosis(DS). During the in-hospital phase, no major cardiac event occurred except 2 cases of transmural myocardial infarction, including one of stent thrombosis(3.1%) and one of side branch occlusion, despite of inclusion of 7 cases of threatened occlusion in the long lesion. The restenosis rate at follow up angiography was 30.7%(8/26 pts). The restenosis rate was higher in patients with stent insertion into right coronary artery or adjuvant high pressure oversize ballooning after stent insertion but not statistically significant. CONCLUSIONS: The results of this study suggested that new Less Shortening Wallstent might reduce the requirement of multiple stent in the long lesion and a lower rate of subacute thrombotic occlusion in comparison to the reports with its prototype. Restenosis rate was not significantly different from other types of stents. Althouth the restenosis rate was high in patients with stent insertion, there was no statistical significance probably due to small sample size. But further large scale long term follow-up study is needed to evaluate the role of new Less Shortening Wallstent.
Angina, Stable ; Angina, Unstable ; Angiography ; Angioplasty, Balloon, Coronary ; Cardiology ; Catheters ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies* ; Heparin ; Humans ; Incidence ; Myocardial Infarction ; Phenobarbital ; Research Personnel ; Sample Size ; Stents ; Transplants ; Veins

Clozapine is accepted as the “gold standard” antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.

Urinary incontinence (UI), affecting 3%-11% of males and 25%-45% of females globally, is expected to rise with an aging population. It significantly impacts mental health, causing depression, stress, and reduced quality of life. UI can exacerbate psychiatric conditions, affecting treatment compliance and effectiveness. Itis categorized into transient and chronic types. Transient UI, often reversible, is caused by factors summarized in the acronym DIAPPERS: Delirium, Infection, Atrophic urethritis/vaginitis, Psychological disorders, Pharmaceuticals, Excess urine output, Restricted mobility, Stool impaction. Chronic UI includes stress, urge, mixed, overflow, functional, and persistent incontinence. Drug-induced UI, a transient form, is frequently seen in psychiatric treatment. Antipsychotics, antidepressants, and other psychiatric medications can cause UI through various mechanisms like affecting bladder muscle tone, altering nerve reflexes, and inducing other conditions like diabetes or epilepsy. Specific drugs like lithium and valproic acid have also been linked to UI, though mechanisms are not al-ways clear. Managing UI in psychiatric patients requires careful monitoring of urinary symptoms and judiciousmedication management. If a drug is identified as the cause, options include discontinuing, reducing, or adjusting the dosage. In cases where medication continuation is necessary, additional treatments like desmopressin, oxybutynin, trihexyphenidyl, or amitriptyline may be considered.

Cytomegalovirus (CMV) colitis is a common opportunistic infection in immunocompromised patients. Affected individuals present with abdominal pain, diarrhea, or hematochezia. Complications of CMV colitis can include massive bleeding, toxic megacolon, bowel perforation and, rarely, colon stricture. A 69-year-old woman who had no specific past history was admitted to the orthopedic department for pelvic bone fracture with right iliac artery rupture caused by a traffic accident. She was successfully managed with emergency transarterial coil embolization. After 2 weeks, she developed hematochezia and recurrent abdominal pain. Colonoscopy showed a huge, deep ulcer in the rectosigmoid colon. Biopsy and immunohistochemical staining revealed giant cells with intracellular inclusion bodies that were positive for CMV antigen. She received antiviral treatment after which her symptoms improved. On follow-up colonoscopy 3 months later, we found a tight luminal narrowing in the rectum. We did a repeat endoscopic balloon dilation in this patient and she experienced improvement.
Abdominal Pain ; Accidents, Traffic ; Aged ; Biopsy ; Colitis ; Colon ; Colonoscopy ; Constriction, Pathologic ; Cytomegalovirus ; Diarrhea ; Emergencies ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Giant Cells ; Hemorrhage ; Humans ; Iliac Artery ; Immunocompromised Host ; Inclusion Bodies ; Megacolon, Toxic ; Opportunistic Infections ; Orthopedics ; Pelvic Bones ; Phenobarbital ; Rectum ; Rupture ; Ulcer

A pulmonary arteriovenous malformation (PAVM) is a rare pulmonary vascular anomaly presenting as dyspnea or recurrent epistaxis. Ebstein's anomaly (EA), a congenital cardiac malformation, is also a rare condition. There have been no reports concerning the co-existence of PAVM with hereditary hemorrhagic telangiectasia (HHT) and EA. A 40-year-old woman was admitted with a 2-month history of increasing dyspnea and several years of recurrent epistaxis. On transthoracic echocardiography, she was diagnosed with EA and agreed to undergo surgical treatment. A chest CT angiography showed a 12-mm serpiginous vascular structure suspicious for a PAVM and a liver CT suggested HTT. Although it is unclear whether or not a concurrent PAVM and EA have an embryologic or genetic relationship, we report a case of a PAVM with EA. Further genetic and embryonic studies are needed to identify a possible relationship of the two medical conditions.
Adult ; Angiography ; Arteriovenous Malformations ; Dyspnea ; Ebstein Anomaly ; Echocardiography ; Epistaxis ; Female ; Humans ; Liver ; Lung ; Telangiectasia, Hereditary Hemorrhagic ; Thorax