Pulmonary arterial hypertension (PAH) is characterized by remodeling of the distal pulmonary arteries resulting in high pulmonary vascular resistance and, eventually, right ventricular heart failure. Although current advances in PAH therapy have improved outcomes, poor survival remains a reality worldwide, including Korea. One of the most important issues in PAH is the late diagnosis, since screening or diagnostic efforts are often overlooked due to the rarity of disease. Data from Korean registries and observational cohorts show that delayed detection leads to increased morbidity. Additionally, low percentages of Korean patients are committed to intensive PAH-targeted therapy. Current Korean health insurance policies' lack of coverage for new PAH-targeted drugs and upfront combination therapy may also hamper the improvement of treatment outcomes. Understanding individual variability in response to therapeutics through deep phenotyping is a novel strategy that should be considered when treating PAH. Overall, early detection of PAH by proactive screening together with early, intensive, individualized PAH therapy using deep phenotyping is crucial for improving prognoses for PAH patients in Korea.

In an epidemiological study of metal workers exposed to metalworking fluids(MWF), the prevalence time of evoultion, seasonal occurrence and clinical type of contact dermatitis were investigated. Composinal analyses of MWF with HPLC, dermatological examination and two consecutive questionnaire surveys were conducted. Study population was divided into two groups ; workers contact to cutting oil and workers contact to rust preventive oil. In the analysis of MWF, aliphatic hydrocarbons, having 12-20 carbons, was most common composition(49.04%) of cutting oil otherwise, major contents (90.99%) of the rust preventives oil were aliphatic hydrocarbons composed of 6-9 carbons. The frequency (point prevalence) of contact dermatitis(CD) was 7(12.7 per 100 subjects) in the dermatological examination of 55 workers. As the result of second survey for contact dermatitis, cumulative prevalence of oil working full-time and recent 1 year prevalence in two groups were 28.0, 16.7 and 15.1, 12.5 per 100 subjects. There were no difference in the prevalence of CD by oil, age, oil contact duration. Summer is the most common evolution season in workers exposed to cuttiogs, but not in workers exposed to rust preventive oil. Major clinical type of CD was erythematous papules in both groups. It presents the importance of preventive measures that 51.1% suffer from contact dermatitis had medical care at their own expense, and 47.1% of them felt serious about their contact dermatitis. From the fact that 68.6% think cotton gloves protective apparatus, we emphasize the need for health education.
Carbon ; Chromatography, High Pressure Liquid ; Dermatitis, Contact* ; Epidemiologic Studies ; Health Education ; Humans ; Hydrocarbons ; Male* ; Prevalence ; Surveys and Questionnaires ; Seasons

Purpose: Heart failure (HF) poses significant morbidity and mortality. Recently, the ventriculo-vascular coupling index (VVI) was introduced as an independent prognostic factor reflective of the overall cardiovascular performance index in HF. We aimed to determine the effectiveness of force-titration of valsartan on VVI values in HF patients. Materials and Methods: In this multicenter and prospective observational trial, the effect of valsartan was stratified according to dosages [non-ceiling dose (NCD) vs. ceiling dose (CD)] in HF patients with left ventricular ejection fraction (LVEF) <55%. Biochemical studies, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography with VVI, the treadmill test, and the activity scale index were assessed at baseline and after 24 weeks of treatment. Results: One-hundred thirty-eight patients were force-titrated to either a CD group (n=81) or a NCD group (n=57). The mean age of the study participants was 59 years and 66% were male. After 6 months of follow up, left ventricular mass index (LVMI) values had significantly improved in the CD group but not in the NCD group. Intriguingly, in HF patients with a reduced ejection fraction (HFrEF) (n=52, LVEF <40%), a significant improvement in VVI was only observed in the CD group (from 2.4±0.6 to 1.8±0.5, p<0.001). Conclusion CDs of valsartan for 6 months showed better improvement in VVI, as well as LVMI, in patients with HFrEF, compared with NCDs.

Purpose: Heart failure (HF) poses significant morbidity and mortality. Recently, the ventriculo-vascular coupling index (VVI) was introduced as an independent prognostic factor reflective of the overall cardiovascular performance index in HF. We aimed to determine the effectiveness of force-titration of valsartan on VVI values in HF patients. Materials and Methods: In this multicenter and prospective observational trial, the effect of valsartan was stratified according to dosages [non-ceiling dose (NCD) vs. ceiling dose (CD)] in HF patients with left ventricular ejection fraction (LVEF) <55%. Biochemical studies, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography with VVI, the treadmill test, and the activity scale index were assessed at baseline and after 24 weeks of treatment. Results: One-hundred thirty-eight patients were force-titrated to either a CD group (n=81) or a NCD group (n=57). The mean age of the study participants was 59 years and 66% were male. After 6 months of follow up, left ventricular mass index (LVMI) values had significantly improved in the CD group but not in the NCD group. Intriguingly, in HF patients with a reduced ejection fraction (HFrEF) (n=52, LVEF <40%), a significant improvement in VVI was only observed in the CD group (from 2.4±0.6 to 1.8±0.5, p<0.001). Conclusion CDs of valsartan for 6 months showed better improvement in VVI, as well as LVMI, in patients with HFrEF, compared with NCDs.

Pulmonary hypertension is a rare and progressive illness with a devastating prognosis. Promising research efforts have advanced the understanding and recognition of the pathobiology of pulmonary hypertension. Despite remarkable achievements in terms of improving the survival rate, reducing disease progression, and enhancing quality of life, pulmonary arterial hypertension (PAH) is not completely curable. Therefore, an effective treatment strategy is still needed. Recently, many studies of the underlying molecular mechanisms and technological developments have led to new approaches and paradigms for PAH treatment. Management based on stem cells and related paracrine effects, epigenetic drugs and gene therapies has yielded prospective results for PAH treatment in preclinical research. Further trials are ongoing to optimize these important insights into clinical circumstances.

OBJECTIVE: Drug compliance is closely related to progress and prognosis of psychiatric disease. We investigated drug compliance in psychiatric outpatients and factors that influence their compliance. METHODS: Patients who visited a university hospital were asked about drug information and drug compliance using questionnaires. Medical records of the patients were reviewed. Demographic variables, clinical characteristics and drug compliance related variables were compared between non-compliance group and compliance group. Logistic regression analysis was performed to clarify predictors of poor compliance. RESULTS: One hundred eighty one patients participate in this study. 150 patients (82.9%) were compliance group, 31 patients (17.1%) were included in non-compliance group. Patient-related, illness-related and treatment-related factors, DAI total score and knowledge of side effect did not show any difference in both groups. However, illness severity was relatively higher in non-compliance group (p = 0.070) and patient's satisfaction about explanation of side effect was lower in noncompliance group (p = 0.061). Moreover, patients who negatively answered for question about negative recognition to psychiatric medication in DAI questionnaire were more common in non-compliance group (p = 0.075). In logistic regression, answering negatively to question about negative recognition to psychiatric medication in DAI questionnaire was related to non-compliance, but did not reached statistical significance (p = 0.086). CONCLUSION: This study suggests that improving negative recognition about psychiatric medication through drug education and good doctor patient relationship could enhance drug compliance.
Compliance ; Humans ; Logistic Models ; Medical Records ; Outpatients ; Prognosis ; Surveys and Questionnaires

OBJECTIVE: The purpose of this study was to compare the discontinuation rate of widely prescribed atypical antipsychotics when administered to newly admitted, acutely ill patients with schizophrenia or bipolar mania. METHODS: Medical records of patients admitted to psychiatric ward of two university hospitals between January 2007 and December 2008 were retrospectively reviewed. Subjects were eligible for inclusion if they prescribed olanzapine, risperidone or aripiprazole for their psychotic or manic symptom control. Patient groups (olanzapine/risperidone/aripiprazole) were compared for rate of antipsychotics discontinuation and duration of treatment continuation. RESULTS: There was no statistically significant difference in the rates of discontinuation during hospitalized period between olanzapine, risperidone and aripiprazole. Rates of discontinuation were 14.5% for olanzapine, 18.6% for aripiprazole and 24.0% for risperidone. Predictor of treatment discontinuation was short titration period and long illness duration. CONCLUSION: This study demonstrated that risperidone, olanzapine and aripiprazole were comparable with no difference found on the discontinuation rate in treating acutely ill psychiatric patients. However, the small number of patients who participated in this study made it difficult to establish significance.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Hospitals, University ; Humans ; Medical Records ; Piperazines ; Quinolones ; Retrospective Studies ; Risperidone ; Schizophrenia ; Aripiprazole

0.9 between all observers). Receiver operating characteristic curve analysis showed that the predictive power for CAD was improved when max-CIMT and plaque information (plaque≥2) was added [area under the curve (AUC): 0.838] to the traditional clinical CV risk factors (AUC: 0.769). The cutoff values for CAD prediction with the standard device and the WHUS device were 1.05 mm (AUC: 0.807, sensitivity: 0.78, specificity: 0.53) and 1.10 mm (AUC: 0.725, sensitivity: 0.98, specificity: 0.27), respectively.CONCLUSION: max-CIMT measured by a WHUS device showed excellent agreement and repeatability, compared with standard ultrasound. Combined max-CIMT and plaque information added predictive power to the traditional clinical CV risk factors in detecting high-risk CAD patients.]]>
Carotid Artery, Common ; Carotid Intima-Media Thickness ; Coronary Angiography ; Coronary Artery Disease ; Humans ; Mass Screening ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography ; Wireless Technology

Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare but fatal disease. Recent advances in PAH-specific drugs have improved its outcomes, although the healthcare burden of novel therapeutics may lead to a discrepancy in outcomes between developing and developed countries. We analyzed how the epidemiology and clinical features of PAH has changed through the rapidly advancing healthcare infrastructure in South Korea. Methods: PAH was defined according to a newly devised 3-component algorithm. Using a nationwide health insurance claims database, we delineated annual trends in the prevalence, incidence, medication prescription pattern, and 5-year survival of PAH in Korea. Cumulative survival and potential predictors of mortality were also assessed among 2,151 incident PAH cases. Results: Between 2002 or 2004 and 2018, the prevalence and incidence of PAH increased 75-fold (0.4 to 29.9 per million people) and 12-fold (0.5 to 6.3 per million person-years), respectively. The proportion of patients on combination PAH-specific drug therapy has also steadily increased up to 29.0% in 2018. Among 2,151 incident PAH cases (median [interquartile range] age, 50 [37–62] years; 67.2% female), the 5-year survival rate and median survival duration were 71.8% and 13.1 years, respectively. Independent predictors of mortality were age, sex, etiology of PAH, diabetes, dyslipidemia, and chronic kidney disease. Conclusions This nationwide study delineated that the prevalence and incidence of PAH have grown rapidly in Korea since the early 2000s. The use of combination therapy has also increased, and the 5-year survival rate of PAH in Korea was similar to those in western countries.

The risk posed to human health by environmental manganese (Mn) exposure is unknown. The purpose of this study is to establish if subclinical effects related to Mn exposure and examine the factors influencing psychoneurobehaviral outcomes of Mn exposed workers. This study involved 121 male workers of welding, alloy furnace, and manufacturing of welding stick. Study investigations include: a questionnaire covering demographic characteristics, job and exposure history and medical symptoms and conditions, monitoring workplace air for personal exposure to respirable and inhalable manganese, analysis of blood and urine samples. psychoneurobehaviral test(neurobehaviral core test battery (NCTB), signal change on magnetic resonance imaging (MRJ) scans, minimental state and neurological examination). The main results of this study were as follows: 1. Preliminary results showed that, with increasing manganese exposure, neurobehaviral performance was poorer and signal change on MRI scans increased. 2. The results of examination revealed significant relations on psychoneurobehaviral out-comes (neurobehaviral performance, signal change on MRI scans, and neurological features). 3. In multiple regression, age and educational status as demographic variables and exposure level were significantly related to 4neurobehaviral test. Also exposure level and serum Mn concentrations were positively relatel to signal change on MRI scans and neurological features affected by Mn on the brain (signal change). 4. Psychoneurobehaviral outcomes from Mn exposure were related to neurobehaviral performance, signal change on MRJ scans, neurological features and profile of mood states (POMS), and influnced positively with age, alcohol and smoking history, and duration of Mn exposure, negatively with educational status. Serum Mn concentrations in combination with brain MRI scans, and perhaps a battery of neurobehaviral tests, appear to be the best way to monitor excessive exposure to Mn. These results are consistent with our knowledge on Mn action on the brain and are similar to the type of neurobehaviral dysfunction. They suggest that there may be age, educational status, and life style (alcohol and drinking history) differences with chronic environmental exposure. These findings suggest further evaluation, particularly on relationships between Mn exposure, aging, and susceptibility factors.
Aging ; Alloys ; Brain ; Drinking ; Educational Status ; Environmental Exposure ; Humans ; Life Style ; Magnetic Resonance Imaging ; Male ; Manganese* ; Questionnaires ; Risk Factors ; Smoke ; Smoking ; Welding