BACKGROUND: We established a bloodless center at Soonchunhyang University Hospital (SCH) in 1996 and have provided medical and surgical care for Jehovah's Witness patients. In this study, we evaluated their outcomes to provide the basis of bloodless medicine and surgery in Korea. METHODS: A retropective review of the medical records of 757 Jehovah's Witness patients admitted in the SCH Bloodless Center from December 1996 to July 2003 was performed. RESULTS: Among 757 patients, 19 (2.5%) expired during treatment and 4 of them died of cardiopul-monary dysfunction secondary to anemia. As alternatives to blood transfusion, 85 (11.2%) patients were treated with iron, 81 (10.7%) with erythropoietin, 49 (6.5%) with aprotinin, 31 (4.1%) with hemodilution and 28 (3.7%) with cell saver. Four hundreds fifteen (54.8%) of 757 patients underwent surgery. The most frequently involved cinical department was Obstetric/Gynecology (23.8%). The ratio of female and the percentage of cases treated with alternatives to blood transfusion were higher in surgery group than non-surgery group patients.(Chi-square test, P<0.01) CONCLUSIONS: Most Jehovah's Witness patients were treated successfully in our bloodless center with various alternatives to blood transfusion, such as erythropoietin, intraoperative autotransfusion, acute normovolemic hemodilution etc. Collaboration and good communication among surgeons, anesthesiologists, hematologists and blood bank physicians are very important to provide qualified medical or surgical treatment to the patients who have a religious objection to receiving blood or blood-related products.
Anemia ; Aprotinin ; Blood Banks ; Blood Transfusion ; Blood Transfusion, Autologous ; Cooperative Behavior ; Erythropoietin ; Female ; Hemodilution ; Humans ; Iron ; Korea ; Medical Records

Chemical labyrinthectomy may be performed in patients with Meniere’s disease who have intractable vertigo that does not respond to drug. By using aminoglycosides, the surgical procedure ablates vestibular type 1 hair cells. However, the risk of hearing loss remains a main concern for clinicians because gentamicin ablates cochlear hair cells as well as vestibular hair cells. To deal with the concern for hearing loss, dexamethasone can be combined with gentamicin during chemical labyrinthectomy. Herein, we show that chemical labyrinthectomy using gentamicin combined with dexamethasone preserve hearing at high-frequency compared to the conventional method.

OBJECTIVES: It is increasingly thought that the human cerebellum plays an important role in emotion and cognition. Although recent evidence suggests that the cerebellum may also be implicated in fear learning, only a limited number of studies have investigated the cerebellar abnormalities in panic disorder. The aim of this study was to evaluate the cerebellar gray matter deficits and their clinical correlations among patients with panic disorder. METHODS: Using a voxel-based morphometry approach with a high-resolution spatially unbiased infratentorial template, regional cerebellar gray matter density was compared between 23 patients with panic disorder and 33 healthy individuals. RESULTS: The gray matter density in the right posterior-superior (lobule Crus I) and left posterior-inferior (lobules Crus II, VIIb, VIIIa) cerebellum was significantly reduced in the panic disorder group compared to healthy individuals (p < 0.05, false discovery rate corrected, extent threshold = 100 voxels). Additionally, the gray matter reduction in the left posterior-inferior cerebellum (lobule VIIIa) was significantly associated with greater panic symptom severity (r = -0.55, p = 0.007). CONCLUSIONS: Our findings suggest that the gray matter deficits in the posterior cerebellum may be involved in the pathogenesis of panic disorder. Further studies are needed to provide a comprehensive understanding of the cerebro-cerebellar network in panic disorder.
Cerebellum* ; Cognition ; Humans ; Learning ; Panic ; Panic Disorder*

Alcohol dependence is a serious disorder that can be related with a number of potential health-related and social consequences. Cortical thickness measurements would provide important information on the cortical structural alterations in patients with alcohol dependence. Twenty-one patients with alcohol dependence and 22 healthy comparison subjects have been recruited and underwent high-resolution brain magnetic resonance (MR) imaging and clinical assessments. T1-weighted MR images were analyzed using the cortical thickness analysis program. Significantly thinner cortical thickness in patients with alcohol dependence than healthy comparison subjects was noted in the left superior frontal cortical region, correcting for multiple comparisons and adjusting with age and hemispheric average cortical thickness. There was a significant association between thickness in the cluster of the left superior frontal cortex and the duration of alcohol use. The prefrontal cortical region may particularly be vulnerable to chronic alcohol exposure. It is also possible that the pre-existing deficit in this region may have rendered individuals more susceptible to alcohol dependence.
Alcoholism ; Brain ; Cerebral Cortex ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging

BACKGROUND/AIMS: Tenofovir disoproxil fumarate (TDF) monotherapy for 48 weeks provided a virological response comparable to that of TDF and entecavir (ETV) combination therapy in patients infected with ETV-resistant hepatitis B virus (HBV). Little long-term data in routine clinical practice are available regarding the optimal treatment of patients with ETV-resistant HBV. METHODS: We investigated the long-term antiviral efficacy of combination therapy of TDF+lamivudine (LAM) or TDF+ETV compared to that of TDF monotherapy in 73 patients with resistance to both LAM and ETV. RESULTS: Patients were treated with TDF monotherapy (n=12), TDF+LAM (n=19), or TDF+ETV (n=42) for more than 6 months. The median duration of TDF-based rescue therapy was 37 months. Virologic response (VR) was found in 63 patients (86.3%). The rates of VR among the three groups (TDF monotherapy, TDF+LAM, and TDF+ETV) were not statistically different (log-rank P=0.200) at 12 months (59.3%, 78.9%, and 51.8%, respectively) or at 24 months (88.4%, 94.7%, and 84.2%). In addition, treatment efficacy of TDF-based combination or TDF monotherapy was not statistically different with ETV-resistant strains or exposure to other antiviral agents. In multivariate analysis, only lower baseline HBV DNA level was an independent predictor for VR (hazard ratio, 0.723; 95% confidence interval, 0.627-0.834; P<0.001). CONCLUSIONS: TDF monotherapy was as effective as combination therapy of TDF+LAM or TDF+ETV in maintaining long-term viral suppression in chronic hepatitis B patients with resistance to both LAM and ETV. HBV DNA level at the start of TDF rescue therapy was the only independent predictor of subsequent VR.
Antiviral Agents ; DNA ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Lamivudine* ; Multivariate Analysis ; Tenofovir ; Treatment Outcome

To date, researchers have developed various animal models of Alzheimer’s disease (AD) to investigate its mechanisms and to identify potential therapeutic treatments. A widely recognized model that mimics the pathology of human sporadic AD involves intracerebroventricular (ICV) injection with streptozotocin (STZ). However, ICV injections are an invasive approach, which creates limitations in generalizing the results. In this study, we produced a rodent model of AD using STZ (3 mg/kg) injection via the cisterna magna (CM) once every week for 4 weeks, and analyzed at 4 weeks and 16 weeks after final injection. In the CM-STZ rodent model of AD, we observed increase in extracellular amyloid-beta (Aβ) deposition and decrease and abnormal morphology of post-synaptic protein, PSD95 in 16 weeks STZ-injected group. The model developed using our less-invasive method induced features of AD-like pathology, including significantly increased extracellular amyloid-beta deposition, and decreased synaptic protein in the hippocampus. These findings supporting the success of this alternative approach, and thus, we suggest this is a promising, less invasive model for use in future AD research.

OBJECTIVES: The aim of this study was to assess variations in caudate volume according to dopamin receptor D2/ankyin repeat and kinase domain containing 1 (DRD2/ANKK1) Taq 1a polymorphisms in young healthy adults and to evaluate the relationship between caudate volumes and psychiatric symptoms as measured by the Brief Psychiatric Rating Scale. METHODS: Genetic information regarding DRD2/ANKK1 Taq 1a and T1-weighted brain magnetic resonance images were acquired from 30 young healthy adults. Automatic segmentation of caudate was performed using the FreeSurfer program. RESULTS: Individuals with A2 homozygotes of DRD2/ANKK1 Taq 1a polymorphisms (n = 10) had greater right caudate volumes compared to those with A1 allele (s)(18.4% greater ; p = 0.019). Right caudate volumes were negatively associated with total scores of the Brief Psychiatric Rating Scale (beta=-0.50 ; p = 0.016). CONCLUSIONS: Our findings suggest the possibility that DRD2/ANKK1 Taq 1a polymorphisms may underlie the psychiatric symptoms by influencing the structure of the right caudate.
Adult ; Alleles ; Brain ; Brief Psychiatric Rating Scale ; Dopamine ; Homozygote ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Phosphotransferases

OBJECTIVES: Novelty seeking (NS) represents a dopaminergically modulated tendency toward frequent exploratory activity. Considering the reports showing the relationship between exploratory activity and amygdalar function and structure, and the fact that amygdala is one of the key structures that constitute the dopaminergic pathway in the brain, amygdala might be closely related to NS tendencies. Amygdalar subregional analysis method, which has the enhanced sensitivity compared to the volumteric approach would be appropriate in investigating the subtle differences of amygdalar structures among healthy individuals. The aim of the current study was to examine whether amygdalar subregional morphometric characteristics are associated with the NS tendencies in healthy adults using the amygdalar subregional analysis method. METHODS: Twenty-six healthy adults (12 males, 14 females ; mean age 29.8 +/- 6.2 years) were screened for eligibility. All subjects completed the Korean version of the Temperament and Character Inventory (TCI) and underwent high-resolution brain magnetic resonance imaging. Individuals were divided into 2 groups according to NS scores of the TCI. RESULTS: Individuals of the high NS group had significantly larger laterobasal subregions in right amygdala, after adjustment with the brain parenchymal volumes. Sensitivity analyses for each potential confounding factor such as age, education years and Hamilton Depression Rating Scale (HDRS) scores demonstrated consistent results. CONCLUSIONS: This study suggests that NS differences are associated with the laterobasal subregion of the amygdala.
Adult ; Amygdala ; Brain ; Depression ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Temperament

OBJECTIVES: Firefighters and rescue workers are likely to be exposed to a variety of traumatic events; as such, they are vulnerable to the risk of post-traumatic stress disorder (PTSD). The psychometric properties of the Korean version of the PTSD Checklist (PCL), a widely used self-report screening tool for PTSD, were assessed in South Korean firefighters and rescue workers. METHODS: Data were collected via self-report questionnaires and semi-structured clinical interviews administered to 221 firefighters. Internal consistency, item-total correlation, one-week test-retest reliability, convergent validity, and divergent validity were examined. Content validity of the PCL was evaluated using factor analysis and receiver operating characteristic (ROC) analyses were used to estimate the optimal cutoff point and area under the curve. RESULTS: The PCL demonstrated excellent internal consistency (alpha = 0.97), item-total correlation (r = 0.72-0.88), test-retest reliability (r = 0.95), and convergent and divergent validity. The total score of PCL was positively correlated with the number of traumatic events experienced (p < 0.001). Factor analysis revealed two theoretically congruent factors: re-experience/avoidance and numbing/hyperarousal. The optimal cutoff was 45 and the area under the ROC curve was 0.97. CONCLUSIONS: The Korean version of the PCL may be a useful PTSD screening instrument for firefighters and rescue workers, further maximizing opportunities for accurate PTSD diagnosis and treatment.
Checklist* ; Diagnosis ; Firefighters* ; Humans ; Mass Screening ; Psychometrics ; Reproducibility of Results* ; Rescue Work* ; ROC Curve ; Stress Disorders, Post-Traumatic*

Background/Aims: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) can serve as biomarkers for diagnosing and assessing disease activity in ulcerative colitis (UC). We investigated their clinical significance in UC. Methods: We analyzed 48 patients with UC who underwent measurement of fecal calprotectin (FC) and endoscopy and 96 age- and sex-matched healthy controls. NLR and PLR were compared between the patients and healthy controls. The endoscopic activity was divided into 2 groups: group 1 (mild to moderate inflammation) and group 2 (severe inflammation) according to the Mayo endoscopic subscore in UC. Results: To diagnose UC, the optimal cutoff of NLR and PLR was 2.26 (sensitivity 54.2%; specificity 90.6%; positive likelihood ratio 5.778, 95% confidence interval [CI] 2.944–11.339; area under the curve [AUC] 0.774, 95% CI, 0.690–0.859) and 179.8 (sensitivity 35.4%; specificity 90.6%; positive likelihood ratio 3.778, 95% CI 1.821–7.838; AUC 0.654, 95% CI 0.556–0.753), respectively. The optimal cutoff to differentiate group 1 and group 2 was 3.44, 175.9, and 453 µg/g for NLR, PLR, and FC, respectively (sensitivity, 63.6% vs. 90.9% vs. 81.8%; specificity, 81.1% vs. 78.4% vs. 73.0%; positive likelihood ratio, 3.364 vs. 4.205 vs. 3.027; AUC, 0.714 vs. 0.897 vs. 0.813). PLR had the highest AUC and positive likelihood ratio. Conclusions NLR and PLR help differentiate patients with UC from healthy controls. NLR, PLR, and FC indicate endoscopic activity and may reflect intestinal mucosal conditions.