Cognitive dysfunction, a significant complication of type 2 diabetes mellitus (T2DM), can potentially manifest even from the early stages of the disease. Despite evidence of global brain atrophy and related cognitive dysfunction in early-stage T2DM patients, specific regions vulnerable to these changes have not yet been identified. The study enrolled patients with T2DM of less than five years’ duration and without chronic complications (T2DM group, n=100) and demographically similar healthy controls (control group, n=50). High-resolution T1-weighted magnetic resonance imaging data were subjected to independent component analysis to identify structurally significant components indicative of morphometric networks. Within these networks, the groups’ gray matter volumes were compared, and distinctions in memory performance were assessed. In the T2DM group, the relationship between changes in gray matter volume within these networks and declines in memory performance was examined. Among the identified morphometric networks, the T2DM group exhibited reduced gray matter volumes in both the precuneus (Bonferronicorrected p=0.003) and insular-opercular (Bonferroni-corrected p=0.024) networks relative to the control group. Patients with T2DM demonstrated significantly lower memory performance than the control group (p=0.001). In the T2DM group, reductions in gray matter volume in both the precuneus (r=0.316, p=0.001) and insular-opercular (r=0.199, p=0.047) networks were correlated with diminished memory performance. Our findings indicate that structural alterations in the precuneus and insular-opercular networks, along with memory dysfunction, can manifest within the first 5 years following a diagnosis of T2DM.

Purpose: Intraoperative frozen section biopsy is used to reduce the margin positive rate and re-excision rate and has been reported to have high diagnostic accuracy. A majority of breast surgeons in the Republic of Korea routinely perform frozen section biopsy to assess margins intraoperatively, despite its long turnaround time and high resource requirements. This study aims to determine whether omitting frozen section biopsy for intraoperative margin evaluation in selected patients is non-inferior to performing frozen section biopsy in terms of resection margin positivity rate. Methods This study is a phase III, randomized controlled, parallel-group, multicenter non-inferiority clinical trial. Patients meeting the inclusion criteria and providing written informed consent will be randomized to the “frozen section biopsy” or “frozen section biopsy omission” group after lumpectomy. Patients with clinical stage T1–T3 disease who are diagnosed with invasive breast cancer by core-needle biopsy and plan to undergo breast-conserving surgery will be included in this study. If a daughter nodule, non-mass enhancement, or microcalcification is identified on preoperative imaging, these features must be within 1 cm of the main mass for inclusion in the trial. The target sample size is 646 patients per arm. The primary endpoint will be the resection margin positive rate, and the secondary endpoints include the reoperation rate, operating time, residual cancer after reoperation, residual cancer after re-excision according to the frozen section biopsy result, resection volume, patient quality of life, and cost-effectiveness.Discussion: This is the first randomized clinical trial utilizing frozen section biopsy for intraoperative margin evaluation and aims to determine the non-inferiority of omitting frozen section biopsy in selected patients compared to performing frozen section biopsy.We expect that this trial will help surgeons perform the procedure more efficiently while ensuring patient safety.

OBJECTIVE: We designed a nationwide study with limited exclusion criteria to investigate the prevalence of metabolic syndrome (MetS) in Korea and its relationship with antipsychotic medications. METHODS: This multicenter, cross-sectional, and observational study included patients diagnosed with schizophrenia or schizoaffective disorder. Sixteen hospitals enrolled 845 patients aged 18 to 65 years prescribed any antipsychotic medication between August 2011 and August 2013. MetS was diagnosed using the criteria of the modified Adult Treatment Panel III of the National Cholesterol Education Program with the Korean abdominal obesity definition (waist circumference ≥85 cm in women, ≥90 cm in men). RESULTS: The prevalence of MetS in all patients was 36.5% and was significantly higher in men than women (men, 40.8%; women, 32.2%) and was significantly correlated with age [odds ratio (OR) 1.02] and duration of illness (OR 1.03). The prevalence of MetS across antipsychotic drugs in the major monotherapy group was as follows: 18.8% for quetiapine, 22.0% for aripiprazole, 33.3% for both amisulpride and paliperidone, 34.0% for olanzapine, 35% for risperidone, 39.4% for haloperidol, and 44.7% for clozapine. CONCLUSION: The prevalence of MetS is very high in patients with schizophrenia or schizoaffective disorder. Screening and monitoring of MetS is also strongly recommended.
Adult ; Antipsychotic Agents ; Aripiprazole ; Cholesterol ; Clozapine ; Cross-Sectional Studies* ; Education ; Female ; Haloperidol ; Humans ; Korea* ; Male ; Mass Screening ; Obesity, Abdominal ; Observational Study ; Paliperidone Palmitate ; Prevalence* ; Psychotic Disorders ; Quetiapine Fumarate ; Risperidone ; Schizophrenia*

PURPOSE: Downstaging after chemoradiotherapy (CRT) for rectal cancer usually occurs. The present study aimed to evaluate pathologic y-stage (yp-stage) and its influence on local recurrence and systemic recurrence in rectal cancer patients treated with CRT followed by surgical resection. METHODS: We retrospectively analyzed 261 patients underwent preoperative CRT and radical resection for rectal cancer between August 2004 and December 2010. Patients received preoperative CRT consisting of 5-fluorouracil and leucovorin delivered with concurrent pelvic radiation of 45.0-50.4 Gy, followed by radical surgery at 6-8 weeks after CRT. RESULTS: Of the 261 patients, 24 (9.2%) had yp-stage 0, 83 (31.8%) had yp-stage I, 86 (32.9%) had yp-stage II, and 68 (26.1%) had yp-stage III. Patients with yp-stage III had a greater prevalence of preoperative CEA, poorly differentiated tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) than patients with lower yp-stages. We found that yp-stage, preoperative CEA, LVI, PNI and tumor regression grade were significant prognostic factors for both local and systemic recurrence. In multivariate analysis, yp-stage, LVI and PNI were significant factors for local and systemic recurrence. During the median follow-up of 37.5 months, the five-year local recurrence-free survival rate was 100.0%, 95.0%, 89.3%, and 80.6% of yp-stage 0-III, respectively. The five-year systemic recurrence-free survival was 95.8%, 75.3%, 71.4%, and 48.8% of yp-stages 0-III, respectively. CONCLUSION: The yp-stage after preoperative CRT for rectal cancer is closely correlated with local and systemic recurrence-free survival. Therefore, yp-stage should be considered as a prognostic factor for rectal cancer patients having a course of preoperative CRT.
Chemoradiotherapy* ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Multivariate Analysis ; Prevalence ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate

OBJECTIVES: The purpose of this study is to evaluate the impact of delirium on clinical outcomes in intensive care unit (ICU) patients in a Korean general hospital. METHODS: All patients admitted to ICU from March 1, 2013 to October 31, 2013 were assessed by Confusion Assessment Method adapted for use in the ICU for delirium daily, and consistently comatose patients were excluded for analysis. Differences in clinical outcomes (mortality, length of hospital stay, length of ICU stay) were analyzed between delirious patients and non-delirious patients. Subsequently, the impact of delirium on clinical outcomes was analyzed with adjusting for covariates including surgery, age, emergent admission, presence of surgery, and severity of illness. RESULTS: The analysis included 129 delirious patients and 469 non-delirious patients. As primary outcome, mortality, length of stay (hospital day, ICU-stay) were significantly high in the delirious group. The association remained the same after adjusting for the covariates. CONCLUSION: The results correspond with those of previous research studies conducted in foreign ICU. Based on this observation that delirium also has an impact on clinical outcomes in Korean ICU, integrative and in-depth investigation on ICU delirium will be needed.
Coma ; Delirium* ; Hospitals, General* ; Humans ; Intensive Care Units* ; Length of Stay ; Mortality ; Observational Study*

PURPOSE: Carbon monoxide (CO) poisoning can cause rhabdomyolysis and acute kidney injury (AKI). However, until recently, studies regarding CO-induced rhabdomyolysis were rarely reported. This study was conducted in order to determine the risk factors for prediction of development of CO-induced rhabdomyolysis. METHODS: We retrospectively reviewed the medical records of 70 CO poisoned patients who presented to an emergency department from January 2010 to December 2012. CO poisoning related parameters, patient demographics, and laboratory data were analyzed. RESULTS: Rhabdomyolysis and AKI were observed in 11 patients (15.7%) and six (8.6%) patients, respectively. Time of exposure to CO, age, Glasgow coma scale, and leukocyte count differed significantly between patients who developed rhabdomyolysis and patients who did not. Exposure time to CO was the only risk factor for predicting development of rhabdomyolysis (odds ratio, 1.365; 95% confidence interval, 1.014-1.836; p=0.040). CONCLUSION: The frequency of rhabdomyolysis in CO poisoning was 15.7% and fluid therapy was very effective in treatment of CO-induced rhabdomyolysis and prevention of AKI progression. An exposure time to CO of over 5 hours was a factor with high potential for predicting development of CO-induced rhabdomyolysis. Along with patients' symptoms and signs, this factor should be considered in assessment of patients with CO poisoning.
Acute Kidney Injury ; Carbon Monoxide ; Carbon Monoxide Poisoning* ; Demography ; Emergency Service, Hospital ; Fluid Therapy ; Glasgow Coma Scale ; Humans ; Leukocyte Count ; Medical Records ; Poisoning ; Retrospective Studies ; Rhabdomyolysis* ; Risk Factors

The role of the day hospital as a mediator between psychiatric ward admission and return to the community has been weakening in general hospitals. The purpose of this paper is to suggest new developmental directions for the day hospital in general hospitals. The history and the operation model of day hospitals were investigated through a bibliographic search. The national mental health care system and the operational realities of the day hospital were also reviewed. The Seoul National University Hospital (SNUH) Day intensive care center (DICC) was introduced ; we then observed several indexes of the SNUH day hospital before and after the institution of DICC. The number of national community mental health care centers is increasing, and the role of this center is similar to the role of the day hospital. The SNUH day hospital invented a short-term intensive care program named DICC for patients with obsessive compulsive disorder, panic and mood disorders and showed marked increment of the number of patients and income after introduction of the DICC. There might be some benefits in introduction of the DICC to psychiatric day hospitals. The role of the DICC will be highlighted in general hospitals, not only for improvement of day hospital management, but also to help patients through early intervention.
Early Intervention (Education) ; Hospitals, General ; Humans ; Critical Care ; Mental Health ; Mood Disorders ; Obsessive-Compulsive Disorder ; Panic

PURPOSE: The preoperative prediction of malignant potential in patients with gastric submucosal tumors (SMTs) plays an important role in decisions regarding their surgical management. METHODS: We evaluated the predictors of malignant gastric SMTs in 314 patients with gastric SMTs who underwent surgery in Chonnam National University Hospital. RESULTS: The malignant SMTs were significantly associated with age (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.042 to 1.091; P < 0.0001), presence of central ulceration (OR, 2.690; 95% CI, 1.224 to 5.909; P = 0.014), and tumor size (OR, 1.791; 95% CI, 1.483 to 2.164; P < 0.0001). Receiver operating characteristic curve analysis showed that tumor size was a good predictor of malignant potential. The most relevant predictor of malignant gastric SMT was tumor size with cut-offs of 4.05 and 6.40 cm. CONCLUSION: Our findings indicated that age, central ulceration, and tumor size were significant preoperative predictors of malignant SMTs. We suggest that 4 cm be selected as a threshold value for malignant gastric SMTs. In patients with a gastric SMT larger than 4 cm with ulceration, wide resection of the full thickness of the gastric wall or gastrectomy with adequate margins should be performed because of its malignant potential.
Gastrectomy ; Humans ; ROC Curve ; Stomach Neoplasms ; Ulcer

PURPOSE: The relationship between the prognosis and the age of patients with gastric carcinoma is controversial. This study examined the clinicopathologic features of elderly gastric carcinoma patients with serosal invasion. METHODS: We reviewed the hospital records of 136 elderly gastric carcinoma patients with serosal invasion retrospectively to compare the clinicopathologic findings in the elderly (aged > 70 years) and young (aged < 36 years). RESULTS: The 5-year survival rates of elderly and young patients with curative resection did not differ statistically (33.9% vs. 43.3%; P = 0.318). Multivariate analysis showed that two factors were independent, statistically significant parameters associated with survival: histologic type (risk ratio, 1.805; 95% confidence interval [CI], 1.041 to 3.132; P < 0.05) and operative curability (risk ratio, 2.506; 95% CI, 1.371 to 4.581; P < 0.01). CONCLUSION: This study demonstrated that elderly gastric carcinoma patients with serosal invasion do not have a worse prognosis than young patients. The important prognostic factor was whether the patients underwent curative resection.
Aged ; Hospital Records ; Humans ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Survival Rate

Chronic obstructive pulmonary disease (COPD) is a substantially under-diagnosed disorder, and the diagnosis is usually delayed until the disease is advanced. However, the benefit of early diagnosis is not yet clear, and there are no guidelines in Korea for doing early diagnosis. This review highlights several issues regarding early diagnosis of COPD. On the basis of several lines of evidence, early diagnosis seems quite necessary and beneficial to patients. Early diagnosis can be approached by several methods, but it should be confirmed by quality-controlled spirometry. Compared with its potential benefit, the adverse effects of spirometry or pharmacotherapy appear relatively small. Although it is difficult to evaluate the benefit of early diagnosis by well-designed trials, several lines of evidence suggest that we should try to diagnose and manage patients with COPD at early stages of the disease.
Early Diagnosis ; Humans ; Korea ; Pulmonary Disease, Chronic Obstructive ; Spirometry