With rapid population aging, the socioeconomic burden caused by dementia care is snowballing. Although a few community-based studies of Alzheimer's disease (AD) have been performed in Korea, there has never been a nationwide hospital-based study thereof. We aimed to identify the demographics and clinical characteristics of mild-to-moderate AD patients from the Clinical Research Center for Dementia of Korea (CREDOS) registry. A total of 1,786 patients were consecutively included from September 2005 to June 2010. Each patient underwent comprehensive neurological examination, interview for caregivers, laboratory investigations, neuropsychological tests, and brain MRI. The mean age was 74.0 yr and the female percentage 67.0%. The mean period of education was 7.1 yr and the frequency of early-onset AD (< 65 yr old) was 18.8%. Among the vascular risk factors, hypertension (48.9%) and diabetes mellitus (22.3%) were the most frequent. The mean score of the Korean version of Mini-Mental State Examination (K-MMSE) was 19.2 and the mean sum of box scores of Clinical Dementia Rating (CDR-SB) 5.1. Based on the well-structured, nationwide, and hospital-based registry, this study provides the unique clinical characteristics of AD and emphasizes the importance of vascular factors in AD in Korea.
Aged ; Aged, 80 and over ; Alzheimer Disease/complications/*diagnosis ; Brain/radionuclide imaging ; Caregivers ; Dementia/diagnosis ; Demography ; Diabetes Mellitus, Type 2/etiology ; Female ; Hospitals ; Humans ; Hypertension/etiology ; Interviews as Topic ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Questionnaires ; *Registries ; Republic of Korea ; Risk Factors

We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.
Aged ; Area Under Curve ; Humans ; Logistic Models ; Male ; Middle Aged ; Nomograms ; Predictive Value of Tests ; Preoperative Period ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/*pathology/surgery ; Republic of Korea

OBJECTIVE: The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF). METHODS: The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed. RESULTS: Surgery was performed as the primary treatment in one patient because the anterior spinal artery originated from the same arterial pedicle as the artery feeding the fistula. Embolization was used as the primary treatment modality in 17 patients, with an initial success rate of 82.4%. Two patients with incomplete embolization had to undergo surgery. One patient underwent multiple embolizations, which failed to completely occlude the fistula but relieved the patient's symptoms. Spinal DAVF recurred in two patients (one collateral development and one recanalization) during the follow-up period. The collateral development was obliterated by repeated embolization, but the patient with recanalization refused further treatment. The overall clinical status improved in 15 patients (83.3%) during the follow-up period. CONCLUSION: Endovascular therapy can be successfully used as a primary treatment for the majority of patients with spinal DAVFs. Although it is difficult to perform in some patients, endovascular embolization should be the primary treatment of choice for spinal DAVF.
Arteries ; Central Nervous System Vascular Malformations ; Embolization, Therapeutic ; Fistula ; Follow-Up Studies ; Humans ; Spine

Recently it was shown that single nucleotide polymorphisms (SNPs) can explain individual variation because of the small changes of the gene expression level and that the 50% decreased expression of an allele might even lead to predisposition to cancer. In this study, we found that a decreased expression of an allele might cause predisposition to genetic disease. Dopa responsive dystonia (DRD) is a dominant disease caused by mutations in GCH1 gene. The sequence analysis of the GCH1 in a patient with typical DRD symptoms revealed two novel missense mutations instead of a single dominant mutation. Family members with either of the mutations did not have any symptoms of DRD. The expression level of a R198W mutant allele decreased to about 50%, suggesting that modestly decreased expression caused by an SNP should lead to predisposition of a genetic disease in susceptible individuals.
Child ; Clubfoot/genetics ; Dopamine/deficiency ; Dystonic Disorders/drug therapy/enzymology/*genetics/physiopathology ; GTP Cyclohydrolase/*genetics/metabolism ; Genes, Recessive ; *Genetic Predisposition to Disease ; Humans ; Levodopa/administration & dosage ; Male ; Mutation, Missense ; Pedigree ; Polymorphism, Genetic

PURPOSE: A new health policy, referred to as the National Health Screening Program for Infants and Children, was launched in November 2007 by the Ministry of Health and Welfare and National Health Insurance Corporation in Korea. We have developed a nutrition-counseling program that was incorporated into this project. METHODS: We reviewed the nutritional guidelines published by The Korean Pediatric Society and internationally well-known screening programs such as Bright Future in the United States. We also reviewed the recent Korean national surveys on nutritional issues, including the Korea National Health and Nutrition Examination Survey (KNHANES) and the 2005 National Survey of Physical Body and Blood Pressure in Children and Adolescents. The development of questions, pamphlets, computer programs, and manuals for doctors was carried out after several meetings of researchers and governmental officers. RESULTS: We summarized the key nutritional issues according to age, including breastfeeding in infants, healthier complementary feeding, and prevention of iron deficiency anemia, establishment of healthier diets, as well as dietary prevention of overweight children with an emphasis on physical exercise. We have constructed a new Korean nutrition questionnaire and an anticipatory guidance program based on the primary care schedule of visits at 4, 9, 18, 30, and 60 months of age. Five to eight questions were asked at each visit and age-matched pamphlets for parents and guidelines for doctors were provided. CONCLUSION: We developed a nutrition-counseling program based on recent scientific evidence for Korean infants and children. Further research on this national program for screening the nutritional problems in detail and setting the therapeutic approaches may help identify areas of success as well as those that need further attention.
Adolescent ; Anemia, Iron-Deficiency ; Appointments and Schedules ; Blood Pressure ; Breast Feeding ; Child ; Counseling ; Diet ; Exercise ; Health Policy ; Humans ; Infant ; Infant Nutritional Physiological Phenomena ; Korea ; Mass Screening ; National Health Programs ; Nutrition Surveys ; Obesity ; Overweight ; Pamphlets ; Parents ; Primary Health Care ; Surveys and Questionnaires ; Software ; United States

The methylation of a 23-kDa nuclear protein increased after partial hepatectomy and methylation returned to basal levels after the initial stage of regeneration. The methylating enzyme was partially purified from rat liver by ammonium sulfate precipitation, DEAE-anion exchange chromatography and Butyl-Sepharose chromatography. The 23-kDa protein was purified from a nuclear fraction of liver tissue with SP-Sepharose. When the 23-kDa protein was methylated with the partially purified methyltransferase and analyzed on C18 high performance liquid chromatography (HPLC), the methylated acceptor amino acid was monomethyl lysine (MML). Previously, only arginine N-methylation of specific substrate proteins has been reported during liver regeneration. However, in this report, we found that lysine N-methylation increased during early hepatic regeneration, suggesting that lysine N-methylation of the 23-kDa nuclear protein may play a functional role in hepatic regeneration. The methyltransferase did not methylate other proteins such as histones, hnRNPA1, or cytochrome C, suggesting the enzyme is a 23-kDa nuclear protein- specific lysine N-methyltransferase.
Animals ; Cytochromes c/metabolism ; DNA Helicases/metabolism ; Hepatectomy ; Histone-Lysine N-Methyltransferase/*metabolism ; Histones/metabolism ; Liver ; Liver Regeneration/*physiology ; Lysine/*metabolism ; Methylation ; Proteins/*metabolism ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't

BACKGROUND: Screening tests for hepatocellular carcinoma (HCC) in the high risk population can detect tumors at an earlier stage and thus confer a higher chance of receiving treatment. However, the usefulness, frequency and cost-effectiveness of screening for HCC may differ in different areas, possibly reflecting differences in risk factors. Last decade, we have identified risk factors for HCC in 4339 Korean patients. The aim of this study was to investigate the efficacy and usefulness of individual prediction model for the early diagnosis of HCC. METHODS: We studied a total of 833 patients who visited Yonsei University Medical Center for regular check-up including ultrasonography and alpha-fetoprotein from January 1999 to December 2000. The patients were classified into a low risk group (< 5%), an intermediate risk group (5~15%), and an high risk group (> 15%) by the probability of HCC development according to individual prediction model (IPM). The patients who developed HCC during the follow-up periods were analyzed using IPM. All the detailed data of clinical parameters were obtained by our self-exploited data base system prospectively and analyzed by SAS program. RESULTS: 44 (5.3%) out of 833 patients developed HCC during mean follow-up periods of 36 months. According to IPM, 2 (0.62%) of 324 patients in the low risk group, 20 (4.84%) of 413 patients in the intermediate risk group, and 22 (22.9%) of 96 patients in the high risk group were diagnosed as HCC. In 29 of 44 HCC patients (65.9%), initial presentation of tumor size was less than 3 cm in diameter. CONCLUSION: We confirmed the reliability of established IPM for screening of HCC and this model may help screening program to be done effectively by focusing high risk groups for HCC.
Academic Medical Centers ; alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Early Diagnosis* ; Follow-Up Studies ; Humans ; Mass Screening ; Prospective Studies ; Risk Factors ; Ultrasonography

Chronic pancreatitis causes a variety of complications such as glucose intolerance, pancreatic pseudocyst and duodenal obstruction. However pericardial effusion is very rarely complicated with chronic pancreatitis and life-threatening. The hypothesis of the development of pleuropericardial effusion in chronic pancreatitis has been variously proposed; fistula formation through esophageal or aortic hiatus, local transfer of pancreatic enzyme. Recently, we experienced a case of pleuropericardial effusion complicated by chronic recurrent pancreatitis causing cardiac tamponade. There was a contrast leakage appearing from the pancreatic duct to the mediastinum in endoscopic retrograde pancreaticography. The transpapillary pancreatic stent insertion led to the disappearance of pleuropericardial effusion on the radiography. We report this unusual manifestation of chronic recurrent pancreatitis with the review of literature.
Cardiac Tamponade* ; Duodenal Obstruction ; Fistula ; Glucose Intolerance ; Mediastinum ; Pancreatic Ducts ; Pancreatic Pseudocyst ; Pancreatitis* ; Pancreatitis, Chronic ; Pericardial Effusion ; Radiography ; Stents

The development of a multiplex polymerase chain reaction (PCR) method for rapid and accurate detection and typing of herpes simplex virus type 1 (HSV-1), and type-2 (HSV-2), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) is very important for clinical diagnosis to allow the deliver of therapy as early as possible. Large scale amplifications by multiplex PCR of viral DNA can lower the cost and time for viral diagnosis. In this study, therefore sensitive quadruplex PCR was achieved by optimizing parameters such as primers, and 1.5 mM magnesium and 200 uM dNTPs concentrations. The concentrations of HSV-1, HSV-2, CMV and EBV primers were 0.5, 0.3, 0.25 and 0.25 pmoles, respectively. Optimal annealing temperature was 54 degrees C. Employing these conditions, we could detect 10 copies of reconstructed template plasmid DNA, which were cloned to vectors containing target sequences of viral DNA. PCR products of 271 bp for HSV-1, 231 bp for HSV-2, 368 bp for CMV, and 326 bp for EBV were separated on 5.0% polyacrylamide gel electrophoresis and confirmed by direct sequencing. The present study showed that the quadruplex PCR assay described herein has potential application in clinical diagnosis, when rapid, accurate detection and typing of viruses HSV-1, HSV-2, CMV or EBV are necessary.
Cytomegalovirus/classification/*isolation & purification ; Herpesvirus 1, Human/classification/*isolation & purification ; Herpesvirus 2, Human/classification/*isolation & purification ; Herpesvirus 4, Human/classification/*isolation & purification ; Human ; *Polymerase Chain Reaction/methods ; Sensitivity and Specificity ; Support, Non-U.S. Gov't

Brugada syndrome, an autosomal dominantly inherited form of ventricular fibrillation, is characterized by ST-segment elevation in leads V1-3 and right bundle-branch block on surface electrocardiogram. It is caused by mutations in the cardiac sodium channel gene, SCN5A, and to the best of our knowledge, there has been no report of this mutation in Korea. Three members of a family were heterozygous for a G to T substitution at the nucleotide position 5851 in exon 28 of the SCN5A gene. This nucleotide alteration makes a missense mutation, leading to a valine to leucine substitution (V1951L), in the carboxy terminal region of the sodium channel a subunit. We report here a missense mutation in a Korean family with Brugada-type electrocardiogram.
Brugada Syndrome ; Bundle-Branch Block ; Electrocardiography ; Exons ; Humans ; Korea ; Leucine ; Mutation, Missense* ; Sodium Channels ; Valine ; Ventricular Fibrillation