Background/Aims: It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD).We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosive GERD or mild erosive esophagitis. Methods: Patients whose GERD symptoms improved after 4 weeks of standard dose PPI treatment were prospectively enrolled at 25 hospitals.Subsequently, the enrolled patients were randomly assigned to either an on-demand or a continuous maintenance treatment group, and followed in an 8-week interval for up to 24 weeks. Results: A total of 304 patients were randomized to maintenance treatment (continuous, n = 151 vs on-demand, n = 153). The primary outcome, the overall proportion of unwillingness to continue the assigned maintenance treatment modality, failed to confirm the noninferiority of on-demand treatment (45.9%) compared to continuous treatment (36.1%). Compared with the on-demand group, the GERD symptom and health-related quality of life scores significantly more improved and the overall satisfaction score was significantly higher in the continuous treatment group, particularly at week 8 and week 16 of maintenance treatment. Work impairment scores were not different in the 2 groups, but the prescription cost was less in the on-demand group. Serum gastrin levels significantly elevated in the continuous treatment group, but not in the on-demand group. Conclusions Continuous treatment seems to be more appropriate for the initial maintenance treatment of non-erosive GERD or mild erosive esophagitis than on-demand treatment. Stepping down to on-demand treatment needs to be considered after a sufficient period of continuous treatment.

Glial cell line-derived neurotrophic factor (GDNF) has been reported to be involved in negatively regulating the effects of addictive disorders. The objective of this study was to investigate alterations in the levels of GDNF in patients with Internet gaming disorder (IGD) and to assess the relationship between GDNF levels and the severity of IGD indices. Nineteen male patients with IGD and 19 sexmatched control subjects were evaluated for alteration of plasma GDNF levels and for relationship between GDNF levels and clinical characteristics of Internet gaming, including the Young's Internet Addiction Test (Y-IAT). The GDNF levels were found to be significantly low in patients with IGD (103.2±62.0 pg/mL) compared with the levels of controls (245.2±101.6 pg/mL, p<0.001). GDNF levels were negatively correlated with Y-IAT scores (Spearman's rho=-0.645, p=<0.001) and this negative correlation remained even after controlling for multiple variables (r=-0.370, p=0.048). These findings support the assumed role of GDNF in the regulation of IGD.
Case-Control Studies ; Glial Cell Line-Derived Neurotrophic Factor ; Humans ; Immunoglobulin D ; Internet ; Male ; Neuroglia ; Pilot Projects ; Plasma

OBJECTIVES: Internet gaming disorder (IGD) is known to be related to stress and the serotonin-transporter-linked polymorphic region (5-HTTLPR) that is known to be associated with stress and has been studied to affect various psychiatric illness outbreaks. We tried to examine the relationship between stress, 5-HTTLPR and IGD. METHODS: A total of 59 participants with IGD, diagnosed according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria and 67 normal controls (NC) were enrolled. The IGD group and the NC were compared using chisquare test and independent sample t-test, and logistic regression analysis was used to examine the relationship between stress, the 5-HTTLPR, and IGD. RESULTS: The mean scores for anxiety, impulsivity and stress were significantly higher in the IGD group than in the NC. In addition, there was a significant association between stress and IGD [odds ratio (OR) = 1.172, 95% confidence interval (CI) = 1.008–1.362]. CONCLUSIONS: This study showed that stress would affect IGD. Therefore, the evaluation and management of stress should be included in the diagnosis and treatment of IGD.
Adult* ; Anxiety ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Disease Outbreaks ; Humans ; Immunoglobulin D ; Impulsive Behavior ; Internet* ; Logistic Models

OBJECTIVE: In our series, endovascular coiling with Target® Nano™ coils (Stryker Neurovascular, Fremont, CA, USA) with diameters of 1 or 1.5 mm exhibited favorable technical feasibility in the treatment of small cerebral aneurysms (< 4 mm). However, little is known about the recurrence of small cerebral aneurysms treated using Target® Nano™ coils. We investigated recurrence following the treatment of small cerebral aneurysms using Target® Nano™ coils. MATERIALS AND METHODS: Between January 2012 and November 2013, 143 patients with 148 small cerebral aneurysms (< 4 mm) were included our study. A total of 135 cerebral aneurysms (91.2%) were unruptured; 45 cerebral aneurysms (30.4%) were treated by endovascular coiling using Target® Nano™ coils. Follow-up radiological images were obtained for 132 cerebral aneurysms (89.2%) over a range of 3 to 58 months (mean, 34.3 months; standard deviation, 14.2). RESULTS: In the group treated with Target® Nano™ coils, radiological outcomes revealed complete occlusion in 33 (73.3%), residual necks in eight (17.8%), and residual sacs in four (8.9%) cases. Follow-up radiological outcomes revealed complete occlusion in 35 (77.8%) and residual necks in four (8.9%) cases that exhibited stable coil masses. In the group that was not treated with Target® Nano™ coils, radiological outcomes revealed complete occlusion in 69 (67%), residual necks in 18 (17.5%), and residual sacs in 16 (15.5%) cases. Follow-up radiological outcomes revealed complete occlusion in 87 (84.5%) and residual necks (5.8%) in six cases that exhibited stable coil masses. No significant differences were observed in the radiological outcomes or follow-up radiological outcomes between the two groups. No recurrences or retreatments occurred in our series. CONCLUSION: Endovascular treatment using Target® Nano™ coils may be a robust treatment option for small cerebral aneurysms (< 4 mm).
Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Neck ; Recurrence* ; Retreatment

OBJECTIVE: Nowadays smartphone overuse has become a social and medical concern. For the diagnosis and treatment, clinicians use the self-report information, but the report data often does not match actual usage pattern. The paper examines the similarity and variance in smartphone usage patterns between the measured data and self-reported data. METHODS: Together with the self-reported data, the real usage log data is collected from 35 college students in a metropolitan region of Northeast Asia, using Android smartphone monitoring application developed by the authors. RESULTS: The unconscious users underestimate their usage time by 40%, in spite of 15% more use in the actual usage. Messengers are most-used application regardless of their self-report, and significant preference to SNS applications was observed in addict group. The actual hourly pattern is consistent with the reported one. College students use more in the afternoon, when they have more free time and cannot use PCs. No significant difference in hourly pattern is observed between the measured and self-report. CONCLUSION: The result shows there are significant cognitive bias in actual usage patterns exists in self report of smartphone addictions. Clinicians are recommended to utilize measurement tools in diagnosis and treatment of smartphone overusing subjects.
Asia ; Bias (Epidemiology) ; Diagnosis ; Humans ; Methyltestosterone ; Pilot Projects* ; Self Report ; Smartphone*

Sjögren's syndrome is a systemic autoimmune disease characterized by sicca symptoms and extraglandular manifestations. Anemia, leukopenia, thrombocytopenia and lymphoproliferative disorders are well-known extraglandular, hematological complications of Sjögren's syndrome. These hematologic alterations are usually mild and respond well with steroid therapy. We report a case of a 52-year-old female patient who was initially presented with thrombocytopenia. The patient was then diagnosed with primary Sjögren's syndrome and initially treated with steroid. The patient's platelet count was decreased when steroid was tapered. The dose of steroid could be effectively reduced after combined medication with hydroxychloroquine.
Anemia ; Autoimmune Diseases ; Female ; Humans ; Hydroxychloroquine ; Leukopenia ; Lymphoproliferative Disorders ; Middle Aged ; Platelet Count ; Thrombocytopenia*

Bordetella bronchiseptica is a common cause of respiratory disease in animals but is a rare cause of human infection. Furthermore, most patients with Bordetella bronchiseptica infections are immunocompromised. The Bordetella bronchiseptica organism can cause pneumonia, septicemia, and peritonitis in humans with impaired immune systems. Additionally, it can lead to a life-threatening infection patients who have an underlying debilitation or impaired immunity. The respiratory tract is the most common site of infection. Sixty-two human cases of Bordetella bronchiseptica have been published in the English literature, and 84 % hadof the cases were associated with pneumonia or bronchitis. However, only one case of Bordetella bronchiseptica has been reported in South Korea, and it was associated with peritonitis. In the current study, we report a case of Bordetella bronchiseptica pneumonia diagnosed in an immunocompromised patient.
Animals ; Bordetella bronchiseptica* ; Bordetella* ; Bronchitis ; Humans ; Immune System ; Immunocompromised Host ; Korea ; Lung Neoplasms ; Peritonitis ; Pneumonia ; Respiratory System ; Sepsis

Intra-articular hyaluronic acid injections for symptomatic treatment of osteoarthritis are widely used but can result in complications, such as infectious arthritis. Staphylococcus lugdunensis is a common normal skin flora but can cause severe infectious disease, such as infective endocarditis. We present the first report of infectious arthritis caused by methicillin-sensitive S. lugdunensis after intra-articular hyaluronic acid injection in an immunocompromised patient in Korea.
Arthritis, Infectious* ; Arthritis, Rheumatoid* ; Communicable Diseases ; Diabetes Mellitus* ; Endocarditis ; Humans ; Hyaluronic Acid* ; Immunocompromised Host ; Korea ; Osteoarthritis ; Skin ; Staphylococcus lugdunensis* ; Staphylococcus*

A growing body of evidence supports that Internet gaming disorder (IGD) is considered as ‘behavioral addiction’ with neurobiological alterations. We have reviewed previous research into the clinical and neurobiological features of IGD, and suggest a flowchart for the comprehensive evaluation of IGD. Several self-rating screening tests based on Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM-5) IGD criteria were developed. IGD is often comorbid with depressive disorder, social anxiety disorder, attention deficit/hyperactivity disorder (ADHD), and smartphone addiction. Individuals with IGD are prone to act impulsively and make risky decisions, especially in response to game-related cues. Functional neuroimaging results have shown altered functional activities in prefrontal cortex, cingulate cortex, superior temporal gyrus and nucleus accumbens (NAc). Structural neuroimaging demonstrated gray matter volume changes in prefrontal cortex and NAc, while showing white matter integrity disruption in thalamus and posterior cingulate cortex. There are few evidences on the attribution of specific genes to IGD. To evaluate IGD comprehensively, self-rating scales based on DSM-5 are useful, but a diagnostic interview by a clinician is more helpful to assess functional impairments of IGD. Presence of psychiatric comorbidities such as depressive disorder, social anxiety disorder, ADHD, and smartphone addiction should be evaluated. Neurocognitive tests that assess impulsivity, decision-making under risk, and cue-reactivity are helpful when planning individualized IGD treatment.
Anxiety Disorders ; Comorbidity ; Cues ; Depressive Disorder ; Functional Neuroimaging ; Gray Matter ; Gyrus Cinguli ; Immunoglobulin D ; Impulsive Behavior ; Internet* ; Mass Screening ; Mental Disorders ; Neuroimaging ; Nucleus Accumbens ; Prefrontal Cortex ; Smartphone ; Software Design ; Temporal Lobe ; Thalamus ; Weights and Measures ; White Matter

OBJECTIVE: The Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) proposed nine diagnostic criteria and five cut-point criteria for Internet Gaming Disorder (IGD). We aimed to examine the efficacy of such criteria. METHODS: Adults (n=3041, men: 1824, women: 1217) who engaged in internet gaming within last 6 months completed a self-report online survey using the suggested wordings of the criteria in DSM-5. Major characteristics, gaming behavior, and psychiatric symptoms of IGD were analyzed using ANOVA, chi-square, and correlation analyses. RESULTS: The sociodemographic variables were not statistically significant between the healthy controls and the risk group. Among the participants, 419 (13.8%) were identified and labeled as the IGD risk group. The IGD risk group scored significantly higher on all motivation subscales (p<0.001). The IGD risk group showed significantly higher scores than healthy controls in all nine psychiatric symptom dimensions, i.e., somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism (p<0.001). CONCLUSION: The IGD risk group showed differential psychopathological manifestations according to DSM-5 IGD diagnostic criteria. Further studies are needed to evaluate the reliability and validity of the specific criteria, especially for developing screening instruments.
Adult* ; Anxiety ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Hostility ; Humans ; Immunoglobulin D ; Internet* ; Male ; Mass Screening ; Motivation ; Reproducibility of Results