Objective: This is the first prospective cohort study of Huntington’s disease (HD) in Korea. This study aimed to investigate the caregiver burden in relation to the characteristics of patients and caregivers. Methods: From August 2020 to February 2022, we enrolled patients with HD from 13 university hospitals in Korea. We used the 12-item Zarit Burden Interview (ZBI-12) to evaluate the caregiver burden. We evaluated the clinical associations of the ZBI-12 scores by linear regression analysis and investigated the differences between the low- and high-burden groups. Results: Sixty-five patients with HD and 45 caregivers were enrolled in this cohort study. The average age at onset of motor symptoms was 49.3 ± 12.3 years, with an average cytosine-adenine-guanine (CAG)n of 42.9 ± 4.0 (38–65). The median ZBI-12 score among our caregivers was 17.6 ± 14.2. A higher caregiver burden was associated with a more severe Shoulson–Fahn stage (p = 0.038) of the patients. A higher ZBI-12 score was also associated with lower independence scale (B = -0.154, p = 0.006) and functional capacity (B = -1.082, p = 0.002) scores of patients. The caregiving duration was longer in the high- than in the low-burden group. Caregivers’ demographics, blood relation, and marital and social status did not affect the burden significantly. Conclusion HD patients’ neurological status exerts an enormous impact on the caregiver burden regardless of the demographic or social status of the caregiver. This study emphasizes the need to establish an optimal support system for families dealing with HD in Korea. A future longitudinal analysis could help us understand how disease progression aggravates the caregiver burden throughout the entire disease course.

PURPOSE: This study aimed to examine the development of socializing and emotional expressions through vocalizations and joint attention (JA) behaviors in Korean-speaking children with autism spectrum disorder (ASD), compared to those with developmental delay (DD). MATERIALS AND METHODS: Video samples were collected from 28 toddlers with ASD and 18 age-matched toddlers with DD, and vocalizations were each coded in detail for the purpose of this retrospective research. In addition to some statistical analysis, Computerized Language Analysis was conducted to obtain the final results. RESULTS: Although they produced a higher number of vocalizations than the DD group, the ASD group did not engage in emotional or social interactions with their caretakers, whereas the DD group did. The children with ASD used more atypical vocalizations and socially unengaged vocalizations than the children with DD did. JA using vocalizations in the ASD group, in particular, was largely dyadic, with triadic types occurring at a significantly lower frequency than those in the DD group. CONCLUSION: Results from this study indicate the importance of assessing early vocalizations in toddlers with ASD, suggesting that some common symptoms of ASD, such as lack of typical, emotional, and social functions in early vocalizations, could be used to develop screening and intervention programs related to ASD.
Autism Spectrum Disorder* ; Autistic Disorder* ; Child ; Child Behavior ; Communication Disorders ; Developmental Disabilities ; Humans ; Interpersonal Relations ; Joints ; Mass Screening ; Mother-Child Relations ; Retrospective Studies

OBJECTIVE: The objective of this study was to evaluate clinical and laboratory characteristics of torsion on mature cystic teratomas (MCTs). In addition, we examined whether these factors could be helpful in diagnosing MCT torsion. METHODS: A retrospective medical record review was conducted for 384 patients who had undergone surgery and histologically verified ovarian MCTs at single university hospital between July 2006 and May 2017. Patients with or without torsion groups were compared with respect to clinical presentation, laboratory findings and surgical course. In addition, statistically significant indicators of the factors were additionally evaluated for diagnostic value. RESULTS: White blood cell (WBC) count, neutrophil count, neutrophil to lymphocyte (N/L) ratio, and tumor size were higher in the torsion group (n=24) than in the control group (n=360; P≤0.005 for all). The age was younger in the torsion group than in the control (P=0.009). In the area under the curve (AUC) of the 5 factors obtained by univariate and multivariate logistic regression, the age was 0.657, the WBC count was 0.838, the neutrophil count was 0.806, the N/L ratio was 0.725, and the cyst size was 0.705. Receiver operating characteristic analysis indicated that the AUC for the combined use of age, WBC count, neutrophil count, N/L ratio, and tumor size was 0.898 (95% confidence interval, 0.833–0.962; P < 0.001). CONCLUSION: The combined measurement of age, WBC count, neutrophil count, N/L ratio, and tumor size may be used as a potential diagnostic marker for the torsion on MCTs.
Area Under Curve ; Humans ; Leukocytes ; Logistic Models ; Lymphocytes ; Medical Records ; Neutrophils ; Retrospective Studies ; ROC Curve ; Teratoma*

PURPOSE: To analyze the benefit and feasibility of this procedure compared with those of open method. METHODS: Abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. The actual procedure performed during open surgery is the same as those of laparoscopic surgery except for the main incision. Minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications were analyzed and compared with 44 cases of open method. RESULTS: Although the total operative time was not different between 2 groups (349.8 minutes vs. 374.8 minutes, P = 0.153), the operation time of abdominal procedure was shorter in laparoscopic group (90.6 minutes vs. 162.1 minutes, P < 0.001). Operation related complications and hospital stay were not significantly different between the 2 groups. The number of transfused patients was significantly smaller in laparoscopic group (11.1% vs. 27.9%, P = 0.030). CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatment option for patients with esophageal cancer.
Axis, Cervical Vertebra ; Esophageal Neoplasms* ; Esophagectomy ; Feasibility Studies ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Operative Time ; Postoperative Complications ; Surgical Procedures, Minimally Invasive

PURPOSE: We examined the question of whether one-hand chest compression for a small child could compress intraabdominal organs. METHODS: We retrospectively examined medical charts and multidirectional computed tomography (MDCT) images obtained from children aged 1 to 18 years who presented to the hospital from March 2002 to March 2012. We measured the length of the sternum (Stotal) and the length of the lower half of the sternum (Stotal/2~X). We also measured the distance from the diaphragm to the midpoint of the sternum (Stotal/2~D) and half the width of an adult hand (Wtotal/2). Finally, we counted the number of instances at each age in which Stotal/2~X and Stotal/2~D were less than Wtotal/2. RESULTS: This study included records and MDCT images for 301 children with a mean age of 12.05+/-5.59 years. We also enrolled 47 adult rescuers (25 men, 53.2%) with a mean age of 23.20+/-2.13 years. The mean Wtotal/2 was 4.62+/-0.46 cm. All 1-year-old children had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 2 years, six (60.0%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 3 years, four (26.7%) had Stotal/2~X and Stotal/2~D less than Wtotal/2, and among those aged 4 years, two (13.3%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. However, Stotal/2~X and Stotal/2~D were greater than Wtotal/2 in children aged 5 years or more. CONCLUSION: Our measurements indicate that one-hand chest compression for a small child could cause intraabdominal organ injury.
Adult ; Cardiopulmonary Resuscitation ; Child* ; Diaphragm ; Hand ; Humans ; Male ; Retrospective Studies ; Sternum ; Thorax

PURPOSE: We report on a novel method and outcomes of laparoscopic gastric tubing with pyloromyotomy. METHODS: The abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. Between January 2009 and April 2013, our minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications, were analyzed. RESULTS: There were no cases of conversion to open surgery. Of 54 patients, 52 patients had squamous cell carcinoma (SCC) and two had adenocarcinoma. The total operative time was 349.8+/-77.4 minutes, of which 90.6+/-27.6 minutes was required for the abdominal procedure. The mean estimated operative blood loss during the abdominal procedure was 40.0+/-355.5 ml. The postoperative complication rate was 24.1%; three patients died of pneumonia. CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatm ent option for patients with esophageal cancer.
Adenocarcinoma ; Axis, Cervical Vertebra ; Carcinoma, Squamous Cell ; Conversion to Open Surgery ; Esophageal Neoplasms* ; Esophagectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Operative Time ; Pneumonia ; Postoperative Complications

BACKGROUND: Up to now, lobectomy, bilobectomy and pneumonectomy combined with extensive lymph node dissection have been regarded as the standard procedures for non-small cell lung cancer (NSCLC). In high-risk patients, however, limited resection (LR) has been attempted as a salvage procedure, and, recently, indication for LR has been extended to selected cases with early-stage NSCLC. MATERIAL AND METHODS: Among the 773 patients who underwent surgical procedures for NSCLC in Seoul National University Bundang Hospital from May 2003 to December 2008, 43 patients received LR. Medical records of these patients were retrospectively reviewed. RESULTS: Mean age at operation was 66.0+/-12.4 years, and there were 30 males. Twenty-five patients underwent conservative limited resection (CLR) and 18 underwent intentional limited resection (ILR). Indications for CLR were multiple primary lung cancer in 9 (9/25, 36%) and severe concomitant diseases in 5 (5/25, 20%). Of these, 6 patients underwent segmentectomy and 19 received wedge resection. During the follow-up period of 28.0+/-17.8 months, 15 patient developed recurrent lung cancer. ILR was selectively performed in lesions almost purely composed of ground glass opacity (> or =95%), or in small solid lesions (< or =2 cm). Of these, 11 patients underwent segmentectomy and 7 underwent wedge resection. During the follow-up period of 31.7+/-11.6 months, no patient developed recurrence. CONCLUSION: Intermediate-term outcome of LR for early-stage lung cancer is comparable to that of standard operation. For the delineation of the indications and appropriate surgical techniques for LR, prospective randomized multi-institutional study may be expedient.
Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Glass ; Humans ; Lung ; Lung Neoplasms ; Lymph Node Excision ; Male ; Mastectomy, Segmental ; Medical Records ; Pneumonectomy ; Retrospective Studies

BACKGROUND: We evaluated the feasibility and the efficacy of Video-Assisted Thoracic Surgery (VATS) lobectomy for treating patients with non-small cell lung cancer (NSCLC) and we compared the outcomes of VATS lobectomy with those of open lobectomy. MATERIAL AND METHOD: From 2003 to March 2008, 133 NSCLC patients underwent VATS lobectomy. The patients were selected on the basis of having clinical stage I disease on the chest CT and PET scan. The outcomes of 202 patients who underwent open lobectomy (OL group) for clinical stage I NSCLC were evaluated to compare their results with those of the patients who underwent VATS lobectomy (the VL group). RESULT: The number of females and the number of patients with adenocarcinoma and stage IA disease were greater in VL group (p<0.05). There was no operative mortality or major complications in the VL group. Conversion to thoracotomy was needed in 8 cases (6%), which was mostly due to bleeding. The chest tube indwelling time and the length of the postoperative hospital stay were significantly shorter in the VL group (p<0.001). The number of dissected lymph nodes and the size of tumor were significantly smaller in the VL group (p<0.001). For the pathologic stage I patients, there was no significant difference in the three-year survival rates between the two groups (p=0.15). CONCLUSION: VATS lobectomy is a safe procedure with low operative mortality and morbidity. VATS lobectomy is feasible for early stage NSCLC and it provides outcomes that are comparable to those for open lobectomy. Further long-term data are needed
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Chest Tubes ; Female ; Hemorrhage ; Humans ; Length of Stay ; Lung ; Lymph Nodes ; Positron-Emission Tomography and Computed Tomography ; Survival Rate ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thorax

PURPOSE : Aberrant DNA methylation patterns have been commonly associated with human cancers. We have investigated the frequency of DNA hypermethylation in promoter regions from adenocarcinomas of the lung and then attempted to detect the same epigenetic changes from patient serum samples. MATERIALS AND METHODS : We collected tissues from 72 cases of lung adenocarcinomas. The cancer and normal lung tissues were tested for DNA hypermethylation using methylation-specific PCR (MSP). The genes investigated were DAPK, RARbetaP2 and p16. We selected 12 patients where promoter hypermethylation was present for all three genes and four patients where hypermethylation was not seen for any of the three genes. Serum-free DNA was extracted and was tested for promoter hypermethylation. The status of serum-free DNA methylation was analyzed; the hypermethylation status was compared to clinical variables and cancer outcomes. RESULTS : DNA hypermethylation was observed in 32% of samples for DAPK, 63% of samples for RARbetaP2 and 83% of samples for p16 from the cancer tissues. Among the 12 matched serum samples where the primary tumor showed hypermethylation in all three gene promoter regions, we were able to detect five incidences of serum DNA hypermethylation in four patients. The four patients had TNM stage II or higher disease. None of the patients with stage I disease showed serum-free DNA hypermethylation. CONCLUSION : Aberrant promoter hypermethylation was frequently observed in surgically resected adenocarcinoma of the lung. Concurrent serum-free DNA hypermethylation was detected in 34% of patients where the primary tumor showed hypermethylation in all three gene promoter regions. The findings suggest that the serum-free DNA methylation status might be used as a potential target for the diagnosis of lung cancer. However, the low sensitivity should be improved for use in a clinical application
Adenocarcinoma ; DNA ; DNA Methylation ; Epigenomics ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Polymerase Chain Reaction ; Promoter Regions, Genetic

BACKGROUND AND OBJECTIVES: Rapamycin has been shown to inhibit the vascular smooth muscle cell migration and proliferation that contributes to neointimal formation. We investigated whether the perivascular delivery of rapamycin in Pluronic gel could inhibit neointimal hyperplasia in a rat carotid artery model, and we tested the usefulness of carotid arteriography. MATERIALS AND METHODS: To assess the kinetics of rapamycin's release from Pluronic gel, a [3H] thymidine incorporation assay was performed with using the media exposed to rapamycin in Pluronic gel for 10, 20, 60 and 120 min. We applied 100 microgram of rapamycin in Pluronic gel to the perivascular space of the carotid artery after the balloon injury (n=9), whereas only gel was applied in a control group (n=9). We performed the carotid arteriography and the morphometric analysis 14 days after injury. RESULTS: The [3H] thymidine incorporation assay showed a reduction of uptake in a time-dependent manner (86%, 48%, 45% and 40% of the control, respectively, at 10, 20, 60 and 120 minutes). The inhibiting effect of rapamycin on neointimal hyperplasia was identified on the carotid arteriography (mean luminal diameter; 0.75+/-0.11 vs. 0.60+/-0.12 arbitrary units, respectively, p< 0.05) and on the morphometric analysis (neointima area: 0.09+/-0.03 vs. 0.17+/-0.06 mm(2), respectively, p< 0.05). CONCLUSION: This study demonstrated that perivascular delivery of rapamycin in Pluronic gel inhibits neointimal hyperplasia in a rat carotid injury model. This animal model combined with arteriography can be used for developing new drugs to treat restenosis. In addition, this technique might be useful for vascular surgery such as coronary artery bypass grafting, arteriovenous fistula formation and peripheral vascular bypass graft insertion.
Angiography ; Animals ; Arteriovenous Fistula ; Carotid Arteries ; Carotid Artery Injuries ; Cell Movement ; Coronary Artery Bypass ; Drug Delivery Systems ; Hyperplasia ; Kinetics ; Models, Animal ; Muscle, Smooth, Vascular ; Phenobarbital ; Rats ; Sirolimus ; Thymidine ; Transplants