Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

Purpose: Atrial fibrillation (AF) patients with low to intermediate risk, defined as non-gender CHA2DS2-VASc score of 0–1, are still at risk of stroke. This study verified the usefulness of ABCD score [age (≥60 years), B-type natriuretic peptide (BNP) or N-terminal pro-BNP (≥300 pg/mL), creatinine clearance (<50 mL/min/1.73 m2 ), and dimension of the left atrium (≥45 mm)] for stroke risk stratification in non-gender CHA2DS2-VASc score 0–1. Materials and Methods: This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0–1. The primary endpoint was the incidence of stroke with or without antithrombotic therapy (ATT). An ABCD score was validated. Results: Overall, 2694 patients [56.3±9.5 years; female, 726 (26.9%)] were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100 P-Y for an ABCD score of 0; 1.02/100 P-Y for an ABCD score ≥1. The ABCD score was superior to non-gender CHA2DS2-VASc score in the stroke risk stratification (C-index=0.618, p=0.015; net reclassification improvement=0.576, p=0.040; integrated differential improvement=0.033, p=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score ≥1 than in those without ATT (0.44/100 P–Y vs. 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11–0.63, p=0.003). Conclusion The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0–1. Furthermore, NOAC with an ABCD score ≥1 was associated with significantly lower stroke rate in AF patients with non-gender CHA2DS2-VASc score 0–1.

PURPOSE: The prevalence and treatment patterns of abdominal aortic aneurysm (AAA) vary according to ethnicity and region. This study analyzed nationwide data on the epidemiology, practice patterns, and mortality rates of AAA in Korea.MATERIALS AND METHODS: Data from patients treated for AAA from 2012 to 2016 were extracted from the Korean Health Insurance Review and Assessment (HIRA) database.RESULTS: A total of 30,766 patients in Korea had treatment codes for AAA and 2,618 patients were treated for ruptured AAA. Of the 6,356 patients treated surgically, 1,849 and 4,507 underwent open surgical aneurysmal repairs (OSAR) or endovascular aneurysmal repairs (EVAR), respectively. The number of surgical treatments performed annually for AAA increased from 1,129 cases in 2012 to 1,501 cases in 2016. The number of EVAR cases increased from 753 to 1,109 during these five years, while the number of OSAR cases remained similar, at 376 and 392, respectively. The 30-day mortality rates after EVAR and OSAR were 4.2% and 10.6%, respectively. The mortality rates were significantly higher in patients with hypertension, dyslipidemia, chronic renal disease, diabetes mellitus, and congestive heart failure. There were significant differences in the prevalence, proportion of EVAR, and mortality rates according to the regional area.CONCLUSION: The prevalence of AAA and the proportion of EVAR in Korea increased in the past 5 years, while the rupture rate and the proportion of OSAR remained similar. To minimize mortality and regional discrepancies, nationwide registry and treatment standardization are needed.
Aneurysm ; Aortic Aneurysm, Abdominal ; Cross-Sectional Studies ; Diabetes Mellitus ; Dyslipidemias ; Epidemiologic Studies ; Epidemiology ; Heart Failure ; Humans ; Hypertension ; Insurance, Health ; Korea ; Mortality ; National Health Programs ; Prevalence ; Renal Insufficiency, Chronic ; Rupture

BACKGROUND AND OBJECTIVES: Residual platelet reactivity in patients who are taking clopidogrel is commonly measured with VerifyNow assay, which is based on the principle of light transmission aggregometry. However, to evaluate the residual platelet reactivity, it would be more accurate if the reactivity of platelet glycoprotein (GP) IIb/IIIa is directly monitored. In this study, PAC1, a monoclonal antibody against activated platelet GP IIb/IIIa, was used to measure the residual platelet reactivity. SUBJECTS AND METHODS: Twenty seven patients with coronary artery disease taking clopidogrel were enrolled. Platelets in whole blood were stained with fluorescein isothiocyanate (FITC)-conjugated PAC1. Mean fluorescence intensity (MFI) and % positive platelets (PP) were measured with flow cytometry, and the binding index (BI; MFI x %PP/100) was calculated. P2Y12 reaction unit (PRU) and % inhibition of VerifyNow assay were also measured in the usual manner. RESULTS: PRU of VerifyNow assay correlated significantly with MFI, %PP, and BI at 10 microM (r=0.59, 0.73, and 0.60, respectively, all p<0.005) and 20 microM of adenosine diphosphate (ADP; r=0.61, 0.75, and 0.63, respectively, all p<0.005). The % inhibition also correlated significantly with MFI, %PP, and BI at 10 microM (r=-0.60, -0.69, and -0.59, respectively, all p<0.005) and 20 microM of ADP (r=-0.63, -0.71, and -0.62, respectively, all p<0.005). CONCLUSION: Direct measurements of the reactivity of platelet GP IIb/IIIa were feasible using PAC1 and flow cytometry in patients taking clopidogrel. Further clinical studies are required to determine the cut-off values which would define high residual platelet reactivity in patients on this treatment protocol.
Adenosine Diphosphate ; Blood Platelets* ; Coronary Artery Disease ; Flow Cytometry ; Fluorescein ; Fluorescence ; Glycoproteins* ; Humans ; Platelet Function Tests

OBJECTIVES: Cognitive behavioral therapy of schizophrenia has been developed as a psychological therapy for drug resistant patients with schizophrenia. However, there are some controversial issues regarding the size and mode of the therapeutic effect. The aim of this study is to compare the effect of cognitive behavioral therapy with supportive therapy after treatment. METHODS: Patients with drug resistant schizophrenia were randomly allocated, and stratified according to two mental health institutes to two different therapy groups. We used four assessment scales to evaluate residual symptoms of patients in detail. Patients were assessed twice by a blind rater, at baseline and after treatment. RESULTS: No significant differences in the change of PANSS (Positive and Negative Syndrome Scale) scores were observed between the cognitive behavioral therapy and supportive therapy groups at one month after treatment. There was no significant difference in change of K-PSYRATS (Korean-Psychotic Symptom Rating Scale)-Delusion score, however, a trend toward significance in K-PSYRATS - Hallucination was observed between the two groups. In the aspect of insight, a significant difference in the change of SDMD-K (The Scale to assessment Unawareness of Mental Disorder-Korean version) score was observed between the two groups after treatment. CONCLUSION: Despite remarkable development of pharmacotherapy for schizophrenia, many patients still suffer from residual symptoms. Findings of this study showed that cognitive behavioral therapy can improve the insight of patients and reduce the severity of residual positive symptoms, especially hallucination. Cognitive behavioral therapy should be practiced effectively in the psychiatric clinic and community mental health system.
Academies and Institutes ; Cognitive Therapy ; Hallucinations ; Humans ; Mental Health ; Schizophrenia ; Weights and Measures

Exposure of cells to ultraviolet B (UVB) radiation can induce production of free radicals and reactive oxygen species (ROS), which damage cellular components. In addition, these agents can stimulate the expression of matrix metalloproteinase (MMP) and decrease collagen synthesis in human skin cells. In this study, we examined the anti-photoaging effects of extracts of Tetraselmis suecica (W-TS). W-TS showed the strongest scavenging activity against 2,2-difenyl-1-picrylhydrazyl (DPPH) and peroxyl radicals, followed by superoxide anions from the xanthine/xanthine oxidase system. We observed that the levels of both intracellular ROS and lipid peroxidation significantly increased in UVB-irradiated human skin fibroblast cells. Furthermore, the activities of enzymatic antioxidants (e.g., superoxide dismutase) and the levels of non-enzymatic antioxidants (e.g., glutathione) significantly decreased in cells. However, W-TS pretreatment, at the maximum tested concentration, significantly decreased intracellular ROS and malondialdehyde (MDA) levels, and increased superoxide dismutase and glutathione levels in the cells. At this same concentration, W-TS did not show cytotoxicity. Type 1 procollagen and MMP-1 released were quantified using RT-PCR techniques. The results showed that W-TS protected type 1 procollagen against UVB-induced depletion in fibroblast cells in a dose-dependent manner via inhibition of UVB-induced MMP-1. Taken together, the results of the study suggest that W-TS effectively inhibits UVB-induced photoaging in skin fibroblasts by its strong anti-oxidant ability.
Antioxidants ; Collagen ; Fibroblasts ; Free Radicals ; Glutathione ; Humans ; Lipid Peroxidation ; Malondialdehyde ; Oxidoreductases ; Procollagen ; Reactive Oxygen Species ; Skin ; Superoxide Dismutase ; Superoxides

Tuberculosis generally affects the respiratory tract. In developing nations, the pericardium is the most common location of extrapulmonary tuberculosis; however, tuberculous pericarditis rarely appears as a localized mass or tuberculoma. We present here a case of a 62-year-old woman with pericardial tuberculoma. She had a history of effusive tuberculous pericarditis and drainage. Because she had taken regular medication over a period of six months, the pericardial mass with an adjacent lung nodule newly detected on the chest radiogram was initially suspected of being invasive lung cancer. Prior to pathologic confirmation, precise information from imaging tests, including computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography are helpful when making decisions regarding which methods should be used for surgical approach and treatment. Through imaging, our case showed typical features of pericardial tuberculoma and a favorable clinical course after two months with a change in antituberculous therapy.
Developing Countries ; Drainage ; Electrons ; Female ; Humans ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Middle Aged ; Pericarditis, Tuberculous ; Pericardium ; Respiratory System ; Thorax ; Tuberculoma ; Tuberculosis

OBJECTIVES: To investigate the nature of emotional responsiveness in normal adults, we exam the emotional responses to emotional pictures in an evaluative space defined by arousal and valence. METHODS: Subjects were instructed to rate the arousal and valence that they experienced from the presentation of one of two sets of 60 emotional pictures. These two picture sets were comprised of 107 pictures: 101 selected from International Affective Pictures System and six pictures from our own collection. According to "evaluative space model", the authors set an evaluative space defined by the arousal scores as independent variable and the valence scores as dependent variable. In this evaluative space, one-hundred-and-seven pairs of coordinates representing respective emotional pictures were plotted. With regression analyses, the steepness of the regression lines on the plots with positive emotional responsiveness (n=51) and those with negative emotional responsiveness (n=56) were compared. RESULTS: In the evaluative space, the regression line of negative emotional responsiveness was significantly different from that of positive responsiveness. The slope of negative responsiviveness was significantly steeper than that of positive responsiveness. At a low arousal level, the absolute valence of a positive stimuli was larger than that of a negative picture. CONCLUSION: This finding indicates that the function of the negative affective responsiveness might be different from that of the positive responsitiveness. IAPS also seems applicable to Korean subjects.
Adult ; Arousal ; Humans

The association of neoplastic disease and thromboembolic disorder was first recognized by Trousseau in 1865. Since then, thromboembolic events have often been reported in a variety of malignant conditions. Recently, we experienced an unusual case of a 67-year-old ovarian cancer patient with extensive thromboembolic events involving lung, brain, extremity and abdominal cavity. In this report, we describe a systemic coagulopathy fluctuating in accordance with anticoagulant therapy, and have special regard for a role of anticoagulants for the treatment of this syndrome.
Abdominal Cavity ; Aged ; Anticoagulants ; Brain ; Extremities ; Humans ; Lung ; Ovarian Neoplasms ; Thromboembolism

BACKGROUND AND OBJECTIVES: Peritonsillar abscess (PTA) is a collection of pus lateral to tonsil and is located between the fibrous capsule of the palatine tonsil, usually at its upper pole, and the superior to the pharyngeal constrictor muscle. It frequently occurs as a complication of acute tonsillitis. Bacteriology including clinical characteristics in PTA were evaluated. SUBJECTS AND METHOD: Sixty-one patients with peritonsillar abscess, who visited National Medical Center from January 1997 through August 2001 were entered into the study. Each patient was asked to answer a questionnaire for clinical aspects of PTA. Needle aspirations were performed and pus was drained in all cases. Bacterial susceptibility to ampicillin, cephazoline, ciprofloxacin, erythromycin, tetracyclin, and vancomycin was tested on the ioslated bacteria. RESULTS: Among 61 cases, aerobes were isolated in 15 cases (24.6%) and anaerobes in 16 cases (26.2%). There was no significant difference in the culture positive rate of aerobes (p=0.767) and anaerobes (p=1.0) between antibiotics-medicated patients and nonmedicated patients. Among the cultured organisms, peptostreptococcus was the most common and the second most common was beta-hemolytic streptococcus. However, alpha-hemolytic streptococcus, an important pathogen considered in the previous study, was detected at 1.6%. CONCLUSION: Antibiotics medication was not a significant factor in culture positive rate in our study. Peptostreptococcus as an anaerobe and beta-hemolytic streptococcus as an aerobe were the major causes that contributed to the decreased state of peritonsillar abscess and culture positive rate of alpha-hemolytic streptococcus.
Ampicillin ; Anti-Bacterial Agents ; Aspirations (Psychology) ; Bacteria ; Bacteriology ; Cefazolin ; Ciprofloxacin ; Erythromycin ; Humans ; Needles ; Palatine Tonsil ; Peptostreptococcus ; Peritonsillar Abscess* ; Surveys and Questionnaires ; Streptococcus ; Suppuration ; Tonsillitis ; Vancomycin