Purpose: Renal tumors account for approximately 7% of all childhood cancers. These include Wilms tumor (WT), clear cell sarcoma of the kidney (CCSK), malignant rhabdoid tumor of the kidney (MRTK), renal cell carcinoma (RCC), congenital mesoblastic nephroma (CMN) and other rare tumors. We investigated the epidemiology of pediatric renal tumors in Korea. Materials and Methods: From January 2001 to December 2015, data of pediatric patients (0–18 years) newly-diagnosed with renal tumors at 26 hospitals were retrospectively analyzed. Results: Among 439 patients (male, 240), the most common tumor was WT (n=342, 77.9%), followed by RCC (n=36, 8.2%), CCSK (n=24, 5.5%), MRTK (n=16, 3.6%), CMN (n=12, 2.7%), and others (n=9, 2.1%). Median age at diagnosis was 27.1 months (range 0-225.5) and median follow-up duration was 88.5 months (range 0-211.6). Overall, 32 patients died, of whom 17, 11, 1, and 3 died of relapse, progressive disease, second malignant neoplasm, and treatment-related mortality. Five-year overall survival and event free survival were 97.2% and 84.8% in WT, 90.6% and 82.1% in RCC, 81.1% and 63.6% in CCSK, 60.3% and 56.2% in MRTK, and 100% and 91.7% in CMN, respectively (p < 0.001). Conclusion The pediatric renal tumor types in Korea are similar to those previously reported in other countries. WT accounted for a large proportion and survival was excellent. Non-Wilms renal tumors included a variety of tumors and showed inferior outcome, especially MRTK. Further efforts are necessary to optimize the treatment and analyze the genetic characteristics of pediatric renal tumors in Korea.

Background: Postmenopausal status increases the risk of cardiovascular disease, and C-reactive protein (CRP) constitutes an independent cardiovascular risk factor. This study aimed to investigate the factors associated with increased high-sensitivity CRP (hs-CRP) level in postmenopausal women. Methods: We included postmenopausal women without laboratory test results that suggested acute inflammation who participated in the Korea National Health and Nutrition Examination Survey between 2016 and 2017. The participants were divided into high and low hs-CRP groups (cutoff value, 3.0 mg/L). We investigated factors that influenced the hs-CRP level with logistic regression analysis. Results: The total number of subjects was 2,739, of whom 76.4% had low hs-CRP levels and 23.6% had high hs-CRP levels. The mean age and body mass index were higher in the high than in the low hs-CRP group. In the simple logistic regression analysis, high hs-CRP level was associated with smoking, whereas low hs-CRP level was associated with aerobic exercise, use of oral contraceptives, and history of pregnancy in postmenopausal women. When the analysis was adjusted for confounding variables, histories of smoking and pregnancy had a statistically significant association with high hs-CRP level. Conclusion This study showed that the important modifiable risk factors of elevated hs-CRP level in postmenopausal women of Korea include obesity, smoking, and lack of aerobic exercise, but well-controlled prospective investigations should be considered.

Background: Hodgkin's lymphoma (HL) constitutes 10%–20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea. Methods: We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016. Results: A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype.Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively (P = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, highrisk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level.In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively. Conclusion This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.

This study explored long-term changes in self-report auditory verbal hallucinations (AVHs) among patients with schizophrenia taking clozapine. Forty-four patients who were evaluated more than twice and were above the mild severity category on the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) were enrolled. The mean observation period was 492.5±350.1 days (median, 452 days). The mean total, physical, and emotional factor scores on the HPSVQ were significantly reduced from baseline to the final observations except for one item “interference with life,” which was not significantly reduced. Regarding the time-dependent longitudinal changes modeled using linear mixed-effect regression, the total and physical factor scores showed significant changes during the first year, but the emotional factor score did not satisfy a more stringent level of significance. Female gender was negatively associated with the reduction in total and physical factor scores. The duration of treatment with clozapine also had a negative relationship with the reductions in all three scores.
Clozapine ; Female ; Hallucinations ; Humans ; Schizophrenia ; Voice

OBJECTIVE: This study aimed to investigate the effectiveness and tolerability of the combination of electroconvulsive therapy (ECT) in patients with clozapine-treated schizophrenia. METHODS: Patients with clozapine-treated schizophrenia during five years of pre-determined period were recruited from Electronic Medical Record. Clinical effects of acute ECT on psychotic symptoms were investigated. We also tried to identify predictive variables requiring maintenance treatment of ECT. RESULTS: Fourteen patients received ECT and clozapine and sixteen were treated with clozapine alone. In the ECT group, which could be refined as clozapine-resistance, PANSS total score was significantly reduced by 19.0±9.9 points, corresponding to a reduction rate of 18.5±8.3%. The clinical remission defined as 20% PANSS reduction criteria was achieved at 42.9%. The subscale factors were significantly reduced, among which the negative symptom was the least. There was no difference in demographic and clinical information between patients receiving and not receiving maintenance ECT, and not all patients seemed to need maintenance ECT if clozapine is continued. CONCLUSION: Combination of ECT and clozapine in patients with clozapine-resistant schizophrenia resulted in a rapid and substantial reduction of psychotic symptoms. Further studies are needed to improve the effectiveness and tolerability of ECT.
Clozapine* ; Electroconvulsive Therapy* ; Electronic Health Records ; Humans ; Schizophrenia*

During antipsychotic drug treatment, clinicians occasionally encounter sudden attacks of oculogyric crisis (OGC) and/or paroxysmal perceptual alteration (PPA) which occur mostly in the afternoon or early evening lasting for minutes to hours and are eventually remitted with rests or short sleep and/or medications such as benzodiazepines, anticholinergics and so forth. Moreover, these attacks are usually accompanied with psychiatric symptoms such as various modalities of hallucinations and illusions, delusions, obsessive thoughts, panic attacks, agitation as well as autonomic symptoms. These accompanying psychiatric symptoms can be perceived as a worsening of psychiatric symptoms if the clinician does not understand the symptoms due to the side effects of antipsychotic drugs, which may result in increasing the dosage of antipsychotics instead of reducing doses or switching to less offending drugs. On the other hand, patients could easily recognize the symptoms as the adverse effects of drugs. This literature review and case-series study is aimed to raise awareness of OGC and PPA by providing clinical cases and author's views with the literature reviews about concepts, recognitions and managements from the works of Japanese authors who first reported the clinical importance of these attacks, particularly PPA.
Antipsychotic Agents ; Asian Continental Ancestry Group ; Benzodiazepines ; Cholinergic Antagonists ; Delusions ; Dihydroergotamine ; Hallucinations ; Hand ; Humans ; Illusions ; Panic Disorder ; Schizophrenia

BACKGROUND: Hepatitis B virus (HBV) infection leads to hepatic and extrahepatic manifestations including chronic kidney disease (CKD). However, the association between HBV and CKD is not clear. This study investigated the association between chronic HBV infection and CKD in a nationwide multicenter study. METHODS: A total of 265,086 subjects who underwent health-check examinations in 33 hospitals from January 2015 to December 2015 were enrolled. HBV surface antigen (HBsAg) positive cases (n = 10,048), and age- and gender-matched HBsAg negative controls (n = 40,192) were identified. CKD was defined as a glomerular filtration rate (GFR) < 60 mL/min/1.73 m² or proteinuria as at least grade 2+ of urine protein. RESULTS: HBsAg positive cases showed a significantly higher prevalence of GFR < 60 mL/min/1.73 m² (3.3%), and proteinuria (18.9%) than that of the controls (2.6%, P < 0.001, and 14.1%, P < 0.001, respectively). In the multivariate analysis, HBsAg positivity was an independent factor associated with GFR < 60 mL/min/1.73 m² along with age, blood levels of albumin, bilirubin, anemia, and hemoglobin A1c (HbA1c). Likewise, HBsAg positivity was an independent factor for proteinuria along with age, male, blood levels of bilirubin, protein, albumin, and HbA1c. A subgroup analysis showed that HBsAg positive men but not women had a significantly increased risk for GFR < 60 mL/min/1.73 m². CONCLUSION: Chronic HBV infection was significantly associated with a GFR < 60 mL/min/1.73 m² and proteinuria (≥ 2+). Therefore, clinical concern about CKD in chronic HBV infected patients, especially in male, is warranted.
Anemia ; Antigens, Surface ; Bilirubin ; Case-Control Studies* ; Female ; Glomerular Filtration Rate ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Male ; Multivariate Analysis ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic*

OBJECTIVES: This study was designed to develop and validate a scale for measuring the negative effects of job stress on an individual, its family, and its community. METHODS: Based on open-ended questions, interviews, and expert comments, 73 preliminary scale items consisting of 12 factors were assembled. The initial survey was administered to 344 employees in order to conduct item analyses, reliability tests, and factor analyses of the stress assessment scale. The results of the factor analyses indicated that an 8 factor model comprising 43 items was most meaningful. For the final survey, data were obtained from 2732 employees. RESULTS: Factor analysis of the final survey data showed that the developed 8 factor model was appropriate for its intended use. Results of correlation analyses showed that the assessment scale was significantly related to stress response, thereby confirming convergent validity, and was related to various criteria including life satisfaction, hope, optimism, and subjective happiness, thereby confirming criterion-related validity. CONCLUSION: A scale useful in the assessment of negative effects on job stress on workers and on their community members including their families was developed and validated.
Happiness ; Hope ; Humans ; Optimism

PURPOSE: Prediction of neurologic outcome in survivors after cardiac arrest is difficult. In particular, since therapeutic hypothermia has emerged as the standard treatment for post cardiac arrest syndrome, the prediction has been more difficult. Methods for prediction of neurologic prognosis include the general neurologic examination, SSEPs, EEG, serum biomarkers, and so on. Among these, EEG was recommended for detection of non-convulsive seizure since early phase of post cardiac arrest syndrome. However, the relationship between EEG finding and neurologic outcome is not yet clear. METHODS: We conducted a retrospective observational study using a prospectively collected hypothermia database. We collected EEG findings during hypothermia and other data from January 2010 to December 2012. The EEG findings were classified according to five patterns as extremely low voltage, continuous slow wave, burst suppression, status epilepticus, and other. We analyzed the relationship between EEG pattern and one-month CPC score after cardiac arrest. RESULTS: During the study period, 121 patients were enrolled in the hypothermia database. Among these patients, 84 patients underwent EEG during hypothermia and were enrolled. The EEG patterns of enrolled patients were 20 extremely low voltage, 39 generalized slow wave, 15 burst suppression, 8 status epilepticus, and 2 alpha coma. None of the periodic, status eplilepticus, and alpha coma pattern patients showed a good neurologic outcome (CPC 1 or 2). Two of 20 extremely low voltage and 28 of 39 continuous slow wave pattern patients recovered to good neurologic outcome. CONCLUSION: Burst suppression and status epilepticus EEG pattern during hypothermia treatment showed an association with poor neurologic outcome.
Biomarkers ; Coma ; Electroencephalography* ; Heart Arrest ; Humans ; Hypothermia* ; Hypothermia, Induced ; Neurologic Examination ; Observational Study ; Out-of-Hospital Cardiac Arrest* ; Prognosis* ; Prospective Studies ; Retrospective Studies ; Seizures ; Status Epilepticus ; Survivors