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Hypertrophic cardiomyopathy (HCM) is a multigenic disease that occurs due to various genetic modifiers. We investigated phenotype-based clinical and genetic characteristics of HCM patients using comprehensive genetic tests and rare variant association analysis.A comprehensive HCM-specific panel, consisting of 82 nuclear DNAs (nDNAs: 33 sarcomere-associated genes, 5 phenocopy genes, and 44 nuclear genes linked to mitochondrial cardiomyopathy) and 37 mitochondrial DNAs (mtDNAs), was analyzed. Rare variant analysis was performed to determine the association of specific genes with different phenotypes.Among the 212 patients, pathogenic variants in sarcomere-associated genes were more prevalent in non-apical HCM (41.4%, 46/111; P = 0.001) than apical HCM (20.8%, 21/101). Apical HCM exhibits mild phenotypes than non-apical HCM, and it showed fewer numbers of sarcomere mutations than non-apical HCM. Interestingly, inverted mutation frequency of TNNI3 (35%) and MYH7 (9%) was observed in apical HCM. In a rare variant analysis, MT-RNR2 positively correlated with apical HCM (OR: 1.37, P = 0.025). And, MYBPC3 (sarcomere gene) negatively contributed to apical HCM (OR: 0.54, P = 0.027). On the other hand, both pathogenic mutation (P 0.05) and rare variants in sarcomere-associated genes (OR: 2.78-3.47, P 0.05) were related to diastolic dysfunction and left atrium remodeling, which correlated with poor prognosis in HCM patients.Our results provide a clue towards explaining the difference between the prevalence and phenotype of apical HCM in Asian populations, and a foundation for genetics-based approaches that may enable individualized risk stratification for HCM patients.

Objective Early detection and proper management of mental illness can help to prevent severe deterioration. However, with limited financial and human resources of community mental health services, it is not practical to carry out all conventional screening tools simultaneously. In this study, we aimed to develop and validate a brief but comprehensive screening questionnaire for four common mental illnesses of the elderly.Methods The brief screening for four mental illnesses of elderly (BS4MI-elderly) is a 14-item binary response questionnaire that covers dementia, depressive disorder, sleep disorder, and hwa-byung. To test validity, we compared conventional scale scores for three groups of participants classified using the BS4MI-elderly. The sensitivity, specificity, predictive value of positive test, likelihood ratio of positive test and internal consistency of the BS4MI-elderly were assessed. Finally, a correlation analysis between the BS4MI-elderly and general mental health scales was conducted.Results A total of 254 participants aged over 65 years were recruited. The BS4MI-elderly showed moderate to high sensitivity for the test that distinguishes the normal group from the risk and disorder groups (dementia: 0.61, depressive disorder: 0.88, sleep disorder: 0.85, hwa-byung: 0.94) and high specificity for the test that distinguishes the disorder group from the normal and risk groups (dementia: 0.91, depressive disorder: 0.93, hwa-byung: 0.84, sleep disorder: 0.84). The BS4MI-elderly also exhibited good internal consistency and significant correlations with general mental health scales.Conclusion The BS4MI-elderly, a brief but comprehensive screening tool, could be a useful instrument for screening the elderly in community mental health services.

주의력 결핍 과잉행동장애(ADHD)는 아동기에 흔한 장애이며, 아동 및 청소년, 성인기에 이르기까지 영향을 미칠 수 있다. ADHD에 대한 심리치료방법이 다양해지면서 예전에 비하면 어떤 방식의 심리치료를 시행할 것인지 정하는 것이 복잡하고 어려워졌다. 본 논문은 ADHD 치료에 대한 문헌을 고찰해 근거가 확립된 치료기법을 확인해보고자 하였다. 미국과 한국에서 이루어진 메타 연구에 따르면 ADHD에 가장 효과가 높은 심리치료는 행동수정에 기반한 부모교육, 행동수정에 기반한 교실 관리, 행동수정에 기반한 또래관계 개입 및 행동적 기법의 조합으로 확인되었다. 즉, 행동수정의 원리가 ADHD의 심리적 개입으로는 가장 우수한 방법이며, 이런 결과는 반복해서 입증되었다. 한국 연구에서는 행동수정 외에 놀이치료나 그림 치료와 같은 방법도 효과가 있는 것으로 나타났으나 연구방식이나 측정도구와 같은 요인이 영향을 미쳤을 것으로 추정되어 추후 잘 설계된 연구를 통해 확인할 필요가 있을 것 같다.

Background: Perceived justice after man-made disaster bereavement may involve as a protective factor in the recovery process. However, perceived justice related to posttraumatic stress disorder (PTSD) or complicated grief (CG) after disaster bereavement has not been sufficiently discussed in previous studies. Aims: This study aims to assess PTSD and CG in bereaved parents of Sewol disaster and to explore whether perceived justice is related with the diagnostic groups. Methods: Bereaved parents of Sewol disaster ( N = 122) were interviewed approximately 2 years after the incident. Structured interviews for PTSD and CG were assessed, and perceived institutional justice surrounding the incident was measured. Symptom groups were identified, and multinomial logistic regression was conducted to find whether perceived justice was related with PTSD or CG. Results: Participants showed high rates of CG and PTSD, and were classified into the both PTSD and CG group, the CG-only group and the resilient group. The analysis revealed that less perceived justice and being a mother increased the likelihood of having both PTSD and CG. Less perceived justice also showed a tendency to be associated with having CG without PTSD. Conclusion: Parents bereaved by the Sewol disaster had high PTSD and CG related to lower levels of perceived justice surrounding the post-disaster period. Post-disaster environment seeking justice may facilitate the natural grieving process or encourage access to effective individual interventions.

Background Given that current unimodal strategies for treating late-life depression are insufficient, the awareness of the necessity and importance of multidomain intervention has increased. We assessed the efficacy of multidomain intervention in reducing symptoms of late-life depression. Methods This was a 12-week community-based randomized controlled trial in 78 older adults diagnosed with major depressive disorder. Participants were randomly assigned to the multidomain intervention or supportive therapy group. We provided four home visits and 12 telephone calls over 12 weeks. Four therapeutic approaches (physical activity, healthy diet, social activity, and brief cognitive restructuring) were incorporated into the multidomain intervention. The primary outcome was the change in depressive symptoms, as measured by the Montgomery–Asberg Depression Rating Scale (MADRS). Secondarily, we investigated changes in resting-state functional connectivity. Results The MADRS total score was reduced more in the multidomain intervention group than in the supportive therapy group during the 12 weeks (intervention × time interaction, P = =0.007). After correction for multiple comparisons, the multidomain intervention group exhibited a lower MADRS total score at week 12 (score difference 5.117; P = =0.029). At follow-up, the multidomain intervention group also exhibited less functional connectivity between the posterior cingulate cortex and left inferior parietal lobule within the default mode network (FDR Limitations Caution is needed in the interpretation of the results, considering the small sample size and high percentage of female participants. Conclusions A 12-week multidomain intervention resulted in a greater reduction of depressive symptoms among the elderly with major depressive disorder than their counterparts who received supportive therapy.

The smartphone has many attractive attributes and characteristics that could make it highly addictive, particularly in adolescents. The purpose of this study was to examine the prevalence of young adolescents in risk of smartphone addiction and the psychological factors associated with smartphone addiction. Four hundred ninety middle school students completed a self-questionnaire measuring levels of smartphone addiction, behavioral and emotional problems, self-esteem, anxiety, and adolescent-parent communication. One hundred twenty-eight (26.61%) adolescents were in high risk of smartphone addiction. This latter group showed significantly more severe levels of behavioral and emotional problems, lower self-esteem, and poorer quality of communication with their parents. Multiple regression analysis revealed that the severity of smartphone addiction is significantly associated with aggressive behavior (β = .593, t = 3.825) and self-esteem (β = −.305, t = −2.258). Further exploratory and confirmatory studies should consider different sites, demographics, technological mobile devices, platforms, and applications.

BACKGROUND This study aimed to identify pathogenic variants of PRSS1, SPINK1, CFTR, and CTRC genes in Korean patients with idiopathic pancreatitis. METHODS The study population consisted of 116 Korean subjects (65 males, 51 females; mean age, 30.4 yr, range, 1-88 yr) diagnosed with idiopathic chronic pancreatitis (ICP), idiopathic recurrent acute pancreatitis (IRAP), or idiopathic acute pancreatitis (IAP). We analyzed sequences of targeted regions in the PRSS1, SPINK1, CFTR, and CTRC genes, copy numbers of PRSS1 and SPINK1, and clinical data from medical records. RESULTS We identified three types of pathogenic PRSS1 variants in 11 patients, including p.N29I (n=1), p.R122H (n=1), and p.G208A (n=9). Sixteen patients exhibited heterozygous pathogenic variants of SPINK1, including c.194+2T>C (n=12), p.N34S (n=3), and a novel pathogenic splicing variation c.194+1G>A. A heterozygous CFTR p.Q1352H pathogenic variant was detected in eight patients. One patient carried a heterozygous CTRC p.P249L pathogenic variant, which is a known high-risk variant for pancreatitis. All patients had normal PRSS1 and SPINK1 gene copy numbers. Weight loss occurred more frequently in patients carrying the p.G208A pathogenic variant, while pancreatic duct stones occurred more frequently in patients with the c.194+2T>C pathogenic variant. CONCLUSIONS Pathogenic variants of PRSS1, SPINK1, and CFTR were associated with idiopathic pancreatitis, while pathogenic variants of CTRC were not. Copy number variations of PRSS1 and SPINK1 were not detected.

Background We sought to investigate the possible associations of rest-activity patterns with cortical amyloid burden, medial temporal lobe (MTL) neurodegeneration, and cognitive function in patients in the early stage of cognitive impairment. Methods Rest-activity patterns were assessed in 100 participants (70 with mild cognitive impairment and 30 with mild dementia) using wrist actigraphy. All participants underwent 18F-flutemetamol positron emission tomography (PET) imaging to quantify cortical amyloid burden, structural brain magnetic resonance imaging (MRI) to quantify MTL grey matter volume, neuropsychological testing, and clinical diagnosis. We used multiple linear regression models adjusted for covariates, including demographics, diabetes, hypertension, depressive symptom, psychotropic medication, sleep medication, weekend effect, and apolipoprotein-e allele status. Findings After adjusting for possible confounders, we found that the midline estimation of statistic of rhythm (MESOR) associated positively with frontal/executive function (estimate = 1.17, standard error [SE] = 0.37, p = 0.002). The least active 5-h (L5) onset time associated positively with MTL grey matter volume and memory function (estimate = 1.24, SE = 0.33, p = 0.001, and estimate = 3.77, SE = 1.22, p = 0.003, respectively), particularly in amyloid-negative participants. Additional path analysis revealed that MTL grey matter volume partially mediated the association between L5 onset time and memory function in amyloid-negative participants. Interpretation Decreased MESOR and advanced L5 onset time may be useful as early signs of cognitive decline or MTL neurodegeneration. Furthermore, amyloid pathology may act as a moderator of the relationships between rest-activity patterns, neurodegeneration, and cognitive function. Funding Korea Centres for Disease Control and Prevention (#4845–303); National Research Foundation of Korea (2019M3C7A1031905, 2019R1A5A2026045).

Objectives The rapid diagnosis of tuberculosis (TB) is important for patient treatment and infection control. Current molecular diagnostic techniques for TB have insufficient sensitivity to detect samples with low bacterial loads. The sensitivity of molecular testing depends on not only the performance of the assay technique but also the nucleic acid extraction method. Here, we present a novel approach using exosomal DNA (exoDNA) and droplet digital PCR (ddPCR) platforms to detect Mycobacterium tuberculosis DNA in clinical samples. Methods The ddPCR platform targeting IS6110 was evaluated in parallel using total DNA and exoDNA. The clinical performance of ddPCR method was assessed with 190 respiratory samples from patients with suspected pulmonary TB. Results Compared with mycobacterial culture, sensitivity and specificity of ddPCR were 61.5% (95% CI 44.6–76.6%) and 98.0% (95% CI 94.3–99.6%) using total DNA, and 76.9% (95% CI 60.7–88.9%) and 98.0% (95% CI 94.3–99.6%) using exoDNA, respectively. Among 15 culture-positive specimens with low concentrations of target molecules (2~99 positive droplets with exoDNA), only 53.3% (8/15), 46.7% (7/15), and 26.7% (4/15) of cases were detected using ddPCR with total DNA, real-time PCR with exoDNA, and real-time PCR with total DNA, respectively. Discussion Our platform using ddPCR and exoDNA has the potential to provide sensitive and accurate methodology for TB diagnosis.

and purpose: The stress and systemic lupus erythematosus (SLE) are intertwined and affecting each other. This pilot study evaluated the mindfulness-based cognitive therapy (MBCT) in Korean patients with SLE.The Korean version of the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Satisfaction with Life Scale (SWLS), and Perceived Stress Scale (PSS) were evaluated for the effect of the MBCT in 25 patients.The BDI-II, BAI, SWLS, and PSS before the MBCT were 24.2 ± 10.6, 19.1 ± 9.7, 14.7 ± 6.5, and 20.4 ± 3.8, respectively. Eighteen patients completed the MBCT. After the MBCT, BDI-II, BAI, and PSS improved to 17.4 ± 13.0 (p 0.01), 13.4 ± 7.7 (p = 0.04), and 17.9 ± 4.6 (p = 0.04), respectively. However, SWLS and SLE disease activity did not.The MBCT could reduce the anxiety, depression, and stress but not SLE disease activity.

Victimization by sexual violence is strongly associated with the development of posttraumatic stress disorder (PTSD). While several psychological and cognitive factors are known to be associated with PTSD prognosis, multivariable analysis is scarce. This study examined factors affecting the severity of PTSD symptoms in early stage of traumatic experience of sexual violence, including initial post-traumatic symptoms and cognitive characteristics.Participants were recruited from the center for women and children victims of violence in a university hospital. Thirty-four sexual assault victims were assessed at the baseline and the second visit one to five months after the baseline. At the baseline, an array of posttraumatic symptoms and cognitive functions were measured: at follow-up, PTSD symptoms were determined by Clinician Administered PTSD Scale.Stepwise multiple regression showed that avoidance symptoms (β = 0.551, P0.01) and delayed verbal memory (β = -0.331, P0.05) at early stage of trauma predicted the severity of PTSD symptoms one to five month later. The regression model, factoring in avoidance and delayed verbal memory, showed a 34.9% explanatory power regarding the PTSD symptom severity.This study suggests that avoidance symptoms and verbal memory at the early stage of trauma are associated with later PTSD symptoms. It is also suggested that early intervention targeting avoidance symptoms may be beneficial in decreasing PTSD symptoms.

Depression is a common disorder among women with young children. Compared to non-depressed mothers, depressed mothers tend to display less positive affection, provide less emotional support, and inconsistently respond to their child's every day and emotional needs. We examined the association between maternal depression and child (middle childhood) mental health problems according to the child's gender. This study was conducted between June and August 2006 on 3,911 subjects aged 7-12 years. The data for this study was collected through a questionnaire that included the Beck Depression Inventory (BDI) and Korean Child Behavior Checklist (K-CBCL). Most of the CBCL scores were higher for children in the depressed mother group. The two way ANOVAs (depressed group by gender) found girls to have significantly higher scores than boys on somatization. Children may experience somatic complaints when they also suffer from emotional disorders, and therefore must be observed closely.

Background:mutation is an emerging biomarker for treatment selection in non-small-cell lung cancer (NSCLC) patients. However, optimal mutation detection is hindered by complications associated with the biopsy procedure, tumor heterogeneity and limited sensitivity of test methodology. In this study, we evaluated the diagnostic utility of real-time PCR using malignant pleural effusion samples.Methods:A total of 77 pleural fluid samples from 77 NSCLC patients were tested using the cobas EGFR mutation test (Roche Molecular Systems). Pleural fluid was centrifuged, and separated cell pellets and supernatants were tested in parallel. Results were compared with Sanger sequencing and/or peptide nucleic acid (PNA)-mediated PCR clamping of matched tumor tissue or pleural fluid samples.Results:All samples showed valid real-time PCR results in one or more DNA samples extracted from cell pellets and supernatants. Compared with other molecular methods, the sensitivity of real-time PCR method was 100%. Concordance rate of real-time PCR and Sanger sequencing plus PNA-mediated PCR clamping was 98.7%.Conclusions:We have confirmed that real-time PCR using pleural fluid had a high concordance rate compared to conventional methods, with no failed samples. Our data demonstrated that the parallel real-time PCR testing using supernatant and cell pellet could offer reliable and robust surrogate strategy when tissue is not available.

OBJECTIVE The tripartite model categorizes symptoms of depression and anxiety into three groups: 1) non-specific general distress that is shared between depression and anxiety, 2) depression-specific symptoms that include low positive affect and loss of interest, and 3) anxiety-specific symptoms that include somatic arousal. The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure these three factors of depression and anxiety. The purpose of the present study was to test the psychometric properties of the Korean version of the MASQ (K-MASQ) in adolescents. METHODS Community-dwelling adolescents (n=933) were randomly assigned to two groups. Exploratory factor analysis and confirmatory factor analysis were conducted in each group to identify the factor structure of the K-MASQ. The reliability and validity of the K-MASQ were also evaluated. RESULTS Our results support the three-factor structure of the K-MASQ in adolescents. However, we found that the specific items of each factor differed from those of the original MASQ. That is, the depression-specific factor was only related to low positive affect and not loss of interest, and the anxiety-specific factor included more items related to general somatic symptoms of anxiety. The reliability and validity of the K-MASQ were found to be satisfactory. CONCLUSION The K-MASQ supports the tripartite model of depression and anxiety and has satisfactory reliability and validity among Korean adolescents. The K-MASQ can be used to distinguish unique symptoms of depression and anxiety in Korean adolescents.

This study prospectively examined the relationships among cognitive factors and severity of Posttraumatic stress disorder (PTSD) symptoms in female victims of sexual violence. Thirty-eight victims of sexual violence recruited from Center for Women Victims of Sexual and Domestic Violence at Ajou University Hospital. Cognitive factors and PTSD symptom were assessed within 4 months of sexual violence and 25 victims were followed-up 1 month after initial assessment. Repeated-measured ANOVA revealed that PTSD incidence and severity decreased over the month (F [1, 21]=6.61). Particularly, avoidant symptoms might decrease earlier than other PTSD symptoms (F [1, 21]=5.92). This study also showed the significant relationship between early negative trauma-related thoughts and subsequent PTSD severity. Shame and guilt proneness had significant cross-sectional correlations with PTSD severity, but did not show associations when depression severity is controlled. Our results suggest that avoidant symptoms might decrease earlier than other PTSD symptoms during the acute phase and that cognitive appraisals concerning the dangerousness of the world seem to play an important role in the maintenance of PTSD (r=0.499, P

In this paper, we explore underlying factors of Internet Addiction Scale (IAS) and examine how the dimensions of the IAS relate to psychiatric symptoms in Korean adolescents. Exploratory factor analysis with a sample of N = 1,722 consisted of 13–15 year old Korean adolescents identified three distinctive factors of IAS and they were labeled ‘time management’, ‘withdrawal behaviors’ and ‘neglect work’. Then, multiple regression models were applied to assess the association between each factor and eight psychological problems, which were evaluated by Youth Self Report. The overall IAS was significantly associated with Somatic, Immature, Thought, Attention, Delinquent and Aggressive behaviors. However, three factor scores showed different association patterns and indicated multidimensional aspects of problematic Internet use.

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.

Weissella confusa is a catalase-negative and gram-positive coccobacillus that is intrinsically resistant to vancomycin [1]. This species can cause infections, such as bacteremia, endocarditis, and abscess in immunocompromised patients [2-7]. Until now, reports on infections caused by W. confusa have been limited as this species has been frequently misidentified as Lactobacillus or Leuconostoc when identified using commercial kits [8]. Herein, we report the second case of W. confusa bacteremia in an immunocompetent patient from Korea, who had intramural hematomas of the aorta.

Objectives This study was conducted to determine whether or not newly proposed high-resolution activity features could provide a superior analytic foundation compared to those commonly used to assess transitions in children's activities, under circumstances in which the types of courses attended exert different situational effects on activity levels. Methods From 153 children at a local elementary school, 10 subjects with attention deficit hyperactivity disorder (ADHD) and 7 controls were recruited. Their activity data was collected using an actigraph while they attended school. Ratios of partitioned activity ranges (0.5-2.8 G) during the entire activity were extracted during three classes: art, mathematics, and native language (Korean). Extracted activity features for each participant were compared between the two groups of children (ADHD and control) using graphs and statistical analysis. Results Activity distributions between ADHD and control groups for each class showed statistically significant differences spread through the entire range in art class compared to native language and mathematics classes. The ADHD group, but not the control group, experienced many significantly different intervals (> 50%) having low to very high activity acceleration regions during the art and languages courses. Conclusions Class content appears to influence the activity patterns of ADHD children. Monitoring the actual magnitude and activity counts in a wide range of subjects could facilitate the examination of distributions or patterns of activities. Objective activity measurements made with an actigraph may be useful for monitoring changes in activities in children with ADHD in a timely manner.

This study examined the degree of perceived need and use of child mental health services in Korea, as well as the factors associated therewith. The sample consisted of 3,477 children aged 8-13 years. Overall, 10.4% of the parents demonstrated a perceived need for mental health services regarding their children's emotional or behavioral problems, while 1.9% used mental health services. Although the perceived need for mental health services is high, only a small proportion of children receive them. Whether a child receives mental health care is influenced by the child's psychopathology, especially when social and/or thought problems exist.

Purpose The genes for cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) have been identified as important genetic determinants of warfarin dosing and have been studied. We developed warfarin algorithm for Korean patients with stroke and compared the accuracy of warfarin dose prediction algorithms based on the pharmacogenetics. Materials and Methods A total of 101 patients on stable maintenance dose of warfarin were enrolled. Warfarin dosing algorithm was developed using multiple linear regression analysis. The performance of all the algorithms was characterized with coefficient of determination, determined by linear regression, and the mean of percent deviation was used to predict doses from the actual dose. In addition, we compared the performance of the algorithms using percentage of predicted dose falling within ±20% of clinically observed doses and dividing the patients into a low-dose group (≤3 mg/day), an intermediate-dose group (3–7 mg/day), and high-dose group (≥7 mg/day). Results A new developed algorithms including the variables of age, body weight, and CYP2C9 and VKORC1 genotype. Our algorithm accounted for 51% of variation in the warfarin stable dose, and performed best in predicting dose within 20% of actual dose and intermediate-dose group. Conclusion Our warfarin dosing algorithm may be useful for Korean patients with stroke. Further studies to elucidate clinical utility of genotype-guided dosing and find the additional genetic association are necessary.

Full Text | Links | Korean J Med Educ. 2004 Dec;16(3):299-308. Published online 2004 December 31. doi: 10.3946/kjme.2004.16.3.299. Copyright © 2004 The Korean Society of Medical Education The Status of Violence among the Doctors and Its Relationship to Authoritarianism, Aggression and Personality Characteristics Ki-Young Lim, MD, Sun-Mi Cho, PhD and Ho-Jeong Song, MA Department of Psychiatry, Ajou University School of Medicine, Seoul, Korea. Corresponding author (Email: [email protected]/* */ ) Abstract Purpose The purpose of this study was to inquire about the present status of violence among doctors. It also examined the relationship between the violent act and authoritarianism, aggression and the offenders personality characteristics. Methods 93 doctors (22 professors, 33 residents, and 33 medical students) participated through survey questionnaires and standardized scales including Eysenck Type A Questionnaire, Barratt Impulsivity Scale, Korean Version Authoritarianism Scale, and Aggression Questionnaire. Results 51.6% of the subjects experienced abusive words from other doctors and 11.8% experienced physical violence. 18.3% of the subjects inflicted abusive words on other physicians. Most of the offenders were superiors of the victims. Offenders experienced abusive words from other doctors significantly more than non-offenders. Among the respondents, residents showed a higher score in the Aggression Questionnaire. There was no difference between the offenders and the victims on authoritarianism, aggression and personality scales. Conclusion Verbal and physical violence among doctors is common. Almost all offenders were superiors of the victims and there was no official system set up to prevent or manage violence among doctors. A campaign to rid of violence in the medical field is strongly needed.

The Sewol ferry incident on April 16, 2014 in South Korea claimed the lives of 304 individuals, including about 250 high school students on a school trip. The majority of South Korean citizens were watching live updates on the capsized Sewol ferry, anxiously watching on TV how the vessel fully sunk over time. They were desperately hoping for the rescue of the survivors inside. However, their anxiety had become shock, anger, and helplessness, and the disaster has become a daunting, collective trauma, not just to the victims and their families, but also to the citizens who were exposed only through the media. In this study, we interviewed victims' families two years after the incident. We explored how they have experienced changes in their social relationships. We conducted semi-structured interviews of 54 family members of the student victims. We qualitatively examined the data applying a thematic analysis. Changes in their social relationships were largely divided into the relationships in the proximal environment and the relationships in distal environments. The former included subcategories such as immediate family, coworkers, friends, relatives, survived students and their parents, and concepts corresponding to each subcategory. The latter involved subcategories such as neighbors, other citizens, the victims' family committee, government, and society, and concepts subject to each subcategory. Based on these findings, rehabilitation plans for trauma victims and their families should take into account the significant changes in their social relationships and the further consequences of those changes.

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal neuropathy that is commonly caused by a reciprocal 1.5 Mb deletion on chromosome 17p11.2, at the site of the peripheral myelin protein 22 (PMP22) gene. Other patients with similar phenotypes have been shown to harbor point mutations or small deletions, although there is some clinical variation across these patients. In this report, we describe a case of HNPP with copy number changes in exon or promoter regions ofPMP22. Multiplex ligation-dependent probe analysis revealed an exon 1b deletion in the patient, who had been diagnosed with HNPP in the first decade of life using molecular analysis.

Objectives Defining pediatric reference intervals is one of the most difficult tasks for laboratory physicians. The continuously changing physiology of growing children makes their laboratory values moving targets. In addition, ethnic and behavioral differences might also cause variations. The aim of this study was to establish age- and sex-specific partitioned reference intervals for 13 serum biochemical analytes in Korean children. Design and methods A total of 2474 patients, girls aged 2–14 years and boys aged 2–16 years, who underwent a short stature workup but were diagnosed as normal at the Pediatric Endocrinology Clinic of Severance Hospital (Seoul, Korea) between September 2010 and June 2012 were included in this study. The levels of serum calcium, inorganic phosphorus, blood urea nitrogen, creatinine, uric acid, glucose, total cholesterol, total protein, albumin, alkaline phosphatase, aspartic aminotransferase, alanine aminotransferase, and total bilirubin were measured using a Hitachi 7600 analyzer (Hitachi High-Technologies Corporation, Tokyo, Japan). Reference intervals were partitioned according to sex or age subgroups using the Harris and Boyd method. Results Most analytes except calcium and albumin required partitioning either by sex or age. Age-specific partitioned reference intervals for alkaline phosphatase, creatinine, and total bilirubin were established for both males and females after being partitioned by sex. Additional age-specific partitioning of aspartic aminotransferase in females and total protein and uric acid in males was also required. Inorganic phosphorus, total cholesterol, alanine aminotransferase, blood urea nitrogen, and glucose were partitioned only by sex. Conclusions This study provided updated age- and sex-specific pediatric reference intervals for 13 basic serum chemistry analytes from a sufficient number of healthy children by using a modern analytical chemistry platform.

Among many signals to regulate hypoxia inducible factor 1α (HIF-1α), sphingosine kinase 1 (SPHK1) is also involved in various biological activities such as cell growth, survival, invasion, angiogenesis, and carcinogenesis. Thus, in the present study, molecular mechanisms of coumestrol were investigated on the SPHK1 and HIF-1α signaling pathway in hypoxic PC-3 prostate cancer cells. Coumestrol significantly suppressed SPHK1 activity and accumulation of HIF-1α in a time- and concentration-dependent manner in hypoxic PC-3 cells. In addition, coumestrol inhibited the phosphorylation status of AKT and glycogen synthase kinase-3β (GSK 3β) signaling involved in cancer metabolism. Furthermore, SPHK1 siRNA transfection, sphigosine kinase inhibitor (SKI), reactive oxygen species (ROS) enhanced the inhibitory effect of coumestrol on the accumulation of HIF-1α and the expression of pAKT and pGSK 3β in hypoxic PC-3 cells by combination index. Overall, our findings suggest that coumestrol suppresses the accumulation of HIF-1α via suppression of SPHK1 pathway in hypoxic PC-3 cells.

Background Though Mica, a thin and sheet like mineral, has been used as a mineral medicine for treatment of bleeding, dysentery and inflammation in traditional medicine including Ayurveda, the biological evidences of Mica were not clearly elucidated so far. Thus, in the present study, the antitumor mechanism of particled Mica (STB-HO) was examined in colorectal cancers. Methods Athymic nude mice were inoculated with HCT116 colon cancer cells and orally administered STB-HO daily for 41 days, and HCT116 and human umbilical vein endothelial cells (HUVECs) were treated with STB-HO for 0 ~ 24 hours to perform immunoblotting, cytotoxicity assay, FACs analysis and measurement of matrix metalloproteinase 9 (MMP-9) secretion and other experiments. Significant differences of all date were evaluated using Student’s t-test and a Turkey-Kramer multiple-comparison post test. Results STB-HO significantly suppressed the tumor volume and weight in athymic nude mice inoculated with HCT116 cells at a dose of 100 mg/kg. Thus, the in vivo antitumor mechanism of STB-HO was to elucidated in vitro as well. STB-HO exerted cytotoxicity in HCT116, SW620 and HCT15 colorectal cancer cells. Also, STB-HO increased G1 cell population in a time and concentration dependent manner, enhanced the expression of p21, p27, p53 as cyclin dependent kinase (CDK) inhibitors, attenuated the expression of proliferating cell nuclear antigen (PCNA) and cyclin D1 and also reduced the production of vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) in HCT116 cells. Consistently, STB-HO suppressed the phosphorylation of VEGFR2 in HCT116, SW620 and HCT15 cells. Also, STB-HO inhibited the VEGF mediated proliferation and also attenuated the phosphorylation of VEGFR2 and Akt in human umbilical vein endothelial cells (HUVECs). Conclusions Collectively, these findings suggest that STB-HO has chemopreventive potential via G1 arrest and inhibition of proliferation and VEGFR2 in HCT116 colorectal cancer cells.

This study investigated childhood psychopathology and Internet addiction in adolescents. Initial assessment data were obtained from 1998 to 1999, and a follow-up assessment was performed in 2006, when the original subjects entered middle school. Personal information for the 524 male subjects was obtained from the original data. The subjects were evaluated with the Korean version of the child behavior checklist, which was administered to the children’s parents. Demographic and psychosocial factors were also evaluated. Children were reassessed with the self-reported Korea Internet Addiction Scale. Our results indicated that 3.6 % of the subjects had Internet addiction, and revealed a significant relationship between withdrawal and anxiety/depression and future Internet addiction. The results suggest that withdrawal and anxiety/depression during childhood should be considered in the etiology of problematic Internet use in boys. Accordingly, clinicians should consider anxiety/depression and withdrawal during childhood to prevent Internet addiction.

With the population of the elderly increasing, suicides among elderly people present a serious problem for global societies. However, there are few studies on suicide among elderly subjects, especially in Asia. The study aimed to determine the relationship between physical health, mental health, social environmental condition, and the suicide behavior among elderly subjects in the city of Suwon, located southeast of Seoul. We analyzed 1548 Korean aged over 60 years from baseline data of a larger prospective study called the Suwon Project. The study protocol included sociodemographic variables, mental health factors, and physical health factors. In the interview, the subjects were asked about suicide ideation and history of suicide attempt. Of the total subjects, 7.42% reported suicide ideation and 1.42% reported a history of suicide attempt. A logistic regression analysis showed that physical illness, five stroke warning signs, anxiety and depression associated with suicide ideation, and depression strongly corresponded to the suicide ideation. Anxiety, depression, and stroke warning signs were associated with history of suicide attempt among the elderly. Additionally, stroke warning signs and depression are independently associated with history of suicide attempt. This study revealed that stroke warning signs have a high correlation with history of suicide attempt in the elderly, independent from the depression factors. This study suggests that there is an independent relationship between physical health status and suicide behavior in the case of elders.

This study prospectively investigated developmental psychopathology pathway from the age of 7 to ages 14–16. The subjects (N = 1,857) were evaluated using the Korean version of the Child Behavior Checklist and reassessed using the Korean Youth Self Report. In path analyses, total problems, externalizing problems, and internalizing problems in childhood associated significantly with problems in adolescence. In particular, childhood externalizing problems associated with adolescent externalizing problems, for both genders. However, our results differ from those of previous studies in that internalizing problems showed a restrictive stability by gender and in that early externalizing problems correlated negatively with later internalizing problems for girls. In the syndrome scales analyses, we confirmed that some syndromes showed heterotypic pathways, despite the general continuity of the developmental psychopathology. The importance of Anxiety/Depression and Attention problems in childhood suggested that adolescent difficulties are a consequence of an accumulation of such risk factors.

Objective We aimed to evaluate the psychometric properties of Korean version of Ruminative Response Scale (K-RRS) for Korean adolescents. Methods A community sample of 1220 adolescents was recruited from middle schools and high schools. Exploratory factor analyses and confirmatory factor analyses were conducted, and additional analyses were performed to assess the reliability and validity of the K-RRS. Results An exploratory factor analysis of a sample of adolescents (n=550) yielded a three factor structure: 'depressive rumination', 'reflective pondering', and 'brooding'. Confirmatory factor analyses of another sample of adolescents (n=530) supported the three-factor model for the K-RRS. The K-RRS was found to have good internal consistency and construct validity. Conclusion Our results suggest that K-RRS is a valid measurement to assess rumination in adolescents, as well as in adults.

Myung Jin Jo, MD, Jee Won Lee, MD, Minje Sung, PhD, Sook Hyung Song, MD, Young Moon Lee, MD, Je Jung Lee, MD, Sun Mi Cho, PhD, Mi Kyoung Park, and Yun Mi Shin, MD, PhD 1 Department of Psychiatry and Behavioral Sciences, Ajou University School of Medicine, Suwon, Korea School of Business, Ajou University, Suwon, Korea Yong-In Mental Hospital, Yongin, Korea Gongju National Hospital, Gongju, Korea Suwon Child & Adolescent Community Mental Health Service Center, Suwon, Korea

As children with emotional or behavioral problems often fail to receive the treatment available to them, this study examined (1) the degree of perceived need (PN) among Korean parents regarding mental health services for their children, (2) the factors associated with such perceptions, (3) the degree to which Korean parents actually engage mental health services for their children, and (4) the factors associated with such use. To determine the degrees of PN and actual use, 1,058 children aged between 9 and 12 years were asked to complete the Children's Depression Inventory, while their parents completed the Child Behavior Checklist. About 11.4% of the parents demonstrated PN, compared to 2.7% who actually engaged child mental health services. While most of the CBCL factors were associated with PN, the child's self-report significantly affected the perception as well. The attention problem score in the CBCL was the only factor that strongly corresponded to the actual use of services in Korea, a country where academic achievement is considered paramount, which suggests that cultural forces may play a powerful role in determining parents' decisions regarding child mental health care.

To search for a marker that predicts the efficacy of radiation therapy in human cervical cancer, gene expression profiles between parental SiHa cervical cancer cells and radiation-resistant SiHa/R cells have been compared by the microarray technique. Microarray and Northern blot analyses demonstrated that the ICAM-3 expression was upregulated in SiHa/R cells. This increased expression of ICAM-3 in SiHa cells enhanced cell survival by about 34.3% after a 2 Gy dosage of radiation. In addition, SiHa/ICAM-3 cells showed a 2.45-fold higher level of FAK phosphorylation than that of the control cells. In tumor specimens, ICAM-3 staining was restricted to tumor stromal endothelial cells and lymphocytes. The overexpression of ICAM-3 was significantly more frequent in radiation-resistant cervical cancer specimens when compared with radiation-sensitive specimens (83.3% vs. 35.3%; p = 0.015). With these observations, we can suggest that an increased expression of ICAM-3 is associated with radiation resistance in cervical cancer cells and the expression of ICAM-3 can be used as a valuable biomarker to predict the radiation resistance in cervical cancer that occurs during radiotherapy.

Herein, we report that the human myotubularin-related protein (KIAA0371) induced growth suppression of lung cancer cells. Colony formation assays demonstrated that the exogenous expression of the human myotubularin-related gene induced a significant growth inhibition of H1299 cells in which the expression of the human myotubularin-related gene was undetectable. Colony formation of these cells was reduced by 39% after transfection with this gene, as compared with the control vector. Cells stably transfected with this gene showed a reduction in growth of 48% compared with those cells transfected with the empty vector. We also showed that this negative regulation of the myotubularin-related protein is correlated with cell-cycle arrest at G1. In addition, we found that the cyclin-dependent kinase inhibitor, p27, is induced by increased expression of the human myotubularin-related gene. These results suggest that the human myotubularin-related protein can negatively regulate the growth of lung cancer cells.

OBJECTIVE: The aim of this study was to examine the prevalence of Internet addiction in middle school students and to identify associated psychosocial risk factors and depression. METHODS: This study was part of a larger epidemiological study on childhood psychiatric disorders conducted in Osan, a city of Republic of Korea. We used IAS for internet addiction, K-YSR for subjects' emotional and behavioral problems and K-CDI for depressive symptoms. We used the data of n=1217 completed cases. We put on independent variables, which are sex, age, smoking and alcohol experiences, economic status, age of first Internet use, K-YSR and K-CDI score. RESULTS: The subjects consisted of addicted users (2.38%), over users (36.89%) and normal Internet users (60.72%). Attention problems, sex, delinquent problems, K-CDI scores, thought problems, age and aggressive behavior were predictable variables of internet addiction. Age of initial Internet use negatively predicted Internet addiction. CONCLUSION: This result showed similar to other researches about sociodemographic, emotional or behavioral factors related to internet addiction. Generally, subjects with more severe internet addiction had more emotional or behavioral problems. It means that they already have had various difficulties when we found internet addiction of adolescents. Therefore it is necessary to evaluate whether the subjects have any emotional or behavioral troubles and to intervene to prevent internet addiction. Language: en

Drug resistance causes a serious limitation for the chemotherapy of multiple myeloma. Combination cancer therapy is one of attractive approaches to overcome drug resistance of cancer cells. In the present study, we investigated the synergistic effect of decursin (a major compound in Angelica gigas) and doxorubicin on the induction of apoptosis in three human multiple myeloma cells. Concurrent treatment of decursin and doxorubicin significantly exerted significant cytotoxicity, while doxorubicin or decursin alone had no cytotoxic effect at physiologically relevant concentrations in signal transducer and activator of transcription 3 (STAT3) positive cell lines such as U266 and RPMI8226 cells and also STAT3 negative cell line MM.1S cells. We further demonstrated that the loss of the viability of the cells co-treated with decursin and doxorubicin was due to the induction of apoptosis. Combination treatment of doxorubicin and decursin enhanced the activation of caspapse-9 and 3, the cleavage of poly (ADP-ribose) polymerase (PARP) and sub G1 population compared to either drug alone in three multiple myeloma cells. In addition, the combined treatment of doxorubicin and decursin downregulated the phosphorylation of the mammalian target of rapamycin (mTOR) and its downstream S6K1 and activated the phosphorylation of extracellular signal regulated kinase (ERK) in three multiple myeloma cells. Furthermore, the combined treatment of doxorubicin and decursin reduced mitochondrial membrane potential, suppressed the phosphorylation of JAK2, STAT3 and Src, activated SHP-2 and attenuated the expression of cyclind-D and survivin in STAT3 positive U266 cells. Conversely, the broadly-acting tyrosine phosphatases inhibitor pervanadate reversed STAT3 inactivation and also PARP cleavage and caspase-3 activatio induced by combine treatment of doxorubicin and decursin in U266 cells. Citation Format: Duck-Beom Jung, Soo-Jin Jeong, Hee-Young Kwon, Ji Hoon Jung, Eunjung sohn, Eun Ah Sin, Ji-Hyun Kim, Sun-Mi Cho, Miyong Yun, Hyo-jung Lee, Sung Hoon Kim. Decursin and doxorubicin are in synergy for the induction of apoptosis via STAT3 and/or mTOR pathways in human multiple myeloma cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 836. doi:10.1158/1538-7445.AM2013-836

Although beta sitosterol has been well known to have anti-tumor activity in liver, lung, colon, stomach, breast and prostate cancers via cell cycle arrest and apoptosis induction, the underlying mechanism of anti-cancer effect of beta sitosterol in multiple myeloma cells was never elucidated until now. Thus, in the present study, the role of reactive oxygen species (ROS) in association with AMP-activated protein kinase (AMPK) and c-Jun N-terminal kinase (JNK) pathways was demonstrated in beta sitosterol treated multiple myeloma U266 cells. Beta sitosterol exerted cytotoxicity, increased sub-G1 apoptotic population and activated caspase-9 and -3, cleaved poly (ADP-ribose) polymerase (PARP) followed by decrease in mitochondrial potential in U266 cells. Beta sitosterol promoted ROS production, activated AMPK, acetyl-CoA carboxylase (ACC) and JNK in U266 cells. Also, beta sitosterol attenuated the phosphorylation of AKT, mammalian target of rapamycin (mTOR) and S6K, and the expression of cyclooxygenase (COX)2 and VEGF in U266 cells. Conversely, AMPK inhibitor compound C and JNK nhibitor SP600125 suppressed apoptosis induced by beta sitosterol in U266 cells. Furthermore, ROS scavenger N-acetyl-L-cysteine (NAC) attenuated beta sitosterol mediated sub-G1 accumulation, PARP cleavage, JNK and AMPK activation in U266 cells. Overall, these findings for the first time suggest that ROS mediated activation of cancer metabolism related genes such as AMPK and JNK plays an important role in beta sitosterol induced apoptosis in U266 multiple myeloma cells. Citation Format: Sun-Mi Cho, Ji-Sung Kim, Hyosook song, Eun-Jung Sohn, Ji-Hyun Kim, Ji Hoon Jung, Jung-Hyo Kim, Soo-Jin Jeong, Eun-OK Lee, HyoJeong Lee, Sung Hoon Kim. Reactive oxygen species mediated activation of AMP activated protein kinase and c-Jun N-terminal kinase plays a critical role in beta sitosterol induced apoptosis in multiple myeloma U266 cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 849. doi:10.1158/1538-7445.AM2013-849

Depression during adolescence is critical to the individual's own development. Hence, identifying individuals with high-risk depression at an early stage is necessary. This study aimed to identify childhood emotional and behavioral risk factors related to depressive symptoms in Korean adolescents through a longitudinal study. The first survey took place from 1998 to 2000, and a follow-up assessment conducted in 2006, as the original participants reached 13-15 yr of age. The first assessment used the Korean version of Child Behavior Checklist and a general questionnaire on family structure, parental education, and economic status to evaluate the participants. The follow-up assessment administered the Korean Children's Depression Inventory. Multiple regression analysis revealed that childhood attention problems predicted depressive symptoms during adolescence for both boys and girls. For boys, family structure also predicted adolescent depressive symptoms. This study suggests that adolescents with attention problems during childhood are more likely to experience depressive symptoms.

Children with chronic illness are known to have an increased risk of emotional and behavioral problems. Many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children. It is a major theoretical framework of the Wallander and Varni model that modifiable risk and resistance factors can be identified empirically. Risk factors in the original model include disease/ disability parameters, functional dependence in the activities of daily living, and psychosocial stressors. Resistance factors in the original model are delineated in three categories: intrapersonal factors such as competence, temperament; socialecological factors such as family psychological environment, social support; and stressprocessing factors such as cognitive appraisal and coping strategies. In addition, it is proposed that the factors such as age of onset, certainty of diagnosis and prognosis of illness affect adjustment. Children with chronic illness are known to have an increased risk of emotional, behavioral, academic problems. Research findings show that children with chronic illnesses are at a higher risk for developing emotional problems such as anxiety, depression, social withdrawal and low self-esteem. The parents of children with Type 1 diabetes and asthma reported emotional and behavioral problems more. Also children with chronic illness tend to more behavior problems than healthy peers. Especially, increased risk of children with neurological conditions is explained by the lower level of cognitive functioning. The association of poor school performance with type I diabetes and sickle cell anemia is proposed

Objective: To estimate dental maturity using the Demirjian Index for the mandibular third molar and investigate the relationships between dental maturity and skeletal maturity among growing children. Methods: The samples were derived from panoramic, lateral cephalometric and hand-wrist radiographs of 270 female subjects registered as patients at the orthodontic department, dental hospital, Yonsei University. Dental maturity [Demirjian Index (DI)] and skeletal maturity [skeletal maturation indicators (SMIs)] and cervical vertebrae maturation indicators (CVMIs)] were estimated from these radiographs. Results: There was a significant correlation (r = 0.64) between SMIs and DI, and a similar correlation (r = 0.59) was observed between CVMIs and DI (p ＜ 0.001). If DI was above Stage E, then the SMI was above Stage 10 and the CVMI was above Stage 5. There was a weak correlation (r = 0.26) between age at menarche and DI (p ＜ 0.001). There was no significant difference in DI among Class I, II or III malocclusions. Conclusions: Dental maturity evaluation using the mandibular third molar will be an adjunctive tool in combination with cervical vertebrae and hand-wrist maturity evaluations.