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Limited data are available regarding the proper application time and long-term outcomes of extracorporeal membrane oxygenation (ECMO) in patients with cardiogenic shock. This cohort study appraised the clinical outcomes according to ECMO application without or before cardiopulmonary resuscitation (CPR) in patients with acute myocardial infarction (AMI) combined with cardiogenic shock.Between 2011 and 2015, a total of 13,104 patients with AMI were enrolled in a nationwide AMI registry. Eligible patients with cardiogenic shock, who underwent percutaneous coronary intervention, with a 3-year clinical follow-up, were analyzed. The 949 included patients were divided into two groups: no ECMO (n = 845) and ECMO application (n = 104). The ECMO group was further divided into ECMO without or before CPR (n = 11) and ECMO after CPR (n = 93).Significant differences were noted in major adverse cardiac events (MACEs) between the no ECMO and ECMO application groups during the 3-year follow-up (41.5% vs. 80.8%; p0.001). However, the ECMO without or before CPR group showed similar outcomes to the no ECMO group in 3-year MACEs (63.6% vs. 41.5%; p = 0.055). MACEs during 3 years of follow-up were significantly lower in the ECMO without or before CPR group than in the ECMO after CPR group (63.6% vs. 82.8%; p = 0.005).A significantly lower risk of major cardiac events in ECMO without or before CPR suggests that early application of ECMO can be a reasonable strategy to improve outcomes in patients with AMI complicated by cardiogenic shock.

Stable angina is a chronic, systemic disease with a wide range of associated symptoms and clinical outcomes. Prompt diagnosis can be challenging for clinicians. Typical chest pain caused by stable angina occurs when the myocardium receives inadequate oxygen, resulting in myocardial ischemia. Various diagnostic tools including non-invasive tests such as coronary computed tomographic angiography and image-based stress tests have evolved over the last decade. An important factor in the selection of the proper diagnostic test for stable angina is assessment of the pre-test probability in the event of possible coronary arterial stenosis. (Korean J Med 2021;96:218-224)

Purpose This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction. Materials and Methods Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated. Results The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of all-cause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359–0.600, p100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality. Conclusion The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.

In this study, we identified several factors related to left ventricular remodeling (LVR) and examined the impact of LVR on the prognosis of patients with ST-elevated myocardial infarction and multivessel disease treated with complete (CR) or incomplete (IR) revascularization. LVR was defined as an LV end-diastolic diameter >55 mm. A total of 262 patients without LVR at presentation were followed up with echocardiography between 1 month and 1 year. The primary outcome was a composite of all-cause death (AD), MI, and heart failure (HF), referred to as a major adverse cardiovascular endpoint (MACE). Then, each variable was analyzed as a secondary outcome. Follow-up echocardiography identified 26 patients (9.9%) with LVR. LVR was associated with an initial LV ejection fraction 70 mg/dL. Survival analysis showed an association between LVR and adverse outcomes only in the IR group, in which the adjusted hazard ratio (HR) was increased for the MACE (HR = 3.22, 95% confidence interval (CI) = 1.19–8.71, p = 0.002) and HF (HR = 21.37, 95% CI = 4.47–102.09, p< 0.001), but not for the CR group. In STEMI with MVD, LVR within the first year after percutaneous coronary intervention was associated with worse outcomes in the IR but not the CR group.

The selection of appropriate contrast media (CM) remains an important issue in terms of renal preservation in patients with acute myocardial infarction (AMI) and renal impairment scheduled for percutaneous coronary intervention (PCI). We compared the clinical outcomes of patients with AMI and renal impairment, depending on the CM type (iso-osmolar CM [IOCM] vs. low-osmolar CM [LOCM]) that was used during PCI.From the Convergent Registry of Catholic and Chonnam University for Acute Myocardial Infarction, 3174 post-PCI patients with AMI and renal impairment were subdivided into two groups (IOCM [n = 2101] and LOCM [n = 1073]).Regarding in-hospital clinical outcomes, the IOCM group had a higher peak creatinine (Cr) level and lower "Cr differential" than the LOCM group. A higher proportion of dialysis was noted in the IOCM group. In 30-day clinical outcomes, the IOCM group showed higher incidence of new-onset heart failure (HF) but lower incidence of revascularization than the LOCM group. The differences in in-hospital and 30-day clinical outcomes were attenuated after inverse probability of treatment weighting, except for new-onset HF. All other variables in 30-day clinical outcomes, including all-cause death, non-fatal myocardial infarction, cerebrovascular accidents, stent thrombosis, and any dialysis events, were similar between the two groups.Iso-osmolar CM use did not prevent future incidence of dialysis compared to LOCM use in AMI patients with renal impairment.

Recurrent acute myocardial infarction (AMI) is an adverse cardiac event in patients with a first AMI. The predictors of recurrent AMI after the first AMI in patients who underwent successful percutaneous coronary intervention (PCI) have not been elucidated.We analyzed the data collected from 9,869 patients (63.2 ± 12.4 years, men:women = 7,446:2,423) who were enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and October 2015, had suffered their first AMI and had received successful PCI during the index hospitalization. Multivariable logistic regression analysis was performed to identify the independent predictors of recurrent AMI following the first AMI.The cumulative incidence of recurrent AMI after successful PCI was 3.6% (359/9,869). According to the multivariable logistic regression analysis, the significant predictive factors for recurrent AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.In this Korean prospective cohort study, the independent predictors of recurrent AMI after successful PCI for the first AMI were diabetes mellitus, renal dysfunction, atypical chest pain, and multivessel disease.

BACKGROUND: In the cause of increase the clinical research observational evidence on type 2 myocardial infraction (T2MI), the study compared the characteristics of T2MI and T1MI with respect to major adverse cardiac events (MACE) and mortality as long-term outcomes from a large, nationwide, prospective Korean cohort registry. METHODS: From 13,105 consecutively enrolled individuals in the Korea Acute Myocardial Infarction-National Institute of Health (KAMIR-NIH) registry between October 2011 and December 2015, 11,053 acute myocardial infarction (AMI) patients were divided into the T1MI (n=10,545) and T2MI (n=508) groups. All patients completed ≥3 years of follow-up. RESULTS: The Kaplan-Meier curve analysis and Cox proportional hazard regression models showed that the cumulative rate of MACE was similar between the 2 groups (11.4% vs. 13.4%, log-rank P=0.185) at 3 years. However, the T2MI group showed higher rates of all-cause death [12.6% vs. 9.4%, log-rank P=0.019; hazard ratio (HR), 1.42; 95% CI: 1.08–1.85; P=0.012] and non-cardiac death (3.5% vs. 5.3%, log-rank P=0.043; HR, 1.55; 95% CI: 1.01–2.37; P=0.043) than the T1MI group. Male sex (HR 1.540; 95% CI: 1.218–1.947, P100 beats/min; HR, 1.852; 95% CI: 1.436–2.388, P25 kg/m(2); HR, 0.644; 95% CI: 0.514–0.805, P

Current treatment guidelines for acute myocardial infarction (AMI) recommend lowering low density lipoprotein cholesterol (LDL-C). However, previous clinical studies among East Asian AMI patients failed to prove its clinical efficacy of lipid lowering therapy based on Western target LDL-C level. Thus, the purpose of this study is directly to compare the clinical outcomes of target LDL-C 70 mg/dL and 55 mg/dL and identify optimal target LDL-C level and in Korean AMI patients.A total of 2198 AMI patients in Korea AMI Registry - National Institute of Health were enrolled. Patients were initially divided into LDL-C non-target group (n = 1115) and target group (n = 1083). Successful achievement of follow up target LDL-C was defined as70 mg/dL and ≥ 50% reduction from baseline. Target group patients were additionally divided to70 mg/dL group (n = 698) and55 mg/dL group (n = 385). Propensity score matching analysis was done in non-target vs. target group and70 mg/dL vs.55 mg/dL group. In the matched population, the risk of 3 years major adverse cardiac event (MACE) (13.0% vs 9.8%, HR: 0.73; 95% CI: 0.56-0.96; p = 0.025) was higher in non-target group patients. However, the risk of MACE was similar in70 mg/dL and 55 mg/dL group patients (10.0% vs 8.1%, HR: 0.75, 95% CI: 0.46-1.22; p = 0.247).In the present study, target LDL-C level of70 mg/dL and ≥ 50% reduction from baseline level was associated with better clinical outcomes in Korean AMI patients. However, further lowering target LDL-C level of55 mg/dL showed no additional benefits.

Background Noise has been a major issue in children due to its effect on emotional symptoms and sleep problems. The present study investigated the effect of noise on sleep and autonomic activity in children according to three variables, namely, road traffic noise, aircraft noise, and noise sensitivity (NS). Methods The study is epidemiological in nature. A total of 474 subjects of four elementary schools were evaluated in conjunction with the 2014 noise map data gathered from two metropolitan regions, Seoul and Ulsan, in South Korea. Each subject completed the children's sleep habits questionnaire, and heart rate variability (HRV) was recorded. Analysis of covariance was performed using monthly income as a covariate. Results Aircraft noise was associated with night waking (P = 0.047), whereas no significant association was observed between sleep and road traffic noise. After stratifying by NS, no significant results were obtained for road traffic noise. However, high levels of aircraft noise in the high-NS group were associated with high degrees of bedtime resistance (P = 0.049). In terms of HRV, no significant difference was observed in the results between groups. Conclusion Road traffic noise did not significantly alter sleep or autonomic activity in children, whereas aircraft noise exerted a negative effect on sleep. The findings suggest that the impact of noise on sleep in children varies depending on noise sources., Graphical Abstract

Real-world data on baseline characteristics, clinical practice, and outcomes of late presentation (12 to 48 h of symptom onset) in patients with ST-segment elevation myocardial infarction (STEMI) are limited.This study aimed to investigate real-world features of STEMI late presenters in the contemporary percutaneous coronary intervention (PCI) era.Of 13,707 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, 5,826 consecutive patients diagnosed with STEMI within 48 h of symptom onset during 2011 to 2015 were categorized as late (12 to 48 h; n = 624) or early (12 h; n = 5,202) presenters. Coprimary outcomes were 180-day and 3-year all-cause mortality.Late presenters had remarkably worse clinical outcomes than early presenters (180-day mortality: 10.7% vs. 6.8%; 3-year mortality: 16.2% vs. 10.6%; both log-rank p 0.001), whereas presentation at ≥12 h of symptom onset was not independently associated with increased mortality after STEMI. The use of invasive interventional procedures abruptly decreased from the first (12 h) to the second (12 to 24 h) 12-h interval of symptom-to-door time ("no primary PCI strategy" increased from 4.9% to 12.4%, and "no PCI" from 2.3% to 6.6%; both p0.001). Mortality rates abruptly increased from the first to the second 12-h interval of symptom-to-door time (from 6.8% to 11.2% for 180-day mortality; from 10.6% to 17.3% for 3-year mortality; all p 0.05).Data from a nationwide prospective Korean registry reveal that inverse steep differences in the use of invasive interventional procedures and mortality rates were found between early and late presenters after STEMI. A multidisciplinary approach is required in identifying late presenters of STEMI who can benefit from invasive interventional procedures until further studied.

Background: Selecting angiotensin converting enzyme inhibitor (ACEI) or angiotensin II type I receptor blocker (ARB) in patients diagnosed as acute myocardial infarction (AMI) with non-obstructive coronary arteries (MINOCA) is not established. The purpose of this study is to compare the clinical effect of ACEI vs. ARB in MINOCA patients. Methods and results: A total of 273 patients between November 2011 to June 2015, diagnosed with MINOCA who were registered in the Korea Acute Myocardial Infarction Registry — National Institute of Health were enrolled. Patients were divided into ACEI (n = 112) and ARB groups (n = 161). The primary endpoint was cumulative incidence of major adverse cardiac events (MACE) defined as cardiac death, recurrent MI, any new revascularization during 2 years clinical follow-up. Secondary endpoint was heart failure requiring re-hospitalization. Propensity score matching analysis was done. The incidence of primary endpoint was similar (10.4% vs. 15.6%, HR: 0.65; 95% CI: 0.29–1.47; p = 0.301) among both groups. However, the incidence of recurrent MI was significantly lower in ACEI group compared to ARB group (2.1% vs. 10.4%, HR: 0.18, 95% CI: 0.04–0.86; p = 0.031). Conclusions: In the present study, the risk and incidence of MACE was similar between ACEI and ARB therapy in MINOCA patients. However, ACEI significantly reduced the risk of recurrent MI. Further larger scale multi-center randomized clinical trials are needed to clarify the proper use of renin–angiotensin–aldosterone system blocker in these patients.

The clinical efficacy of ticagrelor is questionable in East Asian populations. Patients with acute myocardial infarction (AMI) with multivessel disease (MVD) are considered as high risk patients who might benefit from ticagrelor treatment. The purpose of this study is to compare the clinical effect of ticagrelor and clopidogrel in AMI patients with MVD in Korea.A total of 2275 patients between November 2011 and June 2015, diagnosed with AMI with MVD after successful percutaneous coronary intervention who were registered in the Korea Acute Myocardial Infarction Registry - National Institute of Health (KAMIR-NIH) were enrolled. Patients were divided into ticagrelor (n = 837) and clopidogrel group (n = 1438). The primary endpoint was major adverse cardiac events (MACE) defined as cardiac death, non-fatal MI, target vessel revascularization, or ischemic stroke during 2 years of clinical follow-up. Secondary endpoints were thrombolysis in myocardial infarction (TIMI) major or minor bleeding, net clinical event composed of MACE and TIMI major bleeding, any repeated percutaneous coronary intervention, heart failure requiring re-hospitalization, and stent thrombosis. After propensity score matching analysis, the primary endpoint was lower in ticagrelor group compared to the clopidogrel group (8.6 % vs. 11.9 %; HR: 0.68; 95 % CI: 0.50-0.94; p = 0.018). The risk of TIMI major or minor bleeding was higher in the ticagrelor group (10.8 % vs. 4.8 %; HR: 2.51; 95 % CI: 1.68-3.76; p 0.001). The net clinical event was similar between ticagrelor and clopidogrel group (11.3 % vs. 13.6 %; HR 0.82; 95 % CI: 0.60-1.11; p = 0.195).Ticagrelor significantly reduced the risk of MACE than clopidogrel for AMI patients with MVD in Korea. However, the risk of TIMI major or minor bleeding was higher and the net clinical benefit was similar. Further large-scale multi-center randomized clinical trials are needed to clarify the proper use dual antiplatelet therapy in East Asian populations.

The State-Trait Anxiety Inventory (STAI), composed of two 20-item subscales (STAI-state and STAI-trait), has been increasingly used to assess anxiety symptoms in patients with Parkinson's disease (PD). However, the clinimetric attributes of the STAI under the statistical framework of the item-response theory (IRT) have not been fully elucidated within this population to date. We performed an IRT-based Rasch analysis of the STAI outcomes of patients with de novo PD from the Parkinson's Progression Markers Initiative database. The unidimensionality, Rasch model fit, scale targeting, separation reliability, differential item functioning, and response category utility of the STAI were statistically evaluated. A total of 326 (209 males, 117 females) patients without cognitive dysfunction were enrolled in our study. The original versions of the STAI-state and STAI-trait had acceptable separation reliability but lacked appropriate response category functioning, exhibited scale off-targeting, and several items demonstrated poor fit to the Rasch model. The response categories were reduced from four to three, and the rescored three-point TASI-trait demonstrated a marked improvement in clinimetric properties without a significant impact on unidimensionality and separation reliability. The rescored three-point version of the STAI-state required the additional removal of four misfitting items in order to improve the Rasch model fit. To our knowledge, this is the first study to assess the measurement properties based on the IRT of the STAI in patients with PD. Our Rasch analysis identified the components requiring possible amendments in order to improve the clinimetric attributes of the STAI.

Spontaneous spinal epidural hematoma is extremely rare. It can cause fatal complication such as permanent neurologic deficit. Even though the exact cause of epidural hematoma is not known in most cases, anticoagulation treatment is associated in some cases. In this situation, prompt reversal of anticoagulation and immediate decompression surgery is required. Seventy-year-old woman presesnted with sudden hemiplegia. She had history of hypertension, dyslipidemia, and paroxysmal atrial fibrillation and had taken antihypertensive agent, statin, and warfarin. She did not have any history of trauma and her international normalized ratio was within therapeutic range during follow-up and at the time of event. Physical examination revealed decreased right extremities’ motor and sensory function but cognitive function was normal. Detailed neurologic examination and spinal magnetic resonance imaging identified extensive, spontaneous spinal epidural hematoma. After the reversal of anticoagulation with vitamin K injection, the patient underwent emergent hematoma removal surgery and recovered completely. Our case suggests epidural hematoma should be considered in sudden hemiplegia patients with anticoagulation therapy. Immediate reversal of anticoagulation and decompression surgery can avoid neurologic deficit.

To the Editor, A 54-year-old man presented with frequent episodes of sudden palpitation. Twelve-lead electrocardiogram demonstrated narrow QRS complex tachycardia at a rate of 150/min. The initial part of the ST segment occasionally became deeper and sharper during the tachycardia (arrow, Fig. 1). A cardiac electrophysiological study was performed and the narrow QRS complex tachycardia was reproducibly induced by a single atrial extra-stimulus. The tachycardia intermittently changed at the initial part of the ST segment (arrow, Fig. 2A). Atrial activity at the high right atrium (HRA) always preceded those of the His bundle and coronary sinus (CS) during the first induced supraventricular tachycardia (SVT) with an atrial cycle length of 344 ms, but the retrograde atrial activation sequence in the CS electrogram changed occasionally. Simultaneous activation of the right anterolateral and left lateral accessory pathways (APs) deepened and sharpened the initial point of the ST segment compared to right anterolateral AP activation alone. Radiofrequency catheter ablation abolished conduction over the right side AP. A single ventricular extra-stimulus induced a second tachycardia (388 ms) with the earliest, consistent retrograde atrial activity at the distal CS (Fig. 2B). The earlier retrograde atrial activation at HRA and ST segment change were not present after radiofrequency catheter ablation of the right anterolateral AP. The exact locations of both APs are described in Fig. 3A and ​and3B.3B. We ablated the second AP at the left lateral wall using a transaortic approach. Ventriculoatrial conduction occurred through the atrioventricular node after catheter ablation of the two APs. Figure 1. Twelve-lead surface electrocardiogram (25 mm/sec, 10 mm/mV) during a spontaneous episode of paroxysmal tachycardia and four magnified beats of tachycardia (A, B). The initial part of the ST segment of the first and fourth beats (arrows) during tachycardia ... Figure 2. (A) Surface electrocardiogram (ECG) and intracardiac electrograms from the high right atrium (HRA), His bundle region (His), right ventricular apex (RVa), and coronary sinus (Cs) during the first induced supraventricular tachycardia (SVT) with a cycle ... Figure 3. (A, B) Proposed locations of the two accessory pathways (AP) and (C, D) their contribution to tachycardia. (C) The clinical SVT used the right anterolateral AP as a re-entry circuit and intermittently used the left lateral AP as a bystander but conduction ... Electrocardiographic or electrophysiologic findings that demonstrate the presence of multiple AP include (1) changing antegrade delta waves; (2) evidence of multiple retrograde atrial activation routes; and (3) orthodromic SVT with intermittent antegrade fusion complexes [1]. Concealed conduction through another pathway may not be apparent until the dominant pathway is ablated [2]. Detecting multiple APs requires detailed atrial mapping during programmed stimulation, and elimination of an apparent AP [3]. If the V-A interval or P-wave morphology changes during orthodromic tachycardia, the presence of additional AP should be suspected [4,5]. Although a single, fixed retrograde atrial activation pattern is observed in the presence of two or more AP, the presence of different retrograde atrial activation patterns documents the presence of multiple AP [1]. In our case, an additional AP was recognized by the appearance of more than one atrial breakthrough point during the first induced tachycardia. Intermittent changes in the retrograde atrial activation sequence occurred in the CS (from distal-to-proximal to proximal-to-distal), whereas retrograde atrial activation in the HRA was the earliest. The consistent earliest activation in the HRA suggests that clinical SVT uses the right anterolateral AP as a re-entry circuit and intermittently the left lateral AP as a bystander. Atrial fusion due to intermittent, simultaneous activation of the two AP changed the initial point of the ST segment on the surface electrocardiogram (Fig. 3C and ​and3D).3D). Careful attention to the ST segment during tachycardia could help identify multiple AP before an electrophysiologic study.

Background This study examined the long-term preventive effects of a case management service on suicide reattempts, and clarified the factors related to suicide reattempts. Methods We reviewed the medical records of suicide attempters who visited the emergency department of Ulsan University Hospital from August 28, 2013 to July 31, 2017. A 4-week case management service was provided to consenting participants, either face-to-face or by telephone. Using survival analysis, we analyzed differences in the time to the next emergency department visit for a suicide attempt according to whether participants completed the case management service. We also assessed which characteristics of participants were associated with suicide reattempts. Results We found no overall difference in time to suicide reattempt between case-managed participants and controls over the entire observation period (median period: 19 months). However, in the first 24 weeks after the initial suicide attempt, the case-managed group showed a longer time to reattempt than did the control group (log-rank test = 4.243; P = 0.039). A higher risk of reattempt was found among participants with the medical benefit type of health insurance compared to those with national health insurance (hazard ratio [HR], 5.134; P < 0.001) and among participants aged 20–39 compared to those aged ≥ 60 (HR, 3.502; P = 0.05). Conclusion Case management had only short-term benefits (within 24 weeks of initial suicide attempt). Risk factors for suicide reattempts were having a medical benefit health insurance and being aged 20–39 years., Graphical Abstract

Objective The present study aimed to examine the potential mediating effect of income level on the association between noise exposure and insomnia. Methods 706 individuals were evaluated in conjunction with 2014 noise map data from Seoul, South Korea. Cross-sectional analysis was performed to examine differences in noise level according to household income, while three separate logistic regression models were used to examine factors influencing insomnia. Odds ratios (ORs) were calculated after adjusting for depression, anxiety, auditory acuity and noise sensitivity in the first model. Analyses were adjusted for sociodemographic variables in the second model, lifestyle factors and medical illnesses in the third model. Results Noise level was significantly associated with an increased risk of insomnia in the low-income group, although no such association was observed in the high-income group. Groups exposed to >60 dB of noise (Lden; day-evening-night equivalent) exhibited a 1.79-fold increase in the incidence of insomnia relative to those exposed to

：A total of 447 adolescents who were recruited from a child and adolescent psychiatric clinic of university hospital completed a self-report questionnaire consisting of Korean Internet Addiction Self-scale (K-scale), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Korean-Attention-Deficit Hyperactivity Disorder Rating Scale (K-ARS), and Adolescent Happiness Index (AHI). They were classified into three internet user groups, non-addicted group (below or equal to 94), poten-tial risk group (95 to 107) and high risk group above or equal to 108) according to K-scale total score.

A great deal of research has been devoted to identifying subclinical functional brain abnormalities in manganese (Mn)-exposed welders. However, no previous study has investigated morphological brain abnormalities, such as changes in brain volume, in welders. This study evaluates morphological changes in brain volume among welders, and investigates the relationship between structural brain abnormalities and subclinical dysfunction in this population.We used voxel-based morphometry (VBM) to assess differences in gray and white matter brain volumes between 40 welders with chronic Mn exposure and 26 age-matched control subjects. Correlation analyses were used to investigate the relationship between brain volume changes and decreased performance on neurobehavioral tests.Brain volumes in the globus pallidus and cerebellar regions were significantly diminished in welders with chronic Mn exposure compared to controls (FDR-corrected P0.05). These changes in brain volume were negatively correlated with cognitive performance and grooved pegboard scores.There are measurable brain volume reductions in the globus pallidus and cerebellum of welders chronically exposed to Mn, and these volume reductions correlate with cognitive and motor neurobehavioral deficits. Our findings therefore indicate that volumetric measurement could be a useful subclinical marker among welders that show no signs of manganism.

Objective: The present study tested the effectiveness of the Heavy Smoking Index (HSI) for the screening of high nicotine dependence and the predictive value of HSI on smoking cessation within a community sample in a public health center. Methods: The Fagerstrom Test for Nicotine Dependence (FTND) scores from 1069 smokers who visited a public health center in Korea was analyzed. Receiver operating characteristic analyses were performed to calculate sensitivity and specificity values to compare the effectiveness of HSI to items 1 and 4 of FTND. In addition, HSI at baseline was found to predict smoking cessation after 4 weeks and after 6 months using logistic regression. We assessed whether HSI at baseline would predict smoking cessation after 4 weeks and after 6 months using logistical regression. Results: For the results, a score of 4 on HSI was considered optimal. Additionally, the predictive value for smoking cessation of both HSI and FTND were found to be statistically valid at baseline. Conclusions: O...

Objective: This study evaluated the diagnostic application of continuous performance tests in children with ADHD. Method: We recruited 114 children (aged 6-12) from August 2012 to May 2014. Seventy-nine children were diagnosed with ADHD and 35 were enrolled as controls. The Advanced Test of Attention (ATA) was administered to all participants. Results: There were significant between-group differences for the frequency distribution of four ATA variables. The ATA criteria yielded a diagnostic sensitivity and specificity of 84.8% and 45.7%, respectively. Discriminant analysis revealed that auditory reaction time variability and visual commission errors helped distinguish between the groups. Discriminate functions indicated correct classification of 64.9% children. ADHD children tended to have lower intra-class correlation coefficients. Conclusion: Our results suggest that the ATA distributions of ADHD individuals may differ from the general population; in addition, the ATA results could not independently diagnose ADHD. Therefore, they should be considered carefully before diagnosis.

Introduction Our objective was to identify the factors related to returning to smoking by analyzing data obtained from a smoking cessation clinic. Methods We analyzed data from 2,089 subjects (age 44.0 ± 12.9 years) who started a smoking cessation program between 16 July 2007 and 31 December 2008 in a community health center in the city of Ulsan. We analyzed demographic information and clinical variables using Kaplan–Meier survival analysis and calculated the hazard ratio for returning to smoking. Results Mean abstinence time differed according to the following factors: sex, past attempts to quit, employment status, type of health insurance, CO levels, results from Fagerstrom test for nicotine dependence (FTND), number of cigarettes smoked daily, use of a nicotine replacement, and number of contacts in the program. Using multivariate analysis, we identified negative relationships between treatment intensity and hazard ratio for the following: visits ≤4 (Exp(B) = 3.752, P

Aggregation of a peptide, beta-amyloid (Aβ), is a hallmark molecular process found in Alzheimer's disease (AD). During Aβ aggregation, oligomeric and fibrillar Aβ are formed, and these molecular self-assembly steps are implicated in generation of toxic effects in AD. Crocetin is a natural carotenoid dicarboxyl acid displaying various pharmaceutical effects and may be co-localized with Aβ mediated by human serum albumin. In the study presented here, we examined the effects of crocetin on Aβ aggregation in three different molecular pathways. Our results demonstrate that crocetin inhibited Aβ fibril formation and destabilized pre-formed Aβ fibrils. Moreover, crocetin caused stabilization of Aβ oligomers and prevented their conversion into Aβ fibrils. Our study reveals potential pathological and pharmaceutical implication of crocetin in AD and suggests possible application of crocetin for currently limited structural studies on unstable Aβ oligomers.

OBJECTIVES The objectives of this 12-week multicenter, open-label, noncomparative study were to evaluate the overall effectiveness of paliperidone extended release (ER), the feasibility of maintaining patients on the initial dose of 6 mg, and the relationship between dose pattern and treatment response in schizophrenic patients with inadequate responses to initial treatment in a natural setting. METHODS All patients received 6 mg of paliperidone ER during the first 2 weeks, and subsequently, the dose was adjusted at each visit based on the patient response. We examined the response rate and the effectiveness of different dose patterns of paliperidone ER such as "early increase (dose increased to 9 mg at week 2)," "late increase (dose increased to 9 mg at week 4)," and "maintenance group." RESULTS The response rate based on the Clinical Global Impression of Improvement or Severity response criteria was 33.6% or 61.7%, respectively. The proportion of patients who stayed with the initial dose of 6 mg was 44.5% and the response rate of these patients was 79.8%. When the treatment response to the initial dose of 6 mg is inadequate (Clinical Global Impression of Improvement ≥ 4 at week 2), an early increase in the dose seems to be more effective than maintenance or late increase of the initial dose. CONCLUSIONS This study suggests that paliperidone ER may be an effective and well-tolerated antipsychotics in the treatment of patients with schizophrenia.

Chronic exposure to manganese (Mn), which can be an occupational hazard or can result from liver failure, is associated with adverse motor and cognitive outcomes. Evidence from previous neuroimaging and magnetic resonance spectroscopy studies suggested alteration of function in Mn-exposed brains. However, the effect of chronic exposure of the human brain to Mn on white matter (WM) structure has not yet been determined. In the present study, we used diffusion tensor imaging (DTI) to investigate whether welders exposed to Mn demonstrate differences in WM integrity, compared with control subjects. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were measured on a voxel-wise basis in 30 male welders with exposure to Mn and in 19 age- and gender-matched control subjects. Direct comparison between welders and controls using investigator-independent Statistical Parametric Mapping (SPM) voxel-wise analysis of DTI metrics revealed a reduction of FA in the corpus callosum (CC) and frontal WM in Mn-exposed welders. Further, marked increases in RD and negligible changes in AD suggested that the microstructural changes in the CC and frontal WM result from compromised radial directionality of fibers in these areas, caused primarily by demyelination. Correlation analysis with neurobehavioral performance also suggested that the microstructural abnormalities were associated with subtle motor and cognitive differences in welders.

The aim of this study is to examine relationships of sleep duration with sociodemographic and health‐related factors, psychiatric disorders and sleep disturbances in a nationwide sample in Korea. A total of 6510 subjects aged 18–64 years participated in this study. Logistic regression was used to calculate the odd ratios and 95% confidence intervals of the covariates, psychiatric disorders and sleep disturbances across the following sleep duration categories: 5 h or less, 6, 7, 8 and 9 h or more per day. Low levels of education, unemployment and physical illness were associated with sleeping for 5 h or less and 9 h or more. Being older and widowed/divorced/separated, high levels of physical activity, pain/discomfort, obesity and high scores on the General Health Questionnaires were associated with sleeping for 5 h or less. Female, being younger and underweight were associated with sleeping for 9 h or more. Alcohol dependence, anxiety disorder and social phobia were associated significantly with sleeping for 5 h or less and 9 h or more. Other psychiatric disorders were more common in subjects who slept for 5 h or less (e.g. alcohol use disorder, mood disorder, major depressive disorder, dysthymic disorder, obsessive‐compulsive disorder and specific phobia) or 9 h or more (e.g. post‐traumatic stress disorder). In addition, subjects who slept for 5 h or less reported more sleep disturbances than did subjects who slept for 7 h. Short or long sleep is associated with psychiatric disorders and/or sleep disturbance, therefore attention to the mental health of short or long sleepers is needed.

ObjectiveaaThis study aimed to examine the effectiveness of quetiapine and the effects of dosage relates to its effectiveness on schizophrenia and schizoaffective disorder in a naturalistic setting in Korean people. MethodsaaThis study was a 24-week, open-label, non-comparative, naturalistic study of quetiapine in patients diagnosed with schizophrenia and schizoaffective disorder according to DSM-IV. We stratified the patients into mild [(clinical global impression severity (CGI-S)

Purpose: To evaluate which T1-wieghted technique between 3D gradient-echo (FSPGR) and conventional spin-echo (SE) sequence is more sensitive predictor of neurobehavioral dysfunction found in welders with chronic manganese (Mn) acquired at 3 Tesla. Materials and Methods: Forty-three current male welders and 29 age- and gender-matched, nonwelding production workers (control individuals) were recruited to the present study. Each subject underwent neurological examination, blood sample collection, and neurobehavioral tests, in addition to magnetic resonance imaging (MRI) examination. The MRI examinations were performed using a 3.0 Tesla whole-body scanner. T1-weighted axial images were obtained using SE and FSPGR with a 180° inversion recovery prepared pulse, and the corresponding pallidal indices (PI), PI (SE), and PI (FSPGR), were calculated. Results: Both PI (SE) and PI (FSPGR) were well correlated with blood Mn level, but only PI (FSPGR) was significantly correlated with air Mn concentration (P = 0.007). Of the neurobehavioral performance indicators, after controlling for covariates, PI (FSPGR) was significantly associated with cognitive components, such as the digit symbol score, the digit span backward score, the Stroop test score and also with the grooved pegboard (dominant hand) score, whereas PI (SE) was associated only with grooved pegboard (dominant hand) score. Conclusion: PI using a T1-weighted 3D FSPGR sequence shows the best correlation with neurobehavioral performance indicators and is the best measure for detection of blood and airborne Mn concentrations in welders exposed to excessive occupational Mn. J. Magn. Reson. Imaging 2010;31:1020–1026. ©2010 Wiley-Liss, Inc.

Objectives The aim of this study was to estimate the prevalence of the DSM-IV major mental disorders in the Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). Methods The Korean Epidemiologic Catchment Area study Replication (KECA-R) was conducted between August 2006 and April 2007. The sampling of the subjects was carried out across 12 catchment areas using a multistage, cluster sampling design. The target population included all eligible community dwelling residents aged 18–64 years. Face-to-face interviews were conducted using the K-CIDI based on the DSM-IV. Results A total of 6510 participants completed the interview (response rate = 81.7%). The lifetime and 12-month prevalence rates for DSM-IV major mental disorders were 29.0% and 16.9%, respectively. Those of specific disorders were as follows: (1) alcohol use disorder, 16.2% and 5.6%; (2) nicotine use disorder, 9.0% and 6.0%; (3) specific phobia, 3.8% and 3.4%; (4) major depressive disorder, 5.6% and 2.5%; and (5) generalized anxiety disorder, 1.6% and 0.8%. Additionally, data related to nicotine and alcohol use disorder revealed a very high male to female ratio. Further, mood and anxiety disorders were more prevalent in females than in males. Conclusion The prevalence of major mental disorders was high. In comparison with the studies performed in other countries, notable differences were observed with respect to the distribution of mental disorders in Korea.

Objectives The aim of the study was to evaluate subclinical neurological effects in welders, using an extensive list of neurobehavioral batteries and determine if there is a link between pallidal index (PI) and subclinical neurobehavioral effects in the spectrum of manganese (Mn) symptomatology. Methods A total of 43 asymptomatic male welders and 29 age- and sex-matched healthy control individuals completed questionnaires, and underwent blood examinations, brain magnetic resonance imaging (MRI) scans, and a wide range of neurobehavioral examinations. Results Digit symbol, auditory verbal learning test (delayed recall), complex figure test (copy and immediate recall), digit span, verbal fluency test, Stroop test, grooved pegboard, finger tapping, frequency dispersion and harmonic index of tremor, and maximum frequency of hand coordination showed differences between welders and control individuals. No differences were noted for simple reaction time, postural sway, smell test, and profile of mood states (POMS). Blood Mn levels were shown to be significantly associated with grooved pegboard (dominant hand) and complex figure test (copy) results. PI was significantly associated with digit symbol, digit span backward, Stroop Word and Stroop error index, and grooved pegboard (dominant hand) results. Conclusions The present findings that there were significant correlations between several neurobehavioral deficits and PI as well as blood Mn suggest that they may be attributed to Mn exposure in welding fumes. The present study also shows that PI is a better predictor of neurobehavioral performance than blood Mn levels in asymptomatic welders.