• Sleep Medicine and Psychophysiology
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• v.18 no.1
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• pp.40-44
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• 2011

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

• Journal of the Korean Institute of Landscape Architecture
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• v.44 no.5
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• pp.26-37
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• 2016

As activities and convenience of residents in outdoor spaces in apartment houses have been considered important, strategies for making outdoor spaces in apartment houses healing spaces have emerged as a major interest. The purpose of this study is to draw elements for planning healing to create healing spaces in collective housing areas and to present design guidelines. The findings of this study are as follows. Functional elements of a healing environment were classified into safe environment, therapeutic environment, ancillary environment, orientation-reinforcing environment, amenities, and social environment. Outdoor spaces in collective housing areas were divided into collective housing entrance areas, internal and external spread areas, outdoor activity areas, and areas by theme. First, collective housing entrance areas should be planned in such a manner that residents can feel the area is private and easy to recognize. Second, internal and external spread areas should be planned in such a manner that they are easy to access and communicate with neighbors. Third, outdoor activity areas should be divided into an open space, resting space, playing space, and sports space. Open spaces should be planned in such a manner that they can command a fine view and respect the privacy of nearby residents. Resting spaces should be equipped with a shelter that protects users from direct sunlight, rain, and snow as well as include a movable bench. Playing spaces should be built considering development of children's curiosity, adventurous spirit, character, stimulation, and physical health. Playing spaces should be designed in such a manner that roadways and sidewalks can be separated for safe traffic. Sport spaces should be planned in such a manner that they can be associated with a pavilion and trail that provide residents with an opportunity to communicate with each other and rest. Fourth, spaces by theme are classified into sense garden, therapeutic garden, experiential garden, and learning garden. Sense gardens are a small garden based on the five senses. Sense gardens should be designed in such a manner that they can improve users' mental and physical health through programs that stimulate the sense of sight, auditory sense, and olfactory sense. Therapeutic gardens should be designed in such a manner that they can provide a comfortable and relaxing space by minimizing noise. It is advisable for therapeutic gardens to be equipped with a medicinal herb garden, meditation garden, and sense garden. Experiential and learning gardens should be designed in such a manner that they can provide users with a space in which they can enjoy nature and leisure activities. It is advisable for experiential and learning gardens to be equipped with a tea garden, vegetable garden, and camping garden. Healing programs should be designed in such a manner that users can feel relaxed by providing a healing environment, making the most of the natural environment. Further research on evaluating whether the findings of this study are effective in healing in a qualitative and quantitative manner is needed.

• Journal of Korean Society of Environmental Engineers
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• v.27 no.8
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• pp.870-876
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• 2005

The multiple regression models which have two factors(population and commercial area) have been used to forecast the water demand in the future. But, the coefficient of population had a negative value because proper regional classification wasn't performed, and it is not reasonable because the population must be a positive factor. So, the regional classification was performed by principal component and cluster analysis to solve the problem. 6 regional characters were transformed into 4 principal components, and the areas were divided into two groups according to cluster analysis which had 4 principal components. The new regression models were made by each group, and the problem was solved. And, the future water demands were estimated by three scenarios(Active, moderate, and passive one). The increase of water demand ore $89.034\;m^3/day$ in active plat $49,077\;m^3/day$ in moderate plan, and $19,996\;m^3/day$ in passive plan. The water supply ability as scenarios is enough in water treatment plant, however, 2 reservoirs among 4 reservoirs don't have enough retention time in all scenarios.

• Journal of Hospice and Palliative Care
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• v.15 no.1
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• pp.10-17
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• 2012

Purpose: This study was conducted to identify the perception regarding palliative care among Korean doctors and referral barriers toward palliative care for terminal cancer patients. Methods: Between May and June 2010, 477 specialists mainly caring cancer patients using a web-based, self-administered questionnaire. Results: A total of 128 doctors (26.8%) responded. All respondents (100%) deemed palliative care a necessary service for terminal cancer patients. More than 80% of the respondents agreed to each of the following statements: all cancer centers should provide palliative care service (80.5%); all terminal cancer patients should receive concurrent palliative care along with anti-cancer therapies (89.1%) and caring for terminal cancer patients requires interdisciplinary approach (96.9). While more than 58% of the respondents were satisfied with their performance of physical and psychological symptoms management and emotional support provided by patient's family members, 64% of the responded answered that their general management of the end-of-life care was less than satisfactory. Doctors without prior experience in referring their patients to palliative care specialists accounted for 26.6% of the respondents. The most common barrier to hospice referral, cited by 47.7% of the respondents, was "refusal of patient or family member", followed by "lack of available palliative care resources" (46.1%). Conclusion: Although most doctors do recognize the importance of palliative care for advanced cancer patients, comprehensive and sufficient palliative medicine, including interdisciplinary cooperation and end-of-life care, has not been put into practice. Thus, more active palliative consultation or referral is needed for effective care of terminal cancer patients.

• Neonatal Medicine
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• v.17 no.1
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• pp.64-74
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• 2010

Purpose : The aim of this study was to determine the risk factors, clinical characteristics and prognosis for the development of periventricular leukomalacia (PVL) in preterm infants according to the extent and site of the PVL. Methods : The medical records of infants (under 36 weeks of gestational age) delivered from January 1999 to December 2008 were reviewed. Twenty-five preterm infants with were PVL were diagnosed by brain magnetic resonance imaging (MRI) and an addition 50preterm infants with no brain lesions were enrolled in this study. The perinatal and neonatal risk factors for the development of PVL was determine in these infants. Mental and Psychomotor Developmental Indices (MDI, PDI) were assessed by a clinical psychologist using the Bayley Scales of Infant Development II. We compared the differences of the clinical characteristics and prognosis according to brain MRI findings. Results : Maternal fever, young maternal age, extended oxygen use, hypotension within the first week of birth, use of inotropics within the first week of birth, and respiratory distress syndrome were the risk factors associated with PVL (P <0.05). In the multivariate analysis, maternal fever and extended oxygen use were statistically significant independent risk factors (P <0.05). The mean MDI and PDI scores of the PVL group (74.4$\pm$ 27.8 and 58.0$\pm$17.7) were significantly lower than those of the control group (103.5$\pm$8.9 and 101.7$\pm$16.1, P <0.05). Conclusion : Maternal fever and extended oxygen use were independent risk factors for PVL. We should pay attention to infants who had the risk factors and follow them up closely by brain imaging study and Bayley Scales of Infant Development II.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.89-94
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• 2008

Background: Thoracoscopic R3 sympathicotomy can effectively treat palmar hyperhidrosis. Here, we evaluated post-operative outcomes of patients receiving a thoracoscopic R3 sympathicotomy due to palmar hyperhidrosis. Material and Method: From January 2001 to December 2006, 225 patients were treated with a R3 sympathicotomy, and follow up was completed for 200 patients, with an average follow up period of 51.7 ($11{\sim}80$) months. We measured postoperative hand sweating according to four grades; dry (grade 1), proper (grade 2), light sweating (grade 3), heavy sweating (grade 4) and evaluated patient satisfaction using 4 grades: very good (grade 0), good (grade1), regular (grade 2), and deficient (grade 3). Result: There were no differences in clinical parameters between the compensatory sweating group and the non-compensatory sweating group. There was a 83.5% compensatory sweating rate. The degree of compensatory sweating related to the patient's body mass index and was influenced by the season, environmental temperature, and emotional stress. Conclusion: The satisfaction rate was 61.5%, and the degree of satisfaction related to the development of compensatory sweating. Therefore, reducing compensatory sweating would increase patient satisfaction with R3 sympathicotomies.

• Journal of Life Science
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• v.28 no.5
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• pp.621-626
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• 2018

We introduced the physiological responses of aging, active aging and also suggest the impact of physical exercise on body health status and elderly immunity. In this purpose, we searched the Pub Med data base for the articles (include our experimental papers) and review papers having the terms 'Aging', 'Active aging' and 'Physical activity and elderly' in the title, published from 1999 until 2018. The results were as follows: Exercise training has been extensively studied about the reduction of inflammation, oxidative stress, disease, and aging in syndrome X patients and elderly. Combined and aerobic or resistance exercise training could reduce obesity, insulin resistance, type 2 diabetes and hypertension. Exercise training has been extensively studied in cancer settings as part of prevention or treatment strategies. From this research, regular exercise has the potential to target tumor growth through regulation of inflammation and immune responses such as lactate clearance, NK cell activation (innate immunity), activation of cytotoxic immune cells, T cell activation (adaptive immunity), and immune surveillance. However, Endurance physical activity not only induces thermogenesis and diverse sports injuries but also elicits mobilization and functional enhancement of monocytes, neutrophils (which is caused by the cytokine changes such as TNF-alpha, IL-1) whereas it suppresses cell mediated immunity causing to increased susceptibility to inflammation and infections like cough and URTIs (upper respiratory track infections) in young and especially in elderly people. Therefore, Strategies to prevent physical fatigue, sports injuries include avoid overtraining, Adequate recovery and various type of rest during and after physical activity and assuring adequate nutrition supplementation such as glutamine, vitamin B, vitamin C, carbohydrate, ion or berry-contain sports beverages is helpful in physically active elderly.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.85-95
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• 1996

Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.

• Journal of dental hygiene science
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• v.15 no.3
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• pp.348-354
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• 2015

The purpose of this study was to provide a basic data for developing and solutions to prevent verbal abuse and to determine the actual overall verbal abuse experience of dental hygienist. Participants were 289 dental hygienists who work in dental hospitals and clinics. The results of this study, 177 dental hygienists experienced verbal abuse. Perpetrators of verbal abuse experience became patient (67.9%), dentist (21.1%). The most common reason for verbal abuse were 'anger about the dental service' (17.0%), 'anger about physical and emotional suffering' (14.1%), 'consider the dental hygienists as subordinate not as colleague or practitioner' (12.6%). The types of verbal abuse were 'taking down' (21.7%), 'yelling' (16.3%), 'being sarcastic' (11.3%). The types of coping with verbal abuse were many aspects of passive coping in order of 'suppress' (12.3%), 'ignore' (8.2%). The result of verbal abuse experience according to working characteristics was significant different to clinical career, main duty, position. The result of self-esteem and job satisfaction according to verbal abuse experience, dental hygienist who had experienced verbal abuse was lower in job satisfaction. Therefore, it should be recognized that experience of verbal abuse in dental hygienist was serious and need to develop prevention programs and research.

• Sleep Medicine and Psychophysiology
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• v.12 no.1
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• pp.32-38
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• 2005

Objectives: Obstructive sleep apnea syndrome (OSAS) has drawn increasing attention as medical community has become to be aware of its co-morbidities and complications, especially cardiovascular complications and excessive daytime sleepiness with accident proneness. As of now, polysomnography is the standard tool to diagnose sleep apnea and estimate the treatment validity. However, its being rather expensive and inconvenient, alternate diagnostic tools have been proposed including wrist actigraphy. So far, actigraphies have been adopted usefully to field-survey sleep apnea prevalence. In this study, we attempted in a sleep laboratory setting to assess the supplemental value of actigraphy in diagnosing OSAS. Methods: This study was done at the Division of Sleep Studies, the Seoul National University Hospital. Thirty-seven clinically suspected cases of OSAS underwent the one-night polysomnography, simultaneously wearing an actigraphy on non-dominant wrist. We analyzed the data of 27 polysomnographically-proven OSAS patients (male：female 20： 7；age $47.6{\pm}12.9$ years old；age range 23 to 72 years) with no other sleep disorders. We calculated RDI (respiratory disturbance index) from the polysomnography data and FI (fragmentation index) from the actigraphy data. Pearson correlation was calculated in order to compare FI with RDI and to evaluate the supplemental diagnostic value of the actigraphy. Results: Mean total sleep time on polysomnography was $401.4{\pm}57.8\;min$ (range of 274.0 to 514.1 min). Mean RDI was $21.7{\pm}20.4/hour$. Mean FI was $21.9{\pm}13.0/hour$. RDI and FI showed significant correlation (r=0.55, p<0.01). Conclusions: Wrist actigraphy in OSAS patients generates a comparable outcome to polysomnography, in measuring the nocturnal sleep fragmentation. The actigraphy could be used supplementally in inpatients, outpatients, and field survey subjects, if polysomnography is unavailable or impossible. In follow-ups related with nasal CPAP (continuous positive airway pressure), upper airway surgery, and oral appliance in OSAS patients, the actigraphy might play a more dominant role in the future.