• Journal of fish pathology
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• v.22 no.1
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• pp.67-73
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• 2009

It was examined whether the common belief that "cultured puffer fishes do not contain tetrodotoxin (TTX)", the major lethal substance that accidently causes death in consumers of those fishes, is true in river puffer fish Takifugu obscurus. In mouse bioassay, lethal levels of toxins were detected in the ranks: gonad>liver>intestine>muscle>skin in wild puffer fish. In contrast, no mortality occurred in the mouse bioassay on cultured fish. However, there were sleepiness, sluggish behavior, and hind limb paralysis with the tissue extracts of cultured fish suggesting the presence of TTX or other similarly acting toxins. An attempt to confirm the presence of TTX in cultured fish with high performance liquid chromatography (HPLC) was not very successful. The results suggest possible existence of TTX toxins or similarly acting toxins.

• The Korean Journal of Pain
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• v.6 no.2
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• pp.213-219
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• 1993

The use of buprenorphine by epidural route in the prevention of postoperative pain has been controversial. High lipid solubility of buprenorphine caused the same parenteral/epidural analgesic dose ratio, and the analgesic effect of epidural buprenorphine possibly due to systemic absorption, which revealed no advantages of epidural administration against parenteral injection. On the contrary, epidural buprenorphine had longer duration of action and fewer side effects than parenteral buprenorphine, which advocated the epidural use of buprenorphine. We studied the efficacy of epidural buprenorphine by comparing epidural buprenorphine with epidural morphine in terms of latency and the duration of analgesic action, and the incidence of side effects. 0.15mg and 0.3mg of epidural buprenorphine had shorter latency than 2mg of morphine. 0.3 mg of buprenorphine had longer duration of action than 4 mg of morphine. The incidence of nausea and vomiting were slightely higher in buprenorphine group than in morphine group. Voiding difficulty and pruritus were little in buprenorphine group, while the incidence of somnolence was markedly higher in buprenorphine group. Form our results we conclude that epidural buprenorphine may be useful in the treatment of postoperative pain, and but recognize both advantages and disadvantages as compared epidural morphine.

• Clinical and Experimental Pediatrics
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• v.51 no.2
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• pp.162-169
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• 2008

Purpose : Oxcabarzepine (OXC), newly recommended antiepileptic drug, has been prescribed for patients with partial seizures and generalized tonic clonic seizures in Korea from 1999. There are limited reports about an efficacy of OXC therapy in epileptic children in Korea. This study evaluated the efficacy and safety of OXC in the light of our experience. Methods : The patients, who had visited the pediatric neurology clinic of Korea University Guro Hospital from January 2001 to December 2006, were included. The data of 144 patients who were administrated OXC as monotherapy or polytherapy, was summarized retrospectively and we evaluated the efficacy and safety of OXC. Results : After 6 months of OXC therapy, 77 patients (53.5%, n=144) achieved seizure freedom, 48 patients (33.3%) experienced >50% improvement. After 12 months of OXC therapy, cessation of seizure was observed in 88 patients (61.1%, n=133), and 27 patients (18.8%) manifested an improvement. Monotherapy group showed superior efficacy to polytherapy one. The frequent side effects of OXC were drowsiness (20.1%), headache (12.5%), dizziness (9.7%) and rash (8.3%). They did not related to patient's age or sex, and dosage of OXC. Twenty four patients (16.7%) experienced hyponatremia, but which were neither symptomatic nor significant one. Conclusion : The efficacy and safety of OXC in our patients were excellent and had less significant side effects than established international one. We expect this report contributes toward OXC therapy in epileptic children.

• Journal of Nutrition and Health
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• v.53 no.3
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• pp.288-302
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• 2020

Purpose: This study examined the factors related to skipping breakfast in high school girls. Methods: A survey of a total of 581 high school girls residing in Incheon was conducted. The subjects were classified into 2 groups according to the breakfast frequency: "breakfast skipping" group (eating breakfast ≤ 2 times/week, n = 250) and "breakfast eating" group (eating breakfast ≥ 3 times/week, n = 331). This study compared the general characteristics, lifestyles, interest in weight control and beauty care, food habits, the reasons and symptoms of skipping breakfast, as well as the attitude toward breakfast between the 2 groups. Results: The mean age of the subjects was 16.5 years old. Approximately, 33.9%, 33.6%, and 32.5% of the subjects were in first grade, second grade, and third grade, respectively, with no significant difference between the 2 groups. The breakfast skipping group showed a high interest in weight control, and beauty care than the breakfast eating group. The breakfast skipping group consumed more afternoon snacks and late-night snacks, and ate dinner irregularly. Although the breakfast skipping group experienced the negative effects of skipping breakfast, they showed low recognition for the importance or role of breakfast. The most common reason for skipping breakfast was lack of time, which appears to be related to the late wake-up time and the time spent on make-up or beauty-care. Conclusion: Skipping breakfast by high school girls was related to a high interest in beauty care, irregular meals and low attitude toward the importance of breakfast for health and nutrition. Therefore, it is necessary to conduct nutrition education to change the perceptions and attitudes of female adolescents regarding the importance of breakfast by recognizing that breakfast can affect not only balanced nutrition and health, but also healthy physical beauty.

• Sleep Medicine and Psychophysiology
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• v.10 no.2
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• pp.93-99
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• 2003

Objectives：Sleep loss and excessive daytime sleepiness may have serious consequences, including traffic and industrial accidents, decreased productivity, learning disabilities and interpersonal problems. Yet despite these adverse effects, there are few epidemiological studies on sleep loss and daytime sleepiness in the general population of Korea. This study investigates the number of people who suffer from sleep insufficiency, how much recovery sleep occurs on weekends, and the relationship between the amount of recovery sleep and daytime sleepiness. Methods：A total 164 volunteers, aged 20 and over, were recruited by advertisement. The subjects were workers and college students living in Seoul, Korea. Subjects were excluded if they were aged over 60；if they had medical, neurological, psychiatric or sleep disorders that could cause insomnia or daytime sleepiness；if they were not following a regular sleep schedule；if they traveled abroad during the study；or if they did not leave home to work or were shift workers. They were interviewed and given a sleep log to complete on each of 14 consecutive mornings. They also completed the Epworth Sleepiness Scale (ESS) at noontime on the last day of the second week. All statistical data were analyzed by t-test, $X^2$-test or ANOVA, using SPSS/PC+. Results：The results showed that the subjects woke up at 6：50 (${\pm}1$：16) on weekdays, 7：09 (${\pm}1$：29) on Saturdays, and 8：12 (${\pm}1$：39) on Sundays and holidays. They took more frequent and longer naps on Sundays than on weekdays and Saturdays. The mean sleep duration was 6h 35 min. on week nights, with a mean increase of about 1h on weekends. Only 9.1% of the subjects spent more than 8h in bed on week nights, with 67% spending less than 7h, and 49.4% reported recovery sleep of more than 1h on Sundays. The subjects who reported recovery sleep of more than 2h on Sundays, showed significantly more excessive daytime sleepiness than those who reported less than 30 min (F=2.62, p<.05). Conclusions：These findings suggest that sleep insufficiency and excessive daytime sleepiness are relatively common in Korea, and that the people who get insufficient sleep on weekdays try to compensate for sleep loss with oversleeping and daytime napping on Sundays and holidays. It appeared that daily sleep insufficiency had a cumulative effect and increased daytime sleepiness.

• 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.

• Sleep Medicine and Psychophysiology
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• v.20 no.2
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• pp.69-74
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• 2013

Introduction: Although it is well known that medical students are not getting an adequate amount of sleep, there have been only a few studies on the sleep patterns of medical students and the related factors. Therefore, the present study aimed to investigate the medical students' sleep patterns and the related factors. Methods: A questionnaire package was administered to the $1^{st}$ to $4^{th}$ year medical students at one medical school. It consisted of questions asking about their lifestyles as well as Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), global assessment of recent stress scale (GASS), the center for epidemiologic studies-depression scale (CES-D), and Moudsley obsessive-compulsive inventory (MOCI). A total of 352 students (206 males and 146 females) responded to the survey and the result was analyzed using the independent t-test, the chi-square test, the paired t-test, Pearson's correlation and ANOVA. p-values of less than 0.05 were considered statistically significant in analyses. Results: The weekend bedtime was significantly delayed (0 : 49 on weekday ; 1 : 34 on weekend ; t=-5.23, p<0.001), the weekend rise time was delayed (6 : 58 on weekday ; 9 : 30 on weekend ; t=-24.48, p<0.001) and the total sleep time was increased on weekends (5 : 36 on weekday ; 7 : 39 on weekend ; t=15.94, p<0.001). The PSQI score of all subjects was 6.43{\pm}2.64. PSQI was positively correlated with ESS (r=0.383, p<0.001), GASS (r=0.326, p<0.001), CES-D (r=0.393, p< 0.001), and MOCI (r=0.247, p<0.001), but not with GPA (r=0.072, p=0.228. The more senior students had lower PSQI, GASS, CES-D, and MOCI score (p<0.05). Conclusion: Medical students were experiencing a lack of sleep during weekdays as they have a later bedtime and earlier rise time, and consequently had more hours of sleep on weekends. Overall, the medical students were experiencing poor sleep quality and sleep deprivation. Poor sleep quality is associated with psychological problems (daytime sleepiness, stress, depression, and obsessive tendency).

• 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.

• Sleep Medicine and Psychophysiology
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• v.26 no.1
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• pp.23-32
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• 2019

Objectives: Insomnia is not only the most common sleep-related disorder, but also is one of the most important. Knowledge of the comorbidities of insomnia is essential for proper treatment including pharmacological and non-pharmacological methods to prevent disease chronification. This study aimed to determine sleep clinic patients' knowledge of insomnia. Methods: This study recruited 44 patients (24 males and 20 females; mean age $54.11{\pm}16.30years$) from the sleep clinic at National Center for Mental Health. All subjects were asked to complete a self-report questionnaire about their reasons for visiting a sleep clinic and about their knowledge of treatment and comorbidities of insomnia. Results: The reasons for visiting the sleep clinic were insomnia symptoms of daytime sleepiness, irregular sleeping time, nightmares, snoring, and sleep apnea, in that order. Of the responders, 72.7% had a comorbidity of insomnia, and 22.7% showed high-risk alcohol use. In addition, 70.5% of responders chose pharmacological treatment of insomnia as the first option and reported collection of information about treatment of insomnia mainly from the internet and medical staff. More than half (52.3%) of the respondents reported that they had never heard about non-pharmacological treatments of insomnia such as cognitive behavioral treatment (CBT-I) or light therapy. The response rate about comorbidities of varied, with 75% of responders reporting knowledge of the relation between insomnia and depression, but only 38.6% stating awareness of the relation between insomnia and alcohol use disorder. Of the total responders, 68.2% were worried about hypnotics for insomnia treatment, and 70% were concerned about drug dependence. Conclusion: This study showed that patients at a sleep clinic had limited knowledge about insomnia. It is necessary to develop standardized insomnia treatment guidelines and educational handbooks for those suffering from insomnia. In addition, evaluation of alcohol use disorders is essential in the initial assessment of sleep disorders.

• Sleep Medicine and Psychophysiology
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• v.24 no.2
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• pp.106-117
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• 2017

Objectives: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). Methods: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. Results: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and ${\ddot{O}}stberg$ questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. Conclusion: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.