Stress can be defined generally as reponses to stressors on the body or in a definition more focused on the central nervous system, it can be defined as alterations in neuropsychological homeostatic processes. There is a psychological aspect to stress, related to issues such as memory, emotion, arousal, and also a biological aspect which included activation of specific brain and endocrine circuits. This article reviews a series of neurobiological mechanisms aimed at understanding what are pathways by which stress is perceived, processed, and transduced into a neuroendocrine response. Multiple brain structures are involved in the organization of responses to stressful stimuli. Among them the hypothalamus, septohippocampal structures, amygdala, cingulate and prefrontal cortices, hindbrain regions such as the brainstem catecholamine cell body group (A2/C2 cell groups in the nucleus of the tractus solitaris; A1/C1 cell groups in the ventrolateral medulla; A6 cell groups in the locus ceruleus), the parabrachial nucleus, cuneiform nucleus, and dorsal raphe nucleus are prominent structures. We reviewed with the focus on the classic stress circuits: the limbic-hypothalamic-pituitary-adrenal axis (LHPA) and locus ceruleus-norepinephrine (LC-NE) system. Our review indicates that the LHPA stress circuit and LC- NE system are the complex systems with multiple control mechanisms and that these mechanisms are altered in pathological states, such as chronic stress and depression. The holistic features described in this reviews can provide insight into the nature and location of brain circuits and neurotransmitter receptors involved in stress and the treatment of stress-related disorders.
Background : It has been suggested that CDT is a potential biological marker in the Western countries to reflect the degree of past alcohol consumption. This study was performed to compare CDT, AST (aspartate transaminase), ALT (alanine transaminase), and GGT (gamma-glutamyl transferase) as a biological marker reflecting drinking amounts in Korean patients.
Methods : The 25 males with moderate drinking (＜14 drinks/week) and 26 males with heavy drinking (＞21 drinks/week) were studied for the relationships between their weekly drinking amount and the blood levels of CDT, AST, ALT, and GGT.
Results : Only CDT was significantly correlated (P=0.001) with weekly drinking amount among heavy drinkers, while both CDT (P=0.029) and GGT (P=0.000) were significantly correlated in moderate drinkers. Stepwise multiple regression revealed that GGT had R2 of 49.1% in moderate drinkers and CDT had R2 of 38.9% in heavy drinkers for the weekly drinking amount.
Conclusion : The results described above suggested that CDT can be a potential biological marker for the purpose of quantitative monitoring the drinking behavior of heavy drinkers in Korea.
Background : Numerous diabetes patients do not know the name of hypoglycemic agents that they are taking, even though they have taken them for a long time. The aim of this study was to find out the percentage of diabetes patients who recognize the name of their hypoglycemic agents and to clarify whether such recognition have effect on their glycemic control.
Methods : A cross-sectional questionnaire survey was done from March to May 2004, targeting inpatients and outpatients who had been taking oral hypoglycemic agents for diabetes treatment in 2 hospitals.
Results : 134 patients (89.3%) of 150 completed the questionnaire. Only 20 (14.9%) patients accurately knew the name of at least one of the hypoglycemic agents they were taking. Smoking (P=0.0086), recognition of the name of hypoglycemic agents (P＜0.0001), history of change of prescribed hypoglycemic agents (P=0.0095), diet and exercise (P＜0.0001), explanation of hypoglycemic agents (P=0.0231), and forgetting to take medicine (P＜0.0001) were significantly related to the HbA1c level. Among these factors, history of change of prescribed hypoglycemic agents (P=0.0006), diet and exercise (P=0.0002), and forgetting to take medicine (P＜0.0001) were the independent related factors after adjustment.
Conclusion : The recognition rate of the name of hypoglycemic agents was low. It may be associated with patients' HbA1c, but was not an independent related factor.
Background : The purpose of this study was to find out whether primary physicians know the new guidelines (JNC VII) of target BP (blood pressure) and whether they educate their patients properly or not.
Methods : We made calls to local clinicians (family medicine (FM), internal medicine (IM), oriental medicine (OM)) under the disguise of the patient's caretaker and asked them the target BP for patients with hypertension without any cardiovascular disease and those with hypertension and DM (diabetes mellitus). We categorized the participants according to sex, age and departments.
Results : Out of the 145 clinics, 88 clinics responded (28 clinicians of FM, 30 clinicians of IM, 30 clinicians of OM). Questions on systolic target BP for patients with hypertension without cardiovascular disease, 87 clinicians answered. Among them, 64 clinicians (73.6%) answered correctly to the target BP (≤140 mmHg), in the order of FM, IM, and OM. Questions on the diastolic pressure (≤90 mmHg), 78 clinicians answered and all of them answered correctly. On the question of the target BP for the patients and hypertension and DM, 55 clinicians (63.2%) answered correctly to the systolic target BP (≤130 mmHg) in the order of IM, FM, and OM. Only 19 clinicians (32.4%) answered correctly to the diastolic target BP (≤90 mmHg) in the order of FM, IM, and OM.
Conclusion : The clinicians have given less correct answers on the target BP in the patients and hypertension and DM than those with only essential hypertension. In conclusion, local clinicians should be fully aware of the target BP in patients with hypertension associated with cardiovascular disease or other complications. Also they should educate their patients properly.
Background : The purpose of this study was to examine the prevalence of obesity based on body mass index data and to assess the long-term effect of breast feeding on obesity among children in elementary schools.
Methods : A total of 997 children in 1st grade were recruited from 3 public primary schools in Gangdong-gu and 1 private primary school in Nowon-gu, Seoul. A questionnaire was used to gather demographic background and lifestyle-related information infant feeding methods and duration.
Results : There were 101 boys (24.6%) and 100 girls (25.0%) identified as an obese group (BMI ≥85 percentile). The birth weight was higher in the obese group (3.34±0.46kg) than in the normal body mass index group (3.24±0.43kg). The parental body mass index was higher in the obese group than the normal group. Average hours of daily watching TV, video or computer use was higher in the obese group (2.2±1.2) than in the normal body mass index group (2.0±1.0). In the obese group, children ate more than the normal group. After adjusting for potential confounding factors, there seemed to be some risk reduction for obesity in the breast fed group for at least 7 months, compared to the never breast fed group, but had no statistical significance.
Conclusion : Whether child was breast fed or not nor the duration of breast feeding did not seem to reduce the risk of developing obesity.
Background : Even though tuberculosis (TB) is still a major public concern in Korea, there are few data on the management of TB patients and its outcome in the private sector in contrast with those of the public sector.
Methods : The nine-hundred-twelve TB patients who were registered in a private university hospital from 2001 to 2002 were enrolled. The patients were divided into pulmonary (TBP), extrapulmonary (TBE), and combined (TBP+E) groups, and were also divided into initial and retreatment groups. The clinical characteristics, diagnostic methods, treatment regimens, and outcomes were analyzed and compared between the groups.
Results : The mean age of 912 patients was 49.2 years and the male-to-female ratio was 56%:44%. The number of patients of the initial and retreatment groups of TBP, and those of (TBE+TBP+E) were 449, 169, 237, 57, respectively. The bacteriological study was performed in 97.9%, and positive culture was confirmed in 54.5% and 29.6% of patients with TBP and (TBE+TBP+E), respectively (P＜0.05). The AFB smear was positive in 40.8% of TBP patients. The PCR was done in 63.6% of (TBE+TBP+E) group. The MDR was detected in 7.6% of isolates. Overall, treatment completion rate was 74.6%, default rate 13.7%, and death rate 0.5%.
Conclusion : Even though the management of TB patients in a private hospital was satisfactory in terms of national guidelines, the high default rate was still a problem. Efforts to decrease the default rate is needed independently or in cooperation with the public sector.
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