The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea

Background@#Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. @*Methods@#From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. @*Results@#Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). @*Conclusion@#In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.

Assessing Clinical Feasibility and Safety of Percutaneous Dilatational Tracheostomy During Extracorporeal Membrane Oxygenation Support in the Intensive Care Unit

Purpose@#A tracheostomy is often used to wean patients off the ventilator, as it helps maintain extracorporeal membrane oxygenation (ECMO) without sedation. A percutaneous dilatational tracheostomy (PDT) performed in critically ill patients is widely accepted, however, its feasibility and safety in ECMO is unclear. @*Methods@#This retrospective observational study included 78 patients who underwent a PDT and ECMO at the surgical intensive care unit (SICU) in a tertiary hospital between January 1, 2016 and December 31, 2019. We analyzed their medical records, including PDT-related complications and clinical variables. @*Results@#The median values of hemoglobin, platelet count, international normalized ratio, partial thromboplastin time, and activated partial thromboplastin time before the tracheostomy were 9.2 (8.5-10.2) g/dL, 81 (56-103) × 103/dL, 1.22 (1.13-1.30), 15.2 (14.3-16.1) seconds, and 55.1 (47.4-61.1) seconds, respectively. No clotting was observed within the extracorporeal circuit, however, minimal bleeding was observed at the tracheostomy site in 10 (12.8%) patients. Of 4 patients with major bleeding, local hemorrhage was controlled in 3 patients, and intratracheal bleeding continued in 1 patient. The mortality rate was 60.9% and 57.1% in the complication and no-complication group, respectively. The durations of SICU stay, hospital stay, and mechanical ventilation were not statistically different between the groups. @*Conclusion@#A PDT performed in critically ill patients was associated with a low rate of bleeding. Complications did not appear to significantly affect the patient outcome. PDT can be performed in patients who usually require a tracheostomy to maintain ECMO.

Application of Computed Tomography in the Identification of Hollow Viscus Injuries in Blunt Trauma Patients

Purpose@#Despite advances in diagnostic and imaging technologies, the diagnosis of traumatic hollow viscus injury (HVI) remains a great challenge in clinical practice. This study aimed to determine the accuracy of computed tomography (CT) in the diagnosis of HVI in emergent blunt trauma patients. @*Methods@#The study was conducted on patients with abdominal trauma who were admitted to our center, regional emergency center, Kyung Hee University Medical Center, between January 2008 and December 2018. The clinical data of patients with abdominal trauma who underwent CT and abdominal surgery within 24 hours of hospitalization were analyzed to determine the diagnostic capacity of CT. @*Results@#In total, 156 patients were included in the study. There were 88 cases of blunt trauma. Among these patients, 27 were diagnosed with HVI using CT, and 38 patients were diagnosed with HVI in the operating room. The median injury severity score for these patients was 10.0, the revised trauma score was 7.841, and the trauma injury severity score was 0.96. The sensitivity and specificity of CT in predicting HVI in these patients were 65.8%, and 96.0%, respectively. The positive and negative predictive values were 92.6%, and 78.7%, respectively. @*Conclusion@#In urgent situations, CT findings alone are insufficient for diagnosing HVI. Further research on the HVI diagnostic capacity of CT is required.

Protease-Activated Receptor-2 Is Associated with Terminal Differentiation of Epidermis and Eccrine Sweat Glands

BACKGROUND: Protease-activated receptor 2 (PAR-2) participates in various biological activities, including the regulation of epidermal barrier homeostasis, inflammation, pain perception, and melanosome transfer in the skin. OBJECTIVE: To evaluate the basic physiological role of PAR-2 in skin. METHODS: We investigated PAR-2 expression in human epidermis, skin tumors, and cultured epidermal cells using western blot and immunohistochemical analysis. Additionally, we examined the effect of the PAR-2 agonist, SLIGRL-NH2, on cultured keratinocytes. RESULTS: Strong PAR-2 immunoreactivity was observed in the granular layer of normal human skin and the acrosyringium of the eccrine sweat glands. In contrast, weak PAR-2 immunoreactivity was seen in the granular layer of callused skin and in the duct and gland cells of the eccrine sweat glands. Interestingly, PAR-2 immunoreactivity was very weak or absent in the tumor cells of squamous cell carcinoma (SCC) and syringoma. PAR-2 was detected in primary keratinocytes and SV-40T-transformed human epidermal keratinocytes (SV-HEKs), an immortalized keratinocyte cell line, but not in SCC12 cells. SV-HEKs that were fully differentiated following calcium treatment displayed higher PAR-2 expression than undifferentiated SV-HEKs. Treatment of cultured SV-HEKs with PAR-2 agonist increased loricrin and filaggrin expression, a terminal differentiation marker. CONCLUSION: Our data suggest that PAR-2 is associated with terminal differentiation of epidermis and eccrine sweat glands.

Patterns and Biologic Features of p53 Mutation Types in Korean Breast Cancer Patients / 한국유방암학회지

PURPOSE: The p53 gene is one of the most frequently mutated genes in breast cancer. We investigated the patterns and biologic features of p53 gene mutation and evaluated their clinical significance in Korean breast cancer patients. METHODS: Patients who underwent p53 gene sequencing were included. Mutational analysis of exon 5 to exon 9 of the p53 gene was carried out using polymerase chain reaction-denaturing high performance liquid chromatography and direct sequencing. RESULTS: A total of 497 patients were eligible for the present study and p53 gene mutations were detected in 71 cases (14.3%). Mutation of p53 was significantly associated with histologic grading (p<0.001), estrogen receptor and progesterone receptor status (p<0.001), HER2 status (p<0.001), Ki-67 (p=0.028), and tumor size (p=0.004). The most frequent location of p53 mutations was exon 7 and missense mutation was the most common type of mutation. Compared with patients without mutation, there was a statistically significant difference in relapse-free survival of patients with p53 gene mutation and missense mutation (p=0.020, p=0.006, respectively). Only p53 missense mutation was an independent prognostic factor for relapse-free survival in multivariate analysis, with an adjusted hazard ratio of 2.29 (95% confidence interval, 1.08-4.89, p=0.031). CONCLUSION: Mutation of the p53 gene was associated with more aggressive clinicopathologic characteristics and p53 missense mutation was an independent negative prognostic factor in Korean breast cancer patients.

Total Hip Arthroplasty for Osteonecrosis of the Femoral Head Following Cardiac Transplantation: A Case Report

Cardiac transplantation has become the treatment of choice for end stage heart disease, and the long-term survival rates of cardiac transplant patients continue to improve, due to the continued improvements made in operation methods and postoperative immunological therapies. However, the incidences of disabling orthopedic complications, such as, osteopenia, osteoporosis, fractures, and osteonecrosis, have been increased by the postoperative administrations of steroids and immunosuppressive agents. Accordingly, several orthopedic surgeons have evaluated treatments for these complications, and a number of reports have been issued on osteonecrosis after cardiac transplantation. However, all of these reports have been issued is the US and European countries, and in particular, no report has been published on osteonecrosis following cardiac transplantation in an Asian patient. In this report, the authors report the case of a patient who underwent total hip arthroplasty due to osteonecrosis of the femoral head after cardiac transplantation.

A Case of Granulocytic Sacoma in Esophagus / 대한소화기내시경학회지

Granulocytic sarcoma.(chloroma) is a localized tumor mass composed of immature cells of the granulocytic series infiltrating an extramedullary site. The tumor may involve anywhere in the body, especially orbit, bone, epidural space and lymph node, but there is no case involved the esophagus. In a 34-year-old male presented with sudden anset of dysphagia, esophagoscopic examination revealed concentric narrowing of the esophageal lumen wirith alight granular mucosa in the midesophagus, which hiatologically proved to b a granulocytic sarcoma. Peripheral blood and bone marrow aspiration smears showed blastic crisis of chronic myelocytic leukemia. After the systemic chemotherapy, dysphagia and mid-esophageal luminal narrowing disappeared completely.

A study on the Status of Air and Water Pollutants Emission from Industries in Korea / 예방의학회지

In order to provide some basic data for the control of air water pollution in Korea, the suthors have estimated the amount of air and water pollutant emitted from industries which are employed over 20 employes. This study have done from July 1, 1972 to the end March 1973. The results are as follows: 1. Total number of establishments tith over 20 employees is 5,197 in Korea and the largest gorup establishments was the manufacturing of texttiles with 1,363 establishments(26.2%). 2. By order of number of employees it was observed that there 2,800 industries with 20-59(53.9%) employees, 1,101 with 50-99(21.2%), 571 with 100-199(11.0%), 501 with 200-499(9.6%) and 225with over 500(4.3%) respectively. 3. By order of regional distribution, it was observed that there were 2,257 industries in Seoul (43.3%) and 736 industries in Pusan(14.2%). 4. Industrial coal consumption was 596,154 M/T in 1972, but it'11 be 315,000 M/T in 1980, Fuel consumption was 4,972,000 K1 in 1972, and estimated volume will be 19,3700,000 K1 in 1980. 5. Ttotal amounts of air polutants emitted from industris by fuel combustion were sulfur oxides 79,459 tons, carbon monoxide 33,908 tons, particulate 31,304 tons and hydrocarbon 30,280 tons in 1972 but in 1990 there will be sulfur oxides 1,010,474 tons, nitrogen oxides 204,575 tons, carbon monoxide 68,014 tons, particulate 64,820 tons and hydrocarbon 67,622 tons, respectively. 6. Annual emitted air pollutants through the working processes were sulfur oxides 91,250 tons and nitrogen oxides 32,485 tons in 1972, but sulfur oxieds 118,625 tons and nitrogen oxides 42,555 tons will be present in 1980, respectively. 7. Annual emitted air pollutants by national unit area amounted to 0.77 tons/km2/year in 1965 and 14.7 ton/km2/year in 1980. 8. Total industrial wastes from all industries in Korea were estimated at 810,360 tons/day in 1972; manufacturing of chemicals and plastic products showed the highest amount of wastes at 470,000 tons/day. 9. The amounts of water pollutants due to industrial wastes were the .B.O.D., 471.5 tons/day,suspended solid 331.5 tons/day, CN, 2.3 tons/day, and Cr. 3. 4 tons/day in 1972, but it might be evident of a B.O.D of 3.388 tons/day, suspended solid 2,544 tons/day, CN 20.1 tons/day, and 26.5 tons/day in 1990. 10. Total population equivalent of B.O.D. was 943,000 in 1972, and the estimated value in 1990 will be6, 780, 000.