Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

Purpose@#This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients. @*Methods@#The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed. @*Results@#Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013). @*Conclusion@#Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

Preventable Death Rate of Trauma Patients in a Non-Regional Trauma Center

Purpose@#A nationwide study (2012-2017) of preventable trauma death rates (PTDR) showed a 15.3% decrease after Regional Trauma centers were initiated. However, in non-trauma centers with an Emergency Department there is limited data of preventable mortality in trauma patients. Therefore, the purpose of this retrospective study was to investigate preventable mortality in trauma patients in a nonregional trauma center and determine the effect of initiating a Trauma Team. @*Methods@#There were 46 deaths of trauma patients recorded in the National Health Insurance service Ilsan Hospital (NHISIH) in South Korea from January 2019 to December 2021. These patients’ preventable deaths were analyzed by an expert panel review considering the implementation of the Trauma Team in April 2020. @*Results@#All deaths were attributable to blunt trauma with an average Injury Severity Score of 26.0 ± 19.2, Revised Trauma Score of 5.05 ± 3.20 and Trauma and Injury Score of 56.6 ± 41.3. The most frequent cause of death was traumatic brain injury followed by respiratory arrest. The most frequent error was delayed transfusion followed by delayed treatment of bleeding. Treatment errors occurred the most in the Emergency Room followed by the Intensive Care Unit. The PTDR of patients before the involvement of a Trauma Team (January 2019 to March 2020) and after the Trauma Team was initiated in April 2020 decreased from 27.27% to 4.27%, respectively (p = 0.021). @*Conclusion@#The introduction of a dedicated Trauma Team in a non-regional trauma center significantly reduced the overall PTDR in trauma patients.

Risk Factors Associated with 30-day Mortality in Patients with Postoperative Acute Kidney Injury Who Underwent Continuous Renal Replacement Therapy in the Intensive Care Unit

Purpose@#To evaluate the risk factors associated with 30-day mortality in patients with postoperative acute kidney injury who underwent continuous renal replacement therapy (CRRT). @*Methods@#Retrospective analysis of the medical charts of patients with postoperative acute kidney injury who underwent CRRT in the intensive care unit between April 2012 and May 2019 was conducted. @*Results@#There were 71 patients whose average age was 64.8 years, and average Acute Physiology and Chronic Health Evaluation 2 score was 26.2. There were 37 patients who had non-trauma emergency surgery, 16 who required trauma surgery, and 18 who had elective major surgery. In most patients, CRRT was started based on Stage 3 Acute Kidney Injury Network criteria, and the mean creatinine level at the time of CRRT initiation (3.62 mg/dL). The median period from surgery to CRRT was 3 days, and the median CRRT application was 4 days. Forty-seven patients died within 30 days of receiving CRRT. Age, elective major surgery, creatinine level on initiation of CRRT, use of norepinephrine upon the initiation of CRRT, and average daily fluid balance/body weight for 3 days following the initiation of CRRT were associated with increasing 30-day mortality in univariate analysis. In multivariate analysis, age, major elective surgery, and norepinephrine use upon initiation of CRRT were identified as independent risk factors for 30-day mortality. @*Conclusion@#Surgical patients who underwent CRRT postoperatively had a poor prognosis. The risk of death in elderly patients who have undergone major elective surgery, or are receiving norepinephrine upon initiation of CRRT should be considered.

Procalcitonin as a Predictive Factor for the Clinical Outcome of Patients with Coronavirus Disease 2019

Purpose@#The coronavirus disease 2019 (COVID-19) pandemic continues. It has been reported that patients with bacterial coinfection have a higher mortality rate than patients without coinfection. However, there are no clear standard guidelines for the use of antibacterial drugs. Therefore, the purpose of this study was to determine the usefulness of procalcitonin, a specific indicator of bacterial infection, as a biomarker for predicting death in COVID-19 patients. @*Methods@#This was a retrospective study of confirmed COVID-19 patients (N = 283) between December 2020 and February 2021 who survived or died. Logistic regression analysis was performed to determine whether there was an association between the level of procalcitonin and death. In addition, receiver operating characteristic curve analysis was performed to determine the usefulness of procalcitonin as a predictor of death. @*Results@#In the non-survivor group, age, the number of patients transferred from a health care center, segment neutrophil ratio, C reactive protein, ferritin, and procalcitonin were significantly higher in the survivor group. In multivariate analysis, procalcitonin was identified as an independent factor associated with death (hazard ratio 6.162, confidential interval 2.285-26.322, p = 0.014). In addition, the predictive power of procalcitonin level and mortality was statistically significant using receiver operating characteristic curve analysis which gave an area under the curve value of 0.823, a cut-off value of 0.05, a sensitivity of 72.2%, a specificity of 87.5% (p < 0.001). @*Conclusion@#Measurement of procalcitonin and other biomarkers may be useful to determine whether to use or discontinue use of antibacterial drugs in patients with COVID-19.

Relationship between Stress-Coping and Personality in Patients with Bipolar and Depressive Disorders / 우울ㆍ조울병

Background@#Personality might be one of the important factors related to stress-coping in mood disorders. This study aimed to investigate the relationship between personality and stress-coping strategies in patients with bipolar and depressive disorders. @*Methods@#A total of 195 patients diagnosed with bipolar and depressive disorders according to the criteria mentioned in Diagnostic and Statistical Manual of Mental disorders’ 5th edition were included. Pearson’s correlation and multiple regression analyses were used to analyze the relationship between personality, measured by Temperament and Character Inventory and NEO-Five Factor Inventory, and coping strategies, measured by Coping Inventory for Stressful Situations. @*Results@#Self-directedness was reported to be positively associated with task-oriented coping in bipolar disorders, and harm avoidance was negatively associated with task-oriented coping in depressive disorders. Beck Depression Inventory score, neuroticism, and extroversion were found to be positively associated with emotion-oriented coping in bipolar disorders, and neuroticism was positively associated with emotion-oriented coping in depressive disorders. Extroversion was reported to be positively associated with avoidance-oriented coping in bipolar disorders, and extroversion, novelty seeking, and reward dependence were positively associated with avoidance-oriented coping in depressive disorders. @*Conclusion@#This study concluded that the relationship between personality and stress-coping strategies may vary based on the type of mood disorder that is diagnosed. The interaction between personality and stress-coping might be considered for the modification of coping strategies in mood disorders.

Psychometric Properties of Behavioral Checklist for Coping with Stress in Patients with Mood Disorders

Objective@#Even though the importance of stress-coping, there is no reliable and valid scale to measure the stress-coping behavior yet. The purpose of this study is to explore the psychometric properties of Behavioral Checklist for Coping with Stress (BCCS). @*Methods@#A total of 458 subjects including healthy subjects and patients with bipolar or depressive disorders were analyzed. The reliability and validity of BCCS were examined by Chronbach’s alpha and exploratory factor analysis using Principal Component Analysis. In order to evaluate criterion-related validity, the Pearson’s correlation analyses between factors of BCCS and relevant scales were performed. @*Results@#BCCS showed good Chronobach’s alpha (0.695–0.833) and had acceptable validity. Factor 1 and factor 4 of BCCS were negatively correlated with depression, anxiety and positivity correlated with task and problem-solving, avoidance, tension-releasing copings in common. Factor 2 and 3 were positively correlated with impulsivity, emotionality, avoidance, behavioral and verbal aggression and tension-releasing copings in common. Different from factor 2, factor 3 was positively correlated with depression, anxiety and anger-suppression. @*Conclusion@#The results of this study suggest that this BCCS might be a reliable and valid scale for measuring stress-coping behaviors. This scale could facilitate research to investigate clinical implications related to behavioral stress-coping.

A Family-Based Association Analysis of Activity-Dependent Neuroprotective Protein-2(ADNP2) Gene in a Korean Population with Schizophrenia : A Pilot Study / 생물치료정신의학

Objectives@#：It is found that imbalance in activity-dependent neuroprotective protein(ADNP) and the homologous protein ADNP2 in schizophrenia may impact the disease progression. Yet, further research is required to clarify their connection to schizophrenia. This is a pilot study for a family-based association analysis of ADNP2 gene in a Korean population with schizophrenia. @*Methods@#：Twenty-seven probands with schizophrenia were recruited with their parents and siblings. We have used lifetime dimensions of psychosis scale for measuring psychotic features. Promising endophenotypic markers such as age at interview, apparent onset, apparent onset of psychosis, and first treatment age were also included. We analyzed 2 single nucleotide polymorphisms (SNPs) of ADNP gene. Then, we performed family based association test(FBAT) and linkage disequilibrium analyses for each individual SNPs. @*Results@#：A significant SNP of ADNP2 gene in chromosome 18 (p-value<0.05) for the qualitative phenotype of schizophrenia was found (rs575682; ADNP2). The result was replicated for the quantitative phenotype of apparent onset, apparent onset of psychosis, and the first treatment age. We also found one significant SNP of ADNP2 gene in chromosome 18 (p-value<0.05) for the quantitative phenotype of any delusions. (rs575682; ADNP2) No SNPs were found for the quantitative phenotype of any hallucinations. @*Conclusion@#：Our results showed that quantitative traits such as age of onset, any delusions, and any hallucinations could be continuous with qualitative trait in schizophrenia. However, a caution must be taken in interpreting these results because there were clear limitations in FBAT analyses which included nominal number of SNPs in the small incomplete pedigrees.

Effect of Fetal Sex Hormone on the Development of Alzheimer’s Disease in Woman:A Cross-Sectional Study Using 2D/4D Digit Length Ratio

Objective@#The purpose of this study is to investigate an association between sex-hormone exposure during fetal period and the development of Alzheimer’s disease (AD). @*Methods@#Twenty four AD patients and 25 normal controls were included from Memory Impairment Clinic of Pusan National University Hospital in Korea. Subjects are measured the ratio of the length of the second to the fourth digit (2D/4D) to estimate fetal sex-hormone exposure. Analysis of covariance was used to investigate an association between fetal sex-hormone exposure and the development of AD after adjusting age, education level, Korean Mini-Mental Status Examination and head circumference. @*Results@#We found that the females with AD had significantly lower 2D/4D ratios than the female controls. In the females withAD, the 2D/4D ratios in the left hand was 0.021 and 0.017 in the right hand compared with the controls. @*Conclusion@#Our findings suggest that the development of AD in female may be related with higher testosterone and lower es-trogen exposure during fetal period.

Decreased Hippocampal Metabolism in Amnestic Mild Cognitive Impairment: Positron Emission Tomography Study

Objective@#Little is known about factors influencing of hippocampal metabolism (HM) in mild cognitive impairment (MCI). Our objective was to determine whether HM in patients with amnestic MCI (aMCI) is decreased than non-amnestic MCI (naMCI). @*Methods@#Overall, 32 MCI patients underwent 18F-fluorodeoxyglucose-positron emission tomography. They were characterized as aMCI (n=18) or naMCI (n=14) according to comprehensive neuropsychological criteria. Analysis of variances were used to assess differences on HM between aMCI and naMCI after controlling age, sex, education and Korean version of Mini Mental Status Examination. @*Results@#We found that HM was more decreased in aMCI than naMCI. This result was not changed after controlling hippocampal volume. @*Conclusion@#Our findings suggest that aMCI is associated with decreased HM in MCI.

Investigation of Maternal Effects, Maternal-Fetal Interactions, and Parent-of-Origin Effects (Imprinting) for Candidate Genes Positioned on Chromosome 18q21, in Probands with Schizophrenia and their First-Degree Relatives

OBJECTIVE: A popular design for the investigation of such effects, including effects of parent-of-origin (imprinting), maternal genotype, and maternal-fetal genotype interactions, is to collect deoxyribonucleic acid (DNA) from affected offspring and their mothers and to compare with an appropriate control sample. We investigate the effects of estimation of maternal, imprinting and interaction effects using multimodal modeling using parents and their offspring with schizophrenia in Korean population. METHODS: We have recruited 27 probands (with schizophrenia) with their parents and siblings whenever possible. We analyzed 20 SNPs of 7 neuronal genes in chromosome 18. We used EMIM analysis program for the estimation of maternal, imprinting and interaction effects using multimodal modeling. RESULTS: Of analyzed 20 single nucleotide polymorphisms (SNPs), significant SNP (rs 2276186) was suggested in EMIM analysis for child genetics effects (p=0.0225438044) and child genetic effects allowing for maternal genetic effects (p=0.0209453210) with very stringent multiple comparison Bonferroni correction. CONCLUSION: Our results are the pilot study for epigenetic study in mental disorder and help to understanding and use of EMIM statistical genetics analysis program with many limitations including small pedigree numbers.

Effect of Amyloid Deposition in PET on Hippocampal Metabolism in Amnestic-Mild Cognitive Impairment : Pilot Study / 생물치료정신의학

OBJECTIVES: Most studies of hippocampal metabolism(HM) in amnestic mild cognitive impairment(aMCI) gave inconsistent results. Our objective was to evaluate the effect of amyloid-beta(Aβ) status on hippocampal metabolism in aMCI.METHODS: Overall, 23 aMCI underwent three-dimensional magnetic resonance imaging(MRI), ¹⁸F-fluorodeoxyglucose-positron emission tomography(¹⁸FDG-PET) and ¹⁸F-Fluorbetaben amyloid positron emission tomography (amyloid-PET). According to Aβ status on amyloid PET, 23 aMCI were classified as either Aβ+aMCI(N=13) or Aβ−aMCI(N=10). The primary outcome was HM using ¹⁸FDG-PET and we investigate the difference on HM between Aβ+aMCI and Aβ−aMCI using analysis of variance(ANOVA) model, after controlling hippocampal volume.RESULTS: We found that HM was more decreased in Aβ+aMCI than Aβ−aMCI. This result was not changed after controlling hippocampal volume.CONCLUSION: Our findings suggest that Aβ+ is associated with decreased HM, regardless of hippocampal volume, in aMCI.

Hippocampal Atrophy and Psychotic Symptoms in Patients with Alzheimer's Disease / 신경정신의학

OBJECTIVES: This study examined the difference in the volume or thickness of the medial temporal lobe between Alzheimer's disease patients with psychosis (AD+P) and those without psychosis (AD−P). METHODS: Overall, 31 AD+P patients and 29 AD−P patients were included from the Memory impairment clinics of Pusan National University Hospital in Korea. AD+P was diagnosed according to Jeste and Finkel's proposed diagnostic criteria for psychosis of Alzheimer's disease. AD−P included AD patients with no psychotic symptoms during a 5-year follow-up period. Medial temporal volume or thickness was measured by 3-tesla MRI and freesufer analysis. Analysis of variance was used to examine the difference in the volume or thickness of medial temporal lobe between AP+P and AD−P after controlling for age, gender, education years, Clinical Dementia Rating scale-Sum of Box, and total intracranial volume. RESULTS: The hippocampal volume in AD+P was smaller than that in AD−P. CONCLUSION: These findings suggest that AD+P is associated with a reduced hippocampal volume.

Heritability and Familiality of MMPI Personality Dimensions in the Korean Families with Schizophrenia

OBJECTIVE: Categorical syndrome such as schizophrenia could be the complex of many continuous mental structure phenotypes including several personality development/degeneration dimensions. This is the study to search heritability and familiality of MMPI personality dimensions in the Korean schizophrenic LD (Linkage Disequilibrium) families. METHODS: We have recruited 204 probands (with schizophrenia) with their parents and siblings whenever possible. We have used MMPI questionnaires for measuring personality and symptomatic dimensions. Heritabilities of personality dimensions in total 543 family members were estimated using Sequential Oligogenic Linkage Analysis Routines (SOLAR). Personality dimensions in total family members were compared with those in 307 healthy unrelated controls for measuring the familialities using ANOVA analysis. RESULTS: Seven of the 10 MMPI variables were significantly heritable and were included in the subsequent analyses. The three groups (control, unaffected 1st degree relative, case) were found to be significantly different with the expected order of average group scores for all heritable dimensions. CONCLUSION: Our results show that the aberrations in several personality dimensions could form the complexity of schizophrenic syndrome as a result of genetic-environment coactions or interactions in spite of some limitations (recruited family, phenotyping).

Association of Temporal Lobe Atrophy and Psychosis in Patients with Alzheimer's Disease

OBJECTIVE: The purpose of this study is to investigate the difference on regional volume in temporal lobe between Alzheimer's disease patients with psychosis (AD+P) and Alzheimer's disease patients without psychosis (AD-P). METHODS: Altogether, 24 AD+P and 25 AD-P matched age, gender, and clinical dementia rating sum of box (CDR-SOB) were include from a Memory impairment clinics of Pusan National University Hospital in Korea. AD+P were diagnosed according to Jeste and Finkel's proposed diagnostic criteria for psychosis of Alzheimer's disease. Grey matter volume of temporal lobe was measured with 3-tesla magnetic resonance imaging and freesufer analysis. Analysis of variance was used to investigate the association between temporal lobe and AD+P after controlling age, gender, education years, CDR-SOB and total intracranial volume. RESULTS: We found an association between AD+P and reduced grey matter volume in total temporal lobe as well as in specific temporal regions such as left middle temporal lobe, left inferior temporal lobe, both hippocampus and both fusiform. CONCLUSION: Our findings suggest that AD+P are associated with reduced grey matter volume of temporal lobe.

Reduced Cortical Thickness in Patients with Late Life Depression without Cerebral Vascular Disease

OBJECTIVES: The aim of this study is to compare cortical thickness in late life major depression patients without cerebral vascular disease (CVD) with that of non-depressed normal comparison subjects using magnetic resonance imaging (MRI). METHODS: Altogether, 47 subjects were finally recruited from the Memory impairment clinics of Pusan National University Hospital in Korea. All subjects (late life major depression patients without CVD : n=21, matched non-depressed normal comparison subjects : n=26) underwent 3-tesla MRI. RESULTS: Late life major depression patients without CVD showed reduced cortical thickness in left precuneus, left inferior temporal gyrus, and left cuneus compared with non-depressed normal comparison subjects. CONCLUSION: Our findings suggest that late life major depression without CVD is associated with reduced cortical thickness.

Comparison of Short Fusion versus Long Fusion for Degenerative Lumbar Scoliosis / 대한정형외과학회잡지

PURPOSE: To compare the results of short fusion versus long fusion for degenerative lumbar scoliosis. MATERIALS AND METHODS: Forty-seven patients undergoing short fusion (n=28) and long fusion and instrumentation (n=19) were evaluated. Short fusion was defined as fusion within the deformity, not exceeding the upper end vertebra. Long fusion was defined as fusion extended above the upper end vertebra. The number of levels fused in the short and long fusion groups was 3.14 and 6.89 segments, respectively. RESULTS: Before surgery, the Cobb angle was 16.3 degrees in the short fusion group and 22 degrees in the long fusion group, which changed to 10.1 degrees and 8.47 degrees, respectively, at the last visit. The correction of coronal imbalance was better in the long fusion group. In contrast, the correction of sagittal imbalance was similar in both groups. The mean estimated blood loss in the short and long fusion groups was 1,671 ml and 2,742 ml, respectively. Early perioperative complications developed frequently in the long fusion group. Adjacent segment disease occurred more frequently in the short fusion group. CONCLUSION: Long fusion and instrumentation for degenerative lumbar scoliosis was better at correcting the coronal deformity and imbalance than short fusion but was ineffective in correcting the sagittal imbalance.