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Objectives@#. Voice abuse in noisy environments can result in voice disorders. However, insufficient studies have sought to differentiate vocal cord lesions through laryngoscopic examinations among workers in noisy environments. This study investigated the relationship between a history of noise exposure in the workplace and benign vocal fold lesions (BVFLs). @*Methods@#. We used Korea National Health and Nutrition Examination Survey data from 2010 to 2012. The chi-square test was used to compare characteristics between two groups according to the presence or absence of BVFLs. To investigate the association between BVFLs and noise exposure in the workplace, we calculated adjusted odds ratios and 95% confidence intervals (CIs) using multiple logistic regression analysis. @*Results@#. In total, 10,170 participants with available laryngoscopy results were enrolled. Smoking history, hypertension, diabetes, and exposure to noise for more than 3 months at the workplace were significantly more common in participants with BVFLs. After adjusting for age, sex, smoking, drinking, obesity, hypertension, diabetes, income, education, and occupation as confounders, we confirmed that BVFLs were 1.52 times more likely (95% CI, 1.157–1.990) to occur in individuals with occupational noise exposure. @*Conclusion@#. Working in a noisy environment could induce BVFLs in workers through voice abuse. Social recognition that a noisy environment is a risk factor for BVFLs needs to be improved, and preventive measures should be implemented.
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The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.
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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.
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BACKGROUND@#Stem cell-based therapies have been developed to treat various types of wounds. Human adiposederived stem cells (hADSCs) are used to treat skin wounds owing to their outstanding angiogenic potential. Although recent studies have suggested that stem cell spheroids may help wound healing, their cell viability and retention rate in the wound area require improvement to enhance their therapeutic efficacy. @*METHODS@#We developed a core–shell structured spheroid with hADSCs in the core and human dermal fibroblasts (hDFs) in the outer part of the spheroid. The core–shell structure was formed by continuous centrifugation and spheroid incubation. After optimizing the method for inducing uniform-sized core–shell spheroids, cell viability, cell proliferation, migration, and therapeutic efficacy were evaluated and compared to those of conventional spheroids. @*RESULTS@#Cell proliferation, migration, and involucrin expression were evaluated in keratinocytes. Tubular assays in human umbilical vein endothelial cells were used to confirm the improved skin regeneration and angiogenic efficacy of core–shell spheroids. Core–shell spheroids exhibited exceptional cell viability under hypoxic cell culture conditions that mimicked the microenvironment of the wound area. @*CONCLUSION@#The improvement in retention rate, survival rate, and angiogenic growth factors secretion from core– shell spheroids may contribute to the increased therapeutic efficacy of stem cell treatment for skin wounds.
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Cell-based therapies have been used as promising treatments for several untreatable diseases. However, cellbased therapies have side effects such as tumorigenesis and immune responses. To overcome these side effects, therapeutic effects of exosomes have been researched as replacements for cell-based therapies. In addition, exosomes reduced the risk that can be induced by cell-based therapies. Exosomes contain biomolecules such as proteins, lipids, and nucleic acids that play an essential role in cell–cell and cell–matrix interactions during biological processes. Since the introduction of exosomes, those have been proven perpetually as one of the most effective and therapeutic methods for incurable diseases. Much research has been conducted to enhance the properties of exosomes, including immune regulation, tissue repair, and regeneration. However, yield rate of exosomes is the critical obstacle that should be overcome for practical cell-free therapy. Three-dimensional (3D) culture methods are introduced as a breakthrough to get higher production yields of exosomes. For example, hanging drop and microwell were well known 3D culture methods and easy to use without invasiveness. However, these methods have limitation in mass production of exosomes. Therefore, a scaffold, spinner flask, and fiber bioreactor were introduced for mass production of exosomes isolated from various cell types. Furthermore, exosomes treatments derived from 3D cultured cells showed enhanced cell proliferation, angiogenesis, and immunosuppressive properties. This review provides therapeutic applications of exosomes using 3D culture methods.
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Background@#Cellular senescence is defined as an irreversible cell cycle arrest caused by various internal and external insults. While the metabolic dysfunction of senescent cells in normal tissue is relatively well-established, there is a lack of information regarding the metabolic features of senescent tumor cells. @*Methods@#Publicly available single-cell RNA-sequencing data from the GSE166555 and GSE178341 datasets were utilized to investigate the metabolic features of senescent tumor cells. To validate the single-cell RNA-sequencing data, we performed senescence-associated β-galactosidase (SA-β-Gal) staining to identify senescent tumor cells in fresh frozen colorectal cancer tissue. We also evaluated nicotinamide adenine dinucleotide dehydrogenase–tetrazolium reductase (NADH-TR) and succinate dehydrogenase (SDH) activity using enzyme histochemical methods and compared the staining with SA-β-Gal staining. MTT assay was performed to reveal the complex 1 activity of the respiratory chain in in-vitro senescence model. @*Results@#Single-cell RNA-sequencing data revealed an upregulation in the activity of complexes 1 and 2 in oxidative phosphorylation, despite overall mitochondrial dysfunction in senescent tumor cells. Both SA-β-Gal and enzyme histochemical staining using fresh frozen colorectal cancer tissues indicated a high correlation between SA-β-Gal positivity and NADH-TR/SDH staining positivity. MTT assay showed that senescent colorectal cancer cells exhibit higher absorbance in 600 nm wavelength. @*Conclusions@#Senescent tumor cells exhibit distinct metabolic features, characterized by upregulation of complexes 1 and 2 in the oxidative phosphorylation pathway. NADH-TR and SDH staining represent efficient methods for detecting senescent tumor cells in colorectal cancer.
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Background and Objectives@#Embryologically, mesodermal development is closely related to the development of various organs such as muscles, blood vessels, and hearts, which are the main organs that make up the body. However, treatment for mesoderm developmental disorders caused by congenital or acquired factors has so far relied on surgery and drug treatment for symptom relief, and more fundamentally, treatment for mesoderm developmental disorders is needed. @*Methods@#and Results: In our study, microRNA (miRNA), which plays an important role in the mesoderm development process, was identified and the developmental function was evaluated. miRNAs consist of small nucleotides, which act as transcription factors that bind to the 3’ untranslated region and suppressed target gene expression. We constructed the human embryonic stem cell (hESC) knockout cell line and analyzed the function and characteristics of miR-5739, which plays an important role in mesoderm lineage. miR-5739 acts as a transcription factor targeting SMA, Brachyury T, Hand1, which controls muscle proliferation and differentiation, and KDR gene, which regulates vessel formation in vitro. In vivo results suggest a role in regulating muscle proliferation and differentiation. Gene ontology analysis confirmed that the miR-5739 is closely related to genes that regulate muscle and vessel proliferation and differentiation. Importantly, abnormal expression of miR-5739 was detected in somatic cells derived from patients with congenital muscle disease. @*Conclusions@#Our study demonstrate that miR-5739 gene function significantly affects transcriptional circuits that regu-late muscle and vascular differentiation during embryonic development.
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Background and Objectives@#Sialendoscopy is useful for the diagnosis and treatment of obstructive salivary gland diseases, but not yet universally employed because it requires dedicate, expensive, and fragile endoscopic equipment; moreover, the surgical technique is also delicate. Here, we describe our initial experience of sialendoscopy, as well as the learning curve, precautions, and drawbacks that beginners must overcome in employing sialendoscopy.Subjects and Method The medical records of 98 patients who underwent sialendoscopic procedures at Eunpyeong St. Mary’s Hospital from May 2019 to March 2022 were retrospectively reviewed. The type of procedure, success rate, operation time, and complications were analyzed. @*Results@#We have performed a total of 85 sialendoscopic procedures, including 79 to treat submandibular sialolithiasis, two to treat submandibular ductal stenosis, two to treat parotid sialolithiasis, and two to treat parotid ductal stenosis. Of the total of 81 patients with sialolithiasis, 82.4% were treated by sialendoscopy only, 15.3% by hybrid procedure, and 2.3% opted to preserve the salivary gland and convert to external submandibular gland excision. Four patients with ductal stenosis were treated via endoscopic bougination; stents were placed for 4 weeks without any restenosis. The operation time was significantly shorter for the second half than for the first half of the patients (58.6 min vs. 39.8 min). Longer operation time was associated with the parotid gland diseases, larger stones (>5 mm in diameter), more proximal stones (from the salivary gland), and multiple stones. We encountered no major surgical complications. @*Conclusion@#Sialendoscopy is useful and safe; even beginners can evaluate and manage obstructive salivary gland diseases.
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Objective@#The purpose of this study was to compare the physical work intensity of emergency medicine (EM) and non-EM residents during a 24-hour work duty cycle using a smartwatch. @*Methods@#This study was conducted for a month from 7 May to 4 June 2021. A total of 27 residents submitted their consent to be recruited as subjects for the study. We distributed a smartwatch to each of the participants and measured their physical work intensity. Twenty non-EM residents wore a smartwatch for a week. Also, seven EM residents wore a watch during the time they were on 24-hour duty for the whole research period. After finishing their 24-hour duty, participants took off the smartwatch and stopped recording their physical activities. Sixty-five samples were matched for comparison between the non-EM and EM residents. Each of the samples comprised a pair of 24-hour records of EM and non-EM residents. The data were matched to ensure the same date and grade and thus control the variables. @*Results@#The results of this study showed that the maximum heart rate of the EM residents was 129.7±3.8 beats/min, which was higher than that of the non-EM residents. A comparison of the sleep hours during the 24-hour duty showed that the average sleep time of the EM residents was 156.9±84.8 minutes, which was significantly lower than that of the non-EM residents. However, calorie consumption, moving distance, and step count during the 24-hour duty cycle showed no significant difference between the EM and non-EM residents. @*Conclusion@#The maximum heart rate was higher among EM residents during their 24-hour work duty compared to the non-EM residents. In addition, the sleep time of the EM residents was significantly lower than that of the non-EM residents.
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Orthognathic surgery is the primary treatment option for severe skeletal discrepancy. However, orthodontic camouflage should be considered as an alternative treatment option, considering the risks of surgery. A 19.5-yearold man presented with a severe prognathic mandible with a Class III molar relationship and an anterior crossbite. Orthognathic surgery could be considered because of his severe skeletal discrepancy and mandibular prognathism. However, the anesthetist for orthognathic surgery did not recommend surgery under general anesthesia because of risk factors associated with the patient’s aplastic anemia, including bleeding and infections. Thus, a camouflage treatment to promote backward rotation of the mandible via orthodontic extrusion of the posterior teeth was planned. An anterior bite plate, intermaxillary elastics, and fixed orthodontic appliances were used to extrude the posterior teeth and to align the dentition. After 17 months of nonsurgical orthodontic treatment, normal occlusion was achieved, and the facial profile was dramatically improved. This case report describes the dentoskeletal and soft-tissue effects of mandibular rotation and its long-term stability.
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Anhydrous ammonia is a commonly used chemical in industry. Ammonia gas inhalation causes thermal injuries and alkali burns in the airway and lung parenchyma. Previous case reports have stated that respiratory sequelae after acute ammonia inhalation burns were associated with structural lung disease, such as bronchiectasis or interstitial lung disease. We herein report two cases of long-term sequelae with persistent airflow limitation after ammonia inhalation burns.
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Purpose@#To report a case of metastatic breast cancer to the optic nerve with a favorable response to an increased dose of intravitreal bevacizumab injection.Case summary: A 60-year-old female presented to our clinic with blurred vision in her left eye for 3 weeks. The patient had a history of intraductal breast cancer carcinoma, metastasized to the mediastinum lymph nodes, liver, and bone and had received palliative chemotherapy and radiotherapy for 16 months. At her first presentation, best-corrected visual acuity of the left eye was 20/50 and the intraocular pressure was 11 mmHg. A yellowish elevated mass with hemorrhage at the optic disc with peripapillary swelling was observed in the left eye. Fluid at the subperipapillary and subfoveal areas and choroidal thickening with folds were observed with optic coherence tomography. The patient was diagnosed as having breast cancer metastasis to the optic nerve head. Three monthly intravitreal bevacizumab injections (0.05 mL, 1.25 mg) were administered, but showed limited effect. Two more intravitreal bevacizumab injections having twice the concentration of the previous dose (0.1 mL, 2.50 mg) were given. Tumor infiltration of the optic nerve head decreased, and serous retinal detachment subsided. No malignant cancer cells were detected in the anterior chamber. @*Conclusions@#We report a rare case of breast cancer metastasis to the optic nerve. Administering intravitreal bevacizumab injections with twice the dosage concentration could be an alternative treatment option, to alleviate exudative retinal detachment associated with metastatic tumor progression to the optic nerve head.
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Objective@#This study evaluates the general clinico-toxicological characteristics, and determines whether they are varied with toxin source, in patients admitted to the hospital and diagnosed with grayanotoxin (GTX)/mad honey poisoning. @*Methods@#Patients diagnosed with GTX/mad honey poisoning at the University Teaching Hospital emergency department between January 2001 and December 2015 were included in this retrospective study. The clinico-toxicological characteristics were compared by classifying patients into two groups, according to the toxin source: group A, poisoned by the Himalayan mad honey, and group B, poisoned by biologic materials containing GTX other than Himalayan mad honey. @*Results@#Totally, 26 patients were identified with symptomatic grayanotoxin/mad honey poisoning. There were no statistical differences in the clinico-toxicological characteristics, except systolic blood pressure (SBP). At presentation, the SBP was significantly decreased in group B (P=0.013). Although dizziness and blurred vision were statistically not significant symptoms, there was a trend of significance (P<0.1) in group B. Notably, 5 of the 8 patients who consumed Rhododendron brachycarpum complained of blurred vision, and had a relatively low mean SBP (68.6±15.6 mmHg). @*Conclusion@#The general clinico-toxicological characteristics were similar, subsequent to ingestion of Himalayan mad honey and Rhododendron species. However, since blurred vision and hemodynamic instability were relatively more common in poisoning by R. brachycarpum than other Rhododendron species, emergency physicians need to be aware that the symptoms or severity of poisoning may vary according to the Rhododendron species ingested.
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Purpose@#To evaluate the therapeutic efficacy and safety of intravitreal dexamethasone implant in non-infectious uveitis (divided into anterior, intermediate, posterior, and panuveitis types). @*Methods@#The medical records of patients who received intravitreal dexamethasone implants between June 2013 and January 2018 at a tertiary referral hospital were analyzed retrospectively. @*Results@#A total of 38 eyes of 36 patients were included. All patients were diagnosed with non-infectious uveitis and received intravitreal dexamethasone implants. The mean age was 55.6 years, and 18 (50.0%) patients were male. In total, 6 (15.8%) eyes were diagnosed with anterior uveitis, 5 (13.2%) with intermediate uveitis, 16 (42.1%) with posterior uveitis, and 11 (28.9%) with panuveitis. Patients with all types of uveitis showed significant improvement in clinical outcomes after intravitreal dexamethasone implant. Three eyes showed increased intraocular pressure, while four showed cataract progression and thus received cataract extraction after injection. Seventeen (44.7%) eyes relapsed an average of 1.18 ± 0.39 times and received additional treatments. @*Conclusions@#Non-infectious uveitis patients showed significant improvement in clinical outcomes after intravitreal dexamethasone implant injection. However, care is required during injection due to the risk of recurrence, as well as side effects such as increased intraocular pressure and cataract progression.
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Objective@#This study evaluates the general clinico-toxicological characteristics, and determines whether they are varied with toxin source, in patients admitted to the hospital and diagnosed with grayanotoxin (GTX)/mad honey poisoning. @*Methods@#Patients diagnosed with GTX/mad honey poisoning at the University Teaching Hospital emergency department between January 2001 and December 2015 were included in this retrospective study. The clinico-toxicological characteristics were compared by classifying patients into two groups, according to the toxin source: group A, poisoned by the Himalayan mad honey, and group B, poisoned by biologic materials containing GTX other than Himalayan mad honey. @*Results@#Totally, 26 patients were identified with symptomatic grayanotoxin/mad honey poisoning. There were no statistical differences in the clinico-toxicological characteristics, except systolic blood pressure (SBP). At presentation, the SBP was significantly decreased in group B (P=0.013). Although dizziness and blurred vision were statistically not significant symptoms, there was a trend of significance (P<0.1) in group B. Notably, 5 of the 8 patients who consumed Rhododendron brachycarpum complained of blurred vision, and had a relatively low mean SBP (68.6±15.6 mmHg). @*Conclusion@#The general clinico-toxicological characteristics were similar, subsequent to ingestion of Himalayan mad honey and Rhododendron species. However, since blurred vision and hemodynamic instability were relatively more common in poisoning by R. brachycarpum than other Rhododendron species, emergency physicians need to be aware that the symptoms or severity of poisoning may vary according to the Rhododendron species ingested.
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Purpose@#To evaluate the therapeutic efficacy and safety of intravitreal dexamethasone implant in non-infectious uveitis (divided into anterior, intermediate, posterior, and panuveitis types). @*Methods@#The medical records of patients who received intravitreal dexamethasone implants between June 2013 and January 2018 at a tertiary referral hospital were analyzed retrospectively. @*Results@#A total of 38 eyes of 36 patients were included. All patients were diagnosed with non-infectious uveitis and received intravitreal dexamethasone implants. The mean age was 55.6 years, and 18 (50.0%) patients were male. In total, 6 (15.8%) eyes were diagnosed with anterior uveitis, 5 (13.2%) with intermediate uveitis, 16 (42.1%) with posterior uveitis, and 11 (28.9%) with panuveitis. Patients with all types of uveitis showed significant improvement in clinical outcomes after intravitreal dexamethasone implant. Three eyes showed increased intraocular pressure, while four showed cataract progression and thus received cataract extraction after injection. Seventeen (44.7%) eyes relapsed an average of 1.18 ± 0.39 times and received additional treatments. @*Conclusions@#Non-infectious uveitis patients showed significant improvement in clinical outcomes after intravitreal dexamethasone implant injection. However, care is required during injection due to the risk of recurrence, as well as side effects such as increased intraocular pressure and cataract progression.
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We sought to analyze the efficacy of adalimumab in active noninfectious uveitis, and evaluate its efficacy and safety for the management of refractory noninfectious uveitis in Korean patients. A retrospective observational study was conducted. A total of 23 eyes of 14 Korean patients with noninfectious uveitis refractory to conventional treatment, including corticosteroid and immunosuppressive agents, were treated with adalimumab between December 2017 and February 2020. The primary outcomes were vitreous haziness grades, anterior chamber cell grades, and central macular thickness measured prior to injection and at 1, 3, 6, and 12 months after the first adalimumab injection. Among the 23 eyes, 14 eyes (60.9%) were diagnosed with panuveitis and 9 eyes (39.1%) with posterior uveitis [mean follow-up period: 22.3 months (7–27)]. The most common etiologic diagnoses requiring adalimumab injection were Behçet's disease (9 eyes, 39.1%), followed by undifferentiated inflammation (6 eyes, 26.1%), Vogt-Koyanagi-Harada disease (3 eyes, 13.0%), psoriasis (2 eyes, 8.7%), serpiginous chorioretinopathy (2 eyes, 8.7%), and systemic lupus erythematosus (1 eye, 4.3%). At the 1-year follow-up after the first injection, anterior chamber cell grade decreased from 0.5±0.4 to 0.3±0.4, and vitreous haziness grade decreased from 1.1±1.1 to 0.3±0.5 (p<0.05). Central macular thickness improved from 347.2±98.1 µm to 264.3±61.1 µm (p<0.05). Adalimumab injection in patients with refractory noninfectious uveitis decreased the anterior chamber cell grade, vitreous haziness grade, and central macular thickness with no severe side effect. Overall, adalimumab injection may, therefore, be an effective and relatively safe treatment modality for noninfectious uveitis in Korean patients.
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Background@#Intrapleural urokinase is one of the most widely used fibrinolytic agents in the treatment of complicated parapneumonic effusion (CPPE). However, little research has been performed on the optimal urokinase dosage. The aim of this study was to evaluate the treatment efficacy of half dose urokinase compared with conventional dose urokinase. @*Methods@#We retrospectively enrolled 92 patients with CPPE or empyema who underwent intrapleural urokinase treatment at two tertiary hospitals. Patients received antibiotics, chest tube drainage, and other treatments as part of routine care. The primary outcome was the treatment success rate in the half dose urokinase group (50,000 IU daily for maximal 6 days) and the conventional dose urokinase group (100,000 IU daily). Treatment success was defined as clinical and radiological improvements without surgical treatment or re-admission within one month. @*Results@#Forty-four patients received half dose urokinase, whereas 48 patients were treated with conventional dose urokinase. Both groups were relatively well matched at baseline, excluding higher serum white blood cell count and higher empyema prevalence in the half dose urokinase group. The treatment success rate was not different between the two groups (p=0.048). There were no differences in the rate of in-hospital death and surgical treatment, hospitalization duration, and indwelling catheter duration. In the multivariate analysis, urokinase dose was not a predictor of treatment success. @*Conclusion@#Half dose intrapleural urokinase is equally effective conventional dose urokinase in treating patients with CPPE or empyema.
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Background@#A rapid response system (RRS) contributes to the safety of hospitalized patients. Clinical deterioration may occur in the general ward (GW) or in non-GW locations such as radiology or dialysis units. However, there are few studies regarding RRS activation in non-GW locations. This study aimed to compare the clinical characteristics and outcomes of patients with RRS activation in non-GW locations and in the GW. @*Methods@#From January 2016 to December 2017, all patients requiring RRS activation in nine South Korean hospitals were retrospectively enrolled and classified according to RRS activation location: GW vs non-GW RRS activations. @*Results@#In total, 12,793 patients were enrolled; 222 (1.7%) were non-GW RRS activations.There were more instances of shock (11.6% vs. 18.5%) and cardiac arrest (2.7% vs. 22.5%) in non-GW RRS activation patients. These patients also had a lower oxygen saturation (92.6% ± 8.6% vs. 88.7% ± 14.3%, P < 0.001) and a higher National Early Warning Score 2 (7.5 ± 3.4 vs. 8.9 ± 3.8,P < 0.001) than GW RRS activation patients. Although non-GW RRS activation patients received more intubation (odds ratio [OR], 3.135; P < 0.001), advanced cardiovascular life support (OR, 3.912; P < 0.001), and intensive care unit transfer (OR, 2.502;P < 0.001), their hospital mortality (hazard ratio, 0.630; P = 0.013) was lower than GW RRS activation patients upon multivariate analysis. @*Conclusion@#Considering that there were more critically ill but recoverable cases in non-GW locations, active RRS involvement should be required in such locations.
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Background@#Sputum Gram stains and cultures are standard tests for thediagnosis of lower respiratory tract infections. Analysis reports of the sputumquality are scarce in relation to cultures as well as clinical diagnosis. @*Methods@#A total of 1,523 sputum specimens, requested for culture, wereevaluated for their quality using the modified Murray–Washington (MW)grouping system in association with the culture results. The clinical diagnosiswas investigated for the culture positive cases. @*Results@#There was a significant difference in bacterial growth (odds ratio,2.01; P =0.0164) and diagnosis of pneumonia (odds ratio, 4.18; P =0.002)between the acceptable groups (groups 4–5) and the unacceptable groups(groups 1–3). However, one-quarter did not belong to the current MW group.More than half of the sputum cultures were in group 6, with the lowestpositive rate (18.0%). Overall, 10% of the sputum cultures were related to aclinical diagnosis of pneumonia. @*Conclusions@#The MW grouping system should be revised, because onequarterdid not belong to the current group. Further evaluation of group 6will be needed. Improvement of sputum cultures is required to enhance thediagnosis of pneumonia.