Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture

Purpose@#This study compared the clinical and radiological results of the femoral neck system (FNS) and cannulated compression screws (CCS) for the fixation of femoral neck fractures. @*Materials and Methods@#Patients who underwent FNS or CCS internal fixation for femoral neckfractures between January 2016 and January 2022 were analyzed retrospectively. The hip joint function using the Harris hip score (HHS) was evaluated three months and one year after surgery. The operation time, fracture healing time, and associated surgical complications in the two groups were compared and analyzed statistically. @*Results@#Seventy-nine patients were categorized into 38 FNS and 41 CCS groups. The FNS group had a longer operation time and higher postoperative HHS at three months (p<0.01). Femoral neck shortening was lower in the FNS group (p=0.022). There were no significant differences in the fracture healing time and other complications. @*Conclusion@#There were no differences in most clinical outcomes and complications between the two groups except for the three-month HHS and femoral neck shortening. This study suggests that FNS could be an alternative to CCS for treating femoral neck fractures.

Do American Consumers Perceive Corporate Social Responsibility Actions and Exhibit Loyalty Intentions Differently according to the Reputation of Fast Food Restaurants? / 대한지역사회영양학회지

Objectives@#This study investigated the different perceptions of customers toward traditional and non-traditional fast-food restaurants regarding restaurant healthfulness, corporate reputation, and the impact of corporate reputation on loyalty intentions through corporate social responsibility (CSR) motive. @*Methods@#An online survey was conducted on U.S. residents who were aware of fast food restaurants’ CSR activities. Participants selected one fast food restaurant participating in CSR activities, coded as either traditional (n = 117) or non-traditional (n = 48), and answered questions about the selected restaurant’s healthfulness, reputation, CSR motives, and loyalty intentions. The participants’ perceptions of healthfulness and corporate reputation of the two types of fast-food restaurants were compared. A mediation path of corporate reputation – CSR motive – loyalty intention was analyzed. @*Results@#Non-traditional fast-food restaurants (5.02 ± 1.26) were perceived to be more healthful than traditional ones (3.93 ± 1.72). The participants perceived that compared to traditional fastfood restaurants, non-traditional ones had a better overall corporate reputation (P = 0.037), were more concerned about their customers (P = 0.029), better workplaces (P = 0.007), more environmentally and socially responsible (P < 0.001), and offered higher quality products and services (P = 0.042). Significant positive correlations were shown between restaurant healthfulness and corporate reputation (P < 0.001 for all reputation items). The suggested mediation path was supported with 95% CIs excluding zero, implying that when fast-food restaurants had a better reputation overall, were customer oriented, good employers, strong companies with a good product and service quality, social and environmental responsibility, the participants were more likely to perceive their CSR activities to be sincere and were hence loyal to that restaurant. @*Conclusions@#Overall, participants were more favorable towards non-traditional fast-food restaurants which had a healthier image and better reputation than traditional ones. Therefore, fast food restaurants need to consider offering healthy food and enhance their image, which would maximize the return on their investment in CSR.

Do American Consumers Perceive Corporate Social Responsibility Actions and Exhibit Loyalty Intentions Differently according to the Reputation of Fast Food Restaurants? / 대한지역사회영양학회지

Objectives@#This study investigated the different perceptions of customers toward traditional and non-traditional fast-food restaurants regarding restaurant healthfulness, corporate reputation, and the impact of corporate reputation on loyalty intentions through corporate social responsibility (CSR) motive. @*Methods@#An online survey was conducted on U.S. residents who were aware of fast food restaurants’ CSR activities. Participants selected one fast food restaurant participating in CSR activities, coded as either traditional (n = 117) or non-traditional (n = 48), and answered questions about the selected restaurant’s healthfulness, reputation, CSR motives, and loyalty intentions. The participants’ perceptions of healthfulness and corporate reputation of the two types of fast-food restaurants were compared. A mediation path of corporate reputation – CSR motive – loyalty intention was analyzed. @*Results@#Non-traditional fast-food restaurants (5.02 ± 1.26) were perceived to be more healthful than traditional ones (3.93 ± 1.72). The participants perceived that compared to traditional fastfood restaurants, non-traditional ones had a better overall corporate reputation (P = 0.037), were more concerned about their customers (P = 0.029), better workplaces (P = 0.007), more environmentally and socially responsible (P < 0.001), and offered higher quality products and services (P = 0.042). Significant positive correlations were shown between restaurant healthfulness and corporate reputation (P < 0.001 for all reputation items). The suggested mediation path was supported with 95% CIs excluding zero, implying that when fast-food restaurants had a better reputation overall, were customer oriented, good employers, strong companies with a good product and service quality, social and environmental responsibility, the participants were more likely to perceive their CSR activities to be sincere and were hence loyal to that restaurant. @*Conclusions@#Overall, participants were more favorable towards non-traditional fast-food restaurants which had a healthier image and better reputation than traditional ones. Therefore, fast food restaurants need to consider offering healthy food and enhance their image, which would maximize the return on their investment in CSR.

Parents' meal choices for their children at fast food and family restaurants with different menu labeling presentations

BACKGROUND/OBJECTIVES: This study examined the effect of nutrition labeling formats on parents' food choices for their children at different restaurant types. SUBJECTS/METHODS: An online survey was conducted with 1,980 parents of children aged 3–12 years. Participants were randomly assigned to fast food or family restaurant scenarios, and one of four menu stimuli conditions: no labeling, low-calorie symbol (symbol), numeric value (numeric), and both low-calorie symbol and numeric value (symbol + numeric). Participants selected menu items for their children. Menu choices and total calories were compared by nutrition labeling formats in each type of the restaurant. RESULTS: Low-calorie item selections were scored and a two-way analysis of variance (ANOVA) was conducted for an interaction effect between restaurant and labeling type. In the fast food restaurant group, parents presented with low-calorie symbols selected the lowest calorie items more often than those not presented with the format. Parents in the symbol + numeric condition selected significantly fewer calories (653 kcal) than those in the no labeling (677 kcal) or numeric conditions (674 kcal) (P = 0.006). In the family restaurant group, no significant difference were observed among different labeling conditions. A significant interaction between restaurant and labeling type on low-calorie selection score (F = 6.03, P < 0.01) suggests that the effect of nutrition labeling format interplays with restaurant type to jointly affect parents' food choices for their children. CONCLUSIONS: The provision of easily interpretable nutritional information format at fast food restaurants may encourage healthier food choices of parents for their children; however, the effects were negligible at family restaurants.

Elevated Blood Urea Nitrogen/Creatinine Ratio Is Associated with Venous Thromboembolism in Patients with Acute Ischemic Stroke

OBJECTIVE: Although venous thromboembolism (VTE) is frequently related to dehydration, the impact of dehydration on VTE in acute ischemic stroke (AIS) is not clear. This study investigated whether dehydration, as measured by blood urea nitrogen (BUN)/creatinine (Cr) ratio, influences the occurrence of VTE in patients with AIS. METHODS: This is a retrospective study of patients with AIS between January 2012 and December 2013. Patients with newly diagnosed AIS who experienced prolonged hospitalization for at least 4 weeks were included in this study. RESULTS: Of 182 patients included in this study, 17 (9.3%) suffered VTE during the follow-up period; in two cases, VTE was accompanied by deep vein thrombosis and pulmonary embolism. Patients with VTE were more frequently female and had higher National Institutes of Health Stroke Scale (NIHSS) score, more lower limb weakness, and elevated blood urea nitrogen BUN/Cr ratio on admission. In a multivariate analysis, BUN/Cr ratio >15 (odds ratio [OR] 8.75) and severe lower limb weakness (OR 4.38) were independent risk factors for VTE. CONCLUSION: Dehydration on admission in cases of AIS might be a significant independent risk factor for VTE.

Reduction of Midline Shift Following Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. METHODS: We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies. Midline shift was measured preoperatively and postoperatively using computed tomography (CT). Consciousness level was evaluated using the Glasgow Coma Scale on postoperative day 1. Patient survival was assessed six months after stroke onset. RESULTS: The median time interval between preoperative and postoperative CT was 8.3 hours (interquartile range, 6.1–10.2 hours). Reduction in midline shift was associated with higher postoperative Glasgow Coma Scale scores (P<0.05). Forty-three patients (61.4%) were alive at six months after the stroke. Patients with reductions in midline shifts following hemicraniectomy were more likely to be alive at six months post-stroke than those without (P<0.001). Reduction of midline shift was associated with lower mortality at six months after stroke, after adjusting for age, sex, National Institutes of Health Stroke Scale score, and preoperative midline shift (adjusted hazard ratio, 0.71; 95% confidence interval, 0.62–0.81; P<0.001). CONCLUSIONS: Reduction in midline shift following hemicraniectomy was associated with improved consciousness and six-month survival in patients with MMI. Hence, it may be an early indicator of effective decompression following hemicraniectomy.

Extended Use of Hypothermia in Elderly Patients with Malignant Cerebral Edema as an Alternative to Hemicraniectomy / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. METHODS: Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included. Patients who could not receive DHC were treated with TH. Hypothermia was started within 72 hours of symptom onset and was maintained for a minimum of 72 hours with a target temperature of 33°C. Modified Rankin Scale (mRS) scores at 3 months following treatment and complications of TH were used as functional outcomes. RESULTS: Eleven patients with a median age of 76 years and a median National Institutes of Health Stroke Scale score of 18 were treated with TH. The median time from symptom onset to initiation of TH was 30.3±23.0 hours and TH was maintained for a median of 76.7±57.1 hours. Shivering (100%) and electrolyte imbalance (82%) were frequent complications. Two patients died (18%). The mean mRS score 3 months following treatment was 4.9±0.8. CONCLUSIONS: Our results suggest that extended use of hypothermia is safe and feasible for elderly patients with large hemispheric infarctions. Hypothermia may be considered as a therapeutic alternative to DHC in elderly individuals. Further studies are required to validate our findings.

Therapeutic hypothermia for elevated intracranial pressure in traumatic brain injury: does it do more harm than good? / 대한마취과학회지

No abstract available.

The effect of providing nutritional information about fast-food restaurant menus on parents' meal choices for their children

BACKGROUND/OBJECTIVES: To encourage healthier food choices for children in fast-food restaurants, many initiatives have been proposed. This study aimed to examine the effect of disclosing nutritional information on parents' meal choices for their children at fast-food restaurants in South Korea. SUBJECTS/METHODS: An online experimental survey using a menu board was conducted with 242 parents of children aged 2-12 years who dined with them at fast-food restaurants at least once a month. Participants were classified into two groups: the low-calorie group (n = 41) who chose at least one of the lowest calorie meals in each menu category, and the high-calorie group (n = 201) who did not. The attributes including perceived empowerment, use of provided nutritional information, and perceived difficulties were compared between the two groups. RESULTS: The low-calorie group perceived significantly higher empowerment with the nutritional information provided than did the high-calorie group (P = 0.020). Additionally, the low-calorie group was more interested in nutrition labeling (P < 0.001) and considered the nutritional value of menus when selecting restaurants for their children more than did the high-calorie group (P = 0.017). The low-calorie group used the nutritional information provided when choosing meals for their children significantly more than did the high-calorie group (P < 0.001), but the high-calorie group had greater difficulty using the nutritional information provided (P = 0.012). CONCLUSIONS: The results suggest that improving the empowerment of parents using nutritional information could be a strategy for promoting healthier parental food choices for their children at fast-food restaurants.

Critical Care for Patients with Massive Ischemic Stroke / 대한뇌졸중학회지

Malignant cerebral edema following ischemic stroke is life threatening, as it can cause inadequate blood flow and perfusion leading to irreversible tissue hypoxia and metabolic crisis. Increased intracranial pressure and brain shift can cause herniation syndrome and finally brain death. Multiple randomized clinical trials have shown that preemptive decompressive hemicraniectomy effectively reduces mortality and morbidity in patients with malignant middle cerebral artery infarction. Another life-saving decompressive surgery is suboccipital craniectomy for patients with brainstem compression by edematous cerebellar infarction. In addition to decompressive surgery, cerebrospinal fluid drainage by ventriculostomy should be considered for patients with acute hydrocephalus following stroke. Medical treatment begins with sedation, analgesia, and general measures including ventilatory support, head elevation, maintaining a neutral neck position, and avoiding conditions associated with intracranial hypertension. Optimization of cerebral perfusion pressure and reduction of intracranial pressure should always be pursued simultaneously. Osmotherapy with mannitol is the standard treatment for intracranial hypertension, but hypertonic saline is also an effective alternative. Therapeutic hypothermia may also be considered for treatment of brain edema and intracranial hypertension, but its neuroprotective effects have not been demonstrated in stroke. Barbiturate coma therapy has been used to reduce metabolic demand, but has become less popular because of its systemic adverse effects. Furthermore, general medical care is critical because of the complex interactions between the brain and other organ systems. Some challenging aspects of critical care, including ventilator support, sedation and analgesia, and performing neurological examinations in the setting of a minimal stimulation protocol, are addressed in this review.

Perioperative critical care management for patients with aneurysmal subarachnoid hemorrhage / 대한마취과학회지

Despite significant regional and risk factor-related variations, the overall mortality rate in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) remains high. Compared to ischemic stroke, which is typically irreversible, hemorrhagic stroke tends to carry a higher mortality, but patients who do survive have less disability. Technologies to monitor and treat complications of SAH have advanced considerably in recent years, but good long-term functional outcome still depends on prompt diagnosis, early aggressive management, and avoidance of premature withdrawal of support. Endovascular procedures and open craniotomy to secure a ruptured aneurysm represent some of the numerous critical steps required to achieve the best possible result. In this review, we have attempted to provide a contemporary, evidence-based outline of the perioperative critical care management of patients with SAH. This is a challenging and potentially fatal disease with a wide spectrum of severity and complications and an often protracted course. The dynamic nature of this illness, especially in its most severe forms, requires considerable flexibility in clinician management, especially given the panoply of available treatment modalities. Judicious hemodynamic monitoring and adaptive therapy are essential to respond to the fluctuating nature of cerebral vasospasm and the varying oxygen demands of the injured brain that may readily induce acute or delayed cerebral ischemia.

Diet of children under the government-funded meal support program in Korea

The purpose of this study was to investigate the diet of children under the government-funded meal support program. The 143 children (67 boys and 76 girls) participated in this study among 4th-6th elementary school students receiving free lunches during the summer vacation of 2007 and living in Gwanak-gu, Seoul, Korea. The subjects consisted of four groups supported by Meal Box Delivery (n = 26), Institutional Foodservice (n = 53), Restaurant Foodservice (n = 27), or Food Delivery (n = 37). A three-day 24-hour dietary recall and a self-administered survey were conducted. In addition, the children's heights and weights were measured. The average energy intake of the children was 1,400 kcal per day, much lower than the Estimated Energy Requirements of the pertinent age groups. The results also showed inadequate intake of all examined nutrients; of particular concern was the extremely low intake of calcium. On average, the children consumed eight dishes and 25 food items per day. The children supported by Meal Box Delivery consumed more various dishes and food items than the other groups. The percentage of children preferring their current meal support method was the highest in those supported by Meal Box Delivery and the lowest in those supported by Food Delivery. We requested 15 children among the 143 children participating in the survey to draw the scene of their lunch time. The drawings of the children supported by Institutional Foodservice showed more positive scenes than the other groups, especially in terms of human aspects. In conclusion, the overall diet of children under the government-funded meal support program was nutritionally inadequate, although the magnitude of the problems tended to differ by the meal support method. The results could be utilized as basic data for policy and programs regarding the government-funded meal support program for children from low-income families.

Evaluation of Dietary Intake of Korean School-aged Children from Low-income Families by Comparing with the Korean Food Guide: Analysis of the Data from the 2001 National Health and Nutrition Survey

This study was conducted to evaluate the dietary quality of school-aged children from low-income families in comparison with those from higher income families. The socio-demographic and anthropometric data and one day 24-hour recall dietary intake data of 1,782 school-aged children were used for analysis from the data of 2001 National Health and Nutrition Survey. The children whose family had monthly household income 120% or lower than the 2001 Minimum Cost of Living were classified into Low Income Group (LIG), and the others were classified into Higher Income Group (HIG). The consumption levels of the food groups of the Korean Food Guide as well as the general nutritional status based on their weight and height, energy and nutrient intake were compared between LIG and HIG in elementary (n = 989), middle (n = 432), and high (n = 361) school-aged children, respectively. LIG tended to have lower weight, height, and BMI than HIG, but the difference was significant only in the weight and the BMI of the middle school-aged children. The energy intake of LIG didn't differ from that of HIG, but LIG consumed a higher percentage of energy from carbohydrate and a lower percentage of energy from fat than HIG. Some micronutrient intake was lower in LIG than HIG in case of the elementary and the middle school-aged children. The average numbers of servings of milk . dairy products and fruits consumed by LIG were significantly lower than those consumed by HIG in the elementary and the middle school-aged children, and they were less than the respective recommended serving. The average number of servings of meat . fish . egg . beans consumed by LIG was lower than that consumed by HIG in the middle and the high school-aged children, and it was also less than the recommended serving. The results suggested that the diet of children from low-income families should be intervened by strategies different from the other children in order to improve the consumption level of milk.dairy products, fruits, and meat.fish.egg.beans.

Status of Children's Breakfast Skipping and Their Mothers' Needs for Breakfast Service at Child Care Centers / 대한지역사회영양학회지

The purpose of this study was to investigate the status of children's breakfast skipping and their mothers' needs for breakfast service at child care centers. A survey was conducted with mothers of children aged 3 to 5 years and attending child care centers in Gwanak-gu, Seoul. Out of 960 questionnaires distributed to the caregivers at 32 child care centers, 633 were returned (66% response rate), and 449 were analyzed (47% analysis rate) after excluding data from the respondents not meeting the selection criteria for this study: mothers of children aged 3 to 5 years. Over 2/3 (69%) of children ate breakfast every weekday (Breakfast Eaters) and almost 1/3 (31%) of children skipped breakfast one time or more often on weekdays (Breakfast Skippers). The collected data were compared between Breakfast Eaters and Breakfast Skippers. The average Good Dietary Practice Score of Breakfast Skippers was significantly lower than that of Breakfast Eaters, implying poorer dietary habits. A higher percentage of mothers of Breakfast Skippers (62%) responded that breakfast service was 'necessary' or 'very necessary' at child care centers than those of Breakfast Eaters (27%). A multiple logistic regression analysis was conducted to determine factors affecting mothers' needs for breakfast service at child care centers. The result showed that the children's ages, mothers' occupational status, household monthly income, frequencies of eating breakfast on weekdays and satisfaction level with morning snack provided at child care centers affected mothers' needs for breakfast service at child care centers. In particular, mothers who had a full-time job (OR = 2.06) than housewives, mothers whose children did not eat breakfast at al (OR = 3.54), ate 1~2 times (OR = 5.50) or ate 3~4 times (OR = 3.80) on weekdays than those whose children ate breakfast every weekday were more likely to have needs for breakfast service at child care centers than housewives. In conclusion, Breakfast Skippers tended to have poorer dietary habits than Breakfast Eaters and Full-time working mothers had higher needs for breakfast service at child care centers. This study results suggest that child care centers consider serving breakfast to children as the number of working mothers increases.

Protein Expression of Matrix Metalloproteinases of Mouse Reproductive Organs During Estrous Cycle / 대한불임학회지

Protein expression patterns of matrix metalloproteinases (MMPs) were examined in mouse reproductive organs during estrous cycle. Estrous cycle was classified into diestrus, proestrus, estrus or metestus and MMP expression was analyzed by zymography using gelatin as a substrate. Uterine fluid (UF) obtained both at diestrus and proestrus exhibited 4 major MMPs including 106kDa, 64kDa, 62kDa and 59kDa gelatinases. However, in UF at estrus, the gelatinolytic activity of 64kDa MMP disappeared and that of 106kDa and 62kDa MMPs dramatically decreased. At metestrus, 64kDa MMP activity reappeared and 106kDa and 62kDa MMP exhibited increased activities such that the band intensity of 106kDa was comparable to that in UF at diestrus. Gelatinolytic activity of 59kDa MMP was not changed throughout the cycle. Both ovarian and oviductal tissue homogenate revealed 4 MMPs which corresponded to the 4 MMPs of UF. However, unlike UF MMPs, gelatinolytic activity of these MMPs did not show distinct changes throughout the cycle. Either an inhibitor of MMP, 1, 10-phenanthroline, or a metal chelator, EDTA, abolished the appearance of the above MMP activities in gelatinated gel whereas a serine proteinase inhibitor, phenylmethylsulfonyl fluoride, failed to inhibit the appearance of MMP activities, proving that gelatinolytic activity of the above reproductive tissues were due to the enzymatic activity of MMP. When gelatinolytic activity of mouse serum was examined, it revealed 5 MMPs (131kDa, 106kDa, 89kDa, 64kDa and 62kDa bands) and one gelatinase (84kDa) band. From these results, it is concluded that the protein expression of MMPs of mouse reproductive organs, particularly uterus, is temporally regulated during estrous cycle and uterine 106kDa, 64kDa and 62kDa MMP,3 are suggested to play an important role in cyclic tissue remodeling of mouse uterus.