Substantial Lipid Increases During Menopausal Transition in Korean Middle-Aged Women

Background@#Adverse lipid profiles are observed in postmenopausal women. However, there is insufficient evidence of the association between lipids and reproductive aging in Korean women. We aimed to characterize lipid changes with respect to timing relative to menopause in Korean middle-aged women. @*Methods@#This study included 1,436 premenopausal women who had a natural menopause during the follow-up period (median = 15.76 years) from the Korean Genome and Epidemiology Study (KoGES) Ansan and Anseong cohort. Lipid levels were measured every 2 years, and the magnitudes of annual lipid changes and differences in the changes by premenopausal body mass index were estimated using piecewise linear mixed-effects models. @*Results@#All lipid levels increased greatly from 3 or 5 years before menopause to 1 year after menopause in all women, regardless of their premenopausal body mass index. During the period, high-density lipoprotein cholesterol (HDL-C) levels increased at 0.42 mg/dL per year (95% confidence interval [CI], 0.29 to 0.55 mg/dL). Nevertheless, non-HDL-C levels simultaneously increased at 3.42 mg/dL per year (95% CI, 3.11 to 3.72 mg/dL), and an annual change in the non-HDL-C to HDL-C ratio was 0.05 (95% CI, 0.04 to 0.06). One year after menopause, changes in all lipid parameters significantly slowed down, except for the nonHDL-C to HDL-C ratio (P < 0.001 for all). The ratio continued to increase until 3 years after menopause, but thereafter, the change leveled off. @*Conclusion@#Women experienced remarkable increases in lipid levels during menopausal transition, highlighting the need for early intervention strategies for cardiovascular disease prevention in women.

Incidence and Risk Factors for Atrial Fibrillation in Korea: the National Health Insurance Service Database (2002-2010)

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is a common arrhythmia that is known as an important independent risk factor for stroke. However, limited information is available on AF in Korea. This study evaluated the incidence of AF, its associated co-morbidities and risk factors for AF in Korea. SUBJECTS AND METHODS: The National Health Insurance Service database between 2002 and 2010 was used in the study. Individuals<30 years old and those diagnosed with AF between 2002 and 2004 were excluded. Hazard ratios (HRs) according to co-morbidities and risk factors for AF were determined using a Cox proportional hazard model. Population attributable fractions (PAFs) of AF risk factors were determined. RESULTS: During a 6-year follow-up period, 3517 (1.7%) developed AF. The incidence rates in men and women aged 30-39 years were 0.82 and 0.55 per 1000 person-years, respectively; the incidence rates further increased with age to 13.09 and 11.54 per 1000 person-years in men and women aged≥80 years, respectively. The risk factors for incident AF were age, sex, body mass index (BMI), hypertension, ischemic heart disease (IHD) and heart failure. After adjusting for variables related to AF, the risk of AF was significantly associated with hypertension (HR 1.667), IHD (HR 1.639), heart failure (HR 1.521), and the PAFs for age, sex, BMI, hypertension, IHD, heart failure and diabetes mellitus were 30.6%, 10.1%, 3.4%, 16.6%, 8.2%, 5.3% and 0.8%, respectively. CONCLUSION: Incidence of AF increased with age and was higher in men than in women. A larger proportion of AF events was attributable to hypertension than to other co-morbidities.

The effects of local anesthetic distribution on symptoms using ultrasound image after stellate ganglion block / 대한마취과학회지

BACKGROUND: The aim of this study is to evaluate the effects of local anesthetic distribution on symptoms using ultrasound image after C6 stellate ganglion block (SGB). METHODS: Twenty-six patients underwent SGB via an anterior paratracheal approach at the sixth cervical level using 6 ml of 1% mepivacaine. We divided the patients into two groups by local anesthetic distribution using ultrasound image after SGB. In the group 'sub', injected local anesthetic was beneath the prevertebral fascia. In the group 'supra', some of injected local anesthetic was above the prevertebral fascia. The occurrence of Horner's syndrome, warm sensation on the face and hand, brachial plexus block, hoarseness, and foreign body sensation in the throat were evaluated. The skin temperature of the bilateral thumbs was measured pre and post SGB. RESULTS: The occurrence of hoarseness and the foreign body sensation in the throat was significantly reduced in the group 'sub' than the group 'supra' (P<0.05). The skin temperature of the ipsilateral thumb significantly increased in both groups compared to the pre SGB values, and the change of the skin temperature significantly increased in the group 'sub' than the group 'supra' (P<0.05). CONCLUSIONS: Subfascial distribution of local anesthetic under ultrasound image after SGB reduces the typical complications. It is more effective in the sympathetic block than suprafascial distribution.

The effects of midazolam and remifentanil on induction of anesthesia and hemodynamics during tracheal intubation under target-controlled infusion of propofol / 대한마취과학회지

BACKGROUND: The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. METHODS: Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. RESULTS: The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P < 0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P < 0.05). CONCLUSIONS: The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol.