Mortality of Deep Brain Stimulation and Risk Factors in Patients With Parkinson's Disease: A National Cohort Study in Korea

Background@#This study aimed to investigate 1) long-term outcomes of deep brain stimulation (DBS), such as mortality after DBS as well as the causes of death, 2) demographic and socioeconomic factors influencing mortality, and 3) comorbidities affecting mortality after DBS in patients with Parkinson’s disease (PD). @*Methods@#This study analyzed the National Health Insurance Service-National Health Information Database. Data on patients with PD diagnosis codes from 2002 to 2019 were extracted and analyzed. Data on the causes of death were obtained by linking the causes of death to data from Statistics Korea. The Kaplan-Meier method with the log-rank test was used for survival analysis. Multivariate Cox regression analyses were used to estimate hazard ratios (HRs) and their 95% confidence intervals. Regarding comorbidities such as PD dementia and fracture, which did not satisfy the assumption for the proportional HR, timedependent Cox analysis with the Mantel-Byar method was used. @*Results@#From 2005 to 2017, among 156,875 patients diagnosed with PD in Korea, 1,079 patients underwent DBS surgery, and 251 (23.3%) had died by 2019. The most common cause of death (47.1%) was PD. In the multivariate Cox regression analysis, the higher the age at diagnosis and surgery, the higher the mortality rate. The men and medical aid groups had significantly higher mortality rates. PD dementia and fracture were identified as risk factors for mortality. @*Conclusion@#Older age at diagnosis and surgery, being male, the use of medical aid, and the comorbidity of dementia and fractures were associated with a higher risk of mortality after DBS in patients with PD. Neurologists should consider these risk factors in assessing the prognosis of PD patients undergoing DBS.

The association of pancreatic cancer incidence with smoking status and smoking amount in Korean men / 한국역학회지

OBJECTIVES@#Our study examined the dose-response relationship between smoking amounts (pack-years) and the risk of developing pancreatic cancer in Korean men. @*METHODS@#Of 125,743 participants who underwent medical health checkups in 2009, 121,408 were included in the final analysis and observed for the development of pancreatic cancer. We evaluated the associations between smoking amounts and incident pancreatic cancer in 4 groups classified by pack-year amounts. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident pancreatic cancer by comparing groups 2 (40 pack-year smokers) with group 1 (never smokers). @*RESULTS@#During 527,974.5 person-years of follow-up, 245 incident cases of pancreatic cancer developed between 2009 and 2013. The multivariate-adjusted HRs (95% CIs) for incident pancreatic cancer in groups 2, 3, and 4 were 1.05 (0.76 to 1.45), 1.28 (0.91 to 1.80), and 1.57 (1.00 to 2.46), respectively (p for trend=0.025). The HR (95% CI) of former smokers showed a dose-response relationship in the unadjusted model, but did not show a statistically significant association in the multivariate-adjusted model. The HR (95% CI) of current smokers showed a dose-response relationship in both the unadjusted (p for trend=0.020) and multivariate-adjusted models (p for trend=0.050). @*CONCLUSIONS@#The risk of developing pancreatic cancer was higher in current smokers status than in former smokers among Korean men, indicating that smoking cessation may have a protective effect.

Metformin use and cardiovascular outcomes in patients with diabetes and chronic kidney disease: a nationwide cohort study

Background@#Metformin has recently been shown not to increase the risk of lactic acidosis in patients with chronic kidney disease (CKD). Thus, the criteria for metformin use in this population has expanded. However, the relationship between metformin use and clinical outcomes in CKD remains controversial. @*Methods@#This study considered data from 97,713 diabetes patients with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), and the secondary outcomes were all-cause mortality and incident end-stage renal disease (ESRD). @*Results@#Metformin users had a significantly higher risk of MACCE than non-users (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.14–1.26; p < 0.001). However, metformin users had a lower risk of all-cause mortality (HR, 0.78; 95% CI, 0.74–0.81; p < 0.001) and ESRD (HR, 0.44; 95% CI, 0.42–0.47; p < 0.001) during follow-up than non-users did. The relationships between metformin use and clinical outcomes remained consistent in propensity score matching analyses and subgroup analyses of patients with adequate adherence to anti-diabetes medication. @*Conclusion@#Treatment with metformin was associated with an increased risk of MACCE in patients with diabetes and CKD. However, metformin users had a lower risk of all-cause mortality and ESRD during follow-up than non-users did. Therefore, metformin needs to be carefully used in patients with CKD.

The Prediction of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants through Clinical Indicators within 1 Hour of Delivery

Background@#Despite the advances in neonatology, the incidence of bronchopulmonary dysplasia (BPD) is increasing. It is important to prevent the development of BPD in the first place. The online BPD outcome estimator from National Institute of Children Health and Human Development and Neonatal Research Network is available. However, it is not applicable for Asians. Moreover, limits are set for birth weight and gestational weeks excluding those who may still have BPD. The aim of this study was to develop a prediction model for BPD using first hour perinatal and neonatal factors in Korean very low birth weight infants (VLBWIs). @*Methods@#Data were collected for 8,022 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Multiple logistic regression models reanalyzed by stepwise selection with significant clinical indicators for BPD. PROC package was used to calculate the area under curve (AUC) and corresponding 95% confidence intervals. Moreover, it was used to search the best cut-off value. External validation was performed with the 2017 Korean neonatal network (KNN) data. @*Results@#After all missing data were excluded, 4,600 VLBWIs were included in the training dataset of the prediction model. Predictability of presence of BPD was 90.8% and prediction P value cut off was 0.550. Five-minute Apgar score, birth weight, GA, sex, surfactant use were significant indicators. Predictability of severe BPD was 81.5% and prediction P value cut off was 0.160. Five-minute Apgar score, birth weight, maternal PIH, chronic maternal hypertension, GA, sex, respiratory distress syndrome, need of resuscitation at birth were significant indicators. After external validation, sensitivity and specificity did not change significantly. @*Conclusion@#From this study, high predictability was obtained using clinical parameters obtained within one hour of life. P value for prediction of each grade of BPD and equation for calculation was presented. It can be helpful for the early prediction of BPD in Korean VLBWI. This study will contribute to the prediction of BPD in Asians especially Korean VLBWIs, not currently included in the NICHD BPD online BPD predictor. In addition, the predictive power may be continuously increased with the cumulative data of KNN.

The Prediction of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants through Clinical Indicators within 1 Hour of Delivery

Background@#Despite the advances in neonatology, the incidence of bronchopulmonary dysplasia (BPD) is increasing. It is important to prevent the development of BPD in the first place. The online BPD outcome estimator from National Institute of Children Health and Human Development and Neonatal Research Network is available. However, it is not applicable for Asians. Moreover, limits are set for birth weight and gestational weeks excluding those who may still have BPD. The aim of this study was to develop a prediction model for BPD using first hour perinatal and neonatal factors in Korean very low birth weight infants (VLBWIs). @*Methods@#Data were collected for 8,022 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. Multiple logistic regression models reanalyzed by stepwise selection with significant clinical indicators for BPD. PROC package was used to calculate the area under curve (AUC) and corresponding 95% confidence intervals. Moreover, it was used to search the best cut-off value. External validation was performed with the 2017 Korean neonatal network (KNN) data. @*Results@#After all missing data were excluded, 4,600 VLBWIs were included in the training dataset of the prediction model. Predictability of presence of BPD was 90.8% and prediction P value cut off was 0.550. Five-minute Apgar score, birth weight, GA, sex, surfactant use were significant indicators. Predictability of severe BPD was 81.5% and prediction P value cut off was 0.160. Five-minute Apgar score, birth weight, maternal PIH, chronic maternal hypertension, GA, sex, respiratory distress syndrome, need of resuscitation at birth were significant indicators. After external validation, sensitivity and specificity did not change significantly. @*Conclusion@#From this study, high predictability was obtained using clinical parameters obtained within one hour of life. P value for prediction of each grade of BPD and equation for calculation was presented. It can be helpful for the early prediction of BPD in Korean VLBWI. This study will contribute to the prediction of BPD in Asians especially Korean VLBWIs, not currently included in the NICHD BPD online BPD predictor. In addition, the predictive power may be continuously increased with the cumulative data of KNN.

A Study on Concentration, Identification, and Reduction of Airborne Microorganisms in the Military Working Dog Clinic

Background@#The study was planned to show the status of indoor microorganisms and the status of the reduction device in the military dog clinic. @*Methods@#Airborne microbes were analyzed according to the number of daily patient canines. For identification of bacteria, sampled bacteria was identified using VITEK®2 and molecular method. The status of indoor microorganisms according to the operation of the ventilation system was analyzed. @*Results@#Airborne bacteria and fungi concentrations were 1000.6 ± 800.7 CFU/m3 and 324.7 ± 245.8 CFU/m3. In the analysis using automated identification system, based on fluorescence biochemical test, VITEK®2, mainly human pathogenic bacteria were identified. The three most frequently isolated genera were Kocuria (26.6%), Staphylococcus (24.48%), and Granulicatella (12.7%). The results analyzed by molecular method were detected in the order of Kocuria (22.6%), followed by Macrococcus (18.1%), Glutamicibacter (11.1%), and so on. When the ventilation system was operated appropriately, the airborne bacteria and fungi level were significantly decreased. @*Conclusion@#Airborne bacteria in the clinic tend to increase with the number of canines. Human pathogenic bacteria were mainly detected in VITEK®2, and relatively various bacteria were detected in molecular analysis. A decrease in the level of bacteria and fungi was observed with proper operation of the ventilation system.

A Study on Concentration, Identification, and Reduction of Airborne Microorganisms in the Military Working Dog Clinic

Background@#The study was planned to show the status of indoor microorganisms and the status of the reduction device in the military dog clinic. @*Methods@#Airborne microbes were analyzed according to the number of daily patient canines. For identification of bacteria, sampled bacteria was identified using VITEK®2 and molecular method. The status of indoor microorganisms according to the operation of the ventilation system was analyzed. @*Results@#Airborne bacteria and fungi concentrations were 1000.6 ± 800.7 CFU/m3 and 324.7 ± 245.8 CFU/m3. In the analysis using automated identification system, based on fluorescence biochemical test, VITEK®2, mainly human pathogenic bacteria were identified. The three most frequently isolated genera were Kocuria (26.6%), Staphylococcus (24.48%), and Granulicatella (12.7%). The results analyzed by molecular method were detected in the order of Kocuria (22.6%), followed by Macrococcus (18.1%), Glutamicibacter (11.1%), and so on. When the ventilation system was operated appropriately, the airborne bacteria and fungi level were significantly decreased. @*Conclusion@#Airborne bacteria in the clinic tend to increase with the number of canines. Human pathogenic bacteria were mainly detected in VITEK®2, and relatively various bacteria were detected in molecular analysis. A decrease in the level of bacteria and fungi was observed with proper operation of the ventilation system.

Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients with Terminal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. MATERIALS AND METHODS: Patients with terminal cancer, age ≥ 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians' or patients' barriers were also collected. RESULTS: From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians' barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients' denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients' barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). CONCLUSION: One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.

The Association between Land Use Rate and Low Birth Weight Rate in Seoul: Ecological Study

PURPOSE: This paper is based on an ecological study. From 2008 to 2014, we identified the differences in the Low Birth Weight (LBW) rate according to land use rate among the 25 autonomous regions of Seoul. We also demonstrated the effects of ecological environmental differences on maternal outcomes. METHODS: The National Statistical Office obtained data of residential areas and rates, commercial areas and rates, industrial areas and rates, green areas and rates of the 25 autonomous regions from 2008 to 2014. It also obtained data regarding low birth weight rates for the same region and period. The rate of land use is divided into four stages by residential rate, three by commercial rate, three by industrial rate, and four by green area rate The higher the step, the higher the rate is. The method by Baron and Kenny was used to investigate the mediating effects of the concentration of air pollutants (PM10, PM2.5, SO2, NO2, O3, CO) on LBW and its relationship to land use in each district of Seoul. The relationship between the change of land use and LBW rate in each region was analyzed with general regression analysis and cluster analysis. RESULTS: This study shows that as the rate of green area to overall area increases in Seoul's industrial area, a causal effect is observed with low birth weight, mediated by SO2. Regression analysis revealed that LBW rates were significantly higher in heavily industrial areas (beta=1.27, SE=0.27, p<0.05), while LBW rate was significantly lower in considerably greener areas (beta=−2.21, SE=0.39, p<0.05). CONCLUSION: We confirmed differences in the relationship between residential, commercial, industrial, and green areas, air pollutants, and LBW rate. Areas with high industrial rates have a high LBW rate, while areas with high green rates have a low LBW rate. The autonomous land use ratio includes direct environmental factors. Therefore, pregnant women who are living in highly industrial areas should be especially careful to manage their living environment.

Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients

BACKGROUND AND PURPOSE: Interarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality. METHODS: This study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD. RESULTS: END occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was < 0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02–3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61–5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36–5.35) and mortality (hazard ratio=7.67, 95% CI=3.76–12.83) even after adjusting for END. CONCLUSIONS: This study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.

Is the Serum Uric Acid Level Independently Associated with Incidental Urolithiasis?

OBJECTIVE: Urolithiasis is one of the manifestations of gout and the risk is higher in gouty patients. On the other hand, an independent association between the urinary stone and serum uric acid (UA) level has not been established. This study examined whether the risk of urolithiasis increases with increasing serum UA level. METHODS: Among the people who visited a tertiary hospital from 2010 to 2013, 13,964 individuals who underwent both ultrasonography and a laboratory test were recruited in the study. The risk of urolithiasis on ultrasonography was analyzed in association with the serum UA level by multiple logistic regression analysis with an adjustment for age, sex, body mass index, estimated glomerular filtration rate, and known underlying diseases, including diabetes mellitus and hypertension. RESULTS: Among the 6,743 men (48.3%) and 7,221 women (51.7%), the age was 51.3±13.5 and the serum UA level was 4.5±2.1 mg/dL. Hyperuricemia (>7 mg/dL) was observed in 1,381 cases (9.9%). Urolithiasis was detected by ultrasonography in 608 cases (4.4%). The detection rates of urolithiasis in individuals with hyperuricemia and normouricemia were 5.9% and 4.1%, respectively (p=0.001). Multiple logistic regression analysis showed that individuals with hyperuricemia had a significantly higher risk of urolithiasis (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI], 1.20~1.96; p=0.001). A comparison of the highest with the lowest quartile of serum UA revealed a multivariable-adjusted OR of 3.17 (95% CI, 1.98~5.11) for men and 1.79 (1.08~2.93) for women. CONCLUSION: These results suggest that individuals with a higher serum UA level have a higher risk of subclinical and clinical urolithiasis.

Comparison of wound healing effects between Oncorhynchus keta-derived polydeoxyribonucleotide (PDRN) and Oncorhynchus mykiss-derived PDRN

BACKGROUND: Polydeoxyribonucleotide (PDRN) influencing cellular growth and differentiation is recognized to promote wound healing by stimulating tissue repair. Although PDRN can be extracted from human placentas, PDRN medications have recently been extracted from the semen of trout (Oncorhynchus mykiss) and salmon (Oncorhynchus keta). The present study was designed to evaluate the wound healing effects of O. keta-derived PDRN for injection (Rejuvenex) and PDRN cream (Rejuvenex Cream) in comparison with those of O. mykiss-derived PDRN injection (Placentex). METHODS: Full-thickness skin defects were made on the back of mice (n=60). The mice were divided into the following four groups according to the dressing used for the wounds: O. mykiss-derived PDRN injection group, O. keta-derived PDRN injection group, O. keta-derived PDRN cream group, and normal saline soaked dressing group (control group). We analyzed the gross findings, wound sizes, histological findings, immunohistochemistry and enzyme-linked immunosorbent assays for the groups immediately after the treatment, and again after 4, 7, and 10 days of treatment. RESULTS: The wound healing effects were the greatest in the O. keta-derived PDRN injection and O. mykiss-derived PDRN injection groups, which showed similar scores, followed by the O. keta-derived cream and normal saline soaked dressing groups. CONCLUSION: The injection of PDRN extracted from O. keta was found to be as effective at healing full-thickness skin defects as the O. mykiss-derived PDRN injection, which is currently used in the clinic. Moreover, the O. keta-derived PDRN injection was also found to reduce the time required for wound healing.

Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

PURPOSE: To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens. METHODS: Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit. RESULTS: There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation. CONCLUSIONS: In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

Comparison of Short-term Clinical Outcomes between Scleral Fixation vs. Iris Fixation of Dislocated IOL

PURPOSE: To compare clinical outcomes between iris fixation and scleral fixation as treatments for dislocated Intra Ocular Lens. METHODS: Ten eyes of 10 patients underwent scleral fixation (scleral fixation group) and 8 eyes of 8 patients underwent iris fixation (iris fixation group) were enrolled in this retrospective study. In each group, visual acuity and intra ocular pressure, slit lamp examination, fundus examination, refraction, keratometry, axial length and anterior chamber depth were measured before the surgery. Regular follow up was made 1 day, 1 week, 1 month, and 2 months after surgery and visual acuity, intra ocular pressure, slit lamp exam, refractory error, anterior chamber depth, intraocular lens (IOL) tilting, and decentration were measured at each visit. RESULTS: There were no significant differences in uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and refractive error for patients with iris and scleral fixation before and after surgery. Patients with iris fixation had significantly deeper anterior chamber depth (ACD) and more IOL tilting than patients with scleral fixation. CONCLUSIONS: In this study, the iris fixation group tended to have more IOL tilting and deepening of anterior chamber depth than the scleral fixation group. We can use this information to choose the appropriate surgical method for dislocated IOL and to select of new IOL.

The Safeness of Cataract Surgery in Older Subjects

PURPOSE: To investigate the safeness of cataract surgery in older subjects by comparing the outcomes among different age groups. METHODS: The present study included 150 patients (150 eyes) diagnosed with cataracts that visited the hospital from January 2014 to May 2015 and received phacoemulsification and intraocular lens implantation. The subjects were divided into 5 age groups (40-50, 50-60, 60-70, 70-80 and 80-90). Among the study subjects, 30 patients from each age group were measured for best corrected visual acuity (BCVA), and endothelial cell density (ECD) 2 months after surgery. Intraoperative ultrasound time, cumulative dissipated energy (CDE) and volume of balanced salt solution were also compared among the subjects. RESULTS: The nuclear sclerosis of cataracts before surgery was significantly lower in the 40-50 (2.85 ± 1.05), 50-60 (3.20 ± 0.81), and 60-70 age groups (3.39 ± 0.67) than the 70-80 (4.23 ± 0.68) and 80-90 age groups (4.47 ± 0.51). The CDE during surgery was significantly lower in the 40-50 (10.10 ± 3.20), 50-60 (11.20 ± 3.20) and 60-70 age groups (12.40 ± 3.50) than in the 70-80 (15.10 ± 3.80) and 80-90 age groups (16.70 ± 3.90; p 0.05). The reduction (%) of ECD 2 months after surgery was significantly lower in the 40-50 (17.94 ± 13.50), 50-60 (17.46 ± 9.08) and 60-70 age groups (19.12 ± 16.01) than in the 70-80 (26.36 ± 10.82) and 80-90 age groups (31.80 ± 16.86; p < 0.05). CONCLUSIONS: After cataract surgery, BCVA was not significantly different among the age groups. These findings indicate that cataract surgery using phacoemulsification in older patients is recommended and a viable option since it is relatively safe and provides excellent BCVA effects.

The Safeness of Cataract Surgery in Older Subjects

PURPOSE: To investigate the safeness of cataract surgery in older subjects by comparing the outcomes among different age groups. METHODS: The present study included 150 patients (150 eyes) diagnosed with cataracts that visited the hospital from January 2014 to May 2015 and received phacoemulsification and intraocular lens implantation. The subjects were divided into 5 age groups (40-50, 50-60, 60-70, 70-80 and 80-90). Among the study subjects, 30 patients from each age group were measured for best corrected visual acuity (BCVA), and endothelial cell density (ECD) 2 months after surgery. Intraoperative ultrasound time, cumulative dissipated energy (CDE) and volume of balanced salt solution were also compared among the subjects. RESULTS: The nuclear sclerosis of cataracts before surgery was significantly lower in the 40-50 (2.85 ± 1.05), 50-60 (3.20 ± 0.81), and 60-70 age groups (3.39 ± 0.67) than the 70-80 (4.23 ± 0.68) and 80-90 age groups (4.47 ± 0.51). The CDE during surgery was significantly lower in the 40-50 (10.10 ± 3.20), 50-60 (11.20 ± 3.20) and 60-70 age groups (12.40 ± 3.50) than in the 70-80 (15.10 ± 3.80) and 80-90 age groups (16.70 ± 3.90; p 0.05). The reduction (%) of ECD 2 months after surgery was significantly lower in the 40-50 (17.94 ± 13.50), 50-60 (17.46 ± 9.08) and 60-70 age groups (19.12 ± 16.01) than in the 70-80 (26.36 ± 10.82) and 80-90 age groups (31.80 ± 16.86; p < 0.05). CONCLUSIONS: After cataract surgery, BCVA was not significantly different among the age groups. These findings indicate that cataract surgery using phacoemulsification in older patients is recommended and a viable option since it is relatively safe and provides excellent BCVA effects.

Agreement of Medical Directors for Indirect Medical Oversight on Prehospital Care

PURPOSE: The medical director is a core factor in maintaining high quality emergency medical services. This study was conducted to evaluate the agreement of medical oversight for prehospital emergency care between medical directors. METHODS: Two medical directors assessed the same 119 rescue run sheets with 28 cases of cardiac arrest, 12 cases of withhold or interruption of cardiopulmonary resuscitation (CPR), and 22 cases of severe trauma. The assessment for prehospital evaluation of patients, treatment and medical direction was compared between the two medical directors, RESULTS: The use of an automated external defibrillator in cardiac arrest that was assessed as appropriate was 17/28, 22/28, respectively. In assessing for withhold or interruption of CPR, one medical director assessed as all appropriate for checking for pulse, respiration, and mental status regardless of recording on a 119 rescue runsheet, but the other medical director as inappropriate if there are no records on the runsheet. The assessment for airway treatment, aid for circulation, appropriateness of treatment for trauma, and appropriateness of medical direction in severe trauma differed between the two medical directors. CONCLUSION: Some differences were found in assessing the prehospital care between medical directors. A quality program for improving agreement between medical directors is necessary and the protocol for prehospital care should be modified according to the local situation.

Vitamin D Status and Its Association with the SCORAD Score and Serum LL-37 Level in Korean Adults and Children with Atopic Dermatitis

BACKGROUND: Vitamin D insufficiency could be associated with the prevalence of atopic dermatitis (AD). OBJECTIVE: To examine vitamin D status and the relations between serum 25-hydroxyvitamin D levels, SCORAD score, serum LL-37 level, and body mass index (BMI) in Korean AD patients, and to explore whether these associations differ between adults and children. METHODS: Serum 25-hydroxyvitamin D levels, serum LL-37, and clinical features were analyzed in a total of 72 Korean patients with AD (39 adults and 33 children) and 140 healthy control subjects (70 adults and 70 children). RESULTS: Serum 25-hydroxyvitamin D levels were significantly reduced in children with AD (15.06+/-4.64 ng/ml) compared with normal children in the control group (16.25+/-6.60 ng/ml) (p=0.036). Significant inverse correlations were found between BMI and 25-hydroxyvitamin D level (r=-0.315, p=0.007) and between the SCORAD score and serum LL-37 level (r=-0.3, p=0.011) in the total AD patients. CONCLUSION: The results showed that serum vitamin D levels were lower in children with AD than in healthy children; however, the same relation was not observed between adults with AD and healthy adults. Serum 25-hydroxyvitamin D concentration was not significantly correlated with AD severity or serum LL-37 levels in our study population.

Chronic Subdural Hematomas: Comparison between Unilateral and Bilateral Involvement / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common intracranial hemorrhage, encountered in neurosurgical practice. Most CSDHs are unilateral, but some show bilateral involvement. However, the clinical characteristics of bilateral CSDH remain unclear. In this study, we investigated the clinical differences between bilateral and unilateral CSDH. METHODS: A retrospective study was performed on 120 patients with CSDH surgically treated at our institute from January 2008 to December 2012. Patients were divided into two groups: the bilateral CSDH and the unilateral CSDH groups. Clinical presentations, precipitating factors, computed tomography (CT) findings, postoperative complications, and outcomes of patients were analyzed. RESULTS: Bilateral CSDH was identified in 11 of 120 (10.9%) patients with CSDH. Patients with bilateral CSDH tended to have a lower rate of head injury compared to patients with unilateral CSDH (36.4% vs. 59.6%), but it had no statistical significance (p=0.201). The frequency of marked midline shift on CT scans was significantly greater in unilateral CSDH than in bilateral CSDH (p=0.010). Presenting symptoms, coexisting systemic diseases, postoperative complications, and clinical outcomes were not significantly different between the two groups. CONCLUSION: Bilateral CSDH has comparatively similar clinical features and precipitating factors as unilateral CSDH. Patients with bilateral CSDH have significantly lower incidences of midline shift on CT scans, and most patients with either bilateral or unilateral CSDH have good postoperative outcomes.

Gentamicin-Induced Macular Toxicity after Transconjunctival Sutureless 23-Gauge Vitrectomy with Prophylactic Subconjunctival Gentamicin Injection

PURPOSE: To report a case of macular toxicity due to gentamicin after transconjunctival 23-gauge sutureless vitrectomy with prophylactic subconjunctival gentamicin injection. CASE SUMMARY: A 60-year-old female presented to our department with decreased vision in her left eye that had persisted for several months. Best corrected visual acuity (BCVA) was 0.5 in the left eye and she was diagnosed with epiretinal membrane and lamellar macular hole. The patient underwent transconjunctival 23-gauge sutureless vitrectomy with epiretinal membrane removal and intravitreal gas injection. Prophylactic subconjunctival gentamicin injection was given at the end of surgery. After 1 week, fundus examination of the left eye showed multiple retinal hemorrhages around inferior temporal vascular arcade. After six weeks, the patient underwent extracapsular cataract extraction with posterior chamber intraocular lens implantation in the left eye. After cataract surgery, BCVA of the left eye was 0.16 and atrophic change with retinal hemorrhage of the macula was observed on fundus examination of the left eye. Fluorescein angiography revealed multiple occlusion of temporal retinal arteries and capillaries of the macula. CONCLUSIONS: When a prophylactic subconjunctival drug is injected at the end of transconjunctival sutureless vitrectomy, the drug can inflow into the intraocular space through sutureless sclerotomy sites and induce retinal toxicity.