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Background and Objectives@#Although the shortage of donor is a common problem worldwide, a significant portion of unutilized hearts are classified as marginal donor (MD) hearts. However, research on the correlation between the MD and the prognosis of heart transplantation (HTx) is lacking. This study was conducted to investigate the clinical impact of MD in HTx. @*Methods@#Consecutive 73 HTxs during 2014 and 2021 in a tertiary hospital were analyzed.MD was defined as follows; a donor age >55 years, left ventricular ejection fraction 240 minutes, or significant cardiac structural problems. Preoperative characteristics and postoperative hemodynamic data, primary graft dysfunction (PGD), and the survival rate were analyzed. Risk stratification by Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was performed to examine the outcomes according to the recipient state. Each group was sub-divided into 2 risk groups according to the IMPACT score (low <10 vs. high ≥10). @*Results@#A total of 32 (43.8%) patients received an organ from MDs. Extracorporeal membrane oxygenation was more frequent in the non-MD group (34.4% vs. 70.7, p=0.007) There was no significant difference in PGD, 30-day mortality and long-term survival between groups. In the subgroup analysis, early outcomes did not differ between low- and high-risk groups. However, the long-term survival was better in the low-risk group (p=0.01). @*Conclusions@#The outcomes of MD group were not significantly different from non-MD group. Particularly, in low-risk recipient, the MD group showed excellent early and longterm outcomes. These results suggest the usability of selected MD hearts without increasing adverse events.
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Background@#We hypothesized that most of the atypical femoral fractures (AFFs) associated with bisphosphonate treatment for breast cancer (BC) could be found before the fracture event in another radiological examination already performed by breast surgeons, rather than on simple radiographs (SRs). @*Methods@#We thoroughly inspected the clinical charts of BC patients treated at our institute between 2008 and 2017. In total, 228 patients were categorized into three groups based on SRs: complete AFF on at least one side (group 1); incomplete fracture on at least one side, but not any complete fracture (group 2); and no suspicious lesion (group X) on either femur. Then, we inspected whole-body scintigraphy (WBS) and positron emission tomography (PET)-computed tomography (CT) images in all groups. For group X, patients with radiological clues from at least one femur were categorized, ultimately, into final group 3 and the rest made up the normal group. @*Results@#About 35% of the patients showed AFFs (complete or incomplete) or suspicious lesions as AFFs, associated with the side effect of Bisphosphonate. In group 1, bilateral lesions (complete or incomplete fractures) were more frequently seen on SRs than unilateral lesions (p = 0.008). The initially identified findings in WBS and PET-CT for the respective complete and incomplete fractures on SRs of groups 1 and 2 were seen at a mean of 7 months previously. SRs did not reveal the lesions in group 3 until 5 months after the initial identification of the lesions in WBS and PET-CT. @*Conclusions@#Even before incomplete AFFs were detectable on SRs, they could be found at check-ups using WBS and PET-CT that had been previously examined by breast surgeons and radiologists for metastasis surveillance. Awareness of the lesions creates an opportunity for prophylactic surgery before complete fractures occur.
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Background@#and Purpose We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). @*Methods@#This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. @*Results@#Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040–0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698–0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. @*Conclusion@#Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.
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no abstract available.
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Acute coronary syndrome involves three types of coronary artery disease associated with sudden rupture of coronary artery plaque, and has a clinical presentation ranging from ST-segment elevation myocardial infarction (STEMI) to non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. Cardiac CT can help quantify and characterize atherosclerotic plaques. According to a previous study, low-attenuation plaque, napkin ring sign, positive remodeling, spotty calcification, and increased perivascular fat attenuation are associated with plaque ruptures on cardiac CT. Therefore, coronary artery stenosis, as well as acute coronary artery syndrome, can be diagnosed using cardiac CT.
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Background@#In 2017, we established an airway call (AC) team composed of anesthesiologists to improve emergency airway management outside the operating room. In this retrospective analysis of prospectively collected data from the airway registry, we describe the characteristics of patients attended to and practices by the AC team during the first 4 years of implementation. @*Methods@#All AC team activations in which an airway intervention was performed by the AC team between June 2017 and May 2021 were analyzed. @*Results@#In all, 359 events were analyzed. Activation was more common outside of working hours (62.1%) and from the intensive care unit (85.0%); 36.2% of AC activations were due to known or anticipated difficult airway, most commonly because of acquired airway anomalies (n = 49), followed by airway edema or bleeding (n = 32) and very young age (≤ 1 years; n = 30). In 71.3% of the cases, successful intubation was performed by the AC team at the first attempt. However, three or more attempts were performed in 33 cases. The most common device used for successful intubation was the videolaryngoscope (59.7%). Tracheal intubation by the AC team failed in nine patients, who then required surgical airway insertion by otolaryngologists. However, there were no airway-related deaths. @*Conclusions@#When coupled with appropriate assistance from an otolaryngologist AC system, an AC team composed of anesthesiologists could be an efficient way to provide safe airway management outside the operating room.
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Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Purpose@#This study aimed to find a correlation between the occlusal plane and two reference planes that are frequently used in semi-adjustable articulators. @*Materials and Methods@#Sixty-two males and fifty females with normal articulation were recruited and the lateral cephalograms of these patients were taken. The angles between the Frankfort horizontal (FH) and the occlusal planes, the angles between the gnathologic and the occlusal planes, and the angles between the FH and gnathologic planes were measured on the lateral cephalograms.Result: The mean angles between the FH and the occlusal planes was 8.29°±3.62°, with 8.88°±3.09° and 7.63°±4.10°for male and female patients, respectively. The mean angles between the gnathologic and the occlusal planes was 2.77°±3.62°, and the angle between the FH and the gnathologic planes was 5.52°±3.62°. No significant differences were found in the measured angles between the male and female patients (P>0.05). @*Conclusion@#Different guidance angles may be applied to articulators for prosthodontic restoration, depending on the reference planes that the articulators use.
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Background and Objectives@#Large clinical studies of sodium/glucose cotransporter 2 (SGLT2) inhibitors have shown a significant beneficial effect on heart failure-associated hospitalization and cardiovascular events. As SGLT2 is known to be absent in heart cells, improved cardiovascular outcomes are thought to be accounted for by the indirect effects of the drug. We sought to confirm whether such benefits were mediated through SGLT2 expressed in the heart using myocardial infarction (MI) model. @*Methods@#Mice pre-treated with empagliflozin (EMPA), an SGLT2 inhibitor, showed a significantly reduced infarct size compared with the vehicle group three days post-MI.Interestingly, we confirmed SGLT2 localized in the infarct zone. The sequential changes of SGLT2 expression after MI were also evaluated. @*Results@#One day after MI, SGLT2 transiently appeared in the ischemic areas in the vehicle group and increased until 72 hours. The appearance of SGLT2 was delayed and less in amount compared with the vehicle group. Additionally, there was a significant difference in metabolites, including glucose and amino acids in the 1 H nuclear magnetic resonance analysis between groups. @*Conclusions@#Our work demonstrates that SGLT2 is transiently expressed in heart tissue early after MI and EMPA may directly operate on SGLT2 to facilitate metabolic substrates shifts.
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Background and Objectives@#Large clinical studies of sodium/glucose cotransporter 2 (SGLT2) inhibitors have shown a significant beneficial effect on heart failure-associated hospitalization and cardiovascular events. As SGLT2 is known to be absent in heart cells, improved cardiovascular outcomes are thought to be accounted for by the indirect effects of the drug. We sought to confirm whether such benefits were mediated through SGLT2 expressed in the heart using myocardial infarction (MI) model. @*Methods@#Mice pre-treated with empagliflozin (EMPA), an SGLT2 inhibitor, showed a significantly reduced infarct size compared with the vehicle group three days post-MI.Interestingly, we confirmed SGLT2 localized in the infarct zone. The sequential changes of SGLT2 expression after MI were also evaluated. @*Results@#One day after MI, SGLT2 transiently appeared in the ischemic areas in the vehicle group and increased until 72 hours. The appearance of SGLT2 was delayed and less in amount compared with the vehicle group. Additionally, there was a significant difference in metabolites, including glucose and amino acids in the 1 H nuclear magnetic resonance analysis between groups. @*Conclusions@#Our work demonstrates that SGLT2 is transiently expressed in heart tissue early after MI and EMPA may directly operate on SGLT2 to facilitate metabolic substrates shifts.
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Background@#Muscle strength has been suggested as a cardiovascular marker. The aim of this study was to examine the associations between hand grip strength and biomarkers of cardiovascular disease in the Korean population. @*Methods@#A total of 9,083 participants aged 20–80 years from Korea National Health and Nutrition Examination Survey 2015–2016 were investigated. @*Results@#Among men, both relative and dominant hand grip strength showed a positive association with diastolic blood pressure in those aged 65–80 years (95% confidence interval, P-value of dominant and relative hand grip strength: β=0.06, 0.01; P<0.05). Among women, relative and dominant hand grip strength showed a positive relationship to diastolic blood pressure in those aged 20–64 years (β=0.06, 0.01; P<0.001). Body mass index was positively associated with dominant hand grip strength in younger women (β=0.18, P<0.05), whereas it was positively associated with relative hand grip strength in all sex and age groups. High-sensitivity C-reactive protein showed a negative association with relative and dominant hand grip strength in all women, although the same association was observed only in younger men. Diabetes was inversely related to hand grip strength in younger women and men. @*Conclusion@#Increased hand grip strength may be associated with lower C-reactive protein in women and with less risk of diabetes in the Korean adult population. Further prospective studies are needed for the determination of causality between cardiometabolic markers and hand grip strength.
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The development of microsurgical techniques has also increased the success rate of replantation surgery. This paper reports the results of limb replantation performed on a lower extremity amputation that was associated with crush amputation and an ipsilateral comminuted fracture in and elderly patient. A 68-year-old female presented with a right distal tibia amputation due to a traffic accident. At that time, with a comminuted fracture in the distal femoral condyle, simple wound repair was recommended, but the caregivers strongly wanted replantation. Three years after surgery, normal walking was possible without a cane and the patient was satisfied with the function and aesthetics. What used to be contraindicated in limb replantation in the past are now indications due to the development of microsurgical techniques, surgical experience, and postoperative rehabilitation treatment. If the patient is willing to be treated, good results in contraindications can be obtained.
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Aged , Female , Humans , Accidents, Traffic , Amputation, Surgical , Canes , Caregivers , Esthetics , Extremities , Fractures, Comminuted , Leg , Lower Extremity , Rehabilitation , Replantation , Tibia , Walking , Wounds and InjuriesABSTRACT
Bacillus cereus causes serious central nervous system infections, especially in immunocompromised patients. Successful treatment requires adequate antimicrobial concentrations in the cerebrospinal fluid; however, in some cases, achieving this with systemic treatment alone is difficult. We treated intractable B. cereus ventriculitis with intraventricular vancomycin, with no major adverse events.
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Bacillus cereus , Bacillus , Central Nervous System Infections , Cerebral Ventriculitis , Cerebrospinal Fluid , Immunocompromised Host , Injections, Intraventricular , Pharmacokinetics , VancomycinABSTRACT
BACKGROUND: Despite expanding demands for non-operating room anesthesia (NORA) worldwide, studies in this field are scarce. We compared the overall characteristics and the nature of deaths occurring within 48 hours after surgery between NORA and operating room anesthesia (ORA) cases at a Korean tertiary hospital. METHODS: We retrospectively analyzed the medical records of patients who underwent surgical procedures under anesthesia services in and outside the operating room from January 2013 to November 2017. All of the mortalities were categorized by principal cause into groups such as patient disease or condition, surgery, anesthesia, and others. RESULTS: Overall, 16,383 NORA cases and 183,381 ORA cases were analyzed. Eighty-six deaths were identified. The mortality rate of NORA cases was similar to that of ORA cases (4.9 per 10,000 cases [95% confidence interval (CI), 2.1–9.6] vs. 4.3 per 10,000 cases [95% CI, 3.4–5.3], respectively). Similar to ORA cases, higher American Society of Anesthesiologists physical status and very young age (< 2 years) were significantly associated with mortality in NORA cases. A patient's disease or condition was the most important cause of mortality (65/86, 75.6%), followed by surgery-related causes (16/86, 18.6%). Two cases of anesthesia-related mortality were only identified in the ORA cases, resulting in an overall anesthesia-related mortality of 0.1 per 10,000 cases (95% CI, 0.0–0.4). CONCLUSION: Although NORA cases showed an equivalent perioperative mortality rate compared to ORA cases, there may be more room for improving patient safety when considering their favorable characteristics (healthier patients, less invasive and shorter procedures). Trial registry at Clinical Research Information Service, KCT0002719.
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Humans , Anesthesia , Information Services , Medical Records , Mortality , Operating Rooms , Patient Safety , Perioperative Period , Retrospective Studies , Tertiary Care CentersABSTRACT
PURPOSE: To investigate trends in blood pressure (BP) and hypertension prevalence in Korea. MATERIALS AND METHODS: Based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005), IV (2007–2009), V (2010–2012), and VI (2013–2014), 56077 participants (23974 men and 32103 women) were included. RESULTS: Mean systolic BP (SBP) and diastolic BP (DBP) decreased in both sexes (male SBP: 128.1 to 120.2 mm Hg, male DBP: 82.0 to 78.5 mm Hg; female SBP: 125.7 to 116.0 mm Hg and female DBP: 77.4 to 73.2 mm Hg from the KNHANES I–VI). The age-standardized prevalence of hypertension was significantly decreased in both sexes (male; 33.3% to 30.3%, female; 28.7% to 22.7%, all p for trend < 0.001). Regardless of taking anti-hypertensive medication or not, SBP and DBP declined universally in both sexes. Compared to the KNHANES I, the odds ratios (95% confidence intervals) of the KNHANES II to VI for less-than-normotensive and less-than-hypertensive BP increased in both sexes. CONCLUSION: Mean BP levels in both sexes and hypertension prevalence showed downward trends during the 16-year period.
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Adult , Female , Humans , Male , Blood Pressure , Epidemiology , Hypertension , Korea , Nutrition Surveys , Odds Ratio , PrevalenceABSTRACT
PURPOSE: To investigate the clinical outcome of proton therapy (PT) in patients with chordoma. MATERIALS AND METHODS: Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and diseasespecific survival (DSS) rates were calculated by the Kaplan–Meier method. RESULTS: With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4. CONCLUSION: PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.
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Humans , Chordoma , Cobalt , Disease-Free Survival , Follow-Up Studies , Korea , Methods , Proton Therapy , Protons , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: While reconstruction of soft tissue defects is the common purpose, surgical reconstructions of upper extremities and lower extremities have different goals in terms of functional and aesthetic outcomes. The purpose of the current study was to compare and analyze differences between reconstructions of upper extremities and lower extremities using an anterolateral thigh (ALT) flap. METHODS: We analyzed 74 patients who underwent reconstructions of upper extremities and lower extremities using an ALT flap from October 2006 to August 2012 (upper extremities, 45 cases; lower extremities, 29 cases). The study focused on the statistical analysis of patient satisfaction according to the donor site of the ALT flap and the timing of a debulking procedure. RESULTS: On the choice of donor site, in the upper extremity reconstruction, flap elevation from the opposite side of the recipient limb was preferred (p = 0.019) because it causes less inconvenience while walking. In the lower extremity reconstruction, flap elevation from the same side of the recipient limb (p = 0.002) was preferred. The debulking procedure performed on the upper extremities at 4 weeks after reconstruction led to better functional results and enhanced patient satisfaction (p = 0.022). In the case of lower extremities, enhanced satisfaction was noted in patients who underwent the procedure at 6 months after reconstruction (p < 0.001). CONCLUSIONS: Elevation of the flap in reconstruction reduced inconvenience when performed on the same side of the recipient limb for lower extremities and on the opposite side for upper extremities. In addition, debulking resulted in better satisfaction when performed 4 weeks postoperatively in the upper extremities and 6 months postoperatively in the lower extremities.
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Humans , Extremities , Lower Extremity , Patient Satisfaction , Perforator Flap , Thigh , Tissue Donors , Upper Extremity , WalkingABSTRACT
BACKGROUND: Sarcopenia and proteinuria are significant health difficulties in the elderly; however, few studies have investigated their relationship. In this study, we investigated the association between sarcopenia and proteinuria in Korean subjects over 60 years old. METHODS: We included data from the Korean National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey conducted from 2009 to 2011 (n=4,008). Sarcopenia was defined using appendicular skeletal muscle mass as a percentage of body weight. Proteinuria was defined by a urine dipstick test result above trace levels. RESULTS: The overall proteinuria prevalence was 7.2%. The incidence of sarcopenia was significantly higher in subjects with proteinuria. The prevalence of proteinuria was significantly higher in the sarcopenic group (5.5% vs. 14.5% in the non-chronic kidney disease (CKD) group; 17.2% vs. 23.2% in the CKD group) than in the non-sarcopenic group. Furthermore, sarcopenic participants had worse metabolic parameters, such as higher body mass indexes, waist circumferences, and fasting glucose levels, and lower high-density lipoprotein cholesterol levels than those in the non-CKD group. After adjustment for confounders, the odds ratios (95% confidence interval) for proteinuria were 2.84 (1.92–4.18) in the sarcopenic non-CKD group, 3.70 (2.59–5.30) in the non-sarcopenic CKD group, and 5.19 (2.64–10.18) in the sarcopenic CKD group, compared to the non-sarcopenic, non-CKD group. Sarcopenia increased the proteinuria risk in elderly participants without CKD, even after adjustment for obesity, hypertension, diabetes, and metabolic syndrome. CONCLUSION: These findings showed that sarcopenia was associated with dipstick proteinuria, especially in elderly participants without CKD, regardless of comorbidities.
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Aged , Humans , Body Mass Index , Body Weight , Cholesterol , Comorbidity , Fasting , Glucose , Hypertension , Incidence , Kidney Diseases , Korea , Lipoproteins , Muscle, Skeletal , Nutrition Surveys , Obesity , Odds Ratio , Prevalence , Proteinuria , Renal Insufficiency, Chronic , Sarcopenia , Waist CircumferenceABSTRACT
BACKGROUND: Recently, noise coming from the neighborhood via floor wall has become a great social problem. The noise between the floors can be a cause of physical and psychological problems, and the different types of floor impact sound (FIS) may have the different effects on the human's body and mind. The purpose of this study is to assess the responses of subjective feeling, task performance ability, cortisol and HRV for the various types of floor impact. METHODS: Ten men and 5 women were enrolled in our study, and the English listening test was performed under the twelve different types of FIS, which were made by the combinations of bang machine (B), tapping machine (T), impact ball (I) and sound-proof mattress (M). The 15 subjects were exposed to each FIS for about 3 min, and the subjective annoyance, performance ability (English listening test), cortisol level of urine/saliva and heart rate variability (HRV) were examined. The sound pressure level (SPL) and frequency of FIS were analyzed. Repeated-measures ANOVA, paired t-test, Wilcoxon signed rank test were performed for data analysis. RESULTS: The SPL of tapping machine (T) was reduced with the soundproof mattress (M) by 3.9–7.3 dBA. Impact ball (I) was higher than other FIS in low frequency (31.5–125 Hz) by 10 dBA, and tapping machine (T) was higher than other FIS in high frequency (2–4 k Hz) by 10 dBA. The subjective annoyance is highest in the combination of bang machine and tapping machine (BT), and next in the tapping machine (T). The English listening score was also lowest in the BT, and next in T. The difference of salivary cortisol levels between various types of FIS was significant (p = 0.003). The change of HRV parameters by the change of FIS types was significant in some parameters, which were total power (TP) (p = 0.004), low frequency (LF) (p = 0.002) and high frequency (HF) (p = 0.011). CONCLUSIONS: These results suggest that the human's subjective and objective responses were different according to FIS types and those combinations.
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Female , Humans , Male , Heart Rate , Hydrocortisone , Noise , Pilot Projects , Residence Characteristics , Social Problems , Statistics as Topic , Task Performance and AnalysisABSTRACT
Endoscopic submucosal dissection (ESD) is widely performed these days as the standard procedure for the treatment of early gastric cancer. During ESD, insertion and rotation of the scope, air insufflation, incision and hemostasis may provoke pain, which commonly requires either general anesthesia or moderate to deep sedation. Deep sedation precludes the need for general anesthesia, and can help endoscopists speed up the procedure compared to light sedation. But, there are risks of respiratory complication. We report a case of respiratory compromise caused by pneumoperitoneum from unrecognized gastric perforation during ESD under deep sedation.