An analysis of HIV patients visiting hospitals in Korea by complete enumeration:based on the Health Insurance Review and Assessment Service database

Objective@#This study investigated the hospital use patterns of patients with human immunodeficiency virus (HIV) infections in Korea. The prevalence of HIV infections in Korea is very low and there is no data on the type of medical treatment HIV patients receive. We therefore decided to perform a complete enumeration of the utilization of medical facilities by HIV patients using a nationwide claims database. @*Methods@#The nationwide Health Medical Insurance Review and Assessment (HIRA) service claims database was used to identify and include all new patients with HIV infections from 2013 to 2018. The current inpatient, outpatient, and emergency service use of these patients were investigated. The number of invasive procedures, interventions, and operations performed on these patients, and their death rate, was also investigated. @*Results@#The number of patients visiting outpatient departments increased by 44% from 2013 to 2018. The most frequently visited department was internal medicine, followed by emergency medicine. Dental procedures followed intravenous line insertions as the most common procedures undertaken by patients with HIV. @*Conclusion@#The results of this study show the status of hospital visits by patients with HIV infections in Korea and provide the basic data upon which policy decisions can be based.

Clinical and Anatomical Outcomes of Arthroscopic Repair of Large Rotator Cuff Tears with Allograft Patch Augmentation: A Prospective, Single-Blinded, Randomized Controlled Trial with a Long-term Follow-up

Background@#Arthroscopic rotator cuff repair using human dermal matrix allograft augmentation has been widely used. We assessed the effect of acellular human dermal matrix augmentation after arthroscopic repair of large rotator cuff tears through a prospective, single-blinded, randomized controlled trial with a long-term follow-up. @*Methods@#Sixty patients with large-sized rotator cuff tears were randomly assigned to two groups. Patients in the control group underwent arthroscopic rotator cuff repair. Allograft patch augmentation was additionally performed in the allograft group. All patients were subdivided into a complete coverage (CC) group or an incomplete coverage (IC) group according to footprint coverage after cuff repair. Constant and American Shoulder and Elbow Surgeons (ASES) scores were assessed preoperatively and at final follow-up. Magnetic resonance imaging was also performed at the same time to evaluate the anatomical results. @*Results@#Forty-three patients were followed up for an average of 5.7 years. Clinical scores (Constant and ASES) increased significantly at the last follow-up in both groups. The increase in ASES score in the allograft group was statistically significantly greater than that in the control group. The degree of Constant score improvement did not differ significantly between the two groups. The retear rate was 9.1% in the allograft group, which was significantly lower than that in the control group (38.1%). In the control group, the CC subgroup had a statistically significantly lower retear rate (16.7%) than did the IC subgroup. There were no retear cases in the CC subgroup of the allograft group. @*Conclusions@#Long-term follow-up of arthroscopic repair of large rotator cuff tears with allograft patch augmentation showed better clinical and anatomical results. Footprint coverage after rotator cuff repair was an important factor affecting the retear rate. If the footprint was not completely covered after rotator cuff repair, allograft patch augmentation may reduce the retear rate.

Analysis of pre-hospital emergency medical services use feasibility with emergency department visit patient

Objective@#Patients are taken to the emergency department (ED) via a variety of transport systems. Proper ambulance use is important for improving patients’ transport quality and using limited resources allotted by the system effectively. Korea is a country with a well-developed public ambulance system established by the government. Therefore, this study was conducted to analyze the overuse or underuse of the ambulance system by patients who visited the ED. @*Methods@#This study was conducted at the ED in three hospitals. A total of 459,647 patients visited these EDs over the three-year study period from 2016 to 2018. Medical records were investigated retrospectively. The study subjects were divided into three groups based on their triage score and ambulance use. Patients were classified into adequacy (Korean Triage and Acuity Scale [KTAS] 1-3, ambulance use or KTAS 4-5, non-ambulance use), underuse (KTAS 1-3, non-ambulance use) and overuse (KTAS 4-5, ambulance use) groups. @*Results@#The mean age of patients was 46.7±26.0 years, and 237,118 (51.6%) were male. The adequacy group included 269,046 patients (58.5% of the patients). The underuse group had 162,575 patients (35.4%), and the overuse group included 328,026 patients (6.1%). Despite having KTAS level 1 or 2, the number of patients who did not use an ambulance was 14,792. Ambulances were used by 5,154 patients at KTAS 5 level. @*Conclusion@#Many patients use ambulances appropriately, but overuse and underuse of ambulances can still be observed. Guidelines on ambulance use are necessary for the efficient use of emergency medical resources and the safety of patients.

Clinical Outcomes after Reverse Total Shoulder Arthroplasty According to Primary Diagnosis

Background@#To compare the clinical outcomes of reverse total shoulder arthroplasty (RTSA) according to the primary diagnosis. @*Methods@#In 98 shoulders (97 patients), RTSA was performed for cuff tear arthropathy (45), massive rotator cuff tear without glenohumeral arthritis (31), posttraumatic arthritis (9), primary osteoarthritis (6), rheumatoid arthritis (4), and arthritis due to infection sequelae (3). The average age of the patients at surgery was 68.9 years (range, 46–84 years). The mean follow-up duration was 48.4 months (range, 24–85 months). @*Results@#In the overall series, the mean subjective pain score (visual analog scale) during motion decreased from 5.2 preoperatively to 1.8 at 2 years of follow-up. There were significant improvements in active forward flexion (preoperatively 51.5° to 121.8° at 2 years of follow-up). The average Constant score improved from 35.4 points to 57.8 points and UCLA score improved from 13.4 points to 28.8 points. The Constant score and UCLA score were 60.8 and 31.0 points, respectively, in patients with rheumatoid arthritis. The Constant score and UCLA score were 58.4 and 29.1 points, respectively, in patients with cuff tear disease and 55.7 and 27.7 points, respectively, in patients with posttraumatic arthritis. Patients’ subjective satisfaction was 86.8 points in the overall series; highest in the patients with arthritis by infection sequelae (96.7 points) and lowest in the patients with posttraumatic arthritis (82.2 points). In terms of complications, there were 17 cases (17.3%) of scapular notching and 2 patients with suprascapular nerve irritation symptom, but no patients with permanent neuropathy. @*Conclusions@#The range of forward flexion and abduction motion, pain relief, and functionality were improved after RTSA in not only patients with cuff tear disease but also those with other arthritic diseases. There was no difference in the clinical outcomes of RTSA between patients with cuff tear disease and those with other arthritic diseases.

Comparison of traumatic brain injury patients with brain computed tomography in the emergency department by age group

Objective@#Traumatic brain injury (TBI) is an important public health concern due to its high prevalence and mortality rate among young people. We investigated the clinical and social characteristics of patients who visited the emergency department due to TBI in whom brain computed tomography, was performed by age. @*Methods@#We retrospectively analyzed 15,567 TBI patients who received a brain computed tomography evaluation at the emergency department of Korea University Hospital from March 2013 to February 2016. We divided patients into age groups by decade and analyzed factors such as sex, trauma mechanism, need for operation, hospitalization, and results of treatment. @*Results@#The mean age was 42.0±22.8 years; the most common age group was the 50s (16.5%). Except for the age group over 70 years, males predominated. Under 9 years of age, public ambulance usage rate was lower than in other age groups. Regarding severity based on the Glasgow Coma Scale score, the proportion of mild cases was higher in those under 9 years of age (99.3%) and the proportion of severe cases was higher in those in their 20s (4.6%). The most common injury mechanism was blunt trauma, followed by car accidents. For those under 9 years of age, falls were more common than in other age groups. Only 20.5% of TBI patients were hospitalized and 11.9% were treated surgically, while 70.6% of patients were discharged home after treatment. @*Conclusion@#TBI may present with different characteristics depending on the age of the patients, thus prevention policies and clinical practice should be tailored to age.

Proteomic Classification and Identification of Proteins Related to Tissue Healing of Platelet-Rich Plasma

BACKGROUND: Platelet-rich plasma (PRP) is a plasma component of autologous blood containing a high concentration of platelets. PRP is used to promote healing of damaged tissues. However, there are not many studies on the composition and expression patterns of active proteins in PRP. The purpose of this study was to identify unknown factors that contribute to tissue healing by proteomic analysis of proteins in PRP.METHODS: Three men in their 30s with no basal disease participated in this study. All identified proteins were classified for tissue healing-related functions on the basis of the gene ontology analysis of adhesion molecule with Ig-like domain 2 (AmiGO2). PRP was prepared by using the ACP kit and GPS III kit.RESULTS: We identified a total of 125 proteins related to wound healing, along with three proteins for angiogenesis involved in wound healing, two proteins for fibroblast migration, four proteins for collagen biosynthesis process, two proteins for glycosaminoglycan biosynthesis process, and 13 proteins for glycosaminoglycan binding. So, in addition to the growth factors that have been already known to be involved in tissue healing, 25 new proteins were identified.CONCLUSIONS: We identified the unknown proteins associated with tissue healing in PRP. Our findings may serve as a foundation for the establishment of basic medical evidence for PRP applications.

Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy

BACKGROUND@#The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP.@*METHODS@#Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure.@*RESULTS@#There was a statistically significant difference in ΔASES(3months) (ASES(3months)-ASES(first)) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05).@*CONCLUSIONS@#This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy

BACKGROUND: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP. METHODS: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure. RESULTS: There was a statistically significant difference in ΔASES(3months) (ASES(3months)-ASES(first)) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05). CONCLUSIONS: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

Significance of Biomarkers as a Predictive Factor for Post-Traumatic Sepsis

PURPOSE@#Many traumatic patients die from sepsis and multiple organ failure. Early recognition of post-traumatic sepsis in traumatic patients will help improve the prognosis. Recently, procalcitonin (PCT), macrophage migration inhibitory factor (MIF), and lactic acid have emerged as predictive factors. Our study aims to explore the significance of PCT, MIF and lactic acid as a predictor of posttraumatic-sepsis in trauma patients.@*METHODS@#This study was conducted on prospective observational study patients who visited an emergency medical center in a university hospital from March 2014 to February 2016. We measured the white blood cells, c-reactive protein (CRP), lactic acid, PCT, and MIF with serum taken from the patient's blood within 1 hour of the occurrence of the trauma. The definition of post-traumatic sepsis was defined as being part of systemic inflammation response syndrome criteria with infections within a week.@*RESULTS@#A total of 132 patients were analyzed, wherein 74 patients were included in the low injury severity score (ISS) group (ISS < 15) and 58 patients were included in the high ISS group (ISS ≥15). The mean PCT, MIF, and lactic acid levels were higher in the high ISS group (p < 0.05). Meanwhile, 38 patients were included in the early sepsis group and 94 patients were included in the non-sepsis group. The mean MIF levels were higher in the sepsis group than the non-sepsis group (p < 0.05) and there were no significant differences in the initial CRP, lactic acid, and PCT levels in these two groups.@*CONCLUSIONS@#MIF may be considered as a predictive factor for sepsis in trauma patients.

Analysis of Patients with Acute Toxic Exposure between 2009 and 2013: Data from the Korea Health Insurance Review and Assessment Service and the National Emergency Department Information System

BACKGROUND: According to domestic studies, patients visiting the emergency departments (ED) with acute toxic exposure comprise 0.68%–5.5% of all ED patients, with various causes and motives. The purpose of this study is to investigate the clinical and social characteristics of patients with toxic exposure visiting the ED. METHODS: This study spanned a period of five years, from January 1, 2009 to December 31, 2013. The data were extracted using the National Emergency Department Information System (NEDIS) and The Korea Health Insurance Review and Assessment Service (HIRA). RESULTS: From the HIRA database, during the study period (2009–2013); 310,159 (2009), 289,829 (2010), 288,906 (2011), 285,514 (2012), and 279,575 (2013) patients, respectively, visited EDs with diagnoses related to exposure to toxic substances. The number of patients who presented with acute toxic exposure compared to all ED visits significantly decreased consistently (7.8%, 6.9%, 6.0%, 5.0%, 4.1%) over 5 years. Regarding the cause of toxic exposure, substances other than drugs accounted for the largest percentage, and increased annually. Acetylcysteine was the most commonly prescribed antidote, and patients in their 40s and 50s showed the most frequent visits. The monthly distribution was highest in July-September, and higher in January than in other months. CONCLUSION: This study found that the percentage of patients visiting the ED is decreasing, the exposure to quasi-drugs was the most common, and the exposure to antipsychotic drugs was the most frequent.

Reverse Total Shoulder Arthroplasty: Salvage Procedure for Failed Prior Arthroplasty

BACKGROUND: To evaluate the clinical outcome of revision of primary shoulder replacement by using reverse total shoulder arthroplasty (RTSA). METHODS: Seven patients underwent revision RTSA with a mean follow-up of 22.1 months (range, 12 to 54 months). Their mean age at the time of operation was 75.5 years (range, 70 to 80 years). Assessments were performed on the preoperative and postoperative visual analogue scale (VAS) score, muscle strength, range of motion, University of California at Los Angeles (UCLA) score, Constant score, subjective satisfaction and the anteroposterior and axillary views of the glenohumeral joint. The primary operation was hemiarthroplasty in 5 patients, total shoulder replacement in 1 patient, and reverse shoulder arthroplasty in 1 patient. The cause of revision surgery was infection in 2 patients, humeral stem loosening in 2 patients, glenoid arthropathy in 2 patients, and glenoid loosening in 1 patient. The mean duration from primary operation to revision surgery was 52 months (range, 27 to 120 months). RESULTS: The VAS score for pain during motion was improved from 7.3 preoperatively to 2.1 postoperatively (p = 0.03). There were increases in the mean active forward flexion (from 62.1° to 92.8°), abduction (from 70° to 87.1°), external rotation (from 44.2° to 47.4°), and internal rotation (from L5 to L4; p > 0.05) postoperatively. Performance in activities of daily living improved (p > 0.05), except for lifting 10 lb above the shoulder (from 1.2 to 1.1; p = 0.434). Overall, 5 of 7 patients were satisfied with the results of revision surgery. The mean Constant score improved from 44.8 preoperatively to 57.1 postoperatively (p = 0.018). The mean UCLA score improved from 12.8 preoperatively to 22.8 postoperatively (p = 0.027). In the postoperative radiological evaluation, no radiolucency was observed around the base plate or humeral stem. CONCLUSIONS: Pain could be reduced after revision RTSA, but improvements in range of motion and function were difficult to achieve. We think that the patients' satisfaction was relatively high despite the low function score due to the preoperative severe pain and marked limitation of range of motion.

Outcomes of Rotator Cuff Repair in Patients with Comorbid Disability in the Extremities

BACKGROUND: Rehabilitation and overuse of the shoulder after rotator cuff repair are a concern in patients with comorbid disability in other extremities. Improvement of outcomes can be hampered in this situation. This study was to describe the clinical outcomes of rotator cuff repair in patients with comorbid disability in other extremities. METHODS: In two tertiary institutions, 16 patients with comorbid disability (9 men and 7 women; mean age of 57.1 years [range, 45 to 71 years]; 14 dominant arms; mean follow-up of 18 months [range, 12 to 38 months]) underwent rotator cuff repair. There were 5 massive tears, 1 large tear, 9 medium tears, and 1 small tear. Open repair was performed in 3 patients and arthroscopic repair in 13. The most common comorbid condition was paralysis (n = 7). Eight patients walked with crutches preoperatively. Anatomical outcome was investigated in 12 patients using either magnetic resonance imaging or ultrasonography at least 6 months postoperatively. RESULTS: Range of motion, visual analogue scale for pain and satisfaction, and all functional scores improved significantly. Healing failure occurred in 4 patients (2 large-to-massive and 2 medium size tears), but none required revision surgery. All 4 retears involved the dominant side, and 3 patients were crutch users. CONCLUSIONS: The current data suggested favorable outcome of rotator cuff repair in patients with comorbid disability. Careful surgical planning and rehabilitation is particularly important for crutch users and in the case of dominant arm involvement in disabled patients.

The inflammatory response of neutrophils in an in vitro model that approximates the postcardiac arrest state

PURPOSE: Postcardiac arrest syndrome (PCAS) shares many features with sepsis including plasma cytokine elevation with dysregulation of cytokine production, and the presence of endotoxin in plasma. PCAS is closely related to ischemia-reperfusion injury. During ischemia-reperfusion injury, neutrophil, which is the first line of innate immunity, plays a major role. In this study, we investigated the inflammatory response of human neutrophils in an in vitro model which we simulated with hypoxia-normoxia and hypoxia-hyperoxia environments. METHODS: After separation of neutrophils from the whole blood, they were divided into 3 experimental groups: normoxia-normoxia, hypoxia-normoxia, and hypoxia-hyperoxia groups. The production of H₂O₂, the expression of Toll-like receptor 4 (TLR₄) receptor, and the extent of apoptosis of the neutrophils were checked. RESULTS: The in vitro hypoxia-normoxia and -hyperoxia models, which simulated the PCAS, showed initiation of the neutrophils' inflammatory reaction by hypoxia insult. Lipopolysaccharide amplifies such inflammation; therefore, prevention of secondary infection may be critical in postresuscitation patients. Temporary hyperoxia following hypoxic insult showed no difference in inflammatory reaction compared with hypoxia-normoxia. Rather, temporary hyperoxia may suppress or minimize inflammation by attenuation of TLR4 receptor. CONCLUSION: It is well known that continuous hyperoxygenation after successful cardiac arrest harms patients, but temporary hyperoxygenation with 100% O₂ in a clinical situation may be helpful.

Analysis of Trauma Patients with Massive Transfusion in the Emergency Department / 대한수혈학회지

BACKGROUND: It is important that proper protocols are in place for trauma patients who require massive transfusion upon arrival at the emergency department. This study is a preliminary analysis of massive transfusion cases at the emergency department of our institution aimed to review the characteristics and situations in which massive transfusion occurs in an effort to better manage trauma patients receiving massive transfusion in the emergency department. METHODS: This study was conducted at the Department of Emergency Medicine in the Korea University Guro Hospital. We retrospectively reviewed the medical charts of trauma-related patients who required massive blood transfusions between January 2013 and December 2015. The inclusion criteria were as follows: patients who were over the age of 18 years and received more than 4 packed RBC (pRBC) units per hour, or 10 or more pRBC units during a period of 24-hours. RESULTS: A total of 669 patients were included in the study. There were significant differences of initial systolic blood pressure (P<0.0001), diastolic blood pressure (P<0.0001), and Injury Severity Score (P<0.0001) between those who survived and those who expired. CONCLUSION: Proper initial resuscitation is essential for the improvement of outcome in trauma patients that require a massive transfusion. The findings from this study may serve as preliminary data in developing proper transfusion protocols for massive transfusion among trauma patients.

Restoration of Lumbar Lordosis in Flat Back Deformity: Optimal Degree of Correction

STUDY DESIGN: A retrospective comparative study. PURPOSE: To provide an ideal correction angle of lumbar lordosis (LL) in degenerative flat back deformity. OVERVIEW OF LITERATURE: The degree of correction in degenerative flat back in relation to pelvic incidence (PI) remains controversial. METHODS: Forty-nine patients with flat back deformity who underwent corrective surgery were enrolled. Posterior-anterior-posterior sequential operation was performed. Mean age and mean follow-up period was 65.6 years and 24.2 months, respectively. We divided the patients into two groups based on immediate postoperative radiographs-optimal correction (OC) group (PI-9degrees or =55degrees). Radiological and clinical results were analyzed. RESULTS: Patients in OC group had significantly less correction loss and maintained normal sagittal alignment (sagittal vertical axis<5 cm), as compared to patients in UC group (p<0.05). LL of low PI group significantly maintained within 9degrees better than high PI group (p<0.05). Oswestry disability index (ODI) significantly decreased at last follow-up, as compared to preoperative state. However, there was no significant difference in last follow-up ODI between the groups. CONCLUSIONS: In flat back deformity, correction of LL to within 9degrees of PI will result in better sagittal balance. Thus, we recommend sufficient LL to prevent correction loss, especially in patients with high PI.

Relation between Inferior Vena Cava Collapsibility and Central Venous Pressure

PURPOSE: For evaluation of volume status in the emergency department, central venous pressure (CVP) measurement is a standard practice. However, this is an invasive method. Measuring inferior vena cava (IVC) size through ultrasound is promising as a non-invasive method. However, few studies have been reported in Korea. Therefore this study measured IVC size and collapsibility in order to examine the clinical usefulness. METHODS: In a prospective study setting, IVC size was measured with ultrasound for patients whose CVP was measured in the emergency department. IVC size of healthy applicants was measured. RESULTS: The healthy group included 100 people: 68 men and 32 women. The average IVC size of men was 1.8+/-0.4 cm and that of women was 1.8+/-0.3 cm. For collapsibility, men were 0.28+/-0.14 and women were 0.23+/-0.14, thus there was no statistical difference in size and collapsibility between men and women. The patient group included 51 people, average age was 59.9+/-18.5, and 28 (54.9%) were men. This group showed a significant negative correlation between CVP and collapsibility. IVC Max was 1.7+/-0.5 cm, IVC Min was 1.2+/-0.5 cm, median collapsibility was 0.26 (0.15-0.38), mean lactate was 6.4+/-4.4 mmol/L, and median CVP was 10.0 (1.0-14.5) cmH2O. CONCLUSION: IVC collapsibility can be used as a reference measure, or even instead of CVP in certain cases.

Effects of Adenosine after Instruction of Injection in Patients with Paroxysmal Supraventricular Tachycardia Presented to the Emergency Department

PURPOSE: There are many cases of paroxysmal supraventricular tachycardia (PSVT) presenting to the emergency department (ED) with palpitation as the presenting symptom. Adenosine is usually administered for conversion to normal sinus rhythm, with a possible second dose in the case of no response. As adenosine has a short acting time, administration of the drug at a vessel as close to the heart as possible is recommended, followed by an extra normal saline bolus infusion. In this study, we hypothesized a better outcome when adenosine was administered after proper injection method instruction was given to the medical staff. METHODS: We retrospectively studied the population of PSVT patients treated with adenosine. The cases were divided into two groups: one group consisted of cases a year before instruction for adenosine use became routine practice, and the second was comprised of cases a year after instruction protocols had been put into place. We further analyzed the proportion of patients who converted to normal sinus rhythm after a single dose of adenosine. RESULTS: All 306 patients were included. Before instruction, 46 patients (40.0% of 115) converted to normal sinus rhythm after the first dose. After instruction, 108 patients (56.5% of 191) converted to normal sinus rhythm after the first dose, which was statistically significant (p<0.05). CONCLUSION: After receiving proper education, more patients converted to normal sinus rhythm after the first dose. Instruction for proper adenosine injection technique for PSVT cases can increase the success rate of rhythm conversion on the first attempt.

Association of COL2A1 Gene Polymorphism with Degenerative Lumbar Scoliosis

BACKGROUND: Degenerative lumbar scoliosis (DLS) progresses with aging after 50-60 years, and the genetic association of DLS remains largely unclear. In this study, the genetic association between collagen type II alpha 1 (COL2A1) gene and DLS was investigated. METHODS: COL2A1 gene polymorphism was investigated in DLS subjects compared to healthy controls to investigate the possibility of its association with COL2A1 gene. Based on a single nucleotide polymorphism (SNP) database, SNP (rs2276454) in COL2A1 were selected and genotyped using direct sequencing in 51 patients with DLS and 235 healthy controls. The SNP effects were analyzed using three models of codominant, dominant, and recessive. Logistic regression models were calculated for odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values, controlling age and gender as co-variables. RESULTS: SNP (rs2276454) in COL2A1 was significantly associated with the degenerative lumbar scoliosis in the codominant (OR, 1.90; 95% CI, 1.17 to 3.10; p = 0.008) and dominant models (OR, 3.58; 95% CI, 1.59 to 9.29; p = 0.001). CONCLUSIONS: The results suggest that COL2A1 is associated with the risk of DLS in Korean population.

Comparative Analysis of Acute Toxic Poisoning in 2003 and 2011: Analysis of 3 Academic Hospitals

Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 +/- 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.

Prediction of Massive Blood Transfusion at Emergency Department in Non-trauma Patients / 대한수혈학회지

BACKGROUND: Many patients received transfusion in emergency department because of blood loss. There are few studies on massive transfusion for non-traumatic patients. This study investigated mortality and risk factor for non-traumatic bleeding patients who received transfusion. METHODS: Non-trauma patients who received transfusion at the emergency department for 3 years from March 2009 to February 2011 were enrolled. The patients who are younger than 15 years, trauma patients, and transfused FFP or platelet alone are excluded. Medical records was investigated retrospectively. We investigated predictive factors for MT on non-trauma patients and predictive factors for mortality on MT patients. RESULTS: Among 1655 non-trauma patients, 150 patients (9.24%) received MT. The age of MT group was younger than that of non-MT group and systolic bloor pressure, diastolic blood pressure, mean arterial pressure were significantly lower. Base excess, pH, lactate levels were significantly different between MT and non-MT group. Intensive care unit length of stay was longer, mortality of 24 hours was higher and survival discharge was lower than non-MT group. Mortality rate of MT group was 20.7% which was significantly higher than non-MT group's 9.3%. FFP:RBC ratio was higher in MT group than non-MT group. Among the MT group, non-survival group used higher FFP:RBC ratio product than survival group. On multivariate analysis, sBP, MAP, lactate, pH, BE were significant as predictors of MT. CONCLUSION: For non-trauma patients in emergency department, if sBP, MAP, lactate, pH, BE are abnormal, massive transfusion could be expected. Like trauma patients, basic scoring system that can predict MT would be necessary and useful.