Graph Theoretical Analysis of Brain Structural Connectivity in Patients with Alcohol Dependence

This study aimed to compare brain structural connectivity using graph theory between patients with alcohol dependence and social drinkers. The participants were divided into two groups; the alcohol group (N=23) consisting of patients who had been hospitalized and had abstained from alcohol for at least three months and the control group (N=22) recruited through advertisements and were social drinkers. All participants were evaluated using 3T magnetic resonance imaging. A total of 1000 repeated whole-brain tractographies with random parameters were performed using DSI Studio. Four hundred functionally defined cortical regions of interest (ROIs) were parcellated using FreeSurfer based on the Schaefer Atlas.The ROIs were overlaid on the tractography results to generate 1000 structural connectivity matrices per person, and 1000 matrices were averaged into a single matrix per subject. Graph analysis was performed through igraph R package. Graph measures were compared between the two groups using analysis of covariance, considering the effects of age and smoking pack years. The alcohol group showed lower local efficiency than the control group in the whole-brain (F=5.824, p=0.020), somato-motor (F=5.963, p=0.019), and default mode networks (F=4.422, p=0.042). The alcohol group showed a lower global efficiency (F=5.736, p=0.021) in the control network. The transitivity of the alcohol group in the dorsal attention network was higher than that of the control (F=4.257, p=0.046). Our results imply that structural stability of the whole-brain network is affected in patients with alcohol dependence, which can lead to ineffective information processing in cases of local node failure.

Disparities in All-cancer and Lung Cancer Survival by Social, Behavioral, and Health Status Characteristics in the United States: A Longitudinal Follow-up of the 1997-2015 National Health Interview Survey-National Death Index Record Linkage Study

Most research on cancer patient survival uses registry-based (e.g., SEER) incidence and survival data that have limited socioeconomic status and health-risk information. In this study, we used the 1997-2015 National Health Interview Survey-National Death Index prospectively-linked pooled cohort database (n = 40,291 cancer patients) to examine disparities in patient survival by a broad range of social determinants, including race/ethnicity, nativity, educational attainment, income/poverty level, occupation, housing tenure, physical and mental health status, smoking, physical activity, body mass index, and alcohol consumption. We used Cox proportional hazards models to estimate mortality hazard ratios and cause-specific 1-year, 5-year, and 10-year survival rates for all-cancer and lung cancer. During 1997-2015, the 10-year age-adjusted (all-cause) survival rate for cancer patients with professional and managerial occupations was 89.66%, significantly higher than the survival rate of 83.17% for laborers or 83.66% for the unemployed. Cancer patients with renting house had significantly lower age-adjusted survival rates than those owning house (82.65% vs. 85.80%). The 10-year age-adjusted survival rates were significantly greater among cancer patients with regular physical activity than those without regular physical activity (90.18% vs. 83.24%). Age-adjusted survival rates were significantly reduced for cancer patients with lower income and education, poor health, and serious psychological distress, and among current and former smokers. The gap in survival narrowed with additional sociodemographic, health, or behavioral adjustment. Similarly large differentials were found in lung cancer survival. Marked disparities in all-cancer and lung cancer survival were found by a wide range of sociodemographic and health characteristics.

The relationship between metabolic syndrome and the incidence of colorectal cancer

OBJECTIVES@#This study evaluated the incidence of colorectal cancer (CRC) according to the number of metabolic syndrome (MetS) components.@*METHODS@#Using health checkup and insurance claims data of 6,365,409 subjects, the occurrence of CRC according to stage of MetS by sex was determined from the date of the health checkup in 2009 until December 31, 2018.@*RESULTS@#Cumulative incidence rates (CIR) of CRC in men and women was 3.9 and 2.8 per 1000 (p < 0.001), respectively. CIR of CRC for the normal, pre-MetS, and MetS groups in men was 2.6, 3.9, and 5.5 per 1000 (p < 0.001) and CIR in women was 2.1, 2.9, and 4.5 per 1000 (p < 0.001), respectively. Compared with the normal group, the hazard ratio (HR) of CRC for the pre-MetS group was 1.25 (95% CI 1.17-1.33) in men and 1.09 (95% CI 1.02-1.17) in women, and the HR of CRC for the MetS group was 1.54 (95% CI 1.43-1.65) in men and 1.39 (95% CI 1.26-1.53) in women after adjustment.@*CONCLUSIONS@#We found that MetS is a risk factor for CRC in this study. Therefore, the prevention and active management of MetS would contribute to the prevention of CRC.

Development of Lower Extremity Lymphedema Nursing Practice Protocol for Patients Following Gynecologic Cancer Treatment

PURPOSE: This study aimed to develop and evaluate the lower extremity lymphedema nursing practice protocol for patients following gynecologic cancer treatment. METHODS: Thirteen web-sites were searched for eligible clinical practice guidelines (CPGs) and eleven databases were searched to identify evidence to develop a lower extremity lymphedema nursing practice protocol for patients following gynecologic cancer treatment. RESULTS: Based on the inclusion and exclusion criteria, eight CPGs and ninety-six studies, two guidelines and eight studies were identified as evidence. The protocol development group consisted of ten experts who have at least five years' experience in the related area. A lower extremity lymphedema nursing practice protocol for patients following gynecologic cancer treatment was developed including forty-three recommendations in five domains. Significant differences were found in nurses' pre and post knowledge and confidence on lower extremity lymphedema prevention and management. CONCLUSION: Nurses and other professionals could utilize this evidence based lower extremity lymphedema nursing practice protocol and apply it to patients undergoing gynecologic cancer treatment.

The Recognition Capability of Cardiac Arrest for Lay Person, Nurse and Dispatcher: A Comparison Study through the Video Question

PURPOSE: The rapid recognition of cardiac arrest is an important factor for survival in cardiac arrest patients, and gasping is a primary barrier to the recognition of a cardiac arrest. This study examined differences in capability of recognizing a cardiac arrest and gasping among lay people, hospital nurses, and medical dispatchers. METHODS: From January to July 2016, 193 participants (65 lay people 62 hospital nurses, and 66 medical dispatchers) watched video clips of a collapsed virtual patient with unresponsiveness, gasping or seizure and answered a questionnaire asking whether the patient was in cardiac arrest or not. The results of the questionnaire were analyzed and compared among the groups. RESULTS: The total score of the questionnaire on the determination of cardiac arrest among lay people, nurses, and medical dispatchers were significant (3.09±1.43 vs. 4.15±1.22 vs. 4.45±1.29 points, p < 0.01). In the questions regarding cardiac arrest with gasping, the correct answer rate was highest in the dispatchers, followed in order by nurses and lay people (82.5% vs. 54.8% vs. 29.7%, p < 0.001). CONCLUSION: In this study, lay people had the lowest recognition capability of a cardiac arrest and gasping among the groups. In addition, gasping is a meaningful barrier to cardiac arrest recognition for both lay people and healthcare providers.

Validation of the finger counting method using the Monte Carlo simulation

PURPOSE: The dose of drug and the size of instrument are determined based on children's weight. We aimed to validate the finger counting method (FCM) for weight estimation in Korean children using the Monte Carlo simulation. METHODS: We estimated the weight of Korean children aged 1 to 9 years by the FCM. These measurements were compared with the weight extracted by the Monte Carlo simulation applied to the “2007 Korean Children and Adolescents Growth Standard”. Pearson correlation coefficients (r) were measured to assess the correlation between the weight extracted by the simulation and that estimated by FCM. Bland-Altman analyses were performed to assess the agreement between the weight extracted by the simulation and that estimated by FCM and 2 other well-known pediatric weight estimation formulas (the Advanced Pediatric Life Support and Luscombe formulas). RESULTS: Data regarding 9,000 children's weight selected by age and gender was randomly extracted using the simulation. We found a positive correlation between the weight estimated by the FCM and the weight extracted (in boys, r = 0.896, P < 0.001; in girls, r = 0.899, P < 0.001). The FCM tended to underestimate weight in the children aged 7 years or old. CONCLUSION: This article suggests the usefulness of FCM in weight estimation, particularly in children younger than 7 years. With appreciation of the limitation in older children, the FCM could be applied to emergency practice.

The Influence of Vertical Location of Cardiac Arrest and Application of Mechanical Cardiopulmonary Resuscitation Device on out of Hospital Cardiac Arrest in a Community: A Retrospective Observational Study

PURPOSE: The use of mechanical compression devices may be considered as an alternative method to treat cardiac arrest. This study aimed to assess the influence of vertical location of cardiac arrest scene to survival rate. Furthermore, it set out to examine the effect of mechanical compression devices on the survival rate. METHODS: This is retrospective, observational study of cardiac arrest patients from Gangdong-gu, Seoul between September 2015 and February 2016. The data were collected by 119 rescue records and cardiac arrest summary list, and the resuscitation result variables were analyzed. We also conducted a survey on 119 paramedics regarding the subjective valuation and drawback of using mechanical compression devices. RESULTS: The odd ratio of return of spontaneous circulation (ROSC) in vertical location of cardiac arrest scene was 0.40 (95% confidence interval, 0.17 to 0.98; p=0.044). The odd ratio of survival to admission comparing manual compression with mechanical compression was 0.73 (95% confidence interval, 0.26 to 1.99; p=0.532). A total of 54 paramedics completed the survey, and 46 (85.2%) of them answered that there was a decrease in the quality of chest compression if the scene was other than the 1st floor. Fifty-three (93.1%) replied that mechanical compression devices can be a counter-measure. CONCLUSION: Vertical location of cardiac arrest scene independently effects ROSC of out of hospital cardiac arrest. However, there was no difference in the survival rate between manual and mechanical compressions.

Optimal effect-site concentration of remifentanil when combined with dexmedetomidine in patients undergoing cystoscopy / 대한마취과학회지

BACKGROUND: Cystoscopic procedure is a very common practice in the field of urology due to its ability to survey the bladder for a variety of indications. However, patients who undergo cystoscopy feel intense pain and discomfort. This study investigated the half maximal effective concentration (EC50) of remifentanil in preventing cystoscope insertion pain under sedation using dexmedetomidine. METHODS: The study was prospectively conducted on 18 male patients, aged 18 to 65. Remifentail infusion was initiated together with dexmedetomidine, and started at a dose of 2.4 ng/ml on the first patient. The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml. Patients received a loading dose of 1.0 microg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.6 microg/kg/hr. After the patient's OAA/S score (Observer's Assessment of Alertness/Sedation scale) reached 3-4, and the Ce of remifentanil reached target concentration, the urologist was allowed to insert the cystoscope and the pain responses were observed. RESULTS: The effect-site concentration of remifentanil required to prevent cystoscope insertion pain in 50% of patients under sedation using dexmedetomidine was 1.30 +/- 0.12 ng/ml by Dixon's up-and-down method. The logistic regression curve of the probability of response showed that the EC50 and EC95 values (95% confidence limits) of remifentanil were 1.33 ng/ml (1.12-1.52 ng/ml) and 1.58 ng/ml (1.44-2.48 ng/ml), respectively. CONCLUSIONS: Cystoscopic procedure can be carried out successfully without any pain or adverse effects by optimal remifentanil effect-site concentration (EC50, 1.33 ng/ml; EC95, 1.58 ng/ ml) combined with sedation using dexmedetomidine.

Anesthesiologist's satisfaction using between cisatracurium and rocuronium for the intubation in the anesthesia induced by remifentanil and propofol / 대한마취과학회지

BACKGROUND: Although cisatracurium has many advantages in anesthetic practices, the best choice of a nondepolarizing neuromuscular blocking agent that can replace succinylcholine is rocuronium. However, it is reported that remifentanil with propofol might provide reliable intubating condition, even without a neuromuscular blocking agent; therefore, it might improve the intubating condition with cisatracurium. This study examined intubating conditions after administering rocuronium or cisatracurium in a rapid sequence induction with remifentanil-propofol. METHODS: Fifty two ASA physical status 1 or 2 adult patients scheduled for an elective surgery were enrolled in a randomized double-blinded trial. Anesthesia was induced in all patients with propofol 2.0 mg/kg and remifentanil 0.5 microgram/kg, administered over 60 seconds. Rocuronium 0.9 mg/kg (3 x ED95, R group, n = 23) or cisatracurium 0.15 mg/kg (3 x ED95, C group, n = 29) was administered after the induction sequence. Laryngoscopy was attempted when the anesthesiologist thought it was 90 seconds after drug administration and appropriate time for intubation. The examiner, another anesthesiologist, recorded the exact time to intubation and suppression of maximal T1 on TOF. The intubating condition was assessed by the first anesthesiologist, as excellent, good, poor or not possible. RESULTS: The best time to laryngoscopy was predicted by measuring TOF and was found to be significantly longer in the C group (197 +/- 53 s) than in the R group (102 +/- 49 s) (P value < 0.05). However, time to larygoscopy, intubating condition during the laryngoscopy, and hemodynamic changes after intubation was similar in both groups. CONCLUSIONS: Despite fundamentally slower onset time, cisatracurium can provide quite good intubating conditions, which were comparable to those achieved with equipotent doses of rocuronium, which is more expensive in anesthesia inducted with remifentanil and propofol.

The Association of Nurse Staffing Levels and Patient Outcome in Intensive Care Units / 대한구급학회지

Nurses play a crucial role in providing high-quality care in intensive care units (ICU). Previous studies have shown an association between nurse staffing levels and outcome of critically ill patients. Increasing nurse staffing levels in ICU has been recommended to improve the outcome of critically ill patients. However, nursing staff shortages associated with decreased budgets may prevent adequate nurse-to-patient ratios although there lies increasing needs for critical care. Several studies have suggested that higher nurse staffing level is associated with favorable patient outcome, including mortality, length of stay, and infections, but some of studies did not find an association between nurse staffing and patient outcome. Although there are some controversies in the associations between nurse staffing levels and patient outcome, it is difficult to apply such effect as compared with other developed countries in North American and Europe as the nurse-to-patient ratio in Korea's ICU is relatively low. By studying the nurse staffing effects for patient outcome from the Korea ICU, it is found that higher nurse staffing level is associated with improved patient mortality. This finding may suggest that a shortage of nursing staff is currently a serious issue for caring of critically ill patients in Korea.