Impact of Diabetes Control on Subclinical Atherosclerosis: Analysis from Coronary Computed Tomographic Angiography Registry

Background@#There are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis. @*Methods@#We analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively. @*Results@#Compared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; p=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; p=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; p<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; p<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (p=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (p=0.023). @*Conclusion@#Asymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.

The experience of infection prevention for coronavirus disease 2019 (COVID-19) during general anesthesia in an epidemic of COVID-19: including unexpected exposure case- Two cases report -

Background@# Coronavirus disease 2019 (COVID-19) has been an epidemic in the Republic of Korea since the first patient who came in China was confirmed as having the disease on January 19, 2020. Therefore, surgery for COVID-19-related patients is expected to increase.Case: We experienced two cases of COVID-19-related patients who underwent surgery for femur fracture under general anesthesia. In one case, infection control to prevent transmission was achieved, while in the second case, healthcare workers were exposed to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). @*Conclusions@#In areas where there is COVID-19 epidemic, SARS-CoV-2 RT-PCR should be performed before surgery in patients with symptoms of respiratory infection such as fever, cough, and sputum, or for those in whom the possibility of COVID-19 cannot be completely excluded. Efforts should be made to prevent healthcare worker’s exposure and the contamination of the operating room.

Recent Seroprevalence of Anti-hepatitis A IgG in the Korean Population: a Large, Population-based Study

Background@#Because there is limited recent information on this topic, this study investigated the seroprevalence of anti-hepatitis A virus (HAV) immunoglobulin G (IgG) in the South Korean population in 2015–2017. @*Methods@#Anti-HAV IgG seroprevalence data were obtained from the laboratory information system of Green Cross Laboratories, one of the largest referral laboratories in South Korea. @*Results@#During the three-year study period, we obtained test results from 240,840 individuals (124,353 men and 116,487 women) from 1,348 hospitals and local clinics throughout South Korea. The median (range) age of subjects was 38.0 (18.0–97.2) years. The annual seroprevalence of anti-HAV IgG was 53.3%, 53.0%, and 53.1% in 2015, 2016, and 2017, respectively. The median age differed among geographic regions and anti-HAV seroprevalence differed among age groups and geographic regions (P1.0, P<0.05). @*Conclusions@#This study provides basic information about the recent seroprevalence of anti-HAV IgG in the Korean population and contributes to identifying groups at high risk of an HAV epidemic.

Effectiveness and Safety of Zotarolimus-Eluting Stent (Resolute™ Integrity) in Patients with Diffuse Long Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. METHODS: From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. RESULTS: Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. CONCLUSIONS: Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.

Effectiveness and Safety of Zotarolimus-Eluting Stent (Resoluteâ„¢ Integrity) in Patients with Diffuse Long Coronary Artery Disease

BACKGROUND AND OBJECTIVES@#Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD.@*METHODS@#From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months.@*RESULTS@#Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE.@*CONCLUSIONS@#Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.

Report on the External Quality Assessment Scheme of Serologic Tests for Syphilis in Korea (2016–2017)

The 2016–2017 surveys on the external quality assessment scheme for serologic tests for syphilis in Korea were conducted by the Korean Association of External Quality Assessment Service. Proficiency testing (PT) panels consisting of three pooled serum samples were shipped to 430 and 432 laboratories participating in the program in the 1st and 2nd trials of 2016 and 465 and 503 laboratories in the 1st and 2nd trials of 2017, respectively. The rates of returning results were 94.2% and 50.2% for non-treponemal and treponemal tests, respectively, in the 1st trial of 2016; 94.7% and 49.5% in the 2nd trial of 2016; 94.2% and 49.5% in the 1st trial of 2017; and 92.8% and 48.7% in the 2nd trial of 2017, respectively. The most commonly used methods for non-treponemal tests were rapid plasma reagin (RPR) card test, followed by RPR turbidoimmunoassay and venereal disease research laboratory tests. The most commonly used methods for treponemal tests were Treponema pallidum particle agglutination, followed by immunochromatographic assay, Treponema pallidum latex agglutination, chemiluminescence immunoassay, and fluorescent treponemal antibody-absorption. The accuracy rates of the 2017 PT for non-treponemal and treponemal tests were 92.5%–99.8% and 93.3%–100.0%, respectively, which were significantly lower compared to the 98.4%–100.0% and 97.0%–100.0% in 2016. A possible explanation for the lower accuracy rates in the 2017 PT survey is the matrix effect caused by pooling multiple individual serum samples. These data suggest that pooling of serum samples obtained from a small number of donors may help avoid the matrix effect affecting standard materials used for syphilis serology PT.

Harmonization of laboratory results by data adjustment in multicenter clinical trials

BACKGROUND/AIMS: In multicenter clinical trials, laboratory tests are performed in the laboratory of each center, mostly using different measuring methodologies. The purpose of this study was to evaluate coefficients of variation (CVs) of laboratory results produced by various measuring methods and to determine whether mathematical data adjustment could achieve harmonization between the methods. METHODS: We chose 10 clinical laboratories, including Green Cross Laboratories (GC Labs), the central laboratory, for the measurement of total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum triglycerides, creatinine, and glucose. The serum panels made with patient samples referred to GC Labs were sent to the other laboratories. Twenty serum samples for each analyte were prepared, sent frozen, and analyzed by each participating laboratory. RESULTS: All methods used by participating laboratories for the six analytes had traceability by reference materials and methods. When the results from the nine laboratories were compared with those from GC Labs, the mean CVs for total cholesterol, HDL-C, LDL-C, and glucose analyzed using the same method were 1.7%, 3.7%, 4.3%, and 1.7%, respectively; and those for triglycerides and creatinine analyzed using two different methods were 4.5% and 4.48%, respectively. After adjusting data using Deming regression, the mean CV were 0.7%, 1.4%, 1.8%, 1.4%, 1.6%, and 0.8% for total cholesterol, HDL-C, LDL-C, triglyceride, creatinine, and glucose, respectively. CONCLUSIONS: We found that more comparable results can be produced by laboratory data harmonization using commutable samples. Therefore, harmonization efforts should be undertaken in multicenter trials for accurate data analysis (CRIS number; KCT0001235).

Sigma-Metrics of Electrolyte Tests From a Recently Launched New-Generation Proficiency Testing Program of the Korean Association of Quality Assurance for Clinical Laboratory

No abstract available.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

Propacetamol as an alternative of ketorolac for postoperative pain management using patient-controlled analgesia

BACKGROUND: The objective of this study was to examine effect of propacetamol in comparison with ketorolac in intravenous patient-controlled analgesia after gynecologic surgeries. METHODS: Patients aged 18 to 70 years and undergoing laparoscopic gynecologic surgeries were selected. They were randomly allocated to either group K (180 mg of ketorolac with fentanyl and ramosetron) or group P (10 g of propacetamol with fentanyl and ramosetron). Their vital signs and visual analogue scale (VAS) were examined six times (0 min, 15 min, 30 min, 60 min, 12 h, and 24 h) and laboratory workup was done 48 hours after PCA application. Development of side effects was examined 15 minutes after the PCA application. Data from 111 patients were used for the final analysis. RESULTS: There were no significant differences in changes of systolic and diastolic blood pressures, heart rate, body temperature, and VAS between the groups (P = 0.325, 0.835, 0.346, 0.524, and 0.382, respectively). There were significant differences in the levels of hemoglobin, hematocrit, blood urea nitrogen, and international normalized ratio but it was not clinically meaningful. The development of vomiting, dizziness, and headache were not significantly different between the groups and no patient developed pruritus. Although the overall number of patients with nausea was higher in group P with statistical significance (P = 0.002), there were no significant differences between the groups when examined at each detection time. CONCLUSIONS: The present study suggested propacetamol as a possible alternative of ketorolac in postoperative care after laparoscopic gynecologic surgeries.

Increased amount of pleural effusion during head-down tilt position in ovarian cancer patient with ascites: A case report

Pseudo-Meigs syndrome is accompanied with pleural effusion, ascites and a benign or malignant tumor of ovary, tubes, uterus, round ligament or colon. We reported a case of hypoxia in an ovarian cancer patient with moderate ascites after head-down tilt position for central venous catheterization under general anesthesia. Massive pleural effusion was detected on portable chest X-ray, which was not observed in a preoperative radiologic test. The patient had no respiratory symptoms and breath sound was normal in both lungs prior to surgery. The pleural effusion was resolved by a chest tube insertion.

Dexmedetomidine combined with midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia / 대한마취과학회지

BACKGROUND: Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation. METHODS: Ninety patients classified as American Society of Anesthesiologists physical status I–II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused. RESULTS: At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively). CONCLUSIONS: Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia.

A Case of Perimembranous Ventricular Septal Defect Associated with Sinus of Valsalva Aneurysm Mimicking Membranous Septal Aneurysm

Sinus of Valsalva aneurysms are rare. Sinus of Valsalva aneurysms are frequently associated with ventricular septal defect (VSD) and aortic regurgitation. They often remain asymptomatic until abruptly presenting with acute chest pain and heart failure secondary to rupture. Here, we describe a case of 20-year-old man who presented with chest pain with a history of VSD. Initial work-up concluded that the patient had VSD associated membranous septal aneurysm. Four years later, the patient presented with symptoms of heart failure. Work-up showed that the ruptured sinus of Valsalva aneurysm was the cause of symptoms. Due to its close proximity to the aortic annulus, sinus of Valsalva aneurysm should be differentiated from membranous septal aneurysm.

Myofascial pain syndrome of gluteus minimus mimicking lumbar radiculitis: A case report

Myofascial pain syndrome (MPS) can be characterized by pain caused by trigger points (TrPs) and fascial constrictions. Patients with MPS of the gluteus minimus muscles often complain of symptoms such as hip pain, especially when standing up after sitting or lying on the affected side, limping, and pain radiating down to the lower extremities. A 24-year-old female patient presenting with motor and sensory impairments of both lower extremities was referred to our pain clinic after initially being diagnosed with lumbar radiculitis. Under the impression of MPS of the gluteus minimus muscles following through evaluation and physical examination of the patient, we performed trigger point injections under ultrasonography guidance on the myofascial TrPs. Dramatic improvement of the patient's symptoms was observed following this treatment, and she was discharged without any further remaining symptoms.

Effects of the Combination Herbal Extract on Working Memory and White Matter Integrity in Healthy Individuals with Subjective Memory Complaints : A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

OBJECTIVES: The combination extract of four kinds of herbs, Gastrodia elata, Liriope platyphylla, Dimocarpus longan, and Salvia miltiorrhiza, has shown to have memory improving effects in mice. The aim of this study was to investigate the efficacy and safety of the herbal mixture for improving working memory as well as microstructural changes in white matter integrity in individuals with subjective memory complaints. METHODS: Seventy-five individuals with subjective memory complaints were assigned to receive either placebo (n = 15) or herbal mixture (low-dose group, n = 30 and high-dose group, n = 30) supplementation in an 8-week, randomized, double-blind, placebo-controlled clinical trial. Changes in working memory performance and fractional anisotropy (FA) values reflecting white matter integrity from baseline to 8-week endpoint were assessed. RESULTS: The herbal mixture group showed an increase in working memory performance compared to the placebo group (p for interaction = 0.001). In addition, the herbal mixture group showed an increase in FA values in the temporo-parietal regions (corrected p < 0.05), which are crucially involved in working memory function and are among the most affected regions in patients with cognitive impairments. CONCLUSIONS: Findings from this study indicate that the herbal mixture may be a promising therapeutic option for individuals with subjective memory complaints.

Superior Mesenteric Artery Syndrome in Patient with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that causes progressive muscular weakness, severe weight loss, and ultimately death. Gastrostomy or nasogastric tube is beneficial for ALS patients with severe weight loss and dysphagia. However, the development of superior mesenteric artery (SMA) syndrome in ALS patients when the enteral feeding time is delayed is rarely reported. We report herein the first case of SMA syndrome in a Korean ALS patient who showed improvement after percutaneous endoscopic gastrojejunostomy(PEGJ).

Ultrasound-guided infraorbital alcohol neurolysis for intractable trigeminal neuralgia: A case report

Trigeminal neuralgia is a severe pain disorder characterized by recurrent paroxysms of unilateral facial pain that is typically lancinating or stabbing, and is activated by cutaneous stimulation. Trigeminal alcohol neurolysis is an accepted treatment for trigeminal neuralgia. However, injections of alcohol must be placed accurately because alcohol is highly toxic. In this study, infraorbital alcohol neurolysises were performed under an ultrasound guidance. Ultrasound imaging is a safe, simple and non-invasive modality. This imaging tool allows fine adjustment of the needle tip and direct observation of the injectate. Two patients suffering from trigeminal neuralgia were treated with ultrasound-guided trigeminal alcohol neurolysis. They showed favorable pain relief without any serious complications over the 5- and 7-month follow-up, respectively.

Antibodies to the Antiganglioside GD1b in a Guillain-Barre Syndrome Patient with Bilateral Cerebellar Lesions

No abstract available.

Coronary artery spasm following intravenous phenylephrine on a patient under general anesthesia with previously undiagnosed variant angina and successful treatment by nitroglycerin: A case report

Coronary artery spasm under general anesthesia induces interruption of blood flow of coronary arteries and can be detected by a sudden ST elevation on electrocardiogram, which may be followed by severe cardiovascular complications. We have experienced a case of a sudden ST elevation on a 52-year-old patient with no history of coronary artery diseases undergoing spine surgery under general anesthesia. Following administration of nitroglycerin, ST elevation returned to normal. Postoperative coronary angiogram showed positive on ergonovine provocation test and the patient was diagnosed as variant angina. Correlating with the results, we concluded that the ST elevation was probably due to coronary artery spasm. Although the definite mechanism of the coronary artery spasm is unclear. A-adrenergic stimulation by phenylephrine may have acted as a solitary factor or as one of many factors. Early administration of nitroglycerin and calcium channel blocker seems to be useful in treatment and prevention of recurrence.

Usefulness of additional polarized light irradiation for those treated with stellate ganglion block in sudden deafness

BACKGROUND: Both stellate ganglion block (SGB) and polarized light irradiation (Superlizer) have a tendency to increase blood flow. Increases in blood flow can be estimated indirectly by changes in tympanic membrane temperature. In this study, we sought to evaluate how simultaneous SGB and Superlizer treatment affects tympanic temperature and tympanic blood flow in individuals suffering from sudden deafness. METHODS: Among patients who visited the pain clinic complaining of sudden deafness, we divided them into two groups: one receiving only SGB; the other receiving both SGB and Superlizer treatment. By comparing the tympanic membrane temperature measurements of both groups on 10, 30, and 60 minutes after treatment through a prospective study, we intended to evaluate the effect of treatment with SGB and Superlizer. RESULTS: Temperature changes measured after the injection were statistically significant in both groups. Temperature changes of the tympanic membrane were greater in the group who received both SGB and Superlizer compared to the group receiving only SGB. CONCLUSIONS: The results suggest that SGB followed by Superlizer has effects on the amount of increase in tympanic membrane temperature. This seems to be attributed to the increase in blood circulation of the inner ear compared with the group receiving only SGB. We came to the conclusion that in sudden deafness patients, the use of SGB combined with polarized light irradiation appears to be more effective in the treatment of sudden deafness.