High-Sensitivity Troponin I Assay for DifferentialDiagnosis of New-Onset Myocardial Infarctionin Patients with Acute Decompensated Heart Failure

Purpose@#Acute decompensated heart failure (ADHF) caused by ischemic heart disease is associated with higher mortality and requires immediate diagnosis. Recently, novel methods to diagnose non-ST elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin have been applied. We compared the clinical utility of high-sensitivity troponin I (hS-TnI), delta troponin I, and other traditional methods to diagnose NSTEMI in patients with ADHF. @*Materials and Methods@#This retrospective cross-sectional study was conducted to analyze patients with ADHF who underwent hS-TnI evaluation of 0–2-h protocol in our emergency department. Patients were grouped according to a diagnosis of NSTEMI. @*Results@#A total of 524 ADHF [ADHF with NSTEMI, n=109 (20.8%)] patients were enrolled in this analysis. The mean values of hS-TnI (ng/mL) in the ADHF with and without NSTEMI groups were 2.44±5.60 and 0.25±0.91, respectively. Multivariable analysis revealed that regional wall-motion abnormality, T-wave inversion/hyperacute T wave, and initial and delta hS-TnI were predictive factors for NSTEMI. Laboratory values related to cardiac biomarkers, including hS-TnI [odds ratio (OR) (95% confidence interval, CI): 2.18], and the delta hS-TnI [OR (95% CI): 1.55] were significant predictors of NSTEMI. Moreover, receiver operating characteristic analysis showed that the areas under receiver operating characteristic curves for electrocardiographic abnormalities, initial hS-TnI, and delta hS-TnI were 0.794, 0.802, and 0.773, respectively. @*Conclusion@#For diagnosis of suspected NSTEMI in patients with ADHF, initial hS-TnI assay has similar predictive value as ischemic changes on electrocardiogram and superior predictive value than delta hS-TnI calculated by the 0–2-h protocol.

Analysis of the Impact of the Coronavirus Disease Epidemic on the Emergency Medical System in South Korea Using the Korean Triage and Acuity Scale

Purpose@#Severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has spread worldwide. Global health systems, including emergency medical systems, are suffering from a lack of medical resources. Using a method for classifying patients visiting the emergency department (ED), we aimed to investigate trends in emergency medical system usage during the COVID-19 epidemic in Korea. @*Materials and Methods@#This retrospective observational study included patients who visited emergency medical institutions registered with the National Emergency Department Information System database from January 1, 2017 to May 31, 2020. The primary outcome was identification of changes in the distribution of patients visiting the ED according to the type of emergency medical institution. The secondary outcome was a detailed comparison of Korean Triage and Acuity Scale (KTAS) levels and patient distributions before and during the infectious disaster crisis period. @*Results@#Severe patients visited regional emergency centers (RECs) and local emergency centers (LECs) more frequently during the COVID-19 period, and disposition status warranting admission to the intensive care unit or resulting in death was more common in RECs and LECs during the COVID-19 period [RECs, before COVID-19: 300686 (6.3%), during COVID-19: 33548 (8.0%) (p<0.001); LECs, before COVID-19: 373593 (3.7%), during COVID-19: 38873 (4.5%) (p<0.001)]. @*Conclusion@#During the COVID-19 period, severe patients were shifted to advanced emergency medical institutions, and the KTAS better reflected severe patients. Patient distribution according to the stage of emergency medical institution improved, and validation of the KTAS triage increased more in RECs.

Validation of a novel diagnostic nomogram for pulmonary thromboembolism in the emergency department

Objective@#Diagnosis of pulmonary thromboembolism (PTE) is essential for preventing serious complications in the emergency department (ED) or intensive care unit. Contrast computed tomography (CT) of the chest is used for confirming pulmonary embolism, but there is a low specificity and radiation- or contrast-related side effects. We developed a novel nomogram to facilitate decision-making for performing contrast CT of the chest in the ED. @*Methods@#A retrospective observational study was conducted to develop a prediction model of PTE. The prediction model was derived from demographic characteristics, clinical history data and results of laboratory tests, ultrasonography and echocardiography. A nomogram was constructed from the variables of the prediction model and validated. @*Results@#A total of 326 patients were analyzed (a training cohort, 260; a validation cohort, 66). Wells’ score, D-dimer level>1,100 ng/dL, positive McConnell’s sign and D-shaped left ventricle were associated with the occurrence of PTE. The overall predictive accuracy of the prediction model was 0.802 (0.748-0.849) (area under the curve with 95% confidence interval). The calibration plots for the probability of PTE showed good agreement between the nomogram prediction and actual probability among cohorts. @*Conclusion@#A novel nomogram using risk stratification, laboratory test and sonographic examination findings is a good screening tool for predicting PTE, and it can be helpful to decide whether an ED physician should perform a contrastenhanced chest CT in the ED.

Analysis of the Impact of the Coronavirus Disease Epidemic on the Emergency Medical System in South Korea Using the Korean Triage and Acuity Scale

Purpose@#Severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has spread worldwide. Global health systems, including emergency medical systems, are suffering from a lack of medical resources. Using a method for classifying patients visiting the emergency department (ED), we aimed to investigate trends in emergency medical system usage during the COVID-19 epidemic in Korea. @*Materials and Methods@#This retrospective observational study included patients who visited emergency medical institutions registered with the National Emergency Department Information System database from January 1, 2017 to May 31, 2020. The primary outcome was identification of changes in the distribution of patients visiting the ED according to the type of emergency medical institution. The secondary outcome was a detailed comparison of Korean Triage and Acuity Scale (KTAS) levels and patient distributions before and during the infectious disaster crisis period. @*Results@#Severe patients visited regional emergency centers (RECs) and local emergency centers (LECs) more frequently during the COVID-19 period, and disposition status warranting admission to the intensive care unit or resulting in death was more common in RECs and LECs during the COVID-19 period [RECs, before COVID-19: 300686 (6.3%), during COVID-19: 33548 (8.0%) (p<0.001); LECs, before COVID-19: 373593 (3.7%), during COVID-19: 38873 (4.5%) (p<0.001)]. @*Conclusion@#During the COVID-19 period, severe patients were shifted to advanced emergency medical institutions, and the KTAS better reflected severe patients. Patient distribution according to the stage of emergency medical institution improved, and validation of the KTAS triage increased more in RECs.

Betulinic acid lowers lipid accumulation in adipocytes through enhanced NCoA1-PPARγ interaction.

BACKGROUND: Investigation for a naturally occurring anti-obesity drug has become the need of society all over the world. Betulinic acid (BA) is a lupane-type pentacyclic triterpene and is sourced from various organisms. This high potential biologically active molecule is reported to have anti-obesity effect. In this study, we report the molecular mechanism of action of BA that underlies anti-obesity activity and also an improved method of its isolation common teak tree. METHODS: Mouse pre-adipocyte cells were used to develop hyperlipidemic conditions in vitro. Change in expression of genes associated to adipogenesis was checked using quantitative real-time PCR (qPCR). Co-factor specificity of PPAR gamma was analyzed through immune precipitation and immunoblot. RESULTS: Betulinic acid was found to be effective in reducing the lipid content in 3T3L1 cells. Level of PPAR gamma and LXR alpha was reduced in connection to reduced adipogenesis. Change in steroid responsive co-activators (SRCs) during BA treatment proved that the compound can impart profound change in co-factor selectivity, which is crucial in determining the activity profile of PPAR gamma. BA treatment enhanced the SRC-1 interaction with PPAR gamma while reducing the levels of SRC-3. CONCLUSION: Present study has proved that betulinic acid, a promising candidate in anti-obesity drug development, has potential in regulating the activity of PPAR gamma through co-factor modulation.

Comparison of Information between Domestic and International Web-Pages for E-Cigarettes: What Are the Differences between Naver and Google?

BACKGROUND: Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world. METHODS: We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes. RESULTS: There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%. CONCLUSIONS: We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

Comparison of Information between Domestic and International Web-Pages for E-Cigarettes: What Are the Differences between Naver and Google?

BACKGROUND@#Online health information can influence consumers to make informed decisions. There are conflicting messages online about health concerns on the use of e-cigarettes. We aimed to investigate differences in those messages through Naver and Google's English versions, which are the most representative portal sites in Korea and in the world.@*METHODS@#We reviewed the top 100 web pages related to health effects of e-cigarettes on Naver and Google in May 2018. Two medical doctors sorted the web pages into three groups as positive, negative, and mixed messages for e-cigarettes, as well as two groups based on the relative safety of conventional smoking versus e-cigarettes.@*RESULTS@#There were 10 and 27 positive, 65 and 45 negative, and 25 and 28 mixed messages on Naver and Google, respectively. There were 15 messages on Naver and 53 on Google that considered e-cigarettes safer than conventional cigarettes. The most frequent topics were toxicity (71%) and diseases (22%) on Naver. Google provides topics of health concerns for young people, including gateway effect (47%), diseases (35%), and toxicity (25%). Particularly, harm reduction which was not present on Naver, came up on Google as 24%.@*CONCLUSIONS@#We found that Naver provides more negative messages on e-cigarettes than does Google, which means that Koreans are exposed more to negative information on e-cigarettes than are foreign people who use Google. In future, more open discussions about harm reduction should be conducted to resolve the imbalance in information regarding health effects of e-cigarettes in Korea.

Is It Possible to Prove the Effect of Prenatal Education, 'Taegyo'?

OBJECTIVES: 'Taegyo,' prenatal education, is steeped into Korean culture. Although there has been a traditional focus on providing education and care for the fetus in Korea, there is a lack of medical evidence for its effectiveness. METHODS: The authors assessed the scientific basis for 'Taegyo' by reviewing the evidences. RESULTS: 'Taegyo' in Korea began with the spread of Buddhist culture from China, and transmitted by word-of-mouth. The first 'Taegyo' book, the Tae-gyo-shin-gi, was published on 1803. Modern prenatal education is very diverse. However, only a few studies on its effect have been conducted. Development of medicine, especially obstetrics, fetology, pediatrics, psychiatry, and etc., has learned that many factors, including bad environmental conditions and maternal stress, influenced against the fetus and mother. As for the paternal side, occupation, smoking, and stress were also revealed to have consequences for the development of the fetus. On the contrary, adequate maternal nutrition, exercise, and music stimulation positively impact the fetal development and healthy birth. CONCLUSION: Traditional contents of 'Taegyo' were proved to have effectiveness from evidence-based medicine and animal experiments. We need further studies to explore the impact of prenatal education for the fetal development and maternal health.

Distress of the Patients with Ostomy / 종양간호학회지

PURPOSE: The purpose of this study was to explore and describe the distress of the patients with ostomy. METHODS: A descriptive research design was adopted for data collection and analysis. Six patients with ostomy participated in the study. The consent from the participants was obtained for ethical protection. Data were collected from July 31, 2009 to January 10, 2010 using in-depth interview technique. Krippendorff's content analysis method was utilized for data analysis. RESULTS: Eight categories and 26 themes were extracted from the data which illustrated the lived distress of the patients with ostomy. The categories were "do not have any freedom to eat whatever I wish to eat", "uncontrolled defecation", "have to live through tough situation", "keep stoma in suspense", "disgusting ostomy", "can not live with comfort", "easily take a pessimistic view", and "see how the wind blows in daily family life". CONCLUSION: Ostomates were affected by the distress of having an ostomy in their physical, psychological, social and spiritual life. Individualized and continued nursing education program has to be developed in hospital and community settings in order to improve the quality of life of the ostomates.

The Effects of Indoor Air Quality on the Neurobehavioral Performance of Elementary School Children / 대한산업의학회지

OBJECTIVES: Most studies on the indoor air quality of newly built schools have focused only on the number of schools exceeding a standard or on subjective symptoms, such as sneezing, irritated eyes and an irritated nose. However, there has been no report on how poor indoor air quality affects children's academic performance. This study evaluated the effects of indoor air quality on the neurobehavioral performance of elementary school children. METHODS: This study measured the indoor air pollutants and compared children's performance, using a computerized neurobehavioral test, between a newly built and a 12-year-old school. In addition, a questionnaire was administered regarding the indoor air quality related symptoms of children in a newly built and a 12-year-old school. RESULTS: In the newly built school, the formaldehyde levels in the 1st and 4th classes with an open window were 34.6 and 27.3 microgram/m3, respectively. The levels in the 1st and 4th classes with the window closed were 80.2 and 127.1 microgram/m3, respectively. In the 12-year-old school, the formaldehyde levels in 1st and 4th class with open and closed window were 12.6 and 7.5 microgram/m3, and 19.8 and 25.2 microgram/m3, respectively. With respect to total volatile organic compounds, the levels in the 1st and 4th classes with the window open in the newly built school were 87.2 and 428.2 microgram/m3, respectively. In the 1st and 4th classes with the window closed, the total volatile organic compounds were 1,283.5 and 1,715.4 microgram/m3, respectively. In the 12-year-old school, the total volatile organic compounds were 240.9 and 150.8 microgram/m3, and 371.9 and 448.0 microgram/m3 in the 1st and 4th classes, respectively. In the case of a newly built school, the performance of the students in the neurobehavioral test in the 4th class with the window closed was 8.3% lower than for those in the 1st class with the window closed, but was only 5.9% lower when the windows were open. There was a statistical significant difference in the total numbers of symptoms between the two schools. CONCLUSIONS: These results suggest a proper evaluation of the indoor air quality within schools is required into both the level of contamination and the health effects of these contaminants toward children.

Expression Patterns of Tumor Related Proteins for Differential Diagnoses of Intrahepatic Adenocarcinomas

Background : Differential diagnoses of intrahepatic adenocarcinomas (IHAC) play an important role in the detecting primary sites and the determining type of treatment and overall prognosis of the patient. However, histopathologic findings alone have limitations of differential diagnoses of IHAC. Methods : To clarify which tumor related proteins (TRP) are useful for differential diagnoses of IHAC, TRP expression were investigated immunohistochemically, using MUC5AC, MUC2, mAb 91.9H, MUC1, and pS2, and by high iron diamine (HID) staining in 61 clinically confirmed IHACs. Results : MUC5AC (9/18, p0.05) displayed the most frequent expression in cholangiocarcinomas, and MUC2 (11/18, p0.05) was expressed more often in pancreatic adenocarcinomas than other IHAC, while MUC2 and 91.9H were not expressed at all in pancreatic adenocarcinomas. The positivity of several TRP did not correlate with tumor differentiation. Conclusions : MUC5AC, MUC2, mAb 91.9H, and HID may be useful in differentiating cholangiocarcinomas from colorectal adenocarcinomas.

A study on the limit of orthodontic treatment / 대한치과교정학회지

Information on the limits of treatment could allow for more rational treatment planning and better results after treatment. From this point of view, this article has attempted to discuss the limits of orthodontic tooth movement. A relatively wider range of tooth movement is expected after Class III surgical-orthodontics than after conventional orthodontic treatment in general. The purposes of this paper were: first, to evaluate the reliability of teeth position measuring gauge; and second, to elucidate the limits of orthodontic tooth movement. Dental casts of fifty-five subjects were analyzed by using Set-up model checker (InVisitec Co., Korea) before and after the Class III surgical-orthodontic treatment. The changes of maxillary and mandibular dental arch widths were also measured from the canines to the second molars. To test the inter-examiner reliability, randomly selected casts were measured by another examiner. Descriptive statistics and paired t tests were used to explain the tooth movement during treatment. The results showed a relatively good reliability of measuring instruments and a very diverse range of tooth movement. Collective changes by the orthodontic tooth movement evaluated in Class III surgical-orthodontics allowed for a suggestive interpretation of specific treatment patterns. Arch width changes during the inter-arch coordination were mainly the result of tipping in both buccal segments. Based on the results of this study, the possibility of a change in dentition as a result of orthodontic treatment should be understood in order to launch a well-organized plan of treatment.

A Case of Nonsurgical Treatment in Boerhaave's Syndrome Concomitantly Developed with Acute Pancreatitis / 대한소화기내시경학회지

Spontaneous rupture of the esophagus is an uncommon disease which was first reported by Boerhaave in 1724. This esophageal rupture usually occurs during nausea or vomiting, with incoordinate esophageal contraction. Early diagnosis and prompt surgical repair are critical for survival; however late recognition of esophageal rupture is not unusual. In recent years, a variety of nonsurgical approaches have been proposed, particularily in the case of delayed diagnosis. We have experienced one case of Boerhaave's syndrome concomitantly developed with acute pancreatitis which was successfully treated by nonsurgical measures including endoscopic clipping, antibiotics and hyperalimentation. We review the choice of treatment method in delayed diagnosed Boerhaave's syndrome.

A Case of Colonic Tuberculosis Cured by Secondary Anti - Tuberculosis Medicine / 대한소화기내시경학회지

Tuberculosis is common disease in developing countries manifested by multi-organ involvement. Although the incidence of tuberculosis has been reducing recently due to the advancement of anti-tuberculosis chemotherapy, improvement of public health, and early diagnosis, the rate is still higher in developing countries. The diagnasis of colonic tubcrculosis is difficult due to its frequency, vague manifestation, and difficulty in confirming the disease process. Fortunately, the advent of flexible colonoscopy has provided an opportunity to confirm the diagnosis of colonic tuberculosis, however biopsy can frequently leveal false negative results. A-27-year-old man was admitted with a 2 week history of rectal bleeding. He complained of anorexia, abdominal pain, and weight loss. Routine laboratory tests and chest X-ray findings were within normal limits, with the exception of left pleural thickening. A colonoscopy showed irregular and small, multiple, and shallow polypoid mucosal lesions in the ascending colon and multiple ulcers in the transverse colon. Multiple colonic biopsies suggested tuberculosis. After three months of prirnary anti-tuberculosis medica tion, the patient showed slightly improved coiono- scopic findings. Follow-up colono- scopic findings revealed more aggrevation and chest X-ray findings showed multiple patch consolidation in the left lung field. Primary anti-tuberculosis medication was stopped and substituted for secondary anti-tuberculosis medication. When clinical and colonoscopic methods are found to be compatible with intestinal tuberculosis in countries with a high prevalence of colonic tuberculosis, a therapeutic trial with an antituberculosis agent is usually considered. In a failed therapeutic trial, considerations must be made not only to other inflammatory bowel diseases such as crohn's disease, but also to multi-drug resistance tuberculosis.

A Study of Antimicrobial Sensitivity to Isolated Bacteria in Ulsan

No abstract available.

A Case of Esophageal Perforation during Endoscopic Variceal Ligation / 대한소화기내시경학회지

Endoscopic variceal ligation(EVL) was developed to provide a safer alternative than injection sclerotherapy for treatment of bleeding esophageal varices. EVL adds a new indication that will significantly increase the use of overtubes. overtube itself may have a role in predisposing to esophageal perforation but only one report has been published regarding an esophageal perforation related to the placement of an overtube. Recently, we experienced a case of esophageal perforation caused by overtube placement during endoscopic variceal ligation. So we report this case with review of relevant literatures.

A Case of Biliary Mucinous Cystadenocarcinoma / 대한소화기내시경학회지

Biliary cystadenoma and cystadenocarcinoma are rare tumors which have a good prognosis after complete surgical removal. Correct pre-operative diagnosis depends on the imaging characteristics of the tumors. Computed tomography, Ultrasono-graphy, angiography and cholangiogram are useful diagnostic procedure in biliary cystic tumor but definite diagnosis cannot be made without histologic diagnosis. Before the surgery, cholangioscopy is necessary for deciding operation field. The prognosis of the biliary cystic tumor seems to be much better than that of other solid hepatic tumors. If there is no evidence of metastasis, complete resection of these tumors is, therefore, necessary for these possibly curable disease. Recently, we experienced a 60-year-old woman complained of jaundice and generalized itching sensation, which was diagnosed as biliary mucinous cystadenocarcinoma. We decided operation field by cholangioscopy, and performed left hepatic lobectomy and T-tube choledochojejunostomy. So, we report this case with a review of relevant literature.