• Journal of Korean Neurosurgical Society
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• 제66권6호
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• pp.618-631
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• 2023

The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population.

• Korean Journal of Radiology
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• 제22권7호
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• pp.1213-1224
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• 2021

Objective: To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables. Materials and Methods: Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists. Results: Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively. Conclusion: CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.

• Journal of Yeungnam Medical Science
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• 제38권1호
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• pp.27-33
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• 2021

The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.

• 동서간호학연구지
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• 제25권2호
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• pp.183-192
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• 2019

Purpose: This study aimed to examine the mediating effect of illness perception on the relationship between family function and health behavior of patients with risk factors for metabolic syndrome. Methods: This is a cross-sectional correlational study. Data were collected from 160 patients using self-administered questionnaires including the Illness Perception Questionnaire-Revised, Family APGAR, and the Health Behavior Scale. The data were analyzed using Pearson's correlation coefficients, independent t-test and multiple linear regression analysis by the SPSS 23.0 program. Results: Health behavior was significantly correlated with family function (r=.30, p<.001) and illness perception of controllability by treatment (r=-.21, p=.007). Family function was a significant predictor of health behavior and illness perception, and the influence of family function on health behavior was partially mediated by illness perception of controllability by treatment. Conclusion: The findings of this study indicate that family function is a critical factor affecting health behavior and illness perception, and illness perception of controllability by treatment mediates the influence of family function on health behavior. It is necessary to develop a psycho-cognitive intervention program for enhancing supportive family function and for modifying negative illness perceptions to improve health behavior in patients with risk factors for metabolic syndrome.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.71-80
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• 2018

Nutritional assessment and support are often overlooked in the critically ill due to other urgent priorities. Unlike oxygenation, organ dysfunction, infection, or consciousness, there is no consensus of indicators. Making it difficult to evaluate the effectiveness of an intervention. Nevertheless, appropriate nutritional support in the critically ill has been associated with less morbidity and lower mortality. But, nutritional support has been considered an adjunct, for body weight maintenance and to help patients during the inflammatory phase of illness. Thus, it has been assigned a lower priority, compared to mechanical ventilation or hemodynamic stability. Recent findings have shown that nutritional support may prevent cellular injury due to oxidative stress and help strengthen the immune response. Large-scale randomized trials and clinical guidelines have shown a shift from nutritional support to nutritional therapy, with an emphasis on the importance of protein, minerals, vitamins, and trace elements. Nutrition is also important in neurocritically ill patients. Since there are few studies or recommendations with regard to the neurocritical population, the general recommendations for nutritional support should be applied.

• 보험의학회지
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• 제21권
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• pp.89-106
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• 2002

• 보험의학회지
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• 제21권
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• pp.107-119
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• 2002

• Journal of Chest Surgery
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• 제51권2호
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• pp.109-113
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• 2018

Background: Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment. Methods: We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014. CIRCI was diagnosed by a change in serum cortisol of <$9{\mu}g/dL$ after the ACTH test or a random cortisol level of <$10{\mu}g/dL$. Results: Twenty of the 28 patients met the diagnostic criteria. The patients with CIRCI showed higher Sequential Organ Failure Assessment (SOFA) scores than those without CIRCI ($16.1{\pm}2.3$ vs. $11.4{\pm}3.5$, p=0.001). Six of the patients with CIRCI (30%) received glucocorticoids. With an average elevation of the mean blood pressure by $22.2{\pm}8.7mm\;Hg$ after steroid therapy, the duration of inotropic support was shorter in the steroid group than in the non-steroid group ($14.1{\pm}2.3days$ versus $30{\pm}22.8days$, p=0.001). Three infections (15%) developed in the non-steroid group, but this was not a significant between-group difference. Conclusion: CIRCI should be suspected in patients with LCOS after cardiac surgery, especially in patients with a high SOFA score. Glucocorticoid replacement therapy may be considered to reduce the use of inotropes without posing an additional risk of infection.

• Preventive Nutrition and Food Science
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• 제10권1호
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• pp.68-73
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• 2005

A significant number of cases of illness has been attributed to food consumption in restaurants, and as the number of meals eaten away from home continues to rise, the potential for large-scale, foodborne illness outbreaks will continue to increase. It is critical that hospitality and culinary arts students preparing for careers as professionals in foodservice establishments or restaurants have an appropriate understanding of food safety. The level of food safety knowledge was similar between hospitality and culinary arts students, and an analysis of 266 questionnaires indicated that specific areas, such as hand washing, cross contamination in refrigerator, reheating leftovers, refrigeration of cooked food within two hours, proper temperature of food storage, using of thermometers to monitor temperatures, proper egg handling, and possible food borne illness caused by fruits, should be the primary focus of educational resources. Student respondents showed a higher awareness level of responsibility in their roles for food safety, but more emphasis needs to be given to the correct understanding of food safety issues. Hospitality and culinary arts educators can use this precise information to develop food safety education materials and programs to assist in the prevention of foodborne illness and to knowledgeably educate their graduates about food safety.

• 유통과학연구
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• 제14권7호
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• pp.21-31
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• 2016

Purpose - With globalization, medical tourism has developed as a new industry, which attracts practitioners and academics to have more interest in researches on customers' behavior. This research was to investigate empirically WOM effects on the intention of Chinese customers when they select an international medical tourism destination. Interestingly, WOM effects on their choice and decision process may vary by the extent of their severity of illness. Research design, data, and methodology - The data was collected from 1,747 potential Chinese residents in main districts of China. Moderated regression analysis was used to estimate WOM effects on Chinese customers' choice intention. Results - Results imply that WOM determinants of tie strength, credibility, and vividness do interact with medical tourism information and affect customers' intention for health care abroad. Results also reveal that the severity of illness plays a critical moderating role in customers' decision process. Conclusions - WOM and the severity of illness are important moderators for Chinese customers to make a decision for medical tourism. It provides some implications for service organizations for developing and implementing marketing strategies in international health care markets.