Purpose: Blunt cardiac injuries (BCI) have a wide clinical spectrum, ranging from asymptomatic myocardial contusion to cardiac rupture and death. BCIs rarely require surgical intervention, but can be rapidly fatal, requiring prompt evaluation and surgical treatment in some cases. The aim of this study was to identify potential factors associated with in-hospital mortality after surgery in patients with BCI. Methods: The medical records of 15 patients who had undergone emergency cardiac surgery for BCI between January 2014 and August 2020 were retrospectively reviewed. We included trauma patients older than 18 years admitted to Regional Trauma Center, Gachon University Gil Medical Center during the study period. Clinical and laboratory variables were compared between survivors and non-survivors. Results: Non-survivors showed a significantly higher Injury Severity Score (p=0.001) and Abbreviated Injury Scale in the chest region (p=0.001) than survivors. American Association for the Surgery of Trauma-Organ Injury Scale Grade V injuries were significantly more common in non-survivors than in survivors (p=0.031). Non-survivors had significantly more preoperative packed red blood cell (PRBC) transfusions (p=0.019) and were significantly more likely to experience preoperative cardiac arrest (p=0.001) than survivors. Initial pH (p=0.010), lactate (p=0.026), and base excess (BE; p=0.026) levels showed significant differences between the two groups. Conclusions: Initial pH, lactate, BE, ventricular injury, the amount of preoperative PRBC transfusions, and preoperative cardiac arrest were potential predictors of in-hospital mortality.
Bilirubin has an anti-inflammatory effect as an endogenous antioxidant and has been reported to be inversely correlated with hypertension, diabetes, metabolic syndrome, and insulin resistance. On the other hand, there is a lack of research evaluating the association between bilirubin and metabolic syndrome compared to liver-specific indicators. This study examined the association between the total bilirubin and metabolic syndrome prevalence in Korean adults who underwent health screening compared to ALT and GGT. This cross sectional study included 22,568 adult males and females aged 20 years or older who underwent a health examination at the General Hospital of Gyeonggi Province from March 2015 to February 2018. Metabolic syndrome was diagnosed based on the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) guidelines. In both genders, the metabolic syndrome diagnosed group had higher liver enzymes, and the total bilirubin and direct bilirubin were lower than those without the metabolic syndrome risk factors. The serum total bilirubin showed a weak inverse correlation with abdominal obesity (r=-0.066 vs r=-0.055) and triglyceride (r=-0.127 vs r=-0.136) in both males and females, which is weaker than ALT and GGT The data were statistically significant. In addition, total bilirubin as well as ALT and GGT in both men and women were not predictors of the likelihood of developing metabolic syndrome.
Purpose: The aim of this study is to examine various national standards and to suggest problems and improvements on KS (Korean Industrial Standards) in spectacle frames. Methods: We surveyed the latest published KS, ISO (International Organization for Standardization), JIS (Japanese Industrial Standards), DIN (Deutsches Institut fur Normung) and ANSI (American National Standards Institute) standards with relating spectacle frames. The titles that were considered in comparative study were terms and vocabulary, measuring system and terminology, marking, requirements and test methods, formers, screw threads, and others. Results: There were 9 different languages such as English (USA and UK), French, Russian, Japanese, Chinese, German, Italian and Spanish for the lists of equivalent terms and vocabulary in all standards except KS and ANSI, but gave an explanation for terms and vocabulary in only KS. Complementary terms and definitions were not existed in annex of KS and ANSI for measuring system and terminology, but they were included in annex of standards of the others. KS and ANSI standard for requirements and test methods differed from the ISO revision. Except JIS and ANSI, standards of formers were almost identical. KS standard of screw threads were similar to JIS. Standards of welded joints and nickel release did not exist in KS. Conclusions: All standards except ANSI tend to follow ISO, especially DIN is almost entirely identical to ISO. But KS is behind the times because it has been amended lately or established in accordance with older editions of ISO. Therefore, in order to assist quality control and safety for spectacle frames, KS standards shall be superseded by the specifications which is identical to ISO within a reasonable time.
We evaluated the possible clinical application of Non HDL-cholesterol and triglyceride to HDL-cholesterol ratio as a metabolic syndrome predictor for the elderly in Korea. 1,543 elderly persons aged 65 years or older who visited the health examination center of Gyeonggi Regional General Hospital from January 2015 to December 2017 and had a health checkup were enrolled in this study. Metabolic syndrome was diagnosed based on the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) standards. Abdominal obesity was assessed by the Asia-Pacific standards presented at the World Health Organization (WHO) West Pacific Region. Non-HDL-cholesterol was calculated as the difference between total cholesterol and HDL-cholesterol. The metabolic syndrome predictive power was higher for triglyceride to HDL-cholesterol ratio than for Non HDL-cholesterol. After correcting for related factors, triglyceride to HDL-cholesterol ratio was higher in the $4^{th}$ quartile, which had a higher risk of developing metabolic syndrome, than in the $1^{st}$ quartile. The optimal cutoff value for the triglyceride to HDL-cholesterol ratio that predicts the onset of metabolic syndrome was 2.8. triglyceride to HDL-cholesterol ratio can be a simple and practical indicator of the risk of metabolic syndrome.
Background: To evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear. Methods: Between October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images. Results: There were 402 female patients (79%) with mean age of 55 years (range, 31-87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0-35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1-10) and 47 (range, 8-95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p<0.05). Conclusions: This study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.
The purpose of this study was to identify the differences in dietary consumption patterns according to the exercise level of Korean adults. The study subjects were the 7,370 Koreans aged 20 years and older of the 1998 Korean Health and Nutrition Survey. The dietary assessment was conducted by means of the 24 hour recall method. Data for individual exercise behavior were collected by interviews as part of the National Health Behavior Survey. Following the analysis of variances the Duncan's Multiple Range Test was used to test the differences in food and nutrient intakes among groups with different levels of exercise. Current exercise practices were reported by 22% of the male subjects and 15% of the female subjects. Unlike observations from the American and European studies, a greater amount of meat intake was observed more frequently among high exercises group than among middle and low exercisers in the case of the male subjects. This was reflected in the increasing levels of protein and fat intake in proportion to the exercise levels. However, the food and nutrient intake patterns of female exercisers were quite different from those of the males. The least intake of fatty foods was observed among the high exercisers. Energy intake from fat was the lowest among the high exercisers. These results may imply that the motivation to exercise was quite different between male and female Koreans. This dietary pattern may have a risk of undernution. Summerizing the results, whatever the motivation of the exercise, the Korean exercisers of both sexes had unhealthy dietary pattern. Therefore, nutritional education should be conducted to encourage the eating of a balanced diet along with exercise, among Koreans of both sexes, in order to promote a healthy lifestyle.
Choi, Bong Kyoon;Kim, Young Seok;Lee, Won Jai;Lew, Dae Hyun;Tark, Kwan Chul
Archives of Plastic Surgery
/
v.33
no.3
/
pp.289-293
/
2006
By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer
Yahya Alwatari;Devon C. Freudenberger;Jad Khoraki;Lena Bless;Riley Payne;Walker A. Julliard;Rachit D. Shah;Carlos A. Puig
Journal of Chest Surgery
/
v.57
no.2
/
pp.160-168
/
2024
Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.
Purpose: The purposes of this secondary data analysis study were first to identify the number of Korean adults achieving goals set by the American Diabetes Association for hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C), and secondly to identify the characteristics associated with lack of goals attainment. Methods: The sample was 413 Koreans with diagnosed diabetes aged thirty years or older who participated in the Fourth Korea National Health and Nutrition Examination Survey. Goals attainment for HbA1c, BP, and LDL-C were presented in percentages. Logistic regressions were used to examine associations between participants' characteristics and lack of goals attainment. Results: About 48% had HbA1c<7%, 48.2% had BP<130/80mmHg, and 34.1% had LDL-C<100mg/dL. Only 8.7% of the sample achieved all three parameters. In multivariate analysis, younger age, longer diabetes duration, insulin use, and abdominal obesity were associated with not meeting HbAlC goal. Smoking and use of antihypertensive medication were associated with BP${\geq}$130/80 mmHg. No use of lipid lowering agents was associated with LDL-C${\geq}$100 mg/dL. Conclusion: Many Koreans with diabetes were not at goals for HbA1c, BP, and LDL-C. For optimal control, appropriateness of therapy and poor lifestyle habits should be assessed periodically and managed accordingly.
The purposes of this study were to provide information on the prevalence and change of Korean adolescent alcohol use and to identify related factors to adolescent alcohol use. This study collected data from a total of 4,373 adolescents nationally. Followings are the major findings of this study. First, 75.7 percent of respondents reported that they tried alcohol in their life time. More male respondents tried alcohol in their lifetime than female respondents, but there was no big difference. Findings on alcohol consumption by grade showed that as adolescents get older, they are more likely to try alcohol. Second, this study also found that whereas the drinking rates of male adolescents and higher graders were steady, the rates of female adolescents and lower graders were increased since 1997. Third, this study compared its findings with adolescent alcohol use in the United States. Little differences existed in measures of adolescent alcohol use in the two countries, but the differences in the rates of the past-month alcohol use and heavy drinking was greater in Korean adolescents than in American adolescents. Finally, this study found that peer related factors such as friend's alcohol use was the strongest factor related to respondents' alcohol use. Family-related factors and respondents' levels of psychosocial resources (cognitive control, coping skills, social support) were also significantly related to their alcohol use. This study suggest that future studies consider cultural aspects and regional differences in order to understand adolescent alcohol use in more depth.
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