Impact of Alcohol-Induced Facial Flushing Phenotype on Alcohol Consumption among Korean Adults: A Two-Year Cross-Sectional Study.

BACKGROUND: Alcohol-induced facial flushing phenotype (flushing) is common among East Asians. Despite a small intake of alcohol, they experience heightened levels of acetaldehyde, a group-1 carcinogen, which in turn causes unpleasant symptoms such as redness, acting as a robust protective mechanism against consuming alcohol. However, some individuals with this genetic trait exhibit weakened alcohol restraint, which increases the risk of developing alcohol-related cancers, such as esophageal and head/neck cancer, by more than ten times. Although this flushing phenomenon is crucial for public health, there is a paucity of studies that have comprehensively investigated the effect of flushing or its genotype on alcohol consumption in a large group of East Asians while controlling for various sociodemographic and health-related variables at a country level. OBJECTIVE: This two-year cross-sectional study aimed to explore the effect of flushing on drinking behavior in Koreans and to examine whether the effect varies across sociodemographic and health-related factors. METHODS: We used data from the Korea National Health and Nutrition Examination Survey 2019-2020 conducted by the Korea Disease Control and Prevention Agency. Our sample comprised 10,660 Korean adults. The study investigated the association of 26 variables, including flushing, with drinking frequency and amount. The effect of flushing was examined with and without adjusting for the other 25 variables using multinomial logistic regression analysis. Additionally, we tested the interaction effect with flushing and conducted a simple effect analysis. To ensure unbiased results, we employed complex sample design elements, including strata, clusters, and weights, to obtain unbiased results for the Rao-Scott χ2 test, t-test, and multinomial logistic regression analysis. RESULTS: The suppressive effect of flushing was significant across all pronounced categories of alcohol consumption at the significance level of .001 in 2019. The ranges of the standardized regression slopes and odds ratios were -6.70 ≥  ≥ -11.25 and 0.78 ≥ OR ≥ 0.50 for frequency; -5.37 ≥  ≥ -17.64 and 0.73 ≥ OR ≥ 0.36 for amount, respectively. The effect became somewhat stronger when adjusted for confounders. The effect also exhibited an overall stronger trend as the severity of alcohol consumption increased. The betas and odds ratios were consistently smaller in 2020 compared to the previous year. A simple effect analysis revealed a diminished alcohol-suppressive effect of flushing on alcohol consumption for specific groups (e.g., those with low levels of education, limited family support, physical labor, or health-related issues). CONCLUSIONS: Our findings suggest that flushing suppresses drinking in Koreans overall but has little or no effect in certain vulnerable populations. Therefore, health authorities should conduct targeted epidemiological studies to assess drinking patterns and disease profiles, particularly regarding alcohol-related cancers, and establish effective preventive measures tailored to this population.

Association of Hypertension With the Risk and Severity of Epistaxis.

IMPORTANCE: The association between hypertension and epistaxis has long been a subject of debate. OBJECTIVES: To evaluate the risk of epistaxis in patients with hypertension using a nationwide population cohort and to assess the association of hypertension with the methods of managing cases of epistaxis. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, a hypertension cohort and comparison cohort were built using the Korean National Health Insurance Service-National Sample Cohort that represents the entire population of the Republic of Korea from January 1, 2002, to December 31, 2015. The hypertension cohort comprised 35 749 patients with a record of 3 or more prescriptions of antihypertensive medication and a diagnosis of hypertension (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code I10). Patients with other diseases associated with epistaxis, such as sinonasal tumors, facial trauma, bleeding tendency, and coagulation disorder, as well as those taking anticoagulant medications, were excluded. A comparison cohort comprised 35 749 individuals without hypertension matched sociodemographically in a 1:1 ratio. Statistical analysis was performed from January 1, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES: The incidence and recurrence of epistaxis were evaluated in both cohorts. The risk factors for epistaxis and management strategies were also assessed. RESULTS: Among the 35 749 patients in the hypertension cohort (20 579 men [57.6%]; median age, 52 years [interquartile range, 45-62 years]) the incidence rate (IR) of epistaxis was 32.97 per 10 000 persons (95% CI, 30.57-35.51 per 10 000 persons); among the 35 749 individuals in the comparison cohort (20 910 men [58.5%]; median age, 52 years [interquartile range, 45-62 years]), the IR of epistaxis was 22.76 per 10 000 persons (95% CI, 20.78-24.89 per 10 000 persons) (IR ratio, 1.45; 95% CI, 1.29-1.63; adjusted hazard ratio, 1.47; 95% CI, 1.30-1.66). The IR of recurrent epistaxis was 1.96 per 10 000 persons in the hypertension cohort and 1.59 per 10 000 persons in the nonhypertension cohort (IR ratio, 1.23; 95% CI, 0.77-2.00). Patients with hypertension who experienced epistaxis were more likely to use the emergency department (odds ratio, 2.69; 95% CI, 1.70-4.25; Cohen h effect size, 0.27; 95% CI, 0.16-0.39) and receive posterior nasal packing (odds ratio, 4.58; 95% CI, 1.03-20.38; Cohen h effect size, 0.15; 95% CI, 0.03-0.26) compared with the comparison cohort. CONCLUSIONS AND RELEVANCE: This study suggests that patients with hypertension had an increased risk of epistaxis requiring hospital visits. In addition, epistaxis in patients with hypertension appeared to need more emergency department visits and require more posterior nasal packing procedures compared with patients without hypertension. Medical counseling about epistaxis is advisable for individuals with hypertension, and the presence of hypertension should be considered in managing nasal bleedings.

The Effect of a Modified Constant Flow Insufflation of Oxygen during Cardiopulmonary Resuscitation in a Rat Model of Respiratory Cardiac Arrest on Arterial Oxygenation, Alveolar Barotrauma, and Brain Tissue Injury.

AIM: Intermittent positive pressure ventilation (IPPV) can adversely affect cardiopulmonary resuscitation outcomes by increasing the intrathoracic pressure. Continuous flow insufflation of oxygen (CFIO) has been investigated as a potential alternative, but evidence supporting its superiority over intermittent positive pressure ventilation in cases of cardiac arrest is scant. The aim of the current study was to compare the effects of continuous flow insufflation of oxygen using a one-way valve during cardiopulmonary-resuscitation with intermittent positive pressure ventilation in a rat model of respiratory arrest. METHODS: Male Sprague-Dawley rats weighing 400∼450 g (from minimum to maximum) were randomly assigned to either a sham, IPPV, or CFIO group (n = 10 per group). Respiratory arrest was induced by blocking the endotracheal tube. Arterial blood gas analysis was performed during cardiopulmonary resuscitation to compare the oxygenation levels. Tissues were then harvested to compare the degrees of pulmonary barotrauma and ischemic brain injury. RESULTS: Return of spontaneous circulation was observed in 6/10 rats in the IPPV group and 5/10 in the CFIO group. During cardiopulmonary resuscitation, the mean PaO2 was significantly higher in the CFIO group (83.10 mmHg) than in the IPPV group (56.10 mmHg). Lung biopsy revealed more inflammatory cells and marked thickening of the alveolar wall in the IPPV group; the group also exhibited a higher frequency of neuroglial cells and apoptotic bodies of pyramidal cells, resulting from ischemic injury. CONCLUSION: In a rat model of respiratory arrest, CFIO using a one-way valve resulted in a greater level of oxygenation and less lung and brain injuries than with IPPV.

Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports.

BACKGROUND: Epidural analgesia has become a common procedure to provide excellent pain relief with few complications. Pneumorrhachis and pneumocephalus are rare complications of unintentional dural puncture and injection of air into the subarachnoid or subdural space. No cases of cardiac arrest associated with these complications have been reported in the literature previously. CASE PRESENTATION: We report cases of pneumorrhachis and pneumocephalus in two Korean women who previously visited a local pain clinic and underwent epidural analgesia. Thereafter, they were admitted to the emergency department with cardiac arrest. Cardiopulmonary resuscitation was performed on these patients, and return of spontaneous circulation was achieved. The brain and spine computed tomographic scans showed pneumorrhachis and pneumocephalus, respectively. These cases demonstrate that pneumorrhachis and pneumocephalus may occur after epidural analgesia, which may be associated with cardiac arrest in patients. CONCLUSIONS: If cardiac arrest occurs after epidural analgesia, pneumocephalus and pneumorrhachis should be considered as its cause. Although epidural analgesia is a common procedure, caution is warranted during this procedure.

Comparison of the effectiveness in pain reduction and pulmonary function between a rib splint constructed in the ER and a manufactured rib splint.

BACKGROUND: In the treatment of patients with rib fractures (RFs), pain reduction is the most important consideration. Various studies have examined the effectiveness of treatments administered to RF patients, such as lidocaine patches, IV drugs, nerve blockers, and surgery. In this study, we evaluated the difference in the effectiveness in pain reduction between 2 groups of RF patients: 1 group who received a rib splint constructed in the ER (ER splint) and another group who received a Chrisofix Chest Orthosis (CCO) manufactured rib splint. METHODS: A pilot study for a prospective randomized clinical trial was conducted to compare subjects using the CCO (Group A) with those using the ER splint (Group B) before and after the intervention. The primary outcome was difference in the level of pain based on the visual analogue scale (VAS) and the pulmonary function (PF) variables between before and after intervention in each group during forceful and resting respiration. RESULTS: A total of 24 subjects were enrolled in this study. The VAS results showed that the intervention was significantly effective in each group (before vs after: Group A resting: 8.50 ±â€Š1.05 vs 4.17 ±â€Š1.33, P < .001; Group A forceful: 9.83 ±â€Š0.41 vs 7.17 ±â€Š0.75, P < .001; Group B resting: 8.83 ±â€Š1.60 vs 4.50 ±â€Š1.38, P < .001; and Group B forceful: 9.67 ±â€Š0.82 vs 7.33 ±â€Š1.51, P = .003). The PF variables showed that the intervention was significantly effective in each group (before vs after: Group A, FVC: 2.74 ±â€Š0.92 vs 3.35 ±â€Š0.99, P < .001; FEV1: 2.16 ±â€Š0.74 vs 2.57 ±â€Š0.78, P = .001; PEF: 235.30 ±â€Š43.06 vs 319.00 ±â€Š51.58, P = .004; and Group B, FVC: 2.02 ±â€Š0.49 vs 2.72 ±â€Š0.62, P < .001; FEV1: 1.27 ±â€Š0.25 vs 1.91 ±â€Š0.37, P < .001; PEF: 216.67 ±â€Š67.49 vs 300.33 ±â€Š87.79, P = .003). CONCLUSION: Applying either the CCO or the ER splint to RF patients effectively reduced pain, and no significant differences in pain level were observed between these 2 techniques.

Tension Pneumopericardium after Pericardiocentesis.

Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.

Combined exercise ameliorates ovariectomy-induced cognitive impairment by enhancing cell proliferation and suppressing apoptosis.

OBJECTIVE: Estrogen plays an important role in cognitive function, including attention, learning, and memory, and affects the structure and function of brain areas. We investigated the effects of combined exercise on memory deficits induced by ovariectomy (OVX) in relation to cell proliferation and apoptosis in the hippocampus. METHODS: Rats were randomly divided into four groups: sham, sham and exercise, OVX, and OVX and exercise. Rats in combined exercise groups were subjected to 3 days of resistance training and 3 days of running (for a total of 6 d/wk) for eight consecutive weeks. Rats were tested in step-down avoidance task and Morris water maze task to verify the effects of OVX on short-term and spatial working memory. RESULTS: In the present study, the number of BrdU-positive and doublecortin-positive cells and expression of brain-derived neurotrophic factor, TrkB, and Bcl-2 decreased; expression of Bax and the number of caspase-3-positive and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive cells increased; and short-term and spatial working memory decreased in the OVX group compared with the sham group. Conversely, when the combined exercise group was compared with the OVX group, the number of BrdU-positive and doublecortin-positive cells and expression of brain-derived neurotrophic factor, TrkB, and Bcl-2 increased; expression of Bax and the number of caspase-3-positive and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling-positive cells decreased; and short-term and spatial working memory increased. CONCLUSIONS: Combined exercise increases cell proliferation and inhibits apoptosis in the hippocampus and improves cognitive function despite estrogen deficiency.