The influence of changes in-hospital infection control protocols and cardiopulmonary resuscitation environment to treatment outcomes on out-of-hospital cardiac arrest due to the COVID-19 pandemic: a single center retrospective observational study

Objective@#Coronavirus disease 2019 (COVID-19) pandemic has been affecting the safety of hospital healthcare workers and the outcome of out-of-hospital cardiac arrest patients. This study aimed to analyze the influence of the changes inhospital infection control protocols (ICP) and cardiopulmonary resuscitation (CPR) environment on the treatment outcomes of out-of-hospital cardiac arrest patients. @*Methods@#The medical records of patients who visited the emergency room were retrospectively reviewed for the period from March 13, 2019 to March 13, 2021. Patient data were analyzed before and after March 13, 2020, when the “in-hospital CPR guidelines related to COVID-19 infection” was recommended by the Korean Society of Emergency Medicine. We performed a comparison and analysis of the first epinephrine administration time and the intubation time with other CPR-related factors in both groups. The in-hospital return of spontaneous circulation (ROSC) and the over 24-hour survival rate were defined as treatment outcomes. @*Results@#A total number of 453 patients were included in the study. After ICP, the in-hospital ROSC was increased (29.8% vs. 42.1%, P=0.006), whereas the over 24-hour survival rate was decreased (67.2% vs. 40.6%, P=0.001). The time intervals from the hospital visit to the first epinephrine administration—1.0 (0-1.0) vs. 1.0 (0-2.0), P=0.007—and tracheal intubation—1.0 (0-1.0) vs. 1.0 (1.0-2.8), P<0.001—were statistically significantly higher than those before ICP application. In our multivariable analysis, the ICP application and pre-hospital emergency medical service (EMS) response time were factors associated with the treatment outcome. @*Conclusion@#After the application of the ICP, both the first epinephrine administration time and the tracheal intubation time from the patient’s hospital visit were prolonged. The application of ICP and the delayed EMS response time were factors associated with the treatment outcome.

Analysis of mortality risk by age-group of patients who visit the emergency room due to suicidal attempts

Objective@#Previous studies lacked an accurate analysis of age-specific mortality because they included either a single hospital’s data or survey-based method, rather than the patient’s information from the emergency room (ER). Therefore, this study analyzed the mortality risk by age group among patients who visited the ER with suicidal attempts using large-scale data. @*Methods@#Data were collected from the in-depth surveillance data of injury among patients who visited the ERs of 23 hospitals from January 2011 to December 2018. Their ages were divided into 10-year ranges for patients aged 15 years or older (15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years). The patients’ sex, alcohol consumption before the injury, time of injury, place of injury, ambulance used for transport to the ER, disposition at the ER, and total deaths were investigated. @*Results@#The number of patients was 41,257, of which 38,229 (92.7%) survived and 3,082 (7.3%) died. The proportions of patients in each group who died from suicidal attempts in the 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years groups were 2.7%, 3.1%, 5.4%, 7.8%, 12.0%, 18.5%, and 21.8%, respectively (P<0.001). A statistically positive-response relationship was noted (P trend<0.001). As a result of adjusting for sex, age, place of injury, time of injury, and alcohol consumption in multivariate logistic regression analysis, and the odds ratios of deaths were 1.70, 2.37, 2.86, 5.18, 5.48, and 6.41, respectively (reference, 15-24 years). Moreover, compared to women, the men’s odds ratio of death was 1.58. @*Conclusion@#Among patients who visited the ER due to suicidal attempts, those of advanced age and males have high mortality.

Analysis of mortality risk by age-group of patients who visit the emergency room due to suicidal attempts

Objective@#Previous studies lacked an accurate analysis of age-specific mortality because they included either a single hospital’s data or survey-based method, rather than the patient’s information from the emergency room (ER). Therefore, this study analyzed the mortality risk by age group among patients who visited the ER with suicidal attempts using large-scale data. @*Methods@#Data were collected from the in-depth surveillance data of injury among patients who visited the ERs of 23 hospitals from January 2011 to December 2018. Their ages were divided into 10-year ranges for patients aged 15 years or older (15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years). The patients’ sex, alcohol consumption before the injury, time of injury, place of injury, ambulance used for transport to the ER, disposition at the ER, and total deaths were investigated. @*Results@#The number of patients was 41,257, of which 38,229 (92.7%) survived and 3,082 (7.3%) died. The proportions of patients in each group who died from suicidal attempts in the 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years groups were 2.7%, 3.1%, 5.4%, 7.8%, 12.0%, 18.5%, and 21.8%, respectively (P<0.001). A statistically positive-response relationship was noted (P trend<0.001). As a result of adjusting for sex, age, place of injury, time of injury, and alcohol consumption in multivariate logistic regression analysis, and the odds ratios of deaths were 1.70, 2.37, 2.86, 5.18, 5.48, and 6.41, respectively (reference, 15-24 years). Moreover, compared to women, the men’s odds ratio of death was 1.58. @*Conclusion@#Among patients who visited the ER due to suicidal attempts, those of advanced age and males have high mortality.

Volumetric change of the latissimus dorsi muscle after immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap

BACKGROUND: In immediate breast reconstruction using an extended latissimus dorsi musculocutaneous (eLDMC) flap, the volume of the flap decreases, which causes a secondary deformity of the breast shape. Since little research has investigated this decrease in muscle volume, the authors conducted an objective study to characterize the decrease in muscle volume after breast reconstruction using an eLDMC flap. METHODS: Research was conducted from October 2011 to November 2016. The subjects included 23 patients who underwent mastectomy due to breast cancer, received immediate reconstruction using an eLDMC flap without any adjuvant chemotherapy or radiotherapy, and received a computed tomography (CT) scan from days 7 to 10 after surgery and 6 to 8 months postoperatively. In 10 patients, an additional CT scan was conducted 18 months postoperatively. Axial CT scans were utilized to measure the volumetric change of the latissimus dorsi muscle during the follow-up period. RESULTS: In the 23 patients, an average decrease of 54.5% was observed in the latissimus dorsi muscle volume between the images obtained immediately postoperatively and the scans obtained 6 to 8 months after surgery. Ten patients showed an average additional decrease of 11.9% from 6–8 months to 18 months after surgery. CONCLUSIONS: We studied changes in the volume of the latissimus dorsi muscle after surgery using an eLDMC flap performed after a mastectomy without adjuvant chemotherapy or radiotherapy. In this study, we found that immediate breast reconstruction using a latissimus dorsi muscle flap led to a decrease in muscle volume of up to 50%.

The efficacy of elongated axillary incision on extended latissimus dorsi flap for immediate breast reconstruction

BACKGROUND: In performing extended latissimus dorsi (ELD) flap procedures, a skin paddle design on the bra line helps reduce visible scarring. This improves the patient’s satisfaction with the outcome. However, such a design leads to a longer operation time and increased fatigue of the surgeon due to the narrow operative field. In this study, the authors propose a method that elongates the axillary incision line posteriorly by 1.5 cm from the lateral border of the latissimus dorsi muscle. We examined whether this method could shorten the operation time and compared the incidence of complications between patients who underwent this novel procedure and patients who underwent the traditional procedure. METHODS: In this study of patients who underwent ELD flap procedures for immediate breast reconstruction, 89 underwent surgery with the elongated axillary incision and 45 underwent surgery without the elongated incision. The total operation time and complications were retrospectively examined based on the patients’ medical records, and we examined whether there was any statistically significant difference in the total operation time. RESULTS: In the experimental group with the elongated axillary incision, the operation time ranged from 125 to 255 minutes (median, 175 minutes). In contrast, in the control group without the elongated axillary incision, the operation time ranged from 142 and 340 minutes (median, 205 minutes). The operation time was statistically significantly different between the two groups, and no significant complications were observed in the experimental group. CONCLUSIONS: Elongation of the axillary incision alone may shorten the operation time of the ELD flap procedure without causing additional complications.

Comparative Analysis between Spinning and Other Causes in Exercise-Induced Rhabdomyolysis

PURPOSE@#Spinning-induced rhabdomyolysis (SIR) has been increasing in recent years and accounts for a large proportion of exercise-induced rhabdomyolysis (EIR). The purpose of this study was to compare the clinical features between SIR and non-spinning exercise-induced rhabdomyolysis (NSIR), and to analyze each of these clinical features.@*METHODS@#A retrospective chart review was conducted on patients treated due to EIR from January 2006 to March 2018. Patients were divided into the SIR and NSIR groups, and their clinical factors, outcome, and blood chemistries were compared and analyzed.@*RESULTS@#Sixty-two patients were enrolled in this study, with 23 (37.1%) and 39 (62.9%) patients categorized in the SIR and NSIR groups, respectively. The SIR group were mostly women (78.3% vs. 38.5%, p=0.002), more f requent EIR occurrence in the first exercise class (60.9% vs. 15.4%, p=0.001), and had most complaints of thigh pain (91.3% vs. 43.6%, p=0.001). The SIR group had a higher incidence rate despite its shorter exercise duration (90.5% vs. 62.9%, p=0.024), longer hospital stay (6.0 [4.5-7.0] vs. 5.0 [3.5-6.0] days, p=0.080), and higher rate of peak CPK (15,000 U/L or higher) (91.3% vs. 74.4%, p=0.182) compared to the NSIR group.@*CONCLUSIONS@#SIR occurs at a higher rate during the first exercise class in women compared to NSIR, and the incidence rate is higher in SIR than in NSIR despite its shorter exercise duration (less than 60 minutes). It is necessary to recognize these risks during spinning exercises and to perform these exercises sequentially and systematically.

Impact of Disturbed Wound Healing after Surgery on the Prognosis of Marjolin's Ulcer

BACKGROUND: Marjolin's ulcer is known to present a high proportion of recurrence and poor prognosis compared to other kinds of skin cancer. Based on our experience, Marjolin's ulcer patients who have received reconstructive surgery present a higher proportion of recurrence when there was disturbed wound healing after surgery. The impact of disturbed wound healing after surgery on the prognosis was examined in this study. METHODS: A retrospective study was carried out on 26 patients who were diagnosed with Marjolin's ulcer and received surgery in this hospital from 1996 to 2011. Histologic grading, lymph node metastasis at diagnosis, and the wound healing process were evaluated and chi-squared analysis applied in order to determine the correlation with recurrence. RESULTS: The proportion of recurrence increases in patients with a low histologic grade or lymph node metastasis at diagnosis. The proportion of recurrence is even higher when the problem occurs during the wound healing process after surgery. CONCLUSIONS: Disturbed wound healing after surgery could be used as a sign to quickly identify the recurrence of carcinoma. Therefore, in the event a problem occurs in the wound healing process after surgery, one should keep in mind that this could be a sign of the possibility of recurrence and proceed with careful observation and active diagnosis through additional physical examinations, general X-ray tests, computed tomographys, magnetic resonance imagings, and so on, to obtain an early diagnosis of recurrence.

A Convenient Radiolabeling of 11C(R)-PK11195 Using Loop Method in Automatic Synthesis Module / 핵의학분자영상

PURPOSE: ((R)-1-(2-chlorophenyl)-N-1-[11C]methyl-N-(1-propyl)-3-isoquinoline carboxamide ((R)-PK11195) is a specific ligand for the peripheral type benzodiazepine receptor and a marker of activated microglia, used to measure inflammation in neurologic disorders. We report here that a direct and simple radiosynthesis of [11C](R)-PK11195 inmild condition using NaH suspension in DMF and one-step loop method. MATERIALS AND METHODS: (R)-NDesmethyl- PK11195 (1 mg) in DMSO (0.1 mL) and NaH suspension in DMF (0.1 mL) were injected into a semi-prep HPLC loop. [11C]methyl iodide was passed through HPLC loop at room temperature. Purification was performed using semi-preparative HPLC. Aliquots eluted at 11.3 min were collected and analyzed by analytical HPLC and mass spectrometer. RESULTS: The labeling efficiency of [11C](R)-PK11195 was 71.8+/-8.5%. The specific activity was 11.8 +/-6.4 GBq/micromol and radiochemical purity was higher than 99.2%. The mass spectrum of the product eluted at 11.3 min showed m/z peaks at 353.1 (M+1), indicating the mass and structure of (R)-PK11195. CONCLUSION: By the one-step loop method with the [11C]CH3I automated synthesis module, [11C](R)-PK11195 could be easily prepared in high radiochemical yield using NaH suspension in DMF.

Characteristics of Vertigo Manifestations and Vestibular Function Tests in Patients with Acoustic Neuroma according to the Tumor Size / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic neuromas (ANs) usually manifest ipsilateral peripheral vestibulopathies with various degrees of compensation in vestibular function tests (VFTs). As the tumor grows, the cerebellum and brain stem are compressed and various central signs may develop. However, the clinical usefulness of VFTs in ANs, especially in the early diagnosis, treatment, and rehabilitation, is not yet fully studied. The objective of this study was to evaluate the characteristics of clinical manifestations and VFTs according to the tumor size in ANs. MATERIALS AND METHODS: We reviewed the medical records of 33 patients who were pathologically diagnosed as ANs. We divided the patients into 5 groups according to the tumor size (Tos, 1992) and analyzed the relationship between the tumor size and the characteristics of clinical manifestations and VFTs. RESULTS: 70% of patients had experienced dizziness. True vertigo was more common in patients with smaller tumors; in contrast, unsteadiness or dysequilibrium was manifested more frequently in larger tumors. Most patients (94%) showed peripheral vestibulopathies and among them, 42% of patients were compensated functionally and physiologically. CONCLUSION: Clinical manifestations regarding dizziness and the results of VFTs, especially the degree of compensations, might be helpful in diagnosing early ANs. Further investigations will be needed to confirm these assumptions.

Acoustic Reflex Facilitation with Various Frequencies and Amplitudes of Pure Tone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are several methods for lowering the acoustic reflex hreshold, a process known as "facilitaion". The most popular facilitation method is the simultaneous stimulation of a high-frequency tone (facilitator) with a reflex-elicing tone (activator). This study was performed in order to analyze and generalize the facilitation phenomenon, and infer clinical applications from this phenomenon. MATERIALS AND METHODS: Authors measured the acoustic reflex thresholds when the facilitators of various amplitudes and frequencies was simultaneously stimulated in normal population. Also, the effects of facilitation was observed on the growth function curve (a curve showing the acoustic reflex pattern in subthreshold and suprathreshold stimulation). RESULTS: Facilitation was observed more effectively by using facilitators of high frequencies and high amplitudes. In the analysis of growth function curve, we found similar result as above. But there was no correlation between the frequency of activator and the mode of facilitation. CONCLUSION: We analyzed the factors affecting the phneomenon of facilitation and discussed a several proposals explaining the different tendencies of facilitation. Further studies should be made on the clinical implication of this phenomenon to sensorineurally hearing-impaired patients or children.