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no abstract available.
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Purpose@#Awareness of environmental control is considered a major influence on the performance of asthma self-management behaviors that are involved in maintaining effective control of asthma. The aim of this study was to investigate whether immersive virtual reality (VR) education is effective in environmental control education for asthmatic children. @*Methods@#Thirty asthmatic children aged 9 to 13 years with aeroallergen sensitization were enrolled. Environmental control education for asthmatic subjects were performed using either immersive VR (VR group) or conventional leaflets provided by asthma specialists (control group). Five questionnaires, such as awareness of environmental control, memory, assessment of intent to act, satisfaction test, and asthma control test (ACT) questionnaires were used for estimating the effects of education. @*Results@#Awareness of environmental control, memory, and intent to act scores were significantly increased after education in both groups and the scores were maintained high until 4 weeks after education. In both group, ACT scores were maintained high scores before and 4 weeks after education. Satisfaction scores were very high in the VR group. @*Conclusion@#The increased scores in awareness of environmental control and intent to act indicate that the environmental control education using VR is worthy of attention as an effective educational tool for asthma management. Application of further developed techniques, including active environmental intervention by participants in VR, could be applied to effective asthma management.
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Background@#Skin aging can be divided into intrinsic and extrinsic processes, and occur due to several factors. Although the interest in skin youthfulness is increasing globally, research on facial skin youthfulness and lifestyle is limited. @*Objective@#This study aimed to evaluate the association between facial skin youthfulness and biophysical facial skin parameters in Korean women over 50 years of age. We further investigated lifestyle factors that make people appear younger than their chronological age. @*Methods@#We surveyed the essential information and lifestyle of subjects by questionnaires, and measured the biophysical parameters of the facial skin. We then performed clinical facial assessments, and the values were compared with the chronologic age. The associations between age differences, biophysical parameters, and living habits were evaluated. @*Results@#We identified a positive correlation between age and melanin index (r=0.245, p＜0.001) and erythema index (r=0.119, p=0.002). The melanin index was statistically significantly lower in the group without regular outdoor activities (144.66±43.24 vs. 137.00±55.48, p=0.043). The melanin index and erythema index were the significant differences that defined younger perceived age than chronological age. The perceived age was younger in the group who wore a hat when performing outdoor activities than the group who did not (3.70±1.84 vs. 3.40±1.94, p=0.034). @*Conclusion@#To retain youthful skin, it is essential to reduce sun exposure, as this factor can affect the melanin and erythema indices by inducing photoaging. Therefore, avoiding the sun bia proper methods, such as wearing a hat and sunscreen during outdoor activities, is recommended to maintain skin youthfulness.
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Objective@#Emergency cricothyroidotomy is an infrequently performed procedure and post-procedural complications may result from attempting to pass a device with a large external diameter through the cricothyroid membrane. This study aimed to determine the maximum height of the cricothyroid membrane according to the patient’ s sex and age based on cervical-spine computed tomography (C-spine CT) in the emergency department (ED) and determine the appropriate endotracheal tube (ETT) size. @*Methods@#A retrospective analysis of patients was conducted from May 2014 to April 2020 in the ED. The data were obtained from medical records. Electronic calipers were used to measure the maximum height of the cricothyroid membrane in C-spine CT by an emergency physician and an emergency medicine resident. @*Results@#Six hundred and sixty-four patients were included in the study. The mean height of the cricothyroid membrane was 10.11±2.24 mm in males (n=351) and 8.90±1.84 mm in females (n=313) (P<0.001). In males, the cricothyroid membrane height showed significant variance between the ≥75-year-old and the 25-34-year-old groups (9.26±2.40 mm vs. 11.80±2.36 mm) (P<0.001). The tube size of the cricothyroidotomy equipment was suitable for more than 72.1% of patients when applied with an ETT (internal diameter ≤6.0 mm). @*Conclusion@#This study showed that the height of the cricothyroid membrane differed according to sex and also age in males. It may thus be necessary to consider anatomical differences according to sex and age when selecting the appropriate tube size to reduce complications during emergency cricothyroidotomy.
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Purpose@#In South Korea, investigations into Turner syndrome (TS) prevalence and TS-associated cancer and mortality are lacking.Accurate data were estimated from the National Health Insurance Service (NHIS) and the Rare Diseases Registry (RDR) records. @*Materials and Methods@#Data on patients with TS who were registered in the RDR between 2007 and 2017 were collected. To estimate TS-associated cancer and mortality risk, the data were compared with data of 1:3 age-matched controls. @*Results@#In 2017, 2054 patients with TS were identified from a total population of 26186952 South Korean women; therefore, the prevalence was 7.84 per 100000 persons. TS prevalence across 10-year interval age groups were 11.82, 23.17, 18.37, 10.49, 4.09, and 0.38 for age under 10 years, teenagers, 20s, 30s, 40s, and older than 50, respectively (per 100000 persons). The cancer risk in patients with TS was higher than that of age-matched controls over 5.3 person-years [hazard ratio (HR)=1.82, 95% confidence interval (CI) 1.01–3.27, p=0.045]. Among different types of cancer, thyroid cancer risk in patients with TS was significantly higher than that of age-matched controls (HR=2.78, 95% CI 1.06–7.26, p=0.037). We also observed that TS-associated all-cause mortality risk was higher than that of age-matched controls (HR=3.36, 95% CI 1.59–7.10, p=0.002). @*Conclusion@#National prevalence of TS was suggested, and an increased risk of TS-associated thyroid cancer and mortality were observed in this study.
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Purpose@#In South Korea, investigations into Turner syndrome (TS) prevalence and TS-associated cancer and mortality are lacking.Accurate data were estimated from the National Health Insurance Service (NHIS) and the Rare Diseases Registry (RDR) records. @*Materials and Methods@#Data on patients with TS who were registered in the RDR between 2007 and 2017 were collected. To estimate TS-associated cancer and mortality risk, the data were compared with data of 1:3 age-matched controls. @*Results@#In 2017, 2054 patients with TS were identified from a total population of 26186952 South Korean women; therefore, the prevalence was 7.84 per 100000 persons. TS prevalence across 10-year interval age groups were 11.82, 23.17, 18.37, 10.49, 4.09, and 0.38 for age under 10 years, teenagers, 20s, 30s, 40s, and older than 50, respectively (per 100000 persons). The cancer risk in patients with TS was higher than that of age-matched controls over 5.3 person-years [hazard ratio (HR)=1.82, 95% confidence interval (CI) 1.01–3.27, p=0.045]. Among different types of cancer, thyroid cancer risk in patients with TS was significantly higher than that of age-matched controls (HR=2.78, 95% CI 1.06–7.26, p=0.037). We also observed that TS-associated all-cause mortality risk was higher than that of age-matched controls (HR=3.36, 95% CI 1.59–7.10, p=0.002). @*Conclusion@#National prevalence of TS was suggested, and an increased risk of TS-associated thyroid cancer and mortality were observed in this study.
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Nephrectomy is performed for the treatment of kidney cancer or for the purpose of kidney transplantation. Generally, kidney function decreases after nephrectomy. It is well known that the incidence of cardiovascular disease increases and ultimately the mortality rate increases when kidney function decreases. Therefore, when renal mass is detected, partial nephrectomy (PN) is preferred over radical nephrectomy (RN) to preserve kidney function as much as possible. However, recent studies have shown that PN does not have a survival benefit in all patients compared to RN. Meanwhile, numerous studies for living kidney donors showed that kidney donation itself did not increase the risk of diabetes, high blood pressure, cardiovascular disease, and mortality. However, recent studies have shown that kidney donors have higher incidence of cardiovascular disease and higher mortality rates than the general populations. It is yet difficult to find a conclusion in these debates. We have to make a clinical decision rest on the balance of potential benefits and harms of competing treatments, personalized to the individual patient.
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Objective@#Multiple criteria have been proposed to assess the severity of community-acquired pneumonia (CAP) and predict intensive care unit (ICU) admissions. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker actively researched as a prognostic indicator in various infectious diseases. This study assessed the value of the NLR in predicting ICU admissions among CAP hospitalizations through the emergency department (ED). @*Methods@#A retrospective observational study of hospitalized patients with CAP via ED was performed from March 2017 to December 2018 using electronic medical records from a single center. By analyzing the clinical data at the initial presentation to the emergency room, the predictability of NLR on the admissions to the ICU was compared with other preexisting clinical scores, such as PSI (Pneumonia Severity Index), CURB-65 (Confusion, Uremia, Respiratory rate, Blood pressure, Age ≥ 65 years), and APACHE II (Acute Physiology and Chronic Health Evaluation II) scores. @*Results@#Of 599 CAP hospitalizations, 80 (13.4%) required ICU admissions. In multivariate logistic analysis, mean arterial pressure and NLR have significance in predicting ICU admission. The area of under curve (AUC) of preexisting clinical scores to predict ICU admission had a PSI of 0.70, CURB-65 of 0.58, and APACHE II score of 0.66. The AUC of the NLR model was 0.75, the highest among the preexisting scoring systems. Setting the NLR model as a reference value, the PSI and APACHE II scores showed no statistically significant difference in contrast to CURB-65, which showed less powerful predictability. @*Conclusion@#NLR is a simple, inexpensive, and rapidly available measurement in the ED, which can be used as a useful tool for predicting ICU admissions among patients with CAP over other preexisting clinical scores.
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Background and Objectives@#It is crucial to understand the exact public health burden of out-of-hospital cardiac arrest (OHCA) cases; this is presently unknown since sufficient episodes are not reported in registry studies. We aimed to evaluate the epidemiologic features and outcomes of non-traumatic OHCA. @*Methods@#During January 2008 to December 2017, we enrolled 387,665 patients who had been assigned a code for sudden cardiac arrest or had undergone cardiopulmonary resuscitation in the emergency room using the Korean National Health Insurance Service database. Those whose arrest was of non-cardiac origin were excluded. @*Results@#The incidence of OHCA per 100,000 patients increased steadily from 48.2 in 2008 to, 53.8 in 2011, 60.1 in 2014, and 66.7 in 2017, with a 1-year survival rate of 8.2%. Age and sex-adjusted mortality rates showed a decreasing trend. The hazard ratio was 1.0015 in 2009, 0.9865 in 2012, 0.9769 in 2015, and 0.9629 in 2017 (p for trend <0.0001), with coronary artery disease-related OHCA accounting for 59.8% of the total. Subgroups with coronary artery disease-related OHCA were more likely to be older and have a higher prevalence of all related comorbidities, excluding malignancy, than those with non-coronary artery disease-related OHCA. @*Conclusions@#This nationwide population-based study showed that the incidence of OHCA in Korea had increased during the last decade. The post OHCA 1-year mortality rate showed a poor outcome but improved gradually.
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Objective@#This study was conducted to investigate the association between meteorological factors and the number of patients who visited an emergency department after suicide attempts daily. @*Methods@#We conducted a retrospective analysis study of 359 patients who visited an emergency department after suicide attempts from January 1, 2016, to December 31, 2016. We used the Poisson regression model to analyze the association. @*Results@#Three hundred and fifty-nine patients were enrolled in this study. According to the Poisson regression analysis, the average temperature on the day of visit (adjusted odds ratio [aOR], 1.038; 95% confidence interval [CI], 1.018-1.058), relative humidity (aOR, 0.987; 95% CI, 0.976-0.997), and solar radiation (aOR, 0.965; 95% CI, 0.939-0.993) were meteorological factors associated with the daily number of patients in the non-violent suicidal attempt group. @*Conclusion@#This study showed that meteorological factors are associated with the number of patients who visited an emergency department after suicide attempts daily.
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Purpose@#To observe if obesity is a representative risk factor for vision-threatening proliferative diabetes retinopathy and end stage renal disease, which are major chronic microvascular complications in Korean Type 2 diabetes patients. @*Methods@#A retrospective data analysis was conducted on 2,524,431 adults over the age of 30 years diagnosed with type 2 diabetes using the Korean National Health Insurance Service-Health Screening database from January 2009 to December 2012. The association of body mass index (BMI) and waist circumference with the occurrence of sight-threatening diabetic retinopathy and end-stage renal disease in type 2 diabetes mellitus patients were analyzed. @*Results@#Multivariable Cox regression analysis was carried out on the potential risk factors related to microvascular complications, including vision-threatening diabetic retinopathy and end-stage renal disease. BMI and microvascular complications showed a reverse linear relationship, but a larger waist circumference was associated with a greater risk of microvascular complications (incidence rate ratio [IRR] = 1.049, 95% confidence interval [CI] = 1.021-1.078; IRR = 1.087, 95% CI = 1.05-1.125, and IRR = 1.234, 95% CI = 1.182-1.289) after adjusting other risk factors. @*Conclusions@#In our study, the results showed that type 2 diabetic patients with a larger waist circumference were at greater risk for microvascular complications. Thus, in addition to the BMI, the waist circumference should be used as the obesity parameter in microvascular complication risk assessment among type 2 diabetic patients.
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Background@#The purpose of the study was to investigate the incidence, prevalence, and survival of malignant gliomas (MGs) using population-based Korean National Health Insurance Database (NHID) data. @*Methods@#Using the Korean NHID, we identified patients with MG as C71 codes in KCD 5–7 according to ICD-10 from January 1, 2007 to December 31, 2017. Epidemiological characteristics of MG, including annual incidence, prevalence, mortality rates, and survival rates, were collected and analyzed according to socioeconomic state (SES) and treatments received. @*Results@#We identified 45,066 newly diagnosed-MG patients from 2007 to 2017, for an age-adjusted incidence of 7.47 per 100,000 people. The mean age at diagnosis was 54 years. The male to female ratio was 1.11. Mortality and survival probability were analyzed among total subjects and in subgroups. The mortality rates were lower in female than that of male patients (hazard ratio, 0.69; 95% confidence interval, 0.67–0.71), and in younger age population and in higher income group. Patients operated had a slightly higher survival rate. The 1-, 3-, 5-, and 10-year survival rates were estimated at 63.4%, 46.2%, 39.4%, and 34.8%, respectively. This is the first population-based study to determine the incidence and prevalence of MG according to epidemiological characteristics in Korea using NHID. @*Conclusion@#Our study found that female sex and high SES were factors that significantly lowered the mortality rate in MG, and younger groups and operated patients showed significantly higher survival rates.
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Background@#It is difficult to distinguish subtle differences shown in computed tomography (CT) images of coronavirus disease 2019 (COVID-19) and bacterial pneumonia patients, which often leads to an inaccurate diagnosis. It is desirable to design and evaluate interpretable feature extraction techniques to describe the patient's condition. @*Methods@#This is a retrospective cohort study of 170 confirmed patients with COVID-19 or bacterial pneumonia acquired at Yeungnam University Hospital in Daegu, Korea. The lung and lesion regions were segmented to crop the lesion into 2D patches to train a classifier model that could differentiate between COVID-19 and bacterial pneumonia. The K-means algorithm was used to cluster deep features extracted by the trained model into 20 groups.Each lesion patch cluster was described by a characteristic imaging term for comparison.For each CT image containing multiple lesions, a histogram of lesion types was constructed using the cluster information. Finally, a Support Vector Machine classifier was trained with the histogram and radiomics features to distinguish diseases and severity. @*Results@#The 20 clusters constructed from 170 patients were reviewed based on common radiographic appearance types. Two clusters showed typical findings of COVID-19, with two other clusters showing typical findings related to bacterial pneumonia. Notably, there is one cluster that showed bilateral diffuse ground-glass opacities (GGOs) in the central and peripheral lungs and was considered to be a key factor for severity classification. The proposed method achieved an accuracy of 91.2% for classifying COVID-19 and bacterial pneumonia patients with 95% reported for severity classification. The CT quantitative parameters represented by the values of cluster 8 were correlated with existing laboratory data and clinical parameters. @*Conclusion@#Deep chest CT analysis with constructed lesion clusters revealed well-known COVID-19 CT manifestations comparable to manual CT analysis. The constructed histogram features improved accuracy for both diseases and severity classification, and showedcorrelations with laboratory data and clinical parameters. The constructed histogram features can provide guidance for improved analysis and treatment of COVID-19.
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Background and Objectives@#It is crucial to understand the exact public health burden of out-of-hospital cardiac arrest (OHCA) cases; this is presently unknown since sufficient episodes are not reported in registry studies. We aimed to evaluate the epidemiologic features and outcomes of non-traumatic OHCA. @*Methods@#During January 2008 to December 2017, we enrolled 387,665 patients who had been assigned a code for sudden cardiac arrest or had undergone cardiopulmonary resuscitation in the emergency room using the Korean National Health Insurance Service database. Those whose arrest was of non-cardiac origin were excluded. @*Results@#The incidence of OHCA per 100,000 patients increased steadily from 48.2 in 2008 to, 53.8 in 2011, 60.1 in 2014, and 66.7 in 2017, with a 1-year survival rate of 8.2%. Age and sex-adjusted mortality rates showed a decreasing trend. The hazard ratio was 1.0015 in 2009, 0.9865 in 2012, 0.9769 in 2015, and 0.9629 in 2017 (p for trend <0.0001), with coronary artery disease-related OHCA accounting for 59.8% of the total. Subgroups with coronary artery disease-related OHCA were more likely to be older and have a higher prevalence of all related comorbidities, excluding malignancy, than those with non-coronary artery disease-related OHCA. @*Conclusions@#This nationwide population-based study showed that the incidence of OHCA in Korea had increased during the last decade. The post OHCA 1-year mortality rate showed a poor outcome but improved gradually.
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The aim of this study was to provide pathological information of pediatric oral lesions by retrospectively analyzing oral biopsy results from pediatric patients at the Seoul National University Dental Hospital.Biopsy results of all oral lesions from pediatric patients, aged 0 - 16 years, were collected from the files of the Department of Oral Pathology, Seoul National University Dental Hospital from January 2000 to April 2020. The patients were divided into 3 age groups: 0 - 5, 6 - 11 and 12 - 16 years. All oral lesions were classified into three main categories: inflammatory and reactive, tumor or tumor-like and cystic lesions.Among the total of 2928 biopsy specimens, tumor or tumor-like lesions(35.66%) were the most common, followed by inflammatory and reactive lesions(34.29%) and cystic lesions(30.05%). Regardless of the categories used in this study, odontoma was the most frequently found lesion, mucocele and dentigerous cyst being the next common. This study was the first retrospective review of pediatric oral pathology in Korea, and the results from this study may assist in providing informative insight into the pediatric oral pathology for pediatric dentists.
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Background/Aims@#There have been few multicenter studies on colonic polyps conducted by primary medical institutions. This study examined the detection rate of colonic polyps in primary health care institutions and the related factors while following the guidelines. @*Methods@#The medical records of 14,029 patients who underwent colonoscopy between January-June 2020 at 40 primary medical institutions in Korea were analyzed. High-risk adenoma was defined as advanced adenoma, carcinoma, or ≥3 adenomas. @*Results@#Most patients (71.2%) aged ≥50 years underwent re-colonoscopy within 5 years (51.3%) for diagnostic purposes (61.3%) in Korean primary medical institutions. The detection rates of colon polyps, adenoma, advanced adenoma, high-risk adenoma, and carcinoma was 59.9%, 38.9%, 5.9%, 11.4%, and 0.3% in all subjects and 59.8%, 37.5%, 8.5%, 12.9%, and 0.3% in average-risk patients, respectively. The incidences of adenoma in average-risk patients increased significantly with age (30s/40s/50s: 20.1%/29.4%/43% for adenoma, 4.4%/6.7%/10.3% for advanced adenoma, and 5.6%/9.5%/14.6% for high-risk adenoma; p<0.05). Before 50 years of age, high-risk adenoma was detected in 9.1% of patients in the first-time screening group, and the significant risk factors were being male and ≥40 years of age. The detection rate of high-risk adenoma in the normal index colonoscopy group within 5 years was 9.0%. The significant risk factors included older age, male sex, positive fecal occult blood test, stool form changes, and nonspecific symptoms (gas and indigestion). @*Conclusions@#More colonic adenoma studies targeting real-world clinical practice will be needed to revise the Korean guidelines for colorectal cancer screening and surveillance.
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The aim of this study was to investigate necrophagous blowflies to confirm their forensic importance in criminal investigations and to produce a pictorial key to easily identify blowflies that are likely to be present at the scene of death. Of the 26 calliphorid species recorded in Korea, 16 species were sampled from 103 animal cadavers including 63 rabbits and 40 pigs. We identified 13 species in Calliphorinae, Aldrichina grahami (Aldrich), Calliphora nigribarbis Vollenhoven (= C. lata Coquillett), C. subalpina (Ringdahl), C. vicina (Robineau-Desvoidy), C. vomitoria (L.), Hemipyrellia ligurriens (Wiedemann), Lucilia ampullacea Villeneuve, L. caesar (L.), L. cuprina (Wiedemann), L. illustris (Meigen), L. papuensis Macquart, L. porphyrina (Walker), and L. sericata (Meigen), and three species in Chrysomyinae, Chrysomya megacephala (F.), Ch. pinguis (Walker), and Ch. rufifacies (Macquart). They were repeatedly recorded from various localities in different habitats and seasons. These species should be given importance in approaches to forensic science particularly as their ecological implications are well understood. An identification key for these forensically essential species is prepared in a user-friendly manner using characteristics easily visible to the bare eye or at least under a magnifying glass.
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Background@#We estimated the effect of obesity on the incidence of cardiovascular disease (CVD) and mortality in women according to menopausal status. @*Methods@#Women aged 40 to 69 years under routine health check-ups provided by the National Health Insurance Service in 2009 were followed up till 2018 (n=2,208,559). @*Results@#In premenopausal women, a significant increment of mortality rate was found in underweight and obesity class II (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.31 to 1.67; and HR, 1.25; 95% CI, 1.12 to 1.39) compared to normal body mass index (BMI); overweight and obesity class I did not affect mortality rate. In postmenopausal women, obesity as well as overweight status reduced the risk of mortality compared to normal BMI (HR, 0.86; 95% CI, 0.83 to 0.88; and HR, 0.84; 95% CI, 0.82 to 0.86). By contrast, there was a linear association between CVD and BMI above the normal range irrespective of menopausal status, which was attenuated in diabetic women. @*Conclusion@#The current study replicated the J-shaped relationship between BMI and mortality, being more prominent in the postmenopausal group. The risk of CVD was linearly increased as BMI was increased above the normal range irrespective of menopausal status.
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Objective@#This study was conducted to investigate the association between meteorological factors and the number of patients who visited an emergency department after suicide attempts daily. @*Methods@#We conducted a retrospective analysis study of 359 patients who visited an emergency department after suicide attempts from January 1, 2016, to December 31, 2016. We used the Poisson regression model to analyze the association. @*Results@#Three hundred and fifty-nine patients were enrolled in this study. According to the Poisson regression analysis, the average temperature on the day of visit (adjusted odds ratio [aOR], 1.038; 95% confidence interval [CI], 1.018-1.058), relative humidity (aOR, 0.987; 95% CI, 0.976-0.997), and solar radiation (aOR, 0.965; 95% CI, 0.939-0.993) were meteorological factors associated with the daily number of patients in the non-violent suicidal attempt group. @*Conclusion@#This study showed that meteorological factors are associated with the number of patients who visited an emergency department after suicide attempts daily.
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Purpose@#To observe if obesity is a representative risk factor for vision-threatening proliferative diabetes retinopathy and end stage renal disease, which are major chronic microvascular complications in Korean Type 2 diabetes patients. @*Methods@#A retrospective data analysis was conducted on 2,524,431 adults over the age of 30 years diagnosed with type 2 diabetes using the Korean National Health Insurance Service-Health Screening database from January 2009 to December 2012. The association of body mass index (BMI) and waist circumference with the occurrence of sight-threatening diabetic retinopathy and end-stage renal disease in type 2 diabetes mellitus patients were analyzed. @*Results@#Multivariable Cox regression analysis was carried out on the potential risk factors related to microvascular complications, including vision-threatening diabetic retinopathy and end-stage renal disease. BMI and microvascular complications showed a reverse linear relationship, but a larger waist circumference was associated with a greater risk of microvascular complications (incidence rate ratio [IRR] = 1.049, 95% confidence interval [CI] = 1.021-1.078; IRR = 1.087, 95% CI = 1.05-1.125, and IRR = 1.234, 95% CI = 1.182-1.289) after adjusting other risk factors. @*Conclusions@#In our study, the results showed that type 2 diabetic patients with a larger waist circumference were at greater risk for microvascular complications. Thus, in addition to the BMI, the waist circumference should be used as the obesity parameter in microvascular complication risk assessment among type 2 diabetic patients.