Cause-of-death statistics in 2020 in the Republic of Korea

Background@#This study analyzed the causes of death in the Korean population in 2020. @*Methods@#Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision. @*Results@#In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older. @*Conclusion@#These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea’s natural total population decreased.

Susceptibility of β-Lactam Antibiotics and Genetic Mutation of Drug-Resistant Mycobacterium tuberculosis Isolates in Korea / 결핵및호흡기질환

Background@#Mycobacterium tuberculosis (Mtb) is resistant to the β-lactam antibiotics due to a non-classical transpeptidase in the cell wall with β-lactamase activity. A recent study showed that meropenem combined with a β-lactamase inhibitor clavulanate, was effective in MDR and XDR tuberculosis (TB). However, clavulanate can only be used in drugs containing amoxicillin in Korea. In this study, we investigated the susceptibility and genetic mutations of drug-resistant Mtb isolates to amoxicillin-clavulanate and meropenem-clavulanate to improve the diagnosis and treatment of drug-resistant TB patients. @*Methods@#The minimum inhibitory concentration (MIC) of amoxicillin-clavulanate and meropenem-clavulanate was examined by resazurin microtiter assay. We used 82 MDR and 40 XDR strains isolated in Korea and two reference laboratory strains. Mutations of drug targets blaC, blaI, ldtA, ldtB, dacB2, and crfA were analyzed by PCR and DNA sequencing. @*Results@#The MIC90 values of amoxicillin and meropenem with clavulanate in drug-resistant Mtb isolates were 64 and 16, respectively. Gene mutations related to amoxicillin/clavulanate and meropenem/clavulanate resistance could not be identified, but T448G mutation of was found in the blaC gene related to β-lactam antibiotics high susceptibility. @*Conclusion@#Our results provide clinical consideration of β-lactams in treating drug-resistant TB and potential molecular markers of amoxicillin-clavulanate and meropenem-clavulanate susceptibility.

Maternal, infant, and perinatal mortality statistics and trends in Korea between 2018 and 2020

This study aimed to identify maternal, infant, and perinatal mortality using the nationalpopulation data of South Korea between 2018 and 2020, and to analyze mortality rates according tocharacteristics such as age, date of death, and cause of death in each group. This study updates themost recent study using 2009 to 2017 data.Methods: Analyses of maternal, infant, and perinatal mortality were done with data identifiedthrough the supplementary investigation system for cases of death from the Census of PopulationDynamics data provided by Statistics Korea from 2018 to 2020.Results: Between 2018 and 2020, a total of 99 maternal deaths, 2,427 infant deaths, and 2,408 perinatal deaths were identified from 901,835 live births. The maternal mortality ratio was 11.3 deathsper 100,000 live births in 2018; it decreased to 9.9 in 2019 but increased again to 11.8 in 2020. Thematernal mortality ratio increased steeply in women over the age of 40 years. An increasing trend inthe maternal mortality ratio was found for complications related to the puerperium and hypertensive disorders. Both infant and perinatal mortality continued to decrease, from 2.8 deaths per 1,000live births in 2018 to 2.5 in 2020 and from 2.8 in 2018 to 2.5 in 2020, respectively.Conclusion: Overall, the maternal, infant, and perinatal mortality statistics showed improvements.However, more attention should be paid to women over 40 years of age and specific causes of maternal deaths, which should be taken into account in Korea’s maternal and child health policies.

Comparison of the number of live births, maternal age at childbirth, and weight of live births between Korean women and immigrant women in 2018

Purpose@#This study compared maternal age at childbirth, the number of live births, and the weight of live births between Korean women and immigrant women using statistical data from the Republic of Korea for 2018. @*Methods@#The analysis was conducted using data from the Microdata Integrated Service of Statistics Korea (https://mdis.kostat.go.kr/index.do). @*Results@#Korean women and immigrant women showed a higher age at childbirth in 2018 than in 2008. The percentage of newborns of Korean women with a birth weight of less than 2.5 kg increased slightly for 3 consecutive years from 2016 to 2018, whereas for immigrant women, this percentage increased in 2017 compared to 2016 and then decreased again in 2018. Very low birth weight (less than 1.5 kg) became more common among immigrant women from 2016 to 2018. Birth at a gestational age of fewer than 37 weeks increased both among Korean and immigrant women from 2016 to 2018. In both groups, the percentage of women who had their first child within their first 2 years of marriage decreased from 2008 to 2018. @*Conclusion@#Immigrant women had higher birth rates than Korean women, while both groups showed an increasing trend in premature birth. Greater attention should be paid to the pregnancy and birth needs of immigrant women, and steps are needed to ensure health equity and access in order to prevent premature births. It is also necessary to identify factors that affect preterm birth and birth of very low birth weight infants among immigrant women in the future.

Comparison of the number of live births, maternal age at childbirth, and weight of live births between Korean women and immigrant women in 2018

Purpose@#This study compared maternal age at childbirth, the number of live births, and the weight of live births between Korean women and immigrant women using statistical data from the Republic of Korea for 2018. @*Methods@#The analysis was conducted using data from the Microdata Integrated Service of Statistics Korea (https://mdis.kostat.go.kr/index.do). @*Results@#Korean women and immigrant women showed a higher age at childbirth in 2018 than in 2008. The percentage of newborns of Korean women with a birth weight of less than 2.5 kg increased slightly for 3 consecutive years from 2016 to 2018, whereas for immigrant women, this percentage increased in 2017 compared to 2016 and then decreased again in 2018. Very low birth weight (less than 1.5 kg) became more common among immigrant women from 2016 to 2018. Birth at a gestational age of fewer than 37 weeks increased both among Korean and immigrant women from 2016 to 2018. In both groups, the percentage of women who had their first child within their first 2 years of marriage decreased from 2008 to 2018. @*Conclusion@#Immigrant women had higher birth rates than Korean women, while both groups showed an increasing trend in premature birth. Greater attention should be paid to the pregnancy and birth needs of immigrant women, and steps are needed to ensure health equity and access in order to prevent premature births. It is also necessary to identify factors that affect preterm birth and birth of very low birth weight infants among immigrant women in the future.

In Vivo and In Vitro Quantification of Glucose Kinetics: From Bedside to Bench

Like other substrates, plasma glucose is in a dynamic state of constant turnover (i.e., rates of glucose appearance [Ra glucose] into and disappearance [Rd glucose] from the plasma) while staying within a narrow range of normal concentrations, a physiological priority. Persistent imbalance of glucose turnover leads to elevations (i.e., hyperglycemia, Ra>Rd) or falls (i.e., hypoglycemia, Ra

Effect of transportation method on preoperative anxiety in children: a randomized controlled trial / 대한마취과학회지

Background@#This study was performed to evaluate the effect of a wagon as a transport vehicle instead of the standard stretcher car to reduce children’s anxiety of separation from parents. The secondary goal was to evaluate whether this anxiolytic effect was related to age. @*Methods@#We divided 80 children (age 2–7 years) into two groups. The stretcher group was transferred to the operating room on a conventional stretcher car, whereas the wagon group was transferred using a wagon. The level of anxiety was evaluated three times using the Modified Yale Preoperative Anxiety Scale (mYPAS): in the waiting area (T0), in the hallway to the operating room (T1), and before induction of anesthesia (T2). @*Results@#The mYPAS score was significantly lower in the wagon group (36.7 [31.7, 51.7]) than in the stretcher group (51.7 [36.7, 83.3]) at T1 (P = 0.007). However, there was no difference in the mYPAS score between the two groups at T2 (46.7 [32.5, 54.2] vs. 51.7 [36.7, 75.0], respectively, P = 0.057). The baseline anxiety tended to be lower with increasing age (r = −0.248, P = 0.031). During transportation to the operating room, the increase in the mYPAS score (T1-T0) was greater as the age of children decreased in the stretcher group (r = −0.340, P = 0.034). However, no correlation was observed in the wagon group (r = −0.053, P = 0.756). @*Conclusion@#The wagon method decreased preoperative anxiety, suggesting that it may be a good alternative for reducing preoperative anxiety in children.

In Vivo and In Vitro Quantification of Glucose Kinetics: From Bedside to Bench

Like other substrates, plasma glucose is in a dynamic state of constant turnover (i.e., rates of glucose appearance [Ra glucose] into and disappearance [Rd glucose] from the plasma) while staying within a narrow range of normal concentrations, a physiological priority. Persistent imbalance of glucose turnover leads to elevations (i.e., hyperglycemia, Ra>Rd) or falls (i.e., hypoglycemia, Ra

Quantifications of Lipid Kinetics In Vivo Using Stable Isotope Tracer Methodology

Like other bodily materials, lipids such as plasma triacylglycerol, cholesterols, and free fatty acids are in a dynamic state of constant turnover (i.e., synthesis, breakdown, oxidation, and/or conversion to other compounds) as essential processes for achieving dynamic homeostasis in the body. However, dysregulation of lipid turnover can lead to clinical conditions such as obesity, fatty liver disease, and dyslipidemia. Assessment of “snap-shot” information on lipid metabolism (e.g., tissue contents of lipids, abundance of mRNA and protein and/or signaling molecules) are often used in clinical and research settings, and can help to understand one's health and disease status. However, such “snapshots” do not provide critical information on dynamic nature of lipid metabolism, and therefore may miss “true” origin of the dysregulation implicated in related diseases. In this regard, stable isotope tracer methodology can provide the in vivo kinetic information of lipid metabolism. Combining with “static” information, knowledge of lipid kinetics can enable the acquisition of in depth understanding of lipid metabolism in relation to various health and disease status. This in turn facilitates the development of effective therapeutic approaches (e.g., exercise, nutrition, and/or drugs). In this review we will discuss 1) the importance of obtaining kinetic information for a better understanding of lipid metabolism, 2) basic principles of stable isotope tracer methodologies that enable exploration of “lipid kinetics” in vivo, and 3) quantification of some aspects of lipid kinetics in vivo with numerical examples.

Analytical Performance of INNOVANCE Free Protein S Antigen on Sysmex CS-5100

BACKGROUND: Protein S deficiency is a common cause of thrombophilia. Free protein S has been suggested as one of the best screening tests for this deficiency. We evaluated an immunoturbidimetric free protein S reagent, INNOVANCE Free Protein S Antigen (Free PS Ag; Siemens Healthcare Diagnostics, Germany), using a CS-5100 coagulation analyzer (Sysmex, Japan). METHODS: The performance of INNOVANCE Free PS Ag was evaluated according to the CLSI guidelines. Precision, linearity, and verification of reference intervals were examined. The INNOVANCE Free PS Ag was also compared by the STA-Liatest Free Protein S immunoturbidimetric assay (Diagnostica Stago, France). RESULTS: The repeatability and within-laboratory imprecision of INNOVANCE Free PS Ag were 0.8% CV and 2.0% CV at the normal level, and 1.3% CV and 2.3% CV at the abnormally low level, respectively. This assay showed linearity from 4.0% to 151.9% (correlation coefficient r=1, P < 0.0001). Reference intervals for males and females were verified as acceptable. INNOVANCE Free PS Ag was comparable with STA-Liatest Free Protein S with a very high correlation (r=0.935, P < 0.0001). The results for the INNOVANCE antigen were higher. CONCLUSIONS: The INNOVANCE Free PS Ag on a Sysmex CS-5100 coagulation analyzer has excellent analytical performance and is comparable with the STA-Liatest Free Protein S assay.

Effect of a combination of 2% lidocaine jelly and thermally softened endotracheal tube on postoperative sore throat

BACKGROUND: Postoperative sore throat (POST) is a common adverse event after general anesthesia. The aim of this study was to evaluate the effectiveness of 2% lidocaine jelly applied on the single-lumen endotracheal tube (ETT) and thermal softening of the ETT, and a combination of both interventions on the development of POST. METHODS: Patients (n = 144) undergoing general anesthesia were randomly assigned to one of four groups: Control group (un-softened ETT lubricated with saline); Lidocaine group (un-softened ETT lubricated with 2% lidocaine jelly); Softened group (thermally softened ETT lubricated with saline); and Combined group (thermally softened ETT lubricated with 2% lidocaine jelly). Sore throat was evaluated at 0, 1, 6, 24, and 48 h after extubation. The occurrence of any postoperative complication was also assessed including hoarseness and coughing. RESULTS: No significant difference was observed in the severity of POST at all time points. However, the incidences of POST for overall (0–48 h) and the immediately following period (0 h) were significantly lower in the Combined group (52.9% and 47.1%) than in the Control group (79.4% and 76.5%), Lidocaine group (81.8% and 78.8%), and Softened group (82.9% and 74.3%). The overall incidence of hoarseness did not differ among the groups. No other postoperative complication was observed in any of the patients. CONCLUSIONS: No differences were observed in the severity of POST. However, 2% lidocaine jelly applied on thermally softened ETT reduced the overall incidence of POST. Therefore, this combined intervention could be considered as an alleviating strategy for POST.

Optimal effect-site concentration of remifentanil when combined with dexmedetomidine in patients undergoing cystoscopy / 대한마취과학회지

BACKGROUND: Cystoscopic procedure is a very common practice in the field of urology due to its ability to survey the bladder for a variety of indications. However, patients who undergo cystoscopy feel intense pain and discomfort. This study investigated the half maximal effective concentration (EC50) of remifentanil in preventing cystoscope insertion pain under sedation using dexmedetomidine. METHODS: The study was prospectively conducted on 18 male patients, aged 18 to 65. Remifentail infusion was initiated together with dexmedetomidine, and started at a dose of 2.4 ng/ml on the first patient. The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml. Patients received a loading dose of 1.0 microg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.6 microg/kg/hr. After the patient's OAA/S score (Observer's Assessment of Alertness/Sedation scale) reached 3-4, and the Ce of remifentanil reached target concentration, the urologist was allowed to insert the cystoscope and the pain responses were observed. RESULTS: The effect-site concentration of remifentanil required to prevent cystoscope insertion pain in 50% of patients under sedation using dexmedetomidine was 1.30 +/- 0.12 ng/ml by Dixon's up-and-down method. The logistic regression curve of the probability of response showed that the EC50 and EC95 values (95% confidence limits) of remifentanil were 1.33 ng/ml (1.12-1.52 ng/ml) and 1.58 ng/ml (1.44-2.48 ng/ml), respectively. CONCLUSIONS: Cystoscopic procedure can be carried out successfully without any pain or adverse effects by optimal remifentanil effect-site concentration (EC50, 1.33 ng/ml; EC95, 1.58 ng/ ml) combined with sedation using dexmedetomidine.

Urinary trypsin inhibitor attenuates lipopolysaccharide-induced neutrophil activation / 대한마취과학회지

BACKGROUND: Urinary trypsin inhibitor (UTI), which is speculated to have anti-inflammatory effects, is one of serine protease inhibitors found in human urine and blood. The present study was conducted to clarify the effect of urinary trypsin inhibitor (UTI) on human neutrophil activation and its intracellular signaling mechanism in vitro. METHODS: To assess the possible interactions between UTI and lipopolysaccharide (LPS) in neutrophil activation, neutrophils from human blood were incubated with varying concentrations of UTI (1, 10, 100, 1,000 and 10,000 U/ml) plus LPS (100 ng/ml) or LPS alone in 24-well plates (5 x 106 cells/well). We measured protein levels for interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-alpha) using enzyme-linked immunosorbent assay (ELISA) kits after 4 hours of incubation period. To elucidate the intracellular signaling pathway, we also measured the levels of phosphorylation of p38, ERK1/2 and JNK via Western blot analysis. Moreover, the nuclear levels of nuclear factor-kappa B (NF-kappaB) were determined with electrophoretic mobility shift assays (EMSA). RESULTS: UTI decreased the expression of inflammatory cytokines, including TNF-alpha and IL-6, and activation of intracellular signaling pathways, such as JNK, but not P38, ERK1/2 and nuclear translocation of NF-kappaB. CONCLUSIONS: UTI can attenuate LPS-induced neutrophil responses and may partially contribute to the treatment of neutrophil-mediated inflammatory diseases.

Adolescent nutrition and growth / 소아과

Nutrition is an essential component of total adolescent health care. Two important changes occurring during adolescence can cause a crisis in the teenager's nutritional needs. First, growth in height, weight, and body component is greater and more rapid than at any time since infancy. Second, an adolescent's eating habits may change from regular meals prepared at home to irregular meals, skipped meals, and nutrition-poor snacks and fast-food meals. Adolescents have been found to have the highest prevalence of any age group of an unsatisfactory nutritional status. To understand the nutritional requirements of the adolescent, health practitioners should be aware of the intensity and timing of the adolescent growth spurt, the differences in the growth spurt between males and females, and the individual variation in timing of the growth spurt from teenager to teenager.