Changes in computed tomography perfusion parameters and maximum contrast enhancement in patients having hydrocephalus with a ventriculoperitoneal shunt: a pilot study.

BACKGROUND: Acute hydrocephalus may decrease cerebral perfusion by increasing intracranial pressure. Computed tomography perfusion (CTP) has become a significant adjunct in evaluating regional and global cerebral blood flow (CBF). PURPOSE: To investigate the changes in cerebral perfusion parameters and maximum contrast enhancement (MCE) in patients with hydrocephalus with ventriculoperitoneal shunt (VPS). MATERIAL AND METHODS: We performed brain CTP in 45 patients, including those with subarachnoid hemorrhage (SAH)-induced hydrocephalus with VPS (n = 14, G1), hydrocephalus (not related to SAH) with VPS (n = 11, G2), SAH-induced hydrocephalus without VPS (n = 10, G3), and hydrocephalus (not related to SAH) without VPS (n = 10, G4). We measured the cerebral perfusion in the frontal white matter (FWM), centrum semiovale, basal ganglia (BG), and eight cortical lesions of interest and compared the differences in CTP parameters among the groups. RESULTS: Between the four groups, cerebral blood volume and MCE in the left FWM and CBF in the right FWM increased significantly in G1 and G2 who underwent VP shunt compared to G3 and G4, whereas perfusion significantly reduced in G3 and G4 who did not undergo VP shunt compared to G1 and G2. MCE in the left BG significantly increased in G2 and decreased in G3 and G4. SAH-induced hydrocephalus showed a lower perfusion than hydrocephalus (not related to SAH) in FWM. CONCLUSIONS: Perfusion changes in patients with hydrocephalus after VP shunt were seen in the FWM and BG, which appears to be the result of the hydrocephalus reducing brain perfusion in the deep part of the brain. We concluded that SAH slows brain perfusion recovery.

Reoperations after fusion surgeries for degenerative spinal diseases depending on cervical and lumbar regions: a national database study.

BACKGROUND: Reoperation is one of the key factors affecting postoperative clinical outcomes. The reoperation rates of cervical surgeries might be different from those of lumbar surgeries due to the anatomical and biomechanical differences. However, there has been no study to compare the reoperation rate between them. The purpose is to compare reoperation rates after fusion surgeries for degenerative spinal diseases depending on the anatomic region of cervical and lumbar spines. METHOD: We used the Korean Health Insurance Review & Assessment Service national database. Subjects were included if they had any of the primary procedures of fusion combined with the procedure of decompression procedures under the diagnosis of degenerative diseases (n = 42,060). We assigned the patients into two groups based on anatomical regions: cervical and lumbar fusion group (n = 11,784 vs 30,276). The primary endpoint of reoperation was the repeat of any aforementioned fusion procedures. Age, gender, presence of diabetes, associated comorbidities, and hospital types were considered potential confounding factors. RESULTS: The reoperation rate was higher in the patients who underwent lumbar fusion surgery than in the patients who underwent cervical fusion surgery during the entire follow up period (p = 0.0275). A similar pattern was found during the late period (p = 0.0468). However, in the early period, there was no difference in reoperation rates between the two groups. Associated comorbidities and hospital type were noted to be risk factors for reoperation. CONCLUSIONS: The incidence of reoperation was higher in the patients who underwent lumbar fusion surgery than those who underwent cervical fusion surgery for degenerative spinal diseases.

Association Between Carbon Monoxide Intoxication and Incidence of Ischemic Stroke: A Retrospective Nested Case-Control Study in South Korea.

OBJECTIVES: Severe neurological sequelae occur in patients with carbon monoxide (CO) intoxication; however, whether the latter increases the long-term risk of developing ischemic stroke is unclear. We investigated the association between CO intoxication and ischemic stroke using data from the Korean National Health Information Database. MATERIALS AND METHODS: We performed a retrospective, nested case-control study of 27,984 individuals treated for CO intoxication and 27,984 sex- and age-matched controls. Initially, we calculated the overall incidence and hazard ratio (HR) of ischemic stroke using conditional logistic regression. Thereafter, we calculated the incidences and HRs according to covariates and follow-up periods. RESULTS: The CO intoxication group had a significantly higher risk of developing ischemic stroke than the control group (adjusted HR 2.31, 95% CI [confidence interval] = 2.01-2.65). Male sex (adjusted HR 2.73, 95% CI = 2.23-3.34), age <40 (adjusted HR 3.53, 95% CI = 2.15-5.82), low income (adjusted HR 2.55, 95% CI = 1.56-4.15), comorbidities (adjusted HR 2.59, 95% CI = 1.48-4.52), and current smokers (adjusted HR 3.55, 95% CI = 1.67-7.60) had a higher risk of ischemic stroke. The risk of ischemic stroke was highest within 2 years after CO intoxication (adjusted HR 7.47, 95% CI = 2.76-20.26), and even >6 years after, the risk remained significantly higher than in the control group (adjusted HR 1.84, 95% CI = 1.53-2.20). CONCLUSIONS: CO intoxication and the long-term risk of ischemic stroke are associated.

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study.

BACKGROUND: The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population. METHODS: Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD). RESULTS: GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all P < 0.050). Although GnRHa users had an increased incidence of CVA and IHD (P = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant. CONCLUSION: Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.

Quantitative analysis of cochlear signal intensity on three-dimensional and contrast-enhanced fluid-attenuated inversion recovery images in patients with Meniere's disease: Correlation with the pure tone audiometry test.

PURPOSE: The purpose of this study was to correlate the quantitative analysis of cochlear signal intensity (SI) on 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and contrast-enhanced (CE) 3D-FLAIR images with results of the pure tone audiometry (PTA) test in patients with Meniere's disease (MD). MATERIALS AND METHODS: Over a 3-year period, 123 patients with MD underwent 3-Tesla (3 T) temporal magnetic resonance imaging (MRI), including 3D-FLAIR and CE-FLAIR sequences. The SI of membranous labyrinth of the cochlea in both ears of each patient was measured by drawing a region of interest (ROI) with a seed growing technique. The correlation between measured cochlear SIs on 3D-FLAIR and CE-FLAIR images, contrast enhancement index (CEI), and contrast enhancement ratio (CER) and clinical findings and pre- and post-treatment PTA results were assessed. RESULTS: Cochlear signal ratios of symptomatic ears on 3D-FLAIR and CE-FLAIR images were significantly higher than those of asymptomatic ears (P < 0.001). The area under the curve, from the receiver operating characteristic curve of cochlear SIs on 3D-FLAIR and CE-FLAIR images for discrimination between symptomatic and asymptomatic ears, was 0.729 and 0.728, respectively. Cochlear SIs on 3D-FLAIR and CE-FLAIR images were significantly correlated with patients' sex (P < 0.05 and P < 0.01, respectively), symptomatic ear (both P < 0.0001), and pre-treatment PTA (P < 0.0001 and P < 0.005, respectively), but were not significantly correlated with patients' age, post-treatment PTA or hearing threshold level at 0.5, 1.0, 2.0, or 4.0 kHz. CONCLUSION: Quantitative analysis of cochlear SI on 3D-FLAIR and CE-FLAIR images may be a helpful diagnostic adjunct for MD, but may be of little value in predicting the prognosis of MD.

Validation of body composition using bioelectrical impedance analysis in children according to the degree of obesity.

This study aimed to validate body composition analysis using bioelectrical impedance analysis (BIA) against dual-energy X-ray absorptiometry (DXA) in children with obesity and to compare agreement between BIA and DXA according to their degree of obesity. Three hundred and sixteen children aged 6-17 years participated in the Intervention for Childhood and Adolescents Obesity via Activity and Nutrition study. We divided participants by body mass index (BMI) percentile (group 1: mild to moderate obesity; group 2: severe obesity) and compared body composition variables, eg, percentage of body fat (%BF), fat mass (FM), and fat-free mass (FFM) using BIA and DXA. The %BF and FM of BIA were significantly lower (-1.8% and -0.8 kg, respectively), and the FFM of BIA was significantly higher (1.4 kg) than those of DXA. There were significant negative relationships between the absolute value of differences from BIA and DXA and BMI z-scores in %BF, FM, and FFM (regression coefficient [ß]: -1.39, 95% confidence interval [CI]: -1.81 to -0.97; ß: -0.34, 95%CI: -0.61 to -0.06; ß: -0.73, 95%CI: -1.03 to -0.44, respectively). The gap of body compositions between BIA and DXA decreased as participants became more obese, and the differences of FM in boys with severe obesity and the differences of %BF and FFM in girls with severe obesity were much less than those in children with mild to moderate obesity. In conclusion, the agreement between DXA and BIA was better for children with severe obesity than for children with mild to moderate obesity.

Cesium-137 Contaminated Roads and Health Problems in Residents: an Epidemiological Investigation in Seoul, 2011.

BACKGROUND: In 2011, two roads in a residential area in Seoul were found to be contaminated with the radionuclide cesium-137 (137Cs). In response to public concerns, an epidemiological study was conducted. METHODS: The standardized cancer incidence ratios in the affected and neighboring regions were calculated based on the central cancer registry. Households in the region were sampled using the random stratified sampling technique, and questionnaires were administered to family members, via home visit and via students in elementary to high schools. Information on duration of residency and frequency of use of the roads was applied to calculate cumulative radiation exposure dose from the roads, alongside with the reported 137Cs contamination amounts. Information on past medical history, perceived risk, anxiety and psychological stress was also obtained. Of the 31,053 residents, 8,875 were analyzed. To examine possible associations between radiation exposure and health problems, logistic regression adjusted for covariates were performed with consideration of the sampling design, population weight and stratification. RESULTS: No significant association was found between self-informed diseases, including cancers, and estimated radiation exposure dose. According to an increase of radiation level, a significant increase in anxiety in all and a decline in the psychosocial wellbeing of the adults was noted. The risk perception level was higher in the elderly, females, the less educated, and the highest exposed individuals. CONCLUSION: This study provides a basis for risk communication with residents and community environmental health policy.

Working hours and self-rated health over 7 years: gender differences in a Korean longitudinal study.

BACKGROUND: To investigate the association between long working hours and self-rated health (SRH), examining the roles of potential confounding and mediating factors, such as job characteristics. METHODS: Data were pooled from seven waves (2005-2011) of the Korean Labour and Income Panel Study. A total of 1578 workers who consecutively participated in all seven study years were available for analysis. A generalized estimating equation for repeated measures with binary outcome was used to examine the association between working hours (five categories; 20-35, 36-40, 41-52, 53-68 and ≥ 69 h) and SRH (two categories; poor and good health), considering possible confounders and serial correlation. RESULTS: Associations between working hours and SRH were observed among women, but only for the category of the shortest working hours among men. The associations with the category of shortest working hours among men and women disappeared after adjustment for socioeconomic factors. Among women, though not men, working longer than standard hours (36-40 h) showed a linear association with poor health; OR = 1.41 (95% CI = 1.08-1.84) for 52-68 working hours and OR = 2.11 (95% CI = 1.42-3.12) for ≥ 69 working hours. This association persisted after serial adjustments. However, it was substantially attenuated with the addition of socioeconomic factors (e.g., OR = 1.66 (95% CI = 1.07-2.57)) but only slightly attenuated with further adjustment for behavioural factors (e.g., OR = 1.63 (95% CI = 1.05-2.53)). The associations with job satisfaction were significant for men and women. CONCLUSIONS: The worsening of SRH with increasing working hours only among women suggests that female workers are more vulnerable to long working hours because of family responsibilities in addition to their workload.

High pulse pressure and metabolic syndrome are associated with proteinuria in young adult women.

BACKGROUND: Obesity and metabolic syndrome play causative roles in the increasing prevalence of proteinuria in the general population. However, in young adult women the clinical significance of incidentally discovered proteinuria and its association with metabolic syndrome are unclear. We investigated the prevalence and risk factors for proteinuria in this population. METHODS: A total of 10,385 women aged 20 to 39 years who underwent health screenings were surveyed. Each patient was tested for proteinuria with a dipstick (-, ±, 1+, 2+, or 3+), and proteinuria was defined as 1+ or greater. Persistent proteinuria was established by confirming proteinuria in a subsequent test. Metabolic syndrome was defined in accordance with the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asia. RESULTS: The mean age was 28.9±5.5 years, and the prevalence of persistent proteinuria was 1.0%. Among these subjects with persistent proteinuria, obesity and metabolic syndrome were found in 10.4% and 5.2%, respectively. Metabolic syndrome, as well as its components of hypertension, hyperglycemia, central obesity, low high-density lipoprotein levels, and high triglyceride levels, was closely related to the presence of proteinuria. In addition, a wide pulse pressure of ≥40 mmHg was another independent risk factor for proteinuria [odds ratio (OR) 3.29, 95% confidence interval (CI) 1.03-11.91)]. This had an additive effect on metabolic syndrome in terms of predicting proteinuria. Even in subjects without metabolic syndrome, the influence of an increased pulse pressure was consistent (OR 2.75, 95% CI 1.03-8.61). CONCLUSIONS: Specific attention to proteinuria may be necessary in asymptomatic young women aged 20 to 39 years if they have metabolic syndrome or a wide pulse pressure.

Mild hypoglycemia is independently associated with increased risk of mortality in patients with sepsis: a 3-year retrospective observational study.

INTRODUCTION: Mild hypoglycemia is associated with increased mortality in critically ill patients. However, data regarding the association between mild hypoglycemia and patient outcomes among patients with sepsis are limited. METHODS: Patients admitted to a medical ICU for sepsis, as defined by the Surviving Sepsis Campaign guidelines, during a 3-year period were enrolled retrospectively. Data on blood glucose (BG) control parameters and patient outcomes were collected. The primary outcome was the relationship of mild hypoglycemia (defined as minimum BG of 40 to 69 mg/dl during ICU stay) to hospital mortality, and the secondary outcomes were ICU-acquired complication rates, ICU and 1-year mortality rates. A relationship between glucose variability and hypoglycemic events was also investigated. RESULTS: Three-hundred and thirteen consecutive patients with sepsis were enrolled (mean age, 71.8 ± 11.3 years; male, n = 166; diabetics, n = 102). A total of 14,249 (5.6/day/patient) BG tests were performed, and 175 hypoglycemic events (spontaneous, n = 71; iatrogenic, n = 104) occurred in 80 (25.6%) patients during the ICU stay; severe hypoglycemia (minimum BG level < 40 mg/dl) occurred in 24 (7.7%) patients, and mild hypoglycemia (minimum BG level 40 to 69 mg/dl) was found in 56 (17.9%) patients. The frequency of hypoglycemic events increased with higher glucose variability, and patients with mild hypoglycemia had higher rates of ICU-acquired complications than did those with no hypoglycemia (renal, 36.2% vs. 15.6%, P = 0.003; cardiac, 31.9% vs. 14.3%, P = 0.008; hepatic, 34.0% vs. 18.2%, P = 0.024; bacteremia, 14.9% vs. 4.5%, P = 0.021). Multivariate analysis revealed that mild hypoglycemia was independently associated with increased hospital mortality (odds ratio, 3.43; 95% confidence interval, 1.51 to 7.82), and even a single event was an independent risk factor (odds ratio, 2.98; 95% confidence interval, 1.10 to 8.09). Kaplan-Meier analysis demonstrated that mild hypoglycemia was significantly associated with a lower 1-year cumulative survival rate among patients with sepsis (P < 0.001). CONCLUSION: Mild hypoglycemia was associated with increased risk of hospital and 1-year mortality, as well as the occurrence of ICU-acquired complications. Physicians thus need to recognize the importance of mild hypoglycemia in patients with sepsis.

The clinical effectiveness of oseltamivir in mild cases of pandemic influenza A H1N1 2009 infection.

BACKGROUND: Oseltamivir is widely used for the treatment of influenza infection, but data on its effectiveness in treating infections with pandemic influenza A H1N1 2009 are scarce. Therefore, we compared the effectiveness of oseltamivir and routine symptomatic treatment in pandemic influenza A H1N1 2009 infection. METHODS: Between August and October 2009, among laboratory confirmed influenza cases who were aged over 15 y with no underlying disease, 90 patients with oseltamivir treatment and 72 patients with symptomatic treatment were evaluated by telephone interviews to compare clinical outcomes. No patient was hospitalized. The primary end-point was the duration of illness. We also assessed the time to attain a sense of well-being and the time to return to normal activity. RESULTS: There was no statistically significant difference in the duration of illness between the oseltamivir-treated group and the symptomatic treatment group (mean duration after the start of treatment, 6.50 ± 3.75 days vs 7.04 ± 3.75 days). There was also no statistically significant difference between the 2 groups in the time to a sense of well-being (1.70 ± 1.57 days vs 2.00 ± 2.12 days) and to return to normal activity (7.13 ± 2.61 days vs 7.58 ± 2.71 days). The complication rate was very low (only 2 cases of mild pneumonia in oseltamivir recipients) and no significant difference was found between the 2 groups (p = 0.50). CONCLUSIONS: Oral oseltamivir treatment does not significantly reduce the duration of illness or influenza-related complications in mild pandemic influenza A H1N1 2009 virus infection in previously healthy adults.

The association between nonstandard work and occupational injury in Korea.

BACKGROUND: The number of workers who died due to occupational injury in Korea as of 2007 was 1,383. The aim of this study was to identify whether there were any differences in the risk of occupational injury between nonstandard workers (temporary workers and/or subcontract workers) and regular workers. METHODS: 1,576 injured workers, selected from National Health Insurance and National Workers' Compensation Insurance, were interviewed via telephone survey using standardized questionnaires in 2007. The control group was 1,500 workers matched for age, gender, and severity of injury. A multivariate logistic regression model was used to analyze the association between the type of nonstandard work and occupational injury. RESULTS: Nonstandard temporary workers were more likely to be injured than regular workers even if other related factors of occupational injury were statistically adjusted (adjusted odds ratio, OR 2.87, 95% confidence interval 2.37-3.49). CONCLUSIONS: The reason why the risks of nonstandard workers are higher than those of regular workers is that nonstandard workers are placed in poor working conditions.

Additive Effects of Exercise or Nutrition Intervention in a 24-Month Multidisciplinary Treatment with a Booster Intervention for Children and Adolescents with Overweight or Obesity: The ICAAN Study.

This study compared the effects of a real-world multidisciplinary intervention with additional exercise or nutritional elements and investigated the effectiveness of a booster intervention after weight regain. A total of 242 children and adolescents (age- and sex-specific body mass index [BMI] ≥ 85th percentile, mean age: 10.82 years, 60% male) were allocated to three groups: usual care, exercise, or nutrition. Six-month active treatment with 1:1 session and a maintenance stage with group activities were repeated twice to comprise a 24-month intervention. The primary outcome was change % of the BMI z-score (zBMI). A total of 110 (45.4%) participants completed the 24-month intervention. A mixed-effects model analysis indicated no significant interaction effect of the intervention group and treatment phase on the zBMI change % (p = 0.976). However, there was a significant main effect of the treatment phase on zBMI change % at 6 months (ß = -2.98, [95% CI, -5.69-0.27]), 18 months (ß = -3.99, [95% CI, -6.76-1.22]), and 24 months (ß = -3.23, [95% CI, -5.94-0.52]; p = 0.042). The improvements in zBMI, body fat %, and cardiometabolic markers were observed only among males. Whereas the additive effect of intensive exercise or nutritional feedback was not detected in the long term, a booster intervention with 1:1 counseling was effective even after weight regain during the maintenance period. It may be useful to combine individualized counseling with a less intensive form of group care for long-term maintenance in a real-world setting.

Cholinesterase inhibitors for Alzheimer disease: do they provide more than symptomatic benefits?

OBJECTIVE: This study aims to examine survival of patients with Alzheimer disease (AD) receiving clinical efficacy of cholinesterase inhibitors (ChEIs) and to compare their survival with those of patients with AD who never received ChEIs and cognitively intact old psychiatric outpatients. DESIGN, SETTING, AND PARTICIPANTS: The retrospective cohort study used national mortality data provided by the Korean National Statistics Office and electronic database of 15 general hospitals on older patients who began outpatient treatment with psychiatric medications including ChEIs (N = 3,813). The authors controlled for confounding by using multivariate models and propensity scoring methods. MEASUREMENTS: Mortality rate of patients with AD receiving ChEIs was compared with those of patients with AD who never received ChEIs and cognitively intact old psychiatric outpatients. RESULTS: Observed additional survival of patients with AD receiving ChEIs (mortality rate: 13.1%), when compared with patients with AD who never received ChEIs (15.4%) was not statistically significant (p = 0.74; hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.67-1.59). Patients with AD receiving ChEIs showed higher mortality rate (13.1%) compared with that of cognitively intact old psychiatric outpatients (8.6%) (p <0.001; HR: 1.60, 95% CI: 0.96-2.68). CONCLUSION: This study does not support that ChEIs increase survival of patients with AD, compared with patients with AD who have never treated with ChEIs. Therefore, all ChEIs should be considered for symptomatic use only and not to be capable of modifying mortality of patients with AD.

Health inequalities of 57,541 prisoners in Korea: a comparison with the general population.

OBJECTIVES: This study aimed to examine health disparities between prisoners and the general population in Korea. METHODS: We sought to estimate the prevalence of 17 physical and mental diseases using the nationwide medication prescription dataset among the total population of prisoners (n=57,541) in Korea. Age- and sex- standardized prevalence ratios (SPRs) were estimated to compare the disease prevalence between the prisoners and the general population. The disease prevalence for the general population was calculated from the prescription dataset for a representative of the Korean population (n=926,246) from the 2013 Korean National Health Insurance Service-National Sample Cohort. Furthermore, the prevalence of these diseases was compared between prisoners and a low-income segment of the general population (n=159,781). RESULTS: Compared to the general population, prisoners had higher prevalence of almost all physical and mental diseases, including hyperlipidemia (SPR, 20.18; 95% confidence interval [CI], 19.43 to 20.94), pulmonary tuberculosis (SPR, 9.58; 95% CI, 7.91 to 11.50), diabetes (SPR, 6.13; 95% CI, 5.96 to 6.31), cancer (SPR, 2.36; 95% CI, 2.07 to 2.68), and depression (SPR, 46.73; 95% CI, 44.14 to 49.43). When compared with the low-income population segment, higher prevalence were still found among prisoners for most diseases, including pulmonary tuberculosis (SPR, 6.39; 95% CI, 5.27 to 7.67) and depression (SPR, 34.71; 95% CI, 32.79 to 36.72). CONCLUSIONS: We found that prisoners were more likely to be unhealthy than the general population, even in comparison with a low-income segment of the general population in Korea.

Non-Pathological Opacification of the Cavernous Sinus on Brain CT Angiography: Comparison with Flow-Related Signal Intensity on Time-of-Flight MR Angiography.

Purpose: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). Methods: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. Results: Neuroradiologists identified non-pathological opacification of the CS (n = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (p < 0.0001 for CS, p < 0.0001 for SPS, p < 0.0001 for IPS, and p < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: n = 21, 27.3%; TOF-MRA: n = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (κ = 0.10, 95% confidence interval: -0.12-0.32). Conclusion: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.

Effects of circuit training or a nutritional intervention on body mass index and other cardiometabolic outcomes in children and adolescents with overweight or obesity.

OBJECTIVE: We aimed to assess the effectiveness of the first 6 months of a 24 month multidisciplinary intervention program including circuit training and a balanced diet in children and adolescents with obesity. METHODS: A quasi-experimental intervention trial included 242 participants (age [mean±standard deviation]: 11.3±2.06 years, 97 girls) of at least 85th percentile of age- and sex-specific body mass index (BMI). Participants were grouped into three to receive usual care (usual care group), exercise intervention with circuit training (exercise group), or intensive nutritional and feedback intervention with a balanced diet (nutritional group). Primary outcome was BMI z-score, while secondary outcomes included body composition, cardiometabolic risk markers, nutrition, and physical fitness. RESULTS: Among the participants, 80.6% had a BMI ≥ the 97th percentile for age and sex. The BMI z-score of the overall completers decreased by about 0.080 after 6 months of intervention (p < 0.001). After the intervention, both exercise and nutritional groups had significantly lower BMI z-scores than the baseline data by about 0.14 and 0.075, respectively (p < 0.05). Significant group by time interaction effects were observed between exercise versus usual care group in BMI z-score (ß, -0.11; 95% confidence interval (CI), -0.20 to -0.023) and adiponectin (ß, 1.31; 95% CI, 1.08 to 1.58); and between nutritional versus usual care group in waist circumference (ß, -3.47; 95% CI, -6.06 to -0.89). No statistically significant differences were observed in any of the other secondary outcomes assessed. CONCLUSION: Multidisciplinary intervention including circuit training and a balanced diet for children and adolescents with obesity reduced the BMI z-score and improved cardiometabolic risk markers such as adiponectin and waist circumference.

Survival after in-hospital cardiopulmonary resuscitation from 2003 to 2013: An observational study before legislation on the life-sustaining treatment decision-making act of Korean patients.

We analyzed cardiopulmonary resuscitation (CPR) rates, deaths preceded by CPR, and survival trends after in-hospital CPR, using a sample of nationwide Korean claims data for the period 2003 to 2013.The Korean National Health Insurance Service-National Sample Cohort is a stratified random sample of 1,025,340 subjects selected from among approximately 46 million Koreans. We evaluated the annual incidence of CPR per 1000 admissions in various age groups, hospital deaths preceded by CPR, and survival rate following in-hospital CPR. Analyses of the relationships between survival and patient and hospital characteristics were performed using logistic regression analysis.A total of 5918 in-hospital CPR cases from 2003 to 2013 were identified among eligible patients. The cumulative incidence of in-hospital CPR was 3.71 events per 1000 admissions (95% confidence interval 3.62-3.80). The CPR rate per 1000 admissions was highest among the oldest age group, and the rate decreased throughout the study period in all groups except the youngest age group. Hospital deaths were preceded by in-hospital CPR in 18.1% of cases, and the rate decreased in the oldest age group. The survival-to-discharge rate in all study subjects was 11.7% during study period, while the 6-month and 1-year survival rates were 8.0% and 7.2%, respectively. Survival tended to increase throughout the study period; however, this was not the case in the oldest age group. Age and malignancy were associated with lower survival rates, whereas myocardial infarction and diabetes mellitus were associated with higher survival rates.Our result shows that hospital deaths were preceded by in-hospital CPR in 18.1% of case, and the survival-to-discharge rate in all study subjects was 11.7% during the study period. Survival tended to increase throughout the study period except for the oldest age group. Our results provide reliable data that can be used to inform judicious decisions on the implementation of CPR, with the ultimate goal of optimizing survival rates and resource utilization.