Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy.

OBJECTIVES: We compared the computed tomographic (CT) volumetric analysis and anatomical segment counting (ASC) for predicting postoperative forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLCO) in patients who had segmentectomy for early-stage lung cancer. METHODS: A total of 175 patients who had segmentectomy for lung cancer and had postoperative pulmonary function test were included. CT volumetric analysis was performed by software, which could measure total lung and target segment volume from CT images. ASC and CT volumetric analysis were used to determine predicted postoperative (PPO) values and the concordance and difference of these values were assessed. The relationship between PPO values and actual postoperative values was also investigated. RESULTS: The PPO-FEV1 and PPO-DLCO showed high concordance between 2 methods (concordance correlation coefficient = 0.96 for PPO-FEV1 and 0.95 for PPO-DLCO). There was no significant difference between PPO values as determined by 2 methods (P = 0.53 for PPO-FEV1, P = 0.25 for PPO-DLCO) and actual postoperative values [P = 0.77 (ASC versus actual) and P = 0.20 (CT versus actual) for FEV1; P = 0.41 (ASC versus actual) and P = 0.80 (CT versus actual) for DLCO]. We subdivided the patients according to poor pulmonary function test, the number of resected segments and the location of the resected lobe. All subgroup analyses revealed no significant difference between PPO values and actual postoperative values. CONCLUSIONS: Both CT volumetric analysis and ASC showed high predictability for actual postoperative FEV1 and DLCO in segmentectomy.

Clinical Associations between Serial Electrocardiography Measurements and Sudden Cardiac Death in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

The rate of sudden cardiac death (SCD) for hemodialysis (HD) patients is significantly higher than that observed in the general population and have the highest risk for arrhythmogenic death. In this multi-center study, patients starting hemodialysis in each hospital were enrolled; they underwent regular check-ups in an open-patient clinic. We examined serial electrocardiography (ECG) data in patients undergoing HD and determined their associations with the occurrence of SCD. Of 678 enrolled subjects who underwent serial ECG before and after hemodialysis, 291 died and 39 developed SCD. In all subjects, the QT peak-to-end (QTpe) interval at all leads and QRS duration were shortened after hemodialysis. The SCD group showed a significant change in the QTpe interval of the inferior, anterior, and lateral leads before and after hemodialysis compared with the survivor group (p < 0.001). In the pre-hemodialysis ECG, SCD patients had significantly longer QTpe intervals in all leads (p < 0.001) and a longer QRS duration (92.6 ± 14.0 vs. 100.6 ± 14.9 ms, p = 0.015) than survivors. In conclusion, patients with a longer QTpe interval before hemodialysis and large changes in ECG parameters after hemodialysis might be at a higher risk of SCD. Therefore, changes in the ECG before and after hemodialysis could help to predict SCD.

Comparison of the epidemiology and injury profile among injured patients involved in special purpose vehicle-related incidents in South Korea.

Injuries caused by mobile machinery or special purpose vehicles (SPVs) can lead to high socio-medical cost and fatality. In this descriptive study, we compared the epidemiology and injury profile of injured patients involved in SPVs-related incidents. We analyzed a nationwide database of SPV-related injured patients between January 2011 and December 2016. Injured patients were classified into three groups: pedestrian, motor vehicle occupant (MVO), and SPV operator groups. Of 1,419 cases, the highest number of SPV-related injured patients were found in the age group 40-59 years (671 cases, 47.3%) and at transport area (771 cases, 54.3%). The injury was most severe in the SPV operator group. The lower extremities were the most common fracture site, and intrathoracic injury was the most common visceral regions for SPV-related injured patients. SPV operator could lead to fatal intrathoracic injuries.

Hemodynamic Performance of Pericardial Bioprostheses in the Aortic Position.

BACKGROUND: This study was conducted to evaluate the hemodynamic performance and the incidence of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) using bovine pericardial valves (Carpentier-Edwards Perimount Magana and Magna Ease). METHODS: In total, 216 patients (mean age, 70.0±10.5 years) who underwent AVR using stented bovine pericardial valves and had follow-up echocardiography between 3 months and 2 years (mean, 12.0±6.6 months) after surgery were enrolled. The implanted valve sizes were 19, 21, 23, and 25 mm in 32, 56, 99, and 29 patients, respectively. RESULTS: On follow-up echocardiography, the mean transvalvular pressure gradients for the 19-mm, 21-mm, 23-mm, and 25-mm valves were 13.3±4.4, 12.6±4.2, 10.5±3.9, and 10.2± 3.7 mm Hg, respectively. The effective orifice area (EOA) was 1.25±0.26, 1.54±0.31, 1.81±0.41, and 1.87±0.33 cm2, respectively. These values were smaller than those suggested by the manufacturer for the corresponding sizes. No patients had PPM, when based on the reference EOA. However, moderate (EOA index ≤0.85 cm2/m2) and severe (EOA index ≤0.65 cm2/m2) PPM was present in 56 patients (11.8%) and 9 patients (1.9%), respectively, when using the measured values. CONCLUSION: Carpentier-Edwards Perimount Magna and Magna Ease bovine pericardial valves showed satisfactory hemodynamic performance with low rates of PPM, although the reference EOA could overestimate the true EOA for individual patients.

Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities.

Objective: Road traffic injuries (RTIs) are a major global health issue causing a global burden of mortality and morbidity. Half of all fatalities on the world's roads are vulnerable road users (VRUs). The targeted intervention strategies based on fatality analysis focusing on VRUs can effectively contribute to reducing RTIs. This study aimed to compare VRUs and motor vehicle occupants (MVOs) in terms of epidemiology and injury profile. Methods: We utilized a nationwide, prospective database of RTI-related mortality cases for patients who visited 23 emergency departments between January 2011 and December 2015. All fatalities due to RTIs in the prehospital phase or in-hospital were eligible, excluding patients with unknown mode of transport and those admitted to general wards. The primary and secondary outcomes were fracture injuries and visceral injuries diagnosed using the International Classification of Diseases, Tenth Revision (ICD-10). We compared fracture injuries between VRUs and MVOs using Abbreviated Injury Scale (AIS) 2- and 2+ classification. Results: Among a total 3,694 road traffic fatalities (RTFs), 43.3% were pedestrians, followed by MVOs (27.0%), motorcyclists (18.9), bicyclists (6.6%), and agricultural vehicle users (4.2%). The elderly (>60 years old) accounted for 54.9% of VRU fatalities. RTFs occurred most frequently in the autumn and the VRU group and the MVO group showed significant differences in weekly and diurnal variation in RTFs. The injury severities (AIS 2+) of the head, neck, and thorax were significantly different between the 2 groups (P < 0.05). Head (32.1%) and intracranial (58.6%) injuries were the most common fracture and visceral injury sites for RTFs, followed by the thorax and intrathoracic organs (25.3 and 28.8%, respectively). Conclusions: Elderly pedestrians should be targeted for decreases in RTFs, and road traffic safety interventions for VRUs should be made based on the analysis of temporal epidemiology and injury profiles of RTFs.

Protective effect of helmet use on cervical injury in motorcycle crashes: A case-control study.

INTRODUCTION: Helmet use during motorcycle crashes (MCCs) has been shown to reduce traumatic brain injury and mortality. However, preventive effects of its use on cervical spine injury remain controversial. In this study, we evaluated whether helmet use can reduce cervical spine injury during MCCs. PATIENTS AND METHODS: A case-control study using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) registry was conducted. Cases were defined as patients with cervical spine injury [≥2 points in the Abbreviated Injury Scale (AIS)] in MCCs from 2011 to 2016. Four controls were matched to one case with strata which included age and sex from the EDIIS registry. Primary outcome was cervical spine injury, secondary outcome was intensive care unit (ICU) admission, and tertiary outcomes was mortality. Multivariable logistic regression analysis was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) to evaluate the associations between helmet use and related outcomes. RESULTS: In total, 2600 patients were analysed; among these, 1145 (44.0%) used helmets at the time of crashes. The helmet group showed lower alcohol consumption and mortality rates than the no helmet group (alcohol: 3.2% vs. 9.2%, respectively, and mortality: 2.4% vs. 7.1%, respectively; p < 0.01). Compared with the no helmet group, the helmet group was less likely to have cervical spine injury [adjusted OR, 0.62 (0.51-0.77)]. In addition, helmet use has been shown to help prevent ICU admission and mortality [adjusted OR, 0.45 (0.36-0.56) and 0.32 (0.21-0.51), respectively]. CONCLUSION: Helmet use was found to have significant preventive effects on cervical spine injury during MCCs.