The association between serum free fatty acid levels and neurological outcomes in out-of-hospital cardiac arrest patients: A prospective observational study.

Free fatty acids (FFA) are a known risk factor in the development of sudden cardiac death. However, the relationship between FFA and the outcome of out-of-hospital cardiac arrest (OHCA) patients remains unclear. We aimed to examine the association between FFA and neurological outcomes in OHCA patients. This prospective observational study included adult (≥18 years) OHCA patients between February 2016 and December 2022. We measured serial FFA levels within 1 hour after ROSC and at 6, 12, 24, 48, and 72 hours after the return of spontaneous circulation (ROSC). The primary outcome was neurological outcome at 6 months. A poor neurological outcome was defined by cerebral performance categories 3, 4, and 5. A total of 147 patients were included. Of them, 104 (70.7%) had poor neurological outcomes, whereby the median FFA levels within 1 hour after ROSC (0.72 vs 1.01 mol/L), at 6 hours (1.19 vs 1.90 mol/L), 12 hours (1.20 vs 1.66 mol/L), and 24 hours (1.20 vs 1.95 mol/L) after ROSC were significantly lower than in good outcome group. The FFA levels at 6 hours (odds ratio, 0.583; 95% confidence interval, 0.370-0.919; P = .020), and 12 hours (odds ratio, 0.509; 95% confidence interval, 0.303-0.854; P = .011) after ROSC were independently associated with poor neurological outcomes. The lower FFA levels at 6 hours and 12 hours after ROSC were associated with poor neurological outcomes in patients with OHCA. FFA may reflect oxidative metabolism as well as oxidative stress.

Association between the red cell distribution width and mortality in elderly patients with non-traumatic coma: An observational cohort study.

Elevated red blood cell distribution width (RDW) can be associated with disease severity. However, studies on RDW for the prognosis of elderly patients with non-traumatic coma (NTC) are lacking. This study aims to examine the relationship between RDW and outcomes in elderly patients with NTC. This observational cohort study included elderly patients (aged ≥ 65 years) with NTC between January 2022 and December 2022. We measured RDW upon patient arrival at the emergency department (ED). We conducted a multivariable analysis using logistic regression of relevant covariates to predict in-hospital mortality. Survival curves based on 30-day mortality were designed using the Kaplan-Meier method. The primary outcome was in-hospital mortality, and the secondary outcome was 30-day mortality. A total of 689 patients were included in the study, and in-hospital mortality was 29.6% (n = 204). Our results found that the RDWs of non-survivors were significantly greater than those of survivors (14.6% vs 13.6%). Multivariable analysis showed that RDWs at ED arrival were independently associated with in-hospital mortality (odds ratio, 1.126; 95% confidence interval, 1.047-1.212; P < .001). The Kaplan-Meier curve indicated that the survival probability of patients with a low RDW was greater than those with a high RDW. Having a high RDW at ED arrival was associated with in-hospital mortality in elderly patients with NTC.

Inverse Association of the Adequacy and Balance Scores in the Modified Healthy Eating Index with Type 2 Diabetes in Women.

Type 2 diabetes (T2DM) has markedly increased among Asians as their diets and lifestyles become more westernized. We, therefore, investigated the hypothesis that the Korean healthy eating index (KHEI) scores are associated with gender-specific T2DM risk in adults. The hypothesis was tested using the data from the Korea National Health and Nutrition Examination Survey-VI (2013-2017) with a complex sample survey design. Along with the KHEI scores, the modified KHEI (MKHEI) scores for the Korean- (KSD) and Western-style diets (WSD) were used as independent parameters, calculated using a validated semi-quantitative food-frequency questionnaire (SQFFQ). We estimated the association between the KHEI or MKHEI and the T2DM risk using logistic regression after adjusting for T2DM-related covariates. The adults with T2DM were more frequently older men who were less educated, married, on a lower income, and living in rural areas compared to those without T2DM. Not only the fasting serum glucose concentrations but also the waist circumferences and serum triglyceride concentrations were much higher in adults with T2DM than in those without T2DM in both genders. Serum HDL concentrations in the non-T2DM subjects exhibited a greater inverse relationship to serum glucose than in the T2DM group in both genders. Twenty-four-hour recall data revealed that women, but not men, had higher calcium, vitamin C, saturated and monounsaturated fatty acids, retinol, and vitamin B2 intakes than the T2DM group. Furthermore, overall, the KHEI score and the adequacy and balance scores among its components were significantly higher in the non-T2DM group than in the T2DM group, but only in women. The KHEI scores were inversely associated with T2DM only in women. The mixed grain intake score was higher in the non-T2DM than the T2DM group only in men. However, there were no differences between the groups in the MKHEI scores for KSD and WSD. In conclusion, high KHEI scores in the adequacy and balance components might prevent and/or delay T2DM risk, but only in women.

Association between pre-hospital National Early Warning Score and in-hospital mortality in patients with traumatic brain injury.

BACKGROUND: This study aimed to examine the association between the outcome of traumatic brain injury (TBI) and pre-hospital National Early Warning Score (NEWS), Injury Severity Score (ISS), and Revised Trauma Score (RTS). METHODS: This retrospective and observational study included adult patients with TBI admitted to the pre-hospital emergency medical services system between January 2019 and December 2020. TBI was considered when the abbreviated injury scale score was 3 or higher. The primary outcome was in-hospital mortality. RESULTS: Among 248 patients included in the study, in-hospital mortality was 18.5% (n=46). In the multivariate analysis for predict-ing in-hospital mortality, pre-hospital NEWS (Odds ratio [OR], 1.198; 95% Confidence interval [CI], 1.042-1.378) and RTS (OR, 0.568; 95% CI, 0.422-0.766) were independently associated with in-hospital mortality. The area under the curves (AUCs) for ISS, RTS, and pre-hospital NEWS were 0.731 (95% CI, 0.672-0.786), 0.853 (95% CI, 0.802-0.894), and 0.843 (95% CI, 0.791-0.886), respectively. The AUC of pre-hospital NEWS was significantly different from that of ISS but not from that of RTS. CONCLUSION: Pre-hospital NEWS could contribute to improving prognosis by aiding in the rapid classification of patients with TBI in the field and their transportation to appropriate hospitals.

The Prevalence of Symptomatic Congenital Cytomegalovirus Disease in Korea; A 15-Year Multicenter Study and Analysis of Big Data From National Health Insurance System.

The birth prevalence of symptomatic congenital cytomegalovirus (cCMV) disease among live birth in Korea from a multicenter study was 0.06% during 2001-2015 with increasing frequency. The administrative prevalence of cCMV infection by big-data analysis from the national health insurance system was 0.01% and the average healthcare cost was US$2010 per person.

Cardiovascular age of workers with different employment categories.

INTRODUCTION: We compared the cardiovascular age (an indicator of cardiovascular disease risk) in workers with different employment status after adjustment for demographic and socioeconomic factors. METHODS: This cross-sectional study used data collected from 2007 to 2017 for the Korea National Health and Nutrition Examination Survey (KNHANES). Study participants were placed into different employment categories based on employment status and work schedule: regular full-time, regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time. RESULTS: Analysis of women indicated that regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time workers were more likely to have an older cardiovascular age (OR = 1.180, 1.238, 1.297, 1.493, and 1.408, respectively) after adjustment for age, marriage, education, income, residence, region, and drinking status. Analysis of men indicated employment status was unrelated to cardiovascular age. CONCLUSION: Female nonstandard Korean workers were more likely to have an increased cardiovascular age. However, most of these workers, especially daily workers, are not currently protected by the Occupational Safety and Health Act (OSHA) of Korea. Collaboration or networking with community-based health care services in Korea is essential to better manage the health of these vulnerable female workers.

A Healthy Diet Rich in Calcium and Vitamin C Is Inversely Associated with Metabolic Syndrome Risk in Korean Adults from the KNHANES 2013-2017.

The association between metabolic syndrome and eating patterns remains unclear. We hypothesized that Korean Healthy Eating Index (KHEI) scores were related to metabolic syndrome (MetS) risk in adults in a gender-dependent manner. We aimed to examine the hypothesis using the Korea National Health and Nutrition Examination Survey-VI (2013-2017) data with a complex sample survey design. Adjusted means and 95% confidence intervals of KHEI scores and nutrient intake estimated by the 24-h recall were calculated according to MetS status after adjusting for age, residence area, region, education, obesity, income, drinking status, smoking status, marriage, and exercise. Adjusted odds ratios for MetS were measured according to KHEI quartiles using logistic regression analysis while controlling for covariates. MetS incidence was significantly higher in females than in males. Those who were older, less educated, earning less income, more obese, living in rural areas, drinking severely, non-exercising, and married had higher MetS incidence than those with the opposite state. Total KHEI scores of all components KHEI scores were lower for those with MetS (MetS group) than those without MetS (Non-MetS group) in both genders. For KHEI components, having breakfast and milk and fat intake had lower scores for the MetS group than for the Non-MetS group in women, whereas fruits and milk and milk product intake had lower scores for the MetS group in men. Nutrient intake influenced the MetS risk in females more than in males. Fat, calcium, and vitamin C intakes from 24-h recall were lower in the MetS group than in the Non-MetS group in women. KHEI scores had an inverse association with MetS risk by 0.98-fold in both genders after adjusting for covariates. In conclusion, a healthy diet that includes adequate calcium and vitamin C is associated with a lower the risk of MetS in both men and women.

Performance of Modified Early Warning Score (MEWS) for Predicting In-Hospital Mortality in Traumatic Brain Injury Patients.

The present study aimed to analyze and compare the prognostic performances of the Revised Trauma Score (RTS), Injury Severity Score (ISS), Shock Index (SI), and Modified Early Warning Score (MEWS) for in-hospital mortality in patients with traumatic brain injury (TBI). This retrospective observational study included severe trauma patients with TBI who visited the emergency department between January 2018 and December 2020. TBI was considered when the Abbreviated Injury Scale was 3 or higher. The primary outcome was in-hospital mortality. In total, 1108 patients were included, and the in-hospital mortality was 183 patients (16.3% of the cohort). Receiver operating characteristic curve analyses were performed for the ISS, RTS, SI, and MEWS with respect to the prediction of in-hospital mortality. The area under the curves (AUCs) of the ISS, RTS, SI, and MEWS were 0.638 (95% confidence interval (CI), 0.603-0.672), 0.742 (95% CI, 0.709-0.772), 0.524 (95% CI, 0.489-0.560), and 0.799 (95% CI, 0.769-0.827), respectively. The AUC of MEWS was significantly different from the AUCs of ISS, RTS, and SI. In multivariate analysis, age (odds ratio (OR), 1.012; 95% CI, 1.000-1.023), the ISS (OR, 1.040; 95% CI, 1.013-1.069), the Glasgow Coma Scale (GCS) score (OR, 0.793; 95% CI, 0.761-0.826), and body temperature (BT) (OR, 0.465; 95% CI, 0.329-0.655) were independently associated with in-hospital mortality after adjustment for confounders. In the present study, the MEWS showed fair performance for predicting in-hospital mortality in patients with TBI. The GCS score and BT seemed to have a significant role in the discrimination ability of the MEWS. The MEWS may be a useful tool for predicting in-hospital mortality in patients with TBI.

Comparison of the physical and mental health problems of unemployed with employees in South Korea.

This study compared the physical and mental health problems of adults with standard and nonstandard employment with those who were unemployed. We used data from the Korean National Health and Nutrition Examination Survey to compare adult males and females with standard and nonstandard employment with those who were unemployed. Relative to adults with standard employment, higher proportions of unemployed individuals were women, older, had low monthly incomes, and had mental health problems. Compared to men and women with standard employment, unemployed men and women had greater risk of reporting depressive feelings (OR = 1.683, 95% CI = 1.298-2.183; OR = 1.419, 95% CI = 1.179-1.709) and suicidal ideation (OR = 2.218, 95% CI = 1.682-2.928; OR = 1.250, 95% CI = 1.020-1.530). Among workers with nonstandard employment, there were gender differences in the risk for arthritis. Unemployed individuals also had a higher risk of mental health problems than nonstandard workers. In conclusion, the unemployed were more vulnerable to mental health problems.

Association of the Healthy Eating Index with Estimated Cardiovascular Age in Adults from the KNHANES 2013-2017.

In this paper, we hypothesized that the gap between estimated cardiovascular age (eCV-age) and chronological age had a gender-wise correlation with the Korean Healthy Eating Index (KHEI). We tested the hypothesis in adults aged 20-64 years old using the KNHANES 2013-2017 data. eCV-age was estimated based on the designated risk factors of cardiovascular disease (CVD) and age-gap was calculated by subtracting the eCV-age from the chronological age in 12,317 adults. Adjusted odds ratios for the age-gap were measured according to KHEI, while controlling for covariates to influence risk factors of CVD, using logistic regression analysis with the complex sample survey design. Age-gaps were divided into four groups: >4 (High), 0-4 (Moderate), -4-0 (Mild), and <-4 years (Low). The higher the age-gap, the lower the cardiovascular risk. Persons included in the following categories belonged to the high and moderate age-gap groups: young (<40 years), women, urban living, better than high school education, higher income, lean, mild drinking, and exercising regularly. KHEI scores were overall higher in women than men (p < 0.01). Having breakfast and saturated fat intake were primary factors that influenced the age-gap for men, whereas fresh fruit intake and carbohydrate intake influenced the age-gap in women. The KHEI scores positively correlated with nutrient intake, especially fiber and vitamin C intake in women (p < 0.05). Participants with high KHEI scores increased their chances of belonging to the high age-gap group by 2.16 times for men and 2.10 for women after adjusting for covariates of sex, age, and residence. However, after adding the covariates of education, income, marriage, and obesity, in conjunction with smoking, alcohol, and regular exercise, this reduced to 1.34 times in women. In conclusion, both genders had a positive correlation between age-gap and overall KHEI scores.

Trends in the Intake of Fatty Acids and Their Food Source According to Obese Status Among Korean Adult Population Using KNHANES 2007-2017.

BACKGROUND: Increasing obesity rates are related to energy intake with carbohydrate and fat ratio. Using Korean National Health and Nutrition Examination Survey 2007-2017 data, we examined the hypothesis that the fat intake and food sources of dietary fats had changed over the last 10 years according to gender and obesity status in adult population ≥19 years. METHODS: The food intake of each participant was collected by the 24-hour recall method, and nutrient intake including different fatty acids was calculated. The fatty acid intakes from 7 food groups were determined according to gender and obesity status. RESULTS: Body mass index increased in both genders of the obese group over the decade, but it decreased in the normal-weight group. In men, energy intake was higher in the obese group than in the lean group, but the opposite trend was shown in women. Total fat intake including various fatty acids continuously and sharply increased in both men and women until 2016, then slightly declined only in men. The source of saturated fatty acid (SFA) intake was mainly from the animal food group in men and women regardless of obese status, and SFA and monounsaturated fatty acid from the animal food group gradually increased over time in both genders. N-3 fatty acid intake markedly decreased from fish and crabs and increased from sauces and nuts regardless of genders and the obese status from 2008 to 2017. Polyunsaturated fatty acid and N-6 fatty acid intake increased from bread, cookies, sauces, and nuts regardless of genders and obesity status. CONCLUSION: Fat intake was higher in obese men, but this was opposite in women. The N-3 fatty acid intake from seafood should increase, and the fat composition in sauce needs to be modulated to increase N-3 fatty acids.

The usefulness of neuron-specific enolase in cerebrospinal fluid to predict neurological prognosis in cardiac arrest survivors who underwent target temperature management: A prospective observational study.

AIM: Cerebrospinal fluid (CSF) neuron-specific enolase (NSE) levels increase ahead of serum NSE levels in patients with severe brain injury. We examined the prognostic performance between CSF NSE and serum NSE levels in out-of-cardiac arrest (OHCA) survivors who had undergone target temperature management (TTM). METHODS: This single-centre prospective observational study included OHCA patients who had undergone TTM. NSE levels were assessed in blood and CSF samples obtained immediately (Day 0), and at 24 h (Day 1), 48 h (Day 2), and 72 h (Day 3) after return of spontaneous circulation (ROSC). The primary outcome was the 6-month neurological outcome. RESULTS: We enrolled 34 patients (males, 24; 70.6%), and 16 (47.1%) had a poor neurologic outcome. CSF NSE and serum NSE values were significantly higher in the poor outcome group compared to the good outcome group at each time point, except for serum Day 0. CSF NSE and serum NSE had an area under curve (AUC) of 0.819-0.972 and 0.648-0.920, respectively. CSF NSE prognostic performances were significantly higher than serum NSE levels at Day 1 and showed excellent AUC values (0.969; 95% confidence interval [CI] 0.844-0.999) and high sensitivity (93.8%; 95% CI 69.8-99.8) at 100% specificity. CONCLUSION: We found CSF NSE values were highly predictive and sensitive markers of 6-month poor neurological outcome in OHCA survivors treated with TTM at Day 1 after ROSC. Therefore, CSF NSE levels at day 1 after ROSC can be a useful early prognosticator in OHCA survivors.

Relationship between optic nerve sheath diameter measured by magnetic resonance imaging, intracranial pressure, and neurological outcome in cardiac arrest survivors who underwent targeted temperature management.

AIM: Studies on the prognostic performance of optic nerve sheath diameter (ONSD) in out-of-hospital cardiac arrest survivors (OHCA) have reported conflicting results. We aimed to investigate the usefulness of ONSD measured using magnetic resonance imaging (MRI) to estimate its association with intracranial pressure (ICP) and 6-month neurological outcomes in CA survivors treated with targeted temperature management (TTM). METHOD: This retrospective study included 37 CA survivors who underwent TTM from January 2018 to December 2018. ICP was measured by lumbar catheter during TTM on Days 0, 1, 2, and 3. ONSD was measured using MRI on Days 0 and 3. The primary outcome was the correlation between ONSD and ICP associated with neurological outcomes obtained after 6 months. RESULTS: The median (interquartile range [IQR]) ONSD was not significantly different between the good and poor neurological outcome group on Day 0 (5.2 mm [4.8-5.8] vs 5.2 mm [4.8-5.6]; p = 0.948) and Day 3 (5.0 mm [4.8-5.2] vs 5.5 mm [4.4-5.9]; p = 0.105). ONSD and ICP had excellent correlation on Day 3 (r = 0.90, p < 0.001). ONSD showed excellent correlation with increased ICP (IICP) defined as ICP above 20 mmHg (r = 0.89, p < 0.001). ONSD cut-off of 5.99 mm was used with a sensitivity of 90.0% and specificity of 98.0% to identify IICP. CONCLUSION: The ONSD on Days 0 or 3 did not show differences in neurological outcomes in OHCA patients treated with TTM. However, ONSD had an excellent correlation with ICP on Day 3 and with IICP. Further studies are required to confirm our results.

Non-Standard Workers Have Poorer Physical and Mental Health Than Standard Workers.

OBJECTIVES: To compare the health status of workers who had non-standard and standard employment in Korea. METHODS: Data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2007 to 2017) were used to compare the health of workers with standard and non-standard employment. RESULTS: Workers with non-standard employment (rather than standard employment) were more likely to be women, older, have less education, have lower monthly income, perform manual work, and work fewer hours per week. Men with non-standard employment were more likely to have physician-diagnosed cardiovascular disease, arthritis, and to report depressive and suicidal ideation. Women with non-standard employment were more likely to have physician-diagnosed cardiovascular disease and to report depressive feelings. CONCLUSION: Workers with daily employment were most vulnerable to physical and mental health problems. Health problems differed among individuals who had different types of non-standard employment.

Changes of Atmospheric and Blood Concentrations of Lead and Cadmium in the General Population of South Korea from 2008 to 2017.

We measured changes in atmospheric and blood levels of lead and cadmium in the South Korean general population during the past decade. Blood data of 16,873 adults were taken from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2017). Atmospheric data were taken from 66 air quality monitoring sites in 16 different regions in South Korea. From 2008 to 2017, the geometric mean (GM) blood lead level decreased from 2.37 to 1.46 µg/dL (38.4% decrease), and the atmospheric lead concentration decreased by 61.0% in the overall population. During this time, the GM blood cadmium level decreased from 0.88 to 0.72 µg/L (18.2% decrease), and the atmospheric cadmium concentration decreased by 63.6%. Multiple linear regression analysis indicated that a half reduction in air lead was associated with a 0.09 µg/dL decrease in blood lead (95% CI: 0.03 to 0.15) in a subgroup of the metropolitan city population. However, a half reduction in air cadmium had no significant effect on blood cadmium. Multiple linear regression analyses indicated that the decrease in blood lead level over 10 years in Korea was related to the decrease in atmospheric lead concentration. However, the decrease in blood cadmium level during this time was not significantly associated with the decrease in atmospheric cadmium concentration. Our findings suggest that inhalation is a major source of lead exposure, but not of cadmium exposure. Ingestion of dietary cadmium presumably has a stronger impact on blood cadmium levels.

A Frizzled-Like Cysteine-Rich Domain in Glypican-3 Mediates Wnt Binding and Regulates Hepatocellular Carcinoma Tumor Growth in Mice.

Wnt signaling is one of the key regulators of hepatocellular carcinoma (HCC) tumor progression. In addition to the classical receptor frizzled (FZD), various coreceptors including heparan sulfate proteoglycans (HSPGs) are involved in Wnt activation. Glypican-3 (GPC3) is an HSPG that is overexpressed in HCC and functions as a Wnt coreceptor that modulates HCC cell proliferation. These features make GPC3 an attractive target for liver cancer therapy. However, the precise interaction of GPC3 and Wnt and how GPC3, Wnt, and FZD cooperate with each other are poorly understood. In this study, we established a structural model of GPC3 containing a putative FZD-like cysteine-rich domain at its N-terminal lobe. We found that F41 and its surrounding residues in GPC3 formed a Wnt-binding groove that interacted with the middle region located between the lipid thumb domain and the index finger domain of Wnt3a. Mutating residues in this groove significantly inhibited Wnt3a binding, ß-catenin activation, and the transcriptional activation of Wnt-dependent genes. In contrast with the heparan sulfate chains, the Wnt-binding groove that we identified in the protein core of GPC3 seemed to promote Wnt signaling in conditions when FZD was not abundant. Specifically, blocking this domain using an antibody inhibited Wnt activation. In HCC cells, mutating residue F41 on GPC3 inhibited activation of ß-catenin in vitro and reduced xenograft tumor growth in nude mice compared with cells expressing wild-type GPC3. Conclusion: Our investigation demonstrates a detailed interaction of GPC3 and Wnt3a, reveals the precise mechanism of GPC3 acting as a Wnt coreceptor, and provides a potential target site on GPC3 for Wnt blocking and HCC therapy.

Relationship of Occupational Category With Risk of Physical and Mental Health Problems.

OBJECTIVES: We evaluated the physical and mental health problems of waged workers in Korea who had different classes of occupation. METHODS: We used data from the Korean National Health and Nutrition Examination Survey (2007-2017) to examine 22,788 workers who were waged employees and categorized these workers into 5 occupational classes. RESULTS: "Unskilled manual workers" were more likely to be older, less educated, have lower monthly income, and work fewer hours per week. Among men and relative to "managers and professionals" (reference group), "skilled manual workers" were more likely to have physician-diagnosed osteoarthritis, "clerks" were less likely to report suicidal ideation, and "unskilled manual workers" were more likely to report suicidal ideation. Among women and relative to "managers and professionals" (reference group), "service and sales workers" and "unskilled manual workers" were more likely to report physician-diagnosed osteoarthritis, depressive feelings, and suicidal ideation. However, hypertension, hyperlipidemia, diabetes, and cardiovascular diseases did not differ among the occupational classes for men and women. CONCLUSION: We identified differences between men and women and among those in different occupational classes regarding employment status, physical health, and mental health. "Unskilled manual workers" of both genders were more likely to be older, less educated, have less monthly income, work fewer hours per week, and have suicidal ideation. Female "service and sales workers" were more likely to have osteoarthritis, depressive feelings, and suicidal ideation.

Association of Blood Pressure with Blood Lead and Cadmium Levels in Korean Adolescents: Analysis of Data from the 2010-2016 Korean National Health and Nutrition Examination Survey.

BACKGROUND: We evaluated the association of blood pressure (BP) with blood levels of cadmium, lead, and cadmium and lead together (cadmium + lead) in a representative sample of adolescents from Korea. METHODS: We used 2010-2016 data from the Korean National Health and Nutrition Examination Survey. This cross-sectional study enrolled adolescents aged at 10-18 years-old who completed a health examination survey and had blood measurements of lead and cadmium. The association of adjusted mean differences in diastolic and systolic BP with doubling of blood lead and cadmium were estimated by regression of BP against log2-transformed blood metals and their quartiles after covariate adjustment. Adjusted odds ratio for prehypertension were calculated for log2-transformed blood levels of lead and cadmium and their quartiles. RESULTS: Our analysis of adolescents in Korea indicated that blood levels of lead and cadmium were not significantly associated with increased BP or risk of prehypertension. However, the cadmium + lead level was associated with prehypertension. Previous studies showed that blood levels of lead and cadmium were associated with increased BP and risk of hypertension in adult populations. We found no such association in Korean adolescents. CONCLUSION: We found that the cadmium + lead level was associated with prehypertension. The differences between adults and adolescents are because adolescents generally have lower levels of these blood metals or because adolescents only rarely have hypertension.

Relationship between time related serum albumin concentration, optic nerve sheath diameter, cerebrospinal fluid pressure, and neurological prognosis in cardiac arrest survivors.

AIM: The optimal time to measure serum albumin concentration (SAC) to predict prognosis in cardiac arrest (CA) survivors has not been elucidated. We aimed to compare the relationships between time-related SAC, optic nerve sheath diameter (ONSD), intracranial pressure (ICP), and neurological prognosis in CA survivors. METHODS: We undertook a retrospective study examining CA patients treated with target temperature management (TTM). ICP was measured using cerebrospinal fluid (CSF) pressure and ONSD was obtained before TTM. SAC was measured repeatedly at 4-6 h intervals from the hospital arrival time. We analysed CSF pressure, ONSD, and minimum SAC (MSAC) separately, or in combination, to predict poor neurological outcome. RESULTS: Of 83 patients enrolled, the good outcome group comprised 25 (34%) patients. MSAC at 24 h (MSAC24) had a higher area under the receiver operating characteristic curve (AUC) (0.687; 95% confidence interval (CI), 0.668-0.926) than other time points. CSF pressure showed a higher AUC (0.973; 95% CI, 0.911-0.996) than MSAC24 and ONSD (0.677; 95% CI, 0.565-0.776). In contrast to using MSAC24 and ONSD separately, the combination of both modalities resulted in a better AUC, thus improving the prediction of the neurological outcome (0.734; 95% CI, 0.626-0.825) and ICP (0.758; 95% CI, 0.651-0.845) after return of spontaneous circulation (ROSC) from CA. CONCLUSION: A higher ICP was strongly associated with and seemed predictive of poor outcome. Furthermore, the MSAC24/ONSD combination may be a useful predictor of high ICP and poor neurological outcome. Prospective studies should be conducted to confirm these results.

Environmental exposures to lead, mercury, and cadmium among South Korean teenagers (KNHANES 2010-2013): Body burden and risk factors.

INTRODUCTION: Limited information is available on the association of age and sex with blood concentrations of heavy metals in teenagers. In addition, factors such as a shared family environment may have an association. We analyzed data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2010-2013) to determine whether blood levels of heavy metals differ by risk factors such as age, sex, and shared family environment in a representative sample of teenagers. METHODS: This study used data obtained in the KNHANES 2010-2013, which had a rolling sampling design that involved a complex, stratified, multistage, probability-cluster survey of a representative sample of the non-institutionalized civilian population in South Korea. Our cross-sectional analysis was restricted to teenagers and their parents who completed the health examination survey, and for whom blood measurements of cadmium, lead, and mercury were available. The final analytical sample consisted of 1585 teenagers, and 376 fathers and 399 mothers who provided measurements of blood heavy metal concentrations. RESULTS: Male teenagers had greater blood levels of lead and mercury, but sex had no association with blood cadmium level. There were age-related increases in blood cadmium, but blood lead decreased with age, and age had little association with blood mercury. The concentrations of cadmium and mercury declined from 2010 to 2013. The blood concentrations of lead, cadmium, and mercury in teenagers were positively associated with the levels in their parents after adjustment for covariates. CONCLUSION: Our results show that blood heavy metal concentrations differ by risk factors such as age, sex, and shared family environment in teenagers.