Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia.

Objective: This study aimed to investigate the association between paraspinal muscle measurements using chest computed tomography (CT) and the clinical outcomes of elderly patients with community-acquired pneumonia (CAP). Methods: This was a single-center, retrospective, observational study that included elderly (≥65 years) patients with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. Paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest CT taken within 48 hours before and after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. Results: Of 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with a low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992-0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥ 65 (CURB-65), both of which showed 0.64 in predicting mortality. Conclusion: A high paraspinal muscle index was associated with a low 28-day mortality in patients aged 65 years or older with CAP.

Survival benefit of direct transport to trauma centers among patients with unintentional injuries in Korea: a propensity score-matched analysis.

OBJECTIVE: This study investigated the characteristics and survival rates of patients with unintentional severe trauma who visited a regional trauma center (TC) or a non-TC. METHODS: This retrospective, national, population-based, observational, case-control study included patients with abnormal Revised Trauma Score from January 2018 to December 2018. We divided hospitals into two types, TC and non-TC, and compared several variables, including in-hospital mortality. Propensity score matching was used to reduce the effect of confounding variables that influence survival outcome variables. RESULTS: Of the 25,743 patients, 5,796 visited a TC and 19,947 visited a non-TC. Compared to patients treated at non-TCs, patients treated at TCs were more likely to have a higher Injury Severity Score (TC, 11.5; non-TC, 7.4; P<0.001), higher rate of surgery or transcatheter arterial embolization (TC, 39.2%; non-TC, 17.6%; P<0.001), and higher admission rate (TC, 64.7%; non-TC, 36.9%; P<0.001) through the emergency department. After propensity score matching, 2,800 patients from both groups were analyzed. Patients in the TC had a higher survival rate than patients that were not treated in the TC (TC, 83.0%; non-TC, 78.6%; P=0.003). CONCLUSION: This study using Korean emergency medical services data showed that initial transport to trauma centers was associated with mortality reduction. Further research is required because of limitations with use of single-year data and retrospective design.

Gender effect in survival after out-of-hospital cardiac arrest: A nationwide, population-based, case-control propensity score matched study based Korean national cardiac arrest registry.

OBJECTIVE: This study aimed to describe the relationship between sex and survival of patients with out-of-hospital cardiac arrest (OHCA) and further investigate the potential impact of female reproductive hormones on survival outcomes, by stratifying the patients into two age groups. METHODS: This retrospective, national population-based observational, case-control study, included Korean OHCA data from January 1, 2009, to December 31, 2016. We used multiple logistic regression with propensity score-matched data. The primary outcome was survival-to-discharge. RESULTS: Of the 94,160 patients with OHCA included, 34.2% were women. Before propensity score matching (PSM), the survival-to-discharge rate was 5.2% for females and 9.1% for males, in the entire group (OR 0.556, 95% CI [-0.526-0.588], P<0.001). In the reproductive age group (age 18-44 years), the survival-to-discharge rate was 14% for females and 15.6% for males (OR 0.879, 95% CI [0.765-1.012], P = 0,072) and in the post-menopause age group (age ≥ 55 years), the survival-to-discharge rate was 4.1% for females and 7% for males (OR 0.562, 95% CI [0.524-0.603], P<0.001). After PSM (28,577 patients of each sex), the survival-to-discharge rate was 5.4% for females and 5.4% for males (OR, 1.009 [0.938-1.085], P = 0.810). In the reproductive age group, the survival-to-discharge rate was 14.5% for females and 11.5% for males (OR 1.306, 95% CI [1.079-1.580], P = 0.006) and in the post-menopause age group, the survival-to-discharge rate was 4.2% for females and 4.6% for males (OR 0.904, 95% CI [0.828-0.986], P = 0.022). After adjustment for confounders, women of reproductive age were more likely to survive at hospital discharge. However, there was no statistically significant difference in neurological outcome (OR 1.238, 95% CI [0.979-1.566], P = 0.074). CONCLUSIONS: Females of reproductive age had a better chance of survival when matched for confounding factors. Further studies using sex hormones are needed to improve the survival rate of patients with OHCA.

The comparison of psychological scales as hospitalization predictors between adult and elderly suicide attempters.

BACKGROUND: During the process of managing suicide attempters in the emergency department (ED), the importance of hospitalization has been emphasized. Lethality and intent have been suggested as hospitalization determinants of suicide attempters, but their predictive values remain limited in adult and elderly populations. METHODS: Using prospectively collected the ED-based Suicide Registry, data from suicide attempters over 18 years old was retrospectively studied (2010-2020). The enrolled participants were divided into adult (N = 832) and elderly (>65 years, N = 378) groups. Suicide lethality and intent were assessed by the Risk-Rescue Rating Scale (RRRS) and Suicide Intent Scale (SIS), respectively. The moderating effects of age on the relationship between the psychological scales and hospitalization were examined by entering the interaction terms into a multivariable regression model. The predictive ability of each scale for hospitalization was evaluated in terms of performance and goodness-of-fit. RESULTS: Both scales' scores in both age groups were significantly higher in hospitalized patients than non-hospitalized patients. Interaction result indicated that only the odds of RRRS for hospitalization significantly differed by age group. Moreover, the predictive performance for hospitalization significantly differed by age group in RRRS but not SIS. In predicting hospitalization, the AUC of the RRRS was significantly higher than that of the SIS in the elderly group but not in the adult group. Comparing the two groups, the RRRS of the elderly group tended to have higher AUC than the adult group, whereas the AUC of the SIS was similar. The RRRS in both groups had a better overall fit compared to the SIS for hospitalization, but its best overall fit and strength with greater power were observed in the elderly group. CONCLUSIONS: The age-by-RRRS interaction is significantly associated with hospitalization, and the RRRS implementation as a hospitalization determinant is more useful and suitable for elderly suicide attempters than for adult suicide attempters in an emergency setting.

Parosmia in Right-lateralized Semantic Variant Primary Progressive Aphasia: A Case Report.

Parosmia, defined as the distorted perception of an odor stimulus, has been reported to be associated with head trauma, upper respiratory tract infections, sinonasal diseases, and toxin/drug consumption. To date, little is known about parosmia in right-lateralized semantic variant primary progressive aphasia. A 60-year-old right-handed man presented with a 2-year history of parosmia and prosopagnosia. Brain magnetic resonance imaging demonstrated severe atrophy of the right anterior and mesial temporal lobe, particularly in the fusiform cortex and the regions known as the primary olfactory cortex. 18F-fluorodeoxyglucose position emission tomography showed asymmetric hypometabolism of the bilateral temporal lobes (right > left). We clinically diagnosed him with right-lateralized semantic variant primary progressive aphasia. As the right hemisphere is known to be more involved in the processing of pleasant odors than the left hemisphere, we speculate that the unique manifestation of parosmia observed in this patient might be associated with the lateralization of the olfactory system.

Serum cholesterol as a predictor of mortality among the elderly patients with pneumonia in the emergency department.

BACKGROUND: Reduced cholesterol levels are associated with poor outcomes in critically ill patients. However, the effect of reduced cholesterol levels on the prognosis of patients with community-acquired pneumonia (CAP) is unclear. This study aimed to investigate the association between serum total cholesterol levels and the clinical outcomes of elderly patients with CAP. METHODS: This was a retrospective observational study that included elderly (≥65 years) CAP patients hospitalized through emergency department between January 2016 and December 2019. We collected their baseline characteristics and laboratory data, including total cholesterol levels at the time of admission. Univariate and multivariate analyses were performed to determine the association between total cholesterol levels and 14-day in-hospital mortality. RESULTS: A total of 380 patients were included. The overall 14-day in-hospital mortality rate was 12.37%. Survivors had higher total cholesterol levels than non-survivors (median, 125 mg/dL; interquartile range [IQR], 102-151 mg/dL versus median, 100 mg/dL; IQR, 83-126 mg/dL; p < 0.001). Multivariate analysis using a logistic regression model showed that a total cholesterol level of <97 mg/dL was independently associated with 14-day in-hospital mortality in patients with CAP (odds ratio, 2.93; 95% confidence interval, 1.13-7.599; p = 0.027). CONCLUSIONS: A decreased level of total cholesterol was associated with increased short-term mortality in elderly patients with CAP. Initial total cholesterol levels may be a useful biomarker to predict the outcome of patients with CAP.

Acute Phlegmonous Gastritis Complicated by Subphrenic Abscess.

BACKGROUND: Phlegmonous gastritis (PG) is a rare and potentially fatal disease characterized by bacterial infection of the gastric wall. However, its clinical features are nonspecific, which may delay its diagnosis and treatment. CASE REPORT: We report a case of a previously healthy 53-year-old woman with localized PG complicated by subphrenic abscess formation who was treated successfully with antibiotics and percutaneous catheter drainage. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment initiation are important to improving outcomes. Emergency physicians should consider PG a differential diagnosis of acute abdomen.

The relationship between body mass index and N-terminal pro-B-type natriuretic peptide in community-acquired pneumonia.

BACKGROUND: The relationship between body mass index (BMI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has not been fully investigated in patients with community-acquired pneumonia (CAP). METHODS: This prospective observational study examined 510 consecutive patients hospitalized for CAP. NT-proBNP, BMI, and the pneumonia severity index (PSI) were determined for all participants. The moderating effects of BMI on the relationship between NT-proBNP and CAP mortality were examined using interaction terms in a multivariable regression model. The ability of NT-proBNP to predict mortality was evaluated using the area under the curve (AUC). RESULTS: A significant inverse relationship was observed between BMI and NT-proBNP. After multivariable adjustment including BMI, NT-proBNP remained a significant predictor of CAP mortality. The AUC of the fully adjusted (including BMI) NT-proBNP model was significantly higher than that excluding BMI (p = 0.021) and that of PSI (p = 0.038), respectively. The predictive performance of NT-proBNP for mortality significantly differed by BMI group, with the NT-proBNP of the overweight and obesity group having a significantly higher AUC than that of the underweight and normal-weight group. The AUC of NT-proBNP was significantly higher and tended to be higher than that of PSI in the overweight group (p = 0.013) and the obesity group (p = 0.113), respectively. CONCLUSIONS: BMI significantly strengthens the prognostic performance of NT-proBNP in CAP patients. The BMI-NT-proBNP interaction is significantly associated with CAP mortality, but as a prognostic determinant for CAP, NT-proBNP seems to be more useful for overweight and obese patients than for underweight and normal-weight patients.

A 70-Gene Signature for Predicting Treatment Outcome in Advanced-Stage Cervical Cancer.

Cervical cancer is the fourth most common cancer in women worldwide. The current approaches still have limitations in predicting the therapy outcome of each individual because of cancer heterogeneity. The goal of this study was to establish a gene expression signature that could help when choosing the right therapeutic method for the treatment of advanced-stage cervical cancer. The 666 patients were collected from four independent datasets. The 70-gene expression signature was established using univariate Cox proportional hazard regression analysis. The 70-gene signature was significantly different between low- and high-risk groups in the training dataset (p = 4.24e-6) and in the combined three validation datasets (p = 4.37e-3). Treatment of advanced-stage cancer patients in the high-risk group with molecular-targeted therapy combined with chemoradiotherapy yielded a better survival rate than with only chemoradiotherapy (p = 0.0746). However, treatment of the patients in the low-risk group with the combined therapy resulted in significantly lower survival (p = 0.00283). Functional classification of 70 genes revealed involvement of the angiogenesis pathway, specifically phosphatidylinositol 3-kinase signaling (p = 0.040), extracellular matrix organization (p = 0.0452), and cell adhesion (p = 0.011). The 70-gene signature could predict the prognosis and indicate an optimal therapeutic modality in molecular-targeted therapy or chemotherapy for advanced-stage cervical cancer.

Evaluation of usefulness of smart device-based testing: a survey study of Korean medical students.

PURPOSE: This study aims to understand the characteristics of smart device-based testing (SBT) by comparing the typical characteristics of students' satisfaction with SBT, its usefulness, advantages, and disadvantages when compared with existing testing methods. METHODS: A total of 250 students from the first to third year were selected as the final targets of the study and the questionnaire was developed by faculty members who participated in the survey from the start of the SBT. The total number of questions is 12, and the questionnaire used a 4-point scale. The data obtained were analyzed using the IBM SPSS ver. 23.0 (IBM Corp., Armonk, USA). RESULTS: Answers to the "satisfaction with SBT" were generally negative, while answers to the "usefulness of SBT" were generally positive. There was no difference in satisfaction across gender and smart device ownership, whereas there were significant differences across years. With reference to the usefulness of SBT, students responded positively, while about the overall configuration and completeness of SBT, students responded negatively. Students also seemed to show a greater preference toward the pencil-paper test. CONCLUSION: On the other hand, students generally thought that SBT helped to assess medical knowledge better and was a more objective method of knowledge assessment than a pencil-paper test. We believe that students preferred the traditional paper-pencil test due to their unfamiliarity with SBT. We believe that an appropriate and careful remedy for drawbacks of the SBT will have a significant impact in the accumulation of actual clinical knowledge and in the improvement of practical skills for medical students.

Usefulness of the Geriatric Nutritional Risk Index to predict the severity of cholecystitis among older patients in the emergency department.

AIM: We sought to investigate whether the Geriatric Nutritional Risk Index is associated with systemic organ dysfunction among older patients who present with cholecystitis to the emergency department. METHODS: This was an observational retrospective study among consecutive older patients with cholecystitis in the emergency department from 2012 to 2018. We collected baseline characteristics and laboratory data, and re-categorized the Geriatric Nutritional Risk Index into three risk groups. We carried out univariate and multivariate analyses to identify factors associated with systemic organ dysfunction. Logistic regression was used for statistical analysis. RESULTS: A total of 303 patients were included in this study. The median age of participants was 74 years (interquartile range 68-79 years). The overall proportion of systemic organ dysfunction was 26.4%. The Geriatric Nutritional Risk Index was stratified as: ≥98 (n = 183, systemic organ dysfunction 15.3%), 87 to <98 (n = 90, systemic organ dysfunction 38.9%) and <87 (n = 30, systemic organ dysfunction 56.7%). Multivariate analysis using a logistic regression model showed that age, respiratory rate, temperature, geriatric nutritional risk index and quick Sepsis-related Organ Failure Assessment score in the emergency department were independently associated with systemic organ dysfunction in patients with cholecystitis. CONCLUSIONS: The Geriatric Nutritional Risk Index was recognized as an independent factor associated with systemic organ dysfunction in older patients in the emergency department who presented with cholecystitis. This index might be helpful in screening patient risk and deciding whether to carry out further tests. Geriatr Gerontol Int 2020; 20: 455-460.

PAC-5 Gene Expression Signature for Predicting Prognosis of Patients with Pancreatic Adenocarcinoma.

Pancreatic adenocarcinoma (PAC) is one of the most aggressive malignancies. Intratumoural molecular heterogeneity impedes improvement of the overall survival rate. Current pathological staging system is not sufficient to accurately predict prognostic outcomes. Thus, accurate prognostic model for patient survival and treatment decision is demanded. Using differentially expressed gene analysis between normal pancreas and PAC tissues, the cancer-specific genes were identified. A prognostic gene expression model was computed by LASSO regression analysis. The PAC-5 signature (LAMA3, E2F7, IFI44, SLC12A2, and LRIG1) that had significant prognostic value in the overall dataset was established, independently of the pathological stage. We provided evidence that the PAC-5 signature further refined the selection of the PAC patients who might benefit from postoperative therapies. SLC12A2 and LRIG1 interacted with the proteins that were implicated in resistance of EGFR kinase inhibitor. DNA methylation was significantly involved in the gene regulations of the PAC-5 signature. The PAC-5 signature provides new possibilities for improving the personalised therapeutic strategies. We suggest that the PAC-5 genes might be potential drug targets for PAC.

Femoral Intertrochanteric Fractures of the Patients in the Emergency Department due to Minor Falls: Special Consideration in the Middle-old to Oldest-old Patients.

BACKGROUND: The older population (≥65 years) has rapidly increased in size in recent years. Among them, the middle-to-oldest-old (≥75 years) tend to have a poor health status. Therefore, subdivision and evaluation of older patients with traumatic injury are required. We focused on the risk of femoral intertrochanteric fractures occurring in older adults due to minor falls and compared young-old and middle-to-oldest-old populations. METHODS: The medical records of patients who visited the emergency center due to hip injuries between March 2017 and March 2019 were retrospectively analyzed. Patients were divided into older adult (≥65 years) and non-older (age 18-64 years) groups; the older adult group was subdivided into young-old (65-74 years), middle-old (75-84 years), and oldest-old (≥85 years) groups. This study investigated the occurrence rate of femoral intertrochanteric fractures and related factors. RESULTS: The older adult group had a higher incidence of femoral intertrochanteric fractures than that in the non-older adult group (95.3% vs. 4.7%, p<0.001). However, there was no significant difference between young-old and non-older groups (58.8% vs. 41.2%, p=0.145). Middle-old to oldest-old age and osteoporosis were associated with an increased incidence of femoral intertrochanteric fractures (p<0.001, p=0.004). CONCLUSION: A higher incidence of femoral intertrochanteric fractures from minor falls was found among middle-old to oldest-old patients compared to that in young-old patients. Therefore, physicians should perform more thorough physical examinations and radiograph reading in middle-old to oldest-old patients even if the patients do not complain of pain.