Out-of-hospital cardiac arrest: incidence, patient characteristics, outcomes, and trends over time between 2012 and 2018 in an urban city

Objective@#This study aimed to determine the incidence, characteristics, and outcomes of out-of-hospital cardiac arrests (OHCA) and to investigate the trends for the same in Changwon city, South Korea between 2012 and 2018. @*Methods@#We analyzed a list of adult cardiac arrest cases occurring between 2012 and 2018 from the OHCA surveillance registry and the Changwon Fire Department’s emergency medical services database. The trends in the incidence and resuscitation-related characteristics were assessed using nonparametric tests for trends across ordered groups. The predictors of the primary outcome were investigated using multivariable logistic regression. The primary outcome was a good neurological outcome at hospital discharge. @*Results@#A total of 2,951 OHCAs were attended by the emergency medical services and of these, 2,834 were included in this study. Overall, the proportion of patients discharged with a good neurologic outcome was 4.7% (133/2,834). Both OHCA survival and good neurologic outcomes improved significantly over time, from 4.9% and 2.1%, respectively, in 2012 to 10.3% and 7.4% in 2018 (P<0.001). The Utstein comparator (bystander-witnessed arrests presenting with initial shockable rhythm) increased over the study period (P-for-trend<0.001). Age, response time, scene time, in-hospital cardiopulmonary resuscitation (CPR) time, witness presence, cardiac origin, and shockable rhythm were associated with good neurologic outcomes. @*Conclusion@#With the gradual increase in the proportion of patients with witnessed cardiac arrests, bystander CPR, and initial shockable rhythm, the rate of survival and a good neurologic outcome at discharge also increased annually.

Comparison of Outcomes After Septoplasty With Non-Absorbable or Biodegradable Synthetic Polyurethane Foam Nasal Packing With a Focus on Pain and Cardiac Factors

Background and Objectives@#We compared pain levels, cardiovascular parameters, and complications according to whether patients underwent nasal packing with non-absorbable or biodegradable materials. @*Methods@#Patients who underwent septoplasty from May 2015 to April 2020 were retrospectively reviewed. Numeric rating scale (NRS) scores for pain, blood pressure, and heart rate were measured three times (immediately after surgery, 6 hours later, and on postoperative day [POD] 1). We collected data on complications, including postoperative bleeding, septal hematoma, adhesions, septal perforation, and the recurrence of septal deviation. @*Results@#In total, 200 patients underwent septoplasty, of whom 100 underwent nasal packing with Merocel and 100 underwent packing with Nasopore. The summed NRS scores over the three time points did not differ significantly between the groups. The NRS scores at 6 hours after surgery were highest in both groups. The systolic and diastolic blood pressure and the heart rate immediately after surgery were significantly higher than before surgery in both groups. The blood pressure and heart rate at 6 hours after surgery and on POD 1 did not differ significantly from those before surgery in either group. The incidence of sleep disturbance, postoperative bleeding, septal hematoma, adhesions, septal perforation, and recurrence of septal deviation did not differ significantly between the two groups. @*Conclusion@#Although the level of postoperative pain and the cardiovascular parameters changed over time, we found no significant differences in pain, blood pressure, heart rate, or the complication rate according to whether patients underwent nasal packing with Nasopore or Merocel.

KAAACI Allergic Rhinitis Guidelines: Part 1. Update in pharmacotherapy

The prevalence of allergic rhinitis (AR) and the socioeconomic burden associated with the medical cost and quality of life of AR have progressively increased. Therefore, practical guidelines for the appropriate management of AR need to be developed based on scientific evidence considering the real-world environment, values, and preferences of patients and physicians. The Korean Academy of Asthma, Allergy and Clinical Immunology revised clinical guidelines for AR to address key clinical questions of the management of AR. Part 1 of the revised guideline covers the pharmacological management of patients with AR in Korea. Through a meta-analysis and a systematic review, we made 4 recommendations for AR pharmacotherapy, including intranasal corticosteroid (INCS)/intranasal antihistamine combination therapy, oral antihistamine/INCS combination therapy, leukotriene receptor antagonist treatment in AR patients with asthma, and prophylactic treatment for patients with pollen-induced AR. However, all recommendations are conditional because of the low or very low evidence of certainty. Well-designed and strictly executed randomized controlled trials are needed to measure and report appropriate outcomes.

KAAACI Allergic Rhinitis Guidelines: Part 2. Update in nonpharmacotherapy

Allergic rhinitis is the most common chronic disease worldwide. Various upper airway symptoms lower quality of life, and due to the recurrent symptoms, multiple treatments are usually attempted rather than one definitive treatment. There are alternatives to medical (medication-based) and nonmedical treatments. A guideline is needed to understand allergic rhinitis and develop an appropriate treatment plan. We have developed guidelines for medical treatment based on previous reports. The current guidelines herein are associated with the “KAAACI Evidence-Based Guidelines for Allergic Rhinitis in Korea, Part 1: Update in pharmacotherapy” in which we aimed to provide evidence-based recommendations for the medical treatment of allergic rhinitis. Part 2 focuses on nonpharmacological management, including allergen-specific immunotherapy, subcutaneous or sublingual immunotherapy, nasal saline irrigation, environmental management strategies, companion animal management, and nasal turbinate surgery. The evidence to support the treatment efficacy, safety, and selection has been systematically reviewed. However, larger controlled studies are needed to elevate the level of evidence to select rational non-medical therapeutic options for patients with allergic rhinitis.

YouTube as an Information Resource for Persons Interested in Septoplasty and/or Turbinoplasty

Background and Objectives@#YouTube is a widely used web site. In general, many people search for medical information on YouTube. We evaluated the septoplasty and turbinoplasty videos on YouTube from an expert’s point of view. @*Methods@#We used “septoplasty,” “turbinoplasty,” and “septoplasty turbinoplasty” to search YouTube. Of the 150 videos, we eventually viewed 83. Two researchers assessed the sources, lengths, and numbers of likes, dislikes, and views. The videos were classified as “excellent,” “moderate,” or “poor” in terms of utility; we also evaluated the uploaded material and content. @*Results@#Of the 83 videos, 18 (21.7%) were excellent, 27 (32.5%) were moderate, and 38 (45.8%) were poor. We found no significant differences in length and mean likes, dislikes, and views between the groups classified as useful. Fifteen (39.5%) of 38 poor videos were by patients, and 13 (34.2%) of 38 poor videos were by physicians. When organized by content type, videos on personal experiences were significantly longer than the others. Of 20 videos on personal experiences, 15 (75%) were poor and all 5 advertisement videos (100%) were poor. @*Conclusion@#Information from YouTube on septoplasty and turbinoplasty is not yet adequate. However, since YouTube content cannot be controlled, it is necessary to upload objective and accurate videos for patients and experts in professional groups such as the medical society. Such videos should be promoted and used actively.

Endotype of Eosinophilic Nasal Polyposis According to the Presence of Atopy / 대한이비인후과학회지

Background and Objectives@#We evaluated differences in the pathophysiology of atopic and non-atopic eosinophilic nasal polyps and investigated their distinct inflammatory profiles.Subjects and Method A total of 36 patients were recruited: 10 controls (Group C), 14 with chronic rhinosinusitis with eosinophilic nasal polyps with atopy (Group A), and 12 without atopy (Group NA). @*Results@#Serum eosinophil counts, total immunoglobulin E, eosinophil cationic protein levels, and tissue eosinophil counts were elevated in Groups A and NA vs. Group C. Real-time polymerase chain reaction results showed increased GATA-3, interleukin (IL)-4, IL-33 levels, but decreased levels of retinoic acid-related orphan receptor gamma t, IL-17 in Groups A and NA. Related to the regulatory T (T-reg) cell response, forkhead box P3 (Foxp3+) (A: p<0.001, NA: p<0.001) and IL-10 (A: p<0.001, NA: p<0.001) levels were elevated and transforming growth factor-β levels (A: p<0.001, NA: p<0.001) were decreased in Group A and Group NA in comparison to those in Group C. The Foxp3+ (p=0.001) and IL-10 (p<0.001) were significantly higher in Group A than in Group NA. @*Conclusion@#T-reg cells and IL-10 may be major factors differentiating the pathophysiology of atopic and non-atopic eosinophilic nasal polyps, and the T helper (Th) 2/Th17/T-reg imbalance might be important in the development of eosinophilic nasal polyposis.

Points to consider before the insertion of maxillary implants: the otolaryngologist's perspective

Maxillary implants are inserted in the upward direction, meaning that they oppose gravity, and achieving stable support is difficult if the alveolar bone facing the maxillary sinus is thin. Correspondingly, several sinus-lifting procedures conducted with or without bone graft materials have been used to place implants in the posterior area of the maxilla. Even with these procedures available, it has been reported that in about 5% of cases, complications occurred after implantation, including acute and chronic sinusitis, penetration of the sinus by the implant, implant dislocation, oroantral fistula formation, infection, bone graft dislocation, foreign-body reaction, Schneiderian membrane perforation, and ostium plugging by a dislodged bone graft. This review summarizes common maxillary sinus pathologies related to implants and suggests an appropriate management plan for patients requiring dental implantation.

The Analysis of Anemia in Persons affected leprosy / 나학회지

BACKGROUND@#The anemia still remains the most common hematologic disorder in the world despite improvements in general health and nutrition. Recently, the prevalence of anemia in the persons affected leprosy aged over 60 years in Korea was reported 22.4% in 60–69 years and 47.4% in 70 years or older in male and was reported 33.8% in 60–69 years and 46.0% in 70 years or older in female.@*OBJECTIVE@#In the meantime, the studies were limited to the subjects in a specific region, and the number of subjects was not enough, so it was not enough to evaluate the of anemia of persons affected by leprosy in Korea. So this study was conducted to evaluate it's prevalence, types, & presumed causes in settlement villages nationwide.METHOD: This study was conducted that the mobile team visited the resettlement villages nationwide from 2009 to 2019 and conducted on persons affected by leprosy and residents residing in resettlement village. Obtained bloods & serums were assayed (hemoglobin, mean corpucular volume, red blood cell distribution width, serum ferritin, serum iron, TIBC, serum vitamin B12, serum folate).RESULT: The prevalence of anemia was 34.31%(male 36.49%, female 32.97%), the proportion of the anemia classified by MCV was 2.6%(microcytic), 66.3%(normocytic), and 31.1%(macrocytic). Among micro- & normocytic anemia, a cause of the anemia was attributed 12.5% to anemia of iron deficiencies, 7.5% anemia of iron deficiencies with anemia of chronic diseases, and 5% to anemia of chronic diseases, among normo- & macrocytic anemaia, was attributed 8.6% to anemia of vitamin B12 deficiency(< 211 pg/ml) and 23.8% to anemia of folate deficiency(< 5.38 ng/ml).@*CONCLUSION@#In this study, we found that the prevalence of anemia in the persons affected leprosy aged over 60 years was higher than other past reports of general population over 60 years in Korea. So we will consider about the evaluation of higher prevalence of anemia in persons affected leprosy, causes of anemia, especially dapsone-related & other underline disease and management plan for anemia in them by the in-depth studies.

A Case of Cholesterol Granuloma in the Nasal Septum / 대한이비인후과학회지

Cholesterol granuloma is rare and has occasionally been reported in uncommon sites of the head and neck, such as in the nasal sinus (frontal, ethmoid, sphenoid, or maxillary sinus), endolymphatic sac, and pterygoid process of the sphenoid sinus. The pathogenesis of thisnrare disease is not clear. We experienced one patient with cholesterol granuloma located in the nasal septum, which was managed successfully by endoscopic assisted excision.

A Case of Osseous Hemangioma of Maxillary Sinus

Osseous hemangiomas typicallyoccur in the vertebral column and skull bones. Osseous hemangioma in the nasal cavity is extremely rare; only eight cases originating in theturbinates and maxillar bone have been reported in the English and Korean literature. Recently, we observed a case of osseous hemangioma occupying the right maxillary sinus. After preoperative embolization, the mass was completely removed by endoscopic inferomedial maxillectomy. There wasno evidence of recurrence at24 months postoperatively. To our knowledge, this is the first reported case of osseous hemangioma occupying the maxillary sinus.

Correlation of Threshold of Click-Evoked Auditory Brainstem Response with Pure-Tone Threshold Average in Various Formulas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to assess the correlation between the threshold of click-evoked auditory brainstem response (ABR) and the pure-tone averages in various formulas. SUBJECTS AND METHOD: Data were obtained from 207 patients (326 ears) with sudden sensorineural hearing loss. All subjects underwent hearing threshold evaluation using pure tone audiogram (PTA), speech audiogram and click-evoked ABR. Linear regression analyses were applied to assess the relation between threshold of click-evoked ABR and threshold of separate frequencies of the PTA and to analyze the correlation between threshold for click-evoked ABR and various pure-tone averages. RESULTS: Results revealed a significant relation between the threshold of click-evoked ABR and PTA thresholds at 0.5 kHz, 1 kHz, 2 kHz, 3 kHz, and 4 kHz. The highest coefficients of regression and determination were 1.026 for 4 kHz and R2=0.663 for 3 kHz, respectively. The coefficient of regression was highest (=0.995) for the mean of PTA thresholds for 3 kHz and 4 kHz. The coefficient of determination was highest for the mean of PTA thresholds for 1, 2, 3 and 4 kHz (R2=0.732). Multiple regression analysis showed a significant relation between the ABR threshold and PTA thresholds for 1, 3, and 4 kHz (R2=0.732), with highest correlation coefficient at 3 kHz [ABR=11.79+(0.17x1 kHz)+(0.26x3 kHz)+(0.23x4 kHz), (p<0.05)]. CONCLUSION: The threshold of click-evoked ABR correlates best with the mean of PTA thresholds for 1, 2, 3 and 4 kHz. The PTA threshold for 3 kHz has highest correlation with the ABR threshold.

Ovarian cancer-derived lysophosphatidic acid stimulates secretion of VEGF and stromal cell-derived factor-1alpha from human mesenchymal stem cells

Lysophosphatidic acid (LPA) stimulates growth and invasion of ovarian cancer cells and tumor angiogenesis. Cancer-derived LPA induces differentiation of human adipose tissue-derived mesenchymal stem cells (hASCs) to alpha-smooth muscle actin (alpha-SMA)-positive cancer-associated fibroblasts. Presently, we explored whether cancer-derived LPA regulates secretion of pro-angiogenic factors from hASCs. Conditioned medium (CM) from the OVCAR-3 and SKOV3 ovarian cancer cell lines stimulated secretion angiogenic factors such as stromal-derived factor-1alpha (SDF-1alpha) and VEGF from hASCs. Pretreatment with the LPA receptor inhibitor Ki16425 or short hairpin RNA lentiviral silencing of the LPA1 receptor abrogated the cancer CM-stimulated expression of alpha-SMA, SDF-1, and VEGF from hASCs. LPA induced expression of myocardin and myocardin-related transcription factor-A, transcription factors involved in smooth muscle differentiation, in hASCs. siRNA-mediated depletion of endogenous myocardin and MRTF-A abrogated the expression of alpha-SMA, but not SDF-1 and VEGF. LPA activated RhoA in hASCs and pretreatment with the Rho kinase inhibitor Y27632 completely abrogated the LPA-induced expression of alpha-SMA, SDF-1, and VEGF in hASCs. Moreover, LPA-induced alpha-SMA expression was abrogated by treatment with the ERK inhibitor U0126 or the phosphoinositide-3-kinase inhibitor LY294002, but not the PLC inhibitor U73122. LPA-induced VEGF secretion was inhibited by LY294002, whereas LPA-induced SDF-1 secretion was markedly attenuated by U0126, U73122, and LY294002. These results suggest that cancer-secreted LPA induces differentiation of hASCs to cancer-associated fibroblasts through multiple signaling pathways involving Rho kinase, ERK, PLC, and phosphoinositide-3-kinase.

Synovial fluid of patients with rheumatoid arthritis induces alpha-smooth muscle actin in human adipose tissue-derived mesenchymal stem cells through a TGF-beta1-dependent mechanism

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. Transforming growth factor-beta1 (TGF-beta1) is a secreted protein that promotes differentiation of synovial fibroblasts to alpha-smooth muscle actin (alpha-SMA)-positive myofibroblasts to repair the damaged joints. Synovial fluid from patients with RA (RA-SF) induced expression of alpha-SMA in human adipose tissue-derived mesenchymal stem cells (hASCs). RA-SF-induced alpha-SMA expression was abrogated by immunodepletion of TGF-beta1 from RA-SF with anti-TGF-beta1 antibody. Furthermore, pretreatment of hASCs with the TGF-beta type I receptor inhibitor SB431542 or lentiviral small hairpin RNA-mediated silencing of TGF-beta type I receptor expression in hASCs blocked RA-SF-induced alpha-SMA expression. Small interfering RNA-mediated silencing of Smad2 or adenoviral overexpression of Smad7 (an inhibitory Smad isoform) completely inhibited RA-SF-stimulated alpha-SMA expression. These results suggest that TGF-beta1 plays a pivotal role in RA-SF-induced differentiation of hASCs to alpha-SMA-positive cells.

A Retrospective Clinical Epidemiological Study of the Health Care Utilization of the Outpatients in the Dermatologic Field after 1 year's Separation of Dispensary from Medical Practice / 대한피부과학회지

BACKGROUND: Despite 2 years' separation of dispensary from medical practice since year of 2000, many outpatients in Korea have a lack of understanding this separation. In addition, the illegal practices of pharmacists such as medical examination have contributed to the recent problematic situation. OBJECTIVE: We performed this study to evaluate the actual situation of the separation of dispensary from medical practice in the dermatologic field. METHODS: The clinico-epidemiologic analysis of 17 months' data of 18, 230 outpatients was conducted through the available medical records and serial questionnaires. RESULTS: The medical or non-medical institutions that 18, 230 outpatients with skin diseases had chosen at first, were as follows by the order of frequency; pharmacy(78.5%), folk remedies or self-medication(9.8%), dermatologic institutions(5.5%), non-dermatologic medical clinics(3.4%), herb clinics(2.8%). Accordingly, most(94.5%, 17, 223) of the new patients did not select a dermatologic institution for the care of their skin diseases. The patterns of health care utilization of the patients mostly(72.9%) showed a fixed tendency to visit the one particular institution or formula continuously prior to final visit to the research hospitals. Most of the patients(62.8%) firstly visited a pharmacy for their disease care and did not revisit another institution. Since the first visit to a pharmacy, 9.6% of the patients repetitively utilized one or more herb clinic(s) or folk remedies in addition to one or more medical institution(s). The patients utilizing non-dermatologic measures for skin disease care at first, were mostly in their fifties(25.3%). The patients seeking herb medicine or non-dermatologic medical clinics, were in their teens(27.3% and 24.3%, respectively). Of the cases misdiagnosed as another disease or aggravated in the patients choosing non-dermatologic care, fungal infections are most common(24.0%). In front of 97.1% of the patients seeking pharmacy at first, the pharmacists practiced medicine like a physician in a wrong way instead of dispensing a prescription. CONCLUSION: In Korea, the majority of dermatologic clinics has been deprived of a position as an institution for primary care of skin diseases. It is imperative that dermatologists should be granted independent and unconstrained authority in the medical profession for the benefit of their patients.

A Case of Multiple Bowen's Disease Accompanied with Arsenical Keratosis and Squamous-Cell Lung Cancer / 대한피부과학회지

Bowen's disease is well known that it can be associated with visceral malignancy. However, the relationship of Bowen's disease to internal malignancy remains controversial. We report a case of a 51-year-old male with multiple Bowen's diseases accompanied with arsenical keratosis and squamous-cell lung cancer.

A Case of Primary Cutaneous CD 30 Positive Large Cell Lymphoma Showing Spontaneous Complete Regression / 대한피부과학회지

The phenomenon of spontaneous regression, which is one of the characteristics of primary cutaneous CD 30 positive large cell lymphoma, has been observed in approximately one fourth of patients. However, complete regression is far less frequent than partial regression. We report a case of primary cutaneous CD 30 positive large cell lymphoma in a 53-year-old male patient who showed spontaneous complete regression without any treatment.

The Effect of Stellate Ganglion Block on the Pain of Acute Stage and the Prevention of Postherpetic Neuralgin in the Treatment of Senile Herpes Zoster patients / 대한피부과학회지

BACKGROUND: Stellate ganglion block, which is one of the effective therapeutic tools for treating herpes zoster has been advocated by many investigators. However its efficacy is controversial at present. OBJECTIVE: This study was conducted to examine the role of stellate ganglion block in the prevention of postherpetic neuralgia and relationships between the time of this treatment and the outbreak of postherpetic neuralgia. METHODS: Twenty patients over the age of fifty with herpes zoster were included in this study. Before treatment, we randomly divided patients into two groups, A and B. Group A was treated with stellate ganglion block and acyclovir and group B was treated with acyclovir alone. Also we subdivided each group by starting treatment time into group 1 and 2. Group 1 was defined as the patients who began treatment within 2 weeks of the onset of the skin lesion. We observed the severity of pain and the incidence of postherpetic neuralgia according to each group.

A Case of Bilateral Lichen Aureus with Good Response to PUVA Therapy / 대한피부과학회지

Lichen aureus is regarded as an uncommon variant of the pigmented purpuric dermatosis and resistant to treatment. Recently several authors reported the PUVA therapy to be effective in the pigmented purpuric dermatosis, but there was no report that the PUVA therapy was tried to the lichen aureus. We tried topical PUVA therapy on a 54-year-old male with bilateral lichen aureus. After 23 times of topical PUVA therapy, the lesion improved markedly. This report may provide a new method of treatment for lichen aureus.

Fixed Drug Eruption Caused by Piroxicam / 대한피부과학회지

A fixed drug eruption is a cutaneous reaction caused by various drugs, which include phenazone derivatives, barbiturates, sulfonamides, tetracyclines and phenolphthaleins. An eruption caused by piroxicam is very rare and there have been no previous reports in Korea. A 49-year-old woman was seen with mutiple erythematous patches and some bullae that appeared after oral administration of piroxicam. The patient had had two similar episodes after oral administration of piroxicam. We performed patch test with piroxicam and could confirm a fixed drug eruption caused by this durg.