Background & Objective: The number of ischemic stroke is increasing steadily. The recent stroke prevention strategies have targeted risk factors for preventing ischemic stroke. Community-based data that quantify the prevalence of these risk factors are needed to develop effective stroke prevention strategies. This study was performed aiming to establish customized prevention strategies by investigating vascular risk factors of ischemic stroke among the healthy adults in an urban population in Korea. Methods: The Prevention of Stroke and Dementia (PRESENT) survey collected data associated with stroke risk factors between 2007 and 2009 in Ansan city, Korea. Of 46,537 people, 2,843 were selected by random sampling, and final population included 358 men and 422 women over 50 years old. We checked modifiable risk factors, such as hypertension, diabetes mellitus, smoking, hyperlipidemia, atrial fibrillation, cardiovascular disease, obesity, and physical inactivity. Results: The mean age of study subjects was 60.1±8.2 years; 55.5% had hypertension, 18.6% had diabetes mellitus, 17.7% were current smoker, 44.9% had hyperlipidemia, 1.7% had atrial fibrillation, and 4.5% had cardiovascular disease. Men had more risk factors for stroke, and higher rates of diabetes mellitus and current smoking. However, women had higher cholesterol and obesity rates and lower physical activity. The proportion of individuals with >1 risk factor for stroke increased with age. Hypertension, diabetes mellitus, and cardiovascular diseases also increased with age, but low-density lipoprotein levels and current smoking decreased. Conclusions: This study provides valuable information to develop customized strategic policies for primary and secondary stroke prevention.
Stroke

To define the basic sequential events of the healing process in normal fracture and evaluate the role of growth regulatory molecules and extracellular matrix components, the expression of transforming growth factor β(TGF-β), platelet-derived growth factor(PDGF), type I and II collagen, and chemistry during the healing process of an experimental fracture of tibia in 41 adult rats for 7 weeks using ABC methods. The phases of inflammation, reparation, and remodeling followed each other in sequence. The inflammatory phase was characterized by hemorrhage, edema, and infiltration of inflammatory cells on the first day. During the reparative phase, the undifferentiated mesenchyme undergoes rapid chondrogenesis, followed by endochondral ossification and supplemented by appositional bone formation. At day 3, the expression of TGF-β and PDGF was noted in the undifferentiated mesenchymal cells and from day 5, these two growth factors were detected in the osteoblasts and extracellular matrix in areas of endochondral ossification and newly formed periosteal bone. From day 3, the expression of type I collagen and osteonectin was noted in the osteoblasts and extracellular matrix in both endochondral ossification and appositional bone growth as a marker of ossification. From day 3, type III collagen was mainly expressed in the plump mesenchymal cells showing chondroid differentiation and chondroid matrix as a marker of cartilaginous reparative phase. From day 14, these growth factors and extracellular matrix components were decreased in staining intensity and at the 5th week, the histology and immunostaining pattern were similar to the mature bone.
Adult ; Animals ; Bone Development ; Chemistry ; Chondrogenesis ; Collagen Type I ; Collagen Type III ; Collagen ; Edema ; Extracellular Matrix ; Fracture Healing ; Hemorrhage ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Mesoderm ; Osteoblasts ; Osteogenesis ; Osteonectin ; Rats ; Tibia ; Transforming Growth Factors

No abstract available.
Ascitic Fluid* ; Endometriosis* ; Female ; Humans ; Interleukins*

BACKGROUND: To reduce the amount of homologous transfusion with its inherent problems of transmission of viral hepatitis, acquired immune deficiency syndrome and others, many institutions use comprehensive blood conservation methods (CBCM) in open heart and major aortic operations. The purpose of this study is to compare the amount and cost of homologous transfusion and the efficacy of coagulation between patients with or without CBCM adoption. METHODS: We prospectively assessed available CBCM of our institution in 20 patients, comparing the requirements of blood products, their cost and the efficacy of blood coagulation with those of another 20 patients similar in age, types of operation, operation difficulty and duration of bypass time retrospectively. RESULT: Fewer whole blood and platelet concentrates were transfused in patients with CBCM (p<0.05). There are no significant differences in the amount of used packed red blood cell and fresh frozen plasma between two groups. Partial thromboplastin time is significantly short in patient with CBCM (p<0.05). The prevalence of complications and mean extra-financial cost for using cellsaver, platelete pheresis and homologous blood products are low in patients with CBCM. CONCLUSIONS: The CBCM requires additional cost won but CBCM reduces the requirements of homologous blood effectively.
Acquired Immunodeficiency Syndrome ; Blood Coagulation ; Blood Component Removal ; Blood Platelets ; Blood Transfusion* ; Erythrocytes ; Heart* ; Hepatitis ; Humans ; Partial Thromboplastin Time ; Plasma ; Prevalence ; Prospective Studies ; Retrospective Studies

Endoscopic variceal ligation (EVL) is effective for the management of bleeding esophageal varices, and its use is widespread now. EVL necessitates the use of overtubes. Two primary techniques have been used for overtube placement; one is with endoscope, and the other is with bougie dilator. Overtube placement with endoseope is not without risk. There are reportd of esophageal or pharyngeal laceration or perforation. Overtube placement with bougie dilator circumvents this risk, but it is rather cumbersome to use. The authors devised a safe and easy method for overtube placement, and applied it to a number of patients to test its safety and convenience. First, overtube-dilator assembly was prepared as follows. A Rigiflex achalasia dilator (balloon 30mm OD, 10cm length; Microvasive Co) was lubricated and inserted into the overtube. A tenth of the balloon tip was protruded out of the overtube, then the balloon was insufflated with air at 10-15 psi. Second, standard endoscopy was performed, followed by placement of guide wire in the stomach. Overtube-dilator assembly was lubricated and introduced over the wire as a rail. Once the overtube was properly positioned, the balloon was deflated, and the balloon and wire were removed as a whole, which completed overtube placement. For 65 patients with esophageal variceal bleeding, 82 procedures of EVL were performed using the new technique. Overtube-dilator assembly was easy to prepare and handle. This technique added little time to the procedure and minimizes patients discomfort. No patient suffered major complications such as bleeding, laceration or perforation. This novel method for overtube placement was safe and convenient for use in EVL. It can also be applied to other procedures using overtube such as endoscopic foreign body removal.
Endoscopes ; Endoscopy ; Esophageal Achalasia ; Esophageal and Gastric Varices ; Foreign Bodies ; Hemorrhage ; Humans ; Lacerations ; Ligation* ; Stomach

The diagnostic value of nerve conduction study of spinal stenosis is far limited due to its deeply located lesion and its very short length of diseased nerve compared to the relatively long length of total conduction distance. Recently it became possible to stimulate the deep sited spinal nerve roots non-invasively with magnetic stimulation. The authors made a new method to calculate the motor nerve conduction time of lumbar spinal root using magnetic stimulation and planned to verify the delayed conduction time in patients with spinal stenosis who didn't show any abnormalities in the conventional electrophysiologic studies(peripheral nerve conduction velocity, F-wave and needle EMG). Three steps of magnetic stimulation were applied to vertex(transcortical stimulation), T12 spinous process(thoracic stimulation) and S1 spinous process(sacral stimulation), and three channel recording were performed at rectus abdominis(RA), right and left abductor hallucis(AH) simultaneously. Central motor conduction time(CMCT) was calculated by time difference between vertex and spinal stimulation at RA and AH. Lumbar-segment motor conduction time(LMCT) was defined as conduction time by subtracting CMCT of RA from CMCT of AH. The results as follows; LMCT was delayed in the group of patients with spinal stenosis(5.36+/-2.11 msec) compared to the normal control group(4.05+/-1.23 msec), but the range of LMCT was not quite different individually. Dividing the patients group into multi-level and single-level spinal stenosis group, LMCT in the multi-level spinal stenosis group was 6.12+/-1.95 msec which was significantly different from that of single-level(4.48+/-1.96 msec). The authors conclude that LMCT, the short segmental motor nerve conduction study of lumbosacral nerve root, is useful to confirm the entrapment of spinal nerve root across the lumbosacral spinal canal and is also non- invasive, simple and applicable to any other spinal nerve roots.
Evoked Potentials, Motor ; Humans ; Needles ; Neural Conduction* ; Spinal Canal ; Spinal Nerve Roots ; Spinal Stenosis*

Objective: To determine the characteristics of pediatric spinal cord injury (SCI) in South Korea from 1990 to 2019. Methods: This single-centered retrospective study included pediatric SCIs. Individuals were divided into the following five groups according to onset age: ≤5, 6–12, 13–14, 15–17, and 18–19 years. The severity of complete injury was graded according to the American Spinal Injury Association impairment scale A (AIS A). Incomplete injury was graded according to AIS B, C, and D. Pearson chi-square test was used for statistical analysis. Results: Of the 267 individuals included, 216 (80.9%) had traumatic SCIs (male-to-female ratio of 3.2:1), and 51 (19.1%) had non-traumatic SCIs (male-to-female ratio of 0.7:1). In the traumatic SCI group, 192 (88.9%) individuals were ≥15 years at the time of injury (males, 78.6%). The most common etiologies of traumatic SCIs, ranging from most to least common, were accidents related to motorcycles, falls, cars, and diving. In the non-traumatic SCI group, inflammatory (33.3%) and neoplastic (25.5%) etiologies were found to be the most common ones. Conclusion We found that traumatic SCIs incidence in the pediatric population was high, particularly in male individuals aged 15–19 years. The non-traumatic SCIs mostly cause paraplegia and incomplete injury. Therefore, it can be used as a basic data for the evaluation, treatment and prevention strategy of pediatric patients with SCI.

OBJECTIVE: To analyze the factors related to urinary tract infection (UTI) occurrence after an urodynamic study (UDS) in patients with spinal cord injury (SCI). METHODS: We retrospectively investigated the medical records of 387 patients with SCI who underwent UDS with prophylactic antibiotic therapy between January 2012 and December 2012. Among them, 140 patients met the inclusion criteria and were divided into two groups, UTI and non-UTI. We statistically analyzed the following factors between the two groups: age, sex, level of injury, SCI duration, spinal cord independence measure, non-steroidal anti-inflammatory drug use, diabetes mellitus, the American Spinal Injury Association impairment scale (AIS), lower extremity spasticity, a history of UTI within the past 4 weeks prior to the UDS, symptoms and signs of neurogenic bladder, urination methods, symptoms during the UDS and UDS results. RESULTS: Among the 140 study participants, the UTI group comprised 12 patients and the non-UTI group comprised 128 patients. On univariate analysis, a history of UTI within the past 4 weeks prior to the UDS was significant and previous autonomic dysreflexia before the UDS showed a greater tendency to influence the UTI group. Multivariable logistic regression analysis using these two variables showed that the former variable was significantly associated with UTI and the latter variable was not significantly associated with UTI. CONCLUSION: In patients with SCI, a history of UTI within the past 4 weeks prior to the UDS was a risk factor for UTI after the UDS accompanied by prophylactic antibiotic therapy. Therefore, more careful pre-treatment should be considered when these patients undergo a UDS.
Autonomic Dysreflexia ; Diabetes Mellitus ; Humans ; Logistic Models ; Lower Extremity ; Medical Records ; Muscle Spasticity ; Retrospective Studies ; Risk Factors ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Urinary Bladder, Neurogenic ; Urinary Tract Infections* ; Urinary Tract* ; Urination ; Urodynamics*

PURPOSE: Acute renal failure (ARF) is one of the common complications after liver transplantation (LT) and could be fatal unless promptly treated. Identification of risk factors is needed to prevent ARF and to attenuate the unfavorable outcomes of ARF after LT. The aim of this study was to analyze risk factors for development of postoperative ARF (between day 0 and day 30 after LT). METHODS: Total 72 LTs were performed between 1996 and 2005. Sixty six patients' records, excluding 6 patients with preoperative serum creatinine level more than 2.5 mg/dl, were reviewed retrospectively for preoperative, intraoperative, and postoperative variables to compare patients presenting ARF with the remaining patients. RESULTS: Postoperative ARF occurred in 36 transplants (54.5%) after LT. Preoperative serum sodium, bilirubin and BUN, creatinine level were higher in ARF group. ARF group had more child-pugh class C, and more episodes of preoperative hepatic encephalopathy. During intraoperative period, anhepatic time was longer and total doses of intraoperative furosemide was larger in ARF group. Also, postoperative blood immunosuppressant level was higher, and postoperative episodes of bleeding and hypotension were more common in ARF group. In multivariate analysis, preoperative child-pugh class C (P=0.041), preoperative serum creatinine level (> or =1.0 mg/dL, P=0.032), and postoperative episodes of hypotension and bleeding (P=0.045, P=0.03 respectively) were identified as risk factors for postoperative ARF. CONCLUSION: This study showed that preoperative renal and liver function, and postoperative hemodynamic condition were independent risk factors for development of ARF after LT.
Acute Kidney Injury* ; Bilirubin ; Creatinine ; Furosemide ; Hemodynamics ; Hemorrhage ; Hepatic Encephalopathy ; Humans ; Hypotension ; Intraoperative Period ; Liver Transplantation* ; Liver* ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Sodium

BACKGROUND: Remifentanil efficiently blunts the stress response during endotracheal intubation, but also causes hypotension, especially in geriatric patients. Hence, this study was designed to compare the hemodynamic changes during the induction with propofol or etomidate in geriatric patients. METHODS: Sixty ASA physical status class I or II geriatric patients, who were scheduled for elective surgery, were randomly assigned to two groups (n = 30 each). Induction was performed with either propofol (2 mg/kg mixed with lidocaine 40 mg, Group P) or etomidate (0.2 mg/kg, Group E). Both groups received a bolus dose of remifentanil (1 microg/kg), followed with continuous administration (0.1 microg/kg/min). An additional bolus dose (50 microg) was repeated, if needed. The systolic, diastolic, mean arterial blood pressure, heart rates and cardiac index were measured before induction (baseline vital signs), after propofol or etomidate administration, before intubation, immediately after intubation and at 1, 3, 5 and 10 minutes after intubation. RESULTS: Patient characteristics and baseline vital signs were similar in both groups. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and cardiac output were significantly decreased in group P compared with those in group E (P < 0.05). Heart rates decreased after the injection of both propofol or etomidate, but were recovered after intubation. 5 patients in group P and 14 patients in group E needed an additional bolus dose of remifentanil (P < 0.05). CONCLUSIONS: Etomidate can be used safely with remifentanil for the stable induction of anesthesia in geriatric patients.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Etomidate* ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Intubation ; Intubation, Intratracheal ; Lidocaine ; Propofol* ; Vital Signs