1.Heart Rate Variability and Metabolic Syndrome in Hospitalized Patients with Schizophrenia.
Kyunghee LEE ; Jeongeon PARK ; Jeongim CHOI ; Chang Gi PARK
Journal of Korean Academy of Nursing 2011;41(6):788-794
PURPOSE: Reduced heart rate variability significantly increases cardiovascular mortality. Metabolic syndrome increases the cardiac autonomic dysfunction. Recently, increasing cardiovascular mortality has been reported in patients with schizophrenia. This study was done to compare heart rate variability between adults with and without schizophrenia and to compare the relationship of heart rate variability to metabolic syndrome in hospitalized patients with schizophrenia. METHODS: This was a descriptive and correlational study in which 719 adults without schizophrenia and 308 adults with schizophrenia took part between May and June 2008. We measured the following: five-minute heart rate variability; high-frequency, low-frequency, the ratio of low-frequency to high-frequency, and the Standard Deviation of all the normal RR intervals. Data was also collected on metabolic syndrome, abdominal obesity, triglycerides, HDL cholesterol, blood pressure and fasting glucose. RESULTS: The Standard Deviation of all the normal RR intervals values of heart rate variability indices were 1.53+/-0.18. The low-frequency and high-frequency values of heart rate variability indices were significantly higher in hospitalized patients with schizophrenia (3.89+/-1.36; 3.80+/-1.20) than those in the healthy participants (2.20+/-0.46; 2.10+/-0.46). There were no significant differences between the schizophrenic patients with and without metabolic syndrome. CONCLUSION: The results of this study indicate that schizophrenia patients have significantly lower cardiac autonomic control, but they have significantly higher low-frequency and high-frequency values than those of healthy adults. Use of antipsychotic drug may affect the autonomic nervous system in schizophrenic patients. Metabolic syndrome was not associated with cardiac autonomic control in schizophrenia patients.
Adult
;
Autonomic Nervous System/physiopathology
;
Blood Glucose/analysis
;
Blood Pressure
;
Cardiovascular Diseases/complications/diagnosis/mortality
;
Cholesterol, HDL/blood
;
Female
;
*Heart Rate
;
Hospitalization
;
Humans
;
Male
;
Metabolic Syndrome X/*complications/*physiopathology
;
Middle Aged
;
Obesity/etiology
;
Schizophrenia/*complications/mortality/*physiopathology
;
Triglycerides/blood
2.Analysis of Elderly Patients who visited Emergency Room.
Jin Neyn KIM ; Tae Hoon KIM ; Yang Wook KANG ; Myoung OH ; Sang Cheol KIM ; Sung Hoon KIM ; Kye Hyung KWON ; Hong Woo NAM ; Hong Soon LEE ; Hyung Joon YOO
Journal of the Korean Geriatrics Society 2001;5(3):224-231
BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.
Aged*
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Cardiovascular Diseases
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Cause of Death
;
Crowding
;
Diabetes Complications
;
Diabetic Foot
;
Diagnosis
;
Emergencies*
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Emergency Medical Services
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Emergency Service, Hospital*
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Female
;
Humans
;
Hypoglycemia
;
Korea
;
Male
;
Mortality
;
Retrospective Studies
3.Differential Prognostic Impacts of Diabetes over Time Course after Acute Myocardial Infarction.
Hack Lyoung KIM ; Si Hyuck KANG ; Chang Hwan YOON ; Young Seok CHO ; Tae Jin YOUN ; Goo Yeong CHO ; In Ho CHAE ; Hyo Soo KIM ; Shung Chull CHAE ; Myeong Chan CHO ; Young Jo KIM ; Ju Han KIM ; Youngkeun AHN ; Myung Ho JEONG ; Dong Ju CHOI
Journal of Korean Medical Science 2013;28(12):1749-1755
This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.
Acute Disease
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Aged
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Cardiovascular Diseases/etiology
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Cohort Studies
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Diabetes Mellitus, Type 2/complications/*diagnosis
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Diagnosis, Differential
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Female
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Humans
;
Incidence
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Male
;
Middle Aged
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Myocardial Infarction/*diagnosis/epidemiology/mortality
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Prognosis
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Proportional Hazards Models
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Registries
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Survival Analysis
;
Time Factors
4.A Clinical Analysis of Surgery in the Elderly Patients with Acute Abdomen.
Yun Seung CHOI ; Won Hong KIM ; Yang Hee KIM ; Sun Keun CHOI ; Yoon Seok HUR ; Keon Young LEE ; Sei Joong KIM ; Seung Ik AHN ; Kee Chun HONG ; Ze Hong WOO ; Seok Hwan SHIN
Journal of the Korean Geriatrics Society 2003;7(3):214-221
PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.
Abdomen, Acute*
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Acute Kidney Injury
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Aged*
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Aging
;
Appendicitis
;
Cardiovascular Diseases
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Cholecystitis
;
Cholecystitis, Acute
;
Diagnosis
;
Diverticulitis, Colonic
;
Emergencies
;
Gastrointestinal Neoplasms
;
Hemorrhage
;
Humans
;
Intestinal Obstruction
;
Mortality
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Postoperative Complications
;
Retrospective Studies
;
Vascular Diseases
5.A Clinical Analysis of Surgery in the Elderly Patients with Acute Abdomen.
Yun Seung CHOI ; Won Hong KIM ; Yang Hee KIM ; Sun Keun CHOI ; Yoon Seok HUR ; Keon Young LEE ; Sei Joong KIM ; Seung Ik AHN ; Kee Chun HONG ; Ze Hong WOO ; Seok Hwan SHIN
Journal of the Korean Geriatrics Society 2003;7(3):214-221
PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.
Abdomen, Acute*
;
Acute Kidney Injury
;
Aged*
;
Aging
;
Appendicitis
;
Cardiovascular Diseases
;
Cholecystitis
;
Cholecystitis, Acute
;
Diagnosis
;
Diverticulitis, Colonic
;
Emergencies
;
Gastrointestinal Neoplasms
;
Hemorrhage
;
Humans
;
Intestinal Obstruction
;
Mortality
;
Postoperative Complications
;
Retrospective Studies
;
Vascular Diseases
6.Serum osteoprotegerin is associated with vascular stiffness and the onset of new cardiovascular events in hemodialysis patients.
Jung Eun LEE ; Hyung Jong KIM ; Sung Jin MOON ; Ji Sun NAM ; Jwa Kyung KIM ; Seung Kyu KIM ; Gi Young YUN ; Sung Kyu HA ; Hyeong Cheon PARK
The Korean Journal of Internal Medicine 2013;28(6):668-677
BACKGROUND/AIMS: Osteoprotegerin (OPG) and fetuin-A are vascular calcification regulators that may be related to high cardiovascular (CV) mortality in hemodialysis (HD) patients. We evaluated the relationship between OPG, fetuin-A, and pulse wave velocity (PWV), a marker of vascular stiffness, and determined whether OPG and fetuin-A were independent predictors of CV events in HD patients. METHODS: We conducted a prospective observational study in 97 HD patients. OPG and fetuin-A were measured at baseline and arterial stiffness was evaluated by PWV. All patients were stratified into tertiles according to serum OPG levels. RESULTS: A significant trend was observed across increasing serum OPG concentration tertiles for age, HD duration, systolic blood pressure, cholesterol, triglycerides, and PWV. Multiple linear regression analysis revealed that diabetes (beta = 0.430, p = 0.000) and OPG levels (beta = 0.308, p = 0.003) were independently associated with PWV. The frequency of new CV events was significantly higher in the upper OPG tertiles compared with those in the lower OPG tertiles. In Cox proportional hazards analysis, upper tertiles of OPG levels were significantly associated with CV events (hazard ratio = 4.536, p = 0.011). CONCLUSIONS: Serum OPG, but not fetuin-A, levels were closely associated with increased vascular stiffness, and higher OPG levels may be independent predictors of new CV events in HD patients.
Adult
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Aged
;
Biological Markers/blood
;
Cardiovascular Diseases/blood/diagnosis/*etiology/mortality/physiopathology
;
Female
;
Humans
;
Kaplan-Meier Estimate
;
Linear Models
;
Male
;
Middle Aged
;
Multivariate Analysis
;
Osteoprotegerin/*blood
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Predictive Value of Tests
;
Prognosis
;
Proportional Hazards Models
;
Prospective Studies
;
Pulse Wave Analysis
;
*Renal Dialysis/adverse effects/mortality
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Renal Insufficiency, Chronic/complications/diagnosis/mortality/*therapy
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Risk Factors
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Up-Regulation
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*Vascular Stiffness
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alpha-2-HS-Glycoprotein/analysis
7.Comparison of Clinical Outcomes of Hydrophilic and Lipophilic Statins in Patients with Acute Myocardial Infarction.
Min Chul KIM ; Youngkeun AHN ; Su Young JANG ; Kyung Hoon CHO ; Seung Hwan HWANG ; Min Goo LEE ; Jum Suk KO ; Keun Ho PARK ; Doo Sun SIM ; Nam Sik YOON ; Hyun Ju YOON ; Kye Hun KIM ; Young Joon HONG ; Hyung Wook PARK ; Ju Han KIM ; Myung Ho JEONG ; Jeong Gwan CHO ; Jong Chun PARK ; Jung Chaee KANG
The Korean Journal of Internal Medicine 2011;26(3):294-303
BACKGROUND/AIMS: A controversy exists about which statin is preferable for patients with acute myocardial infarction (AMI), and clinical impacts of different statins according to lipophilicity have not been established. METHODS: The 1,124 patients with AMI included in the present study were divided into hydrophilic- and lipophilic-statin groups. In-hospital complications (defined as death, cardiogenic shock, ventricular arrhythmia, infection, bleeding, and renal insufficiency, and other fatal arrhythmias), major adverse cardiac events (MACE), all-cause death, re-myocardial infarction, re-percutaneous coronary intervention (re-PCI), and surgical revascularization were analyzed during a 1-year clinical follow-up. RESULTS: Baseline characteristics were similar between the two groups, and in-hospital complication rates showed no between-group differences (11.7% vs. 12.8%, p = 0.688). Although MACE at the 1- and 6-month clinical follow-ups occurred more in hydrophilic statin group I (1 month: 10.0% vs. 4.4%, p = 0.001; 6 month: 19.9% vs. 14.2%, p = 0.022), no significant difference in MACE was observed at the 1-year follow-up (21.5% vs. 17.9%, p = 0.172). Both statin groups showed similar efficacy for reducing serum lipid concentrations. A Cox-regression analysis showed that the use of a hydrophilic statin did not predict 1-year MACE, all-cause death, AMI, or re-PCI. CONCLUSIONS: Although short-term cardiovascular outcomes were better in the lipophilic-statin group, 1-year outcomes were similar in patients with AMI who were administered hydrophilic and lipophilic statins. In other words, the type of statin did not influence 1-year outcomes in patients with AMI.
Aged
;
Biological Markers/blood
;
Cardiovascular Diseases/etiology/prevention & control
;
Chi-Square Distribution
;
Female
;
Hospital Mortality
;
Humans
;
Hydrophobic and Hydrophilic Interactions
;
Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects/chemistry/*therapeutic use
;
Korea
;
Lipids/blood
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Male
;
Middle Aged
;
Myocardial Infarction/blood/complications/diagnosis/mortality/*therapy
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Proportional Hazards Models
;
Recurrence
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Retrospective Studies
;
Risk Assessment
;
Risk Factors
;
Time Factors
;
Treatment Outcome
8.Lysophosphatidylcholine, Oxidized Low-Density Lipoprotein and Cardiovascular Disease in Korean Hemodialysis Patients: Analysis at 5 Years of Follow-up.
Young Ki LEE ; Dong Hun LEE ; Jin Kyung KIM ; Min Jeong PARK ; Ji Jing YAN ; Dong Keun SONG ; Nosratola D VAZIRI ; Jung Woo NOH
Journal of Korean Medical Science 2013;28(2):268-273
Although oxidized low-density lipoprotein (LDL) and lysophosphatidylcholine (LPC) have been proposed as important mediators of the atherosclerosis, the long-term contribution to the risk of cardiovascular disease (CVD) in hemodialysis patients has not been evaluated. This study investigated the relation between oxidized LDL and LPC levels with long term risk of CVD. Plasma oxidized LDL and LPC levels were determined in 69 Korean hemodialysis patients as a prospective observational study for 5 yr. During the observation period, 18 cardiovascular events (26.1%) occurred including 6 deaths among the hemodialysis patients. The low LPC level group (< or = 254 microM/L, median value) had much more increased risk of CVD compared to the high LPC level group (> 254 microM/L) (P = 0.01). However, serum levels of oxidized LDL were not significantly different between groups with and without CVD. In adjusted Cox analysis, previous CVD, (hazard ratio [HR], 5.68; 95% confidence interval [CI], 1.94-16.63, P = 0.002) and low LPC level (HR, 3.45; 95% CI, 1.04-11.42, P = 0.04) were significant independent risk factors for development of CVD. It is suggested that low LPC, but not oxidized LDL, is associated with increased risk of CVD among a group of Korean hemodialysis patients.
Adult
;
Aged
;
Asian Continental Ancestry Group
;
Cardiovascular Diseases/*diagnosis/etiology/mortality
;
Case-Control Studies
;
Female
;
Follow-Up Studies
;
Humans
;
Kidney Failure, Chronic/blood/complications/diagnosis
;
Lipoproteins, LDL/*blood
;
Lysophosphatidylcholines/*blood
;
Male
;
Middle Aged
;
Proportional Hazards Models
;
Prospective Studies
;
Renal Dialysis
;
Republic of Korea
;
Risk Factors