Objective: : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods: : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. “Off-hour hospital presentation” was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results: : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106–1.400; HR, 1.402; 95% CI, 1.124–1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.

Superior mesenteric venous aneurysm (SMVA) is rare and no standard treatment protocol has yet been established. We report our experience in performing surgical treatment for SMVA. A 64-year-old man was found to have a SMVA by computed tomography which had been performed during follow-up for gastrectomy. The SMVA was observed to gradually increase in diameter, and surgical treatment was therefore indicated. We successfully resected the aneurysm and then closed the defect with a bovine pericardial patch. Considering the potential risk of rupture, venous aneurysms that present with a saccular shape and an expanding tendency should be immediately surgically treated.

PURPOSE: Lithium-pilocarpine induced status epilepticus (LPSE) causes selective and age-dependent neuronal death, although the mechanism of maturation-related injury has not yet been clarified. The activating transcription factor-2 (ATF-2) protein is essential for the normal development of mammalian brain and is activated by c-Jun N-terminal kinase (JNK). It induces the expression of the c-jun gene and modulates the function of the c-Jun protein, a mediator of neuronal death and survival. Therefore, we investigated the expression of c-Jun and ATF-2 protein in the immature and adult rat hippocampus to understand their roles in LPSE-induced neuronal death. MATERIALS AND METHODS: Lithium chloride was administrated to P10 and adult rats followed by pilocarpine. Neuronal injury was assessed by silver and cresyl violet staining, performed 72 hours after status epilepticus. For evaluation of the expression of ATF-2 and c-Jun by immunohistochemical method and Western blot, animals were sacrificed at 0, 4, 24, and 72 hours after the initiation of seizure. RESULTS: Neuronal injury and expression of c-Jun were maturation-dependently increased by LPSE, whereas ATF-2 immunoreactivity decreased in the mature brain. Since both c-Jun and ATF-2 are activated by JNK, and targets and competitors in the same signal transduction cascade, we could speculate that ATF-2 may compete with c-Jun for JNK phosphorylation. CONCLUSION: The results suggested a neuroprotective role of ATF-2 in this maturation-related evolution of neuronal cell death from status epilepticus.
Activating Transcription Factor 2/*metabolism ; Animals ; Antimanic Agents/pharmacology ; Blotting, Western ; Hippocampus/drug effects/*metabolism ; Immunohistochemistry ; Lithium/pharmacology ; Miotics/pharmacology ; Pilocarpine/pharmacology ; Proto-Oncogene Proteins c-jun/*metabolism ; Rats ; Status Epilepticus/*chemically induced

BACKGROUND: Controversies exist whether arteriovenous fistula (AVF) placement is preferred over arteriovenous graft (AVG) for elderly patients. Current guidelines did not offer specific recommendations. Thus, this study was conducted to analyze the all-cause mortality and primary patency associated with various vascular access (VA) types according to age group. METHODS: This retrospective observational study investigated the Korean insurance claims data of chronic kidney disease patients who began hemodialysis between January 2008 and December 2016. We investigated all-cause mortality associated with initial VA in incident hemodialysis patients and primary patency between AVF and AVG according to age group. RESULTS: The proportion of patients with a tunneled dialysis catheter (TDC) that was first placed for VA increased from 18.4% in 2008 to 52.3% in 2016. Incident hemodialysis patients with a TDC or AVG for the initial VA had significantly higher mortality risk than patients with an AVF, except for patients over 85 years, who showed no significant difference in all-cause mortality regardless of VA type. In the patency analysis on initial AV access, AVG had significantly poorer primary patency than AVF in all age groups. CONCLUSION: AVF had better patency than AVG in all age groups; however, the benefit of AVF attenuated in the older age groups. The mortality rate between AVF and AVG was not significantly different in patients over 85 years. Therefore, a “patient-first” approach should be emphasized over a “fistula-first” approach in AV access creation for incident hemodialysis patients older than 85 years.
Administrative Claims, Healthcare ; Aged ; Arteriovenous Fistula ; Catheters ; Dialysis ; Humans ; Insurance ; Mortality ; National Health Programs ; Observational Study ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Transplants

PURPOSE: The aim of this study was to investigate the epidemiological characteristics and outcomes for in-hospital cardiac arrest (IHCA) patients who were 65 years and older between nursing care hospitals versus non-nursing care hospitals in Korea. METHODS: This is a population study enumerating 24,203 IHCA patients registered in Korean Health Insurance Review and Assessment Service in 2013. The Cardiopulmonary resuscitation (CPR) outcomes including survival discharge and 30 day survival rate were analyzed. The main diagnoses of IHCA patients were categorized according to the Korean Standard classification of Disease version 6 (KCD-6). All data of patients who were CPR recipients in nursing care hospitals were compared with those of CPR recipients in non-nursing care hospitals. RESULTS: The overall survival discharge and 30 day survival rate were 29.5% and 28.1%, respectively. However, the survival discharge rate of IHCA patients was significantly low in nursing care hospitals compared to non-nursing care hospitals (20.0% vs. 30.0%, p<0.001). The 30 day survival rate was similarly low in nursing care hospitals (20.1% vs. 28.4%, p<0.001). The most common diagnosis of IHCA patients was respiratory disease in nursing care hospitals and cardiovascular disease in non-nursing care hospitals. The most common respiratory disease leading to IHCA in nursing care hospitals was acute respiratory infections. CONCLUSION: The survival rate after IHCA was lower in nursing care hospitals, and the major diagnosis leading to CPR was acute respiratory infections rather than chronic underlying diseases. Therefore, it is crucial to set higher standards in performing CPR and controlling infections in nursing care hospitals nationwide.
Cardiopulmonary Resuscitation ; Cardiovascular Diseases ; Classification ; Diagnosis ; Heart Arrest* ; Humans ; Insurance, Health* ; Korea* ; Nursing Care* ; Nursing* ; Respiratory Tract Infections ; Survival Rate

PURPOSE: Poisoning is an important cause of death in Korea. We aimed to investigate the epidemiological characteristics and outcomes for in-hospital cardiac arrest (IHCA) in poisoned patients in Korea. METHODS: This is a population-based study, analyzing 576 IHCA patients who were poisoned and registered in the Korean Health Insurance Review and Assessment Service in 2013. The cardiopulmonary resuscitation outcomes, including survival discharge and 30-day survival rate, were analyzed. The main diagnoses were categorized in accordance with the Korean Standard Classification of Diseases version 6. RESULTS: The overall survival discharge and 30-day survival rate were 31.6% and 15.3%, respectively. The most common etiologies of poisoning were pesticides (54.3%), drugs and medications (21.9%), carbon monoxide (8.9%), and unspecified substances (5.4%); the 30-day survival rate for each etiology was 16.6%, 15.2%, 9.8%, and 19.4%, respectively. A geographical analysis showed a high 30-day survival rate in Gwangju (32.0%), Daejeon (25.0%) and Ulsan (25.0%). CONCLUSION: Pesticides poisoning is the most common cause for IHCA patients. The survival rate after IHCA by poisoning was similar in pesticides poisoning than in other toxic etiologies. Therefore, it is crucial to reduce pesticide poisoning and to establish a poisoning information inquiry system.
Carbon Monoxide ; Cardiopulmonary Resuscitation ; Cause of Death ; Classification ; Diagnosis ; Gwangju ; Heart Arrest* ; Humans ; Insurance, Health* ; Korea* ; Mortality ; Pesticides ; Poisoning ; Survival Rate ; Ulsan

In this study, we investigated whether glycyrrhizin, prunetin and morroniside affect mucin secretion from cultured airway epithelial cells and compared the possible activities of these agents with the inhibitory action on mucin secretion by poly-L-lysine (PLL) and the stimulatory action by adenosine triphosphate (ATP). Confluent primary hamster tracheal surface epithelial (HTSE) cells were metabolically radiolabeled using (3)H-glucosamine for 24 h and chased for 30 min in the presence of varying concentrations of each agent to assess the effects on (3)H-mucin secretion. The results were as follows: 1) glycyrrhizin and morroniside increased basal mucin secretion from airway; 2) prunetin did not affect basal mucin secretion; 3) glycyrrhizin did not inhibit ATP-induced mucin secretion. We conclude that glycyrrhizin and morroniside can increase basal mucin secretion, by directly acting on airway mucin-secreting cells and suggest that two compounds be further investigated for the possible use as mild expectorants during the treatment of inflammatory airway diseases.
Adenosine Triphosphate ; Animals ; Cricetinae ; Epithelial Cells* ; Expectorants ; Glycyrrhizic Acid* ; Mucins*

Schizandrae Fructus has been used for controlling respiratory allergic or inflammatory diseases in folk medicine and their components, schizandrin, schizandrin-A and gomisin-A were reported to have diverse biological effects. In this study, we investigated whether schizandrin, schizandrin-A and gomisin-A affect adenosine triphosphate (ATP)-induced mucin secretion from cultured airway epithelial cells. Confluent primary hamster tracheal surface epithelial (HTSE) cells were metabolically radiolabeled using 3H-glucosamine for 24 h and chased for 30 min in the presence of varying concentrations of each agent to assess the effects on 3H-mucin secretion. The results were as follows: 1) schizandrin significantly inhibited ATP-induced mucin secretion; 2) However, schizandrin-A and gomisin-A did not affect ATP-induced mucin secretion, significantly. We conclude that schizandrin can inhibit ATP-induced mucin secretion by directly acting on airway mucin-secreting cells. Therefore, schizandrin should further be investigated for the possible use as mucoregulators in the treatment of inflammatory airway diseases.
Adenosine Triphosphate ; Adenosine* ; Animals ; Cricetinae ; Epithelial Cells* ; Medicine, Traditional ; Mucins* ; Schisandra

BACKGROUND/AIMS: The purpose of this study was to determine the correlations between inflammatory factors-including absolute lymphocyte count, lactate dehydrogenase, beta2-microglobulin, albumin, C-reactive protein, and ferritin-and the prognosis for survival in patients with multiple myeloma (MM) treated with induction chemotherapy containing thalidomide and who underwent autologous stem cell transplantation (ASCT). METHODS: Data from patients at 13 university hospitals in South Korea were collected retrospectively between December 2005 and May 2013. RESULTS: The median age of the 232 patients was 57 years (range, 33 to 77) and the male to female ratio was 1.09:1. In the multivariate analysis, fewer than two combined abnormal inflammatory factors was the only independent prognostic factor for superior progression-free survival (relative risk [RR], 0.618; 95% confidence interval [CI], 0.409 to 0.933; p = 0.022), and platelet count > 100 x 109/L and fewer than two combined abnormal inflammatory factors were independent prognostic factors for superior overall survival (RR, 4.739; 95% CI, 1.897 to 11.839; p = 0.001 and RR, 0.263; 95% CI, 0.113 to 0.612; p = 0.002, respectively). CONCLUSIONS: Patients with two or more than two combined inflammatory factors who were treated with thalidomide induction chemotherapy and who underwent ASCT showed significantly shorter survival compared to those with fewer than two combined inflammatory factors. These results could be helpful for predicting prognosis in patients with MM.
Adult ; Aged ; Antineoplastic Agents/adverse effects/*therapeutic use ; Biomarkers, Tumor/*blood ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Hospitals, University ; Humans ; Induction Chemotherapy ; Inflammation Mediators/*blood ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multiple Myeloma/blood/diagnosis/*drug therapy/immunology/mortality ; Multivariate Analysis ; Neoadjuvant Therapy ; Odds Ratio ; Proportional Hazards Models ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Stem Cell Transplantation ; Thalidomide/adverse effects/*therapeutic use ; Time Factors ; Transplantation, Autologous ; Treatment Outcome