Purpose: It is important to understand changes in energy requirements in critically ill patients with sepsis. This study investigates alterations in energy requirements based on the clinical course of sepsis in patients admitted to the surgical intensive care unit (SICU) using indirect calorimetry. Methods: In this prospective study, 36 patients admitted to the surgical intensive care unit with sepsis were analyzed. Using indirect calorimetry, the resting energy expenditure (REE) and respiratory quotient (RQ) were assessed on the 1st, 3rd, and 7th day of Intensive Care Unit admission. Measured REE through indirect calorimetry was compared with the predictive equations (Weight-based, Harris-Benedict, IretonJones, and Penn state 2003) using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: Measured REE was highest on Day 1 and remained unchanged on Day 3 and 7 (Day 1 vs. Day 3 vs. Day 7: 24.29 ± 3.72 kcal/kg vs. 22.42 ± 3.72 kcal/kg vs. 23.26 ± 5.78 kcal/kg). RQ decreased on Day 3 but increased on Day 7 after caloric intake (Day 1 vs. Day 3 vs. Day 7: 0.69 ± 0.06 vs. 0.67 ± 0.05 vs. 0.71 ± 0.06). Comparing the correlation between the 4 predictive equations and the measured REE, the Penn state 2003 equation demonstrated the highest correlation at each time point, although it showed a decreasing trend over time (Penn state equation ICC: Day 1-0.71, Day 3-0.65, Day 7-0.53). Conclusion In sepsis patients, it is necessary to understand metabolic changes according to the clinical course and provide appropriate calories as determined by using indirect calorimetry when the patients enter the stable phase.

Purpose: Over the past 3 years, approximately 23,000 emergency surgeries were performed annually in South Korea, accounting for >1% of all surgeries nationwide. With the growing necessity for treating these emergency cases with dedication and proficiency, acute care surgery (ACS) teams were appointed at various hospitals. Regarding the implications of the ACS team, many studies showed promising results with a shorter time from the emergency department (ED) to the operating room (OR), shorter length of stay, and fewer complications. This study aimed to demonstrate the overall effect of ACS implementation at a single institution in South Korea. Methods: This was a single-center, retrospective observational study. Patients aged >18 years who visited the emergency room and received emergency surgery between July 2014 and December 2016 (pre-ACS) and between July 2017 and December 2019 (post-ACS) were included. Results: Among 958 patients, 497 were in the pre-ACS group and 461 in the post-ACS group. After propensity score matching by age, sex, underlying disease, and Emergency Surgery Acuity Score, 405 patients remained in each group. Our analysis showed a reduction in time from ED presentation to operation (547.8 ± 401.0 minutes vs. 476.6 ± 313.2 minutes, P = 0.005) and complication rates (24.7% vs. 16.8%, P < 0.001) in the post-ACS group. There were no significant differences in total operation duration, length of hospital stay, and mortality between the groups. Conclusion As expected, time from ED to OR and complication rates were significantly reduced in the post-ACS group.Implementing an ACS team dedicated to emergency surgery provides better clinical outcomes.

Purpose: Over the past 3 years, approximately 23,000 emergency surgeries were performed annually in South Korea, accounting for >1% of all surgeries nationwide. With the growing necessity for treating these emergency cases with dedication and proficiency, acute care surgery (ACS) teams were appointed at various hospitals. Regarding the implications of the ACS team, many studies showed promising results with a shorter time from the emergency department (ED) to the operating room (OR), shorter length of stay, and fewer complications. This study aimed to demonstrate the overall effect of ACS implementation at a single institution in South Korea. Methods: This was a single-center, retrospective observational study. Patients aged >18 years who visited the emergency room and received emergency surgery between July 2014 and December 2016 (pre-ACS) and between July 2017 and December 2019 (post-ACS) were included. Results: Among 958 patients, 497 were in the pre-ACS group and 461 in the post-ACS group. After propensity score matching by age, sex, underlying disease, and Emergency Surgery Acuity Score, 405 patients remained in each group. Our analysis showed a reduction in time from ED presentation to operation (547.8 ± 401.0 minutes vs. 476.6 ± 313.2 minutes, P = 0.005) and complication rates (24.7% vs. 16.8%, P < 0.001) in the post-ACS group. There were no significant differences in total operation duration, length of hospital stay, and mortality between the groups. Conclusion As expected, time from ED to OR and complication rates were significantly reduced in the post-ACS group.Implementing an ACS team dedicated to emergency surgery provides better clinical outcomes.

Purpose: It is important to understand changes in energy requirements in critically ill patients with sepsis. This study investigates alterations in energy requirements based on the clinical course of sepsis in patients admitted to the surgical intensive care unit (SICU) using indirect calorimetry. Methods: In this prospective study, 36 patients admitted to the surgical intensive care unit with sepsis were analyzed. Using indirect calorimetry, the resting energy expenditure (REE) and respiratory quotient (RQ) were assessed on the 1st, 3rd, and 7th day of Intensive Care Unit admission. Measured REE through indirect calorimetry was compared with the predictive equations (Weight-based, Harris-Benedict, IretonJones, and Penn state 2003) using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: Measured REE was highest on Day 1 and remained unchanged on Day 3 and 7 (Day 1 vs. Day 3 vs. Day 7: 24.29 ± 3.72 kcal/kg vs. 22.42 ± 3.72 kcal/kg vs. 23.26 ± 5.78 kcal/kg). RQ decreased on Day 3 but increased on Day 7 after caloric intake (Day 1 vs. Day 3 vs. Day 7: 0.69 ± 0.06 vs. 0.67 ± 0.05 vs. 0.71 ± 0.06). Comparing the correlation between the 4 predictive equations and the measured REE, the Penn state 2003 equation demonstrated the highest correlation at each time point, although it showed a decreasing trend over time (Penn state equation ICC: Day 1-0.71, Day 3-0.65, Day 7-0.53). Conclusion In sepsis patients, it is necessary to understand metabolic changes according to the clinical course and provide appropriate calories as determined by using indirect calorimetry when the patients enter the stable phase.

Purpose: Over the past 3 years, approximately 23,000 emergency surgeries were performed annually in South Korea, accounting for >1% of all surgeries nationwide. With the growing necessity for treating these emergency cases with dedication and proficiency, acute care surgery (ACS) teams were appointed at various hospitals. Regarding the implications of the ACS team, many studies showed promising results with a shorter time from the emergency department (ED) to the operating room (OR), shorter length of stay, and fewer complications. This study aimed to demonstrate the overall effect of ACS implementation at a single institution in South Korea. Methods: This was a single-center, retrospective observational study. Patients aged >18 years who visited the emergency room and received emergency surgery between July 2014 and December 2016 (pre-ACS) and between July 2017 and December 2019 (post-ACS) were included. Results: Among 958 patients, 497 were in the pre-ACS group and 461 in the post-ACS group. After propensity score matching by age, sex, underlying disease, and Emergency Surgery Acuity Score, 405 patients remained in each group. Our analysis showed a reduction in time from ED presentation to operation (547.8 ± 401.0 minutes vs. 476.6 ± 313.2 minutes, P = 0.005) and complication rates (24.7% vs. 16.8%, P < 0.001) in the post-ACS group. There were no significant differences in total operation duration, length of hospital stay, and mortality between the groups. Conclusion As expected, time from ED to OR and complication rates were significantly reduced in the post-ACS group.Implementing an ACS team dedicated to emergency surgery provides better clinical outcomes.

Purpose: It is important to understand changes in energy requirements in critically ill patients with sepsis. This study investigates alterations in energy requirements based on the clinical course of sepsis in patients admitted to the surgical intensive care unit (SICU) using indirect calorimetry. Methods: In this prospective study, 36 patients admitted to the surgical intensive care unit with sepsis were analyzed. Using indirect calorimetry, the resting energy expenditure (REE) and respiratory quotient (RQ) were assessed on the 1st, 3rd, and 7th day of Intensive Care Unit admission. Measured REE through indirect calorimetry was compared with the predictive equations (Weight-based, Harris-Benedict, IretonJones, and Penn state 2003) using intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: Measured REE was highest on Day 1 and remained unchanged on Day 3 and 7 (Day 1 vs. Day 3 vs. Day 7: 24.29 ± 3.72 kcal/kg vs. 22.42 ± 3.72 kcal/kg vs. 23.26 ± 5.78 kcal/kg). RQ decreased on Day 3 but increased on Day 7 after caloric intake (Day 1 vs. Day 3 vs. Day 7: 0.69 ± 0.06 vs. 0.67 ± 0.05 vs. 0.71 ± 0.06). Comparing the correlation between the 4 predictive equations and the measured REE, the Penn state 2003 equation demonstrated the highest correlation at each time point, although it showed a decreasing trend over time (Penn state equation ICC: Day 1-0.71, Day 3-0.65, Day 7-0.53). Conclusion In sepsis patients, it is necessary to understand metabolic changes according to the clinical course and provide appropriate calories as determined by using indirect calorimetry when the patients enter the stable phase.

Purpose: To investigate the radiologic and clinical outcomes of direct internal fixation for unstable atlas fractures. Materials and Methods: This retrospective study included 12 patients with unstable atlas fractures surgically treated using C1 lateral mass screws, rods, and transverse connector constructs. Nine lateral mass fractures with transverse atlantal ligament (TAL) avulsion injury and three 4-part fractures with TAL injury (two avulsion injuries, one TAL substance tear) were treated. Radiologic outcomes included the anterior atlantodental interval (AADI) in flexion and extension cervical spine lateral radiographs at 6 months and 1 year after treatment. CT was also performed to visualize bony healing of the atlas at 6 months and 1 year. Visual Analog Scale (VAS) scores for neck pain, Neck Disability Index (NDI) values, and cervical range of motion (flexion, extension, and rotation) were recorded at 6 months after surgery. Results: The mean postoperative extension and flexion AADIs were 3.79±1.56 (mean±SD) and 3.13±1.01 mm, respectively. Then mean AADI was 3.42±1.34 and 3.33±1.24 mm at 6 months and 1 year after surgery, respectively. At 1 year after surgery, 11 patients showed bony healing of the atlas on CT images. Only one patient underwent revision surgery 8 months after primary surgery due to nonunion and instability findings. The mean VAS score for neck pain was 0.92±0.99, and the mean NDI value was 8.08±5.70. Conclusion C1 motion-preserving direct internal fixation technique results in good reduction and stabilization of unstable atlas fractures. This technique allows for the preservation of craniocervical and atlantoaxial motion.

Objective: To investigate the distribution, side involvement, phenotype, and associated anomalies of Korean patients with craniofacial clefts (CFC). Methods: The samples consisted of 38 CFC patients, who were treated at Seoul National University Dental Hospital during 1998–2018. The Tessier cleft type, sex, side involvement, phenotype, and associated anomalies were investigated using nonparametric statistical analysis. Results: The three most common types were #7 cleft, followed by #0 cleft and #14 cleft. There was no difference between the frequency of male and female. Patients with #0 cleft exhibited nasal deformity, bony defect, and missing teeth in the premaxilla, midline cleft lip, and eye problems. A patient with #3 cleft (unilateral type) exhibited bilateral cleft lip and alveolus. All patients with #4 cleft were the bilateral type, including a combination of #3 and #4 clefts, and had multiple missing teeth. A patient with #5 cleft (unilateral type) had a posterior openbite. In patients with #7 cleft, the unilateral type was more prevalent than the bilateral type (87.0% vs. 13.0%, p < 0.001). Sixteen patients showed hemifacial microsomia (HFM), Goldenhar syndrome, and unilateral cleft lip and palate (UCLP). There was a significant match in the side involvement of #7 cleft and HFM (87.5%, p < 0.01). Patients with #14 cleft had plagiocephaly, UCLP, or hyperterorbitism. A patient with #30 cleft exhibited tongue tie and missing tooth. Conclusions Due to the diverse associated craniofacial anomalies in patients with CFC, a multidisciplinary approach involving a well-experienced cooperative team is mandatory for these patients.

Patients with lumbar spinal stenosis may exhibit symptoms such as back pain, radiating pain, and neurogenic claudication. Although long-term outcome of treatments manifests similar results for both nonsurgical and surgical treatments, positive effects such as short-term improvement in symptoms and decreased fall risk may be expected with surgery. Surgical treatment is basically decompression, and a combination of treatments can be added depending on the degree of decompression and the accompanying instability. Recently, minimally invasive surgery has been found to result in excellent outcomes in the treatment of lumbar spinal stenosis. Therefore, better treatment effects can be anticipated with an approach aimed at understanding the overall pathophysiology and treatment methods of lumbar spinal stenosis.

Background: Limited information is available about the proportion of patients with degenerative lumbar spinal disease (DLSD) who have gastrointestinal (GI) and cardiovascular (CV) risk factors. Many DLSD patients are prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) that are known to carry risks to the GI and CV systems by increasing GI bleeding and thromboembolic events.This study aimed to measure the prevalence of GI and CV risk in patients with DLSD and to ascertain whether the prescription of NSAIDs is in line with current guidelines. Methods: This study included 153 patients with symptomatic DLSD who were planning to undergo lumbar spinal surgery. The GI profile was checked using the GI Standardized Calculator of Risk for Event system and CV risk was evaluated using the presence of metabolic syndrome. The conformity of the prescription of NSAIDs was investigated according to the recommendations in current guidelines. Results: More than half of the patients (59.5%) had high or very high GI risk, and 66% of the patients were diagnosed with metabolic syndrome, which corresponds with CV risk. The rate of simultaneous GI and CV risk was 40.5% (n = 62 / 153; gastrointestinal Standardized Calculator of Risk for Event, > high and metabolic syndrome, yes). The actual prescription of NSAIDs was not in accordance with current guidelines. Conclusions Two out of 3 patients had GI or CV risk factors, and approximately 40% of patients had both. Detailed assessment of GI and CV risk in patients with DLSD by using effective evaluation tools is mandatory for optimal medical treatment.