STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

BACKGROUND: Emergence agitation (EA) is one of the most common complications after general anesthesia. The goal of this retrospective study was to determine the risk factors of EA in adult patients who underwent general anesthesia. METHODS: We retrospectively investigated the medical records of 5,358 adult patients who stayed in the postanesthesia care unit (PACU) of our hospital after general anesthesia during the 1-year period from January 2014 to December 2014. Psychological and behavioral status in the PACU was determined by the Aono four-point scale. Grade of 3 or 4 were considered as manifestations of EA. Multiple variables assessed EA risk factors. RESULTS: Two-hundred-forty-five patients (4.6%) developed EA. In multivariate analysis, male gender (OR = 1.626, P = 0.001), older age (OR = 1.010, P = 0.035), abdominal surgery (OR = 1.633, P = 0.002), spine surgery (OR = 1.777, P = 0.015), longer duration of anesthesia (OR = 1.002, P < 0.001), postoperative nausea and vomiting (OR = 20.164, P < 0.001) and postoperative pain (OR = 3.614, P < 0.001) were risk factors of EA. CONCLUSIONS: Male gender and older patients were risk factors of EA after general anesthesia in adult patients. Careful attention is needed for patients who receive abdominal or spine surgery, and who receive prolonged anesthesia. Adequate postoperative analgesia and antiemetic therapy should be provided to reduce the incidence of EA.
Adult* ; Analgesia ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, General* ; Delirium ; Dihydroergotamine* ; Humans ; Incidence ; Male ; Medical Records ; Multivariate Analysis ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Retrospective Studies ; Risk Factors* ; Spine

PURPOSE: To compare the clinical and anterior segment anatomical features in primary angle closure sub-groups based on configurations of iris root insertion. METHODS: Primary angle closure patients were imaged using anterior segment optical coherence tomography. Anterior chamber depth, iris curvature, iris thickness (IT) at the scleral spur and 500, 750, and 1,500 µm from the scleral spur (IT(0), IT(500), IT(750), and IT(1500)), lens vault, iris area, angle opening distance (AOD(500)), angle recess area (ARA(750)), and trabecular iris space area (TISA(750)) were measured. Iris root insertion was categorized into a non-basal insertion group (NBG) and basal insertion group (BG). RESULTS: In total, 43 eyes of 39 participants belonged to the NBG and 89 eyes of 53 participants to the BG. The mean age of participants was greater in the NBG than the BG (62.7 ± 5.7 vs. 59.8 ± 7.3 years, p = 0.043), and the baseline intraocular pressure was higher in the BG than the NBG (16.4 ± 4.4 vs. 14.9 ± 3.3 mmHg, p = 0.037). The BG showed a greater IT(0) (0.265 ± 0.04 vs. 0.214 ± 0.03 mm, p < 0.001) and iris area (1.59 ± 0.24 vs. 1.52 ± 0.27 mm2, p = 0.045), lower ARA(750) (0.112 ± 0.08 vs. 0.154 ± 0.08 mm2, p = 0.017) and AOD(500) (0.165 ± 0.07 vs. 0.202 ± 0.08 mm, p = 0.014) compared to the NBG. CONCLUSIONS: The BG had a narrower anterior chamber angle, thicker peripheral iris, and higher pretreatment intraocular pressure.
Anterior Eye Segment/*diagnostic imaging ; Female ; Glaucoma, Angle-Closure/diagnosis/physiopathology/*surgery ; Gonioscopy ; Humans ; *Intraocular Pressure ; Iridectomy/*methods ; Iris/diagnostic imaging/*surgery ; Lens, Crystalline/diagnostic imaging ; Male ; Middle Aged ; Prospective Studies ; Tomography, Optical Coherence/*methods

PURPOSE: The purpose of this study was to assess the safety and early outcomes of the Pipeline device for large/giant or fusiform aneurysms. MATERIALS AND METHODS: The Pipeline was implanted in a total of 45 patients (mean age, 58 years; M:F=10:35) with 47 large/giant or fusiform aneurysms. We retrospectively evaluated the characteristics of the treated aneurysms, the periprocedural events, morbidity and mortality, and the early outcomes after Pipeline implantation. RESULTS: The aneurysms were located in the internal carotid artery (ICA) cavernous segment (n=25), ICA intradural segment (n=11), vertebrobasilar trunk (n=8), and middle cerebral artery (n=3). Procedure-related events occurred in 18 cases, consisting of incomplete expansion (n=8), shortening-migration (n=5), transient occlusion of a jailed branch (n=3), and in-stent thrombosis (n=2). Treatment-related morbidity occurred in two patients, but without mortality. Both patients had modified Rankin scale (mRS) scores of 2, but had an improved mRS score of 0 at 1-month follow-up. Of the 19 patients presenting with mass effect, 16 improved but three showed no changes in their presenting symptoms. All patients had excellent outcomes (mRS, 0 or 1) during the follow-up period (median, 6 months; range, 2-30 months). Vascular imaging follow-up (n=31, 65.9%; median, 3 months, range, 1-25 months) showed complete or near occlusion of the aneurysm in 24 patients (77.4%) and decreased sac size in seven patients (22.6%). CONCLUSION: In this initial multicenter study in Korea, the Pipeline seemed to be safe and effective for large/giant or fusiform aneurysms. However, a learning period may be required to alleviate device-related events.
Aneurysm* ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Korea* ; Learning ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Thrombosis

Because information on biological agents in the workplace is lacking, biological hazard analyses at the workplace to securely recognize the harmful factors with biological basis are desperately needed. This review concentrates on literatures published after 2010 that attempted to detect biological hazards to humans, especially workers, and the efforts to protect them against these factors. It is important to improve the current understanding of the health hazards caused by biological factors at the workplace. In addition, this review briefly describes these factors and provides some examples of their adverse health effects. It also reviews risk assessments, protection with personal protective equipment, prevention with training of workers, regulations, as well as vaccinations.
Biological Factors ; Humans ; Risk Assessment ; Social Control, Formal ; Vaccination

PURPOSE: Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. However, its relationships are not always consistent. Gender difference has been reported to influence asthma severity and asthma control. We investigated the contribution of obesity to airway hyperresponsiveness (AHR) and lung function before and after treatment in adult asthmatics. METHODS: The medical records of a total of 323 adult asthmatics were analyzed retrospectively. Asthma was diagnosed based on the positive result of methacholine bronchial provocation test (PC20< or =25 mg/mL) or bronchodilator test (> or =12% and 200-mL improvement in forced expiratory volume in 1 second after inhalation of a bronchodilator). Follow-up spirometry was performed in 113 patients after at least 3 months of asthma treatment with controller medication. Percent change between spirometry before and after treatment was defined as {[(value after treatment-value before treatment)/value before treatment]x100}. Body mass index (BMI, weight [kg]/height [m2]) was categorized into underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (>30) according to the world health organization classification. RESULTS: BMI did not show any significant correlation with PC20 value of methacholine provocation test and each lung function parameter before and after treatment. When we divided the study subjects according to gender and age, BMI was negatively correlated with PC20 value only in female adult asthmatics under 65 years old (r=-0.024, P=0.036). CONCLUSION: Obesity is positively correlated with the intensity of AHR in female adult asthmatics. Gender seems to differentially contribute to the relationship between BMI and AHR.
Adult* ; Aged ; Asthma ; Body Mass Index* ; Bronchial Provocation Tests ; Classification ; Female ; Follow-Up Studies ; Forced Expiratory Volume ; Humans ; Inhalation ; Lung* ; Medical Records ; Methacholine Chloride ; Obesity ; Overweight ; Retrospective Studies ; Risk Factors ; Spirometry ; Thinness ; World Health Organization

PURPOSE: To evaluate the effect of the scanning laser ophthalmoscope (SLO) guided re-test mode on short- and long-term measurement variability of peripapillary retinal nerve fiber layer (RNFL) thickness obtained by spectral domain-SLO optical coherence tomography (SD-SLO/OCT). METHODS: Seventy five healthy eyes were scanned 3 times per day (intra-session variability) by both the SLO guided re-test mode and the independent mode of SD-SLO/OCT. Subjects were scanned 3 times by both modes at visits within a 2-week interval (inter-session variability). For testing longitudinal variability, 3 separate exams were performed over 6 months by both modes. The coefficient of variation (CV), reproducibility coefficient (RC) and intraclass correlation coefficient of RNFL thickness were compared between the two modes. RESULTS: The intra-session RC and CV ranged from 5.4 to 12.9 microns and 1.76% to 5.72% when measured by independent mode and 5.4 to 12.5 microns and 1.75% to 5.58% by re-test mode, respectively. The inter-session RC and CV ranged from 5.8 to 13.3 microns and 1.89% to 5.78% by independent mode and 5.8 to 12.7 microns and 1.90% to 5.54% by re-test mode, respectively. Intra-session and inter-session variability measurements were not significantly different between the two modes. The longitudinal RC and CV ranged from 8.5 to 19.2 microns and 2.79% to 7.08% by independent mode and 7.5 to 14.4 microns and 2.33% to 6.22% by re-test mode, respectively. Longitudinal measurement variability was significantly lower when measured by the re-test mode compared to the independent mode (average, p = 0.011). CONCLUSIONS: The SLO guided re-test mode for RNFL thickness measurement in SD-SLO/OCT employing a tracking system improved long-term reproducibility by reducing variability induced by inconsistent scan circle placement.
Adult ; Algorithms ; Anatomy, Cross-Sectional ; Female ; Humans ; Male ; Nerve Fibers ; Ophthalmoscopes ; Reference Values ; Reproducibility of Results ; Retinal Ganglion Cells/*cytology ; Tomography, Optical Coherence/*methods

PURPOSE: A new spirometric reference equation was recently developed from the first national chronic obstructive pulmonary disease (COPD) survey in Korea. However, Morris' equation has been preferred for evaluating spirometric values instead. The objective of this study was to evaluate changes in severity staging in Korean COPD patients by adopting the newly developed Korean equation. MATERIALS AND METHODS: We evaluated the spirometric data of 441 COPD patients. The presence of airflow limitation was defined as an observed post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) less than 0.7, and the severity of airflow limitation was assessed according to GOLD stages. Spirometric values were reassessed using the new Korean equation, Morris' equation and other reference equations. RESULTS: The severity of airflow limitation was differently graded in 143 (32.4%) patients after application of the new Korean equation when compared with Morris' equation. All 143 patients were reallocated into more severe stages (49 at mild stage, 65 at moderate stage, and 29 at severe stage were changed to moderate, severe and very severe stages, respectively). Stages according to other reference equations were changed in 18.6-49.4% of the patients. CONCLUSION: These results indicate that equations from different ethnic groups do not sufficiently reflect the airflow limitation of Korean COPD patients. The Korean reference equation should be used for Korean COPD patients in order to administer proper treatment.
Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Humans ; Korea ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/*diagnosis/pathology ; Retrospective Studies ; Spirometry/*methods

BACKGROUND: Persistent cough has recently been found to be associated with Chlamydia pneumoniae infection. We aimed to investigate the infection rate of C. pneumonia in adult patients with chronic cough. METHODS: We recruited 68 patients with persistent cough lasting in excess of 3 weeks, who visited Kangdong Sacred Heart Hospital from January 2005 to August 2005. On the first visit, chest and paranasal sinuses radiography, skin prick test of common allergens, and induced sputum samples for C. pneumoniae were performed in all of patients. Further evaluation for diagnosis included a methacholine provocation test and eosinophil counts in induced sputum. RESULTS: The most common cause of chronic cough was upper airway cough syndrome (UACS) (26.5%), followed by eosinophilic bronchitis (20.6%) and cough variant asthma (16.2%). Idiopathic chronic cough was the cause in 33.8% of patients. The mean duration of cough was 11.7 months. C. pneumoniae was isolated by polymerase chain reaction (PCR) from one patient who had upper respiratory air way syndrome. CONCLUSION: Chlamydia pneumoniae appears to have a minor role as a cause of chronic cough in patients.
Adult ; Allergens ; Asthma ; Bronchitis ; Chlamydia ; Chlamydia Infections ; Chlamydophila pneumoniae ; Cough ; Eosinophils ; Heart ; Humans ; Methacholine Chloride ; Paranasal Sinuses ; Pneumonia ; Polymerase Chain Reaction ; Skin ; Sputum ; Thorax

Bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome has not been previously reported. Williams syndrome is a genetic disorder characterized by infantile hypercalcemia, elfi n facial features, an outgoing personality, and cardiovascular abnormalities. It has been found to be related to elastin gene defect. Cerebrovascular abnormalities with associated strokes in Williams syndrome have been described only recently and rarely. Moyamoya disease is a cerebrovascular disorder characterized by progressive occlusion of the supraclinoid internal carotid artery. The pathogenesis of Moyamoya disease is unclear. Only a single report of Moyamoya disease associated with Williams syndrome manifesting as an intracerebral hemorrhage has been published. We report the fi rst case of bilateral Moyamoya disease manifesting as ischemic stroke in a patient with Williams syndrome. We propose that inherited moyamoya disease is also related to elastin gene defect.