BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors

Purpose: This study aimed to investigate the frequency of BRCA testing and related factors among young breast cancer patients (age < 40 years) in South Korea. Materials and Methods: We conducted a nationwide retrospective cohort study using data from the Health Insurance Review and Assessment claims. Newly diagnosed breast cancer patients younger than 40 were included. Annual BRCA testing ratios (number of BRCA test recipients/the number of patients undergoing breast cancer surgery in each year) were analyzed by region and health care delivery system. We investigated the location of breast cancer diagnosis and BRCA testing. Results: From January 2010 to December 2020, there were 25,665 newly diagnosed young breast cancer patients, of whom 12,186 (47.5%) underwent BRCA testing. The BRCA testing ratios increased gradually from 0.084 (154/1,842) in 2010 to 0.961 (1,975/2,055) in 2020. Medical aid (vs. health insurance) and undergoing surgery in metropolitan cities or others (vs. Seoul), general hospitals, and clinics (vs. tertiary hospitals) were associated with a lower likelihood of BRCA testing. While 97.8% of the patients diagnosed in Seoul underwent BRCA testing in Seoul, 22.9% and 29.2% of patients who were diagnosed in metropolitan areas and other regions moved to Seoul and underwent BRCA testing, respectively. Conclusion The frequency of BRCA testing has increased over time in South Korea, with Seoul showing a particularly high rate of testing. About one-quarter of patients diagnosed with breast cancer outside of Seoul moved to Seoul and underwent BRCA testing.

BACKGROUND: Microbial receptors play an important role in host defense. Microbial receptors- Toll-like receptor 4 (TLR4), CD14, CD11b, and CD18-mediate the responsiveness to Gram-negative lipopolysaccharide (LPS). The host response to LPS is characterized by an influx of inflammatory cells into host tissues, which is mediated, in part, by localized production of cytokines. Although the expression of microbial receptors and production of cytokines in macrophages are well studied, the functional responses of keratinocytes to stimulation with LPS are not well known. OBJECTIVES: We investigated the expression of microbial receptors and production of cytokine in response to LPS in mouse keratinocytes. METHODS: RAW264.7 cells, mouse macrophage cell line, were used as a positive control. Balbc/mk and PAM212 cells, mouse keratinocyte cell lines, were checked for the expression of microbial receptors and production of cytokine in response to LPS stimulation by flow cytometry and ELISA. RESULTS: RAW264.7 cells constitutively expressed high levels of TLR4, CD14, CD11b, and CD18. Balbc/mk and PAM212 cells also constitutively expressed high levels of CD14 and TLR4 similarily with RAW264.7 cells, but the levels of CD11b and CD18 expression was constitutively low. LPS stimulation resulted in increased production of TNF-alpha in RAW264.7 cells and mouse KC in mouse keratinocytes. In addition, LPS stimulation induced up-regulation of TLR4, CD14, CD11b, and CD18 in RAW264.7 cells, and TLR4 and CD14 in mouse keratinocytes. Anti-receptor specific antibodies efficiently blocked mouse KC production in mouse keratinocytes stimulated by low-dose LPS (100ng/ml). CONCLUSION: Taken together, these results indicate that mouse keratinocytes constitutively express microbial receptors and produce cytokine in response to LPS stimulation. Therefore, keratinocytes can actively participate in innate immunity against pathogens by secreting inflammatory cytokines through microbial receptor recognition.
Animals ; Antibodies ; Cell Line ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Immunity, Innate ; Keratinocytes* ; Macrophages ; Mice* ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha ; Up-Regulation

Purpose: Tumescent in nipple-sparing mastectomy (NSM) has been reported to increase the risk of necrosis by impairing blood flow to the skin flap and nipple-areolar complex. At our institution, we introduced a tumescent-free robotic NSM using the da Vinci single-port system (Intuitive Surgical, Inc.). Methods: We conducted a retrospective analysis of patients who underwent tumescent-free robotic NSM between October 2020 and March 2023 at Asan Medical Center (Seoul, Korea). Clinicopathological characteristics, adverse events, and operative time were evaluated. Results: During the study period, 118 patients underwent tumescent-free robotic NSM. Thirty-one patients (26.3%) experienced an adverse event. Five patients (4.2%) were classified as grade III based on the Clavien-Dindo classification and required surgery. The mean total operative time was 467 minutes for autologous tissue reconstruction (n = 49) and 252 minutes for implants (n = 69). No correlation was found between the cumulative number of surgical cases and the breast operative time (P = 0.30, 0.52, 0.59 for surgeons A, B, C) for the 3 surgeons. However, a significant linear relationship (P < 0.001) was observed, with the operative time increasing by 13 minutes for every 100-g increase in specimen weight. Conclusion Tumescent-free robotic NSM is a safe procedure with a feasible operative time and few adverse events.