Background: Hip fracture surgery is associated with blood loss, which may lead to adverse patient outcomes. The hemoglobin level declines gradually in most hip fracture cases involving femoral neck fractures and intertrochanteric fractures. It decreases further after hip fracture surgery due to perioperative bleeding. We developed a protocol, which avoids transfusion in hip fracture surgery, and reviewed the hemodynamic outcomes of patients with hemoglobin less than 10 g/dL without transfusion. Methods: From 2014 to 2019, we retrospectively recruited 34 patients with hip fractures and a hemoglobin level less than 10 g/dL, who refused to undergo transfusion. There were 19 patients with femoral neck fractures and 15 patients with intertrochanteric fractures. Our patient blood management (PBM) protocol involving 4,000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) was applied to all included patients. Intraoperatively, a cell saver and tranexamic acid were used. Postoperatively, the protocol was maintained until the patients’ hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications, and hemodynamic changes. Results: Nineteen patients with femoral neck fractures underwent bipolar hemiarthroplasty and 15 patients with intertrochanteric frac tures underwent internal fixation with a cephalomedullary nail. The mean hemoglobin level was 8.9 g/dL (range, 7.3–9.9 g/dL) pre operatively, 7.9 g/dL (range, 6.5–9.3 g/dL) immediately postoperatively, 7.7 g/dL (range, 4.3–9.5 g/dL) on postoperative day 1, 7.4 g/dL (range, 4.2–9.4 g/dL) on postoperative day 3, 8.1 g/dL (range, 4.4–9.7 g/dL) on postoperative day 5, 8.5 g/dL (range, 4.5–9.9 g/dL) on post­operative day 7, and 9.9 g/dL (range, 5.7–11.1 g/dL) on postoperative day 14. The average intraoperative bleeding was 206.2 ± 78.7 mL. There was no case associated with complications of anemia. Conclusions Hip fracture surgery in patients with hemoglobin less than 10 g/dL was feasible without the need for transfusion using our PBM protocol in 34 patients. Using this protocol, the operation was conducted safely despite the anemic condition of patients with fractures whose hemoglobin was less than 10 g/dL.

White mold (orSclerotinia stem rot), caused bySclerotinia species, is a major air, soil, or seed-transmitted disease affecting numerous crops and wild plants. Microscopic or culturebased methods currently available for their detection and identification are time-consuming, laborious, and often erroneous. Therefore, we developed a multiplex quantitative PCR (qPCR) assay for the discrimination, detection, and quantification of DNA collected from each of the three economically relevant Sclerotinia species, namely, S. sclerotiorum, S. minor, and S. nivalis. TaqMan primer/probe combinations specific for each Sclerotiniaspecies were designed based on the gene sequences encoding aspartyl protease. High specificity and sensitivity of each probe were confirmed for sclerotium and soil samples, as well as pure cultures, using simplex and multiplex qPCRs. This multiplex assay could be helpful in detecting and quantifying specific species of Sclerotinia, and therefore, may be valuable for disease diagnosis, forecasting, and management.

BACKGROUND AND OBJECTIVES: The effective management of tinnitus should start with an accurate diagnosis, but no concensus has been developed in Korea concerning how to measure the features of tinnitus. This study surveyed otologists in the training hospitals and hospitals specialized in otologic care in Korea to identify the current status in the assessment of patients with tinnitus. SUBJECTS AND METHOD: The questionnaire on the assessment of tinnitus was sent by email to otologists in training and to specialized hospitals specializing in otologics in Korea. The questionnaire included inquiry about various types of tests conducted, such as the audiologic test, tinnitus test, blood test, radiologic test, and the methods of history taking and physical examination for somatic tinnitus. RESULTS: Regarding the audiologic assessment of tinnitus, all the otologist were using pure tone audiometry, 97% speech audiometry, and 87% tinnitus test. For the psychophysical measure of tinnitus, both loudness and pitch matching were conducted by all the otologists. The performance rate of blood test were 38.5%, and the most preferred radiologic test in pulsatile tinnitus was temporal bone computed tomography (59%). Finally, the rate of investigation including the history taking and physical examination of somatic tinnitus was between 74-84%. CONCLUSION: Our results showed that although the tests perfermed by otologists varied, the essential tests for assessing tinnitus were commonly practiced. We analyzed the current status of tinnitus assessment and supplemented guidlines to help measure tinnitus. Further concensus on tinnitus diagnosis is needed, particularly about the standadized and unified principles.
Audiometry ; Audiometry, Speech ; Diagnosis ; Electronic Mail ; Hematologic Tests ; Humans ; Korea ; Physical Examination ; Surveys and Questionnaires ; Temporal Bone ; Tinnitus*

PURPOSE: In the mechanism of forward blood flow during cardiopulmonary resuscitation (CPR) in humans, the role of the left ventricle remains to be investigated. The aim of this study was to assess the role of the left ventricle in generating forward blood flow in humans during CPR by performing contrast echocardiography. METHODS: Ten patients with non-traumatic cardiac arrest were enrolled. During CPR, a pigtail catheter was introduced to the left ventricle and a central venous catheter was introduced to the right atrium under transesophageal echocardiographic guidance. Ten (10) ml of agitated saline was injected into the left ventricle to perform contrast echocardiography during CPR. The direction of contrast flow and the presence of mitral regurgitation were assessed with a 135 degree longitudinal view. Pressures were traced in the left ventricle, the aorta, and the right atrium. RESULTS: Forward flow toward the aorta and mitral regurgitation (MR) were visualized during compression systole on left ventricular contrast echocardiography in all patients: grade I in 1, grade II in 3, grade III in 4, and grade IV in 2 patients. There was no differences in the clearing times (29+/-24 vs 22+/-12 sec) or the numbers of chest compressions (53+/-32 vs 48+/-28) of the contrast from the left ventricle, the systolic left ventricular pressures (96+/-13 mmHg vs 126+/-48 mmHg), the systolic aortic pressures (90+/-11 mmHg vs 116+/-58 mmHg), the diastolic aortic pressures (33+/-13 mmHg vs 32+/-9 mmHg), the coronary perfusion pressures (23+/-12 mmHg vs 26+/-8 mmHg), and the end tidal carbon dioxide tensions (13+/-12 mmHg vs 9+/-3 mmHg) between the mild MR group (MR grades I and II) and the severe MR group (MR grades III and IV). The left ventricular ejection fraction was higher in the severe MR group than in the mild MR group. CONCLUSION: Mitral regurgitation on left ventricular contrast echocardiography during compression systole suggests that cardiac pumping is the dominant mechanism in generating forward blood flow during standard CPR in humans.
Aorta ; Arterial Pressure ; Carbon Dioxide ; Cardiopulmonary Resuscitation* ; Catheters ; Central Venous Catheters ; Dihydroergotamine ; Echocardiography* ; Heart Arrest ; Heart Atria ; Heart Ventricles ; Humans* ; Mitral Valve Insufficiency* ; Perfusion ; Stroke Volume ; Systole ; Thorax ; Ventricular Pressure

As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorptive agents, such as bisphosphonates (BPs), to prevent osteoporotic fractures is growing annually. BPs are effective in reducing hip and other fractures. However, the longer a patient takes BPs, the higher the risk of an atypical femoral fracture (AFF). The exact mechanism by which long-term BP use affects the development of AFFs has not yet been clarified. However, several theories have been suggested to explain the pathogenesis of AFFs, such as suppressed bone remodeling, impaired bone healing, altered bone quality, and femoral morphology. The management of AFFs requires both medical and surgical approaches. BPs therapy should be discontinued immediately, and calcium and vitamin D levels should be evaluated and supplemented if insufficient. Teriparatide can be used for AFFs. Intramedullary nailing is the primary treatment for complete AFFs, and prophylactic femoral nailing is recommended if signs of an impending fracture are detected.

This study aimed to identify the risk factors associated with acute hepatitis A virus (HAV) infection in the Korean population. Participants were recruited from five referral hospitals across the country in 2007 and from 11 hospitals in 2009. Patients with positive anti-HAV IgM antibody tests became the case group, while patients treated for non-contagious diseases at the same hospitals were recruited as controls. A total of 222 and 548 case-control pairs were studied in the 2007 and 2009 surveys, respectively. Data from the surveys were analyzed jointly. In a multivariate analysis, sharing the household with HAV-infected family members (OR, 6.32; 95% CI, 1.4-29.6), contact with other HAV-infected individuals (OR, 4.73; 95% CI, 2.4-9.4), overseas travel in 2007 (OR, 19.93; 95% CI, 2.3-174.4), consumption of raw shellfish (OR, 2.51; 95% CI, 1.8-3.5), drinking bottled water (OR, 1.64; 95% CI, 1.3-8.4), and occupation that involve handling food (OR, 3.30; 95% CI, 1.3-8.4) increased the risk of HAV infection. Avoiding contact with HAV-infected individuals and avoiding raw foods eating could help minimize the risk of hepatitis A infection. Immunization must be beneficial to individuals who handle food ingredients occupationally or travel overseas to HAV-endemic areas.
Acute Disease ; Adolescent ; Adult ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Food Handling ; Hepatitis A/*diagnosis/etiology/prevention & control ; Hepatitis A Antibodies/blood ; Humans ; Immunoglobulin M/blood ; Infant ; Infant, Newborn ; Interviews as Topic ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Referral and Consultation ; Risk Factors ; Seafood ; Travel ; Vaccination ; Young Adult