PURPOSE: Mortality in emergency department sepsis (MEDS), sepsis-related organ failure assessment (SOFA), multiple organ dysfunction score (MODS), and serum lactate levels have shown their efficacy in the early detection of patients with a bad prognosis. However, those studies did not consider differences in treatment protocols and could not rule out the interference of these differences in treatment modalities. Hence, we aimed to assess the performance of MEDS, MODS, SOFA, and serum lactate levels for predicting a bad prognosis in patients scheduled for identical, standardized treatment protocols, EGDT. METHODS: Medical records of patients who visited a tertiary level teaching hospital and were enrolled in an EGDT program between October 2009 and May 2010, were retrospectively reviewed. MEDS, SOFA, and MODS scores were calculated and recorded along with serum lactate levels. Receiver operating characteristics (ROC) curves of those predictors of mortality were plotted, Bivariate correlation analyses with overall lengths of admission and ICU lengths of stay were done for surviving patients. RESULTS: None of the diagnostic methods (serum lactate level, MEDS, SOFA, MODS) showed a significant difference on ROC analysis (p=0.819, 0.506, 0.811, 0.873, respectively). Bivariate correlation analyses of MEDS, SOFA, MODS and overall lengths of admission showed significant results (p=0.048, 0.018, and 0.003, respectively. Pearson correlation coefficients were, 0.263, 0.312, and 0.381). Only MEDS showed a significant correlation with intensive care unit (ICU) length of stay (p=0.032, Pearson correlation coefficient = 0.332). CONCLUSION: Neither MEDS, SOFA, MODS, nor serum lactate level can predict mortality in EGDT-enrolled patients. MEDS may be correlated with ICU length of stay.
Clinical Protocols ; Emergencies ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Retrospective Studies ; ROC Curve ; Sepsis ; Severity of Illness Index ; Treatment Outcome

Objective: Rotational atherectomy (RA) and newly developed second-generation drug-eluting stent (DES) support the strategy of longer stent deployment in comparison to short stent implantations in the past. However, studies analyzing the outcome of patients who received long stent implantation following RA are few in number. The present study compared the clinical outcomes of patients with the coronary arterial disease (CAD) who underwent RA with long stent implantation using first- and second-generation DES. Methods: A retrospective cohort study was performed at the single center from March 2003 to October 2019. Eighty-seven patients with CAD who underwent RA with ≥32 mm long stent implantation were enrolled in the study and divided into two groups according to the type of DES. As a primary endpoint, the cumulative 2-year incidence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), target vessel revascularization, and stent thrombosis (ST) was compared by DES type. Adjusted interaction between the type of stent and clinical variables was estimated to determine the predictor variables of MACE. Results: The second-generation DES group was associated with a shorter procedure duration and more common usage of intravascular ultrasound in procedural characteristics. In the second-generation DES group, a trend toward a lower rate of MI and ST existed. All-cause mortality and cardiovascular mortality were not significantly different. When combined with MACE, we could identify a significant reduction in the second-generation DES group. Conclusion In comparison to the first-generation DES group, the second-generation DES group was associated with a lower rate of MACE for 2 years in patients who underwent RA with long stent implantation.

PURPOSE: Image-based computational models with fluid-structure interaction (FSI) can be used to perform plaque mechanical analysis in intracranial artery stenosis. We described a process in FSI study applied to symptomatic severe intracranial (M1) stenosis before and after stenting. MATERIALS AND METHODS: Reconstructed 3D angiography in STL format was transferred to Magics for smoothing of vessel surface and trimming of branch vessels and to HyperMesh for generating tetra volume mesh from triangular surface-meshed 3D angiogram. Computational analysis of blood flow in the blood vessels was performed using the commercial finite element software ADINA Ver 8.5. The distribution of wall shear stress (WSS), peak velocity and pressure was analyzed before and after intracranial stenting. RESULTS: The wall shear stress distributions from Computational fluid dynamics (CFD) simulation with rigid wall assumption as well as FSI simulation before and after stenting could be compared. The difference of WSS between rigid wall and compliant wall model both in pre- and post-stent case is only minor except at the stenosis region. These WSS values were greatly reduced after stenting to 15~20 Pa at systole and 3~5 Pa at end-diastole in CFD simulation, which are similar in FSI simulations. CONCLUSION: Our study revealed that FSI simulation before and after intracranial stenting was feasible despite of limited vessel wall dimension and could reveal change of WSS as well as flow velocity and wall pressure.
Angiography ; Arteries ; Atherosclerosis ; Blood Vessels ; Cerebral Arteries ; Characidae ; Constriction, Pathologic ; Glycosaminoglycans ; Hydrodynamics ; Magic ; Stents ; Systole

Objectives: To assess the trends and disparities in the utilization of F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) in Korea between 2018 and 2022, with a focus on disease classification, patient demographics, and regional distribution. Methods: This national surveillance retrospective study uses data from the Health Insurance Review and Assessment Service (HIRA) database, which includes all FDG PET/CT examinations conducted in Korea from 2018 to 2022. Disease classifications, cancer types, age groups, gender, and geographic regions were analyzed using descriptive statistics. Utilization rates per 100,000 population were calculated for regional comparisons. Results: FDG PET/CT utilization increased by 25.4%, from 174,885 examinations in 2018 to 219,377 in 2022. Older age groups (60 years and above) accounted for the majority of examinations, with males undergoing more examinations than females. Oncology remained the primary indication, with lung, colorectal, and non-Hodgkin lymphoma leading in examination numbers. The number of examinations performed on patients aged 60 and above increased at a higher rate compared to those under 60. Significant geographic disparities were found, with Seoul reporting the highest utilization rate (1,114.3 examinations per 100,000 population), while Gyeongbuk exhibited much lower rate (26.2 examinations per 100,000 population). Conclusions This study highlights the growing utilization of FDG PET/CT in Korea, particularly among older adults, with significant gender differences in cancer types. The findings also reveal disparities in FDG PET/CT utilization across regions, indicating varying access to advanced imaging technology.

Objectives: To assess the trends and disparities in the utilization of F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) in Korea between 2018 and 2022, with a focus on disease classification, patient demographics, and regional distribution. Methods: This national surveillance retrospective study uses data from the Health Insurance Review and Assessment Service (HIRA) database, which includes all FDG PET/CT examinations conducted in Korea from 2018 to 2022. Disease classifications, cancer types, age groups, gender, and geographic regions were analyzed using descriptive statistics. Utilization rates per 100,000 population were calculated for regional comparisons. Results: FDG PET/CT utilization increased by 25.4%, from 174,885 examinations in 2018 to 219,377 in 2022. Older age groups (60 years and above) accounted for the majority of examinations, with males undergoing more examinations than females. Oncology remained the primary indication, with lung, colorectal, and non-Hodgkin lymphoma leading in examination numbers. The number of examinations performed on patients aged 60 and above increased at a higher rate compared to those under 60. Significant geographic disparities were found, with Seoul reporting the highest utilization rate (1,114.3 examinations per 100,000 population), while Gyeongbuk exhibited much lower rate (26.2 examinations per 100,000 population). Conclusions This study highlights the growing utilization of FDG PET/CT in Korea, particularly among older adults, with significant gender differences in cancer types. The findings also reveal disparities in FDG PET/CT utilization across regions, indicating varying access to advanced imaging technology.

Objectives: To assess the trends and disparities in the utilization of F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) in Korea between 2018 and 2022, with a focus on disease classification, patient demographics, and regional distribution. Methods: This national surveillance retrospective study uses data from the Health Insurance Review and Assessment Service (HIRA) database, which includes all FDG PET/CT examinations conducted in Korea from 2018 to 2022. Disease classifications, cancer types, age groups, gender, and geographic regions were analyzed using descriptive statistics. Utilization rates per 100,000 population were calculated for regional comparisons. Results: FDG PET/CT utilization increased by 25.4%, from 174,885 examinations in 2018 to 219,377 in 2022. Older age groups (60 years and above) accounted for the majority of examinations, with males undergoing more examinations than females. Oncology remained the primary indication, with lung, colorectal, and non-Hodgkin lymphoma leading in examination numbers. The number of examinations performed on patients aged 60 and above increased at a higher rate compared to those under 60. Significant geographic disparities were found, with Seoul reporting the highest utilization rate (1,114.3 examinations per 100,000 population), while Gyeongbuk exhibited much lower rate (26.2 examinations per 100,000 population). Conclusions This study highlights the growing utilization of FDG PET/CT in Korea, particularly among older adults, with significant gender differences in cancer types. The findings also reveal disparities in FDG PET/CT utilization across regions, indicating varying access to advanced imaging technology.

Objectives: To assess the trends and disparities in the utilization of F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) in Korea between 2018 and 2022, with a focus on disease classification, patient demographics, and regional distribution. Methods: This national surveillance retrospective study uses data from the Health Insurance Review and Assessment Service (HIRA) database, which includes all FDG PET/CT examinations conducted in Korea from 2018 to 2022. Disease classifications, cancer types, age groups, gender, and geographic regions were analyzed using descriptive statistics. Utilization rates per 100,000 population were calculated for regional comparisons. Results: FDG PET/CT utilization increased by 25.4%, from 174,885 examinations in 2018 to 219,377 in 2022. Older age groups (60 years and above) accounted for the majority of examinations, with males undergoing more examinations than females. Oncology remained the primary indication, with lung, colorectal, and non-Hodgkin lymphoma leading in examination numbers. The number of examinations performed on patients aged 60 and above increased at a higher rate compared to those under 60. Significant geographic disparities were found, with Seoul reporting the highest utilization rate (1,114.3 examinations per 100,000 population), while Gyeongbuk exhibited much lower rate (26.2 examinations per 100,000 population). Conclusions This study highlights the growing utilization of FDG PET/CT in Korea, particularly among older adults, with significant gender differences in cancer types. The findings also reveal disparities in FDG PET/CT utilization across regions, indicating varying access to advanced imaging technology.

Objectives: To assess the trends and disparities in the utilization of F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) in Korea between 2018 and 2022, with a focus on disease classification, patient demographics, and regional distribution. Methods: This national surveillance retrospective study uses data from the Health Insurance Review and Assessment Service (HIRA) database, which includes all FDG PET/CT examinations conducted in Korea from 2018 to 2022. Disease classifications, cancer types, age groups, gender, and geographic regions were analyzed using descriptive statistics. Utilization rates per 100,000 population were calculated for regional comparisons. Results: FDG PET/CT utilization increased by 25.4%, from 174,885 examinations in 2018 to 219,377 in 2022. Older age groups (60 years and above) accounted for the majority of examinations, with males undergoing more examinations than females. Oncology remained the primary indication, with lung, colorectal, and non-Hodgkin lymphoma leading in examination numbers. The number of examinations performed on patients aged 60 and above increased at a higher rate compared to those under 60. Significant geographic disparities were found, with Seoul reporting the highest utilization rate (1,114.3 examinations per 100,000 population), while Gyeongbuk exhibited much lower rate (26.2 examinations per 100,000 population). Conclusions This study highlights the growing utilization of FDG PET/CT in Korea, particularly among older adults, with significant gender differences in cancer types. The findings also reveal disparities in FDG PET/CT utilization across regions, indicating varying access to advanced imaging technology.

OBJECTIVE: Since the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was developed in 2002, the third revision of KMAP-BP was performed in 2014 in order to reflect the recent rapid development and research of bipolar disorder and psychopharmacology. METHODS: According to methodology of previous versions, KMAP-BP 2014 was revised using the same questionnaire consisting of 14 questions. Sixty-four experts of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence. RESULTS: The first-line pharmacotherapeutic strategy for acute bipolar depressive episode with moderate, non-psychotic severe and psychotic severe episode was mood stabilizer combined with atypical antipsychotic (AAP) or AAP with lamotrigine. Compared to KMAP-BP 2010, preference of AAP has been increased in the treatment of bipolar depressive episode in KMAP-BP 2014. Among AAPs, olanzapine, quetiapine and aripiprazole were preferred. When considering the efficacy and safety simultaneously, (es)citalopram, bupropion, and sertraline were recommended among antidepressants for bipolar depression. CONCLUSION: Compared with the previous version, we found that more aggressive pharmacological strategies as an initial treatment were preferred, although various strategies were recommended as same as previous studies. Increased preference of AAP was prominent in KMAP-BP 2014. We expect this algorithm may be helpful in the treatment of bipolar disorder, depressive episode.
Advisory Committees ; Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Drug Therapy ; Psychopharmacology ; Surveys and Questionnaires ; Sertraline ; Aripiprazole ; Quetiapine Fumarate

OBJECTIVE: The pharmacotherapy of bipolar disorder has many difficulties such as various clinical feature according to each episode, recurrence, breakthroughs, treatment resistance, switching and worsening of its course. Recent rapid development and research of bipolar disorder and psychopharmacology, including atypical antipsychotics and new anticonvulsants, make it more difficult to choose the appropriate pharmacological options. Therefore, we decided to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2010 in order to provide more proper guideline for clinicians. METHODS: Like the previous version, KMAP-BP 2010, we performed the survey using questionnaire comprising 55 main questions in which 8 main questions and 478 sub-items for treatment of manic or hypomanic episode were included. Sixty-four members of the review committee completed the survey. The executive committee analyzed the results and discussed the final production of algorithm considering scientific evidence. RESULTS: The first-line pharmacotherapeutic strategy for acute manic episode is combination of mood stabilizer and an atypical antipsychotic, and it is the treatment of choice for euphoric, psychotic and dysphoric/mixed mania. The preference for monotherapy with atypical antipsychotic (for all three types of mania) or mood stabilizer (for euphoric mania) was increased in KMAP-BP 2014. Valproic acid and lithium are chosen as the preferred mood stabilizer of the first-line treatment of acute manic episode and valproic acid was the treatment of choice for all types of mania. Atypical antipsychotics is more widely accepted than before in manic and hypomanic episode. Moreover, the preference for combination treatment in manic patients who failed to respond in early stage treatment was increased. CONCLUSION: Compared with the previous version, we found that 'no-consensus' decreases in this revision. These suggest that the many clinicians agree with others in the treatment of acute manic/hypomanic episode, and the pharmacotherapy of manic/hypomanic episode become more obvious than before. Atypical antipsychotics such as aripiprazole, olanzapine and quetiapine gain more awareness in the treatment of bipolar mania and hypomania. We expect this algorithm may provide clinicians good information and help about the treatment of bipolar disorder, manic/hypomanic episode.
Advisory Committees ; Anticonvulsants ; Antipsychotic Agents ; Bipolar Disorder* ; Drug Therapy ; Humans ; Lithium ; Psychopharmacology ; Surveys and Questionnaires ; Recurrence ; Valproic Acid ; Aripiprazole ; Quetiapine Fumarate