BACKGROUND: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. METHODS: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. RESULTS: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. CONCLUSIONS: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.
Adult ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Mortality ; Multivariate Analysis ; Respiration, Artificial ; Risk Factors

Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Adult ; Aged ; Emergency Service, Hospital ; Endotoxins ; Extracorporeal Membrane Oxygenation* ; Hemodynamics ; Hemoperfusion ; Humans ; Nephrectomy* ; Polymyxin B ; Pyelonephritis ; Shock, Septic*

Objectives: ：This study was aimed to investigate whether 1) sexual dimorphism in subcortical gray matter volumes (GMV) and the length ratio between the second and fourth digits (2D:4D) would be found and 2) 2D:4D would have associated with subcortical GMV in healthy elderly people. Methods: ：Sixty-two females aged 70.3±6.3 (mean±SD) years and 23 males aged 70.4±4.9 years were recruited from the Dementia Clinic in the Pusan National University Hospital. The subjects with the clinical dementia rating scale-sum of boxes (CDR-SB) total score greater than 2.0, any psychiatric or neurological disease, or any pathologic lesion on brain MRI other than micro-angiopathy were excluded. The 2D:4D of the left and right hands were measured 3 times each. Volumetric segmentation of T1-weighted MRI scans was done by Freesurfer software (v7.1.1.1). Results: ：2D:4Ds of males were smaller than those of females significantly on repeated measures ANOVA. The males’ thalamus, putamen, hippocampus in both hemispheres and the right amygdala were larger than females’. These differences were not significant after controlling for age, education and total intracranial volume (ICV). In the females, the left 2D:4D was negatively correlated with the left hippocampal volume. In the males, 2D:4D was positively correlated with the volumes of ipsilateral or contralateral thalamus, hippocampus, amygdala and accumbens. These correlations were not significant after Bonferroni’s correction, except for the right accumbens. Conclusions ：Sexual dimorphism of 2D:4D is preserved in healthy elderly people. There is a significant correlation between the right 2D:4D and GMV of the accumbens in males.

No abstract available.
Diagnosis* ; Pancreas* ; Ultrasonography*

Mucormycosis is an uncommon opportunistic fungal infection mostly affecting immunocompromised patients and gastrointestinal mucormycosis is a rare and life-threatening. We describe a 31-year-old man with a history of idiopathic cyclic neutropenia who developed perforations of the stomach and intestine and intra-abdominal bleeding due to disseminated gastrointestinal mucormycosis after the initial operation.
Adult ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Intestines ; Mucormycosis* ; Neutropenia ; Stomach

PURPOSE: To evaluate the in vivo corneal endothelial changes after intravitreal bevacizumab (Avastin(R); Genentech Inc., San Francisco, California, USA) injection. METHODS: A total of 30 eyes of 28 patients who received intravitreal bevacizumab injections were included in the present study. Before injection and one and three months after injection, specular microscopy was performed to analyze the corneal endothelial cell changes. In order to compare the differences in the changes of corneal endothelial cells, the eyes were divided into two groups, a single injection group and a multiple injection group. RESULTS: The mean endothelial cell count decreased from 2,497.4 +/- 427.8 at baseline to 2,421.2 +/- 430.5 at one month and to 2,362.7 +/- 366.2 at three months after the injection in all patients. However, the change in endothelial cell count was not statistically significant. In addition, the postoperative change in endothelial cell count was more prominent in the multiple injection group than in the single injection group, although the difference was again not significant. No significant changes in preoperative or postoperative coefficients of variation for cell area or hexagonalities were observed in either patient group or within each group. CONCLUSIONS: There was no significant change in corneal endothelial cells after intravitreal bevacizumab injection. In addition, there was no significant difference in the changes in corneal endothelial cells according to the number of bevacizumab injections.
Antibodies, Monoclonal, Humanized ; California ; Cornea ; Endothelial Cells ; Endothelium ; Eye ; Humans ; Microscopy ; San Francisco ; Bevacizumab

There are some controversies on the mechanism of the lumbar disc degeneration and disc prolapse. But,it is clear that many factors are related to the disc degeneration. Configurations of the lower lumbar and lumbosacral spine have long been proposed as one of the important factors of disc degeneration in these areas. To look for the configurational risk factors and the probability of disc degeneration by the combinations of these factors, we analyzed simple radiographs and MRI of 73 patients who complaints of low back pain and are between 20 years and 39 years of age. We performed chi-square test and multivariate logistic regression analysis: L4-5 disc degeneration and L5-Sl disc degeneration as dependent variables and lumbar lordosis, sacral inclination, height of intercrest line, transitional vertebra and facet joint asymmetry as independent variables. We could not find any of these variables significantly related to the L4-5 intervertebral disc degeneration. For L5-S1 disc degeneration, only the presence of transitional vertebra was signicantly related. When there is no transitional vertebra, the probability of disc degeneration is 9 times(8.889) as large as that of presence of transitional vertebra. The probability of L4-5 disc degeneration without the degeneration of L5-S1 is 3 times as large as that of degeneration of both of L4-5 and L5-S1 disc in case of the presence of transitional vertebra.
Animals ; Humans ; Intervertebral Disc Degeneration* ; Logistic Models ; Lordosis ; Low Back Pain ; Magnetic Resonance Imaging ; Prolapse ; Risk Factors ; Spine* ; Zygapophyseal Joint

Background: Dopamine receptor agonists (DRAs) have been associated with impulse control disorders (ICDs) in Parkinson’s disease (PD) in preliminary studies. Whether the association holds true when DRAs are used to treat non-PD, such as restless legs syndrome, prolactinoma, and several mood disorders is uncertain. Objective: The present study aimed to understand the research gaps related to the risk of ICDs associated with pramipexole or ropinirole (PRX/ROP) use as a treatment for specific underlying diseases, excluding Parkinson’s disorders. Methods: We conducted a scoping review, systematically searching databases to identify literature on the types, prevalence, and factors associated with ICD in non-PD patients receiving PRX/ROP. All relevant information that helped understand the epidemiology of ICDs among non-PD patients taking PRX/ROP were extracted and analyzed. We also evaluated the potential associations between PRX/ROP and ICDs, utilizing the Naranjo scale or statistical analysis, depending on the type of literature. Results: We included 24 articles (19 case reports or case series and 5 populationbased studies) in this scoping review. Evaluating the 19 case reports or case series using Naranjo scores led to the discovery of a possible link between PRX/ROP exposure and ICDs. However, important information to assess causality is frequently missing.Moreover, the population-based studies lack diversity in the study populations and enough study samples to draw conclusive results. Conclusion Our scoping review suggests that the currently available literature requires more details in future case reports and for well-powered studies in various disease conditions where PRX/ROP is frequently used.

Purpose: To assess the association between the choroidal vascularity index (CVI) and prelaminar tissue thickness (PTT) in healthy and glaucomatous eyes. Methods: The study included 86 eyes with perimetric glaucoma (PG), 86 with pre‐perimetric glaucoma (PPG), and 43 agematched healthy eyes. Total choroidal area (TCA) and CVI were measured by image binarization of spectral‐domain optical coherence tomography (SD‐OCT) 3.5 mm from the center of Bruch’s membrane opening. The CVI was the percentage of choroidal vasculature to choroidal tissue. The association between CVI and PTT measured on a center‐horizontal scan of enhanced depth imaging SD‐OCT was assessed. Results: The CVI was lowest in PG (61.67% ± 4.11%), followed by PPG (63.36% ± 3.54%), and healthy (64.84% ± 3.13%) eyes (p < 0.001). PG (102.05 ± 44.01 μm) had a significantly thinner PTT than PPG (106.16 ± 38.03 μm) and the healthy (154.98 ± 79.46 μm) eyes (p < 0.001). In a multivariate regression analysis, CVI was associated with PTT and TCA in all subjects, including healthy and glaucomatous eyes (p < 0.05). Conclusions The CVI and PTT had significantly lower values in glaucomatous eyes than in healthy eyes, and the two parameters were positively associated in all subjects, including healthy and glaucomatous eyes.

Background: Dopamine receptor agonists (DRAs) have been associated with impulse control disorders (ICDs) in Parkinson’s disease (PD) in preliminary studies. Whether the association holds true when DRAs are used to treat non-PD, such as restless legs syndrome, prolactinoma, and several mood disorders is uncertain. Objective: The present study aimed to understand the research gaps related to the risk of ICDs associated with pramipexole or ropinirole (PRX/ROP) use as a treatment for specific underlying diseases, excluding Parkinson’s disorders. Methods: We conducted a scoping review, systematically searching databases to identify literature on the types, prevalence, and factors associated with ICD in non-PD patients receiving PRX/ROP. All relevant information that helped understand the epidemiology of ICDs among non-PD patients taking PRX/ROP were extracted and analyzed. We also evaluated the potential associations between PRX/ROP and ICDs, utilizing the Naranjo scale or statistical analysis, depending on the type of literature. Results: We included 24 articles (19 case reports or case series and 5 populationbased studies) in this scoping review. Evaluating the 19 case reports or case series using Naranjo scores led to the discovery of a possible link between PRX/ROP exposure and ICDs. However, important information to assess causality is frequently missing.Moreover, the population-based studies lack diversity in the study populations and enough study samples to draw conclusive results. Conclusion Our scoping review suggests that the currently available literature requires more details in future case reports and for well-powered studies in various disease conditions where PRX/ROP is frequently used.