OBJECTIVES: The percentage of positional sleep apnea in obstructive sleep apnea (OSA) varies in different reports from 9% to 60%. If there is a positional dependency in patients with OSA, positional therapy alone could be successful in treating about 50% of all OSA cases. The aim of this report is to compare anthropomorphic and polysomnographic data between the positional sleep apnea group and non-positional sleep apnea group with OSA whose conditions were diagnosed in our sleep clinic. METHODS: This is a retrospective study of anthropomorphic and polysomnographic data of patients with OSA who was performed a nocturnal polysomnography. Positional sleep apnea was defined as having a supine apnea-hypopnea index (AHI) of twice or more compared to the AHI in the non-supine position. The patients were divided in the positional sleep apnea group and the non-positional sleep apnea group. RESULTS: In 101 patients with OSA, 81 were male, and the mean age was 49.2+/-11.9 years. Seventy-six (75.2%) were diagnosed as the positional sleep apnea. Waist to hip ratio and body mass index (BMI) were significantly higher in non-positional sleep apnea group. The frequency of severe OSA was significantly higher in this group. In the positional sleep apnea group, nocturnal sleep quality was better preserved, and consequently these patients were less sleepy during daytime. AHI was significantly lower and minimal arterial oxygen saturation during sleep was significantly higher in this group. CONCLUSION: The percentage of positional sleep apnea in OSA was 75.2%. AHI, BMI, and waist to hip ratio were lower in the positional sleep apnea group. These patients have less severe breathing abnormalities than the non-positional sleep apnea group in polysomnography.
Body Mass Index ; Dependency (Psychology) ; Humans ; Male ; Oxygen ; Polysomnography ; Respiration ; Retrospective Studies ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Waist-Hip Ratio

OBJECTIVES: The Berlin Questionnaire (BQ) has been used to help identify patients at high risk of having sleep apnea in primary care. But it has not been validated in a sleep clinic for Korean patients. The aim of this study is to evaluate the usefulness of the BQ as a screening tool for obstructive sleep apnea (OSA) for Korean patients in a sleep clinic. METHODS: The BQ was prospectively applied to 121 subjects with OSA suspicion who visited to our sleep clinic. All subjects performed overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) > or =5. We investigated the sensitivity, specificity, positive and negative predictive values of the BQ according to severity by AHI. RESULTS: In 121 subjects, 73.6% were males, with a mean age of 48.8+/-13.0 years. Twenty-five (20.6%) patients did not have OSA (AHI<5), 30 (25%) patients had mild OSA (AHI> or =5 and <15), 26 (21.4%) had moderate (AHI> or =15 and <30), and 40 (33%) had severe OSA (AHI> or =30). The BQ identified 69.4% of the patients as being at high risk for having OSA. The sensitivity and specificity of the BQ were 71.9% and 40%, for AHI> or =5, 75.8% and 38.2% for AHI> or =15, 77.5% and 34.6% for AHI> or =30, respectively. The positive and negative predictive values of the BQ were 82.1% and 27.0% for AHI> or =5, respectively. Positive and negative likelihood ratios were 1.2 and 0.7, and the overall diagnostic accuracy of the BQ was 65.3%, using an AHI cut-off of 5. CONCLUSION: Due to modest sensitivity and low specificity, the BQ does not seem to be an appropriate tool for identifying patients with obstructive sleep apnea in a sleep clinic population.
Berlin ; Humans ; Male ; Mass Screening ; Polysomnography ; Primary Health Care ; Prospective Studies ; Surveys and Questionnaires ; Sensitivity and Specificity ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

Angiosarcoma is a malignant endothelial cell tumor of lymphatic or vascular origin and is most commonly found in the skin and soft tissue. Primary mesenteric angiosarcoma has rarely been reported. Here, we present a case of primary mesenteric angiosarcoma manifesting as a gradually enhancing mass along with necrosis and hemorrhage.

Angiosarcoma is a malignant endothelial cell tumor of lymphatic or vascular origin and is most commonly found in the skin and soft tissue. Primary mesenteric angiosarcoma has rarely been reported. Here, we present a case of primary mesenteric angiosarcoma manifesting as a gradually enhancing mass along with necrosis and hemorrhage.

Purpose: This study was conducted to examine the role of video education on cancer patient advance directive writing. Methods: To evaluate the effects of video education on cancer patient advance directive knowledge, attitude, writing intention and writing, this study employed a non-equivalent control group and non-synchronized design as a quasi-experimental study. The target population of this study were adults aged ≥50 years old, diagnosed with cancer in South Korea. The proximity population were also cancer patients who visited a university hospital. The control group (n=31) were educated verbally using a leaflet and the experimental group (n=30) were educated by a video program developed by the National Bioethics Policy Institute for 10 minutes, supplemented with a leaflet. The advance directives video program form provided by the Korean Ministry of Health and Welfare was used. Results: The experimental group showed a positive change in knowledge level (F=52.82, p<.001, effect size=0.96), attitude (F=12.21, p<.001, effect size=0.46), the intention to write (F=18.22, p<.001, effect size=0.56) advance directives and a higher proportion of writing (χ2=13.87, p<.001) than the control group. Conclusion The results of this research show that providing information through video is a more effective educational medium for retention of knowledge, attitude, writing intention, and writing of cancer patient's advance directives.

OBJECTIVE: To explore the healing effect of low intensity pulsed ultrasound with three different timing of intervention after tenotomy of Achilles tendon in rats. METHOD: One hundred and thirty-two male rats were divided into experimental and control groups. Both groups were classified according to treatment phase: treatment on inflammatory phase (group I), proliferative phase (group II), and maturation phase (group III). Each groups were divided into 2 subgroups according to tendon excision time: 1 day after 7 consecutive treatment on 3 different phases (I-A, II-A, and III-A) and 30 days after tenotomy (I-B, II-B, and III-B). Three MHz pulsed ultrasound was administered on right tendon for 4 mins at 0.5 W/cm2. The excised tendons of all groups were compared histologically and biochemically as control. RESULTS: The tendons of II-A experimental group revealed increased fibroblasts. The collagen fibers in the neo-tendon of II-B and III-B experimental groups had a tendency to be arrayed more regularly. On I-A group, the neo-tendon showed high immunoreactivity for type I and particularly type III collagen in cytoplasm of fibroblasts and collagen fibers. The imunoreactivity for type III collagen in the neo-tendon of II-A experimental group increased than control. The concentration of collagen of the neo-tendon was significantly increased on I-A and II-A experimental groups compared with control (p<0.05). Collagen concentration of the neo-tendon of II-B experimental group increased significantly compared with control and I-B and III-B experimental groups (p<0.05). CONCLUSION: These results suggest that low intensity pulsed ultrasound therapy on injured Achilles tendon may be of benefit such as increasing collagen synthesis in the early healing process, especially in proliferative phase.
Achilles Tendon* ; Animals ; Collagen ; Collagen Type III ; Cytoplasm ; Fibroblasts ; Humans ; Male ; Rats* ; Tendons ; Tenotomy ; Ultrasonography*

PURPOSE: The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and “a good death” affect attitudes toward terminal care.METHOD: Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the Scheffé test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program).RESULTS: Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of “a good death”) were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (β=.20, p=.035), a sense of closeness(β=.19, p=.041), and the perception of a life-sustaining treatment decision (β=.22, p=.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj R2=.140).CONCLUSION: A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of “a good death” and perceptions of life-sustaining treatment decisions.
Critical Care ; Hospitals, University ; Intensive Care Units ; Methods ; Terminal Care

Purpose: The purpose of this study is to compare the predictive validity of pressure injury risk assessment, Braden, Braden Q and Braden QD for pediatric patients. Methods: Prospective observational study included patients under the age of 19 who were hospitalized to general wards, intensive care units of a children’s hospital.Characteristics related to pressure injury were collected, and predicted validity was compared by calculating the areas under the curve (AUC) of the Braden, Braden Q, and Braden QD scales. Results: A total of 689 patients were included in the study. A total of 13 (1.9%) patients had pressure injuries, and the number of pressure injuries was 17. Factors related to the occurrence of pressure injuries were 9 (52.9%) immobility-related and 8 (47.1%) medical device-related. The AUC for each scale was .91 (95% CI .89~.94) for Braden, .92 (95% CI .90~.95) for Braden Q, and .94(95% CI .92~.96) for Braden QD. The optimal cut-off points were identified as 16 for Braden (sensitivity=88.8%, specificity=86.4%), 17 for Braden Q(sensitivity=63.6%, specificity=94.9%), and 12 for Braden QD (sensitivity=94.4%, specificity=88.7%). Conclusion The Braden QD scale demonstrated the highest predictive validity for pressure injuries in pediatric patients and is expected to be valuable tool in preventing pediatrics pressure injuries.

Background: F-18 Fluorodeoxyglucose positron emission tomography (F-18 FDG PET), which can cover the body from the skull base to the thigh in one scan, is beneficial for evaluating distant metastasis. F-18 FDG PET has interested policymakers because of its relatively high cost. This study investigated the effect of the F-18 FDG PET reimbursement criteria amendment on healthcare behavior in breast cancer using an interrupted time series (ITS) analysis. Methods: We retrospectively analyzed the inpatient and outpatient data from Korea’s Health Insurance Review and Assessment Service (HIRA) from January 1, 2013 to December 31, 2018. ITS analysis was performed for the number of each medical imaging modality and the total medical imaging cost of the breast cancer patients. Results: The annual number of breast cancer patients has been increasing steadily since 2013. The trend of F-18 FDG PET increased before the reimbursement criteria was amended, but intensely decreased immediately thereafter. The chest and abdomen computed tomography scans showed a statistically significant increase immediately after the amendment and kept steadily increasing. A change in the total medical imaging cost for the breast cancer patient claimed every month showed an increasing trend before the amendment (β = 5,475, standard error [SE] = 1,992, P = 0.008) and rapid change immediately after (β = −103,317, SE = 16,152, P < 0.001). However, there was no significant change in the total medical imaging cost at the long-term follow-up (β = −912, SE = 1,981, P = 0.647). Conclusion Restriction of health insurance coverage for cancer may affect healthcare behaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.

BACKGROUND: Recent research demonstrates a strong association between smoking-related behaviors and genetic variation. We investigated the clinical features and genetic effects of dopamine receptors and a serotonin transporter on smoking cessation in Koreans. METHODS: Smokers (n=51) wanting to quit smoking were included as the study population. They were genotyped for polymorphisms in dopamine D2 receptor (DRD2) (TaqI and -141C), dopamine D4 receptor (DRD4), and a serotonin transporter (5-HTT). We defined abstinence as stopping smoking at six months after enrollment. RESULTS: Eighteen patients (35.3%) stopped smoking at six months. The abstinence group had a higher rate of alcohol use whereas the non-abstinence group had more coughing. However, there were no significant differences in average smoking rate, starting age of smoking, gender, nicotine dependence, and forced expiratory volume in one second between the two groups. As for the genes in the dopamine pathway, the polymorphisms of DRD2 TaqI (A1 allele) and DRD2 -141C (Ins C allele) were not genotypically different between the two groups (P=0.245 and 0.409, respectively). The genetic variation in the DRD4 variable number of tandem repeats (VNTR) also showed a similar distribution in the two groups. Regarding the polymorphisms of 5-HTT, there was no difference in the long allele between the two groups (P=0.852). CONCLUSIONS: This study suggests that the genetic variations of DRD2 TaqI, DRD2 -141C, DRD4 VNTR, and 5-HTT might have little influence on smoking cessation in Korean smokers.
Alleles ; Cough ; DNA ; Dopamine ; Forced Expiratory Volume ; Genetic Variation ; Humans ; Minisatellite Repeats ; Polymorphism, Genetic ; Receptors, Dopamine ; Receptors, Dopamine D2 ; Receptors, Dopamine D4 ; Serotonin Plasma Membrane Transport Proteins ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Use Disorder