Objective: To compare two clinically available MR volumetry software, NeuroQuant® (NQ) and Inbrain® (IB), and examine the inter-method reliabilities and differences between them. Materials and Methods: This study included 172 subjects (age range, 55–88 years; mean age, 71.2 years), comprising 45 normal healthy subjects, 85 patients with mild cognitive impairment, and 42 patients with Alzheimer’s disease. Magnetic resonance imaging scans were analyzed with IB and NQ. Mean differences were compared with the paired t test. Inter-method reliability was evaluated with Pearson’s correlation coefficients and intraclass correlation coefficients (ICCs). Effect sizes were also obtained to document the standardized mean differences. Results: The paired t test showed significant volume differences in most regions except for the amygdala between the two methods. Nevertheless, inter-method measurements between IB and NQ showed good to excellent reliability (0.72 < r < 0.96, 0.83 < ICC < 0.98) except for the pallidum, which showed poor reliability (left: r = 0.03, ICC = 0.06; right: r = -0.05, ICC = -0.09). For the measurements of effect size, volume differences were large in most regions (0.05 < r < 6.15). The effect size was the largest in the pallidum and smallest in the cerebellum. Conclusion Comparisons between IB and NQ showed significantly different volume measurements with large effect sizes.However, they showed good to excellent inter-method reliability in volumetric measurements for all brain regions, with the exception of the pallidum. Clinicians using these commercial software should take into consideration that different volume measurements could be obtained depending on the software used.

Objectives: Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. Methods: A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. Results: A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. Conclusions PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.

Objectives: Obstructive sleep apnea (OSA) is a common clinical disease which has been associated with cardiovascular disease and sudden death. Positive airway pressure (PAP) is the most effective treatment for OSA; however, most patients experience difficulties in tolerating machines, masks, or economic burdens. In Korea, National Health Insurance (NHI) application for PAP started in July 2018. Therefore, this study aimed to evaluate the PAP adherence and factors contributing to good adherence after NHI coverage in Korea. Methods: A retrospective study was performed to examine 89 patients with OSA who were treated with PAP in 2019. All medical records were analyzed to obtain demographic and clinical data, including personal history, polysomnographic data, and PAP results. Results: A total of 66 participants were included, of which 56 (84.8%) were maintained on PAP therapy after 3 months, and 32 of 42 (76.1%) were maintained on PAP therapy after 6 months; prolonged rapid eye movement (REM) sleep latency, increased nonREM (NREM) apnea-hypopnea index (AHI), and supine AHI significantly contributed to good PAP adherence for 3 months. At 6 months, prolonged REM sleep latency, increased NREM AHI, supine AHI, and increased arousal index significantly contributed to good PAP adherence. However, comorbid hypertension contributed to poor PAP compliance. Conclusions PAP adherence in patients with OSA was 84.8% after 3 months, and 76.1% after 6 months after NHI coverage in a regional tertiary sleep center in Korea. Prolonged REM sleep latency and increased supine AHI and NREM AHI significantly contributed to good adherence, whereas comorbid hypertension was a factor for poor PAP compliance.

Objective: People vaccinated with the coronavirus disease 2019 (COVID-19) (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) mRNA vaccine have reported experiencing various adverse effects. For instance, reproductive-age women have presented with complaints of abnormal uterine bleeding or menstrual cycle changes. We speculated that differences in basal sex hormone levels before and after vaccination may be present in women who experienced irregular bleeding or menstrual cycle changes; thus, this study aimed to investigate the differences in basal sex hormone levels of women before and after two doses of SARS-CoV-2 mRNA vaccination. Methods: This retrospective study included patients who received SARS-CoV-2 mRNA vaccines between January 2021 and February 2022 at a single center. In an outpatient setting, patients were queried regarding their menstrual cycle, the date of SARS-CoV-2 mRNA vaccination, vaccination type, and vaccination side effects. Differences in basal hormone levels (menstrual cycle days 2–3, follicle-stimulating hormone [FSH], luteinizing hormone [LH], and estradiol) before and after vaccination were compared. Results: Among the 326 patients, patients with no laboratory records of the hormones were excluded. The median time interval between SARS-CoV-2 mRNA vaccination and the laboratory test day was 79 days (interquartile range, 44 to 127). A comparative analysis of these hormones before and after vaccination revealed no significant differences. Subgroup analyses based on age and reported adverse events also found no statistically significant differences. Conclusion This study showed no significant differences in basal hormone levels (FSH, LH, and estradiol) before and after SARS-CoV-2 mRNA vaccination.

The Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) task force assessed the latest pathophysiological parameters associated with sepsis and septic shock and defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. This SEPSIS-3 definition may be applied using relevant clinical and biological criteria including changes in the Sequential Organ Failure Assessment score and serum lactate levels. The new definition does not include criteria for systemic inflammatory response syndrome or the concept of 'severe sepsis.' The SEPSIS-3 definition aims to devise more precise descriptions of sepsis and to improve clinical care. However, there are important questions relating to the clinical application of the new definition. We review the main characteristics and limitations of previous definitions and discuss some of the potential controversies raised by the new framework.
Advisory Committees ; Consensus ; Lactic Acid ; Organ Dysfunction Scores ; Sepsis* ; Shock, Septic ; Systemic Inflammatory Response Syndrome

OBJECTIVES: This study aims to examine the possible reasons of unmet dental need, considering the relationship between the socioeconomic and oral health status in Korea. METHODS: The study was designed as a cross-sectional study, using the data of the 4th Korea National Health and Nutritional Examination Survey. The samples were selected with a stratified clusters sampling method. The subjects were 8,808 out of 23,478 people, which participated in the health examination survey and the oral examination. Statistical analysis was conducted using SPSS18.0, according to complex sampling design. 26 variables reflecting demographic, social and economic characteristics, and an oral health status, were all examined for a complex sampling frequency analysis. Further, their distributional differences were confirmed by chi-square analysis. RESULTS: About 40% of the subjects failed to receive dental treatment when it was required. 'Financial burden' was the main reason, with the percentage of 39.1%, followed by 'busy with school or work' (22.4%), 'lower on the priority scale' (15.2%) and 'fear of dental treatment' (12.1%). 'Other reasons' were 5.9%. In addition to this, 2.9% of the subjects stated 'there was no one to help with their children', 1.6% was 'dental clinics were too far to go' and 0.8% was due to 'poor mobility and other health problems'. It was observed that younger than 6 years old, especially, seemed to have a high level of fear of dental treatment. The students due to school and the elderly were concerned with financial burden. Moreover, low-level educated and low-level income, also have their financial problems as the main reason. On the other hand, highly educated and those that were better-off, financially, were 'busy with school or work' as the main reason. CONCLUSIONS: The primary reason for unmet dental need was the financial burden in Korea. Also, it was confirmed that there were various reasons, according to the demographic, social and economic characteristics, such as their age, education levels and incomes, rather than oral health status.
Aged ; Cross-Sectional Studies ; Diagnosis, Oral ; Hand ; Humans ; Korea ; Oral Health ; Social Class

Diagnosis of a thymic carcinoid was made on transthoracic fine needle aspiration in a 36-year old woman who had an anterior mediastinal mass on chest X-ray and CT scan. The aspiration smears showed numerous anastomosing ribbons and cords of small round tumor cells. The tumor cells had slightly eccentric nuclei and some granular cytoplasm. The small and uniform nuclei of the tumor cells had finely granular chromatin and thin nuclear membrane. The cytologic diagnosis of a carcinoid was confirmed on histopathologic, immunohistochemical, and electromicroscopic examination of surgical specimen.
Adult ; Alleles* ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carotid Body ; Child* ; Chromatin ; Cytoplasm ; Diagnosis ; Female ; Humans ; Immunoglobulin A* ; Nuclear Envelope ; Paraganglioma ; Thorax ; Tomography, X-Ray Computed

PURPOSE: The purpose of this research was to develop and evaluate the effect of a mind map for relief of emotional labor and burnout among nurses in outpatient departments in cancer hospitals. METHODS: We developed a mind map to reduce emotional labor and burnout. A quasi-experimental study was used with a nonequivalent control group pretest-posttest design. Data were collected from December 2012 to April 2013. Participants were 35 nurses working in the outpatient department of a cancer hospital. The experimental group participated in the mind map program biweekly for 10 weeks. Data were analyzed using chi2-test, Mann-Whitney U test, paired t-test, and Wilcoxon sign rank test with the SPSS 21.0 program. RESULTS: The physical burnout and total burnout scores decreased significantly in the intervention group which took the mind map program. CONCLUSION: Findings indicate that the mind map is an effective intervention to reduce burnout in outpatient department nurses.
Cancer Care Facilities* ; Humans ; Outpatients*

BACKGROUND: Cardiopulmonary resuscitation (CPR) is one of the most important medical procedures. However, we could not find any survival rates from in-hospital cardiopulmonary resuscitation in Korea. The objective of this study was to report outcomes according to a Utstein template for in-hospital CPR and to use this report as basic material to enhance our CPR skills and outcome. METHODS: We reviewed all medical records of arrest cases in our hospital in 2001, which were coded as CPR, care for arrest, defibrillation/cardioversion, and Ambu. The data was summarized and analyzed in Utstein style. Most of the data was described in percentage, and the t-test was used to compare survival rate by sex. A P-value below 0.05 was considered significant. RESULTS: In 2001, 218 patients was resuscitated in our hospital and 53 patients (24.3%) survived after CPR. Their mean survival was 10 days. Twenty-seven victims died within the first 24 hours after resuscitation. Nobody was discharged alive from our hospital. The time interval from collapse to CPR was 1.7 minutes, to intubation, 5.62 minutes, to epinephrine injection 7.4 minutes and to defibrillation, 23 minutes. Glascow coma scale and cerebral performance category were less than 8 and 4 for a majority of patients. CONCLUSIONS: In our hospital, we had a low survival rate and quality of life. To improve outcome, we should prepare a better education program and more equipment and well-trained personnel for CPR.
Cardiopulmonary Resuscitation* ; Coma ; Education ; Epinephrine ; Humans ; Incidence* ; Intubation ; Korea ; Medical Records ; Quality of Life ; Resuscitation ; Survival Rate*

Since sepsis was first defined, sepsis management has remained challenging. To improve mortality rates for sepsis and septic shock, an accurate diagnosis and prompt administration of appropriate antibiotics are essential. The goals of antimicrobial stewardship are to achieve optimal clinical outcomes and to ensure cost-effectiveness and minimal unintended consequences, such as toxic effects and development of resistant pathogens. A combination of inadequate diagnostic criteria for sepsis and time pressure to provide broad-spectrum antimicrobial therapy remains an obstacle for antimicrobial stewardship. Efforts such as selection of appropriate empirical antibiotics and de-escalation or determination of whether or not to stop antibiotics may help to improve a patient's clinical prognosis as well as the successful implementation of antimicrobial stewardship.