Leaving behind substantial reflections or skepticisms on the shortage of evidences about blood pressure (BP) thresholds for antihypertensive drug therapy and target BPs, major hypertensive guidelines including Korean hypertension guidelines were recently updated for earlier and more intensive control of BP. Because hypertension is one of the major risk factors for death, stroke, cardiovascular (CV) disease, heart failure, and cognitive impairment, substantial improvement of hypertension management is necessary to reduce disease and socioeconomic burdens and to promote CV health. Theoretically, earlier intervention in terms of age and BP level and thorough control of BP into within normal range would prevent or delay major adverse CV events. Revised hypertension guidelines were developed by the American College of Cardiology/American Heart Association, Korean Society of Hypertension, European Society of Cardiology/European Society of Hypertension, and Japanese Society of Hypertension in order. In this article, recent updates and clinical significances of the Korean hypertension guidelines will be discussed with comparison of foreign hypertension guidelines and considerable changes in the management of hypertension will be introduced for cardiologists and general practitioners.

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

PURPOSE: To identify the structural integrity of the healing site after medial open wedge high tibial osteotomy (MOWHTO) in patients with a posterior root tear of the medial meniscus (PRTMM) and chondral lesion by second-look arthroscopy and to determine the clinical and radiological findings. MATERIALS AND METHODS: From August 2010 to June 2016, 52 consecutive patients underwent MOWHTO and arthroscopic examination without a chondral resurfacing procedure and meniscal treatment for PRTMM. Twenty-four patients were available for second-look arthroscopic evaluation. The mean follow-up period was 19.5 months (range, 5 to 46 months). Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores. RESULTS: There were 5 lax healing, 6 scar tissue, 13 failed healing of PRTMM. Definite change of chondral lesion was not observed. The Kellgren-Lawrence grade did not improve according to the follow-up plain radiograph. The mean Lysholm score improved from 34.7 preoperatively to 77.1 at the last follow-up, and the mean HSS score significantly increased from 36.5 to 82.4. CONCLUSIONS: This study revealed a low rate of healing potency of PRTMM and chondral lesion after MOWHTO without any attempt for meniscal treatment or chondral resurfacing. The cartilage and healing status of PRTMM was not associated with improved clinical outcomes and radiological findings.
Arthroscopy ; Cartilage ; Cicatrix ; Follow-Up Studies ; Humans ; Knee ; Menisci, Tibial ; Osteoarthritis ; Osteotomy ; Tears

Dementia pugilistica (DP) or chronic traumatic encephalopathy (CTE) is a neurodegenerative disease or dementia that may affect amateur or professional boxers as well as athletes in other sports who suffer concussions. The condition is thought to affect around 15% to 20% of professional boxers and caused by repeated concussive or subconcussive blows. CTE was in the past referred to as dementia pugilistica, which reflected the prevailing notion that this condition was restricted to boxers. Recent research, however, has demonstrated neuropathological evidence of CTE in retired American football players, a professional wrestler, a professional hockey player and a soccer player, as well as in nonathletes. It is probable that many individuals are susceptible to CTE, including those who experience falls, motor vehicle accidents, assaults, epileptic seizures, or military combat, and that repeated mild closed head trauma of diverse origin is capable of instigating the neurodegenerative cascade leading to CTE. We report a 62-year old man suspicious of dementia pugilistica with clinical features of frontotemporal dementia and parkinsonism.
Athletes ; Brain Injury, Chronic ; Dementia ; Epilepsy ; Football ; Frontotemporal Dementia ; Head Injuries, Closed ; Hockey ; Humans ; Military Personnel ; Motor Vehicles ; Neurodegenerative Diseases ; Parkinsonian Disorders ; Soccer ; Sports

Microalbuminuria is a marker of generalized endothelial dysfunction resulting from arterial stiffness or insulin resistance, and brachial-ankle pulse wave velocity (baPWV) is a good measure of arterial stiffness. We aimed to investigate whether elevated baPWV is independently associated with microalbuminuria. This study included 1,648 individuals aged over 40 who participated in the baseline Multi-Rural Cohort Study conducted in Korean rural communities between 2005 and 2006. Participants were classified into less than 30 mg/g as normoalbuminuria or 30-300 mg/g as microalbuminuriausing urinary albumin creatinine ratio (UACR). The median and Q1-Q3 baPWV values were significantly higher in the microalbuminuric group both in men (1,538, 1,370-1,777 cm/s vs. 1,776, 1,552-2,027 cm/s, P < 0.001) and women (1,461, 1,271-1,687 cm/s vs. 1,645, 1,473-1,915 cm/s, P < 0.001). BaPWV was independently associated with microalbuminuria in both genders after adjusting for pulse rate; fasting blood glucose; triglyceride; homeostatic model assessment insulin resistance (HOMA(IR)) and, history of hypertension and diabetes. Fasting blood sugar and HOMA(IR) were judged as having nothing to do with multicolinearity (r = 0.532, P < 0.001). Elevated baPWV was independently associated with microalbuminuria regardless of insulin resistance among rural subjects over 40 yr.
Adult ; Aged ; Albuminuria/*diagnosis/etiology/metabolism ; Ankle Brachial Index ; Ankle Joint/*physiopathology ; Blood Chemical Analysis ; Blood Glucose/analysis ; Brachial Artery/*physiopathology ; Cohort Studies ; Diabetes Mellitus, Type 2/complications/diagnosis ; Female ; Humans ; Hypertension/complications/diagnosis ; Male ; Middle Aged ; *Pulse Wave Analysis ; Risk Factors ; *Rural Population ; Serum Albumin/analysis ; Triglycerides/blood ; Vascular Stiffness

PURPOSE: Macrolide resistance rate of Mycoplasma pneumoniae has rapidly increased in children. Studies on the clinical features between macrolide susceptible-M. pneumoniae (MSMP) and macrolide resistant-M. pneumoniae (MRMP) are lacking. The aim of this study was to identify the macrolide resistance rate of M. pneumoniae in Korean children with M. pneumoniae penupmonia in 2015 and compare manifestations between MSMP and MRMP. METHODS: Among 122 children (0–18 years old) diagnosed with M. pneumoniae pneumonia, 95 children with the results of macrolide sensitivity test were included in this study. Clinical manifestations were acquired using retrospective medical records. RESULTS: The macrolide resistant rate of M. pneumoniae was 87.2% (82 of 94 patients) in children with M. pneumoniae pneumonia. One patient showed a mixed type of wild type and A2063G mutation in 23S rRNA of M. pneumoniae. There were no significant differences in clinical, laboratory, and radiologic findings between the MSMP and MRMP groups at the first visit to our hospital. The time interval between initiation of macrolide and defervescence was significantly longer in the MRMP group (4.9±3.3 vs. 2.8±3.1 days, P=0.039). CONCLUSION: The macrolide resistant rate of M. pneumoniae is very high in children with M. pneumoniae pneumonia in Korea. The clinical manifestations of MRMP are similar to MSMP except for the defervescence period after administration of macrolide. Continuous monitoring of the occurrence and antimicrobial susceptibility of MRMP is required to control its spread and establish strategies for treating second-line antibiotic resistant M. pneumoniae infection.
Child* ; Drug Resistance ; Humans ; Korea ; Medical Records ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Prevalence* ; Retrospective Studies

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The first objective of this study was to assess the clinical availability of maximal step length (MSL) as a measurement predicting falling probability in future. The second objective of this study was to try to find out how to use MSL more easily in a clinical setting. METHODS: The study population consisted of 50 community-dwelling people (> or =60 yrs). Demographic data were reviewed by self-recorded questionnaire and MSL, US and TUG had been done when the subjects visited a clinic in March and April 2004. They revisited the clinic after one year and information of fall incidence was obtained and their visual acuity was examined. To examine the association between many performance tests (MSL Unipedal stance, Timed up and go) and their real falling after tests, we analysed data by Mann-Whitney rank Test, pearson correlation and multiple regression. RESULTS: The average MSL predicted future falling (P-value 0.025), but Unipedal stance, Timed up and go did not. The predicting ability of MSL was preserved using many MSL measures (average MSL corrected by leg length and height, one direction measure among six directions of MSL, and average of left and right three directions of MSL). CONCLUSION: This study showed that MSL had the ability to predict elderly adults' falling in future. And this study showed that MSL can be used more easily in a clinical setting.
Adult ; Aged ; Humans ; Incidence ; Leg ; Visual Acuity ; Surveys and Questionnaires

Acute airway obstruction during endotracheal intubation status is embarrassing and critical situation which requires early diagnosis and immediate management. Endotracheal tube obstruction with foreign body is rare but a variety of objects have been reported. We present a case of endotracheal tube obstruction as a result of previous aspirated foreign body that moved from the bronchial tree into the endobroncheal tube.
Airway Obstruction ; Early Diagnosis ; Foreign Bodies* ; Intubation, Intratracheal

BACKGROUND: Most of the blood-test samples are collected and carried in vacuum tubes. We have compared a newly developed vacuum tube, ‘Vacuon’ (Medion, Korea) and ‘BD Vacutainer®’ (BD, USA) in three common clinical assays, i.e., hematological, chemical, and immunological tests. METHODS: A sum of 60 healthy volunteers were recruited in our study and their peripheral blood samples were collected in the tubes of the two brands. EDTA-tube samples were evaluated using 25 hematological tests. Serum separating tube samples were analyzed for 24 chemical parameters and the 3 thyroid hormones. The results were statistically analyzed using the paired t-test and Bland-Altman plot. In addition, the assay outcomes at t=0 hr were compared with those at t=24±2 hr for each of the tubes. RESULTS: The assay results of 22 hematological parameters, 24 chemical parameters, and 3 thyroid hormones had a statistically significant correlation between the 2 brands of vacuum tubes (t=0 hr). Two hematological parameters (mean corpuscular hemoglobin concentration [MCHC] and cell hemoglobin concentration mean [CHCM]) showed higher mean values, while a hematological parameter (lobularity index [LI]) showed lower mean values in Vacuon than BD Vacutainer (t=0 hr). The results after 24 hr showed similarity between the 2 brands, with some inconsistent results in BD Vacutainer (Mean platelet volume [MPV], plateletcrit [Pct], eosinophil, calcium, and triiodothyronine) and Vacuon (MPV, hemoglobin distribution width [HDW], CHCM, Pct, eosinophil, and calcium). CONCLUSIONS: BD Vacutainer and Vacuon tube showed good statistical concordance rate with some exceptions in the hematological parameters (MCHC, CHCM, and LI).
Blood Platelets ; Calcium ; Eosinophils ; Healthy Volunteers ; Hematologic Tests ; Immunologic Tests ; Thyroid Hormones ; Vacuum