Purpose: This study aimed to investigate the effects of grit and body composition on fatigue and burnout in shift-working nurses. Methods: A descriptive cross-sectional design using self-report questionnaires was employed. Data were collected between February and April 2021 from 192 shift-working nurses in 22 units of C tertiary hospitals. Of the 192, 175 nurses returned their completed questionnaires (return rate: 91.1%). The participants objectively measured their body composition for three consecutive days using a home body composition measurement scale. Results: Nurses with higher consistency of interest were more likely to have lower chronic fatigue (B = -5.23, p = .013), lower emotional exhaustion (B = -2.75, p < .001), and decreased depersonalization (B = -1.08, p = .014). Perseverance of effort was not statistically significant for fatigue; however, it was statistically significant for higher personal accomplishment among the subdomains of burnout (B = 2.50, p < .001). Skeletal muscle mass and body mass index had no significant effect on fatigue and burnout. Conclusion To reduce fatigue and burnout in shift-working nurses, comprehensive efforts at the organizational and individual levels should be implemented to increase their grit. Further research is needed to determine whether body composition affects fatigue and burnout in shift-working nurses.

Background: It remains unclear whether coffee intake is associated with the risk of hypertension. This study aimed to investigate the association between coffee intake and the risk of hypertension by using a meta-analysis of cohort studies. Methods: PubMed and Embase were searched using keywords in September 2022 to identify studies on coffee intake and the risk of hypertension. Results: We included a total of 13 longitudinal cohort studies, which involved a total of 64,650 incident cases of hypertension among 314,827 participants. In a random effects model meta-analysis of all the studies, coffee intake was not significantly associated with the risk of hypertension (relative risk [RR], 0.97; 95% confidence interval [CI], 0.90–1.05; I2 = 58.0%; n = 13). In the subgroup meta-analysis, coffee intake was associated with a decreased risk of hypertension in studies conducted in America (RR, 0.93; 95% CI, 0.87–0.98; I 2 = 4.6%; n = 5) and in low-quality studies (RR, 0.92; 95% CI, 0.88–0.96; I2 = 0.0%; n = 7). In the remaining subgroup meta-analyses by amount of coffee intake, gender, type of coffee (decaffeinated vs. caffeinated), smoking, and years of follow-up, coffee intake was not significantly associated with the risk of hypertension. Conclusion The current meta-analysis showed that coffee intake is not associated with the risk of hypertension.

Medication errors such as administration of wrong drugs, wrong dosage and erroneous route of administration are not rare among medical misadventures. We present an autopsy case of accidental injection of tranexamic acid instead of bupivacaine during spinal anesthesia, accompanying the quantitative result of the tranexamic acid in the blood, cerebrospinal fluid and each internal organs. We think that warning signs on syringes and ampoules, simple and unified guideline for drug administration, separative documentation of drug administration and interpersonal communication on drug information should be done to prevent this type of medical errors.
Anesthesia, Spinal ; Autopsy ; Bupivacaine ; Medical Errors ; Medication Errors ; Syringes ; Tranexamic Acid

Objective: To identify the normal range, distribution, and age-dependent differences in the cephalic index (CI) of Korean children with normal brain development and develop a classification of the current CI for Korean children up to 7 years of age. Methods: We retrospectively analyzed 1,389 children who visited our hospital in the emergency room between October 2015 and September 2020 because of suspected head injuries. Finally, 1,248 children (741 male and 507 female) were enrolled after excluding abnormal medical or familial history and divided into 10 groups by age. The CI was measured using brain computed tomography and calculated according to the following equation: cephalic width/cephalic length×100. Results: The averages of CI by age groups were as follows: 89.29 (0–3 months group, n=44); 91.41 (4–6 months group, n=63); 89.68 (7–9 months group, n=62); 87.52 (10–12 months group, n=41); 87.64 (≥2 years group, n=243); 86.63 (≥3 years group, n=178); 85.62 (≥4 years group, n=232); 85.77 (≥5 years group, n=201); 85.15 (≥6 years group, n=75); and 85.34 (≥7 years group, n=109). The CI of Korean children in normal brain development was confirmed to be large, showing a notable difference compared to that of Caucasians. Conclusion The current CI of Korean children will provide a valuable reference for diagnosing and treating cranial deformities, especially dolichocephaly and brachycephaly as well as to monitor the morphology of the cranium in clinics.

Objective: To identify the normal range, distribution, and age-dependent differences in the cephalic index (CI) of Korean children with normal brain development and develop a classification of the current CI for Korean children up to 7 years of age. Methods: We retrospectively analyzed 1,389 children who visited our hospital in the emergency room between October 2015 and September 2020 because of suspected head injuries. Finally, 1,248 children (741 male and 507 female) were enrolled after excluding abnormal medical or familial history and divided into 10 groups by age. The CI was measured using brain computed tomography and calculated according to the following equation: cephalic width/cephalic length×100. Results: The averages of CI by age groups were as follows: 89.29 (0–3 months group, n=44); 91.41 (4–6 months group, n=63); 89.68 (7–9 months group, n=62); 87.52 (10–12 months group, n=41); 87.64 (≥2 years group, n=243); 86.63 (≥3 years group, n=178); 85.62 (≥4 years group, n=232); 85.77 (≥5 years group, n=201); 85.15 (≥6 years group, n=75); and 85.34 (≥7 years group, n=109). The CI of Korean children in normal brain development was confirmed to be large, showing a notable difference compared to that of Caucasians. Conclusion The current CI of Korean children will provide a valuable reference for diagnosing and treating cranial deformities, especially dolichocephaly and brachycephaly as well as to monitor the morphology of the cranium in clinics.

Objective: To investigate the relationship between low back pain (LBP) and sagittal spino-pelvic parameters along with the relationship between LBP and back muscle mass in Korean male and female fishery workers. Methods: This retrospective study included a total of 146 subjects who underwent Fishermen’s health survey conducted between June 2018 and August 2020. LBP was evaluated through visual analogue scale (VAS) and Oswestry Disability Index (ODI). Sagittal spino-pelvic parameters were measured from whole spine standing X-rays. Back muscle cross-sectional areas were identified through lumbar spine magnetic resonance imaging and body composition was analyzed through bioelectrical impedance analysis. Results: The study included 75 males and 71 females, with an average age of 58.33 years for males and 56.45 years for females. Female subjects exhibited higher VAS and ODI scores, larger pelvic tilt (PT) and trunk fat mass and smaller trunk muscle mass compared to males. In female, ODI positively correlated with sagittal vertical axis (SVA) and PT. No significant correlations were found between ODI scores and body composition in either sex. The high ODI group showed greater SVA, PT, and pelvic incidence-lumbar lordosis and higher trunk fat/muscle ratio. Psoas muscle mass, total and skeletal muscle mass and trunk muscle mass of that group were smaller than those of low ODI group. Conclusion Spino-pelvic parameters and back muscle mass were associated with ODI and there were differences between Korean male and female fishery workers.

Background: While hypothyroidism is associated with negative health effects in the general population, older adults with hypothyroidism have better physical function and comparable rates of depression and cognitive impairment relative to their euthyroid counterparts. The aim of this study was to investigate the association between thyroid status and health-related quality of life in Korean older adults. Methods: In this population-based cross-sectional study, 1,060 adults aged over 60 years were classified by thyroid status into four groups based on their thyroid stimulating hormone (TSH) and free T4 values: overt hypothyroid, subclinical hypothyroid, euthyroid, and subclinical hyperthyroid. The main outcome measure was self-reported health-related quality of life based on the three-level version of the EuroQol-5 dimension (EQ-5D), with utility values of -0.171 and 1.000 corresponding to the worst and best health statuses, respectively. The adjusted means of the EQ-5D three-level version utility values according to thyroid status were determined using a linear regression analysis. Results: In the adjusted analysis, the overt hypothyroid group showed significantly higher EQ-5D three-level version utility values than did the euthyroid group (0.998 vs. 0.908, P=0.000). In the subgroup analyses by sex, the overt hypothyroid group also showed significantly higher EQ-5D three-level version utility values for both men and women than did the euthyroid group (0.998 vs. 0.940, P=0.008; 0.983 vs. 0.882, P=0.001). Conclusion Asymptomatic Korean older adults aged over 60 years with TSH and free T4 values corresponding to overt hypothyroidism have better health-related quality of life than their euthyroid counterparts.

Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare but pathologically distinct breast tumor. There have been some case reports on primary MCA of the breast; however, they have all focused on pathologic findings. Here, we report the radiologic findings of two cases of MCA along with a review of the literature. Breast MCA shows a circumscribed mass with some calcifications on mammography, an intracystic solid mass without increased vascularity or a vascular stalk on ultrasound, and a heterogeneously enhancing mass within a rim-enhancing cyst with intermediate signal intensity on T2-weighted magnetic resonance imaging. These radiologic findings and the presence of mucin in the percutaneous biopsy specimen should suggest the possibility of MCA in the differential diagnosis of a breast tumor.
Biopsy ; Breast Neoplasms ; Breast* ; Cystadenocarcinoma, Mucinous* ; Diagnosis, Differential ; Magnetic Resonance Imaging ; Mammography ; Mucins* ; Ultrasonography

OBJECTIVE: This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.METHODS: Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.RESULTS: Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.CONCLUSION: Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.
Angiography ; Brain Death ; Brain ; Cerebral Arteries ; Cerebral Veins ; Heart Arrest ; Humans ; Hypothermia ; ROC Curve ; Sensitivity and Specificity

We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
Aged ; Antifungal Agents ; Biopsy ; Bronchi ; Cardiac Tamponade ; Diabetes Mellitus ; Dyspnea ; Echocardiography ; Female ; Heart ; Heart Atria* ; Heart Neoplasms ; Humans ; Hypertension ; Hyphae ; Immunocompetence ; Invasive Pulmonary Aspergillosis* ; Mediastinal Cyst ; Mediastinal Neoplasms ; Mediastinum* ; Methenamine ; Pathology ; Thorax