Objectives: This study compared the nutritional intakes of early and late preterm infants in a neonatal intensive care unit (NICU) and at home. The dietary problems and the need for community care services for premature infants were further investigated. Methods: This is a cross-sectional and descriptive study on 125 preterm infants and their parents (Early preterm n = 70, Late preterm n = 55). The data were collected by surveying the parents of preterm infants and from hospital medical records. Results: No significant differences were obtained between the early and late preterm infant groups when considering the proportion of feeding types in the NICU and at home. Early preterm infants were fed with a greater amount of additional calories at home and had more hours of tube feeding (P = 0.022). Most preterm infants had feeding problems. However, there was no significant difference between early and late preterm infants in the mental pain of parents, sleeping, feeding, and weaning problems at home. Many parents of preterm babies had no external support, and more than half the parents required community care to take care of their preterm babies. Conclusions Regardless of the gestational age, most preterm infants have several problems with dietary intake. Our study indicates the need to establish community care services for preterm infants.

Objective: This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. Methods: This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. Results: A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). Conclusion In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

Objective: This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. Methods: This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. Results: A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). Conclusion In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

No abstract available.
Brain Abscess* ; Brain* ; Vancomycin-Resistant Enterococci*

Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Acute Disease ; Anticoagulants/*administration & dosage ; Dose-Response Relationship, Drug ; *Extracorporeal Membrane Oxygenation ; Female ; Guanidines/*administration & dosage ; Heart Failure/diagnosis/mortality/therapy ; Heparin/administration & dosage ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/mortality/therapy ; Respiratory Distress Syndrome, Adult/diagnosis/mortality/therapy ; Retrospective Studies ; Shock, Septic/diagnosis/mortality/therapy ; Survival Analysis

PURPOSE: Serine-threonine kinase11 (STK11) was originally identified in 1997 as the causative mutation that's responsible for Peutz-Jeghers Syndrome (PJS). Several recent studies have reported that the STK11 gene is an important human tumor suppressor gene in lung cancer. We evaluated the associations between the polymorphisms of the STK11 promoter region and the risk of lung cancer in 901 Koreans. MATERIALS AND METHODS: By direct sequencing, we first discovered three novel polymorphisms (-1,795 T>C, -981 C>T and -160 G>T) and four known polymorphisms (-1,580 C>T, -1,494 A>C, -881 A>G and -458 G>C) of the STK11 promoter region in 24 blood samples of 24 Korean lung cancer patients. Further genotype analyses were then performed on 443 lung cancer patients and 458 controls. RESULTS: We discovered three novel polymorphisms and we identified four known polymorphisms of the STK11 promoter region in a Korean population. Statistical analyses revealed that the genotypes and haplotypes in the STK11 gene were not significantly associated with the risk of lung cancer in a Korean population. CONCLUSION: This is the first study that's focused on the association of STK11 promoter polymorphisms and the risk of lung cancer in a Korean population. To evaluate the role of the STK11 gene for the risk of lung cancer, the genotypes of the STK11 promoter region (-1,795 T>C, -1,494 A>C and -160 G>T) were determined in 901 Koreans, yet the result revealed no significant difference between the lung cancer patients and the controls. These results suggest that the three promoter polymorphisms we studied are not important risk factors for the susceptibility to lung cancer in Koreans.
Genes, Tumor Suppressor ; Genotype ; Haplotypes ; Humans ; Lung ; Lung Neoplasms ; Peutz-Jeghers Syndrome ; Promoter Regions, Genetic ; Risk Factors

BACKGROUND AND OBJECTIVES: A spasm of the radial artery is one of the most common complications of coronary angiography (CAG) via the transradial approach (TR), and this spasm sometimes disturbs the procedure. Nicorandil has recently shown dose-dependent dilatation of the blood vessels and ischemic preconditioning. This study was designed to evaluate the clinical effects and radial artery vasodilation of high dose nicorandil solution during CAG via the radial artery. SUBJECTS AND METHODS: This study was a prospective, randomized study to compare the effects of 12 mg of nicorandil (the Nicorandil group) and 10 mL of a cocktail solution (nitroglycerine 200 microgram mixed with verapamil 100 microgram) (the Cocktail group) in 146 patients. Vasospasms, which were expressed as the stenosis of the radial artery were examined at 2 parts of the radial artery. RESULTS: There were no significant difference of gender, age and risk factors for the 2 groups of patients. The reductions in the systolic and diastolic blood pressure (BP) 1 minute after drug administration were 33.6+/-11.4/10.4+/-7.7 mmHg in the Nicorandil group and 12.8+/-9.8/3.8+/-5.3 mmHg in the Cocktail group (p<0.001). Both vasodilating agents showed significant radial artery vasodilation after administration of the drugs (p<0.005 for all). The minimal luminal diameter (MLD) after drug administration was more dilated in the Nicorandil group than that in the Cocktail group (0.63+/-0.25 mm vs. 0.48+/-0.19 mm, respectively, p=0.013). CONCLUSION: Nicorandil solution was more effective for inducing vasodilation of the radial artery, but it was not clinical superior to the cocktail solution.
Blood Pressure ; Blood Vessels ; Constriction, Pathologic ; Coronary Angiography ; Dilatation ; Humans ; Ischemic Preconditioning ; Nicorandil ; Phenobarbital ; Prospective Studies ; Radial Artery ; Risk Factors ; Spasm ; Vasodilation ; Vasodilator Agents ; Verapamil

Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.
Aged, 80 and over ; Biliary Fistula/*complications ; Cholelithiasis/complications ; Common Bile Duct Diseases/*complications ; Diverticulum/*complications ; Duodenal Diseases/*complications ; Female ; Humans ; Intestinal Fistula/*complications ; Pancreatic Fistula/*complications

OBJECTIVE: To evaluate the effectiveness of Novalis shaped beam radiation treatment as an adjuvant treatment in patients with craniopharyngiomas. METHODS: We reviewed 8 patients with craniopharyngiomas who had recurring tumors during follow-up or had residual lesions after primary surgery. Three of 8 patients were found to have recurrence after gross total excision of the tumor and 5 patents had residual lesions after subtotal resection. All patients were treated with fractionated stereotactic radiation treatment(FSRT) using Novalis system. The mean age of patients was 28 years (range 16~52). The median irradiation dose per fraction was 1.7Gy (range 1.7~2.0). The median fraction number was 23 (range 15~25), and the median total dose was 39.1Gy (range 25.5~42.5). Follow-up included MR imaging, and ophthalmologic and endocrine examinations. RESULTS: The median follow-up period was 23 months (range 12~43). The local tumor control rate was 87.5%. One patient had a recurring tumor, in which cystic change developed 2 months after FSRT. Four patients showed a decrease in size of their tumor, while 3 patients remained stable. Seven out of 8 patients had hormonal dysfunction that remained unchanged after initial surgery. No further progression of visual impairment was observed. CONCLUSION: FSRT using Novais system is effective and safe for the treatment of recurring or residual craniopharyngiomas without toxicity like optic neuropathy.
Craniopharyngioma* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Optic Nerve Diseases ; Recurrence ; Vision Disorders

OBJECTIVE: We treated 10 pediatric diffuse intrinsic brain stem glioma(BSG) patients with Novalis system (linac based radiotherapy unit, Germany) and examined the efficacy of the Fractionated Stereotactic Radiotherapy(FSRT). METHODS: A retrospective review was conducted on 10 pediatric diffuse intrinsic BSG patients who were treated with FSRT between May, 2001 and August, 2004. The mean age of the patient group was 7.7 years old. Male to female ratio was 4 to 1. The mean dose of FSRT was 38.7Gy, mean fractionated dose was 2.6Gy, mean fractionation size was 16.6, and target volume was 42.78cm3. The mean follow up period was 14 months. RESULTS: Four weeks after completion of FSRT, improvements on neurological status and Karnofsky performance scale(KPS) score were recorded in 9/10 (90%) patients and magnetic resonance imaging(MRI) showed decrease in target tumor volume in 8 pediatric patients. The median survival period was 13.5 months after FSRT and treatment toxicity was mild. CONCLUSION: It is difficult for surgeons to choose surgical treatment for diffuse intrinsic BSG due to its dangerous anatomical structures. FSRT made it possible to control the tumor volume to improve neurological symptoms with minimal complications. We expect that FSRT is a feasible treatment modality for pediatric diffuse intrinsic BSG with tolerable toxicities.
Brain Stem* ; Brain* ; Female ; Follow-Up Studies ; Glioma* ; Humans ; Male ; Radiotherapy* ; Retrospective Studies ; Tumor Burden