OBJECTIVES: This study examined the association of the total diet quality with the incidence risk of metabolic syndrome constituents and metabolic syndrome among Korean adults.METHODS: Based on a community-based cohort of the Korean Genome and Epidemiology Study (KoGES) from 2001 to 2014, data from a total of 5,549 subjects (2,805 men & 2,744 women) aged 40~69 years at the baseline with a total follow-up period of 38,166 person-years were analyzed. The criteria of the National Cholesterol Education Program Adult Treatment Panel was employed to define metabolic syndrome. The total diet quality was estimated using the Korean Healthy Eating Index (KHEI). Hazard ratios (HR) and 95% confidence intervals (CI) for risk of metabolic syndrome constituents and metabolic syndrome in relation to KHEI quintile groups was calculated by multivariate Cox proportional hazards regression model.RESULTS: After adjusting for age, energy intake, income, education, physical activity, smoking, and drinking, the incidence of abdominal obesity and high blood pressure was significantly lower, by approximately 29.7% (P < 0.01) and 25.2% (P < 0.01), respectively, in the fifth KHEI quintile compared to the first quintile in men. A significant decreasing trend of the metabolic syndrome incidence was observed across the improving levels of KHEI (HRq5vs.q1: 0.775, 95% CIq5vs.q1: 0.619~0.971, P for trend < 0.01). In women, the incidence of abdominal obesity and metabolic syndrome was significantly lower, by approximately 29.8% (P < 0.01) and 22.5% (P < 0.05), respectively, in the fifth KHEI quintile compared to the first quintile adjusting for multiple covariates. On the other hand, the linear trend of metabolic syndrome risk across the KHEI levels did not reach the significance level.CONCLUSIONS: A better diet quality can prevent future metabolic syndrome and its certain risk factors among Korean men and women.
Adult ; Cholesterol ; Cohort Studies ; Diet ; Drinking ; Eating ; Education ; Energy Intake ; Epidemiology ; Female ; Follow-Up Studies ; Genome ; Hand ; Humans ; Hypertension ; Incidence ; Male ; Obesity, Abdominal ; Physical Education and Training ; Prospective Studies ; Risk Factors ; Smoke ; Smoking

The purpose of this study was to prospectively investigate the relation between total diet quality and metabolic syndrome in Korean adults. A community-based cohort of the Korean Genome and Epidemiology Study (KoGES) provided basis for this study. During the total follow-up period of 38,171 person-years of 5,549 subjects, a total of 1,891 metabolic syndrome incident cases were identified. Metabolic syndrome was defined by the criteria of the National Cholesterol Education Program Adult Treatment Panel. Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension diet, and Recommended Food Score (RFS) were used to assess total diet quality. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for metabolic syndrome associated with total diet quality. In men, the incidence of metabolic syndrome in the 5th MDS quintile group decreased by approximately 25% compared to the 1st quintile group (p for trend < 0.01) after adjusting for age and energy intake. In women, significant decreasing trend of metabolic syndrome incidence risk was observed across the quintiles of RFS in an age and energy intake-adjusted model (HR [95% CI] of Q5 vs. Q1; 0.662 [0.521–0.842], p for trend < 0.01). However, such associations did not reach at a significance level when additional covariates were included. In this first study looking at prospective relation of metabolic syndrome with total diet quality in a Korean population, study findings suggest some protective role of better diet quality in preventing future metabolic syndrome. But no convincing evidence was observed in this study.
Adult* ; Cholesterol ; Cohort Studies* ; Diet* ; Diet, Mediterranean ; Education ; Energy Intake ; Epidemiology ; Female ; Follow-Up Studies ; Genome ; Humans ; Hypertension ; Incidence* ; Male ; Prospective Studies*

Objectives: The prevalence of obstructive sleep apnea (OSA) and its association with perioperative comorbidities in patients who undergo bariatric surgery remain unclear in South Korea. We investigated the prevalence of OSA and its association with metabolic parameters in patients who underwent bariatric surgery. Methods: This retrospective study included 144 patients who underwent bariatric surgery; 98 patients underwent a sleep study and were included in this study. Patients were categorized into two groups based on the apnea-hypopnea index (AHI) cut-off value of 15/hour. Results: Overall, 52 (53.1%) of the patients showed an AHI ≥15/hour. The neck circumference was larger (43.0±4.7 cm vs. 40.5±3.6 cm, p=0.005) and prevalence of diabetes was higher (65.4% vs. 45.7%, p=0.049) in patients with AHI ≥15/hour than in those with AHI <15/hour. Furthermore, fasting blood glucose levels were higher (134.7±50.5 mg/dL vs. 114.8±34.3 mg/dL , p= 0.028) and serum high-density lipoprotein levels were lower (46.8±9.9 mg/dL vs. 52.8±13.3 mg/dL, p=0.013) in the AHI ≥15/hour than in the AHI <15/hour group. Conclusions More than 50% of patients who underwent bariatric surgery had moderate-to-severe OSA. The prevalence of metabolic comorbidities was higher in those with moderate-to-severe OSA than in those without. OSA screening may be useful for evaluation of the metabolic complications of morbid obesity.

OBJECTIVE: Living donor liver transplantation is a surgical treatment which could impose a heavy burden on both the recipient and the potential donor. Preoperative psychological evaluation of the potential donor is essential in protecting one's psychosocial well-being, as well as one's autonomy. In this research, we examined the correlation between the preoperative psychological profile of the potential donor and one's postoperative pain and opioid analgesic usage. METHODS: Retrospective review of the medical records of all living donors who had completed preoperative psychological evaluation in our transplantation center from January, 2010 to December, 2011 was done. Preoperative psychological evaluation included Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Sentence Complete Test and an interview with a psychiatrist. Mean postoperative pain within 7 days after the surgery was evaluated. Dosages of all opioid analgesics were converted to equivalent dosage of morphine. RESULTS: Depression T-score showed a significant correlation with the duration of opioid analgesics usage (R2=0.306, F=12.363). Also, F score and dosage of opioid analgesics (R2=0.360, F=15.766), as well as Psychasthenia T- score and postoperative mean pain score (R2=0.137, F=4.448) showed significant correlation. CONCLUSION: Depression T-score, F score and Psychastenia T-score from MMPI-2 are well known to reflect one's depression, discontent, psychological instability and chronic anxiety. Such personalized and specified psychiatric intervention could help the donor to cope with post-surgical pain better.
Analgesics, Opioid ; Anxiety ; Depression ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Medical Records ; Minnesota ; MMPI ; Pain, Postoperative ; Phosphatidylethanolamines ; Psychiatry ; Retrospective Studies ; Tissue Donors ; Transplants

It is unclear whether specific agent groups are associated with outcomes in cases of poisoning-induced out-of-hospital cardiac arrest (P-OHCA). The study population comprised cases of confirmed P-OHCA drawn from the national out-of-hospital cardiac arrest (OHCA) registry (2008–2013). Exposures were categorized into five groups according to the International Classification of Disease, 10th version: group 1, prescribed drugs; group 2, vapors and gases; group 3, pesticides; group 4, alcohol and organic solvents; and group 5, other poisons. The outcome was survival to discharge and good neurological recovery. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to test the association between specific groups and outcomes. A total of 2,083 patients were analyzed; group 1 (10.3%), group 2 (23.6%), group 3 (52.9%), group 4 (1.4%), and group 5 (13.2%). The survival to discharge and good neurological recovery rates were 3.3%/1.3% for all patients, 10.3%/5.6% (group 1), 6.9%/3.4% (group 2), 2.4%/0.4% (group 3), 2.2%/1.0% (group 4), and 3.3%/2.4% (group 5) (all P < 0.001). The aORs (95% CIs) of groups 2–5 compared with group 1 for survival to discharge were 0.47 (0.09–2.51), 0.34 (0.17–0.68), 0.33 (0.14–0.77), and 0.31 (0.13–0.77), respectively. The odds ratios (95% CIs) for good neurological recovery were significant only in group 1, the pesticides group (0.07 [0.02–0.26]) and were not significant in the other groups. P-OHCA outcomes differed significantly among the poisoning agent groups. The pesticides group showed the worst outcomes, followed by the group of vapors or gases.
Classification ; Gases ; Heart Arrest ; Humans ; Odds Ratio ; Out-of-Hospital Cardiac Arrest* ; Pesticides ; Poisoning ; Poisons ; Solvents

PURPOSE: Missing subarachnoid hemorrhage (SAH) can cause catastrophic results. We aimed to find clinical factors for predicting SAH in neurologically intact patients with acute non-traumatic headache visiting the emergency department (ED). METHODS: This was a retrospective chart review study. Data were collected from September 2006 until October 2011. We included patients aged over 16 with acute non-traumatic headache who had brain imaging work up results during ED visits. Information on candidate clinical predictor variables was obtained from previous reports, and the outcome was confirmed SAH in brain imaging work up or cerebrospinal fluid study. We found the predictors for SAH through multivariable analysis with variables chosen in univariable analysis considering clinical application. Then we simulated possible SAH prediction scoring models using receiver operating characteristic (ROC) analysis and assessed model fit through the Hosmer-Lemeshow test. RESULTS: A total of 3294 patients were enrolled. Seven clinical characteristics were proven for relation of SAH; age, visiting emergency department within six hours from symptom onset time, visiting mode, vomiting, neck pain or neck stiffness, blood pressure, and respiratory rate. We constructed six available SAH prediction scoring models. The area under the ROC curves of each model ranged from 0.810 to 0.834 and all simulated models were good-fit. With these models, we can expect to reduce unnecessary computed tomography use. CONCLUSION: Seven clinical predictors could be helpful in selection of high risk patients of SAH. The proposed SAH prediction models using these characteristics will have to be tested prospectively for external validation.
Blood Pressure ; Cerebrospinal Fluid ; Decision Support Techniques ; Emergency Service, Hospital* ; Headache* ; Humans ; Neck ; Neck Pain ; Neuroimaging ; Respiratory Rate ; Retrospective Studies ; ROC Curve ; Subarachnoid Hemorrhage* ; Vomiting

Visceral larva migrans is a syndrome presented chronic peripheral eosinophilia, hepatomegaly with eosinophilic granuloma. Originally it results from migration of second stage larva of Toxocara species, animal ascarides, but there are many other causative parasites. It's difficult to detect causative parasite, although immunohistochemical methods like ELISA or Ouchterlony method have been introduced. If the larva were dectected, it's not easy to discriminate causative one from others because of similarities of morphology. Most cases have self-limited course. Only in severe infection, antiparasitic treatment, augmented by corticosteroid when allergic symptopms are also present, is required. Clinical presentations have varieties of spectrum, hepatomegaly with eosinophilic granuloma is most common. Some cases of pulmonary, ocular and CNS symptoms were reported. We now report a case of visceral larva migrans, presented submucosal tumor or diverticulitis in the ascending colon and went through laparoscopic right hemicolectomy. The diagnosis was made with microscopic examination of operation tissue.
Animals ; Colon, Ascending* ; Diagnosis ; Diverticulitis ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophilic Granuloma ; Hepatomegaly ; Larva ; Larva Migrans, Visceral* ; Parasites ; Toxocara ; Toxocariasis

BACKGROUND: Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes. METHODS: This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition. RESULTS: According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.
Critical Illness ; Enteral Nutrition ; Hospital Mortality ; Hospitals, Teaching ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Lymphocyte Count ; Malnutrition ; Medical Records ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Prevalence ; Prognosis ; Respiration, Artificial ; Retrospective Studies

Background: Obesity, obstructive sleep apnea (OSA), and excessive daytime sleepiness (EDS) are common conditions and are interrelated. Obesity is a risk factor for OSA and independently associated with EDS. We aimed to evaluate frequency of EDS in morbid obese patients with OSA and to identify contribution factor for EDS. Methods: This was a retrospective cross-sectional study in single sleep center. Consecutive patients with OSA (with apnea-hypopnea index 5/h or more) with morbid obesity (body mass index over 35 kg/m2) was enrolled. EDS were defined as Epworth Sleepiness Scale of 10 points or more. Clinical and polysomnographic variables were compared between those with and without EDS. Results: Total 110 morbid obese patients with OSA were enrolled, and 34 (31%) of them had EDS. Those with EDS had higher subjective symptom of insomnia and depression. Rapid eye movement sleep latency was shorter and minimum saturation was lower for those with EDS. Multivariate logistic regression analysis identified insomnia severity (odds ratio, 1.117) and minimum saturation (odds ratio, 0.952) as independent contribution factor for EDS. Conclusions Result of this study suggest that 31.4% of morbid obese patients with OSA have EDS, and it can be affected by insomnia severity and desaturation during sleep.

Objective: This study aims to objectively evaluate turning gait parameters in Parkinson’s disease (PD) patients using 2D-RGB video-based analysis and explore their relationships with imbalance. Methods: We prospectively enrolled PD patients for clinical assessment, balance analysis and gait with 180º turning. Spatiotemporal gait parameters during turning were derived using video-based analysis and correlated with modified Hoehn and Yahr (mHY) stages and center of pressure (COP) oscillations. Results: A total of 64 PD patients were enrolled. The PD patients with higher mHY stages (≥2.5) had significantly longer turning times, greater numbers of steps, wider step bases and less variability in step length during turns. COP oscillations were positively correlated with the mean turning time on both the anterior-posterior and right-left axes. Conclusion Spatiotemporal gait parameter during turning, derived from video-based gait analysis, may represent apromising biomarker for monitoring postural instability in PD patients.