OBJECTIVES: This study was performed to investigate the factors related to HRQOL, and a correlation between occupational stress and HRQOL among municipal fire officers. METHODS: In November 2005, 341 male municipal fire officers submitted to the following tests: A general questionnaire, a medical questionnaire, the Korean Occupational Stress Scale Short Form(KOSSSF), and the SmithKline Beecham quality of life scale (SBQOL). RESULTS: Back pain (OR=3.54, 95% C.I.=1.81-6.93) and occupational stress (OR=6.33, 95% C.I.=3.12-12.83) were significantly related to poor HRQOL scores among municipal fire officers, and there is negative relationship between KOSS-SF score and SBQOL score. Logistic regression analysis indicated that the medium occupational stress group (OR=2.21, 95% C.I.=1.04-4.71) and the high occupational stress group (OR=6.33, 95% C.I.=3.12-12.83) were more significantly associated with poor HRQOL than low occupational stress group. CONCLUSIONS: Among municipal fire officers, back pain and occupational stress were found to be related to their HRQOL. Based on this study, we suggest that the management of back pain and occupational stress are instrumental to improving the HRQOL among municipal fire officers.
Back Pain ; Fires ; Humans ; Logistic Models ; Male ; Quality of Life ; Questionnaires

OBJECTIVE: CDA (Clinical Document Architecture) is a markup standard for clinical document exchange. In order to increase the semantic interoperability of documents exchange, the clinical statements in the narrative blocks should be encoded with code values. Natural language processing (NLP) is required in order to transform the narrative blocks into the coded elements in the level 3 CDA documents. In this paper, we evaluate the accuracy of text mapping methods which are based on NLP. METHODS: We analyzed about one thousand discharge summaries to know their characteristics and focused the syntactic patterns of the diagnostic sections in the discharge summaries. According to the patterns, different rules were applied for matching code values of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT). RESULTS: The accuracy of matching was evaluated using five-hundred discharge summaries. The precision was as follows: 86.5% for diagnosis, 61.8% for chief complaint, 62.7%, for problem list, and 64.8% for discharge medication. CONCLUSION: The text processing method based on the pattern analysis of a clinical statement can be effectively used for generating CDA entries.
Diagnosis ; Natural Language Processing ; Semantics ; Systematized Nomenclature of Medicine

Objective: To identify the incidence and clinical course of septic shock combined with neutropenia during chemotherapy in gynecological cancer patients. Methods: We retrospectively reviewed the medical records of all gynecological cancer patients who received intravenous chemotherapy between March 2009 and March 2018.Patients diagnosed with neutropenic septic shock (NSS) during the course of chemotherapy were identified. We calculated the overall incidence and mortality rate of NSS, and analyzed risk factors and clinical course. Results: A total of 1,009 patients received 10,239 cycles of chemotherapy during the study period. Among these, 30 (3.0%) patients had 32 NSS events, of which 12 (1.2%) died. With respect to patient age during the first course of chemotherapy, the incidence of NSS after the age of 50 was significantly higher than that in patients under 50 (3.9% vs. 1.4%, p=0.034).As the number of chemotherapy courses increased, the incidence of NSS increased, and linear-by-linear association analysis showed a positive correlation (p=0.004). NSS events occurred on average 7.8 days after the last cycle of chemotherapy, and the median duration of vasopressor administration was 23.3 hours. The median age (64.0 vs. 56.5, p=0.017) and peak heart rate (149.5 min −1 vs. 123.5 min −1 , p=0.015) were significantly higher in the group of patients who subsequently died of NSS than in those who survived. Conclusion The overall incidence of NSS in gynecological cancer patients receiving chemotherapy was 3.0%, which is higher than previously estimated. Peak heart rate during NSS events may be an indicator for predicting survival.

Background: The anti-oxidative, anti-inflammatory, and anti-apoptotic effects of erythropoietin may provide neuroprotective effects. Erythropoietin also modulates autophagy signaling that may play a role in anesthesia-induced neurotoxicity (AIN). Herein, we investigated whether AIN can be attenuated by the neuroprotective effect of erythropoietin in the Caenorhabditis elegans (C. elegans). Methods: Synchronized worms were divided into the control, Iso, EPO, and EPO-Iso groups. The chemotaxis index (CI) was evaluated when they reached the young adult stage. The lgg-1::GFP-positive puncta per seam cell were used to determine the autophagic events. The erythropoietin-mediated pathway of autophagy was determined by measuring the genetic expression level of let-363, bec-1, atg-7, atg-5, and lgg-3. Results: Increased lgg-1::GFP puncta were observed in the Iso, EPO, and EPO-Iso groups. In the Iso group, only the let-363 level decreased significantly as compared to that in the control group (P = 0.009). bec-1 (P < 0.001), atg-5 (P = 0.012), and lgg-3 (P < 0.001) were expressed significantly more in the EPO-Iso group than in the Iso groups. Repeated isoflurane exposure during development decreased the CI. Erythropoietin could restore the decreased CI by isoflurane significantly in the EPO-Iso group. Conclusions Erythropoietin showed neuroprotective effects against AIN and modulated the autophagic pathway in C. elegans. This experimental evidence of erythropoietin-related neuroprotection against AIN may be correlated with the induced autophagic degradation process that was sufficient for handling enhanced autophagy induction in erythropoietin-treated worms.

PURPOSE: We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique. MATERIALS AND METHODS: 78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 microg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately. RESULTS: The PN group (391.2+/-171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8+/-59.0 sec) and PV2 (211.4+/-58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4+/-149.6 sec) than PV1 (557.6+/-194.9 sec) and PV2 (561.5+/-129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%). CONCLUSION: The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.
Adult ; Anesthetics, Local/*administration & dosage/adverse effects ; Brachial Plexus/*drug effects/*ultrasonography ; Brachial Plexus Block/adverse effects/*methods ; Female ; Forearm/surgery ; Hand/surgery ; Humans ; Injections ; Male ; Middle Aged ; Peripheral Nerves/ultrasonography ; Prospective Studies ; Single-Blind Method ; Treatment Outcome ; *Ultrasonography, Interventional ; Upper Extremity/innervation/*surgery ; Vascular System Injuries/etiology ; Wrist/surgery

BACKGROUND: We conducted prospective, randomized, observer-blinded trial to compare two double-injection perivascular (PV) ultrasound-guided techniques of axillary brachial plexus block (BPB). METHODS: American Society of Anesthesiologists physical status I-II, 50 patients undergoing surgery of the forearm, wrist or hand were randomly allocated to two groups. For PV12 group, injection was carried out at the 12 o'clock position using 24 ml of 2% lidocaine. Patients of PV6 group got their injection of 24 ml of 2% lidocaine at direction of 6 o'clock of axillary artery. For all 2 groups, the musculocutaneous nerve was identified and 5 ml of 2% lidocaine was deposited around the nerve. The performance time and the onset time were recorded. The induction time (sum of performance and onset time), the success rate of the block, the need rate of rescue block, and incidence of adverse events was compared. RESULTS: The success rate was same (84%) in two groups. The performance time, onset time, and induction time showed no differences between two groups. There were no differences in vessel puncture, paresthesia, and numbness. CONCLUSIONS: Double-injection perivascular ultrasound-guided axillary BPB can be performed at 12 o'clock or 6 o'clock position of axillary artery, and performer may choose needle targeting position by considering surgery site. Thus perivascular double-injection technique may be an alternative method for axillary BPB and useful in case of difficult block.
Axillary Artery* ; Brachial Plexus* ; Forearm ; Hand ; Humans ; Hypesthesia ; Incidence ; Lidocaine ; Methods ; Musculocutaneous Nerve ; Needles* ; Paresthesia ; Prospective Studies ; Punctures ; Ultrasonography ; Wrist

Nuclear factor E2-related factor 2 (NRF2) plays an important role in redox metabolism and antioxidant defense. Under normal conditions, NRF2 proteins are maintained at very low levels because of their ubiquitination and proteasomal degradation via binding to the kelch-like ECH associated protein 1 (KEAP1)-E3 ubiquitin ligase complex. However, oxidative and/or electrophilic stresses disrupt the KEAP1-NRF2 interaction, which leads to the accumulation and transactivation of NRF2. During recent decades, a growing body of evidence suggests that NRF2 is frequently activated in many types of cancer by multiple mechanisms, including the genetic mutations in the KEAP1-NRF2 pathway. This suggested that NRF2 inhibition is a promising strategy for cancer therapy. Recently, several NRF2 inhibitors have been reported with anti-tumor efficacy. Here, we review the mechanisms whereby NRF2 is dysregulated in cancer and its contribution to the tumor development and radiochemoresistance. In addition, among the NRF2 inhibitors reported so far, we summarize and discuss repurposed NRF2 inhibitors with their potential mechanisms and provide new insights to develop selective NRF2 inhibitors.
Metabolism ; NF-E2-Related Factor 2 ; Oxidation-Reduction ; Transcriptional Activation ; Ubiquitin ; Ubiquitination

BACKGROUND: The aim of this study was to determine the appropriate target concentrations at the effect site of propofol and remifentanil when deep sedation was achieved by monitored anesthesia care (MAC) anesthesia and related respiratory depression during vein stripping surgery for varicose veins. METHODS: In total, 51 adult patients who were scheduled for varicose vein stripping surgery were sedated with propofol and remifentanil during the surgery, after administration of midazolam. Target concentrations at the effect site of the two drugs were changed based on the patient's status. Respiratory support was applied in the order of oxygen supply, chin lift, and assisted mask ventilation. Target concentrations at the effect site of propofol and remifentanil, the need for respiratory support, and a six-point rating scale satisfaction score were the outcome measurements. RESULTS: Only one patient did not require oxygen, eight patients needed oxygen alone, 22 patients required use of the chin lift technique, and 20 patients were assisted with mask ventilation. There was no significant difference in the target concentration of propofol or remifentanil between the patients who required mask ventilation and those who did not. Fifty of the 51 patients reported a satisfaction score of 6. CONCLUSIONS: Although MAC using low target concentrations of propofol and remifentanil during vein stripping surgery was satisfactory to patients, close observation regarding the need for respiratory assistance was necessary.
Adult ; Anesthesia* ; Chin ; Deep Sedation ; Humans ; Masks ; Midazolam ; Oxygen ; Propofol* ; Prospective Studies* ; Respiration ; Respiratory Insufficiency ; Saphenous Vein* ; Varicose Veins ; Veins ; Ventilation

Background: and Purpose The Boston Autonomic Symptom Questionnaire (BASQ) is a quantitative tool using a numeric rating scale to assess the symptoms of systemic dysautonomia, including cardiovascular, gastrointestinal, urinary, sudomotor, vasomotor, and sexual functions. The aim of this study was to validate the Korean version of the BASQ (KBASQ). Methods: Prospectively enrolled subjects who submitted to autonomic function tests, including tests for cardiovagal, adrenergic, and sudomotor functions, also completed the KBASQ and the Korean version of the Orthostatic Grading Scale (KOGS), a validated questionnaire for assessing orthostatic symptoms.Twenty-eight subjects completed the KBASQ twice to assess test-retest reliability. We classified the subjects to dysautonomia or normal control group according to dysautonomic symptoms and the results of autonomic function tests. Results: This study enrolled 225 subjects aged 54.0±18.1 years (mean±standard deviation), with a male/female ratio of 1/1.03. The internal validity of the KBASQ was excellent (Cronbach’s α=0.922), and that of each of its subscales ranged from excellent to acceptable (Cronbach’s α=0.709–0.952). The test-retest reliability was good, with correlation coefficients ranging from 0.354 to 0.917. The subcategory scores for the KBASQ were significantly higher in the dysautonomia group than in the normal control group. There were significant correlations among the items in the KBASQ and KOGS. There was also a significant correlation between KBASQ scores and the results of the autonomic function tests. Conclusions The internal validity and reliability of the KBASQ were good, indicating that it may be a useful screening tool for the systematic evaluation of autonomic symptoms in patients with dysautonomia.

Purpose: This study compared maternal age at childbirth, the number of live births, and the weight of live births between Korean women and immigrant women using statistical data from the Republic of Korea for 2018. Methods: The analysis was conducted using data from the Microdata Integrated Service of Statistics Korea (https://mdis.kostat.go.kr/index.do). Results: Korean women and immigrant women showed a higher age at childbirth in 2018 than in 2008. The percentage of newborns of Korean women with a birth weight of less than 2.5 kg increased slightly for 3 consecutive years from 2016 to 2018, whereas for immigrant women, this percentage increased in 2017 compared to 2016 and then decreased again in 2018. Very low birth weight (less than 1.5 kg) became more common among immigrant women from 2016 to 2018. Birth at a gestational age of fewer than 37 weeks increased both among Korean and immigrant women from 2016 to 2018. In both groups, the percentage of women who had their first child within their first 2 years of marriage decreased from 2008 to 2018. Conclusion Immigrant women had higher birth rates than Korean women, while both groups showed an increasing trend in premature birth. Greater attention should be paid to the pregnancy and birth needs of immigrant women, and steps are needed to ensure health equity and access in order to prevent premature births. It is also necessary to identify factors that affect preterm birth and birth of very low birth weight infants among immigrant women in the future.