BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
Humans ; Informed Consent* ; Intensive Care Units* ; Korea ; Life Support Care ; Proxy ; Retrospective Studies ; Spouses ; Tertiary Care Centers ; Thorax ; Withholding Treatment

BACKGROUND: As bladder cancer is a superficial tumor with frequent recurrences, early detection and confirmation of recurrence are important. We evaluated the usefulness of NMP22 BladderChek (NMP22BC) for the diagnosis and monitoring of bladder cancer. METHODS: From July to December 2004, we enrolled in the study 670 patients who visited the urology clinic in Ewha Womans University, Dongdaemun Hospital with hematuria or dysuria and were tested with NMP22BC. We also performed the NMP22BC and BTA stat tests simultaneously in 21 patients and interference test in 10 patients. RESULTS: NMP22BC tests were negative in 97% of the patients who had been cured of bladder cancer and were positive in 95% of the patients with recurred bladder cancer. The diagnostic sensitivity, specificity, positive and negative predictive value, and efficiency were 95.0%, 91.5%, 25.7%, 99.8%, and 91.6%, respectively, with 8.5% false positive and 5% false negative rates. Fifty-five patients showed false positive in the NMP22BC test, the main cause of which was the presence of WBCs in urine. There was a good agreement between the NMP22BC and BTA stat tests (kappa agreement value, 0.5; P=0.008). According to the interference test, two patients with more than 3+ in leukocyte esterase results showed false positive in the NMP22BC test. CONCLUSIONS: NMP22BC test was simple to perform, rapid to produce the results, and useful in diagnosing a bladder cancer recurrence; the test shows a high efficiency with a high sensitivity, specificity, negative predictive value, and low false negative rate.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; Nuclear Matrix-Associated Proteins/*urine ; Nuclear Proteins/*urine ; Reagent Kits, Diagnostic ; Urinary Bladder Neoplasms/*diagnosis

PURPOSE: To assess the characteristics of bone metastasis from hepatocellular carcinoma and the radiation field arrangement based on imaging studies. MATERIALS AND METHODS: Fifty-three patients (84 lesions) with bone metastasis from a primary hepatocellular carcinoma completed palliative radiation therapy. All patients underwent one of following imaging studies prior to the initiation of radiation therapy: a bone scan, computed tomography or magnetic resonance imaging. The median radiation dose was 30 Gy (7~40 Gy). We evaluated retrospectively the presence of soft tissue formation and the adjustment of the radiation field based on the imaging studies. RESULTS: Soft tissue formation at the site of bony disease was identified from either a CT/MRI scan (41 lesions) or from a symptomatic palpable mass (5 lesions). The adjustment of the radiation field size based on a bone scan was necessary for 31 of 41 soft tissue forming lesions (75.6%), after a review of the CT/MRI scan. The median survival from the initial indication of a hepatoma diagnosis was 8 months (2 to 71 months), with a 2-year survival rate of 38.6%. The median survival from the detection of a bone metastasis was 5 months (1 to 38 months) and the 1-year overall survival rate was 8.7%. CONCLUSION: It was again identified that bone metastasis from a primary hepatocellular carcinoma is accompanied by soft tissue formation. From this finding, an adjustment of the radiation field size based on imaging studies is required. It is advisable to obtain a CT or MRI scan of suspected bone metastasis for better tumor volume coverage prior to the initiation of radiation therapy.
Carcinoma, Hepatocellular* ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Retrospective Studies ; Survival Rate ; Tumor Burden

Obesity is consistently increasing in prevalence and can trigger insulin resistance and type 2 diabetes. Many lines of evidence have shown that macrophages play a major role in inflammation associated with obesity. This study was conducted to determine metformin, a widely prescribed drug for type 2 diabetes, would regulate inflammation through down-regulation of scavenger receptors in macrophages from obesity-induced type 2 diabetes. RAW 264.7 cells and peritoneal macrophages were stimulated with LPS to induce inflammation, and C57BL/6N mice were fed a high-fat diet to generate obesity-induced type 2 diabetes mice. Metformin reduced the production of NO, PGE2 and pro-inflammatory cytokines (IL-1beta, IL-6 and TNF-alpha) through down-regulation of NF-kappaB translocation in macrophages in a dose-dependent manner. On the other hand, the protein expressions of anti-inflammatory cytokines, IL-4 and IL-10, were enhanced or maintained by metformin. Also, metformin suppressed secretion of TNF-alpha and reduced the protein and mRNA expression of TNF-alpha in obese mice as well as in macrophages. The expression of scavenger receptors, CD36 and SR-A, were attenuated by metformin in macrophages and obese mice. These results suggest that metformin may attenuate inflammatory responses by suppressing the production of TNF-alpha and the expressions of scavenger receptors.
Animals ; Cytokines ; Diet, High-Fat ; Dinoprostone ; Down-Regulation ; Hand ; Inflammation ; Insulin Resistance ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Macrophages, Peritoneal ; Metformin ; Mice ; Mice, Obese ; NF-kappa B ; Obesity ; Prevalence ; Receptors, Scavenger ; RNA, Messenger ; Tumor Necrosis Factor-alpha

BACKGROUND: It has been recently noticed that type 2 diabetes (T2D), one of the most common metabolic diseases, causes a chronic low-grade inflammation and activation of the innate immune system that are closely involved in the pathogenesis of T2D. Cordyceps militaris, a traditional medicinal mushroom, produces a component compound, cordycepin (3'-deoxyadenosine). Cordycepin has been known to have many pharmacological activities including immunological stimulating, anti-cancer, and anti-infection activities. The molecular mechanisms of cordycepin in T2D are not clear. In the present study, we tested the role of cordycepin on the anti-diabetic effect and anti-inflammatory cascades in LPS-stimulated RAW 264.7 cells. METHODS: We confirmed the levels of diabetes regulating genes mRNA and protein of cytokines through RT-PCR and western blot analysis and followed by FACS analysis for the surface molecules. RESULTS: Cordycepin inhibited the production of NO and pro-inflammatory cytokines such as IL-1beta, IL-6, and TNF-alpha in LPS-activated macrophages via suppressing protein expression of pro-inflammatory mediators. T2D regulating genes such as 11beta-HSD1 and PPARgamma were decreased as well as expression of co-stimulatory molecules such as ICAM-1 and B7-1/-2 were also decreased with the increment of its concentration. In accordance with suppressed pro-inflammatory cytokine production lead to inhibition of diabetic regulating genes in activated macrophages. Cordycepin suppressed NF-kappaB activation in LPS-activated macrophages. CONCLUSION: Based on these observations, cordycepin suppressed T2D regulating genes through the inactivation of NF-kappaB dependent inflammatory responses and suggesting that cordycepin will provide potential use as an immunomodulatory agent for treating immunological diseases.
11-beta-Hydroxysteroid Dehydrogenase Type 1 ; Agaricales ; Blotting, Western ; Cordyceps ; Cytokines ; Deoxyadenosines ; Immune System ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; Macrophages ; Metabolic Diseases ; NF-kappa B ; PPAR gamma ; RNA, Messenger ; Tumor Necrosis Factor-alpha

BACKGROUND: The accentuated nitric oxide (NO) release that is induced by the systemic inflammatory response associated with infective endocarditis (IE) and cardiopulmonary bypass (CPB) may result in catecholamine refractory hypotension (vasoplegia) and increased transfusion requirement due to platelet inhibition. Methylene blue (MB) is an inhibitory drug of inducible NO. We aimed to evaluate the effect of prophylactic MB administration before CPB on vasopressor and transfusion requirements in patients with IE undergoing valvular heart surgery (VHS). METHODS: Forty-two adult patients were randomly assigned to receive 2 mg/kg of MB (MB group, n = 21) or saline (control group, n = 21) for 20 min before the initiation of CPB. The primary end points were comparisons of vasopressor requirements serially assessed after weaning from CPB and hemodynamic parameters serially recorded before and after CPB. The secondary endpoint was the comparison of transfusion requirements. RESULTS: Two patients in the control group received MB after weaning from CPB due to norepinephrine and vasopressin refractory vasoplegia and were thus excluded. There were no significant differences in vasopressor requirements and hemodynamic parameters between the two groups. The mean number of units of packed erythrocytes transfused per transfused patient was significantly less in the MB group. The numbers of patients transfused with fresh frozen plasma and platelet concentrates were less in the MB group. CONCLUSIONS: In IE patients undergoing VHS, prophylactic MB administration before CPB did not confer significant benefits in terms of vasopressor requirements and hemodynamic parameters, but it was associated with a significant reduction in transfusion requirement.
Adult ; Blood Platelets ; Cardiopulmonary Bypass ; Endocarditis ; Erythrocytes ; Hemodynamics ; Humans ; Hypotension ; Methylene Blue ; Nitric Oxide ; Norepinephrine ; Plasma ; Thoracic Surgery ; Vasoplegia ; Vasopressins ; Weaning

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.
Anti-Bacterial Agents ; Bacterial Infections ; Burkholderia ; Burkholderia cepacia ; Ceftazidime ; Cystic Fibrosis ; Drug Resistance, Microbial ; Humans ; Immunocompromised Host ; Korea ; Leukopenia ; Lung ; Lung Diseases ; Lung Transplantation ; Opportunistic Infections ; Pneumonia ; Sepsis ; Sputum ; Thienamycins

BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.
Humans ; Informed Consent ; Intensive Care Units ; Korea ; Life Support Care ; Proxy ; Retrospective Studies ; Spouses ; Tertiary Care Centers ; Thorax ; Withholding Treatment

Objective: To generate a Korean version of the Oxford Cognitive Screen (K-OCS) and obtain cutoff scores that determine the impairment of each subdomain. Post-stroke cognitive impairment (PSCI) negatively impacts the rehabilitation process and independence in daily life. Its obscure manifestations require effective screening for appropriate rehabilitation. However, in most rehabilitation clinics, psychological evaluation tools for Alzheimer’s dementia have been used without such considerations. The OCS is a screening assessment tool for PSCI and vascular dementia that can evaluate the cognitive domains most often affected by stroke, including language, attention, memory, praxis, and numerical cognition. It comprises 10 subtasks and enables quick and effective cognitive evaluation. Methods: The K-OCS, which considers Korea’s unique cultural and linguistic characteristics, was developed with the approval and cooperation of the original author. Enrollment of participants without disabilities was announced at Duksung Women’s University, Yongin Sevrance Hospital, CHA Bundang Medical Center. The study was conducted between September 2020 and March 2022 on 97 male and female participants aged ≥30 years. Results: All the 97 participants completed the task. In this study, the 5th percentile score was presumed to be the cutoff value for each score, and the values are provided here. The cutoff score for each OCS subtask was similar to that of the original British version. Conclusion We suggest the usability of the K-OCS as a screening tool for PSCI by providing the cutoff value of each subtask.

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms/complications/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Recurrent Laryngeal Nerve/pathology ; Retrospective Studies ; Thoracic Diseases/*complications ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/complications ; Vocal Cord Paralysis/*etiology/*radiography