Objective: Glufosinate-containing herbicide is being used increasingly in agriculture. Its poisoning is a worldwide concern. This study assessed the ability of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring systems, and Sequential Organ Failure Assessment (SOFA) score to predict mortality in intensive care unit patients poisoned with glufosinate. Methods: This was a retrospective cohort study conducted from January 2001 to January 2019. The demographic factors, hemodynamic variables, and laboratory variables were compared in survivors and non-survivors. Using multivariate logistic analysis, the data for the total population were analyzed retrospectively to determine the factors associated with mortality. Significant predictive variables, PSS, APACHE II scoring system, and SOFA score were compared by analyzing the receiver operating characteristic curves. Results: Two hundred seventy-six patients (mean age, 56 years) were enrolled in this study. Of the 276 patients, 240 (87.0%) survived, and 36 (13.0%) died. The factors associated with mortality were a decreased mean arterial blood pressure, Glasgow Coma Scale, partial pressure of arterial oxygen/fraction of inspired oxygen, HCO3-, pH, and HCO3-, and an increased lactate, ammonia, C-reactive protein, PSS, SOFA score, and APACHE II score. Dyspnea, use of vasopressors, and application of mechanical ventilation were associated with mortality. In multivariate analysis, Glasgow Coma Scale<9, HCO3- <15.8 mmol/L, lactate>5.2 mmol/L, use of vasopressors, and application of mechanical ventilation were predictive of mortality. The areas under the curve and 95% confidence intervals for these indicators were 0.920 (0.834-0.981), 0.865 (0.792-0.923), and 0.824 (0.752-0.897) for the PSS, APACHE II, and SOFA, respectively. Conclusion The PSS can be used to predict in-hospital mortality and stratify the risk among glufosinate-poisoned patients.

Objective: Glufosinate-containing herbicide is being used increasingly in agriculture. Its poisoning is a worldwide concern. This study assessed the ability of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring systems, and Sequential Organ Failure Assessment (SOFA) score to predict mortality in intensive care unit patients poisoned with glufosinate. Methods: This was a retrospective cohort study conducted from January 2001 to January 2019. The demographic factors, hemodynamic variables, and laboratory variables were compared in survivors and non-survivors. Using multivariate logistic analysis, the data for the total population were analyzed retrospectively to determine the factors associated with mortality. Significant predictive variables, PSS, APACHE II scoring system, and SOFA score were compared by analyzing the receiver operating characteristic curves. Results: Two hundred seventy-six patients (mean age, 56 years) were enrolled in this study. Of the 276 patients, 240 (87.0%) survived, and 36 (13.0%) died. The factors associated with mortality were a decreased mean arterial blood pressure, Glasgow Coma Scale, partial pressure of arterial oxygen/fraction of inspired oxygen, HCO3-, pH, and HCO3-, and an increased lactate, ammonia, C-reactive protein, PSS, SOFA score, and APACHE II score. Dyspnea, use of vasopressors, and application of mechanical ventilation were associated with mortality. In multivariate analysis, Glasgow Coma Scale<9, HCO3- <15.8 mmol/L, lactate>5.2 mmol/L, use of vasopressors, and application of mechanical ventilation were predictive of mortality. The areas under the curve and 95% confidence intervals for these indicators were 0.920 (0.834-0.981), 0.865 (0.792-0.923), and 0.824 (0.752-0.897) for the PSS, APACHE II, and SOFA, respectively. Conclusion The PSS can be used to predict in-hospital mortality and stratify the risk among glufosinate-poisoned patients.

OBJECTIVES: Reduced heart rate variability (HRV) is one of the serious risk factors for heart diseases. We evaluated the acute and chronic effects of work-related factors on HRV. METHODS: The five-minute HRV of 85 male workers from an automobile assembly factory were measured at 9 A.M. (before-work) and at 5 P.M. (after-work). The workplace noise, temperature and physical workload levels were measured as work-related factors. We postulated that the HRV measured at beforework represents the chronic effects and the HRV measured at after-work represents the acute effects of work-related factors. We used generalized linear regression analysis with adjusting for the general characteristics and/or the morning HRV. RESULTS: The subjects exposed to noise or a hot environment showed increased HRV in the afternoon and decreased HRV in the morning. Machine oil and interpersonal conflict decreased the HRV in the morning, but other chemicals did not show any effect on the HRV. A physical workload decreased the HRV in both the morning and afternoon. CONCLUSION: The physical and chemical environment, psychosocial stress and a physical workload may affect the autonomic nerve system.
Automobiles ; Autonomic Pathways ; Heart ; Heart Diseases ; Heart Rate ; Humans ; Linear Models ; Male ; Noise ; Risk Factors

BACKGROUND: Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine. METHODS: Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats. RESULTS: The anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group. CONCLUSION: NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent.
Acetylcholine ; Animals ; Anticoagulants ; Aorta, Thoracic ; Apoptosis ; Baths ; Coronary Artery Bypass* ; Coronary Vessels* ; DNA Nucleotidylexotransferase ; Endothelial Cells ; Guanidines ; Human Umbilical Vein Endothelial Cells ; Mesylates* ; Necrosis ; Papaverine ; Perioperative Period ; Phenylephrine ; Rats ; Rats, Sprague-Dawley ; Relaxation ; Survival Rate ; Transplants ; Vasodilation

Cadmium ; Electronic Cigarettes ; Female ; Humans ; Korea ; Male ; Nutrition Surveys ; Odds Ratio ; Smoke ; Smoking ; Tobacco ; Tobacco Products

Background: The International Agency for Research on Cancer classifies 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) as a known carcinogen. This study aimed to investigate the association between exposure to secondhand smoke (SHS) and NNAL concentrations in non-smokers. Methods: This was a cross-sectional study based on data from the 2016 to 2018 Korea National Health and Nutrition Examination Survey. Urine NNAL concentrations were categorized into tertiles of 3,615 study participants who were non-smokers. All sampling and weight variables were stratified, and analyses to account for the complex sampling design were conducted. Results: The overall, male, and female percentages of SHS exposure among non-smokers were 22.4%, 29.2%, and 20.4%, respectively. The geometric means of urine NNAL concentrations were 1.896±0.098 pg/mL and 1.094±0.028 pg/mL in the SHS exposure and non-exposure groups, respectively. After adjusting for confounding variables, in the total group, the geometric mean of urine NNAL concentrations was significantly higher in the SHS exposure group than in the SHS non-exposure group (adjusted P-value <0.001). Compared with the non-exposure group, the adjusted odds ratios (95% confidence intervals) for the highest NNAL tertile group of overall SHS exposure in the total, men, and women groups were 2.44 (1.95–3.05), 1.65 (1.08–2.53), and 2.73 (2.11–3.52), respectively, after full adjustment. Conclusion The urine NNAL concentration in the SHS exposure group was significantly higher than that in the non-exposure group. Exposure to SHS was associated with a higher risk of elevated urine NNAL concentrations in non-smokers.

Background: Few studies have reported on the trends in influenza vaccination rates among cancer survivors in Korea. We investigated these trends over a recent 11-year period (2005–2015). Methods: Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) III– VI (2005–2015). After excluding individuals younger than 40 years of age, the participants included 2,210 cancer survivors (861 men and 1,349 women). We categorized these study participants into four groups according to age and sex. Results: The influenza vaccination rate decreased significantly among male cancer survivors, with rates of 74.8, 64.7, 56.2, and 55.2% (β coefficient=-0.257, P for trend <0.001) in KNHANES III, VI, V, and VI, respectively. While influenza vaccination rates decreased significantly among older male cancer survivors (≥65 years) (β coefficient=-0.359, P for trend=0.017), they increased among older female cancer survivors (β coefficient=0.375, P for trend=0.011) from 2005 to 2015. Conclusion Influenza vaccination rates in older cancer survivors significantly decreased in men but increased in women in successive KNHANES phases. Efforts are needed to improve immunization education and awareness, especially in older male cancer survivors.

BACKGROUND: We investigated the association between blood concentration of cadmium and smoking status including use of electronic cigarettes (E-cigars). METHODS: We used data from the Korea National Health and Nutritional Survey 2013 and 2016. A total of 4,744 participants (2,162 men and 2,582 women) were included and were categorized into five groups (Non-smokers, E-cigar non-users in past-smokers, E-cigar users in past-smokers, E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers). Cadmium blood concentration was categorized into tertiles. All sampling and weight variables were stratified, and analysis to account for the complex sampling design was conducted. RESULTS: In both genders, the geometric cadmium concentration was significantly different according to smoking status (both genders, analysis of variance P value < 0.001). In men, E-cigar users were significantly higher than the non-smokers (P value = past-smokers, 0.017; cigarette-smokers, < 0.001) when fully adjusted. Compared with non-smokers, fully-adjusted odds ratios (95% confidence intervals) for the highest cadmium tertiles of E-cigar non-users in cigarette-smokers and E-cigar users in cigarette-smokers were 6.56 (3.55–12.11) and 5.68 (1.96–16.50) in men and 2.74 (1.42–5.29) and 1.29 (0.10–17.44) in women. CONCLUSION Conventional cigarette smoking in men and women and E-cigar use in men are associated with higher risk of elevated blood cadmium level. Preventive management of cadmium exposure monitoring in conventional cigarette-smokers and E-cigar users may be needed.

Background: This study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea. Methods: Three e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited. Results: Of 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively. Conclusion This national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.

OBJECTIVES: Opioids are prescribed to treat moderate to severe pain. We investigated recent trends in opioid (morphine, oxycodone, fentanyl, and hydromorphone) prescriptions using data from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2015. METHODS: The morphine milligram equivalent (MME) was calculated to standardize the relative potency of opioids. The number (cases) or amount (MME) of annual opioid prescriptions per 10,000 registrants was computed to analyze trends in opioid prescriptions after age standardization. Joinpoint regression analysis was conducted to calculate the annual percentage change and average annual percentage change (AAPC). RESULTS: The number (cases) of prescriptions per 10,000 registrants increased from 0.07 in 2002 to 41.23 in 2015 (AAPC, 76.0%; 95% confidence interval [CI], 61.6 to 91.7). The MME per 10,000 registrants increased from 15.06 in 2002 to 40,727.80 in 2015 (AAPC, 103.0%; 95% CI, 78.2 to 131.3). The highest AAPC of prescriptions and MME per 10,000 registrants were observed in the elderly (60-69 years) and in patients treated at general hospitals. Fentanyl prescriptions increased most rapidly among the 4 opioids. CONCLUSIONS Consumption of opioids greatly increased in Korea over the 14-year study period.