Objectives: ：To describe the differences in long-term outcomes in Alzheimer’s disease (AD) patients according to initial dementia severity. Methods: ：A retrospective chart review of AD patients from a dementia clinic at the University Hospital in Korea was conducted from April 2010 to March 2017. There were 168 patients enrolled, who were divided into three groups based on initial Clinical Dementing Rating (CDR). There were 55 in the very mild group (CDR=0.5 ; mean age 80.64±6.57), 93 in the mild group (CDR=1 ; mean age 80.57±7.28) and 20 in the moderate group (CDR=2 ; mean age 83.00±9.07). Participants were treated with donepezil±memantine. The observation period was 2.44±0.50 years. Cognitive function and severity of dementia were initially assessed by the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Assessment Battery (CERAD-NP) and were annually assessed by Mini-Mental State Exam (MMSE), CDR and CDR-Sum of boxes (CDR-SB). Results: ：The annual decline rate of MMSE score was -0.82 and those of very mild, mild, moderate groups were -0.63, -0.80, -1.96 respectively, while the annual change in CDR-SB score was 0.98, very mild group 0.86, mild group 1.03, moderate group 1.26. Education level, male, initial CDR were found to be significant potential factors in the annual change in MMSE, while initial CDR was a significant potential factor in the annual change in CDR-SB. Conclusion ：It is meaningful that we studied long-term outcomes of anti-dementia medications in real-world clinical setting. The higher the initial severity of AD, the higher the cognitive decline rate.

OBJECTIVES: Heart rate variability (HRV) has gained recognition as a noninvasive marker of autonomic activity. HRV is considered a promising tool in various clinical scenarios. The optimal electrocardiogram (ECG) sampling frequency required to ensure sufficient precision of R–R intervals for HRV analysis has not yet been determined. Here, we aimed to determine the acceptable ECG sampling frequency range by analyzing ECG signals from patients who visited an emergency department with the chief complaint of acute intoxication or overdose. METHODS: The study included 83 adult patients who visited an emergency department with the chief complaint of acute poisoning. The original 1,000-Hz ECG signals were down-sampled to 500-, 250-, 100-, and 50-Hz sampling frequencies with linear interpolation. R–R interval data were analyzed for time-domain, frequency-domain, and nonlinear HRV parameters. Parameters derived from the data on down-sampled frequencies were compared with those derived from the data on 1,000-Hz signals, and Lin's concordance correlation coefficients were calculated. RESULTS: Down-sampling to 500 or 250 Hz resulted in excellent concordance. Signals down-sampled to 100 Hz produced acceptable results for time-domain analysis and Poincaré plots, but not for frequency-domain analysis. Down-sampling to 50 Hz proved to be unacceptable for both time- and frequency-domain analyses. At 50 Hz, the root-mean-squared successive differences and the power of high frequency tended to have high values and random errors. CONCLUSIONS: A 250-Hz sampling frequency would be acceptable for HRV analysis. When frequency-domain analysis is not required, a 100-Hz sampling frequency would also be acceptable.
Adult ; Electrocardiography* ; Emergencies ; Emergency Service, Hospital ; Heart Rate* ; Heart* ; Humans ; Poisoning ; Signal Processing, Computer-Assisted

OBJECTIVES: This study analyzed the incidence and characteristics of in-hospital cardiac arrest (IHCA) in Korea based on a sample group of patients that is representative of the population. METHODS: The incidence of IHCA in adults was extracted from HIRA-NIS-2009, a sample of all patients using medical services in Korea. IHCA patients were analyzed according to gender, age, type of medical institute, and classification under the 6th revision of the Korean Standard Classification of Diseases (KCD-6). In addition, to assess the differences arising from the size of medical institutes, the IHCA incidence was analyzed in relation to the number of inpatient beds. RESULTS: Based on the sample data, the total incidence of IHCA in Korea was found to be 2.46 per 1,000 admissions (95% confidence interval [CI], 2.37–2.55). A higher incidence was found among men at 3.18 (95% CI, 3.03–3.33), compared to women at 1.84 (95% CI, 1.74–1.94). The incidence of IHCA was also higher in hospitals that had more than 600 inpatients beds at 5.40 (95% CI, 5.16–5.66) in comparison to those that had less than 600 inpatients beds at 4.09 (95% CI, 3.76–4.36) (p < 0.001). By primary disease, the incidence was the highest for infectious diseases. CONCLUSIONS: We demonstrated that the IHCA incidence based on gender, age, diagnostic group, and number of beds could be analyzed using the insurance claim data from a national representative sample.
Academies and Institutes ; Adult* ; Cardiopulmonary Resuscitation ; Classification ; Communicable Diseases ; Epidemiology ; Female ; Heart Arrest* ; Humans ; Incidence* ; Inpatients ; Insurance ; Korea* ; Male ; National Health Programs

OBJECTIVES: The purpose of this study was to estimate the distribution and exposure prevalence of total carbohydrate intake and the carbohydrate-based foods such as rice, noodles, sweet potatoes, sweet drinks, milk and fruits and to characterize intake patterns among obese Korean adults. METHODS: Subjects included 137,363 adults aged 40 years or older who participated in a Health Examinees (HEXA) Study. Multiple regression analysis of data from Semi-Quantitative Food Frequency Questionnaire (SQFFQ) identified food sources of carbohydrates. Weight, height and waist circumstance (WC) were measured, and the body mass index (BMI) was calculated. Obesity was defined as BMI ≥ 25 kg/m2 and abdominal obesity as WC ≥ 90 cm and ≥ 85 cm for males and females, respectively. RESULTS: Obese adults appeared to have a higher total carbohydrate intake in the univariate analysis but had eaten less after adjustment for general and lifestyle factors, compared to normal weight adults (OR 0.78, 95% CI 0.73-0.82 for general obesity; OR 0.79, 95% CI 0.74-0.85, for abdominal obesity; P trend < 0.0001, respectively). Based on advance analysis for the food sources of carbohydrates, obese subjects had lower intake of rice (OR 0.86, 95% CI 0.68 -1.09 for general obesity; OR 0.87, 95% CI 0.67-1.13, for abdominal obesity; P trend < 0.0001, respectively) and higher intake of noodles (OR 1.21, 95% CI 1.16-1.27 for general obesity; OR 1.25, 95% CI 1.19-1.32, for abdominal obesity; P trend < 0.0001 respectively). With regard to other food sources of carbohydrates such as milk and fruits, intake was lower among obese compared to normal weight subjects. CONCLUSIONS: In the Korean middle-aged and older obesity groups, the intake of carbohydrates and the related foods was lower than in normal weight subjects, except for noodles. We conclude that a higher intake of noodles may enhance weight-gain. Therefore, this study suggested that the guidelines should consider the types of carbohydrate sources and the amount consumed from foods in order to provide proper guidance with regard to control and prevent obesity among Korean adults.
Adult* ; Body Mass Index ; Carbohydrates ; Eating* ; Female ; Fruit ; Humans ; Ipomoea batatas ; Life Style ; Male ; Milk ; Obesity ; Obesity, Abdominal ; Prevalence*

OBJECTIVE: To evaluate endothelin-1 (ET-1) expression in the villous explants from normal and preeclamptic (PE) placentae under hypoxic condition. METHODS: Villous explants from normal (n=5) and PE (n=4) placentae were obtained. To obtain hypoxic culture condition, villous explants were cultured in hypoxic chamber or treated with deferoxamine (DFO). ET-1 mRNA expressions in villous explants were evaluated by RT-PCR following 0, 24, and 48 h of culture in hypoxic chamber, and 0, 2, 4, 6 h following DFO treatment. ET-1 protein levels in media were measured by enzyme immunoassay. RESULTS: After 24 and 48 hours of incubation of villous explants from normal and PE placentae in hypoxic chamber, ET-1 mRNA and protein levels were increased in both groups, however, ET-1 production seemed to be more exaggerated in the villous explants from PE placentae. During 6 h of DFO exposure, ET-1 mRNA level was increased in the villous explants from PE placenta comparing to those from normal placentae (p<0.05). Interestingly, the increase of ET-1 mRNA expression in the villous explants from PE placentae was more exaggerated than those from normal placentae. Concordantly, increments of protein level between 0 to 2 h and 2 to 4 h were significantly higher in villous explants from PE placentae (p<0.05). CONCLUSION: ET-1 mRNA and protein were increased in villous explants from PE placentae compared to those from normal placentae under hypoxic condition. Furthermore, villous explants from PE placentae showed upregulated ET-1 expression upon hypoxic stimulation. This enhanced sensitivity to hypoxia may contribute to ET-1 overexpression in PE placenta in vivo and it needs further investigation for clarification.
Anoxia ; Deferoxamine ; Endothelin-1* ; Immunoenzyme Techniques ; Placenta ; Pre-Eclampsia ; Pregnancy* ; RNA, Messenger

Purpose: This study is aimed to examine the association between initial enteral nutrition (EN) and the clinical prognosis among patients with severe and multiple traumatic injuries, and to investigate whether this association is modified by the patients’ catabolic status. Methods: This was a retrospective study of 302 adult patients with severe and multiple traumatic injuries admitted between January 2017 and September 2020 at Ajou University hospital in Suwon, Korea. The initial nutritional support by EN and parenteral nutrition were monitored up to day 7 after admission. Patients were classified into “No”, “Low”, and “High” EN groups according to the level of initial EN. Multivariable-adjusted logistic regression and linear regression models were used to estimate the association of the initial EN levels at hospital admission with the risk of mortality, morbidities, and levels of nutrition-associated biochemical markers. Results: High EN support was associated with reduced mortality (odds ratio, 0.07; 95% confidence interval [CI], 0.02, 0.32) and lower levels of C-reactive protein (β, −0.22; 95% CI, −8.66, 1.48), but longer stay in the intensive care unit (β, 0.19; 95% CI, 1.82, 11.32). In analyses stratified by catabolic status, there were fewer incidences of hospital-acquired infections with increasing EN levels in the moderate or higher nitrogen balance group than in the mild nitrogen balance group. Conclusion Our observation of the inverse association between levels of initial EN administration with mortality risk and inflammatory markers may indicate the possible benefits of active EN administration to the recovery process of severe and multiple trauma patients. Further studies are warranted on whether the catabolic status modifies the association between the initial EN and prognosis.

BACKGROUND: Although physical activity is known to be beneficial to lung function, few studies have been conducted to investigate the correlation between physical activity and lung function in dusty areas. Therefore, the purpose of this study is to investigate the correlation between physical activity and lung function in a Korean cohort including normal and COPD-diagnosed participants. METHODS: Data obtained from the COPD in dusty areas (CODA) cohort was analyzed for the following factors: lung function, symptoms, and information about physical activity. Information on physical activity was valuated using questionnaires, and participants were categorized into two groups: active and inactive. The evaluation of the mean lung function, modified Medical Research Council dyspnea grade scores, and COPD assessment test scores was done based on the participant physical activity using a general linear model after adjusting for age, sex, smoking status, pack-years, height, and weight. In addition, a stratification analysis was performed based on the smoking status and COPD. RESULTS: Physical activity had a correlation with high forced expiratory volume in 1 second (FEV₁) among CODA cohort (p=0.03). While the active group exhibited significantly higher FEV₁ compared to one exhibited by the inactive group among past smokers (p=0.02), no such correlation existed among current smokers. There was no significant difference observed in lung function after it was stratified by COPD. CONCLUSION This study established a positive correlation between regular physical activity in dusty areas and lung function in participants.

Objectives: The study aims to investigate the influence of oral health service experience on oral health behavior of North Korean defectors and contribute to the development and implementation of oral health education among this population. Methods: A self-reporting questionnaire survey was conducted with 161 North Korean defectors in Hanawon from April, 2015 to September, 2015. Of these participants, 50 were excluded owing to insufficient questionnaire data. The questionnaire was developed based on the WHO’s Oral Health Survey (OHS) and the Korean National Oral Health Survey (KNOHS). Three categories were included in the questionnaire: demographic characteristics, dental service experience in North Korea, and oral health behavior. Results: Males had higher levels of perceived oral health compared to females, with differences according to the region they are from in North Korea. Those who received tooth brushing instruction in North Korea showed a greater tendency to practice tooth brushing after lunch, while those who received oral health examination showed a higher level of use of oral rinses. Further, the experience of dental scaling significantly influenced both practicing tooth brushing after lunch and use of oral rinses. Conclusions This study confirmed that the previous experience of oral health service in North Korea positively influenced current oral health behavior of North Korean defectors. Continued oral health education can enhance their oral health behavior, oral health, and quality of life. Thus, it is suggested that policies and oral health education should be developed according to their characteristics and oral health service experience in North Korea.

Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.