Subarachnoid hemorrhage (SAH) is a stroke subtype with high mortality and poor functional outcomes. Prompt occlusion of a ruptured aneurysm at an early stage is crucial to prevent rebleeding, which can result in even higher mortality and more severe disabilities. The most critical initial decision in SAH management is the choice of treatment method with surgical clipping or endovascular coiling. We aimed to develop an evidence-based clinical guideline to select the optimal initial treatment in patients with SAH. We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer two population, intervention, comparison, outcome questions comparing clipping and coiling. The risk of bias was assessed using ROB 2.0 and the Newcastle-Ottawa Scale. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcome and mortality. We included six randomized control trials (RCTs) and 58 observational studies. Meta-analysis of RCTs showed that coiling improved functional outcomes compared to clipping (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.86–0.97). No significant mortality difference was observed in RCTs (OR, 1.38; 95% CI, 0.91–2.09), but non-RCTs favored clipping for reduced mortality (OR, 0.77; 95% CI, 0.69–0.86). However, it is difficult to generalize these findings to all clinical situations, as patients with SAH have a highly variable clinical course. Final treatment decision should be tailored to the individual patient’s status, including aneurysm location, morphology, and the expertise available at the treatment center. Such decisions are best made by specialists such as a board-certified physician and should be explained to the patient and their caregivers, along with the rationale for selecting the most appropriate treatment at the given hospital. Korea has many certified endovascular neurosurgeons, cerebrovascular surgeons, and certified cerebrovascular centers. Proper selection of the most suitable treatment method by certified physicians and centers would greatly benefit patient outcomes and healthcare professionals.

Accurate and early identification of stroke and large vessel occlusion (LVO) in emergency settings is essential for improving patient outcomes and ensuring the efficient allocation of medical resources. This clinical practice guideline systematically reviews domestic and international literature and conducts meta-analyses to evaluate the utility and diagnostic accuracy of stroke assessment tools used in prehospital emergency medical services (EMS). We developed a guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted to evaluate the usefulness of diagnostic EMS assessment tools for diagnosing stroke and LVO. Overall, 70 non-randomized control studies were selected for this study. A meta-analysis was conducted with a subgroup analysis to distinguish between patients with stroke and those with LVO. EMS tools demonstrated high sensitivity but low specificity for diagnosing stroke. In the prehospital setting, using validated EMS stroke assessment tools is recommended for the early identification of stroke and LVO. Upon hospital arrival, stroke specialists should conduct further evaluation and triage to confirm the diagnosis and guide appropriate management. Delays in diagnosing LVO are frequently unacceptable. While experts advocate for the use of EMS assessment tools to facilitate early identification of LVO, these tools alone lack adequate sensitivity. Therefore, further diagnostic evaluations and consultation with stroke specialists upon hospital arrival are recommended.

The mothership (MS) model, where patients are directly transferred to a thrombectomy-capable center, and the drip-and-ship (DS) model, where thrombolysis is initiated at the nearest primary stroke center before transfer for thrombectomy, are the primary transport modes for patients with stroke. We aimed to establish guidelines for selecting the appropriate transfer strategy based on emergent large vessel occlusion (LVO). We developed this guideline based on evidence from systematic reviews and meta-analyses via a de novo process. A systematic literature review was conducted across four databases (MEDLINE, Embase, Cochrane, and KoreaMed) to answer three Population, Intervention, Comparison, and Outcome questions comparing MS and DS models. The risk of bias was assessed using the Newcastle-Ottawa Scale. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams and meta-analyses were generated for functional outcomes, mortality, and successful recanalization. Twenty-six non-randomized controlled studies showed that the MS model improved good functional outcomes by approximately 14% compared with the DS model (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00–1.30). Fifteen studies reported that mortality in the MS and DS models showed no significant differences (OR, 0.97; 95% CI, 0.84–1.11). Twenty-four studies revealed no significant difference in successful recanalization between the MS and DS models (OR, 0.87; 95% CI, 0.68–1.10). The MS model should be considered first to improve the functional outcome of patients with LVO. However, if thrombectomy cannot be performed immediately after thrombolysis, or if a thrombectomy-enabled hospital is not nearby, the DS model should be considered by stroke specialists depending on transportation time and regional factors. We suggest a mixed approach with the DS model based on specific circumstances or regions to ensure the optimum treatment of patients with acute ischemic stroke (AIS). Appropriate transport for patients with LVO improves the prognosis of AIS.

Background: Since the introduction of heated tobacco products (HTPs) in Korea in 2017, their annual sales have increased. Several studies have investigated the perceptions of HTPs and smoking cessation behaviors. For the first time, In 2019, questions focused on HTP use were introduced in the Korea National Health and Nutrition Examination Survey (KNHNES). This study aimed to compare smoking cessation behaviors between HTP users and conventional cigarette smokers using KNHANES data. Methods: Data of 947 current adult smokers from the 8th KNHNES (2019) were analyzed. Current smokers were divided into conventional cigarette (CC)–only, HTP-only, and dual-use groups. The general characteristics of the three groups were investigated. Differences in current intention to quit smoking and past attempts to quit smoking among the three groups were analyzed using multivariate logistic regression analysis by IBM SPSS ver. 25.0. Results: HTP-only users demonstrated fewer future smoking cessation plans (adjusted odds ratio [AOR], 0.398; 95% confidence interval [CI], 0.195–0.813; P=0.012) and fewer smoking cessation attempts in the past year (AOR, 0.533; 95% CI, 0.298–0.954; P=0.034) than CC-only smokers. However, there was no significant difference between dual-use (CC+HTP) and CC-only smokers. Conclusion While dual-use and CC-only smokers showed similar smoking cessation behaviors, HTP-only users had fewer previous attempts to quit smoking and were less likely to be currently ready to quit smoking. These findings can be explained by a decrease in the need to quit smoking due to the convenience of HTP and the perception that HTPs are less harmful than CC.

OBJECTIVE: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration.METHODS: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm).RESULTS: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1.CONCLUSION: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.
Adult ; Aneurysm ; Aneurysm, Dissecting ; Dilatation, Pathologic ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Natural History ; Rupture

Mounier-Kuhn syndrome (MKS) is a disease characterized by dilation of the trachea and mainstem bronchi. Due to the risk of airway leakage, pulmonary aspiration, and tracheal damage, MKS can be fatal in patients undergoing tracheal intubation. Moreover, MKS may not be diagnosed preoperatively due to its rarity. In this case, a patient undergoing neurosurgery was incidentally diagnosed with MKS during general anesthesia. During anesthesia induction, difficulties in airway management led the anesthesiologist to suspect MKS. Airway leakage was resolved in this case using oropharyngeal gauze packing. Anesthesiologists should be aware of the possibility of MKS and appropriate management of the airways.
Airway Management ; Anesthesia ; Anesthesia, General ; Bronchi ; Humans ; Intubation ; Intubation, Intratracheal ; Neurosurgery ; Trachea ; Tracheobronchomegaly

OBJECTIVE: To figure out the more optimal method for freezing and thawing the sperm, we compared with the sperm motility after handling of the sperm based on the different types of freezing and thawing methods. METHODS:Twenty four adult males who visited our infertility clinic from Aug 2004 to Feb 2005 were enrolled. We applied two kinds of freezing method to normal sperm according to WHO standard criteria; automatic slow freezing method (Auto) and manual vapor freezing method (Manu). We also use two different methods of thawing; a 37 degreesC warm water bath (37 degreesC) and 22 degreesC room temperature thawing (22 degreesC). Mean motile percent (MMP) was compared by the freezing methods and thawing methods respectively. We also evaluated the motility in four different ways of freezing and thawing combination. A written informed consent was obtained from each client. This study was approved by IRB. RESULTS: MMP by the freezing method was 56% in Auto group and 52% in Manu group. It was significantly different (P=0.037). In thawing method, it was 59% in 37 degreesC group and 49% in 22 degreesC group (P=0.000). Each of freezing and thawing methods was joined to make four different types of freezing and thawing combinations. In MMP there were 63% in Auto/37 degreesC, 50% in Auto/22 degreesC, 56% in Manu/37 degreesC and 48% in Manu/22 degreesC (P>0.05). CONCLUSION: The automatic method in freezing and room temperature in thawing showed respectively the highest MMP. In four different types of freezing and thawing combinations, Auto/37 degreesC MMP was the highest. There was no statistical difference. This means that all four types of freezing and thawing methods might be used clinically. If further study of larger population or comparison of fertility is done, we would have a better result.
Adult ; Baths ; Ethics Committees, Research ; Fertility ; Freezing ; Handling (Psychology) ; Humans ; Infertility ; Informed Consent ; Male ; Sperm Motility ; Spermatozoa ; Water

OBJECTIVE: To figure out the more optimal method for freezing and thawing the sperm, we compared with the sperm motility after handling of the sperm based on the different types of freezing and thawing methods. METHODS:Twenty four adult males who visited our infertility clinic from Aug 2004 to Feb 2005 were enrolled. We applied two kinds of freezing method to normal sperm according to WHO standard criteria; automatic slow freezing method (Auto) and manual vapor freezing method (Manu). We also use two different methods of thawing; a 37 degreesC warm water bath (37 degreesC) and 22 degreesC room temperature thawing (22 degreesC). Mean motile percent (MMP) was compared by the freezing methods and thawing methods respectively. We also evaluated the motility in four different ways of freezing and thawing combination. A written informed consent was obtained from each client. This study was approved by IRB. RESULTS: MMP by the freezing method was 56% in Auto group and 52% in Manu group. It was significantly different (P=0.037). In thawing method, it was 59% in 37 degreesC group and 49% in 22 degreesC group (P=0.000). Each of freezing and thawing methods was joined to make four different types of freezing and thawing combinations. In MMP there were 63% in Auto/37 degreesC, 50% in Auto/22 degreesC, 56% in Manu/37 degreesC and 48% in Manu/22 degreesC (P>0.05). CONCLUSION: The automatic method in freezing and room temperature in thawing showed respectively the highest MMP. In four different types of freezing and thawing combinations, Auto/37 degreesC MMP was the highest. There was no statistical difference. This means that all four types of freezing and thawing methods might be used clinically. If further study of larger population or comparison of fertility is done, we would have a better result.
Adult ; Baths ; Ethics Committees, Research ; Fertility ; Freezing ; Handling (Psychology) ; Humans ; Infertility ; Informed Consent ; Male ; Sperm Motility ; Spermatozoa ; Water