Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.

Objective: Doctors or public health doctors at the nearest institution to a disaster scene often have to treat the casualties at the scene. Therefore, disaster medical education is necessary for medical students and doctors, but such education is not properly implemented. This study investigated the status of disaster medical education in Korean medical schools and the professors' thoughts on the appropriateness and necessity of disaster medical education. Methods: A survey was conducted on working-level professors in charge of student education in emergency medicine in 40 medical schools. The survey asked the professors the current status of disaster medical education at each school and the professors' thoughts on the appropriateness and necessity of disaster medical education. Results: Thirty-seven professors (92.5%) responded to the survey. Twenty-seven schools (73.0%) had a regular curriculum of disaster medicine. Disaster drills were conducted at 34 training hospitals (91.9%), while students of 10 schools (29.4%) were officially participating in the drill. Of the responders, 31 (83.8%) responded that disaster medicine is necessary for clinicians. Thirty-seven professors (100%) thought disaster medical education was necessary for medical students, and 20 (54.1%) of them responded that their schools did not provide adequate disaster medical education. Conclusion Many schools did not have a proper course on disaster medical education. Disaster medical education is necessary for medical students, but such education is not properly implemented.

Objective: Doctors or public health doctors at the nearest institution to a disaster scene often have to treat the casualties at the scene. Therefore, disaster medical education is necessary for medical students and doctors, but such education is not properly implemented. This study investigated the status of disaster medical education in Korean medical schools and the professors' thoughts on the appropriateness and necessity of disaster medical education. Methods: A survey was conducted on working-level professors in charge of student education in emergency medicine in 40 medical schools. The survey asked the professors the current status of disaster medical education at each school and the professors' thoughts on the appropriateness and necessity of disaster medical education. Results: Thirty-seven professors (92.5%) responded to the survey. Twenty-seven schools (73.0%) had a regular curriculum of disaster medicine. Disaster drills were conducted at 34 training hospitals (91.9%), while students of 10 schools (29.4%) were officially participating in the drill. Of the responders, 31 (83.8%) responded that disaster medicine is necessary for clinicians. Thirty-seven professors (100%) thought disaster medical education was necessary for medical students, and 20 (54.1%) of them responded that their schools did not provide adequate disaster medical education. Conclusion Many schools did not have a proper course on disaster medical education. Disaster medical education is necessary for medical students, but such education is not properly implemented.

BACKGROUND AND OBJECTIVES: This trial evaluated the safety and efficacy of the Genoss drug-eluting coronary stent. METHODS: This study was a prospective, multicenter, randomized trial with a 1:1 ratio of Genoss drug-eluting stent (DES)™ and Promus Element™. Inclusion criteria were the presence of stable angina, unstable angina, or silent ischemia. Angiographic inclusion criteria were de novo coronary stenotic lesion with diameter stenosis >50%, reference vessel diameter of 2.5–4.0 mm, and lesion length ≤40 mm. The primary endpoint was in-stent late lumen loss at 9-month quantitative coronary angiography follow-up. Secondary endpoints were in-segment late lumen loss, binary restenosis rate, death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis during 9 months of follow-up. RESULTS: We enrolled 38 patients for the Genoss DES™ group and 39 patients for the Promus Element™ group. In-stent late lumen loss at 9 months was not significantly different between the 2 groups (0.11±0.25 vs. 0.16±0.43 mm, p=0.567). There was no MI or stent thrombosis in either group. The rates of death (2.6% vs. 0%, p=0.494), TLR (2.6% vs. 2.6%, p=1.000), and TVR (7.9% vs. 2.6%, p=0.358) at 9 months were not significantly different. CONCLUSION: This first-in-patient study of the Genoss DES™ stent showed excellent angiographic outcomes for in-stent late lumen loss and major adverse cardiac events over a 9-month follow-up.
Angina, Stable ; Angina, Unstable ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Ischemia ; Mortality ; Myocardial Infarction ; Polymers* ; Prospective Studies ; Sirolimus ; Stents* ; Thrombosis

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papilloma virus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The combination test (cytology with HPV test) is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within ten years (recommendation D).
Developed Countries ; Female ; Humans ; Incidence ; Korea ; Mass Screening* ; Papanicolaou Test ; Papilloma ; Uterine Cervical Neoplasms*

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).
Adult ; Age Factors ; Aged ; Early Detection of Cancer/adverse effects/*methods/standards ; Evidence-Based Medicine ; False Positive Reactions ; Female ; Humans ; Hysterectomy ; Middle Aged ; Papillomavirus Infections/diagnosis ; Papillomavirus Vaccines ; Patient Selection ; Pregnancy ; Pregnancy Complications, Neoplastic/diagnosis ; Republic of Korea ; Review Literature as Topic ; Uterine Cervical Neoplasms/*diagnosis ; Vaginal Smears/adverse effects/methods/standards ; Young Adult

West Nile virus (WNV) is the most widespread arbovirus in the world. It can cause serious or fatal central nervous system (CNS) infection. We present a case of 58-year-old man who developed neuropsychologic and psychiatric impairment such as cognitive impairment, depressive symptoms, health concerns and thought disorder after West Nile virus encephalitis. This is the first imported case of West Nile virus infection in Korean.
Arboviruses ; Central Nervous System ; Depression ; Encephalitis* ; Humans ; Middle Aged ; Neuropsychological Tests ; West Nile virus*

PURPOSE: Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy. METHODS: We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels. RESULTS: No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups. CONCLUSION: Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Follow-Up Studies ; Humans ; Hyperthyroidism ; Iodine ; Osteoporosis ; Prevalence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

OBJECTIVE: The purpose is to study the natural course and clinical feature according to thyroid function at diagnosis of Hashimoto's thyroiditis in children and adolescent. We studied to know the difference of clinical finding and change of thyroid autoantibody titers between Hashitoxicosis and typical Hashimoto's thyroiditis. METHODS: We analyzed retrospectively clinical data in 55 patients diagnosed as Hashimoto's thyroiditis. 47 were followed for more than 2 years and they were classified into euthyroid, compensated hypothyroidism, overt hypothyroidism, and hyperthyroidism according to thyroid hormone status at diagnosis. We investigated age, family history, initial thyroid function, initial thyroid autoantibody titers, changes of thyroid function, and changes of thyroid autoantibody titers. RESULTS: At diagnosis, 10 of 47 patients were in euthyroid, 17 in compensated hypothyroidism, 17 in overt hypothyroidism and 3 in hyperthyroidism. There was no statistically significant difference in the clinical data among the 4 groups of patients. Among the 47 patients, 4 patients had presented Hashitoxicosis. These patients' characteristics were similar to the patients with typical Hashimoto's thyroiditis. They had variable duration of hyperthyroidism range from 3 months to 5 years. It was possible to observe the rise of autoantibody titers from the patients with Hashitoxicosis when thyroid function was shifted to hypothyroidism. However it was not statistically significant. CONCLUSION: The clinical progress of Hashimoto's thyroiditis and hashitoxicosis varied widely. It is necessary to conduct more researches on the occurrence of Hashitoxicosis and the association with the change of autoantibodies on the patients with Hashimoto's thyroiditis.
Adolescent ; Autoantibodies ; Child ; Follow-Up Studies ; Hashimoto Disease ; Humans ; Hyperthyroidism ; Hypothyroidism ; Retrospective Studies ; Thyroid Gland ; Thyroiditis

On page 173, the incorrect image which was not submitted by the author was mistakenly printed for Fig. 5 by a system error of the editing company.