Purpose: This study aimed to identify the factors that influence hospital admission in patients presenting with simple generalized weakness in the emergency department (ED). Methods: We retrospectively analyzed the characteristics and factors affecting hospital admission of patients who visited the ED with simple generalized weakness as their chief complaint between January 1, 2021 and December 31, 2023. Results: Among patients presenting with simple generalized weakness, 47.8% required hospitalization. Of these hospitalized patients, 4.0% were admitted to the intensive care unit. Admission was significantly more likely in patients aged 65 years or older, those who arrived by ambulance and in those classified as socially vulnerable. Conclusion Patients aged 65 years or older, those transported by ambulance, and individuals from socially vulnerable groups had significantly higher odds of hospital admission when presenting with simple generalized weakness in the ED.In assessing patients who present to the ED with simple generalized weakness, incorporating these factors alongside current emergency triage tools may improve the accuracy of patient assessment, particularly in situations where existing tools show limitations.

Purpose: This study examined the effect of the 3 months use of weekly teriparatide on fracture healing, complications, quality of life improvement, and change in bone turnover markers on postmenopausal osteoporotic vertebral fracture patients who received percutaneous balloon kyphoplasty. Materials and Methods: Using a retrospective study design, 64 patients with osteoporotic vertebral fractures with T-scores≤-2.5, and anterior vertebral compression rates ≥30% were included in this study. 19 patients received weekly teriparatide for three months after kyphoplasty (TPTD group) and 45 patients received calcium and vitamin D supplements (control group). The changes in the anterior vertebral compression rate, rate of adjacent vertebral fracture, visual analogue scale/Oswestry Disability Index (VAS/ODI) score, and bone turnover markers were analyzed statistically. Results: The changes in anterior vertebral compression rate showed significant differences at the 1-month (p=0.002) and 6-month followup (p<0.05, t-test, and two-way mixed ANOVA). The VAS scores showed a significant difference at the 3-month and 6-month followup (p<0.05). The ODI score showed a significant difference at the 3-month and 6-month period (p<0.05). An adjacent vertebral fracture occurred 18.8% (3 cases) in the TPTD group, and 21.6% (8 cases) in the control group, respectively (odds ratio=0.87). Osteocalcin showed a significant difference at 6 month (p=0.04). Conclusion Weekly teriparatide after percutaneous balloon kyphoplasty has beneficial effects on vertebral body height loss, pain, quality of life improvement, and bone formation.

Objective: Anosognosia is a common phenomenon in individuals with dementia. Anosognosia Questionnaire for dementia (AQ-D) is a well-known scale for evaluating anosognosia. This study aimed to establish a Korean version of the AQ-D (AQ-D-K) and to evaluate the reliability and validity of the AQ-D-K in patients with Alzheimer’s disease (AD) dementia. Methods: We translated the original English version of AQ-D into Korean (AQ-D-K). Eighty-four subjects with very mild or mild AD dementia and their caregivers participated. Reliability of AQ-D-K was assessed by internal consistency and one-month test-retest reliability. Construct validity and concurrent validity were also evaluated. Results: Internal consistencies of the AQ-D-K patient form and caregiver form were high (Cronbach alpha 0.95 and 0.93, respectively). The test-retest reliability of AQ-D-K measured by intra-class correlation coefficient was 0.84. Three factors were identified: 1) anosognosia of instrumental activity of daily living; 2) anosognosia basic activity of daily living; and 3) anosognosia of depression and disinhibition. AQ-D-K score was significantly correlated with the clinician-rated anosognosia rating scale (ARS), center for epidemiological studies-depression scale (CES-D) and state-trait anxiety inventory (STAI). Conclusion The findings suggest that the AQ-D-K is a reliable and valid scale for evaluating anosognosia for AD dementia patients using Korean language.

Objective: Anosognosia is a common phenomenon in individuals with dementia. Anosognosia Questionnaire for dementia (AQ-D) is a well-known scale for evaluating anosognosia. This study aimed to establish a Korean version of the AQ-D (AQ-D-K) and to evaluate the reliability and validity of the AQ-D-K in patients with Alzheimer’s disease (AD) dementia. Methods: We translated the original English version of AQ-D into Korean (AQ-D-K). Eighty-four subjects with very mild or mild AD dementia and their caregivers participated. Reliability of AQ-D-K was assessed by internal consistency and one-month test-retest reliability. Construct validity and concurrent validity were also evaluated. Results: Internal consistencies of the AQ-D-K patient form and caregiver form were high (Cronbach alpha 0.95 and 0.93, respectively). The test-retest reliability of AQ-D-K measured by intra-class correlation coefficient was 0.84. Three factors were identified: 1) anosognosia of instrumental activity of daily living; 2) anosognosia basic activity of daily living; and 3) anosognosia of depression and disinhibition. AQ-D-K score was significantly correlated with the clinician-rated anosognosia rating scale (ARS), center for epidemiological studies-depression scale (CES-D) and state-trait anxiety inventory (STAI). Conclusion The findings suggest that the AQ-D-K is a reliable and valid scale for evaluating anosognosia for AD dementia patients using Korean language.

Arrhythmias occurring during surgery are mostly benign and improve without special treatment, but sometimes life threatening and poor vital signs may require immediate antiarrhythmic or electrotherapy. In some cases, permanent arrhythmias may require continued treatment after surgery. A cardiac event occurred to a 28-year-old man who underwent Bile duct resection/Roux-en-Y hepaticojejunostomy due to cholelithiasis with cholecystitis and choledocholithiasis. He diagnosed mental retardation level 2. Pre-operation laboratory test is normal except liver function test (AST 64, ALT 141). Electrocardiography shows 57 bpm heart rate, sinus rhythm, first degree AV block and long corrected QT interval that was checked 462ms and echocardiography shows LVEF 67%, normal echocardiogram. When we prepared extubation after finishing operation, Sugammadex 200mg was injected. Suddenly, patient’s oxygen saturation was low at 85%. We started manual ventilation for oxygenation and saturation was increased at 100%. When we extubated endotracheal tube, his ECG changed NSR to idiopathic VT. Firstly we considered that is PSVT and infused adenosine 6mg twice and 12mg once. But arrhythmia was continuous and vital sign changed unstable. We performed reintubation and defibrillated at 200J. After defibrillation, arrhythmia converted sinus rhythm. We transferred the patient to the ICU and evaluated further to see if the patient had heart problems. During admission in ICU, attending surgeon tried to extubate endotracheal tube 2 more times. But, Idiopathic VT occurred whenever try to extubate. Finally, in the fourth attempt, extubation without occurrence of VT succeeded with continuous IV esmolol and dexmedetomidine.

Arrhythmias occurring during surgery are mostly benign and improve without special treatment, but sometimes life threatening and poor vital signs may require immediate antiarrhythmic or electrotherapy. In some cases, permanent arrhythmias may require continued treatment after surgery. A cardiac event occurred to a 28-year-old man who underwent Bile duct resection/Roux-en-Y hepaticojejunostomy due to cholelithiasis with cholecystitis and choledocholithiasis. He diagnosed mental retardation level 2. Pre-operation laboratory test is normal except liver function test (AST 64, ALT 141). Electrocardiography shows 57 bpm heart rate, sinus rhythm, first degree AV block and long corrected QT interval that was checked 462ms and echocardiography shows LVEF 67%, normal echocardiogram. When we prepared extubation after finishing operation, Sugammadex 200mg was injected. Suddenly, patient’s oxygen saturation was low at 85%. We started manual ventilation for oxygenation and saturation was increased at 100%. When we extubated endotracheal tube, his ECG changed NSR to idiopathic VT. Firstly we considered that is PSVT and infused adenosine 6mg twice and 12mg once. But arrhythmia was continuous and vital sign changed unstable. We performed reintubation and defibrillated at 200J. After defibrillation, arrhythmia converted sinus rhythm. We transferred the patient to the ICU and evaluated further to see if the patient had heart problems. During admission in ICU, attending surgeon tried to extubate endotracheal tube 2 more times. But, Idiopathic VT occurred whenever try to extubate. Finally, in the fourth attempt, extubation without occurrence of VT succeeded with continuous IV esmolol and dexmedetomidine.

Objectives: The Korea Centers for Disease Control and Prevention has published “A Guideline for Unknown Disease Outbreaks (UDO).” The aim of this report was to introduce tabletop exercises (TTX) to prepare for UDO in the future. Methods: The UDO Laboratory Analyses Task Force in Korea Centers for Disease Control and Prevention in April 2018, assigned unknown diseases into 5 syndromes, designed an algorithm for diagnosis, and made a panel list for diagnosis by exclusion. Using the guidelines and laboratory analyses for UDO, TTX were introduced. Results: Since September 9th , 2018, the UDO Laboratory Analyses Task Force has been preparing TTX based on a scenario of an outbreak caused by a novel coronavirus. In December 2019, through TTX, individual missions, epidemiological investigations, sample treatments, diagnosis by exclusions, and next generation sequencing analysis were discussed, and a novel coronavirus was identified as the causal pathogen. Conclusion Guideline and laboratory analyses for UDO successfully applied in TTX. Conclusions drawn from TTX could be applied effectively in the analyses for the initial response to COVID-19, an ongoing epidemic of 2019 - 2020. Therefore, TTX should continuously be conducted for the response and preparation against UDO.

Objectives: This study surveyed the quality of the residency training program and clinical competence of Korean psychiatry residents and psychiatrists. Methods: Questionnaires regarding the quality of residency training and clinical competence were administered to Korean psychiatry residents (n=102) and psychiatrists (n=157). The authors analyzed the quality of training education according to the training environment and the correlation between the quality of training and the self-assessment competence level. Results: The average score of the quality of training evaluated by the residents (n=102) was 3.57 (±1.00). Groups with more than or equal to three residents (annual) scored higher (3.69±1.03) than the groups with less than or equal to two residents (3.52±0.99). Groups with more than or equal to seven teaching psychiatrists scored higher (3.42±1.03) than the groups with less than or equal to six teaching psychiatrists (3.42±1.03). The quality of training and self-assessment competence showed a significant static correlation in the residents (R2=0.488, p<0.01) and psychiatrists (R2=0.508, p<0.01). Conclusion This study shows that the quality of residency education varies according to the clinical area and the environment. The importance of training education is emphasized by the static correlation between the quality of education and clinical competence.

BACKGROUND/AIMS: Because there is a lack of effective biomarkers, we aimed to discover proteomic candidate markers for hepatocellular carcinoma (HCC) in cirrhotic patients at the highest-risk of HCC, and to validate the markers. METHODS: We collected tumor tissue from 5 cirrhotics with HCC, and from 5 cirrhotics without HCC, who underwent liver resection or transplantation. These tissue samples were analyzed by 2-dimensional difference gel electrophoresis coupled with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and potential markers were validated at the transcriptional and translational levels. We also performed western blot assays using other blood samples from 10 cirrhotics with HCC and 10 without HCC. RESULTS: Among the 66 distinguishable spots on 2-D gel images, we identified 15 proteins overexpressed more than 1.5 fold in terms of volume ratio in the tumors. Ten of the over-expressed proteins were identified by MALDI-TOF MS; of those, only methionine adenosyltransferase 1 (MAT1), a protein specific for liver, and acyl-CoA dehydrogenase were significantly up-regulated in tumors in further immunoblotting analyses (Ps<0.05). There was no between-pair difference in MAT1 mRNA measured by real-time polymerase chain reaction (P=0.96). However, in western blots of serum samples, distinct MAT1 bands were observed in all 10 HCC patients, but in only 2 of the non-HCC patients. CONCLUSIONS: MAT1 is a potential marker for surveillance in cirrhotic patients with and without prior HCC.
Acyl-CoA Dehydrogenase ; Biomarkers ; Blotting, Western ; Carcinoma, Hepatocellular ; Humans ; Immunoblotting ; Liver ; Liver Cirrhosis ; Mass Spectrometry ; Methionine Adenosyltransferase ; Methionine ; Proteomics ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Two-Dimensional Difference Gel Electrophoresis

PURPOSE: Few studies about laparoscopic surgery for splenic flexure colon cancer have been published. This study aims to compare the short- and long-term outcomes of laparoscopic surgery for splenic flexure colon cancer with those of conventional open surgery. METHODS: From January 2004 to December 2010, 51 consecutive patients who underwent curative resection for stages I–III splenic flexure colon cancer were enrolled. Thirty-three patients underwent laparoscopy-assisted colectomy, while 18 patients underwent conventional open colectomy. Short- and long-term outcomes of the 2 groups were compared. RESULTS: There were no differences in baseline characteristics, intra- and postoperative complications. The laparoscopy group showed longer operation time (median [interquartile range, IQR]: 295.0 [255.0–362.5] minutes vs. 180.0 [168.8–206.3] minutes, P < 0.001). In the laparoscopy group, return of bowel function was faster (median [IQR]: 3 [2–4] vs. 4 [3–5], P = 0.007) and postoperative hospital stay was shorter (median [IQR]: 9 [8–11] vs. 10.5 [9–19], P = 0.026). There were no statistically significant differences in overall survival rate (84.3% vs. 76.0%, P = 0.560) or disease-free survival rate (93.8% vs. 74.5%, P = 0.078) between the 2 groups. CONCLUSION: Laparoscopic surgery for splenic flexure colon cancer has better short-term outcomes than open surgery, as well as acceptable long-term outcomes. Laparoscopic surgery can be a safe and feasible alternative to conventional open surgery for splenic flexure colon cancer.