Objective: The use of a high flow nasal cannula (HFNC) might cover the gap between conventional oxygen therapy andmechanical ventilation in the management of acute respiratory failure patients and could be a significant factor in determiningpatient outcomes. Early predictors of HFNC failure may help a clinician decide whether to shift the patient to amechanical ventilator. We aimed at identifying the predictors associated with HFNC failure and the application of amechanical ventilator using arterial blood gas analysis (ABGA). Methods: We retrospectively analyzed patients who were admitted to the emergency room at a single center with respiratorydistress and a PaO2/FiO2 ratio (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) of less than300. Comparing keeping and weaning HFNC groups with the escalation group, we sought to identify a few discriminatingfactors. Initial ABGA was done when the patients entered the emergency room and this was followed up within 2 hoursafter HFNC therapy. Results: Two hundred and eighteen patients were enrolled and of these HFNC therapy succeeded in 153 and failed in65. At baseline Glasgow Coma Scale, follow-up (F/U) pH, ΔpH, and F/U respiratory rate-oxygenation index were lowerand pro-brain natriuretic peptide, initial lactate, F/U lactate, ΔPCO2, heart rate, acidosis, consciousness, oxygenation,respiratory rate score, Acute Physiology And Chronic Health Evaluation score, Simplified Acute Physiology Score, andSequential Organ Failure Assessment score were significantly higher in the HFNC failure group. The results of the multivariateanalysis indicated that initial lactate (odds ratio [OR], 1.215; 95% confidence interval [CI], 1.081-1.366; P=0.001)and ΔpH (OR, 0.000; 95% CI, 0.000-0.018; P<0.001) were independently associated with the prediction of application ofthe mechanical ventilator. Conclusion Patients who had higher initial lactate levels and insufficiently corrected pH after HFNC therapy may needto be monitored carefully and escalation of oxygen therapy may need to be considered.

Gastric adenocarcinoma of fundic gland type is known to originate from the gastric mucosa of the fundic gland region without intestinal metaplasia. It is difficult to detect during endoscopy and diagnose histopathologically. The development of immunohistochemistry has enabled the diagnosis of gastric adenocarcinoma of fundic gland type by gastric phenotype. A 34-year-old man visited us for treatment of a 5 cm-sized low-grade dysplasia in the gastric fundus which was incidentally found during a health check-up endoscopy. Endoscopic submucosal dissection was performed successfully, and the final histopathology showed gastric adenocarcinoma of fundic gland type. Herein, we report a rare case of gastric adenocarcinoma of fundic gland type and its endoscopic and histopathologic findings.

Objective: The use of a high flow nasal cannula (HFNC) might cover the gap between conventional oxygen therapy andmechanical ventilation in the management of acute respiratory failure patients and could be a significant factor in determiningpatient outcomes. Early predictors of HFNC failure may help a clinician decide whether to shift the patient to amechanical ventilator. We aimed at identifying the predictors associated with HFNC failure and the application of amechanical ventilator using arterial blood gas analysis (ABGA). Methods: We retrospectively analyzed patients who were admitted to the emergency room at a single center with respiratorydistress and a PaO2/FiO2 ratio (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) of less than300. Comparing keeping and weaning HFNC groups with the escalation group, we sought to identify a few discriminatingfactors. Initial ABGA was done when the patients entered the emergency room and this was followed up within 2 hoursafter HFNC therapy. Results: Two hundred and eighteen patients were enrolled and of these HFNC therapy succeeded in 153 and failed in65. At baseline Glasgow Coma Scale, follow-up (F/U) pH, ΔpH, and F/U respiratory rate-oxygenation index were lowerand pro-brain natriuretic peptide, initial lactate, F/U lactate, ΔPCO2, heart rate, acidosis, consciousness, oxygenation,respiratory rate score, Acute Physiology And Chronic Health Evaluation score, Simplified Acute Physiology Score, andSequential Organ Failure Assessment score were significantly higher in the HFNC failure group. The results of the multivariateanalysis indicated that initial lactate (odds ratio [OR], 1.215; 95% confidence interval [CI], 1.081-1.366; P=0.001)and ΔpH (OR, 0.000; 95% CI, 0.000-0.018; P<0.001) were independently associated with the prediction of application ofthe mechanical ventilator. Conclusion Patients who had higher initial lactate levels and insufficiently corrected pH after HFNC therapy may needto be monitored carefully and escalation of oxygen therapy may need to be considered.

Gastric adenocarcinoma of fundic gland type is known to originate from the gastric mucosa of the fundic gland region without intestinal metaplasia. It is difficult to detect during endoscopy and diagnose histopathologically. The development of immunohistochemistry has enabled the diagnosis of gastric adenocarcinoma of fundic gland type by gastric phenotype. A 34-year-old man visited us for treatment of a 5 cm-sized low-grade dysplasia in the gastric fundus which was incidentally found during a health check-up endoscopy. Endoscopic submucosal dissection was performed successfully, and the final histopathology showed gastric adenocarcinoma of fundic gland type. Herein, we report a rare case of gastric adenocarcinoma of fundic gland type and its endoscopic and histopathologic findings.

Glomus tumor is a benign tumor derived from the vascular wall of the arteriovenous anastomosis complex. Glomus tumors in the gastrointestinal tract are rare, especially those in the duodenum. Most gastrointestinal glomus tumors are found incidentally on endoscopy during routine health checkup and sometimes because of bleeding. We experienced a case of duodenal glomus tumor diagnosed after surgical resection of an incidental subepithelial tumor in the duodenum. Herein, we report the characteristic endoscopic ultrasonography, contrast-enhanced CT, and histopathological findings of duodenal glomus tumor.

Glomus tumor is a benign tumor derived from the vascular wall of the arteriovenous anastomosis complex. Glomus tumors in the gastrointestinal tract are rare, especially those in the duodenum. Most gastrointestinal glomus tumors are found incidentally on endoscopy during routine health checkup and sometimes because of bleeding. We experienced a case of duodenal glomus tumor diagnosed after surgical resection of an incidental subepithelial tumor in the duodenum. Herein, we report the characteristic endoscopic ultrasonography, contrast-enhanced CT, and histopathological findings of duodenal glomus tumor.

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
Adult ; Aged ; Alcohol Drinking ; Ambulances ; Atrial Fibrillation ; Cerebral Hemorrhage ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Female ; Hemorrhage ; Hope ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Prevalence ; Reperfusion ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage ; Writing