Purpose: s: The association between alcohol consumption, health, and mortality is intricate, with marital status being a determinant of drinking behavior. This study investigated the combined effect of alcohol consumption patterns and marital status on mortality in middle-aged and older Korean individuals. Methods: This prospective longitudinal study used data from the Korean Longitudinal Study of Aging, conducted from 2006 to 2020. The study population comprised individuals who were consuming alcohol around the time of the basic survey and participated in the 1st wave 2006 study. We divided 3,823 drinkers older than 45 into four groups: “normal drinker and married (NM),” “normal drinker and unmarried (NUM),” “excessive drinker and married (EM),” and “excessive drinker and unmarried (EUM).” A Cox proportional hazards regression analysis was performed for survival analysis. Results: The median survival time of the EUM group was 11.9 years. After adjusting for the covariates, the mortality risk among the NUM, EM, and EUM were approximately 1.67 times, 1.33 times, and 3.10 times higher than that among the NM, respectively. Conclusion Middle- and old-aged unmarried people with excessive drinking patterns constitute a highrisk group for mortality. Community healthcare providers should focus on characteristics that differ by age, considering family-related factors, and assessing alcohol consumption patterns to reduce mortality.Among middle- and old-aged people, support for unmarried and excessive drinkers should be strengthened, and consultation on visiting community-based clinics should be promoted to improve firmly established alcohol consumption patterns.

Purpose: s: The association between alcohol consumption, health, and mortality is intricate, with marital status being a determinant of drinking behavior. This study investigated the combined effect of alcohol consumption patterns and marital status on mortality in middle-aged and older Korean individuals. Methods: This prospective longitudinal study used data from the Korean Longitudinal Study of Aging, conducted from 2006 to 2020. The study population comprised individuals who were consuming alcohol around the time of the basic survey and participated in the 1st wave 2006 study. We divided 3,823 drinkers older than 45 into four groups: “normal drinker and married (NM),” “normal drinker and unmarried (NUM),” “excessive drinker and married (EM),” and “excessive drinker and unmarried (EUM).” A Cox proportional hazards regression analysis was performed for survival analysis. Results: The median survival time of the EUM group was 11.9 years. After adjusting for the covariates, the mortality risk among the NUM, EM, and EUM were approximately 1.67 times, 1.33 times, and 3.10 times higher than that among the NM, respectively. Conclusion Middle- and old-aged unmarried people with excessive drinking patterns constitute a highrisk group for mortality. Community healthcare providers should focus on characteristics that differ by age, considering family-related factors, and assessing alcohol consumption patterns to reduce mortality.Among middle- and old-aged people, support for unmarried and excessive drinkers should be strengthened, and consultation on visiting community-based clinics should be promoted to improve firmly established alcohol consumption patterns.

Purpose: s: The association between alcohol consumption, health, and mortality is intricate, with marital status being a determinant of drinking behavior. This study investigated the combined effect of alcohol consumption patterns and marital status on mortality in middle-aged and older Korean individuals. Methods: This prospective longitudinal study used data from the Korean Longitudinal Study of Aging, conducted from 2006 to 2020. The study population comprised individuals who were consuming alcohol around the time of the basic survey and participated in the 1st wave 2006 study. We divided 3,823 drinkers older than 45 into four groups: “normal drinker and married (NM),” “normal drinker and unmarried (NUM),” “excessive drinker and married (EM),” and “excessive drinker and unmarried (EUM).” A Cox proportional hazards regression analysis was performed for survival analysis. Results: The median survival time of the EUM group was 11.9 years. After adjusting for the covariates, the mortality risk among the NUM, EM, and EUM were approximately 1.67 times, 1.33 times, and 3.10 times higher than that among the NM, respectively. Conclusion Middle- and old-aged unmarried people with excessive drinking patterns constitute a highrisk group for mortality. Community healthcare providers should focus on characteristics that differ by age, considering family-related factors, and assessing alcohol consumption patterns to reduce mortality.Among middle- and old-aged people, support for unmarried and excessive drinkers should be strengthened, and consultation on visiting community-based clinics should be promoted to improve firmly established alcohol consumption patterns.

Objective: The purpose of this study was to identify prognostic factors related to outcomes of out-of-hospital cardiac arrest caused by pesticide poisoning. Methods: This retrospective observational study used countrywide population-based data from the Out-of-Hospital Cardiac Arrest Surveillance of the Korean Centers for Disease Control and Prevention from January 2008 to December 2018. Adult out-of-hospital cardiac arrest (OHCA) patients (over the age of 18) poisoned by a pesticide who experienced cardiac arrest and a subsequent return of spontaneous circulation (ROSC) were included in the study. The primary outcome variables were prognostic factors related to survival at hospital discharge, and the secondary outcome variable was good neurological outcome (Cerebral Performance Categories 1 or 2) at hospital discharge. Results: Three hundred and three patients were enrolled in the study, and 48 (15.8%) survived until hospital discharge (the hospital discharge group), and 255 (84.2%) died in hospital (the in-hospital death group). Fifteen (4.9%) of the 303 study subjects had a good neurological outcome, and 288 (95.1%) had a poor neurological outcome. Multivariate logistic regression showed that sustained pre-hospital ROSC was significantly associated with survival to discharge (adjusted odds ratio [AOR]=3.186; 95% confidence interval [CI], 1.436-7.068; P=0.004) and good neurological outcome (AOR=8.945; 95% CI, 2.974-26.907; P≤0.001). Conclusion Sustained pre-hospital ROSC is associated with a favorable outcome in cases of OHCA induced by pesticide poisoning.

Objective: The purpose of this study was to determine the type of video laryngoscope training that is appropriate for emergency medical technicians (EMT) familiar with direct laryngoscopes, to prepare them for tracheal intubation while they are wearing personal protective equipment (PPE). Methods: Thirty-eight healthy EMTs were recruited. The participants underwent two tests with four different laryngoscopes: Macintosh, McGrath, Pentax Airway Scope (PENTAX-AWS), and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshops. The second test was conducted after a hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc., and asked all the participants to respond to a short questionnaire. Results: The time to complete the insertion of the endotracheal tube with the Macintosh laryngoscope did not significantly change (P=0.098), but the rest of the outcomes significantly improved after the hands-on workshop (all P<0.05). Despite the unfamiliarity of the practitioners with video laryngoscopes and their wearing PPE, intubation-related performances were good with the two-channel type video laryngoscopes after the hands-on workshop (all P<0.05). Conclusion In preparation for an infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), it would be reasonable to train EMTs who would be wearing PPE on the procedure for intubating a trachea with a channeltype video laryngoscope.

Purpose: With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers. Methods: This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing deliri-um. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1),neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology. Results: Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between partici-pants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1—concentrations of urine EVs—were comparatively higher in participants with severe delirium than that in partici-pants without delirium (p = .002 and p = .001, respectively). Conclusion These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

OBJECTIVES: We examined whether pericardial adipose tissue (PAT) is predictive of prediabetes and type 2 diabetes over time. METHODS: In total, 2,570 adults without prediabetes/diabetes from the Coronary Artery Risk Development in Young Adults Study were followed up over 15 years. PAT volume was measured by computed tomography scans, and the new onset of prediabetes/diabetes was examined 5 years, 10 years, and 15 years after the PAT measurements. Multivariable Cox regression models were used to examine the association between the tertile of PAT and incident prediabetes/diabetes up to 15 years later. The predictive ability of PAT (vs. waist circumference [WC], body mass index [BMI], waist-to-height ratio [WHtR]) for prediabetes/diabetes was examined by comparing the area under the receiver operating characteristic curve (AUC). RESULTS: The highest tertile of PAT was associated with a 1.56 times (95% confidence interval [CI], 1.03 to 2.34) higher rate of diabetes than the lowest tertile; however, no association was found between the highest tertile of PAT and prediabetes in the fully adjusted models, including additional adjustment for BMI or WC. In the fully adjusted models, the AUCs of WC, BMI, WHtR, and PAT for predicting diabetes were not significantly different, whereas the AUC of WC for predicting prediabetes was higher than that of PAT. CONCLUSIONS PAT may be a significant predictor of hyperglycemia, but this association might depend on the effect of BMI or WC. Additional work is warranted to examine whether novel adiposity indicators can suggest advanced and optimal information to supplement the established diagnosis for prediabetes/diabetes.

Background/Aims: Patients with liver cirrhosis (LC) have low levels of branchedchain amino acids (BCAAs). There is accumulating evidence that BCAAs have anti- fibrotic effects in cirrhosis. This study is aimed to evaluate the effect of BCAAs on the function and phenotype of activated hepatic stellate cells (HSCs). Methods: LX-2, an immortalized human stellate cell line, was used in in vitro experiments. LX-2 cells were exposed to transforming growth factor β1 (TGF-β1) and BCAAs or to valine, leucine, and isoleucine, which are components of BCAAs. Activation of the TGF-β signaling pathway in LX-2 cells was observed using real- time quantitative polymerase chain reaction and Western blotting. Results: The increased expression of snail family transcriptional repressor 1 (SNAI1) was observed in LX-2 cells activated by TGF-β1. After BCAA treatment, its expression was significantly decreased at the mRNA level. The increased expression of Col1α1 and TIMP2 at the mRNA level and alpha smooth muscle actin at the protein level in activated LX-2 cells decreased after BCAA treatment. Among the BCAA components, leucine and valine significantly abrogated TGF-β-induced activation of LX-2 cells. BCAA treatment led to the decreased phosphorylation of Smad2 and p38 proteins, which are markers for Smad and Smad-independent p38 mitogen-activated protein kinase signaling pathways, respectively. Conclusions BCAA treatment can improve hepatic fibrosis by directly affecting the activated state of hepatic stellate cells through inhibition of the TGF-β signaling pathway. Among BCAA components, leucine and valine mainly abrogated TGF-β-induced activation of HSCs. Our results suggest that BCAA may be used to attenuate the progression of liver fibrosis.

Objective: With the increased incidence and prevalence rates of ST-segment elevation myocardial infarction (STEMI), emergency physicians (EPs) are expected to diagnose STEMI accurately and quickly based on electrocardiograms (ECGs) with minimal clinical information. However, a misdiagnosed ECG by EPs could be diagnosed as STEMI by a cardiologist. We evaluated the diagnostic performance of EPs in interpreting ECGs of STEMI in terms of the agreement of this diagnosis with that of a cardiologist. Methods: This study was performed using 122 de-identified ECGs of STEMI patients who had their diagnosis confirmed through emergent coronary arteriography and percutaneous coronary intervention. Three EPs and a cardiologist participated in the survey. For each ECG, physicians were asked, “Based on the ECG provided, is there ST elevation, ST depression, or no ST-segment change?” The overall agreement for ST change diagnosis between the EPs and a cardiologist was analyzed using Cohen’s kappa coefficient (κ). Fleiss’s kappa was used to determine the level of agreement of the three EPs. Results: There was a substantial level (k>0.6) of inter-rater agreement of the ECG interpretation (IRAE) between the EPs and the cardiologist and between the three EPs. However, in subgroups according to the culprit artery for the overall STEMI ECG, the level of IRAE between the EPs and a cardiologist and between the three EPs was substantially lower (k<0.6) when relating to the anteroseptal wall due to occlusion of the left anterior descending artery. Conclusion In evaluating STEMI ECGs, the accuracy of the EPs suggests a substantial level of IRAE relating to the lateral and inferior wall and a relatively low level of IRAE with respect to the anteroseptal wall.

Objective: This study aimed to analyze the association between the culprit artery and the diagnostic accuracy of automatic electrocardiogram (ECG) interpretation in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This single-centered, retrospective cohort study included adult patients with STEMI who visited the emergency department between January 2017 and December 2020. The primary endpoint was the association between the culprit artery occlusion and the misinterpretation of ECG, evaluated by the chi-square test or Fisher exact test. Results: The rate of misinterpretation of the automated ECG for patients with STEMI was 26.5% (31/117 patients). There was no significant correlation between the ST segment change in the four involved leads (anteroseptal, lateral, inferior, and aVR) and the misinterpretation of ECG (all P > 0.05). Single culprit artery occlusion significantly affected the misinterpretation of ECG compared with multiple culprit artery occlusion (single vs. multiple, 27/86 [31.3%] vs. 4/31 [12.9%], P = 0.045). There was no association between culprit artery and the misinterpretation of ECG (P = 0.132). Conclusion Single culprit artery occlusion might increase misinterpretation of ECG compared with multiple culprit artery occlusions in the automatic interpretation of STEMI.