Continuous renal replacement therapy (CRRT) has become the standard modality of renal replacement therapy (RRT) in critically ill patients. However, consensus is lacking regarding the criteria for discontinuing CRRT. Here we validated the usefulness of the prediction model for successful discontinuation of CRRT in a multicenter retrospective cohort. Methods: One temporal cohort and four external cohorts included 1,517 patients with acute kidney injury who underwent CRRT for >2 days from 2018 to 2020. The model was composed of four variables: urine output, blood urea nitrogen, serum potassium, and mean arterial pressure. Successful discontinuation of CRRT was defined as the absence of an RRT requirement for 7 days thereafter. Results: The area under the receiver operating characteristic curve (AUROC) was 0.74 (95% confidence interval, 0.71–0.76). The probabilities of successful discontinuation were approximately 17%, 35%, and 70% in the low-score, intermediate-score, and highscore groups, respectively. The model performance was good in four cohorts (AUROC, 0.73–0.75) but poor in one cohort (AUROC, 0.56). In one cohort with poor performance, attending physicians primarily controlled CRRT prescription and discontinuation, while in the other four cohorts, nephrologists determined all important steps in CRRT operation, including screening for CRRT discontinuation. Conclusion: The overall performance of our prediction model using four simple variables for successful discontinuation of CRRT was good, except for one cohort where nephrologists did not actively engage in CRRT operation. These results suggest the need for active engagement of nephrologists and protocolized management for CRRT discontinuation.

OBJECTIVE: The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. METHODS: Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. RESULTS: Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. CONCLUSION: The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
Bone Density ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Prognosis ; Vertebroplasty ; Visual Analog Scale ; Weights and Measures

OBJECTIVE: Although minimally invasive posterior cervical foraminotomy (MI-PCF) is an established approach for motion preservation, the outcomes are variable among patients. The objective of this study was to identify significant factors that influence motion preservation after MI-PCF. METHODS: Forty-eight patients who had undergone MI-PCF between 2004 and 2012 on a total of 70 levels were studied. Cervical parameters measured using plain radiography included C2–7 plumb line, C2–7 Cobb angle, T1 slope, thoracic outlet angle, neck tilt, and disc height before and 24 months after surgery. The ratios of the remaining facet joints after MI-PCF were calculated postoperatively using computed tomography. Changes in the distance between interspinous processes (DISP) and the segmental angle (SA) before and after surgery were also measured. We determined successful motion preservation with changes in DISP of ≤3 mm and in SA of ≤2°. RESULTS: The differences in preoperative and postoperative DISP and SA after MI-PCF were 0.03±3.95 mm and 0.34±4.46°, respectively, fulfilling the criteria for successful motion preservation. However, the appropriate level of motion preservation is achieved in cases in which changes in preoperative and postoperative DISP and SA motions are 55.7 and 57.1%, respectively. Based on preoperative and postoperative DISP, patients were divided into three groups, and the characteristics of each group were compared. Among these, the only statistically significant factor in motion preservation was preoperative disc height (Pearson’s correlation coefficient=0.658, p<0.001). The optimal disc height for motion preservation in regard to DISP ranges from 4.18 to 7.08 mm. CONCLUSION: MI-PCF is a widely accepted approach for motion preservation, although desirable radiographic outcomes were only achieved in approximately half of the patients who had undergone the procedure. Since disc height appears to be a significant factor in motion preservation, surgeons should consider disc height before performing MI-PCF.
Foraminotomy* ; Humans ; Neck ; Radiography ; Surgeons ; Zygapophyseal Joint

This study evaluated factors related to swallowing dysfunction after anterior cervical discectomy and fusion (ACDF) using videofluoroscopic swallowing studies (VFSS). Preoperative and postoperative VFSSs were done with 5 mL diluted barium. Oral transit time, pharyngeal delay time, pharyngeal response time (PRT), and pharyngeal transit time were measured. Hyoid bone movement and upper esophageal sphincter (UES) diameter were measured serially. Thickness of prevertebral soft tissue was measured from digitized VFSS images. In results, 12 of 20 patients showed abnormal postoperative VFSS findings. PRT decreased significantly after surgery. Hyoid bone movement did not change significantly after surgery. The maximal distance of UES opening decreased significantly after surgery, and the higher the level of surgery (C3 > C4 > C5 > C6), the greater the decrease in maximal distance of the UES opening after surgery. The time to widest opening of the UES was prolonged significantly. At the C3 and C4 levels, the change in prevertebral soft tissue thickness of patients with VFSS abnormalities was significantly greater than those without abnormalities. In conclusion, patients after ADCF with their highest surgery level at C3 and C4 showed more abnormal VFSS findings, significantly increased soft tissue thickness, and decreased maximal distance of UES opening. VFSS provided objective data related with swallowing dysfunction after ACDF.
Barium ; Deglutition Disorders ; Deglutition* ; Diskectomy* ; Esophageal Sphincter, Upper ; Fluoroscopy ; Humans ; Hyoid Bone ; Prospective Studies* ; Reaction Time ; Spine

OBJECTIVE: Pedicle screw fixation for spine arthrodesis is a useful procedure for the treatment of spinal disorders. However, instrument failure often occurs, and pedicle screw loosening is the initial step of a range of complications. The authors recently used a modified transpedicular polymethylmethacrylate (PMMA) screw augmentation technique to overcome pedicle screw loosening. Here, they report on the laboratory testing of pedicle screws inserted using this modified technique. METHODS: To evaluate pullout strengths three cadaveric spinal columns were used. Three pedicle screw insertion methods were utilized to compare pullout strength; the three methods used were; control (C), traditional transpedicular PMMA augmentation technique (T), and the modified transpedicular augmentation technique (M). After control screws had been pulled out, loosening with instrument was made. Screw augmentations were executed and screw pullout strength was rechecked. RESULTS: Pedicle screws augmented using the modified technique for pedicle screw loosening had higher pullout strengths than the control (1106.2+/-458.0 N vs. 741.2+/-269.5 N; p=0.001). Traditional transpedicular augmentation achieved a mean pullout strength similar to that of the control group (657.5+/-172.3 N vs. 724.5+/-234.4 N; p=0.537). The modified technique had higher strength than the traditional PMMA augmentation technique (1070.8+/-358.6 N vs. 652.2+/-185.5 N; p=0.023). CONCLUSION: The modified PMMA transpedicular screw augmentation technique is a straightforward, effective surgical procedure for treating pedicle screw loosening, and exhibits greater pullout strength than traditional PMMA transpedicular augmentation. However, long-term clinical evaluation is required.
Arthrodesis ; Cadaver ; Osteoporosis ; Polymethyl Methacrylate* ; Postoperative Complications ; Prosthesis Failure ; Spine

BACKGROUND AND OBJECTIVES: Metabolic syndrome and high sodium intake are associated with frequent cardiovascular events. Few studies have estimated sodium intake in subjects with metabolic syndrome by 24-hour urine sodium excretion. We evaluated sodium intake in individuals with metabolic syndrome. SUBJECTS AND METHODS: Participants were recruited by random selection and through advertisement. Twenty four-hour urine collection, ambulatory blood pressure measurements, and blood test were performed. Sodium intake was estimated by 24-hour urine sodium excretion. Participants receiving antihypertensive medications were excluded from analysis. RESULTS: Among the 463 participants recruited, subjects with metabolic syndrome had higher levels of 24-hour urine sodium excretion than subjects without metabolic syndrome (p=0.0001). There was a significant relationship between the number of metabolic syndrome factors and 24-hour urine sodium excretion (p=0.001). The proportion of subjects with metabolic syndrome was increased across the tertile groups of 24-hour urine sodium excretion (p<0.0001). The association of high sodium intake and metabolic syndrome was significant only among women. Among the factors related to metabolic syndrome, body mass index had an independent association with 24-hour urine sodium excretion (p<0.0001). CONCLUSION: Women with metabolic syndrome exhibited significantly higher sodium intake, suggesting that dietary education to reduce sodium consumption should be emphasized for women with metabolic syndrome.
Blood Pressure ; Body Mass Index ; Education ; Female ; Hematologic Tests ; Humans ; Hypertension ; Sodium* ; Sodium, Dietary ; Urine Specimen Collection

BACKGROUND/OBJECTIVES: South Korean's sodium consumption level is more than twice the upper limit level suggested by the WHO. Steep increases in the prevalence of hypertension and cardiovascular disease in Korea necessitate more effective sodium reduction programs. This study was conducted in order to compare sodium intake-related eating behaviors and key psychosocial factors according to age group and gender. SUBJECTS/METHODS: Using an online survey, a total of 1,564 adults (20-59 years old) considered to be geographically representative of South Korea were recruited and surveyed. The major outcomes were perceived behaviors, knowledge, intentions, and self-efficacy related to sodium intake. RESULTS: The results show that perceived behavior and level of self-efficacy related to low sodium consumption differed by age and gender. Female participants showed better behavior and intention towards low sodium intake than male counterparts. Young participants in their 20s showed the lowest intention to change their current sodium intake as well as lowest self-efficacy measures. CONCLUSIONS: Future sodium reduction interventions should be developed with tailored messages targeting different age and gender groups. Specifically, interventions can be planned and implemented at the college level or for workers in their early career to increase their intention and self-efficacy as a means of preventing future health complications associated with high sodium intake.
Adult ; Cardiovascular Diseases ; Feeding Behavior ; Female ; Humans ; Hypertension ; Intention ; Korea ; Male ; Prevalence ; Psychology ; Social Marketing ; Sodium*

OBJECTIVES: To investigate the use frequency and amount of food sources of sodium and knowledge requirement, and job satisfaction with school food services according to the school types in Busan. METHODS: A total of 98 schools were surveyed and knowledge requirement and job satisfaction were assessed using a questionnaire. In addition, the use frequency and amount of food sources of sodium for 10 school days were examined. RESULTS: The response rate of the most difficult area among dietitians' tasks was significantly high in 'nutrition education and counseling' for elementary schools and 'hygiene management' for high schools (p < .05). The response rate of the factors to be considered in meal planning was significantly high in 'energy and nutrients requirement' for elementary schools and 'menu/taste preference of students' for middle and high schools (p < .05). The response rate of whether school food services affect health and eating habits of students or not was significant high in 'very helpful' for elementary schools (p < .001). The average sodium contents in the meals of elementary, middle and high schools was 1981.4 mg/meal/person/day, 1867.3 mg/meal/person/day and 1,329.9 mg/meal/person/day, respectively. For foods in highest sodium, Kimchi, Oribulgogi, and Kare rice were ranked 1st, 2nd and 3rd respectively. The main reason for not providing the fruits was 'price' among all groups. The knowledge requirement such as 'nutrition and menu management', 'nutrition education', and 'nutrition counseling' was significantly higher in elementary school compared with middle and high school (p < .001, p < .01, and p < .01 respectively). The dietitians and nutrition teachers of elementary schools have a higher job satisfaction compared with those of middle schools (p < .01). The job satisfaction was positively correlated with knowledge requirement of dietitians and nutrition teachers of elementary and middle schools. CONCLUSIONS: The results suggest that developing dietitians' education program about knowledge requirement contribute to increasing the school food service and job satisfaction in elementary and middle schools.
Busan ; Eating ; Education ; Food Services ; Fruit ; Humans ; Job Satisfaction* ; Meals ; Nutritionists* ; Surveys and Questionnaires ; Sodium*

This study was designed to investigate the amount of free sugar according to each beverage category in coffee and beverage stores. The groups were categorized as 15 groups based on the kind of beverage material. The beverage groups contributing to total sugar per 100 mL were milk + syrup or powder, hot (12.9 g), ade (12.6 g), milk + syrup or powder + crushed ice (11.9 g), and espresso shot + milk + syrup + crushed ice (11.4 g). The beverage groups contributing to free sugar per 100 mL were ade (12.6 g), milk + syrup or powder + crushed ice (10.8 g), espresso shot + milk + syrup + crushed ice (10.3 g), and milk + syrup or powder, hot (9.7 g). The beverage groups contributing to total sugar (energy) per portion size were milk + syrup or powder + crushed ice 56.6 g (332.3 kcal), espresso shot + milk + syrup + crushed ice 49.3 g (333.4 kcal), milk + syrup or powder, hot 46.3 g (372.1 kcal), and milk + syrup or powder, ice 38.1 g (325.9 kcal). The beverage groups contributing to free sugar per portion size were milk + syrup or powder + crushed ice 51.2 g, espresso shot + milk + syrup + crushed ice 44.9 g, ade 37.1 g, milk + syrup or powder, hot 34.6 g, and milk + syrup or powder, ice 30.1 g. The percent of average free sugar per portion size of the WHO recommendation (free sugars <10% of total energy; <50 g/2,000 kcal) was milk + syrup or powder + crushed ice 102.4%, espresso shot + milk + syrup + crushed ice 89.8%, ade 74.1%, and milk + syrup or powder, hot 69.2%. The proportion of beverage in excess of WHO recommendation per portion size was 14.6% in espresso shot + milk + syrup + crushed ice, 22.7% in ade, and 10.9% in milk + syrup or powder, hot. Therefore, in coffee and beverage stores, menu development with reduced sugar content is needed, and nutrition information should be provided through sugar nutrition labeling.
Beverages ; Carbohydrates ; Coffee ; Food Labeling ; Ice ; Milk

This study was performed to investigate the dietary habits, body satisfaction and nutritional knowledge according to body image of middle school girl students (n = 284). The subjects were classified as lean, normal and fat groups according to body image. The weight, body mass index (BMI) and the score of body image were significantly higher in the students who recognized their body image as 'fat'. The satisfaction of present body image was significantly lower in students who recognized their body image as 'lean'. The interest in weight control and experience of weight control were significantly higher in students who recognized their body image as 'fat'. The necessity of nutrition education was higher in all groups (lean 67.2%, normal 59.0% and fat 52.8%). The products used to feel sweetened were sweetened ice (68.7%), processed milk (68.3%), confectionery (62.3%), carbonated beverage (55.3%), fermented milk (38.0%) and none (6.0%). The frequency of consumption of fruit juices and fried food was significantly higher in 'normal' compared to 'fat'. There was no significant difference in the frequency of consumption of snack and nutritional knowledge among the three groups. In the multiple regression analysis, the score of body image was negatively associated with the frequency of snack consumption in the 'lean'. The score of body image was positively associated with identification of nutrition labels and an interest in weight control but was negatively associated with satisfaction of present body image in the 'fat'. Based on these results, we conclude that, the middle school girl students need correct recognition of body image and continuous and practical nutrition education in order to maintain healthy dietary habits.
Body Image* ; Body Weight ; Carbonated Beverages ; Education ; Female* ; Food Habits* ; Fruit ; Humans ; Ice ; Milk ; Snacks