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: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

BACKGROUND AND OBJECTIVES: Dizziness has been known as a prognostic factor in sudden sensorineural hearing loss (SSHL), but it is difficult to describe and quantify its subjective symptoms. Also, dizziness itself cannot imply vestibular dysfunction in SSHL. Comprehensive evaluation of vestibular function may help us understand the extent of lesions in sudden deafness. The purpose of this study is to determine whether an impaired caloric response is associated with disease severity and hearing outcome. SUBJECTS AND METHOD: A retrospective chart review was conducted of 488 patients diagnosed as unilateral SSHL. The patients were divided into two, an abnormal caloric group (canal paresis >20%) and normal caloric group (canal paresis ≤20%). Initial demographic and audiologic findings and final hearing outcomes were compared between the two groups. RESULTS: The initial pure tone averages of SSHL patients of abnormal caloric group and normal caloric group were 75.4±28.4 dB HL and 68.2±25.4 dB HL (p=0.004), respectively. Patients of abnormal caloric test group showed worse hearing outcome across all frequencies compared to those of the normal caloric group. Also, a significant correlation was noted between the magnitude of hearing recovery and canal paresis (r=-0.223, p < 0.001). CONCLUSION: SSHL patients of abnormal caloric test showed worse initial hearing level and poorer hearing outcome. Evaluation of vestibular function in SSHL patients is important because subjective symptoms alone cannot account for vestibular hypofunction patients, and the caloric test can help in the counseling of patients and prediction of hearing outcome in SSHL patients.
Caloric Tests* ; Counseling ; Dizziness ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Humans ; Methods ; Paresis ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Bone conduction (BC) auditory brainstem response (ABR) is an important factor in determining the type of hearing loss especially in infants and other difficult-to-test populations. However, multiple constraints including technical difficulties make evaluating BC ABR less feasible in the clinic, and there is also lack of information that guides clinicians how to evaluate it. The purpose of this study is to compare the latency of wave V in BC and air conduction (AC) ABR in normal hearing infants and gather reference values for wave V latency of BC ABR. SUBJECTS AND METHOD: A total of 210 ears of normal hearing, of those not belong to the hearing loss risk group, were included. All the infants underwent ABR evoked by clicks via AC (3A insert phone) and BC (Radioear B-71, vibrator positioned on the mastoid) under sedation. The latency of wave V at 30 dB nHL by BC and AC was compared and analyzed according to age. RESULTS: The results revealed that in every age group in the study, wave V latency at 30 dB nHL of BC ABR was shorter than that of AC ABR. There was a significant decrease in BC and AC latencies with age, but among each consecutive age group, significant latency change was not identified after 6 months old. CONCLUSION: The latency of BC ABR in young children was shorter than that of AC ABR, and it decreased significantly as age increased. However, the reference data should be considered by taking each laboratory's test parameter into consideration.
Bone Conduction* ; Child ; Ear ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem* ; Hearing Loss ; Hearing* ; Humans ; Infant* ; Reference Values

BACKGROUND: It has recently been reported that atopic disorders are associated with various neurological diseases. Atopic myelitis (AM) has been defined as an idiopathic myelitis with either (1) an atopic disease such as atopic dermatitis, allergic rhinitis, or bronchial asthma, or (2) positive mite antigen-specific immunoglobulin E (IgE) with hyper-IgE-emia. The aim of this study was to characterize the clinical, radiological, and laboratory profiles of AM. METHODS: The characteristics of a group of patients with AM (n=18) were compared with those of a group of non-AM subjects (n=13). The history, clinical symptoms, serologic and cerebrospinal fluid (CSF) findings, and brain and spinal-cord magnetic resonance imaging (MRI) scans of all of the subjects were reviewed. RESULTS: Clinically, nonacute onset occurred more frequently in the AM group than in the non-AM group (72.2% vs. 30.8%, p=0.033). The positivity of specific IgG antibody to Toxocara canis was greater in the AM group than in the non-AM group (p=0.045). Swelling (p=0.001) and gadolinium enhancement (p=0.014) on MRI was also more prevalent in the AM group. There was tendency toward a greater proportion of males, purely sensory symptoms, a higher recurrence rate, and eosinophilia in the AM group than in the non-AM group. CONCLUSIONS: These findings suggest that AM is responsible for a considerable proportion of cases with idiopathic myelitis. It appears that the progression of symptom onset is slower, the positivity of specific IgG antibody to Toxocara canis higher, and the occurrence of swelling and enhancement of the lesion on spinal-cord MRI is more prevalent among those with AM than those without.
Asthma ; Brain ; Dermatitis, Atopic ; Eosinophilia ; Gadolinium ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Magnetic Resonance Imaging ; Male ; Mites ; Myelitis ; Recurrence ; Rhinitis ; Rhinitis, Allergic, Perennial ; Toxocara ; Toxocara canis

Interleukin (IL)-27 is a novel cytokine of the IL-6/IL-12 family that has been reported to be involved in the pathogenesis of autoimmune diseases and has a pivotal role as both a pro- and anti-inflammatory cytokine. We investigated the in vivo effects of IL-27 on arthritis severity in a murine collagen-induced arthritis (CIA) model and its mechanism of action regarding control of regulatory T (Tregs) and IL-17-producing T helper 17 (Th17) cells. IL-27-Fc-treated CIA mice showed a lower severity of arthritis. IL-17 expression in the spleens was significantly decreased in IL-27-Fc-treated CIA mice compared with that in the CIA model. The Th17 population was decreased in the spleens of IL-27-Fc-treated CIA mice, whereas the CD4+CD25+Foxp3+ Treg population increased. In vitro studies revealed that IL-27 inhibited IL-17 production in murine CD4+ T cells, and the effect was associated with retinoic acid-related orphan receptor gammaT and signal transducer and activator of transcription 3 inhibition. In contrast, fluorescein isothiocyanate-labeled forkhead box P3 (Foxp3) and IL-10 were profoundly augmented by IL-27 treatment. Regarding the suppressive capacity of Treg cells, the proportions of CTLA-4+ (cytotoxic T-lymphocyte antigen 4), PD-1+ (programmed cell death protein 1) and GITR+ (glucocorticoid-induced tumor necrosis factor receptor) Tregs increased in the spleens of IL-27-Fc-treated CIA mice. Furthermore, in vitro differentiated Treg cells with IL-27 exerted a more suppressive capacity on T-cell proliferation. We found that IL-27 acts as a reciprocal regulator of the Th17 and Treg populations in CD4+ cells isolated from healthy human peripheral blood mononuclear cells (PBMCs), as well as from humans with rheumatoid arthritis (RA) PBMCs. Our study suggests that IL-27 has the potential to ameliorate overwhelming inflammation in patients with RA through a reciprocal regulation of Th17 and Treg cells.
Animals ; Arthritis, Experimental/*drug therapy/immunology ; Cells, Cultured ; Humans ; Interleukins/immunology/*therapeutic use ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Inbred DBA ; T-Lymphocytes, Regulatory/*immunology ; Th17 Cells/*immunology

No abstract available.
Herpes Zoster* ; Herpesvirus 3, Human ; Magnetic Resonance Imaging* ; Zoster Sine Herpete*

BACKGROUND AND OBJECTIVES: Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. MATERIALS AND METHODS: Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal sirolimus-eluting stent (SES, Cypher(TM))+proximal paclitaxel-eluting stent (PES, Taxus(TM)) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up angiography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. RESULTS: Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39+/-0.07) and C+T (0.40+/-0.20) than that in the T+C (0.06+/-0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C, p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. CONCLUSION: Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the implantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.
Acetylcholine ; Angiography ; Drug-Eluting Stents ; Endothelium ; Follow-Up Studies ; Iliac Artery ; Incidence ; Rabbits ; Spasm ; Stents ; Taxus ; Vasoconstriction

No abstract available.
Atherosclerosis ; Biomarkers ; C-Peptide ; Humans