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.

Purpose: To investigate the status of protein supply by comparing the recommended amount with the delivered amount of protein in patients in the trauma and surgical intensive care units (ICU). Feedback on the protein supply status was presented to each hospital, and we evaluated whether the protein supply had increased to an appropriate level. Methods: In this retrospective observational multicenter study, nutritional information on patients in the trauma and surgical ICUs who had received nutritional support intervention was collected on the 1st Wednesday of each month at two-month intervals from August 2020 to June 2021, from nine domestic hospitals in Korea. Every two months, the nutritional status of each hospital was shared with all hospitals, and each nutritional support team received feedback on protein supply status. Results: There were 246 patients from nine hospitals included in this study, and data over the study period from six protein days, were analyzed. The mean ratios of delivered calories to calculated required calories were 74.0%, 80.8%, 85.4%, 77.9%, 71.3%, and 82.1% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. The mean ratios of delivered protein to calculated required protein were 73.0%, 77.2%, 78.9%, 79.3%, 69.4%, and 89.6% on Protein Days 1, 2, 3, 4, 5, and 6, respectively. Conclusion Protein supply increased to an appropriate level, feedback on protein supply status may have increased the protein supply ratio and promoted appropriate protein supply and nutritional support for patients in the trauma and surgical ICUs.

Background and Objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. Methods: Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment.Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. Results: mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively.Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). Conclusions Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

Background and Objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. Methods: Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment.Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. Results: mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively.Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). Conclusions Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

BACKGROUND: There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. METHODS: The participants included those aged 20 years and older who responded to the questionnaire about “having a usual source of care” from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with “I do not get sick easily” or “I rarely visit medical institutions” as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. RESULTS: The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. CONCLUSION: This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization.
Health Expenditures ; Humans ; Inpatients ; Korea ; Outpatients ; Primary Health Care

PURPOSE: Porcine reproductive and respiratory syndrome virus (PRRSV) leads to major economic losses in the swine industry. Vaccination is the most effective method to control the disease by PRRSV. MATERIALS AND METHODS: In this study, the efficacy of a glycoprotein (GP) 5-modified inactivated vaccine was investigated in pigs. The study was performed in three farms: farm A, which was porcine reproductive and respiratory syndrome (PRRS)-negative, farm B (PRRS-active), which showed clinical signs of PRRS but had not used vaccines, and farm C (PRRS-stable), which had a history of endemic PRRS over the past years, but showed no more clinical signs after periodic administration of modified live virus vaccine. RESULTS: The inactivated vaccine induced great enhancement in serum neutralizing antibody titer, which was sufficient to protect pigs from further infections of PRRSV in a farm where pre-existing virus was circulating. CONCLUSION: These results indicated that vaccination with the inactivated vaccine composed of viruses possessing deglycosylated GP5 would provide enhanced protection to pigs from farms suffering from endemic PRRSV.
Antibodies, Neutralizing ; Glycoproteins ; Neutralization Tests ; Porcine Reproductive and Respiratory Syndrome* ; Porcine respiratory and reproductive syndrome virus* ; Swine* ; Vaccination ; Vaccines ; Vaccines, Inactivated

The concentration of glucose in the vitreous humor serves as an important diagnostic marker for diabetic mellitus in post-mortem examinations, as the vitreous humor can be easily collected and the glucose test using vitreous humor is not significantly affected by cell autolysis and hemolysis. For a quick and effective glucose test, we suggest a dipstick test of the vitreous humor during autopsy. The results were evaluated and compared with other methods for significance testing. In this study, vitreous humor was analyzed from 257 autopsy cases. Qualitative concordance rate of the dipstick test for glucose and the hexokinase test was 98.7%, positive prediction rate was 89.6%, and negative prediction rate was 100%. However, there was no significant correlation between the dipstick glucose test and the hexokinase test. We conclude that the dipstick glucose test is effective and useful for post-mortem glucose screening testing and for additional post-mortem diabetes testing. Recently, the importance of post-mortem glucose testing has increased with the increase in deaths from diabetes complications. The use of the dipstick glucose test in autopsy practice can improve forensic medicine in Korea.
Autolysis ; Autopsy* ; Diabetes Complications ; Forensic Medicine ; Glucose* ; Hemolysis ; Hexokinase ; Korea ; Mass Screening ; Vitreous Body

The present study investigated the role of central GABA(A) and GABA(B) receptors in orofacial pain in rats. Experiments were conducted on Sprague-Dawley rats weighing between 230 and 280 g. Intracisternal catheterization was performed for intracisternal injection, under ketamine anesthesia. Complete Freund's Adjuvant (CFA)-induced thermal hyperalgesia and inferior alveolar nerve injury-induced mechanical allodynia were employed as orofacial pain models. Intracisternal administration of bicuculline, a GABA(A) receptor antagonist, produced mechanical allodynia in naive rats, but not thermal hyperalgesia. However, CGP35348, a GABA(B) receptor antagonist, did not show any pain behavior in naive rats. Intracisternal administration of muscimol, a GABA(A) receptor agonist, attenuated the thermal hyperalgesia and mechanical allodynia in rats with CFA treatment and inferior alveolar nerve injury, respectively. On the contrary, intracisternal administration of bicuculline also attenuated the mechanical allodynia in rats with inferior alveolar nerve injury. Intracisternal administration of baclofen, a GABA(B) receptor agonist, attenuated the thermal hyperalgesia and mechanical allodynia in rats with CFA treatment and inferior alveolar nerve injury, respectively. In contrast to GABA(A) receptor antagonist, intracisternal administration of CGP35348 did not affect either the thermal hyperalgesia or mechanical allodynia. Our current findings suggest that the GABA(A) receptor, but not the GABA(B) receptor, participates in pain processing under normal conditions. Intracisternal administration of GABA(A) receptor antagonist, but not GABA(B) receptor antagonist, produces paradoxical antinociception under pain conditions. These results suggest that central GABA has differential roles in the processing of orofacial pain, and the blockade of GABA(A) receptor provides new therapeutic targets for the treatment of chronic pain.
Anesthesia ; Animals ; Baclofen ; Bicuculline ; Catheterization ; Catheters ; Chronic Pain ; Facial Pain ; Freund's Adjuvant ; gamma-Aminobutyric Acid* ; Hyperalgesia ; Ketamine ; Mandibular Nerve ; Muscimol ; Nociception* ; Rats* ; Rats, Sprague-Dawley ; Receptors, GABA* ; Receptors, GABA-A

Hepatitis E has traditionally been considered an endemic disease of developing countries. It generally spreads through contaminated water. However, seroprevalence studies have shown that hepatitis E virus (HEV) infections are not uncommon in industrialized countries. In addition, the number of autochthonous hepatitis E cases in these countries is increasing. Most HEV infections in developed countries can be traced to the ingestion of contaminated raw or undercooked pork meat or sausages. Several animal species, including pigs, are known reservoirs of HEV that transmit the virus to humans. HEVs are now recognized as an emerging zoonotic agent. In this review, we describe the general characteristics of HEVs isolated from humans and animals, the risk factors for human HEV infection, and the current status of human vaccine development.
Animals* ; Developed Countries ; Developing Countries ; Eating ; Endemic Diseases ; Hepatitis E virus* ; Hepatitis E* ; Hepatitis* ; Humans* ; Meat ; Risk Factors ; Seroepidemiologic Studies ; Swine ; Vaccines ; Viruses ; Water Pollution ; Zoonoses

Hepatitis E virus (HEV) can infect not only human but also several animals. This study has been conducted to evaluate the comprehensive anti-HEV seroprevalence in zoo animals in Korea. Anti-HEV antibodies were identified in 14 of 64 zoo animal species. HEV antibodies were detected for the first time in Eurasian Lynx, Setland Pony, Fallow Deer, Ezo Sika, Formosa Deer, East Wapitis, Barasingha, Corriedale, American Bison, Guanacos, Reticulated Giraffe, and Saanen. These results indicate that the several zoo animal species were exposed to HEV.
Animals ; Animals, Zoo ; Antibodies ; Bison ; Camelids, New World ; Deer ; Hepatitis ; Hepatitis E ; Hepatitis E virus ; Humans ; Korea ; Lynx ; Seroepidemiologic Studies ; Taiwan