Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a shortage of medical resources and the need for proper treatment guidelines for brain tumor patients became more pressing. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. As part II of the guideline, this consensus survey is to suggest management options in specific clinical scenarios during the crisis period. Methods: The KSNO Guideline Working Group consisted of 22 multidisciplinary experts on neuro-oncology in Korea. In order to confirm a consensus reached by the experts, opinions on 5 specific clinical scenarios about the management of brain tumor patients during the crisis period were devised and asked. To build-up the consensus process, Delphi method was employed. Results: The summary of the final consensus from each scenario are as follows. For patients with newly diagnosed astrocytoma with isocitrate dehydrogenase (IDH)-mutant and oligodendroglioma with IDH-mutant/1p19q codeleted, observation was preferred for patients with low-risk, World Health Organization (WHO) grade 2, and Karnofsky Performance Scale (KPS) ≥60, while adjuvant radiotherapy alone was preferred for patients with high-risk, WHO grade 2, and KPS ≥60. For newly diagnosed patients with glioblastoma, the most preferred adjuvant treatment strategy after surgery was radiotherapy plus temozolomide except for patients aged ≥70 years with KPS of 60 and unmethylated MGMT promoters. In patients with symptomatic brain metastasis, the preferred treatment differed according to the number of brain metastasis and performance status. For patients with newly diagnosed atypical meningioma, adjuvant radiation was deferred in patients with older age, poor performance status, complete resection, or low mitotic count. Conclusion It is imperative that proper medical care for brain tumor patients be sustained and provided, even during the crisis period. The findings of this consensus survey will be a useful reference in determining appropriate treatment options for brain tumor patients in the specific clinical scenarios covered by the survey during the future crisis.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the need for appropriate treatment guidelines for patients with brain tumors was indispensable due to the lack and limitations of medical resources. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. Methods: The KSNO Guideline Working Group was composed of 22 multidisciplinary experts on neuro-oncology in Korea. In order to reach consensus among the experts, the Delphi method was used to build up the final recommendations. Results: All participating experts completed the series of surveys, and the results of final survey were used to draft the current consensus recommendations. Priority levels of surgery and radiotherapy during crises were proposed using appropriate time window-based criteria for management outcome. The highest priority for surgery is assigned to patients who are life-threatening or have a risk of significant impact on a patient’s prognosis unless immediate intervention is given within 24–48 hours. As for the radiotherapy, patients who are at risk of compromising their overall survival or neurological status within 4–6 weeks are assigned to the highest priority. Curative-intent chemotherapy has the highest priority, followed by neoadjuvant/adjuvant and palliative chemotherapy during a crisis period. Telemedicine should be actively considered as a management tool for brain tumor patients during the mass infection crises such as the COVID-19 pandemic. Conclusion It is crucial that adequate medical care for patients with brain tumors is maintained and provided, even during times of crisis. This guideline will serve as a valuable resource, assisting in the delivery of treatment to brain tumor patients in the event of any future crisis.

Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.

PURPOSE: The aim of the study is to evaluate the clinical usefulness of a TWI in the lead aVL of 12-lead ECG for predicting the left ascending artery (LAD) lesion, high risk, and 30-days mortality in patients with acute coronary syndrome (ACS). METHODS: A total of 275 patients who underwent coronary angiography under the diagnosis of ACS were analyzed retrospectively from Jan 2012 to December 2013. RESULTS: A total of 355 patients underwent coronary angiography. Of these, 275 patients (77.5%) were diagnosed with ACS. Of these, 187 patients (68.0%) had a left LAD lesion. Of these, 111 patients (59.3%) had a mid-LAD lesion. Of these, only 23 patients (22.5%) showed a TWI in the aVL lead. However, regarding the prediction of the high risk group, if there is a TWI in the aVL, when compared with patients without a TWI in the aVL, the high risk rate is four times higher in the univariable logistic regression analysis and 2.687 times higher in the multivariable logistic regression analysis. CONCLUSION: A TWI in the lead aVL of ECG of patients with chest pain in the ER was closely associated with high risk of ACS patients.
Acute Coronary Syndrome* ; Arteries ; Chest Pain ; Coronary Angiography ; Diagnosis ; Electrocardiography* ; Humans ; Logistic Models ; Mortality ; Retrospective Studies

PURPOSE: The mortality of motorcycle accidents in old age is very high in Korea compared with other countries. The aim of this study is to compare the differences in injury patterns and severity between younger and older riders in motorcycle accidents. METHODS: Cross sectional data from Konkuk University Chung-ju Hospital were used to evaluate patients who visited the emergency department as a result of a motorcycle accident from June 2012 to May 2014. We separated the patients into younger rider group from 16 to 64 and older rider group over 65 years of age. Injury sustained, the types of severe injuries and injury severity between two groups were compared using Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). RESULTS: The younger and older rider group included 310 and 111 patients, respectively. Injuries in head, face, chest, and lumbar spine were higher in the older rider group (p<0.05). In the comparison of severe injury sustained over AIS 2, the older rider group had a four-fold odds increased rate of head injury (OR 3.718, 95% CI: 2.317-5.965, p<0.001) and a two-fold odds increased rate of chest injury (OR 2.306, 95% CI: 1.199-4.437, p=0.016) compared with the younger rider group. In addition, the older rider group had a nearly seven fold increased odds of severe injury over ISS 15 (OR 7.108, 95% CI: 3.579-14.119, p<0.001). CONCLUSION: In a motorcycle accident, the frequency of head, facial, chest, and lumbar injuries was higher in the older rider group. In addition, the older rider group had a higher injury severity, particularly a higher risk of head and chest injury.
Abbreviated Injury Scale ; Chungcheongbuk-do ; Craniocerebral Trauma ; Emergency Service, Hospital ; Head ; Humans ; Injury Severity Score ; Korea ; Mortality ; Motorcycles* ; Spine ; Thoracic Injuries ; Thorax

OBJECTIVE: The aim of this study was to document the natural course of asymptomatic adult moyamoya disease (MMD) and the factors related to disease progression to aid in treatment decisions. MATERIALS AND METHODS: Among 459 adult MMD patients (aged > or = 20 years), 42 patients were included in this retrospective cohort study. Clinical records of adult asymptomatic MMD patients (n = 42) and follow-up data from September 2013 were reviewed to determine the factors related to disease progression. RESULTS: The mean age of patients at the time of diagnosis was 41.2 years (range, 23-64 years), and the mean follow-up period was 37.3 months (range, 7.4-108.7 months). Of the 42 patients and 75 hemispheres, there were 12 patients (28.6%) and 13 hemispheres (17.3%) with disease progression. There were four hemispheres (5.3%) with symptomatic progression (three hemorrhage, one transient ischemic attack) and nine hemispheres (12.0%) with asymptomatic radiographic progression. There were no relationships with sex, diabetes, hypertension, thyroid disease, family history of MMD, or family history of stroke. However, reduced initial cerebrovascular reserve capacity was observed in seven hemispheres (9.3%) in patients with disease progression. A relationship was found between disease progression and initial cerebrovascular reserve capacity (p = 0.05). None of the patients underwent bypass surgery during the follow-up period. CONCLUSION: It appears that asymptomatic adult MMD is not a permanent stable disease. In particular, reduced cerebrovascular reserve capacity is an indication of MMD progression, so close regular observation is needed.
Adult* ; Asymptomatic Diseases ; Cerebrovascular Disorders ; Cohort Studies ; Diagnosis ; Disease Progression ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension ; Moyamoya Disease* ; Retrospective Studies ; Stroke ; Thyroid Diseases

Hepatic ischemia/reperfusion (I/R) injury leads to oxidative stress and acute inflammatory responses that cause liver damage and have a considerable impact on the postoperative outcome. Much research has been performed to develop possible protective techniques. We aimed to investigate the efficacy of SPA0355, a synthetic thiourea analog, in an animal model of hepatic I/R injury. Male C57BL/6 mice underwent normothermic partial liver ischemia for 45 min followed by varying periods of reperfusion. The animals were divided into three groups: sham operated, I/R and SPA0355 pretreated. Pretreatment with SPA0355 protected against hepatic I/R injury, as indicated by the decreased levels of serum aminotransferase and reduced parenchymal necrosis and apoptosis. Liver synthetic function was also restored by SPA0355 as reflected by the prolonged prothrombin time. To gain insight into the mechanism involved in this protection, we measured the activity of nuclear factor-kappaB (NF-kappaB), which revealed that SPA0355 suppressed the nuclear translocation and DNA binding of NF-kappaB subunits. Concomitantly, the expression of NF-kappaB target genes such as IL-1beta, IL-6, TNF-alpha and iNOS was significantly downregulated. Lastly, the liver antioxidant enzymes superoxide dismutase, catalase and glutathione were upregulated by SPA0355 treatment, which correlated with the reduction in serum malondialdehyde. Our results suggest that SPA0355 pretreatment prior to I/R injury could be an effective method to reduce liver damage.
Animals ; Anti-Inflammatory Agents/*therapeutic use ; Benzoxazines/*therapeutic use ; Liver/*drug effects/immunology/*injuries/pathology ; Male ; Mice, Inbred C57BL ; NF-kappa B/immunology ; Reperfusion Injury/*drug therapy/immunology/pathology ; Signal Transduction/drug effects ; Thiourea/*analogs & derivatives/therapeutic use

PURPOSE: Due to their vulnerability and relatively high driving speed, motorcycles have been associated with a high risk of sustaining multiple severe injuries after traffic accidents. We sought to investigate sustained injuries and the association of accident mechanisms with injury severity for unhelmeted motorcycle accident victims. METHODS: This study was conducted as an observational retrospective study. Unhelmeted motorcycle accident victims who visited the study hospital from January 2010 to December 2011 were included. Data were obtained from medical records, ambulance run-sheets, and telephone interviews. Accident mechanisms were divided into collision with an obstacle, single vehicle accident, collision with another vehicle, collision by another vehicle, and falling accident from the viewpoint of energy. Glasgow coma scale (GCS), Revised trauma score (RTS), and Injury Severity Score (ISS) were analyzed for comparison of injury severity according to the accident mechanisms. RESULTS: Of 404 patients who visited the study hospital, 165 patients were included; 87.3%(144/165) were male, and 78.8%(130/165) were drivers. The incidence of motor cycle accident showed the highest in the teenager and in time during 18:00~24:00 o'clock. Lower extremity was the most common site of injury, followed by upper extremity, head, and face etc. Injury due to falling was the most severe injury mechanism, followed by collision with another vehicle, collision by another vehicle, and a single vehicle and an obstacle (p=0.013). CONCLUSION: Lower extremity injury was the most common injury site in unhelmeted motorcycle accidents, and motorcycle accidents by fall and collision with another vehicle should be considered as a severe mechanism of injury.
Accidents, Traffic ; Adolescent ; Ambulances ; Glasgow Coma Scale ; Head ; Humans ; Incidence ; Injury Severity Score ; Interviews as Topic ; Lower Extremity ; Male ; Medical Records ; Motorcycles ; Retrospective Studies ; Upper Extremity

PURPOSE: Hyperventilation during cardiopulmonary resuscitation (CPR) is common and can be detrimental to survival. We designed a method for delivery of an appropriate rate of ventilation during CPR by setting a compression numbers to ventilation ratio. METHODS: We conducted a virtual simulation trial using 12 randomly sorted actual CPR video files. Participants provided ventilation using a self-inflating bag while watching one minute of CPR video clips utilizing pre-set compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively. Ventilation rates per minute were manually calculated and analyzed. RESULTS: Eight medical doctors and eight emergency medical technician students were included. Among the three groups, significant different mean (S.D) ventilation rate per min (compression to ventilation ratio were 10:1, 12:1, and 15:1) was (9.9 (1.3) vs. 8.8 (1.0) vs. 7.2 (0.8), respectively; p<0.0001). Proportion of the number of appropriately delivered ventilations was 62.5%, 89.6%, and 38.0% for compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively (p<0.0001). CONCLUSION: Compression to ventilation ratio of 12:1 resulted in a significantly appropriate ventilation rate, compared with the ratio of 10:1 or 15:1. Pre-set compression to ventilation ratio of 12:1 seems to be a novel method for delivery of an appropriate number of ventilations during CPR after establishment of an advanced airway.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Ventilation