Objectives: . The supine sleep position and the rapid eye movement (REM) stage are widely recognized to exacerbate the severity of obstructive sleep apnea (OSA). Position-dependent OSA is generally characterized by an apnea-hypopnea index (AHI) that is at least twice as high in the supine position compared to other sleep positions. However, this condition can be misdiagnosed if a particular sleep stage—REM or non-REM (NREM)—predominates in a specific position. We explored the impact of the sleep stage on positional dependency in OSA. Methods: . Polysomnographic data were retrospectively analyzed from 111 patients with OSA aged 18 years or older, all of whom had an AHI exceeding five events per hour and slept in both supine and non-supine positions for at least 5% of the total sleep time. The overall ratio of non-supine AHI to supine AHI (NS/S-AHI ratio) was compared between total, REM, and NREM sleep. Additionally, a weighted NS/S-AHI ratio, reflecting the proportion of time spent in each sleep stage, was calculated and compared to the original ratio. Results: . The mean NS/S-AHI ratio was consistent between the entire sleep period and the specific sleep stages. However, the NS/S-AHI ratios for individual patients displayed poor agreement between total sleep and the specific stages. Additionally, the weighted NS/S-AHI ratio displayed poor agreement with the original NS/S-AHI ratio, primarily due to discrepancies in patients with mild to moderate OSA. Conclusion . The weighted NS/S-AHI ratio may help precisely assess positional dependency.

Background: Although few studies have reported improved clinical outcomes with the administration of vitamin B1 and C in critically ill patients with septic shock or severe pneumonia, its clinical impact on patients with sepsis-related acute respiratory distress syndrome (ARDS) remains unclear. The purpose of this study was to evaluate the association with vitamin B and C supplementation and clinical outcomes in patients with ARDS. Methods: Patients with ARDS requiring invasive mechanical ventilation, admitted to the medical intensive care unit (ICU) were included in this study. Clinical outcomes were compared between patients administered with vitamin B1 (200 mg/day) and C (2 g/day) June 2018–May 2019 (the supplementation group) and those who did not receive vitamin B1 and C administration June 2017–May 2018 (the control group). Results: Seventy-nine patients were included. Thirty-three patients received vitamin B1 and C whereas 46 patients did not. Steroid administration was more frequent in patients receiving vitamin B1 and C supplementation than in those without it. There were no significant differences in the mortality between the patients who received vitamin B1 and C and those who did not. There were not significant differences in ventilator and ICU-free days between each of the 21 matched patients. Conclusion Vitamin B1 and C supplementation was not associated with reduced mortality rates, and ventilator and ICU-free days in patients with sepsis-related ARDS requiring invasive mechanical ventilation.

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
Abdomen ; Budgets ; Chest Pain ; Critical Care ; Dyspnea ; Emergencies ; Heart ; Heart Arrest ; Insurance Coverage ; Insurance ; Insurance, Health ; Korea ; Medical Records ; National Health Programs ; Patient Care ; Point-of-Care Systems ; Prescriptions ; Shock ; Thorax ; Ultrasonography

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

BACKGROUND/AIMS: To investigate medication nonadherence in Korean patients with rheumatoid arthritis (RA) and analyze related factors. METHODS: A total of 292 patients with RA participated in this study. Medication nonadherence, intentional or unintentional, was gauged via self-reported questionnaire. Patient perceptions of illness, treatment beliefs, and moods were measured via Brief Illness Perception Questionnaire, Beliefs about Medicines Questionnaire, and Patient Health Questionnaire-2, respectively. Demographic and clinical data were also collected. Multinomial regression analysis was used to assess the impact of demographic, clinical, and psychological factors on medication nonadherence. RESULTS: The medication nonadherence rate was 54.1% (intentional, 21.6%; unintentional, 32.5%). Intentional nonadherence was reported most often in patients treated daily drugs (nonsteroidal anti-inflammatory drugs and/or disease-modifying antirheumatic drugs) (24.2%), and unintentional nonadherence was highest in patients receiving methotrexate (33.3%) (p = 0.872). In univariate analysis, beliefs in necessity and concerns of medication differed significantly in adherent and nonadherent patients (intentional or unintentional). When controlling for other factors that may impact medication nonadherence, less belief in necessity of medication (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.68 to 0.95) and greater emotional response to disease (OR, 1.19; 95% CI, 1.01 to 1.40) were important predictors of intentional nonadherence. CONCLUSIONS Medication nonadherence is common in Korean patients with RA. Less belief in necessity of medication and greater emotional response to disease were identified as key factors prompting intentional nonadherence. These factors may be strategically targeted to improve medication adherence rates and subsequent clinical outcomes.

No abstract available.
Arthritis, Rheumatoid* ; Humans

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) observer variability to detect ectopic insertion of the pectoralis minor tendon (EIPMT) and to investigate changes in the rotator interval in patients with EIPMT using MRI. MATERIALS AND METHODS: A total of 507 shoulder MRIs (male:female = 259:248; mean age, 55.4 years) were classified into 1) normal type insertion of the pectoralis minor tendon, 2) complete type EIPMT, and 3) partial type EIPMT independently by two radiologists. Inter-observer agreement was calculated using the kappa coefficient. Thickness of the fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess was measured. MRIs were reviewed by consensus with regard to the grade of fibrotic scar tissue proliferation in the rotator interval. Comparisons were made between normal and EIPMT and between partial and complete type EIPMT. RESULTS: The incidence of EIPMT was 13.4% (complete type, 7.7%; partial type, 5.7%). Inter-observer agreement was substantial (kappa = 0.775). Fibrotic scar tissue in the subcoracoid triangle was thicker, and the grade of fibrotic scar tissue proliferation in the rotator interval was higher in the EIPMT group than those in the control group. No significant difference was observed in the thickness of humeral side axillary recess. The thicknesses of fibrotic scar tissue in the subcoracoid triangle and humeral side axillary recess as well as the grade of fibrotic scar tissue in the rotator interval were not significantly different between complete and partial type EIPMT. CONCLUSION: MRI enabled detection of EIPMT with substantial observer agreement. Patients with EIPMT show a high tendency for fibrotic scar tissue proliferation in the rotator interval.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Rotator Cuff/pathology/*radiography ; Shoulder/pathology/radiography ; Tendons/pathology/*radiography ; Young Adult

PURPOSE: The aim of this study was to evaluate the prevalence of Benign Vocal Fold Lesion (polyp, cysts, nodules) and Leukoplakia in Korea. MATERIALS AND METHODS: The data from the 2008 to 2011 Korea National Health and Nutrition Examination Surveys, which were cross-sectional survey of the civilian noninstitutionalized population of South Korea. A survey team that included an otolaryngology residents, nurses, and interviewers moved with a mobile examination unit and performed laryngologic interviews and examinations of vocal folds using rigid telescopic laryngoscopy on survey participants over 19 years old (n=19636). RESULTS: Laryngoscopic examination revealed normal results in 19251 (98.04%) of those included in the survey. Abnormal laryngoscopic findings were observed in 1.96% of the population examined, and vocal cord nodules were the most common abnormal finding. The prevalence of vocal cord nodules was 0.99-1.72%, the prevalence of vocal cord polyps was 0.31-0.55%, the prevalence of vocal cysts was 0.04-0.17%, and the prevalence of vocal cord leukoplakia was 0.07-0.21%. There was no significant correlation of linear trend of prevalence by year, and there were no significant differences in prevalence between males and females. CONCLUSION: This is the first nationwide epidemiologic study to assess the prevalence of Benign Vocal Fold Lesion (polyp, cysts, nodules) and Leukoplakia by both the Korean Otolaryngologic Society and the Ministry of Health and Welfare. The results of this large epidemiologic study provide valuable information regarding the prevalence of voice disorders and the management of laryngologic diseases.
Cross-Sectional Studies ; Epidemiologic Studies ; Epidemiology ; Female ; Humans ; Korea* ; Laryngeal Diseases* ; Laryngoscopy ; Leukoplakia ; Male ; Methods ; Nutrition Surveys* ; Otolaryngology ; Polyps ; Prevalence* ; Republic of Korea* ; Vocal Cords ; Voice Disorders

PURPOSE: To compare concentration of cytokines in the vitreous of rabbit eyes after photocoagulation using a short-pulse pattern scanning laser (PASCAL) or a conventional laser. METHODS: Laser photocoagulation was performed using PASCAL (duration 0.02 seconds) in the right eyes and a conventional laser (duration 0.1 seconds) in the left eyes of 13 pigmented rabbits. To obtain ophthalmoscopically similar mild burns, power was adjusted during the photocoagulation. The rabbits were sacrificed at 1, 3 or 7 days after photocoagulation to investigate histological changes. Levels of interleukins (IL)-1beta, IL-6, IL-8 and tumor necrosis factor (TNF)-alpha in the vitreous humors of ten rabbits were measured using enzyme-linked immunosorbent assay before treatment and at 1, 3 and 7 days after photocoagulation. RESULTS: Histological changes were comparable between the two groups. IL-1beta and TNF-alpha were not detectable. IL-6 did not change significantly. IL-8 increased at day 3 and day 7, but no significant difference was observed between the two groups (p>0.05). CONCLUSIONS: When ophthalmoscopically similar mild burn intensity was achieved, conventional and PASCAL treatments of rabbit eyes caused no difference in intravitreal concentration of inflammatory cytokines.
Burns ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Light Coagulation* ; Rabbits* ; Tumor Necrosis Factor-alpha ; Vitreous Body

PURPOSE: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. MATERIALS AND METHODS: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. RESULTS: The amount of drainage during the first 24 hours postoperatively was 41.68+/-3.93 mL in the negative drain group and 25.3+/-2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19+/-4.26 mL and natural drain groups 21.53+/-2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. CONCLUSION: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.
Adult ; Aged ; Carcinoma/*surgery ; Drainage/*instrumentation/*methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Care/methods ; Postoperative Complications/surgery ; Postoperative Period ; Pressure ; Prospective Studies ; Reproducibility of Results ; Surgical Procedures, Operative ; Thyroid Neoplasms/*surgery ; Thyroidectomy/*instrumentation/*methods ; Time Factors ; Treatment Outcome