Background: Limited data are available on the mortality rates of patients receiving extracorporeal membrane oxygenation (ECMO) support for coronavirus disease 2019 (COVID-19). We aimed to analyze the relationship between COVID-19 and clinical outcomes for patients receiving ECMO. Methods: We retrospectively investigated patients with COVID-19 pneumonia requiring ECMO in 19 hospitals across Korea from January 1, 2020 to August 31, 2021. The primary outcome was the 90-day mortality after ECMO initiation. We performed multivariate analysis using a logistic regression model to estimate the odds ratio (OR) of 90-day mortality. Survival differences were analyzed using the Kaplan–Meier (KM) method. Results: Of 127 patients with COVID-19 pneumonia who received ECMO, 70 patients (55.1%) died within 90 days of ECMO initiation. The median age was 64 years, and 63% of patients were male. The incidence of ECMO was increased with age but was decreased after 70 years of age. However, the survival rate was decreased linearly with age. In multivariate analysis, age (OR, 1.048; 95% confidence interval [CI], 1.010–1.089; P = 0.014) and receipt of continuous renal replacement therapy (CRRT) (OR, 3.069; 95% CI, 1.312–7.180; P = 0.010) were significantly associated with an increased risk of 90-day mortality. KM curves showed significant differences in survival between groups according to age (65 years) (log-rank P = 0.021) and receipt of CRRT (log-rank P = 0.004). Conclusion Older age and receipt of CRRT were associated with higher mortality rates among patients with COVID-19 who received ECMO.

BACKGROUND/OBJECTIVES: Collagen is commonly used in diverse forms as a functional component in skincare products. On the other hand, the effects of collagen on human skin are controversial. Dietary collagen hydrolysates from freshwater Pangasius hypophthalmus fish skin ameliorated photo-aged skin of hairless mice. This study conducted a randomized, double-blind, placebo-controlled clinical trial to determine if liquid fish collagen (CollagenTripep20™, Tripep20) as a drink strengthens skin health and quality. SUBJECTS/METHODS: In this clinical trial, 85 subjects aged 35–60 yrs were diagnosed with photo-aged skin. Eighty-five subjects were randomized to receive either Tripep20 (n = 44) or placebo (n = 41). Seventy-eight subjects fully participating for a 12-week period consumed 1,000 mg of Tripep20 (n = 41) or placebo (n = 37) in a 50-mL bottle as a daily drink. The intend-to-treat and per-protocol populations were 85 and 78, respectively. Skin hydration, wrinkles, and elasticity were assessed at 0 (baseline), 6, and 12 weeks during the study period. RESULTS: Skin hydration in the Tripep20 group was significantly higher from 6 weeks (P < 0.001) than the baseline. After 12 weeks, the Crow’s-feet visual score and skin roughness (Ra , Rq , and Rmax ) were significantly improved in the Tripep20 group than in the placebo group (P < 0.05). Consuming liquid collagen Tripep20 greatly enhanced skin elasticity (Gross R2, Net R5, and Biological elasticity R7) in 6 weeks compared to the placebo group. The Tripep20 group showed a significant increase in skin elasticity from the baseline after 6 and 12 weeks (P < 0.001). Neither abnormal symptoms nor adverse events were encountered during the study period in subjects ingesting Tripep20 or placebo. The changes in parameters related to hematology and clinical chemistry were within the normal ranges. CONCLUSION Oral consumption of liquid collagen Tripep20 was safe and well-tolerated.The results of this study show that freshwater fish-derived liquid collagen Tripep20 can be used as a healthy functional food ingredient to improve skin moisturizing, anti-wrinkling, and elasticity in an aging population.

BACKGROUND: Rifampicin (RFP) is one of the principal first-line drugs used in combination chemotherapies against Mycobacterium tuberculosis, and its use has greatly shortened the duration of chemotherapy for the successful treatment of drug-susceptible tuberculosis. Compensatory mutations have been identified in rpoC that restore the fitness of RFP-resistant M. tuberculosis strains with mutations in rpoB. To investigate rpoC mutation patterns, we analyzed 93 clinical M. tuberculosis isolates from patients in South Korea. METHODS: Drug-resistant mycobacterial isolates were cultured to determine their susceptibility to anti-tubercular agents. Mutations in rpoC were identified by sequencing and compared with the relevant wild-type DNA sequence. RESULTS: In total, 93 M. tuberculosis clinical isolates were successfully cultured and tested for drug susceptibilities. They included 75 drug-resistant tuberculosis species, of which 66 were RFP-resistant strains. rpoC mutations were found in 24 of the 66 RFP-resistant isolates (36.4%). Fifteen different types of mutations, including single mutations (22/24, 91.7%) and multiple mutations (2/24, 8.3%), were identified, and 12 of these mutations are reported for the first time in this study. The most frequent mutation involved a substitution at codon 452 (nt 1356) resulting in amino acid change F452L. CONCLUSION: Fifteen different types of mutations were identified and were predominantly single-nucleotide substitutions (91.7%). Mutations were found only in dual isoniazid- and RFP-resistant isolates of M. tuberculosis. No mutations were identified in any of the drug-susceptible strains.
Base Sequence ; Codon ; Drug Resistance, Multiple ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Korea* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Rifampin ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

A 44-year-old man was admitted for evaluation of asymptomatic graft dysfunction. An allograft biopsy revealed diffuse interstitial infiltration of lymphocytes (i3) with moderate tubulitis (t3) and SV40-positive renal tubular epithelial cells. The patient was diagnosed with BK virus nephropathy, and immunosuppression was modified with discontinuing mycophenolate and reducing tacrolimus. Leflunomide treatment was also started simultaneously. However, serum creatinine increased to 3.0 mg/dL; therefore, the patient underwent a second allograft biopsy, in which the crescent was no longer evident but tubulitis (t2) and fibrosis (i2) persisted. On day 20, leflunomide was switched to ciprofloxacin due to leukopenia. The serum creatinine increased to 3.3 mg/dL, and the third biopsy showed slightly improved tubulitis and interstitial inflammation. We then administered an intravenous infusion of immunoglobulin. On day 70, the renal function was stable and the BK serum viral load was low, and the patient was discharged. This is a case of severe crescentic BK nephropathy with successful outcome treated with aggressive treatment and this method will be useful in renal transplant patients.
Adult ; Allografts ; Biopsy ; BK Virus ; Ciprofloxacin ; Creatinine ; Epithelial Cells ; Fibrosis ; Humans ; Immunoglobulins ; Immunosuppression ; Inflammation ; Infusions, Intravenous ; Kidney Transplantation ; Leukopenia ; Lymphocytes ; Polyomavirus ; Tacrolimus ; Transplants ; Viral Load

On page 47, the definition of stroke progression was erroneously described in the previous version of article.

Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2+/-12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.
Asian Continental Ancestry Group ; Humans ; Korea ; Length of Stay ; Male ; National Institutes of Health (U.S.) ; Stroke ; Tissue Plasminogen Activator

PURPOSE: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. METHODS: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). RESULTS: The patterns of emergency care can be categorized into "general emergency care", "interhospital patient transfer", and the "request for medical treatment sent to another department or hospital". Furthermore, inerthospiatl patient transfer can be categorized into "after request for emergency care" and "after medical treatment." There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. CONCLUSION: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.
Criminals* ; Emergencies* ; Emergency Medical Services* ; Humans ; Internet ; Korea ; Malpractice ; Patient Transfer

PURPOSE: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. METHODS: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). RESULTS: The patterns of emergency care can be categorized into "general emergency care", "interhospital patient transfer", and the "request for medical treatment sent to another department or hospital". Furthermore, inerthospiatl patient transfer can be categorized into "after request for emergency care" and "after medical treatment." There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. CONCLUSION: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.
Criminals* ; Emergencies* ; Emergency Medical Services* ; Humans ; Internet ; Korea ; Malpractice ; Patient Transfer

BACKGROUND AND OBJECTIVES: We performed a retrospective study to elucidate the frequency of tachycardia mechanisms and the characteristics of accessory pathways (APs), confirmed by radiofrequency catheter ablation (RFCA) in pediatric tachycardia. In addition, we analyzed the efficacy and safety of pediatric RFCA. SUBJECTS AND METHODS: The authors retrospectively reviewed the records of a total of 260 patients (aged 2 to 18 years) who had undergone RFCA between August 1993 and July 2011 at two medical centers in Daegu. RESULTS: Two hundred and sixty patients underwent 272 RFCAs at less than 18 years of age. Of these 260 patients, 9 patients (3%) were younger than 6 years, and 175 patients (67%) were older than 12 years. The tachycardia mechanisms observed were atrioventricular reentry tachycardia (AVRT) in 175 patients (65%), atrioventricular nodal reentry tachycardia (AVNRT) in 83 patients (30%), ventricular tachycardia in 12 patients (4%), and atrial tachycardia in 2 patients (0.7%). Among the patients with AVRT, there were 94 concealed APs and 81 manifest APs. Left-side APs were more common in concealed APs than in manifest APs (72/94, 77% vs. 33/81, 41%, p<0.001). Sixty-six percent (55/83) of AVNRT cases were located at the M1 and/or M2 sites. Four patients had multiple tachycardia mechanisms (AVNRT+AVRT) and 9 patients had multiple APs. The recurrence rate was 5% (13/272). Of these recurrent cases, 12 patients had AVRT. The overall success rate was 95%. CONCLUSION: Pediatric RFCA provides a good success rate and an acceptable recurrence. In addition, we suggest that the APs location may be associated with concealed or manifest property of APs.
Catheter Ablation ; Catheters ; Humans ; Pediatrics ; Recurrence ; Retrospective Studies ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

BACKGROUND: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. METHODS: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. RESULTS: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. CONCLUSION: In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
Aged ; Hospitals, University ; Humans ; National Institute of Neurological Disorders and Stroke ; Registries ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator