Patient Perception of Natural Orifice Transluminal Endoscopic Surgery in an Endoscopy Screening Program in Korea

Purpose Natural orifice transluminal endoscopic surgery (NOTES) is a new method of accessing intracavitary organs in order to minimize pain by avoiding incisions in the body wall. The aim of this study is to determine patients' acceptance of NOTES in Korea and to compare their views about laparoscopic surgery and NOTES for benign and malignant diseases. Materials and Methods The target number of total subjects was calculated to be 540. The subjects were classified into 18 sub-groups based on age groups, gender, and history of prior surgery. The questionnaire elicited information about demographic characteristics, medical check-ups, diseases, endoscopic and surgical histories, marital status and childbirth, the acceptance of NOTES, and the preferred routes for NOTES. In addition, the subjects chose laparoscopic surgery or NOTES for a hypothetical cholecystectomy and rectal cancer surgery, and responded to questions regarding the acceptable complication rate of NOTES, the appropriate cost of NOTES, and the reason(s) why they did not select NOTES. Results: 486 of 540 patients (90.0%) who agreed to participate in this study completed the questionnaire. NOTES was preferred by the following patients: elderly; a history of treatment due to a disease; having regular check-ups; and a history of an endoscopic procedure (p<0.05). The most preferred route for NOTES was the stomach (67.1%). Eighty-four percent of the patients choosing NOTES responded that the complication rate of the new surgical method should be the same or lower than laparoscopic surgery. Vague anxiety over a new surgical method was the most common reason why NOTES was not selected in benign and malignant diseases (64% and 73%), respectively. Conclusion: Patients appear to be interested in the potential benefits of NOTES and would embrace it if their concerns about safety are met. We believe that qualified surgical endoscopists can meet these safety concerns, and that NOTES development has the potential to flourish

Biological Profiles of Korean Atomic Bomb Survivors in Residence at Daegu and Kyungbuk, Republic of Korea

In 1945, many Koreans, in addition to Japanese, were killed or injured by the atomic bombs dropped on Hiroshima and Nagasaki, Japan. This study compared the biological profiles of Korean atomic bomb survivors in residence at Daegu and Kyungbuk, Republic of Korea with those of a representative sample of Koreans obtained during a similar period. We evaluated anthropometric measurements, blood pressure, blood cell counts, blood chemistry, and urinalysis of survivors (n=414) and age- and sex-matched controls (n=414) recruited from the third Korea National Health and Nutrition Examination Survey conducted in 2005. Univariate analyses revealed significantly higher systolic blood pressure, white blood cell count, and serum total cholesterol, triglycerides, high-density lipoprotein-cholesterol, and aspartate aminotransferase levels (p<0.01) in the survivors. Conversely, hemoglobin concentration, hematocrit, red blood cell count, and the proportion of positive urine occult blood (p<0.01) were lower in the survivors. Our findings suggest that biological profiles of Korean atomic bomb survivors were adversely affected by radiation exposure

The C677 Mutation in Methylene Tetrahydrofolate Reductase Gene: Correlation with Uric Acid and Cardiovascular Risk Factors in Elderly Korean men

The C677T mutation in the methylene tetrahydrofolate reductase (MTHFR) gene results in elevated homocysteine levels and, presumably, in increased cardiovascular risk. Moreover, elevated homocysteine levels are reportedly associated with high serum uric acid levels. We evaluated the MTHFR genotype and a panel of biochemical, hematological variables, and lifestyle characteristics in 327 elderly Korean men (age range 40-81 yr; mean, 51.87). This study shows that mutation of the MTHFR gene may be a risk for hyperuricemia. The mean uric acid levels for the C/C, C/T and T/T genotypes were 5.54, 5.91 and 6.33 mg/dL, respectively (p=0.000). The T/T genotype was significantly more frequent in subjects with high uric acid levels (p=0.003). Thus, this mutation of the MTHFR gene is implied by the study results to be a risk factor of hyperuricemia in elderly Korean men. However, the relationship between the MTHFR mutation and uric acid metabolism remains unclear. Therefore, further studies are necessary to explain the associated between the MTHFR mutation and elevated uric acid levels, and to examine potential relationships between it and conventional cardiovascular risk factors

Admission Decisions Made by Emergency Physicians Can Reduce the Emergency Department Length of Stay for Medical Patients

Background. Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing treatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and are associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by emergency physicians without consultations on the ED LOS and other quality indicators. Methods. The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions that was implemented in October 2016. During and after the policy change, emergency physicians decided how to arrange for and treat medical patients by processing their admission and providing follow-up care without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared between the study period (January to June 2017) and the control period (January to June 2016). Results. The median ED LOS of patients admitted to the IM department decreased from 673 (IQR: 347–1,369) minutes in the control period to 237 (IQR: 166–364) minutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality between the two periods. Conclusions. The admission decisions regarding medical patients made by emergency physicians without specialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS

Assessment of Lead and Mercury Exposure Levels in the General Population of Korea Using Integrated National Biomonitoring Data

In Korea, the estimated values of blood lead (Pb) and mercury (Hg) levels differ between two national-level biomonitors, namely the Korean National Environmental Health Survey and the Korea National Health and Nutrition Examination Survey. The present study used integrated data from these surveys to estimate the representative values of the change in concentration and recent distribution characteristics. The yearly trend of age-standardized exposure levels in regular adults was identified, and the geometric mean (GM) adjusted according to demographic characteristics was presented. Age-standardized GM for blood Pb and Hg in the integrated data was 2.06 and 3.64 μg/L in 2008, respectively, which decreased to 1.55 and 2.92 μg/L, respectively, by 2017. Adjusted GMs from most recently conducted surveys (2015–2017) were 1.61 and 2.98 μg/L for blood Pb and Hg, respectively. In particular, the adjusted percentage of blood Hg exceeding the reference value of 5 μg/L was 20.79%. While the blood Pb and Hg exposure levels are decreasing in Korea, the levels remain high relative to those in other countries. The Hg levels exceeded the reference value in many individuals. Therefore, continued biomonitoring must be conducted, and a reduction plan and exposure management are needed for harmful metals, including Hg

A cross-sectional study on the pulmonary function of residents in two urban areas with different PM10 concentrations: data from the fourth Korea national health and nutrition examination survey (KNHANES) 2007–2009

Abstract Background The present study aims to compare the pulmonary function of residents of Seoul special city (Seoul) and Jeju special self-governing province including Jeju city and Seogwipo city (Jeju), characterized by vastly different annual average airborne particulate matter with an aerodynamic diameter less ≤10 μm (PM10) concentrations, with the annual average PM10 concentration in Seoul being significantly higher than that in Jeju. Methods This cross-sectional study analyzed the pulmonary function test results and sociodemographic data of Korean adults ≥19 years of age derived from the 4th KNHANES, 2007–2009. A total of 830 individuals residing in Seoul or Jeju were included in this study. T-tests were used to analyze predicted values of forced expiratory volume in 1 sec (FEV1p), predicted values of forced vital capacity (FVCp) and FEV1/FVC ratio (FEV1/FVC), as dependent variables, to examine the differences in the subjects’ pulmonary function according to the city of residence. Stratified analysis was then performed to adjust for variables potentially affecting pulmonary function. The analysis was performed on subjects as a group and also following stratification according to sex and other variables. Results Seoul residents had a significantly lower FVCp than that of the Jeju residents (difference: 3.48%, p = 0.002). FEV1p, FVCp and FEV1/FVC of male Seoul residents were significantly lower than those of male Jeju residents (difference: 6.99, 5.11% and 0.03, respectively; p < 0.001, p = 0.001, p = 0.001). In male subjects, statistically significant results were obtained even after adjusting the influence of other variables through stratified analysis. Conclusion The present analysis was based on cross-sectional data collected at one point in time. Therefore, unlike longitudinal studies, it does not establish a clear causal association between the variables. Nevertheless, this study found that pulmonary function among subjects residing in Seoul was significantly decreased compared to that of subjects residing in Jeju

Neutrophil-to-Lymphocyte Ratio Is Associated with Impaired Interferon-Gamma Release to Phytohemagglutinin.

The neutrophil-to-lymphocyte ratio (NLR) has been shown to predict adverse outcomes in several pathologic conditions. The majority of indeterminate interferon (IFN)-γ release assays were due to inadequate IFN-γ response to the phytohemagglutinin. We sought to study the value of NLR to predict an indeterminate result of QuantiFERON-TB Gold In-Tube (QFT-GIT) performed in routine laboratory practice.Results from 2,773 QFT-GIT assays were analyzed. Data collection included demographic data, the level of IFN-γ to nil, mitogen, and TB antigen of QFT-GIT, total WBC, and a differential count. We calculated the absolute neutrophil count, lymphocyte count, and NLR.Of the total, 224 (8.1%) indeterminate results were observed. Twelve (1.8%) showed indeterminate results in the NLR range from 1.71 to 2.84, but 132 (19.2%) had indeterminate results in NLR ≥ 5.18 (p < 0.0001). The likelihood ratio for indeterminate results were 2.70 (95% CI, 2.36-3.08) in NLR ≥ 5.18 and 1.93 (95% CI, 1.64-2.27) in lymphocyte count ≤ 1050/μL. NLR and neutrophil count were independent predictors for indeterminate QFT-GIT result in multiple regression analysis. The IFN-γ response to PHA was negatively associated with NLR (r = -0.33, p < 0.001).We showed that the NLR is an independent predictor of indeterminate QFT-GIT result. Low frequency of indeterminate results in group with normal NLR may imply the importance of a balance between two cellular compartments in physiological and pathological conditions