Characteristics of Mechanical Ventilation Employed in Intensive Care Units: A Multicenter Survey of Hospitals

A 1D point-prevalence study was performed to describe the characteristics of conventional mechanical ventilation in intensive care units (ICUs). In addition, a survey was conducted to determine the characteristics of ICUs. A prospective, multicenter study was performed in ICUs at 24 university hospitals. The study population consisted of 223 patients who were receiving mechanical ventilation or had been weaned off mechanical ventilation within the past 24 hr. Common indications for the initiation of mechanical ventilation included acute respiratory failure (66%), acute exacerbation of chronic respiratory failure (15%) (including tuberculosis-destroyed lung [5%]), coma (13%), and neuromuscular disorders (6%). Mechanical ventilation was delivered via an endotracheal tube in 68% of the patients, tracheostomy in 28% and facial mask with noninvasive ventilation (NIV) in 4%. NIV was used in 2 centers. In patients who had undergone tracheostomy, the procedure had been performed 16.9±8.1 days after intubation. Intensivists treated 29% of the patients. A need for additional educational programs regarding clinical practice in the ICU was expressed by 62% of the staff and 42% of the nurses. Tuberculosis-destroyed lung is a common indication for mechanical ventilation in acute exacerbation of chronic respiratory failure, and noninvasive ventilation was used in a limited number of ICUs

Tracing the historical origin of Joseon mummies considering the structural similarities between the burial systems of Korean and Chinese dynasties

Joseon mummies have proved to be excellent subjects for scientific research on the health and disease statuses of pre-modern Korean peoples. Despite its academic significance, the origins of the Hoegwakmyo tomb in which the Joseon mummy was discovered have not yet been entirely revealed. Meanwhile, over the past several decades, there have been some reports on mummies and cultural artifacts preserved very well in the tombs of several Chinese dynasties (especially Song, Yuan, Ming and Qing). Although the Chinese tombs were very diverse in structure, we note that some graves among them were structurally very similar to Joseon Hoegwakmyo tombs. Before the Hoegwakmyo tomb in Korea, there were already similar tombs in China, inside which dead persons were mummified like the Joseon mummies. Considering that the Hoegwakmyo tomb of the Joseon Dynasty was established by the influence of the Confucian ideology, the Korean and Chinese mummies might share common cultural origins in history

Analysis of Initial Baseline Clinical Parameters and Treatment Strategy Associated with Medication Failure in the Treatment of Benign Prostatic Hyperplasia in Korea

Purpose To analyze the baseline clinical factors and medication treatment strategy used in cases with medication treatment failure of benign prostatic hyperplasia (BPH). Methods From January 2006 to December 2009, 677 BPH patients with at least 3 months of treatment with medication were enrolled. We analyzed clinical factors by medication failure (n=161) versus maintenance (n=516), by prostate size (less than 30 g, n=231; 30 to 50 g, n=244; greater than 50 g, n=202), and by prostate-specific antigen (PSA) levels (less than 1.4 ng/mL, n=324; more than 1.4 ng/mL, n=353). Results Age, combination medication rate, PSA, and prostate volume were statistically different between the medication treatment failure and maintenance groups. By prostate size, the PSA and medication failure rates were relatively higher and the medication period was shorter in patients with a prostate size of more than 30 g. The combination medication rate was higher in patients with a prostate size of more than 50 g. The medication failure rate and prostate volume were higher in patients with a PSA level of more than 1.4 ng/mL. However, the combination treatment rate was not significantly different in patients with a PSA level lower than 1.4 ng/mL. Suggestive cutoffs for combination medication are a prostate volume of 34 g and PSA level of 1.9 ng/mL. Conclusions The clinical factors associated with medication failure were age, treatment type, and prostate volume. Combination therapy should be considered more in Korea in patients with a PSA level higher than 1.4 ng/mL and a prostate volume of between 30 and 50 g to prevent medication failure

Onlay patch augmentation in rotator cuff repair for moderate to large tears in elderly patients: clinical and radiologic outcomes

Background This study evaluated the clinical and radiologic outcomes of onlay patch augmentation in rotator cuff repair for moderate-to-large tears in elderly patients. Methods We reviewed 24 patients who underwent onlay augmentation with dermal allograft after arthroscopic rotator cuff repair from January 2017 to March 2020. Inclusion criteria were patients aged >65 years with tears >2.5 cm, who were followed for >12 months after surgery, and patients who could raise their arms above 90° preoperatively. American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, pain visual analog scale (VAS), and VAS for satisfaction were used as clinical outcomes. For the evaluation of cuff integrity, magnetic resonance imaging scans were performed every 3 months after surgery. The results were compared before and after surgery in all patients and between the retear and intact groups. Results The average follow-up period was 16.38 months, and the mean age of patients was 71.05 years. All patients showed significant improvement in ASES score, Constant-Murley score, and pain VAS at the last evaluation. The average value of satisfaction VAS was 7.27/10. The retear rate was 25% (6/24) if Sugaya type 3 was categorized in the retear group, otherwise 16.7% (4/24), if Sugaya type 3 was categorized into the intact group. Irrespective of Sugaya type 3 being included in the retear group, there was no significant difference in outcome variables between the intact and retear groups during follow-up. Conclusions In moderate-to-large rotator cuff tear in elderly patients, onlay patch augmentation improved clinical outcomes. Retear did not adversely affect clinical outcomes. Level of evidenceIV

Outcomes of critically ill patients according to the perception of intensivists on the appropriateness of intensive care unit admission

Background It is important for intensivists to determine which patient may benefit from intensive care unit (ICU) admission. We aimed to assess the outcomes of patients perceived as non-beneficially or beneficially admitted to the ICU and evaluate whether their prognosis was consistent with the intensivists’ perception. Methods A prospective observational study was conducted on patients admitted to the medical ICU of a tertiary referral center between February and April 2014. The perceptions of four intensivists at admission (day 1) and on day 3 were investigated as non-beneficial admission, beneficial admission, or indeterminate state. Results A total of 210 patients were enrolled. On days 1 and 3, 22 (10%) and 23 (11%) patients were judged as having non-beneficial admission; 166 (79%) and 159 (79%), beneficial admission; and 22 (10%) and 21 (10%), indeterminate state, respectively. The ICU mortality rates of each group on day 1 were 59%, 23%, and 59%, respectively; their 6-month mortality rates were 100%, 48%, and 82%, respectively. The perceptions of non-beneficial admission or indeterminate state were the significant predictors of ICU mortality (day 3; odds ratio [OR], 4.049; 95% confidence interval [CI], 1.892–8.664; P<0.001) and 6-month mortality (day 1: OR, 4.983; 95% CI, 1.260–19.703; P=0.022; day 3: OR, 4.459; 95% CI, 1.162–17.121; P=0.029). Conclusions The outcomes of patients perceived as having non-beneficial admission were extremely poor. The intensivists’ perception was important in predicting patients’ outcomes and was more consistent with long-term prognosis than with immediate outcomes. The intensivists’ role can be reflected in limited ICU resource utilization

Uncontrolled Self-Medication with Venlafaxine in a Patient with Major Depressive Disorder

Antidepressants are known to have no significant ability to cause addiction. However, a recent study showed many individuals with mood disorders self-medicated with antidepressants to relieve symptoms. We report here a male physician, diagnosed five years ago with major depressive disorder, with insomnia, anxiousness, and chest heaviness. He began self-medicating with 150 mg of venlafaxine daily, without any monitoring. During his most recent severe depressive episode, he was taking up to 1,500 mg of venlafaxine daily. Without this medication, he experienced discontinuation syndrome, which included severe anxiety, chest heaviness, and breathing difficulty, and which he judged as indicating a more severely depressed state. He also experienced overdose symptoms, such as hypertension and tachycardia. He attempted suicide with drugs that he possessed. In conclusion, careful monitoring is needed when treating patients with venlafaxine, because its discontinuation syndrome is similar to symptoms of major depressive disorder, and suicidality may result from an overdose

Determinants of respiratory symptom development in patients with chronic airflow obstruction

SummaryBackgroundThis study was undertaken to identify the determinants of respiratory symptom development in patients with chronic airflow obstruction (CAO).MethodsCategories of symptomatic and asymptomatic CAO were defined using questionnaire responses and spirometric results. We analyzed data obtained as part of the second South Korean National Health and Nutrition Examination Survey (Korean NHANES II).ResultsAmong 187 patients with CAO, 69 had no respiratory symptoms. CAO patients with symptoms were significantly older than those without symptoms (P=0.026), and hypertension was more common among symptomatic CAO patients than among asymptomatic CAO patients (P=0.005). According to questionnaire responses, symptomatic CAO patients had more difficulty in walking or lifting (P<0.001), required more help with personal care (P=0.01), and had poorer general health than asymptomatic CAO patients (P=0.008). Symptomatic CAO patients had higher fasting blood glucose levels than asymptomatic CAO patients (P=0.028). Symptomatic CAO patients had significantly lower forced expiratory volume in 1s (FEV1) (P=0.001), forced vital capacity (FVC) (P=0.008), and a ratio of FEV1/FVC than asymptomatic CAO patients (P<0.001). Statistically significant predictors of symptom development were as follows: age (odds ratio (OR) 1.04, P=0.028), hypertension (OR 4.41, P=0.008), fasting blood glucose (OR 1.02, P=0.034), FEV1 (OR 0.07, P=0.002), FVC (OR 0.08, P=0.009), FEV1/FVC (OR 0.00, P=0.001). Multiple logistic regression analyses revealed two independent factors associated with symptom development: FEV1/FVC (OR 0.001, P=0.002) and hypertension (OR 5.95, P=0.005).ConclusionsIn CAO, respiratory symptom development is significantly associated with low FEV1/FVC and the presence of hypertension