• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.157-163
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• 2019

Purpose: To investigate the incidence and associated factors of delirium after orthopedic surgery. Materials and Methods: A total of 2,122 cases, who were older than 20 years and underwent orthopedic surgery at a single medical center during a one year period were included. Among them, 132 patients who were diagnosed with delirium after surgery under the Diagnostic and Statistical Manual of Mental Disorders-V criteria and medicated under the consultation of a psychiatrist were included in the study The differences in the incidence of delirium and several affecting factors were analyzed. Results: The overall incidence of delirium after surgery was 6.2% (132 in 2,122 cases). The mean age of the delirium group was 77.4 years (range, 54-92 years), which was higher than that of the non-delirium group (58.1 years). The percentage of women in the delirium group was 63.6% (84 in 132 cases), which was higher than that of the women in the non-delirium group (49.0%). The incidence of delirium after surgery was 9.3% (85 in 916 cases) due to trauma and 3.9% (47 in 1206 cases) due to disease. The incidence of postoperative delirium according to the surgical region was 29.2% (7 in 24 cases) in two or more regions, 13.7% (72 in 526 cases) in the hip, and 9.6% (14 in 146 cases) in the spine, 3.5% (20 in 577 cases) in the knee-lower leg, 2.5% (5 in 199 cases) in the foot-ankle, 2.4% (11 in 457 cases) in the shoulder-elbow, and 1.6% (3 in 189 cases) in the forearm-wrist-hand. Delirium occurred more rapidly in women and surgery due to disease, and the duration of delirium was longer in patients with dementia and major depressive disorders. Conclusion: The incidence of postoperative delirium was high in cases of surgery due to trauma and in cases of surgery in two or more sites. The incidence of postoperative delirium according to a single surgical region was higher in the order of the hip, spine, and knee. Active intervention is needed regarding the correctable risk factor.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.600-612
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• 1996

Background : Recent studies deported that untreated patients with obstructive sleep apnea syndrome had high long-term mortality rates, and cardiovascular complications of these patients clad a major effect on mortality. Several data indicates that obstructive sheep apnea syndrome contributes to the development of diurnal systemic hypertension. But the pathophysiological mechanism of the development of systemic hypertension in these patients is still uncertain. This study was performed to evaluate the possible role of sympathetic nervous system activity for the development of systemic hypertension in patients with obstructive sleep apnea syndrome. Method : 35 patients with obstructive sleep apnea syndrome(OSAS) and 13 Control subjects(control) were included in this study. 21 patients of OSAS were normotensives(OSAS-NBP), and 14 patients of OSAS were hypertensives(OSAS-HBP). Full night polysomnography was undertaken to all subjects. We measured plasma norepinephrine(NE) and epinephrine(EP) concentrations during waking and sleep, using high performance liquid chromatography, in all patients and control subjects. Results : In OSAS, OSAS-NBP and control, plasma NE and EP concentrations during sleep were lowed than during waking(p<0.01). But, in OSAS-HBP, these was no difference between during waking and sleep. Plasma NE concentrations during sleep of OSAS, OSAS-NBP and OSAS-HBP were higher than Control(p<0.05). In OSAS-HBP, daytime systolic blood pressure correlated with plasma NE concentration during sleep(r=0.7415, p<0.01), arid correlated inversely with mean arterial oxygen saturation(r=-0.6465, p<0.05) or arterial oxygen saturation nadir(r=-0.6) 14, p<0.05) during sleep. Conclusion : The sympathetic activity during sleep of obstructive sleep apnea syndrome patients was higher than control subjects. In obstructive sleep apnea syndrome patients with systemic hypertension, there was no diurnal variation of sympathetic activity, and there was correlation between daytime systolic blood pressure and sympathetic activity during sleep. These data suggests that chronic hyperactivity of sympathetic nervous system may contribute to the development of diurnal systemic hypertension in patients with obstructive sleep apnea syndrome.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.335-344
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• 2001

Purpose : The aim of this study was to clarify the role of VEGF expression as an independent prognostic factor and to identify the patients at high risk for poor prognosis in stage IB cervical cancer. Materials and methods : A total of 118 patients with stage IB cervical cancer who had radical hysterectomy and pelvic lymph node dissection were included in the study. All known high risk factors of the patients were pathologically confirmed from the surgical specimen. Of the 118 patients, n patients were treated with postoperative radiotherapy and/or chemotherapy. VEGF expression was examined using immunohistochemistry in formalin-fixed, paraffin-embedded specimens of post-hysterectomy surgical materials. A semiquantitative analysis was made using a scoring system of 0, +, ++, and +++ for increasing intensity of stain. We classified the patients with scores from 0 to ++ as low VEGF expression and the patients with a score of +++ as high VEGF expression. Results : Of the 118 patients, 35 patients $(29.7\%)$ showed high VEGF expression. Strong correlations were found between the high VEGF expression and both deep stromal invasion (p=0.01) and the positive pelvic node (p=0.03). The 5-year overall and disease-free survival rates for all 118 patients were $95.5\%\;and\;93.8\%$. The 5-year overall (p=0.03) and disease-free survival (p<0.001) rates were $98.5\%\;and\;100%$ for low VEGF expression (0, +, and ++) and $85.5\%\;and\;79.7\%$ for high VEGF expression, respectively. Pelvic and distant failures for low versus high VEGF expression were $1.2\%$ versus $17.1\%$, (p=0.001) and $0\%$ versus $14.3\%$ (p<0.001), respectively. In a Cox multivariate analysis of survival, the high VEGF expression (p=0.02) and the bulky mass (p=0.02) were significant prognostic factors for overall survival. The high VEGF expression (p=0.002), and bulky mass (p=0.01) demonstrated as significant prognostic indicators for disease free survival. Conclusion : These results showed that VEGF expression was a highly significant predictor for pelvic and distant failure and the most significant prognostic factor of overall and disease free survival for the patients with stage IB cervix cancer treated with radical surgery. We strongly suggest that the immune-histochemistry for VEGF expression be performed in a routine clinical setting in order to identify the patients at high risk for poor prognosis in early stage cervical cancer. Furthermore, postoperative and/or chemotherapy did not reduce the pelvic failure and distant metastasis. To improve the cure rate for the patients with high VEGF expression in stage IB cervical cancer, antiangiogenic therapy including anti-VEGF Ab may be new treatment option.

• Korea journal of population studies
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• v.19 no.2
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• pp.77-105
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• 1996

The rural problems which we are facing start from the extremely small sized population and the skewed population structure by age and sex. Thus we analyzed the change of the rural population. And we analyzed the recent return migration to the rural areas by comparing the recent in-migrants with out-migrants to rural areas. And by analyzing the rural village survey data which was to show the current characteristics of rural population, we found out the effects of the in-migrants to the rural areas and predicted the futures of rural villages by characteristics. The changes of rural population composition by age was very clear. As the out-migrants towards cities carried on, the population composition of young children aged 0~4 years was low and the aged became thick. The proportion of the population aged 0~4 years was 45.1% of the total population in 1970 and dropped down to 20.4% in 1995, which is predicted to become under 20% from now on. In the same period(1970~1995), the population aged 65 years and over rose from 4.2% to 11.9%. In 1960, before industrialization, the proportion of the population aged 0~4 years in rural areas was higher than that of cities. As the rural young population continuously moves to cities it became lower than that in urban areas from 1975 and the gap grew till 1990. But the proportion of rural population aged 0~4 years in 1995 became 6.2% and the gap reduced. We can say this is the change of the characteristics of in-migrants and out-migrants in the rural areas. Also considering the composition of the population by age group moving from urban to rural area in the late 1980s, 51.8% of the total migrants concentrates upon age group of 20~34 years and these people's educational level was higher than that of out-migrants to urban areas. This fact predicted the changes of the rural population, and the results will turn out as a change in the rural society. However, after comparing the population structure between the pure rural village of Boeun-gun and suburban village of Paju-gun which was agriculture centered village but recently changed rapidly, the recent change of the rural population structure which the in-migrants to rural areas becomes younger is just a phenomenon in the suburban rural areas, not the change of the total rural areas in general. From the characteristics of the population structure of rural village from the field survey on these villages, we can see that in the pure rural villages without any effects from cities the regidents are highly aged, while industrialization and urbanization are making a progress in suburban villages. Therefore, the recent partial change of the rural population structure and the change of characteristics of the in-migrants toward rural areas is effecting and being effected by the population change of areas like suburban rural villages. Although there are return migrants to rural areas to change their jobs into agriculture, this is too minor to appear as a statistic effect.

• Korean Journal of Soil Science and Fertilizer
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• v.40 no.5
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• pp.383-391
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• 2007

This study was conducted for an assessment through the estimation of soil loss by each catchment classified by soil catena. Ten catchments, which are Geumgang21, Namgang03, Dongjincheon, Gapyongcheon01, Gyongancheon02, Geumgang16, Byongsungcheon01, Daesincheon, Bukcheon02, Youngsangang08, were selected from the hydrologic unit map and the detailed soil digital map (1:25,000) for this study. The catchments like Geumgang21, Namgang03, Dongjincheon, Gapyongcheon01 and Gyongancheon02 were mainly composed with soils originated from gneiss. The catchments like Geumgang16, Byongsungcheon01, Daesincheon, Bukcheon02 and Youngsangang08 were mainly composed with soils originated from granites. The grades, which are divided into seven grades with A(very tolerable), B(tolerable), C(moderate), D(low), E(high), F(severe), G(very severe), of soil erosion estimated by USLE in catchments were distributed in most A and B because of paddy land and forestry. In detailed, the soil erosion grade of catchments mainly distributing soils originated from gneiss showed more the distribution of B and C than it of catchments mainly distributing soils originated from granites. The reason of results would be derived from topographic characteristics of soils originated from gneiss located at mountainous. The soil loss according to soil catena linked with Songsan and Jigok series, which are soils originated from gneiss was calculated with $7.66ton\;ha^{-1}\;yr^{-1}$. The soil loss of Geumgang16, Byongsungcheon01, Daesincheon, Bukcheon02 which have the soil catena linked with Samgak and Sangju soil series originated from granite, was calculated with $5.55ton\;ha^{-1}\;yr^{-1}$. The soil loss of Youngsangang08 which have the soil catena linked with Songjung and Baeksan soil series originated from granite was calculated with $9.6ton\;ha^{-1}\;yr^{-1}$, but the conclusion on soil loss in this kind of soil catena would be drawn from the analysis of more catchments. In conclusion, the results of this study inform that the classification of soil catena by catchments and estimation of soil loss according to soil catena would be effective for analysis on the grade of non-point pollution by soil erosion in a catchment.