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Zolpidem Detection and Blood Level in Acute Poisoning-suspected Patients in Emergency Departments: Review of 229 Cases (급성중독 응급실 환자에서 Zolpidem 검출과 농도: 일개 중독분석실 229명 사례)

  • Yu, Jaehyung;Chang, Hanseok;Won, Sinae;Yeom, Jeonghun;Lee, Arum;Park, Na-Youn;Oh, Bum Jin
    • Journal of The Korean Society of Clinical Toxicology
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    • v.17 no.2
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    • pp.118-125
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    • 2019
  • Purpose: Non-benzodiazepine hypnotic drugs (including zolpidem) are associated with an increased risk of suicide and suicidal ideation. Considering the wide usage of zolpidem, this drug should be considered a possible etiology for stupor or coma in any patient exposed to this drug. However, there are no reports on zolpidem blood levels in emergency department patients in Korea. We therefore reviewed the analyzed data of a toxicology laboratory at one university affiliated hospital. Methods: The sex, age, chief symptoms, suspiciousness of poisoning, and presumption of poison were analyzed from January 2018 to June 2019. The detection frequency and level of zolpidem in the patient blood were compared to the mental changes presented, which is the main consequence of zolpidem. Results: A total of 229 toxicological analyses, requested to a toxicological laboratory at one university affiliated hospital, were reviewed. Among 229 patients, the mean age was 54.3±20.7 years old with 113 women and 116 men. 8.7% of patients have psychiatric illness and 39.7% were poisoned intentionally. The chief symptoms detected were: mental change 55.0%, gastrointestinal 14.4%, cardiovascular 10.5%, focal neurological 7.4%, respiratory 3.5%, none 8.7%, and unknown 0.4%. A request for detailed reports revealed that causative poisons were specified only in 20.1% cases. Zolpidem was detected in 22.3% cases (51/229), with median blood level 1.26 mg/L (interquartile 0.1, 5.06 mg/L) and urine 0.90 mg/L (interquartile 0.11, 5.6 mg/L). Furthermore, zolpidem was more frequently detected in toxicology analysis of patients where mental change was the primary symptom, as compared to other symptoms (32.5% vs. 9.7%, p<0.01). Conclusion: This study reported the blood level of zolpidem in suspected poisoning patients admitted to the emergency department.

Clinical Course of Suspected Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy: A 10-Year Experience of Rapid Progressive Right Ventricular Failure Syndrome in Advanced Cancer Patients

  • Minjung Bak;Minyeong Kim;Boram Lee;Eun Kyoung Kim;Taek Kyu Park;Jeong Hoon Yang;Duk-Kyung Kim;Sung-A Chang
    • Korean Circulation Journal
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    • v.53 no.3
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    • pp.170-184
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    • 2023
  • Background and Objectives: Several cases involving severe right ventricular (RV) failure in advanced cancer patients have been found to be pulmonary tumor thrombotic microangiopathies (PTTMs). This study aimed to discover the nature of rapid RV failure syndrome with a suspected diagnosis of PTTM for better diagnosis, treatment, and prognosis prediction in clinical practice. Methods: From 2011 to 2021, all patients with clinically suspected PTTM were derived from the one tertiary cancer hospital with more than 2000 in-hospital bed. Results: A total of 28 cases of clinically suspected PTTM with one biopsy confirmed case were included. The most common cancer types were breast (9/28, 32%) and the most common tissue type was adenocarcinoma (22/26, 85%). The time interval from dyspnea New York Heart Association (NYHA) Grade 2, 3, 4 to death, thrombocytopenia to death, desaturation to death, admission to death, RV failure to death, cardiogenic shock to death were 33.5 days, 14.5 days, 7.4 days, 6.4 days, 6.1 days, 6.0 days, 3.8 days and 1.2 days, respectively. The NYHA Grade 4 to death time was 7 days longer in those who received chemotherapy (7.1 days vs. 13.8 days, p value=0.030). However, anticoagulation, vasopressors or intensive care could not change clinical course. Conclusions: Rapid RV failure syndrome with a suspected diagnosis of PTTM showed a rapid progressive course from symptom onset to death. Although chemotherapy was effective, increased life survival was negligible, and treatments other than chemotherapy did not help to improve the patient's prognosis.

Quality Characteristics of Kiwi Wine and Optimum Malolactic Fermentation Conditions (참다래 와인의 최적 malolactic fermentation 조건과 품질 특성)

  • Kang, Sang-Dong;Ko, Yu-Jin;Kim, Eun-Jung;Son, Yong-Hwi;Kim, Jin-Yong;Seol, Hui-Gyeong;Kim, Ig-Jo;Cho, Hyoun-Kook;Ryu, Chung-Ho
    • Journal of Life Science
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    • v.21 no.4
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    • pp.509-514
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    • 2011
  • Maloactic fermentation (MLF) occurs after completion of alcoholic fermentation and is mediated by lactic acid bacteria (LAB), mainly Oenococcus oeni. Kiwi wine more than commercial grape wine has the problem of high acidity. Therefore, we investigated the optimal MLF conditions for regulating strong acidity and improving the quality properties of wine fermented with Kiwi fruit cultivated in Korea. For alcohol fermentation, industrial wine yeast Saccharomyces cerevisiae KCCM 12650 strains and LAB, known as MLF strains, were used to alleviate wine acidity. First, the various experimental conditions of Kiwi fruit, initial pH (2.5, 3.5, 4.5), fermenting temperature (20, 25, $30^{\circ}C$), and sugar contents (24 $^{\circ}Brix$), were adjusted, and after the fermentation period, we measured the acidity, pH, and the change in organic acid content by the AOAC method and HPLC analysis. The alcohol content of fermented Kiwi wine was 12.75%. Further, total acidity and pH of Kiwi wine were 0.78% and 3.5, respectively. Total sugar and total polyphenol contents of Kiwi wine were 38.72 mg/ml and 60.18 mg/ml, respectively. With regard to organic acid content, the control contained 0.63 mg/ml of oxalic acid, 2.99 mg/ml of malic acid, and 0.71 mg/ml of lactic acid, whereas MLF wine contained 0.69 mg/ml of oxalic acid, 0.06 mg/ml of malic acid, and 3.12 mg/ml of lactic acid. Kiwi wine had lower malic acid values and total acidity than control after MLF processing. In MLF, the optimum initial pH value and fermentation temperature were 3.5 and $25^{\circ}C$, respectively. Therefore, these studies suggest that establishment of optimal MLF conditions could improve the properties of Kiwi wine manufactured in Korea.

Patterns of FDG Uptake in Stomach on F-18 FDG Positron Emission Tomography: Correlation with Endoscopic Findings (F-18 FDG Positron Emission Tomography에서 보이는 위(stomach) 섭취 양상의 임상적 의의: 위 내시경 소견과 비교 평가)

  • Chae, Min-Jeong;Cheon, Gi-Jeong;Lee, Sang-Woo;Byun, Byung-Hyun;Kim, Sung-Eun;Kim, Yu-Chul;Choi, Chang-Woon;Lim, Sang-Moo
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.6
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    • pp.456-463
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    • 2005
  • Purpose: we often find variable degrees of FDG uptake and patterns in stomach, which can make difficult to distinguish physiologic uptake from pathologic uptake on FDG PET. The purpose of this study was to find out the significant findings of stomach on FDG PET. Materials and Methods: Thirty-eight patients who underwent both FDG PET and endoscopy within one week from Jun. 2003, to Aug. 2004 were included in this study. We reviewed 38 patients (18 for medical check up, 15 for work up of other malignancies, and 5 for the evaluation of stomach lesion). Their mean age was 56 years old (range:$32{\sim}79$), men and women were 28 and 10, respectively. Two nuclear physicians evaluated five parameters on FDG PET findings of stomach with a consensus: 1) visual grades 2) maximum SUV (max.SUV) 3) focal 4) diffuse and S) asymmetric patterns. We correlated the lesions of FDG PET findings of stomach with those of endoscopy. We considered more than equivocal findings on FDG PET as positive. Results: The six of 38 patients were proven as malignant lesions by endoscopic biopsy and others were inflammatory lesions (ulcer in 3, chronic atrophic gastritis in 12, uncommon forms of gastritis in 5), non-inflammatory lesions (n=3), and normal stomach (n=9). By the visual analysis, malignant lesions had higher FDG uptake than the others. The max.SUV of malignant lesions was $7.95{\pm}4.83$ which was significantly higher than the other benign lesions ($2.9{\pm}0.69$ in ulcer, $3.08{\pm}1.2$ in chronic atrophic gastritis, $3.2{\pm}1.49$ in uncommon forms of gastritis (p=0.044)). In the appearance of stomach on FDG PET, malignant lesions were shown focal (5 of 6) and benign inflammatory lesions were shown diffuse (9 of 20) and asymmetric (14 of 20). Benign lesions and normal stomach were shown variable degrees of uptake and patterns. Some cases of benign inflammatory lesions such as ulcer and gastritis were shown focal and mimicked cancerous lesion (4 of 15). Conclusion: Gastric malignant lesions had higher FDG uptake and focal pattern. However, benign inflammatory lesions had moderate degrees of uptake and diffuse and asymmetric patterns rather than focal. It is difficult to differentiate between benign lesions including normal.

Arthroscoic Anterior Cruciate Ligament Reconstruction with Autogenous Hamstring Gratt - Effect of the Additional Fixation after Fixation of the Graft with Intrafix - (자가 슬괵건을 이용한 관절경적 전방 십자 인대 재건술 - INTRAFIX system을 이용한 경골부 고정 후 부가적 고정의 효과 -)

  • Yoo, Jae-Doo;Roh, Kwon-Jae;Shin, Sang-Jin;Yoon, Jong-Suk;Yeo, Sung-Gu
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.1
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    • pp.51-55
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    • 2005
  • Purpose: To compare the stability and clinical result after anterior cruciate ligament reconstructed knee after graft fixation using Intrafix in tibial tunnel with or without additional tibial post fixation. Materials and Methods: We analyzed 37 cases which were treated with four-strand hamstring tendon autograft during the period from May 2002 to January 2003. The grafts were fixed with Rigidfix system (Mitek Product, Johnson and Johnson, USA) in femur tunnel and Intrafix system (Mitek Product, Johnson and Johnson, USA) in tibial tunnel. After tibial fixation, additional tibial post fixation was done, which was determined by the serial case number prospectively. Patients were followed for average of fourteen months(range, thirteen to twenty-five months) At the time of final follow-up, patients were evaluated in terms of Lachman test, pivot shift test, Lysholm scores, IKDC (International Knee Documentation Committee) assessment, side-to-side KT-1000 maximum-manual arthrometer differences. Results: At last follow-up, Lysholm score was average 93.1(range: 65 to 98), IKDC assessment revealed that 26 cases had score of A, 10 cases had score of B and 1 case had score of C. The average maximum-manual KT-1000 arthrometer side ?to-side difference was 2.5 mm$(0{\sim}6mm)$. There was one case in which the Lachman test was graded as 2+ and four cases in which the Lachman test was graded as 1+ and the remaining thirty-two cases were normal by Lachman test. One case had a 2+ pivot-shift, and 2 cases had a 11 pivot-shift. The remaining 34 knees were normal on pivot -shift testing. The average maximum-manual KT-1000 arthrometer side-to-side difference was average 2.8 mm$(0{\sim}6mm)$ in Intrafix only group and average 2.2 mm$(0{\sim}4mm)$ in additional fixation group (P>0.05). Conclusion: Without additional tibial fixation, the stability of the anterior cruciate reconstructed knee with hamstring graft which was fixed with Intrafix was restored.

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Study on the Recycled Compositing System for Reducing Bulking Agent Cost (부자재 비용절감을 위한 순환퇴비화 시스템에 관한 연구)

  • 최명환;홍지형;박금주;최원춘
    • Journal of Animal Environmental Science
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    • v.6 no.3
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    • pp.191-199
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    • 2000
  • This study was initiated to investigate the influence of biophysical condition on the composting characteristics, and conducted to develop technology for using recycled compost as a bulking agent cost to reduce operating cost. To methods of aeration, continuous aeration (CA: run No. I) and intermittent aeration (IA: run No. 2) were performed with three 12.3 liter laboratory scale vessels for ten days. Manure and rice hulls were mixed for thirst trial (I), rice hulls and recycled compost after first trial were mixed for second trial (II), dairy manure and only recycled compost after second trial were mixed for third trial (III). During the composting process, temperatures of the compost mass and ammonia emissions were measured. The quality and maturity of compost were ascertained by examining the characteristics and composition of the compost. Also, loss of mass was determined by measuring the mass of materials in the vessels before and after composting. The results in this study are as follows: 1. The periods of optimum temperature ($>55^{\circ}C$) to kill pathogens were maintained from 38 to 78 hours for CA and from 60 to 98 hours for IA. 2. The more recycled compost mixed, the more ammonia emitted. The maximum ammonia emissions were 287 ppm at CA and 420 ppm at IA. 3. Biofiltration system was required for the compo sting system using only recycled compost as an amendment, because the ammonia emissions was produced above 100 ppm at the end of composting process. 4. The quality and maturity of compost: - Fresh compost, were required drying, because moisture contents of the compost were approximately 70% in all tests. - The pH values were observed to rise smoothly, from 7.9 to 8.3 at CA and from 8.4 to 8.6 at IA. The CfN ratios of the fresh compost were ranged form 21.05 to 16.42 for CA and from 22.81 to 14.75 for IA. The final C/N ratios for test II and III were below 20.were below 20.

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Analysis of Nutritional Composition and Effects of Yak-sun Tea Prescription from Oriental Medicinal Herbs for Serum Lipid Levels and Homocystein Content (한약자원을 이용한 약선차의 영양성분 분석 및 약선차의 섭취가 여대생의 혈청지질수준과 호모시스테인 농도에 미치는 효과)

  • Han, Jong-Hyun;Song, You-Jin;Park, Sung-Jin;Park, Sung-Hye
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.35 no.5
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    • pp.557-564
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    • 2006
  • This research was planned and executed to evaluate how the composition of Yak-sun (oriental diet therapy) can effect health conditions of people who are suffering from diet-related diseases like obesity and hyper lipidemia by taking Yak-sun in a form of nutritional supplement with our daily meals. We produced Yak-sun tea with $Ky\hat{a}lmy\hat{a}ngja$, Kamguk, $K\hat{u}m\hat{u}nhwa$, Ch'onkung and observed nutritional composition and evaluated how this tea effects on serum lipids and homocystein concentration by clinical practices. With this observation, we found out that this tea has significant effect on increasing of HDL-cholesterol, decreasing of LDL-cholesterol and homocysteine concentration, and we think that scientific and objective evaluation was done on the components of Yak-sun tea prescription. We concluded that we could apply the components not only in a form of tea, but also in other forms of various food. The information we received from this conclusion will be a basic information on how we can apply oriental medicinal resources into other food and will also be a stepping stone for medicinal herbs to step foot in the field of functional food research, which already draws sizable attention world-wide.

Fear of Falling and Related Factors in Elderly Living Alone Based on Fall Experience (독거여성노인의 낙상경험에 따른 낙상두려움과 관련요인)

  • Lee, Myungsuk;Lee, Yunbok
    • Journal of agricultural medicine and community health
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    • v.38 no.4
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    • pp.243-256
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    • 2013
  • Objectives: This study was to investigate fear of falling and related factors in elderly living alone based on fall experience. Methods: Participants were 404 elderly women(faller=148, non-faller=256) over 65 years who were homebound living alone in Jeollanam-do Province. Face-to-face interviews were conducted using questionnaires from April $23^{th}$ to June $9^{th}$ 2013. The questionnaires consisted of demographic variables, fall experience, Fear of falling questionnaire(FOFQ), Falls Efficacy Scale(FES) and Center for Epidemiologic Studies Depression(CES-D). The collected data were analyzed using the SPSS version 14.0. Results: The fear of falling and the influential factors were different according to fall experience. Regression model for fear of falling in fallers significantly accounted for 46.1%(F=6.71, p<0.001); difficulty of performing activity, depression, fall-efficacy, static balance and assistive devices. Regression model for fear of falling in non-fallers significantly accounted for 55.2%(F=15.16, p<0.001); fall-efficacy, environmental hazards, difficulty of performing activity, risk of nutrition, housing type, dizziness and assistive devices. Conclusion: Results demonstrate that fall is an important health problem for elderly women living alone, and show fall experience for factors influencing fear of falling. These results could be used in the developing fall prevention programs.

Symptom Prevalence During Terminal Cancer Patients' Last 48 Hours of Life (말기 암 환자에서 임종 전 48시간 동안 나타나는 신체적 증상 빈도)

  • Jung, Soo-Jin;Lee, Bok-Ki;Choi, Kyung-Hi;Youn, Bang-Bu;Yeom, Chang-Hwan
    • Journal of Hospice and Palliative Care
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    • v.5 no.1
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    • pp.17-23
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    • 2002
  • Purpose : The prevalence of symptoms in patients with terminal cancer varies considerably and these symptoms are very difficult to control. However, patients can spend their last days or hours of life without suffering pain with appropriate care. One of the major concerns during last days of life is to predict the time of death. We would like to investigate symptom prevalence during terminal cancer patients' last 48 hours in Korea, and therefore contribute to predict the time of death and to help to determine appropriate treatments. Methods : The data for this study was recorded from 92 of 132 patients who died with terminal cancer at the hospital between February 1 and October 31, 2000. We investigated the symptom prevalence during the last 48 hours through medical obligation record and analyzed the changes of symptom prevalence at the admission, $48{\sim}24$ hours and $24{\sim}0$ hours before death. Results : The predominant symptom prevalence was pain (57.6%), followed by confusion (55.4%), dyspnea (48.9%), voiding difficulty (42.4%) in the last 48 hours before death. From the statistical analysis for the changes of symptom prevalence in time, pain, nausea and vomiting were decreased but noisy and moist breathing, sweating, groan, restlessness and agitation, and loss of consciousness were increased (P<0.05). Conclusion : The results from this study show the tendency to increase of prevalence of noisy and moist breathing, sweating, groan, restlessness and agitation as well as loss of consciousness in 48 hours before death. Therefore the symptoms above can be used for the important indicators to predict the imminent death.

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Current status and trends in estimated intakes and major food groups of vitamin E among Korean adults: Using the 1~6th Korea National Health and Nutrition Examination Survey (한국 성인의 비타민 E 섭취량 및 급원식품군의 현황 및 추이 : 제 1~6기 국민건강 영양조사 자료를 이용하여)

  • Ahn, Seoeun;Jun, Shinyoung;Kim, Seong-Ah;Ha, Kyungho;Joung, Hyojee
    • Journal of Nutrition and Health
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    • v.50 no.5
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    • pp.483-493
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    • 2017
  • Purpose: The purpose of this study was to determine trends in dietary vitamin E intakes and contributing food groups among Korean adults. Methods: This study included 66,695 subjects aged ${\geq}19years$ who completed a nutrition survey as part of the Korea National Health and Nutrition Examination Survey (1998, 2001, 2005, 2007~2009, 2010~2012, 2013~2015). We estimated individual daily intakes of ${\alpha}-$, ${\beta}-$, ${\gamma}-$, ${\delta}-tocopherol$, and total vitamin E by linking food consumption data with a vitamin E database of commonly consumed foods. Results: Daily vitamin E intake significantly increased from $6.4mg\;{\alpha}-TE/d$ in 1998 to $7.7mg\;{\alpha}-TE/d$ in 2013~2015 (p for trend < 0.0001) among men as well as from $5.4mg\;{\alpha}-TE/d$ in 1998 to $6.5mg\;{\alpha}-TE/d$ in 2013~2015 among women (p for trend < 0.0001). However, the intake of vitamin E was lower than the adequate intake (AI) of Dietary Reference Intakes for Koreans 2015 (2015 KDRI). In 2013~2015, men consumed 6.5 mg/d of ${\alpha}-tocopherol$, 0.5 mg/d of ${\beta}-tocopherol$, 6.0 mg/d of ${\gamma}-tocopherol$, and 3.9 mg/d of ${\delta}-tocopherol$, whereas women consumed 5.7 mg/d of ${\alpha}-tocopherol$, 0.4 mg/d of ${\beta}-tocopherol$, 4.8 mg/d of ${\gamma}-tocopherol$, and 2.8 mg/d of ${\delta}-tocopherol$. The major food groups contributing to vitamin E intake were vegetables (men: 23.3%, women: 22.7%), grains (men: 14.5%, women: 13.9%), and eggs (men: 13.0%, women: 12.5%). Conclusion: This study provides scientific evidence for vitamin E intake in Korean adults. Since the current intake of vitamin E was lower than the reference intakes set by 2015 KDRI, dietary vitamin E intake should be monitored regularly among Korean adults.