• Journal of Trauma and Injury
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• v.37 no.1
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• pp.28-36
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• 2024

Purpose: Recent advancements in interventional radiology have made angioembolization an invaluable modality in trauma care. Angioembolization is typically performed by interventional radiologists. In this study, we aimed to investigate the safety and efficacy of emergency angioembolization performed by trauma surgeons. Methods: We identified trauma patients who underwent emergency angiography due to significant trauma-related hemorrhage between January 2020 and June 2023 at Jeju Regional Trauma Center. Until May 2022, two dedicated interventional radiologists performed emergency angiography at our center. However, since June 2022, a trauma surgeon with a background and experience in vascular surgery has performed emergency angiography for trauma-related bleeding. The indications for trauma surgeon-performed angiography included significant hemorrhage from liver injury, pelvic injury, splenic injury, or kidney injury. We assessed the angiography results according to the operator of the initial angiographic procedure. The term "failure of the first angioembolization" was defined as rebleeding from any cause, encompassing patients who underwent either re-embolization due to rebleeding or surgery due to rebleeding. Results: No significant differences were found between the interventional radiologists and the trauma surgeon in terms of re-embolization due to rebleeding, surgery due to rebleeding, or the overall failure rate of the first angioembolization. Mortality and morbidity rates were also similar between the two groups. In a multivariable logistic regression analysis evaluating failure after the first angioembolization, pelvic embolization emerged as the sole significant risk factor (adjusted odds ratio, 3.29; 95% confidence interval, 1.05-10.33; P=0.041). Trauma surgeon-performed angioembolization was not deemed a significant risk factor in the multivariable logistic regression model. Conclusions: Trauma surgeons, when equipped with the necessary endovascular skills and experience, can safely perform angioembolization. To further improve quality control, an enhanced training curriculum for trauma surgeons is warranted.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.4
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• pp.347-354
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• 2022

Backgrounds/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for a subset of patients with pancreatic fistulae. The objective of this study was reporting outcomes of ERCP and predictors of resolution in patients with pancreatic fistulae refractory to conservative therapy. Methods: Retrospective review of patients who underwent ERCP and pancreatic stent placement for pancreatic fistula not responding to medical therapy was performed. Clinical features, laboratory parameters, radiological features and pancreatogram findings were noted. Clinical resolution of fistula was the primary outcome measure. Results: Sixty-eight patients underwent ERCP for high-output pancreatic fistula (Mean age 34.1 years, 91.1% males, 35/68 chronic pancreatitis, 52.9% alcohol etiology). Internal fistulae (pancreatic ascites, pleural effusion, or pericardial effusion) were seen in 55 (80.9%) patients and external fistula in 13 (19.1%) patients. Technical success for ERCP was 92.6% (63/68). Leak was seen in 98.4% (62/63). The most common leak site was body (69.8%). Multiple leak sites were seen in 23.1%. Pancreatic stricture was found in 36.5%. In 44 (69.4%) patients, stent was placed beyond the site of the leak. Resolution at six weeks was achieved in 76.4% (52/68). On univariate and multivariate analyses, placement of stent beyond site of leak was significantly associated with resolution of high-output fistulae (3/41 [7.3%] vs. 5/19 [26.3%], p = 0.03; odds ratio: 6.5, 95% confidence interval: 1.211-34.94). Conclusions: In our experience, ERCP was successful in 76% of patients with pancreatic fistulae refractory to conservative therapy. Stent placement beyond the site of leak was associated with higher resolution of fistulae.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.4
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• pp.363-374
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• 2022

Backgrounds/Aims: To analyze the results of the neoadjuvant treatment of patients in our center with early pancreatic cancer. Methods: Eighty-four patients with early pancreatic cancer (I-II) were included, of which 59 were considered "bioborderline" (carbohydrate antigen [CA] 19-9 > 37 U/L), and 25 were considered "non-bioborderline" (CA19-9 < 37 U/L). The R0 resection rate, presence of negative nodes, survival, and recurrence rates were analyzed in two groups, the NEO group (neoadjuvant + surgery) and the nonNEO group (upfront surgery). Results: A 28.6% pathologic complete response was observed in the NEO group of the whole sample. The residual R0 was 85.7%, and nodes were negative in 78.6% of the patients in the NEO group of bioborderline patients. All non-bioborderline patients treated with neoadjuvant were R0, and no affected nodes were observed in any of them. The median overall survival (OS) in patients with elevated CA19-9 levels in the NEO group was 31.4 months vs. 13.1 months in the non-NEO (log-rank test p = 0.006), with a 62% relative reduction in the mortality rate (hazard ratio = 0.38, 95% confidence interval: 0.20-0.79; p= 0.008). The median OS in patients with normal CA19-9 levels in the NEO group was 65.9 months vs. 16.2 months in the non-NEO group, without statistically significant differences between the two but with a trend toward significance (log-rank test p = 0.08). Conclusions: A neoadjuvant strategy seemed to improve local control and the survival of patients with early pancreatic cancer, both those with elevated CA19-9 and normal marker levels.

• Korean Circulation Journal
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• v.52 no.8
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• pp.593-603
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• 2022

Background and Objectives: In patients with atrial fibrillation (AF), females taking vitamin K antagonist are at higher risk of stroke or systemic embolism (SSE), bleeding and all-cause death than males. This study investigated the relationship between sex and adverse clinical events in a contemporary AF patient cohort taking anticoagulation. Methods: This prospective multicenter AF registry study comprised 6,067 patients with AF (mean age, 70±9 years; men, 59%) with intermediate to high risk of stroke (CHA₂DS₂-VAscore ≥1) and receiving oral anticoagulation therapy. Adverse clinical outcomes, including SSE, bleeding, death were evaluated in patients stratified by sex and anticoagulation patterns. Results: Women were older and used more direct oral anticoagulants (85% vs. 78%, p<0.001) than men. During a median (25^th and 75^th percentiles) follow-up of 30 (24, 38) months, the incidence rate and risk of SSE (0.7 in women vs. 0.7 in men per 100 person-years) and major bleeding (0.1 in women vs. 0.1 in men per 100 person-years) were not different between the sexes. However, women had a lower all-cause death rate (0.4 in women vs. 0.6 in men per 100 person-years, hazard ratio: 0.48, 95% confidence interval: 0.25-0.91, p=0.025) than men. Conclusions: In contemporary anticoagulation for AF, SSE and major bleeding risks did not differ between sexes. However, women showed a lower risk of all-cause death rate than men, indicating that the use of oral anticoagulants for treating AF in females does not appear to be a risk factor for adverse clinical events.

• Korean Circulation Journal
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• v.52 no.1
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• pp.47-59
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• 2022

Background and Objectives: The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods: A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results: The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15-2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions: Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

• Journal of agricultural medicine and community health
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• v.38 no.3
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• pp.182-194
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• 2013

Objectives: To identify and compare the health behaviors and health status of the elderly between urban and rural areas using the data of the Korean National Health and Nutrition Examination Survey (KNHANES). Methods: The study population comprised 3,823 elderly people aged 65 years or older who participated in the $4^{th}$ KNHANES (2007-2009). The areas were classified into "large cities," "cities," and "rural areas" using the administrative and residential areas. The health behaviors and health status of the elderly between the rural and urban areas were compared using a complex sample design with the Rao-Scott chi-square test and weighted multiple logistic regression analysis. Results: Compared to large cities, the odds ratios (ORs) (95% confidence interval [CI]) of rural areas were as high as 1.58 (1.25-2.01) for the influenza vaccination and as low as 0.47 (0.37-0.59) for flexibility exercises, 0.56 (0.38-0.81) for muscular exercises, and 0.76 (0.62-0.92) for obesity. The ORs (CI) for osteoarthritis and diabetes mellitus were as low as 0.81 (0.66-0.99) and 0.70 (0.55-0.89), respectively. Conclusions: The health behaviors and health status of the elderly are better in rural areas than in urban areas despite the fact that the socioeconomic conditions in rural areas are poorer that those in urban areas. These findings suggest that programs suitable for residential areas should be developed and that studies to explain the differences in residential areas are needed.

• Korean Journal of Environment and Ecology
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• v.34 no.1
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• pp.9-17
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• 2020

Domestic cats (Felis catus) introduced to insular environments can be invasive predators that often threaten endemic species and cause biodiversity loss or local extinction on the island. This study was conducted from March to July 2018 to understand the population size, home range, and spatial use of cats introduced to Mara Islet (N 33° 07', E 126° 16') in Jeju Special Governing Province, the Republic of Korea. Observation records based on their natural marks revealed that there were 20 adult cats on Mara Islet. A capture-recapture method also estimated 20 adult individuals (95% confidence interval: 20-24 individuals). According to our telemetry study on ten adults deployed with GPS-based telemetry units, the home range size was 12.05±6.99 ha (95% KDE: kernel density estimation), and the core habitat size was 1.60±0.77 ha (50% KDE). There were no significant differences in the home range and core habitat sizes by sex. The home range of domestic cats overlapped with the human residential area, where they might secure easy foods. Five of ten tracked cats were active at potential breeding colonies for the Crested Murrlet (Synthliboramphus wumizusume), and six approached potential breeding areas of the Styan's Grasshopper Warbler (Locustella pleskei), suggesting the predation risk of the two endangered species by cats. This study provides novel information on the population size and home range of introduced cats on Mara Islet which is an important stopover site of migratory birds as well as a breeding habitat of the two endangered avian species. Reducing the potential negative impacts of the introduced cats on migratory birds and the endangered species on Mara Islet requires monitoring of the predation rate of birds by cats, the population trends of cats and endangered breeding birds as well as the effective cat population control and management.

• Korean Journal of Psychosomatic Medicine
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• v.13 no.2
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• pp.95-101
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• 2005

Objectives : This study was designed to investigate depression, anxiety, alexithymia, stress res ponses in caregivers of patients with attention deficit hyperactivity disorder. Methods : The subjects were 38 attention deficit hyperactivity disorder patients caregivers(38 women, mean age $37.5{\pm}6.5$). Patients were diagnosed with DSM-IV ADHD criteria. Korean version of Beck Depression Inventory(BDI), State and Trait Anxiety Inventory(STAI), Toronto Alexithymia Scale(TAS) and Stress Response Inventory(SRI) were used for assessment. Results 1) The BDI scores of ADHD patients caregiver group were significantly higher than control group$(16.4{\pm}7.1\;vs.\;10.9{\pm}5.5)(p=0.011)$. 7 of the 38 caregivers(18.4%) and none of control group(0%) had BDI scores over 20 points(p=0.021). Calculated relative risk for ADHD in the presence of caregivers' depression was 1.516 overall(95% confidence interval, 1.234-1.862). 2) In ADHD patient's caregiver group, the scores of Stress Response Inventory were significantly higher than control group$(44.2{\pm}20.2\;vs.\;26.5{\pm}16.8)(p=0.006)$. 3) No significant differences were found in the score of STAI, SIAIS, SIAI-T, TAS between caregiver and control group. Conclusion : This study suggest that ADHD patients' caregivers are likely to have more depressive symptoms and higher stress response level than control group. We propose that physicians should consider integrated approaches for caregiver's psychopathology in the management of ADHD.

• Journal of Nutrition and Health
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• v.48 no.3
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• pp.269-276
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• 2015

Purpose: The aim of the current study was to compare the vegetable and fruit intake between one person households and those living with family. Methods: The 24-hour recall data of 14,914 persons over 20 years old who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012 were used for the final analysis. Consumption of non-salted vegetables and fruits (${\geq}400g/day$), fruits (${\geq}200g/day$), and kimchi (${\geq}120g/day$) was compared between one person households and those living with family. Logistic regression models were used to assess the associations between potential determinants and adequate vegetable and fruit intake. Results: After additional adjustments for age, household income, and total energy intake, no statistically significant differences in likelihood of low intake of nonsalted vegetable and fruit and kimchi were observed between one person households and those living with family. (Nonsalted vegetables and fruits: odds ratio (OR) = 1.15, 95% confidence interval (CI) = 0.79-1.68 for the men; OR = 1.25, 95% CI = 0.98-1.59 for women). However one person households have greater likelihood of low intake of kimchi than those living with family in women (OR = 1.72, 95% CI = 1.31-2.26). Conclusion: Although there were no differences in likelihood of low intake of non-salted vegetables and between individuals living alone and those living with family, women of one person households were great likelihood of low intake of kimchi compared to those living with family.

• Tuberculosis and Respiratory Diseases
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• v.71 no.2
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• pp.120-125
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• 2011

Background: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. Methods: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. Results: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. Conclusion: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.