• 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.

• Journal of Cardiovascular Imaging
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• v.30 no.4
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• pp.292-304
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• 2022

BACKGROUND: Calcium is a determinant of paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI). This is based on a fixed contrast attenuation value while X-ray attenuation is patient-dependent and without considering frame expansion and PVL location. We examined the role of calcium in (site-specific) PVL after TAVI using a patient-specific contrast attenuation coefficient combined with frame expansion. METHODS: 57 patients were included with baseline CT, post-TAVI transthoracic echocardiography and rotational angiography (R-angio). Calcium load was assessed using a patient-specific contrast attenuation coefficient. Baseline CT and post-TAVI R-angio were fused to assess frame expansion. PVL was assessed by a core lab. RESULTS: Overall, the highest calcium load was at the non-coronary-cusp-region (NCR, 436 mm³) vs. the right-coronary-cusp-region (RCR, 233 mm³) and the left-coronary-cusp-region (LCR, 244 mm³), p < 0.001. Calcium load was higher in patients with vs. without PVL (1,137 vs. 742 mm³, p = 0.012) and was an independent predictor of PVL (odds ratio, 4.83, p = 0.004). PVL was seen most often in the LCR (39% vs. 21% [RCR] and 19% [NCR]). The degree of frame expansion was 71% at the NCR, 70% at the RCR and 74% at the LCR without difference between patients with or without PVL. CONCLUSIONS: Calcium load was higher in patients with PVL and was an independent predictor of PVL. While calcium was predominantly seen at the NCR, PVL was most often at the LCR. These findings indicate that in addition to calcium, specific anatomic features play a role in PVL after TAVI.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.4
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• pp.227-243
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• 2024

This study aimed to evaluate pain assessment strategies and factors associated with outcomes after microvascular decompression for the treatment of primary trigeminal neuralgia in adults. We conducted a systematic review and meta-analysis of English, Spanish, and French literature. We searched three databases, PubMed, Ovid, and EBSCO, from 2010 to 2022 and selected studies including patients with primary trigeminal neuralgia, clear pain assessment, and pain outcomes. Population means and standard deviations were calculated. Studies that included factors associated with postoperative outcomes were included in the meta-analysis. A total of 995 studies involving 5673 patients with primary trigeminal neuralgia following microvascular decompression were included. Patients with arteries compressing the trigeminal nerve demonstrated optimal outcomes following microvascular decompression (odds ratio [OR]= 0.39; 95% confidence interval [CI] = 0.19-0.80; X² = 46.31; Dof = 15; I² = 68%; P = < 0.0001). Conversely, when comparing arterial vs venous compression of the trigeminal nerve (OR = 2.72; 95% CI = 1.16-6.38; X² = 23.23; Dof = 10; I² = 57%; P = 0.01), venous compression demonstrated poor outcomes after microvascular decompression. Additionally, when comparing single-vessel vs multiple-vessel compression (OR = 2.72; 95% CI = 1.18-6.25; X² = 21.17; Dof = 9; I² = 57%; P = 0.01), patients demonstrated unfavorable outcomes after microvascular decompression. This systematic review and meta-analysis evaluated factors associated with outcomes following microvascular decompression (MVD) for primary trigeminal neuralgia (PTN). Although MVD is an optimal treatment strategy for PTN, a gap exists in interpreting the results when considering the lack of evidence for most pain assessment strategies.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.23.1-23.14
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• 2022

Background: The musculoskeletal disease (MSD) burden is an important health problem among Korean fishers. We aimed to investigate the indicators of the prevalence of MSD and contributions of significant indicators to MSD in Korean fishers. Methods: This cross-section study included 927 fishers (male, 371; female, 556) aged 40 to 79 years who were enrolled from 3 fishery safety and health centers. The outcome variable was one-year prevalence of MSD in 5 body parts (the neck, shoulder, hand, back, and knee). Independent variables were sex, age, educational attainment, household income, job classification, employment xlink:type, hazardous working environment (cold, heat, and noise), ergonomic risk by the 5 body parts, anxiety disorder, depression, hypertension, diabetes, and hyperlipidemia. The adjusted odds ratio of MSDs by the 5 body parts were calculated using multiple logistic regression analysis. We computed the population attributable fraction (PAF) for each indicators of MSDs using binary regression models. Results: The one-year prevalence of MSD in the neck, shoulder, hand, back, and knee was 7.8%, 17.8%, 7.8%, 27.2%, and 16.2% in males vs. 16.4%, 28.1%, 23.0%, 38.7%, and 30.0% in females, respectively. The ergonomic risk PAF according to the body parts ranged from 22.8%-59.6% in males and 22.8%-50.3% in female. Mental diseases showed a significant PAF for all body parts only among female (PAF 9.1%-21.4%). Cold exposure showed a significant PAF for the neck, shoulder, and hand MSD only among female (25.6%-26.8%). Age was not a significant indicator except for the knee MSD among female. Conclusions: Ergonomic risk contributed majorly as indicators of MSDs in both sexes of fishers. Mental disease and cold exposure were indicators of MSDs only among female fishers. This information may be important for determining priority risk groups for the prevention of work-related MSD among Korean fishers.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.38.1-38.9
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• 2022

Background: This study investigated the risk perceptions, prevalence of environmental diseases (EDs) and associated factors with the prevalence of environmental disease among the population living near an incinerator Methods: Study area were divided into 3 local areas near the incinerator by distance (A, B, C) and control area (D) by distance and geographic isolation. A Questionnaire was conducted with 1,380 in local residents (A, B, C) and 390 in control area (D), gathered information of demographic characteristics, lifestyle, perception of damage by incinerators, experience of EDs (atopic dermatitis, allergic rhinitis, asthma) diagnosed by physician. Analysis of variance, χ² test, and Kruskal Wallis test was applied to determine the difference by area. Logistic regression analysis was performed to identify factors associated with the prevalence of allergic rhinitis. Results: Residents residing closer to the incinerator had negative perception in most items in questionnaire compared with control. The prevalence of allergic rhinitis was higher as they lived nearby the incinerator (p = 0.008). The associated factors with the prevalence of allergic rhinitis were carpet (odds ratio [OR]: 1.79, p = 0.001), residential area (marginally significant), duration of residence (OR: 1.09, p < 0.001). The perception of environmental pollution around the residential area was inversely associated with the prevalence of allergic rhinitis: perceived as very dissatisfied (OR: 4.21, p = 0.02) compared with very satisfied. Conclusions: As closer to the incinerator, the risk perception tend to negative and prevalence of EDs were increased. Carpet, residential area, duration of residence and perception of environmental air pollution around the residential area were associated with prevalence of allergic rhinitis. These results may be useful for the communication with residents to discuss the environmental problems caused by the incinerator.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.20.1-20.12
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• 2022

Background: In the manufacturing industry, work-family conflict (WFC) is related to working hour characteristics. Earlier studies on the relationship between working hour characteristics and WFC in the manufacturing industry have been limited to some regions in Korea. No study has addressed the data on a national scale. Thus, this study investigated the impact of weekly working hours, weekend work, and shift work on WFC using national-scale data. Methods: This study was based on the fifth Korean Working Conditions Survey of 5,432 manufacturers. WFC consists of 5 variables; WFC1 "kept worrying about work"; WFC2 "felt too tired after work"; WFC3 "work prevented time for family"; WFC4 "difficult to concentrate on work"; WFC5 "family responsibilities prevented time for work". As WFC refers to the inter-role conflict between the need for paid work and family work, WFC has been measured in two directions, work to family conflict (WTFC: WFC1, 2, 3) and family to work conflict (FTWC: WFC4, 5). With these WFC variables, we conducted multiple logistic analyses to study how working hours, weekend work, and shift work impact WFC. Results: Korean manufacturers' prolonged working hours increased all aspects of WFCs. Odds ratios (ORs) of WFCs based on working hours (reference of under 40 hours) of 41-52, 53-60, over 61 were 1.247, 1.611, 2.279 (WFC1); 1.111, 2.561, 6.442 (WFC2); 1.219, 3.495, 8.327 (WFC3); 1.076, 2.019, 2.656 (WFC4); and 1.166, 1.592, 1.946 (WFC5), respectively. Shiftwork in the WFC2 model showed a significantly higher OR of 1.390. Weekend work 'only on Saturday' had significant ORs with WFC2 (1.323) and WFC3 (1.552). Conclusions: An increase in working hours leads to the spending of less time attending to problems between work and family, causing both WTFC and FTWC to increase. As weekends, evenings, and nighttime are considered to be family-friendly to people, working on weekends and shift-work were highly correlated to WTFC.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.11.1-11.9
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• 2022

Background: Although coronavirus disease 2019 is causing a variety of psychological problems for workers, there are few longitudinal studies on changes in workers' mental health by workplace intervention. This study aimed to evaluate the change in the prevalence of depression and anxiety according to the active involvement of the workplace. Methods: This study was conducted on 1,978 workers at a workplace who underwent a health screening from January 2019 to August 2020, and classified depression and anxiety disorders using a self-report questionnaire. After the first pandemic, the company stopped health screening, took paid leave and telecommuting, and conducted interventions such as operating its own screening clinic. To see if this workplace intervention affects workers' mental health, we conducted generalized estimating equations to compare odds ratio (OR). Results: In the pre-intervention group, 384 people (16.86%) had depression, and 507 people (22.26%) had anxiety disorder. Based on the OR before intervention, the OR of depression decreased to 0.76 (0.66-0.87) and the OR of anxiety disorder decreased to 0.73 (0.65-0.82). Conclusions: As a result of this study, it was confirmed that workplace intervention was related to a decrease in depression and anxiety. This study provides basic data to improve workers' mental health according to workplace intervention, and further research is needed according to workplace intervention in the future.

• Korean Circulation Journal
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• v.54 no.2
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• pp.63-75
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• 2024

Background and Objectives: Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR. Methods: This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts. Results: Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEEGA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding. Conclusions: ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.

• Journal of the Korean Society of Radiology
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• v.18 no.4
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• pp.373-381
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• 2024

This study aimed to identify and assess the influence of risk factors on the frequency of thyroid nodules diagnosed through ultrasonography among adults visiting for health screenings. The study analyzed 210 adult men and women who underwent thyroid ultrasound at J Hospital in Busan. The differences in variables were analyzed using Chi-square and independent t-tests, and risk ratios were calculated using binary logistic regression. The results showed significant differences in gender, age, T3, Free T4, Uric acid, T-chol, HDL-C and LDL-C. The risk ratios for risk factors indicated that women had a 2.42 times higher risk compared to men, and the age groups 41-50 and over 61 had risks 2.32 and 2.22 times higher, respectively compared to those under 40. Conversely, and increase in T3 and Free T4 levels was associated with a decreased risk of 0.12 and 0.86 times, respectively, while lipid levels had negligible influence. Based on these findings, it is concluded that regular ultrasonography monitoring, rather than solely relying on biochemical markers, is crucial for the early detection and management of thyroid nodules.

• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.600-610
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• 2004

Background : The plasma B-type natriuretic peptide(BNP) concentration increases with the degree of pulmonary hypertension in patients with chronic respiratory disease. The aim of this study was to examine the prognostic role of BNP in the acute exacerbation of chronic obstructive lung disease (COPD). Method : We selected 67 patients who were admitted our hospital because of an acute exacerbation of COPD. Their BNP levels were checked on admission at the Emergency Department. Their medical records were analyzed retrospectively. The patients were divided into two groups according to their in-hospital mortality. The patients' medical history, comobidity, exacerbation type, blood gas analysis, pulmonary function, APACHE II severity score and plasma BNP level were compared. Results : Multiple logistic regression analysis identified three independent predictors of mortality: $FEV_1$, APACHE II score and plasma BNP level. The decedents group showed a lower $FEV_1$($28{\pm}7$ vs. $37{\pm}15%$, p=0.005), a higher APACHE II score($22.4{\pm}6.1$ vs. $15.8{\pm}4.7$, p=0.000) and a higher BNP level ($201{\pm}116$ vs. $77{\pm}80pg/mL$, p=0.000) than the sSurvivors group. When the BNP cut-off level was set to 88pg/mL using the receiver operating characteristic curve, the sensitivity was 90% and the specificity was 75% in differentiating between the survivors and decedents. On Fisher's exact test, the odds ratio for mortality was 21.2 (95% CI 2.49 to 180.4) in the patients with a BNP level > 88pg/mL. Conclusion : The plasma BNP level might be a predictor of mortality in an acute exacerbation of COPD as well as the $FEV_1$ and APACHE II score.