• Journal of Korean Neurosurgical Society
• /
• v.64 no.3
• /
• pp.460-468
• /
• 2021

Objective : Extremely low alanine transaminase (ALT) levels are associated with all-cause mortality in frail elderly individuals; the clinical significance of ALT as a reliable biomarker is now being considered. Predicting mortality with routine tests at the time of diagnosis is important for managing patients after intracranial hemorrhage. We aimed to investigate whether an extremely low ALT level is associated with mortality in the elderly after intracranial hemorrhage. Methods : A retrospective review was performed on 455 patients with intracranial hemorrhage admitted to a university-affiliated tertiary care hospital from February 2014 to May 2019. Multivariate Cox regression analysis was performed for all ages and for each age group to determine whether an extremely low ALT level is an independent predictor of mortality only in the elderly. Results : Overall, 294 patients were enrolled, and the mean age of the subjects was 59.1 years, with 99 (33.8%) aged ≥65 years. The variables associated with all-cause mortality in all subjects were age, C-reactive protein (CRP) levels, hemoglobin (Hb) levels (<11 g/dL), and initial Glasgow coma scale (GCS) scores. In young patients, CRP, low Hb levels, and initial GCS scores were significantly associated with all-cause mortality. However, in the elderly (≥65 years), the variables significantly associated with all-cause mortality were extremely low levels of ALT (<10 U/L) (adjusted hazard ratio, 3.313; 95% confidence interval, 1.232-8.909; p=0.018) and initial GCS scores. Conclusion : Extremely low ALT level (<10 U/L) at the time of diagnosis is a significant risk factor for all-cause mortality in the elderly after intracranial hemorrhage.

• Korean Journal of Biological Psychiatry
• /
• v.27 no.2
• /
• pp.112-116
• /
• 2020

Leucine rich glioma inactivated (LGI1) encephalitis is an uncommon neurological disorder rarely encountered in clinical practice. However, it is a potentially fatal autoimmune syndrome that can decrease the level of consciousness, possibly progressing to coma. Additionally, unless diagnosed and promptly treated, it can cause permanent cognitive impairment. Since LGI1 encephalitis can initially present with psychiatric symptoms, there can be delays in reaching a proper diagnosis. This report describes a case of a 47-year-old woman with LGI1 antibodies-associated limbic encephalitis who initially presented with psychosis. Her blood tests were normal and no MRI and EEG abnormalities were found. Cerebrospinal fluid analysis was negative for other possible infectious causes. Three months after admission, she was found to be LGI1 antibody positive. LGI1 encephalitis should be suspected in patients with symptoms such as memory loss, confusion, seizures, and psychiatric symptoms. Prompt diagnosis and treatment of LGI1 encephalitis are warranted because prognosis becomes worse when such actions are delayed.

• The Journal of Internal Korean Medicine
• /
• v.43 no.6
• /
• pp.1274-1288
• /
• 2022

Objectives: The study investigated the effect of Korean medicine treatment on a hemiplegic patient with conscious and cognitive disorders due to hemorrhagic transformation after interventional reperfusion therapy of anterior circulation infarction. Case presentation: The patient was treated with acupuncture, moxibustion, cupping, and herbal medicine in combination with Western medicine and physical therapy. The effects on clinical symptoms were evaluated using the Manual Muscle Test (MMT), Glasgow Coma Scale (GCS), Korean Mini-Mental State Examination (K-MMSE), Korean Nursing Delirium Screening Scale (Korean Nu-DESC), and Modified Bathel Index (MBI). After the treatment, the MMT grade increased from Gr.0-1 to Gr.0-3, the GCS score increased from 10 to 15, the K-MMSE score increased from 8 to 15, the Korean Nu-DESC score decreased from 3 to 1, night delirium disappeared, and the MBI score increased from 13 to 26. Conclusions: Complex Korean medicine treatments were effective for improving the clinical symptoms of hemorrhagic transformation after interventional reperfusion therapy for anterior circulation infarction in a patient with hemiplegia and conscious and cognitive disorders. However, further studies are needed.

• Journal of Korean Neurosurgical Society
• /
• v.66 no.1
• /
• pp.63-71
• /
• 2023

Objective : Traumatic brain injury (TBI) is one of the most common injuries in patients with multiple trauma, and it associates with high post-traumatic mortality and morbidity. A trauma center was established to provide optimal treatment for patients with severe trauma. This study aimed to compare the treatment outcomes of patients with severe TBI between non-trauma and trauma centers based on data from the Korean Neuro-Trauma Data Bank System (KNTDBS). Methods : From January 2018 to June 2021, 1122 patients were enrolled in the KNTDBS study. Among them, 253 patients from non-traumatic centers and 253 from trauma centers were matched using propensity score analysis. We evaluated baseline characteristics, the time required from injury to hospital arrival, surgery-related factors, neuromonitoring, and outcomes. Results : The time from injury to hospital arrival was shorter in the non-trauma centers (110.2 vs. 176.1 minutes, p=0.012). The operation time was shorter in the trauma centers (156.7 vs. 128.1 minutes, p=0.003). Neuromonitoring was performed in nine patients (3.6%) in the non-trauma centers and 67 patients (26.5%) in the trauma centers (p<0.001). Mortality rates were lower in trauma centers than in non-trauma centers (58.5% vs. 47.0%, p=0.014). The average Glasgow coma scale (GCS) at discharge was higher in the trauma centers (4.3 vs. 5.7, p=0.011). For the Glasgow outcome scale-extended (GOSE) at discharge, the favorable outcome (GOSE 5-8) was 17.4% in the non-trauma centers and 27.3% in the trauma centers (p=0.014). Conclusion : This study showed lower mortality rates, higher GCS scores at discharge, and higher rates of favorable outcomes in trauma centers than in non-trauma centers. The regional trauma medical system seems to have a positive impact in treating patients with severe TBI.

• Journal of Yeungnam Medical Science
• /
• v.40 no.2
• /
• pp.136-145
• /
• 2023

Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as "acute-on-chronic liver failure (ACLF)," a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.

• Journal of Trauma and Injury
• /
• v.36 no.4
• /
• pp.329-336
• /
• 2023

Purpose: In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality. Methods: Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18-64 years), group B (65-79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death. Results: The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death. Conclusions: For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.

• Journal of Trauma and Injury
• /
• v.36 no.4
• /
• pp.354-361
• /
• 2023

Purpose: Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability. Methods: We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures. Results: We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations. Conclusions: Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.

• Journal of Sensor Science and Technology
• /
• v.32 no.5
• /
• pp.290-294
• /
• 2023

Among various types of harmful gases, hydrogen sulfide is a strong toxic gas that is mainly generated during spillage and wastewater treatment at industrial sites. Hydrogen sulfide can irritate the conjunctiva even at low concentrations of less than 10 ppm, cause coughing, paralysis of smell and respiratory failure at a concentration of 100 ppm, and coma and permanent brain loss at concentrations above 1000 ppm. Therefore, rapid detection of hydrogen sulfide among harmful gases is extremely important for our safety, health, and comfortable living environment. Most hydrogen sulfide gas sensors that have been reported are electrical resistive metal oxide-based semiconductor gas sensors that are easy to manufacture and mass-produce and have the advantage of high sensitivity; however, they have low gas selectivity. In contrast, the electrochemical sensor measures the concentration of hydrogen sulfide using an electrochemical reaction between hydrogen sulfide, an electrode, and an electrolyte. Electrochemical sensors have various advantages, including sensitivity, selectivity, fast response time, and the ability to measure room temperature. However, most electrochemical hydrogen sulfide gas sensors depend on imports. Although domestic technologies and products exist, more research is required on their long-term stability and reliability. Therefore, this study includes the processes from electrode material synthesis to sensor fabrication and characteristic evaluation, and introduces the sensor structure design and material selection to improve the sensitivity and selectivity of the sensor. A sensor case was fabricated using a 3D printer, and an Ag reference electrode, and a Pt counter electrode were deposited and applied to a Polytetrafluoroethylene (PTFE) filter using PVD. The working electrode was also deposited on a PTFE filter using vacuum filtration, and an electrochemical hydrogen sulfide gas sensor capable of measuring concentrations as low as 0.6 ppm was developed.

• Journal of The Korean Astronomical Society
• /
• v.56 no.1
• /
• pp.75-89
• /
• 2023

We investigate the astronomical phenomenon records of Sukjong's Chunbang-Ilgi made by Sigangwon (Royal Educational Office of the Crown Prince) at which King Sukjong was the crown prince (i.e., 1667 January 24-1674 September 22). From the daily records of 2,799 days, we extract the astronomical records of 1,443 days and classify them into 14 categories. Then, we group the records of each category into five phenomena (Atmosphere, Eclipse, Daylight Appearance, Apparition, and Appulse) and compare them with the results of modern astronomical computations wherever possible. Except for Atmosphere group comprising records of meteorological events, such as solar halo, lunar halo, and unusual clouds, the significant findings in every other group are as follows: In Eclipse group, the solar eclipse that occurred on 1673 August 12 was unobservable in Korea, which is in contrast to the record of Joseonwangjo-Sillok (Annals of the Joseon Dynasty), which states that the sun was in eclipse around sunset time, as observed at Nam mountain. From the lunar eclipse records, we verify that the Joseon court did not change the date of the events observed after midnight. In Daylight Appearance group, we confirm that this phenomenon was observed during the daytime and not during twilight. We further suggest that if observation conditions are met, a celestial body brighter than -2.3 mag could be seen during the daytime with the naked-eye. In Apparition group, we find the possibilities that the Orionid meteor shower had influence on the meteor records and the seasonality on the aurora records. We also find that the Korean records in which the coma of comet C/1668 E1 was located below the horizon were overlooked in previous studies. Finally, we find that the records of Appulse group generally agree with the results of modern calculations. The records of Beom (trespass in literal) and Sik (eating in literal) events show average angular separations of 1.2° and 1.0°, respectively. In conclusion, we believe this work helps study the astronomical records of other logs of Sigangwon, such as Sukjong's Chunbang-Ilgi.

• Journal of Trauma and Injury
• /
• v.37 no.2
• /
• pp.106-113
• /
• 2024

Purpose: Helicopter transport with medical teams has been proven to be effective, with improvements in patient survival rates. This study compared and analyzed the clinical characteristics and treatment outcomes of trauma patients transported by doctor helicopters according to whether patients were transferred after a clinical evaluation or without a clinical evaluation. Methods: This study retrospectively reviewed data from the Korean Trauma Data Bank of trauma patients who arrived at a regional trauma center through doctor helicopters from January 1, 2014, to December 31, 2022. The patients were divided into two groups: doctor helicopter transport before evaluation (DHTBE) and doctor helicopter transport after evaluation (DHTAE). These groups were compared. Results: The study population included 351 cases. At the time of arrival at the trauma center, the systolic blood pressure was significantly lower in the DHTAE group than in the DHTBE group (P=0.018). The Injury Severity Score was significantly higher in the DHTAE group (P<0.001), and the accident to trauma center arrival time was significantly shorter in the DHTBE group (P<0.001). Mortality did not show a statistically significant between-group difference (P=0.094). Surgical cases in the DHTAE group had a longer time from the accident scene to trauma center arrival (P=0.002). The time from the accident to the operation room or from the accident to angioembolization showed no statistically significant differences. Conclusions: DHTAE was associated with significantly longer transport times to the trauma center, as well as nonstatistically significant trends for delays in receiving surgery and procedures, as well as higher mortality. If severe trauma is suspected, air transport to a trauma center should be requested immediately after a simple screening test (e.g., mechanism of injury, Glasgow Coma Scale, or Focused Assessment with Sonography in Trauma), which may help reduce the time to definitive treatment.