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Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.
The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.
Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.
A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.
Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.
Seoul is the third most densely populated area in the world except for the city-state. However, a national disaster plan has not yet been established.
From September 2017, representatives of seven regional emergency medical centers in Seoul met monthly and decided to investigate basic data for the future establishment of surge capacity planning.
Staff, supply, space, and systems for surge capacity were surveyed in seven hospitals. The additional surveyed data were as follows: hospital incident command system and actual operational experience; performance of disaster drill; safety and security plan; estimation of surge capacity in normal operating conditions and extreme operating conditions; alternative therapeutic spaces; back-up plan to call non-duty medical staff; decontamination equipment; contingency plan for stuff shortage; etc.
All the hospitals reported they have hospital incident command systems and held disaster drills every year, however, the two hospitals (28.5%) had no real experience of hospital incident command system activation. Five hospitals (71.4%) did not have a safety and security plan. They replied they can treat average 7.7 emergency patients (Korean Triage and Acute scale (KTAS) ≤ 3), 10 non-emergent patients (KTAS>4), 0.9 surgical patients and 0.7 unstable patients simultaneously in normal operating conditions. In extreme operating conditions, they replied they can treat average 26.4 emergency patients (KTAS ≤ 3), 54.3 non-emergent patients (KTAS>4), 37 surgical patients and 2.3 unstable patients simultaneously. The two hospitals (28.5%) had no alternative therapeutic spaces, no back-up plan to call non-duty medical staff and no contingency plan for stuff shortage. Three hospitals (42.9%) did not have decontamination equipment.
The survey revealed the basic data for surge capacity planning in Seoul. Data from hospitals other than regional emergency medical centers should be collected for the completion of disaster plans.
Yarn-type supercapacitors should have high energy density in small given spaces, and the one attempt among many is to comprise the electrodes asymmetrically. However, the low capacitance of conventional materials causes the widened operating voltage useless. In this study, we have utilized a novel material MXene with carbon nanotubes (CNTs) to make highly loaded MXene/CNT yarn electrodes, which exhibited a remarkable areal capacitance. With MnO2/CNT biscrolled cathode and PVA/LiCl gel electrolyte, the plied asymmetric yarn supercapacitor had energy density of 100 µWh/cm2. The yarn supercapacitor could operate under mechanical deformations without performance degradation.
A life-threatening cardiopulmonary resuscitation (CPR)-related injury can cause recurrent arrest after return of circulation. Such injuries are difficult to identify during resuscitation, and their contribution to failed resuscitation can be missed given the limitations of conventional CPR. Extracorporeal cardiopulmonary resuscitation (ECPR), increasingly being considered for selected patients with potentially reversible etiology of arrest, may identify previously occult CPR-related injuries by restoring arterial pressure and flow. Herein, we describe two cases of severe CPR-related injuries contributing to recurrent arrest. Each case had ECPR implemented within 60 minutes of the start of CPR. After the presumed cardiac etiology had been addressed with percutaneous coronary intervention, life-threatening cardiovascular injuries with recurrent arrest were noted, and resuscitative thoracotomy was performed under ECPR. One patient survived to hospital discharge.
ECPR may provide an opportunity to identify and correct severe resuscitation-related injuries causing recurrent arrest. Chest compression depth >6 cm, especially in older women, may contribute to these injuries.
Construction of a new science complex in Osong, Cheongwon-gun, Korea, has allowed the investigation of 14 different Paleolithic localities, excavated during 2005–2007. Here, we investigated localities 1 and 12 of the Mansuri Paleolithic site to obtain chronological information using radiocarbon dating. The soil deposition rates varied from 0.09 to 0.15 mm/yr over the period ranging from 33 to 31 kyr BP for locality 1. Locality 12 samples were more recent, <10 ka, and have similar accumulation rates, averaging 0.11 mm/yr. The soil ages of locality 12 were found to be younger than 10 kyr BP. Results for both soil and organic materials at this locality gave much younger ages at shallower depths than the ages expected by the Korean Paleolithic cultural history for this region. Therefore, these more recent deposits may not be associated with the cultural layers and are interpreted to have been hydrologically modified following emplacement. 14C dates of the soil and organic materials at locality 12 confirm that there is evidence for multiple human occupations throughout the last 9 kyr BP.
Many previous studies on the sample preparation of various kinds of radiocarbon dating samples by accelerator mass spectrometry (AMS) have been examined at KIGAM (Korea Institute of Geoscience and Mineral Resources) and our own procedures have been established. Furthermore, an automated reduction system has been developed. The volume of the reduction region was minimized to improve the reduction yield, and air-actuated pneumatic valves and solenoid arrays were used for computer control of the system. Operation of all the valves and vacuum pumps and signals from the temperature sensors and pressure gauges were interfaced to a personal computer with an A/D board. A computer program was also developed to perform automatic operation of the reduction system. This system consistently shows a higher reduction yield than 90%. The reduction time of the system is currently 140 min.
A 1MV AMS was installed in KIGAM (Korea Institute of Geoscience and Mineral Resources). After 4 months of installation, the AMS started normal operation from January 2008. This multi-element AMS was developed by HVEE to measure 14C, 10Be, and 26Al. The results of an acceptance test demonstrate that this machine is capable of routine 14C age dating and of measurements of other radioisotopes in terms of accuracy and precision as well as the background level. After installation, an investigation aimed at determining the stable operating conditions was conducted, and background levels were determined to be as low as 10–15 for 14C and 10–14 for 10Be and 26Al.
Steel coils coated with Zn–Mg alloy containing high Mg content develop dark rust when exposed to an extremely limited amount of aqueous environment. To understand the nature of the dark rust and its formation mechanism, the steel is evaluated by the immersion test and high temperature–humidity test followed by critical evaluation with transmission electron microscopy for cross-sectional observation, field-emission scanning electron microscopy for surface morphology observation, Auger electron spectroscopy and glow discharge spectroscopy for identification of chemical composition as a function of depth. The results indicate that the dark rust is formed by precipitation of Mg-based corrosion product on the outermost surface when the steel is exposed to aqueous environment at high temperature. This is due mainly to preferential dissolution of Mg phases by the galvanic action with MgZn2 and Mg2Zn11 composed of the coating layer, and easy precipitation of Mg2+ ion in a form of Mg(OH)2 in a limited volume of the condensed water film on the surface.
To identify clinical factors that can explain the differences in treatment outcome, and examine the value of human papillomavirus infection as a prognostic biomarker in stage IVa tonsillar carcinomas.
Fifty-nine patients with tonsillar carcinoma classified as stage IVa were retrospectively analysed for survival outcomes according to various clinical factors. Human papillomavirus infection was evaluated using a human papillomavirus DNA chip test and immunohistochemical staining for p16 and p53.
Lower disease-free survival rates were associated with increasing local invasiveness and nodal status. Although human papillomavirus positivity and p16 expression was more common in locally advanced tonsillar carcinomas with advanced nodal status, the overall survival rate was better for patients with human papillomavirus positive, p16-positive tumours.
The disease-free survival rate may differ according to local tumour invasiveness and nodal status, even for stage IVa tonsillar cancers. Human papillomavirus infection may be a useful biomarker for predicting treatment outcomes for stage VIa tumours.
This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL).
We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire–End of Life (QCQ–EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation).
Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ–EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG–PS) scores were significantly associated with survival.
Significance of results:
Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG–PS are needed to help patients experience a dignified and comfortable death.
We aimed to evaluate the reproducibility and validity of the newly developed FFQ for the Korean National Health and Nutrition Examination Survey (KNHANES) and to estimate the measure’s calibration factors.
The 109-item FFQ was administered twice, approximately 9 months apart. We also collected four seasonal 3 d dietary records (DR) as a reference method. Correlation coefficients and joint classification were computed to compare intakes of energy, thirteen nutrients and eleven food groups between the two FFQ to evaluate reproducibility. For validity, de-attenuated and energy-adjusted correlation, joint classification and Bland–Altman statistics were calculated for energy and nutrients between the first FFQ and the DR. To calibrate the FFQ, we performed a linear regression analysis in which the DR were the dependent variables and FFQ, age and sex were the independent variables.
Seoul metropolitan area, Republic of Korea.
A total of 126 adults aged 20–65 years.
The average correlation coefficients measuring reproducibility were 0·54 for nutrients and 0·57 for food groups. The mean correlation coefficient measuring validity was 0·40 for all nutrients between the first FFQ and the DR. On average, 75 % of the participants were classified into the same or adjacent quartiles, while 5 % of the participants were grossly misclassified. The mean energy and nutrient intakes estimated by the calibrated FFQ were similar to the means estimated by the DR.
The newly developed FFQ for assessing dietary intake in the KNHANES has acceptable reproducibility and modest validity compared with a 12 d DR collected over a 9-month period.
This study aimed to investigate the influences of age, education, and gender on the two total scores (TS-I and TS-II) of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological assessment battery (CERAD-NP) and to provide normative information based on an analysis for a large number of elderly persons with a wide range of educational levels.
In the study, 1,987 community-dwelling healthy volunteers (620 males and 1,367 females; 50–90 years of age; and zero to 25 years of education) were included. People with serious neurological, medical, and psychiatric disorders (including dementia) were excluded. All participants underwent the CERAD-NP assessment. TS-I was generated by summing raw scores from the CERAD-NP subtests, excluding Mini-Mental State Examination and Constructional Praxis (CP) recall subtests. TS-II was calculated by adding CP recall score to TS-I.
Both TS-I and TS-II were significantly influenced by demographic variables. Education accounted for the greatest proportion of score variance. Interaction effect between age and gender was found. Based on the results obtained, normative data of the CERAD-NP total scores were stratified by age (six overlapping tables), education (four strata), and gender.
The normative information will be very useful for better interpretation of the CERAD-NP total scores in various clinical and research settings and for comparing individuals’ performance of the battery across countries.
Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports.
We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis.
Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden.
In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.
A 44-year-old man developed sudden non-fluent aphasia and right hemiplegia due to left striatocapsular infarction (Figure). Neurologic examination revealed gaze deviation to the right with eyes closed, but not with eyes open (Video). There was no spontaneous or gaze-evoked nystagmus, even after elimination of visual fixation. Leftward pursuit was impaired in a craniotopic frame of reference, and horizontal saccades were hypometric in both directions. Head impulse test was normal in the horizontal plane and there were no visual field defects. The contralesional gaze deviation with eye closure persisted for ten days.
Leaf stomatal characteristics of Siberian elm (Ulmus pumila) were investigated by electron microscopy and white light scanning interferometry. On the basis of average annual precipitations, two types of tree specimens were collected from Korea, China, and Mongolia: (1) trees under normal environmental conditions and (2) trees under arid conditions. Field emission scanning electron microscopy revealed oval-shaped stomata on the lower surface, and they were ca. 20 μm in width. In-lens secondary electron imaging showed differences in electron density and stomatal pore depth between the two types. According to the line profile analysis by white light scanning interferometry, stomata under arid conditions appeared to have higher levels of the stomatal pore depth than ones under normal conditions. Focused ion beam–field emission electron microscopy supported the increased stomatal pore depth with the increasing drought stress gradient. These results suggest that complementary microscopy can be employed to unravel the adaptive phenotypic plasticity of Siberian elm in response to drought stress.
A new method for determining the vitrification rate of pottery depending on the firing temperature was devised using secondary electron images (SEI) of scanning electron microscope (SEM). Several tests were performed to establish the appropriate operating conditions of SEM and reproducibility as well as to examine the applicability of the method. The grayscale values converted from each pixel of SEI were used to determine the vitrification rate of pottery, which in our study were artificially fired specimens composed of three types of clay. A comparison between the vitrification rate value and appearance temperature of minerals shows that mullite formation starts at 1,100°C, during which the vitrification rate rapidly increases by over 10%. In consequence, the result presented here demonstrates that the new method can be applied to estimate the firing temperature of pottery.