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Background The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53.6%) and infection (39.0%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

BackgroundDue to increased needs to reduce non-fatal as well as fatal cardiac events, preoperative echocardiography remains part of routine clinical practice in many hospitals. Data on the role of preoperative echocardiography in low-risk non-cardiac surgery (NCS) other than ambulatory surgeries do not exist. We aimed to investigate the role of preoperative echocardiography in predicting postoperative adverse cardiovascular events (CVEs) in asymptomatic patients undergoing low-risk NCS.MethodsThe study population was derived from a retrospective cohort of 1,264 patients who underwent elective low-risk surgery at three tertiary hospitals from June 1, 2021, to June 30, 2021. Breast, distal bone, thyroid, and transurethral surgeries were included. Preoperative examination data including electrocardiography, chest radiography, and echocardiography were collected. The primary outcome was a composite of postoperative adverse CVEs including all-cause death, myocardial infarction, cerebrovascular events, newly diagnosed or acutely decompensated heart failure (HF), lethal arrhythmia such as sustained ventricular tachycardia/fibrillation, and new-onset atrial fibrillation within 30 days after the index surgery.ResultsPreoperative echocardiography was performed in 503 patients (39.8%), most frequently in patients with breast surgery (73.5%), followed by transurethral (37.7%), distal bone (21.6%), and thyroid surgeries (11.9%). Abnormal findings were observed in 5.0% of patients with preoperative echocardiography. Postoperative adverse CVEs occurred in 10 (0.79%) patients. Although a history of previous HF was an independent predictor of postoperative CVE occurrence (adjusted odds ratio, aOR: 17.98; 95% confidence interval, CI: 1.21–266.71, P = 0.036), preoperative echocardiography did not significantly predict CVE in multivariate analysis (P = 0.097). However, in patients who underwent preoperative echocardiography, the presence of abnormal echocardiographic findings was independently associated with development of CVE after NCS (aOR: 23.93; 95% CI: 1.2.28–250.76, P = 0.008). In particular, the presence of wall motion abnormality was a strong predictor of postoperative adverse CVE.ConclusionIn real-world clinical practice, preoperative echocardiography was performed in substantial number of patients with potential cardiac risk even in low-risk NCS, and abnormal findings were independently associated with postoperative CVE. Future studies should identify patients undergoing low-risk NCS for whom preoperative echocardiography would be helpful to predict adverse CVE.

Additional file 1. SPIRIT checklist for the PREOP-ECHO trial.

Additional file 2. Case reporting form of the PREOP-ECHO trial.

Additional file 1. Supplemental tables.

Additional file of Concurrent smoking and alcohol consumers had higher triglyceride glucose indices than either only smokers or alcohol consumers: a cross-sectional study in Korea

Background: Dynamic preload indices may predict fluid responsiveness in end-stage liver disease. However, their usefulness in patients with altered vascular compliance is uncertain. This study is the first to evaluate whether dynamic indices can reliably predict fluid responsiveness in patients undergoing liver transplantation with a high femoral-to-radial arterial pressure gradient (PG).Methods: 80 liver transplant recipients were retrospectively categorized as having a normal (n = 56) or high (n = 24, difference in systolic pressure ≥ 10 mmHg and/or mean pressure ≥ 5 mmHg) femoral-to-radial arterial PG, measured immediately after radial and femoral arterial cannulation. The ability of dynamic preload indices (stroke volume variation, pulse pressure variation [PPV], pleth variability index) to predict fluid responsiveness was assessed before the surgery. Fluid replacement of 500 ml of crystalloid solution was performed over 15 min. Fluid responsiveness was defined as ≥ 15% increase in the stroke volume index. The area under the receiver-operating characteristic curve (AUC) indicated the prediction of fluid responsiveness.Results: Fourteen patients in the normal, and eight in the high PG group were fluid responders. The AUCs for PPV in the normal, high PG groups and total patients were 0.702 (95% confidence interval [CI] 0.553–0.851, P = 0.008), 0.633 (95% CI 0.384–0.881, P = 0.295) and 0.667 (95% CI 0.537–0.798, P = 0.012), respectively. No other index predicted fluid responsiveness.Conclusion: PPV can be used as a dynamic index of fluid responsiveness in patients with end-stage liver disease but not in patients with altered vascular compliance.

Although sarcopenia is known to be a risk factor for non-alcoholic fatty liver disease (NAFLD), whether NAFLD is a risk factor for the development of sarcopenia is not clear. We investigated bidirectional relationships between NAFLD and low skeletal muscle mass index (LSMI) using three different datasets. Participants were classified into LSMI and normal groups. LSMI was defined as a body mass index (BMI)-adjusted appendicular skeletal muscle mass

Additional file 1: Table S1. Baseline 18F-flortaucipir SUVR values for each quartile group of PC2 scores in the 114 Aβ-positive individuals. Table S2. Partial correlation analysis between the PC scores and cognitive function in 114 Aβ-positive individuals. PC1 and PC2 scores correlated with the decline of cognitive functions after adjusting for age, years of education, gender, and presence of ApoE ε4 allele. Table S3. Estimated annual changes in cognitive test performances after adjusting for demographic variables in each quartile group of PC2 scores. Table S4. Correlation between the Aβ-positive AD dementia-specific PC scores and regional Aβ burden. Fig. S1. Voxel-based comparisons of tau PET between the 87 Aβ-negative cognitively unimpaired individuals and each quartile group for the expression of Aβ-positive AD dementia-specific PCs. Fig. S2. Voxel-wise maps for Aβ-positive AD dementia-specific PCs of tau PET uncorrected for partial volume effect and group-wise averaged tau PET images for each quartile of PC scores in 114 Aβ-positive individuals. Fig. S3. Principal components of tau PET uncorrected for partial volume effect in Alzheimer disease. Fig. S4. Age-related changes in the PC scores obtained from tau PET images uncorrected for partial volume effect and correlation with cognitive function in 114 Aβ-positive individuals. Fig. S5. Voxel-wise maps for PCs of tau PET created with 114 Aβ-positive individuals and group-wise averaged tau PET images for each quartile of PC scores in 114 Aβ-positive individuals. Fig. S6. Expression of PCs created with 114 Aβ-positive individuals and global cortical tau burden. Fig. S7. Voxel-wise maps for PCs of tau PET created with 49 Aβ-positive MCI patients and group-wise averaged tau PET images for each quartile of PC scores in 114 Aβ-positive individuals. Fig. S8. Expression of PCs created with 49 Aβ-positive MCI patients and global cortical tau burden.

Additional file 1: Table S1. Desikan-Killiany atlas and custom composite VOIs. Table S2. Diagnosis and status of ApoE ε4 genotype of participants. Table S3. Total and direct effect of ApoE ε4 on the baseline tau and annual changes in tau burden. Fig. S1. Comparison of baseline and annual changes in 18F-florbetaben and 18F-flortaucipir SUVR values uncorrected for partial volume effect between the ApoE ε4- and ε4+ groups. Fig. S2. Comparison of baseline 18F-flortaucipir SUVR values (A) and their changes at follow-up (B) between the ApoE ε4- and ε4+ groups after adjusting for the baseline Aβ burden.

Few studies have demonstrated the prognostic potential of neutrophil gelatinase-associated lipocalin (NGAL) in post-cardiac arrest patients. This study evaluated the usefulness of plasma NGAL in predicting neurologic outcome and mortality in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). A prospective observational study was conducted between October 2013 and April 2016 at a single tertiary hospital. We enrolled 75 patients treated with TTM and collected their demographic data, cardiopulmonary resuscitation-related information, data on plasma NGAL concentration, and prognostic test results. Plasma NGAL was measured at 4 hours after return of spontaneous circulation (ROSC). The primary endpoint was the neurologic outcome at discharge and the secondary outcome was 28-day mortality. Neurologic outcomes were analyzed using a stepwise multivariate logistic regression while 28-day mortality was analyzed using a stepwise Cox regression. The predictive performance of plasma NGAL for neurologic outcome was measured by the area under the receiver operating characteristic curve and the predictability of 28-day mortality was measured using Harrell C-index. We also compared the predictive performance of plasma NGAL to that of other traditional prognostic modalities for outcome variables. Thirty patients (40%) had good neurologic outcomes and 53 (70.7%) survived for more than 28 days. Plasma NGAL in patients with good neurologic outcomes was 122.7 ± 146.7 ng/ml, which was significantly lower than that in the poor neurologic outcome group (307.5 ± 269.6 ng/ml; P 124.3 ng/ml group (odds ratio, 3.321; 95% confidence interval [CI], 1.265–8.721]). Plasma NGAL in the survived group was significantly lower than that in the non-survived group (172.7 ± 191.6 vs 379.9 ± 297.8 ng/ml; P = .005). Plasma NGAL was significantly correlated with 28-day mortality (hazard ratio 1.003, 95% CI 1.001–1.004; P

Supplemental Digital Content is available in the text, Obesity is now considered a state of chronic low-grade inflammation. We investigated the relationship between several inflammatory markers and body composition for identifying patients with an increased risk of visceral obesity and compared the predictive values of inflammatory indices in visceral obesity. Six hundred individuals who received health checkups for obesity-related risk factors in Severance Hospital between January 2008 and March 2017 were included in our study. Serum inflammatory markers, such as white blood cell (WBC), high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) levels were assessed. Intra-abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were measured with computed tomography. We performed analysis of covariance, trend analysis, Steiger's Z tests, and multiple linear regression analysis to investigate associations between abdominal adiposity indices and inflammatory markers. Pearson's correlation analysis revealed a stronger association of VAT with WBC counts (r = 0.157, P

Backgroud: The purpose of this study was to evaluate the effects of trigger point injection (TPI) and eutectic mixture local anesthetics (EMLA) cream on the postoperative shoulder pain in patients undergoing total laparoscopic hysterectomy. Methods: In this randomized, single-blinded, and controlled study, total 75 patients were randomly allocated to TPI group (n = 25), EMLA group (n = 25), and control group (n = 25). TPI group received TPIs with 2 mL of 0.2% ropivacaine, and EMLA group received an occlusive dressing with EMLA cream 2 g on both shoulders. Overall, abdominal, and shoulder pains were evaluated at rest and in motion on postoperative day 3. Results: The incidence of shoulder pain was significantly reduced in EMLA group (56%) compared to control (88%) or TPI (88%) groups (P = .025 in both); the severity of shoulder pain was mitigated in EMLA and TPI groups compared to control group (P

Table S1. Effect of intervention on anthropometric and body measurements (PP). Table S2. Effect of intervention on blood lipids and insulin resistance (PP). (DOCX 26 kb)

Supplemental Material for Prevalence and Risk Factors of Chronic Rhinosinusitis in the Elderly Population of Korea by Chi SangHwang, Hye Sun Lee, Si Nae Kim, Ji Hyung Kim, Dong-Joon Park and Kyung-Su Kim in American Journal of Rhinology & Allergy

Papillary thyroid microcarcinoma (PTMC) usually has excellent prognosis, but a small subset shows aggressive behavior. Although the B-Raf proto-oncogene, serine/threonine kinase (BRAF)V600E mutation is the most common oncogenic alteration in PTMCs, it is frequently heterogeneously distributed within tumors. The aim of this study was to investigate the association of the BRAFV600E mutation found in fine needle aspirates from PTMCs with known clinicopathologic prognostic factors, based on both its presence and a quantitative approach that uses cycle threshold (Ct) values obtained by a real-time PCR technique. The 460 PTMC patients were included, with 367 patients having the BRAFV600E mutation. Clinicopathologic variables were compared between patients with and without the BRAFV600E mutation. BRAFV600E Ct values were compared according to clinicopathologic prognostic factors. Multivariate analyses were performed to evaluate factors predicting extrathyroidal extension and central and lateral lymph node metastasis (LNM). Each analysis used either the BRAFV600E mutation status or the Ct value as an independent variable for all the study patients and the 367 BRAFV600E-positive patients. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of BRAFV600E Ct values in predicting central and lateral LNM. The BRAFV600E mutation status was not associated with clinicopathologic prognostic factors among the 460 PTMC patients. Of the 367 BRAFV600E-positive patients, Ct values were significantly lower in patients with central and lateral LNM (P

In order to analyze movement of soil moisture, Time Domain Reflectometry(TDR) with multiplex system has been installed at the Bumreunsa hillslope of Sulmachun Watershed to configure spatial-temporal variation pattern considering seasonal characteristic. An intensive surveying was performed to build a refined digital elevation model(DEM) and flow determination algorithms with inverse surveying have been applied to establish an efficient soil moisture monitoring system. Soil moisture data were collected through an intensive and long term monitoring 380 hrs in November of 2003 and 1037 hrs in May and June of 2004. Soil moisture data shows corresponding variation characteristics of soil moisture on the up slope, buffer, main channel zones of the hillslope which were classified from terrain analysis. Measured soil moisture data were discussed in conjunction with flow characteristic through terrain analysis. Regardless season, immediate responses of soil moisture about rainfall looks similar but recession and recharge are primary characteristics of intermediate soil moisture variation for spring to summer and fall to winter season, respectively.

Background Lack of established guidelines for endoscopic papillary large balloon dilation (EPLBD) may be a reason for aversion of its use in removal of large common bile duct (CBD) stones.

breastfed for less than 6 months (OR 1.7, 95%CI 1.02 2.8, p = 0.04). A composite environmental risk index (ERI) was proposed for CD. Use of this index revealed that 47% of the controls but only 14% of patients with CD had no risk factors, while 14% of the controls and 38% of the patients with CD had at least two risk factors. Conclusions: CD and UC associated with infrequent sports activities in childhood and a short breastfeeding period. CD also associated with smoking and infrequent contact with animals in childhood. UC also associated with a smaller family size in childhood.