Kim T, et al. J Korean Med Sci. 2022 Feb;37(7):e54. https://doi.org/10.3346/jkms.2022.37.e54

Background: Doppler‐based diastolic dysfunction assessment requires optimal apical views and specialized expertise, and up to 30% of evaluations yield indeterminate results. We investigated whether a parasternal long‐axis (PLAX)–only M‐mode scoring system derived from mitral valve anterior leaflet (MVAL) motion could provide clinically useful risk stratification for moderate‐to‐severe left ventricular diastolic dysfunction (LVDD). Methods: This retrospective study analyzed echocardiographic data from 253 patients. Novel M‐mode parameters (EPSS, APSS, EPOL, APOL, and their ratios) were compared with conventional Doppler indices across LVDD severity grades (normal, grade 1, grade 2, grade 3). A logistic regression‐based scoring system combining five M‐mode parameters was developed and internally evaluated using five‐fold cross‐validation with bootstrap confidence intervals. Results: The EPOL/APOL ratio showed moderate correlations with the E/A ratio in both normal‐to‐mild ( r = 0.353, p < 0.001) and moderate‐to‐severe ( r = 0.397, p = 0.001) LVDD groups. The logistic regression–derived scoring system achieved an AUC of 0.754 (95% CI: 0.672–0.825), with 55.7% sensitivity and 85.9% specificity at the optimal cutoff of 63.5. Decision curve analysis demonstrated positive net benefit over default strategies across the clinically plausible threshold probability range of 0.15–0.35. Conclusion: A PLAX‐only M‐mode scoring system provides acceptable discrimination and positive net clinical benefit for risk stratification of moderate‐to‐severe LVDD. External validation in independent populations is required before clinical implementation.

Background and Objectives: Bacteremia is associated with worse outcomes in sepsis, but comparative data between Gram-positive bacteremia (GPB) and Gram-negative bacteremia (GNB) remain scarce. We compared clinical characteristics, empirical antibiotic appropriateness, and outcomes of GPB and GNB in emergency department (ED) patients with sepsis. Materials and Methods: We retrospectively studied ED patients who met the Sepsis-3 criteria with culture-confirmed GPB or GNB from December 2021 to August 2024. The primary outcome was 28-day mortality. Secondary outcomes included 90-day mortality, in-hospital mortality, ICU admission, and length of hospital stay. Multivariable logistic regression assessed the association between Gram status and 28-day mortality. Results: Of 493 patients, 96 had GPB and 397 had GNB. GPB was associated with higher 28-day mortality (26.0% vs. 9.3%), 90-day mortality (34.4% vs. 11.8%), in-hospital mortality (26.0% vs. 10.1%), ICU admission (36.5% vs. 24.7%), longer hospital stay (20.5 [11.8–31.0] vs. 14.0 [9.0–20.0] days), and substantially more frequent inappropriate empirical antibiotic therapy (37.5% vs. 12.8%) (all p < 0.05). The independent association between GPB and 28-day mortality was not consistent across adjusted models and was attenuated after accounting for inappropriate empirical antibiotic therapy (aOR, 1.85; 95% CI, 0.92–3.71). In exploratory analyses, GPB was associated with four-fold higher odds of inappropriate empirical antibiotic therapy than GNB (aOR, 4.07; 95% CI, 2.19–7.54). Conclusions: In bacteremic sepsis, GPB was associated with worse observed outcomes and substantially more frequent inappropriate empirical antibiotic therapy than GNB. GPB should be interpreted less as a standalone microbiologic determinant of mortality and more as a marker of a clinically vulnerable and management-challenging profile. Our findings point to a modifiable diagnostic–treatment gap in early ED recognition and empirical antibiotic selection. Prospective multicenter studies should evaluate whether systematic reassessment of clinical features suggestive of GPB and suspected infection source can improve empirical antibiotic appropriateness and ultimately translate into better clinical outcomes.

Background and Clinical Significance: Sengstaken–Blakemore tube insertion is a temporary but important intervention for uncontrolled upper gastrointestinal bleeding, especially when endoscopic hemostasis fails. Case presentation: We present the case of a 63-year-old man with a history of esophageal cancer surgery and gastric variceal treatment who presented to the emergency department with hematemesis and altered consciousness. Endoscopy revealed a bleeding ulcer at the intrathoracic esophagus. Endoscopic band ligation failed, and the patient’s condition deteriorated, prompting the insertion of an Sengstaken–Blakemore tube. Owing to prior Ivor Lewis surgery, the gastric balloon was not used; only the esophageal balloon was inflated, and hemostasis was successfully achieved. Despite the relative contraindication of prior esophageal surgery, no complications occurred. The patient was discharged on hospital day 20 without recurrence. Conclusions: This case illustrates that in patients with unstable upper gastrointestinal bleeding with surgical history, selective use of Sengstaken–Blakemore tube may offer life-saving hemostasis when endoscopy fails, even when standard indications are not met.

Objectives: How injury-related healthcare is utilized among older adults depends on both the injury mechanism and the stage of care examined. We aimed to characterize mechanism-specific patterns of injury-related healthcare utilization at multiple care stages among Korean adults aged 70 years and older.Methods: We drew on the 10th-14th National Injury Fact Book (2018-2022) and analyzed five data sources: the 119 EMS Activity Database, NEDIS, Korea Hospital Discharge Injury Survey, Cause of Death Statistics, and Community-based Severe Trauma Survey. For each injury mechanism, we calculated frequencies, rates per 100,000 population, and proportions across five care stages. Crude rates were used to examine five-year trends (2018-2022).Results: Among all age groups, adults aged ≥70 years showed the highest rates of EMS transport (2,604/100,000), hospitalization (5,714/100,000), and mortality (171.8/100,000) due to injuries. Falls/slips accounted for 67.3% of EMS transports and 68.2% of hospitalizations, whereas self-harm/suicide emerged as the top single mechanism for mortality (26.9%, excluding ‘others’). The mechanism distribution shifted markedly from one care stage to another. Between 2018 and 2022, falls-related hospitalization rates rose by 23.1% (3,164 to 3,893 per 100,000), while traffic-related mortality fell by 32.9%. Notably, falls-related hospitalization rates continued to climb even in the COVID-19 pandemic year of 2020.Conclusions: For healthcare utilization-based surveillance, falls/slips deserve the highest priority, while mortality-based surveillance should focus on self-harm/suicide among older adults. Relying on any single metric risks an incomplete picture; multi-stage indicators are essential for comprehensive injury surveillance. Given the rapidly growing burden of nonfatal fall-related hospitalizations, targeted fall-prevention strategies for the oldest adults are urgently needed.