Wooridul Hospital

Analysis of 1175 Korean adults in the 2019 KNHANES study found that sensitization to house dust mites and birch pollen significantly increased glaucoma risk, while oak pollen sensitization showed a protective effect. The relationship between allergen sensitization and glaucoma remains poorly understood. This study investigated the association between specific allergen sensitization patterns and glaucoma risk using data from the 2019 Korea National Health and Nutrition Examination Survey. In this population-based cross-sectional study, we analyzed 1175 adult participants (≥19y) who completed ophthalmologic examinations and allergen sensitization assessments. Glaucoma diagnosis was based on International Society of Geographical and Epidemiological Ophthalmology criteria. Specific IgE antibodies against 7 common allergens were measured using ImmunoCAP assays, with significant sensitization defined as IgE ≥3.5kU/L. We employed the Synthetic Minority Over-sampling Technique to address class imbalance. Multiple logistic regression models were employed to evaluate associations between allergen sensitization and glaucoma, adjusting for demographic and clinical factors. Among the participants, 50 (4.3%) were diagnosed with glaucoma. Analysis of allergen sensitization patterns revealed house dust mites as the most prevalent allergen (11.7% overall), with comparable rates between the glaucoma (12.0%) and non-glaucoma groups (11.7%). Birch pollen sensitization followed at 4.1% and 4.0% in the glaucoma and non-glaucoma groups, respectively. Multivariate logistic regression analysis, after adjusting for confounders, identified house dust mite sensitization as having the strongest positive association with glaucoma (OR: 3.08, 95% CI: 1.40-6.77, P =0.005), followed by birch pollen (OR: 2.69, 95% CI: 1.02-7.12, P =0.046). Interestingly, oak pollen sensitization demonstrated a protective effect (OR: 0.24, 95% CI: 0.07-0.81, P =0.022). Our findings suggest a complex relationship between allergen sensitization and glaucoma, with different allergens showing varying associations with disease risk.

PurposeThis study examines the hemodynamic responses elicited by epidural, subdural, and combined epidural-subdural anesthesia during spinal surgery, with a focus on anesthetic levels and ASA classifications. It integrates image findings to enhance understanding of the anesthetic impact on hemodynamic stability.Patients and MethodsA retrospective analysis was conducted involving patients who underwent endoscopic, open, or fusion spine surgeries with epidural anesthesia and monitored anesthesia care (MAC) between March 2018 and September 2023. Comprehensive demographic data, details regarding anesthetic levels, ASA class and hemodynamic measurements were systematically collected. Additionally, fluoroscopic images were assessed to investigate the distribution patterns of anesthetics and their relationship to hemodynamic outcomes.ResultsIn patients undergoing epidural, subdural, and combined epidural-subdural anesthesia with high-level blocks above T5 and classified as ASA class III or higher, no significant differences were observed in hypotensive events or vasopressor usage compared to those with lower-level blocks or ASA classifications. The mean duration of surgery was 90.6 ± 40.9, 105.4 ± 42.5, and 100.8 ± 46.6 minutes, respectively, across the three groups. Subdural anesthesia exhibited a similar hemodynamic profile, with milder blood pressure decreases. Imaging analysis indicated distinct anesthetic distribution patterns primarily in the posterior epidural and subdural spaces, which helped preserve anterior sympathetic and motor functions, suggesting a relationship between fluoroscopic imaging features and hemodynamic stability.ConclusionHemodynamic stability was maintained in the subdural and combined epidural-subdural groups compared to the epidural group in ASA I to III patients. However, epidural anesthesia showed better hemodynamic outcomes for ASA class above III. High-level epidural and subdural anesthesia primarily induced posterior diffusion, resulting in minimal anterior sympathetic block while preserving stability. These findings suggest that epidural anesthesia may be a viable alternative for spinal surgeries and applicable to other procedures for patients with high ASA classifications.

Lactate, once regarded as a metabolic byproduct, is now recognized as a critical immunometabolic regulator that shapes immune responses in both physiological and pathological contexts. This review examines how lactate accumulation occurs across diverse disease settings, including cancer, sepsis, and diabetes, through mechanisms such as hypoxia, mitochondrial dysfunction, and pharmacologic intervention. We then explore how lactate modulates immunity via four integrated mechanisms: transporter-mediated flux, receptor signaling (e.g., GPR81), context-dependent metabolic rewiring, and histone/protein lactylation. Particular emphasis is placed on the dichotomous effects of endogenous versus exogenous lactate, with the former supporting glycolytic effector functions and the latter reprogramming immune cells toward regulatory phenotypes via redox shifts and epigenetic remodeling. The review also highlights how the directionality of lactate transport, and the metabolic readiness of the cell determine, whether lactate sustains inflammation or promotes resolution. After analyzing emerging data across immune cell subsets and disease contexts, we propose that lactate serves as a dynamic rheostat that integrates environmental cues with intracellular metabolic and epigenetic programming. Understanding these context-dependent mechanisms is essential for the rational design of lactate-targeted immunotherapies that aim to modulate immune responses without disrupting systemic homeostasis.

Multiple fractures and fractures associated with underlying diseases commonly occur in older adults. The lower lumbar spine, sacrum, and pelvis are anatomically interconnected, and multiple simultaneous fractures frequently result from trauma. In this case, a patient with isthmic lumbosacral spondylolisthesis and severe osteoporosis sustained post-traumatic vertebral fractures involving the first and second sacral bodies, fractures of the left sacral ala, and fractures of the right anterior pelvic ring. During the initial conservative treatment period, the pelvic ring fracture remained stable. However, following lumbar, sacral, and iliac posterior fixation and fusion, the right anterior pelvic ring fracture worsened. Subsequently, conservative treatment without anterior pelvic fixation led to improvement. The purpose of this study is to review the evaluation and management of combined fractures involving the anterior pelvic ring through both a literature review and an analysis of this case.

Abstract Objective In this case series, we evaluated the potential of ligament reconstruction combined with open midline decompression following lumbar fusion surgery to mitigate adjacent segment disease (ASD). We focused on its capacity to reduce mechanical stress on adjacent segments and support spinal biomechanics. Methods This retrospective analysis included a case series of 32 patients who underwent lumbar fusion surgery with ligament reconstruction and open midline decompression. Radiological evaluations, including computed tomography and dynamic X-ray imaging, were performed preoperatively and postoperatively, with a mean follow-up of 19 months. ASD was assessed based on radiological criteria, including disc-height reduction, segmental instability, and facet-joint changes. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain. Results Radiological ASD was observed in four cases (12.5%) but not in 28 patients (87.5%). No ASD cases required reoperation. Only one patient from the entire cohort underwent additional surgery. Facet arthrodesis was identified in seven cases (21.9%), and five cases (15.6%) demonstrated cortical calcification around the facet joint. Postoperatively, the mean VAS scores for back and leg pain improved significantly. Conclusion Ligament reconstruction and open midline decompression provide dynamic stabilization by reducing hypermobility and mechanical stress on adjacent segments, which may help mitigate the risk of ASD following lumbar fusion surgery. This case series demonstrated a lower-than-expected incidence of radiological ASD and favorable clinical outcomes, suggesting that ligament reconstruction could serve as an effective motion-preserving alternative to traditional fusion, particularly for patients with a high ASD risk.

PurposeThe incidence of the existing respiratory virus and air pollutants had disappeared or decreased due to social distancing during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, there was no increase in asthma exacerbations in 2020. This study aimed to analyze the emergency department (ED) visits of children and adolescent patients with asthma before and after the COVID-19 outbreak and examine the effects of respiratory virus infection and air pollutants. MethodsThis study included pediatric and adolescent patients with asthma aged 2–18 years who visited 419 EDs nationwide during February to December in 2018, 2019, and 2020. The patients who were diagnosed with asthma, ie, J45 or J46 (International Classification of Diseases, 10th revision) in the ED medical history, diagnosis history at discharge, and diagnosis at discharge after hospitalization through the ED were included using the National Emergency Department Information System. Data were analyzed by dividing the period as follows: pre-COVID-19 (from February to December 2018 and 2019) and COVID-19 pandemic (from February to December 2020). ResultsThe monthly average of 673 visiting patients (95% confidence interval [CI], 474–872) during the pre-COVID-19 period decreased to 176 (95% CI, 113–239) during the COVID-19 pandemic, which is a 73.8% decrease (p < 0.001).In the pre-COVID-19 period, peaks were observed in spring and autumn. Meanwhile, during the COVID-19 pandemic, a peak was observed only during autumn. During the COVID-19 pandemic, no relationship was found between the rhinovirus infection and asthma exacerbations (p < 0.001). ConclusionsRespiratory virus infections are strongly associated with asthma exacerbations in children and adolescents. In this study, air pollution is not a major factor for ER visits due to asthma exacerbations. Even though the prevalence of respiratory viruses is decreasing, ED visits due to worsening asthma are trending in the fall. This phenomenon may indicate that asthma has worsened due to other causes such as pollen or fluctuations in temperature and air pressure.

This retrospective case series of prospective data aims to describe the transaxillary approach for the treatment of upper thoracic spine pathology. Various surgical techniques and approaches have been reported across the literature to address upper thoracic spine pathology, including the cervicothoracic approach, anterior transsternal approach, posterolateral approach, supraclavicular approach, and lateral parascapular approaches. These techniques are invasive. A minimally invasive, less morbid, and direct access approach to the pathology of the upper thoracic spine has not been reported in the literature. Patients with pathology affecting the first thoracic vertebra up to the sixth thoracic vertebra were classified into the upper thoracic spine group. Patients with pathology below the sixth thoracic vertebra were excluded. Patients not having a minimum follow-up of 12 months were also excluded. The study analyzed 18 patients. The mean preoperative modified Japanese Orthopedic Association score was 7.2±1.44, which improved to 10.16±1.2 (p<0.05). The majority (14/18) of the patients had an excellent outcome. Three patients had good outcomes, and one patient had a fair outcome. Five cases of intraoperative dural leak were recorded, and one patient had postoperative neurological deficit. The transaxillary approach is a safe, viable, muscle-sparing, and minimally invasive approach for ventral pathologies of the upper thoracic spine.