Coordinates: 37°29′17.4″N 127°5′7.7″E / 37.488167°N 127.085472°E / 37.488167; 127.085472Asan Medical Center (서울아산병원) is a hospital in Seoul, South Korea. It was established to put into practice the founding principles of Asan Foundation founder Chung Ju-Yung. It opened on June 23, 1989, under the name Seoul Jungang (Central) Hospital, and was renamed Asan Medical Center on April 27, 2002. With 2,715 licensed beds and a total area of 85,000 square meters, it is the largest hospital in Korea.Since 1993, a healthcare quality improvement team has been in operation at AMC. In 2011, the hospital implemented an internal model called Asan Global Standard (AGS) designed around the baseline assessment of Joint Commission International (JCI).
Cervical myelopathy with rigid kyphosis often requires multilevel decompression and realignment. Although 540° surgery—posterior decompression with screw fixation, anterior decompression and fusion, and posterior rod connection—can achieve adequate neural decompression and sagittal correction, it involves substantial surgical burden. This study compared vertebral body sliding osteotomy (VBSO), an anterior-based technique, with 540° surgery for multilevel cervical myelopathy with rigid kyphosis. A retrospective cohort of 57 patients treated between 2015 and 2022 was analyzed, including 38 who underwent VBSO and 19 who underwent 540° surgery. All patients required fusion across three or more levels and had a minimum of two years of follow-up. Selective ACDF was added to VBSO when pathology extended across disc spaces. Clinical outcomes included Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and Visual Analog Scale (VAS) for neck pain. Radiological parameters included C2–7 lordosis, segmental lordosis, and canal occupying ratio. Operative time, estimated blood loss (EBL), and complications were also evaluated. Improvements in JOA, NDI, and neck pain VAS were comparable between groups (all p > 0.05). Postoperative C2–7 lordosis was similarly restored, and complication rates showed no significant differences. VBSO demonstrated a markedly shorter operative time (262.1 vs. 440.4 minutes, p < 0.001) and lower EBL (100.4 vs. 272.2 mL, p < 0.001). VBSO achieved clinical and radiological improvement with reduced surgical burden relative to 540° surgery. These findings suggest that VBSO may be considered a reasonable and efficient alternative for treating cervical myelopathy with rigid kyphosis.
To prospectively evaluate positional variability in quantitative CT (qCT)-derived measurements of interstitial lung abnormality (ILA) using the same-day supine and prone CT. In this prospective study (February 2024–February 2025), participants with ILA underwent sequential non-contrast supine and prone CT scans using identical acquisition parameters. A commercially available deep learning-based software quantified fibrotic (reticulation and honeycombing) and nonfibrotic (ground-glass opacity) ILA components in accordance with Fleischner Society definitions. qCT differences between supine and prone measurements were assessed using paired t tests, Bland–Altman analysis with 95
BACKGROUND:The timing of surgery in asymptomatic severe mitral regurgitation remains controversial. This observational study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe mitral regurgitation. METHODS:From 1996 to 2016, a total of 1063 consecutive asymptomatic patients (673 men; mean±SD age, 51±14 years) with severe degenerative mitral regurgitation and preserved left ventricular function were enrolled, and followed prospectively for a median of 12 years (interquartile range, 8-17 years). Early surgery was performed on 545 patients and the conventional treatment strategy was chosen for 518 patients. We compared overall and cardiac mortality rates between these 2 treatment strategies using propensity score adjustment. RESULTS:In the early surgery group, no operative deaths occurred, and mitral valve repair was successfully performed in 97% of patients. During follow-up, 8 (1.5%) patients in the early surgery group and 54 (10.4%) in the conventional management group died from cardiovascular causes (hazard ratio, 0.17 [95% CI, 0.07-0.40]; P<0.001). A total of 74 (13.6%) deaths from any cause occurred in the early surgery group, whereas 116 (22.4%) occurred in the conventional management group (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.046). For the 358 propensity score matched pairs, the early surgery group had a significantly lower risk of cardiac mortality than the conventional treatment group (hazard ratio, 0.18 [95% CI, 0.08-0.43]; P<0.001) and significantly lower cardiac mortality rates (5.6% versus 17.4% at 20 years; P=0.002). Compared with the conventional treatment group, the early surgery group also had a significantly lower risk of overall mortality (hazard ratio, 0.66 [95% CI, 0.47-0.93]; P=0.018) and significantly lower overall mortality rates (28.2% versus 33.9% at 20 years; P=0.015). CONCLUSIONS:Compared with conventional management, early surgery is associated with better long-term outcomes among asymptomatic patients with severe mitral regurgitation and preserved left ventricular function. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01703806.
Sarcopenia significantly impacts quality of life and increases the risk for various health issues. This study aims to establish a new, effective diagnostic criterion for sarcopenia based on psoas muscle volume (PV) using computed tomography (CT). We analyzed the population distribution of psoas muscle volume (PV), assessed its correlation with ASM indices, and developed CT-based diagnostic criteria for sarcopenia. A total of 3,999 adults (2,085 men, 1,914 women; aged 22–89) who underwent abdominal CT and bioimpedance analysis (BIA) were included. Psoas muscle volume was automatically segmented using a deep-learning algorithm. Correlations with ASM indices were evaluated, and diagnostic criteria were established using (1) linear regression, (2) ROC analysis, and (3) T-score analysis referencing young, non-sarcopenic adults. The distribution of PV indices peaked in the 30s and declined with age, more sharply in men. PV showed strong correlations with ASM indices, particularly the PV/BMI index, which demonstrated the highest diagnostic accuracy. T-score adjustment to -2.0 better matched known prevalence rates. This study proposes CT-based diagnostic criteria for sarcopenia using psoas muscle volume, demonstrating strong correlation with established indices. These findings support opportunistic screening via CT, offering a practical, population-wide tool for early sarcopenia detection. This study uncovers the distribution of PV across age groups, noting a significant decline from the 30s to the 70s. This advancement in the objective diagnosis of sarcopenia via imaging positions abdomen CT scans as a potential diagnostic screening tool for low muscle mass compatible with sarcopenia.
The optimal timing of vasopressor initiation in septic shock remains uncertain, and mixed trial results may reflect unmeasured hemodynamic heterogeneity. We hypothesized that the association between early norepinephrine and mortality differs by bedside hemodynamic phenotype, as characterized by diastolic blood pressure (DBP) and pulse pressure (PP). We conducted a retrospective analysis of prospectively collected data from a national sepsis registry (2019–2024). Adults with septic shock presenting to emergency departments were included. Time-to-vasopressor was defined as the time from triage to norepinephrine initiation; restricted cubic splines supported an a priori classification of “early” use as ≤ 25 min. The primary outcome was in-hospital mortality. Patients were stratified by pre-vasopressor DBP (< 50 vs. ≥ 50 mmHg) and, secondarily, by PP (< 25 vs. ≥ 25 mmHg). Multivariable models adjusted for demographics, comorbidities, illness severity (SOFA), three-hour sepsis bundle completion, and mechanical ventilation. Sensitivity analyses explored alternative DBP thresholds (< 40, < 44 mmHg), and subgroup analyses assessed effect consistency. Among 1,104 patients, early norepinephrine was associated with lower mortality only in those with low DBP; there was no mortality benefit when DBP was ≥ 50 mmHg. Mortality associations were stronger at more extreme diastolic hypotension thresholds (< 40 and < 44 mmHg). Hemodynamic phenotyping with PP further refined risk: within the low-DBP group, a wide PP (≥ 25 mmHg) was associated with the most pronounced survival association from immediate vasopressors, whereas a narrow PP showed no clear benefit. Results were directionally consistent across sensitivity and subgroup analyses. The relationship between vasopressor timing and outcomes in septic shock is hemodynamic phenotype dependent. Early norepinephrine appears beneficial when DBP is markedly low, particularly with wide PP, and less critical when DBP is preserved or PP is narrow. Simple bedside measurements (DBP and PP) can guide individualized resuscitation, helping clinicians decide whether to initiate vasopressors or initially emphasize preload or inotropy. Not applicable.
