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Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department. Methods: Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital. Results: The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001). Conclusions:The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3. 255 서 론만성폐쇄성폐질환은 완전히 가역적이지 않은 기류 제한을 특징으로 하는 질환으로, 높은 유병률을 보이고 있으며 사망률 도 높은 것으로 알려졌다. 국내의 한 연구에서는 45세 초과인 사람 중 GOLD (global initiative for chronic obstructive lung dis-ease) 기준에 의해 forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 0.7 미만인 기관지 폐색이 17.2%에서 보이는 것으로 나타났다.[1] 만성폐쇄성폐질환 환자 의 급성 악화 시 사망률은 2.5%, 입원을 해야 하는 급성 악화 환자의 병원 내 사망률은 4%에서 30%까지 보고되어 있다.[2-4] 하지만 응급실에 내원하였을 경우 환자의 예후를 알기가 쉽지 않고 입원의 여부, 중환자실에서의 집중치료의 여부를 판단하기가 힘들다. 만성폐쇄성폐질환의 예후를 확인해주는 여러 예측 도구들이 소개됐으나 응급실 환자에서 유용성 여부 를 알 수 없었다. BODE (the body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease) 지수와 같은 도구는 안정된 만성 폐쇄성폐질환 환자의 예후를 예측하는 것이어서 응급실에서 내원한 환자의 예후를 예측하기가 힘들었다.[5] DECAF

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Purpose: Beta-blockers are efficacious in young hypertensive patients with sympathetic activation. Elderly patients have been known to be at higher risk of hypotension, bradycardia, and other side-effects of beta-blockers when compared with younger patients. This study was to evaluate efficacy and safety of vasodilator beta-blocker in elderly hypertensive patients. Methods: BENEFIT-KOREA study (BEnefits after 24 weeks of NEbivolol administration For essential hypertensIon patients wiTh various co-morbidities and treatment environments in KOREA) was a open labeled non-controlled, prospective, multicenter observational study enrolled total 3,140 subjects [1,871 male(59.6%), mean age=63.5±12.9 years old]. We evaluated efficacy and safety of vasodilator beta-blocker in elderly patients. Results: Subjects of more than 65 years old [n=1,655, 839 male (49.3%), mean age=73.6±5.8] were analyzed. Table shows that vasodilator beta-blocker is effective in reduction of blood pressure, mean arterial pressure and pulse pressure in elderly patients regardless of add-on or switched to beta-blocker. Adverse drug reaction rate was not different between age group (n=19, 1.15% vs. n=17, 1.15%). Table shows lipid profile and body mass index were not aggravated after 24-week treatment of vasodilator beta-blocker. Conclusion: Vasodilator beta-blocker is efficacious and safe without metabolic derangement in elderly patients regardless of prescription patterns. These drug effects in elderly are comparable to in younger patients.

Li-ion batteries (LIBs) have received widespread recognition as power sources for various potable electronics, electric vehicles, and large-scale energy storage systems. To meet ever-increasing demand for energy storage, it is necessary to develop next generation anode materials with a high capacity. Carbon-based materials are widely used as anodes for LIB and however, the theoretical capacity for graphite (372 mAh g–1) is limited due to its intercalation chemistry. Si has been considered as one of the most promising next generation materials as LIB anodes to replace commercial graphite because of its outstanding theoretical gravimetric capacity of 3580 mAh g–1 (for Li15Si4 phase), which can be obtained through the electrochemical alloying reaction with Li ion. Currently, the main challenges for using Si-based active materials are structural transition, low electrical conductivity, and unstable solid electrolyte interphase (SEI) formation caused by the large volume change (~400%) during alloying and dealloying cycle and irreversible side reactions with electrolyte. The large volume changes lead to the pulverization of electrode materials, resulting in degradation of capacity upon cycling. To overcome these drawbacks, many researches have been performed and various strategies have been proposed in terms of structural aspects such as hollow sphere, core-shell structure, and porous structure. In this study, porous Si-C composites were prepared through a simple annealing method of commercial amorphous silica (a-SiO2) and magnesium silicide (Mg2Si). Then, a chemical wet etching process was performed to remove formed magnesium oxide (MgO) and a carbon layer coating was finally carried out. The prepared material exhibited high reversible capacity and good cycle performance with very high initial coulombic efficiency. The enhanced electrochemical properties can be attributed to the porous structure with thin carbon coating.