Background/Aims Few studies have compared modified endoscopic mucosal resection (EMR) techniques for small rectal neuroendocrine tumors (NETs). This study evaluated the clinical outcomes of ligation-assisted EMR (EMR-L) and precutting EMR (EMR-P) for the treatment of small rectal NETs. Methods We retrospectively reviewed patients who underwent EMR-L or EMR-P for rectal NETs ≤ 10 mm at four university hospitals between January 2018 and December 2022. Primary outcomes were en bloc resection and complete resection rates; secondary outcomes included procedural time and complications. Results Among a total of 195 rectal NETs, 143 were resected using EMR-L and 52 using EMR-P. Although the histopathologically measured lesion size (4.0 ± 1.7 mm vs. 5.2 ± 2.4 mm, p = 0.002) was larger in the EMR-P group, the presence of ulcer or depression and lesion location did not significantly differ between the two groups. The en bloc resection rate (100.0% vs. 96.2%, p = 0.070) and complete resection rate (95.8% vs. 90.4%, p = 0.140) also were not significantly different. However, EMR-L had a significantly shorter procedure time (3.9 ± 2.3 min vs. 9.8 ± 5.6 min, p < 0.001). No significant differences were observed in procedure-related bleeding, perforation, recurrence, or hospital stay between the groups. Conclusions Both EMR-L and EMR-P achieved high en bloc and complete resection rates with favorable safety profiles. However, EMR-L was significantly faster, suggesting that it is a more time-efficient approach for small rectal NET resection.
Background/Aims Improvement of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF) has been associated with favorable outcomes; however, corresponding data in patients treated with angiotensin receptor–neprilysin inhibitors (ARNIs) remain limited. This study aimed to examine the characteristics, predictors, and outcomes of HF with improved ejection fraction (HFimpEF) compared with persistent HFrEF in the RECORD-SV registry. Methods Patients with LVEF ≤ 40% in the RECORD-SV registry were classified based on echocardiographic assessments at baseline and 1-year follow-up. Patients with HFimpEF were defined as those with follow-up LVEF of > 40% with an absolute improvement of ≥ 10%, whereas the persistent HFrEF group included those who did not meet these criteria. Baseline characteristics, predictive factors, and clinical outcomes of the patients were analyzed. The primary composite outcome was all-cause mortality and hospitalization for HF management, with secondary outcomes including each component of the primary outcome and frequency of urgent emergency room visits. Results Among 198 patients with HFrEF, 60 patients (30.3%) achieved HFimpEF after one year of ARNI-based therapy. Independent predictors of HFimpEF included female sex, non-ischemic etiology, and de novo HF. HFimpEF patients exhibited significantly lower risks in the primary composite outcome (HR 0.382, 95% CI 0.148–0.985) compared to those with persistent HFrEF, with a similar trend observed for secondary outcomes. Conclusions Patients achieving HFimpEF with ARNIs exhibited distinct clinical features and significantly lower risk of cardiovascular events compared to those with persistent HFrEF, highlighting the prognostic benefit of EF recovery with ARNI therapy.
Background/Aims Knee osteoarthritis (OA), type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) share overlapping mechanisms but are often managed independently. We evaluated whether knee OA increases CVD risk in Korean T2DM patients and whether physical activity (PA) modifies this risk. Methods We conducted a nationwide cohort study using data from the Korean National Health Insurance Service. A total of 1,068,215 adults with T2DM screened between 2009–2012 were followed until CVD events or end of follow-up in 2018. Knee OA was identified by ICD-10 codes and radiographic imaging. PA was classified as none, intermittent (≥ 1 session/week), or regular (≥ 3 sessions/week). Cox models were used to estimate hazard ratios (HRs) for myocardial infarction (MI), stroke, heart failure (HF), and cardiovascular mortality, adjusting for demographics, BMI, eGFR, lifestyle factors, hypertension, dyslipidemia, insulin use, and antidiabetic medication. Results Knee OA independently increased risks for overall CVD (HR 1.13, 95% CI 1.11–1.16), MI (1.07, 1.02–1.13), stroke (1.14, 1.10–1.18), and HF (1.13, 1.09–1.17). Cardiovascular mortality was not significantly increased (HR 0.99, 95% CI 0.92–1.07). The association was stronger among non-insulin users and patients with diabetes duration < 5 years. Even intermittent PA significantly reduced cardiovascular mortality among OA patients (HR 0.69, 95% CI 0.61–0.78). Conclusions Knee OA substantially elevates CVD risk in Korean T2DM patients, particularly early in disease progression. Even modest PA confers meaningful cardiovascular protection. Early cardiovascular assessment and tailored PA recommendations are essential for comprehensive diabetes management in patients with OA.
Background/Aims Remnant cholesterol (RC) has emerged as a novel lipid marker with potential implications in cardiovascular and metabolic diseases. However, its association with colorectal cancer (CRC) remains unclear. Methods We conducted a retrospective cohort study using data from 364,626 Korean adults who underwent a national health screening between 2012 and 2013. RC and other lipid parameters were categorized into quartiles. Participants were followed up until CRC diagnosis, death, or December 31, 2019. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) after controlling for demographic, clinical, and lifestyle factors. Results CRC incidence increased from 1.75 to 2.25 per 1,000 person-years across the RC quartiles. When compared with Q1, adjusted HRs were 1.08 (95% CI, 0.96–1.21) in Q2, 1.13 (1.01–1.26) in Q3, and 1.21 (1.08–1.35) in Q4. A similar trend was observed for triglycerides but not for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or total cholesterol. In the subgroup analyses, the association between RC and CRC was stronger in participants aged ≥ 65 years and those with a body mass index < 23 kg/m2. Conclusions Elevated RC levels were independently associated with an increased risk of CRC. Thus, RC may serve as a useful biomarker for CRC risk stratification beyond traditional lipid parameters.
Background/Aims Prediabetes comprises heterogeneous metabolic phenotypes that may differentially affect bone quality. While type 2 diabetes increases fracture risk despite preserved bone mineral density, phenotype-specific effects on bone quality during prediabetes remain unclear. We compared trabecular bone score (TBS) across prediabetes phenotypes and examined visceral adiposity’s mediating role. Methods We analyzed 876 individuals with prediabetes (451 men, 425 postmenopausal women) from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort. Participants underwent oral glucose tolerance testing for phenotype classification (impaired fasting glucose [IFG], impaired glucose tolerance [IGT], combined IFG+IGT) and dual-energy X-ray absorptiometry for TBS and body composition. Bootstrap mediation analysis (5,000 iterations) tested whether visceral adipose tissue (VAT) accounted for phenotype–TBS associations. Results Prediabetes phenotypes showed distinct, sex-specific patterns of bone quality impairment linked to visceral fat. In men, IGT had the lowest TBS (1.46 ± 0.09) compared with IFG (1.49 ± 0.08) and IFG+IGT (1.48 ± 0.07, both p < 0.05). In women, IFG+IGT had the lowest TBS (1.42 ± 0.08) versus IFG (1.44 ± 0.07, p < 0.05). VAT paralleled these TBS patterns and mediated 51% (95% CI 28–74%) of the IGT effect in men and 26% (95% CI 8–45%) of the IFG+IGT effect in women. Conclusions Prediabetes phenotypes are associated with distinct TBS patterns—IGT in men and IFG+IGT in women showing the lowest values. Visceral adiposity mediated approximately half of the association in men with IGT, suggesting sex- and phenotype-specific pathways linking prediabetes to bone microarchitecture.
Background/Aims Obesity elevates serum uric acid (SUA) levels, but the influence of muscle mass remains unclear. As a major endogenous purine pool, skeletal muscle may affect SUA dynamics. We evaluated the impact of changes in body components, including skeletal muscle mass index (SMI), fat mass index (FMI), and waist-to-hip ratio (WHR), on SUA in a large cohort of healthy Koreans. Methods We analyzed 39,505 adults (24,623 men; 14,180 premenopausal and 702 postmenopausal women) who underwent health checkups in 2015–2017. Body composition was assessed using bioimpedance analysis. Participants were categorized into seven groups based on 2-year changes in SMI, FMI, and WHR (tertiles of increase, decrease, and no change). Hyperuricemia was defined as SUA ≥ 7 mg/dL in men and ≥ 6 mg/dL in women. Odds ratios (ORs) for achieving optimal SUA levels (< 6 mg/dL) and regression coefficients for SUA changes were calculated. Results Mean SUA levels were 6.25 ± 1.21 mg/dL in men, 4.23 ± 0.88 mg/dL in premenopausal women, and 4.34 ± 0.91 mg/dL in postmenopausal women. SUA changed dose-dependently with body component: SMI increases were associated with reduced SUA (OR [95% CI] for the highest tertile = 1.45 [1.32–1.59] in men; 1.48 [1.06–2.06] in premenopausal women), while FMI and WHR increases correlated positively with SUA. Conclusions Two-year changes in body composition significantly influenced SUA levels, particularly in men and premenopausal women. Increasing muscle mass and reducing adiposity may be associated with improved urate control in individuals with hyperuricemia or those prone to gout.
Background/Aims Acute lower gastrointestinal bleeding (LGIB) in Crohn’s disease (CD) is a rare but potentially life-threatening complication. This study aimed to investigate the incidence and risk factors of rebleeding in CD patients with LGIB. Methods We retrospectively analyzed 137 CD patients with acute LGIB from nine tertiary university hospitals in Korea from January 2000 to October 2020. Patient characteristics, disease features, and treatment modalities were assessed, and rebleeding incidence, clinical features, and risk factors were analyzed. Results The median age of patients was 26.5 years, and the male-to-female ratio was 3.72:1. The median duration from diagnosis to first bleeding was 30.6 (0–243) months. Ileocolonic involvement (72 patients, 53%) and inflammatory phenotype (85, 62%) were most prevalent. During index bleeding, 20 and 40 patients were receiving biologics and azathioprine/6-mercaptopurine (AZA/6-MP), respectively. Bleeding focus was confirmed in 58 patients, primarily with endoscopy (33 cases). Management included conservative therapy (115 cases, 84%), endoscopic treatment (11, 8%), embolization (5, 3%), and surgery (6, 4%). After the index bleeding, 77 (56.2%) patients started or changed AZA/6-MP or biologics. Rebleeding occurred in 44 (32%) patients. The median time to recurrence was 13.0 (0.1–209) months. Transfusion requirement was significantly associated with rebleeding in univariate (hazard ratio [HR] = 3.124, 95% confidence interval [CI] = 1.502–6.494; p = 0.002) and multivariate (HR = 3.857, 95% CI = 1.678–8.867; p = 0.001) analyses. Conclusions Rebleeding incidence in patients with CD experiencing acute LGIB was 32%. Transfusion requirement is a significant risk factor for rebleeding.
Background/Aims Although the COVID-19 pandemic has officially ended, SARS-CoV-2 continues to circulate with periodic surges and may exhibit seasonal patterns. Understanding the importance of prompt immunization, particularly in individuals with prior infection, is crucial for developing future vaccination protocols. This study aimed to assess the durability and breadth of neutralizing antibody (nAb) responses against Omicron subvariants based on infection and bivalent vaccination status. Methods In this six-month prospective cohort study, we evaluated nAb responses to the original SARS-CoV-2 strain (D614G), as well as Omicron subvariants BA.4/5 and XBB.1.5 variants, in 79 healthcare workers stratified by prior Omicron infection and bivalent vaccination status. Blood samples were collected at baseline, 3 months, and 6 months, and nAb titers were measured using an optimized pseudovirus neutralization assay. Results At 3 months, individuals with prior Omicron infection followed by bivalent vaccination showed significantly higher nAb titers against BA.4/5 and XBB.1.5 compared to those with infection alone or vaccination alone. At 6 months, the highest titers persisted in the group with both prior infection and bivalent vaccination, while titers declined in previously infected but unvaccinated individuals. Notably, individuals with prior infection alone exhibited comparable nAb titers to infection-naïve vaccinated individuals, suggesting limited durability of infection-induced immunity without vaccine-induced boosting. Conclusions These findings underscore the importance of timely vaccination, even among previously infected individuals, to ensure sustained humoral immunity and broader cross-nAb responses against emerging SARS-CoV-2 variants.
BACKGROUND/AIMS:Polatuzumab vedotin combined with bendamustine and rituximab (Pola-BR) is a treatment option for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), particularly as bridging therapy before chimeric antigen receptor (CAR) T-cell infusion. However, real-world data regarding its feasibility, efficacy, and safety in Korean patients are limited. METHODS:We conducted a single-center retrospective study of 52 patients with R/R DLBCL treated with Pola-BR between April 2021 and April 2024. Patients were categorized into three groups: salvage (n = 26), post-CAR T (n = 13), and bridging (n = 13). The primary endpoints were objective response rate (ORR) and complete response (CR) rate; progression-free survival (PFS), overall survival (OS), and safety were secondary endpoints. RESULTS:The overall ORR was 51.9% (27/52), with 36.5% (19/52) of the patients achieving CR. The ORRs were 46.2%, 53.8%, and 61.5% in the salvage, post-CAR T, and bridging groups, respectively, with corresponding CR rates of 30.8%, 38.5%, and 46.2%. The bridging group achieved the highest response rates despite receiving a median of only one cycle, and patients with fewer prior treatment lines demonstrated superior responses. Grade 3-4 hematologic toxicities occurred in nearly all post-CAR T (100%) and salvage (92.3%) patients but were significantly lower in the bridging group (46.2%). CONCLUSION:Pola-BR provided meaningful disease control in patients with R/R DLBCL. Its use as a bridging therapy before CAR T-cell infusion was associated with high response rates, favorable safety, and a successful transition to cellular therapy, underscoring its value as a practical option in this setting.
Background/Aims: The clinical characteristics of Clostridioides difficile infection (CDI) in patients within the Asia-Pacific region who test positive on the nucleic acid amplification test (NAAT) and negative on the toxin enzyme immunoassay (EIA, hereafter referred to as "Toxin") are unclear. We evaluated the clinical significance and associated factors of NAAT+/Toxinpatients whose diagnosis of CDI was confirmed by toxigenic C. difficile culture. Methods: This retrospective cohort study enrolled adult patients admitted to Seoul St. Mary's Hospital between January 2015 and December 2015 with a diagnosis of active CDI. Results: In total, 3,311 stool samples were subjected to C. difficile culture, NAAT, and toxin EIA. Among them, 298 culture- positive patients fulfilled the criteria for CDI, and 3 NAAT-/Toxin- patients were excluded. The risk factors for a negative EIA and positive NAAT and culture results were evaluated in 295 patients. Among them, 128 patients were Toxin- and 167 were Toxin+. No clinical or laboratory parameters (fever, white blood cell count of < 1,000/mm(3), eosinophils, C-reactive protein, creatinine, or albumin) differed significantly between NAAT+/Toxin+ and NAAT+/Toxin- patients. In addition, the clinical outcomes did not differ between the two groups. In the multivariable analysis, previous use of antibiotics was inversely associated with negative EIA results, whereas high-dose corticosteroid use was positively associated. Conclusions: Clinical outcomes related to CDI are not different between NAAT+/Toxin+ and NAAT+/Toxin- patients, emphasizing the need for individual clinical evaluation.
Background/Aims This matched case-control study investigated the impact of HFE gene mutations on sustained virological response (SVR) in Egyptian patients with chronic hepatitis C (CHC) treated with daclatasvir and sofosbuvir. Methods A total of 150 CHC patients were enrolled (75 responders and 75 non-responders) based on HCV RNA levels 12 weeks post-treatment. HFE gene mutations (C282Y, H63D, S65C) were detected by PCR-restriction fragment length polymorphism. Liver function and iron parameters were assessed. Results Among responders, 86.67% had wild-type HFE alleles, compared to 72.00% of non-responders (p = 0.027). Heterozygous mutant alleles were more common in non-responders (28.00%) than in responders (13.33%). Wild-type carriers had 2.59 times higher odds of achieving SVR (OR, 2.59; 95% CI, 1.10–5.83). HFE mutations were significantly associated with elevated serum iron (p = 0.031) and ferritin (p = 0.044) levels, the with C282Y mutation linked to increased iron. However, after multivariate adjustment using principal component analysis, only iron overload remained a significant predictor of non-response (p < 0.001), while the association with HFE mutations was no longer significant (p = 0.647). Conclusions HFE mutations are associated with lower SVR rates and iron overload, but their impact appears mediated through disrupted iron metabolism. Iron overload emerged as the key independent predictor of treatment failure. These findings underscore the importance of evaluating iron status in conjunction with genetic factors to more accurately predict treatment outcomes in CHC patients receiving direct-acting antivirals.
Advances in treating multiple myeloma (MM) have improved survival, shifting the management focus toward quality of life. Peripheral neuropathy (PN) is a common treatment-related toxicity that significantly impairs quality of life. However, standardized assessment methods for PN in patients with MM are currently lacking. A comprehensive search of multiple databases (PubMed, Embase, Cochrane Library, and KoreaMed) was conducted to identify relevant records. Eligible studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-two studies were included, and 17 PN assessment tools were identified. Nerve conduction studies and the National Cancer Institute Common Terminology Criteria for Adverse Events were the most commonly used clinician-based tools, whereas the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity was the most frequently used patient-reported outcome measure. The use of these tools varies depending on whether their purpose is diagnostic or evaluative. To the best of our knowledge, this is the first systematic review to evaluate PN assessment tools for patients with MM, revealing substantial heterogeneity across studies. By organizing these diverse approaches, our findings can guide researchers and clinicians toward a more consistent and standardized PN evaluation, ultimately improving the management of treatment-related neuropathy in MM.
Background/Aims Drug hypersensitivity reactions (DHRs) are unpredictable adverse drug reactions that can present with varied clinical manifestations, including anaphylaxis. However, data on DHRs initially diagnosed in the emergency department (ED) and subsequently confirmed by allergy specialists remain limited. This study investigated the clinical characteristics of ED-diagnosed DHRs and the outcomes of culprit-drug identification during outpatient allergy follow-ups. Methods We retrospectively analyzed adverse drug reaction reports from the ED of a university hospital in Korea between January 2021 and December 2023. Cases meeting the World Health Organization–Uppsala Monitoring Center criteria for DHRs were included. Clinical features, suspected culprit drugs, reaction phenotypes, severity, and outpatient follow-up outcomes were evaluated. Results Among 668 patients (mean age 43.3 yr), 63.9% had immediate-type and 36.1% had delayed-type reactions. Radiocontrast media, nonsteroidal anti-inflammatory drugs (NSAIDs), and β-lactams were the most common suspected culprits. Cutaneous manifestations predominated in both immediate- and delayed-type reactions. Anaphylaxis occurred in 33.5% of the immediate-type reactions and was significantly associated with allergic comorbidities. Outpatient follow-up was completed in only 12.9% of patients, and a culprit drug was identified in 59.3% of those patients by history, specific IgE, skin testing, or drug provocation. The most frequently confirmed causative agent was cefaclor, followed by amoxicillin/amoxicillin–clavulanate, NSAIDs, and eperisone. Conclusions Immediate-type DHRs were the predominant presentation in the ED and were predominantly caused by radiocontrast media and NSAIDs. Given the low rate of outpatient follow-up, early referral to allergists is essential to improve patient safety and prevent reexposure.
Background/Aims To explore the biological implications of positron emission tomography/computed tomography (PET/CT) findings in multiple myeloma (MM), we investigated the mutational characteristics relevant to PET/CT findings using targeted DNA sequencing. Methods Fourteen newly diagnosed patients with MM who underwent 18F-fluorodeoxyglucose (FDG) PET/CT at diagnosis were retrospectively reviewed. Targeted sequencing was performed on their bone marrow samples using a customized panel covering 80 genes relevant to MM biology. In seven patients, serial PET/CT and sequencing were also conducted after first-line treatment. Results The most frequently identified mutant gene was ATM, followed by HUWE1, PABPC1, and TP53. Patients with high diffuse FDG uptake (high DU) in their bone marrow showed a higher tumor burden than those with low diffuse uptake (low DU), and they were likely to have an inferior overall survival. Mutations detected in high DU were associated with various oncogenic pathways relevant to the disease progression of MM. Notably, pathways involving epigenetic regulators were predominantly enriched in patients with high DU. In serial follow-ups, a patient with residual PET/CT findings showed the emergence of new mutations; however, those with complete resolution of PET/CT abnormalities demonstrated improved mutational characteristics. Conclusions Patients with high DU showed diverse mutational characteristics, which may reflect the heterogeneous nature of MM and contribute to inferior survival outcomes.
BACKGROUND/AIMS:The Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire was developed to measure quality of life and disease impact in patients with psoriatic arthritis (PsA). We aimed to translate the English PsAID-12 into Korean and to evaluate its reliability and validity. METHODS:The PsAID-12 questionnaire was translated into Korean following international cross-cultural adaptation guidelines. After expert review and cognitive debriefing with 10 patients, the final Korean version of the PsAID-12 was established. For validation, 21 patients with PsA completed the Korean PsAID-12 questionnaire, and a retest was conducted one week later to assess reliability. Demographic data and disease activity indices, including the Disease Activity in Psoriatic Arthritis (DAPSA) and Visual Analog Scale (VAS) pain were collected. Correlations between PsAID-12 scores and disease activity indices were analyzed. RESULTS:Minor discrepancies in the translation process were resolved during the synthesis and review. The mean PsAID-12 scores were 3.9 ± 2.6 and 3.6 ± 2.3 for the first and second assessments, respectively. The mean response time was 2.6 ± 1.0 min. The intraclass correlation coefficient was 0.856 (95% CI 0.682-0.939, p < 0.050), indicating good reliability. The first PsAID-12 score was strongly correlated with the second PsAID-12 (r = 0.79), DAPSA (r = 0.66), and VAS pain (r = 0.67). CONCLUSION:The Korean PsAID-12 questionnaire was well translated and validated, showing strong reliability and correlation with disease activity measures. It is therefore appropriate for assessing the impact of PsA in Korean patients.
BACKGROUND/AIMS:This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. METHODS:Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. RESULTS:In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. CONCLUSION:The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.
BACKGROUND/AIMS:Thyroid hormone suppression therapy (THST) is widely used for long-term management of differentiated thyroid cancer (DTC). However, studies have suggested that THST may increase the risk of atrial fibrillation (AF) in patients with DTC. We aimed to evaluate whether the risk of AF in patients with DTC differs according to treatment modality. METHODS:This retrospective cohort study used data from the Korean National Health Information Database between 2006 and 2019. We included 113,791 patients with DTC and age- and sex-matched 455,188 controls. The risk of AF was assessed according to the following treatment modalities: lobectomy or total thyroidectomy with or without radioactive iodine therapy (RAIT). A Cox proportional hazards model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS:Patients with DTC had a two-fold higher risk of incident AF than controls (HR, 2.07; 95% CI, 1.98-2.17). All the treatment groups showed a higher risk of AF than the control group. Patients with DTC who underwent total thyroidectomy without RAIT (HR, 2.20; 95% CI, 2.06-2.34) or with RAIT (HR, 2.07; 95% CI, 1.95-2.20) had a higher risk of AF in contrast to those who underwent lobectomy (HR, 1.93; 95% CI, 1.72-2.15). CONCLUSION:Patients with DTC had an increased risk of incident AF. The risk of AF was higher in patients with DTC who underwent total thyroidectomy than those who underwent lobectomy alone. For long-term management of patients with DTC, increased vigilance is required for AF screening, particularly in this high-risk group.
BACKGROUND/AIMS:Infection remains the second leading cause of mortality in patients with end-stage renal disease (ESRD). Despite the direct relationship between hemodialysis vascular access-related infections (HD-VARI) and both prognosis and mortality in ESRD patients, there is a paucity of research in this area. METHODS:This retrospective study was performed at a tertiary care hospital in Seoul, Korea, from 2009 to 2020. Medical records of adult patients diagnosed with HD-VARI were assessed. We analyzed the distribution of microorganisms, clinical characteristics according to vascular access type, and evaluated risk factors for treatment failure. RESULTS:Data from a total of 367 patients were included over the 12-year study period. Based on vascular access type, 293 (79.8%) had arteriovenous graft infections, 29 (7.9%) had arteriovenous fistula infections, and 45 (12.3%) had tunneled cuffed catheter infections. Thirty-one (8.4%) patients experienced treatment failure within 90 days. Multivariate analysis identified male sex (odds ratio [OR], 2.343; 95% confidence interval [CI], 1.041-5.274) and metastatic infection (OR, 4.297; 95% CI, 1.516-12.178) as independent predictors of 90-day infection-related treatment failure. Subtotal or total excision (removal) of the infected vascular access significantly decreased the risk of 90-day infection-related treatment failure (OR, 0.337; 95% CI, 0.129-0.876). CONCLUSION:Removal of infected vascular access played a crucial role in reducing infection-related deaths or relapses within 90 days. Management of vascular access infection should be individualized based on patient-specific factors.
BACKGROUND/AIMS:Previously developed fracture risk prediction models primarily estimate long-term risk and are limited in their ability to predict imminent fractures. We developed a simplified and practical model to predict the short-term fracture risk (1- to 3-year risk) in elderly Korean women. METHODS:We included 1,440,988 women who underwent a national life-transition health examination at age 66 between 2011 and 2017. The participants were followed-up for 3 years to identify major osteoporotic fractures (MOFs) and hip fractures. Clinical risk factors such as body mass index, bone mineral density, fall history within 6 months, prior fractures within 3 years, recent fractures within 1 year, and recurrent fractures were analyzed. Multivariate logistic regression was used to estimate the odds ratios (ORs) for these risk factors. Each OR was converted into a risk score, and the total scores were stratified into five groups: 0-4, 5-7, 8-10, 11-14, and 15-18 points. RESULTS:Higher scores were associated with a significantly increased risk of fractures. At 3 years, the incidences of MOF were 3.4%, 5.8%, 12.0%, 21.3%, and 36.6%, and the hip fracture incidences were 0.13%, 0.26%, 0.59%, 0.73%, and 1.82% across the five groups, respectively. CONCLUSION:This simplified scoring model is a practical tool for predicting the 1- to 3-year fracture risk in elderly Korean women. By stratifying patients into risk groups based on routine clinical data, it enables the early identification of high-risk individuals and facilitates timely preventive care.
