OBJECTIVE: It is unclear wheth-er photodocumentation is associated with colorectal neoplasm (CRN) detection at colonoscopy, despite its ability to take more images with the development of affordable digital imaging systems. This study aimed to investigate whether photodocumentation-related factors could affect the detection rate of CRNs in healthy subjects.PATIENTS AND METHODS: A total of 2,637 subjects undergoing screening colonoscopy in routine health check-ups at CHA Bundang Medical from January to September 2016 were enrolled in this study. Only the endoscopic image data for observation purposes during colonoscopy withdrawal was used in this analysis. The number of observation images, observation time and the speed of photodocumentation (SPD) defined as the number of observation images per minute were used as quantity measures of photodocumentation. The presence of documented anatomical landmarks such as appendix orifice (AO), ileocecal valve (ICV), anorectal junction was used as quality measures of photodocumentation.RESULTS: Among subject-related factors, the independent factors for CRN detection in the multivariate analysis were age, male sex, waist circumference, and family history of colorectal cancer. In photo-documentation-related factors, SPD [Odds ratio (OR) 0.800; 95% confidence interval (CI), 0.740 to 0.864], observation time over 6 min (OR 1.671; 95% CI, 1.145 to 2.439), clear documentation of appendix orifice (AO) (OR 5.976; 95% CI, 4.548 to 7.852) and ileocecal valve (ICV) (OR 3.826; 95% CI, 2.985 to 4.904), and endoscopists (p < 0.001) were independently significant factors. However, the number of observation images was not associated with the detection of CRNs.CONCLUSIONS: Lower SPD and clear documentation of cecal landmarks might be associated with an increased detection rate of CRNs.

OBJECTIVES:Immune reconstitution inflammatory syndrome (IRIS) is a major concern when starting antiretroviral therapy (ART) in patients with advanced HIV infection. The aim of this study was to determine the incidence and risk factors of IRIS in HIV-infected Koreans initiating ART, and whether integrase strand transfer inhibitor (INSTI) treatment increases the risk of IRIS.METHODS:This retrospective analysis included adults living with HIV, seen at four university-affiliated hospitals in South Korea, who were naïve to ART and had a CD4 T-cell count < 200 cells/μL between January 2004 and May 2019. IRIS was determined through a medical record review within 6 months of ART initiation. Propensity score-matched case-control study between the non-INSTI and INSTI groups was performed.RESULTS:The study included 501 patients; 192 were assigned to the INSTI group, who started ART based on INSTIs as the initial treatment. There were opportunistic infections (OIs) in 253 (50.5%) cases before ART initiation. The three most common OIs were Pneumocystis jirovecii pneumonia, candidiasis and tuberculosis (TB). We identified 47 cases of IRIS; TB-IRIS was the most common type. The incidence of IRIS within 6 months of ART initiation was 9.4%, and there were no significant differences in baseline characteristics and incidence of IRIS between the matched groups. The risk factors for IRIS were pre-ART CD4 T-cell count (< 30 cells/μL), higher pre-ART viral load (≥ 75 000 copies/mL), and TB-OI.CONCLUSIONS:The incidence of IRIS was 9.4% in Korean HIV patients. The INSTI regimen was not related to IRIS occurrence.

Since 2011, 2% chlorhexidine in 70% isopropyl alcohol (2% chlorhexidine tincture) has been widely used in Korea. To investigate changes in chlorhexidine sensitivity of staphylococci causing central line-associated bloodstream infections, 264 blood culture isolates from adult patients treated in intensive care units of five university hospitals between 2008 and 2016 were analysed. We observed no significant changes in chlorhexidine minimum inhibitory and bactericidal concentrations, or in the prevalence of resistance-associated genes before and after introduction of 2% chlorhexidine tincture. Thus, there was no evidence of increased resistance to chlorhexidine in staphylococci causing central line-associated bloodstream infections.

Abstract PURPOSE: To examine whether depression, anxiety disorder and their co-occurrence would increase the risk of mortality in patients with breast cancer, and whether antidepressant treatment would reduce the same. PATIENTS AND METHODS: Data were retrieved from the database of the Korean National Health Insurance Service. Of 145,251 patients diagnosed with breast cancer between 2007 and 2014, 20,870 patients diagnosed with depression or anxiety disorder one year before breast cancer diagnosis were excluded. Thus, data of 124,381 patients were included in this study. RESULTS: Anxiety disorder was more prevalent than depression in patients with breast cancer, and similar factors were associated with both depression and anxiety disorder. Overall, female sex, older age, residence in metropolitan areas, lower income, higher comorbidity, carcinoma in situ, and the receipt of any type of cancer therapies were associated with an increased risk of depression or anxiety disorder. Depression and anxiety disorder were associated with an increased risk of mortality (Hazard Ratio (HR) = 1.26, 95% CI=1.18–1.36; HR=1.14, 95% CI=1.08–1.22, respectively) and their co-occurrence further increased the risk (HR=1.38, 95% CI=1.24–1.54). Antidepressant treatment was related to a reduced risk of mortality. Compared to patients with no depression, among those with depression, the risk of mortality was 2.18 times higher (95% CI=1.69–2.81) in patients who did not receive antidepressant treatment and 1.25 times higher (95% CI =1.17–1.32) in those who received antidepressant treatment. CONCLUSION: The current findings suggest that psychiatric comorbidities are markers of increased mortality risk in patients with breast cancer. This underscores the need for screening and treating depression and anxiety disorders to improve survival in breast cancer. Citation Format: Kim YS, Shim E-J, Lee JW, Cho J, Jung HK, Kim NH, Lee JE, Min J, Noh WC, Park S-H. Association of depression and anxiety disorder with the risk of mortality in breast cancer: A national health insurance service study in South Korea [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-21.

SummaryBenign prostatic hyperplasia (BPH) is characterized by the proliferation of stromal and epithelial cell types in the prostate, and interactions between the two types of cells. We demonstrated previously that proliferation of prostate stromal cells was induced by BPH epithelial cells in response to Trichomonas vaginalis (Tv) infection via crosstalk with mast cells. In this study, we investigated whether IL‐6 released by the proliferating stromal cells in turn induce the BPH epithelial cells to multiply. When culture supernatants of the proliferating prostate stromal cells were added to BPH epithelial cells, the latter multiplied, and expression of cyclin D1, FGF2 and Bcl‐2 increased. Blocking the IL‐6 signalling pathway with anti‐IL‐6R antibody or JAK1/2 inhibitor inhibited the proliferation of the BPH epithelial cells and reduced the expression of IL‐6, IL‐6R and STAT3. Also, epithelial‐mesenchymal transition was detected in the proliferating BPH epithelial cells. In conclusion, IL‐6 released from proliferating prostate stromal cells induced by BPH epithelial cells infected with Tv in turn induces multiplication of the BPH epithelial cells. This result provides first evidence that the inflammatory microenvironment of prostate stromal cells resulting from Tv infection induces the proliferation of prostate epithelial cells by stromal‐epithelial interaction.

Objectives: To assess the outcome of Staphylococcus aureus bacteraemia (SAB) according to factors associated with necessity for longer treatment in conjunction with the duration of treatment. Methods: We prospectively collected the data of patients with SAB consecutively during 12 to 39 months from 11 hospitals. If multiple episodes of SAB occurred in one patient, only the first episode was enrolled. Factors associated with necessity for longer treatment were defined as follows: persistent bacteraemia, metastatic infection, prosthesis and endocarditis. If any of the factors were present, then the case was defined as longer antibiotic treatment warranted (LW) group; those without any factors were defined as shorter antibiotic treatment sufficient (SS) group. Poor outcome was defined as a composite of 90-day mortality or 30-day recurrence. Duration of antibiotic administration was classified as < 14 or >= 14 days in the SS group and < 28 or >= 28 days in the LW group. Results: Among 2098 cases, the outcome was analysed in 1866 cases, of which 591 showed poor outcome. The SS group accounted for 964 cases and the LW group for 852. On multivariate analysis, age over 65 years, pneumonia, higher Sequential Organ Failure Assessment (SOFA) score and chronic liver diseases were risk factors for poor outcome. Administration of antibiotics less than the recommendation was associated with poor outcome, but this significance was observed only in the LW group (adjusted odds ratio = 1.68; 95% confidence interval, 1.00-2.83; p 0.05). Conclusions: Inappropriately short antibiotic treatment was associated with poor outcome in the LW group. Vigilant evaluation for risk factors to determine the duration of treatment may improve the outcome among patients with SAB. (c) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Background CT-P13 is approved as a biosimilar of innovator infliximab for marketing in 79 countries around the world. After approval, observational study has been conducted in Republic of Korea in patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA) and Plaque Psoriasis (PS). Objectives To evaluate the effectiveness and safety of CT-P13 under routine care in Republic of Korea. Methods This observational study included both biologic naïve patients (Naïve group) and patients who switched from other anti-tumor necrosis factor (TNF)s to CT-P13 (Switch group). Effectiveness were evaluated based on remission (DAS28≤2.6 in RA, BASDAI<3 in AS and absence of swollen and tender joint counts in PsA), and response (BASDAI 20/50/70 in AS and PASI 50/75 in PS). Adverse events (AEs) were collected over 6 month period. Results Total 940 patients (400 with RA, 531 with AS, 3 with PsA and 6 with PS) were registered and 338 (36.0%) patients (108 with RA, 228 with AS, 2 with PS) who switched to CT-P13 were included. The proportion of patients achieving remission was similar between Naïve and Switch groups in both RA and AS during post-baseline visits (Table 1). In RA, the proportion of patients achieving each disease activity category by DAS28 was similar between Naïve and Switch groups (Figure 1). The proportion of patients who achieved BASDAI 20/50/70 response gradually increased from week 6 to week 24 or 30 in Naïve group with AS (Figure 1). Fifty percent of naïve patients with PsA achieved clinical remission. The proportions of both PASI 50 and 75 responses were 50% at Week 22 in Naïve group and were 100% and 50% in Switch group, respectively during post-baseline visits in PS patients. Throughout this study, treatment-emergent adverse events (TEAE) and treatment-emergent serious adverse events (TESAE) were reported as Table 2. Only 11% of patients experienced infection. Conclusions CT-P13 is efficacious and well-tolerated in RA/AS/PsA/PS patients. Efficacy and safety results in patients treated with CT-P13 were clinically consistent to historical data [1,2,3]. Especially, Switch group results showed that CT-P13 provides a useful alternative to other anti-TNFs. References Kobayashi et al (2016). Hetland et al (2005). Hetland et al (2010). Disclosure of Interest D.-W. Kim: None declared, T.-H. Kim: None declared, S. R. Kwon: None declared, E. Y. Lee: None declared, C.-N. Son: None declared, Y. S. Kim: None declared, S. H. Kim: None declared, Y.-B. Park: None declared, J.-W. Hur: None declared, H.-S. Lee: None declared, S. J. Lee Employee of: CELLTRION,Inc., S. H. Lee Employee of: CELLTRION,Inc.

Background CT-P13 is approved in both European Union and United States, and licensed for use in 79 countries around the world as a biosimilar to innovator infliximab (INX). The independent registries of CT-P13 have been conducted in a number of European countries and Korea [1]. Objectives To evaluate safety and effectiveness of CT-P13 when administered in a real-life setting in active RA patients. Methods This study collected data of patients who were treated with CT-P13 from 2013 December to 2016 June. Efficacy was assessed at baseline and every 6 months thereafter using DAS28 (ESR) and/or DAS28 (CRP) and collection of adverse events (AEs) was performed. Immunogenicity was assessed at baseline, Week 30 and every year during CT-P13 treatment period. Results Total 125 patients were enrolled; 104 patients started treatment with CT-P13 (Naïve group) and 21 patients (8 from INX, 13 from other anti-TNFs) switched treatment to CT-P13 (Switching group). The mean (SD) duration since RA diagnosis was 6.5 (±6.85) years for all patients. Of all patients treated with CT-P13, only 4.8% (6/125) of patients changed to other anti-TNFs. Two of six patients changed treatment within 8 month after starting CT-P13. The proportion of patients achieving clinical remission by DAS28 (ESR/CRP) increased gradually (Figure 1). DAS28 (ESR/CRP) value decreased from baseline at 6 months and it maintained thereafter (Table 1). Switching group also showed similar results that remission rate by DAS28 (CRP) was 42.9% (3/7) and mean actual value was 2.85 at 12 months. For Naïve group, 50% (52/104) of patients had at least one positive anti-drug antibody result and it is consistent to other published study [2]. Overall safety summarized as the percentage of patients with at least one treatment emergent AE (TEAE) was similar or lower after switching to CT-P13 (Table 2). No cases of active tuberculosis were reported. Conclusions The overall safety profile revealed that CT-P13 is well-tolerated in patients with RA and remission rate for 24 months also showed that CT-P13 is efficacious under real world practice. References Glintborg et al. ACR 2016. Krintel et al. Rheumatology 2013. Disclosure of Interest None declared

OBJECTIVES:No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. METHODS:A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (≥15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics. RESULTS:Among the 242 included cases, the bones and joints (36.8%) were the most common sites of infection and 60.7% of the patients had sepsis. The overall treatment failure rate was 43.8% (106/242). All-cause mortality within 1 month was 6.2% (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4% (24/79) vs. 49.4% (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22% (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group. CONCLUSIONS:Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE.

Background Headaches is common in patients with systemic lupus erythematosus (SLE) [1]. However, the lack of specific clinical distinctions for headache in SLE has made it difficult to elucidate its pathophysiology. Chronic daily headache (CDH) is a category of headache disorders that occurs more than 15 days per month and is associated with a profound decline in the quality of life [2]. Objectives The aim of this study is to investigate the clinical characteristics of CDH in patients with SLE and their association with disease severity and the quality of life. Methods A total of 40 consecutive patients with SLE participated in the survey. We investigated headache characteristics, visual analogue scale (VAS) for pain, and six-question headache impact test (HIT-6) to evaluate the impact of headache on the quality of life. The patients underwent required blood tests for assessment of disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Results Six patients (15%) met the criteria for CDH. The total score of HIT-6 is significantly higher in SLE patients with CDH than in those patients who suffered from headache without CDH (P=0.027). SLE patients with CDH in particular had a higher prevalence of “wish could lie down” than those who suffered from headache without CDH (P=0.017). The multivariate regression analysis indicates that the headache days per month was a predictor for headache-related disabilities. Conclusions As far as we know, this is the first study of its kind to evaluate the correlation of CDH and the quality of life in Korean patients with SLE. CDH may deteriorate the quality of life in patients with SLE. References Cuadrado MJ, Sanna G. Headache and systemic lupus erythematosus. Lupus 2003;12:943–6. Pascual J, Colas R, Castillo J. Epidemiology of chronic daily headache. Curr Pain Headache Rep 2001;5:529–36. Disclosure of Interest None declared

Background Autoantibodies, especially antinuclear (ANAs) and anticytoplasmatic antibodies are essential diagnosing markers for several autoimmune diseases. ANA can sometimes also be found in organ-specific autoimmune diseases such as systemic lupus erythrmatosus. Fibromyalgia (FM) is a common disease characterized by chronic widespread pain and various manifestations. There has been reported high prevalence of psychosomatic distress, comorbidity, inflammatory autoimmune characteristics. Despite of its high prevalence, there is still no standardized laboratory test to suggest FMG or its severity. Objectives Anti-dense fine speckled 70 (Anti-DFS70) antibodies were initially identified as an ANA from a patient with interstitial cystitis. Anti-DFS70 antibodies are found in 10% of healthy individuals, but only in a tiny population of with autoimmune rheumatic disease. These autoantibodies do not suggest any specific rheumatic disease. But there is no report in FM patients. Methods It was based on the 80 fibromyalgia patients over the age of 20 who visited the two University hospitals from August 2008 to January 2013 and for the disease comparison group of 17 systemic lupus erythematosus patients, for the normal comparison group of 19 healthy individuals who have not been diagnosed systemic autoimmune rheumatic disease and without diabetes mellitus, hypertension, dyslipidemia, cerebral infarction, cardiovascular disease, infectious disease and chronic disease like cancer. Especially for physical measurement like height, weight and BMI and disease duration, tender point, FIQ (Fibromyalgia Impact Questionnaire), VAS (Visual Analogue Scale), somatic symptom and anti-DFS70 antibodies were measured and the American college of rheumatology 1990 classification criteria of FM was used to diagnose. Results In this research, in the group with fibromyalgia patients group, systemic lupus erythematosus patients group and normal control group, they were evaluated for anti-DFS70 antibodies differences but statistically, between the three groups, there were high prevalence of anti-DFS70 antibodies in FM group. We checked relativity between anti-DFS70 antibodies and age, height, weight, BMI, disease duration, tender point, FIQ, VAS, and somatic symptom which were evaluated and statistically, they were confirmed to show the positive correlation between anti-DFS70 antibodies and VAS. Conclusions The anti-DFS70 antibody is atypical pattern of ANA that shows availability in the diagnosing of the FM. Moreover, a large-scale research should be processed for the confirmation that reflected the positive correlation between anti-DFS70 antibodies and other clinical manifestations. Disclosure of Interest None declared

We evaluated the clinical significance of the cefazolin inoculum effect (CIE) in methicillin-susceptible Staphylococcus aureus (MSSA) isolates. In total, 146 isolates were recovered from patients with MSSA bacteremia at 9 hospitals in Korea. The CIE was observed in 16 MSSA isolates, and while type A was the only detected β-lactamase in MSSA isolates exhibiting the CIE, no strains expressing type B, C, or D β-lactamases exhibited this effect. The CIE was only observed in agr group III and I isolates and was significantly more common in isolates with agr dysfunction than in those with functional agr (P < 0.001). Even among isolates producing type A β-lactamase, the CIE was also prevalent in isolates with dysfunctional agr than in isolates with functional agr (P = 0.025). This study demonstrates an association between the CIE of MSSA isolates and agr dysfunction, in addition to those between the CIE and type A β-lactamase.

지반은 동결이 발생함에 따라 물리적 특성이 변화하며, 동결현상에 따른 기초구조물의 안정성 평가는 설계시 중요한 고려사항 중 하나이다. 본 연구에서는 동결 및 전단과정 중 연직응력 변화에 따른 동결토의 전단강도 및 강성을 평가하고자 하였다. 동결토의 강도평가를 위하여 직접전단실험을 수행하였으며, 직접전단실험 중 강성평가를 위한 전단파 측정을 동시에 수행하였다. 실험수행을 위하여, 동결용 직접전단상자를 제작하였으며, 상·하부 전단상자의 벽면에는 전단파 트랜스듀서인 벤더 엘리먼트를 각각 설치하였다. 시료는 주문진사 및 실트, 그리고 증류수를 이용하여 포화도 10%로 혼합하였으며, 상대밀도가 모든 조건에서 동일하게 유지되도록 조성하였다. 조성된 시료는 -5℃까지 동결을 진행시킨 후, 온도를 유지한 상태로 직접전단실험을 수행하였다. 동결 및 전단과정 중 시료에는 다양한 크기의 연직응력이 가해졌으며, 전단과정 중 수평변위에 따른 전단응력 및 수직변위, 그리고 전단파를 측정하였다. 실험결과, 모든 구속조건의 경우에서 동결 혹은 전단과정의 연직응력이 증가함에 따라 전단강도는 증가하였으며, 전단과정의 연직응력만 증가한 경우보다 동결과정의 연직응력도 함께 증가한 경우 전단강도가 더 크게 증가하는 것으로 나타났다. 또한, 전단파 속도의 변화는 측정위치에 따라 다른 경향을 보였으며, 전단면을 통과하여 측정한 경우 전단파 속도는 전단변형이 진행됨에 따라 감소하는 것으로 나타났다. 본 연구는 동결 및 전단과정 시 구속조건의 효과를 평가한 연구로써, 포화도가 낮은 상태의 동결토의 강도 및 강성에 대한 기초자료로 활용될 수 있을 것으로 예상된다. The characteristics of frozen soils are one of most important factors for foundation design in cold region. The objective of this study is to evaluate the shear strength and stiffness of frozen soils according to the confining conditions during the freezing and shearing phase. A direct shear box is constructed for the frozen specimens and bender elements are mounted on the wall of the shear box to measure shear wave velocities. Specimens are prepared by mixing sand and silt with a silt fraction of 30% in weight and the degree of saturation of 10%, giving a relative density of 60% for all tests. The temperature of the specimens in the freezer is allowed to fall below -5℃, and then direct shear tests are performed. A series of vertical stresses are applied during the freezing and shearing phase. Shear stress, vertical displacement, and shear wave along the horizontal displacement are measured. Experimental results show that in all the tests, shear strength increases with increasing vertical stress applied during the freezing and shearing phases. The magnitude of the increase in shear strength with increasing vertical stress during shearing under fixed vertical stress in the frozen state is smaller than the magnitude of the increase in vertical stress during freezing and shearing. In addition, the change in shear wave velocities varies with the position of the bender elements. In the case of shear waves passing through the shear plane, the shear wave velocities decrease with increasing horizontal displacement. This study provides an evaluation of the properties of shear strength and stiffness of frozen soils under varied confining condition.