Purpose: The use of direct oral anticoagulants (DOACs) is challenging in fragile patients, including those with cancer, chronic kidney disease (CKD), and old age. We aimed to compare the safety of DOACs in terms of bleeding complications in these patients. Methods: Using hospital data from 2013 to 2019, we compared the risk of bleeding and major bleeding, including intracranial bleeding, any bleeding requiring transfusion, and all-cause bleeding, in patients with venous thromboembolism (VTE) who were naïve to DOAC (n = 12,369) and warfarin (n = 4,123). Hazard ratios (HRs) for the clinical outcomes were analyzed using Cox regression analysis, with warfarin as a reference. Results: The study included 4,078 eligible patients, predominantly female (54.1%), with a mean age of 62.5 years. DOACs were the primary treatment in 74.1% of the patients. DOAC treatment was associated with lower all-cause mortality compared to warfarin (HR, 0.799; 95% confidence interval [CI], 0.707–0.904). Although rates of recurrent VTE or major bleeding did not significantly differ between the groups, DOAC-treated patients had lower bleeding risk (HR, 0.562; 95% CI, 0.393–0.805; P = 0.002). The individual DOAC drugs did not differ significantly in terms of composite outcomes, recurrence, or bleeding events. Conclusion DOAC showed comparable outcomes with warfarin in the fragile patient population.

Purpose: The use of direct oral anticoagulants (DOACs) is challenging in fragile patients, including those with cancer, chronic kidney disease (CKD), and old age. We aimed to compare the safety of DOACs in terms of bleeding complications in these patients. Methods: Using hospital data from 2013 to 2019, we compared the risk of bleeding and major bleeding, including intracranial bleeding, any bleeding requiring transfusion, and all-cause bleeding, in patients with venous thromboembolism (VTE) who were naïve to DOAC (n = 12,369) and warfarin (n = 4,123). Hazard ratios (HRs) for the clinical outcomes were analyzed using Cox regression analysis, with warfarin as a reference. Results: The study included 4,078 eligible patients, predominantly female (54.1%), with a mean age of 62.5 years. DOACs were the primary treatment in 74.1% of the patients. DOAC treatment was associated with lower all-cause mortality compared to warfarin (HR, 0.799; 95% confidence interval [CI], 0.707–0.904). Although rates of recurrent VTE or major bleeding did not significantly differ between the groups, DOAC-treated patients had lower bleeding risk (HR, 0.562; 95% CI, 0.393–0.805; P = 0.002). The individual DOAC drugs did not differ significantly in terms of composite outcomes, recurrence, or bleeding events. Conclusion DOAC showed comparable outcomes with warfarin in the fragile patient population.

Purpose: The use of direct oral anticoagulants (DOACs) is challenging in fragile patients, including those with cancer, chronic kidney disease (CKD), and old age. We aimed to compare the safety of DOACs in terms of bleeding complications in these patients. Methods: Using hospital data from 2013 to 2019, we compared the risk of bleeding and major bleeding, including intracranial bleeding, any bleeding requiring transfusion, and all-cause bleeding, in patients with venous thromboembolism (VTE) who were naïve to DOAC (n = 12,369) and warfarin (n = 4,123). Hazard ratios (HRs) for the clinical outcomes were analyzed using Cox regression analysis, with warfarin as a reference. Results: The study included 4,078 eligible patients, predominantly female (54.1%), with a mean age of 62.5 years. DOACs were the primary treatment in 74.1% of the patients. DOAC treatment was associated with lower all-cause mortality compared to warfarin (HR, 0.799; 95% confidence interval [CI], 0.707–0.904). Although rates of recurrent VTE or major bleeding did not significantly differ between the groups, DOAC-treated patients had lower bleeding risk (HR, 0.562; 95% CI, 0.393–0.805; P = 0.002). The individual DOAC drugs did not differ significantly in terms of composite outcomes, recurrence, or bleeding events. Conclusion DOAC showed comparable outcomes with warfarin in the fragile patient population.

Healthcare accreditation, which in the Republic of Korea is based on Article 58 of the Medical Service Act of July 2010, is an evaluation system designed to improve the quality of medical services and secure patient safety. Although ambulatory health organizations such as clinics comprise the majority of all health facilities, because they are not currently evaluated, securing quality and patient safety nationwide is not possible under the existing system. This article reviewed the accreditation programs of ambulatory health organizations in leading countries such as the United States and Australia in order to propose a successful model for Korea. The Accreditation Association for Ambulatory Health Care of the Unites States is a private, non-profit organization established in 1979. Similarly, Australian General Practice Accreditation Limited is a non-profit organization established in 1997 to deliver services to support general practices in Australia. Both are independent professional organizations and perform accreditation programs by a self-regulatory system. As healthcare quality improvement and accreditation have the characteristics of professional service activities, a self-regulatory approach rather than a government-controlled one, and process-oriented evaluation rather than structure-focused evaluation, are known to be effective. We expect an accreditation program for clinics in Korea to be established using a self-regulatory approach by an independent professional organization, not by the government, in the near future.
Accreditation* ; Ambulatory Care Facilities ; Australia ; Benchmarking* ; Delivery of Health Care* ; General Practice ; Health Facilities ; Korea ; Organizations, Nonprofit ; Patient Safety ; Quality Improvement ; Quality of Health Care ; Republic of Korea ; Societies ; United States

Venous thromboembolism (VTE), a severe condition comprising deep vein thrombosis and pulmonary embolism, requires prompt treatment. Traditional therapies include heparin, low-molecular-weight heparin, and warfarin. Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban has revolutionized VTE management. Clinical trials show that DOACs are as effective as traditional anticoagulants in preventing recurrent VTE, with similar or lower rates of major bleeding. However, DOAC use is complex in vulnerable populations—those with comorbidities, chronic kidney disease, cancer, and advanced age—due to higher VTE and bleeding risks from polypharmacy and altered pharmacokinetics. Trials have shown promising results for DOACs, but these studies often include few patients from these high-risk groups. Moreover, while DOACs are validated for atrial fibrillation, these findings may not apply directly to patients with VTE due to different dosing. In this study, we aimed to address this gap by reviewing the literature on the efficacy and safety of DOACs in these vulnerable populations.

Purpose: This study aims to investigate regional patterns and graft survival rates in kidney transplantation (KT) within South Korea using the National Health Insurance Service database. Methods: By analyzing KT data from 2002 to 2017, including patient residency, KT location, and post-KT dialysis information, graft survival was assessed through post-KT dialysis and validated against Ulsan University Hospital and the Korean Organ Transplantation Registry’s 2017 report. Results: Among the 20,978 KTs, 60.5% occurred in the Korean capital, Seoul, whereas 39.5% occurred outside. The overall graft survival rate was 81.5% with a median survival duration of 57 months. Patient survival was 83.8%, with a median survival duration of 61 months. For KTs from 2002 to 2007, the 10-year graft and patient survival rates were 89.1% and 90.3%, respectively. The KT recipients living outside Seoul who underwent the KT within their residential regions had a graft survival rate of 88.3%, and those receiving KTs outside their original region had a graft survival rate of 88.0%. Among Seoul residents who underwent KTs in the city, the graft survival rate was 90.5%. Importantly, hospital location did not significantly affect graft survival rates (P = 0.136). Conclusion This study revealed a regional preference for KT in South Korea, particularly in the capital city, likely because of nonresidents. Nevertheless, the graft and patient survival rates showed no significant regional disparities. These findings emphasize the necessity for equitable KT service access across regions in order to optimize patient outcomes.

A case of a 30-year-old man who was admitted following a penetrating neck injury is presented. A clinical examination and operative findings identified semi-comatose mentality, neck muscle laceration, and transection of the left common carotid and vertebral arteries and the internal jugular vein. During the operation, the carotid arteries were repaired by interposition grafting, and the internal jugular vein was ligated. The vertebral artery was managed by interventional embolization. Although the patient had some neurological deficit, he was discharged on postoperative Day 52. This surgical case prompted a discussion regarding neurological outcomes, and surgical and endovascular treatment following vascular neck injury.

Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Allografts* ; Amputation ; Blood Vessel Prosthesis ; Cadaver* ; Humans ; Lower Extremity ; Mortality ; Saphenous Vein ; Tissue Preservation ; Transplants* ; Veins

PURPOSE: To assess the technical feasibility of laparoscopic distal pancreatectomy (LDP) focusing on the development of postoperative complications including pancreatic fistula (POPF). METHODS: From March 2001 to April 2010, 57 patients underwent a distal pancreatectomy. The patients were divided into two groups, LDP group (L group, n=15) and open distal pancreatectomy group (O group, n=42). The clinicopathological characteristics, surgical variables and postoperative outcomes of these 2 groups were compared retrospectively. RESULTS: Patients with a malignancy constituted 7% of the L group and 31% of the O group (p=0.084). The tumor size was significantly larger in the O group (2.6 vs. 5.3 cm). The body mass index (BMI) was significantly higher in the L group (24.9 vs. 22.9 kg/m2). One case of a pancreas pseudocyst in the L group was converted to open surgery due to intraoperative bleeding. The L group showed significantly less intraoperative bleeding, earlier start of solid meals and shorter hospital stay. There was no significant difference in the incidence of postoperative complications and POPF between the 2 groups. POPF of ISGPF grade B developed in 0 and 2 patients in the L group and O group, respectively. One intestinal obstruction and 1 fluid collection that required intervention was encountered in the O group. One patient with adenocarcinoma who underwent LDP was alive 25 months after surgery without recurrence. CONCLUSION: LDP provides the advantages of minimal access surgery with a comparable rate of POPF to ODP. LDP is considered suitable for benign and borderline-malignant pancreatic lesions.
Adenocarcinoma ; Body Mass Index ; Hemorrhage ; Humans ; Incidence ; Intestinal Obstruction ; Length of Stay ; Meals ; Pancreas ; Pancreatectomy ; Pancreatic Fistula ; Pancreatic Neoplasms ; Postoperative Complications

Clonorchis sinensis, which causes clonorchiasis, is prevalent in East Asian countries and poses notable health risks, including bile duct complications. Although praziquantel is the primary treatment for the disease, the emerging resistance among trematodes highlights the need for alternative strategies. Understanding the nutrient uptake mechanisms in trematodes, including C. sinensis, is crucial for developing future effective treatments. This study aimed to characterize the function of C. sinensis glucose transporter 4 (CsGTP4) and determine its role in nutrient uptake employing synthesized cDNA of adult C. sinensis worms. The functional characterization of CsGTP4 involved injecting its cRNA into Xenopus laevis oocytes and analyzing the deoxy-D-glucose uptake levels. The results demonstrated that deoxy-D-glucose uptake depended on the deoxy-D-glucose incubation and CsGTP4 expression time, but not sodium-dependent. The concentration-dependent uptake followed the Michaelis–Menten equation, with a Km value of 2.7 mM and a Vmax value of 476 pmol/oocyte/h based on the Lineweaver–Burk analysis. No uptake of radiolabeled α-ketoglutarate, p-aminohippurate, taurocholate, arginine, or carnitine was observed. The uptake of deoxy-D-glucose by CsGTP4 was significantly inhibited by unlabeled glucose and galactose in a concentration-dependent manner. It was significantly inhibited under strongly acidic and basic conditions. These insights into the glucose uptake kinetics and pH dependency of CsGTP4 provide a deeper understanding of nutrient acquisition in trematodes. This study contributes to the development of novel antiparasitic agents, addressing a considerable socioeconomic challenge in affected regions.