No abstract available.
Arthritis, Juvenile* ; Crohn Disease* ; Etanercept

Idiopathic noncirrhotic portal hypertension is a poorly defined clinical condition of unknown etiology. Patients present with signs and symptoms of portal hypertension without evidence of cirrhosis. The disease course appears to be indolent and benign with an overall better outcome than cirrhosis, as long as the complications of portal hypertension are properly managed. This condition has been recognized in different parts of the world in diverse ethnic groups with variable risk factors, resulting in numerous terminologies and lack of standardized diagnostic criteria. Therefore, although the diagnosis of idiopathic noncirrhotic portal hypertension requires clinical exclusion of other conditions that can cause portal hypertension and histopathologic confirmation, this entity is under-recognized clinically as well as pathologically. Recent studies have demonstrated that variable histopathologic entities with different terms likely represent a histologic spectrum of a single entity of which obliterative portal venopathy might be an underlying pathogenesis. This perception calls for standardization of the nomenclature and formulation of widely accepted diagnostic criteria, which will facilitate easier recognition of this disorder and will highlight awareness of this entity.
Diagnosis ; Ethnic Groups ; Fibrosis ; Humans ; Hypertension, Portal* ; Liver ; Risk Factors

PURPOSE: To investigate the overall cancer risk and risk for specific cancers in rheumatoid arthritis (RA) patients in Korea by comparing cancer incidence between RA patients and the general population. MATERIALS AND METHODS: Individuals diagnosed with RA between 1996 and 2009 who underwent treatment at the Daegu Catholic University Medical Center were retrospectively examined. 1885 patients with RA were included in the analyses. Occurrence of cancer and death during follow up was ascertained by linking medical records to the Korean Central Cancer Registry and national death certificates. For comparing cancer incidence between RA patients and general population, standardized incidence ratios (SIR) were calculated. The 95% confidence intervals (CIs) of SIRs were calculated using the shortcut method introduced by Vandenbroucke. RESULTS: The total follow-up time was 10218.9 person-years. During follow up, 100 patients (31 men and 69 women) were diagnosed with cancer. Both men and women had greater risks of having malignancy, although cancer risk was greater in men. Men showed increased risks of lung cancer (SIR=5.46, 95% CI: 2.60–9.36) and leukemia (SIR=16.7, 95% CI: 1.58–47.9). Women showed increased risks of thyroid cancer (SIR=1.75, 95% CI: 1.02–2.68), cervical cancer (SIR=3.65, 95% CI: 1.65–6.42), non-Hodgkin's lymphoma (SIR=6.47, 95% CI: 2.04–13.4), and gallbladder cancer (SIR=3.87, 95% CI: 1.01–8.60). Disease-modifying anti-rheumatic drugs usage and cancer were not related: the relative risks of developing malignancy were not elevated for each medicine. CONCLUSION: The overall cancer incidence was increased in Korean men and women with RA. Increased risk of specific malignancy differed according to sex.
Academic Medical Centers ; Antirheumatic Agents ; Arthritis, Rheumatoid ; Daegu ; Death Certificates ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Incidence ; Korea ; Leukemia ; Lung Neoplasms ; Lymphoma, Non-Hodgkin ; Male ; Medical Records ; Methods ; Retrospective Studies ; Thyroid Neoplasms ; Uterine Cervical Neoplasms

We found an error in our published article.

PURPOSE: The aim of this study was to investigate the clinical characteristics and causative organisms of meningitis in the Daegu region and seek a useful tool for the early prediction of bacterial meningitis in children. METHODS: We retrospectively reviewed the medical records of 115 pediatric patients diagnosed with bacterial or aseptic meningitis at Yeungnam university hospital in Daegu from March 2012 to July 2013. We evaluated their clinical symptoms, laboratory findings, clinical courses, bacterial meningitis scores and complications. RESULTS: The subjects included 106 with aseptic meningitis and 9 with bacterial meningitis. At the time of visit, fever was the most frequent symptom, followed by headache, vomiting and neck stiffness. In cerebrospinal fluid (CSF) analysis, white blood cell (WBC) count were higher in the bacterial meningitis group (1423.8+/-1980.4 vs. 120.0+/-161.6 mg/dL). Mean CSF protein was 219.4+/-183.6 mg/dL in bacterial meningitis and 42.4+/-27.0 mg/dL in aseptic meningitis (P <0.001). Bacterial meningitis score (BMS) were higher in the group with bacterial meningitis. Abnormal radiological findings were found in 44% of the group with bacterial meningitis. CONCLUSION: Although the clinical features between the groups were similar, the CSF analysis revealed significant differences statistically. Furthermore, BMS could be helpful to predict bacterial meningitis in children. During the outbreak of aseptic meningitis, it might reduce unnecessary hospital admissions and antibiotic treatments.
Cerebrospinal Fluid ; Child ; Daegu ; Fever ; Headache ; Humans ; Leukocytes ; Medical Records ; Meningitis ; Meningitis, Aseptic* ; Meningitis, Bacterial ; Neck ; Retrospective Studies ; Vomiting

No abstract available.
Insulinoma ; Liver

Background: Inflammation and structural remodeling may contribute to fibrogenesis in Crohn’s disease (CD). We quantified the immunoexpression of calretinin, CD34, and calprotectin as a surrogate for mucosal innervation, telocytes (interstitial cells playing a role in networking), and inflammation, respectively, and correlated them with bowel alterations in stricturing CD. Methods: Primary resection specimens for ileal CD (n = 44, 31 stricturing CD, 13 inflammatory CD) were identified. Left-sided ulcerative colitis and trauma cases were used as controls. Proximal and distal margin and middle (diseased) sections were stained for calretinin, CD34, and calprotectin. Microscopic images were captured from the mucosa (calretinin), submucosa (calprotectin), and myenteric plexus (CD34), and the immunostaining was quantified using image processing and analysis. Bowel thickness at the corresponding sections were measured and correlated with the amount of immunoexpression. Results: A total of 2,037 images were analyzed. In stricturing CD, submucosal alteration/thickening at the stricture site correlated with calprotectin staining and inversely correlated with calretinin staining at the proximal margin. Muscularis propria alteration/thickening at the stricture site correlated with mucosal calretinin staining at the proximal margin. Submucosal alteration/thickening at the proximal margin correlated with calretinin and CD34 staining at the proximal margin and inversely correlated with CD34 staining at the stricture site. Calretinin immunostaining at the distal margin was significantly higher in stricturing CD than the controls. Conclusions Inflammation and tissue remodeling appear to contribute to fibrogenesis in stricturing CD. Increased mucosal calretinin immunostaining distal to the diseased segment could be helpful in diagnosing CD in the right clinical context.

OBJECTIVE: This study examined lung involvement in patients with rheumatoid arthritis (RA) and identified factors associated with airway disease (AD) and interstitial lung disease (ILD). METHODS: A total of 507 RA patients were enrolled in a cross-sectional study. Lung involvement was assessed by high-resolution computed tomography scan. The patient groups were classified according to normal, AD, and ILD. Multinomial logistic regression analysis was performed to identify factors associated with AD and ILD. RESULTS: The most frequent lung involvement was AD (38.3%) followed by ILD (12.6%). Old age (adjust odds ratio [aOR] 2.58, 95% confidence interval [CI] 1.70 to 3.90 for AD; aOR 4.38, 95% CI 2.30 to 8.35 for ILD), male gender (aOR 2.57, 95% CI 1.22 to 5.42 for AD; aOR 5.48, 95% CI 2.20 to 13.65 for ILD) were factors associated with AD and ILD in RA patients. ILD was associated with short disease duration (aOR 0.30, 95% CI 0.14 to 0.62), AD was associated with high titers of anti-cyclic citrullinated peptides antibodies (anti-CCP; aOR 1.61, 95% CI 1.07 to 2.44). CONCLUSION: AD was the most frequent lung involvement in patients with RA. Old age and male gender were both associated with AD and ILD. Short disease duration was associated with ILD. High titers of anti-CCP was associated with AD.
Antibodies ; Arthritis, Rheumatoid* ; Cross-Sectional Studies ; Humans ; Logistic Models ; Lung ; Lung Diseases, Interstitial* ; Lung Diseases, Obstructive ; Male ; Odds Ratio ; Peptides ; Risk Factors ; Tomography, X-Ray Computed

OBJECTIVE: The aim of this study is to analyze the capacity of three demographic variables - age, sex, and formal education level - as well as disease duration to explain variation in 7 Core Data Set variables and 4 indices used to assess rheumatoid arthritis (RA), in a cohort of Korean patients seen in usual care. METHODS: All RA Core Data Set measures were collected in usual care of 397 RA patients, including tender/swollen joint counts (TJC, SJC) 28, physician global estimate of status, erythrocyte sedimentation rate, C-reactive protein, and a multidimensional health assessment questionnaire to assess physical function, pain, and patient global estimate of status (PATGL). Four indices were computed: disease activity score with 28 joint count (DAS28), simplified disease activity index (SDAI), clinical disease activity index (CDAI), and routine assessment of patient index data 3 (RAPID3). Descriptive statistics and multivariate generalized linear models were used in data analysis. RESULTS: Patients with lower education had higher scores, indicating greater severity, for all 7 Core Data Set measures and 4 indices (significant for TJC, function, pain, PATGL, DAS28, SDAI, CDAI, RAPID3). In a series of regressions that included age, sex, disease duration, and education, formal education level was the only significant variable to explain variation in TJC, pain, PATGL, physician global estimate of status (DOCGL), DAS28, SDAI, CDAI, and RAPID3. CONCLUSION: Significant associations with education were found in Korean RA patients according to most RA Core Data Set measures and 4 indices. Education was more likely than age, sex, or disease duration to explain variation in most measures and indices.
Arthritis, Rheumatoid* ; Blood Sedimentation ; C-Reactive Protein ; Cohort Studies ; Dataset ; Education* ; Humans ; Joints ; Linear Models ; Social Class ; Statistics as Topic

BACKGROUND/AIMS: Rheumatology in Korea has rapidly advanced in the 24 years since the subspecialty board certification program was established in 1992. The objective of this investigation was to analyze the distribution of rheumatology practices in Korea in order to better understand the rheumatology workforce. METHODS: Using a membership list from the Korean College of Rheumatology (KCR), we obtained information on practicing rheumatologists. We mapped the ratio of rheumatologists to the general population and to patients with rheumatologic disease using data from Statistics Korea and the 2015 Health Insurance Review & Assessment Service (HIRA). RESULTS: In the 16 administrative districts of Korea in 2015, there were 311 practicing rheumatologists on the list of KCR members. There were 218 members practicing in metropolitan areas and 93 members in the provinces. The mean number of rheumatologists per 100,000 people was 0.60, with 0.33/100,000 in the provinces, but 0.92/100,000 in metropolitan areas, a 2.7-fold difference. The number of rheumatologists per 100,000 patients with chronic rheumatic disease was 17.21 in metropolitan areas but 6.57 in the provinces, according to 2015 HIRA data. This geographic maldistribution emerged as a problem; indeed, the regional disparity in the distribution of Korean rheumatologists was striking when compared to the published medical professional distribution in 2014. CONCLUSIONS Because of the uneven distribution of rheumatologists, it is likely that some patients with chronic rheumatic conditions have limited access to rheumatology care. Thus, a policy-based approach is needed to alleviate this disparity.