Background: To systematically review studies on inhaled corticosteroids (ICS) and lung cancer incidence in chronic airway disease patients. Methods: We conducted electronic bibliographic searches on OVID-MEDLINE, EM- BASE, and the Cochrane Database before May 2020 to identify relevant studies. Detailed data on the study population, exposure, and outcome domains were reviewed. Results: Of 4,058 screened publications, 13 eligible studies in adults with chronic obstructive pulmonary disease (COPD) or asthma evaluated lung cancer incidence after ICS exposure. Pooled hazard ratio and odds ratio for developing lung cancer in ICS exposure were 0.81 (95% confidence interval, 0.64 to 1.02; I2=95.7%) from 10 studies and 1.02 (95% confidence interval 0.50 to 2.07; I2=94.7%) from three studies. Meta-regression failed to explain the substantial heterogeneity of pooled estimates. COPD and asthma were variously defined without spirometry in 11 studies. Regarding exposure assessment, three and 10 studies regarded ICS exposure as a time-dependent and fixed variable, respectively. Some studies assessed ICS use for the entire study period, whereas others assessed ICS use for 6 months to 2 years within or before study entry. Smoking was adjusted in four studies, and only four studies introduced 1 to 2 latency years in their main or subgroup analysis. Conclusion Studies published to date on ICS and lung cancer incidence had heterogeneous study populations, exposures, and outcome assessments, limiting the generation of a pooled conclusion. The beneficial effect of ICS on lung cancer incidence has not yet been established, and understanding the heterogeneities will help future researchers to establish robust evidence on ICS and lung cancer incidence.

Tumors of the clivus and metastases to the clivus are very rare. Metastasis involving the clivus has previously been described in only two case reports. In skull metastasis, the breast and prostate are the most common primary foci, while metastasis from gastric carcinoma is extremely rare. A review of the English literature revealed only one published case of clivus metastases from gastric adenocarcinoma. There is no literature thoroughly explaining the differential diagnosis between chordoma and metastasis. Here we report a rare case of metastasis to the clivus from a gastric adenocarcinoma in a 42-year-old female patient with sudden blurry vision, presenting as bilateral cranial nerve VI palsy.
Abducens Nerve Diseases* ; Adenocarcinoma* ; Adult ; Breast ; Chordoma ; Cranial Fossa, Posterior* ; Diagnosis, Differential ; Female ; Humans ; Neoplasm Metastasis* ; Prostate ; Skull ; Skull Base

This article was initially published with an error in Table 2.

OBJECTIVES: The mass media play a crucial role in risk communication regarding climate change. The aim of this study was to investigate the trend in journalistic reports on climate change in the daily newspapers of Korea. METHODS: We selected 9 daily newspapers in Korea, which according to the ABC Association, represented 77% of newspaper circulation, out of a total of 44 Korean daily newspapers. The collected articles were from 2009 to 2011. All of the articles were sorted into the following 8 categories: greenhouse gas, climate change conventions, sea level rise, Intergovernmental Panel on Climate Change synthesis reports, expected damage and effect, use of fossil fuels, global warming, and mitigation or adaptation. A chi-squared test was done on the articles, which were counted and classified into cause, effect, and measurement of climate change according to the newspaper's majority or minority ownership structure. RESULTS: From the 9 selected newspapers, the number of articles on climate change by month was greatest in December 2009. Generally, the articles vague about climate change (lack of precise data, negative or skeptical tone, and improper use of terminology) were much more common than the articles presenting accurate knowledge. A statistical difference was found based on ownership structure: the majority-owned newspapers addressed the cause of climate change, while the minority-owned newspapers referred more to climate change measurement. CONCLUSIONS: Our investigation revealed that generally Korean daily newspapers did not deliver accurate information about climate change. The coverage of the newspapers showed significant differences according to the ownership structure.
Asian Continental Ancestry Group ; *Climate Change ; Global Warming ; Greenhouse Effect ; Humans ; Newspapers/*trends ; *Ownership ; Republic of Korea

OBJECTIVES: This study investigated the improvement of food habits and eating behavior of cancer patients during treatment through the continuous nutrition counseling and monitoring. METHODS: Thirty cancer patients during treatment were participated in this study, and the first nutrition counseling and the first and second monitoring were conducted after 2-3 week intervals. RESULTS: As a result of the nutrition counseling and monitoring, all patients improved to a great extent to consume 3 meals a day. The frequency of having breakfast was significantly increased with the nutrition counseling and continuous monitoring as well. The meal fixed quantity was stabilized and the eating speed slowed down as more nutrition counseling were done. The snack intakes of patients did not show any significant difference after the nutrition counseling but showed a slight decline after the monitoring. The frequencies of eating out and a late-night meal significantly decreased after the monitoring. The intakes of fish, meat, vegetables, milk and fruits needed for a well-balanced diet significantly increased as more nutrition counseling were done. The intakes of processed food were significantly decreased after the nutrition counseling and the intakes of fast food were significantly decreased as more nutrition counseling were done. The water intake of patients also significantly increased. In the eating behavior related to health, the frequency of drinking alcohol significantly decreased after nutrition counseling consultation and no patients had dietary supplements after the first monitoring. CONCLUSIONS: These results suggested that continuous nutrition counseling is effective in improving eating habits of cancer patients.
Breakfast ; Counseling* ; Diet ; Dietary Supplements ; Drinking ; Eating ; Fast Foods ; Feeding Behavior ; Food Habits ; Fruit ; Humans ; Meals ; Meat ; Milk ; Snacks ; Vegetables

As the associations between pediatric overweight/obesity and bone health remain controversial, we investigated the effects of overweight/obesity as well as lean mass (LM) and fat mass (FM) on bone parameters in adolescents. Bone parameters were evaluated using dual-energy X-ray absorptiometry (DXA) data of 982 adolescents (aged 12–19 years) from the Korea National Health and Nutrition Examination Survey (2009–2010). Z-scores for LM, FM, bone mass, bone mineral density (BMD), and bone mineral apparent density (BMAD) using Korean pediatric reference values were used for analysis. Adolescents with overweight/obesity had significantly higher bone mass and density of the total-body-less-head (TBLH), lumbar spine, and femur neck than underweight or normal-weight adolescents (P < 0.001) after adjusting for vitamin D deficiency, calcium intake, and insulin resistance in both sexes. LM was positively associated with bone parameters at all skeletal sites in both sexes (P < 0.001). FM was negatively related to TBLH BMD in boys (P = 0.018) but was positively associated to BMD and BMAD of the lumbar spine and femur neck in girls. In conclusion, overweight/obesity and LM play a positive role in bone health in adolescents. The effect of FM on bone parameters is sex- and site-specific.
Absorptiometry, Photon ; Adolescent* ; Body Composition ; Bone Density ; Calcium ; Female ; Femur Neck ; Humans ; Insulin Resistance ; Korea ; Miners ; Nutrition Surveys ; Obesity* ; Overweight* ; Pediatric Obesity ; Reference Values ; Spine ; Thinness ; Vitamin D Deficiency

Objective: We conducted a systematic review and meta-analysis of the tissue adequacy and complication rates of percutaneous transthoracic needle biopsy (PTNB) for molecular analysis in patients with non-small cell lung cancer (NSCLC). Materials and Methods: We performed a literature search of the OVID-MEDLINE and Embase databases to identify original studies on the tissue adequacy and complication rates of PTNB for molecular analysis in patients with NSCLC published between January 2005 and January 2020. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic estimates of the outcomes. To explore heterogeneity across the studies, univariable and multivariable metaregression analyses were performed. Results: A total of 21 studies with 2232 biopsies (initial biopsy, 8 studies; rebiopsy after therapy, 13 studies) were included.The pooled rates of tissue adequacy and complications were 89.3% (95% confidence interval [CI]: 85.6%–92.6%; I2 = 0.81) and 17.3% (95% CI: 12.1%–23.1%; I2 = 0.89), respectively. These rates were 93.5% and 22.2% for the initial biopsies and 86.2% and 16.8% for the rebiopsies, respectively. Severe complications, including pneumothorax requiring chest tube placement and massive hemoptysis, occurred in 0.7% of the cases (95% CI: 0%–2.2%; I2 = 0.67). Multivariable meta-regression analysis showed that the tissue adequacy rate was not significantly lower in studies on rebiopsies (p = 0.058). The complication rate was significantly higher in studies that preferentially included older adults (p = 0.001). Conclusion PTNB demonstrated an average tissue adequacy rate of 89.3% for molecular analysis in patients with NSCLC, with a complication rate of 17.3%. PTNB is a generally safe and effective diagnostic procedure for obtaining tissue samples for molecular analysis in NSCLC. Rebiopsy may be performed actively with an acceptable risk of complications if clinically required.

Objective: To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of nonionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not. Materials and Methods: Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria: 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I2 statistic was used to assess heterogeneity across the studies. Results: Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI]: 1.4%, 7.8%) in the fasting group and 4.6% (95% CI: 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI: 0.0%, 4.2%) in the fasting group and 2.5% (95% CI: 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group–incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI: -4.7%, 4.7%) and 0.4% (95% CI: -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I2 = 0%–13.5%). Conclusion Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.

Purpose: Although chest CT has been discussed as a first-line test for coronavirus disease 2019 (COVID-19), little research has explored the implications of CT exposure in the population. To review chest CT protocols and radiation doses in COVID-19 publications and explore the number needed to diagnose (NND) and the number needed to predict (NNP) if CT is used as a first-line test. Materials and Methods: We searched nine highly cited radiology journals to identify studies discussing the CT-based diagnosis of COVID-19 pneumonia. Study-level information on the CT protocol and radiation dose was collected, and the doses were compared with each national diagnostic reference level (DRL). The NND and NNP, which depends on the test positive rate (TPR), were calculated, given a CT sensitivity of 94% (95% confidence interval [CI]: 91%–96%) and specificity of 37% (95% CI: 26%–50%), and applied to the early outbreak in Wuhan, New York, and Italy. Results: From 86 studies, the CT protocol and radiation dose were reported in 81 (94.2%) and 17 studies (19.8%), respectively. Low-dose chest CT was used more than twice as often as standarddose chest CT (39.5% vs.18.6%), while the remaining studies (44.2%) did not provide relevant information. The radiation doses were lower than the national DRLs in 15 of the 17 studies (88.2%) that reported doses. The NND was 3.2 scans (95% CI: 2.2–6.0). The NNPs at TPRs of 50%, 25%, 10%, and 5% were 2.2, 3.6, 8.0, 15.5 scans, respectively. In Wuhan, 35418 (TPR, 58%; 95% CI: 27710–56755) to 44840 (TPR, 38%; 95% CI: 35161–68164) individuals were estimated to have undergone CT examinations to diagnose 17365 patients. During the early surge in New York and Italy, daily NNDs changed up to 5.4 and 10.9 times, respectively, within 10 weeks. Conclusion Low-dose CT protocols were described in less than half of COVID-19 publications, and radiation doses were frequently lacking. The number of populations involved in a first-line diagnostic CT test could vary dynamically according to daily TPR; therefore, caution is required in future planning.

BACKGROUND: Despite well-known advantages, propofol remains off-label in many countries for general anesthesia in children under 3 years of age due to insufficient evidence regarding its use in this population. This study aimed to evaluate the efficacy and safety of propofol compared with other general anesthetics in children under 3 years of age undergoing surgery through a systematic review and meta-analysis of existing randomized clinical trials. METHODS: A comprehensive literature search was conducted of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to find all randomized clinical trials comparing propofol with another general anesthetic that included children under 3 years of age. The relative risk or arcsine-transformed risk difference for dichotomous outcomes and the weighted or standardized mean difference for continuous outcomes were estimated using a random-effects model. RESULTS: A total of 249 young children from 6 publications were included. The children who received propofol had statistically significantly lower systolic and diastolic blood pressures, but hypotension was not observed in the propofol groups. The heart rate, stroke volume index, and cardiac index were not significantly different between the propofol and control groups. The propofol groups showed slightly shorter recovery times and a lower incidence of emergence agitation than the control groups, while no difference was observed for the incidence of hypotension, desaturation, and apnea. CONCLUSION: This systematic review and meta-analysis indicates that propofol use for general anesthesia in young healthy children undergoing surgery does not increase complications and that propofol could be at least comparable to other anesthetic agents.
Anesthesia, General ; Anesthetics ; Anesthetics, General ; Apnea ; Child ; Dihydroergotamine ; Heart Rate ; Humans ; Hypotension ; Incidence ; Infant ; Propofol ; Stroke Volume