PURPOSE: The average mortality rate for death by suicide among OECD countries is 12.8 per 100000, and 33.5 for Korea. The present study analyzed big data extracted from Google to identify factors related to searches on suicide in Korea. MATERIALS AND METHODS: Google search trends for the search words of suicide, stress, exercise, and drinking were obtained for 2004-2010. Analyzing data by month, the relationship between the actual number of suicides and search words per year was examined using multi-level models. RESULTS: Both suicide rates and Google searches on suicide in Korea increased since 2007. An unconditional slope model indicated stress and suicide-related searches were positively related. A conditional model showed that factors associated with suicide by year directly affected suicide-related searches. The interaction between stress-related searches and the actual number of suicides was significant. CONCLUSION: A positive relationship between stress- and suicide-related searches further confirmed that stress affects suicide. Taken together and viewed in context of the big data analysis, our results point to the need for a tailored prevention program. Real-time big data can be of use in indicating increases in suicidality when search words such as stress and suicide generate greater numbers of hits on portals and social network sites.
Humans ; *Internet ; Republic of Korea ; Socioeconomic Factors ; Suicide/*psychology/*statistics & numerical data

Background/Aims: We investigated the concordance rate of the classification of polymyositis (PM) and dermatomyositis (DM) between the Bohan and Peter criteria and the 2017 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for idiopathic inflammatory myopathies (IIMs) (the 2017 EULAR/ACR criteria) in Korean patients. Methods: We retrospectively reviewed the medical records of 137 patients with PM and DM. We finally included 72 PM patients and 49 DM patients who fulfilled the Bohan and Peter criteria for PM and DM and reclassified them by the 2017 EULAR/ ACR criteria. Results: Three patients (4.2%) with probable PM were newly reclassified as non-IIM due to a total score of 5.3 or smaller. Meanwhile, one patient with possible PM was newly reclassified as probable PM due to the presence of dysphagia. In addition, eight patients (16.3%) with possible DM with DM-specific typical skin rash were newly reclassified as amyopathic DM (ADM) due to the absence of proximal muscle weakness. The concordance rate of the classification between the Bohan and Peter criteria and the 2017 EULAR/ACR criteria was 95.8% for PM patients and 83.7% for DM patients. Conclusions The Bohan and Peter criteria were comparable to the 2017 EULAR/ ACR criteria for classifying PM and DM in Korean patients. Considering the convenience of the Bohan and Peter criteria in the real clinical settings, we suggest that the old criteria should be preferentially applied and then performing muscle biopsy should be considered in a patient suspected of PM without antihistidyl tRNA synthetase (anti-Jo-1). Moreover, we suggest that ADM could also clinically be classified by the old criteria.

Background: There are many models for predicting diabetes mellitus (DM), but their clinical implication remains vague. Therefore, we aimed to create various DM prediction models using easily accessible health screening test parameters. Methods: Two sets of variables were used to develop eight DM prediction models. One set comprised 62 easily accessible examination results of commonly used variables from a tertiary university hospital. The second set comprised 27 of the 62 variables included in the national routine health checkups. Gradient boosting and random forest algorithms were used to develop the models. Internal validation was performed using the stratified 10-fold cross-validation method. Results: The area under the receiver operating characteristic curve (ROC-AUC) for the 62-variable DM model making 12-month predictions for subjects without diabetes was the largest (0.928) among those of the eight DM prediction models. The ROC-AUC dropped by more than 0.04 when training with the simplified 27-variable set but still showed fairly good performance with ROC-AUCs between 0.842 and 0.880. The accuracy was up to 11.5% higher (from 0.807 to 0.714) when fasting glucose was included. Conclusion We created easily applicable diabetes prediction models that deliver good performance using parameters commonly assessed during tertiary university hospital and national routine health checkups. We plan to perform prospective external validation, hoping that the developed DM prediction models will be widely used in clinical practice.

PURPOSE: We investigated whether red blood cell distribution width (RDW) predicts vasculitis activity based on Birmingham vasculitis activity score (BVAS) or BVAS for granulomatosis with polyangiitis (GPA) at diagnosis and poor prognosis during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). MATERIALS AND METHODS: We reviewed the medical records of 150 patients with AAV. We defined severe GPA as BVAS for GPA ≥7 (the highest quartile). Correlation and standardised correlation coefficients were analysed by linear regression tests. The differences between groups were evaluated by Mann-Whitney test. Relative risk (RR) was assessed by chi square test and Cox hazards model. RESULTS: RDW was correlated only with the vasculitis activity of GPA among patients with AAV. An increase in RDW was associated with the absence of ear nose throat (ENT) manifestation, but not proteinase 3-ANCA. Significant differences were noted in cumulative refractory free survival according to RDW ≥15.4% (p=0.007) and the absence of ENT manifestation (p=0.036). Multivariate Cox hazards analysis identified RDW ≥15.4% as the only significant predictor of refractory disease in GPA (RR 17.573). CONCLUSION: RDW predicts vasculitis activity in GPA, and RDW ≥15.4% at diagnosis may increase the risk of severe GPA at diagnosis and predict refractory diseases during follow-up.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*blood/diagnosis ; *Erythrocyte Indices ; Female ; Follow-Up Studies ; Granulomatosis with Polyangiitis/*blood/diagnosis ; Humans ; Linear Models ; Middle Aged ; Multivariate Analysis ; Prognosis

PURPOSE: Delta neutrophil index (DNI) represents the immature granulocytes count associated with neutrophil-consumption. We investigated whether DNI might be associated with Birmingham vasculitis activity score (BVAS) at diagnosis and could predict relapse during the follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). MATERIALS AND METHODS: We reviewed the medical records of 97 patients having DNI results. Twenty patients had granulomatosis with polyangiitis (GPA), 58 had microscopic polyangiitis (MPA), and 19 had eosinophilic GPA (EGPA). We collected clinical and laboratory data including BVAS, five factor score (FFS), and DNI. The correlation coefficient and cumulative relapse free survival rate were obtained. The optimal cut-off of DNI was extrapolated by calculating the area under the receiver operator characteristic curve. RESULTS: DNI was significantly related to cross-sectional BVAS. Furthermore, among continuous variables, only DNI could reflect BVAS of GPA and MPA, but not EGPA. Severe AAV was defined as BVAS ≥20 (the highest quartile). At diagnosis, patients having DNI ≥0.65% had a significantly higher risk of severe GPA and MPA than those having not (relative risk 4.255) at diagnosis. During the follow-up, DNI ≥0.65% could predict the higher relapse rate. CONCLUSION: DNI could reflect BVAS at diagnosis and furthermore, DNI ≥0.65% could not only identify severe AAV at diagnosis, but also predict relapse during the follow-up in patients with GPA and MPA.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis* ; Cytoplasm ; Diagnosis ; Eosinophils ; Follow-Up Studies ; Granulocytes ; Granulomatosis with Polyangiitis ; Humans ; Medical Records ; Microscopic Polyangiitis ; Neutrophils* ; Recurrence* ; Survival Rate ; Vasculitis*

Background/Aims: Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV. Methods: Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated. Results: Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343–37.946; p = 0.021) were independently associated with all-cause mortality during follow-up. Conclusions Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.

Background/Aims: Measures of body composition, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle area (SMA), are considered important prognostic factors in chronic diseases. The association of these measures with auto-inflammatory disorders, such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), remains unclear. We investigated the clinical significance of VAT, SAT, and SMA in patients with AAV. Methods: Patients with AAV subjected to chest computed tomography (CT), abdominal CT, or positron emission tomography-CT on diagnosis of AAV were evaluated. Quantitative assessment of VAT, SAT, and SMA was performed at the third lumbar vertebral level and computed by summing the pixel attenuation for tissue-specific Hounsfield units in the corresponding region. Associations of VAT, SAT, and SMA with clinical and laboratory data and clinical outcome measures were evaluated. Results: Of the 117 patients, 61 (52.1%) were classified as having microscopic polyangiitis, 28 (23.9%) as granulomatosis with polyangiitis, and 28 (23.9%) as eosinophilic granulomatosis with polyangiitis. VAT significantly correlated with age, weight, body mass index (BMI), and Birmingham Vasculitis Activity Score, whereas SAT correlated with weight, BMI, and creatinine levels. A significant association was found between SMA and age, height, weight, BMI, and the Five-Factor Score. Cox proportional hazards analysis showed that creatinine levels (odds ratio [OR], 1.346; 95% confidence interval [CI], 1.034 to 1.753; p = 0.027) and high VAT (OR, 7.137; 95% CI, 1.343–37.946; p = 0.021) were independently associated with all-cause mortality during follow-up. Conclusions Evaluation of VAT using CT is useful for estimating disease activity and all-cause mortality in patients with AAV.

Retrograde intussusception of the jejunum into the stomach through the stroma of a gastroenterostomy is a very rare, but potentially fatal complication after gastrectomy. Once symptoms develop, the mortality rate is high if this is not treated within 48 hours, so making an early diagnosis with a high index of suspicion and administering prompt treatment are mandatory. Gastroscopy could be a useful diagnostic tool for patients with a history of gastrectomy and who present with abdominal pain and hematemesis, and with considering the possibility of intussusception. A 65-year-old man with a history of Billroth II gastrectomy that was done 35 years ago due to gastric ulcer perforation was admitted with abdominal pain and hematemesis. A necrotic mucosa that was suspicious of an intussuscepted small bowel tissue was detected on gastroscopy. Subsequent open reduction and small bowel resection was performed with successful results. We report here on a case of postoperative retrograde jejunogastric intussusception that occurred 35 years after Billroth II gastrectomy, and it was first diagnosed by performing gastroscopy.
Abdominal Pain ; Aged ; Early Diagnosis ; Gastrectomy ; Gastroenterostomy ; Gastroscopy ; Hematemesis ; Humans ; Intussusception ; Jejunum ; Mucous Membrane ; Stomach ; Stomach Ulcer

PURPOSE: To report the follow-up status and neurodevelopmental outcomes of extremely low birth weight (ELBW) survivors at 18 months' corrected age (CA). METHOD: We performed a retrospective study of 130 ELBW infants admitted to neonatal intensive care unit of Seoul National University Children's Hospital between January 2005 and May 2009. The follow-up status and neurodevelopmental outcomes were evaluated until the CA of 18 months. The assessment of outcomes included cerebral palsy, cognitive developmental delay, blindness, deafness and catch-up growth. Clinical data were collected to identify the factors influencing neurodevelopmental disability. RESULTS: Of the 130 survivors at discharge, 122 (93.8%) participated in the follow-up at 18 months' CA. Study characteristics included a mean birth weight of 783 g and a mean gestation of 27 weeks. One hundred and eleven infants (85.4%) were evaluated for cerebral palsy (CP) and 11 (9.9%) were identified with CP. Eighty five infants (74.6%) were assessed with the Bayley Scales of Infant Development-III (BSID-III) at 8 months' CA and 2 (2.4%) had a cognitive scale <70. Fifty four infants (41.9%) were assessed with BSID-III at 18 months' CA and 2 (3.7%) had a cognitive scale <70. There were 2 (1.2%) cases of blindness and the case of deafness was not present in this study. The failure of catch-up growth was seen in 40 (32.8%) infants. Severe intraventricular hemorrhage, periventricular leukomalacia, hydrocephalus and shunt insertion were the most important risk factors for neurologic abnormality. CONCLUSION: In our institution, neurodevelopmental outcomes of ELBW survivors were comparable to recent reports from the USA. ELBW infants need to be monitored on multidisciplinary follow-up programs and more efforts should be made to improve the follow-up.
Birth Weight ; Blindness ; Cerebral Palsy ; Deafness ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydrocephalus ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Outpatients ; Pregnancy ; Retrospective Studies ; Risk Factors ; Survivors ; Weights and Measures