Background: /Aim: Abdominal ultrasonography (USG) is recommended as a surveillance test for high-risk groups for hepatocellular carcinoma (HCC). This study aimed to analyze the current status of the national cancer surveillance program for HCC in South Korea and investigate the effects of patient-, physician-, and machine-related factors on HCC detection sensitivity. Methods: This multicenter retrospective cohort study collected surveillance USG data from the high-risk group for HCC (liver cirrhosis or chronic hepatitis B or C >40 years of age) at eight South Korean tertiary hospitals in 2017. Results: In 2017, 45 experienced hepatologists or radiologists performed 8,512 USG examinations. The physicians had a mean 15.0±8.3 years of experience; more hepatologists (61.4%) than radiologists (38.6%) participated. Each USG scan took a mean 12.2±3.4 minutes. The HCC detection rate by surveillance USG was 0.3% (n=23). Over 27 months of follow-up, an additional 135 patients (0.7%) developed new HCC. The patients were classified into three groups based on timing of HCC diagnosis since the 1st surveillance USG, and no significant intergroup difference in HCC characteristics was noted. HCC detection was significantly associated with patient-related factors, such as old age and advanced fibrosis, but not with physician- or machine-related factors. Conclusions This is the first study of the current status of USG as a surveillance method for HCC at tertiary hospitals in South Korea. It is necessary to develop quality indicators and quality assessment procedures for USG to improve the detection rate of HCC.

Background/Aims: Besifovir dipivoxil maleate (BSV), an acyclic nucleotide phosphonate, shows potent antiviral activity against hepatitis B virus. Our previous 48-week trial revealed that BSV has comparable antiviral efficacy to tenofovir disoproxil fumarate (TDF) and better safety profiles in terms of improved renal and bone safety. This extension study evaluated the prolonged efficacy and safety of BSV in treatment-naive chronic hepatitis B patients. Methods: Patients continued to participate in an open-label BSV study after an initial 48-week double-blind comparison of BSV and TDF treatment. The antiviral efficacy and drug safety was evaluated up to 192 weeks in two groups: patients continuing BSV treatment (BSV-BSV) and patients switching from TDF to BSV after 48 weeks (TDF-BSV). Results: Among 197 patients receiving randomized treatments, 170 (86%) entered the open-label phase and 152 (77%) entered the 192-week extension study. Virological response rates over 192 weeks were 92.50% and 93.06% in the BSV-BSV and TDF-BSV groups, respectively (P=0.90). Hepatitis B envelop antigen seroconversion and alanine aminotransferase normalization rates were similar between the groups (P=0.75 and P=0.36, respectively). There were no drug-resistant mutations to BSV. Bone mineral density and renal function were well preserved in the BSV-BSV group, whereas these initially worsened then recovered after switching therapy in the TDF-BSV group. Conclusions BSV maintained potent antiviral efficacy after 192 weeks and showed no evidence of drug resistance. BSV was safe, well tolerated, and effective in patients who switched from TDF to BSV. Trial Registration Number: NCT01937806 (date: 10 Sep 2013).

Background/Aims: Besifovir dipivoxil maleate (BSV), an acyclic nucleotide phosphonate, shows potent antiviral activity against hepatitis B virus. Our previous 48-week trial revealed that BSV has comparable antiviral efficacy to tenofovir disoproxil fumarate (TDF) and better safety profiles in terms of improved renal and bone safety. This extension study evaluated the prolonged efficacy and safety of BSV in treatment-naive chronic hepatitis B patients. Methods: Patients continued to participate in an open-label BSV study after an initial 48-week double-blind comparison of BSV and TDF treatment. The antiviral efficacy and drug safety was evaluated up to 192 weeks in two groups: patients continuing BSV treatment (BSV-BSV) and patients switching from TDF to BSV after 48 weeks (TDF-BSV). Results: Among 197 patients receiving randomized treatments, 170 (86%) entered the open-label phase and 152 (77%) entered the 192-week extension study. Virological response rates over 192 weeks were 92.50% and 93.06% in the BSV-BSV and TDF-BSV groups, respectively (P=0.90). Hepatitis B envelop antigen seroconversion and alanine aminotransferase normalization rates were similar between the groups (P=0.75 and P=0.36, respectively). There were no drug-resistant mutations to BSV. Bone mineral density and renal function were well preserved in the BSV-BSV group, whereas these initially worsened then recovered after switching therapy in the TDF-BSV group. Conclusions BSV maintained potent antiviral efficacy after 192 weeks and showed no evidence of drug resistance. BSV was safe, well tolerated, and effective in patients who switched from TDF to BSV. Trial Registration Number: NCT01937806 (date: 10 Sep 2013).

Biopsy ; Classification ; Dataset ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.
Breast Feeding ; Cesarean Section ; Child ; Cohort Studies ; Delivery, Obstetric ; Female ; Humans ; Odds Ratio ; Pregnancy ; Prevalence ; Rhinitis ; Rhinitis, Allergic

PURPOSE: To evaluate the usefulness of external bandage suture for bleb-related management that follows trabeculectomy with mitomycin C. METHODS: External bandage sutures were performed on 10 patients having hypotony maculopathy, persistent low intraocular pressure (IOP) caused by either hyperfiltration or focal leakage, or a persisting large bleb caused by hyperfiltration and who received trabeculectomy using mitomycin C as an adjuvant treatment. The changes in IOP measured before and 4 weeks after the procedure along with complication incidences were evaluated. RESULTS: The mean IOP 4 weeks after the procedure compared with the mean IOP prior to the procedure increased from 5.8 +/- 2.0 mm Hg (3.0-9.0 mm Hg) to 14.1 +/- 8.5 mm Hg (4.0-32.0 mm Hg), with statistical significance (p = 0.008). After the procedure, improvement in visual acuity was observed but without statistical significance. One patient had persistent focal leakage from an avascular bleb and conjunctival advancement with removal of the avascular conjunctiva was performed. CONCLUSIONS: An external bandage suture can be a good alternative for correction of post-trabeculectomy hypotony and severe chemosis with minimal effect on blebs while correcting focal leakage and hyperfiltration.
Bandages ; Blister ; Conjunctiva ; Humans ; Incidence ; Intraocular Pressure ; Mitomycin ; Sutures ; Trabeculectomy ; Visual Acuity

Rheumatoid meningitis, one of the most severe complications of rheumatoid arthritis, presents various symptoms such as headache, confusion, loss of consciousness, seizure, fever, and focal neurological deficits. A 63-year-old man with the history of rheumatoid arthritis presented with intermittent left leg weakness, seizures and later developed fever and confusion. Brain MRI demonstrated leptomeningeal enhancement in right fronto-parietal area. Brain biopsy revealed multifocal suppurative inflammation. After aggressive immunosuppressive treatment, he had gradually recovered and the lesion was reduced on a follow-up MRI.
Arthritis, Rheumatoid ; Biopsy ; Brain ; Fever ; Follow-Up Studies ; Headache ; Humans ; Inflammation ; Leg ; Meningitis ; Middle Aged ; Neurologic Manifestations ; Seizures ; Seizures, Febrile ; Unconsciousness

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND: We attempted to determine the prevalence and characteristics of metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) individuals in a large cohort of middle-aged Koreans. METHODS: 8,987 non-diabetic subjects were selected from the Chungju Metabolic disease Cohort Study performed in 2003-2006. MONW was defined as a body mass index (BMI) > or = 18.5 and < 23 kg/m2 with a homeostasis model assessment of insulin resistance (HOMA-IR) in the highest quartile. MHO was defined as BMI > or = 25 kg/m2 with HOMA-IR in the lowest quartile. RESULTS: The mean age of the subjects was 62.3 +/- 10.5 years (men 40.4%). The age-adjusted prevalence of MONW and MHO were 4.3% (5.3% men, 3.7% women) and 5.6% (3.6% men, 7.0% women), respectively. 14.2% of men and 12.9% of women were classified as MONW among the normal weight population, whereas 10.7% of men and 14.5% of women were classified as MHO among the obese subjects. The prevalence of prediabetes was significantly higher in the MONW group than in the MHO group (34.7 vs. 12.5%, P < 0.0001 in men; 23.1 vs. 8.8%, P < 0.0001 in women). The MONW group evidenced an equivalent risk of coronary heart disease (CHD) relative to the MHO group (10.77 +/- 0.68 vs. 10.22 +/- 0.90% in men; 7.02 +/- 0.34 vs. 7.26 +/- 0.26% in women, means +/- standard error [SE]). CONCLUSION: The subjects in the MONW group are characterized by a high risk of diabetes and CHD, despite their normal weights. Their substantial prevalence in the population emphasizes the importance of identifying subjects in the MONW group, and warrants more intensive risk management.
Body Mass Index ; Cohort Studies ; Coronary Disease ; Female ; Homeostasis ; Humans ; Insulin Resistance ; Male ; Metabolic Diseases ; Prediabetic State ; Prevalence ; Risk Management ; Weights and Measures

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. MATERIALS AND METHODS: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: 31~74 years old). The average follow-up period was 18 months (range: 8~32 months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. RESULTS: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was 7.6degrees (range: 2degrees~13degrees). Average postoperative Bohler angle was 24.4degrees (range: 4degrees~33degrees). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. CONCLUSION: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.
Arthritis ; Calcaneus ; Depression ; Female ; Follow-Up Studies ; Humans ; Joints ; Male