Purpose: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) are frequently employed to counteract the detrimental effects of proteinuria on glomerular diseases. However, the effects of ARBs remain poorly examined in pediatric patients with immunoglobulin A (IgA) nephropathy. Herein, we evaluated the efficacy and safety of losartan, an ARB, in pediatric IgA nephropathy with proteinuria. Methods: This prospective, single-arm, multicenter study included children with IgA nephropathy exhibiting proteinuria. Changes in proteinuria, blood pressure, and kidney function were prospectively evaluated before and 4 and 24 weeks after losartan administration. The primary endpoint was the difference in proteinuria between baseline and 24 weeks. Results: In total, 29 patients were enrolled and received losartan treatment. The full analysis set included 28 patients who received losartan at least once and had pre- and post-urinary protein to creatinine ratio measurements (n=28). The per-protocol analysis group included 22 patients who completed all scheduled visits without any serious violations during the study period. In both groups, the mean log (urine protein to creatinine ratio) value decreased significantly at 6 months. After 24 weeks, the urinary protein to creatinine ratio decreased by more than 50% in approximately 40% of the patients. The glomerular filtration rate was not significantly altered during the observation period. Conclusions Losartan decreased proteinuria without decreasing kidney function in patients with IgA nephropathy over 24 weeks. Losartan could be safely employed to reduce proteinuria in this patient population. ClinicalTrials.gov trial registration (NCT0223277)

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

Background/Aims: To investigate epidemiologic characteristics, clinical and economic burdens, and factors associated with mortality in complicated skin and skin structure infection (cSSSI) patients in Korea. Methods: A retrospective, observational, nationwide study was conducted between April to July 2012 at 14 tertiary-hospitals in Korea. Eligible patients were hospitalized adults with community acquired cSSSI, who underwent surgical intervention and completed treatment between November 2009 and October 2011. Data on demography, clinical characteristics, outcomes and medical resource utilization were collected through medical record review. Direct medical costs were calculated by multiplying quantities of resources utilized by each unit price in Korea. Results: Of 473 patients enrolled, 449 patients (except 24 patients with no record on surgical intervention) were eligible for analysis. Microbiological testing was performed on 66.1% of patients and 8.2% had multiple pathogens. Among culture confirmed pathogens (n = 297 patients, 340 episodes), 76.2% were gram-positive (Staphylococcus aureus; 41.2%) and 23.8% were gram-negative. The median duration of hospital stay was 16 days. Among treated patients, 3.3% experienced recurrence and 4.2% died in-hospital. The mean direct medical costs amounted to $4,195/ person, with the greatest expenses for hospitalization and antibiotics. The in-hospital mortality and total medical costs were higher in combined antibiotics therapy than monotherapy (p < 0.05). Charlson’s comorbidity index ≥ 3, standardized early warning scoring ≥ 4, sub-fascia infections and combined initial therapy, were all found to be associated with higher mortality. Conclusions Korean patients with community-onset cSSSI suffer from considerable clinical and economic burden. Efforts should be made to reduce this burden through appropriate initial treatment.

Stent thromboses due to multifactorial causes including hypercoagulable conditions and high on treatment platelet reactivity (HTPR), which means a low response to anti-platelet therapy, especially clopidogrel. Prasugrel is a third generation thienopyridine and inactive pro-drug requiring metabolic activation in vivo, which improves the rate of HTPR with clopidogrel. This drug is mostly effective, with a potent, fast, and consistent anti-platelet action, but rare cases of inadequate platelet inhibition with prasugrel have been reported. Here we describe the case of a 47-year-old man who presented with a recurrent acute myocardial infarction and ST during an intravascular ultrasound pullback and was resistant to prasugrel, was successfully treated with ticagrelor.
Activation, Metabolic ; Blood Platelets ; Humans ; Middle Aged ; Myocardial Infarction ; Prasugrel Hydrochloride* ; Stents* ; Thrombosis* ; Ultrasonography

PURPOSE: The factors related to early-onset tumor recurrence in patients with spontaneously ruptured hepatocellular carcinoma (HCC) after hepatectomy remain unclear. The aims of the present study were to compare characteristics between early and late recurrence groups in spontaneously ruptured HCC patients who received curative hepatectomy and to identify risk factors for mortality. METHODS: We selected 19 patients who had been diagnosed with spontaneously ruptured HCC and who were treated with curative liver resection between 1998 and 2013. The 19 patients were divided into 2 groups: the early recurrence group of patients who experienced tumor recurrence within 12 months after hepatectomy, and the late recurrence group of patients who experienced recurrence after 12 months or who did not experience recurrence. RESULTS: The median tumor size was 7.4 cm, and there were no cases of postoperative mortality. Patient survival rates at 1, 3, and 5 years were 78.9%, 58.6%, and 58.6%, respectively. The incidence of tumor protrusion in the early recurrence group was higher than that in the late recurrence group (100% vs. 30%, respectively, P = 0.003). There were no statistically significant differences in other factors between the 2 groups. Multivariate analysis showed that greater than 30% protrusion of the tumor was a predictor of patient survival. CONCLUSION: The results from the present study suggests that spontaneously ruptured HCC patients with protrusion should be frequently monitored after hepatectomy in order to achieve early detection of tumor recurrence and improve survival.
Carcinoma, Hepatocellular* ; Hepatectomy* ; Humans ; Incidence ; Liver ; Mortality ; Multivariate Analysis ; Recurrence* ; Risk Factors ; Rupture ; Rupture, Spontaneous* ; Survival Rate

PURPOSE: The factors related to early-onset tumor recurrence in patients with spontaneously ruptured hepatocellular carcinoma (HCC) after hepatectomy remain unclear. The aims of the present study were to compare characteristics between early and late recurrence groups in spontaneously ruptured HCC patients who received curative hepatectomy and to identify risk factors for mortality. METHODS: We selected 19 patients who had been diagnosed with spontaneously ruptured HCC and who were treated with curative liver resection between 1998 and 2013. The 19 patients were divided into 2 groups: the early recurrence group of patients who experienced tumor recurrence within 12 months after hepatectomy, and the late recurrence group of patients who experienced recurrence after 12 months or who did not experience recurrence. RESULTS: The median tumor size was 7.4 cm, and there were no cases of postoperative mortality. Patient survival rates at 1, 3, and 5 years were 78.9%, 58.6%, and 58.6%, respectively. The incidence of tumor protrusion in the early recurrence group was higher than that in the late recurrence group (100% vs. 30%, respectively, P = 0.003). There were no statistically significant differences in other factors between the 2 groups. Multivariate analysis showed that greater than 30% protrusion of the tumor was a predictor of patient survival. CONCLUSION: The results from the present study suggests that spontaneously ruptured HCC patients with protrusion should be frequently monitored after hepatectomy in order to achieve early detection of tumor recurrence and improve survival.
Carcinoma, Hepatocellular* ; Hepatectomy* ; Humans ; Incidence ; Liver ; Mortality ; Multivariate Analysis ; Recurrence* ; Risk Factors ; Rupture ; Rupture, Spontaneous* ; Survival Rate