Academic Medical Centers ; COVID-19/prevention & control* ; Cross Infection/prevention & control* ; Disinfection ; Hospitals, Isolation ; Humans ; Infection Control/methods* ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Radiology ; Radiology Department, Hospital/organization & administration* ; SARS-CoV-2 ; Singapore

OBJECTIVE: Rheumatoid arthritis (RA) is known to involve the cervical spine up to 86%. It often causes cervical instability like atlantoaxial subluxation (AAS), subaxial subluxation, and vertical subluxation (VS). In order to find the relation between RA and cord compression, we will evaluate the characteristics and risk factors of basilar invagination (BI) and cervicomedullary junction (CMJ) compression.METHODS: From January 2007 to May 2015, 12667 patients administrated to Hanyang University Medical Center. Four thousand three hundred eighty-six patients took cervical X-ray and 250 patients took cervical computed tomography or magnetic resonance imaging. Radiologic parameters, medication records were obtained from 242 patients. Multivariate logistic regression analysis was performed with correlation of CMJ compression, basin-dental interval (BDI), basin-posterior axial line interval (BAI), pannus formation, BI, and AAS.RESULTS: In the point of CMJ compression, atlantodental interval (ADI), posterior-atlantodental interval, BAI, AAS, and BI are relatively highly correlated. Patients with BI have 82 times strong possibility of radiologic confirmed CMJ compression, while AAS has 6-fold and pannus formation has the 3-fold possibility. Compared to the low incidence of BI, AAS and pannus formation have more proportion in CMJ compression. Furthermore, wrist joint erosion was correlated with VS and AAS.CONCLUSION: BI has a very strong possibility of CMJ compression, while AAS and pannus formation have a high proportion in CMJ compression. Hence bilateral wrist joint erosion can be used as an indicator for the timing of screening test for cervical involvement. We suggest the early recommendation of cervical spine examination for the diagnosis of cervical involvement in order to prevent morbidity and mortality.
Academic Medical Centers ; Arthritis, Rheumatoid ; Diagnosis ; Humans ; Incidence ; Logistic Models ; Magnetic Resonance Imaging ; Mass Screening ; Mortality ; Risk Factors ; Spine ; Wrist Joint

PURPOSE: Screening nonalcoholic fatty liver disease (NAFLD) by body mass index (BMI) as a single surrogate measure for obesity has limitations. We suggest considering body composition zones by drawing a body composition chart composed of body composition indices, including BMI and percent body fat (PBF), to visualize the risk of NAFLD in obese children and adolescents.METHODS: Thirty-eight boys diagnosed with NAFLD were selected retrospectively from patients who visited Konkuk University Medical Center from 2006 to 2015. They had gone through body composition analysis by bioelectrical impedance analysis (BIA), and biochemical analyses, including a liver function test (LFT) and lipid panel, were performed. Fat-free mass index (FFMI) and fat mass index (FMI) were calculated from body composition analysis and height. We plotted FFMI and FMI of patients on a body composition chart and classified the patients into zones A to D. In addition, we analyzed the correlations between LFT, lipid panel, and body composition indices.RESULTS: Thirty-three of 38 boys (86.8%) were located in zone C, corresponding to high BMI and PBF. Four boys (10.5%) were located in zone D, which correlates with sarcopenic obesity. One boy located in zone B was a muscular adolescent. Alanine aminotransferase level was positively correlated with PBF, FMI, and BMI z-score.CONCLUSION: Body composition zones on a body composition chart might be useful in risk assessment in obesity-related diseases such as NAFLD. Zones on a body composition chart could have practical applications, especially in sarcopenic obese children and adolescents.
Academic Medical Centers ; Adipose Tissue ; Adolescent ; Alanine Transaminase ; Body Composition ; Body Mass Index ; Child ; Electric Impedance ; Humans ; Liver Function Tests ; Male ; Mass Screening ; Non-alcoholic Fatty Liver Disease ; Obesity ; Retrospective Studies ; Risk Assessment

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal tract. Management of GIST patients is currently based on clinicopathological features and associated genetic changes. However, the detailed characteristics and molecular genetic features of GISTs have not yet been described in the Vietnamese population.METHODS: We first identified 155 patients with primary GIST who underwent surgery with primary curative intent between 2011 and 2014 at University Medical Center at Ho Chi Minh City, Vietnam. We evaluated the clinicopathological features and immunohistochemical reactivity to p53 and Ki-67 in these patients. Additionally, KIT genotyping was performed in 100 cases.RESULTS: The largest proportion of GISTs was classified as high-risk (43.2%). Of the 155 GISTs, 52 (33.5%) were positive for Ki-67, and 58 (37.4%) were positive for p53. The expression of Ki-67 and p53 were correlated with mitotic rate, tumor size, risk assessment, and tumor stage. Out of 100 GIST cases, KIT mutation was found in 68%, of which 62 (91.2%) were found in exon 11, two (2.9%) in exon 9, and four (5.8%) in exon 17. No mutation in exon 13 was identified. Additionally, KIT mutations did not correlate with any clinicopathological features.CONCLUSIONS: The expression of Ki-67 and p53 were associated with high-risk tumors. Mutations in exon 11 were the most commonly found, followed by exon 17 and exon 9. Additionally, KIT mutation status was not correlated with any recognized clinicopathological features.
Academic Medical Centers ; Asian Continental Ancestry Group ; Exons ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Molecular Biology ; Risk Assessment ; Vietnam

BACKGROUND: This study was aimed to analyze the status and effects of influenza vaccine (IV) and pneumococcal vaccine (PV) in hospitalized patients in a University Hospital with chronic conditions.METHODS: The study is based on the medical records of 3,279 inpatients in pulmonary center of Yeungnam University Medical Center (Korea) between October 2015 and September 2016. The subjects were divided into two groups by age (under 65 years old and over 65 years old), and the preventive effects of IV and PV were analyzed by comparing vaccination rate, hospitalized period, pneumonia attach rate, and mortality rate. Vaccination data were obtained from the Korea Centers for Disease Control and Prevention web system. The chi-squared test, linear regression analysis and logistic regression analysis were used to analyze factors associated with the types of vaccinations and underlying medial factors.RESULTS: In the group under 65 years old, those without any vaccination had higher mortality rate. In addition, patients with IV vaccination were more likely to have shorter hospitalized periods. On the contrary, a group of people without any vaccination, hospitalized period increased. However, in the group of over 65 years old with various underlying conditions, the mortality rate was higher when IV or both IV and PV were vaccinated.CONCLUSION: The preventive effects show the opposite results in two age groups. This study indicates that the vaccines are more effective in the group under 65 years old than the group over 65 years old with chronic conditions.
Academic Medical Centers ; Centers for Disease Control and Prevention (U.S.) ; Hospitalization ; Humans ; Influenza Vaccines ; Influenza, Human ; Inpatients ; Korea ; Linear Models ; Logistic Models ; Medical Records ; Mortality ; Pneumococcal Vaccines ; Pneumonia ; Vaccination ; Vaccines

BACKGROUND: The purpose of this study was to examine the prevalence of and the sociodemographic risk factors for depressive symptoms among inpatients with chronic diseases who completed the Patient Health Questionnaire-9 (PHQ-9) conducted by a social work department at university medical centers. METHODS: In 2015, PHQ-9 data were collected from six medical centers affiliated with Hallym University Medical Center. The sample comprised 517 inpatients aged 18 years or over with chronic diseases. Descriptive statistics, chi-square test, simple logistic regression, and multiple logistic regression were used for data analyses. RESULTS: The prevalence of depressive symptoms among inpatients with chronic diseases was 31.7 percent. The results of the simple and multiple logistic regressions showed that the single/widowed/divorced/separated group was at higher risk for depressive symptoms than married inpatients. Having a religion or being unemployed also increased the risk of depressive symptoms among the respondents. CONCLUSIONS: Findings of this study emphasize the importance of systematic depressive symptom management for inpatients with chronic diseases.
Academic Medical Centers ; Chronic Disease ; Depression ; Humans ; Inpatients ; Logistic Models ; Prevalence ; Risk Factors ; Social Work ; Statistics as Topic ; Surveys and Questionnaires

BACKGROUND/AIMS: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. METHODS: Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. RESULTS: Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. CONCLUSIONS: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA.
Academic Medical Centers ; Carcinoma, Hepatocellular ; Catheter Ablation ; Follow-Up Studies ; Humans ; Liver Neoplasms ; Liver ; Recurrence ; Survival Rate ; Treatment Outcome

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

BACKGROUND/AIMS: Statins have been postulated to lower the risk of colorectal neoplasia. No studies have examined any possible chemopreventive effect of statins in patients with inflammatory bowel disease (IBD) undergoing colorectal cancer (CRC) surveillance. This study examined the association of statin exposure with dysplasia and CRC in patients with IBD undergoing dysplasia surveillance colonoscopies. METHODS: A cohort of patients with IBD undergoing colonoscopic surveillance for dysplasia and CRC at a single academic medical center were studied. The inclusion criteria were IBD involving the colon for 8 years (or any colitis duration if associated with primary sclerosing cholangitis [PSC]) and at least two colonoscopic surveillance exams. The exclusion criteria were CRC or high-grade dysplasia (HGD) prior to or at enrollment, prior colectomy, or limited ( < 30%) colonic disease. The primary outcome was the frequency of dysplasia and/or CRC in statin-exposed versus nonexposed patients. RESULTS: A total of 642 patients met the inclusion criteria (57 statin-exposed and 585 nonexposed). The statin-exposed group had a longer IBD duration, longer follow-up period, and more colonoscopies but lower inflammatory scores, less frequent PSC and less use of thiopurines and biologics. There were no differences in low-grade dysplasia, HGD, or CRC development during the follow-up period between the statin-exposed and nonexposed groups (21.1%, 5.3%, 1.8% vs 19.2%, 2.9%, 2.9%, respectively). Propensity score analysis did not alter the overall findings. CONCLUSIONS: In IBD patients undergoing surveillance colonoscopies, statin use was not associated with reduced dysplasia or CRC rates. The role of statins as chemopreventive agents in IBD remains controversial.
Academic Medical Centers ; Biological Products ; Chemoprevention ; Cholangitis, Sclerosing ; Cohort Studies ; Colectomy ; Colitis ; Colon ; Colonic Diseases ; Colonoscopy ; Colorectal Neoplasms ; Epidemiology ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Inflammatory Bowel Diseases* ; Prevalence* ; Propensity Score

BACKGROUND/AIMS: The eradication of Helicobacter pylori (H. pylori) is an effective treatment in gastric mucosa-associated lymphoid tissue (MALT) lymphoma associated with H. pylori infection. However, the treatment strategy in gastric MALT lymphoma patients who are H. pylori-negative or unresponsive to H. pylori eradication therapy remains controversial. In this study, we investigated the clinical efficacy of treatments other than H. pylori eradication therapy in these groups of patients. METHODS: This was a retrospective single-center study based on the medical records of patients diagnosed with gastric MALT lymphoma at Yeungnam University Medical Center between January 2005 and December 2016. Patients were treated with H. pylori eradication therapy, chemotherapy, or radiotherapy according to their H. pylori infection status and stage of gastric MALT lymphoma. RESULTS: Of the 68 eligible patients, 50 were enrolled in the study. Of the 42 patients with H. pylori-positive gastric MALT lymphoma, 36 (81.7%) were treated with H. pylori eradication therapy as primary treatment and 25 (69.4%) achieved a complete response (CR). Patients without a CR after H. pylori eradication therapy (n=11, 30.6%) received radiotherapy as a secondary treatment. Two patients with H. pylori-positive gastric MALT lymphoma and eight with H. pylori-negative gastric MALT lymphoma received radiotherapy as the primary treatment. CR was achieved in all 21 patients treated with radiotherapy as primary or secondary treatment. The 5-year progression-free survival rate after radiotherapy was 92.9%. CONCLUSIONS: Radiotherapy may be a worthwhile treatment option in patients with H. pylori-negative MALT lymphoma or H. pylori-positive MALT lymphoma that is not responsive to H. pylori eradication therapy.
Academic Medical Centers ; Disease-Free Survival ; Drug Therapy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Medical Records ; Radiotherapy* ; Retrospective Studies ; Stomach Neoplasms ; Treatment Outcome*