Background: Heterotopic ossification (HO) is difficult to characterize and classify on simple radiographs. Therefore, we attempted to evaluate intraobserver and interobserver reliability of simple radiography and computed tomography (CT) for detecting and classifying HO after reverse shoulder arthroplasty (RSA). It was hypothesized that CT would provide more reliable results than simple radiography. Methods: This retrospective study reviewed 30 patients who underwent RSA performed by a single surgeon. Patients were included if they had both postoperative simple radiographs and CT images taken immediately after surgery and at 1 year after surgery and if they had completed clinical assessment at least 1 year after surgery. We first evaluated the intraobserver and interobserver reliability for the detection of the presence of HO and Modified Brooker’s classification both on simple radiographs and CT scans with the use of Kappa statistics. Then, we analyzed the correlation of HO observed in simple radiographs and CT scans with clinical outcomes. All radiographic evaluations were performed by 2 independent reviewers in random orders with 3 weeks of intervals. Results: The intraobserver reliability outcomes of both reviewers in simple radiography and CT were almost perfect or perfect for the detection of HO and classification. However, CT images improved the interobserver reliability for the detection of HO (kappa value for simple radiographs [KXR ] = 0.6018 and kappa value for CT [KCT ] = 0.8316) and classification (KXR = 0.5300 and KCT = 0.6964).At a mean follow-up of 25 months (range, 12–54 months), clinical scores were not significantly different according to the presence of HO based on simple radiographs. However, when CT images were used, the University of California, Los Angeles score and physical component score of short-form 36-item health survey were significantly lower in patients with HO than in patients without HO (27.0 vs. 30.4, p = 0.045 and 57.6 vs. 70.7, p = 0.034, respectively). Conclusions Both simple radiography and CT provided excellent intraobserver reliability for detecting and classifying HO after RSA. Compared to simple radiography, CT tended to improve interobserver reliability and defined the presence and severity of HO more clearly.

Background: Heterotopic ossification (HO) is difficult to characterize and classify on simple radiographs. Therefore, we attempted to evaluate intraobserver and interobserver reliability of simple radiography and computed tomography (CT) for detecting and classifying HO after reverse shoulder arthroplasty (RSA). It was hypothesized that CT would provide more reliable results than simple radiography. Methods: This retrospective study reviewed 30 patients who underwent RSA performed by a single surgeon. Patients were included if they had both postoperative simple radiographs and CT images taken immediately after surgery and at 1 year after surgery and if they had completed clinical assessment at least 1 year after surgery. We first evaluated the intraobserver and interobserver reliability for the detection of the presence of HO and Modified Brooker’s classification both on simple radiographs and CT scans with the use of Kappa statistics. Then, we analyzed the correlation of HO observed in simple radiographs and CT scans with clinical outcomes. All radiographic evaluations were performed by 2 independent reviewers in random orders with 3 weeks of intervals. Results: The intraobserver reliability outcomes of both reviewers in simple radiography and CT were almost perfect or perfect for the detection of HO and classification. However, CT images improved the interobserver reliability for the detection of HO (kappa value for simple radiographs [KXR ] = 0.6018 and kappa value for CT [KCT ] = 0.8316) and classification (KXR = 0.5300 and KCT = 0.6964).At a mean follow-up of 25 months (range, 12–54 months), clinical scores were not significantly different according to the presence of HO based on simple radiographs. However, when CT images were used, the University of California, Los Angeles score and physical component score of short-form 36-item health survey were significantly lower in patients with HO than in patients without HO (27.0 vs. 30.4, p = 0.045 and 57.6 vs. 70.7, p = 0.034, respectively). Conclusions Both simple radiography and CT provided excellent intraobserver reliability for detecting and classifying HO after RSA. Compared to simple radiography, CT tended to improve interobserver reliability and defined the presence and severity of HO more clearly.

Background: Heterotopic ossification (HO) is difficult to characterize and classify on simple radiographs. Therefore, we attempted to evaluate intraobserver and interobserver reliability of simple radiography and computed tomography (CT) for detecting and classifying HO after reverse shoulder arthroplasty (RSA). It was hypothesized that CT would provide more reliable results than simple radiography. Methods: This retrospective study reviewed 30 patients who underwent RSA performed by a single surgeon. Patients were included if they had both postoperative simple radiographs and CT images taken immediately after surgery and at 1 year after surgery and if they had completed clinical assessment at least 1 year after surgery. We first evaluated the intraobserver and interobserver reliability for the detection of the presence of HO and Modified Brooker’s classification both on simple radiographs and CT scans with the use of Kappa statistics. Then, we analyzed the correlation of HO observed in simple radiographs and CT scans with clinical outcomes. All radiographic evaluations were performed by 2 independent reviewers in random orders with 3 weeks of intervals. Results: The intraobserver reliability outcomes of both reviewers in simple radiography and CT were almost perfect or perfect for the detection of HO and classification. However, CT images improved the interobserver reliability for the detection of HO (kappa value for simple radiographs [KXR ] = 0.6018 and kappa value for CT [KCT ] = 0.8316) and classification (KXR = 0.5300 and KCT = 0.6964).At a mean follow-up of 25 months (range, 12–54 months), clinical scores were not significantly different according to the presence of HO based on simple radiographs. However, when CT images were used, the University of California, Los Angeles score and physical component score of short-form 36-item health survey were significantly lower in patients with HO than in patients without HO (27.0 vs. 30.4, p = 0.045 and 57.6 vs. 70.7, p = 0.034, respectively). Conclusions Both simple radiography and CT provided excellent intraobserver reliability for detecting and classifying HO after RSA. Compared to simple radiography, CT tended to improve interobserver reliability and defined the presence and severity of HO more clearly.

Background: Heterotopic ossification (HO) is difficult to characterize and classify on simple radiographs. Therefore, we attempted to evaluate intraobserver and interobserver reliability of simple radiography and computed tomography (CT) for detecting and classifying HO after reverse shoulder arthroplasty (RSA). It was hypothesized that CT would provide more reliable results than simple radiography. Methods: This retrospective study reviewed 30 patients who underwent RSA performed by a single surgeon. Patients were included if they had both postoperative simple radiographs and CT images taken immediately after surgery and at 1 year after surgery and if they had completed clinical assessment at least 1 year after surgery. We first evaluated the intraobserver and interobserver reliability for the detection of the presence of HO and Modified Brooker’s classification both on simple radiographs and CT scans with the use of Kappa statistics. Then, we analyzed the correlation of HO observed in simple radiographs and CT scans with clinical outcomes. All radiographic evaluations were performed by 2 independent reviewers in random orders with 3 weeks of intervals. Results: The intraobserver reliability outcomes of both reviewers in simple radiography and CT were almost perfect or perfect for the detection of HO and classification. However, CT images improved the interobserver reliability for the detection of HO (kappa value for simple radiographs [KXR ] = 0.6018 and kappa value for CT [KCT ] = 0.8316) and classification (KXR = 0.5300 and KCT = 0.6964).At a mean follow-up of 25 months (range, 12–54 months), clinical scores were not significantly different according to the presence of HO based on simple radiographs. However, when CT images were used, the University of California, Los Angeles score and physical component score of short-form 36-item health survey were significantly lower in patients with HO than in patients without HO (27.0 vs. 30.4, p = 0.045 and 57.6 vs. 70.7, p = 0.034, respectively). Conclusions Both simple radiography and CT provided excellent intraobserver reliability for detecting and classifying HO after RSA. Compared to simple radiography, CT tended to improve interobserver reliability and defined the presence and severity of HO more clearly.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Objectives: Excess mortality associated with long-term exposure to fine particulate matter (PM2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM2.5 by considering the potential non-linear concentration–response relationship in Korea. Methods: Daily cause-specific mortality rates and PM2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM2.5 concentrations below 15 μg/m3. Overall deaths attributable to short-term PM2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM2.5 exposure. Results: Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM2.5. The estimated number of all-cause excess deaths due to short-term PM2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472). Conclusions Our findings indicate an association between short-term PM2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM2.5.

Objective: We aimed to ascertain the occurrence and characteristics of CRE isolated from companion animals, dogs and cats. Methods: E. coli strains were tested for antimicrobial susceptibility using the broth microdilution technique. Antimicrobial resistance genes were detected by polymerase chain reaction and sequencing analysis. The molecular characteristics of CRE were determined using multi-locus sequence typing, replicon typing, and pulsed-field gel electrophoresis (PFGE). Results: In total, 13 CRE isolates (0.13%) were identified from dogs possessing blaNDM-5 along with β-lactamase genes, mostly blaCMY-2 (92.2%) and blaTEM-1 (53.8%). The commonly observed mutations were S83L and D87N in gyrA, S80I in parC, and S458A in parE. CRE carried nonbeta-lactam resistance genes, with the majority being tet(B) (100%), sul (84.6%), and aac(3)-II (53.8%). Nine different PFGE patterns (P1–P9), IncX3-type plasmids (69.2%), and ST410 (84.6%) were predominantly detected. Conclusions and Relevance: This investigation provides significant insight into the prevalence and molecular characteristics of blaNDM-5 -carrying E. coli in dogs. The co-existence of blaNDM-5 and other antimicrobial resistance genes in E. coli potentially poses severe health hazards to humans.

Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.

Background: Nilotinib is a tyrosine kinase inhibitor approved by the Ministry of Food and Drug Safety for frontline and 2nd line treatment of Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML). This study aimed to confirm the safety and efficacy of nilotinib in routine clinical practice within South Korea. Methods: An open-label, multicenter, single-arm, 12-week observational post-marketing surveillance (PMS) study was conducted on 669 Korean adult patients with Ph + CML from December 24, 2010, to December 23, 2016. The patients received nilotinib treatment in routine clinical practice settings. Safety was evaluated by all types of adverse events (AEs) during the study period, and efficacy was evaluated by the complete hematological response (CHR) and cytogenetic response. Results: During the study period, AEs occurred in 61.3% (410 patients, 973 events), adverse drug reactions (ADRs) in 40.5% (271/669 patients, 559 events), serious AEs in 4.5% (30 patients, 37 events), and serious ADRs in 0.7% (5 patients, 8 events). Furthermore, unexpected AEs occurred at a rate of 6.9% (46 patients, 55 events) and unexpected ADRs at 1.2% (8 patients, 8 events). As for the efficacy results, CHR was achieved in 89.5% (442/494 patients), and minor cytogenetic response or major cytogenetic response was achieved in 85.8% (139/162 patients). Conclusion This PMS study shows consistent results in terms of safety and efficacy compared with previous studies. Nilotinib was well tolerated and efficacious in adult Korean patients with Ph + CML in routine clinical practice settings.

Background/Aims: The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma. Methods: A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use. Results: A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014). Conclusions Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma