Background: Alcoholic liver disease (ALD) includes a wide clinical spectrum from acute alcoholic hepatitis to severe cirrhosis and/or hepatocellular carcinoma. Until now, there has been no report revealing the bleeding tendency of ALD compared to other diseases in liver transplantation (LT). Thus, we analyzed blood loss and transfusion amounts during operation according to the etiologies of liver disease and model for end-stage liver disease (MELD) score. Methods: Out of 874 recipients who underwent LT, a total of 146 patients were excluded by our exclusion criteria. We compared 728 recipients’ baseline characteristics, operation time, blood loss, and transfusion amounts between ALD and nonALD according to MELD score. Results: The number of patients in the ALD group was 130 (17.9%), and 598 (82.1%) in the non-ALD group. The ALD group showed younger age, higher MELD score, and a higher proportion of deceased donor LT than the non-ALD group. Intraoperative blood loss and transfusions of red blood cells (RBCs), fresh frozen plasma, and platelets were significantly higher in the ALD group. When stratified by MELD score (cut-off: 20), ALD patients in both high and low MELD subgroups demonstrated greater blood loss and RBC transfusion requirements, even when international normalized ratio and platelet counts were similar. In multivariate logistic regression analysis, ALD was a significant risk factor for massive transfusion (odds ratio 1.813, 95% confidence interval 1.158–2.840, p=0.009). Conclusion The ALD group showed increased bleeding tendency than the non-ALD group during LT, irrespective of MELD score. This suggests that transplant surgeons should anticipate greater blood loss and ensure adequate transfusion resources during LT for ALD patients.

Low-dose radiotherapy (LDRT) has been explored as a treatment option for various inflammatory diseases; however, its application in the context of rheumatoid arthritis (RA) is lacking. This study aimed to elucidate the mechanism underlying LDRT-based treatment for RA and standardize it. LDRT reduced the total numbers of immune cells, but increased the apoptotic CD4+ T and B220+ B cells, in the draining lymph nodes of collagen induced arthritis and K/BxN models. In addition, it significantly reduced the severity of various pathological manifestations, including bone destruction, cartilage erosion, and swelling of hind limb ankle. Post-LDRT, the proportion of apoptotic CD4+ T and CD19 + B cells increased significantly in the PBMCs derived from human patients with RA. LDRT showed a similar effect in fibroblast-like synoviocytes as well. In conclusion, we report that LDRT induces apoptosis in immune cells and fibro-blast-like synoviocytes, contributing to attenuation of arthritis.

Low-dose radiotherapy (LDRT) has been explored as a treatment option for various inflammatory diseases; however, its application in the context of rheumatoid arthritis (RA) is lacking. This study aimed to elucidate the mechanism underlying LDRT-based treatment for RA and standardize it. LDRT reduced the total numbers of immune cells, but increased the apoptotic CD4+ T and B220+ B cells, in the draining lymph nodes of collagen induced arthritis and K/BxN models. In addition, it significantly reduced the severity of various pathological manifestations, including bone destruction, cartilage erosion, and swelling of hind limb ankle. Post-LDRT, the proportion of apoptotic CD4+ T and CD19 + B cells increased significantly in the PBMCs derived from human patients with RA. LDRT showed a similar effect in fibroblast-like synoviocytes as well. In conclusion, we report that LDRT induces apoptosis in immune cells and fibro-blast-like synoviocytes, contributing to attenuation of arthritis.

Low-dose radiotherapy (LDRT) has been explored as a treatment option for various inflammatory diseases; however, its application in the context of rheumatoid arthritis (RA) is lacking. This study aimed to elucidate the mechanism underlying LDRT-based treatment for RA and standardize it. LDRT reduced the total numbers of immune cells, but increased the apoptotic CD4+ T and B220+ B cells, in the draining lymph nodes of collagen induced arthritis and K/BxN models. In addition, it significantly reduced the severity of various pathological manifestations, including bone destruction, cartilage erosion, and swelling of hind limb ankle. Post-LDRT, the proportion of apoptotic CD4+ T and CD19 + B cells increased significantly in the PBMCs derived from human patients with RA. LDRT showed a similar effect in fibroblast-like synoviocytes as well. In conclusion, we report that LDRT induces apoptosis in immune cells and fibro-blast-like synoviocytes, contributing to attenuation of arthritis.

Objective: This study evaluated the accuracy of the pre-hospital shock index multiplied by the AVPU scale (PSIAVPU) as a predictor of massive transfusion (MT) and traumatic coagulopathy. Methods: This research was a retrospective single-center study that included patients consecutively presenting to a trauma center between 2017 and 2020. The predictive value of the PSIAVPU for MT, in-hospital mortality, and traumatic coagulopathy was measured using the area under the curve (AUC) of the receiver operating characteristic curve. The AUC of the PSIAVPU was compared with the Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) measured at the trauma center presentation. Results: One thousand seven hundred and ninety-two patients were included, of which 163 patients (9.09%) received MT and 195 patients (10.88%) died during their hospital stay. Traumatic coagulopathy was observed in 245 patients. The AUC values for the PSIAVPU in terms of predicting MT, hospital mortality, and traumatic coagulopathy were 0.755, 0.752, and 0.736, respectively. Conclusion In patients with trauma, the predictive power of the PSIAVPU was higher than that of the prehospital shock index and was comparable to that of the rSIG. The PSIAVPU is a useful indicator that can be used easily and quickly for trauma patients at the prehospital stage.

Objectives: The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). Methods: We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. Results: This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P<0.05). After 4 weeks, the success rates for groups A, B, and C were 90.5%, 92.3%, and 100%, respectively. No significant difference was observed in the success rate across treatment methods and periods (P>0.05). However, CuRM was the only method with a 100% treatment success rate. Conclusion While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Background: The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages. Methods: Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed. Results: MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P< 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%. Conclusion MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.

Purpose: To evaluate set-up error for head and neck cancer (HNC) patients according to each neck lymph node (LN) level. And clinical factors affecting set-up error were analyzed. Materials and Methods: Reference points (RP1, RP2, RP3, and RP4) representing neck LN levels I to IV were designated. These RP were contoured on simulation computed tomography (CT) and cone-beam CT of 89 HNC patients with the same standard. After image registration was performed, movement of each RP was measured. Univariable logistic regression analyses were performed to analyze clinical factors related to measured movements. Results: The mean value of deviation of all axes was 1.6 mm, 1.3 mm, 1.8 mm, and 1.5 mm for RP1, RP2, RP3, and RP4, respectively. Deviation was over 3 mm in 24 patients. Movement of more than 3 mm was observed only in RP1 and RP3. In RP1, it was related to bite block use. Movement exceeding 3 mm was most frequently observed in RP3. Primary tumor and metastatic LN volume change were clinical factors related to the RP3 movement. Conclusion Planning target volume margin of 4 mm for neck LN level I, 3 mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.

Growing evidence suggests that environmental air pollution adversely affects kidney health. To date, the association between carbon monoxide (CO) and mortality in patients with end-stage renal disease (ESRD) has not been examined. Methods: Among 134,478 dialysis patients in the Korean ESRD cohort between 2001 and 2014, 8,130 deceased hemodialysis patients were enrolled, and data were analyzed using bidirectional, unidirectional, and time-stratified case-crossover design. We examined the association between short-term CO concentration and mortality in patients with ESRD. We used a two-pollutant model, adjusted for temperature as a climate factor and for nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter less than 10 μm in diameter as air pollution variables other than CO. Results: Characteristics of the study population included age (66.2 ± 12.1 years), sex (male, 59.1%; female, 40.9%), and comorbidities (diabetes, 55.6%; hypertension, 14.4%). Concentration of CO was significantly associated with all-cause mortality in the three case-crossover designs using the two-pollutant model adjusted for SO2. Patients with diabetes or age older than 75 years had a higher risk of mortality than patients without diabetes or those younger than 75 years. Conclusion: Findings presented here suggest that higher CO concentration is correlated with increased all-cause mortality in hemodialysis patients, especially in older high-risk patients.

Purpose: We aimed to investigate manifestations and patterns of care for patients with brain metastasis (BM) from breast cancer (BC) and compared their overall survival (OS) from 2005 through 2014 in Korea. Materials and Methods: We retrospectively reviewed 600 BC patients with BM diagnosed between 2005 and 2014. The median follow-up duration was 12.5 months. We categorized the patients into three groups according to the year when BM was initially diagnosed (group I [2005-2008], 98 patients; group II [2009-2011], 200 patients; and group III [2012-2014], 302 patients). Results: Over time, the median age at BM diagnosis increased by 2.2 years (group I, 49.0 years; group II, 48.3 years; and group III, 51.2 years; p=0.008). The percentage of patients with extracranial metastasis was 73.5%, 83.5%, and 86.4% for group I, II, and III, respectively (p=0.011). The time interval between BC and BM was prolonged in patients with stage III primary BC (median, 2.4 to 3 years; p=0.029). As an initial brain-directed treatment, whole-brain radiotherapy alone decreased from 80.0% in 2005 to 41.1% in 2014. Meanwhile, stereotactic radiosurgery or fractionated stereotactic radiotherapy alone increased from 13.3% to 34.7% during the same period (p=0.005). The median OS for group I, II, and III was 15.6, 17.9, and 15.0 months, respectively, with no statistical significance. Conclusion The manifestations of BM from BC and the pattern of care have changed from 2005 to 2014 in Korea. However, the OS has remained relatively unchanged over the 10 years.