Background: With the aging population and advancements in medical care worldwide, the number of older patients with end-stage kidney disease continues to rise. This study aimed to identify factors associated with osteoporosis and osteopenia in older patients undergoing incident hemodialysis and assess their impact on mortality. Methods: We analyzed a large multicenter retrospective cohort of patients aged ≥70 years undergoing incident hemodialysis to identify factors associated with osteoporosis using logistic regression analysis and to assess the association of death with osteoporosis and osteopenia using Cox multivariable analysis. Results: Among 710 patients, 39.0% and 19.6% had osteoporosis and osteopenia, respectively. Osteoporosis was significantly associated with female sex, a history of fractures, and the absence of phosphate binder use. During a median follow-up of 36.8 months, 348 participants (58.8%) died. Mortality rates were the highest in the osteoporosis group (79.8%), followed by the osteopenia (77.2%) and normal bone mineral density (BMD) groups (35.2%). Cox regression analysis revealed that even after adjusting for covariates, the osteoporosis group was significantly associated with a higher mortality risk than the normal BMD group. Osteoporosis at the start of hemodialysis was significantly associated with higher mortality. Conclusion We should consider the importance of bone health in patients undergoing incident hemodialysis and pay attention to the use of phosphate binders and fracture prevention.

Diagnostic techniques for spinal pathologies have been developed in accordance with advances in technology. Accurate diagnosis of spinal pathology is essential for appropriate management of spinal diseases. Since the development of X-rays in 1895 and computed tomography (CT) in 1967, several diagnostic imaging modalities have been utilized for detecting spinal pathologies, including radiography, CT, magnetic resonance imaging, and radionuclide imaging. In addition to diagnostic imaging technologies, electrodiagnostic tests, including electromyography and nerve conduction studies, play a significant role as diagnostic tools, as spinal diseases are mostly profoundly associated with pathologies of the neural structures, such as the spinal cord and nerve root, and extent of injury at the structure cannot be adequately detected by conventional imaging techniques. In patient-specific treatment strategies, usage of diagnostic modalities is of great importance; thus, we should be aware of the basic details and approaches of the different diagnostic modalities. In this review, the authors discuss the details of the technologies that aid in the diagnosis of spinal pathologies.

Spine diseases are common and exhibit several causes, including degeneration, trauma, congenital issues, and other specific factors. Most people experience a variety of symptoms of spine diseases during their lifetime that are occasionally managed with conservative or surgical treatments. Accurate diagnosis of the spine pathology is essential for the appropriate management of spine disease, and various imaging modalities can be used for the diagnosis, including radiography, computed tomography (CT), magnetic resonance imaging (MRI), and other studies such as EOS, bone scan, single photon emission CT/CT, and electrophysiologic test. Patient (or case)-specific selection of the diagnostic modality is crucial; thus, we should be aware of basic information and approaches of the diagnostic modalities. In this review, we discuss in detail, about diagnostic modalities (radiography, CT, MRI, electrophysiologic study, and others) that are widely used for spine disease.

OBJECTIVE: Assessing the severity of injury and predicting outcomes are essential in traumatic brain injury (TBI). However, the respiratory rate and Glasgow Coma Scale (GCS) of the Revised Trauma Score (RTS) are difficult to use in the prehospital setting. This investigation aimed to develop a new prehospital trauma score for TBI (NTS-TBI) to predict mortality and disability.METHODS: We used a nationwide trauma database on severe trauma cases transported by fire departments across Korea in 2013 and 2015. NTS-TBI model 1 used systolic blood pressure < 90 mmHg, peripheral capillary oxygen saturation < 90% measured via pulse oximeter, and motor component of GCS. Model 2 comprised variables of model 1 and age >65 years. We assessed discriminative power via area under the curve (AUC) value for in-hospital mortality and disability defined according to the Glasgow Outcome Scale with scores of 2 or 3. We then compared AUC values of NTS-TBI with those of RTS.RESULTS: In total, 3,642 patients were enrolled. AUC values of NTS-TBI models 1 and 2 for mortality were 0.833 (95% confidence interval [CI], 0.815 to 0.852) and 0.852 (95% CI, 0.835 to 0.869), respectively, while AUC values for disability were 0.772 (95% CI, 0.749 to 0.796) and 0.784 (95% CI, 0.761 to 0.807), respectively. AUC values of NTS-TBI model 2 for mortality and disability were higher than those of RTS (0.819 and 0.761, respectively) (P < 0.01).CONCLUSION: Our NTS-TBI model using systolic blood pressure, motor component of GCS, oxygen saturation, and age was feasible for prehospital care and showed outstanding discriminative power for mortality.
Anoxia ; Area Under Curve ; Blood Pressure ; Brain Injuries ; Capillaries ; Fires ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hospital Mortality ; Humans ; Hypotension ; Korea ; Mortality ; Observational Study ; Oxygen ; Quality Improvement ; Respiratory Rate

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.
Colonoscopy ; Colorectal Neoplasms ; Consensus ; Early Detection of Cancer* ; Early Diagnosis ; Endoscopy* ; Endoscopy, Gastrointestinal ; Expert Testimony ; Gastroscopy ; Korea* ; Mass Screening ; Outcome Assessment (Health Care) ; Quality Improvement* ; Stomach

OBJECTIVE: In a proof of concept study, we compared no-touch radiofrequency ablation (NtRFA) in bipolar mode with conventional direct tumor puncture (DTP) in terms of local tumor control (LTC), peritoneal seeding, and tumorigenic factors, in the rabbit VX2 subcapsular hepatic tumor model. MATERIALS AND METHODS: Sixty-two rabbits with VX2 subcapsular hepatic tumors were divided into three groups according to the procedure: DTP-RFA (n = 25); NtRFA (n = 25); and control (n = 12). Each of the three groups was subdivided into two sets for pathologic analysis (n = 24) or computed tomography (CT) follow-up for 6 weeks after RFA (n = 38). Ultrasonography-guided DTP-RFA and NtRFA were performed nine days after tumor implantation. LTC was defined by either achievement of complete tumor necrosis on histopathology or absence of local tumor progression on follow-up CT and autopsy. Development of peritoneal seeding was also compared among the groups. Serum hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) were measured via ELISA (Elabscience Biotechnology Co.) after RFA for tumorigenic factor evaluation. RESULTS: Regarding LTC, there was a trend in NtRFA (80%, 20/25) toward better ablation than in DTP-RFA (56%, 14/25) (p = 0.069). Complete tumor necrosis was achieved in 54.5% of DTP-RFA (6/11) and 90.9% of NtRFA (10/11). Peritoneal seeding was significantly more common in DTP-RFA (71.4%, 10/14) than in NtRFA (21.4%, 3/14) (p = 0.021) or control (0%). Elevations of HGF, VEGF or IL-6 were not detected in any group. CONCLUSION: No-touch radiofrequency ablation led to lower rates of peritoneal seeding and showed a tendency toward better LTC than DTP-RFA.
Autopsy ; Biotechnology ; Catheter Ablation* ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Hepatocyte Growth Factor ; Interleukin-6 ; Necrosis ; Punctures ; Rabbits* ; Vascular Endothelial Growth Factor A

PURPOSE: The purpose of this study was to compare the accuracy of postoperative maxillary cyst (POMC) diagnosis by panoramic radiographs versus computed tomography (CT) and by oral and maxillofacial radiologists versus non-specialists. MATERIALS AND METHODS: Sixty-five maxillary sinuses with POMCs and 63 without any lesion were assessed using panoramic radiographs and CT images by five oral and maxillofacial radiologists and five non-specialists on a five-point scale. The areas under receiver operating characteristic (ROC) curves were analyzed to determine the differences in diagnostic accuracy between the two imaging modalities and between the two groups of observers. The intra-observer agreement was determined, too. RESULTS: The diagnostic accuracy of CT images was higher than that of panoramic radiographs in both groups of observers (p<0.05). The diagnostic accuracy of oral and maxillofacial radiologists for each method was higher than that of non-specialists (p<0.05). CONCLUSION: The use of CT improves the diagnosis of POMC, and radiological training and experience leads to more accurate evaluation.
Diagnosis ; Maxillary Sinus ; Pro-Opiomelanocortin ; Radiography, Panoramic ; ROC Curve

A 73-year-old woman who presented with chest discomfort visited the emergency room. The 12-lead electrocardiography showed ST-segment elevation in II, III, and lead augmented vector foot. Emergent coronary angiography revealed a thrombus in the distal right coronary artery. Percutaneous coronary angioplasty with a stent was performed. After the procedure, persistent dyspnea occurred. Her chest computed tomography (CT) showed occlusion of the bilateral pulmonary artery. We could not find a source for the embolization or a hypercoagulable state. We started a course of dual antiplatelets with oral anticoagulants. Pulmonary embolism was resolved at follow-up chest CT scan. Aspirin, clopidogrel and warfarin were given for 6 months. The patient is doing well now 1 year after the episode.
Aged* ; Angioplasty ; Anticoagulants ; Aspirin ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Electrocardiography ; Emergency Service, Hospital ; Female ; Fibrinolytic Agents ; Follow-Up Studies ; Foot ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Pulmonary Artery ; Pulmonary Embolism* ; Stents ; Thorax ; Thrombosis ; Tomography, X-Ray Computed ; Warfarin

Here, we report a case of newly diagnosed diabetes, with concurrent pancreatic cancer manifested as hyperglycemic crisis, and aggravated by urinary tract infection. We summarize the initial clinical manifestations and pertinent laboratory, radiologic, and clinical findings in an elderly patient with hyperglycemic emergency. A review of the documents involving pancreatic tumors and hyperglycemic hyperosmolar state, which is an acute complication of diabetes mellitus, is presented. In the absence of other identifiable conditions, it is reasonable to speculate that some factor (or factors) produced by the tumor had a role in the metabolic decompensation. In addition, this discussion should be more carefully considered in the aged people group.
Aged ; Diabetes Mellitus ; Emergencies ; Humans ; Pancreatic Neoplasms ; Urinary Tract Infections

No abstract available.
Catheterization ; Catheters ; Jugular Veins ; Paralysis