Background: This study aimed to examine trends in postoperative survival and surgical methods over a 25-year period in patients surgically treated for metastatic spinal tumors. Methods: We performed a retrospective study of patients who underwent surgical treatment for metastatic spinal tumors between 1996 and 2020. For trend analysis, the study cohort was divided into three groups according to the year of surgery: 1996– 2004, 2005–2012, and 2013–2020. A Kaplan-Meier survival analysis was performed to examine survival, and the log-rank test was used to compare the survival of the top six common cancers among the periods. The surgical methods were grouped and examined as follows: fixation only, palliative decompression and fixation, gross total removal and fixation, and total en bloc spondylectomy. Results: This study included a total of 608 patients. There were 78 patients in 1996–2004, 236 in 2005–2012, and 294 in 2013– 2020. Regarding the overall survival trend, the group 2013–2020 had a significantly improved survival as compared to the other two groups (p < 0.001). According to specific cancer sites, significant survival improvement was observed in patients with lung, kidney, and breast cancers (p < 0.001, p < 0.001, and p = 0.022, respectively). There were no significant changes in the primary sites of the liver, colorectum, or prostate. Regarding surgical methods, the proportion of gross total tumor removal declined, whereas the proportion of palliative decompression and fixation and fixation only procedures increased. Conclusions During the past 25 years, significant survival improvement was observed in patients with lung, kidney, and breast cancers. There was no improvement in survival in patients with liver, colorectal, and prostate cancers. In terms of surgical techniques, palliative decompression and fixation only procedures increased, while gross total tumor removal declined

Background/Aims: The aim of this study was to investigate long-term post-discontinuation outcomes in patients with rheumatoid arthritis (RA) who had been treated with tumor necrosis factor-α inhibitors (TNF-αi) which was then discontinued. Methods: Sixty Korean patients with RA who participated in a 5-year GO-BEFORE and GO-FORWARD extension trials were included in this retrospective study. Golimumab was deliberately discontinued after the extension study (baseline). Patients were then followed by their rheumatologists. We reviewed their medical records for 2 years (max 28 months) following golimumab discontinuation. Patients were divided into a maintained benefit (MB) group and a loss-of-benefit (LB) group based on treatment pattern after golimumab discontinuation. The LB group included patients whose conventional disease-modifying antirheumatic drug(s) were stepped-up or added/switched (SC) and those who restarted biologic therapy (RB). Results: The mean age of patients at baseline was 56.5 years and 55 (91.7%) were females. At the end of follow-up, 23 (38.3%) patients remained in the MB group. In the LB group, 75.7% and 24.3% were assigned into SC and RB subgroups, respectively. Fifty percent of patients lost MB after 23.3 months. Demographics and clinical variables at baseline were comparable between MB and LB groups except for age, C-reactive protein level, and corticosteroid use. Restarting biologic therapy was associated with swollen joint count (adjusted hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.01 to 3.55) and disease duration (adjusted HR, 1.12; 95% CI, 1.02 to 1.23) at baseline. Conclusions Treatment strategies after discontinuing TNF-αi are needed to better maintain disease control and quality of life of patients with RA.

Objective: Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. Materials and Methods: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. Results: A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. Conclusion Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.

BACKGROUND: To evaluate the therapeutic benefits of the treat-to-target (T2T) strategy for Asian patients with early rheumatoid arthritis (RA) in Korea. METHODS: In a 1-year, multicenter, open-label strategy trial, 346 patients with early RA were recruited from 20 institutions across Korea and stratified into 2 groups, depending on whether they were recruited by rheumatologists who have adopted the T2T strategy (T2T group) or by rheumatologists who provided usual care (non-T2T group). Data regarding demographics, rheumatoid factor titer, anti-cyclic citrullinated peptide antibody titer, disease activity score of 28 joints (DAS28), and Korean Health Assessment Questionnaire (KHAQ) score were obtained at baseline and after 1 year of treatment. In the T2T group, the prescription for disease-modifying antirheumatic drugs was tailored to the predefined treatment target in each patient, namely remission (DAS28 < 2.6) or low disease activity (LDA) (2.6 ≤ DAS28 < 3.2). RESULTS: Data were available for 163 T2T patients and 162 non-T2T patients. At the end of the study period, clinical outcomes were better in the T2T group than in the non-T2T group (LDA or remission, 59.5% vs. 35.8%; P < 0.001; remission, 43.6% vs. 19.8%; P < 0.001). Compared with non-T2T, T2T was also associated with higher rate of good European League Against Rheumatism response (63.0% vs. 39.8%; P < 0.001), improved KHAQ scores (−0.38 vs. −0.13; P = 0.008), and higher frequency of follow-up visits (5.0 vs. 2.0 visits/year; P < 0.001). CONCLUSION: In Asian patients with early RA, T2T improves disease activity and physical function. Setting a pre-defined treatment target in terms of DAS28 is recommended.
Antirheumatic Agents ; Arthritis, Rheumatoid* ; Asian Continental Ancestry Group* ; Demography ; Follow-Up Studies ; Humans ; Joints ; Korea* ; Multicenter Studies as Topic* ; Prescriptions ; Rheumatic Diseases ; Rheumatoid Factor ; Treatment Outcome

BACKGROUND AND PURPOSE: The diagnostic accuracy for unruptured intracranial aneurysms has increased, and incidental asymptomatic aneurysms have come to represent a substantial clinical burden because of their controversial natural history. However, their prevalence may be attributable to variations in evaluation methods and demographics. We therefore describe the prevalence and magnetic resonance angiography (MRA) findings of incidental intracranial saccular aneurysms over a 5-year period at a single large-volume center. METHODS: MRA images from 18,237 patients obtained between January 2001 and December 2005 were retrieved from the radiology report database. Patients diagnosed with incidental intracranial saccular aneurysms were identified and their MRA data were reviewed. Imaging and clinical follow-up data were evaluated. RESULTS: During the study period, 366 incidental intracranial saccular aneurysms were identified in 330 patients (prevalence, 1.8%; 95% confidence interval, 1.63%-2.01%; 115 men and 215 women; age range, 22-82 years; median age, 63 years). The prevalence was higher in women (215/8,112) than in men (115/10,125; P=0.02). The prevalence increased with age in women (P<0.01), but not in men (P=0.30). Aneurysm size ranged from 1.5 mm to 13 mm, with a median size of 4 mm. The most common location was the bifurcation of the middle cerebral artery (131/366; 35.8%). CONCLUSIONS: Our real world experience indicated a slightly lower overall prevalence of incidental intracranial saccular aneurysms than previously reported. The prevalence increased with age in women but not in men.
Aneurysm* ; Angiography* ; Demography ; Female ; Follow-Up Studies ; Head* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Male ; Middle Cerebral Artery ; Natural History ; Prevalence

BACKGROUND AND PURPOSE: The diagnostic accuracy for unruptured intracranial aneurysms has increased, and incidental asymptomatic aneurysms have come to represent a substantial clinical burden because of their controversial natural history. However, their prevalence may be attributable to variations in evaluation methods and demographics. We therefore describe the prevalence and magnetic resonance angiography (MRA) findings of incidental intracranial saccular aneurysms over a 5-year period at a single large-volume center. METHODS: MRA images from 18,237 patients obtained between January 2001 and December 2005 were retrieved from the radiology report database. Patients diagnosed with incidental intracranial saccular aneurysms were identified and their MRA data were reviewed. Imaging and clinical follow-up data were evaluated. RESULTS: During the study period, 366 incidental intracranial saccular aneurysms were identified in 330 patients (prevalence, 1.8%; 95% confidence interval, 1.63%-2.01%; 115 men and 215 women; age range, 22-82 years; median age, 63 years). The prevalence was higher in women (215/8,112) than in men (115/10,125; P=0.02). The prevalence increased with age in women (P<0.01), but not in men (P=0.30). Aneurysm size ranged from 1.5 mm to 13 mm, with a median size of 4 mm. The most common location was the bifurcation of the middle cerebral artery (131/366; 35.8%). CONCLUSIONS: Our real world experience indicated a slightly lower overall prevalence of incidental intracranial saccular aneurysms than previously reported. The prevalence increased with age in women but not in men.
Aneurysm* ; Angiography* ; Demography ; Female ; Follow-Up Studies ; Head* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Male ; Middle Cerebral Artery ; Natural History ; Prevalence

OBJECTIVES: Exposure to second-hand smoke varied by smoking rate in the workplace and no-smoking policies. The purpose of this study was to estimate the status of second-hand smoke exposure by occupation through urine cotinine analysis in Busan, Ulsan, and Kyeongnam provinces. METHODS: Data was obtained from the National Institute of Environmental Research of Korea as 'The 2008 Korea National Survey for Environmental Pollutants in Human Body'. We selected 629 non-smokers who lived in Busan, Ulsan and Gyeongnam provinces. General and occupational characteristics were gathered using a structured questionnaire. Urine cotinine concentrations were analyzed by a gas chromatograph-mass selective detector. Statistical analysis was carried out using the Chi-square test, Student t-test and ANOVA. RESULTS: The geometric mean (geometric standard deviation) of urine cotinine concentration was 17.11 (2.74) ng/ml. The urine cotinine concentration of the middle school graduate group (18.47 (2.86) ng/ml) was higher than the college graduate group (15.64 (2.60) ng/ml, p=0.212). Also, the cotinine concentration of current drinkers (18.98 (2.47) ng/ml) was higher than non-drinkers (16.15 (2.88) ng/ml, p=0.054). The proportion who smelled smoke was higher in workers (38.5%) than in non-workers (29.7%, p=0.02). Therefore, urine cotinine concentration was higher in workers (17.29 (2.66) ng/ml) than in non-workers (16.97 (2.81) ng/ml) but not at a statistically significant amount (p=0.826). In addition, cotinine concentration between the group who smelled smoke (20.45 (2.42) ng/ml) and the group who did not smelled smoke (15.53 (2.78) ng/ml) was significantly different (p=0.016) in workers but not in non-workers (17.08 (2.42) ng/ml vs 16.92 (2.98) ng/ml, p=0.942). According to the National Center for Health Statistics occupational categories in the US and the Korea Standard Classification of Occupations, the urine cotinine concentration of white collar workers such as technical workers and administrators, professional specialists, and managers was higher (18.01 (2.55) ng/ml) than that of blue collar workers such as plant and machine operators and assemblers, elementary occupations, and craft and related trades workers (15.36 (3.48) ng/ml). CONCLUSIONS: The workplace is an important contributor to second-hand smoke exposure in Busan, Ulsan and Kyeongnam provinces. Unlike in advanced countries, where anti-smoking policies have been implemented, urine cotinine concentration in people in Busan, Ulsan and Kyeongnam provinces was higher in the white collar group than in the blue collar group. This result might be due to a higher indoor second-hand smoking rate of workplaces in these areas. Further studies are needed to evaluate the correlation between regional characteristics of industries, anti-smoking policies in the workplace, smoking rates and urine cotinine concentrations of workers.
Administrative Personnel ; Cotinine ; Environmental Pollutants ; Humans ; Korea ; National Center for Health Statistics (U.S.) ; Occupations ; Plants ; Questionnaires ; Smell ; Smoke ; Smoking ; Specialization

Neoplastic lymphoid cells of chronic lymphocytic leukemia (CLL) typically co-express CD5 and CD23. CD5-negative CLL is a rare variant of CLL; only 1 case of it has been reported in Korea. We describe a case of CD5-negative CLL. A 48-year-old female complained of a palpable neck mass that had been present for over 1 year. The initial WBC count was 7,300/microliter, with 69% lymphocytes. A CT scan revealed multiple enlarged lymph nodes, both of each in the neck, axilla, and common iliac areas. The athologic results of the cervical lymph node was consistent with small lymphocytic lymphoma, of which tumor cells do not express CD5. In a bone marrow study, neoplastic lymphoid cells comprise 34.8% of all nucleated cells, which showed small size, round nuclei with clumped chromatin, and sparse cytoplasm. Immunophenotyping of small lymphoid cells displayed phenotypes that were CD45-, CD23-, CD20-, and CD19-positive, but CD5-negative. The patient was diagnosed with CD5-negative CLL, and has been followed up for 2.5 years after chemotherapy.
Antigens, CD5 ; Axilla ; Bone Marrow ; Chromatin ; Cytoplasm ; Female ; Humans ; Immunophenotyping ; Korea ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymph Nodes ; Lymphocytes ; Middle Aged ; Neck ; Phenotype

PURPOSE: To design a reliable and quick lesion volume estimation method for hyperintensities on diffusion-weighted images (DWI) for the evaluation of hyperacute stroke. MATERIALS AND METHODS: Twenty patients with obvious high signal lesions seen on DWI in the middle cerebral artery territory due to acute ischemia were enrolled to evaluate the performance of four tentatively designed semi-quantitative methods: the 25-area method, the 20-area method, the 10-area method, and the modified 10-area method. Two radiologists performed the volume analyses using these methods. Intraclass correlation coefficients were calculated to compare the correlation between the reference values and the measured values and to evaluate the interobserver agreement of each method. RESULTS: For the correlation between the measured value and the reference value, the performance of the modified 10-area method was the most powerful, with a value of 0.8981 and 0.8090 for observer 1 and 2, respectively. The interobserver agreement was satisfactory for both the 25-area method and the modified 10-area method, with a value of 0.9212 (95% CI: 0.8123-0.9681) and 0.9063 (95% CI: 0.7790-0.9618), respectively. CONCLUSION: The performance of the modified 10-area method was satisfactory for both lesion volume estimation and interobserver correlation in the evaluation of an acute cerebral infarction by the use of DWI.
Cerebral Infarction* ; Humans ; Ischemia ; Middle Cerebral Artery ; Reference Values ; Stroke

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.
Abscess ; Aminoglycosides ; Anti-Bacterial Agents ; Diagnosis ; Dysuria ; Fever ; Follow-Up Studies ; Hematuria ; Humans ; Incidence ; Korea ; Massage ; Patient Admission ; Prostate ; Prostate-Specific Antigen ; Prostatitis* ; Pyuria ; Retrospective Studies ; Urinalysis