Purpose: In the treatment of concurrent chemoradiotherapy (CCRT) in limited-stage small cell lung cancer, the optimal once-daily radiotherapy (RT) dose/fractionation remain unclear although it is the most frequently used. Therefore, this study aimed to compare the treatment outcomes and toxicities of modest dose RT (≤ 54 Gy) with those of standard dose RT (> 54 Gy) and investigate the benefit of the high dose based on patient factors. Materials and Methods: Since 2004, our institution has gradually increased the thoracic RT dose. Among the 225 patients who underwent CCRT, 84 patients (37.3%) received > 54 Gy. Because the patients treated with RT > 54 Gy were not randomly assigned, propensity score matching (PSM) was performed. Results: The proportion of patients treated with > 54 Gy increased over time (p=0.014). Multivariate analysis revealed that the overall tumor stage and dose > 54 Gy (hazard ratio, 0.65; p=0.029) were independent prognostic factors for overall survival (OS). PSM confirmed that thoracic RT doses of > 54 Gy showed significantly improved progression-free survival (3-year, 42.7% vs. 24.0%; p < 0.001) and OS (3-year, 56.2% vs. 38.5%; p=0.003). Sensitivity analysis also showed that 60 Gy resulted in better survival than 54 Gy. However, in patients with underlying lung disease, OS benefit from > 54 Gy was not observed but considerable rates of severe pulmonary toxicities were observed (p=0.001). Conclusion Our analysis supports that the 60 Gy RT dose should be considered in the once-daily regimen of CCRT for limited-stage small cell lung cancer without underlying lung disease, but RT dose > 54 Gy did not seem to benefit for patients with chronic obstructive pulmonary disease or interstitial lung disease. Further study is needed to validate these results.

. The findings indicate that analog facebow transfer produced a linear deviation ranging from 3 to 16 mm and an angular deviation of the occlusal plane between 5 to 7 degrees. This case report confirms that, across two patients, analog facebow transfer can result in varying degrees of positional deviation, thereby potentially leading to inaccuracies in the fabrication of dental pros-theses. These results suggest that, in clinical practice, the use of analog facebow transfer may yield significant deviations during the process of mounting maxillary casts.

Background/Aims: We examined the efficacy and safety of tegoprazan as a part of first-line triple therapy for Helicobacter pylori eradication. Methods: A randomized, double-blind, controlled, multicenter study was performed to evaluate whether tegoprazan (50 mg)-based triple therapy (TPZ) was noninferior to lansoprazole (30 mg)-based triple therapy (LPZ) (with amoxicillin 1 g and clarithromycin 500 mg; all administered twice daily for 7 days) for treating H. pylori. The primary endpoint was the H. pylori eradication rate. Subgroup analyses were performed according to the cytochrome P450 (CYP) 2C19 genotype, the minimum inhibitory concentration (MIC) of amoxicillin and clarithromycin, and underlying gastric diseases. Results: In total, 350 H. pylori-positive patients were randomly allocated to the TPZ or LPZ group. The H. pylori eradication rates in the TPZ and LPZ groups were 62.86% (110/175) and 60.57% (106/175) in an intention-to-treat analysis and 69.33% (104/150) and 67.33% (101/150) in a per-protocol analysis (non-inferiority test, p=0.009 and p=0.013), respectively. Subgroup analyses according to MICs or CYP2C19 did not show remarkable differences in eradication rate. Both first-line triple therapies were well-tolerated with no notable differences. Conclusions TPZ is as effective as proton pump inhibitor-based triple therapy and is as safe as first-line H. pylori eradication therapy but does not overcome the clarithromycin resistance of H. pylori in Korea

BACKGROUND: There have been few studies to evaluate the prognostic implications of guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately. METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed. Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist. RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.95), mortality (HR, 0.41; 95% CI, 0.24–0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36–0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41–0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47–0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint. CONCLUSION: The prognostic implications of adherence to guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.
Angiotensins ; Cohort Studies ; Heart Failure ; Heart ; Humans ; Mortality ; Receptors, Mineralocorticoid

OBJECTIVE: Glyphosate intoxicated patients are increasing as glyphosate use increases. This study was conducted to analyze clinical characteristics of glyphosate intoxication patients to provide early treatment to high risk patients. METHODS: We retrospectively collected data pertaining to glyphosate intoxicated patients who visited emergency department from January 2012 to December 2016 based on medical records. The patients were divided into survivors and deaths, after which their clinical characteristics and laboratory results were compared. RESULTS: Among 84 glyphosate intoxicated patients, 12 died (14.3%). The mortality group showed advanced age (P=0.006), low blood pressure (P=0.001), worse mental status (P=0.000), low arterial blood pH (P=0.000), high serum creatinine (P=0.030), high glucose (P=0.000), high serum lactate (P=0.011), and low serum albumin (P=0.034). Logistic multivariate regression analysis revealed that the mortality group had advanced age (odds ratio [OR], 1.193), high serum glucose (OR, 1.018), and low systolic blood pressure (OR, 0.961) compared to the survivor group. CONCLUSION: On the scene and emergency department, glyphosate intoxicated patients with advanced age, high serum glucose level, and low systolic blood pressure should be provided early supportive treatments and transported to a toxicology facility.
Blood Glucose ; Blood Pressure ; Creatinine ; Emergency Service, Hospital ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Lactic Acid ; Medical Records ; Mortality ; Retrospective Studies ; Serum Albumin ; Survivors ; Toxicology

We report a case of difficult endotracheal intubation in a patient with tracheobronchopathia osteochondroplastica. A 65-year-old man was scheduled to undergo ulnar nerve decompression and ganglion excisional biopsy under general anesthesia. During induction of general anesthesia, an endotracheal tube could not be advanced through the vocal cords due to resistance. A large number of nodules were identified below the vocal cords using a Glidescope® video-laryngoscopy, and fiberoptic bronchoscopy revealed irregular nodules on the surface of the entire trachea and the main bronchus below the vocal cords. Use of a small endotracheal tube was attempted and failed. a laryngeal mask airway (LMA Supreme ™) rather than further intubation was successfully used to maintain the airway.
Aged ; Anesthesia, General ; Biopsy ; Bronchi ; Bronchoscopy ; Decompression ; Ganglion Cysts ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks* ; Trachea ; Ulnar Nerve ; Vocal Cords

No abstract available.
Brain ; Brain Abscess ; Lateral Sinus Thrombosis ; Otitis ; Otitis Media ; Petrositis ; Transverse Sinuses

No abstract available.
Brain ; Brain Abscess ; Lateral Sinus Thrombosis ; Otitis ; Otitis Media ; Petrositis ; Transverse Sinuses

BACKGROUND: This study was to verify the necessity of a control program developed to improve compliance, by conducting a research on the status of medication compliance in the elderly with chronic diseases in rural area and analyzing the related variables. METHODS: The organized questionnaire and pill-count were used to collect information on personal details, physical status, drugs taken in the elderly over 65 years old suffering from more than two chronic diseases in one rural area. RESULTS: The mean age of the subjects was 73.13+/-6.36 (65~93), and the number of the subjects in compliance group was 60 (77.9%) and the accuracy of self-report which was identified by pill-count was 0.86. Polypharmacy and visiting several clinics were the main factors that decided a low- degree of compliance, with OR of 5.92 (95% CI 1.11~31.44, P=0.037), and 4.25 (95% CI 1.03~17.53, P=0.045), respectively. CONCLUSION: Systematic efforts are necessary and plans must be established without delay to increase compliance in the elderly in the rural, expansively to manage chronic diseases in stay-at-home elders.
Aged ; Chronic Disease ; Compliance ; Humans ; Medication Adherence ; Polypharmacy ; Republic of Korea ; Stress, Psychological ; Surveys and Questionnaires

PURPOSE: The nose of most Koreans is characterized as a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a modified septal extension graft, along with augmentation rhinoplasty has been developed. METHODS: With this technique, a septal extension graft is fixed on the entire caudal margin of the septum (the cephalic-caudal axis) and at the same time, it is placed above the anterior nasal spine, in the membranous portion of the septum and at the base of the columella(the anterior-posterior axis). The present report describes the results obtained in 13 patients and offers an analysis of the results as judged by the columella- labial angle and 4 proportional indices(nose height index, nasal bridge length index, nasal tip projection index, columella length index), measured by photogrammetry. RESULTS: The postoperative values obtained in these 5 categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally and lengthened. Moreover, these positive outcomes were still maintained during the follow-up period, and no side effects, such as saddle nose deformity, were reported. CONCLUSION: A modified septal extension graft can be considered as an effective method for the surgical correction of the nasal tip and columella in Koreans.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Nose ; Photogrammetry ; Rhinoplasty ; Spine ; Transplants*