Purpose: This study evaluated the treatment outcomes of benign and malignant tumors of the foot to establish the treatment guidelines for foot tumors. Materials and Methods: Eighty-three (41 male and 42 female) cases were included in the study. All patients were treated in a single institution from January 2006 to December 2022. The mean age was 43 years (range, 12–92). The mean follow-up period was 91 months (range, 5–208 months). The location of the tumor, recurrence following surgery, histologic diagnosis, overall five-year survival rate, and disease-specific five-year survival rate were evaluated. The oncologic results were analyzed at the final follow-up. Results: Benign tumors were found in 60 cases and malignant tumors were found in 23 cases. The 41 male cases composed 25 cases of benign tumors and 16 cases of malignant tumors. The 42 female cases composed 35 cases of benign tumors and seven cases of malignant tumors. The tumor locations were 61 cases in the forefoot, five in the midfoot, and 17 in the hindfoot. Reoperation was performed in two cases due to recurrence. An un-planned excision was done in two cases, which led to secondary wide resections. The overall five-year survival rate was 65.9% (58.3% in males and 85.7% in females). The disease-specific five-year survival rate was 62.3% (62.5% in males and 66.7% in females). The oncologic outcomes of 23 malignant cases were continuous disease-free in 16 cases and died of disease in seven cases at the final follow-up. Conclusion Benign foot tumors were dominant (72%) in this study. The preferred location was the forefoot, with statistical significance (p<0.05). There were no statistical significant differences between males and females (p>0.05). This study provides the guidelines for treating benign and malignant foot tumors by analyzing the treatment and oncologic outcomes.

Purpose: This study evaluated the treatment outcomes of benign and malignant tumors of the foot to establish the treatment guidelines for foot tumors. Materials and Methods: Eighty-three (41 male and 42 female) cases were included in the study. All patients were treated in a single institution from January 2006 to December 2022. The mean age was 43 years (range, 12–92). The mean follow-up period was 91 months (range, 5–208 months). The location of the tumor, recurrence following surgery, histologic diagnosis, overall five-year survival rate, and disease-specific five-year survival rate were evaluated. The oncologic results were analyzed at the final follow-up. Results: Benign tumors were found in 60 cases and malignant tumors were found in 23 cases. The 41 male cases composed 25 cases of benign tumors and 16 cases of malignant tumors. The 42 female cases composed 35 cases of benign tumors and seven cases of malignant tumors. The tumor locations were 61 cases in the forefoot, five in the midfoot, and 17 in the hindfoot. Reoperation was performed in two cases due to recurrence. An un-planned excision was done in two cases, which led to secondary wide resections. The overall five-year survival rate was 65.9% (58.3% in males and 85.7% in females). The disease-specific five-year survival rate was 62.3% (62.5% in males and 66.7% in females). The oncologic outcomes of 23 malignant cases were continuous disease-free in 16 cases and died of disease in seven cases at the final follow-up. Conclusion Benign foot tumors were dominant (72%) in this study. The preferred location was the forefoot, with statistical significance (p<0.05). There were no statistical significant differences between males and females (p>0.05). This study provides the guidelines for treating benign and malignant foot tumors by analyzing the treatment and oncologic outcomes.

Purpose: This study evaluated the treatment outcomes of benign and malignant tumors of the foot to establish the treatment guidelines for foot tumors. Materials and Methods: Eighty-three (41 male and 42 female) cases were included in the study. All patients were treated in a single institution from January 2006 to December 2022. The mean age was 43 years (range, 12–92). The mean follow-up period was 91 months (range, 5–208 months). The location of the tumor, recurrence following surgery, histologic diagnosis, overall five-year survival rate, and disease-specific five-year survival rate were evaluated. The oncologic results were analyzed at the final follow-up. Results: Benign tumors were found in 60 cases and malignant tumors were found in 23 cases. The 41 male cases composed 25 cases of benign tumors and 16 cases of malignant tumors. The 42 female cases composed 35 cases of benign tumors and seven cases of malignant tumors. The tumor locations were 61 cases in the forefoot, five in the midfoot, and 17 in the hindfoot. Reoperation was performed in two cases due to recurrence. An un-planned excision was done in two cases, which led to secondary wide resections. The overall five-year survival rate was 65.9% (58.3% in males and 85.7% in females). The disease-specific five-year survival rate was 62.3% (62.5% in males and 66.7% in females). The oncologic outcomes of 23 malignant cases were continuous disease-free in 16 cases and died of disease in seven cases at the final follow-up. Conclusion Benign foot tumors were dominant (72%) in this study. The preferred location was the forefoot, with statistical significance (p<0.05). There were no statistical significant differences between males and females (p>0.05). This study provides the guidelines for treating benign and malignant foot tumors by analyzing the treatment and oncologic outcomes.

Background: The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented. Methods: We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values. Results: The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, −5%; 95% CI, −13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value (P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, −8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, −2%; 95% CI, −3 to −1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001). Conclusions In 2020, the incidence rate of hip fracture did not significantly decrease, and inhospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.

Background: This study compared the effects of hip fractures on mortality according to sex and age in a nationwide cohort of elderly patients with hip fractures and controls. Methods: Patients with hip fractures and matched controls were selected from the National Health Insurance Service-Senior cohort. Time-dependent propensity score matching was estimated from a Cox proportional hazards model with January 1, 2005, as the baseline and hip fracture as an event. Patients were matched by age and sex to participants at risk of developing a hip fracture at time zero. The effect size is presented as hazard ratio (HR) using a Cox proportional hazards model with a robust variance estimator that accounts for clustering within the matched pairs. Results: Altogether, 14,283 patients with incident hip fractures and 28,566 matched controls were identified. The HR of male sex in hip fractures was 1.31 (95% confidence interval [CI], 1.22−1.40; Pinteraction<0.01). Moreover, the HR of age group in hip fractures was 0.73 (95% CI, 0.66−0.80; Pinteraction<0.01) between the 65 to 74 and 75 to 84 years groups, 0.76 (95% CI, 0.71−0.81; Pinteraction<0.01) between the 75 to 84 and ≥85 years groups, and 0.55 (95% CI, 0.50−0.61; Pinteraction<0.01) between the 65 to 74 and ≥85 years groups. Conclusions Male sex increases the risk of death in elderly patients with hip fractures versus matched controls, but the increased risk of death with age in hip fractures was decreased compared to that in matched controls.

Objective: We investigated the effects of a quick Sequential Organ Failure Assessment (qSOFA)–negative result (qSOFA score <2 points) at triage on the compliance with sepsis bundles among patients with sepsis who presented to the emergency department (ED). Methods: Prospective sepsis registry data from 11 urban tertiary hospital EDs between October 2015 and April 2018 were retrospectively reviewed. Patients who met the Third International Consensus Definitions for Sepsis and Septic Shock criteria were included. Primary exposure was defined as a qSOFA score ≥2 points at ED triage. The primary outcome was defined as 3-hour bundle compliance, including lactate measurement, blood culture, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration. Multivariate logistic regression analysis to predict 3-hour bundle compliance was performed. Results: Among the 2,250 patients enrolled in the registry, 2,087 fulfilled the sepsis criteria. Only 31.4% (656/2,087) of the sepsis patients had qSOFA scores ≥2 points at triage. Patients with qSOFA scores <2 points had lower lactate levels, lower SOFA scores, and a lower 28-day mortality rate. Rates of compliance with lactate measurement (adjusted odds ratio [aOR], 0.47; 95% confidence interval [CI], 0.29–0.75), antibiotics administration (aOR, 0.64; 95% CI, 0.52–0.78), and 30 mL/kg crystalloid administration (aOR, 0.62; 95% CI, 0.49–0.77) within 3 hours from triage were significantly lower in patients with qSOFA scores <2 points. However, the rate of compliance with blood culture within 3 hours from triage (aOR, 1.66; 95% CI, 1.33–2.08) was higher in patients with qSOFA scores <2 points. Conclusion A qSOFA-negative result at ED triage is associated with low compliance with lactate measurement, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration within 3 hours in sepsis patients.

Background: The aim of this study was to investigate the incidence rate of suicide deaths in elderly patients with pelvic fractures using a nationwide database and to analyze change in the risk of suicide death overtime after pelvic fractures compared to controls. Methods: We used the National Health Insurance Service-Senior cohort (NHIS-Senior) of South Korea. Cases and controls were matched for sex, age, history of hospital admission within 1 year, and presence of depression on the date of suicide death. Controls were collected by random selection at a 1 : 5 ratio from patients at risk of becoming cases when suicide cases were collected. Incident pelvic fractures were identified from the NHIS-Senior as follows: first admission during the observational period (2002–2015) to an acute care hospital with a diagnostic code of International Statistical Classification of Diseases and Related Health Problems, 10th revision S321, S322, S323, S324, S325, or S328 and age 65–99 years. Conditional logistic regression analysis was performed to evaluate the association between pelvic fractures and the risk of suicide death. Results: A total of 2,863 suicide cases and 14,315 controls were identified. Suicide case patients had been more frequently exposed to steroids (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.21–1.45), benzodiazepines (OR, 1.76; 95% CI, 1.61–1.93), and non-steroidal anti-inflammatory drugs (OR, 1.18; 95% CI, 1.07–1.29). Pelvic fractures within 1 year from the date of suicide death were statistically significantly associated with increased risk of suicide (adjusted OR [AOR], 2.65; 95% CI, 1.29–5.45; p = 0.008) compared to controls. The risk of suicide death declined as the incidence date of pelvic fracture was more remote from the date of suicide death: AORs of 2.59 (95% CI, 1.33–5.04; p = 0.005) within 2 years and 2.13 (95% CI, 1.15–3.95; p = 0.017) within 3 years. However, there was no statistical significance in the increased risk of suicide death for pelvic fractures that had occurred ≥ 4 years ago (p > 0.05). Conclusions Pelvic fractures in the elderly population increased the risk of suicide death within 3 years, suggesting the need for psychiatric support among elderly patients with pelvic fractures.

Background: The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. Methods: We used the National Health Insurance Service-Senior cohort of South Korea.Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. Results: Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57–4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04–2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74–2.77; P = 0.282). Conclusion There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

Background: The purpose of study was to investigate the incidence rate of suicide in elderly patients with osteoporotic fractures in a nested case-control model and to analyze the change in the risk of suicide death over time after each osteoporotic fracture. Methods: We used the National Health Insurance Service-Senior cohort of South Korea.Suicide cases and controls were matched based on sex and age at the index date. Controls were randomly selected at a 1:5 ratio from the set of individuals who were at risk of becoming a case at the time when suicide cases were selected. Conditional logistic regression analysis was performed to evaluate the association between each type of osteoporotic fracture and the risk of suicide death. Results: Three thousand seventy suicide cases and 15,350 controls were identified. Patients with hip fracture showed an increased risk of suicide death within 1 year of fracture (adjusted odds ratio [aOR] = 2.64; 95% confidence interval [CI], 1.57–4.46; P < 0.001) compared to controls. However, the increased risk of suicide death in patients with hip fracture lasted up to 2 years (aOR = 1.59; 95% CI, 1.04–2.41; P = 0.031). Spine fracture increased the risk of suicide deaths for all observation periods. There was no evidence that humerus fracture increased the risk of suicide death during the observational period. Radius fracture increased only the risk of suicide death within 2 years of fracture (aOR = 1.43; 95% CI, 0.74–2.77; P = 0.282). Conclusion There were noticeable differences in both degree and duration of increased suicide risks depending on the type of osteoporotic fracture. Mental stress and suicide risk in elderly patients after osteoporotic fracture should be assessed differently depending on the types of fracture.

Background: Insulin resistance (IR) and inflammation are closely related to each other and share common pathophysiological and metabolic mechanisms. We aimed to investigate the combined effect of IR and inflammation on comorbidities of type 2 diabetes mellitus (T2DM). Methods: A total 3,758 patients with T2DM were recruited through Huh’s Diabetes Center from January 2003 to June 2009. Insulin sensitivity was measured by a rate constant for plasma glucose disappearance (Kitt , %/min) using short insulin tolerance test. High sensitivity C-reactive protein (hs-CRP) was used as a surrogate for inflammation. Results: Patients with the lowest tertile of Kitt (IR group) showed worse cardio-metabolic parameters while those with the highest tertile of hs-CRP levels had worse cardio-metabolic parameters. The prevalence of metabolic syndrome, fatty liver, albuminuria, and carotid atherosclerosis decreased with Kitt tertile, but increased with hs-CRP tertile. In multiple regression analysis, both Kitt and hs-CRP were independent risk factors for comorbidities of T2DM. In addition, they showed synergistic effects on these comorbidities. Conclusion Both IR and inflammation were significantly associated with comorbidities of T2DM in a dose dependent manner. In addition, the coexistence of IR and inflammation may synergistically contribute to increased comorbidities of T2DM.