Purpose: There is a high possibility of trauma patients being referred to an unsuitable medical institution for their rehabilitation treatment since the decision is made by them. This study sought to develop a standardized scale to evaluate the need for specialized rehabilitation in patients with multiple traumas and evaluate the effectiveness of the developed scale. Methods: This study employed a systematic review of existing literature to inform the development of a specialized rehabilitation evaluation scale. An expert panel consisting of trauma surgeons, orthopedic surgeons, and rehabilitation medicine physicians collaborated to create a discharge-planning checklist by assessing the need for specialized rehabilitation. The checklist was validated using retrospective data from trauma patients treated at Seoul National University Hospital. Results: We identified 12 studies, providing factors influencing the discharge location and rehabilitation needs of trauma patients. The checklist was developed through expert consensus and comprised 3 criteria: discharge feasibility to specialized rehabilitation facilities, diagnostic eligibility for specialized rehabilitation, and functional assessment. Validation of the checklist demonstrated that the percentage agreement, likelihood ratio of a positive test, and Cohen’s kappa value were 82.1%, 5.21, and 0.375, respectively when comparing whether the checklist was met and the actual discharge location, indicating its effectiveness. Conclusion This study established standardized criteria for assessing the need for specialized rehabilitation in trauma patients, offering a practical tool for clinical use. Implementation of this assessment scale has the potential to improve the trajectory of trauma survivors by facilitating access to appropriate rehabilitation services.

Purpose: There is a high possibility of trauma patients being referred to an unsuitable medical institution for their rehabilitation treatment since the decision is made by them. This study sought to develop a standardized scale to evaluate the need for specialized rehabilitation in patients with multiple traumas and evaluate the effectiveness of the developed scale. Methods: This study employed a systematic review of existing literature to inform the development of a specialized rehabilitation evaluation scale. An expert panel consisting of trauma surgeons, orthopedic surgeons, and rehabilitation medicine physicians collaborated to create a discharge-planning checklist by assessing the need for specialized rehabilitation. The checklist was validated using retrospective data from trauma patients treated at Seoul National University Hospital. Results: We identified 12 studies, providing factors influencing the discharge location and rehabilitation needs of trauma patients. The checklist was developed through expert consensus and comprised 3 criteria: discharge feasibility to specialized rehabilitation facilities, diagnostic eligibility for specialized rehabilitation, and functional assessment. Validation of the checklist demonstrated that the percentage agreement, likelihood ratio of a positive test, and Cohen’s kappa value were 82.1%, 5.21, and 0.375, respectively when comparing whether the checklist was met and the actual discharge location, indicating its effectiveness. Conclusion This study established standardized criteria for assessing the need for specialized rehabilitation in trauma patients, offering a practical tool for clinical use. Implementation of this assessment scale has the potential to improve the trajectory of trauma survivors by facilitating access to appropriate rehabilitation services.

Purpose: There is a high possibility of trauma patients being referred to an unsuitable medical institution for their rehabilitation treatment since the decision is made by them. This study sought to develop a standardized scale to evaluate the need for specialized rehabilitation in patients with multiple traumas and evaluate the effectiveness of the developed scale. Methods: This study employed a systematic review of existing literature to inform the development of a specialized rehabilitation evaluation scale. An expert panel consisting of trauma surgeons, orthopedic surgeons, and rehabilitation medicine physicians collaborated to create a discharge-planning checklist by assessing the need for specialized rehabilitation. The checklist was validated using retrospective data from trauma patients treated at Seoul National University Hospital. Results: We identified 12 studies, providing factors influencing the discharge location and rehabilitation needs of trauma patients. The checklist was developed through expert consensus and comprised 3 criteria: discharge feasibility to specialized rehabilitation facilities, diagnostic eligibility for specialized rehabilitation, and functional assessment. Validation of the checklist demonstrated that the percentage agreement, likelihood ratio of a positive test, and Cohen’s kappa value were 82.1%, 5.21, and 0.375, respectively when comparing whether the checklist was met and the actual discharge location, indicating its effectiveness. Conclusion This study established standardized criteria for assessing the need for specialized rehabilitation in trauma patients, offering a practical tool for clinical use. Implementation of this assessment scale has the potential to improve the trajectory of trauma survivors by facilitating access to appropriate rehabilitation services.

: Immune checkpoint inhibitors (ICIs) are approved for treating non-small-cell lung cancer (NSCLC); however, the safety and efficacy of combined ICI and Gamma Knife radiosurgery (GKS) treatment remain undefined. In this study, we retrospectively analyzed patients treated with ICIs with or without GKS at our institute to manage patients with brain metastases from NSCLC. Methods : We retrospectively reviewed medical records of patients with brain metastases from NSCLC treated with ICIs between January 2015 and December 2017. Of 134 patients, 77 were assessable for brain responses and categorized into three groups as follows : group A, ICI alone (n=26); group B, ICI with concurrent GKS within 14 days (n=24); and group C, ICI with non-concurrent GKS (n=27). Results : The median follow-up duration after brain metastasis diagnosis was 19.1 months (range, 1–77). At the last follow-up, 53 patients (68.8%) died, 20 were alive, and four were lost to follow-up. The estimated median overall survival (OS) of all patients from the date of brain metastasis diagnosis was 20.0 months (95% confidence interval, 12.5–27.7) (10.0, 22.5, and 42.1 months in groups A, B, and C, respectively). The OS was shorter in group A than in group C (p=0.001). The intracranial disease progression-free survival (p=0.569), local progression-free survival (p=0.457), and complication rates did not significantly differ among the groups. Twelve patients showed leptomeningeal seeding (LMS) during follow-up. The 1-year LMS-free rate in treated with ICI alone group (69.1%) was significantly lower than that in treated with GKS before ICI treatment or within 14 days group (93.2%) (p=0.004). Conclusion : GKS with ICI showed no favorable OS outcome in treating brain metastasis from NSCLC. However, GKS with ICI did not increase the risk of complications. Furthermore, compared with ICI alone, GKS with ICI may be associated with a reduced incidence of LMS. Further understanding of the mechanism, which remains unknown, may help improve the quality of life of patients with brain metastasis.

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.
Aged ; Alzheimer Disease* ; Atrophy* ; Cognition Disorders ; Dementia* ; Diagnosis ; Humans ; Korea* ; Pemetrexed ; ROC Curve

Although the overall incidence of hepatitis A in Korea has been decreasing, adolescents remain highly vulnerable to its outbreaks. This study was conducted to compare the immunogenicity and safety of three hepatitis A vaccines in Korean adolescents. Healthy anti-hepatitis A virus seronegative subjects aged 13 to 19 yr were randomized in three equal groups to receive two doses of Avaxim(TM), Epaxal(R), or Havrix(R), 6 to 12 months apart. Seroconversion rates one month after the first dose were 98%, 95%, and 93% for Avaxim(TM), Epaxal(R), and Havrix(R), respectively. Seroconversion rates reached 100% for all vaccine groups one month after the second dose. Anti-HAV geometric mean concentrations (GMCs) were 7,207.7 mIU/mL (95% CI, 6023.1-8684.7), 1,750.5 mIU/mL (95% CI, 1362.9-2248.3), and 1,953.5 mIU/mL (95% CI, 1459.4-2614.7) after two doses of Avaxim(TM), Epaxal(R), and Havrix(R) respectively. Avaxim(TM) was significantly more immunogenic than Epaxal(R) and Havrix(R), whereas there were no significant differences in antibody responses between Epaxal(R) and Havrix(R). Local and systemic solicited adverse events (AEs) were mostly of mild-to-moderate intensity and resolved within 5 days. No serious AEs were reported. In conclusion, all three vaccines are highly immunogenic and well-tolerated in Korean adolescents. (Clinical Trial Registry NCT00483470)
Adolescent ; Antibody Formation ; Female ; Hepatitis A/immunology/*prevention & control ; Hepatitis A Antibodies/blood ; Hepatitis A Vaccines/adverse effects/*immunology ; Humans ; Male ; Republic of Korea ; Vaccines, Inactivated/adverse effects/immunology ; Young Adult

BACKGROUND/AIMS: Bloating is common bothersome symptoms and most studies conducted in the Western countries found that bloating was frequently associated with lower gastrointestinal (GI) symptoms but many patients complaint bloating as upper GI symptoms in the clinical setting. This study was conducted to assess the prevalence of bloating, and to identify symptom grouping and finally document the impact of bloating in the diagnosis of functional GI disorders. METHODS: Participants in a comprehensive health-screening cohort were enrolled. They were asked about demographic, medical, and social history and upper and lower GI symptoms by using a validated questionnaire. Factor analysis with principal component analysis method with varimax rotation was used. RESULTS: Among the total of 1050 subjects (mean age, 44.6 ± 10.2 years; females, 46.4%), significant bloating symptoms were found in 282 (26.9%); the prevalence of functional bloating was 6.9%. Factor analysis revealed a 5-component structure with upper GI symptoms, constipation, diarrhea-predominant irritable bowel syndrome (IBS), constipation-predominant IBS, and fecal incontinence. Abdominal bloating loaded on both the upper GI symptoms (0.51 of loadings) and constipation (0.40). On logistic regression analysis, bloating was more predictable for IBS (OR, 7.5; P < 0.001) than functional dyspepsia (FD; OR, 3.7; P = 0.002). Bloating was more frequently combined with IBS according to their severity, but this association was not detected in patients with FD. CONCLUSIONS: Abdominal bloating is common symptom in about a quarter of patients and appears as upper as well as lower GI symptoms. However, abdominal bloating is more predictable for IBS, especially constipation-predominant IBS, than FD.
Cohort Studies ; Constipation ; Diagnosis ; Dyspepsia ; Epidemiology ; Fecal Incontinence ; Female ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Logistic Models ; Methods ; Prevalence ; Principal Component Analysis

Radon is likely the second most common cause of lung cancer after smoking. We estimated the lung cancer risk due to radon using common risk models. Based on national radon survey data, we estimated the population-attributable fraction (PAF) and the number of lung cancer deaths attributable to radon. The exposure-age duration (EAD) and exposure-age concentration (EAC) models were used. The regional average indoor radon concentration was 37.5 95 Bq/m3. The PAF for lung cancer was 8.3% (European Pooling Study model), 13.5% in males and 20.4% in females by EAD model, and 19.5% in males and 28.2% in females by EAC model. Due to differences in smoking by gender, the PAF of radon-induced lung cancer deaths was higher in females. In the Republic of Korea, the risk of radon is not widely recognized. Thus, information about radon health risks is important and efforts are needed to decrease the associated health problems.
Adult ; Demography ; *Environmental Exposure ; Female ; Humans ; Lung Neoplasms/*epidemiology/etiology/mortality ; Male ; Models, Theoretical ; Neoplasms, Radiation-Induced/*epidemiology/etiology ; Radon/*toxicity ; Republic of Korea/epidemiology ; Risk Assessment ; Smoking ; Survival Analysis

The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (> or = SM2 or > or = 1,000 microm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with > or = SM2 or > or = 1,000 microm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.
Colectomy ; Colorectal Neoplasms/*pathology/surgery ; Endoscopy ; Female ; Humans ; Intestinal Polyps/surgery ; Lymphatic Metastasis ; Male ; Neoplasm Invasiveness

Hepatitis A can cause serious illness among adolescents and adults with low vaccination coverage. Even though hepatitis A vaccine is one of the strong candidates for Korean national immunization program, adolescents aged older than 12 yr would not benefit. Our purpose was to assess the willingness and analyze the correlates of Korean mothers for hepatitis A (HepA) vaccination to develop strategies for HepA vaccination. A national telephone survey on 800 mothers with children aged 7-18 yr was conducted with random-digit dialing method. Sixty-two percent and 92% of the mothers reported that they were willing to HepA vaccination at current cost and at half of the current cost, respectively. However, at current cost, only 79% wished to vaccinate their child in an epidemic and 32% wished to vaccinate promptly. Having two or more children, not having future plans to send the child overseas, and low family income were significantly associated with not willing to HepA vaccination. Low perception of the susceptibility for hepatitis A and perception of the current cost as barrier increased the odds of unwillingness to vaccination at current cost and to prompt vaccination. The mothers' willingness to HepA vaccination for the children aged 7-18 yr in Korea was not very high at current cost and associated socioeconomic status and health-belief. Targeted intervention or strategies are needed to increase the HepA vaccination rate among children in Korea.
Adolescent ; Adult ; Child ; Demography ; Female ; Health Status ; Health Surveys ; Hepatitis A/economics/*prevention & control ; Hepatitis A Vaccines/economics/*immunology ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Mothers/psychology ; Republic of Korea ; Social Class ; *Vaccination