Background: The number of revision total knee arthroplasty (TKA) has been increasing. Although many studies have analyzed the causes of revision TKA in Western countries, a limited number of studies have analyzed changes in causes of or trends in revision TKA in Asia. This study analyzed and determined the frequency and causes of failures after TKA in our hospital. We also analyzed the differences and trends over the past 17 years. Methods: A total of 296 revision TKAs performed in a single institution from 2003 to 2019 were analyzed. During the 17-year study period, patients who had undergone primary TKA between 2003 and 2011 were classified into a past group, while those who had undergone primary TKA from 2012 to 2019 were classified into a recent group. A revision performed within 2 years after primary TKA was defined as early revision. Further, differences in causes of revision TKA according to the interval from primary TKA to revision TKA were determined. The causes of revision TKA were analyzed through a comprehensive analysis of patients’ medical records. Results: Overall, infection was the most common cause of failure (151/296 cases, 51.0%). Compared to the past group, the recent group had a relatively higher proportion of patients undergoing revision TKA for mechanical loosening (past group, 19.1% vs.recent group, 31.9%) and instability (11.2% vs. 13.5%) and a relatively lower proportion of patients undergoing revision TKA for infection (56.2% vs. 48.8%), polyethylene (PE) wear (9.0% vs. 2.9%), osteolysis (2.2% vs. 1.9%), and malalignment (2.2% vs. 1.0%).On comparison according to the interval from primary TKA to revision TKA, the rate of infection relatively decreased, whereas the rate of mechanical loosening and instability relatively increased in the late revision TKA compared to the early revision TKA. Conclusions Infection and aseptic loosening were the most common reasons of revision TKA in both past and recent groups.Compared to the past, revision TKA due to PE wear has decreased significantly and revision TKA due to mechanical loosening has relatively increased recently. Orthopedic surgeons need to be aware of recent trends in mechanisms of failure and should try to recognize and address the probable causes in TKA

Objectives: This study aimed to analyze the outcomes of the Comprehensive Health and Social Need Assessment (CHSNA) system, which identifies community residents’ health and social needs, and to link these needs with the International Classification of Functioning, Disability, and Health (ICF). Methods: Adult community residents in a metropolitan city in Korea were recruited. They were asked to assess their health and social needs via the CHSNA system, which was integrated into an online community-care platform. Three assessment steps (basic health assessment, needs for activities of daily living, and in-depth health assessment) associated with five ICF components were used to evaluate physical health impairment, difficulties in activities and participation, and environmental problems. The final list of health and social needs was systematically linked to the domains and categories of the ICF. Only data from participants who completed all three assessment steps were included. Results: Wide ranges of impairments and difficulties regarding the daily living activities, physical health, and environmental status of the community were recorded from 190 people who completed assessments of their health and social needs by the CHSNA system. These participants reported various health and social needs for their community life; common needs corresponded to the ICF components of body functions and activities/participation. Conclusions The ICF may be suitable for determining the health-related problems and needs of the general population. Possible improvements to the present system include providing support for completing all assessment steps and developing an ICF core set for an enhanced understanding of health and social needs.

Remarkable developments in immuno-oncology have changed the landscape of gastric cancer (GC) treatment. Because immunotherapy intervenes with tumor immune response rather than directly targeting tumor cells, it is important to develop a greater understanding of tumor immunity. This review paper summarizes the tumor immune reaction and immune escape mechanisms while focusing on the role of T cells and their co-inhibitory signals, such as the immune checkpoint molecules programmed death-1 and programmed deathligand 1 (PD-L1). This paper also describes past clinical trials of immunotherapy for patients with GC and details their clinical implications. Strong predictive markers are essential to improve response to immunotherapy. Microsatellite instability, Epstein-Barr virus, PD-L1 expression, and tumor mutational burden are now regarded as potent predictive markers for immunotherapy in patients with GC. Novel immunotherapy and combination therapy targeting new immune checkpoint molecules such as lymphocyte-activation gene 3, T cell immunoglobulin, and mucin domain containing-3, and indoleamine 2,3-dioxygenase have been suggested, and trials are ongoing to evaluate their safety and efficacy. Immunotherapy is an important treatment option for patients with GC and has great potential for improving patient outcome, and further research in immuno-oncology should be carried out.

PURPOSE: Activated leukocyte cell adhesion molecule (ALCAM), a member of the immunoglobulin superfamily, is highly expressed on dendritic cells. ALCAM and its receptor CD6 are co-stimulatory molecules in the immunological synapse; their interaction is required for T cell activation. While atopic dermatitis (AD) is recognized as a T helper 2 (Th2)-mediated allergic disease, the role of ALCAM in its pathogenesis is unclear. METHODS: ALCAM levels were measured in the serum of AD patients and AD-induced murine model by ovalbumin treatment. We next investigated transepidermal water loss, clinical score, Th2-immune responses, skin barrier gene expression and T-cell activation using wild-type (WT) and ALCAM deficiency mice. An oxazolone-induced AD-like model was also established and analyzed using WT- and ALCAM-deficient mice. RESULTS: We found that serum ALCAM levels were elevated in pediatric AD patients as well as WT AD mice, whereas Th2-type cytokine production and AD symptoms were suppressed in ALCAM-deficient mice. In addition, CD4+ effector T-cell counts in murine skin and skin-draining lymph nodes were lower in ALCAM-deficient mice than in their WT counterparts. ALCAM deficiency was also linked to higher expression of skin barrier genes and number of lamellar bodies. CONCLUSIONS: These findings indicate that ALCAM may contribute to AD pathogenesis by meditating a Th2-dominant immune response and disrupting the barrier function of the skin.
Activated-Leukocyte Cell Adhesion Molecule ; Animals ; Dendritic Cells ; Dermatitis, Atopic ; Gene Expression ; Humans ; Immunoglobulins ; Immunological Synapses ; Lymph Nodes ; Mice ; Ovalbumin ; Skin ; T-Lymphocytes ; Water

BACKGROUND: Pulmonary infection with nontuberculous mycobacteria (NTM) is increasing in South Korea. Since treatment strategy differs by NTM species, accurate identification is necessary. In this study, using Mycobacterium pulmonary isolates recently recovered from a general hospital in Seoul, the prevalence of NTM isolates was investigated. METHODS: A total of 483 Mycobacterium pulmonary strains isolated between May and November 2018 from an 814-bed general hospital in South Korea were analyzed. Bacterial species were identified based on nucleotide sequences of the 16S–23S rDNA internal transcribed spacer and the rpoB gene. RESULTS: From a total of 1,209 pulmonary specimens from patients suspected to be infected with mycobacteria, 324 deduplicate strains were isolated, comprising 90 Mycobacterium tuberculosis and 229 NTM strains. Among the NTM isolates, 61.5% (n=144) were Mycobacterium avium complex (MAC), including 92 M. avium and 52 Mycobacterium intracellulare, while 8.1% (n=19) represented Mycobacterium abscessus, including 10 M. abscessus subsp. abscessus and 9 M. abscessus subsp. massiliense. In addition, 12 (5.1%) Mycobacterium lentiflavum, 12 (5.1%) Mycobacterium gordonae, 6 (2.6%) Mycobacterium kansasii, and 5 (2.1%) Mycobacterium fortuitum were identified. In addition, Mycobacterium mucogenicum (n=2), Mycobacterium septicum (n=1), Mycobacterium colombiens (n=1), Mycobacterium asiaticum (n=1), and Mycobacterium celatum (n=1) were identified. CONCLUSION: Among the recently recovered Mycobacterium pulmonary strains, more than half were identified as NTM, and MAC was the most prevalent NTM, followed by M. abcessuss.
Base Sequence ; DNA, Ribosomal ; Hospitals, General ; Humans ; Korea ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium fortuitum ; Mycobacterium kansasii ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Prevalence ; Seoul ; Tertiary Care Centers ; Tertiary Healthcare

OBJECTIVES: This study developed an information and communication technology (ICT)-based comprehensive health and social-needs assessment (CHSNA) system based on the International Classification of Functioning, Disability, and Health (ICF) with the aim of enhancing person-centered community care for community residents and supporting healthcare professionals and social workers who provide healthcare and social services in the community. METHODS: Items related to a CHSNA tool were developed and mapped with ICF codes. Experts validated the CHSNA system design and process using the Delphi method, and a pilot test of the initial version of the system was conducted. RESULTS: The following three steps of CHSNA were embedded in the system, which had a user-friendly screen and images: basic health assessment, life and activity assessment, and in-depth health assessment. The assessment results for the community residents were presented with visualized health profiles, including images, graphs, and an ICF model. CONCLUSIONS: The developed CHSNA system can be used by healthcare professionals, social workers, and community residents to evaluate the reasoning underlying health and social needs, to facilitate the identification of more appropriate healthcare plans, and to guide community residents to receive the best healthcare services. A CHSNA system can improve the implementation of standardized terminology utilizing the ICF and the accuracy of needs assessments of community residents.
Classification ; Community Health Services ; Decision Support Techniques ; Delivery of Health Care ; Methods ; Needs Assessment ; Patient-Centered Care ; Social Work ; Social Workers

BACKGROUND: In the present multi-institutional study, the prevalence and clinicopathologic characteristics of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were evaluated among Korean patients who underwent thyroidectomy for papillary thyroid carcinoma (PTC).METHODS: Data from 18,819 patients with PTC from eight university hospitals between January 2012 and February 2018 were retrospectively evaluated. Pathology reports of all PTCs and slides of potential NIFTP cases were reviewed. The strict criterion of no papillae was applied for the diagnosis of NIFTP. Due to assumptions regarding misclassification of NIFTP as non-PTC tumors, the lower boundary of NIFTP prevalence among PTCs was estimated. Mutational analysis for BRAF and three RAS isoforms was performed in 27 randomly selected NIFTP cases.RESULTS: The prevalence of NIFTP was 1.3% (238/18,819) of all PTCs when the same histologic criteria were applied for NIFTP regardless of the tumor size but decreased to 0.8% (152/18,819) when tumors ≥1 cm in size were included. The mean follow-up was 37.7 months and no patient with NIFTP had evidence of lymph node metastasis, distant metastasis, or disease recurrence during the follow-up period. A difference in prevalence of NIFTP before and after NIFTP introduction was not observed. BRAF(V600E) mutation was not found in NIFTP. The mutation rate for the three RAS genes was 55.6% (15/27).CONCLUSIONS: The low prevalence and indolent clinical outcome of NIFTP in Korea was confirmed using the largest number of cases to date. The introduction of NIFTP may have a small overall impact in Korean practice.
Carcinoma, Papillary ; Diagnosis ; Follow-Up Studies ; Genes, ras ; Hospitals, University ; Humans ; Korea ; Lymph Nodes ; Mutation Rate ; Neoplasm Metastasis ; Pathology ; Prevalence ; Protein Isoforms ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

BACKGROUND: Social anxiety and suicide are serious common problems in college students. However, there are few studies on the relationship between social anxiety symptoms and suicidal risk. Therefore, we evaluated the associationbetween social anxiety symptoms and suicidal risk in college students.METHODS: A total of 579 college students were recruited for a college-based cross-sectional survey in the Jeju area. The participants completed a questionnaire gathering sociodemographic information; they also completed the Korean Social Avoidance and Distress Scale (SADS) to assess social anxiety symptoms and the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms. To obtain information regarding suicidal risk, we administered the Korean version of the Suicide module of the Mini International Neuropsychiatric Interview (M.I.N.I.).RESULTS: The prevalence of higher levels of social anxiety symptoms among college students was 28.0% (n=162). A higher level of social anxiety symptoms resulted in a 2.10-times higher suicidal risk after adjusting for depression in college students (95% confidence interval, 1.05-4.23; p=0.037).CONCLUSION: Based on the results of this study, social anxiety symptoms should be managed and controlled to prevent suicidality in Korean college students.
Anxiety ; Cross-Sectional Studies ; Depression ; Epidemiologic Studies ; Humans ; Prevalence ; Suicide