Background and Objectives: Ultimaster™, a third-generation sirolimus-eluting stent using biodegradable polymer, has been introduced to overcome long term adverse vascular events, such as restenosis or stent thrombosis. In the present study, we aimed to evaluate the 12-month clinical outcomes of Ultimaster™ stents in Korean patients with coronary artery disease. Methods: This study is a multicenter, prospective, observational registry across 12 hospitals. To reflect real-world clinical evidence, non-selective subtypes of patients and lesions were included in this study. The study end point was target lesion failure (TLF) (the composite of cardiac death, target vessel myocardial infarction [MI], and target lesion revascularization [TLR]) at 12-month clinical follow up. Results: A total of 576 patients were enrolled between November 2016 and May 2021. Most of the patients were male (76.5%), with a mean age of 66.0±11.2 years. Among the included patients, 40.1% had diabetes mellitus (DM) and 67.9% had acute coronary syndrome (ACS).At 12 months, the incidence of TLF was 4.1%. The incidence of cardiac death was 1.5%, MI was 1.0%, TLR was 2.7%, and stent thrombosis was 0.6%. In subgroup analysis based on the presence of ACS, DM, hypertension, dyslipidemia, or bifurcation, there were no major differences in the incidence of the primary endpoint. Conclusions The present registry shows that Ultimaster™ stent is safe and effective for routine real-world clinical practice in non-selective Korean patients, having a low rate of adverse events at least up to 12 months.

Background/Aims: The prospective Crohn’s Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn’s disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD. Methods: Patients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis: cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019). Results: A total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35;95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection. Conclusions The prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection.

PURPOSE: The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. METHODS: We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. RESULTS: Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. CONCLUSION: IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.
Breast Implants ; Breast Neoplasms ; Breast ; Chemotherapy, Adjuvant ; Cohort Studies ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mastectomy ; Propensity Score ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies

BACKGROUND: Gamma knife radiosurgery (GKRS) has become a major alternative in the neurosurgical field. However, many patients complained of considerable discomfort during the fixation of rigid headframe. This study investigated whether our modified procedure could reduce fixation-related pain. METHODS: Sixty-six patients who underwent GKRS were enrolled in this study. Thirty-one patients (Group A) underwent the conventional subcutaneous infiltration technique, and 35 patients (Group B) did the modified procedure. In group A, the headframe was held in position by an assistant, and local anesthetics were injected subcutaneously using a 23-gauge spinal needle at pinning sites. Subsequently, pins were applied according to measurements based on spinal needle depth. In group B, with the frame held in position by an assistant, pin sites were marked with a surgical pen under the guidance of needle cap placed on the pin holes. The head frame was then removed, and local anesthetics were injected subcutaneously and periosteally at each marked pin site using a 26-gauge needle. The headframe was then repositioned 5 minutes after local infiltration, and pins were applied according to measurements based on spinal needle depth. To evaluate pain severity during procedures, visual analogue scale (VAS) scores were recorded during local infiltration and frame placement with pins. The pain scores of the two groups were analyzed statistically. RESULTS: Group B had a significantly lower VAS score during frame placement than group A (7.26 vs. 3.61; p<0.001), and mean VAS score at local infiltration was also significantly lower in group B (4.74 vs. 3.74; p=0.008). CONCLUSION: Patients in group B experienced significantly less pain than those in group A during pin placement. Pre-fixation time advanced local anesthesia might reduce pain during stereotactic procedures, and the use of a 26-gauge needle appeared in less pain during local infiltration.
Anesthesia, Local ; Anesthetics, Local ; Head ; Humans ; Needles ; Radiosurgery

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux disease (LPRD) is relatively common disease. N-acetyl cysteine (NAC) has both mucolytic and antioxidant effect, also may be beneficial in inflammatory airway diseases. The purpose of this study was to evaluate the efficacy and safety of inhaled NAC therapy in LPRD. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 525 LPRD patients at 12 medical centers. Finally 401 patients subjected to inhaled NAC therapy for 2 months were enrolled in the study. We analyzed the change of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) after use of NAC for 4 weeks and 8 weeks in addition to the patient's compliance of the treatment. RESULTS: The RSI score significantly decreased from 19.87±6.34 to 12.78±6.93 after 4 weeks and to 10.65±7.47 after 8 weeks. The RFS score also significantly decreased from 9.29±3.4 to 7.17±3.41 after 4 weeks and to 6.1±3.73 after 8 weeks (p<0.05). During the treatment periods, 42 patients (10.4%) reported to have 80 episodes of discomfort. Throat discomfort (33%) and nausea (28%) were most common complaints, but the duration of discomfort was usually less than 4 weeks. CONCLUSION: Inhaled NAC treatment is highly effective for the reduction of both subjective and objective findings in LPRD patients. This study will provide the evidence of new treatment option for patients with LPRD. However, further studies will be needs to assess the real effect of inhaled NAC therapy as a standard treatment regimen of LPRD.
Antioxidants ; Compliance ; Cysteine ; Cystine ; Humans ; Inhalation ; Laryngopharyngeal Reflux ; Medical Records ; Nausea ; Pharynx ; Retrospective Studies

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
Acute Kidney Injury* ; Body Mass Index* ; Epidemiologic Studies ; Humans ; Mortality* ; Obesity ; Observational Study ; Renal Replacement Therapy*

PURPOSE: Triage tags help prioritize the treatment for disaster patients based on the severity of the illness and help distribute limited resources during a time of disaster. In this study, we developed a novel triage tag and evaluated its feasibility during a hospital-based disaster drill. METHODS: For the first stage, we developed a new triage tag. The most commonly used triage tags (Medical Emergency Triage-TAG and SMART tag) were analyzed. We reassembled their advantages and invented a novel triage tag (NT tag). The second stage involved an evaluation of the quality of NT tag. The NT tag was used in a hospital-based disaster drill held in a single center with 22 mock patients. After the drill, hospital staffs were asked to complete a questionnaire which included visibility, comprehensibility, and ease of use with respect to the new NT tag. A five-category Likert scale was used to quantify the answer. RESULTS: The NT tag was successfully developed considering 6 quality indexes: visibility, expandability, flexibility, solidity, space, and fixity. Forty-two out of ninety (46.7%) subjects answered the questionnaire. Approximately 21% of participants had previous disaster drill experience and 33% had previous education of the SMART triage system. The visibility scale of the severity category was on average 3.3 (standard deviation (SD): 1.0), the comprehensiveness of the severity category was 3.6 (SD:0.9), the ease to understand patient information was 2.2-4.2, the ease to follow up symptoms and vital signs was 2.3-4.1. Eighty and percent of participants preferred to use the NT tag in a future disaster situation or disaster drill. CONCLUSION: We successfully developed a novel triage tag. The NT tag showed moderate feasibility.
Disasters ; Education ; Emergencies ; Follow-Up Studies ; Humans ; Pliability ; Triage* ; Vital Signs

Patient expectations for specialized medical care have spawned fellowship programs that require additional subspecialty training after residency training completion. The present study assessed the curricula and training environment adequacy of fellowship programs as perceived by current trainees and identified improvement areas for South Korea's overall fellowship program. A questionnaire was distributed to 1,764 fellows training at 6 university hospitals in Seoul, Korea during October 2014. From a return rate of 33.1%, 26.2% (403 responses) of all questionnaires distributed were compete enough to include in the analysis. Fellows participating in the survey were enrolled in fellowship programs with occupational aspirations of professorship and academic aspirations of subspecialty exploration. Nevertheless, more than half of the participating fellows did not have a clear understanding of their program's objectives. Many hoped for reduced clinical hours, increased research time allowance, and higher pay compared to current training environment and salary. The fellows' satisfaction with their program's curriculum and training environment was above 3 points on a Likert scale of 1 to 5. Receiving a training objective and financial support for academic activities by the training institution were factors influencing fellows' satisfaction level regarding both the curriculum and training environment. Clearly defined program objectives, a specialized curriculum for fellows, improved working conditions, and reflection on medical workforce policies are imperative for the advancement of Korean fellowship programs.
Aspirations (Psychology) ; Curriculum ; Fellowships and Scholarships* ; Financial Support ; Hope ; Hospitals, University ; Humans ; Internship and Residency ; Korea ; Personal Satisfaction ; Salaries and Fringe Benefits ; Seoul

OBJECTIVES: This study was designed to investigate the association between the dopamine D2 receptor (DRD2) genetic polymorphism [TaqIB (rs17294542) and TaqID (rs1800498)] and patients with schizophrenia. METHODS: TaqIB (rs17294542) and TaqID (rs1800498) polymorphism of the DRD2 gene were typed in 100 patients with schizophrenia and 109 normal controls. RESULTS: There were no statistical differences in genotype and allele distribution of TaqIB (rs17294542) and TaqID (rs1800498) genetic polymorphism between patients with schizophrenia and normal controls. CONCLUSIONS: These results suggest that the TaqIB (rs17294542) and TaqID (rs1800498) polymorphisms of the DRD2 gene may not be associated with schizophrenia in the Korean population.
Alleles ; Genotype ; Humans ; Polymorphism, Genetic ; Receptors, Dopamine D2 ; Schizophrenia