Background: The optimal treatment of BRCA wild-type patients with platinum-sensitive recurrent ovarian cancer remains unknown. Recently, there is an increase in the evidence to support the role of the combination of a poly(adenosine diphosphate-ribose) polymerase inhibitor, anti-angiogenic agents, and immunotherapy as maintenance therapy in BRCA wild-type patients with platinum-sensitive recurrence. We hypothesized that adding pembrolizumab and bevacizumab to olaparib maintenance can increase progression-free survival (PFS) in BRCA wild-type patients with platinum-sensitive recurrent ovarian cancer. Methods BRCA wild-type patients who received two previous courses of platinum-containing therapy, achieved complete or partial response to last treatment, and the treatment-free interval is >6 months after the penultimate platinum-based chemotherapy offered olaparib maintenance with pembrolizumab and bevacizumab. Forty-four patients will be included from 4 sites across Singapore and Korea. The primary endpoint of the study is 6-month PFS rate.

PURPOSE: This study was designed to provide a basis for building a master plan for a regional trauma system by analyzing the distribution of trauma deaths in the most populous province in Korea.MATERIALS AND METHODS: We investigated the time distribution to death for trauma patients who died between January and December 2017. The time distribution to death was categorized into four groups (within a day, within a week, within a month, and over a month). Additionally, the distribution of deaths within 24 hours was further analyzed. We also reviewed the distribution of deaths according to the cause of death and mechanism of injury.RESULTS: Of the 1546 trauma deaths, 328 cases were included in the final study population. Patients who died within a day were the most prevalent (40.9%). Of those who died within a day, the cases within an hour accounted for 40.3% of the highest proportion. The majority of trauma deaths within 4 hours were caused by traffic-related accidents (60.4%). The deaths caused by bleeding and central nervous system injuries accounted for most (70.1%) of the early deaths, whereas multi-organ dysfunction syndrome/sepsis had the highest ratio (69.7%) in the late deaths. Statistically significant differences were found in time distribution according to the mechanism of injury and cause of death (p<0.001).CONCLUSION: The distribution of overall timing of death was shown to follow a bimodal pattern rather than a trimodal model in Korea. Based on our findings, a suitable and modified trauma system must be developed.
Cause of Death ; Central Nervous System ; Hemorrhage ; Humans ; Korea ; Wounds and Injuries

Background: Trauma mortality review is the first step in assessing the quality of the trauma treatment system and provides an important basis for establishing a regional inclusive trauma system. This study aimed to obtain a reliable measure of the preventable trauma death rate in a single province in Korea. Methods: From January to December 2017, a total of 500 sample cases of trauma-related deaths from 64 hospitals in Gyeonggi Province were included. All cases were evaluated for preventability and opportunities for improvement using a multidisciplinary panel review approach. Results: Overall, 337 cases were included in the calculation for the preventable trauma death rate. The preventable trauma death rate was estimated at 17.0%. The odds ratio was 3.97 folds higher for those who arrived within “1–3 hours” than those who arrived within “1 hour.” When the final treatment institution was not a regional trauma center, the odds ratio was 2.39 folds higher than that of a regional trauma center. The most significant stage of preventable trauma death was the hospital stage, during which 86.7% of the cases occurred, of which only 10.3% occurred in the regional trauma center, whereas preventable trauma death was more of a problem at emergency medical institutions. Conclusion The preventable trauma death rate was slightly lower in this study than in previous studies, although several problems were noted during inter-hospital transfer; in the hospital stage, more problems were noted at emergency medical care facilities than at regional trauma centers. Further, several opportunities for improvements were discovered regarding bleeding control.

BACKGROUND: Prothrombin time (PT) measurement is an important test for screening blood coagulation disorders and monitoring anticoagulant therapy. In this study, we evaluated the analytical performance of HemosIL ReadiPlasTin (Instrumentation Laboratory, USA), a liquid reagent for PT measurement. METHODS: The precision of HemosIL ReadiPlasTin was evaluated according to the Clinical and Laboratory Standards Institute (CLSI) EP5-A3 guidelines. Further, comparison with HemosIL RecombiPlasTin 2G (Instrumentation Laboratory, USA) was made according to the CLSI EP9-A3 guidelines. The reference intervals were established according to the CLSI C28-A3 guidelines. RESULTS: The coefficient of variation values for repeatability and total imprecision at two levels of control materials were lower than 1.1% and 3.4%, respectively. The performance of HemosIL ReadiPlasTin was comparable to that of HemosIL RecombiPlasTin 2G, with a high correlation (r=0.996). The reference interval for normal subjects was 10.4–13.3 seconds. CONCLUSIONS: HemosIL ReadiPlasTin showed an acceptable degree of imprecision and its performance showed high correlation with that of a conventional reagent. Therefore, it is expected to be useful for PT measurement in clinical laboratories.
Blood Coagulation Disorders ; Blood Coagulation Tests ; Mass Screening ; Prothrombin Time ; Prothrombin ; Thromboplastin

PURPOSE: A new unmatched type-O packed red blood cell (UORBC) storage system was established in Ajou University Hospital Trauma Center. This system was expected to deliver faster and more efficient transfusion. METHODS: On March 2016, a new blood storage bank was installed in the trauma bay. Sixty patients who received UORBC from March 2016 to August 2016 were compared with 50 traumatic shock patients who received transfusions at the trauma bay in 2015. Time of transfusion, mortality, adverse transfusion reaction and change of systolic blood pressure were reviewed. RESULTS: Transfusion time from arrival at the hospital was significantly shorter in 2016 (14.07±11.14 min vs. 34.72±15.17 min, p < 0.001), but 24-hour mortality was not significantly different (13.3% vs. 20.8%, p=0.292). Systolic blood pressure significantly increased after UORBC transfusion (92.49 mmHg to 107.15 mmHg, p=0.002). Of the 60 patients who received UORBC in trauma bay, 47 (78.3%) patients had an incompatible ABO type, but no adverse transfusion reaction was notated. CONCLUSION: UORBC allows early blood transfusion and improved systolic blood pressure without significant adverse reactions.
ABO Blood-Group System ; Bays ; Blood Pressure ; Blood Transfusion ; Erythrocyte Transfusion* ; Erythrocytes* ; Humans ; Mortality ; Shock* ; Shock, Traumatic ; Transfusion Reaction ; Trauma Centers

OBJECTIVES: The purpose of this study was to compare lymph node (LN) staging using ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) with contrast-enhancement (CE) PET/CT and contrast-enhanced neck CT (neck CT) in patients with thyroid cancer with level-by-level comparison with various factors. METHODS: This was a retrospective multicenter study. A total of 85 patients were enrolled. Patients who underwent a preoperative evaluation by CE PET/CT and neck CT for thyroid cancer were enrolled. The gold standard for LN was the combination of surgical pathology and clinical follow-up. We compared CE PET/CT with neck CT using a level-by-level method. Factors, including age, sex, camera, arm position, tumor size, extra-thyroidal extension, tumor location, number of primary tumors, primary tumor maximum standardized uptake value, and the interval from scan to operation were also analyzed. RESULTS: Overall accuracy was 81.2% for CE PET/CT and 68.2% for neck CT. CE PET/CT was more sensitive than neck CT (65.8% vs. 44.7%). Also, CE PET/CT showed higher negative predictive value (77.2% vs. 66.1%). CE PET/CT showed good agreement with the gold standard (weighted kappa [κ], 0.7) for differentiating N0, N1a, and N1b, whereas neck CT showed moderate agreement (weighted κ, 0.5). CE PET/CT showed better agreement for the number of levels involved with the gold standard (weighted κ, 0.7) than that of neck CT with the gold standard (weighted κ, 0.5). The accuracies for differentiating N0, N1a, and N1b were 81.2% for CE PET/CT and 68.2% for neck CT. Level-by-level analysis showed that CE PET/CT was more sensitive and has higher negative predictive value for detecting ipsilateral level IV and level VI LNs than neck CT. Other analyzed factors were not related to accuracies of both modalities. CONCLUSION: CE PET/CT was more sensitive and reliable than neck CT for preoperative LN staging in patients with thyroid cancer.
Arm ; Electrons ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Methods ; Neck* ; Pathology, Surgical ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: This study aimed to evaluate the situations and problems of the current health insurance fees for trauma surgeries. METHODS: We reviewed the medical records and billing data from trauma surgeries performed in the hospital from August 2012 to July 2014. The name and number of surgeries were investigated and the code and number of operations prescribed by surgeons were compared with the number of cases actually billed to insurance. In addition, the results returned by the Health Insurance Review & Assessment Services (HIRA) after deduction were investigated and compared to verify the insurance review findings. RESULTS: During the study period, total 1,534 trauma surgical procedures were performed for a total of 253 trauma patients. Based on names, 1,092 procedures were performed; however, 442 cases (28.8%) could not be prescribed because of lack of proper insurance codes for the procedures. A total of 1,046.5 surgical procedures were prescribed by surgeons, adjusted by the insurance team, and finally billed to the HIRA; 162 bills were returned from the HIRA after rate reductions, corresponding to a reduction rate of 15.5%. The major reason for reduction was “fee criteria and limited number”. The compensation rate for billed surgical procedures was 84.5%. CONCLUSION: The high reduction and low compensation rate for trauma surgery under the current Korean National Health Insurance System need to be reviewed and improved. Furthermore, it is necessary to establish new criteria for surgical procedures fees for latest ones such as damage control surgery performed on severe trauma patients.
Compensation and Redress* ; Fees and Charges ; Humans ; Insurance ; Insurance, Health ; Korea ; Medical Records ; National Health Programs* ; Surgeons ; Surgical Procedures, Operative ; Wounds and Injuries

The Korean government previously established a national blood policy and national blood system based on basic and essential legislation. This achievement was the result of collaborative efforts between the Korean Centers for Disease Control and Prevention, the Korean Society of Blood Transfusion, the Korean Society for Laboratory Medicine, the Laboratory Medicine Foundation, and/or the Korean Association of External Quality Assessment Service. To ensure a safe and effective transfusion, a comprehensive quality assurance (QA) system to assess every process from donor selection to transfusion is mandatory. From a blood safety perspective, selection of appropriate donor blood screening tests for transfusion-transmissible infections (TTI) and the QA program is of great importance. In this article, we review legislation regarding the national blood policy and national blood system as well as the selection logic regarding diagnostic immunologic tests for TTI and quality assurance efforts for TTI of each blood center.
Blood Safety ; Blood Transfusion ; Centers for Disease Control and Prevention (U.S.) ; Donor Selection ; Humans ; Immunologic Tests* ; Logic ; Mass Screening* ; Quality Control ; Tissue Donors

BACKGROUND AND OBJECTIVES: The purpose was to record the time at which biological phenomena stop in different hospital wards and determine regular patterns in times of death, as well as any associated factors. SUBJECTS AND METHODS: A total of 6,517 inpatients at the Keimyung University Dongsan Medical Center who died between January 2006 and December 2012 were retrospectively enrolled. A comparative analysis was conducted for the mortality distribution between the intensive care unit (ICU) and general wards (GW). RESULTS: A total of 3,198 (49%) died in the ICU and 3,319 (51%) in the GW. The ICU showed an increase in mortality over the most recent 3 years. There was no difference in monthly or daily pattern. ICU mortality peaked at 14:00 to 16:00 hours (9.2%) and 20:00 to 22:00 hours (9.1%), and GW mortality peaked at 06:00 to 08:00 hours (9.6%) and 10:00 to 12:00 hours (9.4%), with a significant statistical difference between the two wards (p=0.03). Patients with diseases of the circulatory system died most often in the ICU (28.3%), whereas those with neoplasms had the highest mortality rate in the GW (77.7%) (p<0.01). CONCLUSIONS: Some differences between the ICU and GW may be accounted for by a preserved circadian rhythm that was affected by disease distribution, hospital room environment, and use of various drugs.
Biological Phenomena ; Circadian Rhythm* ; Critical Care* ; Humans ; Inpatients ; Intensive Care Units* ; Mortality ; Patients' Rooms ; Retrospective Studies