RESUMO
BACKGROUND: Pneumococcal vaccination is a preventive method to reduce pneumonia related mortality. However, real-world data on efficacy of the pneumococcal vaccine in reducing mortality is lacking, especially in elderly patients. This study was conducted to assess the effects of prior pneumococcal vaccination in elderly pneumonia patients. METHODS: The data was procured from the Health Insurance Review and Assessment and Quality Assessment database. Hospitalized patients who met the criteria of community-acquired pneumonia (CAP) were included and they were grouped according to vaccination state. Patients were aged ≥ 65 years and treated with beta-lactam, quinolone, or macrolide. Patients were excluded when treatment outcomes were unknown. RESULTS: A total of 4515 patients were evaluated, and 1609 (35.6%) of them were vaccinated prior to hospitalization. Mean age was 77.0 [71.0;82.0], 54.2% of them were male, and mean Charlson comorbidity index (CCI) was 3.0. The patients in the vaccinated group were younger than those in the unvaccinated group (76.0 vs. 78.0 years; P < 0.001), and showed higher in-hospital improvement (97.6 vs. 95.0%; P < 0.001) and lower 30-day mortality (2.6 vs. 5.3%; P < 0.001). After adjusting confounding factors such as age, gender, CURB score and CCI score, the vaccinated group demonstrated a significant reduction in 30-day mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.41-0.81; P < 0.01) and in-hospital mortality (HR 0.53, 95% CI0.37-0.78; P < 0.001) compared to the unvaccinated group in multivariate analysis. Vaccinated group showed better 30-day survival than those in non-vaccinated group (log-rank test < 0.05). CONCLUSIONS: Among elderly hospitalized CAP patients, prior pneumococcal vaccination was associated with improved in-hospital mortality and 30-day mortality.
Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Pneumocócica , Humanos , Idoso , Masculino , Feminino , Pneumonia Pneumocócica/prevenção & controle , Pneumonia Pneumocócica/epidemiologia , Mortalidade Hospitalar , Hospitalização , Vacinação , Resultado do Tratamento , Vacinas PneumocócicasRESUMO
BACKGROUND: With a rapid decrease in tuberculosis (TB) incidence, the significance of latent tuberculosis infection (LTBI) has been underscored in South Korea. Although South Korea does not have a high proportion of immigrants compared to other countries, there is a growing argument that it should actively embrace immigrants as a solution to address issues of low birth rates and population aging. This study aimed to assess TB incidence among immigrants who participated a pilot LTBI screening program in South Korea. METHODS: Records of immigrants participated in a pilot LTBI screening program in South Korea between 2018 and 2019 were linked with Korean National TB Surveillance System to determine TB development. Participants underwent interferon-gamma release assay (IGRA) and chest X-rays. Standardized incidence ratios (SIRs) stratified by age, country of origin's TB burden was calculated with a reference group of general South Korean population. RESULTS: Of a total of 9,517 participants, 14 TB cases were identified. Participants with positive IGRA results who did not initiate LTBI treatment showed TB incidence of 312.5 per 100,000 person-years, whereas those with negative results showed TB incidence of 34.4 per 100,000 person-years, resulting in an incidence rate ratio of 9.08 (95% confidence interval [CI], 2.50-32.99). SIR of TB among total participants including those with negative IGRA results was 2.60 (95% CI, 1.54-4.38; P < 0.001), whereas SIR among those with positive IGRA results was 5.86 (95% CI, 3.15-10.89; P < 0.001). In the calculation of SIR among participants with positive IGRA results, those aged under 35 from high TB-burden countries or intermediate TB-burden countries showed a high SIR (18.08; 95% CI, 2.55-128.37; P = 0.004), and 11.30 (95% CI, 2.82-45.16; P < 0.001), respectively). Contrary to previous reports that suggest the majority of elderly population with a positive IGRA result were due to remote infection and had a lower TB risk compared to younger ages, SIR among those aged 65 or over from intermediate TB-burden countries was 6.15 (95% CI, 0.87-43.69; P = 0.069), which was comparable to that in younger participants aged between 35 and 49 (SIR, 4.87; 95% CI, 1.22-19.49; P = 0.025) or those aged between 50 and 64 (SIR, 4.62; 95% CI, 1.73-12.31; P = 0.002). CONCLUSION: Young immigrants with positive IGRA results from countries with high or intermediate TB burden showed a relatively high TB risk compared to a general South Korea population. In addition, unexpected high TB risk was observed among elderly immigrants with positive IGRA results. In establishing future policies for LTBI in immigrants in South Korea, screenings should primarily focus on younger age group (who aged under 35). Additionally, further research is needed on the high TB risk observed in elderly immigrants.
Assuntos
Emigrantes e Imigrantes , Testes de Liberação de Interferon-gama , Tuberculose Latente , Programas de Rastreamento , Humanos , República da Coreia/epidemiologia , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Adulto , Incidência , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Idoso , Criança , Pré-Escolar , LactenteRESUMO
BACKGROUND: Swallowing of foreign bodies (FBs) is the most common indication of therapeutic endoscopy in children. Endoscopic removal may be necessary depending on the type of FB, age of the child, and location of the FB. We attempted to analyze the characteristics of each device used for the endoscopic removal of FBs in children. METHODS: Medical records of the patient's age, sex, weight, type, location, size, shape, type of device used for endoscopic removal, and endoscopic time were retrospectively collected. RESULTS: A total of 424 FB removal procedures were analyzed. The average age of the patients at the time of FB removal was 4.1 ± 3.7 years. Coins were the most common FBs (192, 45.3%). The most common locations of the FBs were the esophagus (45.7%) and the stomach (48.3%), respectively. For a total of 371 cases, forceps were used in 96 cases (25.9%) for esophageal FBs and in 25 cases for gastric FBs (6.7%), while nets were used in 250 cases (67.4%) for gastric FBs retrieval; the average durations of the procedures were 7.2 ± 7.4 minutes, 8.5 ± 7.2 minutes, and 5.7 ± 7.3 minutes, respectively (P = 0.003). The procedure time was significantly shorter, in the group of patients with low body weights, when nets were used than when forceps were used to remove gastric FBs (P = 0.001). CONCLUSION: The endoscopic procedure duration, in low-weight children, was shorter when retrieval nets were used than that with forceps.
Assuntos
Endoscopia , Corpos Estranhos , Criança , Humanos , Lactente , Pré-Escolar , Estudos Retrospectivos , Endoscopia/métodos , Esôfago/cirurgia , Corpos Estranhos/cirurgia , República da CoreiaRESUMO
BACKGROUND: Subtype-specific alpha-antagonists are medications commonly prescribed for lower urinary-tract symptoms, benign prostatic hyperplasia in older populations. Our study aims to investigate the association between subtype-specific alpha-antagonists and fall risk. METHODS: A total of 4,202,739 men aged 60-75 years eligible for Korean Health Insurance Review and Assessment Service (HIRA) during 2017-2018 were enrolled retrospectively. After propensity score matching, 53,303 people in the exposed and unexposed groups were considered in the final study analysis. RESULTS: The subtype-specific alpha-antagonists significantly increased the risk of fall in the exposed cohort compared to the unexposed cohort (odds ratio [OR] 1.80; 95% confidence interval [CI] 1.62-2.00). Low income increased the fall risk only in the unexposed cohort (OR 1.34; 95% CI 1.04-1.73). A seasonal difference appeared only in the exposed cohort, with a significantly higher risk of fall in summer (OR 1.23; 95% CI 1.03-1.47). A total of 968 events occurred in the exposed group, and 455 of these falls occurred on the first day of medication (47%). CONCLUSIONS: Subtype-specific alpha-antagonists significantly increased the risk of falls, especially on the first day of drug initiation and during the summer season. Education on orthostatic hypotension and fall prevention should be implemented when prescribing subtype-specific alpha-antagonists.
Assuntos
Hiperplasia Prostática , Masculino , Humanos , Idoso , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/diagnóstico , Antagonistas Adrenérgicos alfa/uso terapêutico , Estudos de Coortes , Estudos Retrospectivos , República da Coreia/epidemiologiaRESUMO
BACKGROUND: It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far. METHODS: All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4). RESULTS: Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies. CONCLUSION: The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.
Assuntos
Desinfetantes , Pneumopatias , Lesão Pulmonar , Animais , Desinfetantes/toxicidade , Humanos , Umidificadores , Lesão Pulmonar/etiologia , República da Coreia/epidemiologiaRESUMO
BACKGROUND: Pneumonia, which is the third leading cause of death in South Korea, is continuously increasing with the aging society. The Health Insurance Review and Assessment of South Korea conducted a quality assessment (QA) for improving the outcome of community-acquired pneumonia (CAP). METHODS: We conducted a nationwide cross-sectional study of hospitalized CAP in South Korea. First to third QA data were gathered into a single database. The national health insurance database was merged with the QA database for analyzing the medical claims data. Comorbidities, pneumonia severity, and pneumonia care appropriateness were calculated using Charlson comorbidity index (CCI), CURB-65, and core assessment of CAP scores (CAP scores), respectively. RESULTS: Overall, 54,307 patients were enrolled. The CAP scores significantly improved on QA program implementation (P < 0.001). All the variables demonstrated an association with in-hospital mortality, hospital length of stay (LOS), and 30-day mortality in the univariate analyses. Following the adjustments, higher CCI and CURB-65 scores were associated with higher in-hospital mortality, longer hospital LOS, and higher 30-day mortality. Male sex was associated with higher in-hospital/30-day mortality and shorter hospital LOS. Higher CAP scores were associated with shorter hospital LOS (P < 0.001). Upon QA program implementation, in-hospital mortality (P < 0.001), hospital LOS (P < 0.001), and 30-day mortality (P < 0.001) improved. CONCLUSION: Continuing QA program is effective in improving the clinical outcomes of hospitalized CAP.
Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Estudos Transversais , Mortalidade Hospitalar , Hospitalização , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: In 2017, Korea implemented nationwide latent tuberculosis infection (LTBI) project targeting healthcare workers (HCWs). We aimed to assess its performance using the cascade of care model. METHODS: We included 45,503 employees of medical institutions with positive interferon-gamma release assay result who participated between March 2017 and December 2018. We described percentages of LTBI participants completing each step in the cascade of care. Poisson regression model was conducted to assess individual characteristics and factors associated with not-visiting clinics for further care, not-initiating LTBI treatment, and not-completing treatment. RESULTS: Proportions of visiting clinics and initiating and completing treatment in HCWs were 54.9%, 38.5%, and 32.0%, respectively. Despite of less likelihood of visiting clinics and initiating LTBI treatment, older age ≥ 65 years were more likely to complete treatment (adjusted relative risk [aRR], 0.80; 95% confidence interval [CI], 0.64-0.99), compared to young age < 35 years. Compared to nurses, doctors were less likely to visit clinic; however, were more likely to initiate treatment (aRR, 0.88; 95% CI, 0.81-0.96). Those who visited public health centers were associated with not-initiating treatment (aRR, 1.34; 95% CI, 1.29-1.40). When treated at private hospitals, 9-month isoniazid monotherapy was less likely to complete treatment, compared to 3-month isoniazid and rifampicin combination therapy (aRR, 1.33; 95% CI, 1.16-1.53). CONCLUSION: Among employees of medical institutions with LTBI, only one third completed treatment. Age, occupation, treatment center, and initial regimen were significantly related to LTBI treatment performance indicators. Rifampicin-based short treatment regimens were effective under standard of care.
Assuntos
Tuberculose Latente , Adulto , Antituberculosos/uso terapêutico , Estudos de Coortes , Pessoal de Saúde , Humanos , Isoniazida/uso terapêutico , Tuberculose Latente/diagnóstico , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/epidemiologia , Rifampina/uso terapêuticoRESUMO
In 2017, the Korean government launched an unprecedentedly large-scaled latent tuberculosis infection (LTBI) screening project which covered more than a million individuals in congregate settings. A total of 1,047,689 participants of source population (n = 2,336,157) underwent LTBI testing from 2017 to 2018. The overall LTBI test uptake rate during this project was 44.8%. Workers in daycare centers (83.5%) and kindergartens (78.9%) showed high participation rate. A total of 1,012,206 individuals with valid results of interferon-gamma release assay (IGRA) were selected to constitute the IGRA cohort. Most of the enrolled participants in the IGRA cohort were in their working age. Approximately, three-quarters of total enrolled population were female. Investigating the LTBI prevalence, stages of LTBI care cascade, natural history of LTBI, efficacy of LTBI treatment and cost-effectiveness of LTBI screening are feasible within this IGRA cohort.
Assuntos
Testes de Liberação de Interferon-gama/métodos , Tuberculose Latente/diagnóstico , Programas de Rastreamento/economia , Adulto , Antituberculosos/uso terapêutico , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Tuberculose Latente/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , República da CoreiaRESUMO
BACKGROUND: We examined the association between obesity and prostate cancer based on both body mass index (BMI) and waist circumference (WC) using the National Health Insurance System (NHIS) database for the entire male population of Korea. METHODS: A total of 1,917,430 men who underwent at least one health examination in 2009 without a previous diagnosis of any other cancer were tracked through December 2015. The hazard ratio (HR) and 95% confidence interval (CI) value for the association between prostate cancer and obesity were analyzed using multiple Cox regression model. Since there was a statistically significant interaction between WC and BMI, a multiple HR for prostate cancer was estimated with stratifying both WC and BMI to control the interaction between WC and BMI. RESULTS: Without considering WC as an adjustment factor, very weak association between BMI and prostate cancer development risk was observed. When WC was considered as an adjustment factor, no significant change in the HRs for prostate cancer development beyond the reference BMI was observed in the group with WC < 85 cm in the multivariable-adjusted models. However, in the group with WC ≥ 85 cm, the HRs for prostate cancer increased as the BMI increased beyond the reference BMI. In addition, there was a discrepancy in the trend of prostate cancer development according to BMI among the groups with different categories for WC. CONCLUSION: In groups with abdominal obesity, a significant linear relationship was observed between increasing BMI and prostate cancer risk. Higher the WC category, the stronger was the association with BMI, signifying that the association of BMI with risk of prostate cancer development depends on abdominal obesity.
Assuntos
Índice de Massa Corporal , Obesidade Abdominal/epidemiologia , Neoplasias da Próstata/epidemiologia , Circunferência da Cintura , Idoso , Estudos de Coortes , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/diagnóstico , Valores de Referência , República da Coreia/epidemiologia , Medição de Risco/estatística & dados numéricos , Fatores de RiscoRESUMO
BACKGROUND: Globally, the prevalence of chronic disease continues to rise and is likely to grow further over the coming decades due to population ageing. Since older age is associated closely with development of chronic disease, it stands to reason that demographic changes will increase the proportion of older workers with chronic disease. The aim of the present study was to determine how chronic diseases affect employment status in Korea and the USA. METHODS: The study was based on National Health and Nutrition Survey data (2007-2014) obtained by the Korean and American Centers for Disease Control and Prevention. A total of 44,693 subjects were categorized into two geographical groups: Korea (29,260 subjects) and the USA (15,433 subjects). A chi-square test was used to compare the groups in terms of socio-demographic factors, health-related factors, and chronic disease. Multivariate logistic regression analysis was conducted to determine the effect of five chronic diseases (hypertension, diabetes, dyslipidemia, cardiovascular disease, and cancer) on employment status. RESULTS: There were 29,260 Korean and 15,433 American respondents. Chronic disease increased the risk of unemployment in Korea markedly (Odds ratio [OR] range, 1.17-2.47). Cardiovascular disease and cancer had the most profound negative effect on Korean unemployment (OR = 2.47 and 2.03, respectively). The risk of unemployment was generally 2-3-fold lower in the USA (OR range, 0.5-1.04). CONCLUSIONS: Chronic disease had a significant impact on economic activity in Korea, but a smaller impact in the USA. This difference may be related to different health insurance schemes and cultural approaches to people with diseases in the two countries. It is important to explore factors that limit economic participation by people with chronic diseases, and to identify social policies that will overcome these factors. Further between-country studies are needed to identify social solutions to the socio-economic burden of chronic illness.
Assuntos
Emprego , Doenças não Transmissíveis , Adulto , Idoso , Emprego/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/etnologia , Inquéritos Nutricionais , Razão de Chances , Prevalência , Política Pública , República da Coreia/epidemiologia , Fatores Socioeconômicos , Estados UnidosRESUMO
Global data on the epidemiology and susceptibility of Aspergillus are crucial in the management of invasive aspergillosis. Here, we aimed to determine the characteristics of clinical and environmental Aspergillus isolates, focusing mainly on hematologic malignancy patients. We prospectively collected all consecutive cases and clinical isolates of culture-positive proven/probable invasive aspergillosis patients from January 2016 to April 2018 and sampled the air inside and outside the hospital. Cryptic species-level identification of Aspergillus, antifungal susceptibilities, and cyp51 gene sequencing were performed, and clinical data were analyzed. This study was conducted as part of the Catholic Hematology Hospital Fungi Epidemiology (CAFÉ) study. A total of 207 proven/probable invasive aspergillosis and 102 clinical and 129 environmental Aspergillus isolates were included in this analysis. The incidence of proven/probable invasive aspergillosis was 1.3 cases/1,000 patient-days during the study period. Cryptic Aspergillus species accounted for 33.8%, with no differences in proportions between the clinical and environmental isolates. Section Nigri presented a high proportion (70.5%) of cryptic species, mainly from A. tubingensis and A. awamori: the former being dominant in environmental samples, and the latter being more common in clinical isolates (P < 0.001). Of 91 A. fumigatus isolates, azole-resistant A. fumigatus was found in 5.3% of all A. fumigatus isolates. Three isolates presented the TR34/L98H mutation of the cyp51A gene. Patients with invasive aspergillosis caused by azole-resistant A. fumigatus showed 100% all-cause mortality at 100 days. This study demonstrates the significant portion of cryptic Aspergillus species and clinical implications of azole resistance and underscores the comparison between clinical and environmental isolates.
Assuntos
Antifúngicos/farmacologia , Aspergilose/epidemiologia , Aspergilose/microbiologia , Aspergillus/efeitos dos fármacos , Aspergillus/isolamento & purificação , Microbiologia Ambiental , Neoplasias Hematológicas/complicações , Aspergilose/complicações , Aspergillus/genética , Aspergillus fumigatus/efeitos dos fármacos , Aspergillus fumigatus/isolamento & purificação , Farmacorresistência Fúngica/efeitos dos fármacos , Farmacorresistência Fúngica/genética , Genes Bacterianos/genética , Humanos , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/microbiologia , Testes de Sensibilidade Microbiana , Mutação , Estudos Prospectivos , República da Coreia/epidemiologiaRESUMO
BACKGROUND: The present study aimed to update the prediction equations for spirometry and their lower limits of normal (LLN) by using the lambda, mu, sigma (LMS) method and to compare the outcomes with the values of previous spirometric reference equations. METHODS: Spirometric data of 10,249 healthy non-smokers (8,776 females) were extracted from the fourth and fifth versions of the Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-2009; V, 2010-2012). Reference equations were derived using the LMS method which allows modeling skewness (lambda [L]), mean (mu [M]), and coefficient of variation (sigma [S]). The outcome equations were compared with previous reference values. RESULTS: Prediction equations were presented in the following form: predicted value = e{a + b × ln(height) + c × ln(age) + M - spline}. The new predicted values for spirometry and their LLN derived using the LMS method were shown to more accurately reflect transitions in pulmonary function in young adults than previous prediction equations derived using conventional regression analysis in 2013. There were partial discrepancies between the new reference values and the reference values from the Global Lung Function Initiative in 2012. CONCLUSION: The results should be interpreted with caution for young adults and elderly males, particularly in terms of the LLN for forced expiratory volume in one second/forced vital capacity in elderly males. Serial spirometry follow-up, together with correlations with other clinical findings, should be emphasized in evaluating the pulmonary function of individuals. Future studies are needed to improve the accuracy of reference data and to develop continuous reference values for spirometry across all ages.
Assuntos
Pulmão/fisiologia , Espirometria/normas , Adulto , Algoritmos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Inquéritos Nutricionais , Valores de Referência , Análise de Regressão , República da Coreia , Capacidade Vital , Adulto JovemRESUMO
In this study, we examined whether the peroxisome proliferator-activated receptor γ (PPARγ) agonists, ciglitazone (CGZ) and troglitazone (TGZ), induce cell death in human cervical cancer HeLa cells. The cells were treated with a range of CGZ or TGZ doses for 24 or 48 h. Low concentrations of CGZ (≤10 µM) or TGZ (≤20 µM) had no effect on cell viability whereas higher doses induced cell death in a time- and dose-dependent manner as evidenced by the detection of activated caspase-3 and PARP cleavage. Treatment with the PPARγ antagonist GW9662 followed by PPARγ agonists did not increase CGZ- or TGZ-induced cell death, indicating that PPARγ agonists induced HeLa cell death independently of PPARγ. Moreover, ERK1/2 activation was observed at a CGZ concentration of 25 µM and a TGZ concentration of 35 µM, both of which induced cell death. To elucidate the role of ERK1/2 activated by the two PPARγ agonists, the effect of U0126, an inhibitor of ERK1/2, on PPARγ-agonist-induced cell death was examined. Treatment with 10 or 20 µM U0126 followed by CGZ or TGZ induced the down-regulation of ERK1/2 activity and a decrease in Bcl-2 expression accompanied by the collapse of mitochondrial membrane potential, which in turn significantly enhanced CGZ- or TGZ-induced apoptotic cell death. Our results suggest that PPARγ agonists are capable of inducing apoptotic cell death in HeLa cells independently of PPARγ and that inhibition of ERK1/2 activity offers a strategy to enhance the cytotoxicity of PPARγ agonists in the treatment of cervical cancer.
Assuntos
Antineoplásicos/farmacologia , Cromanos/farmacologia , Proteína Quinase 1 Ativada por Mitógeno/antagonistas & inibidores , Proteína Quinase 3 Ativada por Mitógeno/antagonistas & inibidores , PPAR gama/agonistas , Tiazolidinedionas/farmacologia , Neoplasias do Colo do Útero/tratamento farmacológico , Apoptose/efeitos dos fármacos , Butadienos/farmacologia , Caspase 3/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Colo do Útero/citologia , Colo do Útero/efeitos dos fármacos , Colo do Útero/metabolismo , Sinergismo Farmacológico , Inibidores Enzimáticos/farmacologia , Feminino , Células HeLa , Humanos , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Nitrilas/farmacologia , PPAR gama/metabolismo , Troglitazona , Neoplasias do Colo do Útero/metabolismoRESUMO
BACKGROUND: Lateral lymph node metastasis is an important prognostic factor and is predictive of tumor recurrence and cause-specific survival in patients with papillary thyroid cancer (PTC). However, the factors predicting recurrence and clinical outcomes after therapeutic lateral neck dissection are not well established. The aims of this study were to evaluate the incidence, pattern, and factors predictive of PTC recurrence after therapeutic lateral neck dissection. MATERIALS AND METHODS: The records of 126 consecutive patients who underwent total thyroidectomy with therapeutic lateral neck dissection for primary PTC at the National Cancer Center were retrospectively reviewed. The factors predictive of recurrence were determined using both univariate and multivariate analyses considering several clinicopathologic variables. RESULTS: The median follow-up period was 61.2 months, during which 22 patients (17.5 %) experienced recurrence with 1 death (0.8 %) due to disease. Locoregional recurrence and distant metastasis were found in 20 cases (15.9 %) and 2 cases (1.6 %), respectively. Male gender, aggressive histology, number of lymph node metastases, initial level of T4-off Tg per ng/mL, and ATA risk categories (high risk) were independent risk factors for recurrence. Of note, initial T4-off Tg levels greater than 4.2 ng/mL showed highest sensitivity and specificity in predicting recurrence. CONCLUSIONS: These results provide useful information regarding the clinical outcomes after therapeutic lateral neck dissection for primary PTC and can be used to identify at-risk patients who need aggressive treatment and intensive surveillance for postoperative recurrence.
Assuntos
Carcinoma Papilar/secundário , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Área Sob a Curva , Autoanticorpos/sangue , Carcinoma Papilar/sangue , Carcinoma Papilar/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/cirurgia , Tireotropina/sangue , Tiroxina/sangue , Carga TumoralRESUMO
Purpose: This study aimed to assess the long-term risks associated with a history of infectious mononucleosis (IM), primarily caused by the Epstein-Barr virus (EBV). Specifically analyzing the potential increase in developing nasopharyngeal cancer (NPC) and lymphoma in patients with a history of IM and exploring the prevalence of other EBV-associated conditions. Materials and Methods: The Korean National Health Insurance Service (NHIS) database was utilized for a retrospective analysis, covering data from 2002 to 2021. A total of 25,582 IM patients and controls were included, with 1:1 propensity score matching. The study monitored outcomes, including lymphoma, NPC, gastric cancer, multiple sclerosis, and all-cause mortality. Results: Patients with a history of IM demonstrated a significantly higher incidence of lymphoma (HR=5.32, 95% CI 3.208â8.82, p<0.001) and NPC (HR=7.116, 95% CI 1.617â31.314, p=0.009) during the follow-up period compared with the control group. Additionally, the IM group showed an increased rate of all-cause mortality (HR=2.225, 95% CI 1.858â2.663, p<0.001). Conclusion: This study suggests that individuals with a history of IM have an elevated risk of developing lymphoma and NPC in South Korea, emphasizing the importance of vigilant follow-up and monitoring. The results advocate for heightened awareness and potential national monitoring policies to address the long-term health implications of EBV infection and to implement preventive measures.
RESUMO
Background: The International Agency for Research on Cancer (IARC) Monograph conducted a systematic review of the relationship between asbestos and ovarian cancer. However, there may have been information bias due to the undue weight given to few articles. To address this limitation, the present study performed a meta-analysis integrating studies published both before and after the 2012 IARC Monograph on Asbestos, with the aim of investigating the association between asbestos exposure and ovarian cancer. Methods: A comprehensive search of major journal databases was conducted to identify studies examining the relationship between asbestos exposure and ovarian cancer, including those featured in the 2012 IARC Monograph on Asbestos. A meta-analysis on asbestos exposure and cancer risk was performed. Results: The meta-analysis of studies published after the 2012 IARC Monograph on Asbestos found a summary Standardized Mortality Ratio (SMR) of 2.04 (95% CI: 1.03-4.05; p = 0.0123; 5 studies), with a significant degree of heterogeneity among the studies (I2 = 72.99%). The combined analysis of 15 studies before and after the 2012 IARC Monograph showed an overall summary SMR of 1.72 (95% CI: 1.43-2.06; p = 0.0349; 15 studies), with a moderate degree of heterogeneity (I2 = 42.99%). Conclusion: This meta-analysis provides evidence of a significant association between asbestos exposure and ovarian cancer mortality. While the possibility of misdiagnosis in earlier studies cannot be completely ruled out, recent findings suggest a robust correlation between asbestos exposure and ovarian cancer. This highlights the importance of sustained efforts to minimize asbestos exposure and protect public health.
RESUMO
OBJECTIVE: This study investigated the effects of hot and cold temperature on the renal function of people with chronic diseases, such as diabetes, hypertension, and chronic kidney disease, using large-scale clinical data. METHODS: We used retrospective cohort data from the Clinical Data Warehouse of the Seoul St. Mary's Hospital, which was containing clinical, diagnostic, laboratory, and other information of all patients who have visited the hospital since 1997. We obtained climate data from the Automated Synoptic Observing System of the Korea Meteorological Administration. The heat index was used as a measuring tool to evaluate heat exposure by indexing the actual heat that individuals feel according to temperature and humidity. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. To investigate changes in renal function trends with heat index, this study used generalized additive mixed models. RESULTS: Renal function decreased linearly with the increasing heat index after approximately 25°C, which was considered the flexion point of temperature. A linear decrease in the eGFR was observed with the effects of 0 to 5 lag days. While there was a correlation observed between the decrease in eGFR and temperatures below -10°C, the results do not indicate statistical significance. CONCLUSIONS: The results of our study provide scientific evidence that high temperatures affect the renal function of people with chronic diseases. These results can help prevent heat-related morbidity by identifying those who are more likely to develop renal disease and experience worsening renal function.
RESUMO
BACKGROUND: The bilateral axillo-breast approach for endoscopic/robotic thyroid surgery (BABA) shows good oncologic and surgical outcomes and does not result in neck scars. However, there is concern about potential sensory changes of the skin flaps after BABA, especially of the breast areas. This prospective study was undertaken to evaluate sensory changes in the skin flaps after BABA. PATIENTS AND METHODS: A total of 19 women (mean age 36.9 ± 8.7; age range 21-51 years) who underwent BABA were enrolled. Skin flap sensory assessments were performed for each patient preoperatively and again at 1 and 3 months postoperatively. The Semmes-Weinstein monofilament test was used to evaluate the cutaneous light-pressure thresholds, a biothesiometer was used to evaluate the vibration thresholds, and an infrared thermometer was used to measure skin temperatures of the skin flaps. RESULTS: There were changes in the sensations of the anterior chest areas over time, as determined by the Semmes-Weinstein monofilament test (1.5 vs 4.3 versus 1.4; P < 0.05) and the biothesiometer (26.8 vs 31.2 vs 22.3; P < 0.05). The sensations in the anterior chest areas normalized to preoperative levels at 3 months postoperatively. No significant differences were seen in the infrared thermometer test at any of the time points (36.2 vs 36.2 vs 36.3 °C; P = 0.9927). CONCLUSIONS: While anterior chest area sensations were changed at 1 month postoperatively, the sensations normalized at 3 months after BABA. These results suggest that BABA has minimal adverse effects on anterior chest area sensation.
Assuntos
Endoscopia , Complicações Pós-Operatórias , Robótica , Distúrbios Somatossensoriais/etiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Análise de Variância , Axila , Mama , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Distúrbios Somatossensoriais/diagnóstico , Tórax , Resultado do TratamentoRESUMO
Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians.