Risk of pancreatic cancer after acute pancreatitis: A population-based matched cohort study.

BACKGROUND: We investigated the short- and long-term risks of pancreatic cancer after the diagnosis of acute pancreatitis. METHODS: This population-based matched-cohort study used data from the Korean National Health Insurance Service database. Patients with acute pancreatitis (n = 25,488) were matched with the control group (n = 127,440) based on age, sex, body mass index, smoking status, and diabetes. We estimated the hazard ratios for developing pancreatic cancer in both groups using Cox regression analysis. RESULTS: During a median follow-up of 5.4 years, pancreatic cancer developed in 479 patients (1.9%) in the acute pancreatitis group and 317 patients (0.2%) in the control group. Compared with the control group, the risk of pancreatic cancer in the acute pancreatitis group was very high within the first 2 years, which gradually decreased over time. The hazard ratio for the risk of developing pancreatitis was 8.46 (95% confidence interval, 5.57-12.84) at 1-2 years, and then decreased to 3.62 (95% confidence interval, 2.26-4.91) at 2-4 years. However, even after 8-10 years, the hazard ratio was still statistically significantly increased to 2.80 (95% confidence interval, 1.42-5.53). After 10 years, there was no significant difference in the risk of pancreatic cancer between the two groups. CONCLUSIONS: The risk of pancreatic cancer increases rapidly after acute pancreatitis diagnosis, gradually declines after 2 years, and remains elevated for up to 10 years. Further studies are needed to determine the long-term effects of acute pancreatitis on the risk of pancreatic cancer.

Experience and perspectives of end-of-life care discussion and physician orders for life-sustaining treatment of Korea (POLST-K): a cross-sectional study.

BACKGROUND: This study aimed to identify the healthcare providers' experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician's order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act. METHODS: A cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects-94 attending physicians, 87 resident physicians, and 293 nurses-participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the SPSS 24.0 program. RESULTS: Study results showed that respondents were aware of terminal illness and physician's order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers' side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation. CONCLUSION: Based on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician's order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for.

Lifestyle, body mass index, diabetes, and the risk of pancreatic cancer in a nationwide population-based cohort study with 7.4 million Korean subjects.

BACKGROUND: Large-scale epidemiological studies on pancreatic cancer in non-Western populations are insufficient. We investigated the risk factors for pancreatic cancer. METHODS: Using the Korean National Health Insurance database, subjects who participated in the health examination program between 2005 and 2006 were identified and followed up until 2017. Adjusted hazard ratios (HRs) for pancreatic cancer risk were estimated using a Cox proportional hazards model. RESULTS: During 11.5 years follow-up, 22,543 of 7,445,947 participants were newly diagnosed with pancreatic cancer. Compared with normal-weight subjects, pancreatic cancer risk was increased in those with severe obesity (BMI ≥ 28 kg/m2) (HR = 1.16; 95% CI, 1.11-1.23). Subjects with diabetes had an increased risk compared with those without diabetes (HR = 1.48; 95% CI, 1.43-1.53). Current smokers had a higher risk than never smokers (HR = 1.43; 95% CI, 1.38-1.48). Current smoking combined with diabetes increased the risk compared with never smokers without diabetes (HR = 2.13; 95% CI, 2.00-2.28). Current smoking combined with BMI ≥ 25 kg/m2 had an increased risk compared with never smokers with BMI < 23 kg/m2 (HR = 1.55; 95% CI, 1.46-1.65). CONCLUSION: Smoking, obesity, and diabetes are significant risk factors for pancreatic cancer in Koreans. Lifestyle modifications for smoking and obesity would be beneficial for pancreatic cancer prevention.

Nationwide validation study of diagnostic algorithms for inflammatory bowel disease in Korean National Health Insurance Service database.

BACKGROUND AND AIM: We conducted a nationwide validation study of diagnostic algorithms to identify cases of inflammatory bowel disease (IBD) within the Korea National Health Insurance System (NHIS) database. METHOD: Using the NHIS dataset, we developed 44 algorithms combining the International Classification of Diseases (ICD)-10 codes, codes for Rare and Intractable Diseases (RID) registration and claims data for health care encounters, and pharmaceutical prescriptions for IBD-specific drugs. For each algorithm, we compared the case identification results from electronic medical records data with the gold standard (chart-based diagnosis). A multiple sampling test verified the validation results from the entire study population. RESULTS: A random nationwide sample of 1697 patients (848 potential cases and 849 negative control cases) from 17 hospitals were included for validation. A combination of the ICD-10 code, ≥ 1 claims for health care encounters, and ≥ 1 prescription claims (reference algorithm) achieved excellent performance (sensitivity, 93.1% [95% confidence interval 91-94.7]; specificity, 98.1% [96.9-98.8]; positive predictive value, 97.5% [96.1-98.5]; negative predictive value, 94.5% [92.8-95.8]) with the lowest error rate (4.2% [3.3-5.3]). The multiple sampling test confirmed that the reference algorithm achieves the best performance regarding IBD diagnosis. Algorithms including the RID registration codes exhibited poorer performance compared with that of the reference algorithm, particularly for the diagnosis of patients affiliated with secondary hospitals. The performance of the reference algorithm showed no statistical difference depending on the hospital volume or IBD type, with P-value < 0.05. CONCLUSIONS: We strongly recommend the reference algorithm as a uniform standard operational definition for future studies using the NHIS database.

A cadaveric study for the volar needle approach to the pronator quadratus using the palmaris longus tendon landmark.

INTRODUCTION: Our aim in this work was to determine the safety and accuracy of the volar approach to the pronator quadratus (PQ) through cadaver dissection. METHODS: Twenty upper limbs from 10 fresh cadavers were investigated. At the level 3 cm proximal to the ulnar styloid process (USP), a needle was inserted just medial to the palmaris longus (PL) tendon. Distances of the median nerve (MN) and ulnar artery (UA) from the needle insertion point (IP) were measured using ultrasonography and cadaver dissection. RESULTS: The PQ was located at a depth of 10.8-19.9 mm from the skin and had a median thickness of 9.1 mm, measured 3 cm proximal to the USP. The median distances of the MN and UA from the IP were 7.6 and 13.4 mm, respectively. DISCUSSION: A needle insertion for the volar approach to the PQ was safe at 3 cm proximal to the USP, just medial to the PL tendon.

Sonography-guided recording for superficial peroneal sensory nerve conduction study.

INTRODUCTION: We sought to establish the optimal recording position for antidromic conduction of the superficial peroneal nerve (SPN) by using ultrasonography (USG). METHODS: The sensory nerve action potentials (SNAPs) of the intermediate dorsal cutaneous nerve (IDCN) and medial dorsal cutaneous nerve (MDCN) in 64 limbs of 32 healthy participants were recorded (nerve conduction study [NCS]-1). Both nerves were identified by using USG, and the SNAPs were obtained from the USG-guided repositioned electrodes (NCS-2). RESULTS: The IDCN and MDCN were located at 29.3% ± 5.1% and 43.9% ± 4.9% of the intermalleolar distance from the lateral malleolus, respectively. Significantly greater amplitude was shown for SNAPs of both nerves in NCS-2 versus NCS-1. DISCUSSION: The optimal recording position is likely to be lateral, one-third from the lateral malleolus for the IDCN, and just lateral to the midpoint of the intermalleolar line for the MDCN. When the SPN response is unexpectedly attenuated, USG-guided repositioning of the electrodes should be considered. Muscle Nerve 57: 628-633, 2018.

Sonoanatomy of sensory branches of the ulnar nerve below the elbow in healthy subjects.

INTRODUCTION: We identify sensory branches of the ulnar nerve-palmar ulnar cutaneous nerve (PUCN), dorsal ulnar cutaneous nerve (DUCN), and superficial sensory branch-using ultrasonography. METHODS: In 60 forearms of 30 healthy adult volunteers, the origin and size of the PUCN, DUCN, and superficial sensory branch were measured by ultrasonography. The relative pathway of the DUCN to the ulnar styloid process was also investigated. RESULTS: The PUCN was observed in 47 forearms (78%), and the DUCN was observed in all forearms. Average distances from the pisiform to the origin of the PUCN and DUCN were 11.9 ± 1.4 and 7.0 ± 1.0 cm, respectively. Superficial and deep divisions split 0.9 ± 0.3 cm distal to the pisiform. Cross-sectional areas of the PUCN, DUCN, and superficial sensory branch were 0.3 ± 0.1, 1.5 ± 0.5, and 3.9 ± 1.0 mm2 , respectively. DISCUSSION: Sensory branches of the ulnar nerve can be visualized by ultrasonography, helping to differentiate ulnar nerve injury originating at either wrist or elbow. Muscle Nerve 57: 569-573, 2018.

Aurantio-obtusin, an anthraquinone from cassiae semen, ameliorates lung inflammatory responses.

The purpose of the present study is to find the natural compound(s) having a therapeutic potential to treat lung inflammatory disorders. In our screening procedure, the methanol extract of the seeds of Cassia obtusifolia (cassiae semen) inhibited inducible nitric oxide synthase-catalyzed nitric oxide production in alveolar macrophages (MH-S). From the extract, 8 major anthraquinone derivatives were successfully isolated. They are chrysophanol, physcion, 2-hydroxy-emodin 1-methyl ether, obtusifolin, obtusin, aurantio-obtusin, chryso-obtusin, and gluco-obtusifolin, among which aurantio-obtusin (IC50  = 71.7 µM) showed significant inhibitory action on nitric oxide production from lipopolysaccharide-treated MH-S cells, mainly by downregulation of inducible nitric oxide synthase expression. This down-regulatory action of aurantio-obtusin was mediated at least in part via interrupting c-Jun N-terminal kinase/IκB kinase/nuclear transcription factor-κB pathways. Aurantio-obtusin also inhibited IL-6 production in IL-1ß-treated lung epithelial cells, A549. Importantly, this compound (10 and 100 mg/kg) by oral administration attenuated lung inflammatory responses in a mouse model of lipopolysaccharide-induced acute lung injury. Therefore, it is for the first time found that aurantio-obtusin may have a therapeutic potential for treating lung inflammatory diseases.

Clinicopathological characteristics of biliary neuroendocrine neoplasms: a multicenter study.

OBJECTIVES: This study assessed the clinicopathological features, therapeutic approaches, and prognosis of patients with biliary neuroendocrine neoplasm (NENs). MATERIALS AND METHODS: Multicenter retrospective study of patients with biliary tract NENs in the gallbladder, the extrahepatic bile duct, or the ampulla of Vater between 2005 and 2014. RESULTS: Total of 43 patients were included in the study. The median age was 62 years (range: 29-84 years) and 58.1% of the patients were male. The tumors occurred in the gallbladder (n = 11), the extrahepatic bile duct (n = 5) or the ampulla of Vater (n = 27). The liver was the most common metastatic site. Based on the 2010 World Health Organization classification, more patients with gallbladder NENs (11/11 (100%)) had neuroendocrine carcinoma G3 than those with NENs in the ampulla of Vater (10/27 (37.1%)). The median progression free survival time (39.3 vs 5.1 months, p = 0.001) and median overall survival time (46.9 vs 7.9 months, p < 0.001) were significantly longer in patients with ampulla of Vater NENs than gallbladder NENs. A 2010 World Health Organization classification of neuroendocrine carcinoma G3 was independently related to poor overall survival (hazard ratio (HR), 27.1; 95% confidence intervals (CI), 2.81-260.68; p = 0.004). CONCLUSION: The 2010 World Health Organization classification of neuroendocrine carcinoma G3 was the only factor related to poor prognosis in patients with biliary neuroendocrine neoplasms.

Safety Window for the Volar Needle Approach for Examination of the Pronator Quadratus Using Ultrasonography.

OBJECTIVES: To investigate pronator quadratus (PQ) anatomy and determine the proper volar needle insertion point based on landmarks, the tip of the ulnar styloid (an imaginary vertical line passing the tip of the ulnar styloid process [U line]), and the ulnar margin of the palmaris longus tendon (uPL) using ultrasonography. DESIGN: Descriptive study. SETTING: Department of physical medicine and rehabilitation. PARTICIPANTS: Participants between 20 and 60 years without any diseases. (N=25; 13 men, 12 women; 50 forearms). INTERVENTIONS: Ultrasonography. MAIN OUTCOME MEASURES: The proximal and distal volar surface points of origin, the proximal and distal insertion sites, and the midpoint of the PQ (PQ_M) were determined. The distance of each of the PQ surface indices from the U line was measured, and the probe was positioned at the level of PQ_M parallel to the U line. The relative distances from the vertical surface points of the median nerve and ulnar artery to the uPL were measured. RESULTS: The mean age and body mass index were 32.7±10.4 years and 21.98±2.83kg/m2. The PQ_M was located at a mean distance of 2.63±0.35cm proximal from the U line (men 2.79±0.37cm and women 2.45±0.21cm; P<.05). The mean safety window for the volar approach was 0.72±1.8cm toward the radial side and 1.51±0.30cm toward the ulnar side from the uPL. The PQ was at a mean depth of 1.30±0.19cm from the skin and had a mean thickness of 1.19±0.24cm at the level of PQ_M. The distance between the U line and the proximal edge of the PQ, as well as the PQ thickness, was greater in men than in women. CONCLUSIONS: The volar approach for needle electromyographic examination of the PQ can be performed precisely and safely.

A case of lateral calcaneal neuropathy: Lateral heel pain.

INTRODUCTION: Although isolated injury of the sural nerve is frequently reported, entrapment involving the lateral calcaneal branch of the sural nerve (LCSN) is very rare. METHODS: We report the case of a 29-year-old man with lateral calcaneal neuropathy of the sural nerve without any history of trauma. The diagnosis was based on clinical, electrophysiologic, and radiologic studies, including ultrasonography (US) and MRI. RESULTS: US revealed a spindle-shaped swelling in the posterior part of the sural nerve around the lateral malleolus. MRI showed a small lesion in the sural nerve close to the lesser saphenous vein around the level of the lateral malleolus. Two months after conservative management, the numbness and tingling in the lateral calcaneal region improved. CONCLUSIONS: Entrapment of the LCSN can arise from tight shoes. US is useful for evaluating the cutaneous nerve lesions that may be too small to detect by MRI. Muscle Nerve 54: 801-804, 2016.

Superficial radial sensory neuropathy: Medial and lateral branch injury.

INTRODUCTION: Superficial radial sensory nerve (SRN) injury may involve the main nerve or its distal medial or lateral branch. We investigated the utility of SRN conduction studies on the medial and lateral branches in patients with suspected SRN injury. METHODS: Fifteen patients with symptoms of SRN neuropathy were studied. Their clinical and electrophysiological findings were assessed according to sensory symptom areas. Three active recording electrode positions were used: snuff box (position A); medial branch (position B); and lateral branch (position C). RESULTS: In 7 patients with medial area symptoms, abnormal findings were seen in position B (100%) and position A (71%). In 3 patients with medial and lateral area symptoms, abnormal findings were seen in all positions. In 5 patients with lateral symptoms, abnormal findings were seen in position C only. CONCLUSIONS: Nerve conduction studies for each branch of the SRN are useful in patients with suspected SRN neuropathy.

Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience.

BACKGROUND: Performing ERCP in patients with previous pancreaticoduodenectomy (PD) is technically challenging. Balloon-assisted ERCP has recently been recognized as a useful tool in patients with surgically altered anatomies. However, there are few studies that focus on ERCP in post-PD patients. AIM: This study aimed to evaluate the outcome of ERCP in patients in post-PD and the patterns for type of endoscopes used. METHODS: Patients with previous PD who had undergone ERCP were included in this retrospective study. RESULTS: One hundred and thirty ERCP procedures were performed on 47 post-PD patients. The overall success of ERCP was 82.3 % (107/130). Endoscope insertion to the pancreaticobiliary anastomoses was accomplished in 93.8 % (122/130), which resulted in successful completion of ERCP in 87.7 % (107/122) of the procedures: 89.5 % (94/105) in biliary indications and 76.5 % (13/17) in pancreas indications. Using the conventional endoscopes (CEs) led to ERCP success in 66.4 % (71/107) of attempts versus 78.3 % (36/46) with balloon-assisted enteroscopes (BAEs). Among 105 cases in which CEs were initially tried, ERCP was successful in 69 (65.7 %) cases with CEs alone. When CEs failed to reach the pancreaticobiliary anastomoses, the subsequent use of BAEs resulted in a successful ERCP in 16/19 (84.2 %) of attempts. CONCLUSIONS: ERCP in post-PD patients can be performed with a high success rate. We recommend that CEs should be used initially for ERCP in patients with PD and that BAEs be reserved for situation in which CEs have failed to reach the pancreaticobiliary anastomoses.

Estimation of the Three Phases by Direct Cost of Care for Non-surviving Patients with Cancer: A National Population-based Patient-level Study.

Background: Determining the cost structure of medical care from diagnosis to the death of patients with cancer is crucial for establishing budgets to support patients with cancer. The breakdown of the cost estimation in distinct phases of survival is essential for optimizing the allocation of limited funds. Therefore, this study aims to examine the patterns of direct medical costs of cancer care associated with seven major cancer types and estimate cost thresholds to distinguish each phase based on the incurred cost. Methods: In this nationwide, population-based study, we used claims data from the National Health Insurance Service, Korea. Patients newly diagnosed with cancer since 2006 and who died in 2016-2017 were enrolled, and their use of medical services during cancer survival from at least 6 months up to 12 years was observed. The monthly cost exhibited a non-linear function with two unknown thresholds resembling a U-shape; therefore, we fitted three linear segment models. Individual costs were assessed by dividing the survival time into the initial, continuing, and terminal phases by estimated thresholds, and the average medical cost for each phase was calculated. Results: Based on survival durations of 12 years or less, the initial phase occurred within 1.1-4.8 months after diagnosis, while the terminal phase was observed in 1.4-4.7 months before death. The length of these two phases increased with the increased survival time of the patients. Medical costs in these phases ranged from $4067-7431 and $3127-6114 (US dollars), respectively, regardless of the variations in survival time. However, the average costs in the continuing phase were higher for patients with a short survival time. Conclusions: This study highlights the cost dynamics in cancer care through a breakdown of the phases of survival. It suggests that through a more refined definition of the initial and terminal phases, the average cost in these stages increases, indicating the significant implications of the findings for resource allocation and tailored financial support strategies for patients with cancer with varying prognoses.

One-pot synthesis of yolk-shell materials with single, binary, ternary, quaternary, and quinary systems.

A facile, one-pot method of systematically synthesizing yolk-shell materials with complex compositions is proposed. The spray pyrolysis process for obtaining yolk-shell materials is advantageous because it is highly efficient, allows high throughput, comprises a single-step reaction, and is a continuous process that yields homogeneous composition and enables facile control of the mean size.

Electrophysiological and ultrasonographic findings in ulnar neuropathy with Martin-Gruber anastomosis.

INTRODUCTION: It is important to understand the presence of Martin-Gruber anastomosis in patients with complete ulnar neuropathy at the elbow. CASE REPORT: We describe a patient with complete ulnar neuropathy at the elbow and Martin-Gruber anastomosis in the forearm, mimicking incomplete ulnar neuropathy with complete conduction block in the forearm segment. Ultrasonography of the ulnar nerve around the elbow demonstrated severe swelling of the ulnar nerve, which was compatible with severe ulnar neuropathy at the elbow. CONCLUSIONS: This case report demonstrates that combination of ultrasonography with electrophysiological studies can provide more detailed information about the changes of nerve structures and lesion sites.

Synthesis and characterisation of polygonal indium tin oxide nanocrystals.

Polygon ITO (Sn-doped In2O3) nanocrystals were synthesised via electrospinning, and their morphology, structural properties, and chemical composition were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and X-ray photoelectron spectroscopy (XPS). To determine the optimum conditions for the fabrication of polygon ITO nanocrystals, calcination temperature after the electrospinning process was controlled at 500 degrees C, 600 degrees C, 700 degrees C, and 800 degrees C, and the amount of PVP polymer was controlled at 4 wt%, 7 wt%, and 10 wt%. For comparison purposes, single In2O3 nanocrystals were also synthesised via electrospinning and calcination. The results show that ITO nanocrystals fabricated at a calcination temperature of 800 degrees C and with 10 wt% of PVP polymer exhibit clear polygon structure with single-crystallinity, which may be explained in terms of the effect of Sn doping in the In2O3 matrix and the oriented aggregation and Oswald ripening growth during the fusion process of ITO nanocrystals.

Conversational analysis of medical discourse in rehabilitation: a study in Korea.

OBJECTIVE: The purpose of this study is to conduct an analysis of actual communicative behaviors, including nonverbal ones, between physicians and patients in rehabilitation. DESIGN: Sixteen videotaped physician-patient interactions in a rehabilitation center in Korea were transcribed. And three coders placed utterances in transcripts into categories while watching the videotapes. RESULTS: Consistent with results of previous studies, patient active communicative behaviors varied considerably depending on individual patients. The findings revealed that, on average, patients' active communicative behaviors were less than 9% of patients' total utterances. In particular, almost half of the patients (N = 7) did not even ask one single question. The results also showed that physicians' empathic communicative acts averaged less than 3% of physicians' total utterances. In addition, among physicians' nonverbal behaviors, eye-contact showed significant correlation with physician empathic listening and supportive talks. CONCLUSIONS: The findings of this study indicated a considerable lack of empathic communicative behaviors of physicians in Korea. This might have led to infrequent use of active communicative behaviors by patients. In addition, the importance of physician's partnership for enhancement of active communicative behaviors of patients was demonstrated. To better serve patients, physicians who wish to improve their communication should first identify components of their empathic communicative behaviors that need improvement and then attempt to refine their skills.

Evaluation of pesticide residues in vegetables and risk assessment from Incheon, Korea.

This study investigated pesticide residues to evaluate food safety caused by vegetables in Incheon. A total of 385 samples of 33 different types of vegetables mainly consumed by Koreans were collected from the Incheon market in 2021. The pesticide residues were analyzed by the multi-residue methods of the Korean Food Code for 339 different pesticides. Of the 385 vegetables, no residual pesticides were detected in 329 samples (85.5%), while 56 samples (14.5%) contained residual pesticides and 13 samples (3.4%) had residues above the maximum residue limit. A total of 34 different pesticide residues were detected and 8 pesticides exceeded maximum residue limits (MRLs). The most frequently detected pesticide residues were fluxametamide (7 samples), azoxystrobin (4 samples), chlorantraniliprole (3 samples), flubendiamide (3 samples), and procymidone (3 samples). The highest values in the risk assessment were obtained when Chinese chives were consumed with terbufos. But the values of HQ and cHI were lower than 100%. Therefore, the results showed that the detected pesticides were no potential risk from consumption of vegetables.

Influence of the Foaming Process on the Burning Behavior of the PET-PEN Copolymer.

The manufacturing process can modify the micromechanical structure, usefulness, and functionality of foams. Although one-step foaming is a simple process, controlling the morphology of the foams is difficult compared to the two-step processing method. In this study, we investigated the experimental differences in thermal and mechanical properties, particularly combustion behavior, between PET-PEN copolymers prepared by the two methods. With an increase in foaming temperature Tf, the PET-PEN copolymers became more fragile, and the breaking stress of the one-step PET-PEN foamed at the highest Tf was only 2.4% of that of the raw material. For the pristine PET-PEN, 24% of the mass was burned, leaving 76% as a molten sphere residue. The two-step MEG PET-PEN had only 1% of its mass remaining as a residue, whereas the one-step PET-PENs had between 41 and 55%. The actual mass burning rates were similar for all the samples except the raw material. The coefficient of thermal expansion of the one-step PET-PEN was about two orders of magnitude lower than that of the two-step SEG.