Incidence rates of retinal vascular occlusive diseases from 2011 to 2020 in South Korea: a nationwide cohort study.

BACKGROUND: Retinal vascular occlusions, including retinal vein occlusion and retinal artery occlusion, are common causes of visual impairment. In order to evaluate the national medical burden and help improve ophthalmic health care policy planning, we investigated the incidence of retinal vascular occlusive diseases from 2011 to 2020 in Korea. METHODS: This study is a nationwide population-based retrospective study using data from the Korea national health claim database of the Health Insurance Review and Assessment (HIRA) service. We identified retinal vascular occlusive diseases registered from January 1, 2009, to December 31, 2020, according to the retinal vascular occlusion code (H34) and its sub-codes from international classification of disease, tenth revision diagnosis code. We used data from the entire Korean population based on the 2015 census of the population in Korea to calculate standardized incidence rates. RESULTS: We identified 348,775 individuals (male, 161,673 [46.4%]; female, 187,102 [53.6%]) with incident retinal vascular occlusion (H34), 10,451 individuals (males, 6,329 [60.6%]; females, 4,122 [39.4%]) with incident central retinal artery occlusion (H34.1), and 252,810 individuals (males, 114,717 [45.4%]; females, 138,093 [54.6%]) with incident retinal vein occlusion (H34.8) during the 10-year study period. The weighted mean incidence rate of retinal vascular occlusion was 70.41 (95% CI, 70.18-70.65) cases/100,000 person-years. The weighted mean incidence rate of central retinal artery occlusion was 2.10 (95% CI, 2.06-2.14) cases/100,000 person-years. The weighted mean incidence rate of retinal vein occlusion was 50.99 (95% CI, 50.79-51.19) cases/100,000 person-years. CONCLUSION: The total retinal vascular occlusion and retinal vein occlusion showed a decreasing trend until 2020. However, the central retinal artery occlusion decreased until 2014 and remained stable without a significant further decline until 2020. The incidence of total retinal vascular occlusion and retinal vein occlusion was higher in females than in males, while the incidence of central retinal artery occlusion was higher in males. All retinal vascular occlusive diseases showed an increasing incidence with older age; the peak age incidence was 75-79 years for total retinal vascular occlusion and retinal vein occlusion, and 80-85 years for central retinal artery occlusion.

Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea.

BACKGROUND: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. METHODS: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. RESULTS: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. CONCLUSIONS: Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

Interference with daily functioning by breakthrough pain in patients with cancer.

PURPOSE: To investigate the association between quality of life (QOL) and breakthrough cancer pain (BTCP) intensity in patients who met the commonly accepted definition of BTCP. METHODS: This study was a subset analysis of a South Korean multicenter, non-interventional, cross-sectional, nationwide survey. Participants were recruited from March 2016 to December 2017. BTCP was defined as a controlled background pain of less than a numeric rating scale (NRS) of 3 and any flare-up pain intensity. Pain intensity data were collected using the Brief Pain Inventory (BPI), which includes an interference assessment of the affective and physical domains. Patients were categorized by BTCP intensity into mild (NRS 1-3), moderate (4-6), and severe (7-10) groups. RESULTS: Of the 969 screened patients with cancer, 679 had ≤ NRS 3 background pain, of whom 438 completed the BPI. Of these 438 patients, 40, 204, and 194 were in the mild, moderate, and severe BTCP groups, respectively. The median NRS of BTCP was 6.0 (interquartile range = 5.0-8.0). Patients with moderate-severe BTCP had significantly higher interference with daily functioning (IDF) scores than did mild BTCP patients (3.3 vs. 5.7; p < 0.01). Both domains of IDF were significantly hampered proportionally by increased BTCP intensity (p < 0.001). The median total IDF scores of the no, moderate, and severe BTCP groups were 3.3, 5.0, and 6.9, respectively. Furthermore, IDF depended on BTCP intensity, duration, and frequency (p < 0.01) but not on pain type and cause. CONCLUSION: An increase in BTCP intensity is likely to result in IDF, regardless of the cause or type of BTCP.

Aqueous humor and serum 25-Hydroxyvitamin D levels in patients with cataracts.

BACKGROUND: Serum 25-hydroxyvitamin D (25 (OH) D) levels are associated with various pathologic ocular conditions. Few studies have assessed 25 (OH) D concentrations in non-serum specimens, and none to date has assessed 25 (OH) D concentrations in human aqueous humor and their association with ocular diseases. This study investigated the possible correlations between 25 (OH) D concentrations in aqueous humor and serum and whether vitamin D concentrations in aqueous humor were associated with cataract. METHODS: This study prospectively enrolled 136 patients, including 87 with senile cataract and 49 with diabetic cataract, who underwent cataract surgery from January to November 2017. 25 (OH) D was measured in aqueous humor and serum specimens collected from all patients, and their correlation was analyzed statistically. Clinical and laboratory data, including the results of ophthalmologic examinations, were compared in the two groups of cataract patients. RESULTS: No correlation was observed between 25 (OH) D concentrations in aqueous humor and serum (P = 0.381). 25 (OH) D concentrations in aqueous humor were significantly higher in patients with diabetic than senile cataract (P = 0.006). Multivariate logistic regression analysis showed that the adjusted odds ratio for diabetic cataract for the highest compared with the lowest quartile of 25 (OH) D concentration in aqueous humor was 4.36 ng/ml (95% confidence interval [CI]: 1.33-14.34 ng/ml; P = 0.015). Multivariate linear regression analysis showed that 25(OH) D concentration in aqueous humor was 2.68 ng/ml (95% CI: 0.34-5.01 ng/ml; P = 0.025) higher in patients with diabetic than senile cataract. CONCLUSIONS: 25(OH) D concentrations in aqueous humor and serum did not correlate with each other. Higher 25(OH) D level in aqueous humor was associated with diabetic cataract. These findings suggest that studies of vitamin D levels in patients with ocular conditions should include measurements of vitamin D levels in aqueous humor.

Factors associated with myopia in Korean children: Korea National Health and nutrition examination survey 2016-2017 (KNHANES VII).

BACKGROUND: To evaluate the prevalence and risk factors associated with myopia and high myopia in children in South Korea. METHODS: A total of 983 children 5-18 years of age who participated in the Korean National Health and Nutrition Examination Survey 2016-2017 (KNHANES VII), a nationwide population-based cross-sectional study, were evaluated. Myopia and high myopia were defined as a spherical equivalent (SE) ≤ - 0.5 diopters (D) and SE ≤ --6.0 D. The association between refractive errors and potential risk factors for myopia was analyzed. RESULTS: The prevalence of myopia and high myopia was 65.4 and 6.9%, respectively. Older age and parental myopia were significantly associated with both myopia and high myopia, while higher body mass index (BMI) was associated with high myopia only. Although the proportion of subjects who spent more time on near work activities (≥4 h/day) was sequentially increased with increased refractive error, this tendency was not statistically significant by multivariable logistic regression. CONCLUSIONS: Korean children had a high prevalence of myopia and high myopia. In this age group, the risk of myopia increased with aging and parental myopia. Higher BMI may be associated with high myopia.

The Trend in Incidence and Case-fatality of Hospitalized Acute Myocardial Infarction Patients in Korea, 2007 to 2016.

BACKGROUND: The trend in the incidence of hospitalized acute myocardial infarction (AMI) and the difference between regions has not been reported in Korea since 2010. Thus, we aimed to inspect recent trends and regional differences in the incidence of AMI and case-fatality between 2007 and 2016. METHODS: Data from the medical utilization cohort from 2002 to 2016 were analyzed. New incidence of AMI was identified by checking the diagnosis code, duration of admission, type of test, treatment, and medication. Age-standardized incidence rate by gender, age group, and resident region was calculated from 2007 to 2016. Cumulative case-fatality rate was calculated until 3 years. RESULTS: Age-standardized incidence of hospitalized AMI decreased from 53.6 cases per 100,000 person-years in 2007 to 38.9 cases in 2011. Thereafter, the incidence gradually increased to 43.2 cases in 2016. The trend by gender and age groups was also similar to the total trend. The regional age-standardized incidence was the highest in Daegu (50.3 cases per 100,000 person-years) and the lowest in Sejong (30.2 cases), which were similar to the ischemic heart disease mortality in these regions. The 7-, 30-, and 90-days and 1- and 3-years average case-fatality over 10 years were 3.2%, 6.9%, 9.9%, 14.7%, and 22.4%, respectively. CONCLUSION: Although case-fatality continuously decreased from 2007 to 2016, hospitalized AMI incidence decreased from 2007 to 2011 and gradually increased from 2011 to 2016, with marked disparity between regions. Effective preventive strategies to decrease AMI incidence are required to decrease cardiovascular disease mortality in Korea.

The association of disease activity, pro-inflammatory cytokines, and neurotrophic factors with depression in patients with rheumatoid arthritis.

Inflammation and trophic factors (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor, glial cell line-derived neurotrophic factor, and insulin-like growth factor-1) are associated with depression in the general population. Rheumatoid arthritis (RA) is a chronic representative inflammatory autoimmune disease; however, the association of disease activity, pro-inflammatory cytokines, and neurotrophic factors with depression has not been sufficiently investigated. Therefore, we determined the prevalence of depression and risk factors for depression and deterioration of depressive symptoms in RA patients. In addition, we analyzed the association between disease activity, pro-inflammatory cytokines, trophic factors, and depression in RA (N = 474). Demographic and laboratory data were examined, and routine assessment of patient index data 3 (RAPID 3) and disease activity score 28-joint count C-reactive protein (DAS 28-CRP) was performed to assess disease activity of RA. Depression was measured using the Korean version of the Beck Depression Inventory-second edition (K-BDI II). A K-BDI score ≥18 was considered the cut-off for depression in accordance with a previous validation study. The serum level of pro-inflammatory cytokines and neurotrophic factors was assessed by enzyme-linked immune sorbent assay. The prevalence of depression was 32.4% in patients with RA. The severity of disease activity of RA (RAPID 3 score [OR 2.34; 95% confidence interval, CI 1.22-4.51], DAS 28-CRP [≥3.2] [OR 1.60, 95% CI 1.01-2.53]) and severity of fatigue (OR 1.26 95% CI 1.15-1.38) were associated with depression and deterioration of depressive symptoms in the multivariate analysis. Among the components of RAPID 3 and DAS 28-CRP, patient assessment for global health and abilities for daily performance were more related to depression. The level of pro-inflammatory cytokines (IL-1ß, IL-6, TNF-alpha) was not related to depression. The level of BDNF was significantly lower in RA patients with depression and was negatively correlated with K-BDI II score. Depression was related with the level of fatigue, low expression of BDNF, and high RA disease activity, which was associated with impaired ability to perform activities of daily life. Strict control of fatigue and disease activity to improve one's capacity to perform daily life activities would be important to regulate depression. The level of BDNF might be one of the possible biomarkers to predict or monitor depression in patients with RA.

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study.

BACKGROUND: The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients. METHODS: A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview. RESULTS: In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5-91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4-93.3). CONCLUSIONS: Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.

Laboratory measurement of apixaban using anti-factor Xa assays in acute ischemic stroke patients with non-valvular atrial fibrillation.

Apixaban is effective and safe for preventing stroke, and its usage has increased exponentially in recent years. However, data concerning the therapeutic range of apixaban is limited. This study determined the trough and peak levels of apixaban-specific anti-factor Xa activity (AFXaA) in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF) in Korea. The study included 85 patients who received apixaban. Blood samples were taken to measure the trough and peak levels of AFXaA using a chromogenic anti-factor assay, as well as prothrombin time (PT) and activated partial thromboplastin time (aPTT). We also reviewed complications such as major bleeding of patients treated with apixaban. In patients given a 5.0-mg apixaban dose, the median trough and peak levels of AFXaA were 104.5 and 202.0 ng/mL. In patients given a 2.5-mg apixaban dose, the median trough and peak AFXaA levels were 76.0 and 151.0 ng/mL. The PT showed a positive correlation with increased AFXaA activity at both levels (Trough R = 0.486, Peak R = 0.592), but the aPTT had no relationship with AFXaA activity at both levels (Trough R = 0.181, Peak R = 0.129). Two cases with intracranial bleeding belonged to the highest AFXaA quartile (Trough, p = 0.176; Peak, p = 0.053). In conclusion, we determined the trough and peak levels of AFXaA in patients with NVAF while being treated with the apixaban in Korea. Our results could be used as a starting point when setting the reference ranges for laboratories using anti-Xa assay. Large-scale studies are needed to establish the reference range for AFXaA in patients with NVAF.

Predictor of Isolated Trauma in Head: A New Simple Predictor for Survival of Isolated Traumatic Brain Injury.

BACKGROUND: Mortality prediction in patients with brain trauma during initial management in the emergency department (ED) is essential for creating the foundation for a better prognosis. OBJECTIVE: This study aimed to create a simple and useful survival predictive model for patients with isolated blunt traumatic brain injury that is easily available in the ED. METHODS: This is a retrospective study based on the trauma registry data of an academic teaching hospital. The inclusion criteria were age ≥ 15 years, blunt and not penetrating mechanism of injury, and Abbreviated Injury Scale (AIS) scores between 1 and 6 for head and 0 for all other body parts. The primary outcome was 30-day survival probability. Internal and external validation was performed. RESULTS: After univariate logistic regression analysis based on the derivation cohort, the final Predictor of Isolated Trauma in Head (PITH) model for survival prediction of isolated traumatic brain injury included Glasgow Coma Scale (GCS), age, and coded AIS of the head. In the validation cohort, the area under the curve of the PITH score was 0.970 (p < 0.0001; 95% confidence interval 0.960-0.978). Sensitivity and specificity were 95% and 81.7% at the cutoff value of 0.9 (probability of survival 90%), respectively. CONCLUSIONS: The PITH model performed better than the GCS; Revised Trauma Score; and mechanism of injury, GCS, age, and arterial pressure. It will be a useful triage method for isolated traumatic brain injury in the early phase of management.

Crossed cerebellar hyperperfusion in patients with seizure-related cerebral cortical lesions: an evaluation with arterial spin labelling perfusion MR imaging.

PURPOSE: Crossed cerebellar (CC) diaschisis refers to a decrease in cerebellar perfusion in the presence of contralateral supratentorial lesions. Most of the previous studies have examined stroke patients. In contrast to strokes, seizure-related cerebral cortical lesions (SCCLs) usually show hyperperfusion, and therefore, cerebellar perfusion patterns are expected to be different from those of strokes. With arterial spin labelling (ASL), we evaluated the cerebellar perfusion status in patients with SCCLs. MATERIALS AND METHODS: Using a search of the recent database over the last 31 months, 26 patients were enrolled in this study. The inclusion criteria were as follows: (1) a history of seizures, (2) MR examination taken within 24 h from the last seizure, (3) the presence of SCCLs on T2/FLAIR or DWI, (4) hyperperfusion in the corresponding areas of SCCLs on ASL, and (5) no structural abnormality in the cerebellum. The perfusion status in the contralateral cerebellum was evaluated and categorized as hyper-, iso- and hypoperfusion. The asymmetric index (AI) of cerebellar perfusion was calculated by ROI measurement of the signal intensity on ASL. RESULTS: The mean time between the last seizure and MR examinations was 5 h 30 min. CC hyperperfusion was observed in 17 patients (65.4%), hypoperfusion in 7 (26.9%) and isoperfusion in 2 (7.7%). Regarding the location of SCCLs, CC hyperperfusion was more frequent (71.4 vs. 58.3%), and the mean AI was higher (42.0 vs. 11.5) when the lesion involved the frontal lobe. CONCLUSIONS: In patients with SCCLs, CC hyperperfusion occurred more often than hypo- and isoperfusion, especially when the lesions involved the frontal lobe.

Antiemetic Corticosteroid Rotation from Dexamethasone to Methylprednisolone to Prevent Dexamethasone-Induced Hiccup in Cancer Patients Treated with Chemotherapy: A Randomized, Single-Blind, Crossover Phase III Trial.

BACKGROUND: To assess whether the rotation of dexamethasone to methylprednisolone decreases the intensity of dexamethasone-induced hiccup (DIH) in cancer patients treated with chemotherapy. MATERIALS AND METHODS: Adult patients who experienced DIH within 3 days after the administration of dexamethasone as an antiemetic were screened. Eligible patients were randomly assigned to receive dexamethasone (n = 33) or methylprednisolone (n = 32) as an antiemetic (randomization phase). In the next cycle of chemotherapy, the dexamethasone group received methylprednisolone and vice versa in the methylprednisolone group (crossover phase). The primary endpoint was the difference in hiccup intensity as measured using the numeric rating scale (NRS) between two groups. RESULTS: No female patients were enrolled, although the study did not exclude them. At the randomization phase, hiccup frequency was 28/33 (84.8%) in the dexamethasone group versus 20/32 (62.5%) in the methylprednisolone group (p = .04). Intensity of hiccup was significantly higher in the dexamethasone group than that in the methylprednisolone group (mean NRS, 3.5 vs. 1.4, p < .001). At the crossover phase, hiccup intensity was further decreased after the rotation of dexamethasone to methylprednisolone in the dexamethasone group (mean NRS, 3.5 to 0.9, p < .001), while it was increased by rotating methylprednisolone to dexamethasone in the methylprednisolone group (mean NRS, 1.4 to 3.3, p = .025). There were no differences in emesis intensity between the two groups at either the randomization or crossover phases. Clinicaltrials.gov identifier: NCT01974024. CONCLUSION: Dexamethasone-induced hiccup is a male-predominant phenomenon that can be ameliorated by rotating dexamethasone to methylprednisolone without compromising the antiemetic efficacy. IMPLICATIONS FOR PRACTICE: In this randomized, multicenter, phase III trial, hiccup intensity was significantly lower when the antiemetic corticosteroid was rotated from dexamethasone to methylprednisolone without a change in emesis intensity than that when dexamethasone was maintained. At the crossover phase, hiccup intensity was increased again if dexamethasone was readministered instead of methylprednisolone. The present study demonstrated that dexamethasone-induced hiccup can be improved by rotating from dexamethasone to methylprednisolone without compromising its antiemetic efficacy.

The General Public's Awareness of Early Symptoms of and Emergency Responses to Acute Myocardial Infarction and Related Factors in South Korea: A National Public Telephone Survey.

BACKGROUND: Prompt treatment affects prognosis and survival after acute myocardial infarction (AMI) onset. This study evaluated the awareness of early symptoms of AMI and knowledge of appropriate responses on symptom occurrence, along with related factors. METHODS: Participants' knowledge of the early symptoms of and responses to AMI onset were investigated using a random digit dialing survey. We included 9600 residents of 16 metropolitan cities and provinces in Korea. RESULTS: The proportions of respondents who were aware of early symptoms of AMI ranged from 32.9% (arm or shoulder pain) to 79.1% (chest pain and discomfort). Of the respondents, 67.0% would call an ambulance if someone showed signs of AMI, 88.7% knew ≥1 symptom, 10.9% knew all five symptoms, and 3.1% had excellent knowledge (correct identification of all five AMI symptoms, not answering "Yes" to the trap question, and correctly identifying calling an ambulance as the appropriate response when someone is exhibiting AMI symptoms). The odds ratio (OR) for having excellent knowledge was significantly higher for those who graduated college or higher (OR 3.42; 95% confidence interval [CI], 1.09-10.76) than for those with less than a primary school education, as well as for subjects with AMI advertisement exposure (OR 1.49; 95% CI, 1.10-2.02) and with knowledge of AMI (OR 1.63; 95% CI, 1.16-2.27). The 60- to 79-year-old group had significantly lower OR for excellent knowledge than the 20- to 39-year-old group (OR 0.53; 95% CI, 0.28-0.99). CONCLUSIONS: Awareness of AMI symptoms and the appropriate action to take after symptom onset in South Korea was poor. Therefore, educational and promotional strategies to increase the overall awareness in the general public, especially in the elderly and those with low education levels, are needed.

Shear-wave elastography in invasive ductal carcinoma: correlation between quantitative maximum elasticity value and detailed pathological findings.

BACKGROUND: Further information is needed regarding whether histopathological characteristics affect breast tumor elasticity. PURPOSE: To determine whether maximum elasticity values vary according to tumor-stroma ratio, dominant stroma type, or presence of fibrosis in invasive breast cancer. MATERIAL AND METHODS: This study included 71 patients with invasive ductal carcinoma not otherwise specified (IDC NOS) who underwent breast shear-wave elastography (SWE). Maximum elasticity (Emax) values were retrospectively correlated with pathological findings that included tumor-stroma ratio, dominant stroma type (collagen, fibroblast, lymphocyte), and fibrosis. Multiple linear regression analysis was performed to determine variables independently associated with Emax. RESULTS: High histologic grade was significantly correlated with higher Emax (P = 0.042). Estrogen receptor and progesterone receptor expression negatively correlated with high elasticity values (P = 0.013 and P = 0.03, respectively). Breast cancers that exhibited higher cellularity demonstrated a greater level of stiffness that was not statistically significant (ρ = 0.153; P = 0.193). While dominant stroma type and fibrosis did not affect Emax (P = 0.197 and P = 0.598, respectively), lesion size was significantly associated with Emax (ρ = 0.474, P < 0.001). On multivariate analysis, only lesion size was significantly associated with Emax (P < 0.001). CONCLUSION: The composition of tumors did not affect their Emax.

Effect of menstrual cycle and menopausal status on apparent diffusion coefficient values and detectability of invasive ductal carcinoma on diffusion-weighted MRI.

The purpose of this study was to determine whether the apparent diffusion coefficient (ADC) and tumor detectability based on diffusion-weighted imaging (DWI) are affected by the menstrual cycle or menopausal status in breast cancer patients. Institutional review board approval was obtained, and the requirement for informed consent was waived. A total of 124 women with invasive ductal carcinoma not otherwise specified (IDC NOS) who underwent breast MRI with DWI were included in this study. Two radiologists retrospectively measured the ADCs of tumor and contralateral normal glandular tissue and scored the tumor detectability. The ADCs and detectability were compared to menstrual cycle and menopausal status, based on patient questionnaires. ADCs of tumors and contralateral tissue were significantly lower in postmenopausal women than in premenopausal women (P = 0.006 and P < 0.001, respectively). Tumor detectability did not differ significantly between the premenopausal and postmenopausal groups (P = 0.454). Normalized ADCs were not significantly lower in postmenopausal women compared to premenopausal women (P = 0.880). There was no statistically significant difference in the absolute, contralateral, and normalized ADCs (P = 0.091, 0.809, and 0.299, respectively), and the tumor detectability (P = 0.680) according to the menstrual cycle. Although ADCs of the IDC and normal glandular tissue in postmenopausal women were significantly lower than those in premenopausal women, the menstrual cycle did not affect tumor detectability and ADCs of IDC.

Prognostic significance of the absolute monocyte counts in lung cancer patients with venous thromboembolism.

We investigated the clinical significance of the absolute monocyte count (AMC) as a predictor of the response to anticoagulation and survival in lung cancer patients with venous thromboembolism (VTE). We retrospectively reviewed 1707 patients with pathologically proven lung cancer who visited the hospital between July 2008 and May 2014. Among them, the clinical data of patients newly diagnosed with VTE and treated with anticoagulation were compared between the low and high AMC groups according to the median value of AMC (640/µL) at the time of VTE diagnosis. The incidence of VTE was 7.9 % during the study period. Most of the patients had non-small-cell lung cancer (82.1 %), stage IV (64.2 %), and pulmonary thromboembolism (76.1 %) and were incidentally diagnosed with VTE (76.9 %). The patients' characteristics and laboratory values were not significantly different between the low and high AMC groups. Among patients available for evaluation of the response to anticoagulation, the high AMC group was significantly more refractory to anticoagulation than the low AMC group (no response to anticoagulation, 21.7 vs. 6.8 %, respectively; p = 0.044). Additionally, the high AMC group showed worse overall survival (OS) than the low AMC group (median, 9.6 vs. 5.9 months; p = 0.038). On multivariate analysis, high AMC, low albumin, and advanced stage were independent poor prognostic factors for OS. High AMC is associated with refractoriness to anticoagulation and poor prognosis in lung cancer patients with VTE.

Natural history of metastatic biliary tract cancer (BTC) patients with good performance status (PS) who were treated with only best supportive care (BSC).

BACKGROUND: Although chemotherapy is widely recommended for patients with metastatic biliary tract cancer, the natural course of these patients, especially those with good performance status who are indicated for chemotherapy, is not known. METHODS: We retrospectively reviewed patients with metastatic or locally advanced biliary cancer who were diagnosed at six cancer centers. Patients were eligible if they had good performance (ECOG 0-2) and no history of any treatment for cancer. The primary objective was to evaluate the survival time of patients with advanced biliary cancer with good performance who were untreated. RESULTS: Of the 1677 patients, 204 met the inclusion criteria. The median age and overall survival were 72.0 years and 7.1 months. Overall survival (months) by location was 4.7 for intrahepatic, 9.7 for extrahepatic, 4.4 for gallbladder and 11.2 for ampulla of vater cancer. In subgroup analysis, overall survival of locally advanced biliary cancer was 13.8 months and that of patients with normal carcinoembryonic antigen/carbohydrate antigen 19-9 was 10.6 months. In multivariate analysis, variables that were associated with poor prognosis were metastatic biliary cancer [hazard ratio 2.19 (P = 0.001)], high baseline carcinoembryonic antigen level (defined as >4.0 ng/ml) [hazard ratio 1.51 (P = 0.024)] and high baseline carbohydrate antigen 19-9 level (defined as >100 U/ml) [hazard ratio 1.93 (P = 0.001)]. CONCLUSIONS: Advanced biliary tract cancer with good performance status showed modest survival without any treatment. Furthermore, subgroup analysis showed that patients with normal carbohydrate antigen 19-9 or carcinoembryonic antigen level or locally advanced status had favorable survival. Further studies comparing the outcome of chemotherapy with that of best supportive care in patients with unresectable biliary tract cancer are warranted.

Thyroid nodules with repeat nondiagnostic cytologic results: the role of clinical and ultrasonographic findings.

OBJECTIVES: Ultrasound-guided fine-needle aspiration (FNA) is the most valuable procedure in the diagnosis of thyroid nodules. One possible result of FNA of thyroid nodules, however, is "nondiagnostic" cytology. In these cases, consensus guidelines suggest repeating FNA with ultrasound guidance, but the results obtained may continue to be nondiagnostic. These results cause confusion due to the fact that there exist conflicting potential treatment modalities, such as performing diagnostic surgery or recommending follow-up. Hence, the present study aimed to establish a protocol for performing diagnostic operations for thyroid nodules with repeat nondiagnostic cytology. MATERIALS AND METHODS: This study was performed on patients who underwent ultrasound-guided FNA and molecular testing for BRAF gene mutation. Out of 1,203 patients, 84 had nondiagnostic cytology and were BRAF negative, and ultrasound-guided FNA was repeated on these patients. Out of this group, 54 patients once again had nondiagnostic cytology, and 51 of these underwent diagnostic surgery. We analyzed the characteristics and ultrasonographic findings of the group of patients with repeat nondiagnostic cytology. RESULTS: On the initial ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 6.98 %, and on repeat ultrasound-guided FNA, the percentage of patients with nondiagnostic cytology was 67.5 %. The majority of these patients underwent diagnostic surgery, and 36 (70.6 %) patients were diagnosed as having a malignant thyroid nodule, while15 (29.4 %) patients were diagnosed with a benign nodule. Univariate analysis showed a significant difference in the size of the nodule, hypoechogenicity, and microcalcification in the ultrasonography findings. Multivariate analysis revealed only hypoechogenicity as a factor that showed a significant difference (p value 0.017, 95 % confidence interval 1.494-62.426).The diagnostic accuracy of the ultrasonography was 76.5 %. CONCLUSIONS: Hypoechogenicity on ultrasonography represents an excellent parameter for the selection of those who should be referred for diagnostic operation among patients with thyroid nodules and repeat nondiagnostic cytology.

The prognostic value of immunohistochemical markers for oral tongue squamous cell carcinoma.

The objective of the study was to examine the prognostic value of hypoxia-inducible factor-1α (HIF-1α), carbonic anhydrase-IX (CA-IX), cyclooxygenase-2 (COX-2), Ki-67, and erythropoietin receptor in patients with oral tongue squamous cell carcinoma. Immunohistochemical analysis of marker expression was performed on tissue samples from 25 patients with tongue squamous cell carcinoma. The Kaplan-Meier method, univariate and multivariate analyses, and the Cox proportional hazards model were used to examine associations between patient and tumor characteristics, and the immunohistochemical results and disease-specific survival. There was no association between the expression of the five markers and disease-specific survival, and there was no statistically significant difference in the hazards ratio according to postoperative radiotherapy. There was no correlation between marker expression and prognosis. There was no association between marker expression and radioresistance or disease-specific survival. Therefore, HIF-1α, CA-IX, COX-2, Ki-67, and erythropoietin receptor are not suitable prognostic markers for tongue squamous cell carcinoma.

Trend of blood lead, mercury, and cadmium levels in Korean population: data analysis of the Korea National Health and Nutrition Examination Survey.

This study was performed to assess the recent trends in lead, mercury, and cadmium levels in the blood among Korean adult population. The geometric means and 95 % confidence intervals (CIs) of blood lead, mercury, and cadmium concentrations were calculated using the data of the subjects from the third (2005, n = 1997), fourth (2008, n = 2005; 2009, n = 1991), and fifth (2010, n = 1989; 2011, n = 2014) Korea National Health and Nutrition Examination Survey. Blood lead levels in 2005, 2008, 2009, 2010, and 2011 declined to 2.61 µg/dL (2.51-2.71), 2.32 µg/dL (2.27-2.37), 2.29 µg/dL (2.23-2.35), 2.09 µg/dL (2.04-2.13), and 1.99 µg/dL (1.94-2.05), respectively. Blood mercury levels were 4.19 µg/L (3.99-4.39), 4.73 µg/L (4.57-4.89), 4.25 µg/L (4.09-4.41), 3.64 µg/L (3.49-3.80), and 3.08 µg/L (2.95-3.22), respectively, which indicated an increase in 2008 compared with those in 2005, and a clear downward trend from 2008 to 2011. Blood cadmium levels were 1.52 µg/L (1.47-1.57), 0.93 µg/L (0.89-0.97), 0.94 µg/L (0.90-0.98), 0.89 µg/L (0.87-0.92), 0.86 µg/L (0.83-0.89), respectively, which indicated very high levels in 2005, but a downward trend since 2008. Although the lead, mercury, and cadmium levels in the blood of the Korean adult population are on the decline, they are still relatively high compared with those for the population of the USA, Canada, and Germany. Thus, continuous biological monitoring and measures to reduce these levels are needed in Korea.