Risk of Ischemic Heart Disease in Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study.

BACKGROUND: Subjects with chronic obstructive pulmonary disease (COPD) have a higher risk of ischemic heart disease (IHD) than individuals without COPD; however, longitudinal evidence is lacking. Therefore, we aimed to estimate the risk of IHD between COPD and control cohorts using a longitudinal nationwide database. METHODS: We used 2009-2017 data from the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC). Adult participants at least 20 years of age who underwent health examinations and without a history of COPD or IHD were included (n = 540,976). Participants were followed from January 1, 2009, until death, development of IHD, or December 31, 2019, whichever came first. RESULTS: At baseline, there were 3,421 participants with incident COPD and 537,555 participants without COPD. During a median of 8.0 years (5.3-9.1 years) of follow-up, 2.51% of the participants with COPD (n = 86) and 0.77% of the participants without COPD (n = 4,128) developed IHD, with an incidence of 52.24 and 10.91 per 10,000 person-years, respectively. Participants with COPD had a higher risk of IHD (adjusted hazard ratio, 1.55; 95% confidence interval, 1.25-1.93) than subjects without COPD. Demographics such as age, sex, body mass index, and personal health behaviors including smoking status and physical activity did not show significant interaction with the relationship between COPD and IHD (P for interaction > 0.05 for all). CONCLUSION: The results indicate that COPD is associated with the development of IHD independent of demographic characteristics and health-related behaviors. Based on these results, clinicians should closely monitor the onset of IHD in subjects with COPD.

Trends in Frailty Prevalence Among Older Adults in Korea: A Nationwide Study From 2008 to 2020.

BACKGROUND: We aimed to evaluate the nationwide trend of the prevalence of frailty in older adults in Korea from 2008 to 2020 to inform future geriatric healthcare policies. METHODS: The study used data of individuals aged 65 years and older from the Korea National Health and Nutrition Examination Survey, a nationwide repeated cross-sectional survey. Frailty was defined using frailty index, classified as non-frail (frailty index ≤ 0.15), pre-frail (0.15 < frailty index ≤ 0.25), or frail (frailty index > 0.25). RESULTS: The study included 17,784 individuals, with the mean age of 72.4 and mean frailty index of 0.2. The prevalence of frailty in older adults in South Korea decreased significantly from 2008 (41.1%) to 2020 (23.1%). The decrease in the frailty index was observed in all age groups (all P < 0.05). As components of frailty index, we found that certain comorbidities, such as dyslipidemia, diabetes mellitus, and cardiovascular disease, have increased over time, while factors such as chewing difficulty, activity limitation, and smoking, have decreased. CONCLUSION: The prevalence of frailty in older adults in South Korea has decreased significantly during the study period. Historical improvements in healthcare access and preventive measures may have contributed to this trend.

Characteristics of spinal and bulbar muscular atrophy in South Korea: a cross-sectional study of 157 patients.

Spinal and bulbar muscular atrophy, namely Kennedy disease, is a rare progressive neurodegenerative disorder caused by the expansion of a CAG repeat in the first exon of the androgen receptor gene on the X chromosome. We assessed the clinical history, laboratory findings, functional scales and electrophysiological data, as well as the levels of luteinizing hormone, follicle-stimulating hormone and testosterone, in 157 Korean patients with genetically confirmed spinal and bulbar muscular atrophy (mean age at data collection = 56.9 years; range = 33-83 years). Hand tremor was the first symptom noticed by patients at a median age of 35 years, followed by gynaecomastia, orofacial fasciculation, cramps and fatigability in ascending order. Clinical symptoms such as paraesthesia and dysphagia appeared during the later stages of the disease. Cane use during ambulation began at a median age of 62 years. There were statistically significant differences between patients and controls in the results of sensory nerve studies, motor conduction velocity, and distal latencies. Furthermore, among the hormone markers analysed, the level of luteinizing hormone exhibited a negative correlation with the spinal and bulbar muscular atrophy functional rating scale, Korean version. However, among the patients with a disease duration of ≤5 years, the levels of luteinizing hormone showed a significant correlation with assessments using the amyotrophic lateral sclerosis functional rating scale-revised, spinal and bulbar muscular atrophy functional rating scale, Korean version and the 6-minute walk test. In conclusion, our findings provide clinical information from a substantial number of patients with spinal and bulbar muscular atrophy in Korea that accorded with that of patients with this disease worldwide but with updated clinical features.

Association of adenotonsillar disease and adenotonsillectomy with the development of vitiligo: A nationwide population-based cohort study.

Background: Vitiligo is a common acquired skin depigmentation disorder and is associated with various other autoimmune diseases which include thyroid disease and rheumatoid arthritis. Similarly, adenotonsillar disease (ATD) may induce inflammatory or autoimmune diseases in other organs which include the skin. However, the influence of ATD on the development of vitiligo has not been studied. Objectives: To determine the association between ATD and adenotonsillectomy, and the development of vitiligo. Design and methods: Using data from the National Health Insurance Service database, patients diagnosed with ATD between 2008 and 2010 were included in the study. We performed two rounds of 1:1 propensity score matching in the ATD and adenotonsillectomy groups. The ATD and non-ATD groups both included 206,514 individuals. Among the ATD group, the adenotonsillectomy and non-adenotonsillectomy groups both included 23,354 individuals. Each individual was monitored until 2019. The primary end point was the risk of vitiligo. Using the Cox Proportional Hazards model, the incidence of vitiligo and the hazard ratio (HR) were calculated. Results: The incidence of vitiligo was 1.16-fold higher in the ATD group than in the non-ATD group [adjusted HR (aHR), 1.16; 95% confidence interval (CI), 1.09-1.24] and 0.82-fold lower in the adenotonsillectomy group than in the non-adenotonsillectomy group (aHR, 0.82; 95% CI, 0.68-0.99). Additionally, the other risk factors for developing vitiligo included thyroid disease (aHR, 1.48; 95% CI, 1.11-1.98), age younger than 30 years (aHR, 1.18; 95% CI, 1.09-1.27), and age over 60 years (aHR, 1.22; 95% CI, 1.06-1.41), whereas factors including rural residency (aHR, 0.91; 95% CI, 0.85-0.98) and low economic status (aHR 0.87; 95% CI, 0.82-0.93) were associated with decreased incidence of vitiligo. Conclusion: In this study, ATD increases the risk of vitiligo and adenotonsillectomy attenuates its development. Clinicians should consider ATD as a pathogenic factor for vitiligo and the potential effect of adenotonsillectomy in its management.

COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS): a protocol of pragmatic trials within a cohort.

INTRODUCTION: There is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS) study will test the effectiveness of comprehensive geriatric assessment (CGA) and multidisciplinary intervention by comparing it with conventional care among acute hospitalised older adults in Korea. METHODS AND ANALYSIS: A multicentre trial within a cohort comprising three substudies (randomised controlled trials) will be conducted. The intervention includes CGA and CGA-based multidisciplinary interventions by physicians (geriatricians, oncologists), nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is living at home 3 months after discharge. In addition to assessing the economic effects of the intervention, a cost-utility analysis will be conducted. ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the ethics committees of Seoul National University Bundang Hospital and each study site. The study findings will be published in peer-reviewed journals. Subgroup and further in-depth analyses will subsequently be published. TRIAL REGISTRATION NUMBER: KCT0006270.

Overexpression of Prohibitin 2 Protein is Associated with Adverse Prognosis in Cytogenetically Normal Acute Myeloid Leukemia.

Cytogenetically normal acute myeloid leukemia (CN-AML) accounts for 40%-50% of all AML cases. Despite advances in understanding the molecular pathophysiology of CN-AML, its clinical outcome remains unsatisfactory and unpredictable. To investigate its clinical implication in CN-AML, we measured the expression of prohibitin 2 (PHB2) using immunohistochemical staining (IHCS) of paraffin-embedded bone marrow sections from 134 CN-AML patients. IHCS results were semi-quantitatively scored. Clinical outcome was analyzed in comparison with other prognostic markers, including NPM1 polymorphism and FLT3 internal tandem duplication, and WT1 and BAALC mRNA expression. Except for BAALC mRNA expression, the known molecular markers showed no prognostic effect in the CN-AML patients. PHB2 protein overexpression was significantly associated with adverse prognosis in CN-AML patients. The PHB2 protein expression status may serve as an independent prognostic indicator in CN-AML.

Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis.

BACKGROUND: Unilateral vocal cord paralysis may result from nerve compression by tumors or direct nerve injuries during tumor resections, which can cause dysphonia or dysphagia, and reduced quality of life. OBJECTIVES: This prospective, single-group study aimed to investigate the effect of percutaneous injection laryngoplasty on voice and swallowing function in patients with cancer-related unilateral vocal cord paralysis. METHODS: Patients underwent percutaneous injection laryngoplasty with hyaluronic acid under local anesthesia. Stroboscopy and videofluoroscopic swallowing study were conducted to evaluate the voice- and swallowing-related outcome measures, respectively. The participants were evaluated before injection laryngoplasty, as well as after two weeks and three months. RESULTS: Injection laryngoplasty significantly improved the glottal gap, vocal fold position, Maximum Phonation Time, and Voice Handicap Index-10. Post-hoc analysis using Bonferroni correction showed that the improvements occurred within two post-treatment weeks and remained at three post-treatment months. In the subgroup analysis, the patients who underwent injection laryngoplasty within 8 weeks from onset showed significantly higher improvements in the videofluoroscopic dysphagia scale and swallowing function than the patients who received the procedure after 8 weeks or more. CONCLUSION: Percutaneous injection laryngoplasty improves glottal closure and voice in patients with cancer-related unilateral vocal cord paralysis. Early injection laryngoplasty may lead to greater benefits on swallowing function. LEVEL OF EVIDENCE: 4.

Effect of leuprorelin in bulbar function of spinal and bulbar muscular atrophy patients: observational study for 1 year.

BACKGROUND: This study aimed to investigate the effect of androgen suppression therapy using leuprorelin focused on the bulbar function of patients with spinal and bulbar muscular atrophy (SBMA). METHODS: Genetically confirmed SBMA patients who consented to participate in this observational study were enrolled. Leuprorelin was subcutaneously injected every 12 weeks. Videofluoroscopic swallowing study was performed at baseline and after androgen suppression therapy for 1 year. The primary outcome measures were the changes in the vallecular residue and pyriform sinus residue. The videofluoroscopic swallowing study data were analyzed and interpreted by two experienced physiatrists. RESULTS: A total of 40 patients with SBMA were analyzed in this study. The inter-rater reliability testing showed good agreement for the pharyngeal residue (ICC = 0.84) and videofluoroscopic dysphagia scale (ICC = 0.75). The vallecular residue and pyriform sinus residue after swallowing 9 mL yogurt were significantly reduced (26.8 ± 22.6 to 14.6 ± 14.5, p < 0.001, 14.9 ± 16.9 to 7.6 ± 9.9, p < 0.001, respectively). The swallowing subscore of amyotrophic lateral sclerosis functional rating scale-revised improved after androgen suppression therapy (3.3 ± 0.5 to 3.5 ± 0.6, p = 0.041). CONCLUSIONS: Leuprorelin significantly reduced the pharyngeal residue in patients with SBMA after 1 year of treatment without any serious adverse events and longitudinal studies are needed to confirm these results.

Alterations of functional connectivity in auditory and sensorimotor neural networks: A case report in a patient with cortical deafness after bilateral putaminal hemorrhagic stroke.

RATIONALE: Cortical deafness is a rare auditory dysfunction caused by damage to brain auditory networks. The aim was to report alterations of functional connectivity in intrinsic auditory, motor, and sensory networks in a cortical deafness patient. PATIENT CONCERNS: A 41-year-old woman suffered a right putaminal hemorrhage. Eight years earlier, she had suffered a left putaminal hemorrhage and had minimal sequelae. She had quadriparesis, imbalance, hypoesthesia, and complete hearing loss. DIAGNOSES: She was diagnosed with cortical deafness. After 6 months, resting-state functional magnetic resonance imaging (rs-fMRI) and diffuse tensor imaging (DTI) were performed. DTI revealed that the acoustic radiation was disrupted while the corticospinal tract and somatosensory track were intact using deterministic tracking methods. Furthermore, the patient showed decreased functional connectivity between auditory and sensorimotor networks. INTERVENTIONS: The patient underwent in-patient stroke rehabilitation therapy for 2 months. OUTCOMES: Gait function and ability for activities of daily living were improved. However, complete hearing impairment persisted in 6 months after bilateral putaminal hemorrhagic stroke. LESSONS: Our case report seems to suggest that functional alterations of spontaneous neuronal activity in auditory and sensorimotor networks are related to motor and sensory impairments in a patient with cortical deafness.

Changing the frequency and spectra of chromosomal aberrations in Korean patients with acute leukemia in a tertiary care hospital.

BACKGROUND: Chromosomal analysis is essential for the diagnosis and risk stratification of all leukemia patients. Not surprisingly, racial differences in chromosomal aberrations (CA) in hematological malignancies could be found, and CA incidence in leukemia might change over time, possibly due to environmental and lifestyle changes. Thus, we compared the frequency and range of CA in patients with acute leukemia (AL) during two time periods (2006‒2009 vs. 2010‒2015) and compared them with other prior studies. METHODS: We enrolled 717 patients with AL during a six-year period (2010‒2015). We compared the results to those of our earlier study (2006‒2009) [1]. Conventional cytogenetics, a multiplex reverse transcriptase (RT)-PCR system, and fluorescence in situ hybridization were employed to assess bone marrow specimens or peripheral blood at the diagnostic stage in AL patients to detect CA. RESULTS: The incidence of CA changed in the leukemia subgroups during the two time periods. Notably, the most frequent CA of childhood acute myeloid leukemia (AML) was PML/RARA, and was followed by RUNX1/RUNX1T1 in the current study. In contrast, the most common CA was RUNX1/RUNX1T1 in a previous study [1] and was followed by PML/RARA. In this study, the most frequent CA of the mixed phenotype AL was BCR/ABL1, which was followed by KMT2A/MLLT3. In a previous report, [1] the most frequent CA was BCR/ABL1, which was followed by KMT2A/ELL. CONCLUSION: The distribution of CA in Korean AL patients changed over time in a single institute. This change might be due to environmental and lifestyle changes.

A medical care model using comprehensive geriatric assessment for community-dwelling older Korean adults.

BACKGROUND: The quality of life of older adults deteriorates when they lose their ability to perform activities of daily living. Therefore, the older adults should be assessed to identify risk factors for functional decline and to correct these factors so that they may live as independently as possible in the community. We developed a medical care model using comprehensive geriatric assessment (CGA) for community-dwelling older patients. METHODS: Three hundred and ninety-one older adults who were frail or likely to be frail were selected. CGA was performed before and after the interventions to determine the effect of the interventions. Three interventions-exercise training, nutritional education, and medication reconciliation-were performed for 5.1 ± 0.6 months. RESULTS: A comparison of the results of the first and second assessments revealed that the participants showed improvement in physical function, quality of life, medication, and nutrition. The average gait speed had increased from 0.77 ± 0.17 m/s to 0.89 ± 0.20 m/s (P < 0.001). For health-related quality of life, the average EuroQol-5 dimension-3L score for each domain decreased significantly. The number of patients with polypharmacy decreased from 181(50 %) to 155(43 %) (P = 0.001). The number of patients who were at risk of malnutrition or malnourished decreased from 72(20 %) to 45(12 %) (P < 0.001). The majority of participants were highly satisfied and were willing to participate again. CONCLUSION: Our medical model based on CGA showed a significantly positive effect on the physical function and quality of life of community-dwelling older adults. Our model may be a promising strategy for improving the care of them.

Association Between Serum Uric Acid and Prediabetes in the Korean General Population.

The purpose of this study is to examine the relation of serum uric acid with prediabetes in Korea. We conducted a cross-sectional study in 4633 individuals aged 20 to 81 years who participated in the 2016 Korean National Health and Nutrition Examination Survey. Participants are considered to have prediabetes if they have one or more of the following: impaired fasting glucose (fasting blood glucose levels between 5.6 and 6.9 mmol/L); impaired hemoglobin A1c (hemoglobin A1c ranges of 5.7% to 6.4% [39-46 mmol/mol]). Multiple logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). Prediabetes was more prevalent in the hyperuricemia group compared with the normal-range group among men (OR = 1.51; 95% CI = 1.11-2.05; P < .01) and women (OR = 1.84; 95% CI = 1.01-3.37; P = .04) after adjustment for age, body mass index, abdominal obesity, blood pressure, triglyceride, high-density lipoprotein cholesterol, renal function, alcohol consumption, smoking, and physical activity level. For a standard deviation increment in uric acid, the odds of having prediabetes as compared with that of not having prediabetes increased about 114% in men (P = .05) and 116% in women (P = .01). Higher levels of uric acid were associated with an increased risk of prediabetes among the general Korean population.

Impact of a delirium prevention project among older hospitalized patients who underwent orthopedic surgery: a retrospective cohort study.

BACKGROUND: Postoperative delirium (POD) is a common clinical syndrome with significant negative outcomes. Thus, we aimed to evaluate the feasibility and effectiveness of a delirium screening tool and multidisciplinary delirium prevention project. METHODS: A retrospective cohort study was conducted at a single teaching center in Korea. A cohort of patients who underwent a delirium prevention program using a simple delirium screening tool from December 2018 to February 2019 (intervention group, N = 275) was compared with the cohort from the year before implementation of the delirium prevention program (December 2017 to February 2018) (control group, N = 274). Patients aged ≥65 years who were admitted to orthopedic wards and underwent surgery were included. The incidence rates of delirium before and after implementation of the delirium prevention program, effectiveness of the delirium screening tool, change in the knowledge score of nurses, and length of hospital stay were assessed. RESULTS: The sensitivity and specificity of the screening tool for the incidence of POD were 94.1 and 72.7%, respectively. The incidence rates of POD were 10.2% (control group) and 6.2% (intervention group). The odds ratio for the risk reduction effect of the project related to the incidence of POD was 0.316 (95% confidence interval: 0.125-0.800, p = 0.015) after adjustment for possible confounders. The delirium knowledge test score increased from 40.52 to 43.24 out of 49 total points (p < 0.001). The median length of hospital stay in the intervention and control groups was 6.0 (interquartile range, 4-9) and 7.0 (interquartile range, 4-10) days, respectively (p = 0.062). CONCLUSION: The screening tool successfully identified patients at a high risk of POD at admission. The POD prevention project was feasible to implement, effective in preventing delirium, and improved knowledge regarding delirium among the medical staff. TRIAL REGISTRATION: None.

Spectrum of mitochondrial genome instability and implication of mitochondrial haplogroups in Korean patients with acute myeloid leukemia.

BACKGROUND: Mitochondrial DNA (mtDNA) mutations may regulate the progression and chemosensitivity of leukemia. Few studies regarding mitochondrial aberrations and haplogroups in acute myeloid leukemia (AML) and their clinical impacts have been reported. Therefore, we focused on the mtDNA length heteroplasmies minisatellite instability (MSI), copy number alterations, and distribution of mitochondrial haplogroups in Korean patients with AML. METHODS: This study investigated 74 adult patients with AML and 70 controls to evaluate mtDNA sequence alterations, MSI, mtDNA copy number, haplogroups, and their clinical implications. The hypervariable (HV) control regions (HV1 and HV2), tRNAleu1 gene, and cytochrome b gene of mtDNA were analyzed. Two mtDNA minisatellite markers, 16189 poly-C (16184CCCCCTCCCC16193, 5CT4C) and 303 poly-C (303CCCCCCCTCCCCC315, 7CT5C), were used to examine the mtDNA MSI. RESULTS: In AML, most mtDNA sequence variants were single nucleotide substitutions, but there were no significant differences compared to those in controls. The number of mtMSI patterns increased in AML. The mean mtDNA copy number of AML patients increased approximately 9-fold compared to that of controls (P<0.0001). Haplogroup D4 was found in AML with a higher frequency compared to that in controls (31.0% vs. 15.7%, P=0.046). None of the aforementioned factors showed significant impacts on the outcomes. CONCLUSION: AML cells disclosed more heterogeneous patterns with the mtMSI markers and had increased mtDNA copy numbers. These findings implicate mitochondrial genome instability in primary AML cells. Therefore, mtDNA haplogroup D4 might be associated with AML risk among Koreans.

Secondary Gluteal Augmentation: Surgical Technique and Outcomes.

BACKGROUND: As interest in posterior body contour has increased, there has been an upward trend in the number of gluteal augmentations performed. However, there has also been a proportional increase in postoperative complications and subsequent revision operations. Nevertheless, there are currently few studies or reports on secondary gluteal augmentation. The purpose of the present study was to identify methods to treat and prevent complications resulting from gluteal augmentation. METHODS: In this study, the authors review 18 cases of secondary gluteal augmentation. New intramuscular pockets were dissected more deeply than were previous pockets. Capsulotomy or capsulectomy was applied to the deep capsules of the previous pockets to sufficiently expand the new pockets and soft tissue to cover the implants. After triple-antibiotic irrigation, implants were inserted using the "no-touch technique." Next, "hybrid gluteal augmentation" was performed by grafting autologous fat into the subcutaneous fat layer. RESULTS: Among 18 cases of secondary gluteal augmentation performed, nine cases were performed by means of hybrid gluteal augmentation and seven cases were implant-only augmentations. Postoperative complications occurred in two cases. One case involved the hybrid technique (remaining rippling), and the other case involved implant-only augmentation (implant palpability). However, there was no need for surgical correction. CONCLUSION: Secondary gluteal augmentation can be successfully performed using the hybrid technique if the gluteus maximus is accurately dissected, the capsules are appropriately managed, and infection is rigidly controlled.

Simple Method of Screening for Frailty in Older Adults Using a Chronometer and Tape Measure in Clinic.

OBJECTIVES: Detecting frailty in older adults scheduled for surgery is important to predict the occurrence of adverse outcomes, but because of its complexity, frailty screening is not commonly performed. The objective of the current study was to assess whether frailty can be screened for using automatically measured usual gait speed (UGS) and mid-arm circumference (MAC) in the outpatient clinic. DESIGN: Prospective, cross-sectional study. SETTING: Geriatric center of a tertiary hospital. PARTICIPANTS: Outpatients aged 65 and older (N = 113). MEASUREMENTS: Frailty status was evaluated according to a multidimensional frailty score (MFS) using a comprehensive geriatric assessment, and participants were classified into 5 categories. UGS was evaluated by having participants walk through the clinic using an automated laser-gated chronometer. MAC was recorded using a tape measure on a blood pressure cuff. Correlations between these two physical measurements and MFS were assessed. RESULTS: The mean age of the 93 participants who successfully underwent UGS evaluation was 75.8 ± 4.7; 35 were male. In this population, the mean Charlson Comorbidity Index was 2.2 ± 1.4, mean MFS was 4.1 ± 2.0, and 20 participants were considered to be at high risk of experiencing adverse outcomes. Mean UGS was 0.75 ± 0.16 m/s, and mean MAC was 31.2 ± 1.9 cm); both physical parameters were correlated with MFS (UGS: standardized beta = -0.420, P < .001; MAC: standardized beta = -0.457, P < .001). Using UGS and MFS, the area under curve of receiver operating curve for determining which participants were at high risk of experiencing adverse outcomes was 0.809 (P < .001). CONCLUSION: UGS and MAC are viable methods of clinically screening for frailty.

Prediction of Mortality and Postoperative Complications using the Hip-Multidimensional Frailty Score in Elderly Patients with Hip Fracture.

High mortality and dependent living after hip fracture pose a significant public health concern. Retrospective study was conducted with 481 hip fracture patients (≥65 years of age) undergoing surgery from March 2009 to May 2014. The Hip-MFS was calculated by Comprehensive Geriatric Assessment (CGA). The primary outcome was the 6-month all-cause mortality rate. The secondary outcomes were 1-year all-cause mortality, postoperative complications and prolonged hospital stay, and institutionalization. Thirty-five patients (7.3%) died within 6 months after surgery (median [interquartile range], 2.9 [1.4-3.9] months). The fully adjusted hazard ratio per 1 point increase in Hip-MFS was 1.458 (95% confidence interval [CI]: 1.210-1.758) for 6-months mortality and odds ratio were 1.239 (95% CI: 1.115-1.377), 1.156 (95% CI: 1.031-1.296) for postoperative complications and prolonged total hospital stay, respectively. High-risk patients (Hip-MFS > 8) showed higher risk of 6-month mortality (hazard ratio: 3.545, 95% CI: 1.466-8.572) than low-risk patients after adjustment. Hip-MFS successfully predict 6-month mortality, postoperative complications and prolonged hospital stay in elderly hip fracture patients after surgery. Hip-MFS more precisely predict 6-month mortality than age or existing tools (P values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age and NHFS, respectively).

Coexistence of JAK2 and CALR mutations and their clinical implications in patients with essential thrombocythemia.

Janus kinase 2 (JAK2) and calreticulin (CALR) constitute the two most frequent mutations in essential thrombocythemia (ET), and both are reported to be mutually exclusive. Hence, we examined a cohort of 123 myeloproliferative neoplasm (MPN) patients without BCR-ABL1 rearrangement and additional ET patients (n=96) for coexistence of JAK2 and CALR mutations. The frequency of CALR mutations was 20.3% in 123 MPN patients; 31.1% in ET (n=74), 25% in primary myelofibrosis (n=4) and 2.2% in polycythemia vera (n=45). JAK2 and CALR mutations coexisted in 7 (4.2%) of 167 ET patients. Clinical characteristics, progression-free survival (PFS), and elapsed time to achieve partial remission across 4 groups (JAK2+/CALR+, JAK2+/CALR-, JAK2-/CALR+, JAK2-/CALR-) were reviewed. The JAK2+/CALR- group had higher leukocyte counts and hemoglobin levels and more frequent thrombotic events than JAK2-/CALR- group. JAK2 mutations have a greater effect on the disease phenotype and the clinical features of MPN patients rather than do CALR mutation. JAK2+ groups showed a tendency of poor PFS than JAK2- groups regardless of CALR mutation. CALR+ was a predictor of late response to the treatment. Our study also showed that thrombosis was more frequent in ET patients with type 2 CALR mutations than in those with type 1 CALR mutations.