Current status of laparoscopic emergency surgery in Korea: multicenter restrospective cohort study

Purpose@#Laparoscopic surgery is a choice in several emergency settings. However, there has been no nationwide study or survey that has compared the clinical use of laparoscopic emergency surgery (LES) versus open abdominal emergency surgery (OES) in Korea.Therefore, we examined the state of LES across multiple centers in Korea and further compared this data with the global state based on published reports. @*Methods@#Data of 2,122 patients who received abdominal emergency surgery between 2014 and 2019 in three hospitals in Korea were collected and retrospectively analyzed. Several clinical factors were investigated and analyzed. @*Results@#Of the patients, 1,280 (60.3%) were in the OES group and 842 (39.7%) were in the LES group. The most commonly operated organ in OES was the small bowel (25.8%), whereas that for LES was the appendix. In appendectomy and cholecystectomy, 93.7% and 88.0% were in the LES group. In small bowel surgery, gastric surgery, and large bowel surgery, 89.4%, 92.0%, and 79.1% were in the OES group. The severity-related factors of patient status demonstrated statistically significant limiting factors of selection between LES and OES. @*Conclusion@#Although our study has several limitations, compared to the LES data from other countries, the general LES state was similar in appendectomies, cholecystectomies, and small bowel surgeries. However, in gastric and colorectal surgeries, the LES state was different from those of other countries. This study demonstrated the LES state and limiting factors of selection between LES and OES in various operated organs. Further studies are required to analyze these differences and the various limiting factors.

The Incidence and Care Cascade of the Hepatitis C Virus in Korea

Background/Aims@#The 2030 hepatitis C virus (HCV) elimination targets of the World Health Organization are an 80% reduction in incidence and 65% reduction in mortality compared to the 2015 rates. However, information on the nationwide incidence and treatment rates of HCV infection are limited. We aimed to investigate the nationwide incidence and status of the care cascade for HCV infection in Korea. @*Methods@#This study used data from the Korea Disease Control and Prevention Agency linked with the data of the Korea National Health Insurance Service. Linkage to care was defined as visiting hospitals twice or more due to HCV infection within 1.5 years of the index date. The treatment rate was the number who had been prescribed antiviral medication within 1.5 years from the index date out of patients newly diagnosed with HCV. @*Results@#The new HCV infection rate was 17.2 per 100,000 person-years (n=8,810) in 2019. The number of new HCV infections was the highest in patients aged 50 to 59 years (n=2,480), and the new HCV infection rate significantly increased with age (p<0.001). Among newly infected patients with HCV, the linkage to care rate was 78.2% (78.2% men, 78.2% women) and the treatment rate was 58.1% (56.8% men, 59.3% women) within 1.5 years. @*Conclusions@#The new HCV infection rate was 17.2 per 100,000 person-years in Korea. It is necessary to continuously monitor the incidence and care cascade of HCV to establish proper strategies to reach the goal of HCV elimination by 2030.

Accuracy of Digital Breast Tomosynthesis for Detecting Breast Cancer in the Diagnostic Setting: A Systematic Review and Meta-Analysis

Objective@#To compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis. @*Materials and Methods@#Ovid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies. @*Results@#Twenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86–0.93) and 0.90 (95% CI 0.84–0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68–0.83) and 0.83 (95% CI 0.73–0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93–0.97) for DBT and 0.86 (95% CI 0.82–0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses. @*Conclusion@#Use of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.

Accuracy of Digital Breast Tomosynthesis for Detecting Breast Cancer in the Diagnostic Setting: A Systematic Review and Meta-Analysis

Objective@#To compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis. @*Materials and Methods@#Ovid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies. @*Results@#Twenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86–0.93) and 0.90 (95% CI 0.84–0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68–0.83) and 0.83 (95% CI 0.73–0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93–0.97) for DBT and 0.86 (95% CI 0.82–0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses. @*Conclusion@#Use of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.

Association between Metformin Use and Survival in Nonmetastatic Rectal Cancer Treated with a Curative Resection: A Nationwide Population Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Metformin is associated with an anticancer effect. However, the effects of metformin in rectal cancer are controversial. This study investigated the impact of metformin on the survival of patients with diabetes mellitus and nonmetastatic rectal cancer who underwent curative surgery. MATERIALS AND METHODS: The database was provided by the Korea Center Cancer Registry and National Health Insurance Service of the Republic of Korea. A cohort of patients with newly diagnosed rectal cancer between 2005 and 2011 was identified. Drug exposure was defined as receiving the oral hypoglycemic agent for at least 90 days over the period from 6 months before the initial diagnosis of rectal cancer to the last follow-up. RESULTS: A total of 4,503 patients were prescribed oral hypoglycemic agents and classified as the diabetic group, of which 3,694 patients received metformin for at least 90 days. Unadjusted analyses showed a significantly higher overall survival (hazard ratio, 0.596; 95% confidence interval, 0.506 to 0.702) and rectal cancer-specific survival (hazard ratio, 0.621; 95% confidence interval, 0.507 to 0.760) in the metformin group than in the nonmetformin group. The adjusted overall survival (hazard ratio, 0.631; 95% confidence interval, 0.527 to 0.755) and cancer-specific survival (hazard ratio, 0.598; 95% confidence interval, 0.479 to 0.746) in the group with a medication possession ratio of 80% or greater was significantly higher than in the group with a medication possession ratio of less than 80%. CONCLUSION: Metformin use is associated with overall and cancer-specific survival in diabetic patients with a nonmetastatic rectal cancer treated with a curative resection.

Availability of the Optic Nerve Sheath Diameter Measured by Using Facial CT as a Predictive Factor for Traumatic Brain Injury in the Emergency Department

PURPOSE: Traumatic brain injury (TBI) occurs frequently in patients with facial injuries. In patients with facial injuries without neurologic deficit, it is a challenging decision for emergency physicians whether brain computed tomography (CT) is necessary or not. Our objective is to evaluate the availability of optic nerve sheath diameter (ONSD) measured by facial CT in predicting TBI. METHODS: From January, 2010, to December, 2012, we conducted a retrospective study of patients with head or facial injuries who underwent both facial CT and brain CT simultaneously in the emergency department. Patients with obvious orbital trauma or ocular disease were excluded. We analyzed correlation between ONSD measured by facial CT and the brain CT findings of TBI. RESULTS: A total of 229 patients were enrolled. Ninety six patients without TBI on facial CT showed mean ONSD of 5.11+/-0.44 mm, and 82 patients with TBI showed mean ONSD of 5.89+/-0.78 mm. The sensitivity and the specificity compared with the presence of TBI findings on brain CT were 78.05% and 82.29%, respectively, when the cut-off value was set to 5.5 mm. The area under the curve (AUC) was 0.826 in the receiver operating characteristic curve (ROC curve). CONCLUSION: ONSD measured on facial CT is available for predicting TBI in patients with facial injuries.

Relationship between Socioeconomic Position and Suicide Attempts among the Korean Adolescents

This study explored the relationship of the subjective socioeconomic position (SEP) as well as the objective SEP with the rate of suicide attempts in 74,186 adolescents from the 2012 Korea Youth Risk Behavior Web-based Survey (KYRBS). The SEP was measured by the Family Affluence Scale (FAS) and the self-rated household economic status. The low perceived SEP for either the high or low FAS score was related to the elevated likelihood of suicide attempts in both genders. As compared with the adolescents in both the high level of perceived SEP and FAS score after adjusting for other confounding factors, the middle school students were more likely to attempt suicide in both low level of perceived SEP and FAS score (OR, 1.81; 95% CI, 1.18-2.78 for boys, OR, 1.46; 95% CI, 1.13-1.90 for girls). The high school students were more likely to attempt suicide in the low perceived SEP and high FAS score (OR, 1.44; 95% CI, 1.14-1.81 for boys, OR, 1.29; 95% CI, 1.07-1.56 for girls). In conclusion, the relationship of subjective SEP is important in suicide attempts as much as objective SEP and far more important in the high school students.

Use of big data for evidence-based healthcare

Data pools and their integration are fueling the big data revolution in health care with the recent advances in information technology. Korea has shown tremendous promise in the utilization of big data for its advanced technology, computerized health data, and unique identifiers. However, the Personal Information Protection Act (PIPA) severely limits access to personal identifiers, which has discouraged the use of health data even for the public good. In contrast, western countries have focused on research without the use of identifiers, which has augmented the use of the available data while maintaining and respecting privacy; they have allowed some exemptions of informed consent and utilized limited data sets, which have the identifiers removed. The amount of research output has increased rapidly and an in-depth understanding of cancer has been made possible based on the linkage of Surveillance, Epidemiology, and End Results (SEER) and Medicare in the US. More than 700 projects covering a wide range of medical areas have been conducted, which has led to changes in clinical practice based on the Western Australian Data Linkage System. Although rare, evidence-driven decisions based on data linkage have been found in some cases in Korea; the adoption of prostate cancer screening as a national screening program was suspended as its cost-effectiveness has not been verified on the basis of data linkage by the National Evidence-Based Healthcare Collaboration Agency. For the active use of health data, there is an urgent need to amend PIPA, prepare regulations for data analysis, and foster collaboration among data-related institutions. Great projects based on data linkage will guarantee the world's leading research output and will be major sources for moving forward to success.

Relations of Pulse Wave Velocity to Waist Circumference Independent of Hip Circumference / 한국역학회지

OBJECTIVES: Little is known about the effect of waist circumference (WC) on brachial artery pulse wave velocity (baPWV) independent of hip circumference (HC). Therefore, this study aimed to dissociate specific effect of WC on baPWV independent of HC. METHODS: Of 1,053 rural residents (2004-2005), 777 subjects with no known history of coronary artery diseases or diabetes mellitus over 40 yr were included. To reduce collinearity, we assessed the independent effect of WC with HC on PWV by residual method (WC [RM]). RESULTS: In women, most correlation coefficients were significant between measures of abdominal obesity and baPWV, with the highest (0.32) in waist to hip ratio (WHR), whereas no significance was found in men. All mean values of baPWV among the abdominally obese were higher than those of normal group in women, which were in the order of WHR, WC (RM), and WC. Adjusted OR with 95% CI for baPWV was significantly elevated by increase of WC (RM) upto 4.8 (95% CI: 2.1-11.2), and as 4.3 by WHR (95% CI: 1.6-11.4). CONCLUSION: Considering the difficulty in biologically interpreting WHR, WC (RM) may be a useful indicator of abdominal obesity among females in that it reflects the risk of pulse wave velocity.

Clinical Comparisons of Laparoscopic Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy in the Huge Uterine Myoma / 대한산부인과학회잡지

OBJECTIVE: This study is to evaluate the effectiveness and the value of laparoscopic assisted vaginal hysterectomy (LAVH) and the possibility of replacing total abdominal hysterectomy (TAH) to LAVH. METHODS: Retrospective study of 25 cases of LAVH and 157 cases of TAH for huge uterine myoma (uterus weight 500 gram) in Dept. of OB/GYN, Kyungpook National University Hospital from Jan. 1998 to May. 2000 was carried out and postoperative results were compared between 2 methods. Statistical analysis was performed using x2 test and Student t-test as appropriate. Statistical significance was defined as p0.05). The mean operating time was 126+/-53 (range 53-240) min vs 109+/-29 (range 60-250) min (p>0.05). The mean weight of uterus was 719+/-389 (range 500-2414) gram vs 791+/-541 (range 500- 4700) gram (p>0.05). The mean of hospital stay was 4.3+/-1.1 (range 3-8) days vs 6.9+/-3.4 (range 4-25) days (p0.05). Postoperative hospital stay was significantly shorter in LAVH than TAH. CONCLUSION: Even though fewer cases have been done, there was no episode of changing the surgery from LAVH to TAH in huge uterine myoma operation. For the more, neither was increase of morbidity compared to TAH. In huge uterine myoma operation, LAVH may replace the role of TAH in limited number of cases we have experienced. The advantages of LAVH are cosmetic superiority and early hospital discharge. In hands of experienced laparoscopic operator, huge uterine myoma is not an absolute contraindication of LAVH.

The Role of Epidemiology against Emerging and Reemerging Diseases / 한국역학회지

PURPOSE: Due to remarkable developments in technology and great efforts made by Health Organizations, most of infectious diseases had been under control. However, ecological changes and biological variations resulted in emerging and re-emerging infectious diseases, which threaten the global health and may have the possibility of being abused as biological weapon. Therefore it is indispensable to understand the latest information and knowledge in order to cope with the emergency situation. RESULTS: In Korea, several reemerging diseases such as Malaria, Hepatitis A, Shigellosis, Mumps, and food poisoning has been increasing conspicuously since 1990. Also Diphtheria, plague, yellow fever and dengue fever have been potential threats, considering substantial international trades. CONCLUSION: There have many newly emerged and re-emerged infectious diseases identified in recent few decades in Korea. Thus as epidemiologic professionals, we have to get ready, particularly following missions to be carried out : 1) to keep eyes open to look for emerging and reemerging diseases continuously and keep up the latest global information, 2) establish the co-operational organizations to prepare immediate action against the sudden outbreak, 3) publicize, educate, establish and perform the missions, taking initiative in training clinicians, 4) upgrade professional competency by familiarizing ourselves with epidemiologic investigations, and 5) fulfill the responsibilities as health keepers of the nation.