Validation of prognostic scores to predict short-term mortality in patients with acute-on-chronic liver failure.

BACKGROUND AND AIM: The aim of this study was to validate the chronic liver failure-sequential organ failure assessment score (CLIF-SOFAs), CLIF consortium organ failure score (CLIF-C OFs), CLIF-C acute-on-chronic liver failure score (CLIF-C ACLFs), and CLIF-C acute decompensation score in Korean chronic liver disease patients with acute deterioration. METHODS: Acute-on-chronic liver failure was defined by either the Asian Pacific Association for the study of the Liver ACLF Research Consortium (AARC) or CLIF-C criteria. The diagnostic performances for short-term mortality were compared by the area under the receiver operating characteristic curve. RESULTS: Among a total of 1470 patients, 252 patients were diagnosed with ACLF according to the CLIF-C (197 patients) or AARC definition (95 patients). As the ACLF grades increased, the survival rates became significantly lower. The areas under the receiver operating characteristic of the CLIF-SOFAs, CLIF-C OFs, and CLIF-C ACLFs were significantly higher than those of the Child-Pugh, model for end-stage liver disease, and model for end-stage liver disease-Na scores in ACLF patients according to the CLIF-C definition (all P < 0.05), but there were no significant differences in patients without ACLF or in patients with ACLF according to the AARC definition. The CLIF-SOFAs, CLIF-C OFs, and CLIF-C ACLFs had higher specificities with a fixed sensitivity than liver specific scores in ACLF patients according to the CLIF-C definition, but not in ACLF patients according to the AARC definition. CONCLUSIONS: The CLIF-SOFAs, CLIF-C OFs, and CLIF-C ACLFs are useful scoring systems that provide accurate information on prognosis in patients with ACLF according to the CLIF-C definition, but not the AARC definition.

The Efficacy and Safety of 660 nm and 411 to 777 nm Light-Emitting Devices for Treating Wrinkles.

BACKGROUND: Low-level light therapy (LLLT) using light-emitting diodes (LEDs) is considered to be helpful for skin regeneration and anti-inflammation. OBJECTIVE: To evaluate the efficacy and safety of 2 types of LLLTs using 660 nm-emitting red LEDs and 411 to 777 nm-emitting white LEDs in the treatment of facial wrinkles. MATERIALS AND METHODS: A prospective, randomized, double-blinded, comparative clinical trial involving 52 adult female subjects was performed. The faces of the subjects were irradiated daily with 5.17 J of red or white LEDs for 12 weeks. RESULTS: In both groups treated with red and white LEDs, the wrinkle measurement from skin replica improved significantly from baseline at Week 12. The red LED group showed slightly better improvement, but there were no statistical differences. In assessments by blinded dermatologists, no significant differences were observed in both groups. In the global assessment of the subjects, the mean improvement score of the red LED group was higher than that of the white LED group. CONCLUSION: Low-level light therapy using 660 nm LEDs or 411 to 777 nm LEDs significantly improved periocular wrinkles. Especially, 660 nm LEDs could be an effective and tolerable treatment option for wrinkles.

The perception of animal experimentation ethics among Indian teenage school pupils.

To promote awareness of animal experimentation ethics among teenagers, we created an educational pamphlet and an accompanying questionnaire. One hundred Indian teenage school pupils were given the pamphlet and subsequently surveyed with the questionnaire, to evaluate: a) their perception of animal experimentation ethics; and b) their opinion on the effectiveness of the pamphlet, according to gender and school grade/age. There was a significant correlation between grade/age and support for animal experimentation, i.e. senior students were more inclined to show support for animal experimentation. There was also a significant correlation between gender and perception of the need to learn about animal experimentation ethics, with girls more likely to feel the need to learn about ethics than boys. In addition, the four questions relating to the usefulness of the pamphlet, and student satisfaction with its content, received positive responses from the majority of the students. Even though the pamphlet was concise, it was apparent that three quarters of the students were satisfied with its content. Gender and age did not influence this level of satisfaction. Overall, our study shows that there is a significant correlation between a pupil`s school grade/age and their support for animal experimentation, and that there is also a significant correlation between gender and the perceived need to learn about animal experimentation ethics. This pilot scheme involving an educational pamphlet and questionnaire could be beneficial in helping to formulate basic strategies for educating teenage school pupils about animal ethics.

Comparison of push-out bond strength of fiber-reinforced composite resin posts according to cement thickness.

STATEMENT OF PROBLEM: Post space size and cement thickness can differ because of variations in root canal morphology, such as an oval shape, and because the entire canal space cannot be included in the post space preparation. As a result, increased cement thickness around the post may affect the bond strength between the post and the dentin. PURPOSE: The purpose of this in vitro study was to evaluate the push-out bond strength of fiber-reinforced composite resin posts to root dentin with cement layers of varying thickness. MATERIAL AND METHODS: Thirty human premolars were endodontically treated and restored with fiber-reinforced composite resin posts. Post space was prepared using a drill with a 1.5-mm diameter and diameters of 1.25 mm (small [S] group), 1.375 mm (medium [M] group), and 1.5 mm (large [L] group) were cemented. The specimens were sectioned horizontally into 1-mm-thick slices, and the push-out bond strengths of the apical and coronal fragments were evaluated. Bond strength was compared using analysis of variance and 2-sample t tests (α=.05). RESULTS: No significant differences were found in the debonding force and push-out bond strength among fiber-reinforced composite posts of different sizes (P>.05). The mean debonding force and standard deviation of the posts were 25.05 ±9.52 N for the S group, 28.17 ±11.38 N for the M group, and 33.78 ±12.47 N for the L group. The corresponding push-out bond strength values were 3.11 ±1.54 MPa, 3.39 ±1.4 MPa, and 4.15 ±1.75 MPa. The differences in debonding force between the apical (26.43 ±10.72 N) and coronal (31.57 ±12.03 N) areas were not significant (P>.05). However, the differences in push-out bond strength between the apical (4.27 ±1.73 MPa) and coronal areas (2.83 ±1.08 MPa) were significant (P<.05). CONCLUSIONS: The widening of post spaces and, consequently, the increased cement thickness do not significantly affect the bond strength of fiber-reinforced composite resin posts to root dentin.

Histological improvement following administration of autologous bone marrow-derived mesenchymal stem cells for alcoholic cirrhosis: a pilot study.

BACKGROUND: In experimental models, bone marrow-derived mesenchymal stem cells (BM-MSCs) have the capacity to differentiate into hepatocytes and exhibit antifibrotic effects. However, there have been no studies in humans with alcoholic cirrhosis. AIM: The aim of this study was to elucidate the antifibrotic effect of BM-MSCs in patients with alcoholic cirrhosis, as a phase II clinical trial. METHODS: Twelve patients (11 males, 1 female) with baseline biopsy-proven alcoholic cirrhosis who had been alcohol free for at least 6 months were enrolled. BM-MSCs were isolated from each patient's BM and amplified for 1 month, and 5 × 10(7) cells were then injected twice, at weeks 4 and 8, through the hepatic artery. One patient was withdrawn because of ingestion of alcohol. Finally, 11 patients completed the follow-up biopsy and laboratory tests at 12 weeks after the second injection. The primary outcome was improvement in the patients' histological features. RESULTS: According to the Laennec fibrosis system, histological improvement was observed in 6 of 11 patients (54.5%). The Child-Pugh score improved in ten patients (90.9%) and the levels of transforming growth factor-ß1, type 1 collagen and α-smooth muscle actin significantly decreased (as assessed by real-time reverse transcriptase polymerase chain reaction) after BM-MSCs therapy (P < 0.05). No significant complications or side effects were observed during this study. CONCLUSIONS: Bone marrow-derived mesenchymal stem cells therapy in alcoholic cirrhosis induces a histological and quantitative improvement of hepatic fibrosis.

A comparison of tapered and cylindrical miniscrew stability.

OBJECTIVES: This study compared the stability of tapered miniscrews with cylindrical miniscrews. MATERIALS/METHODS: One hundred and five tapered and 122 cylindrical self-drilling miniscrews were placed into the maxillary and mandibular buccal alveolar areas of 132 patients (43 males and 89 females). The insertion torque and removal torque were measured and Periotest values (PTVs) were recorded at implantation. RESULTS: The success rates of the tapered and cylindrical miniscrews examined were similar. In the maxilla, the insertion torque of the tapered miniscrews (8.3 Ncm) was significantly higher than that of the cylindrical miniscrews (6.3 Ncm) (P < 0.05). The PTVs of the tapered miniscrews were statistically significantly lower in the maxilla (P < 0.05). The removal torque values showed no significant difference between the tapered and cylindrical miniscrews in the upper and lower buccal areas (P > 0.05). CONCLUSIONS: Tapered miniscrews had higher initial stability when compared to cylindrical miniscrews, whereas the clinical success rates and removal torques were similar between the two designs. The long-term stability is not directly affected by the miniscrew design.

Application of the adjuvant! Online model to Korean breast cancer patients: an assessment of prognostic accuracy and development of an alternative prognostic tool.

BACKGROUND: Adjuvant! Online (AOL) is a Web-accessible risk-assessment model that predicts the mortality and the benefits of adjuvant therapy for breast cancer. METHODS: Using the Yonsei Tumor Registry database, patients with T1-3, N0-3, M0 breast cancer who were treated at the Yonsei Cancer Center between 1986 and 1999 were entered into AOL version 8.0 to calculate survival. RESULTS: The median age of the study population was 45 years (range, 23-76 years) and the median follow-up duration was 10.8 years (range, 0.1-25.9 years) for all 699 patients. AOL significantly overestimated overall survival (OS) (by 11.1 %, P < 0.001), breast cancer-specific survival (BCSS) (by 11.6 %, P < 0.001), and event free-free survival (EFS) (by 9.25 %, P < 0.001) in Korean patients. Therefore, we developed a Korean version of AOL (KAOL), which is a new model for prognosis based on AOL's parameters. The observed 10-year OS (61.4 %), BCSS (62.3 %), and EFS (59.1 %) and the KAOL predicted OS (61.5 %), BCSS (63.5 %) and EFS (57.6 %) were not different (P = 0.976, P = 0.771, and P = 0.674, respectively). CONCLUSIONS: AOL was not found to be suitable in Korean patients with breast cancer. The newly developed KAOL accurately predicted 10-year outcomes in Korean breast cancer patients.

Risk assessment of hepatitis B virus-related hepatocellular carcinoma development using liver stiffness measurement (FibroScan).

UNLABELLED: Liver stiffness measurement (LSM) using FibroScan accurately assesses the degree of liver fibrosis and the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C. This study investigated the usefulness of LSM as a predictor of HCC development in patients with chronic hepatitis B (CHB). A total of 1,130 patients with non-biopsy-proven CHB who underwent LSM between May 2005 and December 2007 were enrolled in this prospective study. After LSM was performed, patients attended regular follow-up as part of a surveillance program for the detection of HCC. The mean age of the patients (767 men, 363 women) was 50.2 years, and the median LSM was 7.7 kPa. Six hundred seventy-two (59.5%) patients received antiviral treatment before or after enrollment. During the follow-up period (median, 30.7 months; range, 24.0-50.9 months), HCC developed in 57 patients (2.0% per 1 person-year). The 1-, 2-, and 3-year cumulative incidence rates of HCC were 0.80%, 3.26%, and 5.98%, respectively. On multivariate analysis, together with old age, male sex, heavy alcohol consumption (>80 g/day), serum albumin, and hepatitis B e antigen positivity, patients with a higher LSM (>8 kPa) were at a significantly greater risk of HCC development, with the following hazard ratios: 3.07 (95% confidence interval [CI], 1.01-9.31; P = 0.047) for LSM 8.1-13 kPa; 4.68 (95% CI, 1.40-15.64; P = 0.012) for LSM 13.1-18 kPa; 5.55 (95% CI, 1.53-20.04; P = 0.009) for LSM 18.1-23 kPa; and 6.60 (95% CI, 1.83-23.84; P = 0.004) for LSM >23 kPa. CONCLUSION: Our data suggest that LSM could be a useful predictor of HCC development in patients with CHB.

Prediction of recurrence after curative resection of hepatocellular carcinoma using liver stiffness measurement (FibroScan®).

BACKGROUND: The purpose of this study was to investigate whether preoperative liver stiffness measurement (LSM) can predict recurrence after curative resection of hepatocellular carcinoma (HCC). LSM using FibroScan(®) can assess the severity of liver fibrosis, which is significantly associated with recurrence after curative resection of HCC. METHODS: Between February 2006 and March 2009, 133 patients who underwent preoperative LSM and curative resection for HCC were enrolled in this prospective study. LSM values were analyzed for association with recurrence, together with other clinical variables. RESULTS: The mean age of the patients (117 men and 16 women) was 57 years. During the follow-up period (median, 25.0 (range, 3.0-54.6) months), HCC recurred in 62 (46.6 %) patients. In multivariate analysis, together with satellite nodule and Edmonson-Steiner grade III-IV, LSM was selected as an independent predictor of recurrence (P < 0.05; hazard ratio, 1.034; 95 % confidence interval, 1.007-1.061). When the study population was stratified into two groups using the optimal cutoff value (13.4 kPa) that maximized the sum of sensitivity (64.7 %) and specificity (76.1 %) from time-dependent receiver operating characteristic curves (area under the receiver operating characteristic curve = 0.676), patients with LSM values >13.4 kPa were at a significantly greater risk for recurrence with a hazard ratio of 1.925 (P = 0.01; 95 % confidence interval, 1.17-3.168) compared with those with LSM values ≤ 13.4 kPa. CONCLUSIONS: Our data suggest that LSM can be a useful predictor of recurrence after curative resection of HCC.

Early on-treatment predictions of clinical outcomes using alpha-fetoprotein and des-gamma-carboxy prothrombin responses in patients with advanced hepatocellular carcinoma.

BACKGROUND AND AIM: The clinical utility of alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) as a predictor of treatment outcome in patients with advanced hepatocellular carcinoma (HCC) receiving hepatic artery infusional chemotherapy (HAIC) or concurrent chemoradiation therapy (CCRT) has been poorly defined. METHODS: Between January 2003 and December 2007, we enrolled 127 treatment-naïve patients who received HAIC (n = 60) or CCRT (n = 67) as an initial treatment modality. An AFP or DCP response was defined as a reduction of more than 20% from the baseline level. RESULTS: AFP responders showed significantly better overall survival (OS) than non-responders among patients with HAIC (median 17.3 vs 6.4 months, P < 0.001) and with CCRT (median 17.6 vs 8.7 months, P = 0.014). DCP responders in the CCRT group also showed significantly better progression-free survival (PFS) than non-responders (median 9.2 vs 3.1 months, P < 0.001). Multivariate Cox regression analyses showed that AFP response was independently predictive of OS in both groups (P = 0.009 in HAIC and P = 0.008 in CCRT) whereas DCP only predicted PFS in patients with CCRT (P = 0.015). CONCLUSIONS: Early on-treatment AFP response was predictive of OS in treatment-naïve patients with advanced HCC receiving HAIC and CCRT as an initial treatment modality. Furthermore, DCP response was useful for predicting PFS in patients with CCRT.

"Normal" liver stiffness values differ between men and women: a prospective study for healthy living liver and kidney donors in a native Korean population.

BACKGROUND AND AIM: Liver stiffness (LS) measurement can distinguish individuals with potential liver disease (LD) from the general population. However, if LS is sex-sensitive, prevalence of LD may be incorrectly estimated when the same reference LS value is applied irrespective of sex. Here, we evaluated whether normal ranges of LS differ between healthy men and women. METHODS: LS was measured in a cohort of healthy living liver and kidney donors, none of whom suffered from diabetes mellitus, hypertension, hepatitis B or C virus infection, heart or liver dysfunction, or metabolic syndrome. Patients with abnormal laboratory findings related to potential LD (platelet count < 150 × 10(3) /µL; aspartate aminotransferase > 40 IU/L; alanine aminotransferase [ALT] > 40 IU/L; albumin < 3.3 g/dL; total bilirubin > 1.2 mg/dL; gamma-glutamyl transpeptidase > 54 IU/L; alkaline phosphatase > 115 IU/L) were excluded. RESULTS: Among 242 patients analyzed, the mean age was 34.1 for men (n = 121) and 40.5 years for women (n = 121) (P < 0.001). Men had a higher mean LS value than women (5.2 ± 1.2 vs 4.8 ± 1.1 kPa/P < 0.001). Multivariate-linear regression analysis identified sex as the only independent factor for LS values (ß = 0.361/P = 0.021). Using the 5th-95th percentiles, we determined normal LS ranges of 3.7-7.0 kPa in men and 3.3-6.8 kPa in women. In subgroups with ALT < 30 IU/L (subgroup-1, n = 216) and ALT < 20 IU/L (subgroup-2, n = 163), men had significantly higher LS values than women (5.2 ± 1.3 vs 4.7 ± 1.1 kPa/P = 0.003 and 5.1 ± 1.2 vs 4.7 ± 1.1 kPa/P = 0.030, respectively), demonstrating an independent sex effect (ß = 0.483/P = 0.003 and ß = 0.389/P = 0.030, respectively). CONCLUSIONS: An independent sex effect on LS values was confirmed. Thus, sex-specific references should be used for effective screening based on LS measurements.

The usefulness of liver stiffness measurement using FibroScan in chronic hepatitis C in South Korea: a multicenter, prospective study.

AIM: We investigated the accuracy of liver stiffness measurement (LSM) in chronic hepatitis C (CHC) in a multicenter, prospective study in South Korea. METHODS: Between June 2005 and July 2009, 91 CHC patients without a previous history of antiviral treatment, clinical evidences of cirrhosis, coinfection with other viruses, and heavy alcohol consumption and with alanine aminotransferase (ALT) ≤5x upper limit of normal, total bilirubin ≤1.5 mg/dL, sufficient liver biopsy quality (≥15 mm and more than six portal tracts), interquartile range to median liver stiffness (LS) value ratio ≤0.21, and more than 10 valid measurements, were recruited. The Batts and Ludwig scoring system was used for histologic assessment. Age-platelet index (API), aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and age-spleen-platelet ratio index (ASPRI) were calculated. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of LSM and other noninvasive models. RESULTS: The mean age was 47.9 years, and the mean LS value was 7.7 kPa (44 men and 47 women). LS value was highly correlated to the fibrosis stages (r=0.835, P<0.001). The AUROCs of LSM were 0.909 for ≥F2, 0.993 for ≥F3, and 0.970 for F=4 and were superior to those of API (0.72, 0.858, and 0.948, respectively), APRI (0.780, 0.887, and 0.904, respectively), and ASPRI (0.713, 0.862, and 0.957, respectively). The optimal cutoff LS values were 6.2 kPa for ≥F2, 7.7 kPa for ≥F3, and 11.0 kPa for F=4. CONCLUSIONS: Our data suggest that LSM can accurately assess liver fibrosis in patients with CHC and be applied in South Korea.

Serotonin-related gene pathways associated with undifferentiated somatoform disorder.

It has been suggested that serotonergic hypofunction and serotonergic pathway genes underlie the somatic symptoms of somatoform disorders. We examined a variety of serotonin-related gene polymorphisms to determine whether undifferentiated somatoform disorder is associated with specific serotonin-related gene pathways. Serotonin-related polymorphic markers were assessed using single nucleotide polymorphism (SNP) genotyping. One hundred and two patients with undifferentiated somatoform disorder and 133 healthy subjects were enrolled. The genotype and allele frequencies of tryptophan hydroxylase (TPH)1 A218C, TPH2 rs1386494, serotonin receptor 2A-T102C (5-HTR 2A-T102C), 5-HTR 2A-G1438A and serotonin transporter (5HTTLPR) gene were compared between the groups. The Hamilton Rating Scale for Depression and the somatization subscale of the Symptom Checklist-90-Revised (SCL-90-R) were used for psychological assessment. Patients with undifferentiated somatoform disorder had higher frequencies of the TPH1 C allele than healthy controls (p=0.02) but the difference was not significant after Bonferroni correction. The frequency of TPH1 genotype also did not differ significantly between the patients and the healthy controls, nor did TPH2 rs1386494, 5-HTR 2A-T102C, 5-HTR 2A-G1438A or 5HTTLPR allele and genotype frequencies differ significantly between the two groups. These findings suggest that a variety of serotonin-related gene pathways are unlikely to be definite genetic risk factors for undifferentiated somatoform disorder. Therefore, the pathogenesis of the disorder may be related to epigenetic factors, including psychosocial and cultural factors. Nonetheless, future studies need to include a larger sample of subjects and polymorphisms of more serotonin-related gene variants.

Comparisons of nerve fiber layer thickness measurements between Stratus, Cirrus, and RTVue OCTs in healthy and glaucomatous eyes.

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements obtained by two spectral-domain optical coherence tomographies (SD OCTs; Cirrus-HD OCT and RTVue) and a time domain OCT (TD OCT; Stratus OCT). The diagnostic ability of the three instruments for glaucoma has also been compared. METHODS: One hundred eight open-angle glaucoma patients and 46 normal controls were enrolled. Three OCT scans were repeated to obtain peripapillary RNFL thickness measurements from all participants on the same day. The relationships between RNFL measurements from three OCTs were evaluated with regression analyses. RESULTS: The thickest RNFL measurements were generally obtained with the RTVue, followed by the Stratus, and finally by the Cirrus OCT (mixed model, p < 0.05). However, the tendency was reversed or no longer present in severe glaucomatous eyes and nasal quadrant maps. Regression analysis between the TD OCT and the two SD OCTs revealed a quadratic relation (linear vs. non-linear, Akaike information criterion, all p < 0.05), whereby RNFL measurements of the TD OCT became exponentially thinner than those by the SD OCTs in thin RNFL thicknesses. Comparing the two SD OCTs, RTVue measured thicker values consistently regardless of the RNFL thickness (pairwise comparisons, p < 0.05). There were no significant differences in the diagnostic ability of all three instruments in average and each quadrants of RNFL thickness (p > 0.05). CONCLUSIONS: Direct comparisons of RNFL thickness measurements among OCT instruments may be misleading as there are considerable differences among devices. The measurement differences between SD OCT and TD OCT differed according to the RNFL thickness and also possibly to severity of the glaucoma. The diagnostic ability of each instrument for glaucoma detection was not significantly different.

What are 'true normal' liver stiffness values using FibroScan?: a prospective study in healthy living liver and kidney donors in South Korea.

AIMS: To identify the normal range of liver stiffness (LS) values by recruiting healthy living liver and kidney donors in South Korea. METHODS: Liver stiffness measurement (LSM) was performed in 69 healthy living liver and kidney donors who were admitted for transplantation. None of the subjects suffered from diabetes mellitus, hypertension, hepatitis B virus infection, hepatitis C virus infection, heart dysfunction, liver dysfunction or metabolic syndrome. RESULTS: LSM failure rate was 2.7%. Among 12 liver donors (17.4%) with available liver histology, eight showed normal liver histology and four showed liver steatosis of <5% of the hepatocytes. The mean age of our study population was 38.9+/-11.9 years (35 men and 34 women), with a mean LS value of 4.6+/-0.5 kPa (range 3.3-5.6 kPa). LS values were not significantly different between men (4.6+/-0.6 kPa) and women (4.5+/-0.5 kPa, P=0.636), nor were they significantly different according to age (P=0.851). Using the fifth and 95th percentiles, we determined the normal range of LS values to be 3.9-5.3 kPa. CONCLUSIONS: We identified the normal range of LS values and found that LS values were not significantly influenced by age and gender.

Development and validation of a novel prognostic scoring model for ischemic colitis.

PURPOSE: This study was conducted to identify prognostic factors affecting the course of ischemic colitis and to develop a prognostic scoring model. METHODS: We analyzed medical records of consecutive patients with ischemic colitis treated between October 2002 and September 2008 at Severance Hospital, Seoul, Republic of Korea. Patients were excluded if results of endoscopy were unavailable. Patients were classified as having severe ischemic colitis on the basis of outcome (improvement delayed for more than 2 weeks, complications requiring surgery, or death). Univariate analyses and multivariate logistic regression analyses with backward stepwise selection were used to identify clinical, endoscopic, and laboratory variables associated with severe ischemic colitis. A novel prognostic scoring model was derived from the data, with probability of severe ischemic colitis and risk index determined for 8 risk groups based on independent risk factors identified by multivariate analyses. Predictive power was tested by means of 10-fold cross-validation, with area under the receiver operating characteristic curve representing discrimination accuracy. RESULTS: Analyzable data were available for 153 of 173 consecutive patients. Ischemic colitis was classified as severe in 20 patients. Multivariate analyses showed the following significant independent predictors of severe ischemic colitis: tachycardia (adjusted odds ratio = 4.6; 95% CI, 1.4-14.7), shock within 24 hours after admission (adjusted odds ratio = 6.5; 95% CI, 2.0-21.2), and endoscopic evidence of ulceration (adjusted odds ratio = 9.9; 95% CI, 2.0-48.8). Probability of severe ischemic colitis and risk index were 74 times higher for patients with all 3 risk factors (group 8) than for patients with none (group 1). Internal validation showed the area under the receiver operating characteristic curve to be 0.91 (95% confidence interval, 0.86-0.96). CONCLUSIONS: Endoscopic findings and instability of vital signs were associated with the disease course of ischemic colitis. A novel scoring model based on presence of tachycardia, shock within 24 hours after admission, and endoscopic evidence of ulceration provides a method of assessing patient prognosis and should be further validated.

Advanced synchronous adenoma but not simple adenoma predicts the future development of metachronous neoplasia in patients with resected colorectal cancer.

BACKGROUND: Patients with resected colorectal cancer remain at a high risk for developing metachronous neoplasia in the remnant colorectum. The aim of this study was to identify baseline clinical and colonoscopic features predictive of metachronous neoplasia after curative resection of colorectal cancer. METHODS: The baseline clinical and colonoscopic data and follow-up details of 503 patients who had colonoscopic surveillance after curative colorectal resection between January 2000 and October 2005 in a single tertiary institution were analyzed. Univariate and multivariate analyses were done to identify risk factors for metachronous adenoma. RESULTS: Metachronous adenomas were diagnosed in 176 patients (35.0%) and advanced adenomas in 39 (7.8%) during the follow-up period (35.7+/-20.9 mo). Among the clinical and colonoscopic factors at baseline, advanced age (> or = 60 y) (odds ratio (OR)=3.64; 95% confidence intervals (CI), 1.55-8.52), the presence of advanced synchronous adenoma (OR=4.38; 95% CI, 1.77-10.85), and longer total follow-up period (OR=1.03; 95% CI, 1.01-1.04) were independently correlated with developing advanced metachronous adenoma. Patients who had synchronous tubular adenoma without advanced features at baseline were not found to have an increased risk for future development of advanced metachronous adenoma compared with those in the synchronous adenoma-free group (OR=1.75; 95% CI, 0.69-4.43, P=0.650). CONCLUSIONS: Our data showed that patients with advanced synchronous adenoma at baseline were identified to have an increased risk of advanced metachronous neoplasia during a longer follow-up period but those with tubular adenoma without advanced features at baseline were not.

How can we enhance the performance of liver stiffness measurement using FibroScan in diagnosing liver cirrhosis in patients with chronic hepatitis B?

GOAL: This study aimed to enhance the diagnostic accuracy by defining different cutoff liver stiffness measurement (LSM) values according to alanine aminotransferase (ALT) level and combining LSM with noninvasive models in patients with chronic hepatitis B (CHB). BACKGROUND: Several studies have indicated that ALT influences LSM using FibroScan. STUDY: The study prospectively enrolled 200 patients (143 men, mean age 45.4 y) between June 2007 and November 2008 who had been diagnosed with CHB and underwent both liver biopsy and LSM on the same day. RESULTS: The area under the receiver operating characteristic curves (AUROC) of LSM for predicting cirrhosis in patients with ALT < or = upper limit of normal (ULN) was higher than that of all patients or those with ALT >ULN and < or = 2x ULN (AUROC=0.884 vs. 0.849 and 0.867). The cutoff LSM values for > or = F2, > or = F3, and F4 were 6.0, 7.5, and 10.1 kPa, respectively, in patients with ALT < or = ULN, whereas they were 8.9, 11.0, and 15.5 kPa, respectively, in those with ALT >ULN and < or = 2x ULN. The combination of LSM and the age-spleen-platelet ratio index performed the best at predicting cirrhosis, regardless of ALT level (AUROC=0.917 in patients with ALT < or = ULN, 0.909 in those with ALT < or = 2x ULN, and 0.894 in all patients). CONCLUSIONS: Different cutoff LSM values according to ALT level and combination with age-spleen-platelet ratio index can enhance the performance of LSM in CHB, regardless of ALT level.

Ascitic fluid infection in patients with hepatitis B virus-related liver cirrhosis: culture-negative neutrocytic ascites versus spontaneous bacterial peritonitis.

BACKGROUND AND AIM: Ascitic fluid infection (AFI) consists of culture-negative neutrocytic ascites (CNNA) and spontaneous bacterial peritonitis (SBP). The present study compared the clinical characteristics and prognosis of CNNA and SBP in hepatitis B virus (HBV)-related cirrhotic patients. METHODS: We analyzed 130 consecutive patients hospitalized due to the first episode of AFI between January 1998 and December 2007. RESULTS: The mean age of the patients was 52.3 years (88 men, 42 women). Ninety-three patients (71.5%) had CNNA and 37 patients (28.5%) had SBP; 117 patients (90.0%) died after a median survival period of 6.4 months. Patients with CNNA and SBP survived for a median period of 6.9 months and 5.4 months, respectively (P = 0.417). Patients with SBP showed higher in-hospital mortality than those with CNNA (16.2 vs 4.3%; P = 0.031). Binary logistic regression analysis showed that culture positivity of ascitic fluid (CNNA vs SBP) was the only independent predictor of in-hospital mortality (P = 0.042). In a Cox regression model for the 120 patients (92.3%) who survived the first episode of AFI, only the Child-Pugh score remained significant for survival (P = 0.007), whereas no association was observed for culture positivity of ascitic fluid (CNNA vs SBP) during the first episode of AFI (P = 0.752). CONCLUSIONS: Although in-hospital mortality was higher in patients with SBP than CNNA, the clinical course of the two groups was similar after the first episode of AFI. Thus, liver transplantation should be considered, irrespective of culture positivity of ascitic fluid.

Needs Assessment for a VR-Based Adult Nursing Simulation Training Program for Korean Nursing Students: A Qualitative Study Using Focus Group Interviews.

Virtual reality programs are being actively utilized in various education fields, but not many have been developed/used in nursing. This study aimed to explore the essential components and improvements needed in an adult nursing VR-based simulation training program for nursing students through focus group interviews (FGIs). This was a qualitative study. Fourteen nursing students from three cities in Korea who had experienced clinical practice and simulation training participated. They were divided into three FGIs. Data were collected from February-March 2020. We analyzed the data from the FGIs using Colaizzi's phenomenological methodology. In total, 40 themes emerged, divided into 13 theme clusters and the following four categories. When developing an adult nursing VR-based simulation training program, the development should focus on addressing the limitations of conventional clinical practice, and these should be analyzed; it should also reflect students' needs, including the following: provide an array of scenarios/skills to be trained; difficulty-specific learning scenarios; immediate feedback (e.g., those in computerized games); simulate emergency situations; simulate clinical cases that are difficult to experience in clinical practice; and allow for the training of patient-nurse communication skills.