Effect of Comprehensive and Integrative Medical Services on Patients with Degenerative Lumbar Spinal Stenosis: A Pilot Study.

Background and Objectives: Two types of medicinal systems are available in Korea: Western and oriental. These exist as separate services that independently provide medical care to patients. We determined the utility and benefits of compressive and integrated medical services (CIMS) comprising 12 sessions of acupuncture and healing programs over 6 weeks. Methods and Methods: In this two-group parallel single-center randomized controlled assessor-blinded trial, 25 participants were assigned to either the experimental (conventional medical treatment plus CIMS, n = 12) or control (conventional medical treatment, n = 13) group. Spinal nerve root block was performed on the compressed spinal nerve root (identified using magnetic resonance imaging) when no improvement was observed after the initial treatment. The experimental group received 12 cycles of acupuncture and manual therapy for 6 weeks; the control group received conventional medical treatment alone. Results: The average age of participants in the experimental and control groups was 70.73 ± 5.95 and 67.33 ± 8.89 years, respectively. There were no significant differences between the groups in terms of age, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs, sex, and current medical history. We found high compliance for both programs (acupuncture and healing). On exclusion of between-group effects, the visual analog scale (VAS) score improved significantly over time (p = 0.045). Further, comparison of the groups after excluding the effects of visits revealed significantly lower VAS scores in the experimental group than in the control group (p = 0.000). Conclusions: Patients with degenerative lumbar spinal stenosis who mainly complain of radiating pain in the lower leg may benefit from CIMS after spinal nerve root block for ≤3 months after treatment. Our study findings suggest that this treatment improves spinal function and Oswestry Disability Index score. However, CIMS did not improve QoL.

Effectiveness of Repetitive Transcranial Magnetic Stimulation on Managing Fibromyalgia: A Systematic Meta-Analysis.

OBJECTIVE: In fibromyalgia, central sensitization is a key mechanism, and repetitive transcranial magnetic stimulation (rTMS) has been reported to potentially manage symptoms of fibromyalgia. In this meta-analysis, we evaluated the therapeutic effect of rTMS in patients with fibromyalgia according to stimulation locations and follow-up time points. METHODS: We searched the MEDLINE, Cochrane, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases for articles published from January 1, 1990, to August 26, 2021, including randomized controlled studies investigating the effectiveness of rTMS on managing fibromyalgia. RESULTS: In total, 10 articles and 299 participants were included. High-frequency rTMS on the left primary motor cortex (Lt. M1) had a significant effect on pain reduction immediately and 1-4 weeks after the end of the session but had no significant effect after 5-12 weeks. Additionally, after high-frequency rTMS sessions on the Lt. M1, the effect on patients' quality of life appeared late at 5-12 weeks of follow-up. In contrast, high-frequency rTMS on the left dorsolateral prefrontal cortex (Lt. DLPFC) did not reduce pain from fibromyalgia. The effect on controlling the affective problem was not observed after rTMS treatment on either the Lt. M1 or the Lt. DLPFC. CONCLUSIONS: High-frequency rTMS had a positive pain-reducing effect immediately and at 1-4 weeks after completion of the rTMS sessions, and the patients' quality of life improved after 5-12 weeks. However, Lt. DLPFC stimulation was not effective in controlling fibromyalgia symptoms.

Stronger correlation of peak oxygen uptake with distance of incremental shuttle walk test than 6-min walk test in patients with COPD: a systematic review and meta-analysis.

BACKGROUND: The 6-min walk test (6MWT) and incremental shuttle walk test (ISWT) are valid and reliable measures to assess exercise capacity of patients with chronic obstructive pulmonary disease (COPD). However, the comparison of correlation between peak oxygen uptake (peak VO2) and 6MWT or ISWT distance has not been investigated. We aimed to investigate the correlation between peak VO2 and 6MWT and ISWT distances in COPD patients through a meta-analysis. METHODS: We systematically searched MEDLINE, Scopus, Embase, and the Cochrane Library up to June, 2020 for studies comparing the correlation of peak VO2 with either 6MWT or ISWT in COPD patients. Meta-analysis was performed with R software using a fixed-effect model. We compared the correlation coefficient and measured the heterogeneity using I2 statistics. RESULTS: We identified 12 studies involving 746 patients. Meta-analysis showed a significant correlation between peak VO2 and 6MWT and ISWT distances (6MWT: r = 0.65, 95% CI 0.61-0.70; ISWT: r = 0.81, 95% CI 0.74-0.85; p < 0.0001). The heterogeneity was lower in ISWT than in 6MWT (6MWT: I2 = 56%, p = 0.02; ISWT: I2 = 0%, p = 0.71). Subgroup analysis showed a higher correlation coefficient in the low exercise capacity group than in the high exercise capacity group in both field tests. CONCLUSIONS: 6MWT and ISWT significantly correlated with peak VO2. Our findings suggest that ISWT has a stronger correlation with peak VO2 than 6MWT. The exercise capacity in COPD patients may affect the strength of the relationship between peak VO2 and walking distance in both field tests, suggesting the importance of using various exercise tests. Trial registration CRD 42020200139 at crd.york.ac.uk/prospero/.

Effectiveness of prednisolone in complex regional pain syndrome treatment: A systematic narrative review.

BACKGROUND: Many patients with complex regional pain syndrome (CRPS) experience refractory pain with severe restrictions in the activities of daily living. Oral prednisolone is commonly used to treat these patients. PURPOSE: To review previous studies assessing the effects of prednisolone in CRPS patients. METHODS AND MATERIALS: Articles published from January 1, 1980 to July 23, 2021 in the PubMed database were searched using the following key phrases: (prednisolone OR corticosteroid OR steroid) AND (complex regional pain syndrome OR reflex sympathetic dystrophy OR shoulder-hand syndrome OR causalgia). Specifically, we included those articles in which oral prednisolone or corticosteroids were used to control the CRPS symptoms. RESULTS: In total, 11 articles were included, comprising 3 randomized trials, 5 single-arm prospective observational studies, and 3 retrospective studies. Nearly all previous studies reported that oral prednisolone can effectively control the CRPS symptoms. Moreover, though 30-100 mg/day of oral prednisolone was initially administered in these studies, 30 mg/day was also found to be effective in controlling the symptoms. Although prednisolone was usually administered for 1-3 months, short-term treatment for 1-2 weeks was also reportedly effective. Furthermore, only 0%-30% of the patients in these studies had minor side effects after prednisolone treatment. CONCLUSIONS: Our review showed that prednisolone may be effective in alleviating the CRPS symptoms. To determine higher levels of evidence, a full systematic review with more highly qualified studies, such as randomized controlled trials, should be conducted in the future.

Incidence and prevalence of immune thrombocytopenia under the copayment waiver policy for pediatric patients in Korea: Data from the National Health Claims Database.

The purpose of this study was to investigate the epidemiology of immune thrombocytopenia (ITP) under the copayment waiver policy for pediatric patients in Korea. The data were collected from the National Health Insurance Claims Database of Korea. ITP was identified based on the diagnostic code D69.38 from the Korean Standard Classification of Diseases. Patients between one and 18 years old, who had at least one health insurance claim for ITP as a final diagnosis, from 1 January 2016, to 31 December 2017, were analyzed. Prevalent cases were defined as patients who used, at least one time, any medical services coded as D69.38. Incident cases were defined as patients who did not use D69.38 coded medical services during the prior year and were newly registered in 2017. The prevalence and incidence of ITP were 24.53 and 13.39 per 100,000 persons. The peak rates were observed in 1-year-old patients. The gender-specific prevalence of ITP was significantly higher in one-year-old males than females. According to the change-point analysis, we found that the prevalence and incidence diminished rapidly at the ages of four and three, respectively. This Korean population-based epidemiological study of ITP provided meaningful insights into the current epidemiology of ITP and demonstrated the implications of interpreting epidemiologic studies to reflect age categorizing and health care system characteristics.

Prediction of the motor prognosis with diffusion tensor imaging in hemorrhagic stroke: a meta-analysis.

This paper investigates whether diffusion tensor imaging performed within 2 weeks of intracerebral hemorrhage onset could predict the motor outcome by categorizing previous diffusion tensor imaging studies based on the time-point of performing diffusion tensor imaging (<2 weeks and ≥2 weeks after intracerebral hemorrhage onset). A comprehensive database search on PubMed, Embase, Cochrane Library, and SCOPUS was conducted. The pooled estimate was acquired using correlation analysis between the diffusion tensor imaging parameters of fractional anisotropy and motor recovery based on the period of stroke onset. In the results, out of 511 retrieved articles, eight were finally included in the meta-analysis. In patients who underwent diffusion tensor imaging within 2 weeks of intracerebral hemorrhage onset, a random-effects model revealed that the ratio of fractional anisotropy is a significant predictor of motor recovery of the hemi-side extremity after intracerebral hemorrhage (p = 0.0015). In patients who underwent diffusion tensor imaging after 2 weeks of intracerebral hemorrhage onset, a fixed-effects model revealed that the ratio of fractional anisotropy was also a significant predictor of motor recovery of the hemi-side extremity after intracerebral hemorrhage (p < 0.0001). Our meta-analysis revealed that ratio of fractional anisotropy (rFa) calculated from diffusion tensor imaging (DTI) performed ≥2 weeks of intracerebral hemorrhage onset had a positive correlation with the motor outcomes after intracerebral hemorrhage (ICH). Also, although diffusion tensor imaging was performed <2 weeks after intracerebral hemorrhage onset, the ratio of fractional anisotropy calculated from diffusion tensor imaging helped predict the motor outcome. Further analyses, including a more significant number of studies focused on this topic, are warranted.

Anti-Sm Antibody, Damage Index, and Corticosteroid Use Are Associated with Cardiac Involvement in Systemic Lupus Erythematosus: Data from a Prospective Registry Study.

BACKGROUND: Disease-specific factors that predispose patients to diverse cardiac diseases in systemic lupus erythematosus (SLE) have been established. The aim of this study was to identify risk factors for cardiac involvement in patients with SLE drawn from the Korean Lupus Network (KORNET) registry. METHODS: A total of 437 patients with SLE recruited from the KORNET registry were included in the analysis. The Cox proportional hazard model was used to identify risk factors for the development of cardiac involvement during the follow-up period. The hazard ratios for risk factors of cardiac involvement were assessed using Kaplan-Meier curves and log-rank test. RESULTS: Of 437 patients with SLE, 12 patients (2.7%) developed new cardiac involvement during a median follow-up period of 47.6 months. Frequencies in men and in patients with anti-Sm antibody, anti-Ro antibody, and at least one Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) score in patients with cardiac involvement were higher, compared to those without cardiac involvement (P < 0.001, P = 0.026, P = 0.015, and P < 0.001, respectively). Men gender, older age, anti-Sm antibody, SDI, and corticosteroid dosage were potent predictors for cardiac involvement in patients with SLE in the determination of risk factors for cardiac involvement. Men, anti-Sm antibody positivity, and SDI ≥ 1 increased incidence rates of cardiac involvement for (P < 0.001, P = 0.036, and P < 0.001, respectively). CONCLUSION: The results of this study reveal that SLE-related factors such as anti-Sm antibody, SDI, and corticosteroid dosage at baseline are risk factors for cardiac involvement in SLE.

Clinicopathologic characteristics of paranasal sinus fungus ball: retrospective, multicenter study in Korea.

PURPOSE: Fungus ball (FB) is the most common type of fungal rhinosinusitis and the prevalence of FB has increased over the past 10 years. The aim of this study was to compare the clinical characteristics of Korean adult patients with FB and chronic rhinosinusitis (CRS) without FB. METHODS: We retrospectively analyzed data on 1362 patients (147 FB and 1215 CRS) who underwent endoscopic sinus surgery at nine Korean medical centers in 2005, 2010, and 2016. We evaluated the prevalence of FB and compared the clinical characteristics of FB and CRS. Medical records, computed tomography (CT) findings, atopic status, concomitant diseases, tissue, and blood eosinophil count were assessed. RESULTS: The prevalence of FB was significantly higher in 2016 (15.9%) than in the other years (7.8% in 2005 and 7.5% in 2010). The FB patients were more likely to be female, older, have unilateral disease and less likely to have allergy compared to the CRS patients. The most common main complaint related to CRS and FB was nasal obstruction. CT determined that unilateral disease and maxillary sinus dominancy were common in patients with FB. The incidence of concomitant diseases was much higher in FB, with lower tissue and blood eosinophilia. CONCLUSION: FB is commonly encountered in older women with the increased prevalence. FB had a different clinical presentation, radiological findings, and prognosis than CRS. Further studies are needed to understand the pathophysiologic mechanisms underlying the development of FB.

Deterioration of Brain Neural Tracts in Elderly Women with Sarcopenia.

OBJECTIVES: Sarcopenia is known to be associated with increased stiffness in brain arteries, which causes deterioration in brain structure and function. In this study, the authors evaluated the deterioration of neural tracts using diffusion tensor tractography (DTT) in elderly women with sarcopenia and investigated whether deterioration of neural tracts is consistent with clinical findings. METHODS: Twenty elderly women with sarcopenia were recruited. Muscle mass was measured by dual energy x-ray absorptiometry. Hand-grip power and gait speed were also assessed. Memory function was evaluated using the Seoul Neuropsychological Screening Battery. Additionally, using DTT-Studio software, the authors evaluated eight neural tracts: the corticospinal tract (CST), corticoreticular pathway, fornix, cingulum, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. The authors measured the DTT parameters (fractional anisotropy [FA] and fiber volume [FV]) for each neural tract. RESULTS: The FA and FV values were decreased in all the evaluated neural tracts, compared with those of the 20 normal comparison subjects. The FVs of the CST were significantly correlated with the hand-grip power of elderly women with sarcopenia. The FVs of the fornix and cingulum in elderly women with sarcopenia were significantly correlated with their memory function. CONCLUSION: The authors found that the neural tracts in elderly women with sarcopenia were extensively deteriorated, and their hand-grip power and memory function were associated with related neural tracts. The DTT seems to be a useful tool for evaluating structural changes in the brains of people with sarcopenia.

Long-term Oncologic Outcomes After Neoadjuvant Chemoradiation Followed by Intersphincteric Resection With Coloanal Anastomosis for Locally Advanced Low Rectal Cancer.

BACKGROUND: To date only few data have been available relating to the oncologic safety of intersphincteric resection in such advanced tumors. OBJECTIVE: This study aimed to elucidate the oncologic outcomes and clinical factors affecting the long-term survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers. DESIGN: This was a retrospective analysis of prospectively collected departmental data. SETTINGS: The study was conducted at a department of colorectal surgery in a tertiary care teaching hospital between January 2009 and September 2015. PATIENTS: A cohort of 147 consecutive patients with low rectal cancer undergoing intersphincteric resection after preoperative chemoradiotherapy was included. MAIN OUTCOME MEASURES: Kaplan-Meier analyses were used to evaluate the 3-year disease-free survival and local recurrence rates. Logistic regression analyses were used to analyze the influence of tumor response and other prognostic factors on survival outcomes. RESULTS: Median follow-up was 34 months (range, 8-94 mo). The estimated overall 3-year disease-free survival and local recurrence rates were 64.9% and 11.7%. Circumferential resection margin involvement and pathologic T stage (ypT stage) were significant predictors of cancer relapse. The 3-year disease-free survival was 47.4% for patients with ypT3 tumors compared with 82.0% for those with ypT0-2 tumors (p = 0.001). The 3-year disease-free survival was 36.5% for patients with involved circumferential resection margins compared with 69.7% for those with a noninvolved circumferential resection margin (p = 0.003). On multivariate analysis, ypT stage, ymrT stage, and circumferential resection margin status were associated with worse disease-free survival. Clinical T-stage and pathologic distal margin status were not independent factors affecting oncologic outcomes. LIMITATIONS: This study is limited with respect to its retrospective design. CONCLUSIONS: In these patients with locally advanced low rectal cancers, intersphincteric resection after preoperative chemoradiotherapy was associated with acceptable oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/A941.

The Effect of Mycophenolate Mofetil on Non-Renal Manifestations in Systemic Lupus Erythematosus: Results from Korean Lupus Network Registry.

BACKGROUND: The objective of this study was to identify the effects of mycophenolate mofetil (MMF) on non-renal manifestations in systemic lupus erythematosus (SLE). METHODS: The study population comprised 439 SLE patients from the Korean Lupus Network registry who were followed up annually and completed the baseline survey and two follow-up visits from 2014 to 2018. Disease activity, laboratory markers, and clinical manifestations including mucocutaneous lesions, arthritis, serositis, neurological disorders, and hematologic/immunologic abnormalities were assessed. All variables by group (MMF and non-MMF) effects with time (baseline, 1st follow-up, and 2nd follow-up) were analyzed by generalized estimation equation. RESULTS: Seventy-two patients were treated with MMF. There was significant difference in frequencies of malar rash, arthritis, renal disorder, and hematologic disorder between MMF and non-MMF groups in total SLE patients. In subgroup analysis of hematologic abnormalities in total patients, frequency of leukopenia was significantly different between the two groups during follow-up (P = 0.001), but frequencies of hemolytic anemia, lymphopenia, and thrombocytopenia were not. In addition, frequencies of leukopenia in patients without lupus nephritis were significantly decreased in MMF group compared to non-MMF group (P = 0.012). CONCLUSION: This study showed that MMF might be a beneficial treatment for hematologic abnormalities, especially leukopenia, in SLE.

Effect of tumour necrosis factor-alpha inhibitors on renal function in patients with rheumatoid arthritis from the KOBIO registry from 2012 to 2016.

OBJECTIVES: The effect of biological disease-modifying anti-rheumatic drugs (bDMARDs) on renal function in patients with rheumatoid arthritis (RA) has not been well established. We assessed whether tumour necrosis factor (TNF) inhibitors could affect renal function in RA. METHODS: A total of 2110 patients with RA enrolled in the Korean College of Rheumatology Biologics (KOBIO) registry were analysed. All patients were taking bDMARDs or conventional synthetic DMARDs (csDMARDs). Renal function was evaluated by calculating the estimated glomerular filter rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. Renal insufficiency was defined as eGFR <60 mL/min/1.73 m2. Differences in eGFR changes between different types of DMARDs were assessed at each follow-up time using the generalised linear model (GLM) method. Risk factors for renal insufficiency were identified using binary logistic regression analysis. RESULTS: The changes of eGFR values in patients treated with TNF inhibitors were not significantly different from those with csDMARDs alone or non-TNF inhibitors in all RA patients regardless of renal function. Among patients with renal insufficiency, GLM analysis revealed that the changes of eGFR values by TNF inhibitors were also compatible to those treated with csDMARDs alone or non-TNF inhibitors. Older age (>55 years), longer disease duration (>5 years), and use of methotrexate were identified as clinical determinants for renal insufficiency. CONCLUSIONS: TNF inhibitors did not influence the change of renal function during RA treatment. TNF inhibitors may be a safe treatment option irrespective of renal function.

Disease Activity Patterns Recorded Using a Mobile Monitoring System Are Associated with Clinical Outcomes of Patients with Crohn's Disease.

BACKGROUND: Usefulness of a mobile monitoring system for Crohn's disease (CD) has not been evaluated. We aimed to determine whether disease activity patterns depicted using a web-based symptom diary for CD could indicate disease clinical outcomes. METHODS: Patients with CD from tertiary hospitals were prospectively invited to record their symptoms using a smartphone at least once a week. Disease activity patterns for at least 2 months were statistically classified into good and poor groups based on two factors in two consecutive time frames; the degree of score variation (maximum-minimum) in each frame and the trend (upward, stationary, or downward) of patterns indicated by the difference in the mean activity scores between two time frames. RESULTS: Overall, 220 (82.7%) and 46 (17.3%) patients were included in good and poor groups, respectively. Poor group was significantly more associated with disease-related hospitalization (p = 0.004), unscheduled hospital visits (p = 0.005), and bowel surgery (p < 0.001) during the follow-up period than good group. In the multivariate analysis, poor patterns [odds ratio (OR) 2.62, p = 0.006], stricturing (OR 4.19, p < 0.001) or penetrating behavior (OR 2.27, p = 0.012), and young age at diagnosis (OR 1.06, p = 0.019) were independently associated with disease-related hospitalization. Poor patterns (OR 4.06, p = 0.006) and an ileal location (OR 5.79, p = 0.032) remained independent risk factors for unscheduled visits. Poor patterns (OR 15.2, p < 0.001) and stricturing behavior (OR 9.77, p = 0.004) were independent risk factors for bowel surgery. CONCLUSION: The disease activity patterns depicted using a web-based symptom diary were useful indicators of poor clinical outcomes in patients with CD.

Serum uric acid level is not associated with osteoarthritis in Korean population: data from the Seventh Korea National Health and Nutrition Examination Survey 2016.

There is an ongoing debate regarding the relationship between uric acid and osteoarthritis (OA). Therefore, we sought to clarify this association using data from the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-1) 2016 in the Korean population. A total of 5842 subjects over 19 years old were analyzed from the KNHANES VII-1 2016 data, which was conducted by the Korean Centers for Disease Control and Prevention. All of the statistical analyses were performed on the basis of a sampling weight that represents the entire Korean population. The data were described as case numbers with weighted percentages (%), and means with standard errors (SE). The association between OA and the serum uric acid level was statistically analyzed using univariate and multivariate logistic regression methods. A total of 669 subjects (8.6%) had OA, of which 557 were female (14.0%), and 112 male (3.0%). OA was more frequent in female than male subjects (n = 557, 82.6% in women) (p < 0.001). The serum uric acid level was significantly higher in subjects without OA than those with OA (p < 0.001). Subgroup analysis in female subjects demonstrated that the serum uric acid level in OA was much higher than those without OA [4.48 (SE 0.05) vs. 4.34 (SE 0.02), p = 0.013]. In contrast, there was no such difference in male subjects. However, the statistical significance in women was lost after adjusting for covariates (OR 0.888, 95% CI 0.785-1.005, p = 0.060). The serum uric acid level was not significantly associated with OA in the Korean population, although there was a trend toward such a relationship in female subjects.

The prevalence of Behçet's disease in Korea: data from Health Insurance Review and Assessment Service from 2011 to 2015.

OBJECTIVES: The aim of this study is to identify the prevalence of Behçet's disease (BD) from data in the Healthcare Bigdata Hub of the Health Insurance Review & Assessment (HIRA) Service from 2011 to 2015 in Korea. METHODS: This study collected information on primary and auxiliary diagnoses of BD (M352) by physicians according to the Korean Standard Classification of Diseases (KCD) codes. The prevalence of BD was assessed on the basis of age, sex, and geographical distribution. We used time series analysis, using the ARIMA model for the expected prevalence of BD from 2016 to 2025. RESULTS: The overall prevalence of BD was gradually increased, ranging from 32.8 to 35.7 per 100,000 population over the study period. The male to female ratio of BD ranged from 0.54:1 to 0.56:1, revealing a female predominance from 2011 to 2015. Among five districts in Korea, the prevalence in the Seoul Metropolitan district was the highest, with a slowly increasing trend for the study period, accounting for about 60.3% of total BD patients. The expected prevalence of BD patients was estimated to range from 36.9 (95% CI 35.0 - 39.0) to 44.7 (95% CI 40.2 - 49.6) between 2016 and 2025. CONCLUSIONS: This study found that the overall prevalence of BD is estimated to be approximately 35.0 per 100,000 population, with female predominance, and predicts gradually increased prevalence of BD in Korea.

Prevalence and incidence of gout in Korea: data from the national health claims database 2007-2015.

The purpose of the present study was to investigate the prevalence and incidence of gout in Korea and predict the future prevalence and incidence of gout. Data were collected from the national health claims database. Patients who had at least one claim for gout between 2007 and 2015 were included in the study. The prevalence of gout from 2007 to 2015 and the incidence of gout from 2009 to 2015 were determined. We estimated sex- and age-specific prevalence and incidence of gout during the period. The prevalence and incidence of gout were predicted using time series analysis. The prevalence of gout (95% CI) increased from 3.49 (3.48-3.51) per 1000 persons in 2007 to 7.58 (7.55-7.60) per 1000 persons in 2015. The incidence of gout (95% CI) was 1.52 (1.51-1.53) in 2009 and rose to 1.94 (1.93-1.95) per 1000 persons in 2015. The prevalence and incidence of gout were higher in men than in women. The older population had a higher prevalence and incidence than the younger population. The increase in prevalence was higher in the older population than the younger population, whereas the increase in incidence was higher in the younger population than the older population. The predicted prevalence and incidence of gout (95% CI) in 2025 were 16.59 (15.85-17.34) per 1000 persons and 3.81 (3.14-4.47) per 1000 persons. The prevalence and incidence of gout increased in Korea between 2007 and 2015. Men and the older population had a higher prevalence and incidence of gout compared to women and the younger population. However, the incidence of gout in the younger population has increased rapidly in recent years.

Validation of the Korean-Version of the Clinical Assessment Interview for Negative Symptoms of Schizophrenia (CAINS).

The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed to overcome the limitations of existing instruments and reflect the current view of negative symptoms. The aim of the present study was to evaluate the reliability and validity of the Korean version of the Clinical Assessment Interview for Negative Symptoms (K-CAINS). Inpatients (n = 49) and outpatients (n = 70) with schizophrenia were recruited from three institutions. The confirmative factor analysis, test-retest reliability, inter-rater reliability, convergent validity, and discriminant validity were assessed. The study group consisted of 71 males (59.7%) and 48 females (40.3%). Their mean age was 42.15 years (SD = 12.2). The K-CAINS was confirmed to be divided into two subscales of 9 items related to "motivation/pleasure" and 4 items related to "expression" in concordance with the original version of the CAINS. The results showed that the K-CAINS had a good inter-rater reliability (ICC = 0.84-0.94), test-retest reliability (r = 0.90, P < 0.001). Convergent validity was proven by demonstrating a significant correlation with the Positive and Negative Syndrome Scale (PANSS) negative subscale, and the Scale for the Assessment of Negative Symptoms (SANS). Discriminant validity was proven by the lack of a significant correlation with the PANSS positive subscale, the Korean version of the Beck depression inventory (BDI), the Korean version of the Calgary depression scale for schizophrenia (K-CDSS), and the Modified Simpson Angus scale (MSAS). The K-CAINS could be a reliable and valid tool to assess the negative symptoms of Korean schizophrenia patients.

Prognostic Factors of Patients with Gastric Gastrointestinal Stromal Tumor after Curative Resection: A Retrospective Analysis of 406 Consecutive Cases in a Multicenter Study.

BACKGROUND/PURPOSE: Gastric gastrointestinal stromal tumors (GISTs) have a highly variable clinical course, and recurrent disease sometimes develops despite curative surgery. This study was undertaken to investigate the surgical role in treating gastric GISTs and evaluate the clinicopathological features of a large series of patients who underwent curative resection for gastric GISTs to clarify which features were independent prognostic factors. METHODS: The clinicopathological data of 406 patients with gastric GISTs who underwent curative resection at 4 university hospitals in Daegu, South Korea, from March 1998 to March 2012 were reviewed. All cases were confirmed as gastric GISTs by immunohistochemical staining, in which CD117 or CD34 was positive. Clinical follow-up was performed periodically, and disease-free survival rates were retrospectively investigated using the medical records. RESULTS: The mean follow-up period was 42.9 months (range: 2-166). There were 11 recurrent patients (2.7%). Due to the small number of recurrences, age, sex and location were controlled using propensity score matching before performing any statistical analysis. Tumor size, mitotic count, NIH classification, and cellularity were judged to be independent prognostic factors for recurrence by univariate analysis. In a multivariate analysis, tumor size and mitotic count were significantly and independently related to recurrence, and tumor size was determined to be the most important prognostic factor for recurrence after curative resection (hazard ratio: 1.204; p < 0.01). CONCLUSIONS: The results of this multicenter study demonstrate that disease-free survival rates are good. Tumor size was disclosed as the most important factor for recurrence in gastric GIST patients who underwent radical resection.