Usefulness of C-curved stylet for intubation with the C-MAC® Miller videolaryngoscope in neonates and infants: a prospective randomized controlled trial / 대한마취과학회지

Background@#Optimizing endotracheal tube (ETT) shape is important for successful videolaryngoscope-aided intubation. This prospective randomized controlled study aimed to compare the tube-handling time between a C-curved and hockey stick-shaped stylet in infants and neonates using the C-MAC® videolaryngoscope Miller blade. @*Methods@#A total of 110 infants (age < 1 year) were randomly assigned to either the hockey stick-curved stylet group (group H, n = 53) or the C-curved stylet group (group C, n = 57). The primary outcome was tube handling time after glottis visualization and the secondary outcomes were the total intubation time, incidence of successful intubation, initial tube tip location at the laryngeal inlet, and numerical rating scale for ease of intubation. @*Results@#Tube insertion time and total intubation duration (both in seconds) were significantly shorter in group C than in group H (13.3 ± 8.9 vs. 25.1 ± 27.0, P = 0.002; 19.9 ± 9.4 vs. 32.8 ± 27.1, P = 0.001, respectively). Group C displayed a higher rate of intubation success within 30 s than group H (87.7% vs. 69.8%, P = 0.029). The initial tube tip was located at the center in 34 children in group C (59.6%) and 12 children in group H (26.1%, P < 0.001). Laryngoscope operators rated intubation as easier when provided with a C-curved stylet. @*Conclusions@#In neonates and infants, modification of the ETT shape into a C-curve may reduce tube handling time compared to the conventional hockey stick-shaped tube during intubation using a C-MAC® video laryngoscope Miller blade.

Learning curve of fiberoptic bronchoscope-guided tracheal intubation through supraglottic airway device for pediatric airway management: a manikin study / 대한마취과학회지

Background@#Although fiberoptic-guided endotracheal intubation using a supraglottic airway device (SAD) is a good alternative for the management of difficult airways, its learning curve for residents has not been evaluated in pediatric patients. We aimed to train residents using a pediatric manikin and obtain learning curves to evaluate the efficiency of the training. @*Methods@#We conducted a single-armed prospective study with anesthesiology residents. Plain endotracheal tube (ETT) intubation guided by a fiberoptic bronchoscope through Ambu® AuraGainTM was demonstrated in a pediatric manikin to the participants before training. The procedure was divided into four steps: SAD insertion, vocal cord identification, carina identification, and ETT insertion into the trachea. The results and elapsed procedure times of each trial were recorded. The learning curves for the participants were constructed and analyzed using the cumulative sum method. @*Results@#All the 30 participants acquired proficiency at the end of practice between eight and 25 trials. The overall success rate for the procedure was 92.8%, and above 80% for all participants. Mean ± standard deviation procedure time was 71.3 ± 50.7 s. The 4th step accounted for 86.2% and 48.0% of the total failures and procedure time, respectively. The procedure time rapidly decreased in the 2nd trial; a modest decline was observed thereafter. @*Conclusions@#Trainees can obtain proficiency for fiberoptic-guided intubation through SAD within 25 times when using pediatric manikin. Effect of the training on performance in actual clinical situation should be studied.

Association of the perfusion index with postoperative acute kidney injury: a retrospective study / 대한마취과학회지

Background@#Many studies have examined the risk factors for postoperative acute kidney injury (AKI), but few have focused on intraoperative peripheral perfusion index (PPI) that has recently been shown to be associated with postoperative morbidity and mortality. Therefore, this study aimed to evaluate the relationship between intraoperative PPI and postoperative AKI under the hypothesis that lower intraoperative PPI is associated with AKI occurrence. @*Methods@#We retrospectively searched electronic medical records to identify patients who underwent surgery at the general surgery department from May 2021 to November 2021. Patient baseline characteristics, pre- and post-operative laboratory test results, comorbidities, intraoperative vital signs, and discharge profiles were obtained from the Institutional Clinical Data Warehouse and VitalDB. Intraoperative PPI was the primary exposure variable, and the primary outcome was postoperative AKI. @*Results@#Overall, 2,554 patients were identified and 1,586 patients were included in our analysis. According to Kidney Disease Improving Global Outcomes (KDIGO) criteria, postoperative AKI occurred in 123 (7.8%) patients. We found that risks of postoperative AKI increased (odds ratio: 2.00, 95% CI [1.16, 3.44], P = 0.012) when PPI was less than 0.5 for more than 10% of surgery time. Other risk factors for AKI occurrence were male sex, older age, higher American Society of Anesthesiologists physical status, obesity, underlying renal disease, prolonged operation time, transfusion, and emergent operation. @*Conclusions@#Low intraoperative PPI was independently associated with postoperative AKI.

Effectiveness of exercise for improving physical and renal function in older adults with pre-dialysis chronic kidney disease: A systematic review and meta-analysis / 중환자간호학회지

Purpose@#: Exercise may prevent the worsening of chronic kidney disease (CKD) and progression of cardiovascular diseases in patients with CKD. This review aims to identify the best type of exercise modality and summarizes the beneficial effects of exercise on physical and renal function among older adults with pre-dialysis CKD. @*Methods@#: A systematic search of PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SCOPUS, and domestic database was performed for randomized controlled trials (RCTs) assessing the effect of exercise intervention on older adults with pre-dialysis CKD published until February 2023. A random-effects metaanalysis was conducted. The risk of bias was assessed using a Cochrane tool for assessing the risk of bias in RCTs (RoB 2.0). @*Results@#: The systematic review included 11 RCTs (n = 591, average age 60.2–76), of which 8 could be included for meta-analysis. Exercise was significant in increasing peak oxygen consumption and knee muscle strength among physical functions, and also in improving glomerular filtration rate among kidney functions. @*Conclusion@#: Exercise has beneficial effects on physical and renal function among older adults with pre-dialysis CKD. In the future, it is necessary to verify the effectiveness of exercise by subdividing it by type, intensity, duration, and delivery.

The Effect of Work Value, Psychological Ownership and Nursing Working Environment on Intention of Retention in Hospital Nurses / 중환자간호학회지

Purpose@#: This study aims to assess the extent of work value, psychological ownership, the nursing work environment, and retention intention, examine the correlation between these variables, and identify the factors that influence retention intention. The goal is to provide foundational data to enhance retention intention.Method : The study involved 159 nurses employed at a tertiary general hospital and a general hospital. Data were gathered through structured questionnaires and analyzed using an independent t-test, one-way ANOVA, Scheffé test, Pearson correlation coefficient, and multiple regression analysis with a simultaneous stepwise method, all conducted using the SPSS 26.0 software. @*Results@#: The intention to remain in the profession was found to have a positive correlation with work value (r = .45, p ＜ .001), psychological ownership (r = .37, p ＜ .001), and the nursing work environment (r = .27, p = .001). Significant factors influencing the intention to stay included total clinical career (β = .17, p = .016), work value (β = .38, p ＜ .001), and psychological ownership (β = .19, p = .020). These variables accounted for 24.1% of the variance in the intention to remain in the profession (F = 17.71, p ＜ .001). @*Conclusion@#To enhance the intention of hospital staff to remain in their positions, it is crucial to identify and bolster positive psychological competencies, such as a sense of work value and psychological ownership.

Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment:A Focus on Deceased Patients with Hematologic Neoplasms / 한국호스피스완화의료학회지

Purpose@#This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of lifesustaining treatment (LST). @*Methods@#A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. @*Results@#In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. @*Conclusion@#The key to discussing the decision to suspend hospice care and LST is respecting the patient’ s self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

Factors Influencing Professional Quality of Life in Intensive Care Unit Nurses of University Hospitals / 중환자간호학회지

Purpose@#: This study aims to identify job stress, emotional intelligence, and exhaustion of the nurses in comprehensive nursing service units and then verify the moderating and mediating effects of emotional intelligence on the relationship between job stress and exhaustion. @*Methods@#: Participants are 118 nurses working in two general hospitals. The collected data are analyzed using the SPSS WIN 27.0 and AMOS 18.0 programs by assessing frequency and percentage, mean and standard deviation, independent t-test and one-way ANOVA, Scheffé test, Pearson correlation coefficient, and hierarchical multiple regression analysis and bootstrapping. @*Results@#: Exhaustion has a statistically significant positive correlation with job stress (r=.40, p ＜.001) and a statistically significant negative correlation with emotional intelligence (r=-.26, p =.004). A partial mediating effect of emotional intelligence is found between job stress and exhaustion, however, there is no moderating effect. @*Conclusion@#: It is expected that to reduce the exhaustion of nurses in comprehensive nursing service units, it is necessary to assess job stress and emotional intelligence, and strengthen emotional intelligence along with job stress intervention.

Is an Anatomical Suprapectineal Quadrilateral Surface Plate Superior to Previous Fixation Methods for Anterior Column-Posterior Hemitransverse Acetabular Fractures Typical in the Elderly?: A Biomechanical Study

Background@#This study aimed to compare the mechanical characteristics of four fixation methods including an anatomical suprapectineal quadrilateral surface (QLS) plate in hemipelvic models of anterior column–posterior hemitransverse acetabular fractures typical in elderly patients. @*Methods@#In total, 24 composite hemipelvic models were used and allocated to four groups: group 1, pre-contoured anatomical suprapectineal QLS plate; group 2, suprapectineal reconstruction plate with two periarticular long screws; group 3, suprapectineal reconstruction plate with a buttress reconstruction plate; group 4, suprapectineal reconstruction plate with a buttress T-plate. Axial structural stiffness and displacement of each column fragment in four different fixation constructs were compared. @*Results@#Multiple group comparisons of axial structural stiffness demonstrated significant difference (p = 0.001). Although there was no significant difference between groups 1 and 2 (p = 0.699), group 1 showed greater stiffness than groups 3 and 4 (p = 0.002 and 0.002, respectively). Group 1 showed less displacement in the anterior region of the anterior fragment than group 4 (p = 0.009) and in the posterior region than groups 3 and 4 (p = 0.015 and p = 0.015, respectively). However, group 1 demonstrated greater displacement than group 2 in the posterior region of the posterior fragment (p = 0.004), while showing similar displacement to groups 3 and 4. @*Conclusions@#The anatomical suprapectineal QLS plate provided the mechanical stability comparable or superior to other existing fixations in osteoporotic models of anterior column–posterior hemitransverse acetabular fractures typical in the elderly. However, additional plate modification would be needed for better stability and outcomes.

Predictive Factors of Event-Free Survival at 24 Months in Patients with Peripheral T-Cell Lymphoma: A Retrospective Study / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Event-free survival at 24 months (EFS24) is known to be a surrogate marker for overall survival (OS) for patients with peripheral T-cell lymphoma (PTCL). We examined the role of EFS24 in PTCL compared to diffuse large B-cell lymphoma (DLBCL), and then assessed the clinical predictive factors of achieving EFS24. @*Materials and Methods@#Patients with newly diagnosed PTCL treated with anthracycline-based chemotherapy were included. Subsequent OS was defined as the time elapsed from 24 months after diagnosis until death from any cause in those who achieved EFS24. @*Results@#Overall, 153 patients were evaluated, and 51 patients (33.3%) achieved EFS24. Patients who achieved EFS24 showed superior OS compared to patients who did not (p < 0.001). EFS24 could stratify the subsequent OS although it did not reach to that of the general population. After matching the PTCL group to the DLBCL group based on the international prognostic index, the subsequent OS in patients who achieved EFS24 was similar between the two groups (p=0.094). Advanced stage was a significant factor to predict the failing EFS24 by multivariable analysis (p < 0.001). @*Conclusion@#Patients with PTCL who achieve EFS24 could have a favorable subsequent OS. Since advanced disease stage is a predictor of EFS24 failure, future efforts should focus on developing novel therapeutic strategies for PTCL patients presenting with advanced disease.

The Effects of Communication Ability, Job Satisfaction, and Organizational Commitment on Nursing Performance of Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: This study aimed to provide basic data for developing strategies to improve the nursing performance of nurses working in the intensive care unit by identifying the degree of their communication ability, job satisfaction, organization commitment, and nursing performance, and the relation between each of these variables in the intensive care unit by examining the factors affecting nursing performance. @*Methods@#: The participants comprised of 150 nurses working in the intensive care unit in two advanced general hospitals. Data were collected using structured questionnaires and analyzed using a t-test, ANOVA, the Scheffé test, Pearson’s correlation coefficients, and multiple regression analysis using the SPSS/WIN 25.0 program. @*Results@#: Nursing performance of the participants was positively correlated with communication ability (r=.64, p<.001), job satisfaction (r=.26, p<.001), and organization commitment (r=.29, p<.001). Factors significantly influencing the participants’ nursing performance included academic background (β=.16, p=.032) and communication ability (β=.50, p<.001). The explanatory power of these variables for nursing performance was recorded at 49.9% (F=19.04, p<.001). @*Conclusion@#: The use of various programs in the hospital and the development of effective communication ability with medical staff and other departments among nurses will help improve nursing performance, cooperation with other departments, and patient care.

Efficacy and Safety of Treatment with Quadruple Oral Hypoglycemic Agents in Uncontrolled Type 2 Diabetes Mellitus: A Multi-Center, Retrospective, Observational Study

BackgroundOnly few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).MethodsFrom March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated.ResultsIn total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9±14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, −1.1%±1.2%; PPConclusionThis study shows the therapeutic efficacy of the quadruple OHA regimen T2DM and demonstrates that it can be an option for the management of T2DM patients who cannot use insulin or reject injectable therapy.

Lenalidomide for anemia correction in lower-risk del(5q) myelodysplastic syndrome patients of Asian ethnicity

Background@#To estimate real-world outcomes in East Asian populations, we conducted a nationwide retrospective analysis of the efficacy and safety of lenalidomide for del(5q) myelodysplastic syndrome (MDS) patients with transfusion-dependent anemia in Korea. @*Methods@#Patients aged ≥19 years who had received lenalidomide for the treatment of lower-risk, red blood cell (RBC) transfusion-dependent del(5q) MDS were selected. A filled case report form (CRF) with information from electronic medical records was requested from members of the acute myeloid leukemia (AML)/MDS Working Party of the Korean Society of Hematology. All the CRFs were gathered and analyzed. @*Results@#A total of 31 patients were included in this study. Of 28 evaluable patients, 19 (67.9%) achieved RBC transfusion independence (RBC-TI). Female sex and the development of thrombocytopenia during treatment were associated with achieving RBC-TI. The most common non-hematologic toxicities were pruritus, fatigue, and rashes. All non-hematologic toxicities of grades ≥3 were limited to rash (12.9%) and pruritus (6.5%). Dose reduction was required in 15 of the 19 responders (78.9%). The most common final stable dosing schedule for the responders was 5 mg once every other day (31.6%). @*Conclusion@#Lenalidomide efficacy and tolerability were similar in the Asian del(5q) MDS patients and western patients. Dose reduction during treatment was common, but it was not associated with inferior outcomes.

Ultrasound-guided arterial catheterization

Ultrasonography facilitates arterial catheterization compared to traditional palpation techniques, especially in small arteries. For successful catheterization without complications, practitioners should be familiar with the anatomic characteristics of the artery and ultrasound-guided techniques. There are two approaches for ultrasound-guided arterial catheterization: the short-axis view out-of-plane approach and the long-axis view in-plane approach. There are several modified techniques and tips to facilitate ultrasound-guided arterial catheterization. This review deals with the anatomy relevant to arterial catheterization, several methods to improve success rates, and decrease complications associated with arterial catheterization.

Allomyrina dichotoma larva extract attenuates free fatty acid-induced lipotoxicity in pancreatic beta cells

RESULTS@#The administration of ADLE to HFD-induced diabetic mice reduced the hyperplasia, 4-hydroxynonenal levels, and the number of apoptotic cells while improving the insulin levels compared to the HFD group. Treatment of INS-1 cells with palmitate reduced insulin secretion, which was attenuated by the ADLE treatment. Furthermore, the ADLE treatment prevented palmitate-induced cell death in INS-1 cells and isolated islets by reducing the apoptotic signaling molecules, including cleaved caspase-3 and PARP, and the Bax/Bcl2 ratio. ADLE also reduced the levels of reactive oxygen species generation, lipid accumulation, and nitrite production in palmitate-treated INS-1 cells while increasing the ATP levels. This effect corresponded to the decreased expression of inducible nitric oxide synthase (iNOS) mRNA and protein. @*CONCLUSIONS@#ADLE helps prevent lipotoxic beta-cell death in INS-1 cells and HFD-diabetic mice, suggesting that ADLE can be used to prevent or treat beta-cell damage in glucose intolerance during the development of diabetes.

The Utilization of Dental Hygienists in Oral Healthcare Exchanges between the South and North Korea / 치위생과학회지

Background@#This study aimed to identify the role of dental hygienists in exchanges between North and South Korea to lower gaps in the level of dental healthcare between the two countries by conducting a Delphi survey with specialists and identifying alternative policies regarding the utilization of dental hygienists in such exchanges. @*Methods@#Two Delphi surveys were conducted with the participation of nine specialists, and descriptive statistical analyses including mean and standard deviation were performed on the collected data. @*Results@#Among methods of exchange and cooperation regarding oral healthcare under the current North Korean medical system, the issue considered most urgent was the “establishment of oral healthcare infrastructure.” The most important short-term strategy was identified as the “selection and formation of partnerships in the field of inter-Korean oral health exchange and cooperation.” The mid-term strategy was identified as the “establishment of cooperation in the dental industry, centered on educational cooperation projects.” The long-term strategy included “joint R&D projects, oral health surveys, and business development.” In order to determine how best to use dental hygienists during inter-Korean exchanges and cooperation, the respondents placed urgency on the “establishment of joint cooperation projects for oral health promotion and early examination and the treatment of dental diseases and planning of community research projects” and “the role of oral health education and media development for residents.” Conclusion: Cooperation is necessary regarding the preparation of oral healthcare exchanges that aim to encourage unity between North and South Korea and reduce the gaps between the North and South regarding oral health conditions. Therefore, continuous and reasonable discussions and research are needed regarding the utilization of dental hygienists in such exchanges.

Feasibility of Surgical Treatment for Laryngomalacia Using the Spontaneous Respiration Technique

Objectives@#. In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique. @*Methods@#. The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed. @*Results@#. Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease. @*Conclusion@#. The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.

Ability of dynamic preload indices to predict fluid responsiveness in a high femoral-to-radial arterial pressure gradient: a retrospective study

Background@#Dynamic preload indices may predict fluid responsiveness in end-stage liver disease. However, their usefulness in patients with altered vascular compliance is uncertain. This study is the first to evaluate whether dynamic indices can reliably predict fluid responsiveness in patients undergoing liver transplantation with a high femoral-to-radial arterial pressure gradient (PG). @*Methods@#80 liver transplant recipients were retrospectively categorized as having a normal (n = 56) or high (n = 24, difference in systolic pressure ≥ 10 mmHg and/or mean pressure ≥ 5 mmHg) femoral-to-radial arterial PG, measured immediately after radial and femoral arterial cannulation. The ability of dynamic preload indices (stroke volume variation, pulse pressure variation [PPV], pleth variability index) to predict fluid responsiveness was assessed before the surgery. Fluid replacement of 500 ml of crystalloid solution was performed over 15 min. Fluid responsiveness was defined as ≥ 15% increase in the stroke volume index. The area under the receiver-operating characteristic curve (AUC) indicated the prediction of fluid responsiveness. @*Results@#Fourteen patients in the normal, and eight in the high PG group were fluid responders. The AUCs for PPV in the normal, high PG groups and total patients were 0.702 (95% confidence interval [CI] 0.553–0.851, P = 0.008), 0.633 (95% CI 0.384–0.881, P = 0.295) and 0.667 (95% CI 0.537–0.798, P = 0.012), respectively. No other index predicted fluid responsiveness. @*Conclusion@#PPV can be used as a dynamic index of fluid responsiveness in patients with end-stage liver disease but not in patients with altered vascular compliance.

Ultrasound-guided insertion of peripherally inserted central catheter after anesthetic induction in children undergoing surgery for moyamoya disease - Thirty cases report-

Background@#Pediatric patients with moyamoya disease are vulnerable to ischemic attacks following physical or emotional stress, such as those experienced during blood sampling. A central venous catheter might be beneficial for blood sampling, and a peripherally inserted central catheter (PICC) is a considerable option for central venous access. However, PICC insertion during anesthetic management is relatively rare.Case: Thirty cases of ultrasound-guided PICC insertion were performed in children undergoing surgery for moyamoya disease after anesthetic induction. Positioning was successful in 22 cases, and 5 were malpositioned. In three cases, the peripheral insertion failed. Adjustment of the insertion depth was performed in nine cases. No complications related to catheterization were observed during the procedure or the catheter indwelling period. @*Conclusions@#We report the successful use of PICC in children undergoing surgery for moyamoya disease with a considerable success rate and low incidence of malpositioning or complications.

Different roles of surveillance positron emission tomography according to the histologic subtype of non-Hodgkin’s lymphoma

Background/Aims@#Although the use of surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is discouraged in patients with diffuse large B-cell lymphoma, its usefulness in different subtypes has not been thoroughly investigated. @*Methods@#We retrospectively evaluated 157 patients who showed positive results on surveillance FDG-PET/CT every 6 months following complete response for up to 5 years. All of the patients also underwent biopsies. @*Results@#Seventy-eight (49.6%) of 157 patients had true positive results; the remaining 79 (50.3%), including eight (5.1%) with secondary malignancies, were confirmed to yield false positive results. Among the 78 patients with true positive results, the disease in seven (8.9%) had transformed to a different subtype. The positive predictive value (PPV) of FDG-PET/CT for aggressive B-cell non-Hodgkin’s lymphoma (NHL) was lower than that for indolent B-cell or aggressive T-cell NHL (p = 0.003 and p = 0.018, respectively), especially in patients with a low/low-intermediate international prognostic index (IPI) upon a positive PET/CT finding. On the other hand, indolent B-cell and aggressive T-cell NHL patients showed PPVs of > 60%, including those with low/low-intermediate secondary IPIs. @*Conclusions@#The role of FDG-PET/CT surveillance is limited, and differs according to the lymphoma subtype. FDG-PET/CT may be useful in detecting early relapse in patients with aggressive T-cell NHL, including those with low/low-intermediate risk secondary IPI; as already known, FDG-PET/CT has no role in aggressive B-cell NHL. Repeat biopsy should be performed to discriminate relapse or transformation from false positive findings in patients with positive surveillance FDG-PET/CT results.

Efficacy and Safety of Treatment with Quadruple Oral Hypoglycemic Agents in Uncontrolled Type 2 Diabetes Mellitus: A Multi-Center, Retrospective, Observational Study

BackgroundOnly few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM).MethodsFrom March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated.ResultsIn total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9±14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, −1.1%±1.2%; PPConclusionThis study shows the therapeutic efficacy of the quadruple OHA regimen T2DM and demonstrates that it can be an option for the management of T2DM patients who cannot use insulin or reject injectable therapy.