External Validation of the Endoscopic Features of Sessile Serrated Adenomas in Expert and Trainee Colonoscopists

BACKGROUND/AIMS: It is unclear whether the endoscopic features of sessile serrated adenomas (SSAs) would be useful to trainee colonoscopists to predict SSA. Therefore, the present study aimed to identify features that expert and trainee colonoscopists can use to independently and reliably predict SSA by using high-resolution white-light endoscopy. METHODS: Endoscopic images of 81 polyps (39 SSAs, 22 hyperplastic polyps, and 20 tubular adenomas) from 43 patients were retrospectively evaluated by 10 colonoscopists (four experts and six trainees). Eight endoscopic features of SSAs were assessed for each polyp. RESULTS: According to multivariable analysis, a mucous cap (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.72 to 19.07), indistinctive borders (OR, 4.21; 95% CI, 2.74 to 7.16), dark spots (OR, 3.64; 95% CI, 1.89 to 7.00), and cloud-like surface (OR, 2.43; 95% CI, 1.27 to 4.668) were independent predictors of SSAs. Among these, a mucous cap, indistinctive borders, and cloud-like surface showed moderate interobserver agreement (mean κ>0.40) among experts and trainees. When ≥1 of the three predictors was observed, the sensitivity and specificity for diagnosing SSAs were 79.0% and 81.4%, respectively. CONCLUSIONS: Colonoscopy trainees and experts can use several specific endoscopic features to independently and reliably predict SSAs.

The Relationship between 10-Year Cardiovascular Risk Calculated Using the Pooled Cohort Equation and the Severity of Non-Alcoholic Fatty Liver Disease

BACKGROUND: We investigated the association between the severity of non-alcoholic fatty liver disease (NAFLD) and the estimated 10-year risk of cardiovascular disease (CVD) calculated by Pooled Cohort Equation (PCE) and Framingham risk score (FRS). METHODS: A total of 15,913 participants (mean age, 46.3 years) in a health screening program were selected for analysis. The presence and severity of fatty liver was assessed by abdominal ultrasonogram. Subjects who drank alcohol more than three times a week were excluded from the study. RESULTS: Among the participants, 57.6% had no NAFLD, 35.4% had grade I, 6.5% had grade II, and 0.5% had grade III NAFLD. Mean estimated 10-year CVD risk was 2.59%, 3.93%, 4.68%, and 5.23% calculated using the PCE (P for trend <0.01) and 4.55%, 6.39%, 7.33%, and 7.13% calculated using FRS, according to NAFLD severity from none to severe (P for trend <0.01). The odds ratio for ≥7.5% estimated CVD risk calculated using the PCE showed a higher correlation with increasing severity of NAFLD even after adjustment for conventional CVD risk factors (1.52, 2.56, 3.35 vs. the no NAFLD group as a reference, P<0.01) compared with calculated risk using FRS (1.65, 1.62, 1.72 vs. no NAFLD group as a reference, P<0.01). CONCLUSION: In our study of apparently healthy Korean adults, increasing severity of NAFLD showed a higher correlation with estimated 10-year CVD risk when calculated using the PCE than when calculated using FRS.

Metabolic Health Is More Important than Obesity in the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Retrospective Study

BACKGROUND: The aim of this study is to compare the risk for future development of nonalcoholic fatty liver disease (NAFLD) according to different status of metabolic health and obesity. METHODS: A total of 3,045 subjects without NAFLD and diabetes at baseline were followed for 4 years. Subjects were categorized into four groups according to the following baseline metabolic health and obesity statuses: metabolically healthy, non-obese (MHNO); metabolically healthy, obese (MHO); metabolically unhealthy, non-obese (MUHNO); and metabolically unhealthy, obese (MUHO). Being metabolically healthy was defined as having fewer than two of the following five components: high blood pressure, high fasting blood glucose, high triglyceride, low high density lipoprotein cholesterol, and being in the highest decile of the homeostasis model assessment-insulin resistance index. Obesity was defined as a body mass index >25 kg/m2. The presence of NAFLD was assessed by ultrasonography. RESULTS: The proportions of subjects included in the MHNO, MHO, MUHNO, and MUHO groups were 71.4%, 9.8%, 13.0%, and 5.8%, respectively. The proportions of subjects who developed NAFLD were 10.5%, 31.4%, 23.2%, and 42% in the MHNO, MHO, MUHNO, and MUHO groups, respectively. The risk for developing NAFLD was highest in subjects who were metabolically unhealthy both at baseline and after 4 years compared with subjects who were consistently metabolically healthy during the follow-up period (odds ratio, 2.862). Using the MHNO group as reference, the odds ratios for the MHO, MUHNO, and MUHO groups were 1.731, 1.877, and 2.501, respectively. CONCLUSION: The risk for NAFLD was lower in MHO subjects than in MUNO subjects.

Successful Treatment of Fungemia Caused by Cyberlindnera fabianii with Anidulafungin: A Case Report / 대한임상미생물학회지

Cyberlindnera fabianii (previously known as Hansenula fabianii, Pichia fabianii, and Lindnera fabianii) is a yeast species that forms a biofilm, allowing it to resist azole drugs. In this study, we report a case of fungemia with C. fabianii that was successfully treated with anidulafungin. In this case, the organism was initially misidentified as Candida utilis (with a high probability of 93%, suggesting good identification) using the VITEK 2 yeast identification card (YST ID; bio-Merieux, USA). The species responsible for the patient's fungemia was correctly identified after sequencing the internally transcribed spacer region and the D1/D2 domain of the large subunit (26S) rDNA gene. The CLSI M27-A3 broth microdilution method was used to determine the in vitro antifungal activity of anidulafungin and fluconazole against C. fabianii. The MICs of anidulafungin and fluconazole were found to be 0.03 microg/mL and 2 microg/mL, respectively. The patient recovered after 14 days of anidulafungin treatment.

Psychometric Properties of the Korean Version of the HIV Self-Management Scale in Patients with HIV

PURPOSE: The purpose of this study was to examine validity and reliability of Webel and colleagues' HIV Self-Management Scale when used with a Korean sample. METHODS: The original 20-item HIV Self-Management Scale was translated into Korean using translation and back-translation. Nine HIV nurse experts tested content validity. Principal component analysis (PCA) and confirmatory factor analysis (CFA) of data from 203 patients was used to test construct validity. Concurrent validity was evaluated using correlation with patients' self-rating as a "smart patient" measured using a visual analogue scale. Internal consistency was tested by Cronbach's alpha coefficients. RESULTS: All items were rated as having satisfactory content validity. Based on PCA and consideration of conceptual meaning, a three-factor solution was selected, explaining 48.76% of the variance. CFA demonstrated the adequacy of the three-domain structure of the construct HIV self-management: daily self-management health practices, social support and HIV self-management, and chronic nature of HIV self-management. Goodness-of-fit indices showed an acceptable fit overall with the full model (chi2/ df(164)=1.66, RMSEA=0.06, SRMR=0.05, TLI=0.91, and CFI=0.92). The Korean version of the HIV Self-Management Scale (KHSMS) was significantly correlated with patients' self-rated smart patient (r=.41). The subscale Cronbach's alpha coefficients ranged from .78 to .81; alpha for the total scale was .89. CONCLUSION: The KHSMS provides a valid and reliable measure of self-management in Korean patients with HIV. Continued psychometric testing is recommended to provide further evidence of validity with this population.