Clinical Benefit of Hepatic Arterial Infusion Concurrent Chemoradiotherapy in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to evaluate whether hepatic arterial infusion concurrent chemoradiotherapy (CCRT) could improve overall survival (OS) in patients with locally advanced hepatocellular carcinoma (LAHCC). MATERIALS AND METHODS: Two databases were reviewed from Yonsei Cancer Center (YCC) and Korean Liver Cancer Study Group (KLCSG) nationwide multi-center hepatocellular carcinoma (HCC) cohort. The CCRT group included 106 patients, with stage III-IV, Child-Pugh classification A, Eastern Cooperative Oncology Group performance status 0 or 1, who underwent definitive CCRT as the initial treatment at YCC. We used propensity score matching to adjust for seven clinical factors, including age, tumor size, TNM stage by the Liver Cancer Study Group of Japan, T stage, Barcelona Clinic Liver Cancer (BCLC) staging system, etiology of HCC, and portal vein invasion, which all differed significantly in the two databases. From the KLCSG cohort enrolled at 32 institutions, 106 patients for the non-CCRT group were defined. RESULTS: After propensity score matching, all patient characteristics were balanced between the two groups. The CCRT group had better OS (median, 11.4) than the non-CCRT group (6.6 months, p=0.02). In multivariate analyses for all patients, CCRT (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.11 to 1.97; p=0.007), tumor size (HR, 1.08; 95% CI, 1.04 to 1.12; p < 0.001), and BCLC stage (HR, 0.54; 95% CI, 0.36 to 0.8; p=0.003) were independent prognostic factors for OS. CONCLUSION: CCRT showed better OS for LAHCC patients. In LAHCC patients with a good performance and normal liver function, CCRT could be a feasible treatment option. All of these findings need to be validated in prospective clinical trials.

Effect of sevoflurane on grafted kidney function in renal transplantation / 대한마취과학회지

BACKGROUND: The objective of this retrospective study was to determine if there are any differences in grafted kidney function in recipients of kidney transplantation (KT) when donors and recipients were anesthetized with sevoflurane compared to desflurane. METHODS: Seventy-three pairs of donors-recipients were anesthetized with sevoflurane (Sevo group) and 71 pairs were anesthetized with desflurane (Des group). We retrospectively investigated the blood urea nitrogen (BUN) levels, creatinine (Cr) levels, and estimated glomerular filtration rates (eGFR) of the recipients in both groups for 1 year postoperatively. We tested non-inferiority for serum creatinine at discharge and 1 year after KT. Short-term (1 year) outcomes of KT were assessed by the incidence of delayed graft function (DGF), acute rejection episodes (ARE), and graft failure. RESULTS: There were no differences in BUN, Cr, eGFR, or outcomes of KT at 1 year postoperatively. Specifically, the 95% confidence interval for the difference in creatinine levels between the Sevo and Des groups was less than the margin of equivalence at the time of discharge and 1 year after surgery. The occurrences of DGF, ARE, and graft failure were comparable between the groups. CONCLUSIONS: Compared to desflurane, sevoflurane had no adverse effects on grafted renal function or on the short-term outcome of renal transplantation.

Effect of sevoflurane on grafted kidney function in renal transplantation / 대한마취과학회지

BACKGROUND: The objective of this retrospective study was to determine if there are any differences in grafted kidney function in recipients of kidney transplantation (KT) when donors and recipients were anesthetized with sevoflurane compared to desflurane. METHODS: Seventy-three pairs of donors-recipients were anesthetized with sevoflurane (Sevo group) and 71 pairs were anesthetized with desflurane (Des group). We retrospectively investigated the blood urea nitrogen (BUN) levels, creatinine (Cr) levels, and estimated glomerular filtration rates (eGFR) of the recipients in both groups for 1 year postoperatively. We tested non-inferiority for serum creatinine at discharge and 1 year after KT. Short-term (1 year) outcomes of KT were assessed by the incidence of delayed graft function (DGF), acute rejection episodes (ARE), and graft failure. RESULTS: There were no differences in BUN, Cr, eGFR, or outcomes of KT at 1 year postoperatively. Specifically, the 95% confidence interval for the difference in creatinine levels between the Sevo and Des groups was less than the margin of equivalence at the time of discharge and 1 year after surgery. The occurrences of DGF, ARE, and graft failure were comparable between the groups. CONCLUSIONS: Compared to desflurane, sevoflurane had no adverse effects on grafted renal function or on the short-term outcome of renal transplantation.

A Scoring System for Prediction of Lateral Neck Node Metastasis from Papillary Thyroid Cancer

Lateral neck node metastasis is an important prognostic factor in thyroid carcinoma. We developed a scoring system for use in prediction of lateral neck node metastasis from papillary thyroid cancer. In this study, 161 consecutive patients were included in the training data set. This scoring system, named the Yonsei Estimated Value (YEV) for lymph node metastasis in papillary thyroid cancer, was developed on the basis of results from multivariate logistic regression analysis of preoperative clinical and radiologic data. Sixty eight consecutive patients were included for testing of the validity of the scoring system. The equation for prediction of lateral neck node metastasis was follows: YEV (Yonsei Estimated Value) = 1/(1+X) X = Exp (5.333-[0.902 x sex]+[0.036 x age]-[1.020 x tumor size]-[0.177 x lymph node size]-[0.032 x lymph node density]) When the YEV was 0.3 or more, the probability of lateral neck node metastasis was 79.0%, with sensitivity of 76.3%, specificity of 69.8%, positive predictive value of 56.7%, and negative predictive value of 85.1% in the training set. When fine needle aspiration biopsy for suspicious lateral neck nodes is not possible, or the results are inadequate, our scoring system for prediction of lateral neck node metastasis can be helpful in optimization of the surgical extent for each patient.

Therapeutic Efficacy of Gliptide(R) (Sulglycotide) on Gastritis - A Double Blind, Randomized, Active Drug Comparative, Multi-Center, Phase IV Study

BACKGROUND/AIMS: Sulglycotide is a sulphoglycopeptide isolated from porcine duodenal mucosa. It has antiulcer and cytoprotective activity with anti Helicobacter pylori (H. pylori) effect. This study was performed to assess the therapeutic efficacy and safety of gliptide(R) (sulglycotide) in comparison with another mucosal protective agent, selbex(R) (teprenone) for the treatment of gastritis. MATERIALS AND METHODS: One hundred and twenty one patients with symptomatic erosive gastritis were randomized to receive sulglycotide (gliptide(R)) or teprenone (selbex(R)) for 4 weeks. Improvement and cure rates on endoscopic findings, improvement rates of symptoms, and eradication rates of H. pylori were compared. RESULTS: Of the 121 intention-to-treat (ITT) population, 82 patients comprised the per protocol (PP) analysis. Endoscopic cure rates and improvement rates in the sulglycotide and teprenone group were 36.7% vs. 29.5% and 41.7% vs. 37.7% in ITT and 46.3% vs. 34.2% and 53.7% vs. 43.9% in PP population, respectively. Symptom improvement rates in the sulglycotide and teprenone group were 71.7% vs. 65.6% in ITT and 85.4% vs. 75.6% in PP. Eradication rates of H. pylori were not significantly different between the groups. Results of 95% CIs for the difference in endoscopic cure rate and improvement rate, symptom improvement rate, and eradication rate of H. pylori between the two groups met the criteria for the non-inferiority of sulglycotide to teprenone. No significant adverse events were encountered during the study period. CONCLUSIONS: Gliptide(R) (sulglycotide) is not inferior to selbex(R) (teprenone) in therapeutic efficacy and is a safe and useful therapeutic agent for the treatment of gastritis.

Effects of Paroxetine on Symptoms of Hwa-Byung / 대한정신약물학회지

OBJECTIVE: This study consists of a single open clinical trial to evaluate the treatment effects of paroxetine on symptoms of hwa-byung, a Korean culture-related anger syndrome. METHODS: Eighty-nine patients with depressive disorders, anxiety disorders, somatoform disorders, or self-labeled hwa-byung were treated with paroxetine (Paxil CR) 12.5-37.5 mg/day for 8 weeks. Treatment effects were evaluated using the Hamilton Depression Scale (HAMD), the State and Trait Anger Inventory (STAXI), and the Hwa-byung Scale. RESULTS: Scores on all items ; total score on the Hwa-byung Scale ; scores on state anger, trait anger, and anger-in ; total score on the STAXI ; and total score on the HAM-D decreased significantly after eight weeks of paroxetine treatment compared to baseline. CONCLUSION: Paroxetine was shown to be effective for treating symptoms of hwa-byung, a chronic anger syndrome.

Symptoms to Use for Diagnostic Criteria of Hwa-Byung, an Anger Syndrome

OBJECTIVE: The aim of this study was to identify the characteristic symptoms which can be used for the diagnosis of hwa-byung, a culture-related anger syndrome in Korea. METHODS: The symptoms of the Hwa-byung Scale were correlated with the Korean versions of the Hamilton Depression Rating Scale (K-HDRS) and the State and Trait Anger Inventory (K-STAXI) in 89 patients, who were diagnosed as having major depressive disorder, dysthymic disorder, anxiety disorders, somatoform disorders, or adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria and who had self-labeled hwa-byung. Also, the symptoms of the Hwa-byung Scale were correlated with each other. RESULTS: The symptoms of the Hwa-byung Scale which were significantly correlated with the state anger of the K-STAXI but not with the depressive mood (item 1 of K-HDRS) included feelings of unfairness, subjective anger, external anger, heat sensation, pushing-up in the chest, dry mouth, and sighing. The symptoms which were significantly correlated with state anger and depressed mood included respiratory stuffiness, "haan" and hate. The symptoms which were not significantly correlated with depressed mood and state anger included going-out, epigastric mass, palpitation, headache/pain, frightening easily, many thoughts, and much pleading. These symptoms also showed higher correlation with each other in the correlation matrix. CONCLUSION: Our findings suggest that hwa-byung is different from depressive syndrome in terms of its symptom profile, and suggest what symptoms should be included in the diagnostic criteria of hwa-byung, an anger disorder.

Development of Hwa-Byung Scale and Research Criteria of Hwa-Byung / 신경정신의학

OBJECTIVES : The aim of this study was to identify the characteristic symptoms for diagnosis of Hwabyung (HB), a culture-related anger syndrome in Korea; to construct a rating scale for HB and test its validity and reliability; and propose diagnostic criteria for HB. METHODS : Subjects were male and female Korean patients, who were diagnosed following Structured Clinical Interview (SCID) as having depressive disorders, anxiety disorders and somatoform disorders and who reported as having self-labeled HB. A HB Scale was constructed with 22 of the most common symptoms of HB as identified by previous studies. The HB scale's inter-rated reliability was tested with 60 subjects. Its validity was tested by comparison between a HB only group(n=47) and depressive disorder only group (n=44). Logistic regression analysis was conducted to make a predictive model of HB. Based on these results diagnostic criteria for HB was proposed. RESULTS : Inter-rated reliability in each of all the items and the total score of the HB Scale were statistically significant. The HB scale differentiated HB from depressive disorder with statistical significance. In logistic regression analysis, the ability of the HB model to predict symptoms of heat sensation, ukwool/boon (feeling of unfairness), and subjective anger was high with sensitivity of 80.0%, specificity of 88.4%, accuracy of 84.1% and area under ROC of 0.92. Based on these results and information from previous research, diagnostic criteria of HB were formulated. CONCLUSION : The HB Scale was found to be reliable and valid. Consequently, diagnostic criteria of HB were proposed, to include subject anger, "kwool/boon" (Feeling of unfairness), expressed anger, heat sensation, hostility, "haan", pushing-up in the chest, epigastric mass, respiratory stuffiness, palpitation, dry mouth, sighing, racing thoughts, and lamentation.

Prevalence Estimation of Cataract based on a Screening Test

PURPOSE: To estimate the prevalence of cataracts based on screening test results and statistical estimation methods. METHODS: Between June 1994 and September 2005, 85,505 persons aged 20 years and older were screened at a health promotion center for a general health care screen. We assumed that all subjects had complete screening results; however some subjects had an unknown disease status. A 2x3 table form could be generated from this data set. To estimate cataract prevalence, we used a maximum likelihood estimation method to reconstruct a 2x2 table including probabilities for each cell. RESULTS: The overall estimated cataract prevalence was 13.98% (95% confidence intervals, 13.75% to 14.21%). We estimated the prevalence of cataracts to be 15.29% in men (95% confidence intervals, 14.95% to 15.63%) and 12.97% in women (95% confidence intervals, 12.65% to 13.29%). In addition, we found that the cataract prevalence distinctly increased in people aged 60 years or older. CONCLUSIONS: We found that these estimated cataract prevalences were not considerably different from study results obtained in other countries. Therefore, our method may be considered to be appropriate for estimating prevalence. Our results indicate that cataract prevalence in our study population increases with age and highlight the need for early detection and early interventions.

Natural History of HBeAg Negative Chronic Hepatitis B Virus Infection: A Cohort Study / 대한간학회지

BACKGROUND/AIMS: The long-term virologic and biochemical changes in patients with HBeAg negative HBV infection, especially in Asia, remain unclear. To address this issue, we conducted a 3 year- retrospective, cohort study. METHODS: A total of 157 patients with HBeAg negative HBV infection who were monitored without treatment were reviewed between January 1999 and March 2004. Those patients were followed up every 3 months with liver function tests and serologic tests. All patients were stratified into 3 groups; inactive carrier (IC), viremic carrier (VC) and chronic hepatitis (CH). Serum HBV DNA was measured by a hybridization assay (sensitivity: 1.4 x 10(5) genomes/mL, Digene Diagnostics, Silver Spring, USA). RESULTS: The median age of enrolled patients was 42.7 years (M:F=2.3:1). By single time-point observations, the 3 year-cohort prevalence of HBeAg negative CH varied from 12.7 to 35.8% (median 20.7%) HBeAg negative CH was accumulated over time (P=0.002) and transition rates among three groups after 3 years of follow-up are as follows: IC to CH, 6.0%; IC to VC, 4.1%; VC to CH, 23.2%. VC seems to be a disease state in the middle of transition from IC to CH. CONCLUSIONS: We demonstrated the dynamic changing patterns of HBeAg negative CH with time, of which the change from IC or VC to CH was dominant.

Regression Methods for Overdispersed Dichotomous Response Data / 신경정신의학

In neuropsychiatrical research, many problems of statistical inference concern the relationship between the PTSD and traumatic experiences. The logistic model is widely used for modeling a relationship between the covariate and the magnitude of the PTSD. A common complication in the logistic model for dichotomous response data is overdispersion. In this study, two different methods for analyzing dichotomous response data are illustrated and compared. One method is the logistic regression approach, where the numbers of dichotomous responses are predicted by the logistic function of covariates. The other one is the overdispersed logistic regression approach, where the overdispersion is measured by a scale parameter in the variance function of the dichotomous response. In dichotomous response model, when reponses are overdispersed, the overdispersed logistic regression produces more appropriate standard errors of the regression coefficients and the 95% confidence intervals of odds ratios. Therefore, in neuropsychiatrical research, it is recommended to examine the overdispersion problems for their data set before applying the logistic regression model.

Regression Methods for Overdispersed Dichotomous Response Data / 신경정신의학

In neuropsychiatrical research, many problems of statistical inference concern the relationship between the PTSD and traumatic experiences. The logistic model is widely used for modeling a relationship between the covariate and the magnitude of the PTSD. A common complication in the logistic model for dichotomous response data is overdispersion. In this study, two different methods for analyzing dichotomous response data are illustrated and compared. One method is the logistic regression approach, where the numbers of dichotomous responses are predicted by the logistic function of covariates. The other one is the overdispersed logistic regression approach, where the overdispersion is measured by a scale parameter in the variance function of the dichotomous response. In dichotomous response model, when reponses are overdispersed, the overdispersed logistic regression produces more appropriate standard errors of the regression coefficients and the 95% confidence intervals of odds ratios. Therefore, in neuropsychiatrical research, it is recommended to examine the overdispersion problems for their data set before applying the logistic regression model.

Efficacy of Individual Prediction Model for the Early Diagnosis of Hepatocellular Carcinoma / 대한내과학회지

BACKGROUND: Screening tests for hepatocellular carcinoma (HCC) in the high risk population can detect tumors at an earlier stage and thus confer a higher chance of receiving treatment. However, the usefulness, frequency and cost-effectiveness of screening for HCC may differ in different areas, possibly reflecting differences in risk factors. Last decade, we have identified risk factors for HCC in 4339 Korean patients. The aim of this study was to investigate the efficacy and usefulness of individual prediction model for the early diagnosis of HCC. METHODS: We studied a total of 833 patients who visited Yonsei University Medical Center for regular check-up including ultrasonography and alpha-fetoprotein from January 1999 to December 2000. The patients were classified into a low risk group ( 15%) by the probability of HCC development according to individual prediction model (IPM). The patients who developed HCC during the follow-up periods were analyzed using IPM. All the detailed data of clinical parameters were obtained by our self-exploited data base system prospectively and analyzed by SAS program. RESULTS: 44 (5.3%) out of 833 patients developed HCC during mean follow-up periods of 36 months. According to IPM, 2 (0.62%) of 324 patients in the low risk group, 20 (4.84%) of 413 patients in the intermediate risk group, and 22 (22.9%) of 96 patients in the high risk group were diagnosed as HCC. In 29 of 44 HCC patients (65.9%), initial presentation of tumor size was less than 3 cm in diameter. CONCLUSION: We confirmed the reliability of established IPM for screening of HCC and this model may help screening program to be done effectively by focusing high risk groups for HCC.

Establishment of Individual Prediction Model According to Risk Factors for Development of Hepatocellular Carcinoma in Korea: Establishment of Individual Prediction Model for Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIM: We identified risk factors for hepatocellular carcinoma (HCC) through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver diseases. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. METHODS: We studied a total of 994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. RESULTS: 90 (9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into three groups by their risk index and probability of HCC development. These patients were classified into a low risk group (less than 5% probability), an intermediate risk group (5% to 10% probability), and a high risk group (more than 10% probability). According to this classification, 1 of 191 patients in the low risk group (0.523%), 5 of 176 patients in the intermediate risk group (2.84%), and 21 of 113 patients in the high risk group (18.6%) were diagnosed with HCC. CONCLUSION: We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC.

Risk factors for hepatocellular carcinoma in Korea / 대한내과학회지

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common neoplasms in the world. Although screening test for HCC has been performed, the high risk factors were not well evaluated in Korea. This study was undertaken to evaluate the risk factors of HCC development in Korea. METHODS: We studied a total of 2,020 patients who visited Yonsei University Medical Center for regular check-up including ultrasonography (US) and alpha-fetoprotein (AFP) from January 1990 to December 1998. All the detailed data of clinical parameters were obtained by our self-exploited data base system prospectively and analyzed by SAS program. RESULTS: Among 2,020 subjects, 1295 were male and 725 were female (mean age, M: 47 years, F: 50 years). 117 (5.8%) out of 2,020 subjects developed HCC during follow-up period (33months). Annual detection rate of HCC was 1.64%. The independent risk factors by univariate analysis were liver cirrhosis, chronic hepatitis, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, old age (over 40 years old), heavy alcoholics, severe liver parencymal echogenic pattern in US, initial level of serum AFP (>20 ng/mL) or alanine aminotransferase (ALT) (>40 IU/L). Multivariate analysis with a proportional hazards model showed liver cirrhosis (p=0.000), chronic hepatitis (p=0.014), HCV infection (p=0.007), HBV infection (p=0.049), and old age over 40 years old (p=0.000) to be significant risk factors for HCC. We also found that the more risk factors, the higher HCC development. The development of HCC might not be related to history of smoking, family history of HCC, previous therapy such as interferon (IFN), diet, drugs, and transfusion. CONCLUSION: Screening test for early detection of HCC should be reconsidered according to the relative risk rate of these risk factors.

Statistical Methods for Multivariate Missing Data in Health Survey Research / 예방의학회지

Missing observations are common in medical research and health survey research. Several statistical methods to handle the missing data problem have been proposed. The EM algorithm (Expectation-Maximization algorithm) is one of the ways of efficiently handling the missing data problem based on sufficient statistics. In this paper, we developed statistical models and methods for survey data with multivariate missing observations. Especially, we adopted the Em algorithm to handle the multivariate missing observations. We assume that the multivariate observations follow a multivariate normal distribution, where the mean vector and the covariance matrix are primarily of interest. We applied the proposed statistical method to analyze data from a health survey. The data set we used came from a physician survey on Resource-Based Relative Value Scale(RBRVS). In addition to the EM algorithm, we applied the complete case analysis, which used only completely observed cases, and the available case analysis, which utilizes all available information. The residual and normal probability plots were evaluated to access the assumption of normality. We found that the residual sum of squares from the EM algorithm was smaller than those of the complete-case and the available-case analyses.