Considerations on ABO Genotyping Results: Lessons from ABO*AW.10 Allele Cases / 대한수혈학회지

We would like to introduce domestic subscribers of the Korean Journal of Blood Transfusion to the important aspects to be considered while selecting a reference allele and reporting a new allele candidate. ABO*A1.02 has only a single nucleotide substitution of c.467C＞T in ABO*A1.01, and when ABO*A1.01 is used as the reference allele, the ABO*AW.10 allele should be marked as having both c.467C＞T and c.784G＞A variants. Unfortunately, it has not been modified as such in the ISBT database. For this reason, in the journal Transfusion (2020), the official journal of the Association for the Advancement of Blood Biotherapies, there was a report of a new allele with c.467C＞T and c.784G＞A variants. Cases of ABO*AW.10 allele with a weak A phenotype are not uncommon in Koreans, and it is necessary to accurately mark the reference allele. The blood type A reference allele of the International Society of Blood Transfusion (ISBT) database currently used for ABO alleles reporting is based on ABO*A1.01. Therefore, it should be considered that the ABO*AW.10 allele has both the c.467C＞T and c.784G＞A variants together.

Relationship between the Prevalence of Dry Eye Syndrome and the Parity of Women Using KNHANES-V

Purpose@#We explored the relationship between dry eye syndrome (DES) and parity in women over 20 years of age. @*Methods@#We retrieved data from the Fifth Korean National Health and Nutrition Examination Survey. Of women over 20 years of age, 7,573 diagnosed with DES by ophthalmologists and 7,347 who self-diagnosed DES were included. We used logistic regression to explore the relationship between DES prevalence and parity, and the chi-squared test to compare differences in DES prevalence by someo children. @*Results@#On univariate logistic regression, the DES incidence was significantly affected by residential status, educational level, hours of sleep, and hyperlipidemia, osteoarthritis, thyroid disorder, and menopause status. We subjected these parameters (and age) to multivariate logistic regression. We found no significant relationship between the doctor-diagnosed DES rate and the number of children. Subjectively, the number of children significantly reduced the prevalence of self-diagnosed DES but not that diagnosed by ophthalmologists. The self-diagnosed DES prevalence was significantly lower in women with than without children. @*Conclusions@#The KNHANES-V data showed that the prevalence of self-diagnosed DES decreased with the number of children in women aged over 20 years. The prevalence of self-diagnosed DES in women with children was significantly less than that in women without children. However, we found no significant correlation between the number of children and DES status, because DES does not simply reflect poor tear secretion, being rather multifactorial.

Dysphagia after Multiple Fractures of the Neck Structures Due to Near-Hanging: A Case Report / 대한연하장애학회지

Although hanging is the most common method of suicide in Korea, there are few reports of dysphagia following laryngeal injuries due to near-hanging. This is a case report of a patient who complained of dysphagia after a complex fracture of the neck structures caused due to attempted suicide by hanging. A 51-year-old male visited our hospital with neck injuries after a near-hanging episode. Laryngoscopy suspected dislocation of the right arytenoid cartilage. A computed tomography (CT) scan revealed fractures of the right hyoid bone and thyroid cartilage, as well as soft tissue emphysema. A closed reduction for the dislocation of the right arytenoid cartilage was performed. After surgery, oral feeding was attempted five days after surgery but stopped due to a large amount of aspiration. After two weeks, a videofluoroscopic swallowing study (VFSS) revealed a decreased laryngeal elevation and severe impairment of the upper esophageal sphincter opening. The patient was then given rehabilitation for oropharyngeal dysphagia to restore swallowing function. Four months after the injury, VFSS showed that the residue in the pyriform sinus after multiple swallowing attempts decreased compared to the previous studies. However, oral diet and enteral feeding were combined due to the patient experiencing early fatigue due to swallowing difficulties.Our observations, in this case, show that it was necessary to provide treatment through a multidisciplinary approach coupled with long-term follow-up for patients with dysphagia after complex fractures by near-hanging.

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Safety and Effectiveness of Empagliflozin in Korean Patients with Type 2 Diabetes Mellitus: Results from a Nationwide Post-Marketing Surveillance

Background@#To evaluate the safety and effectiveness of empagliflozin in routine clinical settings, we collected and assessed the clinical profiles of Korean patients with type 2 diabetes mellitus. @*Methods@#This was a post-marketing surveillance study of empagliflozin 10 and 25 mg. Information on adverse events and adverse drug reactions (ADRs) was collected as safety data sets. Available effectiveness outcomes, including glycosylated hemoglobin (HbA1c) level, fasting plasma glucose, body weight, and blood pressure, were assessed. @*Results@#The incidence rate of ADRs was 5.14% in the safety dataset (n=3,231). Pollakiuria, pruritis genital, and weight loss were the most common ADRs. ADRs of special interest accounted for only 1.18%, and there were no serious events that led to mortality or hospitalization. In the effectiveness data set (n=2,567), empagliflozin significantly reduced the mean HbA1c level and body weight during the study period by –0.68%±1.39% and –1.91±3.37 kg (both P<0.0001), respectively. In addition, shorter disease duration, absence of dyslipidemia, and higher baseline HbA1c levels were identified as the clinical features characteristic of a “responder” to empagliflozin therapy. @*Conclusion@#Empagliflozin is a safe and potent glucose-lowering drug in routine use among Korean patients with type 2 diabetes mellitus. It is expected to have better glycemic efficacy in Korean patients with poorly controlled type 2 diabetes mellitus.

The Effect of Model for End-Stage Liver Disease 3.0on Disparities between Patients with and without Hepatocellular Carcinoma in Korea

Purpose@#The model for end-stage liver disease (MELD) 3.0 has recently been suggested for determining liver allocation. We aimed to apply MELD 3.0 to a Korean population and to discover differences between patients with and without hepatocellular carcinoma (HCC). @*Materials and Methods@#This study is a retrospective study of 2203 patients diagnosed with liver cirrhosis at Severance Hospital between 2016–2022. Harrell’s concordance index was used to validate the ability of MELD scores to predict 90-day survival. @*Results@#During a mean follow-up of 12.9 months, 90-day survival was 61.9% in all patients, 50.4% in the HCC patients, and 74.8% in the non-HCC patients. Within the HCC patients, the concordance index for patients on the waitlist was 0.653 using MELD, which increased to 0.753 using MELD 3.0. Among waitlisted patients, the 90-day survival of HCC patients was worse than that of non-HCC patients with MELD scores of 31–37 only (69.7% vs. 30.0%, p=0.001). Applying MELD 3.0, the 90-day survival of HCC patients was worse than that of non-HCC patients across a wider range of MELD 3.0 scores, compared to MELD, with MELD 3.0 scores of 21–30 and 31–37 (82.0% vs. 72.5% and 72.3% vs. 24.3%, p=0.02 and p<0.001, respectively). @*Conclusion@#MELD 3.0 predicted 90-day survival of the HCC patients more accurately than original MELD score; however, the disparity between HCC and non-HCC patients increased, particularly in patients with MELD scores of 21–30. Therefore, a novel exception score is needed or the current exception score system should be modified.

Neurobehcet’s Disease with Extensive Invasion of Cerebral Parenchyma

Neuro-Behcet’s disease (NBD) is defined as a combination of neurologic symptoms and/or signs in a patient with Behcet’s disease. A 38-year-old woman was admitted due to sensory aphasia. She had past medical history of generalized tonic-clonic seizure, retinal vasculitis, oral ulcer and cerebral vasculitis. Brain magnetic resonance imaging showed broad lesion in the left parieto-occipital lobe. Brain biopsy was performed to differentiate between central nervous system lymphoma and NBD. We report a rare case of NBD with extensive involvement of cerebral parenchyma.

Delayed-Onset Dysphagia after Whiplash Injury: A Case Report / 대한연하장애학회지

Various symptomatic complaints, including dysphagia, have been reported by patients with whiplash injury, which greatly impacts their life. There are few reports on the treatment and progression of dysphagia following whiplash injuries. This case report describes a patient who presented with delayed dysphagia after a whiplash injury. A 37-year-old female visited the Department of Rehabilitation Medicine of our institution and presented with delayed dysphagia one year after a traffic accident. At the time of the accident, the patient was diagnosed with a whiplash injury and had no symptoms of dysphagia. A videofluoroscopic swallowing study revealed decreased laryngeal elevation and impaired upper esophageal sphincter opening in the pharyngeal phase. The Penetration-Aspiration Scale score was 3 for pureed food and 7 for liquid food. Laryngeal needle electromyography showed abnormal spontaneous activity in both cricothyroid muscles. The patient underwent swallowing rehabilitation for oropharyngeal dysphagia. There were recurrences of improvement and deterioration during the treatment period. However, after five months, problems related to swallowing improved until there were no complaints. Our study indicates a differentiated treatment approach and the importance of continuous rehabilitation for dysphagia after a whiplash injury.

Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage

Background@#The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages. @*Methods@#Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed. @*Results@#MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P< 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%. @*Conclusion@#MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.

A Nomogram for Predicting Extraperigastric Lymph Node Metastasis in Patients With Early Gastric Cancer

Background@#There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). @*Materials and Methods@#Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. @*Results@#Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. @*Conclusions@#A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.

The Effects of Online-Based Interventions for Chronic Low Back Pain Patients: A Clinical Trial

Objective@#Chronic low back pain (LBP) is a huge social burden, and optimal exercise therapies for chronic LBP patients are continuously being studied. To evaluate the effects of digital intervention on pain and disability in patients with chronic LBP, we performed a prospective cohort study. Method: From February 2020 to January 2021, 25 patients with chronic LBP were recruited. Digital intervention contains education contents and video demonstration for individually prescribed exercise. The exercise prescription was renewed every 4 weeks according to subjects’ condition and accomplishment of exercise. This intervention was performed for more than 30 weeks. The pain intensity was assessed using a numeric rating scale (NRS) while their degree of disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The pain intensity and disability was evaluated at short term (8∼20 weeks) and long term (30 weeks). @*Results@#As a result, pain intensity (NRS) decreased significantly over the short term and long term (p<0.05). However, pain related disability (RMDQ score) did not change significantly over the follow-up period (p=0.554). @*Conclusion@#Our findings indicate that online-based digital intervention reduced the intensity of chronic LBP. Further research is needed to identify methods to cost-effectively and consistently manage chronic LBP.

Artificial Intelligence-Based Speech Analysis System for Medical Support / 대한배뇨장애요실금학회지

Purpose@#Prior research has indicated that stroke can influence the symptoms and presentation of neurogenic bladder, with various patterns emerging, including abnormal facial and linguistic characteristics. Language patterns, in particular, can be easily recognized. In this paper, we propose a platform that accurately analyzes the voices of stroke patients with neurogenic bladder, enabling early detection and prevention of the condition. @*Methods@#In this study, we developed an artificial intelligence-based speech analysis diagnostic system to assess the risk of stroke associated with neurogenic bladder disease in elderly individuals. The proposed method involves recording the voice of a stroke patient while they speak a specific sentence, analyzing it to extract unique feature data, and then offering a voice alarm service through a mobile application. The system processes and classifies abnormalities, and issues alarm events based on analyzed voice data. @*Results@#In order to assess the performance of the software, we first obtained the validation accuracy and training accuracy from the training data. Subsequently, we applied the analysis model by inputting both abnormal and normal data and tested the outcomes. The analysis model was evaluated by processing 30 abnormal data points and 30 normal data points in real time. The results demonstrated a high test accuracy of 98.7% for normal data and 99.6% for abnormal data. @*Conclusions@#Patients with neurogenic bladder due to stroke experience long-term consequences, such as physical and cognitive impairments, even when they receive prompt medical attention and treatment. As chronic diseases become increasingly prevalent in our aging society, it is essential to investigate digital treatments for conditions like stroke that lead to significant sequelae. This artificial intelligence-based healthcare convergence medical device aims to provide patients with timely and safe medical care through mobile services, ultimately reducing national social costs.

Do Magnets Have the Potential to Serve as a Stabilizer for the Shoulder Joint in Massive Rotator Cuff Tears?: A Biomechanical Cadaveric Study

Background@#Disruption of the rotator cuff muscles compromises concavity compression force, which leads to superior migration of the humeral head and loss of stability. A novel idea of using the magnetic force to achieve shoulder stabilization in massive rotator cuff tears (MRCTs) was considered because the magnets can stabilize two separate entities with an attraction force. This study aimed to investigate the biomechanical effect of the magnetic force on shoulder stabilization in MRCTs. @*Methods@#Seven fresh frozen cadaveric specimens were used with a customized shoulder testing system. Three testing conditions were set up: condition 1, intact rotator cuff without magnets; condition 2, an MRCT without magnets; condition 3, an MRCT with magnets. For each condition, anterior-posterior translation, superior translation, superior migration, and subacromial contact pressure were measured at 0°, 30°, and 60° of abduction. The abduction capability of condition 2 was compared with that of condition 3. @*Results@#The anterior-posterior and superior translations increased in condition 2; however, they decreased compared to condition 2 when the magnets were applied (condition 3) in multiple test positions and loadings (p <0.05). Abduction capability improved significantly in condition 3 compared with that in condition 2, even for less deltoid loading (p < 0.05). @*Conclusions@#The magnet biomechanically played a positive role in stabilizing the shoulder joint and enabled abduction with less deltoid force in MRCTs. However, to ensure that the magnet is clinically applicable as a stabilizer for the shoulder joint, it is necessary to thoroughly verify its safety in the human body and to conduct further research on technical challenges.

Lyophilized allogeneic costal cartilage graft for septorhinoplasty

Background@#As rhinoplasty techniques have become more complex, surgeons often need more than what septal or conchal cartilage can provide. While costal cartilage became more popular for that reason, some surgeons are still uncomfortable with its invasiveness and donor site morbidity. Here, we used lyophilized allogeneic costal cartilage for septorhinoplasty and investigated its safety and usefulness. @*Methods@#The costal cartilage was harvested from a cadaveric donor and treated via multiple steps, including defatting and lyophilization, to remove all viable cells and antigenicity. The cartilage was then stored at room temperature and rehydrated 24 hours before use. Lyophilized cartilage allografts were used in 20 patients. Three types of septal graft were performed — spreader, batten, and extension — to correct septal or columellar deviation and enhance the nasal tip. @*Results@#The mean follow-up period was 4.3 years. In all cases, the graft successfully met the rhinoplasty purpose. No significant deformation was detected in any of the patients. Although warping was observed in one patient (5%), there was no case of clinical infection, extrusion, or graft removal and no revisional surgery for an unfavorable aesthetic result. @*Conclusions@#Lyophilized allogeneic cartilage was used for septorhinoplasty very safely and effectively. It can be carved into any shape and has all other properties required for perfectly replacing autologous costal cartilage. The main advantage of cartilage allografts is a limitless supply of high-quality cartilage without donor site morbidity. The disadvantages include the need for special facilities and manpower and extra covering cost.

Prognostic value of perioperative change of neutrophil elastase and myeloperoxidase in coronary circulation on perioperative myocardial injury and clinical outcome of patients underwent surgical valve replacement / 中华心血管病杂志

Objective: To investigate the clinical value of observing perioperative changes of myeloperoxidase (MPO) and neutrophil elastase (NE) in coronary artery circulation in patients underwent valve replacement surgery. Methods: This perspective cohort study was performed in patients who underwent valvular surgery in Nanjing Drum Tower Hospital and Fuwai Hospital from June 2021 to June 2022. Patients were divided into perioperative myocardial injury group and age-, sex- and type of cardiac procedure-matched non-perioperative myocardial injury control group in the ratio of 1∶1. Perioperative myocardial injury was defined as cardiac troponin T (cTnT)>0.8 μg/L on the first postoperative day (POD), and the cTnT level on the second POD increased by more than 10% compared with the cTnT level on the first POD. During the operation, blood samples were collected from the coronary sinus before clamping ascending aorta, and within 5 minutes after de-clamping ascending aorta. Then, the levels of MPO and NE on coronary sinus were continuously measured. The death, severe ventricular arrhythmia, pneumonia, re-intubation, repeat cardiac surgery, extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), mechanical ventilation time and the duration of intensive care unit (ICU) were recorded. The levels of MPO and NE and the incidence of clinical outcomes were compared between the myocardial injury group and the control group. The independent risk factors of myocardial injury were analyzed by multivariate logistic regression. Results: A total of 130 patients were enrolled, aged (60.6±7.6) years old, with 59 males (45.4%). There were 65 patients in the myocardial injury group and 65 patients in the control group. During hospitalization, there was no death, ECMO, IABP and CRRT cases in both groups. Compared with the control group, the incidence of severe ventricular arrhythmia (13.8%(9/65) vs. 3.1%(2/65), P=0.03), pneumonia (20.0%(13/65) vs. 3.1%(2/65), P=0.03), re-intubation (6.2%(4/65) vs. 0, P=0.04) was significantly higher in myocardial injury group. The mechanical ventilation time (16.8(10.7, 101.7) h vs. 7.5(4.7, 15.1) h, P<0.01), and the duration of ICU (3.7(2.7, 18.9) vs. 2.7(1.8, 6.9)d, P<0.01) were significantly longer in myocardial injury group compared with the control group. There was no significant difference in the levels of MPO and NE in coronary sinus blood between the two groups before aortic clamping (all P>0.05). However, MPO ((551.3±124.2) μg/L vs. (447.2±135.9) μg/L, P<0.01) and NE ((417.0±83.1)μg/L vs. (341.0±68.3)μg/L, P<0.01) after 5 min aortic de-clamping were significantly higher in myocardial injury group than in the control group. Multivariate logistic regression analysis showed that the levels of NE (OR=1.02, 95%CI: 1.01-1.02, P<0.01), MPO (OR=1.00, 95%CI: 1.00-1.01, P=0.02) and mechanical ventilation time (OR=1.03, 95%CI: 1.01-1.06, P=0.02) were independent risk factors of myocardial injury in patients after surgical valvular replacement. Conclusion: Perioperative myocardial injury is related poor clinical outcomes, perioperative NE and MPO in coronary artery circulation are independent risk factors of perioperative myocardial injury in patients undergoing valve replacement surgery.

Treatment of CD19-Positive Mixed Phenotype Acute Leukemia with Blinatumomab / 대한내과학회지

Mixed phenotype acute leukemia (MPAL) encompasses a rare group of acute leukemia with blasts expressing markers specific to several lineages, which accounts for 2-5% of all newly diagnosed cases of acute leukemia. At present, patients with MPAL are treated with acute lymphoblastic leukemia (ALL)-directed chemotherapy. However, the prognosis of MPAL, especially in cases of relapsed/refractory (R/R) disease, remains poor. Blinatumomab, a bispecific T cell-engaging antibody, has shown encouraging outcomes in R/R B cell ALL positive for CD19. Here, we report a patient with CD19+ MPAL who achieved complete remission after treatment with blinatumomab, which may be a therapeutic option for patients with relapsed CD19+ MPAL. To our knowledge, this is the first case report of MPAL treated with blinatumomab in Korea.

Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus

Background@#Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated. @*Methods@#This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models. @*Results@#During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30−34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35−39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse. @*Conclusion@#Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.

Diagnosis of Lung Cancer in a Patient with Chronic Knee Pain Caused by Hypertrophic Osteoarthropathy

Patients with chronic knee pain are common, and symptoms are usually caused by degenerative disorders of the knee joint. Although hypertrophic osteoarthropathy (HOA) is a rare cause of knee pain in patients who visit the department of rehabilitation medicine, clinicians should consider this paraneoplastic syndrome. Herein, we report an uncommon case of hypertrophic pulmonary osteoarthropathy (HPO) in a patient with chronic knee pain who was finally diagnosed with lung cancer. A 49-year-old male was referred to the department of rehabilitation medicine from a local clinic for uncontrolled bilateral knee pain. The plain radiograph and magnetic resonance image (MRI) of the knee showed symmetric periosteal reaction and prepatellar bursitis. For additional evaluation, bone scan was done, and it revealed symmetric linear uptake along the diaphyseal and metaphyseal surfaces of both femurs and tibias, a typical feature of HPO. A plain chest radiograph was taken and showed a mass at the left hilar region. The patient was finally diagnosed with non-small cell lung cancer. After receiving chemotherapy for lung cancer, knee pain improved.

Thoughts on the construction of digital hospitals in " 14th Five-Year Plan" period of China / 中华医院管理杂志

Under the background of high-quality development of public hospitals, the construction of digital hospitals plays an important role in improving hospital management and service quality. By analyzing the problems and experience of digital hospital construction, the authors identified such key paths of digital hospital construction in the " 14th Five-Year Plan" period as strengthening organizational leadership, increasing capital investment, consolidating talent teams and promoting data sharing, hence providing references to hospitals transformation to digital ones.

Results of Hip Arthroplasty Using a COREN Stem at a Minimum of Ten Years / 대한고관절학회지

Purpose@#We report on the 10-year clinical hip function and radiologic outcomes of patients who underwent hip arthroplasty using a COREN stem. @*Materials and Methods@#A consecutive series of 224 primary cementless hip arthroplasty implantations were performed using a COREN stem between 2009 and 2011; among these, evaluation of 128 hips was performed during a minimum follow-up period of 10 years. The mean age of patients was 65.4 years (range, 40-82 years) and the mean duration of follow-up was 10.8 years (range, 10-12 years). Evaluation of clinical hip function and radiologic implant outcomes was performed according to clinical score, thigh pain, and radiologic analysis. @*Results@#Dramatic improvement of the mean Harris hip score (HHS) from 59.4 preoperatively to 93.5 was observed at the final follow-up (P≤0.01). Stable fixation was demonstrated for all implants with no change in position except for one case of Vancouver type B2 periprosthetic femur fracture. A radiolucent line (RLL) was observed in 16 hips (12.5%). Thigh pain was observed in only two hips (1.6%) at the final follow-up. There were no cases of osteolysis around the stem. The survival rate for the COREN stem was 97.7%. @*Conclusion@#Good long-term survival with excellent clinical and radiological outcomes can be achieved using the COREN femoral stem regardless of Dorr type.