Influence of Vitreoretinal Surgery on Ocular Surface Dynamics Using Keratograph 5M

Purpose@#To evaluate changes of ocular surface dynamics using Keratograph 5M for 3 months after vitreoretinal surgery. @*Methods@#Eighty-three patients were divided into three groups: phacoemulsification group, vitrectomy group, and combined group. Keratograph 5M was performed for all patients at 1 week, 1 month, and 3 months after the surgery. Ocular surface dynamics parameters measured by Keratograph 5M, including noninvasive keratograph first tear film breakup time (NifBUT), noninvasive keratograph average tear film breakup time (NiaBUT), and tear meniscus height (TMH) were compared among the three groups over time. @*Results@#The mean age of all patients (46 men and 37 women) was 62.2 ± 8.4 years. NifBUT and NiaBUT were significantly decreased at 1 week after surgery compared to those at baseline in all three groups (all p < 0.001). NifBUT and NiaBUT in the phacoemulsification group almost recovered to the preoperative level, while those in the vitrectomy group and the combined group were still significantly less than those at baseline. NifBUT and NiaBUT in the phacoemulsification group were significantly longer than those in the vitrectomy group and the combined group at 3 months. After 1 week, TMHs were significantly higher in the vitrectomy group (p = 0.001) and the combined group (p = 0.022) than in the phacoemulsification group, while TMHs were significantly less in the vitrectomy group (p = 0.010) and the combined group (p < 0.001) than in the phacoemulsification group at 3 months after surgery. @*Conclusions@#These results suggest that vitreoretinal surgery could induce alteration of ocular surface dynamics for 3 months. The vitrectomy group and the combined group showed tear film instability compared to the cataract surgery alone group. Patients who underwent vitreoretinal surgery experienced more severe dry eye syndrome symptoms than those who underwent cataract surgery. Thus, managing dry eye syndrome after vitreoretinal surgery should be considered important for patients.

Visual Acuity Changes with a Position Shift in a Patient with an Endocapsular Hematoma

Purpose@#To report a vitrectomy performed on a patient with an endocapsular hematoma whose visual acuity changed with her position.Case summary: A 92-year-old woman visited our hospital complaining of a visual acuity change in her left eye with good visibility while standing but poor visibility when lying. She was taking aspirin, had underlying hypertension, diabetes, and heart failure, and underwent left eye cataract surgery 15 years previously. At presentation, her best-corrected visual acuity in the left eye was 0.5, with an intraocular pressure of 23 mmHg. An endocapsular hematoma that partially covered the fundus in the left eye was found. The left eye was observed for 3 months. However, there was no change in the endocapsular hematoma and the discomfort persisted with the position shift; therefore, a vitrectomy, posterior capsulotomy, and anterior chamber irrigation were performed. One month postoperatively, the visual acuity in the left eye was 0.4 and there was no longer a change in the visual acuity with position. @*Conclusions@#A patient with an endocapsular hematoma may have changes in visual acuity with position, and a vitrectomy can be used to treat the endocapsular hematoma.

A Retrospective Clinical Evaluation of an Artificial Intelligence Screening Method for Early Detection of STEMI in the Emergency Department

Background@#Rapid revascularization is the key to better patient outcomes in ST-elevation myocardial infarction (STEMI). Direct activation of cardiac catheterization laboratory (CCL) using artificial intelligence (AI) interpretation of initial electrocardiography (ECG) might help reduce door-to-balloon (D2B) time. To prove that this approach is feasible and beneficial, we assessed the non-inferiority of such a process over conventional evaluation and estimated its clinical benefits, including a reduction in D2B time, medical cost, and 1-year mortality. @*Methods@#This is a single-center retrospective study of emergency department (ED) patients suspected of having STEMI from January 2021 to June 2021. Quantitative ECG (QCG™), a comprehensive cardiovascular evaluation system, was used for screening. The non-inferiority of the AI-driven CCL activation over joint clinical evaluation by emergency physicians and cardiologists was tested using a 5% non-inferiority margin. @*Results@#Eighty patients (STEMI, 54 patients [67.5%]) were analyzed. The area under the curve of QCG score was 0.947. Binned at 50 (binary QCG), the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 98.1% (95% confidence interval [CI], 94.6%, 100.0%), 76.9% (95% CI, 60.7%, 93.1%), 89.8% (95% CI, 82.1%, 97.5%) and 95.2% (95% CI, 86.1%, 100.0%), respectively. The difference in sensitivity and specificity between binary QCG and the joint clinical decision was 3.7% (95% CI, −3.5%, 10.9%) and 19.2% (95% CI, −4.7%, 43.1%), respectively, confirming the non-inferiority. The estimated median reduction in D2B time, evaluation cost, and the relative risk of 1-year mortality were 11.0 minutes (interquartile range [IQR], 7.3–20.0 minutes), 26,902.2 KRW (22.78 USD) per STEMI patient, and 12.39% (IQR, 7.51–22.54%), respectively. @*Conclusion@#AI-assisted CCL activation using initial ECG is feasible. If such a policy is implemented, it would be reasonable to expect some reduction in D2B time, medical cost, and 1-year mortality.

Mapping the Korean National Health Checkup Questionnaire to Standard Terminologies / 대한의료정보학회지

Objectives@#An increasing emphasis has been placed on the integration of clinical data and patient-generated health data (PGHD), which are generated outside of hospitals. This study explored the possibility of using standard terminologies to represent PGHD for data integration. @*Methods@#We chose the 2020 general health checkup questionnaire of the Korean Health Screening Program as a resource. We divided every component of the questionnaire into entities and values, which were mapped to standard terminologies—Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) version 2020-07-31 and Logical Observation Identifiers Names and Codes (LOINC) version 2.68. @*Results@#Eighty-nine items were derived from the 17 questions of the 2020 health examination questionnaire, of which 76 (85.4%) were mapped to standard terms. Fifty-two items were mapped to SNOMED CT and 24 items were mapped to LOINC. Among the items mapped to SNOMED CT, 35 were mapped to pre-coordinated expressions and 17 to post-coordinated expressions. Forty items had one-to-one relationships, and 17 items had one-to-many relationships. @*Conclusions@#We achieved a high mapping rate (85.4%) by using both SNOMED CT and LOINC. However, we noticed some issues while mapping the Korean general health checkup questionnaire (i.e., lack of explanations, vague questions, and overly narrow concepts). In particular, items combining two or more concepts into a single item were not appropriate for mapping using standard terminologies. Although it is not the case that all items need to be expressed in standard terminology, essential items should be presented in a way suitable for mapping to standard terminology by revising the questionnaire in the future.

Chronic Eosinophilic Pneumonia Masquerading As Bronchogenic Malignancy / 전남의대학술지

No abstract available.

Current Status of Bariatric and Metabolic Surgery in Daejeon and Chungcheong Province: Early Experiences after Public Medical Insurance Coverage in 2019

Purpose@#This study aimed to investigate the current status of bariatric and metabolic surgery in Daejeon and Chungcheong province and to describe the early experiences after public medical insurance coverage in 2019. @*Materials and Methods@#Between January 2019 and August 2019, 64 cases of bariatric and metabolic surgery were performed in patients with morbid obesity or uncontrolled type 2 diabetes. We prospectively collected and analyzed data regarding the patients’ demographics and comorbidities, surgical results, and early complications. The patient information before and after the insurance coverage was also compared. @*Results@#The number of surgeries in 9 years has been caught up only in the last 8 months after insurance coverage (58 vs. 64 patients). The mean body mass index was 37.7±5.8 kg/m2 (range, 22.7-52.1 kg/m2). The most frequently performed surgery was sleeve gastrectomy (53 cases, 82.8%), followed by Roux-en-Y gastric bypass (9 cases, 14.1%), and adjustable gastric banding (2 cases, 3.1%). Postoperative complications occurred in 6 patients (9.4%), and there was no mortality. The mean operation time (225.3±85.4 vs. 156.1±61.8 min, P＜0.001) and postoperative stay (5.9±4.5 vs. 4.3±2.0 days, P=0.013) after the insurance coverage were significantly shorter than those before the insurance coverage. @*Conclusion@#We could assess the patients who had bariatric and metabolic surgery in Daejeon and Chungcheong province after public medical insurance coverage in 2019.

Medicare System and Family Doctor Training Program in Australia: A Study Tour to a Leading Country for Family Medicine / 日本プライマリ・ケア連合学会誌

In February 2017, general practitioners (GPs) from the Department of Community and Family Medicine of Fukushima Medical University in Japan visited Australia for a study tour where the tour participants met with local GPs, GP registrars and researchers. During this tour, we visited public hospitals and observed multiple GPs providing community-based health care. We also attended a new GP registrars' orientation where the two authors gave a presentation about the current status of primary care in Japan. We then visited an Aboriginal health research center, and learned about the cultural values of the Aboriginal people and the challenges of implementing large-scale cohort studies.

Asymptomatic Cholecystocolic Fistula Diagnosed Accurately before Surgery / 대한췌담도학회지

Cholecystocolic fistula (CCF) is a rare and late complication of gallbladder disease. The cause of CCF is known to be peptic ulcer, gallbladder disease, malignant tumor, trauma, and postoperative complications. The proper treatment method is to perform cholecystectomy and to identify and alleviate the CCF. However, cholecystectomy is not always possible owing to technical difficulties and disease severity. CCF is difficult to diagnose preoperatively, and CCF operation without an accurate preoperative diagnosis can lead to a more complicated surgery and cause surgeons to face more difficult situations or to endanger patients' lives. We report a case of asymptomatic CCF successfully treated with laparoscopic surgery after accurate diagnosis before surgery.

Birt-Hogg-Dubé Syndrome Associated with a Renal Tumor / 대한내과학회지

Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder characterized by the formation of hair follicle tumors, kidney tumors, and pulmonary cysts with recurrent spontaneous pneumothorax. A 44-year-old woman visited Wonkwang University Hospital with mild dyspnea. A chest X-ray on admission revealed pneumothorax in both lung fields. Chest computed tomography (CT) revealed both pneumothorax and multiple, irregularly shaped, variable-sized cysts in both lung fields. Upon physical examination, white dome-shaped papules were observed on the face. Histological examination of the skin lesion confirmed fibrofolliculoma, and genetic studies revealed a folliculin gene mutation. Abdominal CT revealed a 1-cm small solid renal mass at the lower pole of the right kidney. We surgically removed the renal tumor, and a histological diagnosis of oncocytoma was made. Here, we report a case of BHD that demonstrated all three clinical manifestations; this is the first case report of its kind in Korea.

Comparisons of item difficulty and passing scores by test equating in a basic medical education curriculum / 한국의학교육

PURPOSE: Test equating studies in medical education have been conducted only for high-stake exams or to compare two tests given in a single course. Based on item response theory, we equated computer-based test (CBT) results from the basic medical education curriculum at the College of Medicine, the Catholic University of Korea and evaluated the validity of using fixed passing scores. METHODS: We collected 232 CBTs (28,636 items) for 40 courses administered over a study period of 9 years. The final data used for test equating included 12 pairs of tests. After test equating, Wilcoxon rank-sum tests were utilized to identify changes in item difficulty between previous tests and subsequent tests. Then, we identified gaps between equated passing scores and actual passing scores in subsequent tests through an observed-score equating method. RESULTS: The results of Wilcoxon rank-sum tests indicated that there were no significant differences in item difficulty distribution by year for seven pairs. In the other five pairs, however, the items were significantly more difficult in subsequent years than in previous years. Concerning the gaps between equated passing scores and actual passing scores, equated passing scores in 10 pairs were found to be lower than actual passing scores. In the other two pairs, equated passing scores were higher than actual passing scores. CONCLUSION: Our results suggest that the item difficulty distributions of tests taught in the same course during successive terms can differ significantly. It may therefore be problematic to use fixed passing scores without considering this possibility.

Primary Care Perspectives in Japan

With an increase in aging population and medical expenditure worldwide, primary care has been rising as a solution to these. Japan, a representative aging society which has the most elderly population in the world, also has tried to develop a primary care system and implemented many changes recently. Based on what authors experienced and observed at the points of care in Japan, we are going to review the primary care system and training strategy of family medicine in Japan and come up with some suggestions that could apply to Korea.

Comparison of cobas EGFR Mutation Test v2 and PANAMutyper-R-EGFR for Detection and Semi-Quantification of Epidermal Growth Factor Receptor Mutations in Plasma and Pleural Effusion Supernatant

BACKGROUND: Plasma epidermal growth factor receptor (EGFR) mutation tests are less invasive than tissue EGFR mutation tests. We determined which of two kits is more efficient: cobas EGFR Mutation test v2 (cobasv2; Roche Molecular Systems, Pleasanton, CA, USA) or PANAMutyper-R-EGFR (Mutyper; Panagene, Daejeon, Korea). We also evaluated whether pleural effusion supernatant (PE-SUP) samples are assayable, similar to plasma samples, using these two kits. METHODS: We analyzed 156 plasma and PE-SUP samples (31 paired samples) from 116 individuals. We compared the kits in terms of accuracy, assessed genotype concordance (weighted κ with 95% confidence intervals), and calculated Spearman's rho between semi-quantitatively measured EGFR-mutant levels (SQIs) measured by each kit. We also compared sensitivity using 47 EGFR-mutant harboring samples divided into more-dilute and less-dilute samples (dilution ratio: ≥ or <1:1,000). RESULTS: cobasv2 tended to have higher accuracy than Mutyper (73% vs 69%, P=0.53), and PE-SUP samples had significantly higher accuracy than plasma samples (97% vs 55–71%) for both kits. Genotype concordance was 98% (κ=0.92, 0.88–0.96). SQIs showed strong positive correlations (P<0.0001). In less-dilute samples, accuracy and sensitivity did not differ significantly between kits. In more-dilute samples, cobasv2 tended to have higher sensitivity than Mutyper (43% vs 20%, P=0.07). CONCLUSIONS: The kits have similar performance in terms of EGFR mutation detection and semi-quantification in plasma and PE-SUP samples. cobasv2 tends to outperform Mutyper in detecting less-abundant EGFR-mutants. PE-SUP samples are assayable using either kit.

Recurrent Optic Neuritis and Acute Encephalopathy with Myelin Oligodendrocyte Glycoprotein Antibodies in a Korean Child

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases are reported to have distinct pathogenic mechanisms, clinical courses, and therapeutic implications in comparison to other acquired demyelinating syndromes. Here, we report the case of a 6-year-old Korean girl with recurrent steroid-responsive optic neuritis (ON) and an episode of acute disseminated encephalomyelitis (ADEM) with a high MOG antibody titer. Initially, she suffered from left ON with subclinical brain lesions including magnetic resonance imaging hyperintensities in the bilateral frontal subcortical white matter, the left thalamus, and the right cerebral peduncle. Her vision improved dramatically after steroid therapy; however, 3 months after the 1st episode, she developed acute encephalopathy with extensive newly developed ADEM-like lesions and resolution of previous hyperintensities. Despite regular interferon β-1a injection after steroid tapering, she developed a 3rd episode presenting as a right ON. Throughout these three episodes, serological tests associated with autoimmune diseases, viral markers, anti-aquaporin-4 antibodies, and cerebrospinal fluid oligoclonal bands were negative, with the immunoglobulin G index in the normal range. After the 3rd episode, anti-MOG antibody testing was performed and higher titer was detected. Testing for anti-MOG antibodies is highly recommended for relapsing inflammatory demyelinating central nervous system diseases in pediatric patients, in order to define early an adequate long-term treatment.

Comparisons of item difficulty and passing scores by test equating in a basic medical education curriculum / 한국의학교육

PURPOSE@#Test equating studies in medical education have been conducted only for high-stake exams or to compare two tests given in a single course. Based on item response theory, we equated computer-based test (CBT) results from the basic medical education curriculum at the College of Medicine, the Catholic University of Korea and evaluated the validity of using fixed passing scores.@*METHODS@#We collected 232 CBTs (28,636 items) for 40 courses administered over a study period of 9 years. The final data used for test equating included 12 pairs of tests. After test equating, Wilcoxon rank-sum tests were utilized to identify changes in item difficulty between previous tests and subsequent tests. Then, we identified gaps between equated passing scores and actual passing scores in subsequent tests through an observed-score equating method.@*RESULTS@#The results of Wilcoxon rank-sum tests indicated that there were no significant differences in item difficulty distribution by year for seven pairs. In the other five pairs, however, the items were significantly more difficult in subsequent years than in previous years. Concerning the gaps between equated passing scores and actual passing scores, equated passing scores in 10 pairs were found to be lower than actual passing scores. In the other two pairs, equated passing scores were higher than actual passing scores.@*CONCLUSION@#Our results suggest that the item difficulty distributions of tests taught in the same course during successive terms can differ significantly. It may therefore be problematic to use fixed passing scores without considering this possibility.

Birt-Hogg-Dubé Syndrome Associated with a Renal Tumor / 대한내과학회지

Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder characterized by the formation of hair follicle tumors, kidney tumors, and pulmonary cysts with recurrent spontaneous pneumothorax. A 44-year-old woman visited Wonkwang University Hospital with mild dyspnea. A chest X-ray on admission revealed pneumothorax in both lung fields. Chest computed tomography (CT) revealed both pneumothorax and multiple, irregularly shaped, variable-sized cysts in both lung fields. Upon physical examination, white dome-shaped papules were observed on the face. Histological examination of the skin lesion confirmed fibrofolliculoma, and genetic studies revealed a folliculin gene mutation. Abdominal CT revealed a 1-cm small solid renal mass at the lower pole of the right kidney. We surgically removed the renal tumor, and a histological diagnosis of oncocytoma was made. Here, we report a case of BHD that demonstrated all three clinical manifestations; this is the first case report of its kind in Korea.

The development of a community-based medical education program in Korea / 한국의학교육

PURPOSE: The introduction of community-based medical education would help improve the quality of primary care. This paper suggests learning objectives and an educational program for community-based medical education. METHODS: The educational program was developed in a 1-day consensus workshop. Twenty experts, including faculty members from family medicine department of a college of medicine in Seoul and community-based preceptors, participated in the program. A needs-assessment survey was conducted among community-based preceptors before the workshop. Through this workshop, we derived learning objectives and a standardized curriculum for community-based medical education. RESULTS: In the questionnaire before the workshop, community-based preceptors voiced concerns over the program's potential costs and the time required for teaching. The learning objectives and educational programs derived from the workshop's consensus were consistent with the characteristics of the primary care. Based on the results of this workshop, the joint expert team developed a standard educational program on two core topics: clinical teaching and mentoring. CONCLUSION: From this curriculum development process, participants could construct a more standardized curriculum for community-based medical education. Future studies are needed to evaluate the long-term outcomes of these educational programs, such as the learners' satisfaction and achievement.

Current Status of Metabolic and Bariatric Surgery in Daejeon/Chungcheong Area

PURPOSE: The aim of our study is to investigate the current status of metabolic and bariatric surgery in Daejeon and Chungcheong province and examine the role and necessity of the community research society. MATERIALS AND METHODS: In this retrospective study, 58 patients who underwent bariatric and metabolic surgery from January 2010 to June 2018 were included. Patients' demographics and comorbidities, operation type and early complications were analyzed. RESULTS: Mean age was 36.9±11.4 (range, 18–64) years, and mean preoperative body mass index was 39.2±6.9 (range, 24.6–56.1) kg/m². The most frequently performed operation was sleeve gastrectomy (48 cases, 82.8%), followed by adjustable gastric banding (8 cases, 13.8%) and Roux-en-Y gastric bypass (2 cases, 3.4%). Postoperative complications were reported in two patients; however, no mortality was reported. CONCLUSION: We investigated the patients who underwent metabolic and bariatric surgery in Daejeon Chungcheong province. Our research society will continue to ensure safe operation and proper management of morbidly obese patients in our community.

Computed tomography morphologic features of pulmonary adenocarcinoma with brain/bone metastasis

BACKGROUND/AIMS: Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. METHODS: We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. RESULTS: In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ≥ 50 mm (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ≥ 30% (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ≥ 30% (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). CONCLUSIONS: We found that necrosis ≥ 30% was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.

Response Evaluation of Chemotherapy for Lung Cancer / 결핵및호흡기질환

Assessing response to therapy allows for prospective end point evaluation in clinical trials and serves as a guide to clinicians for making decisions. Recent prospective and randomized trials suggest the development of imaging techniques and introduction of new anti-cancer drugs. However, the revision of methods, or proposal of new methods to evaluate chemotherapeutic response, is not enough. This paper discusses the characteristics of the Response Evaluation Criteria In Solid Tumor (RECIST) version 1.1 suggested in 2009 and used widely by experts. It also contains information about possible dilemmas arising from the application of response assessment by the latest version of the response evaluation method, or recently introduced chemotherapeutic agents. Further data reveals the problems and limitations caused by applying the existing RECIST criteria to anti-cancer immune therapy, and the application of a new technique, immune related response criteria, for the response assessment of immune therapy. Lastly, the paper includes a newly developing response evaluation method and suggests its developmental direction.

Introduction Process of the Tobacco Graphic Health Warning Law in Korea: Analysis on the National Assembly Minutes / 보건행정학회지

Graphic health warning on the tobacco product package is a cost-effective tobacco control policy to convey information on harmful effect of tobacco use to health, and it is known not only to motivate smokers to quit but also to deter adolescents from start smoking. In case of Korea, amendments to National Health Promotion Act requiring implementation of graphic health warning had been submitted 13 times, from 2002 to May 2015. In May 2015, the amendment had been approved by the National Assembly and it enters into force on December 23, 2016. This research analyzed the discussions from Health and Welfare Committee of the National Assembly during the implementation of the graphic health warning in order to study decision making process of legislators. Study found that there was a shift from a general opposition on implementing graphic health warning at first to a harsh conflict over relaxation of the regulation once discussing the implementation in earnest. Particularly, while the group supporting the implementation of the graphic health warning or opposing relaxation advocated the amendment with scientific and knowledge-based evidences including the World Health Organization Framework Convention on Tobacco Control, the group opposing the adoption of the amendment itself or suggesting relaxation tended to defend their position with empathy on smokers or tobacco industries.