Validation of the Friedewald formula for estimating low density lipoprotein cholesterol: the Korea National Health and Nutrition Examination Survey, 2009 to 2011

Background/Aims@#The aim of this study is to compare Friedewald-estimated and directly measured low density lipoprotein cholesterol (LDL-C) values and assess the concordance in guideline risk classification between the two methods. @*Methods@#The data were derived from the 2009 to 2011 Korea National Health and Nutrition Examination Survey. We included subjects with triglyceride (TG) levels < 400 mg/dL. Analysis was done for 6,454 subjects who had all lipid panels— total cholesterol, directly measured LDL-C, high density lipoprotein cholesterol (HDL-C), and TG. @*Results@#The subjects ranged in age from 10 to 87 years old. The mean age was 41.5 ± 17.3 years. For subjects with TG < 400 mg/dL, overall concordance in guideline risk classification was 79.1%. The Friedewald formula tended to underestimate LDL-C more at higher TG or lower HDL-C levels. Especially, the percent of subjects who were misclassified into a lower risk category was 31% when TG were 200 to 299 mg/dL; and 45.6% when TG were 300 to 399 mg/dL. A greater underestimation of LDL-C occurred at higher TG and lower Friedewald-estimated LDL-C levels. Of subjects with a Friedewald-estimated LDL-C < 70 mg/dL, 55.4% had a directly measured LDL-C ≥ 70 mg/dL when TG were 200 to 399 mg/dL. @*Conclusions@#The Friedewald equation tends to underestimate LDL-C in highrisk subjects such as hypertriglyceridemia and hypo-HDL-cholesterolemia. For these individuals accurate assessment of LDL-C is crucial, and therefore additional evaluation is warranted.

Evaluation of the QuantaMatrix Multiplexed Assay Platform for Molecular Diagnosis of Multidrug- and Extensively Drug-Resistant Tuberculosis Using Clinical Strains Isolated in Myanmar

BACKGROUND: Although the incidence of tuberculosis (TB) is decreasing, cases of multidrug-resistant (MDR) TB and extensively drug-resistant (XDR) TB continue to increase. As conventional phenotype drug susceptibility testing (pDST) takes six to eight weeks, molecular assays are widely used to determine drug resistance. we developed QuantaMatrix Multiplexed Assay Platform (QMAP) MDR/XDR assay (QuantaMatrix Inc., Seoul, Korea) that can simultaneously detect mutations related to both first- and second-line drug resistance (rifampin, isoniazid, ethambutol, fluoroquinolones, second-line injectable drugs, and streptomycin). METHODS: We used 190 clinical Mycobacterium tuberculosis (MTB) strains isolated from Myanmar, compared QMAP and pDST results, and determined concordance rates. Additionally, we performed sequence analyses for discordant results. RESULTS: QMAP results were 87.9% (167/190) concordant with pDST results. In the 23 isolates with discordant results, the QMAP and DNA sequencing results completely matched. CONCLUSIONS: The QMAP MDR/XDR assay can detect all known DNA mutations associated with drug resistance for both MDR- and XDR-MTB strains. It can be used for molecular diagnosis of MDR- and XDR-TB to rapidly initiate appropriate anti-TB drug therapy.

Evaluation of the Usefulness of Cardiac Enzyme Analysis for the Diagnosis of Acute Myocardial Infarction in Postmortem Inspection / 대한법의학회지

Acute myocardial infarction is one of the most common causes of unexpected deaths, but there are limitations to its diagnosis in postmortem inspection. In this study, we aimed to investigate the usefulness of cardiac marker analysis for the diagnosis of acute myocardial infarction in postmortem inspection. This study was conducted on 30 postmortem inspection cases conducted by the National Forensic Service from 2016 to 2018. Tests for three myocardial enzymes (myoglobin, creatinine kinase-MB, and cardiac troponin I) were performed in each case, and the relationships between enzyme levels, cause of death, and factors affecting the postmortem tests were analyzed. Cardiac enzyme concentrations were not significantly different between the heart disease group and other disease groups, and the false-positive rate was increased due to postmortem changes. Therefore, we can conclude that it is not appropriate to use cardiac enzyme analysis for the diagnosis of acute myocardial infarction in postmortem inspection.

Evaluation of the Usefulness of Cardiac Enzyme Analysis for the Diagnosis of Acute Myocardial Infarction in Postmortem Inspection / 대한법의학회지

Acute myocardial infarction is one of the most common causes of unexpected deaths, but there are limitations to its diagnosis in postmortem inspection. In this study, we aimed to investigate the usefulness of cardiac marker analysis for the diagnosis of acute myocardial infarction in postmortem inspection. This study was conducted on 30 postmortem inspection cases conducted by the National Forensic Service from 2016 to 2018. Tests for three myocardial enzymes (myoglobin, creatinine kinase-MB, and cardiac troponin I) were performed in each case, and the relationships between enzyme levels, cause of death, and factors affecting the postmortem tests were analyzed. Cardiac enzyme concentrations were not significantly different between the heart disease group and other disease groups, and the false-positive rate was increased due to postmortem changes. Therefore, we can conclude that it is not appropriate to use cardiac enzyme analysis for the diagnosis of acute myocardial infarction in postmortem inspection.

Management Status of Cardiovascular Disease Risk Factors for Dyslipidemia among Korean Adults

PURPOSE: Dyslipidemia, hypertension, and diabetes are well-established risk factors for cardiovascular disease (CVD). This study investigated the prevalence and management status of these factors for dyslipidemia among Korean adults aged 30 years old and older. MATERIALS AND METHODS: The prevalence and management status of dyslipidemia, hypertension, and diabetes were analyzed among 12229 subjects (≥30 years) participating in the Korea National Health and Nutrition Survey 2010–2012. Dyslipidemia was defined according to treatment criteria rather than diagnostic criteria in Korea. Therefore, hyper-low-density lipoprotein (LDL) cholesterolemia was defined if LDL cholesterol levels exceeded the appropriate risk-based threshold established by the National Cholesterol Education Program Adult Treatment Panel III. RESULTS: The age-standardized prevalence was highest for dyslipidemia (39.6%), followed by hypertension (32.8%) and diabetes (9.8%). The lowest patient awareness was found for dyslipidemia (27.9%). The treatment rate was 66.5% for diabetes and 57.3% for hypertension, but only 15.7% for dyslipidemia. The control rate among those undergoing treatment was highest for hypertension (64.2%), followed by dyslipidemia (59.2%) and diabetes (22.1%). The higher the risk levels of CVD were, the lower the control rate of dyslipidemia. CONCLUSION: While the prevalence of dyslipidemia was higher than hypertension and diabetes, awareness and treatment rates thereof were lower. Higher CVD-risk categories showed lower control rates of dyslipidemia. In order to improve awareness and control rates of dyslipidemia, diagnostic criteria should be reconciled with treatment targets based on cardiovascular risk in Korean populations.

Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy

OBJECTIVE: The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. MATERIALS AND METHODS: We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. RESULTS: Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). CONCLUSION: There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis.

Age-Related Changes in the Prevalence of Osteoporosis according to Gender and Skeletal Site: The Korea National Health and Nutrition Examination Survey 2008-2010

BACKGROUND: The incidence of osteoporosis and its related fractures are expected to increase significantly in the rapidly aging Korean population. Reliable data on the prevalence of this disease is essential for treatment planning. However, sparse data on Korean patients is available. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2008 to 2010. Bone mineral density (BMD) was measured at the femoral neck and lumbar spine using dual-energy X-ray absorptiometry. Osteopenia and osteoporosis were diagnosed according to the World Health Organization T-score criteria. We analyzed the BMD data of 17,208 people (men, 7,837; women, 9,368). RESULTS: The adjusted prevalence of osteoporosis was 7.8% in men versus 37.0% in women. No significant difference was observed in the prevalence of osteopenia between genders (men, 47.0%; women, 48.7%). The prevalence of osteoporosis in men in their 50s was 4.0%, in their 60s was 7.2%, in their 70s was 15.1%, and in their 80s was 26.7%. The figures in women were 15.2%, 36.5%, 62.7%, and 85.8%, respectively. The age group with the maximal BMD differed between genders. In the men, 20s had the highest value in all the skeletal sites. However, in the women, the maximal BMD in the femoral neck, lumbar spine, and the total hip was observed in their 20s, 30s, and 40s, respectively. The onset age of osteoporosis differed between genders. Osteoporosis in the femoral neck began at 55 years in the women and at 60 years in the men. CONCLUSION: The prevalence of osteoporosis in Korea was significantly high. In addition, the age-related changes in the prevalence of osteoporosis differed according to gender and skeletal site.

Comparison of Single and Double Fusions in Transverse Tarsal Joint / 대한족부족관절학회지

PURPOSE: The purpose of this study was to compare the clinical and radiological results of single and double fusions in the transverse tarsal joint. MATERIALS AND METHODS: Between December 2000 and April 2009, 16 patients (16 feet) who had been treated by fusion of transverse tarsal joint were included in this study. In 8 patients, only talonavicular joint was fused and in the other 8 patients, both talonavicular and calcaneocuboid joints were fused simultaneously. We have measured talo-first metatarsal angle, calcaneal pitch angle, talonavicular coverage angle and presence of adjacent joint arthritis for radiological assessment at both preoperative and last visit. Furthermore, we have evaluated Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction. RESULTS: In a single fusion group, VAS was improved from 6.4+/-1.4 to 0.8+/-1.0 (p=0.0011) and AOFAS score was improved from 63.8+/-6.2 to 89.4+/-9.8 (p=0.0012). In a double fusion group, VAS was improved from 8.0+/-0.75 to 2.0+/-1.8 (p=0.0011) and AOFAS score was improved from 60.5+/-11.2 to 89.5+/-6.0 (p=0.0012). In the difference of talo-first metatarsal angle between two groups, a single fused group was more improved than a double fused group (p=0.04). CONCLUSION: Both single and double fusions are useful and attractive treatment for the transverse tarsal joint arthritis. Furthermore, a single fusion has advantages of less invasiveness and preserving some degree of hindfoot motion and could be an effective alternative to a double fusion if patient meets appropriate criteria through careful preoperative evaluation.

Comparison of Clinical Outcome of Excision versus Osteosynthesis in Type II Accessory Navicular / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the clinical outcome of excision versus osteosynthesis of type II accessory navicular performed by a single surgeon. MATERIALS AND METHODS: Cases of 14 feet treated with excision and 13 feet by osteosynthesis for type II accessory navicular of 25 patients from 2002 to 2009 were included in this study. Radiological measurements and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale was evaluated. RESULTS: AOFAS midfoot scale of both excision and osteosynthesis groups at last follow-up showed improvement from pre-operation. However, there was no statistical difference in AOFAS midfoot scale and subjective satisfaction between the two groups at last follow-up. In detail of AOFAS midfoot scale, pain and footwear requirements showed statistically favorable results for the excision group, while activity limitation and support showed statistically favorable results for the osteosynthesis group. Subjective recovery time returning to daily activities and starting rehabilitation exercise were 14.6 weeks in the excision group and 13.7 weeks in the osteosynthesis group (p=0.025, Mann-Whitney). Suture anchor loosening was observed in one case in the excision group and non-union in two cases in the osteosynthesis group. CONCLUSION: Both excision and osteosynthesis are favorable surgical methods, but each method has advantages and possible complications such as suture anchor loosening or non-union. Surgeon's preference, patient's chief complaint, specific needs of patient after the operation and consideration of the size of accessory navicular can be a criteria to consider when selecting a surgical method.

A Case Report of Delayed Hemolytic Transfusion Caused by Anti-Fyb Antibody / 대한혈액학회지

As a minor blood antigen, the Duffy blood group has 5 antigens which are Fya, Fyb, Fy3, Fy4 and Fy5. When the Duffy group is implicated in delayed transfusion reactions, one expects to find anti-Fya rather than Fyb. We experienced a case of delayed hemolytic transfusion reaction caused by anti-Fyb antibody. A 69 year-old woman was referred having had hematuria, fever, chill and jaundice 9 days after transfusion. The hemoglobin was 9.5mg/dl, reticulocyte count 1.4%, liver function test showed total bilirubin 10.8mg/dL, LDH 5,225IU/L, alkaline phosphatase 26IU/L. Indirect antiglobulin test was positive, while the direct one was negative. A delayed hemolytic transfusion reaction was suspected as patient's serum was reacted with panel cells for the antibody identification test and the anti-Fyb was finally identified. The patient recovered without specific treatment. There were no severe complication and sequele.It appears to be the first reported case of hemolytic transfusion reaction caused by anti-Fyb in Korea.

Synovectomy of the Rheumatoid Knee Using Intra-articular Injection of 165Dy Hydroxide Macroaggregates / 대한정형외과학회잡지

165Dy Hydroxide Macroaggregates(165Dy HMA) has a short half life(2.3 hours) and a size range of 3-5µm that give the advantage of reduced leakage and a shorter hospital stay. This report will show the results of a prospective open study on the efficacy and safety of 165Dy HMA in 178 knees of 141 patients with chronic synovitis refractory to conventional antirheumatic therapy. The final global assessment was classified as good, fair or poor. Extra-articular leakage of 165Dy HMA was determined by the scintigraphic evaluation of liver, groin and knee joints. The optimum radiation dose was 250 mCi. The mean follow up periods were 32.4(14-112) weeks. Thirty seven percent of the knees showed good results, 48% fair results and 15% poor results. In the knees with stage I radiographic changes, 82% showed improvement including 32% of the patients with good results. In the knees with stage II radiographic changes, 90% showed improvement including 42% of the patients with good results. The mean period of improvement for the 158 knees that responded to treatment was 41.4(24-106) weeks. Leakage of radioactivity from the injected joint was minimal. Adverse reactions were rare(radiation burn : 4 cases, transient postinjection swelling : 14 cases). In conclusion, 165Dy HMA radiation synovectomy is a safe and useful therapy for chromic synovitis of the rheumatoid knees.