Long-term risk of all-cause mortality in live kidney donors: a matched cohort study

Long-term outcomes of live kidney donors remain controversial, although this information is crucial for selecting potential donors. Thus, this study compared the long-term risk of all-cause mortality between live kidney donors and healthy control. Methods: We performed a retrospective cohort study including donors from seven tertiary hospitals in South Korea. Persons who underwent voluntary health screening were included as controls. We created a matched control group considering age, sex, era, body mass index, baseline hypertension, diabetes, estimated glomerular filtration rate, and dipstick albuminuria. The study outcome was progression to end-stage kidney disease (ESKD), and all-cause mortality as identified in the linked claims database. Results: We screened 1,878 kidney donors and 78,115 health screening examinees from 2003 to 2016. After matching, 1,701 persons remained in each group. The median age of the matched study subjects was 44 years, and 46.6% were male. Among the study subjects, 2.7% and 16.6% had underlying diabetes and hypertension, respectively. There were no ESKD events in the matched donor and control groups. There were 24 (1.4%) and 12 mortality cases (0.7%) in the matched donor and control groups, respectively. In the age-sex adjusted model, the risk for all-cause mortality was significantly higher in the donor group than in the control group. However, the significance was not retained after socioeconomic status was included as a covariate (adjusted hazard ratio, 1.82; 95% confidence interval, 0.87–3.80). Conclusion: All-cause mortality was similar in live kidney donors and matched non-donor healthy controls with similar health status and socioeconomic status in the Korean population.

Metabolic risks in living kidney donors in South Korea

Background@#Considering the growing prevalence of Western lifestyles and related chronic diseases occurring in South Korea, this study aimed to explore the progression of metabolic risk factors in living kidney donors compared to a control group. @*Methods@#This study enrolled living kidney donors from seven hospitals from 1982 to 2016. The controls were individuals that voluntarily received health check-ups from 1995 to 2016 that were matched with donors according to age, sex, diabetes status, baseline estimated glomerular filtration rate, and date of the medical record. Data on hyperuricemia, hypertension, hypercholesterolemia, and overweight/obesity were collected to determine metabolic risks. The proportion of individuals with three or more metabolic risk factors was evaluated. Logistic regressions with interaction terms between the medical record date and donor status were used to compare the trends in metabolic risks over time in the two groups. @*Results@#A total of 2,018 living kidney donors and matched non-donors were included. The median age was 44.0 years (interquartile range, 34.0–51.0 years) and 54% were women. The living kidney donors showed a lower absolute prevalence for all metabolic risk factors, except for those that were overweight/obese, than the non-donors. The proportion of subjects that were overweight/obese was consistently higher over time in the donor group. The changes over time in the prevalence of each metabolic risk were not significantly different between groups, except for a lower prevalence of metabolic risk factors ≥ 3 in donors. @*Conclusion@#Over time, metabolic risks in living kidney donors are generally the same as in non-donors, except for a lower prevalence of metabolic risk factors ≥ 3 in donors.

Clinical Significance of Acute Kidney Injury in Lung Cancer Patients / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Acute kidney injury (AKI) in cancer patients is associated with increased morbidity and mortality. The incidence of AKI in lung cancer seems to be relatively higher compared with other solid organ malignancies, although its impact on patient outcomes remains unclear. @*Materials and Methods@#The patients newly diagnosed with lung cancer from 2004 to 2013 were enrolled in this retrospective cohort study. The patients were categorized according to the presence and severity of AKI. We compared all-cause mortality and long-term renal outcome according to AKI stage. @*Results@#A total of 3,202 patients were included in the final analysis. AKI occurred in 1,783 (55.7%) patients during the follow-up period, with the majority having mild AKI stage 1 (75.8%). During the follow-up of 2.6±2.2 years, total 1,251 patients (53.7%) were died and 5-year survival rate was 46.9%. We found that both AKI development and severity were independent risk factors for all-cause mortality in lung cancer patients, even after adjustment for lung cancer-specific variables including the stage or pathological type. In addition, patients suffered from more severe AKI tend to encounter de novo chronic kidney disease development, worsening kidney function, and end-stage kidney disease progression. @*Conclusion@#In this study, more than half of the lung cancer patients experienced AKI during their diagnosis and treatment period. Moreover, AKI occurrence and more advanced AKI were associated with a higher mortality risk and adverse kidney outcomes.

Post-stroke Hyperglycemia in Non-diabetic Ischemic Stroke is Related With Worse Functional Outcome: A Cohort Study

Objective@#To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia. @*Methods@#The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset. @*Results@#There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months. @*Conclusion@#The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.

Influenza Vaccine Effectiveness in Children at the Emergency Department during the 2018-2019 Season: the First Season School-aged Children Were Included in the Korean Influenza National Immunization Program

Background@#For the 2018–2019 season, the national influenza immunization program expanded to cover children aged from 6 months to 12 years in Korea. This study aimed to analyze vaccine effectiveness (VE) against influenza in children visiting the pediatric emergency room at a tertiary hospital during the 2018-2019 season. @*Methods@#Patients tested for influenza antigens from October 1st 2018 to May 31st 2019 at the pediatric emergency room of Samsung Medical Center were included. Patients' influenza antigen test results, influenza vaccination history, and underlying medical conditions were reviewed retrospectively. VE was estimated from the test-negative design study. @*Results@#Among the 2,901 visits with influenza test results 1,692 visits of 1,417 patients were included for analysis. Among these 1,417 patients, 285 (20.1%) were positive (influenza A, n = 211, 74.0%; influenza B, n = 74, 26.0%). The VE in all patients was 36.4% (95% confidence interval [CI], 13.9 to 53.1). The VE for influenza A was 37.6% (95% CI, 12.6 to 55.5) and VE for influenza B was 24.0% (−38.5 to 58.3). The VE in the age group 6 months to 12 years was significant with a value of 35.6% (95% CI, 10.5 to 53.7); it was not statistically significant in the age group 13 to 18 years. In a multivariate logistic regression model, patients who received an influenza vaccination were less likely to get influenza infection (OR, 0.6; 95% CI, 0.4 to 0.8; P = 0.001), with significant confounding factors such as age group 13 to 18 years (OR, 0.5; 95% CI, 0.3 to 0.8; P = 0.003) and underlying hematology-oncology disease (OR, 0.3;95% CI, 0.1 to 0.6; P = 0.002). @*Conclusion@#We report moderate effectiveness of influenza vaccination in previously healthy children aged from 6 months to 12 years in the 2018-2019 season.

Influenza Vaccine Effectiveness in Children at the Emergency Department during the 2018-2019 Season: the First Season School-aged Children Were Included in the Korean Influenza National Immunization Program

Background@#For the 2018–2019 season, the national influenza immunization program expanded to cover children aged from 6 months to 12 years in Korea. This study aimed to analyze vaccine effectiveness (VE) against influenza in children visiting the pediatric emergency room at a tertiary hospital during the 2018-2019 season. @*Methods@#Patients tested for influenza antigens from October 1st 2018 to May 31st 2019 at the pediatric emergency room of Samsung Medical Center were included. Patients' influenza antigen test results, influenza vaccination history, and underlying medical conditions were reviewed retrospectively. VE was estimated from the test-negative design study. @*Results@#Among the 2,901 visits with influenza test results 1,692 visits of 1,417 patients were included for analysis. Among these 1,417 patients, 285 (20.1%) were positive (influenza A, n = 211, 74.0%; influenza B, n = 74, 26.0%). The VE in all patients was 36.4% (95% confidence interval [CI], 13.9 to 53.1). The VE for influenza A was 37.6% (95% CI, 12.6 to 55.5) and VE for influenza B was 24.0% (−38.5 to 58.3). The VE in the age group 6 months to 12 years was significant with a value of 35.6% (95% CI, 10.5 to 53.7); it was not statistically significant in the age group 13 to 18 years. In a multivariate logistic regression model, patients who received an influenza vaccination were less likely to get influenza infection (OR, 0.6; 95% CI, 0.4 to 0.8; P = 0.001), with significant confounding factors such as age group 13 to 18 years (OR, 0.5; 95% CI, 0.3 to 0.8; P = 0.003) and underlying hematology-oncology disease (OR, 0.3;95% CI, 0.1 to 0.6; P = 0.002). @*Conclusion@#We report moderate effectiveness of influenza vaccination in previously healthy children aged from 6 months to 12 years in the 2018-2019 season.

Characteristics of kidney transplantation recipients over time in South Korea

Background/Aims@#Detailed nationwide information regarding the recent status and time trends of kidney transplantation (KT) in South Korea is limited. @*Methods@#We performed a nationwide, population-based cohort study using the national claims database of Korea. We included KT recipients from 2008 to 2016, and their demographic and clinical characteristics were collected. The prognostic outcome was graft failure consisted of patient death and death-censored graft failure (DCGF). @*Results@#We studied 14,601 KT recipients with median follow-up duration of 3.96 years. The median age at the time of transplantation consistently increased from the past, and proportion of underlying diabetes mellitus prominently increased, reaching 35.6% in 2016. The preemptive KT accounted for approximately 30% of the total transplantation cases. The recipients showed a 10-year cumulative graft survival rate of 71.8%, consisting of 10-year DCGF free survival of 77.6% and patient survival of 92.8%. Age ≥ 20 and 60,000,000$ in 2016. However, the expansion was mainly burdened by the national insurance service but not by the patients. @*Conclusions@#In South Korea, the number of kidney transplantation in elderly or in patients with comorbidities has been increasing. Complex clinical factors were associated with medication compliance and patient prognosis.

Left Ventricular End-Systolic Volume Can Predict 1-Year Hierarchical Clinical Composite End Point in Patients with Cardiac Resynchronization Therapy

PURPOSE: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). MATERIALS AND METHODS: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. RESULTS: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p < 0.001). CONCLUSION: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.

Comparison of Functions, Activity of Daily Living, and Quality of Life according to Hand Dominance in Stroke

OBJECTIVE: We investigated the differences of functions, activity of daily living (ADL), and quality of life (QoL) according to hand dominance in hemiplegic stroke patients. METHOD: The participants were diagnosed as stroke at P hospital. 370 participants (356 right dominant hand, 14 left dominant hand) were right hemisphere stroke, and 258 participants (248 right dominant hand, 10 left dominant hand) were left hemisphere stroke. To compensate the differences of imbalance in the number of participants' hand dominance, we performed the propensity score matching analysis. We analyzed the variation of stroke severity, disability, motor, mobility, cognition and language functions from 7 days until 3 months after onset using analysis of covariance (ANCOVA). Then, we performed independent t-test to compare hand dexterity, ADL, mood, subjective health condition and QoL of participants according to the hand dominance and the affected hemisphere. RESULTS: All groups showed increased functions during 3 months without statistically significant differences according to hand dominance in both right and left hemisphere stroke patients. In addition, ADL, mood, subjective health condition and QoL were also not significantly different depending on hand dominance in the right and left hemisphere. CONCLUSION: The difference of hand dominance did not influence stroke severity, disability, motor, mobility, cognition or language functions. It also didn't correlate with ADLs, mood or QoL.

Web-Based Integrated Public Healthcare Information System of Korea: Development and Performance / 대한의료정보학회지

OBJECTIVES: The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system. METHODS: We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system. RESULTS: The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level. CONCLUSIONS: PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance.

Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature

A 35-year-old woman was determined to have an ovarian cyst and underwent a right ovarian cystectomy at 10 weeks of gestation. A histopathological examination revealed follicular carcinoma arising in a teratoma. No evidence of metastasis was found after delivery. She underwent a total thyroidectomy, followed by radioactive iodine (RAI) therapy. However, her serum thyroglobulin level increased to 1,437 ng/ml (normal range: 0-52 ng/ml) after 10 months. Radioiodine scintigraphy and abdominal computed tomography revealed liver metastasis and peritoneal seeding. She underwent debulking surgery of the liver, right salpinx, and peritoneal seeding nodules. A pathological examination showed metastatic follicular carcinoma with focal poorly differentiated features. Adjuvant RAI therapy was restarted, and her serum thyroglobulin levels returned to normal. In conclusion, metastatic lesions were successfully treated with a combination of debulking surgery and RAI therapy. Close medical follow-up monitoring serum thyroglobulin levels is mandatory in such patients.

Trimix Intracavernosal Injection Therapy in Patients with Erectile Dysfunction: Long-term Follow-up Result / 대한비뇨기과학회지

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.

Use of Serum PSA in Comparison of Biopsy Gleason Score with Radical Prostatectomy Gleason Score / 대한비뇨기과학회지

PURPOSE: The Gleason score of needle biopsies of the prostate and preoperative serum level of prostate-specific antigen(PSA) are two useful factors in predicting the final pathological staging of patients with prostate cancer treated by radical prostatectomy. Unfortunately, the Gleason score of the biopsy cores often differs from the Gleason score of radical prostatectomy specimen. We evaluated the role of Gleason scores of biopsy cores and the influence of PSA in predicting the Gleason scores of prostatectomy specimens and final pathological staging. MATERIALS AND METHODS: The records of 52 patients with prostate cancer treated by radical prostatectomy from June 1990 to June 1997 were reviewed. The patients were divided into three groups according to the sum of the Gleason scores, i.e. well differentiated(Gleason score 2-4), intermediate(5-7) and poorly differentiated tumors(8-10). The concordance between Gleason score of biopsy and prostatectomy specimen was analysed according to the Gleason score of tumor in biopsy specimen. Furthermore, we evaluated the different level of PSA could affect the concordance rate between Gleason scoreofbiopsyandprostatectomyspecimen. RESULTS: In well-differentiated tumors(Gleason score 2-4) in biopsy specimen, the concordance rate was 55.6%, In intermediate(5-7) differentiated cancers the Gleason score remained the same in 68%. In poorly differentiated tumors, the concordance rate was 72.2%. When PSA was less than 10ng/m1, concordance rate of well differentiated tumors and poorly differentiated tumors was 75%, 40%, respectively. Whereas the concordance rate of well differentiated tumors was 50% and that of poorly differentiated tumors was 90% when the PSA was higher than 20ng/m1. Using linear regression analysis, the preoperative PSA highly correlated with radical prostatectomy Gleason score(correlation coefficient(r)=0.38, p =0.005). CONCLUSIONS: The Gleason score of prostatectomy specimen was upgraded in 44.4% when the biopsy Gleason score was well differentiated, especially when preoperative PSA was higher than 20ng/m1. Therefore, the significance of biopsy Gleason score in the clinical application must be used cautiously when it is used to predict the pathological stage or biological potential of the cancer especially when it is low Gleason score with high PSA( > 20ng/m1). In the meantime, the level of PSA plays an significant role in determining organ confined disease, while high Gleason scone reflect the Iymph node positive disease.

Age-specific Reference Ranges for Prostate-specific Antigen from a Community-based Study / 대한비뇨기과학회지

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.

Two-year Experiences of Ureteral Stones: SWL Versus Ureteroscopic Manipulation / 대한비뇨기과학회지

PURPOSE: Shockwave lithotripsy(SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stone management. MATERIALS AND METHODS: From January 1994 to December 1995, 651 patients of ureteral stones were treated and 589 patients were retrospectively reviewed excluding 62 patients for incomplete follow ups. Four hundred and forty-two patients were treated with SWL using MPL 9000 with ultrasonic guidance, 115 patients with ureteroscopic manipulation using 7.9 to 11.5Fr rigid and semirigid ureteroscopes. RESULTS: In SWL treatments, overall stone free rate was 74.7% with one session, Stone free rate was significantly affected by the size of stones. Stone free rate was 83.6% when the stone was smaller than 1.0cm and 42.1% when the stone was larger than 1.0cm Stone free rate after second SWL session was 84.4% and 90.3% after third session. The stone free rates according to the site of stones were 72.4(proximal), 70.0(mid), 80.2(distal), respectively. In ureteroscopic manipulation, overall stone free rate of 87.8% was obtained regardless of the size of stones. The success rates according to the location of stones were 75.0(proximal), 94.6(mid), 86.4%(distal), respectively. Open ureterolithotomy was performed in 32 patients with 100% success rate. CONCLUSIONS: In our study, the size of stones was the most important factor influencing the success rate of SWL treatment for ureteral stones. We consider ureteroscopic manipulation as the first line treatment modality when the stone is larger than 1.0cm, especially in distal ureter, Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.