Machine-Learning Model for the Prediction of Hypoxaemia during Endoscopic Retrograde Cholangiopancreatography under Monitored Anaesthesia Care

Purpose@#Hypoxaemia is a significant adverse event during endoscopic retrograde cholangiopancreatography (ERCP) under monitored anaesthesia care (MAC); however, no model has been developed to predict hypoxaemia. We aimed to develop and compare logistic regression (LR) and machine learning (ML) models to predict hypoxaemia during ERCP under MAC. @*Materials and Methods@#We collected patient data from our institutional ERCP database. The study population was randomly divided into training and test sets (7:3). Models were fit to training data and evaluated on unseen test data. The training set was further split into k-fold (k=5) for tuning hyperparameters, such as feature selection and early stopping. Models were trained over k loops; the i-th fold was set aside as a validation set in the i-th loop. Model performance was measured using area under the curve (AUC). @*Results@#We identified 6114 cases of ERCP under MAC, with a total hypoxaemia rate of 5.9%. The LR model was established by combining eight variables and had a test AUC of 0.693. The ML and LR models were evaluated on 30 independent data splits. The average test AUC for LR was 0.7230, which improved to 0.7336 by adding eight more variables with an l 1 regularisation-based selection technique and ensembling the LRs and gradient boosting algorithm (GBM). The high-risk group was discriminated using the GBM ensemble model, with a sensitivity and specificity of 63.6% and 72.2%, respectively. @*Conclusion@#We established GBM ensemble model and LR model for risk prediction, which demonstrated good potential for preventing hypoxaemia during ERCP under MAC.

Association between Complementary and Alternative Medicine Use and Fear of Cancer Recurrence among Breast Cancer Survivors / 가정의학회지

Background@#This study aimed to evaluate the association between complementary and alternative medicine (CAM) use and fear of cancer recurrence (FCR) among breast cancer survivors, using a validated multidimensional FCR-assessing instrument. Despite the debate over its medical effects, the use of CAM in breast cancer survivors is increasing. @*Methods@#We recruited 326 breast cancer survivors who had completed the primary cancer treatment. Information on CAM use was obtained using a self-administered questionnaire, and FCR was assessed using the Korean version of the FCR Inventory (FCRI). Multivariate linear regression analysis was performed to evaluate the association between CAM use and FCR. @*Results@#CAM users had higher total FCR scores than CAM non-users after covariate adjustment (CAM users: 74.6 vs. CAM non-users: 68.7; P=0.047). Among the FCRI subscales, CAM users showed higher coping strategy scores (CAM users: 22.3 vs. CAM non-users: 20.6; P=0.034) in the multivariable adjusted analysis. The use of multiple types of CAM was associated with increased FCR in a dose-dependent manner (P=0.002). @*Conclusion@#Breast cancer survivors who used CAM had a higher FCR than CAM non-users. The dose-response relationship between the use of multiple types of CAM and FCR suggests that breast cancer survivors who use multiple types of CAM should be provided with appropriate psychological interventions to decrease FCR.

Revised Korean Antiviral Guideline Reduces the Hepatitis B-related Hepatocellular Carcinoma Risk in Cirrhotic Patients

Background@#Since September 2015, the initiation of antiviral therapy (AVT) for patients with chronic hepatitis B (CHB)-related cirrhosis has been reimbursed according to the revised Korean Association for the Study of Liver (KASL) guideline, if the patient had hepatitis B virus DNA level ≥ 2,000 IU/L, regardless of aminotransferase or alanine aminotransferase levels. This study investigated whether the KASL guideline implementation reduced the risk of CHB-related hepatocellular carcinoma (HCC) in patients with cirrhosis in South Korea. @*Methods@#A total of 429 patients with CHB-related cirrhosis who initiated AVT between 2014 and 2016 were recruited. The risk of HCC development was compared between patients who initiated AVT before and after September 2015 (pre-guideline [n = 196, 45.7%] vs. postguideline implementation [n = 233, 54.3%]). @*Results@#Univariate analysis showed that AVT initiation before guideline implementation, older age, male gender, and diabetes significantly predicted increased risk of HCC development (all P < 0.05). Subsequent multivariate analysis showed that AVT initiation before guideline implementation (HR = 1.941), older age (HR = 5.762), male gender (HR = 2.555), and diabetes (HR = 1.568) independently predicted increased risk of HCC development (all P < 0.05). Additionally, multivariate analysis showed that AVT initiation before guideline implementation (HR = 2.309), male gender (HR = 3.058), and lower platelet count (HR = 0.989) independently predicted mortality (P < 0.05). The cumulative incidences of HCC and mortality were significantly higher in patients who initiated AVT before guideline implementation than in those who initiated AVT after guideline implementation (all P < 0.05, log-rank test). @*Conclusion@#The prognosis of patients with CHB-related cirrhosis who initiated AVT improved after guideline implementation according to the revised KASL guideline.

Revised Korean Antiviral Guideline Reduces the Hepatitis B-related Hepatocellular Carcinoma Risk in Cirrhotic Patients

Background@#Since September 2015, the initiation of antiviral therapy (AVT) for patients with chronic hepatitis B (CHB)-related cirrhosis has been reimbursed according to the revised Korean Association for the Study of Liver (KASL) guideline, if the patient had hepatitis B virus DNA level ≥ 2,000 IU/L, regardless of aminotransferase or alanine aminotransferase levels. This study investigated whether the KASL guideline implementation reduced the risk of CHB-related hepatocellular carcinoma (HCC) in patients with cirrhosis in South Korea. @*Methods@#A total of 429 patients with CHB-related cirrhosis who initiated AVT between 2014 and 2016 were recruited. The risk of HCC development was compared between patients who initiated AVT before and after September 2015 (pre-guideline [n = 196, 45.7%] vs. postguideline implementation [n = 233, 54.3%]). @*Results@#Univariate analysis showed that AVT initiation before guideline implementation, older age, male gender, and diabetes significantly predicted increased risk of HCC development (all P < 0.05). Subsequent multivariate analysis showed that AVT initiation before guideline implementation (HR = 1.941), older age (HR = 5.762), male gender (HR = 2.555), and diabetes (HR = 1.568) independently predicted increased risk of HCC development (all P < 0.05). Additionally, multivariate analysis showed that AVT initiation before guideline implementation (HR = 2.309), male gender (HR = 3.058), and lower platelet count (HR = 0.989) independently predicted mortality (P < 0.05). The cumulative incidences of HCC and mortality were significantly higher in patients who initiated AVT before guideline implementation than in those who initiated AVT after guideline implementation (all P < 0.05, log-rank test). @*Conclusion@#The prognosis of patients with CHB-related cirrhosis who initiated AVT improved after guideline implementation according to the revised KASL guideline.

Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation

PURPOSE: Descent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by “true cervical elongation,” compared with vaginal hysterectomy (VH). MATERIALS AND METHODS: Medical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤−4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage. RESULTS: During the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08–2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01–0.75) were identified as significant risk factors for recurrence of POP. CONCLUSION: The Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.

Frequency of Depression and Suicidality in Patients with Neurological Disorders: Epilepsy, Parkinson's Disease, and Ischemic Stroke

BACKGROUND: Depression and suicide are common in neurological disorders. However, their reported frequencies have varied widely due to heterogeneities in methodology and assessment timing. We evaluated the frequencies of current depression and suicidality in patients with epilepsy, Parkinson's disease (PD), and ischemic stroke (IS). METHODS: We enrolled patients who visited a tertiary care hospital in Seoul between January and December 2013. All of the patients completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D). Any patient with depressive symptoms (defined as a total HADS-D or BDI score of ≥9 or ≥17, respectively) was reassessed with a structured psychiatric interview based on the Mini International Neuropsychiatric Interview Plus 5.0.0 (MINI). RESULTS: In total, 305 patients were recruited, comprising epilepsy (n=92, 30.2%), PD (n=99, 32.4%), and IS (n=114, 37.4%). Depressive symptoms were exhibited by 52 epilepsy patients (56.5%), 56 PD patients (56.6%), and 54 IS patients (47.4%), and these were further evaluated with the aid of the MINI. Seven epilepsy patients were diagnosed as major depressive disorder (MDD), five as dysthymic disorder (DD), and nine as depressive disorder not otherwise specified (DDNOS). Twelve PD patients were diagnosed as MDD, 7 as DD, and 10 as DDNOS. Ten stroke patients were diagnosed as MDD, 7 as DD, and 11 as DDNOS. Most patients with depressive symptoms (91.4%) exhibited suicidality. CONCLUSIONS: Patients with epilepsy, PD, and IS frequently exhibit depression and suicidality. Neurologists should always be concerned about comorbid psychiatric problems when they see patients with neurological disorders.

Development of a validated liquid chromatography-tandem mass spectrometry assay for the quantification of simvastatin acid, the active metabolite of simvastatin, in human plasma

Simvastatin is a lipid-lowering drug that is metabolized to its active metabolite simvastatin acid (SA). We developed and validated a sensitive liquid chromatography-tandem mass spectrometry (LC/MS/MS) method to quantitate SA in human plasma using a liquid-liquid extraction method with methanol. The protonated analytes generated in negative ion mode were monitored by multiple reaction monitoring. Using 500-mL plasma aliquots, SA was quantified in the range of 0.1-100 ng/mL. Calibration was performed by internal standardization with lovastatin acid, and regression curves were generated using a weighting factor of 1/χ2. The linearity, precision, and accuracy of this assay for each compound were validated using quality control samples consisting of mixtures of SA (0.1, 0.5, 5, and 50 ng/mL) and plasma. The intra-batch accuracy was 95.3-107.8%, precision was -2.2% to -3.7%, and linearity (r2) was over 0.998 in the standard calibration range. The chromatographic running time was 3.0 min. This method sensitively and reliably measured SA concentrations in human plasma and was successfully used in clinical pharmacokinetic studies of simvastatin in healthy Korean adult male volunteers.

Expression of MAGE-1, -2, and -3 genes in gastric carcinomas and cancer cell lines derived from Korean patients

We investigated the expression of MAGE-1, -2, and -3 genes in tissues of 51 gastric carcinomas from Korean patients and in 11 gastric cancer cell lines established in Korea using reverse transcriptase-polymerase chain reaction along with immunohistochemical analyses and DNA sequencing. Among the 51 gastric carcinomas, MAGE-1, -2, and -3 genes were expressed in 16 (31%), 22 (43%), and 17 (33%), respectively, and 31 (60%) expressed at least one of the three genes. In contrast, none of the three MAGE genes were expressed in normal sites of gastric tissue from each cancer patient. Out of 11 gastric cancer cell lines, MAGE-1, -2, and -3 genes were expressed in two (18%), five (46%), and four (36%), respectively. According to the clinicopathological analysis, the expression of any of the three MAGE genes was not significantly correlated with several clinicopathological factors except histologic types (p= 0.067). Immunohistochemical analyses identified positive staining with monoclonal antibodies 77B and 57B specifically against MAGE-1 and -3 proteins, respectively, in nuclei and cytoplasms of cells in mRNA-positive tumor tissue. These findings suggest the possibility as a target for tumor-specific immunotherapy for Korean patients.

A Case of Abdominal Actinomycosis / 대한소화기내시경학회지

Actinomycosis is a chronic suppurative and granulomatous disease caused by actinomyces species and caracterized by sulfur granule formation which frequently discharged via draining sinus. Actinomyces can affect cervicofacial, pulmonary, abdominal and pelvic area. Most of abdominal actinomycosis is developed after abdominal operation, trauma or inflammatory bowel disease and it must be differentiated from colon cancer, amaeboma, chronic appendicitis or intestinal tuberculosis. We report a case of abdominal actinomycosis, preoperatively impressed as colon carcinoma, which was diagnosed by histological study of the operative specimen. Adequate surgical excision and drainage procedure followed by administration of massive dose of penicilline for weeks. In this case we noted secondary abscess formation after surgery of primary disease. Herein we present our experience with reviewed literatures.

A Case of Primary Angiosarcoma of the Liver / 대한간학회지

In spite of its rarity, hepatic angiosarcoma is of special interest because specific risk factors such as thorium dioxide, arsenic, and vinyl chloride have been identified. We report a case of histopathologically confirmed primary angiosarcoma of the liver which was found in a farmer. In this case, 73-ear old man was presented with right upper abdominal pain and fatigue. Abdominal ultrasonography, CT scan and MRI revealed a mass occupying broad area of the right lobe of the liver. Histopathologic diagnosis of angiosarcoma was made by percutaneous needle biopsy.

A case of acute coma & respiratory arrest in Wernicke's encephalopathy caused by malnutrition / 대한내과학회지

We shoud give attention to Wernicke's encephalopathy as a cause of sudden coma & respiratory arrest in patients, who are not usually suspected to develop the disorder and empirical treatment with thiamine in cases of coma of unknown cause is recommended. Respiratory stimulants, doxapram & aminophylline have an effect in assisting ventilatory weaning in patient with central hypoventilation as a complication of acute Wernicke's encephalopathy No previous reports where doxapram had been used to assist weaning from mechanical ventilation in adults were noted. Nor has newly developed central hypoventilation been identified as an impediment to weaning in literature to date in Korea. We reported a rare case of Wernicke's encephalopathy caused by poor oral intake & inadequate nutritional suppliment after car accident, showing acute coma & respiratory arrest and treated adequately by thiamine replacement & mechanical ventilation with respiratory stimulant.

Clinical analysis of 8 cases on double primary malignancy associated with hematopoietic malignancy / 대한혈액학회지

No abstract available.