Five-year Progress of Gastric MALT Lymphoma Presenting as Gastric Outlet Obstruction / 대한소화기학회지

This paper reports a 70-year-old female with gastric extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (gastric MALT lymphoma) as a rare case of gastric outlet obstruction. Five years earlier, she initially presented with weight loss and anemia. Esophagogastroduodenoscopy (EGD) revealed multiple gastric and duodenal ulcers with a pyloric deformity, while histology revealed chronic active inflammation and a Helicobacter pylori (H. pylori) infection. Three years earlier, she underwent EGD per the National Cancer Screening Program and was diagnosed with antral and duodenal ulcers. A forceps biopsy specimen from one of the ulcers showed the findings of gastric MALT lymphoma, but she did not visit the hospital for proper management. She visited complaining of a loss of appetite. EGD revealed a gastric outlet obstruction (GOO) caused by antral deformity and pyloric narrowing. A staged workup with CT and PET revealed full-layered, encircling antral wall thickening and several enlarged mesenteric lymph nodes. She was finally diagnosed with a gastric MALT lymphoma at Ann Arbor stage I1E with translocation t(11;18). She was treated with palliative surgery for GOO and systemic chemotherapy with a CHOP regimen. This paper reports a gastric MALT lymphoma that progressed from superficial mucosal lesions to an overt mass with regional lymph node metastasis for five years. (Korean J Gastroenterol 2023;81:265 -269)

Machine Learning Prediction for the Recurrence After Electrical Cardioversion of Patients With Persistent Atrial Fibrillation

Background and Objectives@#There is limited evidence regarding machine-learning prediction for the recurrence of atrial fibrillation (AF) after electrical cardioversion (ECV).This study aimed to predict the recurrence of AF after ECV using machine learning of clinical features and electrocardiograms (ECGs) in persistent AF patients. @*Methods@#We analyzed patients who underwent successful ECV for persistent AF. Machine learning was designed to predict patients with 1-month recurrence. Individual 12-lead ECGs were collected before and after ECV. Various clinical features were collected and trained the extreme gradient boost (XGBoost)-based model. Ten-fold cross-validation was used to evaluate the performance of the model. The performance was compared to the C-statistics of the selected clinical features. @*Results@#Among 718 patients (mean age 63.5±9.3 years, men 78.8%), AF recurred in 435(60.6%) patients after 1 month. With the XGBoost-based model, the areas under the receiver operating characteristic curves (AUROCs) were 0.57, 0.60, and 0.63 if the model was trained by clinical features, ECGs, and both (the final model), respectively. For the final model, the sensitivity, specificity, and F1-score were 84.7%, 28.2%, and 0.73, respectively. Although the AF duration showed the best predictive performance (AUROC, 0.58) among the clinical features, it was significantly lower than that of the final machine-learning model (p<0.001).Additional training of extended monitoring data of 15-minute single-lead ECG and photoplethysmography in available patients (n=261) did not significantly improve the model’s performance. @*Conclusions@#Machine learning showed modest performance in predicting AF recurrence after ECV in persistent AF patients, warranting further validation studies.

Consumers’ perceptions of dietary supplements before and after the COVID-19 pandemic based on big data / 한국영양학회지

Purpose@#This study identified words closely associated with the keyword “dietary supplement” (DS) using big data in Korean social media and investigated consumer perceptions and trends related to DSs before (2019) and after the coronavirus disease 2019 (COVID-19) pandemic (2021). @*Methods@#A total of 37,313 keywords were found for the 2019 period, and 35,336 keywords were found for the 2021 period using blogs and cafes on Daum and Naver. Results were derived by text mining, semantic networking, network visualization analysis, and sentiment analysis. @*Results@#The DS-related keywords that frequently appeared before and after COVID-19 were “recommend”, “vitamin”, “health”, “children”, “multiple”, and “lactobacillus”. “Calcium”, “lutein”, “skin”, and “immunity” also had high frequency-inverse document frequency (TF-IDF) values. These keywords imply a keen interest in DSs among Korean consumers. Big data results also reflected social phenomena related to DSs; for example, “baby” and “pregnant woman” had lower TD-IDF values after the pandemic, suggesting lower marriage and birth rates but higher values for “joint”, indicating reduced physical activity. A network centered on vitamins and health care was produced by semantic network analysis in 2019. In 2021, values were highest for deficiency and need, indicating that individuals were searching for DSs after the COVID-19 pandemic due to a lack an awareness of the need for adequate nutrient intake. Before the pandemic, DSs and vitamins were associated with healthcare and life cycle-related topics, such as pregnancy, but after the COVID-19 pandemic, consumer interests changed to disease prevention and treatment. @*Conclusion@#This study provides meaningful clues regarding consumer perceptions and trends related to DSs before and after the COVID-19 pandemic and fundamental data on the effect of the pandemic on consumer interest in dietary supplements.

The association of the Korean Healthy Eating Index with chronic conditions in middle-aged single-person households

BACKGROUND/OBJECTIVES@#This study investigated the association between dietary quality based on the Korean Healthy Eating Index (KHEI), and the prevalence of chronic conditions among middle-aged individuals (40–60 yrs of age) living alone.MATERIALS/METHODS: The participants were selected (1,517 men and 2,596 women) from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2018 and classified into single-person households (SPH) and multi-person households (MPH).Nutrient intake, KHEI, and the prevalence of chronic conditions were compared according to household size. The odds ratios (ORs) of chronic conditions were analyzed according to the tertile levels of KHEI by gender within each household size category. @*RESULTS@#Men in SPH had a significantly lower total KHEI score (P < 0.0001) and a lower prevalence of obesity (OR, 0.576) than those in MPH. For men, the adjusted ORs for obesity, hypertension, and hypertriglyceridemia in the first tertile (T1) of KHEI scores within SPH compared with the third tertile (T3) were 4.625, 3.790, and 4.333, respectively. Moreover, the adjusted OR for hypertriglyceridemia in the T1 group compared to the T3 group within the MPH was 1.556. For women, the adjusted ORs for obesity and hypertriglyceridemia in T1 compared to T3 within the SPH were 3.223 and 7.134, respectively, and 1.573 and 1.373 for obesity and hypertension, respectively, within MPH. @*CONCLUSIONS@#A healthy eating index was associated with a reduced risk of chronic conditions in middle-aged adults. Greater adherence to a healthy eating index could lower the risk of chronic conditions in middle-aged adults living alone.

The Role of Age in Subclinical Atherosclerosis in Asian People Living with Human Immunodeficiency Virus

Background@#People living with human immunodeficiency virus (PLHIV) have an increased risk of atherosclerosis and cardiovascular disease, but specific guidance on when to suspect the onset of these diseases is limited. @*Materials and Methods@#We aimed to identify cardiovascular risk factors in PLHIV using carotid intima-media thickness (IMT) through a cross-sectional, retrospective cohort study that enrolled 217 PLHIV who underwent carotid IMT measurement at a teaching hospital in Korea. We compared clinical characteristics between PLHIV with subclinical atherosclerosis and PLHIV with IMT within the normal range, and used a receiver operating characteristic curve to determine the cut-off age for predicting subclinical atherosclerosis. @*Results@#Among the study population, 115 participants (53.0%) had subclinical atherosclerosis. In logistic regression, age and dyslipidemia were significantly associated with increased carotid IMT even after adjusting for other variables (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.06 - 1.15, P <0.001; OR: 3.92, 95% CI: 1.87 - 8.22, P <0.001, respectively). The cut-off age for predicting subclinical atherosclerosis was 39.5 years (area under the curve 0.78, 95% CI: 0.72 - 0.84, P <0.001). @*Conclusion@#Conventional risk factors including age and dyslipidemia were associated with subclinical atherosclerosis in Asian PLHIV. In particular, Asian PLHIV older than 40 years had an increased risk of subclinical atherosclerosis and may benefit from carotid IMT screening.

Dietary acculturation and changes of Central Asian immigrant workers in South Korea by health perception / 한국영양학회지

Purpose@#This study analyzed the dietary patterns of Central Asian immigrant workers (Mongolia, Kazakhstan, Uzbekistan, and Kyrgyzstan) living in South Korea to determine the food acculturation and how their dietary practices have changed after immigration. @*Methods@#Self-administered questionnaires were completed by 186 Central Asian immigrant workers living in South Korea. A food frequency questionnaire (FFQ) was used to obtain information on the consumption frequency of 22 food items before and after their immigration to Korea. @*Results@#Central Asians switched to Korean meat consumption patterns, which consume mainly pork, chicken, and beef, showing a decrease in the intake of beef and lamb and an increase in that of pork. Their consumption of Namul (cooked vegetable), Kimchi, rice, and marine products increased while that of potatoes decreased during acculturation to Korean food culture. Positive changes were observed in Mongolians’ eating habits. Their meat-based diet turned into a healthy one in which nutritional balance was achieved by consuming the various food groups. Negative dietary changes were also observed; intake of instant foods and coffee increased while black and green tea consumption decreased. Intake of Namul (p < 0.01), Kimchi (p < 0.01), rice (p < 0.001), ramen (p < 0.001), pork, chicken (p < 0.01), fish (p < 0.01), seafood (p < 0.001), and coffee (p < 0.001) increased significantly in the group that responded and their health improved after moving to Korea. This result suggests that health improved among those who were well settled in Korea and ate the various food groups. @*Conclusion@#These findings can help understand the acculturation process to Korean food culture and provide a basis for developing policies to help them adjust to Korean food culture.

Clinical and Virologic Effectiveness of Remdesivir Treatment for Severe Coronavirus Disease 2019 (COVID-19) in Korea: a Nationwide Multicenter Retrospective Cohort Study

Background@#Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. @*Methods@#A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. @*Results@#A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). @*Conclusion@#The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

Dietary acculturation and changes of Central Asian immigrant workers in South Korea by health perception / 한국영양학회지

Purpose@#This study analyzed the dietary patterns of Central Asian immigrant workers (Mongolia, Kazakhstan, Uzbekistan, and Kyrgyzstan) living in South Korea to determine the food acculturation and how their dietary practices have changed after immigration. @*Methods@#Self-administered questionnaires were completed by 186 Central Asian immigrant workers living in South Korea. A food frequency questionnaire (FFQ) was used to obtain information on the consumption frequency of 22 food items before and after their immigration to Korea. @*Results@#Central Asians switched to Korean meat consumption patterns, which consume mainly pork, chicken, and beef, showing a decrease in the intake of beef and lamb and an increase in that of pork. Their consumption of Namul (cooked vegetable), Kimchi, rice, and marine products increased while that of potatoes decreased during acculturation to Korean food culture. Positive changes were observed in Mongolians’ eating habits. Their meat-based diet turned into a healthy one in which nutritional balance was achieved by consuming the various food groups. Negative dietary changes were also observed; intake of instant foods and coffee increased while black and green tea consumption decreased. Intake of Namul (p < 0.01), Kimchi (p < 0.01), rice (p < 0.001), ramen (p < 0.001), pork, chicken (p < 0.01), fish (p < 0.01), seafood (p < 0.001), and coffee (p < 0.001) increased significantly in the group that responded and their health improved after moving to Korea. This result suggests that health improved among those who were well settled in Korea and ate the various food groups. @*Conclusion@#These findings can help understand the acculturation process to Korean food culture and provide a basis for developing policies to help them adjust to Korean food culture.

Clinical and Virologic Effectiveness of Remdesivir Treatment for Severe Coronavirus Disease 2019 (COVID-19) in Korea: a Nationwide Multicenter Retrospective Cohort Study

Background@#Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. @*Methods@#A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. @*Results@#A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). @*Conclusion@#The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

Association between depression and eating behavior factors in Korean adults: the Korea National Health and Nutrition Examination Survey 2018 / 한국영양학회지

Purpose@#This study aimed to examine the association between depression and eating behavior factors in Korean adults. @*Methods@#Study subjects were selected (n = 5,103) from the participants of the 7th Korea National Health and Nutrition Examination Survey 2018 and divided into depression (men, 59; women, 162) and normal groups (men, 2,083; women, 2,799). Subjects with a Patient Health Questionnaire 9 score ≥ 10 (out of 27 points) were defined as having depression. @*Results@#A higher prevalence of depression was observed in both men and women who were unemployed (p < 0.001, p = 0.008), had lower income (both p < 0.001), poorer subjective health (both p < 0.001), and poor food safety (both p < 0.001). The prevalence of depression was higher in women with lower education levels (p = 0.008), who were unmarried (p = 0.010), smokers (p < 0.001), and in a one-person household (p = 0.001). Obese men showed a higher prevalence of depression (p = 0.009). Men who were eating alone or skipping lunch had a high prevalence of depression (p = 0.009), while women who were eating breakfast (p = 0.012), lunch (p = 0.001), and dinner (p = 0.010) alone had a high prevalence of depression. The relationship analysis between men and women according to dietary habits using logistic regression showed that, in women, after variable adjustment, skipping lunch (odds ratio [OR], 2.677; 95% confidence interval [CI], 1.090–6.574), meal frequency of 2 times per day (OR, 1.658; 95% CI, 1.084–2.536), and lunch frequency of 3–4 times per week (OR, 3.143; 95% CI, 1.725–5.728) were significantly associated with a higher prevalence of depression. @*Conclusion@#Depression in women was not only affected by more sociodemographic variables but also associated with decreased frequency of lunch and dinner, especially with skipping lunch.

Previous Long-term Care Facility Admission as a Risk Factor for Scabies in a Medical Facility

The study aimed to elucidate simple and effective risk factors for scabies infection in the medical environment for early detection and prevention of exposure to other patients and medical staff. We conducted a case-control study of patients who were diagnosed with scabies among hospitalized patients between 2008 and 2019 in an acute-care teaching hospital. Each case was matched according to sex and age with two randomly selected controls without scabies during hospitalization. Clinical characteristics of cases at the time of hospital admission were compared to those of the control group. The scabies group included 34 patients and 68 patients who were included in the control group. After adjusting for confounding factors, previous long-term care facility admission was only associated with scabies (adjusted odds ratio, 5.44; 95% confidence interval, 1.46–20.27; P = 0.012). Careful examination, particularly for patients with previous long-term care facility admission, might be useful for the early detection of scabies.

Infectious Diseases Physician Workforce in Korea

This study aimed to evaluate the infectious disease (ID) physician workforce in Korea. We investigated the acquisition of ID physicians from 1992 to 2019 with their current working place in the Health Care System. We defined ID physicians working at general or tertiarycare hospitals as active ID physicians. A total 275 physicians acquired ID as a sub-specialty.Among the 275, 242 were active ID physicians. The density of active ID physicians was 0.47 per 100,000 population. Of all the 17 administrative districts, 11 (64.7%) fell short of 0.47, and 131 medical institutions employed the service of ID physicians. The median number of beds per adult ID physician was 372 (interquartile range, 280–507). It is essential to secure human resources to respond to emerging infectious diseases and perform the inherent work of ID physicians.

Application of machine learning to ultrasound images to differentiate follicular neoplasms of the thyroid gland

Purpose@#This study was conducted to evaluate the diagnostic performance of machine learning in differentiating follicular adenoma from carcinoma using preoperative ultrasonography (US). @*Methods@#In this retrospective study, preoperative US images of 348 nodules from 340 patients were collected from two tertiary referral hospitals. Two experienced radiologists independently reviewed each image and categorized the nodules according to the 2015 American Thyroid Association guideline. Categorization of a nodule as highly suspicious was considered a positive diagnosis for malignancy. The nodules were manually segmented, and 96 radiomic features were extracted from each region of interest. Ten significant features were selected and used as final input variables in our in-house developed classifier models based on an artificial neural network (ANN) and support vector machine (SVM). The diagnostic performance of radiologists and both classifier models was calculated and compared. @*Results@#In total, 252 nodules from 245 patients were confirmed as follicular adenoma and 96 nodules from 95 patients were diagnosed as follicular carcinoma. As measures of diagnostic performance, the average sensitivity, specificity, and accuracy of the two experienced radiologists in discriminating follicular adenoma from carcinoma on preoperative US images were 24.0%, 84.0%, and 64.8%, respectively. The sensitivity, specificity, and accuracy of the ANN and SVM-based models were 32.3%, 90.1%, and 74.1% and 41.7%, 79.4%, and 69.0%, respectively. The kappa value of the two radiologists was 0.076, corresponding to slight agreement. @*Conclusion@#Machine learning-based classifier models may aid in discriminating follicular adenoma from carcinoma using preoperative US.

Persistent severe acute respiratory syndrome coronavirus 2 detection after resolution of coronavirus disease 2019-associated symptoms/signs

There are limited data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory specimens after resolution of coronavirus disease 2019 (COVID-19)-associated symptoms/signs. We determined duration of SARS-CoV-2 virus shedding in symptomatic patients after remission of symptoms. We investigated the duration of SARS-CoV-2 RNA detection using real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 in nasopharyngeal/oropharyngeal swabs or sputum or saliva. Six patients were included in the final analysis. The median (range) duration of SARS-CoV-2 viral detection after hospitalization was 34 days (22 to 67). After resolution of symptoms/signs, SARS-CoV-2 RNA was detected for median (range) of 26 days (9 to 48). Among the six patients, one had persistent detection of SARS-CoV-2 RNA until day 67 of hospitalization, which was 30 days after symptom resolution. This case represents the longest duration of SARS-CoV-2 detection, and highlights the need for long-term follow up of COVID-19 patients despite resolution of symptoms to confirm SARS-CoV-2 clearance.

Infectious Diseases Physician Workforce in Korea

This study aimed to evaluate the infectious disease (ID) physician workforce in Korea. We investigated the acquisition of ID physicians from 1992 to 2019 with their current working place in the Health Care System. We defined ID physicians working at general or tertiarycare hospitals as active ID physicians. A total 275 physicians acquired ID as a sub-specialty.Among the 275, 242 were active ID physicians. The density of active ID physicians was 0.47 per 100,000 population. Of all the 17 administrative districts, 11 (64.7%) fell short of 0.47, and 131 medical institutions employed the service of ID physicians. The median number of beds per adult ID physician was 372 (interquartile range, 280–507). It is essential to secure human resources to respond to emerging infectious diseases and perform the inherent work of ID physicians.

Early Intravenous Colistin Therapy as a Favorable Prognostic Factor for 28-day Mortality in Patients with CRAB Bacteremia: a Multicenter Propensity Score-Matching Analysis

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with high mortality. One of the strategies to reduce the mortality in patients with CRAB infections is to use intravenous colistin early but the effect of this strategy has not been proven. Therefore, we investigated the association of early colistin therapy with 28-day mortality in patients with CRAB bacteremia. METHODS: This retrospective multicenter propensity score-matching analysis was conducted in the Korea by reviewing the medical records of adult patients with CRAB bacteremia between January 2012 and March 2015. Early colistin therapy was defined as intravenous colistin administration for > 48 hours within five days after the blood culture collection. To identify the risk factors associated with the 28-day mortality in CRAB bacteremia, the clinical variables of the surviving patients were compared to those of the deceased patients. RESULTS: Of 303 enrolled patients, seventy-six (25.1%) patients received early colistin therapy. The 28-day mortality was 61.4% (186/303). Fatal or rapidly-fatal McCabe classifications, intensive care unit admission, Sequential Organ Failure Assessment scores ≥ 8, vasopressor use, and acute kidney injury were statistically independent poor prognostic factors. Catheter-related infection and early colistin therapy (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.21–0.94) were independent favorable prognostic factors associated with 28-day mortality in patients with CRAB bacteremia. Early colistin therapy was still significantly associated with lower 28-day mortality in the propensity score-matching analysis (aOR, 0.31; 95% CI, 0.11–0.88). CONCLUSION: This study suggests that early colistin therapy might help reduce the mortality of patients with CRAB bacteremia.

Comparison of the Mismatch Repair System between Primary and Metastatic Colorectal Cancers Using Immunohistochemistry

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignancies worldwide. Approximately 10%–15% of the CRC cases have defective DNA mismatch repair (MMR) genes. Although the high level of microsatellite instability status is a predictor of favorable outcome in primary CRC, little is known about its frequency and importance in secondary CRC. Immunohistochemical staining (IHC) for MMR proteins (e.g., MLH1, MSH2, MSH6, and PMS2) has emerged as a useful technique to complement polymerase chain reaction (PCR) analyses. METHODS: In this study, comparison between the MMR system of primary CRCs and paired liver and lung metastatic lesions was done using IHC and the correlation with clinical outcomes was also examined. RESULTS: Based on IHC, 7/61 primary tumors (11.4%) showed deficient MMR systems, while 13/61 secondary tumors (21.3%) showed deficiencies. In total, 44 cases showed proficient expression in both the primary and metastatic lesions. Three cases showed deficiencies in both the primary and paired metastatic lesions. In 10 cases, proficient expression was found only in the primary lesions, and not in the corresponding metastatic lesions. In four cases, proficient expression was detected in the secondary tumor, but not in the primary tumor. CONCLUSIONS: Although each IHC result and the likely defective genes were not exactly matched between the primary and the metastatic tumors, identical results for primary and metastatic lesions were obtained in 77% of the cases (47/61). These data are in agreement with the previous microsatellite detection studies that used PCR and IHC.

Ultrasonographic Evaluation of Diffuse Thyroid Disease: a Study Comparing Grayscale US and Texture Analysis of Real-Time Elastography (RTE) and Grayscale US

BACKGROUND AND OBJECTIVES: To evaluate and compare the diagnostic performances of grayscale ultrasound (US) and quantitative parameters obtained from texture analysis of grayscale US and elastography images in evaluating patients with diffuse thyroid disease (DTD). MATERIALS AND METHODS: From September to December 2012, 113 patients (mean age, 43.4±10.7 years) who had undergone preoperative staging US and elastography were included in this study. Assessment of the thyroid parenchyma for the diagnosis of DTD was made if US features suggestive of DTD were present. Nine histogram parameters were obtained from the grayscale US and elastography images, from which ‘grayscale index’ and ‘elastography index’ were calculated. Diagnostic performances of grayscale US, texture analysis using grayscale US and elastography were calculated and compared. RESULTS: Of the 113 patients, 85 (75.2%) patients were negative for DTD and 28 (24.8%) were positive for DTD on pathology. The presence of US features suggestive of DTD showed significantly higher rates of DTD on pathology, 60.7% to 8.2% (p0.05). CONCLUSION: Diagnostic performances were the highest for grayscale US features in diagnosis of DTD. Grayscale index may be used as a complementary tool to US features for improving sensitivity and NPV.

Does Polymerase Chain Reaction of Tissue Specimens Aid in the Diagnosis of Tuberculosis?

BACKGROUND: Mycobacterial culture is the gold standard test for diagnosing tuberculosis (TB), but it is time-consuming. Polymerase chain reaction (PCR) is a highly sensitive and specific method that can reduce the time required for diagnosis. The diagnostic efficacy of PCR differs, so this study determined the actual sensitivity of TB-PCR in tissue specimens. METHODS: We retrospectively reviewed 574 cases. The results of the nested PCR of the IS6110 gene, mycobacterial culture, TB-specific antigen-induced interferon-γ release assay (IGRA), acid-fast bacilli (AFB) staining, and histological findings were evaluated. RESULTS: The positivity rates were 17.6% for PCR, 3.3% for the AFB stain, 22.2% for mycobacterial culture, and 55.4% for IGRA. PCR had a low sensitivity (51.1%) and a high specificity (86.3%) based on the culture results of other studies. The sensitivity was higher (65.5%) in cases with necrotizing granuloma but showed the highest sensitivity (66.7%) in those with necrosis only. The concordance rate between the methods indicated that PCR was the best method compared to mycobacterial culture, and the concordance rate increased for the methods using positive result for PCR or histologic features. CONCLUSIONS: PCR of tissue specimens is a good alternative to detect tuberculosis, but it may not be as sensitive as previously suggested. Its reliability may also be influenced by some histological features. Our data showed a higher sensitivity when specimens contained necrosis, which indicated that only specimens with necrosis should be used for PCR to detect tuberculosis.

SIRT7, H3K18ac, and ELK4 Immunohistochemical Expression in Hepatocellular Carcinoma

BACKGROUND: SIRT7 is one of the histone deacetylases and is NAD-dependent. It forms a complex with ETS-like transcription factor 4 (ELK4), which deacetylates H3K18ac and works as a transcriptional suppressor. Overexpression of SIRT7 and deacetylation of H3K18ac have been shown to be associated with aggressive clinical behavior in some cancers, including hepatocellular carcinoma (HCC). The present study investigated the immunohistochemical expression of SIRT7, H3K18ac, and ELK4 in hepatocellular carcinoma. METHODS: A total of 278 HCC patients were enrolled in this study. Tissue microarray blocks were made from existing paraffin-embedded blocks. Immunohistochemical expressions of SIRT7, H3K18ac and ELK4 were scored and analyzed. RESULTS: High SIRT7 (p = .034), high H3K18ac (p = .001), and low ELK4 (p = .021) groups were associated with poor outcomes. Age < 65 years (p = .028), tumor size ≥ 5 cm (p = .001), presence of vascular emboli (p = .003), involvement of surgical margin (p = .001), and high American Joint Committee on Cancer stage (III&V) (p < .001) were correlated with worse prognoses. In multivariate analysis, H3K18ac (p = .001) and ELK4 (p = .015) were the significant independent prognostic factors. CONCLUSIONS: High SIRT7 expression with poor overall survival implies that deacetylation of H3K18ac contributes to progression of HCC. High H3K18ac expression with poor prognosis is predicted due to a compensation mechanism. In addition, high ELK4 expression with good prognosis suggests another role of ELK4 as a tumor suppressor beyond SIRT7's helper. In conclusion, we could assume that the H3K18ac deacetylation pathway is influenced by many other factors.