Machine Learning to Compare Frequent Medical Problems of African American and Caucasian Diabetic Kidney Patients / 대한의료정보학회지

OBJECTIVES: End-stage renal disease (ESRD), which is primarily a consequence of diabetes mellitus, shows an exemplary health disparity between African American and Caucasian patients in the United States. Because diabetic chronic kidney disease (CKD) patients of these two groups show differences in their medical problems, the markers leading to ESRD are also expected to differ. The purpose of this study was, therefore, to compare their medical complications at various levels of kidney function and to identify markers that can be used to predict ESRD. METHODS: The data of type 2 diabetic patients was obtained from the 2012 Cerner database, which totaled 1,038,499 records. The data was then filtered to include only African American and Caucasian outpatients with estimated glomerular filtration rates (eGFR), leaving 4,623 records. A priori machine learning was used to discover frequently appearing medical problems within the filtered data. CKD is defined as abnormalities of kidney structure, present for >3 months. RESULTS: This study found that African Americans have much higher rates of CKD-related medical problems than Caucasians for all five stages, and prominent markers leading to ESRD were discovered only for the African American group. These markers are high glucose, high systolic blood pressure (BP), obesity, alcohol/drug use, and low hematocrit. Additionally, the roles of systolic BP and diastolic BP vary depending on the CKD stage. CONCLUSIONS: This research discovered frequently appearing medical problems across five stages of CKD and further showed that many of the markers reported in previous studies are more applicable to African American patients than Caucasian patients.

Periodontitis is associated with rheumatoid arthritis: a study with longstanding rheumatoid arthritis patients in Korea

BACKGROUND/AIMS: A cross-sectional study was undertaken to investigate the association between severity of periodontitis and clinical manifestation of rheumatoid arthritis (RA). METHODS: Two hundred sixty-four RA patients and 88 age- and sex-matched controls underwent dental exam. Additionally, clinical manifestations including disease activity and anti-citrullinated protein antibodies were evaluated in RA patients. RESULTS: The prevalence of moderate or severe periodontitis was higher in RA patients compared to controls (63.6% vs 34.1%, p < 0.001). In markers of periodontal inflammation, bleeding on probing was correlated with disease activity score 28 (r = 0.128, p = 0.041), RA disease duration (r = 0.211, p = 0.001), erythrocyte sedimentation rate (ESR; r = 0.141, p = 0.023), anti-cyclic citrullinated peptide antibody (r = 0.183, p = 0.009), and anti-citrullinated α-enolase peptide-1 antibody (r = 0.143, p = 0.025). Gingival index was correlated with RA duration (r = 0.262, p < 0.001), ESR (r = 0.162, p = 0.009), anti-cyclic citrullinated peptide antibody (r = 0.203, p = 0.004) and anti-citrullinated α-enolase peptide-1 antibody (r = 0.225, p < 0.001). Periodontal structural damage represented by probing pocket depth and clinical attachment level were less in RA patients with human leukocyte antigen (HLA)-DRB1 shared epitope compared than those without shared epitope (p = 0.005 and p =0.006, respectively). CONCLUSIONS: The prevalence of moderate or severe periodontitis was increased in RA patients compared to controls. Periodontal inflammation was correlated with RA disease duration, ESR, and anti-citrullinated protein antibodies. Periodontal structural damage was less in RA patients with HLA-DRB1 shared epitope.

Cancer Rehabilitation: Experience, Symptoms, and Needs

The aim of this study was to examine the experience of cancer patients undergoing rehabilitation, to identify symptoms associated with rehabilitation from cancer, and to assess the need for rehabilitation services for cancer patients. Cancer patients (n = 402) at the Asan Medical Center (Seoul, Korea) were enrolled from June to September 2008. A chart review was used to collect demographic and clinical data, including type of cancer, current treatment, time from initial diagnosis to screening, and cancer stage. Each participant provided informed consent and was then given a questionnaire that asked about experience with rehabilitation, symptoms associated with rehabilitation, and the need for different types of rehabilitation services. Clinicians recommended rehabilitation for 8.5% of patients, and 6.7% underwent rehabilitation. Among study patients, 83.8% had one or more symptoms associated with rehabilitation, and 71.6% of patients with symptoms wanted rehabilitation management. The need for rehabilitation was associated with the presence of metastasis, advanced cancer stage, time to diagnosis, and type of current treatment. Our results provide specific information about particular functional symptoms and the rehabilitative needs of subgroups of cancer patients. It is suggested to develope and implement rehabilitation programs for cancer patients.

The Effect of Virtual Reality Training on Unilateral Spatial Neglect in Stroke Patients

OBJECTIVE: To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients. METHOD: Twenty-four stroke patients (14 males and 10 females, mean age=64.7) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited. All patients were randomly assigned to either the virtual reality (VR) group (n=12) or the control group (n=12). The VR group received VR training, which stimulated the left side of their bodies. The control group received conventional neglect therapy such as visual scanning training. Both groups received therapy for 30 minutes a day, five days per week for three weeks. Outcome measurements included star cancellation test, line bisection test, Catherine Bergego scale (CBS), and the Korean version of modified Barthel index (K-MBI). These measurements were taken before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between the two groups. The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment. The changes in line bisection test score and the K-MBI in the VR group were not statistically significant. CONCLUSION: This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients.

Sequential Tongue Pressure and Laryngeal Movement during Swallowing

OBJECTIVE: To test the repeatability and the reproducibility of a newly developed device which measures tongue pressure and laryngeal movement, to identify the range of tongue pressure and to reveal the relationships between tongue pressure and age, gender and diet formula. METHOD: One hundred five healthy subjects (50 males, 55 females, range 20 to 74 years) were recruited for the study. They had examinations of tongue pressure and laryngeal movement. The pressure was measured with two air-filled bulbs connected to a transducer. Laryngeal movement was measured with a strain gauge. The test was repeated three times with a two minute rest interval and monitored twice by the same investigator and once by another investigator. All subjects performed 10 times of swallowing: 5 times each of 3 ml liquid and dry swallowing. RESULTS: Intraclass correlation coefficient (ICC) for both the repeatability and the reproducibility revealed good to moderate reliability for tongue pressure measurement and the time of maximum tongue pressure (ICC, 0.60~0.84). However, it was poor for measurement of laryngeal movement. There were no significant differences between gender and age groups in tongue pressure, the time to maximum tongue pressure and laryngeal movement. The tongue pressure was higher in dry swallowing than in wet swallowing. Also, the time to maximum tongue pressure and overall laryngeal movement were prolonged in dry swallowing. CONCLUSION: The newly developed tongue pressure measurement system is a reliable apparatus and there are no significant age and gender differences in tongue and laryngeal movement in healthy subjects.

Trunk Impairment Scale for Evaluation of Functional Improvement in Acute Stroke Patients

OBJECTIVE: To evaluate the change of balance of the trunk using the Trunk Impairment Scale (TIS) in acute stroke patients and to compare it with the improvement in activities in their daily living (ADL) and gait. METHOD: The mean days from the onset of stroke were 11.3 (6~17) days, and functional improvement of 24 hemiplegic patients was evaluated using the trunk impairment scale, Berg balance scale, timed up and go test, 6 minutes walk test, and the modified Barthel index every week for 4 weeks' conventional rehabilitation programs. Correlations between the trunk impairment scale and the other parameters were evaluated. RESULTS: The trunk impairment scale and the modified Barthel index, both which showed significant improvement after 4 weeks, had statistically significant correlation (p<0.05). The Berg balance scale had not improved significantly in 4 weeks. The timed up and go test and the 6 minutes' walk test could not be evaluated in most of these patients within 4 weeks. CONCLUSION: The trunk impairment scale could be a useful parameter for evaluating activities in their daily living (ADL) improvement in acute stroke patients who are unable to ambulate independently. And good trunk balance in acute stroke period is positive correlation with ambulation potential.

The Effect of Neuromuscular Electrical Stimulation on Trunk Control in Hemiparetic Stroke Patients

OBJECTIVE: To determine the effectiveness of electrical stimulation over the trunk in improving trunk control during early stroke rehabilitation. METHOD: Thirty-two acute and subacute hemiparetic stroke patients were enrolled in this study. All patients were randomly assigned to one of two groups, control group or electrical stimulation (ES) group. Both groups received the same physical therapy for 3 weeks. ES group received additional electrical stimulation over the posterior back muscles for 30 minutes a day, 5 days per week for 3 weeks. Outcome measurements included Korean version of Berg balance scale (K-BBS), total score of postural assessment scale for stroke patients (PASS), trunk control subscale of postural assessment scale for stroke patients (PASS-TC), trunk control test (TCT), Korean version of modified Barthel index (K-MBI), and motricity index (MI). These measurements were checked before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between two groups. Following 3 weeks therapy, the changes of TCT and PASS-TC scores in the ES group were significantly higher than those of the control group (p <0.05). The changes of K-BBS, PASS, and K-MBI scores in the ES group tend to be higher than those in the control group. However the differences were not statistically significant. The changes of PASS-TC and TCT scores were significantly correlated with the changes of BBS and K-MBI scores at discharge. CONCLUSION: This study suggests that electrical stimulation over the trunk may be a beneficial therapeutic technique in improving trunk control in acute and subacute hemiparetic stroke patients.

Stroke in Colorectal Cancer Patients

OBJECTIVE: To find the characteristics of stroke in colorectal cancer patients. METHOD: We retrospectively analyzed 32 patients of stroke in colorectal cancer who were operated from January 2001 to December 2002 by reviewing their charts and brain CTs or MRIs. The type, risk factor, localization and origin of stroke and the stage of colorectal cancer were analyzed. RESULTS: The mean age was 69.2 years. TNM stage II (41%) was the most common. Twenty-three cases were ischemic stroke, four were hemorrhagic stroke and the others were unidentified. Diabetes (63%), hypertension (53%), cardiac disease (19%), and family history of stroke (9%) were observed in patients. The main cause of ischemic stroke was arterial thrombosis, and lacunar and middle cerebral infarction were more common in ischemic stroke. CONCLUSION: Several common risk factors between colorectal cancer and stroke were observed, and these risk factors are associated with the atherosclerosis of cerebral vascular system. To reduce the incidence of cerebrovascular disease and colorectal cancer, we may need to control those risk factors.

The efficacy of umbilical artery blood flow velocity waveform to predict the perinatal outcome of term pregnancies with small for gestational age / 대한산부인과학회지

OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.

The efficacy of umbilical artery blood flow velocity waveform to predict the perinatal outcome of term pregnancies with small for gestational age / 대한산부인과학회지

OBJECTIVE: To investigate whether umbilical artery Doppler blood flow velocity waveform is effective in predicting perinatal outcome of term pregnancies with small for gestational age (SGA). METHODS: A total of 381 patients at 37~41 weeks of gestational age (GA) who received antenatal umbilical artery Doppler blood flow test and delivered singleton SGA infants. The ratio of peak-systolic to end-diastolic (S/D) blood flow velocities in the umbilical artery was measured in each patient. The patients were divided into a normal group (n=307) with a S/D ratio equal to or less than 3.0, and an abnormal group with a S/D ratio of greater than 3.0 (n=74). These groups were comparatively analysed with respect to maternal characteristics and neonatal outcomes. Results: There were no significant differences between the two groups in mean maternal age, gestational age at the time of delivery, and cesarean section rate due to fetal distress. There was significantly increased incidence of hypertensive disorders in pregnancy in the abnormal S/D ratio group. And the abnormal S/D ratio group showed lower neonatal birthweight, higher incidence of admission to neonatal intensive care unit (NICU), and longer stay in neonatal intensive care unit. According to linear regression, in pregnancies complicated by SGA, abnormal S/D ratio was still a risk factor for low birthweight even after controlling for the incidence of hypertension. Conclusion: In term pregnancies accompanied by SGA, abnormal umbilical artery S/D ratio is an independent predictor of neonatal birth weight, incidence of admission to NICU, and NICU stay.

Does pretreatment HPV viral load correlate with prognosis in patients with early stage cervical carcinoma? / 부인종양

OBJECTIVE: Recent data suggest that pretreatment HPV (Human papillomavirus) viral load is useful to predict the severity of intraepithelial lesions of the uterine cervix and formulate a treatment plan. However, the relationship between initial HPV viral load and prognosis of cervical cancer patients has not yet been clearly defined. The objective of this study was to determine whether HPV viral load has prognostic significance in patients with early stage cervical carcinoma treated by surgery. METHODS: A retrospective review of all patients with early stage cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy at our institution from August 2003 to December 2007 was conducted. Patients were included only if they had pretreatment Hybrid Capture II test for HPV DNA detection. RESULTS: We identified 34 patients who met the inclusion criteria. Two groups were identified: patients who had low HPV viral load (100 RLU). There were no differences in age, FIGO stage, histology, pathologic risk factors - tumor size, deep stromal invasion, lymph-vascular space invasion, parametrial extensions, vaginal margin involvement, and lymph node metastasis - and adjuvant CCRT. There was no significant difference of disease-free survival regard to pretreatment HPV viral load (p=0.7756). CONCLUSION: In our study, survival was not significantly different between early stage cervical cancer patients who had low and high pretreatment HPV viral load. It seems that pretreatment HPV viral load may not be of help to predict disease prognosis.

Factors influencing quality of life of cervical cancer patients in Korea / 대한산부인과학회지

OBJECTIVE: To assess the quality of life (QOL) of uterine cervical cancer patients after treatment in Korea and to demonstrate influencing factors. METHODS: 127 uterine cancer survivors, 107 controls of benign gynecologic surgery patients were interviewed with study questionnaire by research assistant. RESULTS: Participants were with the mean age of 54 years (cancer patients) and 43 years (controls). Physical component score of General QOL was statistically significant in uterine cervical cancer group compared with control group (p=0.049). Parts of MCS, CS-QOL, Emotional support, Coping efforts didn't show differences between two groups. In patients' characteristics, high economic status and advanced stage influenced patient's adaptation to treatment. When evaluating QOL including sexual function, most parts were statistically significantly worsen in uterine cancer patients, ie, sexual dysfunction (p=0.004), sexual discomfort (p=0.070), sexual pleasure (p=0.011), gynecological symptom (p=0.001). Most factors except age didn't influence sexual function deterioration between cancer group and control group. Common presenting concerns of cancer patients before treatment was health (51%), children (23%), economic problem (16%) but after treatment health (92%). The most helpful people were family members in 84% and physicians in 9%. CONCLUSION: Uterine cervical cancer survivors in Korea appear to experience greater distress on sexual function especially in young age. Therefore it is important for health care professionals to recognize that aspects of cancer survivorship continue to require education and adequate follow-up program.

The association of the cervical intraepithelial neoplasia and human papillomavirus viral load / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to determine the relationship between the cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) DNA load and to evaluate the efficacy of viral load in prediction of histologic severity. METHODS: The cervical cytology and Hybrid Capture II tests for HPV detection were performed in 2411 women visited our hospital, from August 2003 to October 2004. A total of 259 consecutive women underwent cervical colposcopy directed biopsy and operations with confirmed final histologic diagnoses were included. Viral load was measured by Hybrid Capture II system expressed as relative lights unit (RLU) ratio of specimens and controls. RESULTS: There was no significant difference of CIN 1, CIN 2, CIN 3, SCC group and control group in the clinical characteristics. The higher the viral load, the higher stage of CIN was shown. HPV viral load test showed sensitivity of 82.9%, specificity of 37.7%, positive predictability of 60.0%, negative predictability of 66.2% in detecting CIN, while 94.4%, 34.3%, 67.5%, 80.8% in detecting HGSIL. The viral loads were categorized into four groups (negative, low, intermediate, high) for analysis and it was shown that higher viral load group tended to exist CIN more frequently (odds ratio=1, 1.8, 3.4, 3.5). In addition, viral load was more strongly associated with the risk of HGSIL than that of LGSIL (odds ratio=1, 6.7, 9.0, 9.6). CONCLUSION: We found that the higher HPV viral load is significantly associated with the higher stage of CIN. The measurement of HPV DNA load is useful for predicting the severity of lesions of the uterine cervix and making decision of treatment plans.