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Background@#Angiotensin-converting enzyme 2 facilitates the entry of severe acute respiratory syndrome coronavirus 2 into the human body. We investigated the association of renin-angiotensin-aldosterone system (RAAS) inhibitor use with severe coronavirus disease 2019 (COVID-19) outcomes in hypertensive patients. @*Methods@#We identified hypertensive patients with confirmed COVID-19 from the Korean Health Insurance Review and Assessment Service from inception to May 15, 2020. The primary outcome was the composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and death from COVID-19. The individual components were evaluated as secondary outcomes. @*Results@#Of 1,374 hypertensive patients with COVID-19, 1,076 (78.3%) and 298 (21.7%) were users and never-users of RAAS inhibitors, respectively. The RAAS inhibitor users were not associated with the risk of the primary outcome (adjusted odds ratio [aOR], 0.72; 95% confidence interval [CI], 0.46 to 1.10). The risk of ICU admission was significantly lower in the users than the never-users (aOR, 0.44; 95% CI, 0.24 to 0.84). The RAAS inhibitors were beneficial only in ICU admissions that did not require IMV (aOR, 0.28; 95% CI, 0.14 to 0.58). The risk of death from COVID-19 was comparable between the groups (aOR, 1.09; 95% CI, 0.64 to 1.85). We could not evaluate the risks of CRRT and ECMO owing to the small number of events. @*Conclusion@#RAAS inhibitor use was not associated with the composite of severe outcomes in the hypertensive patients with COVID-19 but significantly lowered the risk of ICU admission, particularly in patients who did not require IMV.
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Background@#Angiotensin-converting enzyme 2 facilitates the entry of severe acute respiratory syndrome coronavirus 2 into the human body. We investigated the association of renin-angiotensin-aldosterone system (RAAS) inhibitor use with severe coronavirus disease 2019 (COVID-19) outcomes in hypertensive patients. @*Methods@#We identified hypertensive patients with confirmed COVID-19 from the Korean Health Insurance Review and Assessment Service from inception to May 15, 2020. The primary outcome was the composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and death from COVID-19. The individual components were evaluated as secondary outcomes. @*Results@#Of 1,374 hypertensive patients with COVID-19, 1,076 (78.3%) and 298 (21.7%) were users and never-users of RAAS inhibitors, respectively. The RAAS inhibitor users were not associated with the risk of the primary outcome (adjusted odds ratio [aOR], 0.72; 95% confidence interval [CI], 0.46 to 1.10). The risk of ICU admission was significantly lower in the users than the never-users (aOR, 0.44; 95% CI, 0.24 to 0.84). The RAAS inhibitors were beneficial only in ICU admissions that did not require IMV (aOR, 0.28; 95% CI, 0.14 to 0.58). The risk of death from COVID-19 was comparable between the groups (aOR, 1.09; 95% CI, 0.64 to 1.85). We could not evaluate the risks of CRRT and ECMO owing to the small number of events. @*Conclusion@#RAAS inhibitor use was not associated with the composite of severe outcomes in the hypertensive patients with COVID-19 but significantly lowered the risk of ICU admission, particularly in patients who did not require IMV.
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Purpose@#Several investigations have been performed for a postoperative edema after extraction, but the results have been controversial due to low objectivity or poorly reproducible assessments of the edema. The aim of this study was to suggest a classification and patterns of postoperative edema according to the anatomical division associated with extraction of mandibular third molar as a qualitative evaluation method. @*Methods@#This study was conducted forty-four mandibular third molars extracted and MRI was taken within 48 h after extraction. The postoperative edema space was classified by MRI (one anatomic component—buccinator muscle—and four fascial spaces—supra-periosteum space, buccal space, parapharyngeal space, and lingual space), and evaluated independently by two examiners. The inter-examiner reliability was calculated using Kappa statistics. @*Results@#The evaluation of buccinator muscle edema showed good agreement and the fascial spaces showed constant high agreement. The incidence of postoperative edema was high in the following order: supra-periosteum space (75.00%), buccinator muscle (68.18%), parapharyngeal space (54.55%), buccal space (40.91%), and lingual space (25.00%). @*Conclusion@#Postoperative edema could be assessed clearly by each space, which showed a different tendency between the anatomic and fascial spaces.
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Background@#Dental studies of precocious puberty have focused on examination of jaw and dentition growth. The aim of the study was to analyze the relationship between precocious puberty and maxillary dental developmental abnormalities (DDAs). @*Methods@#This retrospective study was conducted on the Korean patients in whom dental panoramic and hand-wrist radiographs had been taken before they were 15 years of age. The maxillary DDAs were assessed as mesiodens, congenital missing teeth, peg-shape lateral incisors, or impacted teeth. The chronological ages of the control group members were within the normal range of the hand-wrist bone age. Others with a peak luteinizing hormone of ≥ 5 and < 5 IU/L were allocated to central precocious puberty (CPP) and peripheral precocious puberty (PPP), respectively. @*Results@#Of the enrolled 270 patients, 195, 52, and 23 were allocated to the control, CPP, and PPP groups, respectively. The maxillary DDAs were significantly more prevalent in the CPP group than in the other groups. Among those with maxillary DDA, the mesiodens predominated. Age- and sex-adjusted multivariate analysis revealed maxillary DDA (odds ratio, 3.36; 95% CI, 1.60-7.05) and especially mesiodens (odds ratio, 5.52; CI, 2.29-13.28) to be significantly associated with CPP. @*Conclusions@#Maxillary DDAs were significantly more prevalent in the CPP group than in the PPP or control groups. Among the many types of maxillary DDAs, mesiodens was significantly associated with CPP and may be considered a predictor of the development of CPP.
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Objectives@#This study aimed to validate the effectiveness of a recently proposed difficulty index for removal of impacted mandibular third molars based on extraction time and suggest a modified difficulty index including the presence of pathologic conditions associated with third molars. @*Materials and Methods@#This retrospective study enrolled 65 male patients younger than 25 years with third molars. Extraction time was calculated from start of the incision to the last suture. The difficulty scores for third molars were based on spatial relationship (1-5 points), depth (1-4 points), and ramus relationship (1-3 points) using cone-beam computed tomography. The difficulty index was defined as follows: I (3-4 points), II (5-7 points), III (8-10 points), and IV (11-12 points). The modified difficulty score was calculated by adding one point to the difficulty score if the third molar was associated with a pathologic condition. Two modified difficulty indices, based on the presence of pathologic conditions, were as follows: the half-level up difficulty index (HDI) and the one-level up difficulty index (ODI) from the recently proposed difficulty index. @*Results@#The correlations between extraction time and difficulty index and or modified difficulty indices were significant (P<0.001). The correlation coefficient between extraction time and difficulty index was 0.584. The correlation coefficients between extraction time and HDI and ODI were 0.728 and 0.764, respectively. @*Conclusion@#Extraction time of impacted third molars exhibited a moderate correlation with difficulty index and was strongly correlated with the modified indices. Considering the clinical implications, the difficulty index of surgical extraction should take into consideration the pathologic conditions associated with third molars.
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Background/Aims@#Helicobacter pylori (Hp) suppresses gastric acid secretion by repressing the expression of the H+, K+ -adenosine triphosphatase (H+, K+ -ATPase) and stimulat-ing interleukin-1 (IL-1β; encoded by IL-1B). This study was aimed at evaluating the expression of the H+, K+ -ATPase and IL-1β after Hp eradication. @*Methods@#Two hundred twentyone subjects were categorized as Hp-negative (n=84) or Hppositive (n=137) according to the results of Hp tests (histol-ogy, CLO test, culturing, and serology). The mRNA expression levels of IL-1B and ATP4A (the gene encoding the α-subunit of H+, K+ -ATPase) were measured in biopsy specimens from the gastric corpus using real-time polymerase chain reac-tion. @*Results@#The Hp-positive group had significantly higher IL-1B mRNA levels than the whole Hp-negative group and the intestinal metaplasia (IM)-negative subgroup. After Hp eradication, the difference between the Hp-negative and Hperadicated groups disappeared, including in the IM-negative subgroup. The IL-1B mRNA level did not significantly change from the baseline level. Within the gastric cancer (GC)/dys-plasia subgroup, the IL-1B mRNA levels at 1, 2, 3–4, and ≥5 years after Hp eradication were significantly lower than the baseline level. The difference in ATP4A mRNA levels between the Hp-negative and Hp-positive groups was not significant at baseline, and the changes in the ATP4A mRNA levels after Hp eradication compared to the baseline levels in the whole group and subgroups stratified by the presence of IM and GC/dysplasia were not significant. @*Conclusions@#Infection with Hp has an effect on the level of IL-1B mRNA in IM-negative subjects. The continuous reduction in the IL-1B mRNA level in patients with GC/dysplasia after Hp eradica-tion contributes to the prevention of metachronous GC after Hp eradication.
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Background@#Dental studies of precocious puberty have focused on examination of jaw and dentition growth. The aim of the study was to analyze the relationship between precocious puberty and maxillary dental developmental abnormalities (DDAs). @*Methods@#This retrospective study was conducted on the Korean patients in whom dental panoramic and hand-wrist radiographs had been taken before they were 15 years of age. The maxillary DDAs were assessed as mesiodens, congenital missing teeth, peg-shape lateral incisors, or impacted teeth. The chronological ages of the control group members were within the normal range of the hand-wrist bone age. Others with a peak luteinizing hormone of ≥ 5 and < 5 IU/L were allocated to central precocious puberty (CPP) and peripheral precocious puberty (PPP), respectively. @*Results@#Of the enrolled 270 patients, 195, 52, and 23 were allocated to the control, CPP, and PPP groups, respectively. The maxillary DDAs were significantly more prevalent in the CPP group than in the other groups. Among those with maxillary DDA, the mesiodens predominated. Age- and sex-adjusted multivariate analysis revealed maxillary DDA (odds ratio, 3.36; 95% CI, 1.60-7.05) and especially mesiodens (odds ratio, 5.52; CI, 2.29-13.28) to be significantly associated with CPP. @*Conclusions@#Maxillary DDAs were significantly more prevalent in the CPP group than in the PPP or control groups. Among the many types of maxillary DDAs, mesiodens was significantly associated with CPP and may be considered a predictor of the development of CPP.
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PURPOSE: A soft tissue sarcoma (STS) is a rare type of cancer, accounting for 1% of adult solid cancers. The aim of the present study is to determine the incidence of localized and advanced STS in Korean patients, their treatment patterns, and the survival of patients by disease status. MATERIALS AND METHODS: The STS patient cohort was defined using National Health Insurance Service medical data from 2002 to 2015. Incidence, distribution, anatomical location of tumors, survival rates (Kaplan-Meyer survival function) and treatment patterns were analyzed by applying different algorithms to the STS cohort containing localized and advanced STS cases. RESULTS: A total of 7,813 patients were diagnosed with STS from 2007 to 2014, 4,307 were localized STS and 3,506 advanced STS cases. The total incidence of STS was 2.49 per 100,000 person- years: 1.37 per 100,000 person-years for localized STS and 1.12 per 100,000 person-years for advanced STS. The 5-year survival rate after diagnosis was 56.4% for all STS, 82.4% for localized, and 27.2% for advanced STS. Half of the advanced STS patients (49.98%) received anthracycline-containing chemotherapy as initial treatment after diagnosis. CONCLUSION: This study provides insights into localized and advanced STS epidemiology, treatment patterns and outcomes in Korea, which could be used as fundamental data in improving clinical outcomes of STS patients in the future.
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Adulto , Humanos , Estudos de Coortes , Diagnóstico , Tratamento Farmacológico , Epidemiologia , Incidência , Coreia (Geográfico) , Programas Nacionais de Saúde , Sarcoma , Taxa de SobrevidaRESUMO
Intussusception is seen often in children but relatively few cases occur in adults. In many cases, the etiology of intussusception in adults is a tumor, with adenocarcinoma being the most common tumor in the small intestine. Gastro-intestinal stromal tumor (GIST) is caused by a mutation of the interstitial cells of Cajal, which controls the speed of peristalsis by being involved in the autonomic innervation between the bowel wall and the smooth muscles of the gastrointestinal tract, and is rarely a factor in adult intussusception. We reported a case of a 74-year-old male patient who came to our hospital with hematochezia and was found to have jejunal intussusception from GIST.
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Adulto , Idoso , Criança , Humanos , Masculino , Adenocarcinoma , Hemorragia Gastrointestinal , Tumores do Estroma Gastrointestinal , Trato Gastrointestinal , Células Intersticiais de Cajal , Intestino Delgado , Intussuscepção , Músculo Liso , Peristaltismo , PorfirinasRESUMO
A 71-year-old man with a history of percutaneous transluminal coronary angioplasty(PTCA) was referred to our clinic with a one-day history of a continuous substernal chest pain radiating to his left shoulder. In retrospect, he experien- ced chest discomfort after eating fish one day before but did not seek medical attention then. An upper gastrointestinal endoscopy was performed. The cause was not visible during the advancement of the endoscope through the eso- phagus, but a small segment of a fish bone protruding from an ulcerative lesion in the lower esophagus was iden- tified while withdrawing the endoscope. The fishbone was immediately removed. A follow-up CT scan revealed pneumo- mediastinum. Now hemodynamically stable, the patient underwent conservative medical treatment including total parenteral nutrition(TPN) and intravenous antibiotic drugs. The patient made complete recovery. We report a case of a 71- year-old male found to have an esophageal perforation from an ingested fish bone, which was managed successfully with conservative treatment. A pertinent literature review is also included.