Mutations in myeloid transcription factors and activated signaling genes predict chronic myeloid leukemia outcomes.

ABSTRACT: Advancements in genomics are transforming the clinical management of chronic myeloid leukemia (CML) toward precision medicine. The impact of somatic mutations on treatment outcomes is still under debate. We studied the association of somatic mutations in epigenetic modifier genes and activated signaling/myeloid transcription factors (AS/MTFs) with disease progression and treatment failure in patients with CML after tyrosine kinase inhibitor (TKI) therapy. A total of 394 CML samples were sequenced, including 254 samples collected at initial diagnosis and 140 samples taken during follow-up. Single-molecule molecular inversion probe (smMIP)-based next-generation sequencing (NGS) was conducted targeting recurrently mutated loci in 40 genes, with a limit of detection of 0.2%. Seventy mutations were detected in 57 diagnostic samples (22.4%), whereas 64 mutations were detected in 39 of the follow-up samples (27.9%). Carrying any mutation at initial diagnosis was associated with worse outcomes after TKI therapy, particularly in AS/MTF genes. Patients having these mutations at initial diagnosis and treated with imatinib showed higher risks of treatment failure (hazard ratio, 2.53; 95% confidence interval, 1.13-5.66; P = .0239). The adverse prognostic impact of the mutations was not clear for patients treated with second-generation TKIs. The multivariate analysis affirmed that mutations in AS/MTF genes independently serve as adverse prognostic factors for molecular response, failure-free survival, and progression risk. Additionally, there was an observable nonsignificant trend indicating a heightened risk of progression to advanced disease and worse overall survival. In conclusion, mutations in the AS/MTF genes using smMIP-based NGS can help identify patients with a potential risk of both treatment failure and progression and may help upfront TKI selection.

Expired Platelet Concentrate Up-Cycling: Growth Factor-Rich Bioproduct Preparation for FBS Substitute.

Due to the short storage period, large quantities of platelet concentrate (PC) are expiring. The expired PC cannot be injected into a blood vessel, but the activity of bioactive molecules, especially growth factors, is still preserved. In this paper, we organized a process to obtain a growth factor-rich bioproduct for use as a supplement in human cell culture by optimizing freezing, thawing, and sterilization conditions. Each unit of PC displayed visual differences, diverse biochemical values, and growth factor concentrations. To minimize lot-to-lot variation, we pooled a minimum of 10 PC units. The concentrations of growth factors were maximized through five freeze-thaw cycles for 12 h at -80 °C for freezing and for 5 min at 36 °C for thawing. We used a cell strainer with 40 µm pores, followed by a 0.45 µm filter and a 0.22 µm filter sequentially to sterilize the bioproduct with minimizing loss. The obtained growth factors remained stable for 4-6 h at room temperature (23 °C), 24 h at 4 °C, and 12 months at -80 °C. Cellular responses to the growth factor-rich bioproduct were tested with primary human renal proximal tubule epithelial cells. The cells exhibited a significantly increased growth rate, compared to the fetal bovine serum (FBS)-treated control group. The cells maintained their characteristic cuboidal shape, and stem cells and renal progenitor cells also preserved their genetic characteristics during culture. Therefore, the growth factor-rich bioproduct isolated from expired PC through our process can be used as a medium supplement to replace FBS in human cell culture for clinical application.

Bound for Gaussian-state quantum illumination using a direct photon measurement.

It is important to find feasible measurement bounds for quantum information protocols. We present analytic bounds for quantum illumination with Gaussian states when using an on-off detection or a photon number resolving (PNR) detection, where its performance is evaluated with signal-to-noise ratio. First, for coincidence counting measurement, the best performance is given by the two-mode squeezed vacuum (TMSV) state which outperforms the coherent state and the classically correlated thermal (CCT) state. However, the coherent state can beat the TMSV state with increasing signal mean photon number in the case of the on-off detection. Second, the performance is enhanced by taking Fisher information approach with all counting probabilities including non-detection events. In the Fisher information approach, the TMSV state still presents the best performance but the CCT state can beat the TMSV state with increasing signal mean photon number in the case of the on-off detection. Furthermore, we show that it is useful to take the PNR detection on the signal mode and the on-off detection on the idler mode, which reaches similar performance of using PNR detection on both modes.

The Impact of Regular Exercise, Competition Experience, and Physical Self-efficacy on Psychological Resilience / El impacto del ejercicio regular, la experiencia competitiva y la autoeficacia física en la resiliencia psicológica

The concept of resilience has a crucial role in various aspects of individuals' lives, including physical exercise, self-efficacy, self-esteem, body image, and overall welfare. The importance of this factor in assisting athletes in effectively navigating the demands of sports performance should not be underestimated. The present study aims to investigate the effects of consistent physical exercise and participation in competitive activities on an individual's psychological resilience. A cross-sectional analysis was conducted on a sample of 329 participants, consisting of 229 individuals who engaged in regular exercise and 100 individuals who did not exercise. The participants were selected from athletics club members and college students. The Resilience Scale and Physical Self-Efficacy Questionnaire were administered to the participants using a survey conducted through Google Forms. Prior informed consent was obtained from all participants. The findings suggest that those in the regular exercise group had enhanced emotional impulse control, heightened positive emotions, improved communication skills, more empathy, and greater self-improvement in comparison to those in the non-exercise group. In a similar vein, individuals who took part in competitive activities had a significant improvement in their ability to regulate their emotional impulses, showed a greater understanding and management of positive emotions, exhibited improved communication abilities, displayed heightened empathetic capacities, and experienced enhanced personal growth compared to those who did not participate. The aforementioned results highlight the beneficial impact of consistent physical activity in strengthening one's psychological resilience, which is consistent with previous research that has demonstrated exercise's ability to reduce stress and enhance resilience. This study highlights the positive associations between consistent physical activity, engagement in competitive sports, and increased psychological resilience among athletes. Examining these connections offers practical knowledge for athletes and sports professionals aiming to enhance their psychological well-being and performance in demanding environments.(AU)

Trajectories of Anxiety Symptoms for COVID-19 Patients Using Multimodal Data Collected from Telemedicine.

We designed and developed Remote Patient Monitoring (RPM) system specific for coronavirus (COVID-19) patients, and collected multimodal data. Using the collected data, we explored the trajectories of anxiety symptoms for 199 COVID-19 patients quarantined at home. Two classes were identified using latent class linear mixed model. Thirty-six patients showed an exacerbation of anxiety. Presence of initial psychological symptoms, pain on the start day of quarantine, and abdominal discomfort at one month after finishing the quarantine were associated with exacerbation of anxiety.

How do automated reasoning features impact the usability of a clinical task management system? Development and usability testing of a prototype.

BACKGROUND: Electronic clinical task management systems (ECTMSs) have been developed and adopted by care providers to improve care coordination. Some systems utilised automated reasoning (AR) to enable more intelligent task management functionalities, such as automated task allocation. Yet, the impact of such features on usability remains unclear. Poor usability of health information systems has been described to cause frustration and contribute to patient safety incidents. AIM: To design AR features for an ECTMS and to evaluate their impact on usability. METHODS: In this mixed methods study, four ECTMS feature prototypes were co-designed with two clinicians. For each prototype, one AR variant and one non-AR variant with equivalent functionalities were developed. A moderated usability testing was conducted with seven clinicians to obtain ease-of-use ratings of prototypes and measure task durations. Parameters related to demographics and attitudes of participants were obtained via a questionnaire. A framework analysis was performed to summarise qualitative feedback. To determine statistical relationships of study variables, Spearmans rank coefficients were calculated and presented as a correlation matrix. RESULTS: Three out of four prototypes received higher median ease-of-use ratings for AR variants and were associated with shorter average task durations. Multiple clinical use cases suitable for AR were identified. Preference for AR was found to moderately correlate with digital proficiency and prior experience with ECTMSs. Insufficient trust in automation, alert fatigue, and system customisation were identified as challenges in the adoption of AR features. CONCLUSIONS: This study provides evidence for the potential of AR to enhance usability in ECTMSs. Consideration of psychological and organisational context of users in the feature design was found to be decisive for usability. Future research should explore implications for operational and clinical outcomes.

Development of New Plastic-Crystal Based Electrolytes using Pyrrolidinium- Bis(fluorosulfonyl)imide Dicationic Salts.

Dicationic organic salts are an interesting class of solid-state electrolyte materials due to their unique structure. Here we present, for the first time, the synthesis and characterization of three dicationic-FSI salts, 1,2-bis(N-methylpyrrolidinium)ethane bi(bis(fluorosulfonyl)imide) ([C2 -Pyrr1][FSI]2 ), 1,2-bis(N-ethylpyrrolidinium)ethane bi(bis(fluorosulfonyl)imide) ([C2 -Pyrr2][FSI]2 ) and 1,2-bis(N-n-propylpyrrolidinium)ethane bi(bis(fluorosulfonyl)imide) ([C2 -Pyrr3][FSI]2 ). The structure and dynamics of the organic salts were probed using variable temperature solid-state NMR and were compared with the thermal and transport properties. The investigation revealed that [C2 -Pyrr1][FSI]2 , with shorter alkyl-side chains on the dication, displayed increased transport properties compared to [C2 -Pyrr2][FSI]2 and [C2 -Pyrr3][FSI]2 . To determine the proficiency of these dicationic-FSI salts as electrolyte materials for battery applications, 10 mol% and 50 mol% lithium bis(fluorosulfonyl)imide (LiFSI) was mixed with [C2 -Pyrr1][FSI]2 and [C2 -Pyrr2][FSI]2 . Increased transport properties were observed for [C2 -Pyrr1][FSI]2 /10 mol % LiFSI in comparison to [C2 -Pyrr2][FSI]2 /10 % LiFSI, while pulse field gradient NMR analysis revealed the highest Li+ self-diffusion ratio for [C2 -Pyrr1][FSI]2 /50 % LiFSI out of the four Li-salt-containing mixtures.

Effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with chronic spinal stenosis accompanying mild spondylolisthesis: a longitudinal cohort study

Background@#Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. @*Methods@#Patients’ sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. @*Results@#A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. @*Conclusions@#Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

Incidence of Upper Respiratory Diseases During the COVID-19 Pandemic: A Nationwide Data-Based Epidemiological Study / 대한이비인후과학회지

Background and Objectives@#Nonpharmacologic interventions (NPIs), such as social distancing and preventive measures, were administered during the coronavirus disease (COVID-19) pandemic, which may influence the incidence of upper respiratory diseases (URDs). The present study compared the incidence of URDs during the COVID-19 pandemic and during the years prior to COVID-19, and investigated the effect of NPIs on URD in the nationwide general population.Subjects and Method This is an epidemiologic study based on the Korean National Health Insurance Database from March 2016 to February 2021. We compared the monthly incidence of URDs from March 2020 to February 2021 (12 months) with that of the past four years. A negative binomial regression model was used to evaluate the annual difference in the incidence of each URD and adjusting temperature, humidity, and the level of particulate matter 10 (PM10). @*Results@#The monthly incidence of ‘the five common URDs’ in 2020 was significantly lower than that in the past four years. The incidence of other chronic diseases, however, such as hypertension and diabetes mellitus, was comparable or higher in the past four years. Among the five common URDs, influenza virus infections decreased most dramatically, nearing 99%, from 296.4-377.1 per 100000 people during the period of 2016 to 2019 to 3.7 per 100000 people in 2020. @*Conclusion@#The present study shows that the incidence of ‘five common URDs’ significantly decreased during the era of COVID-19 in Korea. We believe that nationwide NPI might prevent the transmission of COVID-19 as well as other infectious sources associated with URDs.

Changes in Patients Who Receive Coverage for Positive Airway Pressure Therapy According to Alterations in National Health Insurance Benefit Standards for Mild Obstructive Sleep Apnea / 대한이비인후과학회지

Background and Objectives@#The aim of this study was to identify the frequency of indicators of National Health Insurance (NHI) coverage for positive airway pressure (PAP) therapy and to investigate the changes in patients receiving coverage for PAP therapy after the alterations were made in the insurance benefit standards for mild obstructive sleep apnea (OSA).Subjects and Method We divided the mild OSA patients into two groups according to altered categorization in insurance benefit standards (Mild1: 5≤AHI<10; Mild2: 10≤AHI<15). Eight indicators related to the NHI coverage were identified: four symptoms, three complications, and the minimal blood oxygen saturation during polysomnography (min SpO2) of ≤85% during polysomnography. We also investigated the change in the number of patients receiving insurance benefits under the altered insurance benefit standards. @*Results@#Of the 233 OSA patients, 66, 57, and 110 patients were diagnosed as mild, moderate and severe OSA, respectively. For all of them, the most common indicator related to NHI coverage for PAP therapy was the minimum SpO2 of less than 85% during polysomnography, and the second most common indicator was daytime sleepiness. In the mild OSA group, however, daytime sleepiness was found to be the most common indicator, found in 46 (70%) patients, followed by 38 (58%) patients with min SpO2 of less than 85%. In this group, 59 (89.4%) would have been benefited before the change in the insurance benefit standards whereas 51 patients (77.3%) would now be benefited under the changed insurance benefit standards. @*Conclusion@#Daytime sleepiness was the most commonly observed indicator in the mild OSA patients. The number of patients receiving insurance benefits for PAP therapy significantly decreased after the change was made in the NHI benefit standards for mild OSA

In Vitro Study on the Bond Strength Between 3D-Printed Resin and Resin Cement for Pediatric Crown Restoration / 대한소아치과학회지

A 3D-printed resin crown is a novel option for esthetic crown restoration for primary teeth, which are typically bonded with resin cement. The purpose of this study was to evaluate the bonding ability of a 3D printing resin and compare it with other indirect resin materials for crown fabrication. The shear bond strengths of two 3D printing resin materials, Graphy (GP) and NextDent (NXT), and two indirect resin materials, VIPI Block (VIPI) and MAZIC Duro (MZ), were compared in the study. For all materials, the shear bond strength at the interface between the surface of the resin material and resin cement was measured. The mean shear bond strength values of GP, NXT, MZ, and VIPI were 23.29 ± 3.88, 26.14 ± 4.67, 25.41 ± 4.03, and 18.79 ± 4.26 MPa, respectively. There was no significant difference among the SBSs of GP, NXT and MZ except for VIPI. The result of this study indicates that the 3D printing resin meets the essential requirement for clinical use by showing clinically adequate bond strength.

Cancer risk in patients with Peutz-Jeghers syndrome in Korea: a retrospective multi-center study

Background/Aims@#There have been little research on the cancer risks of patients with Peutz-Jeghers syndrome (PJS) in Korea. We aimed to investigate the clinical features of PJS patients and their cancer incidence rate. @*Methods@#Patients with PJS from nine medical centers were enrolled. In those patients diagnosed with cancer, data obtained included the date of cancer diagnosis, the tumor location, and the cancer stage. The cumulative risks of gastrointestinal cancers and extra-gastrointestinal cancers were calculated using the Kaplan-Meier method. @*Results@#A total of 96 PJS patients were included. The median age at diagnosis of PJS was 23.4 years. Cancer developed in 21 of the 96 patients (21.9%). The age of PJS diagnosis was widely distributed (0.9 to 72.4 years). The most common cancers were gastrointestinal cancer (n = 12) followed by breast cancer (n = 6). The cumulative lifetime cancer risk was calculated to be 62.1% at age 60. The cumulative lifetime gastrointestinal cancer risk was 47.1% at age 70. The cumulative lifetime extra- gastrointestinal cancer risk was 40.3% at age 60. @*Conclusions@#PJS onset may occur at any age and the risks of gastrointestinal and extra-gastrointestinal cancer are high. Thorough surveillance of PJS patients for malignancies is vital.

Use of Device-Assisted Enteroscopy in Small Bowel Disease: An Expert Consensus Statement by the Korean Association for the Study of Intestinal Diseases / 대한소화기학회지

The introduction of device-assisted enteroscopy (DAE) in the beginning of the 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of small bowel diseases, DAE has the unique advantages of allowing the observation of the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how it is to be performed and what technical factors should be taken into consideration. In response to these needs, the Korean Association for the Study of Intestinal Diseases has developed an expert consensus statement on the performance of DAE by reviewing current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

Neutral zone approach for rehabilitation in a patient who underwent mandibulotomy: A case report / 대한치과보철학회지

We present the case of a 65-year-old man with maxillary and mandibular complete dentures prepared using neutral zone technique after undergoing mandibulotomy due to tonsil cancer 10 years ago. The patient had a short edentulous period; hence, there was minimal absorption of the alveolar ridge and no abnormality in the motor function of the tongue. However, the retromolar pad was located inside the hamular notch, and the posterior alveolar ridge was relatively turned inward. If the artificial teeth would have been aligned conventionally, the functional space of the tongue would have been invaded, which would have moved the tongue posteriorly thereby reducing the stability of the denture. Therefore, applying the concept of the neutral zone can be a good reference point in such cases. The neutral zone was registered using tissue conditioner, and tooth alignment was performed by making a silicone putty index. The biggest advantage of using neutral zone concept is denture stability. In this case, the neutral zone technique was applied to obtain the lingual alignment limit of the posterior teeth to avoid invasion of the tongue space by the left posterior part of the mandible. Particularly, in case of a patient in which denture stability is difficult to obtain due to absorption of the alveolar ridge, it is believed that better results can be obtained using neutral zone technique.

A Modified Length-Based Grading Method for Assessing Coronary Artery Calcium Severity on Non-Electrocardiogram-Gated Chest Computed Tomography: A Multiple-Observer Study

Objective@#To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT). @*Materials and Methods@#This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen’s kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods. @*Results@#For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496–0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636–0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen’s kappa, 0.565 [95% CI: 0.511–0.619 for visual assessment vs. 0.695 [95% CI: 0.638–0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001). @*Conclusion@#The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.

Comparison of dominant and nondominant C3 deposition in primary glomerulonephritis

Alternative complement pathway dysregulation plays a key role in glomerulonephritis (GN) and is associated with C3 deposition. Herein, we examined pathological and clinical differences between cases of primary GN with C3-dominant (C3D-GN) and nondominant (C3ND-GN) deposition. Methods: We extracted primary GN data from the Korean GlomeruloNEphritis sTudy (KoGNET). C3D-GN was defined as C3 staining two grades greater than C1q, C4, and immunoglobulin via immunofluorescence analysis. To overcome a large difference in the number of patients between the C3D-GN and C3ND-GN groups (31 vs. 9,689), permutation testing was used for analysis. Results: The C3D-GN group exhibited higher serum creatinine (p ≤ 0.001), a greater prevalence of estimated glomerular filtration rate of <60 mL/min/1.72 m2 (p ≤ 0.001), higher (but not significantly so) C-reactive protein level, and lower serum C3 level (p ≤ 0.001). Serum albumin, urine protein/creatinine ratio, number of patients who progressed to end-stage renal disease, and all-cause mortality were comparable between groups. Interstitial fibrosis and mesangial cellularity were greater in the C3D-GN group (p = 0.04 and p = 0.01, respectively) than in the C3ND-GN group. C3 deposition was dominant in the former group (p < 0.001), in parallel with increased subendothelial deposition (p ≤ 0.001). Conclusion: Greater progression of renal injury and higher mortality occurred in patients with C3D-GN than with C3ND-GN, along with pathologic differences in interstitial and mesangial changes.

Long-term Clinical Course of Amniotic Membrane after Permanent Amniotic Membrane Transplantation

Purpose@#To investigate the long-term clinical outcomes of transplanted amniotic membrane in patients who underwent permanent amniotic membrane transplantation (P-AMT) on cornea. @*Methods@#From April 2014 to March 2021, medical records and digital photographs of 68 patients (72 eyes) who underwent P-AMT were analyzed retrospectively. The duration of complete re-epithelization of cornea and wearing therapeutic contact lense (T-lens) after surgery were investigated, the size of preserved amniotic membrane (AM) excluding the melted portion was analyzed using the Image J program every year up to 6 years after surgery, and it was compared by dividing into a single-layer group and a double-layer group. In addition, when the AM melts, the cause, time, and related factors of melting were analyzed. @*Results@#The average duration to complete re-epithelialization after surgery was 12.2 ± 11.0 days, and T-lens were worn on average up to 8.7 ± 8.5 months after surgery. In total group, the average ratio of preserved AM annually up to 6 years after surgery was 94.9%, 94.3%, 97.8%, 96.4%, 95.8%, 91.6% respectively, and there was no significant difference between the single-layer group and the double-layer group. AM melting appeared in 38.9% (28 eyes) of the total group, and melting was first observed on average 16.4 ± 17.2 months after surgery. The formation and rupture of bullae was the most common cause of melting at 71.4% (20 eyes), and there were no statistically significant related factors involved in the formation of bullae. @*Conclusions@#In the case of P-AMT performed in various diseases of the cornea, the transplanted AM is partially melt but considered to be well preserved up to 6 years after surgery to form a stable ocular surface.

Hip Fractures in the Elderly: Perioperative Management and Prevention of Medical Complications

Elderly patients with hip fractures are at an increased risk of developing medical complications with higher mortality rates. Most patients require surgical treatment, and an early surgical intervention can reduce complications and lower mortality risk. A restrictive red blood cell transfusion strategy is usually applied, and the amount of transfusion can be reduced through medications such as tranexamic acid. Delirium can be prevented using non-pharmacological methods. In addition, it is necessary to prevent venous thromboembolism through mechanical or chemical prophylaxis. A multidisciplinary approach using the ERAS (Enhanced Recovery After Surgery) protocol and orthogeriatric care can help to reduce medical complications and mortality.

The relationship between long-term use of nonsteroidal anti-inflammatory drugs and kidney function in patients with ankylosing spondylitis

Objective@#Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for ankylosing spondylitis (AS), their effect on kidney function remains unclear. This longitudinal study investigated the correlation between long-term NSAID use and kidney function in patients with AS using electronic medical records. @*Methods@#The electronic medical records of 1,280 patients with AS collected from a single center between January 2001 and December 2018 were reviewed. The Assessment of Spondyloarthritis International Society (ASAS) NSAID Intake Score was used to determine the cumulative dose of all NSAIDs prescribed for a different time intervals. Each ASAS NSAID Intake Score was obtained for intervals of 6 months, 1 year, 2 years, 3 years, 5 years, and 10 years. The correlation between the ASAS NSAID Intake Score and final estimated glomerular filtration rate (eGFR) for each interval was investigated. @*Results@#The mean ASAS Intake Scores for 6-month, 1-year, 2-year, 3-year, 5-year, and 10-year intervals were 55.30, 49.28, 44.84, 44.14, 44.61, and 41.17, respectively. At each interval, the pearson correlation coefficients were −0.018 (95% CI: −0.031 to −0.006, p=0.004), −0.021 (95% CI: −0.039 to −0.004, p=0.018), −0.045 (95% CI: −0.071 to −0.019, p=0.001), −0.069 (95% CI: −0.102 to −0.037, p<0.001), −0.070 (95% CI: −0.114 to −0.026, p=0.002), −0.019 (95% CI: −0.099 to 0.062, p=0.645), respectively. There was a very weak negative relationship between ASAS Intake Score and eGFR at each interval. @*Conclusion@#Long-term NSAID use did not correlate with kidney function based on real-world data in patients with AS.

Role of Neurosurgeons in the Treatment of Acute Ischemic Stroke in the Emergency Room

Objective@#: With the recent increase in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the role of neurosurgeons in AIS treatment has become increasingly important. This study aimed to assess the outcomes of patients with AIS treated by neurosurgeons and neurologists in the emergency room (ER) of a tertiary hospital in South Korea. @*Methods@#: From January 2020 to June 2021, 536 patients with AIS within 24 hours of symptom onset were admitted to our hospital via the ER. Based on the type of doctors who provided initial care for AIS in the ER, patients were divided into two groups : (a) neurosurgeon group (n=119, 22.2%) and (b) neurologist group (n=417, 77.8%). @*Results@#: Intravenous tissue plasminogen activator (tPA) was administered in 82 (15.3%) of 536 patients (n=17 [14.3%] in the neurosurgeon group and n=65 [15.6%] in the neurologist group). The door-to-tPA time was not significantly different between both groups (median, 53 minutes; interquartile range [IQR], 45–58 vs. median, 54 minutes; IQR, 46–74; p=0.372). MT was performed in 69 patients (12.9%) (n=25, 36.2% in the neurosurgeon group and n=44, 63.8% in the neurologist group). The neurosurgeon group achieved a shorter door-to-puncture time than the neurologist group (median, 115 minutes; IQR, 107–151 vs. median, 162 minutes; IQR, 117–189; p=0.049). Good clinical outcomes (3-month modified Rankin Scale 0–2) did not differ significantly between the two groups (96/119 [80.7%] vs. 322/417 [77.2%], p=0.454). @*Conclusion@#: The neurosurgeon group showed similar door-to-treatment time and clinical outcomes to the neurologist group in patients with AIS in the ER. This study suggests that neurosurgeons have comparable abilities to care for patients with AIS in the ER.