J. Lee

Educational intervention as an effective step for reducing blood culture contamination: a prospective cohort study.

BACKGROUNDnContaminated blood cultures lead to diagnostic challenges and place a burden on healthcare services.nnnAIMnTo determine the impact of introducing a clinical skills test (CST) as part of the medical licensing examination and an institutional education programme on the contamination rates of blood cultures.nnnMETHODSnA prospective cohort study was conducted from 2009 through 2013 in all wards of a tertiary-care teaching hospital. We evaluated the effects of the CST, which was added to the National Medical Licensing Examination in Korea (KMLE) in 2010 and our institutional education programme, which began in 2013. The medical interns in charge of collection of blood for culture were divided in three groups with presence or absence of CST and the institutional education programme. The primary outcome was the percentage of blood cultures contaminated in each group, which were compared using the Poisson regression model. Participants self-rated scores for the blood draw procedure were also analysed.nnnFINDINGSnAlthough introduction of the CST in the KMLE failed to reduce blood culture contamination rate (1.36% vs 1.35%; P = 0.734), the institutional education programme significantly reduced the contamination rate (1.35% vs 1.00%; P < 0.0001). Most participants answered that they always followed each step correctly except for waiting the recommended contact time after applying the antiseptic.nnnCONCLUSIONnThe educational intervention, not the introduction of CST in the KMLE, was effective in reducing overall contamination rates.

Attribution to Heterogeneous Risk Factors for Breast Cancer Subtypes Based on Hormone Receptor and Human Epidermal Growth Factor 2 Receptor Expression in Korea.

AbstractWe conducted a heterogeneous risk assessment of breast cancer based on the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) calculating the risks and population-based attributable fractions (PAFs) for modifiable and nonmodifiable factors.Using matched case–control study design from the Seoul Breast Cancer Study and the national prevalence of exposure, the risks and PAFs for modifiable and nonmodifiable factors were estimated for total breast cancers and subtypes.The attribution to modifiable factors was different for each subtype (luminal A, PAFu200a=u200a61.4% [95% confidence interval, CIu200a=u200a54.3%–69.8%]; luminal B, 21.4% [95% CIu200a=u200a18.6–24.9%]; HER2-overexpression, 59.4% [95% CIu200a=u200a47.8%–74.3%], and triple negative tumors [TNs], 27.1% [95% CIu200a=u200a22.9%–32.4%)], and the attribution to the modifiable factors for the luminal A and HER2-overexpression subtypes was higher than that of the luminal B and TN subtypes (P heterogeneityu200a⩽u200a0.001). The contribution of modifiable reproductive factors to luminal A type in premenopausal women was higher than that of the other subtypes (18.2% for luminal A; 3.1%, 8.1%, and −3.1% for luminal B, HER2-overexpression, and TN subtypes, respectively; P heterogeneityu200a⩽u200a0.001). Physical activity had the highest impact preventing 32.6% of luminal A, 14.5% of luminal B, 38.0% of HER2-overexpression, and 26.9% of TN subtypes (P heterogeneityu200a=u200a0.014). Total reproductive factors were also heterogeneously attributed to each breast cancer subtype (luminal A, 65.4%; luminal B, 24.1%; HER2-overexpression, 57.9%, and TN subtypes, −3.1%; P heterogeneityu200a⩽u200a0.001).Each pathological subtype of breast cancer by HRs and HER2 status may be associated with heterogeneous risk factors and their attributable risk, suggesting a different etiology. The luminal B and TN subtypes seemed to be less preventable despite intervention for alleged risk factors, even though physical activity had a high preventable potential against breast cancer.

Idiophathic Retroperitoneal Fibrosis Presented as an Abdominal Mass and Nephrotic Syndrome

We present a 30-year-old male patient who was initially diagnosed as minimal change nephrotic syndrome. 5 years later, the patient developed a localized form of idiopathic retroperitoneal fibrosis (IRF). An elevated ESR and concomitant nephrotic syndrome in the patient suggested the immunologic nature of IRF. IRF has been reported in association with collagen diseases and rarely with proliferative and nonproliferative glomerulopathies. To our knowledge, the association between minimal change lesion (MC) and IRF has not been reported. Furthermore, the fact that IRF presented itself as an abdominal mass and lacked systemic symptoms was also unusual.

Association between Dietary Mineral Intake and Chronic Kidney Disease: The Health Examinees (HEXA) Study

Few studies have explored the association between mineral intake and chronic kidney disease (CKD). A cross-sectional analysis investigated the association between mineral intake (calcium, phosphorus, sodium, potassium, iron, and zinc) and CKD using the Health Examinee (HEXA) cohort of the Korean Genome and Epidemiologic Study (KoGES). For 159,711 participants, mineral intake was assessed by a food frequency questionnaire. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. Dietary intake of each mineral was divided into quartiles and the quartile including recommended dietary allowance (RDA) or adequate intake (AI) of each mineral was used as a reference. We assessed the association between the quartile of mineral intakes and CKD using polytomous logistic regression models. The lowest quartiles of phosphorus (≤663.68 mg/day, odds ratio [OR] = 1.64, 95% confidence interval [CI]: 1.25–2.15), potassium (≤1567.53 mg/day, OR = 1.87, 95% CI: 1.27–2.75), iron (≤6.93 mg/day, OR = 1.53, 95% CI: 1.17–2.01), and zinc (≤5.86 mg/day, OR = 1.52, 95% CI: 1.02–2.26) were associated with higher odds for advanced CKD compared with the references. The present study suggests that an inadequate intake of some minerals may be associated with CKD occurrence in the general population. Due to the reverse causation issue in this cross-sectional study design, further longitudinal prospective studies are needed in order to prove the results.

AB0317 Drug Survival of Biologic Agents in Rheumatoid Arthritis Using 10 Years of Data from The National Health Insurance in Korea: A Population-Based Study and Comparison with A Single-Institution Cohort

Background Since 2004, Korean national health insurance began to cover the cost of biologic agents in rheumatoid arthritis (RA) patients experiencing treatment failure by conventional disease modifying antirheumatic agents. However, real-world issues such as selecting or switching among biologic agents in clinical practice became more complicated as types of the agents increased. Objectives To evaluate 1) first choice among biologic agents, 2) drug retention rate and duration and 3) switching rate and duration before switching of each biologic agent in RA. Methods We used prospective cohort data by the National Health Insurance Service (NHIS) in Korea, which consisted of more than one million subjects representing age, sex and income status of whole Korean population followed from 2004 to 2013. All RA patients with any experience of biologic agents were checked by the code of each drug and KCD9 code of diagnosis including all types of RA. To supplement the results of the population based study, we also compared and validated with the independent cohort of biologic agent users in Seoul national university hospital (SNUH). Results One hundred and seventy three patients were found to experience any of TNFa inhibitors from Jan. 2004 to Dec. 2013. Etanercept was the most frequent choice as first TNFa inhibitor (43.4%), followed by adalimumab (35.3%), infliximab (20.2%), golimumab (0.6%) and abatacept (0.6%). Among TNFa inhibitors, retention rates of etanercept (73.1%, 62.7%) at month 12 and 24 were significantly higher (p=0.039, both) than adalimumab (57.7%, 44.2%) and infliximab (45.5%, 36.4%). In SNUH cohort, etanercept (79.8%, 67.0%) also had better retention rate than adalimumab (51.3%, 48.7%) and infliximab (58.6%, 34.5%) at month 12 and 24 respectively. Mean duration of retention was almost twice longer in etanercept (3.42 years) than adalimumab (1.83 years, p=0.004) and infliximab (1.71 years, p=0.011). Similarly, etanercept (3.24 years) prescribed longer than adalimumab (1.98 years) and infliximab (1.63 years) with statistical significance in SNUH cohort. Etanercept also had lower switching rate (20.9%) than adalimumab (32.1%) and infliximab (38.5%, p=0.040) and the tendency were similar in SNUH cohort. Preferred biologic agents after switching were adalimumab (27.4%) and rituximab (24.2%). Etanercept users (1.35 years) had longer duration of use before switching than infliximab (0.60 years, p=0.050) but no significant difference was shown comparing with adalimumab (0.73years, p=0.483). Conclusions As golimumab, abatacept, tocilizumab were available relatively later than existing TNFa inhibitors and rituximab, more follow up period would be required to evaluate their value in treating RA. This research can be a pilot study before analyzing nationwide population cohort encompassing whole population of Korea. Conclusively, etanercept has been prescribed longer in general and the rate of retention till 2 years was also better then adalimumab and infliximab for 10 years after national insurance coverage. Disclosure of Interest None declared

SAT0394 Prevalence of Psoriatic Arthritis Based on an Algorithm beyond ICD-10 Codes Using National Health Insurance Claims Data in Korea

Background Psoriatic arthritis (PsA) is a chronic inflammatory condition featuring arthritis/periarthrits that is well known to accompany comorbidities such as metabolic syndrome, obesity and cardiovascular illness. In Korea, the spondylitis subset has been recognized as the most common feature of PsA in tertiary medical facilities1. However, there is no data of the true prevalence or incidence of PsA in Korea to date, and it is likely to be under-appreciated. Studies based on nationwide data are in need to better understand the characteristics of PsA in Korea. Objectives To study the prevalence and baseline characteristics of Korean PsA patients using National Health Insurance claims data Methods Four identification algorithms for defining patients with PsA were established by using electronic medical records and clinical database at SMG-SNU Boramae Medical Center. The first step was to obtain a pool of patients with the International Classification of Diseases (ICD-10) diagnostic code for PsA (M07.0-M07.3, L40.5). The next step was to select patients that have been prescribed with medications for PsA: biologic disease modifying anti-rheumatic drugs (DMARD), non-steroidal anti-inflammatory drugs (NSAID) and/or non-biologic DMARDs. The best performing algorithm was chosen to identify PsA patients in then nationwide data (2008-2012) provided by the Korean Health Insurance Review and Assessment Service (HIRA). The five-year data included 85,168 patients linked with information including age, gender, ICD-10 codes, and prescribed medications. Descriptive analysis was performed to present PsA patient characteristics for each year. Results Among the four algorithms, the one defining PsA patients first by biologic DMARD use, secondly by non-biologic DMARD plus NSAID use was validated to be the best option (sensitivity 95%, specificity 99.8%, accuracy 99.8%). With the HIRA data, the baseline demographic of Korean PsA patients each year was as follows (Table). The overall prevalence of PsA in 2012 was 0.13%. Biologic DMARDs use in PsA has been covered by the National Health Insurance only after 2010 in Korea. Between 2010-2012, approximately 3% of PsA patients were registered in the Korean National Rare Disease Registry. Conclusions This is the first study to analyze the prevalence and baseline characteristics of PsA patients in Korea. Values of basic parameters have been rather consistent during 2008-2012, yet the proportion of patients visiting secondary or tertiary hospitals has increased by year, coinciding with the time point when biologic DMARDs became available for PsA patients in Korea. References Beak HJ, Yoo CD, Shin K, et al. Spondylitis is the most common pattern of psoriatic arthritis in Korea. Rheumatol Int. 2000;19(3):89-94. Acknowledgements We would like to thank Mr. Seung Won Yu and Ms. Hae-Kyung Park at HIRA for aiding data analysis. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4312

Age and HER2 expression status affect the accuracy of preoperative MRI in predicting tumor extent after neoadjuvant chemotherapy.

Abstract #5108 Introduction: Neoadjuvant chemotherapy (NAC) can increase the breast conservation rate and provides prognostic information by identifying patients with pathologic complete remission (pCR). While breast conservation can be safely done in patients who show response to NAC, the presence of chemotherapy-induced fibrosis and the heterogeneous patterns of tumor shrinkage may mislead the determination of residual tumor extent during breast conserving surgery. Recent reports show improved preoperative assessment of residual tumor extent after NAC by performing preoperative breast magnetic resonance imagining (MRI) when compared to conventional methods. In this study, we evaluated the accuracy of preoperative breast MRI in predicting residual tumor extent in patients who underwent NAC, and investigated the factors which may influence its accuracy in a relatively large cohort of patients.u2028 Materials and Methods: From Jan 2006 to Feb 2008, 195 non-metastatic breast cancer patients received NAC and surgery in Department of Surgery, Seoul National University Hospital. In all patients, preoperative breast MRI was performed in addition to physical examination, mammography, and ultrasonography (USG) to estimate the residual tumor extent. The results were compared to pathologic tumor sizes, and the accuracy of MRI was determined by simple regression analysis. By using the results of immunohistochemical staining, patients were divided into molecular subtypes, and the accuracy of MRI was compared between each subtypes. To identify a subgroup of patients who might benefit from preoperative MRI, the association of MRI accuracy and various clinicopathologic features as well as molecular markers were investigated using linear regression analysis.u2028 Results: The mean age of the patients was 45.5 (±9.4) and mean pathologic tumor size was 4.9 (±2.1) cm. pCR was achieved in 31 patients (15.8%). Preoperative MRI and USG showed similar correlation with pathologic invasive tumor size measured from resected specimens (Pearson Coefficient of 0.492 and 0.462, respectively). However, MRI showed superior correlation with tumor extent when the size of surrounding in situ lesions were taken into consideration (Pearson Coefficient of 0.584 for MRI and 0.495 for USG). MRI showed highest correlation with pathologic tumor size in triple negative subtype and lowest correlation in HER2 subtype. Multivariate analysis showed older age (>45 yrs) and HER2 negativity as independent predictors of MRI accuracy. Mammographic density and initial tumor size did not have significant association with MRI accuracy.u2028 Conclusion: Preoprative MRI had high correlation with the extent of residual invasive and in situ tumor size after NAC. The accuracy of MRI was highest in patients with triple negative subtype. Multivariate analysis suggested age and CerbB2 expression as independent predictors of MRI accuracy. Although our results need further validation in a prospective setting, this results may provide a basis for selecting patients in whom the benefit of MRI can be maximized. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5108.

Scoring system to predict under-evaluation in patients diagnosed with benign papilloma at ultrasound-guided core needle biopsy (CNB).

Abstract #2001 Background: The aim of this study was to determine factors that predict under-evaluation of atypical lesion or malignancy in patients diagnosed with benign papilloma at ultrasound-guided core needle biopsy (CNB), and to develop a prediction algorithm for scoring the possibility of a diagnosis upgrade to atypical lesion or malignancy based on clinical, radiological and pathological factors. Methods: The study enrolled patients diagnosed with benign papilloma at ultrasound-guided CNB who subsequently underwent surgical excision of the lesion. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict malignancy. Results: A total of 262 patients with benign papilloma at CNB were identified. Of the 110 patients who underwent subsequent surgical excision, 22 (20%) were diagnosed with atypical papilloma or malignancy. Multivariate analysis revealed that mass or calcification on mammography, size on imaging >15 mm, peripheral location, and a palpable lesion were independent predictors of malignancy. A scoring system was developed based on logistic regression models and beta coefficients for each variable. The area under the ROC curve was 0.868 (95% CI: 0.794-0.941), and the negative predictive value was 100% for a score of 0 or 1 (Of the 110 patients, 58 patients had the score of 0 or 1). Conclusions: A scoring system to predict malignancy in patients diagnosed with benign papilloma at CNB was developed based on four factors: peripheral location, palpable lesion, mass or calcification on mammography, size on imaging. This system was able to identify a subset of patients with lesions likely to be benign, indicating that imaging follow-up rather than surgical excision may be appropriate. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2001.

Triple negative phenotype: not affecting survival in young patients with operable breast cancer.

Abstract #1083 Purpose: To investigate the clinicopathological characteristics and outcomes of triple negative breast cancer in young patients.u2028 Experimental Design: We analyzed 1,498 patients with primary invasive breast cancer who underwent surgery between January 2000 and December 2003. Patients were divided into those Results: A total of 326 (21.8%) were aged Conclusions: Triple negative phenotype did not affect survival in patients Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1083.

Human Circulating Endorepellin LG3 Fragment and Breast Density: A Potential Combination with Screening Mammography in Women with Dense Breast.

(Background) In vitro studies have reported that the endorepellin LG3 fragment (ERLG3F), which is matrix-derived endogenous anti-angiogenic factor, can be a circulating biomarker candidate for breast cancer. This study examined the plasma ERLG3F levels in breast cancer patients and normal healthy controls, and evaluated its potential roles as a screening biomarker for breast cancer (Methods) ERLG3F levels were determined by competitive ELISA in the plasmas from prospectively constructed independent cohorts (train and test set) from July 2006 to September 2007 for the Biomarker Discovery Project (funded by 21C Frontier Functional Proteomics Program of South Korea). The Breast Cancer Cohort (BC) (n=366) has plasmas drawn preoperatively; the Healthy Control Cohort (HC) (n=305), drawn when volunteers visited our Healthcare Center for medical check-up. Circulating ERLG3F, mammography, and the combining marker (CM) of both were evaluated for their performance of identifying breast cancer in the train set and verified again in the test set. (Results) Decreased ERLG3F levels were observed in the individual plasmas from BC compared to the HC. The decrease was significantly prominent in patients without axillary lymph node metastasis (negative vs. positive), young age ( (Conclusion) We conclude that ERLG3F can be a useful diagnostic biomarker for breast cancer and its role can be even better when used for young women with dense breast for whom mammography is less helpful. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3026.