JungBok Lee

MDCT-based scoring system for differentiating angiomyolipoma with minimal fat from renal cell carcinoma.

Background Subtype-related various computed tomography (CT) features of renal cell carcinoma (RCC) are a confusing factor in differentiating angiomyolipoma with minimal fat (AMLmf) from RCC. To overcome RCC heterogeneity, a scoring system, which integrates multiple discrimitive parameters can be helpful for differentiating AMLmf from RCC. Purpose To develop a MDCT-based scoring system for differentiating AMLmf from RCC. Material and Methods In 407 patients with pathologically confirmed 48 AMLmfs and 359 RCCs (247 clear cell RCCs, 67 papillary RCCs, and 45 chromophobe RCCs), MDCT features (ratio of long-to-short diameter, enhancement characteristics, tumor attenuation on unenhanced scan, tumor margin, calcification), age, and sex were compared between AMLmf and RCCs. Based on logistic regression, a scoring system for diagnosing AMLmf over RCC was built, and its diagnostic accuracy was evaluated. Results Scores suggesting AMLmf, i.e. the logit function as used in logistic regression analysis, were calculated as follows: Score = e 6 . 16 . A - 0 . 003 . B + 1 . 20 . C + 0 . 97 . D + 2 . 13 . E - 0 . 05 . F 1 + e 6 . 16 . A - 0 . 003 . B + 1 . 20 . C + 0 . 97 . D + 2 . 13 . E - 0 . 05 . F , where A = ratio of long-to-short diameter, B = enhancement amount in early excretory phase, C = homogeneous enhancement, D = tumor attenuation on unenhanced scan, E = sex, and F = age. Area under receiver-operating characteristics curve of scoring system was 0.919. With a score of 0.204 or higher, the scoring system yielded greatest accuracy (90%, 368/407) for diagnosing AMLmf over RCC, which was greater than that of any single MDCT or clinical parameter (53–85%) (P < 0.05). With a score of 0.317 or higher, sensitivity and specificity were 68% (32/48) and 95% (340/359). Conclusion MDCT-based scoring system can improve diagnostic performance of MDCT in differentiating AMLmf from RCC and help patients with AMLmf to avoid unnecessary surgery with high specificity.

Elevated Serum Ferritin Level Is Associated with the Incident Type 2 Diabetes in Healthy Korean Men: A 4 Year Longitudinal Study

Background Elevated ferritin concentration has been implicated in the etiology of type 2 diabetes. Accumulating evidence, mostly from studies conducted on western populations, has demonstrated a strong association between the elevated ferritin concentrations and incident type 2 diabetes. In Asian populations, however, the longitudinal studies investigating the association of elevated serum ferritin levels and type 2 diabetes are lacking. In present study, we aimed to determine whether elevated serum ferritin levels are related to the incident type 2 diabetes in healthy Korean men. Methodology/Principal Findings This 4 year longitudinal observational study was conducted at the Asan Medical Center, Seoul, Republic of Korea. The study population consisted of 2,029 men without type 2 diabetes who underwent routine health examination in 2007 (baseline) and 2011 (follow-up). Baseline serum ferritin concentrations were measured by chemiluminescent two-site sandwich immunoassay. In multiple-adjusted model, the relative risk (RR) for incident type 2 diabetes was significantly higher in highest compared with the lowest ferritin quartile category, even after adjusting for confounding variables including homeostasis model assessment of insulin resistance (RR = 2.17, 95% confidence interval 1.27–3.72, P for trend = 0.013). Conclusions/Significance These results demonstrated that elevated level of serum ferritin at baseline was associated with incident type 2 diabetes in an Asian population.

Korean Guidelines for the Diagnosis and Management of Dry Eye: Development and Validation of Clinical Efficacy

Purpose To evaluate the clinical efficacy of newly developed guidelines for the diagnosis and management of dry eye. Methods This retrospective, multi-center, non-randomized, observational study included a total of 1,612 patients with dry eye disease who initially visited the clinics from March 2010 to August 2010. Korean guidelines for the diagnosis and management of dry eye were newly developed from concise, expert-consensus recommendations. Severity levels at initial and final visits were determined using the guidelines in patients with 90 ± 7 days of follow-up visits (n = 526). Groups with different clinical outcomes were compared with respect to clinical parameters, treatment modalities, and guideline compliance. Main outcome measures were ocular and visual symptoms, ocular surface disease index, global assessment by patient and physician, tear film break-up time, Schirmer-1 test score, ocular surface staining score at initial and final visits, clinical outcome after three months of treatment, and guideline compliance. Results Severity level was reduced in 47.37% of patients treated as recommended by the guidelines. Younger age (odd ratio [OR], 0.984; p = 0.044), higher severity level at initial visit, compliance to treatment recommendation (OR, 1.832; p = 0.047), and use of topical cyclosporine (OR, 1.838; p = 0.011) were significantly associated with improved clinical outcomes. Conclusions Korean guidelines for the diagnosis and management of dry eye can be used as a valid and effective tool for the treatment of dry eye disease.

A novel high-resolution anorectal manometry parameter based on a three-dimensional integrated pressurized volume of a spatiotemporal plot, for predicting balloon expulsion in asymptomatic normal individuals

Anorectal manometry with simulated evacuation (SE) has limited applicability in predicting balloon expulsion (BE) test results. The newly developed high‐resolution anorectal manometry (HRAM) technique can yield spatiotemporal plots with three‐dimensional pressurization. We aimed to define new parameters based on three‐dimensional integrated pressurized volume (IPV) for predicting the BE test results in asymptomatic normal individuals.

Can Stroke Volume Variation Be an Alternative to Central Venous Pressure in Patients Undergoing Kidney Transplantation

BACKGROUND Stroke volume variation (SVV) is known to be a simple and less invasive hemodynamic parameter for evaluating fluid responsiveness and preload status. Central venous pressure (CVP) has been targeted to achieve an adequate level for improving the graft perfusion and long-term graft function in kidney transplantation (KT) recipients, despite the various potential complications. The aim of this study was to investigate whether SVV could substitute for CVP in guiding intravascular volume management during KT. METHODS This retrospective study evaluated 635 patients who underwent KT because of end-stage renal disease. Hemodynamic variables including CVP and SVV were obtained before skin incision (T1), 5 minutes after iliac vein clamping (T2), and 10 minutes after renal graft reperfusion (T3). The ability of SVV to predict CVP level was investigated with receiver operating characteristic (ROC) curve analysis. RESULTS CVPs were 6.0 ± 2.6, 8.6 ± 2.7, and 9.3 ± 2.5 mm Hg, and SVVs were 6.9 ± 3.0, 5.0 ± 2.1, and 4.3 ± 2.1% at T1, T2, and T3, respectively. ROC analysis showed that the discriminative power of SVV was fairly good with an area under the ROC curve of 0.70 (95% confidence interval, 0.67-0.72) for a CVP of 8 mm Hg, and that an optimal cutoff value of SVV was 6% as an alternative to CVP of 8 mm Hg during KT. CONCLUSIONS SVV may replace CVP in the volume management of patients who have undergone KT. Our results suggest that SVV can guide volume management to improve graft perfusion at critical time points during KT.

The effect of age on the key parameters in the Chicago classification: a study using high‐resolution esophageal manometry in asymptomatic normal individuals

High‐resolution manometry using the Chicago classification, which utilizes parameters including integrated relaxation pressure (IRP), distal contractile integral (DCI), and contractile front velocity (CFV), shows better diagnostic ability than previous conventional criteria. However, the current normal cut‐off values for the Chicago classification are based on individuals aged 19–48 years and do not include older people. Here, we aimed to assess the normal values for the Chicago classification in individuals aged 20–67 years and compare the parameters across age groups.

Duplicate publication of articles used in meta-analysis in Korea

With the increasing use of meta-analysis, duplicate publication of original research is particularly problematic. Duplicate publication can result in an inappropriate weighting of the study results. The purpose of our study was to assess the incidence and characteristics of duplicate publications in Korea, and to estimate the impact of duplicate publication on meta-analyses. The meta-analysis literature written by Korean authors was searched using the online search engines PubMed, KMbase, and KoreaMed. Duplication patterns were classified into the following 4 combinations: identical samples and identical outcomes (copy), identical samples and different outcomes (fragmentation), increased samples and identical outcomes (imalas), and decreased samples and identical outcomes (disaggregation). To estimate the multiple publication bias, we performed a meta-analysis with and without duplicated data. We estimated that 6 (6.9%) of the 86 analyzed meta-analyses included duplicate publications, and 6 of the 1,194 articles (0.5%) used in the meta-analyses were duplicate publications. In this study, duplicate publications were usually due to disaggregation and overlapping (imalas) publications. Of 6 duplicated articles, 1 was considered a copy (16.6%); 1, a fragmentation (16.6%); 2, imalas (33.3%); and 2, disaggregations (33.3%). There was an increase in the mean effect size and fail-safe number with duplicated data. Our study found only 6 instances of duplicate publication after analyzing 1,194 articles used in meta-analyses written by Korean authors. However, 6.9% of the meta-analyses included duplicate publications. Our findings suggest that meta-analyses should be interpreted cautiously, taking into account the possibility of duplicated studies.

Impact of the Time of Coronary Angiography on Acute Kidney Injury After Elective Off-Pump Coronary Artery Bypass Surgery

BACKGROUND Previous studies have suggested that early surgery after coronary angiography may be associated with the risk of acute kidney injury (AKI) in cardiac surgery with cardiopulmonary bypass. However, the effect of coronary angiography on the risk of AKI after off-pump coronary artery bypass graft surgery (OPCABG) remains uncertain. METHODS We assessed preoperative and perioperative data in 1,364 consecutive adult patients who underwent elective OPCABG surgery after coronary angiography. Acute kidney injury was defined by Acute Kidney Injury Network criteria based on changes in serum creatinine within the first 48 hours after OPCABG. Multivariable logistic regression was performed to evaluate the association of the time interval between coronary angiography and OPCABG with postoperative AKI. RESULTS Acute kidney injury occurred in 391 patients (28.7%). The unadjusted and adjusted rates of AKI according to the length of time between coronary angiogram and OPCABG did not show any increasing or decreasing trend (p = 0.86 and p = 0.33 for trends of unadjusted and adjusted AKI rates, respectively), and early OPCABG after coronary angiography was not related to postoperative AKI. Results were the same in high-risk patients with preoperative renal insufficiency, low ejection fraction, or who received an ionic contrast agent or a high dose of contrast agent. CONCLUSIONS The risk of postoperative AKI was not related to the time between coronary angiography and OPCABG. These findings suggest that delaying elective OPCABG after coronary angiography owing to the sole concern for renal function may be unnecessary.

Antioxidant and ACE Inhibiting Activities of Sugared-Buchu (Allium ampeloprasum L. var. porum J. Gay) Fermented with Lactic Acid Bacteria

In recent years, the growing interest in the health care benefits of sugared-plant fermented enzymes has led to increased consumption. This study investigated the fermentation of sugared-buchu (Leek:sugar, 1:3) by lactic acid bacteria (Lactobacillus acidophilus AML 0422, Lactobacillus brevis HLJ 59, Lactobacillus helveticus AML0410, Lactobacillus plantarium KCTC 13093) and the antibacterial activity, antioxidant activity, and functionality (e.g., anti-hypertensive activity) of the fermented product. The fermented sugared-buchu showed high antibacterial activity against Staphylococcus aureus KCTC 1916, at 31.43 mm, and its total polyphenols, total flavonoid content, and DPPH scavenging activity were 160.8-178 mg/ml, 100-108 mg/ml, and 51.4-58.1%, respectively. DPPH scavenging activity was to that of vitamin C (50 ppm). ACE inhibitory activity was 50.4-67%, depending on the strain of lactic acid bacteria, and the control of sugared-buchu activity was higher than 32.6%. These results suggest that sugared-buchu fermented with lactic acid bacteria has strong antibacterial, antioxidant, and ACE inhibitory activities.L. var. porum J. Gay) Fermented with Lactic Acid Bacteria Jung-Bok Lee, Jung-Shik Bae, Il-Kwon Son, Chun-Pyou Jeon, Eun-Ho Lee, Woo-Hong Joo and Gi-Seok Kwon 1 * Department of Bioresource Sciences, Andong National University, Andong 760-749, Korea Wellfine Co., Ltd, 168,Gasan digital 1-ro, Geumcheon-gu, Seoul 153-786, Korea Department of Medicine Quality Analysis, Andong Science College, Andong 760-709, Korea Department of Biology, Changwon National University, Kyungnam 641-713, Korea

Life-threatening methemoglobinemia after unintentional ingestion of antifreeze admixtures containing sodium nitrite in the construction sites

Context. Construction workers are exposed to a wide variety of health hazards such as poisoning at the construction sites. Various forms of poisoning incidents in construction workers have been reported. However, studies on methemoglobinemia caused by unintentional ingestion of antifreeze admixtures containing sodium nitrite at the construction sites have not been reported yet. Objective. The aim of this study was to evaluate life-threatening methemoglobinemia after unintentional ingestion of antifreeze admixtures containing sodium nitrite at the construction sites and describe similar incidents involving ingestion of antifreeze admixtures in Korea. Materials and methods. Retrospective observational case series study on patients with methemoglobinemia after unintentional ingestion of antifreeze admixtures containing sodium nitrite admitted to the emergency department (ED) from January 1, 2010 to December 31, 2012 and cases reported to the Korea Occupational Safety and Health Agency (KOSHA) was performed. Results. Six victims were admitted to our ED. They had methemoglobin levels ranging from 32.4% to 71.5% and all of them recovered after receiving one (2 mg/kg) or two doses infusion of methylene blue. From the data of the KOSHA, six incidents that caused 27 victims were identified. Of 27 victims, five were included in the ED cases. For all incidents, antifreeze admixtures were not contained in their original containers and all new containers did not have a new label. All workers mistook antifreeze admixtures for water. Among the 28 victims included in this study, four died. Conclusion. Unintentional ingestion of antifreeze admixtures containing sodium nitrite at the construction sites can cause life-threatening methemoglobinemia. There is a need to store and label potentially hazardous materials properly to avoid unintentional ingestion at the construction sites.