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NONTYPHOIDAL SALMONELLA OSTEOMYELITIS IN IMMUNOCOMPETENT CHILDREN REPORT OF TWO CASES AND LITERATURE REVIEW
No full textSalmonella is a rare causative pathogen of osteomyelitis and is commonly detected in patients with sickle cell disease. We described 2 consecutive cases of nontyphoidal Salmonella osteomyelitis identified in immunocompetent children. It is evident that even children without apparent risk factors for immune dysfunctions can be affected, so maintaining clinical suspicion is crucial for early diagnosis and prompt treatment
Delayed central nervous system progression with atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer (LU23-15)
No full textBACKGROUND: The combination of atezolizumab with etoposide and carboplatin (AECb) has become a new standard of care for extensive-stage small-cell lung cancer (ES-SCLC). This study evaluates its impact on central nervous system (CNS) progression, specifically brain metastases. METHOD: We analyzed the outcomes of 550 ES-SCLC patients who received first-line therapy between 2016 and 2022, focusing on time to intracranial progression (TTicP), progression-free survival (PFS), and overall survival (OS). RESULTS: Of the 550 patients, 247 (44.9 %) received AECb, while 303 (55.1 %) received conventional chemotherapy (CTx). Intracranial progression occurred in 179 patients (32.5 %), with the AECb group showing a significantly prolonged TTicP compared to the CTx group (median 24.4 vs. 14.3 months; p = 0.038). In patients without brain metastasis at diagnosis (n = 408), TTicP was also longer in the AECb group (27.2 vs. 15.3 months; p = 0.016). This benefit persisted even after excluding patients who underwent prophylactic cranial irradiation (PCI) (27.2 vs. 15.2 months; p = 0.02) (n = 394). These findings remained consistent after adjusting for age, initial metastatic site, and PCI. Additionally, the AECb group showed improved PFS (5.0 vs. 4.7 months; p = 0.004) and OS (11.1 vs. 9.8 months; p = 0.003). CONCLUSION: Our findings suggest that the AECb regimen is superior to conventional chemotherapy in delaying CNS progression and controlling systemic disease in ES-SCLC. These results support the AECb regimen as the new standard of care. Further research is needed to explore the mechanisms behind these improved CNS outcomes and to reassess the necessity of PCI in this treatment era
South Korean study to prevent cognitive impairment and protect brain health through multidomain interventions via face-to-face and video communication platforms in mild cognitive impairment (SUPERBRAIN-MEET): A randomized controlled trial
No full textINTRODUCTION: We investigated the efficacy of a multidomain intervention (MI) via face-to-face and video communication platforms using a tablet personal computer application in patients with mild cognitive impairment (MCI). METHODS: Three hundred participants with MCI and >/= 1 modifiable dementia risk factor, aged 60-85 years, were randomly assigned to either the MI group, who underwent a 24-week intervention, or the control group, who received usual care. RESULTS: The overall adherence rate to MI was 84.7%. The adjusted mean change from baseline at 24 weeks in the total scale index score of the repeatable battery for the assessment of neuropsychological status was 8.43 in the MI group and 4.26 in the control group (difference, 4.17; 95% confidence interval, 1.92-6.43; p < 0.001). MI showed significant beneficial effects on cognition in both apolipoprotein E (APOE) epsilon4 carriers and noncarriers. DISCUSSION: MI can exert beneficial effects on the cognition of patients with MCI. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05023057 HIGHLIGHTS: Although the controls also demonstrated improved performance in cognition, multidomain interventions showed significantly greater benefits for cognition in MCI compared to the controls in a randomized controlled trial. Multidomain interventions improved depression and quality of life. Multidomain interventions significantly positively impacted cognition in both APOE epsilon4 carriers and noncarriers. Multidomain interventions may be more effective for amnestic than nonamnestic MCI
Revascularisation patterns and characteristics after erythropoietin pretreatment and multiple burr holes in patients who had acute stroke with perfusion impairment
No full textBACKGROUND: Transdural collaterals, originating mainly from the extracalvarial superficial temporal artery and intracalvarial middle meningeal artery via the external carotid artery (ECA), have been observed after revascularisation surgery. However, the origin of these collaterals in patients with stroke with perfusion insufficiency is not yet known. Therefore, we studied the revascularisation patterns and characteristics based on the origin of these collaterals. METHODS: We employed erythropoietin pretreatment and performed multiple burr holes under local anaesthesia to achieve transdural revascularisation in patients with acute stroke with perfusion insufficiency. After 6 months, we reassessed the transfemoral cerebral angiography to evaluate the revascularisation patterns. The collaterals were categorised into intracalvarial ECA-dominant (originating from the middle meningeal artery), extracalvarial ECA-dominant (originating from the superficial temporal or occipital artery) and balanced groups. We compared various imaging parameters among these groups. RESULTS: Overall, 87 patients with 103 treated hemispheres were involved. Among them, 57.3% were classified as intracalvarial ECA-dominant, 20.4% as extracalvarial ECA-dominant and 22.3% as balanced. Most of the hemispheres with intracalvarial or extracalvarial collaterals (vs balanced collaterals) showed successful revascularisation (78/80 (97.5%) vs 12/23 (52.1%)), p<0.001). In ultrasonographic haemodynamic changes according to revascularisation pattern, only the intracalvarial ECA-dominant revascularisation was significantly associated with specific changes in ECA blood flow, leading to the conversion to a low-resistance ECA Doppler sonography waveform. CONCLUSIONS: Our findings suggest that intracalvarial ECA-dominant revascularisation plays a crucial role in the formation of transdural collaterals following combined therapy. These distinct changes in ECA haemodynamics can be non-invasively identified through bedside ultrasound studies
Learning curve for endoscopic submucosal dissection in early gastric neoplasm using a multibending endoscope
No full textBACKGROUND: Endoscopic submucosal dissection (ESD) is a representative treatment modality for early gastric neoplasms. However, the learning curve for beginners performing ESD using a multibending endoscope has not been introduced. OBJECTIVE: This study aimed to evaluate the learning curves of operators undergoing intensive training using a multibending endoscope. DESIGN: This was a retrospective single center study. METHODS: We retrospectively analyzed data of over 1500 consecutive gastric ESDs performed by two operators using a multibending endoscope. A change-point analysis with 50 cases of moving average speeds was used to determine the new target resection speed. Cumulative sum (CUSUM) analysis was used to identify the cases required for proficiency in ESD. Risk-adjusted CUSUM (RA-CUSUM) analysis was performed for each operator after adjusting for confounding factors influencing the resection speed. RESULTS: In total, 1491 cases were enrolled, with early gastric cancer accounting for 43.2% (n = 644). Overall, the en bloc resection, R0 resection, and curability rates were 97.7%, 96.0%, and 92.3%, respectively. The mean resection speed was 19.8 cm(2)/h. Because both operators surpassed the commonly used benchmark resection speed of 9 cm(2)/h in the first 50-case block, we established a new target benchmark of 17.9 cm(2)/h in the change-point analysis. CUSUM analysis indicated that performing 166 cases overall was required to achieve the benchmark, with the 2 operators needing 153 and 69 cases to meet this target speed after RA-CUSUM analysis. CONCLUSION: Using a multibending endoscope for gastric ESD can help beginners achieve safe and excellent outcomes. These findings will serve as a useful guide for beginners attempting to use a multibending endoscope
Comparison of Clinical Outcomes Using Left and Right Liver Grafts in Adult-to-adult Living-donor Liver Transplantation: A Retrospective Cohort Study Using the Korean Organ Transplantation Registry
No full textBACKGROUND: Living-donor liver transplantation has been widely performed as an alternative to the scarce liver grafts from deceased donors. More studies are reporting favorable outcomes of left liver graft (LLG). This study compared the clinical outcomes between living-donor liver transplantation using LLG and right liver graft (RLG) with similar graft-to-recipient body weight ratios. METHODS: This study analyzed 4601 patients from a multicenter observational cohort using the Korean Organ Transplantation Registry between 2014 and 2021. After matching the Model for End-stage Liver Disease score and graft-to-recipient body weight ratios because of the extremely different number in each group, the LLG and RLG groups comprised 142 (25.1%) and 423 (74.9%) patients, respectively. RESULTS: For donors, the median age was higher in the LLG group than in the RLG group (34 y [range, 16-62 y] versus 30 y [16-66 y] ; P = 0.002). For recipients, the LLG group showed higher 90-d mortality than the RLG group (11 [7.7%] versus 9 [2.1%]; P = 0.004). The long-term graft survival was significantly worse in the LLG group ( P = 0.011). In multivariate Cox proportional hazards regression analysis for graft survival, LLG was not a significant risk factor (hazard ratio, 1.01 [0.54-1.87]; P = 0.980). Otherwise, donor age (>/=40 y; 2.18 y [1.35-3.52 y]; P = 0.001) and recipients' body mass index (<18.5 kg/m 2 ; 2.98 kg/m 2 [1.52-5.84 kg/m 2 ]; P = 0.002) were independent risk factors for graft survival. CONCLUSIONS: Although the short-term and long-term graft survival was worse in the LLG group, LLG was not an independent risk factor for graft survival in multivariate analysis. LLGs are still worth considering for selected donors and recipients regarding risk factors for graft survival
Evaluation of Inflammatory Scores as Diagnostic Markers for Polymyalgia Rheumatica
No full textOBJECTIVE: Polymyalgia rheumatica (PMR) is a chronic inflammatory rheumatic disease affecting older adults, with symptoms often overlapping with those of other conditions, thus making its diagnosis challenging. The present study evaluated the utility of laboratory-based inflammatory scores, including the systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio (CAR), albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI), as diagnostic tools for PMR and explored their association with clinical manifestations. METHODS: This retrospective study analyzed the medical records of 156 patients diagnosed with PMR and 408 diagnosed with rheumatoid arthritis (RA) between 2001 and 2021 to evaluate the diagnostic performance of inflammatory scores in distinguishing between the two conditions. Statistical analyses, including receiver operating characteristic (ROC) curve analysis and logistic regression, were used to assess the accuracy and effectiveness of the scores. RESULTS: Patients with PMR exhibited higher SII and CAR scores and lower AGR and PNI values than those with RA. CAR demonstrated the best diagnostic performance, with an area under the ROC curve (AUC) of 0.823 (95% confidence interval [CI], 0.784-0.861), followed by SII (AUC, 0.797 [95% CI, 0.757-0.837]), AGR (AUC, 0.696 [95% CI, 0.648-0.743]), and PNI (AUC, 0.691 [95% CI, 0.641-0.741]). Combining these scores improved diagnostic ability, with an AUC of approximately 0.835. Furthermore, elevated SII or CAR values and decreased AGR or PNI values were associated with leucocytosis, anemia, elevated erythrocyte sedimentation rate/C-reactive protein, hypalbuminaemia, fever, weight loss, and headache. CONCLUSIONS: Serological inflammatory scores, such as SII, CAR, AGR, and PNI, were useful as diagnostic markers for PMR, with combined scores enhancing overall diagnostic accuracy
Hypertension prevalence in Korean adolescents according to parental hypertension: data from the Korea National Health and Nutrition Survey
No full textThe prevalence of hypertension among children and adolescents has risen to 4% globally in recent decades, presenting a significant public health challenge due to its association with increased cardiovascular risks. Existing research on the transmission of hypertension risk between parents and offspring lacks comprehensive data from general population-based samples with clinically collected measurements spanning generations. This study utilized nationally representative data to assess the risk of developing hypertension in offspring based on parental hypertension status, employing standardized blood pressure measurements rather than relying solely on historical data. A positive correlation exists between the increasing number of hypertensive parents and the risk of hypertension development in offspring. The prevalence of hypertension among individuals aged 10 to 18 years did not substantially increase with age. Adolescents whose parents were affected by hypertension exhibited a 2-fold greater prevalence of hypertension compared to the general population with the same age, with approximately a quarter of boys with both hypertensive parents having hypertension. Among nonobese individuals, the risk of hypertension associated with parental hypertension was comparable to that observed in obese subjects. Blood pressure monitoring from the early stage of life would benefit adolescents with hypertensive parents
Impact of early life antibiotic exposure on the preschool developmental status: a nationwide population-based study
No full textOBJECTIVE: Growing concerns exist about the potential adverse effects of early antibiotic exposure on neurodevelopmental outcomes. However, large-scale studies exploring these implications in early childhood are rare. DESIGN: A nationwide, population-based retrospective cohort study using data from the Korean National Health Insurance System and the National Health Screening Program for Infants and Children (NHSPIC) between 2015 and 2022. PATIENTS: A total of 1 848 841 children who participated in the NHSPIC at both 4-6 months and 54-60 months of age were included. INTERVENTIONS: Antibiotic exposure under 90 days old. MAIN OUTCOME MEASURES: Developmental delays in preschool-aged children assessed by the Korean Developmental Screening Test at 54-60 month of age. RESULTS: Among the 1 848 841 children assessed, 23% experienced antibiotic exposure within the first 3 months of life. Early use of antibiotics was linked to a slightly elevated risk of developmental delays at a median age of 4.94 years (OR 1.03, 95% CI 1.00 to 1.17), particularly affecting gross motor (OR 1.08, 95% CI 1.04 to 1.13), fine motor (OR 1.09, 95% CI 1.05 to 1.13), cognition (OR 1.08, 95% CI 1.04 to 1.13) and communication (OR 1.08, 95% CI 1.04 to 1.12). A dose-response relationship was also observed, with longer durations of antibiotic exposure associated with an increased risk of developmental delays. CONCLUSIONS: Exposure to antibiotics in infants under 90 days old may be associated with a modest increase in the risk of global developmental delays, especially in motor skills, cognitive functions and communication abilities. Careful consideration is necessary when prescribing antibiotics to this age group
Evaluation of the Efficacy and Safety of a Dual Delayed-Release Formulation of 10-mg Esomeprazole in Patients with Gastric Erosions: A Multicenter, Randomized, Double-Blind, Active-Control, Phase III Study
No full textBACKGROUND/AIMS: Clinical data on the efficacy and safety of the dual delayed-release formulation of 10-mg esomeprazole (HIP2101) are currently limited. Therefore, this study compared the efficacy and safety of HIP2101 and 20-mg famotidine (RLD2101) in patients with gastric erosions. METHODS: In this multicenter, randomized, double-blind, active-control, phase III study, 326 patients with endoscopically proven gastric mucosal erosion were randomly assigned to receive either HIP2101 or RLD2101 once daily for 2 weeks. The primary endpoint was the rate of improvement of erosion. Secondary endpoints (rate of cure of erosion and edema, and rate of improvement of hematin and gastrointestinal symptoms) and treatment-emergent adverse events were compared between the groups. RESULTS: Based on the per-protocol set (PPS) analysis, the improvement rates for erosion were 64.9% (98/151) and 63.7% (100/157) in the HIP2101 and RLD2101 groups, respectively (95% confidence interval, -9.5 to 11.9). The lower bound of the 95% confidence interval was greater than the noninferiority margin of -14%. These results were similar to those of the full analysis set (FAS) (HIP2101 group, 64.6%; RLD2101 group, 62.7%). Based on the PPS and FAS analyses, the cure rates for erosion and edema and the improvement rates for hematin and gastrointestinal symptoms were comparable between the groups. The number of adverse events did not differ significantly between the groups. CONCLUSIONS: The efficacy and safety of HIP2101 were comparable to those of RLD2101 in the treatment of gastric erosions and symptomatic improvement. These findings suggest that HIP2101 may be a novel treatment option for gastritis (ClinicalTrials.gov identifier: NCT05024721)