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Benchmarking the Quality of Trauma Care in South Korea through Risk-Adjusted Mortality : An International Comparison
No full textDoctorI. Introduction 1
A. Background and Significance of the Study 2
1. The Establishment and Development of Regional Trauma Centers and the Trauma System in South Korea 2
2. The Historical Background of Trauma Centers and the Trauma System in the United States 3
3. The Importance of Utilizing Risk-Adjusted Mortality Metrics for Quality Management in Trauma Care 5
4. The Necessity and Significance of This Study 6
B. Research Objectives 8
C. Research Hypotheses and Research Questions 8
D. Structure of the Dissertation 8
II. Conceptual and Methodological Foundations 11
A. Trauma System Design: Principles and Components 11
B. Risk-Adjusted Outcome Measurement in Trauma Care 12
C. Benchmarking Trauma Center Performance with Adjusted Metrics 14
D. Importance of Subgroup Analysis 17
III. Methods 19
A. Study Design 19
B. Data Sources and Patient Selection 19
1. TQIP Dataset 19
2. KTDB Dataset 20
C. Definition of Variables and Measurement Tools 20
1. Primary Outcome 20
2. Risk Adjustment Factors 21
D. Analysis Methods 21
1. Descriptive Statistics 21
2. Risk-Adjusted Model Construction and Model Fit 21
3. Comparison Between Korean and TQIP Centers and Statistical Testing 22
4. Sensitivity and Subgroup Analyses 22
E. Ethical Considerations 22
IV. Results 23
A. Participating Centers and Patient Volume 23
B. Trauma Center Characteristics 25
1. Trauma Center Level and Size 25
2. Teaching Status and Hospital Type 27
C. Patient Demographics 30
D. Pre-Existing Conditions 31
E. Injury Characteristics and Severity 35
1. Mechanism of Injury 35
2. Physiologic Condition on Arrival 35
3. Injury Severity Score 35
4. Glasgow Coma Scale - Neurologic Status 36
F. Unadjusted Mortality 38
G. Risk-Adjusted Mortality Comparison 41
1. 2019 41
2. 2020 41
3. 2021 42
4. 2022 43
H. Trends in TQIP Rankings for the 17 KTDB Trauma Centers 49
I. Center-Level Subgroup Contributions to Adjusted Mortality 52
1. Centre-specific patterns 52
2. Network-wide strengths and weaknesses 53
J. Model Performance and Discrimination (C-index) 72
1. 2019 Model Fitness 72
2. 2020 Model Fitness 72
3. 2021 Model Fitness 72
4. 2022 Model Fitness 72
V. Discussion 77
A. Trauma Center Performance Variability and Quality Management 78
B. Center-Level Subgroup Contributions to Adjusted Mortality 79
C. Limitations and Generalizability 82
VI. Conclusion 84
VII. References 87
VIII. Abstract in Korean 9
폐절제술 후보자에서 패치형 단일 유도 심전도 모니터링 기기를 활용한 VO2max 추정 머신러닝 모델 개발
No full textMasterI. INTRODUCTION 1
II. MATERIALS AND METHODS 4
A. Study design and subjects 4
B. Cardio-pulmonary exercise test (CPET) 4
C. Measuring device (mobiCARE-MC100, MC-100) 5
D. Developing a machine learning algorithm to predict VO2max 5
(A) Measurement variables by MC-100: Heart Rate, Acceleration, and Gyroscope 5
(B) Feature selection 6
(C) Model development 7
(D) Comparison between the machine-learning model and clinical equation 8
(E) Statistical analysis 8
III. RESULTS 10
A. Baseline characteristics 10
B. Pulmonary function test (PFT) and CPET 10
C. Heart rate accuracy during graded exercise testing 10
D. VO2max estimation 11
IV. DISCUSSION 13
V. CONCLUSION 17
REFERENCES 30
국문요약 3
Clinical Efficacy of Laparoscopic Sentinel Node Navigation Surgery for Stomach Preservation in Patients with Early Gastric Cancer: 5-year Results of the SENORITA Trial
No full textObjective: This study aimed to compare laparoscopic standard gastrectomy (LSG) and laparoscopic sentinel node navigation surgery (LSNNS) for early gastric cancer (EGC) in terms of 5-year long-term oncologic outcomes. Background: The oncological safety of LSNNS for EGC has not been confirmed. Three-year disease-free survival (DFS), which is the primary endpoint of phase III multicenter randomized controlled clinical trial [SEntinel Node ORIented Tailored Approach (SENORITA) trial], did not show the noninferiority of LSNNS relative to LSG. Methods: The SENORITA trial, a multicenter randomized clinical trial, was designed to show that LSNNS is noninferior to LSG in terms of 3-year DFS. In the present study, we collected 5-year follow-up data from 527 patients recruited in the SENORITA trial as the full analysis set. DFS, overall survival (OS), disease-specific survival (DSS), and recurrence patterns were evaluated using the full analysis set of both LSG (n=269) and LSNNS (n=258). Results: The 5-year DFS was not significantly different between the LSG and LSNNS groups (P=0.0561). During the 5-year follow-up, gastric cancer-related events, such as metachronous cancer, were more frequent in the LSNNS group than in the LSG group. However, 10 recurrent cancers in the remnant stomach of both groups were curatively resected by additional gastrectomy and 1 by additional endoscopic resection. Two of the 198 patients who underwent local resection for stomach preservation based on the LSNNS results developed distant metastasis. However, there was no statistically significant difference in the 5-year OS and DSS (P=0.7403 and P=0.9586, respectively) between the two groups. Conclusions: The 5-year DFS, DSS, and OS did not differ significantly between the two groups. Considering the benefits of LSNNS on postoperative quality of life, LSNNS could be recommended as an alternative treatment option for EGC
Radiofrequency Ablation for Recurrent Thyroid Cancers: 2025 Korean Society of Thyroid Radiology Guideline
No full textRadiofrequency ablation (RFA) is a minimally invasive treatment modality used as an alternative to surgery in patients with benign thyroid nodules, recurrent thyroid cancers (RTCs), and primary thyroid microcarcinomas. The Korean Society of Thyroid Radiology (KSThR) initially developed recommendations for the optimal use of RFA for thyroid tumors in 2009 and revised them in 2012 and 2017. As new meaningful evidence has accumulated since 2017 and in response to a growing global interest in the use of RFA for treating malignant thyroid lesions, the task force committee members of the KSThR decided to update the guidelines on the use of RFA for the management of RTCs based on a comprehensive analysis of current literature and expert consensus
Establishment of Local Diagnostic Reference Levels for Pediatric Neck CT at Nine University Hospitals in South Korea
No full textObjective: To establish local diagnostic reference levels (DRLs) for pediatric neck CT based on age, weight, and water-equivalent diameter (WED) across multiple university hospitals in South Korea. Materials and Methods: This retrospective study analyzed pediatric neck CT examinations from nine university hospitals, involving patients aged 0–18 years. Data were categorized by age, weight, and WED, and radiation dose metrics, including volume CT dose index (CTDIvol) and dose length product, were recorded. Data retrieval and analysis were conducted using a commercially available dose-management system (Radimetrics, Bayer Healthcare). Local DRLs were established following the International Commission on Radiological Protection guidelines, using the 75th percentile as the reference value. Results: A total of 1159 CT examinations were analyzed, including 169 scans from Institution 1, 132 from Institution 2, 126 from Institution 3, 129 from Institution 4, 128 from Institution 5, 105 from Institution 6, 162 from Institution 7, 127 from Institution 8, and 81 from Institution 9. Radiation dose metrics increased with age, weight, and WED, showing significant variability both within and across institutions. For patients weighing less than 10 kg, the DRL for CTDIvol was 5.2 mGy. In the 10–19 kg group, the DRL was 5.8 mGy; in the 20–39 kg group, 7.6 mGy; in the 40–59 kg group, 11.0 mGy; and for patients weighing 60 kg or more, 16.2 mGy. DRLs for CTDIvol by age groups were as follows: 5.3 mGy for infants under 1 year, 5.7 mGy for children aged 1–4 years, 7.6 mGy for ages 5–9 years, 11.2 mGy for ages 10–14 years, and 15.6 mGy for patients 15 years or older. Conclusion: Local DRLs for pediatric neck CT were established based on age, weight, and WED across nine university hospitals in South Korea
Communication needs regarding heart failure trajectory and palliative care between patients and healthcare providers: A cross-sectional study
No full textIntroduction: Heart failure (HF) is a chronic condition with an unpredictable trajectory, making effective communication between patients and healthcare providers crucial for optimizing outcomes. This study aims to investigate and compare the communication needs regarding HF trajectory and palliative care between patients and healthcare providers and to identify factors associated with the communication needs of patients with HF.
Methods: A cross-sectional study design was employed, involving 100 patients with HF and 35 healthcare providers. Data were collected using structured questionnaires assessing communication needs, health literacy, self-care behavior, and social support. Statistical analyses were performed, including Spearman's rank correlation, Pearson's correlation, and multiple regression analyses.
Results: Patients prioritized communication related to device-related questions, whereas healthcare providers focused more on aspects of HF in daily life. Both groups ranked end-of-life communication as the lowest priority. The communication needs of patients were positively correlated with health literacy (r = 0.27, p = .007), self-care behavior (r = 0.32, p = .001), and social support (r = 0.24, p = .016). Multiple regression analyses indicated that self-care behavior was a significant factor influencing the communication needs of patients (β = 0.27, p = .011).
Conclusions: Enhanced patient-centered communication strategies are required to address the communication priority gaps between patients and healthcare providers. Improving health literacy, supporting self-care behaviors, and leveraging social support are critical in meeting patients' communication needs. Tailored communication training for healthcare providers can bridge this gap and improve overall HF management
Senolytic Targeting of Anti-Apoptotic Bcl Family Increases Cell Death in UV-Irradiated Senescent Melanocytes: Search for Senolytics
No full textSenescent melanocytes have been suggested to play a role in the development of ageing-associated pigmentary changes and skin ageing. Here, we assessed the senolytic capacity of recognised senolytic chemicals and natural compounds in UV-irradiated senescent melanocytes. Among the tested agents, only ABT-737 and ABT-263 showed a significant reduction in the number of SA-β-Gal-positive senescent melanocytes and in the expressions of p16INK4A and p21Waf1. The senolytic effects of the ABT drugs were associated with increased expression of cleaved caspase-3, which was hindered with a caspase inhibitor, Z-VAD. These findings indicate that ABT-737 and ABT-263 eliminate senescent melanocytes through caspase-mediated apoptosis, suggesting their future potential to address ageing skin
Prognostic Value of Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With Intermediate Coronary Stenosis
No full textBackground: The association between coronary microcirculation and clinical outcomes in patients with intermediate stenosis remains unclear. Objectives: The aim of this study was to assess the prognostic significance of angiography-derived index of microcirculatory resistance (angio-IMR) in patients with intermediate coronary stenosis. Methods: This post hoc analysis included 1,658 patients from the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, with angio-IMR measured in each vessel exhibiting intermediate stenosis. The primary endpoint was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction, or revascularization over a 2-year period. Results: The median follow-up period was 24.8 months (Q1-Q3: 24.4-26.4 months). Over the 2-year follow-up period, patients with angio-IMR >25 exhibited a significantly higher POCO rate in both the percutaneous coronary intervention (PCI) group (35.06% [27 of 77] vs 7.2% [51 of 708]; P < 0.001) and the non-PCI group (17.95% [21 of 117] vs 4.23% [32 of 756]; P < 0.001). After adjusting for potentially related risk factors, angio-IMR >25 remained an independent predictor of the POCO in the PCI group (HR: 6.235; 95% CI: 3.811-10.203; P < 0.001) and the non-PCI group (HR: 5.282; 95% CI: 2.948-9.462; P < 0.001). The addition of angio-IMR demonstrated incremental prognostic value in both an angiographic risk factor model (C-index 0.710 [95% CI: 0.663-0.756] vs 0.615 [95% CI: 0.563-0.664] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.191-0.362; P < 0.001]; integrated discrimination improvement 0.055 [95% CI: 0.030-0.108; P < 0.001]) and a clinical risk factor model (C-index 0.705 [95% CI: 0.658-0.751] vs 0.594 [95% CI: 0.544-0.644] [P < 0.001]; net reclassification index 0.268 [95% CI: 0.171-0.350; P < 0.001]; integrated discrimination improvement 0.057 [95% CI: 0.027-0.102; P < 0.001]). Conclusions: In individuals with intermediate coronary stenosis, elevated angio-IMR is linked to an adverse prognosis. Using angio-IMR significantly enhanced the capability to reclassify patients and accurately estimate the risk for the POCO
Structural insights into antibody-based immunotherapy for hepatocellular carcinoma
No full textHepatocellular carcinoma (HCC) is one of the most common types of primary liver cancer and remains a leading cause of cancer-related deaths worldwide. While traditional approaches like surgical resection and tyrosine kinase inhibitors struggle against the tumor's immune evasion, monoclonal antibody (mAb)-based immunotherapies have emerged as promising alternatives. Several therapeutic antibodies that counter the immunosuppressive tumor microenvironment have demonstrated efficacy in clinical trials, leading to FDA approvals for advanced HCC treatment. A crucial aspect of advancing these therapies lies in understanding the structural interactions between antibodies and their targets. Recent findings indicate that mAbs and bispecific antibodies (bsAbs) can target different, non-overlapping epitopes on immune checkpoints such as PD-1 and CTLA-4. This review delves into the epitope-paratope interactions of structurally unresolved mAbs and bsAbs, and discusses the potential for combination therapies based on their non-overlapping epitopes. By leveraging this unique feature, combination therapies could enhance immune activation, reduce resistance, and improve overall efficacy, marking a new direction for antibody-based immunotherapy in HCC
