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Three-Dimensional Bone Structural Analysis in Postmenopausal Patients With Rheumatoid Arthritis With and Without Bone Erosion
No full textINTRODUCTION: This study compared the three-dimensional (3D) bone structure based on bone erosion in postmenopausal patients with rheumatoid arthritis (RA) using a novel dual-energy X-ray absorptiometry (DXA)-based 3D analysis tool. METHODS: In this cross-sectional study, 171 postmenopausal women with RA (aged >/= 50 years) were categorized based on bone erosions on hand and foot X-rays. We conducted 3D bone structure analyses on DXA hip scans using 3D-Shaper software, measuring volumetric BMD of integral (IvBMD), trabecular (TvBMD), and cortical (CvBMD) compartments. RESULTS: The study included 94 patients without erosion and 77 with erosion. The erosion-positive group showed significantly lower femoral neck (FN) parameters: areal BMD (0.722 +/- 0.090 vs. 0.756 +/- 0.102 g/cm(2), p = 0.023), IvBMD (269.784 +/- 49.306 vs. 288.610 +/- 59.220 mg/cm(3), p = 0.027), TvBMD (157.043 +/- 39.154 vs. 170.787 +/- 45.168 mg/cm(3), p = 0.037), and CvBMD (709.563 +/- 68.028 vs. 735.182 +/- 81.470 mg/cm(3), p = 0.026). Multiple regression analysis revealed that disease activity score (DAS28) was independently associated with FN CvBMD (beta = -24.693, p = 0.023). CONCLUSIONS: This study demonstrated that bone erosion in RA is associated with significant alterations in bone structure, particularly in the FN region. Disease activity primarily affects cortical bone, highlighting the need for stringent disease management to maintain bone health in patients with RA
Prevalence and progression rate of interstitial lung abnormalities detected on thoracic CT: a systematic review and meta-analysis
No full textObjectives: To estimate the pooled prevalence and progression rate of ILAs and identify the risk factors for radiological progression. Materials and methods: An EMBASE and PubMed search was undertaken, identifying all studies meeting the inclusion criteria performed before May 10, 2023. Random effect models were used to estimate pooled prevalence, ILA progression rates, and odds ratio for radiological progression based on radiological subtype. Subgroup analyses were performed to compare the general and high-risk populations for lung cancer. The quality of the included studies was evaluated using the risk of bias assessment tool for non-randomized studies. Results: We analyzed 19 studies (241,541 patients) and 10 studies (1317 patients) for the pooled prevalence and progression rate of ILA, respectively. The pooled ILA prevalence was 9.7% (95% CI, 6.1–13.9%). The pooled prevalence was 6.8% (95% CI, 3.1–11.6%) and 7.1% (95% CI, 2.2–14.4%) in the general (six studies) and high-risk population for lung cancer (six studies), respectively. The pooled progression rate was 47.1% (95% CI, 29.1–65.5%). The pooled progression rate was 64.2% (95% CI, 45.0–81.2%, five studies) and 31.0% (95% CI, 8.2–60.5%, five studies) for longer (≥ 4.5 years) and shorter follow-up periods (< 4.5 years), respectively (p = 0.009). Fibrotic ILAs were significantly associated with a higher progression probability (combined OR, 5.55; 95% CI, 1.95–15.82). Conclusions: The prevalence of ILAs was approximately 9.7%. Approximately half of the patients exhibited radiological progression, with the rate increasing over a longer follow-up period. Fibrotic ILA was a significant risk factor for radiological progression. Clinical relevance statement: The prevalence of interstitial lung abnormalities (ILAs) is approximately 9.7%, with about half exhibiting progression; a longer follow-up duration and fibrotic ILAs are associated with a higher progression rate. Key Points: ILAs are increasingly recognized as important, but few population data are available. ILAs exhibited a pooled prevalence of 9.7% with a progression rate of 47.1%. Fibrotic ILAs were associated with increased progression likelihood
ASO Visual Abstract: Minimally Invasive Surgery: Is It a Risk Factor for Postoperative Peritoneal Metastasis in pT4 Colon Cancer?
No full textConcurrent Fabry disease and IgA nephropathy in a patient with Crohn's disease: A case report
No full textWe present a unique case of concurrent Fabry disease (FD) and IgA nephropathy (IgAN) in a 27-year-old female with a 10-year history of Crohn's disease (CD). The patient presented to the nephrology clinic with microscopic haematuria and proteinuria on routine tests. A kidney biopsy revealed mesangial matrix widening, mesangial cell proliferation, and podocyte enlargement with prominent lacy and clear cytoplasm, as observed with haematoxylin and eosin staining. Immunofluorescence staining demonstrated diffuse immunoglobulin A deposits in the mesangium. Electron microscopy identified myelin-like figures in the cytoplasm of podocytes and electron-dense deposits in the mesangium, confirming IgAN and suggesting FD. Subsequent testing showed low alpha-galactosidase A (α-gal) enzyme activity in the patient's white blood cells, confirming the FD diagnosis. Enzyme replacement therapy was initiated following the diagnosis. To our knowledge, this is the first reported case of the coexistence of FD, IgAN, and CD in a single patient. This case highlights the importance of considering FD in patients with proteinuria, emphasising the need for comprehensive diagnostic evaluations in complex cases
Clinical Characteristics of Chronic Obstructive Pulmonary Disease according to Smoking Status
No full textChronic obstructive pulmonary disease (COPD) can be caused by various factors, including lung infections, asthma, air pollution, childhood growth disorders, and genetic factors, though smoking is the predominant risk factor. The main pathological mechanisms in COPD involve small airway disease, emphysema, mucus hypersecretion, and vascular disorders. COPD in non-smokers is characterized by a normal 1-second forced expiratory volume decline, equal sex distribution, younger age of onset, fewer comorbidities, milder airflow obstruction, preserved diffusing capacity of the lungs for carbon monoxide, and radiological features such as more air-trapping and less severe emphysema compared to COPD in smokers. Nevertheless, non-smokers with COPD still experience a high prevalence of acute exacerbations, nearly equal to that of smokers with COPD. Moreover, COPD itself is an independent risk factor for developing lung cancer, regardless of smoking status. Given that COPD coexists with numerous comorbidities, effectively managing these comorbidities is crucial, requiring multifaceted efforts for comprehensive treatment
Leveraging deep transfer learning and explainable AI for accurate COVID-19 diagnosis: Insights from a multi-national chest CT scan study
No full textThe COVID-19 pandemic has emerged as a global health crisis, impacting millions worldwide. Although chest computed tomography (CT) scan images are pivotal in diagnosing COVID-19, their manual interpretation by radiologists is time-consuming and potentially subjective. Automated computer-aided diagnostic (CAD) frameworks offer efficient and objective solutions. However, machine or deep learning methods often face challenges in their reproducibility due to underlying biases and methodological flaws. To address these issues, we propose XCT-COVID, an explainable, transferable, and reproducible CAD framework based on deep transfer learning to predict COVID-19 infection from CT scan images accurately. This is the first study to develop three distinct models within a unified framework by leveraging a previously unexplored large dataset and two widely used smaller datasets. We employed five known convolutional neural network architectures, both with and without pretrained weights, on the larger dataset. We optimized hyperparameters through extensive grid search and 5-fold cross-validation (CV), significantly enhancing the model performance. Experimental results from the larger dataset showed that the VGG16 architecture (XCT-COVID-L) with pretrained weights consistently outperformed other architectures, achieving the best performance, on both 5-fold CV and independent test. When evaluated with the external datasets, XCT-COVID-L performed well with data with similar distributions, demonstrating its transferability. However, its performance significantly decreased on smaller datasets with lower-quality images. To address this, we developed other models, XCT-COVID-S1 and XCT-COVID-S2, specifically for the smaller datasets, outperforming existing methods. Moreover, eXplainable Artificial Intelligence (XAI) analyses were employed to interpret the models’ functionalities. For prediction and reproducibility purposes, the implementation of XCT-COVID is publicly accessible at https://github.com/cbbl-skku-org/XCT-COVID/
Diminished lactate utilization in LDHB-deficient neurons leads to impaired long-term memory retention
No full textNeurons' high energy demands for processing, transmitting, and storing information in the brain necessitate efficient energy metabolism to maintain normal neuronal function. The astrocyte-neuron lactate shuttle (ANLS) hypothesis suggests neurons preferentially use lactate from astrocytes over glucose for energy. This study investigated lactate dehydrogenase B (LDHB), which preferentially converts lactate to pyruvate, in neuronal energy metabolism and cognitive function. LDHB-deficient neurons showed reduced lactate-driven energy metabolism in culture, while LDHB-deficient brains accumulated lactate, both indicating decreased lactate utilization. This reduced lactate utilization was correlated with impaired long-term memory in LDHB-deficient mice, while short-term memory remained unaffected and overall neuropathology was only mildly disturbed. Unexpectedly, LDHB-deficient neurons maintain stable energy metabolism under physiological glucose conditions, indicating the presence of lactate dehydrogenase (LDH) activity in LDHB-deficient neurons. The observation of lactate dehydrogenase A (LDHA), which preferentially converts pyruvate to lactate but can also catalyze the reverse reaction less efficiently, in LDHB-deficient neurons may explain their stable energy metabolism and reduced lactate utilization. This study challenges the established concept of strict LDH isoform compartmentalization in brain cells, questioning the exclusive presence of LDHB in neurons and suggesting a more flexible neuronal metabolic profile than previously assumed by the ANSL hypothesis
Long-Term Impact of Delirium on the Risk of Dementia in Hospitalized Older Patients: A Real-World Multicenter Study
No full textBackground: The association between delirium and dementia has been suggested, but mostly in the postoperative setting. This study aims to explore this relationship in a broader inpatient population, leveraging extensive real-world data to provide a more generalized understanding. Methods: In this retrospective cohort study, electronic health records of 11,970,475 hospitalized patients aged over 60 from nine institutions in South Korea were analyzed. Patients with and without delirium were identified, and propensity score matching (PSM) was used to create comparable groups. A 10-year longitudinal analysis was conducted using the Cox proportional hazards model, which calculated the hazard ratio (HR) and 95% confidence interval (CI). Additionally, a meta-analysis was performed, aggregating results from all nine medical institutions. Lastly, we conducted various subgroup and sensitivity analyses to demonstrate the consistency of our study results across diverse conditions. Results: After 1:1 PSM, a total of 47,306 patients were matched in both the delirium and nondelirium groups. Both groups had a median age group of 75–79 years, with 43.1% being female. The delirium group showed a significantly higher risk of all dementia compared with the nondelirium group (HR: 2.70 [95% CI: 2.27–3.20]). The incidence risk for different types of dementia was also notably higher in the delirium group (all dementia or mild cognitive impairment, HR: 2.46 [95% CI: 2.10–2.88]; Alzheimer's disease, HR: 2.74 [95% CI: 2.40–3.13]; vascular dementia, HR: 2.55 [95% CI: 2.07–3.13]). This pattern was consistent across all subgroup and sensitivity analyses. Conclusions: Delirium significantly increases the risk of onset for all types of dementia. These findings highlight the importance of early detection of delirium and prompt intervention. Further research studies are warranted to investigate the mechanisms linking delirium and dementia
Burnout among intensivists and critical care fellows in South Korea: Current status and associated factors
No full textBurnout among critical care physicians is an important issue that affects patient care and staff well-being. This study, conducted by the Korean Society of Critical Care Medicine, aimed to investigate the prevalence and associated factors of burnout among intensivists and critical care fellows in South Korea. From May to July 2019, a cross-sectional survey was conducted in 51 hospitals and 79 intensive care units offering subspecialty training in critical care medicine. Invitations were sent by email and text, and responses were collected using NownSurvey and Google Forms. Of the 502 invited participants, 253 responded (response rate: 50.4%). Significant contributing factors of burnout included being in an intensivist position (assistant professor/fellow) (odds ratio [OR], 3.916; 95% confidence interval [CI], 1.485-10.327; p = 0.006), working in a medical ICU (OR, 4.557; 95% CI, 1.745-11.900; p = 0.002), the number of stay-home night calls per month (OR, 1.070; 95% CI, 1.005-1.139; p = 0.034), and recent conflicts with colleagues (OR, 5.344; 95% CI, 1.140-25.051; p = 0.033). Similar factors were found to influence severe levels of burnout. This nationwide study indicates that a significant proportion of critical care physicians in South Korea experience burnout. Strategies to reduce overtime and workplace conflict are imperative to reduce burnout among these physicians and protect their mental health. Future research should explore targeted interventions for these specific factors
Confounding effects of socioeconomic status on the association between long-term PM2.5 exposure and mortality in Korea
No full textBACKGROUND: This study assesses the national distribution of ambient fine particulate matter (PM2.5) exposure across socioeconomic status (SES) and its confounding on long-term PM2.5 mortality in Korea, aiming to minimize SES influence. METHODS: A nationwide cohort of 5% of Koreans, aged 30 or older, from 2007 to 2019, from the National Health Information Database, was analysed. PM2.5 exposure levels were estimated at the city level using the Community Multiscale Air Quality system. Mortality data were obtained from Statistics Korea. The study examined annual PM2.5 exposure by SES indicators and its confounding on mortality risks associated with PM2.5, using time-varying Cox proportional hazards models. RESULTS: The study followed 1 453 036 individuals from 2007 to 2019, totalling 17 760 227 person-years (PYs). The non-accidental (A00-R99), cardiovascular (I00-I99) and respiratory (J00-J99) mortality rates per 1000 PY were 7.6, 1.9 and 0.8, respectively. We observed a trend of decreasing PM2.5 exposure levels but increased mortality among medical aid beneficiaries, those with lower household incomes and those residing in neighbourhoods with a higher area deprivation index. When adjusting for these SES covariates, the long-term mortality effects of PM2.5 shifted in the direction of increased risk [hazard ratio (HR) for cardiovascular mortality in the unadjusted model = 0.968 (95% CI: 0.909-0.959); HR in the fully adjusted model = 1.053 (95% CI: 1.004-1.105)]. CONCLUSION: In regions where SES and PM2.5 concentrations are positively correlated, as in Korea, it is crucial to rigorously control for SES confounding to avoid underestimating the mortality effects associated with PM2.5