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Predictors for the Development of Hypergastrinemia in Maintenance Treatment for Mild Gastroesophageal Reflux Disease Using a Half-dose Proton Pump Inhibitor
No full textBACKGROUND/AIMS: Serum gastrin levels may be elevated following proton pump inhibitor (PPI) therapy. We aim to elucidate the predictors for the development of hypergastrinemia in maintenance treatment for mild gastroesophageal reflux disease (GERD) using a half-dose PPI. METHODS: This study analyzed data from a prospective randomized trial to compare continuous versus on-demand maintenance treatment modalities in patients with mild GERD. Age, sex, body mass index, Helicobacter pylori infection, serum gastrin levels, pepsinogen (PG) I/II ratios, total days of PPI intake, and weight-based PPI dosage (mg/kg) were evaluated. RESULTS: Data from 293 patients who completed a randomized trial were analyzed (continuous group, n = 147 vs on-demand group, n = 146). In univariate analysis, age (P < 0.001), H. pylori infection (P = 0.012), baseline gastrin levels (P < 0.001), and baseline PG ratios (P = 0.016) significantly correlated with post-treatment gastrin levels. In multivariate analysis, age, baseline gastrin levels, and baseline PG ratios were independently associated with final serum gastrin levels. In univariate analysis, age (P = 0.018), H. pylori infection (P = 0.028), baseline gastrin levels (P = 0.011), and baseline PG ratios (P = 0.031) significantly correlated with the development of hypergastrinemia. In multivariate analysis, age, baseline gastrin levels, and baseline PG ratios were independently associated with the development of hypergastrinemia. CONCLUSION: Old age, high baseline serum gastrin levels, and low baseline PG ratios are significant predictors of the development of hypergastrinemia in maintenance treatment for mild GERD using a half-dose PPI
Incidental Detection of Meningioma on 18F-Flutemetamol PET
No full textMeningioma is typically a benign tumor that may incidentally be found on imaging. This case demonstrates the utility of 18 F-flutemetamol (FMM) PET/CT in an 80-year-old woman evaluated for memory decline. Although the scan was performed for dementia assessment, it revealed an incidental mass in the frontal region. Early-phase PET showed relatively low uptake, while delayed-phase imaging displayed intense uptake of 18 F-FMM. Magnetic resonance imaging and surgical pathology confirmed the lesion as a meningioma. This report may aid in interpreting incidental mass lesions on 18 F-FMM PET, providing a reference for physicians who may encounter similar findings
Facial retaining ligaments based on real color sectioned images with 3D models: Toward a more precise classification
No full textFacial retaining ligaments play a crucial role in maintaining and supporting skin with the superficial musculoaponeurotic system. However, visualizing these ligaments in detail has been challenging due to the limitations of cadaver dissection and radiologic images for plastic surgery. This study aims to visualize and refine the anatomical definitions of the facial retaining ligaments using high-resolution, true-color sectioned images and three-dimensional models. Facial retaining ligaments with their neighboring structures were identified in the sectioned images and reconstructed into 3D models. Using these sectioned images and 3D models, the ligaments were anatomically analyzed alongside neighboring structures. The study revealed distinct morphological features of the retaining ligaments (orbital retaining ligament with the lateral orbital thickening, zygomatic ligament, maxillary ligament, platysma-auricular ligament, masseteric ligament, mental ligament, medial mandibular ligament, mandibular osteocutaneous ligament, cervicomental angle suspensory ligament), including their orientation relative to the skin and their role in anchoring SMAS and adjacent tissues on the real color datasets. These findings enhance our understanding of facial anatomy and offer valuable insights for surgical planning and safer aesthetic procedures. This approach demonstrates the potential of high-resolution anatomical imaging as a superior alternative to traditional dissection and grayscale radiologic imaging
Association Between Muscle Quality and Quantitative Changes According to Nutritional Intake Differences in Patients Recovering From Trauma
No full textAdequate nutrition reportedly can help reduce the degree of muscle loss and improve muscle quality in hospitalized patients recovering from trauma. This study investigated the association between nutritional intake and changes in muscle quality and quantity in these patients. The handgrip strength (HGS) and body composition of 52 patients admitted to the trauma ward were measured at 1-week intervals. According to their dietary intake, they were categorized into the hypocaloric nutrition group (HNG; < 70% of recommended caloric intake) and the isocaloric nutrition group (ING; ≥ 70% of recommended caloric intake). Within one week, body mass index (24.3 ± 4.4 kg/m2 vs. 23.4 ± 4.5 kg/m2), body fat percentage (24.1% ± 9.8% vs. 17.2% ± 9.2%), and skeletal muscle mass (28.6 ± 4.9 kg vs. 27.5 ± 4.3 kg) significantly decreased in the ING compared with those in the HNG. Although the skeletal muscle mass decreased, the ING's left HGS significantly increased (26.6 ± 9.6 kg vs. 28.5 ± 10.1 kg). The ING also consumed a significantly greater amount of protein (beyond the recommended amount) than the HNG (72.6 ± 43.2 → 100.8 ± 27.0% vs. 58.6 ± 25.9 → 49.5 ± 20.1%; p = 0.039). In bioelectrical impedance vector analysis, the vectors of the ING shifted more within the normal range of the 75% tolerance ellipse than those of the HNG (23% vs. 10%). These results suggest that, although the muscle mass quantitatively decreased during trauma recovery, adequate nutritional support helps preserve muscle quality
The risk of pregnancy-related adverse outcomes after COVID-19 vaccination: Propensity score-matched analysis with influenza vaccination
No full textIntroduction: Coronavirus 2019 (COVID-19) vaccination rates in pregnant women remain low owing to safety concerns. When evaluating vaccine safety, comparisons with unvaccinated individuals may lead to healthy vaccinee bias. This study aimed to investigate the association between mRNA-based COVID-19 vaccination and pregnancy-related adverse outcomes compared with influenza vaccination. Methods: A propensity score-matched cohort study was conducted using the National Health Insurance Service insurance claims database, combined with COVID-19 and influenza vaccination registration data from the Korea Disease Control and Prevention Agency. Based on the age, comorbidities, insurance type, region, hospital type, gestational age at vaccination, and primiparity, the COVID-19 vaccination-only group and influenza vaccination-only group were matched in a 1:3 ratio, while both (COVID-19 and influenza) vaccination group and influenza vaccination-only group were also matched in a 1:3 ratio. Logistic regression analysis was used to calculate odds ratios (ORs) with 95 % confidence intervals (CIs) between the two groups. Results: From October 18, 2021, to March 3, 2022, 71,902 pregnant women were identified, and the vaccination records of 67,522 individuals were verified. Among them, 610 received the COVID-19 vaccination only, 49,952 received the influenza vaccination only, and 2405 received both vaccines. In the COVID-19 vaccination-only group, the risk of large for gestational age was higher than in the influenza vaccination-only group (OR = 2.285, 95 % CI = 1.155–4.522, P = 0.018). In the group that received both vaccinations, the risk of premature birth was higher (OR = 1.365, 95 % CI = 1.124–1.656, P = 0.002) than that in the influenza vaccination-only group but lower than the domestic baseline incidence rates. No significant differences were observed in other maternal and neonatal outcomes. Conclusion: mRNA-based COVID-19 vaccination in pregnant women is safe without a remarkable increase in adverse maternal and neonatal outcomes. Given the high morbidity and mortality rates of COVID-19 in pregnant women, it is reasonable to recommend COVID-19 vaccination for pregnant women
Patient-Reported Outcomes Between Whole-Breast Plus Regional Irradiation and Whole-Breast Irradiation Only in pN1 Breast Cancer After Breast-Conserving Surgery and Taxane-Based Chemotherapy: A Randomized Phase 3 Clinical Trial (KROG 17-01)
No full textPurpose: The role of regional node irradiation (RNI) with whole-breast irradiation (WBI) in patients with pN1 breast cancer receiving taxane-based adjuvant chemotherapy is not well defined. The KROG 1701 trial, a phase 3, multicenter, noninferiority study, aimed to compare the disease-free survival between WBI+RNI and WBI alone in this patient cohort. Comprehensive patient-reported outcomes (PROs) collected at multiple timepoints are reported. Methods and Materials: The trial (NCT03269981) enrolled patients with pN1 breast cancer after breast-conserving surgery and taxane-based adjuvant chemotherapy, allocating them to receive either WBI+RNI or WBI only. PROs were assessed using European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaires Core 30and breast cancer-specific module 23 modules at baseline, during radiation therapy, and at subsequent follow-up intervals of 3 to 6 months, and annually up to 4 years. Results: From April 2017 to December 2021, 840 patients were enrolled; 777 received intervention as assigned, and 750 completed baseline PRO questionnaires (387 in WBI+RNI, 363 in WBI only). All PRO domains showed improvements over time (P < .001). During radiation therapy, the WBI+RNI group reported greater fatigue and nausea. Higher arm symptom scores were observed in the WBI+RNI group 3 months post-treatment (P = .030). No other significant PRO domain differences, including arm/breast symptoms, were observed between the 2 groups. Conclusions: In patients with pN1 breast cancer treated with taxane-based chemotherapy, adding RNI to WBI resulted in minor, temporary declines in specific PRO domains, but these differences were not clinically significant. This indicates that overall patient experience between WBI+RNI and WBI is comparable, supporting the safety and patient tolerability of both treatments
Improving Outcomes with Sequential Fixation Using Long-Threaded Screws for Valgus-Impacted Femoral Neck Fractures
No full textBackground and Objectives: Valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) are considered stable fractures with favorable outcomes compared to displaced fractures. However, complications such as femoral neck shortening, screw sliding, and suboptimal recovery can occur, particularly in severe deformities. This study evaluated the outcomes of a sequential fixation technique using short-threaded screws followed by long-threaded screws. Materials and Methods: This prospective study included 135 patients aged 60 years or older with valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) treated between March 2017 and February 2021. Patients were divided into two groups: those treated solely with short-threaded screws (the control group) and those treated using a sequential fixation technique involving initial compression with short-threaded screws followed by stabilization with long-threaded screws. Exclusion criteria included follow-up < 12 months, pathological fractures, high-energy trauma, or periprosthetic fractures. Clinical outcomes, including the Harris Hip Score (HHS), and radiological parameters, such as screw sliding distance (SDS) and fixation failure, were analyzed. Multivariate regression identified predictors of outcomes to assess the effectiveness of the sequential fixation technique. Results: The mean follow-up was 38.3 months. Multivariate regression revealed that posterior tilt > 15° (β = 2.944, p < 0.001) and the use of long-threaded screws (β = −1.906, p < 0.001) were significant predictors of reduced SDS. Posterior tilt > 15° (OR 15.085, p = 0.002), valgus tilt > 15° (OR 28.616, p = 0.002), and bone mineral density (OR 0.285, p = 0.005) were predictors of fixation failure, while long-threaded screws significantly reduced fixation failure risk (OR 0.062, p = 0.005). Conclusions: The sequential use of short-threaded screws for compression, followed by long-threaded screws for stabilization, effectively reduced screw sliding and fixation failure while improving functional and radiological outcomes. This technique shows promise as an effective treatment for valgus-impacted femoral neck fractures
Minimally Invasive Surgery: Is It a Risk Factor for Postoperative Peritoneal Metastasis in pT4 Colon Cancer?
No full textBackground: Performing laparoscopic surgery for T4 colon cancer remains controversial because of concerns about whether its oncologic outcomes are comparable to those of open surgery, and postoperative peritoneal metastasis (PM) has been reported to occur more frequently in laparoscopic colectomy for T4 colon cancer. We investigated whether minimally invasive surgery (MIS) demonstrated a higher PM rate than open surgery and analyzed the risk factors for PM in pT4 colon cancer. Methods: This study included 392 patients with pT4 colon cancer who underwent curative surgery at a referral hospital between January 2000 and December 2018. Patients with previous neoadjuvant therapy, synchronous malignancy, metastasis, or those who underwent hyperthermic intraperitoneal chemotherapy were excluded. Results: The MIS group had fewer high-risk clinical features, such as tumors too large for endoscope admission or complications like perforation and fistula. The group also exhibited shorter operative time, intraoperative blood loss, multivisceral resection, hospital stay, fewer postoperative complications, smaller tumor size, lower pT4b ratio, and higher pN+ rates. Multivariate analysis revealed that high-risk clinical features, MIS, pT4b, pN+, tumor size < 5 cm, high histological grade, lymphovascular invasion, and postoperative complications were significant risk factors for PM. During the median 59-month follow-up, the 5-year cumulative incidence of PM was elevated in the MIS group (17.5% vs. 8.2%; P = 0.057). No significant differences were observed in the 5-year overall and disease-free survival rates. Conclusions: Minimally invasive surgery increases the risk of postoperative PM in patients with pT4 colon cancer. Surgeons may require thorough tumor staging and radical resection to prevent PM
The Effect of Hematopoietic Stem Cell Transplantation on Treatment Outcome in Children with Acute Lymphoblastic Leukemia
No full textPURPOSE: Hematopoietic stem cell transplantation (HSCT) has been an important method of treatment in the advance of pediatric acute lymphoblastic leukemia (ALL). The indications for HSCT are evolving and require updated establishment. In this study, we aimed to investigate the efficacy of HSCT on the treatment outcome of pediatric ALL, considering the indications for HSCT and subgroups. MATERIALS AND METHODS: A retrospective analysis was conducted on ALL patients diagnosed and treated at a single center. Risk groups were categorized based on age at diagnosis, initial white blood cell count, disease lineage (B/T), and cytogenetic study results. Data on the patients' disease status at HSCT and indications of HSCT were collected. Indications for HSCT were categorized as upfront HSCT at 1st complete remission, relapse, and refractory disease. RESULTS: Among the 549 screened patients, a total of 418 patients were included in the study; B-cell ALL (n=379) and T-cell ALL (T-ALL) (n=39). HSCT was conducted on a total of 106 patients (25.4%), with a higher frequency as upfront HSCT in higher-risk groups and specific cytogenetics. The overall survival (OS) was significantly better when done upfront than in relapsed or refractory state in T-ALL patients (p=0.002). The KMT2A-rearranged ALL patients showed superior event-free survival (p=0.002) and OS (p=0.022) when HSCT was done as upfront treatment. CONCLUSION: HSCT had a substantial positive effect in a specific subset of pediatric ALL. In particular, frontline HSCT for T-ALL and KMT2A-rearranged ALL offered a better prognosis than when HSCT was conducted in a relapsed or refractory setting
Prospective domain adaptation for longitudinal data
No full textLongitudinal data includes the information of samples in various timepoints. When applying machine learning algorithms to this data, the use of up-to-date information will yield more accurate results. In this case, if the labels are derived from the up-to-date information, out-of-date samples for which data has not yet been collected are excluded from the prediction. To alleviate this problem, domain adaptation can be a method for the prediction of out-of-date samples in that the method transforms those features similar with the up-to-date samples and bridges to the use of labels. Especially, domain adversarial training methods with a gradient reversal layer derive feature representation where samples in different domains appear to be one set so as to make the origin of them indistinguishable. However, since existing methods focus on different data with heterogeneous features, by considering that homogeneous features are continuously collected in longitudinal data, those need to be improved for the out-of-date and up-to-date samples so that their features are exactly matched. Motivated by this, we propose a method of domain adaptation, namely prospective domain adaptation, where the transformation of the out-of-date features purposes to match the properties of the up-to-date features. Therefore, in the proposed method, the out-of-date features are adapted to the manifold and distribution of the up-to-date features so that two feature sets are implicitly and explicitly matched. The experimental results demonstrated that the proposed method derives well-matched feature representation and outperforms comparative methods