Kangwon National University Hospital Research Articles

A Machine Learning Model for Prostate Cancer Prediction in Korean Men

Purpose: Unnecessary prostate biopsies for detecting prostate cancer (PCa) should be minimized. Therefore, this study developed a machine learning (ML) model to predict PCa in Korean men and evaluated its usability.Materials and Methods: We retrospectively analyzed clinical data from 928 patients who underwent prostate biopsies at Kangwon National University Hospital between May 2013 and May 2023. Of these, 377 (41.6%) were diagnosed with PCa, and 551 (59.4%) did not have cancer. For external validation, clinical data from 385 patients aged 48–89 years who underwent prostate biopsies from September 2005 to September 2023 at Wonju Severance Christian Hospital were also included. Twenty-two clinical features were used to develop an ML model to predict PCa. Features were selected based on their contributions to model performance, leading to the inclusion of 15 features. A meta-learner was constructed using logistic regression to predict the probability of PCa, and the classifier was trained and validated on randomly extracted training and test sets at an 8:2 ratio.Results: The prostate health index, prostate volume, age, nodule on digital rectal examination, and prostate-specific antigen were the top 5 features for predicting PCa. The area under the receiver operating characteristic curve (AUC) of the meta-learner logistic regression model was 0.89, and the accuracy, sensitivity, and specificity were 0.828, 0.711, and 0.909, respectively. Our model also showed excellent prediction performance for high-grade PCa, with a Gleason score of 7 or higher and an AUC of 0.903. Furthermore, we evaluated the performance of the model using external cohort clinical data and achieved an AUC of 0.863.Conclusions: Our ML model excelled in predicting PCa, specifically clinically significant PCa. Although extensive cross-validation in other clinical cohorts is needed, this ML model is a promising option for future diagnostics.

Optimizing anemia management using artificial intelligence for patients undergoing hemodialysis

Patients with end-stage kidney disease (ESKD) frequently experience anemia, and maintaining hemoglobin (Hb) levels within a targeted range using erythropoiesis-stimulating agents (ESAs) is challenging. This study introduces a gated recurrent unit-attention-based module (GAM) for efficient anemia management among patients undergoing chronic dialysis and proposes a novel alert system for anticipating the need for red blood cell transfusions. Data on demographic characteristics, dialysis metrics, drug administration, laboratory tests, and transfusion history were retrospectively collected from patients undergoing hemodialysis at Kangwon National University Hospital between 2017 and 2022. After preprocessing, a final dataset of 252 patients was used for model training. Our model functions in two major phases: (1) Hb level prediction and ESA dose recommendation and (2) transfusion alert framework. The GAM model outperformed traditional machine learning algorithms, including linear regression, XGBoost, and multilayer perceptron, in predicting Hb levels (R-squared value = 0.60). The model also demonstrated a recommendation accuracy of 0.78 compared to that of clinical experts, indicating a high degree of concordance with the ESA dosing recommendations. Additionally, the model exhibited considerably high accuracy (0.99) for transfusion alarms. Thus, the GAM model holds promise for improving anemia management in patients with ESKD by optimizing ESA dosages and providing timely transfusion alerts.

Acute kidney injury as a prognostic marker in severe fever with thrombocytopenia syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne illness with a notable morality risk that is becoming increasingly prevalent in East Asia (14–36%). Increasing evidence indicates a more direct role of the SFTS virus in renal impairment. However, few studies have explored the risk factors for and clinical outcomes of AKI in patients with SFTS. Therefore, in this study, we aimed to investigate risk factors and outcomes associated with AKI in patients with SFTS. In this retrospective cohort study, we included the data of 53 patients who were diagnosed with SFTS virus infection at Kangwon National University Hospital between 2016 and 2020. We incorporated laboratory data and medical information including comorbidities, complications, and mortality. Baseline characteristics, clinical features, laboratory parameters, and mortality rates of the non-AKI and AKI groups were compared. Patient survival of non-AKI and AKI groups were compared using the Kaplan–Meier method. To identify the population with poor prognosis, Cox regression analysis was used to identify the independent risk factors for in-hospital mortality in patients with SFTS. Of the 53 individuals, 29 (54.7%) were male, with an average age of 66.5 years. Nine patients (15.1%) died of SFTS. Twenty-seven (50.9%) patients exhibited AKI; the average time interval from fever onset to AKI occurrence was 3.6 days. Notably, 24 (88.9%) patients developed AKI within the first week of fever onset. Patients in the AKI group exhibited a significantly higher prevalence of diabetes and were older than those in the non-AKI group. The mortality rate was notably higher (29.6%) in the AKI group than in the non-AKI group (3.8%). Within the AKI cohort, advanced stages (stages 2 and 3) showed a 50% mortality rate, which was significantly higher than the 17.6% mortality rate in patients with stage 1 AKI. Additionally, Kaplan–Meier curves revealed lower survival rates among patients with AKI than among those without AKI (P = 0.017). Cox regression analysis identified leukopenia and elevated serum creatinine levels as significant risk factors for mortality. AKI is a common complication associated with SFTS. Moreover, the mortality rate was significantly higher in the patients who developed AKI than in those who did not. Our findings underscore the pivotal role of AKI as a prognostic marker of disease severity in patients with SFTS.

Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index.

Colorectal adenomas are precancerous lesions that may lead to colorectal cancer. Recent studies have shown that colorectal adenomas are associated with atherosclerosis. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) are noninvasive methods for evaluating atherosclerosis. This study examined the association between atherosclerosis and high-risk colorectal adenomas based on the CAVI and ABI. The data of patients aged ≥50 years who had a colonoscopy and CAVI and ABI measurements from August 2015 to December 2021 at the Kangwon National University Hospital were analyzed retrospectively. After the colonoscopy, subjects were divided into no, overall, and high-risk (size ≥1 cm, high-grade dysplasia or villous adenoma, three or more adenomas) adenoma groups based on the pathology findings. The data were subjected to univariate and multivariate logistic regression analyses. Among the 1,164 subjects, adenomas and high-risk adenomas were found in 613 (52.6%) and 118 (10.1%) patients, respectively. The rate of positive ABI (<0.9) and positive CAVI (≥9.0) were significantly higher in the high-risk adenoma group (22.0% and 55.9%) than in the no adenoma (12.3% and 39.6%) and the overall adenoma group (15.7% and 44.0%) (p=0.008 and p=0.006, respectively). Multivariate analysis revealed a positive CAVI and smoking status to be significantly associated with high-risk adenoma with an odds ratio of 1.595 (95% confidence interval 1.055-2.410, p=0.027) and 1.579 (1.072-2.324, p=0.021), respectively. In this study, a significant correlation between positive CAVI and high-risk adenomas was observed. Therefore, CAVI may be a significant predictor for high-risk colorectal adenoma.

Association of obstructive sleep apnea and diurnal variation of cystatin C

PurposeObstructive sleep apnea is a known risk factor for the progression of chronic kidney disease. To find early signs of the progression in subjects with obstructive sleep apnea., we assessed the diurnal variation of kidney biomarkers.MethodsA prospective observational study was conducted at Kangwon National University Hospital, Chuncheon, South Korea. All participants underwent in-laboratory polysomnography and phlebotomy in the evening before the polysomnography and in the morning after the polysomnography. Kidney biomarkers, including serum creatinine, blood urea nitrogen, and serum cystatin C, were measured. Delta kidney biomarkers were calculated by subtracting the evening level of the biomarkers from the morning level.ResultsTwenty-six of 50 participants had severe obstructive sleep apnea. Delta cystatin C was significantly correlated with apnea–hypopnea index, oxygen desaturation index, and total arousal index with coefficients of -0.314, -0.323, and -0.289, respectively. In participants without severe obstructive sleep apnea, the morning cystatin C level (0.84 ± 0.11 mg/L) was significantly higher than the evening cystatin C level (0.81 ± 0.11 mg/L) (P = 0.005). With severe obstructive sleep apnea, the cystatin C levels were not different between the morning (0.85 ± 0.11 mg/L) and the evening (0.85 ± 0.10 mg/L).ConclusionsCystatin C level was increased in the morning in participants without severe obstructive sleep apnea, but not in participants with severe obstructive sleep apnea.

Management of frontal sinus trauma: a retrospective study of surgical interventions and complications

BackgroundFrontal sinus injuries are relatively rare among facial bone traumas. Without proper treatment, they can lead to fatal intracranial complications, including meningitis or brain abscesses, as well as aesthetic and functional sequelae. The management of frontal sinus injuries remains controversial, with various treatment methods and outcomes being reported. This article describes the clinical characteristics, surgical methods, and outcomes among 17 patients who underwent surgery for frontal sinus injury and related complications.Case presentationWe retrospectively included 17 patients who underwent surgery for frontal sinus injury and its related complications at the Kangwon National University Hospital between July 2010 and September 2021. Among them, six underwent simple open reduction and fixation of the anterior wall, eight underwent sinus obliteration, and three underwent cranialization. Two patients who underwent sinus obliteration died due to infection-related complications. The patient who underwent cranialization reported experiencing chronic headache and expressed dissatisfaction regarding the esthetic outcomes of the forehead. Except for these three patients, the other patients achieved satisfactory esthetic and functional recovery.ConclusionActive surgical management of frontal sinus injuries is often required owing to the various complications caused by these injuries; however, several factors, including the fracture type, clinical presentation, related craniomaxillofacial injury, and medical history, should be considered while formulating the treatment plan. Surgical treatment through the opening of the frontal sinus should be actively considered in patients with severely damaged posterior wall fractures and those at risk of developing infection.

In-Advance Prediction of Pressure Ulcers via Deep-Learning-Based Robust Missing Value Imputation on Real-Time Intensive Care Variables.

Pressure ulcers (PUs) are a prevalent skin disease affecting patients with impaired mobility and in high-risk groups. These ulcers increase patients' suffering, medical expenses, and burden on medical staff. This study introduces a clinical decision support system and verifies it for predicting real-time PU occurrences within the intensive care unit (ICU) by using MIMIC-IV and in-house ICU data. We develop various machine learning (ML) and deep learning (DL) models for predicting PU occurrences in real time using the MIMIC-IV and validate using the MIMIC-IV and Kangwon National University Hospital (KNUH) dataset. To address the challenge of missing values in time series, we propose a novel recurrent neural network model, GRU-D++. This model outperformed other experimental models by achieving the area under the receiver operating characteristic curve (AUROC) of 0.945 for the on-time prediction and AUROC of 0.912 for 48h in-advance prediction. Furthermore, in the external validation with the KNUH dataset, the fine-tuned GRU-D++ model demonstrated superior performances, achieving an AUROC of 0.898 for on-time prediction and an AUROC of 0.897 for 48h in-advance prediction. The proposed GRU-D++, designed to consider temporal information and missing values, stands out for its predictive accuracy. Our findings suggest that this model can significantly alleviate the workload of medical staff and prevent the worsening of patient conditions by enabling timely interventions for PUs in the ICU.

Analysis of persistence rate of cognitive enhancers in Alzheimer’s disease using the common data model

AbstractBackgroundAchEIs are used by first‐diagnosed Alzheimer’s dementia patients. The effect of drug has been proven in safety and efficacy but it is known that the drug cannot be taken continuously due to side effects of about 10% in existing studies. However, studies report higher drug discontinuation rates. Cognitive function improvers or ‘nootropics’ such as choline alfocerate are used together with AchEI. Therefore, purpose of this study was to analyze the usage patterns of cognitive enhancers in Alzheimer’s patients and to confirm retention rate using a common data model.MethodFrom 2010 to 2019, using the data of Alzheimer’s patients registered in the common data model server of Kangwon National University Hospital, we will investigate the prescription rate of cognitive function improving drugs (choline alfocerate) and drug analysis patterns such as ChEI and combination therapy. The analysis is conducted using the FeederNet‐based ATLAS WEB tool, and additional analysis is compared with the results obtained through the DBMS approach using SQL.ResultAs a result of the analysis of treatment trends and persistence for 10 years, among 2,658 newly diagnosed patients with Alzheimer’s disease, donepezil was prescribed the most with 1,518 patients (57.11%), choline alfocerate with 654 patients (24.6%), and memantine with 214 patients. (8.05%), rivastigmine in 74 (2.78%), and galantamine in 147 (5.53%) each. During observation, trend of increasing prescriptions was Donepezil (31.5% in 2010 to 68.7% in 2019), Nootropics (24.6% in 2010 to 34.2% in 2019), Memantine (3.7% in 2010 to 7.9% in 2019), and Rivastigmine(0.53% in 2010 to 3.32% in 2019), while galantamine decreased (12.2% in 2010 to 0.3% in 2019). Persistence was approximately 50% for donepezil and memantine and approximately 40% for rivastigmine, galantamine and choline alfocerate over 12 monthsConclusionComparing treatment trends of cognitive function improvers, donepezil, memantine, ribistigmine, and choline alfocerate showed a tendency to increase, whereas galantamine showed a tendency to decrease. Also, donepezil and memantine were associated with longer persistence than rivastigmine and galantamine and choline alfocerate. In particular, in case of Nootropics, a high rate of initial prescription is given to patients with dementia, but rate of continuous prescription is not high.

Factors Associated with Smokers Attending More Than One Smoking Cessation Clinic Visit

Smoking remains a primary cause of cancers, cardiovascular and respiratory diseases and death. Globally, efforts have been made to reduce smoking rates, but the addictive nature of nicotine, a key component of tobacco, makes cessation challenging for smokers. Medical interventions including medical advice and pharmacotherapies are effective methods for smoking cessation. The frequency of medical interventions correlates with success in smoking cessation. This study aims to compare the characteristics of the patients who visited the smoking cessation clinic once with those who visited more than once, in order to identify factors that are associated with repeat clinic visits. A total of 81 patients who have visited the smoking cessation clinic in Kangwon National University Hospital were included. Patients answered the questionnaire at their first visit. If the patient visited only once, the outcome was defined as negative and if the patient visited more than once, the outcome was defined as positive. The proportion of patients who answered “within 5 min” to the Fagerstrom Test for Nicotine Dependence’s (FTND) 1st question and answered “yes” to the FTND’s 6th question was higher in the negative outcome group. In the logistic regression, patients who had withdrawal symptoms previously were associated with positive outcomes (adjusted OR 3.466, 95% CI 1.088–11.034 and p value = 0.0354). Withdrawal symptoms during previous attempts were positively related to visiting the clinic more than once.

Translation, Cultural Adaptation, and Validation of a Korean Version of the Information Needs in Cardiac Rehabilitation Scale.

: To translate and culturally adapt the Information Needs in Cardiac Rehabilitation (INCR) questionnaire into Korean and perform psychometric validation. : The original English version of the INCR, in which patients are asked to rate the importance of 55 topics, was translated into Korean (INCR-K) and culturally adapted. The INCR-K was tested on 101 cardiac rehabilitation (CR) participants at Kangwon National University Hospital and Seoul National University Bundang Hospital in Korea. Structural validity was assessed using principal component analysis, and Cronbach's alpha of the areas was computed. Criterion validity was assessed by comparing information needs according to CR duration and knowledge sufficiency according to receipt of education. Half of the participants were randomly selected for 1 month of re-testing to assess their responsiveness. : Following cognitive debriefing, the number of items was reduced to 41 and ratings were added to assess participants' sufficient knowledge of each item. The INCR-K structure comprised eight areas, each with sufficient internal consistency (Cronbach's alpha>0.7). Criterion validity was supported by significant differences in mean INCR-K scores based on CR duration and knowledge sufficiency ratings according to receipt of education (p<0.05). Information needs and knowledge sufficiency ratings increased after 1 month of CR, thus supporting responsiveness (p<0.05). : The INCR-K demonstrated adequate face, content, cross-cultural, structural, and criterion validities, internal consistency, and responsiveness. Information needs changed with CR, such that multiple assessments of information needs may be warranted as rehabilitation progresses to facilitate patient-centered education.

Korean Version of the Longer-Term Unmet Needs After Stroke Questionnaire.

: To translate the 22-item Longer-term Unmet Needs after Stroke (LUNS) questionnaire, validate it in the Korean stroke population, and assess the reliability of face-to-face and telephone surveys. : Sixty-six adult patients with stroke from Seoul National University Bundang Hospital and Kangwon National University Hospital were involved in the validation. Participants were interviewed twice using the LUNS Korean version: first, a face-to-face survey for validation, and second, a telephone survey for test-retest reliability. Participants completed the Frenchay Activities Index (FAI) and Short Form 12 (SF-12) Mental and Physical Component Summary (MCS and PCS) scores at the first interview. For concurrent validity, the differences in health status (FAI, SF-12 MCS and PCS) between the groups that reported unmet needs and those that did not were analyzed for each item. Cohen's kappa and percentage of agreement between the first and second administrations were calculated for each item to determine the test-retest reliability. : The average age of the participants was 61.2±12.8 years and 74.2% were male. Fifty-seven patients were involved in the second interview. Depending on the unmet needs, SF-12 MCS, PCS, and FAI were significantly different in 12 of 22 items. In the test-retest reliability test, 12 items had a kappa of 0.6 or higher, and two had a kappa of <0.4. : The LUNS instrument into Korean (LUNS-K) is a reliable and valid instrument for assessing unmet health needs in patients with stroke. In addition, telephone surveys can be considered reliable.

Investigation of Contact Lens Use and Perception among Hospital Workers: A Survey on Contact Lens Use, Knowledge and Attitude among Hospital Workers

Purpose: To investigate the patterns of contact lens (CL) use and knowledge and attitude regarding the CL use among worker at a Kangwon National University Hospital.Methods: QA survey regarding the use of CL and CL-related knowledge and attitude were distributed over 2 month period starting in March, 2021 to Kangwon National University Hospital workers who had experience of CL use. The survey included questions regarding age, gender, occupation, type of CL, reason for wearing, period of use, purchase route, CL wearing pattern, complications, causative factors, and regular eye examination. The answer to each question was collected and analyzed.Results: One hundred and twelve participants completed the survey. The mean age was 30.1±5.8 years and the male-to-female ratio was 1:2.6. Soft and cosmetic CLs comprised the majority (95.5%, 107/112). Most respondents (99.1%, 111/112) purchased their CL from an optical store or through internet without prescription. Only 71.4% (80/112) washed their hands when wearing and removing lenses. In many cases, respondents had incorrect knowledge about method of CL and lens case cleaning. Most respondents 99.1% (111/112) experienced complications like foreign body sensation, dry-eye, hyperemia, blurred vision, tearing, of which only 8.0% (9/112) received regular eye examinations.Conclusions: The study finding showed even hospital workers may have incorrect knowledge regarding use of CL. Although most CL user experienced complications regarding CL, only a small proportion of CL users are receiving regular eyeexamination. Education of CL users regarding the CL care and importance of regular eye examinations are therefore warranted.

#4314 IMPACT OF ACUTE KIDNEY INJURY ON OUTCOME OF SEVERE FEVER WITH THROMBOCYTOPENIA SYNDROME

Abstract Background and Aims Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high case-fatality rate in East Asia. In addition, acute kidney injury (AKI) has been reported in 14∼36% of the SFTS virus-infected patients. However, the risk factor for AKI and the clinical outcome of AKI in patients with SFTS has not been well understood. Method Patients who confirmed SFTS virus infection during five years from 2016 to 2020 in Kangwon national university hospital were retrospectively reviewed. Their laboratory data and medical records, such as comorbidity, complications, and mortality, were obtained from the electronic medical record. AKI was defined according to KDIGO criteria. The risk factors for death were assessed by Cox proportional hazards regression analysis. Results Of the 53 patients, 29 (54.7%) were male, and the mean age was 66.5 years. Twenty-seven (50.9%) patients were defined as AKI; 17 patients were AKI stage 1, 5 patients were AKI stage 2, and 5 patients were AKI stage 3. Of these, 5 patients underwent dialysis and all of them needed continuous renal replacement therapy. Patients with AKI were significantly older and had a higher proportion of diabetes (p = 0.041 and p = 0.019, respectively). In baseline laboratory tests, levels of aspartate aminotransferase, alanine aminotransferase and c-reactive protein were higher in AKI group (p = 0.011, p = 0.019, and p = 0.012, respectively). Among 53 patients, nine died due to SFTS, and the fatality rate was 15.1%. The AKI group (29.6%) had a higher mortality rate than the no AKI group (3.8%). In univariate analysis, higher levels of white blood cells, blood urea nitrogen, creatinine, and alkaline phosphatase were risk factors for death. In multivariate analysis, leukocytosis and AKI stage 3 were independent risk factors for death. Conclusion AKI frequently occurs among patients with SFTS. In patients with AKI stage 3, the mortality rate is significantly higher than no or mild AKI, so special attention should be paid when it occurs.

0906 Feasibility of measures of sleep, circadian timing and lipid profiles for identifying mild cognitive impairment

Abstract Introduction Sleep disruption and circadian misalignment has been evident in patients with mild cognitive impairment (MCI). Together, sleep and circadian rhythm dysregulation can contribute to dyslipidemia, which has been proposed to play crucial roles in neurodegenerative process according to its known neurotoxicity. We aimed to compare parameters regarding lipid, nocturnal sleep and circadian timing between amnestic MCI (aMCI) and normal controls (NC), and to determine whether those parameters can be associated with the presence of aMCI in the elderly. Methods Participants above 50 years old were recruited from the Dementia Clinic at Kangwon National University Hospital, and two Public Care Centers for dementia patients. Neurocognitive tests were administered to each participant. The diagnosis of aMCI was made according to Petersen’s criteria. Eighteen aMCI patients (76.6 ±6.1 years) and 21 NC (70.4±6.7years) were finally selected. Actigraphy monitoring (Actiwatch 2; Respironics, USA) was conducted for 5 days. The dim light melatonin onset (DLMO) as an indicator of circadian timing was determined from five hourly saliva samples obtained before sleep onset. Fasting plasma total cholesterol, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol were assayed. The sleep parameters, DLMO and lipid profiles were compared between the two groups. For these measures, receiver operating characteristic (ROC) analysis was performed to assess the usefulness of discriminating between the aMCI and NC. Results There were no significant differences in sleep parameters, DLMO and lipid profiles between the aMCI and NC groups. The bedtime and sleep onset were derived as indicators for discriminating aMCI (p=0.003 and p=0.054, respectively). The area under the ROC for bedtime was 0.861(cut-off scores ≥ 22:02, sensitivity= 0.76, specificity=0.75). Conclusion We did not reveal the usefulness of the DLMO and lipid profiles for identifying aMCI. However, we found that the bedtime had good discrimination power between aMCI and cognitively normal elderly, suggesting later sleep habits would be associated with the presence of aMCI in the elderly. Support (if any) Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science and ICT (2020R1F1A1050416); Research Funds from the Institute of Medical Science, Chosun University, Republic of Korea, 2022.

Hypertriglyceridemia is a Risk Factor for Fever in Early Acute Non-biliary Pancreatitis.

Fever is a common symptom of acute pancreatitis (AP). This study examined the factors associated with fever due to pancreatic inflammation in the early stages of non-biliary AP. This study analyzed the AP database from Kangwon National University Hospital from January 2018 until April 2021 and identified patients who developed fever within 1 week of hospitalization. Patients with gallstone pancreatitis, pseudocyst, walled-off necrosis, chronic pancreatitis, bacteremia, and other site infections were excluded. The febrile group was compared with the afebrile group. One hundred and fifty-two patients were analyzed, and fever was diagnosed in 79 patients (52.0%). Based on multivariate analysis, fever was positively correlated with hypertriglyceridemia-induced AP (OR 16.8, 95% CI 4.0-70.7, p<0.01) and computed tomography severity index (OR 1.7, 95% CI 1.2-2.6, p<0.01). Recurrent AP was negatively associated with fever (OR 0.3, 95% CI 0.1-0.8, p=0.01). Fever was more frequent in patients with higher initial serum triglyceride (TG) levels than those with lower levels (TG <200 mg/dL; 35.1%, 200≤TG<500 mg/dL; 42.3%, TG ≥500 mg/dL; 88.6%, p<0.01). Hypertriglyceridemia and CT severity index are associated with fever in early non-biliary AP.

Presence of tophi is associated with a rapid decline in the renal function in patients with gout

We aimed to compare clinical characteristics of patients with and without tophi at the time of the diagnosis of gout and investigate the association of tophi and renal function in gout patients. The patients who were first diagnosed with gout at the Kangwon National University Hospital were retrospectively studied. Patients were divided into 2 groups according to the presence of tophi at the diagnosis. We compared clinical characteristics and the progression of renal dysfunction between the two groups. Of 276 patients, 66 (25.5%) initially presented with tophi. Tophi group was older, had a longer symptom duration, and a higher prevalence of multiple joint involvement than those without tophi. In multivariate logistic regression analysis, prolonged symptom duration and multiple joint involvement were significantly associated with increased risk of formation of tophi. The decline in the eGFR was more prominent in patients with tophi than in those without (− 4.8 ± 14.5 vs. − 0.7 ± 11.9 ml/min/1.73 m2/year, respectively; P = 0.039). The presence of tophi was significantly associated with a rapid decline in the eGFR (β = − 0.136; P = 0.042). In conclusion, the presence of tophi was associated with a rapid declining renal function. Therefore, an early diagnosis and closely monitoring of renal function might be important in gout patients with tophi.

Serum Ferritin Concentration in the Early Third Trimester of Pregnancy and Risk of Preterm Birth and Low Birth Weight Based on Gestational Age

Objective: Although serum ferritin is considered the best measure of total body iron, with low levels indicating iron deficiency, recent studies have shown that high levels are associated with gestational diabetes, premature birth, and low birth weight. This study aimed to analyze the association between serum ferritin levels in the third trimester of pregnancy and low birth weight and preterm birth.Methods: This study included pregnant women who delivered a single fetus at Kangwon National University Hospital between January 2009 and December 2013 and in whom serum ferritin levels were measured between 28 and 34 weeks of gestation. The association between serum ferritin levels measured in the early third trimester of pregnancy and preterm birth and low birth weight infants was analyzed.Results: A total of 1,079 women fulfilled the study criteria and had their serum ferritin level measured during the third trimester (28–33.9 weeks of gestation) and later delivered at Kangwon National University Hospital. Comparison of the group with serum ferritin levels above the 75th percentile and those below the 25th percentile at the beginning of the third trimester revealed that the incidence of preterm births (&lt;34 weeks of gestation, &lt;37 weeks of gestation) and low birth weight were significantly higher in the group with serum ferritin levels above the 75th percentile than those below the 25th percentile (p&lt;0.05). When variable factors were controlled through multiple regression analysis, the group whose serum ferritin levels were above the 75th percentile at 30–31.9 weeks of gestation had the highest risk of preterm birth before 34 weeks of gestation (adjusted odds ratio [OR], 7.85; 95% confidence interval [CI], 1.32–29.9) and low birth weight (adjusted OR, 6.49; 95% CI, 2.10–20.0).Conclusion: In this study, when serum ferritin was high in the third trimester of pregnancy, it was significantly increased with preterm birth (&lt;34 and 37 weeks) and low birth weight. In particular, when serum ferritin levels were high at 30–31.9 weeks of gestation, the risk of premature birth before 34 weeks and low birth weight was statistically highest.

Association between interstitial cells of Cajal and anti-vinculin antibody in human stomach.

Interstitial cells of Cajal (ICC) are known as the pacemaker cells of gastrointestinal tract, and it has been reported that acute gastroenteritis induces intestinal dysmotility through antibody to vinculin, a cytoskeletal protein in gut, resulting in small intestinal bacterial overgrowth, so that anti-vinculin antibody can be used as a biomarker for irritable bowel syndrome. This study aimed to determine correlation between serum anti-vinculin antibody and ICC density in human stomach. Gastric specimens from 45 patients with gastric cancer who received gastric surgery at Kangwon National University Hospital from 2013 to 2017 were used. ICC in inner circular muscle, and myenteric plexus were counted. Corresponding patient's blood samples were used to determine the amount of anti-vinculin antibody by enzyme-linked immunosorbent assay. Analysis was done to determine correlation between anti-vinculin antibody and ICC numbers. Patients with elevated anti-vinculin antibody titer (above median value) had significantly lower number of ICC in inner circular muscle (71.0 vs. 240.5, p = 0.047), and myenteric plexus (12.0 vs. 68.5, p < 0.01) compared to patients with lower anti-vinculin antibody titer. Level of serum anti-vinculin antibody correlated significantly with density of ICC in myenteric plexus (r = −0.379, p = 0.01; Spearman correlation). Increased level of circulating anti-vinculin antibody was significantly correlated with decreased density of ICC in myenteric plexus of human stomach.

Restriction of Central Line Insertion and Prophylactic Antibiotics Usage in Moderate and Late Preterm Infants from a Quality Improvement Perspective

Objective: The care provided to moderate and late preterm (MLPT) infants is an area of significant practice variation and most of the quality improvement initiations are for very low birth weight infants. The objective of this study was to analyze hospital outcome changes in MLPT infants with central line insertion and prophylactic antibiotics usage restriction as a quality improvement method. Methods: This was a retrospective cohort study for MLPT infants who were admitted at Kangwon National University Hospital neonatal intensive care unit during 2013-2016. The groups were divided into period I (from 2013 to 2014) and period II (from 2015 to 2016) based on the changes in clinical practices. Since period II, feeding protocol was changed to rapid full-feeding and central line insertion practice was restricted to cases with feeding intolerance over 3 days of life. Prophylactic antibiotics were restricted to ampicillin with gentamycin except for special cases and indications were restricted depending on maternal factors plus clinical symptoms after birth. Results: Gestational age was lower and respiratory distress syndrome was frequent at period II. Central line insertion was reduced from period I to II (83% [147/177] vs. 36% [75/207]). Antibiotics exposures were less at period II (584 vs. 206 days per 1,000 patient-days). Clinical sepsis and central line associated bloodstream infection was significantly decreased at period II. Conclusion: Quality improvement for reducing central line insertion and prophylactic antibiotics usage in MLPT infants may be effective to reduce the incidence of infection related complications, especially sepsis.

Statins Have No Role in Preventing the Progression of Aortic Valve Sclerosis.

BACKGROUNDStatins are thought to have little effect on the progression of aortic stenosis, but the data on their role in patients with aortic valve sclerosis (AVS) are limited and inconsistent.METHODSWe retrospectively analyzed 541 consecutive patients (214 men, age: 70 ± 11 years) with AVS. Each patient underwent two or more electrocardiography examinations at least 6 months apart at Kangwon National University Hospital from August 2010 to August 2015. AVS is defined as irregular thickening of the leaflets, focal increases in echogenicity and minimal elevation of the peak aortic valve velocity (> 1.5 and < 2 m/s). The progression rate of AVS was expressed as the increase in peak velocity per year (m/s/yr).RESULTSThe mean follow-up duration was 24.9 ± 13.3 months in the statin-treated group and 24.1 ± 12.4 months in the non-statin-treated group (p = 0.460). There were no differences between the statin-treated and non-statin-treated groups in mean age, gender or smoking status. Relative to the non-statin-treated group, a higher number of patients in the statin-treated group had hypertension, diabetes, ischemic heart disease, and stroke. The progression rate of AVS did not differ between the statin-treated and non-statin-treated groups (0.012 ± 0.340 m/s/yr vs. 0.014 ± 0.245 m/s/yr, p = 0.956). Multivariate analysis showed initial peak aortic jet velocity was significantly associated with AVS progression (β = 0.153, p = 0.009).CONCLUSIONSOur study demonstrated that statins had no effect on the progression of AVS. However, well-designed studies are needed to define the prognosis and management of AVS.