Keimyung University Dongsan Medical Center Research Articles

Effects of an arteriovenous fistula stenosis prevention program in patients receiving hemodialysis.

To increase the efficiency of hemodialysis, an appropriate vascular pathway must be created, and its function must be maintained. This study aimed to identify the effects of an arteriovenous fistula (AVF) stenosis prevention program on upper muscular strength, blood flow, physiological indexes, and self-efficacy among patients receiving hemodialysis. The participants were patients receiving hemodialysis at Keimyung University Dongsan Medical Center in Daegu, Republic of Korea. They were divided into experimental and control groups based on the day of the week they received hemodialysis at the outpatient department and included 25 participants each. The study was conducted for 8 weeks. The AVF stenosis prevention program was effective in improving upper extremity muscle strength (F=15.23, p<0.001) and blood flow rate (F=36.00, p<0.001). As a result of the program, the phosphorus index level, which is a physiological indicator in hemodialysis patients, decreased (F=8.64, p<0.001). Encouragement and support through text messages and practice lists also resulted in an increase in self-efficacy (F=18.62, p<0.001). The AVF stenosis prevention program in this study resulted in an increase in upper extremity muscle strength through grip strength exercises and was effective in preventing AVF stenosis by increasing the blood flow rate.

The frequency and characteristics of saccadic dysmetria in isolated cerebellar infarction.

To investigate the frequency and pattern of horizontal saccadic dysmetria in unilateral cerebellar infarction and identify the responsible region for horizontal saccadic dysmetria. From the acute stroke registry of Keimyung University Dongsan Medical Center between July 2016 and October 2020, 43 patients with acute unilateral cerebellar infarction were enrolled. Eye movements were recorded during the acute period and the lesion was mapped using MRIcron software for subtraction analysis. Saccadic dysmetria was marked as hypometric when the gain is < 0.85 and hypermetric when > 1.0. Among the 43 participants, 30 patients (69.8%) demonstrated saccadic dysmetria. The age was significantly higher in patients with dysmetria (66.87 ± 12.82 vs. 53.54 ± 14.09, p = 0.004). Type of dysmetria showed a significant difference according to the vascular territory of the lesion. The posterior inferior cerebellar artery (PICA) infarction group presented ipsiversive saccadic dysmetria, while the superior cerebellar artery (SCA) group showed contraversive dysmetria (p < 0.001). In the SCA group, the culmen, fastigium, and dentate were the most frequently damaged regions, while the tonsil and inferior semilunar lobule were in the PICA group. Saccadic dysmetria was observed in a large proportion of cerebellar stroke patients, and the types of saccades were distinctive according to the vascular territory of the lesion.

Clinical characteristics and risk factors for kidney failure in patients with autosomal dominant polycystic kidney disease: A retrospective study.

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary and progressive renal disease. By the age of 65 years, 45% to 70% of patients with ADPKD reach end-stage renal disease (ESRD). Although there are various treatments for this condition, no standard therapy exists to delay the progression of ADPKD. Hence, understanding the factors that affect disease progression may be helpful for the treatment of ADPKD. The medical records of 288 patients with ADPKD at Keimyung University Dongsan Medical Center between January 1989 and August 2018 were analyzed retrospectively. Furthermore, we inspected the risk factors involved in the progression of ADPKD and the kidney survival rates of patients using the Cox proportional hazards model and Kaplan-Meier survival analysis. The mean age at the time of diagnosis was 43.1 ± 14.1 years, and there were 146 males (50.7%). In total, 197 patients (68.4%) had hypertension and 11 patients (3.8%) had cerebral aneurysm. Stroke occurred in 35 patients (12.1%), including 11 cases of cerebral hemorrhage and 24 cases of cerebral infarction. Twenty-eight patients (9.7%) died during the follow-up period (117.1 ± 102.1 months). Infection (42.9%) was the most common cause of mortality, followed by sudden cardiac death (25.0%). Overall, 132 patients (45.8%) progressed to ESRD and 104 patients (36.1%) required renal replacement therapy (RRT). The mean duration from diagnosis to RRT was 110.8 ± 93.9 months. Age at diagnosis after 30 years (odd's ratio [OR], 2.737; 95% confidence interval [CI], 1.320-5.675; P = .007), baseline serum creatinine levels (OR, 1.326; 95% CI, 1.259-1.396; P < .001), and cyst infection (OR, 2.065; 95% CI, 1.242-3.433; P = .005) were the independent risk factors for kidney failure in multivariable analysis. To delay the advance of ADPKD to ESRD, early diagnosis and close observation for the onset of cyst infection are crucial.

Therapeutic and tectonic keratoplasty with simple cryopreserved remnants of donor corneas: an 11 year retrospective case series.

This study sought to describe the use of deep-frozen donor corneal remnants preserved after keratoplasty procedures for therapeutic or tectonic keratoplasty without subsequent optical keratoplasty. This single-center retrospective consecutive case series analyzed the electronic medical records of patients who had undergone therapeutic or tectonic keratoplasty using deep-frozen donor remains preserved in Optisol-GS, for the past 11 years at Keimyung University Dongsan Medical Center. Fifty-five surgical cases in 46 patients were included. Twenty-three surgical cases in 18 patients underwent therapeutic keratoplasty for refractory infectious corneal ulcer. Complete eradication of primary infection was achieved in 14 patients (77.8%). Tectonic keratoplasty were performed 32 cases in 28 patients. Twenty-seven of 28 patients were ultimately able to maintain anatomical integrity (96.4%). Mean uncorrected visual acuity improved from 1.77 ± 0.94 preoperatively to 1.31 ± 0.95 at the last follow-up postoperatively in the tectonic graft group by logarithm of the minimal angle of resolution (P = 0.002). There were no cases of graft rejection. Keratoplasty using cryopreserved donor tissue is a suitable surgical alternative for infectious or non-infectious corneal ulcers in elderly patients or patients with poor general condition. It could be a viable alternative to overcome the shortage of corneal donors.

The prevalence and clinical characteristics of restless legs syndrome in patients with iron deficiency anemia in Korea.

While the prevalence and clinical characteristics of restless legs syndrome (RLS) are known to vary according to ethnicity, a detailed evaluation of this condition among patients with iron deficiency anemia (IDA) has not yet been reported in an Asian population. We investigated the prevalence and clinical characteristics of RLS in patients with IDA in Korea compared with age- and sex-matched patients diagnosed with idiopathic RLS. This prospective single-center study was performed at a regional university hospital. Consecutive patients with IDA were enrolled over a 4-year period. Clinical interviews and laboratory tests were conducted at the first visit. RLS diagnosis was confirmed through face-to-face interviews. We randomly selected patients with idiopathic RLS without comorbid medical disorders from our sleep center dataset as control patients. The clinical characteristics of both groups were compared. We enrolled 124 patients with IDA. Fifty (40.3%) patients were diagnosed with RLS, with 82% exhibiting severe to very severe symptoms. Patients with IDA and RLS were older and reported more sleep deterioration than patients with IDA without RLS. Patients with IDA and RLS also had a more depressed mood and higher periodic limb movement index scores than patients with idiopathic RLS. The prevalence of RLS among patients with IDA in Korea was high, with the majority having severe to very severe symptoms. Patients with IDA and RLS had poorer sleep quality and more emotional problems than patients with IDA without RLS. Therefore, patients with IDA should be screened for RLS to prevent adverse effects on the quality of sleep and life.

Impact of donor factors on post-transplant delayed recovery of graft function in deceased donor kidney transplantation

Background: Deceased donor (DD) factors influence absolutely the post-transplant delayed recovery of graft function (DGF) in deceased donor kidney transplantation (DDKT). Although there are some tools for the status of DD such as expanded criteria donor criteria or kidney donor profile index score, but these tools do not fully reflect impact of DD factors on post-transplant DGF. Therefore, we aimed at investigating the DD factors related with the occurrence of DGF in DDKT. Methods: We retrospectively analyzed the medical records of DDKT performed at Keimyung University Dongsan Medical Center between February 2014 and September 2019. Our study enrolled 186 kidney transplant recipients (KTRs), with median follow-up of 45 months after DDKT. Results: Eighty-seven DDs (46.5%) had a documented history of smoking; 108 (57.8%), proteinuria; 80 (42.8%), transfusion; 95 (50.8%), acute kidney injury (AKI); and continuous renal replacement therapy (CRRT), 18 (9.6%). The incidence of DGF was sig nificantly higher in KTRs from DDs with CRRT compared to those from DDs without CRRT (P=0.002). The incidence of DGF was also higher in KTRs from DDs with smoking history, but there were no significant association with the presence and amount of proteinuria and transfusion. Allograft function was significantly lower in the KTRs with DGF until 1 month after KT compared to those without DGF, but there was no significant difference of allograft function between the two groups at 12 months after KT. In Kaplan-Meier analysis, graft and patient survivals did not show the differences according to the characteristics of DDs with smoking, proteinuria, transfusion, AKI, and CRRT. In multivariate logistic analysis, AKI, CRRT, smoking, and donor hypertension were independent risk factors for DGF. Conclusions: DDs with AKI, CRRT, smoking, and hypertension can increase the risk of occurrence of DGF in KTRs. Therefore, DDKT from DDs with significant risk factors should be performed carefully.

Abstract CT222: Colon cancer in elderly patients: Retrospective analysis of targeted therapy era

Abstract Purpose: This study was conducted in order to evaluate the response rate, progression free survival (PFS), safety and prognostic factors of targeted combination chemotherapy in colon cancer patients older than 65 years. Methods: This retrospective study included 69 elderly patients (≥ 65 years) with metastatic Colon cancer who have not received palliative chemotherapy before. All patients were histologically confirmed colon cancer at Keimyung university Dongsan medical center from Jan 2007 to July 2017. All recruited patients received either cetuximab or bevacizumab every 2 weeks. Results: The median age was 73.35 (65-87) and 33 were right side, 32 were left, 2 were transverse and rest of 2 patients were multiple primary sites. Bevecizumab was administerd to 42 patients (60.9%) and cetuximab was administered to 27 patients (39.1%). Complete response was 9 patients (13%), partial response was 23 (33.3%) and progression disease was 9 (13.0%). Overall response rate was 31 (46.4%) and disease control rate was 42 (62.3%). Progression free survival was 12.038 ±1.565 months (95% CI: 8.97~12.12). The most common hematologic side effects was anemia with grade 3/4 in 14 (20.3%). Systemic chemotherapy with targeted agents were moderately tolerated with grade 3/4 neutropenia 40 (57.9%). Conclusion: In elderly patients with colon cancer, clinical outcomes showed similar results compared with prior clinical trials. Preventing such complications may improve survival. Citation Format: JIN YOUNG KIM, Sojin Shin, Mi Hwa Heo, Kang Kook Lee. Colon cancer in elderly patients: Retrospective analysis of targeted therapy era [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT222.

MO052BIOPSY PROVEN KIDEY DISEASES IN TYPE 2 DIABETIC PATIENTS WITH IMPAIRED RENAL FUNCTION

Abstract Background and Aims Diabetic nephropathy (DN) is a major microvascular complication of diabetes mellitus (DM) and the most common cause of end stage of renal disease worldwide. The nature of kidney disease in type 2 DM is more complex than type 1 DM. However, the usefulness of kidney biopsy in type 2 DM is still controversial and there are few reports about the biopsy proven kidney disease, especially in patients with impaired renal function. Method We retrospectively reviewed 1454 patients who received native kidney biopsy at Keimyung university Dongsan medical center between 2005 and 2018. Among 1454 patients, 92 patients were diagnosed with type 2 DM before kidney biopsy. Fifty-three patients with impaired renal function (estimated glomerular filtration rate &amp;lt; 60 mL/min/1.73 m2 using Modification of Diet in Renal Disease formula) were finally enrolled in this study. We categorized the pathologic diagnoses as DN, non-diabetic renal disease (NDRD), and NDRD mixed with DN (Mixed). Results The mean age at kidney biopsy was 58.4 ± 11.2 and mean eGFR was 28.6 ± 14.6 mL/min/1.73 m2. Nineteen patients (35.8%) had diabetic retinopathy and mean duration of DM before kidney biopsy was 102.1 ± 82.2 months. Of the 53 patients, there were 28 NDRD (52.8%), 18 DN (34.0%), and 7 Mixed (13.2%). Diabetic retinopathy was more common in DN, following Mixed and NDRD (72.2%, 42.9%, and 10.7%, respectively, p &amp;lt; 0.001). Multivariable logistic regression analysis revealed that diabetic retinopathy was significantly associated with DN (OR, 23.672; 95% CI, 4.290-130.609; p &amp;lt; 0.001). In multivariable cox proportional hazard models, creatinine level (HR, 1.779; 95% CI, 1.404-2.255; p &amp;lt; 0.001) and dipstick albuminuria ≥ 2+ (HR, 22.721; 95% CI, 4.670-110.542; p &amp;lt; 0.001) were identified as independent prognostic factors for renal survival. Conclusion Kidney disease of type 2 diabetic patients were various and clinical parameters could not completely predict. Kidney biopsy is an important tool for the definite diagnosis and the proper treatment of kidney disease in diabetic patients with impaired renal function.

SAT-453 Delayed TSH Elevation in Small for Gestational Age Infants: A Need for Second Screening?

The incidence of CH with a delayed TSH elevation was higher in ELBW and VLBW infants compared with infants weighing ≥1500 grams. Second screening should be considered in preterm neonates, low birth weight (LBW) and very low-birth weight (VLBW) neonates, ill and preterm newborns admitted to NICU, specimen collection within the first 24 hours of life, and multiple births (particularly same-sex twins). Purpose of this study was to determine incidence of delayed TSH elevation with or without congenital hypothyroidism in SGA infants and to Investigate necessity for second screening. Retrospective analysis was performed. 66 SGA newborns with 34-40 weeks’ gestation born at Keimyung University Dongsan Medical Center from 2015 to 2018 were enrolled. Primary screening was performed 48 hours - 7 days after birth. Second screening including venous TSH and venous free T4 at postnatal 8-40 days. Exclusion criteria were infants with congenital hypothyroidism at primary screening (NBS), descendants of mothers with immune thyroid disease, congenital malformations, renal, hepatic, and metabolic diseases, history of steroid or dopamine usage. Initial NBS were collected onto pre-printed filter at the age of 2-7 days by heel prick. (normal TSH < 10 mIU/L). Second sample was obtained at the age of 8-49 days by venous sampling (normal TSH < 5 mIU/L). TSH and free T4 were measured on venous samples with Cobas 8000 e801 (electrochemiluminescence, Roche, Diagnostics, Basel, Switzerland) using standard methods.Incidence of delayed TSH elevation was 27% (18/66). Of them number of transient hyperthyrotropinemia was 13. Mean TSH at initial elevation was 7.56 mIU/L and median age at initial TSH elevation was 18.6 days. Median age at resolution of TSH elevation was 41.5 days. Number of hypothyroidism undergoing l-thyroxine medication was 5. Mean TSH at initial elevation was 22.1 mIU/L. Median age at initial TSH elevation was 14 days. Mean peak TSH was 23.4 mIU/L.The presence of delayed TSH elevation was not related to very low birth weight. SGA infants might be at a risk of delayed TSH elevation. Considering 2nd screening test within 1 month. Further study with more SGA infants are needed. Limitation of this study was relative small number of patients and iodine status was not considered

PS1297 EFFICACY AND SAFETY OF INTRAVENOUS IRON THERAPY IN CHILDREN: A KOREAN SINGLE CENTER STUDY

Background:Although Intravenous (IV) iron is widely and safely administrated to adults for various indications including severe anemia, chronic blood loss and postoperative anemia, Administration of IV iron is rarely used in children due to lack of pediatric data.Aims:The aim of this study was to determine the indications for IV iron and to evaluate the efficacy and safety of IV iron infusions to children who were visited a single Korean center.Methods:This retrospective study collected data from ≤18 year‐old children who were received IV iron at the Keimyung University Dongsan Medical Center between July 2003 to December 2018. Exclusion criteria included: (1) receiving a packed red blood cell transfusion or erythropoietin, (2) surgery or massive bleeding before obtaining the laboratory results of post IV iron infusion. We compared laboratory results including hemoglobin (Hb) concentrate, mean corpuscular volume (MCV), serum ferritin level between pre and post‐IV iron infusion. Also, the medical records were reviewed for adverse effects. All statistical analyses were performed using IBM SPSS software (version 23.0; IBM Corp., Armonk, NY), and P‐values of &lt;0.05 were considered statistically significant.Results:Total 31 children (male:female = 18:13; median age 4.5 years, range 0.3–17.9) received total 80 infusions of IV iron therapy. The most common etiology of anemia was gastrointestinal cause. Oral iron intolerance (32%) and refractoriness (26%) were common indications for IV iron infusion. Seventeen patients received a total 43 infusions of iron sucrose (median dose, 3.9 mg/kg, range 1.0 to 20.4), fifteen patients received a total 37 infusions of ferric carboxymaltose (median dose, 5 mg/kg, range 3.3 to 18.8). All Patients had follow up laboratory test at 1–120 days (median 15 days) after their infusions. Except 2 patients, all patients showed good hematologic response. The median pre‐infusion Hb, MCV and ferritin values were 9.0 g/dL (range 6.1–13.6), 75.9 fL (55.9–94.3) and 12.2 ng/mL (1.7–284.9), respectively. The median post‐infusion Hb, MCV and ferritin values were 10.7 g/dL (6.3–14.7), 79.6 fL (64.9–103.5) and 54.0 ng/mL (3.9–842.8), respectively. There were statistically significant improvements in these values (p‐value &lt;0.001). No patients experienced severe adverse effects such as anaphylaxis.Summary/Conclusion:The most common indication for IV iron among Korean children was oral iron intolerance. The use of IV iron is effective and safe treatment in children.image

A Hundred Experiences of Liver Transplantation in Local University Hospital

Introduction Liver transplantation (LT) is the complex and challenging procedure in preoperative work-up, surgical techniques, postoperative care, management of complications and out-patients follow-up. For these reasons, it is difficult to build up the liver transplantation program independently in small volume center and most cases of LT had been performed in a few high volume centers. However, many centers have been trying to launch the liver transplantation program recently for a local population who needs LT but has limited opportunity due to the cost and conditions. In here, we introduce our experiences and outcomes of 100 cases of LT as a small volume center. Method From November 2002 to July 2017, 100 patients were received LT in Keimyung University Dongsan Medical Center. On March 2014, we renewed the LT program by reinforcement of trained staff and establishment of complemented protocol. Fifty cases of LT were performed before renewal of LT program on March 2014 and 50 cases were performed after that time. We reviewed the outcomes of these 100 cases of LT retrospectively. Results Among 100 cases of LT, DDLT was performed in 60 cases and LDLT in 40 cases. The indications of LT were liver cirrhosis due to HBV in 62 patients, HCV in 7 patients, alcoholics in 30 patients, other causes in 10 patients and hepatocellular carcinoma in 34 patients. The perioperative mortality rate was 18 % before 2014, but decreased to 2 % after renewal (p<0.001). The 3-year survival rate was 74% before 2014, but improved to 95% after renewal (p<0.001). The rate of complications was also improved after renewal of LT program. After renewal of LT program, the outcomes of LT have been more improved and comparable to those of big centers. Conclusion It is challenging to establish stabilized LT program in small volume center due to complexity and difficulty in operative technique and management of complications. Small volume centers need long time to experience sufficient cases for overcoming learning-curve and stabilizing program independently due to small number of cases. The recruitment of trained and experienced member or support from big centers can be considered for establishment of comparable LT program to big centers in a short period of time and stable LT program in small volume center can provide a practical service for a local population.

What Is the Prognosis of Patients with Benign Paroxysmal Positional Vertigo in Sudden Sensorineural Hearing Loss?

Objectives Vertigo is considered a poor prognostic factor in patients with sudden sensorineural hearing loss (SSNHL). Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo and may accompany SSNHL. However, whether BPPV is a poor prognostic factor remains controversial. We identified features of prognostic utility in patients with both SSNHL and BPPV. Methods We retrospectively evaluated data on all patients diagnosed with SSNHL at Keimyung University Dongsan Medical Center between January 2011 and December 2015. We reviewed medical records, the results of vestibular function testing, and audiographic data. Results Of the 524 idiopathic SSNHL patients, 20 (3.8%) were also diagnosed with unilateral BPPV. The average pure tone average (PTA) of those with both SSNHL and BPPV was higher than that of those without BPPV. Of the 471 patients with SSNHL only, 143 (30%) exhibited complete recovery. Of the 33 SSNHL patients with vertigo, 3 (9%) exhibited complete recovery, but only 3 (15%) of those with both SSNHL and BPPV exhibited complete recovery. Of the 20 patients with both SSNHL and BPPV, 15 had ipsilateral BPPV and 5 contralateral BPPV. Conclusions Patients with BPPV had a higher average initial PTA score and poorer hearing recovery after treatment, than patients with SSNHL alone. Patients with contralateral BPPV had a somewhat better prognosis than those with ipsilateral BPPV, but statistical significance was not attained. Keywords: Benign paroxysmal positional vertigo; Hearing loss 중심 단어: 현훈, 양성돌발성체위성현훈, 난청

Association between Serum Dipeptidyl Peptidase-4 Concentration and Obesity-related Factors in Health Screen Examinees.

BackgroundDipeptidyl peptidase-4 (DPP-4) is an aminopeptidase that inhibits the enzymatic degradation of glucagon-like peptide-1, glucose-dependent insulinotropic polypeptides, neuropeptides, and various chemokines. Recent studies reported that serum DPP-4 concentration is correlated with clinical parameters of obesity. However, research on these correlations has never been conducted in Korea. Therefore, we investigated the relationship between serum DPP-4 concentration and various clinical parameters of obesity in the Korean population.MethodsPatients who visited the Health Promotion Center at Keimyung University Dongsan Medical Center for a regular medical examination between January 2013 and March 2013 and consented to participate in this study were included. We measured and analyzed parameters of obesity. In addition, serum DPP-4 concentration was determined using an enzyme-linked immunosorbent assay kit.ResultsSerum DPP-4 concentration was positively correlated with lean body mass, total cholesterol level, and creatinine level. Serum DPP-4 concentration was higher in the obese group than in the normal body mass index (BMI) group. No significant difference in serum DPP-4 concentration was found between the metabolically healthy group and metabolically unhealthy group.ConclusionSerum DPP-4 concentration was higher in the obesity group than in the normal BMI group, which was associated with obesity-related factors.

Clinical significance of the lymph node ratio in N1 breast cancer.

PurposeThe purpose of this study was to evaluate the prognostic value of the lymph node ratio (LNR), which was defined as the proportion of involved nodes of all dissected nodes, in pN1 breast cancer.Materials and MethodsWe retrospectively analyzed the clinical data of patients with pN1 breast cancer (N = 144) treated at Keimyung University Dongsan Medical Center, Daegu, Korea between 2001 and 2010. The median age was 46 years (range, 27 to 66 years). The LNR was 0.01–0.15 (low LNR) in 130 patients and >0.15 (high LNR) in 14 patients. Sixty-five patients (45.1%) had T1 tumors, 74 (51.4%) had T2 tumors, and 5 (3.5%) had T3 tumors. Eighty-eight patients (61.1%) underwent total mastectomy and 56 (38.9%) underwent partial mastectomy. Fifty-nine patients (41.0%) underwent radiotherapy and 12 (8.3%) underwent regional radiotherapy. The median follow-up period was 65 months.ResultsThe 5- and 10-year disease-free survival (DFS) rates were 92.7% and 82.4%, respectively. Univariate analyses revealed that high LNR (p = 0.004), total mastectomy (p = 0.006), no local radiotherapy (p = 0.036), and stage T2 or T3 (p = 0.010) were associated with worse DFS. In multivariable analysis, only high LNR (p = 0.015) was associated with worse DFS.ConclusionHigh LNR is an independent prognostic factor in pN1 breast cancer and could be an indication for adjuvant radiotherapy in these patients.

Kidney Transplantation in Korean Patients With End-Stage Renal Disease Aged 65 and Older: A Single-Center Experience

BackgroundThe mean age of patients starting dialysis in Korea has increased to older than 60 years and the proportion of patients aged 65 and older exceeded 40% in 2014. Although the number of elderly dialysis patients is increasing rapidly, percentages of elderly patients undergoing kidney transplantation (KT) are very low. MethodsWe retrospectively reviewed the medical records of patients who underwent KT at Keimyung University Dongsan Medical Center between 1982 and 2016. Elderly patients (≥65 years old) were compared with the control group of patients in their early sixties (60–64 years old). ResultsAmong a total of 1209 KT patients, those in their early sixties totaled 34 (2.8%) and the elderly totaled only 18 (1.5%). Patient and allograft survival rate showed no significant differences between the elderly and those in their early sixties. Death with a functioning graft accounted for 50% in both groups. However, occurrences of bacterial infection and tuberculosis were higher in the elderly (P = .011 and .047, respectively). In a multivariate analysis, longer duration of renal replacement therapy before KT and the occurrence of malignancy were independent risk factors for patient death (hazard ratio [HR], 1.027; P = .014; HR, 31.934; P = .016, respectively). Also, albuminuria at 6 months after KT was an independent risk factor for allograft loss (HR, 51.155; P = .016). ConclusionThe overall survival rate of the elderly was not significantly lower than those in their early sixties. Even in the elderly, KT should not be delayed. In addition, careful surveillance for malignancy and measures to decrease the risk of infection are necessary.

A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy.

ObjectiveThe aim of our study is to compare the overall survival (OS), progression-free survival (PFS), and treatment-related morbidities between primary concurrent chemoradiation therapy (CCRT) vs. radical hysterectomy (RH) with or without tailored adjuvant therapy in patients with stages IB2 and IIA cervical cancer.MethodsThis was a retrospective study of 113 patients with IB2 or IIA cervical cancer treated with either primary CCRT (n=49) or RH (n=64) with or without tailored adjuvant therapy between 2002 and 2011 at Keimyung University Dongsan Medical Center. Patients in RH group was divided into those undergoing surgery alone (n=26) and those undergoing surgery with adjuvant therapy (n=38).ResultsThe median follow up period was 66 months. The 5-year OS by treatment modality was 88.7% for the 64 patients in the RH group and 72.8% for 49 patients in the CCRT group (P=0.044). The 5-year PFS was 82.3% and 65.6% after RH group and CCRT group (P=0.048), respectively. Grade 3–4 complication was less frequent after RH alone (7.7%) than RH with adjuvant therapy (34.2%) or CCRT group (28.6%) (P=0.047).ConclusionThe RH group seems to be superior to the CCRT group in oncologic outcomes. However, considering the selection bias including tumor size, lymph node meta, and parametrial invasion in pretreatment magnetic resonance imaging, both treatment modalities are reasonable and feasible in cervical cancer IB2 and IIA. It is important to choose the appropriate treatment modality considering the age and general condition of the patient. Randomized controlled study is needed to confirm the result of our study and determine the optimal treatment.

Association of biofilm production with colonization among clinical isolates of Acinetobacter baumannii.

Background/AimsThe pathogen Acinetobacter baumannii is increasingly causing healthcare-associated infections worldwide, particularly in intensive care units. Biofilm formation, a factor contributing to the virulence of A. baumannii, is associated with long-term persistence in hospital environments. The present study investigates the clinical impact of biofilm production on colonization and acquisition after patient admission.MethodsForty-nine A. baumannii isolates were obtained between August and November 2013 from Keimyung University Dongsan Medical Center, Daegu, Korea. All isolates were obtained from sputum samples of new patients infected or colonized by A. baumannii. The microtiter plate assay was used to determine biofilm formation.ResultsTwenty-four A. baumannii isolates (48%) demonstrated enhanced biofilm formation capacity than that of the standard A. baumannii strain (ATCC 19606). All isolates were resistant to carbapenem, 38 isolates (77%) were collected from patients in an intensive care unit, and 47 isolates (95%) were from patients who had been exposed to antibiotics in the previous month. The median duration of colonization was longer for biofilm-producing isolates than that of the biofilm non-biofilm producing isolates (18 days vs. 12 days, p < 0.05). Simultaneous colonization with other bacteria was more common for biofilm-producing isolates than that for the non-biofilm producing isolates. The most prevalent co-colonizing bacteria was Staphylococcus aureus.ConclusionsBiofilm-producing isolates seem to colonize the respiratory tract for longer durations than the non-biofilm producing isolates. During colonization, biofilm producers promote co-colonization by other bacteria, particularly S. aureus. Additional research is required to determine possible links between biofilm formation and nosocomial infection.

Hepatic resection and prognosis for patients with single hepatocellular carcinoma larger than 5 cm

Purpose: This study aimed to determine the factors that affect on the prognosis of hepatic resection for HCC larger than 5 cm. Methods: A total of 421 patients underwent hepatic resection for the HCC at Keimyung University Dong-San Medical Center between January, 2001 and November, 2013, we analyzed 114 patients underwent resection with single HCC larger than 5 cm, retrospectively. Results: During median follow-up period was 26.4 months (range), 3- and 5- year disease-free survival rates of 42%, 30%. Iin univariate analysis, positive hepatitis B surface antigen, AFP of 2000 ng/mL or higher, PIVKA-II of 200 mIU/mL or higher, Edmonson grade III/IV, the presence of macrovascular invasion, the presence of microvascular invasion, and the presence of satellite nodule were all significant predictors of poor prognosis. However, tumor size larger than 10 cm and surgical margin status were not associated with a poor prognosis. In multivariate analysis, positive hepatitis B surface antigen, PIVKA-II 200 mIU/ml, macrovascular invasion, and microvascular invasion remained independent predictors of poor survival. Conclusion: After resection of the tumors larger than 5 cm in diameter, more restrict application of surveillance modalities, imaging studies and tumor markers, is recommended to detect earlier recurrence for the patients who have poor prognostic factors.

Circadian Rhythm of Hospital Death: Difference Between the Intensive Care Unit and General Room

Background and Objectives: The purpose was to record the time at which biological phenomena stop in different hospital wards and determine regular patterns in times of death, as well as any associated factors. Subjects and Methods: A total of 6,517 inpatients at the Keimyung University Dongsan Medical Center who died between January 2006 and December 2012 were retrospectively enrolled. A comparative analysis was conducted for the mortality distribution between the intensive care unit (ICU) and general wards (GW). Results: A total of 3,198 (49%) died in the ICU and 3,319 (51%) in the GW. The ICU showed an increase in mortality over the most recent 3 years. There was no difference in monthly or daily pattern. ICU mortality peaked at 14:00 to 16:00 hours (9.2%) and 20:00 to 22:00 hours (9.1%), and GW mortality peaked at 06:00 to 08:00 hours (9.6%) and 10:00 to 12:00 hours (9.4%), with a significant statistical difference between the two wards (p=0.03). Patients with diseases of the circulatory system died most often in the ICU (28.3%), whereas those with neoplasms had the highest mortality rate in the GW (77.7%) (p<0.01). Conclusion: Some differences between the ICU and GW may be accounted for by a preserved circadian rhythm that was affected by disease distribution, hospital room environment, and use of various drugs.

Beneficial Effect of Diet Intervention on School Children with Atopic Dermatitis

Jae Hyuck Lee, Seung Wan Hong, Sung-Ae Kim, Hee Joung Choi, Mi Kyung Kim, Young-Sung Suh Department of Family Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea Department of Dermatology, Keimyung University Dongsan Medical Center, Daegu, Korea Department of Pediatrics, Keimyung University Dongsan Medical Center, Daegu, Korea Department of Endocrinology, Keimyung University Dongsan Medical Center, Daegu, Korea