Pusan National University Hospital Research Articles

Impact of Neoadjuvant Chemotherapy (NAC) on Biomarker Expression in Breast Cancer.

Background and Objectives: This study aimed to explore biomarker change after NAC (neoadjuvant chemotherapy) and to investigate biomarker expression as a prognostic factor in patients with residual disease (RD) after NAC. Materials and Methods: We retrospectively evaluated 104 patients with invasive breast cancer, who underwent NAC and surgery at Pusan National University Hospital from 2015 to July 2022. The expression of the biomarker was assessed, and the overall survival (OS) and disease-free survival (DFS) were investigated. Results: After NAC, 24 patients (23.1%) out of 104 total patients had a pathological complete response (pCR). We found that changes in at least one biomarker were observed in 41 patients (51.2%), among 80 patients with RD. In patients with RD after NAC (n = 80), a subtype change was identified in 20 patients (25.0%). Any kind of change in the HER2 status was present 19 (23.7%) patients. The hormone receptor (HR)+/HER2+ subtype was significantly associated with better disease-free survival (DFS) (HR, 0.13; 95% CI, 0.02-0.99; p = 0.049). No change in p53 was associated with better DFS, and negative-to-positive change in p53 expression after NAC was correlated with worse DFS (p < 0.001). Negative-to-positive change in p53 was an independent, worse DFS factor in the multivariate analysis (HR,18.44; 95% CI, 1.86-182.97; p = 0.013). Conclusions: Biomarker change and subtype change after NAC were not infrequent, which can affect the further treatment strategy after surgery. The expression change of p53 might have a prognostic role. Overall, we suggest that the re-evaluation of biomarkers after NAC can provide a prognostic role and is needed for the best decision to be made on further treatment.

Neglected upper-extremity fractures at a severe trauma center in the Republic of Korea

Purpose: Missed injuries and delayed diagnoses are likely when diagnosing patients with severe trauma. This research aimed to investigate the incidence of missed fractures in the upper extremities by retrospectively analyzing factors leading to an overlooked diagnosis.Methods: We retrospectively investigated patients hospitalized with newly diagnosed upper-extremity fractures after an initial diagnosis at Severe Trauma Center of Pusan National University Hospital. We analyzed the accompanying injuries, Injury Severity Score (ISS), reasons for a missed diagnosis, and treatment results.Results: Twenty-four patients and 27 cases were identified. The incidence of fracture was 0.4%, and the average diagnostic period was 33 days. The mean ISS was 24.3. Among the 27 cases of neglected fractures there were 1 intercondylar fracture of the humerus, 11 were radial or ulnar forearm fractures , six were carpus or metacarpal fractures, and nine were phalangeal fractures. Among the 24 patients with a delayed diagnosis, 21 patients had orthopedic-related fractures at other sites at the time of initial diagnosis. There were 12 cases of fracture in the ipsilateral limb. At final follow-up, 15 patients exhibited &lt;50% of normal range of motion in the injured area.Conclusion: A neglected upper-extremity fracture can result in missing the optimal surgery window and rehabilitation period, culminating in poor outcomes. Therefore, an orthopedic surgeon must conduct repeated, careful physical examinations with appropriate consideration of the injury mechanisms.

Clinical Characteristics of Congenital Pulmonary Airway Malformation of The Lungs: A Single-Center Study

Objective: Congenital pulmonary airway malformation (CPAM) is a rare developmental abnormality of the lungs. We investigated clinical characteristics of CPAM based on patient age at diagnosis. Methods: In this retrospective study, we analyzed the medical records of 51 patients diagnosed with CPAM at Pusan National University Hospital between January 2000 and December 2019. Results: We investigated 39 children and 12 adults. The mean age at the diagnosis of the patients was 15.9 ± 14.3 years. The mean ages of children and adults at the time of diagnosis of CPAM were 6.8 ± 5.8 years and 31.2 ± 10.2 years, respectively. Among the 51 patients investigated, 20 (39%) were asymptomatic and 31 (61%) showed clinical symptoms, such as dry cough, recurrent respiratory infections, and dyspnea at the time of diagnosis. Notably, clinical symptoms at diagnosis were observed in 28 children (72%) and in only 3 adults (25%) (P = 0.006), and children were more symptomatic than adults. Children with large cysts tended to be more symptomatic than those with small cysts (P &lt; 0.001). Combined anomalies were detected in 12 patients (23%). Patients with cystic lesions in the right lower lobe of the lung showed a higher prevalence of combined anomalies (P =0.015). Surgical resection was performed in 40 patients (78%), and all patients showed good prognosis. Conclusion: This study revealed that the presence of clinical symptoms of CPAM differed between children and adults, depending on the age at diagnosis and that patients with cysts in the right lower lobe of the lungs tended to show a higher prevalence of combined anomalies. (Allergy Asthma Respir Dis 2021, 9: 21–26)

Learning potential and visuospatial memory could predict amyloid-beta positron emission tomography positivity in amnestic mild cognitive impairment

We investigate the role of neuropsychological tests, including the learning potential, in predicting amyloid-beta positron emission tomography (Aβ-PET) status in amnestic mild cognitive impairment (aMCI). This cross-sectional study included 64 patients with aMCI (31 Aβ-PET (-) and 33 (+)) who visited a memory impairment clinic at Pusan National University Hospital between 2014 and 2019. Patients underwent Aβ-PET scans using 18F-florbetaben and the Seoul Neuropsychological Screening Battery. Learning potential was determined based on the difference in scores between the first and third trials of the Seoul Verbal Learning test (SVLT). Binary logistic regression was used to demonstrate the association between Aβ-PET status and cognitive tests. Predictive ability of cognitive tests for Aβ deposition was investigated using receiver operating characteristic curves analysis. From logistic regression models, the SVLT learning potential and Rey-Osterrieth Complex Figure Test (RCFT) delayed recall were found to predict Aβ-PET positivity. The areas under the curve (AUC) of the SVLT learning potential and RCFT delayed recall were significantly different from 0.5. Our findings of an association between Aβ deposition status and learning potential and visuospatial memory suggest that these cognitive tests could be used to screen patients with aMCI for Aβ deposition status.

Assessment of the Impact of Anti-Hormonal Treatment on Bone Health in Patients With Breast Cancer Using Machine-Learning Analysis

Purpose: This study analyzed the effects of anti-hormonal treatment (HTx) on bone health using real-world evidence and machine-learning analysis.Methods: We extracted 20 clinical variables and patient history of HTx by reviewing the records of 244 patients treated for breast cancer between January 2014 and June 2018 at Pusan National University Hospital. Baseline and first follow-up dual-energy absorptiometry were analyzed. To identify which of the 20 clinical variables were highly associated with the patients’ bone mineral density and trabecular bone score (TBS), we applied partial least squares discriminant analysis (PLS-DA) and MetaboAnalyst. A self-organizing map (SOM) was used to sort the patient groups based on the selected variables.Results: The patients were classified as ‘no change’ (n=161, 70.6%), ‘deteriorated’ (n=43, 18.9%), or ‘improved’ (n=24, 10.5%) according to the change in TBS during the follow-up period. The baseline TBS value was significantly lower in the improved group. The top five variables (age, HTx, duration of vitamin D and/or calcium intake, cancer stage, and body mass index) were selected using PLS-DA, which generated variable importance value (VIP) scores for all variables and high VIP scores contributed greatly to patient classification. To identify the patients’ clinical patterns using the top five selected variables, a 3×4 grid structure SOM was generated. Clusters were selected to represent the most improved, no change, and most deteriorated groups.Conclusion: This study evaluated the clinical association between HTx and bone health in patients with breast cancer under various clinical conditions and found that the characteristics of patients included in the study were too heterogeneous to be classified in clusters. Therefore, additional data should be collected for future research.

P-642 Estrogen deprivation and related risks in primary ovarian insufficiency with various hormone therapy initiation time points - evaluating 122,785 Asian women

Abstract Study question Does the initiation time point and/or duration of hormone therapy affect the long-term health consequences in primary ovarian insufficiency (POI)? Summary answer POI women with immediate hormone therapy following their diagnosis showed significantly reduced risk of metabolic syndrome and dyslipidemia, and such effect magnified with aging. What is known already POI women are exposed to extended duration of estrogen deficiency and premature aging, consequently associated with higher risks of cardiovascular, metabolic, osteoporotic and neurodegenerative diseases. The first line of treatment is hormone therapy (HT), preferably until the age of natural menopause. “Timing hypothesis” in terms of hormone replacement therapy (HRT) in menopause has globally changed the treatment protocol, but its evidence in POI is scarce. Study design, size, duration This population-based retrospective cohort study included 122,785 women registered to the National Health Insurance in South Korea from 2009 to 2015. The study group with POI diagnosis contained 24,557 women, determined by the International Classification of Disease, tenth revision (ICD-10) code E283 in the database. Women aged more than 40 years with the E283 code were considered being previously-diagnosed POI. The 1:4 age-matching control group with the systematic random-sampling method included 98,228 women. Participants/materials, setting, methods The participants’ demographic data, diagnosis codes, use of inpatient and outpatient services, pharmacy dispensing claims and mortality data were retrieved and statistically analyzed. According to their use of HT, the study group was further divided into two groups: with (n = 13,240) or without HT (n = 11,317); their routine health check-up data collected in the database were then compared. In all analysis, a p-value &amp;lt;0.05 was considered statistically significant. Main results and the role of chance Compared to the control group, POI women had significantly lower body mass index (BMI), blood pressure, serum total cholesterol and triglyceride (TG), but the incidence rate ratio (IRR) was significantly higher in POI regarding thyroid diseases, type 2 diabetes, dyslipidemia, hypertension, osteoporosis and cardiovascular diseases (IRR with 95% confidence interval (CI) of 1.731[1.691; 1.772], 1.300[1.260; 1.342], 1.499[1.470; 1.529], 1.100[1.071; 1.129], 2.449[2.388;2.513] and 1.468[1.392; 1.547], respectively). Among POI women overall, the HT users had significantly lower BMI, lower systolic blood pressure but similar diastolic blood pressure, and lower serum total cholesterol and TG, compared to the non-users. In terms of IRRs for chronic diseases, the HT users under the age of 40 years did not show any statistically significant difference in comparison to the non-users; however, the HT users aged more than 40 years had significantly lower IRRs for type 2 diabetes, dyslipidemia and hypertension compared to the non-users (0.876[0.822; 0.933], 0.873[0.840; 0.907], 0.849[0.805; 0.896], respectively). Such effect became more statistically vivid when the participants grew older (IRR[95% CI] of 0.849[0.749; 0.963] for thyroid diseases; 0.806[0.708; 0.917] for type 2 diabetes; 0.652[0.592; 0.718] for dyslipidemia; 0.739[0.662; 0.825] for hypertension; 0.835[0.752; 0.928] for osteoporosis; and 0.890[0.728; 1.089] for cardiovascular disease, respectively). Limitations, reasons for caution The current study relied on the health insurance claim data which did not include detailed patient medical record including menstruation pattern and obstetrical/gynecological histories. Also, critical biochemical assay results such as anti-mullerian hormone or pituitary hormones were not available because they were not covered by the national health insurance program. Wider implications of the findings Agreeing with the previous literature, the immediate use of HT is associated with the reduced incidence of chronic diseases in POI women, and its extended use exerts more significant results with aging. If acknowledged early and initiated with HT, previously-inevitable health risks with POI could be conceivably compensated. Trial registration number The current study was supported by Biomedical Research Institute Grant (#202201970001), Pusan National University Hospital.

Validation of AI-based postoperative nomograms for biochemical recurrence in prostate adenocarcinoma.

e17104 Background: After radical prostatectomy (RP), a steep increase in PSA level is an early sign of the disease progression in prostate cancer, which is known as biochemical recurrence (BCR). The risk of BCR can be evaluated based on a combination of clinicopathological factors, and the patient’s Gleason score plays a significant role. However, this scoring system may have lower consistency due to interobserver reproducibility in classifying Gleason Patterns (GP) as well as in quantifying the amount of each GP. We developed AI-based nomograms, with the aim of investigating their prognostic efficacy. Methods: In this study, digitized whole-slide images (WSIs) of H&amp;E-stained prostatectomy specimens and clinical follow-up information were obtained from two sources: Pusan National University Hospital (PNUH, n = 967, event = 342) from 2010 to 2021 with the median follow-up being 3.7 years, and The Cancer Genome Atlas (TCGA, n = 352, event = 79) from 2000 to 2013 with the median follow-up 2.6 years. We used the DeepDx Prostate - RP, an AI-based prostate cancer Gleason grading model, to compute a pixel-wise probability map of each GP in WSIs. Then, a weighted sum of the probabilities and GPs was calculated for each pixel. The proposed slide-level score (AI score) was then determined by averaging them across all pixels in WSI, resulting in a value ranging from 3 to 5. Also, patients were divided into five groups using AI score thresholds (3.1, 3.5, 3.9, and 4.1), and five binary variables (AI score group 1-5) were generated, where a value of 1 indicates a patient’s categorization into a group. To evaluate predictability we created new nomograms incorporating AI scores based on existing nomograms: MSKCC and CAPRA-S. Unlike the original nomograms, the proposed nomograms do not include the Grade Group (GG) made by pathologists. Then, we fitted a Cox regression model on one of two datasets using the original and newly formed nomograms, and validated on the other dataset reporting the concordance index (c-index). Confidence intervals for the c-index were generated via the non-parametric bootstrap resampling with 9,999 samples. Results: The table shows the prognostic performance of sets of clinicopathological factors and demonstrates that the proposed AI score improved the predictive power. The nomograms with AI score group 1-5 outperformed the original nomograms, as shown in (d). Conclusions: In conclusion, we developed the AI-based nomograms which can improve the accuracy of predicting the biochemical recurrence in prostate cancer compared to the existing nomograms. [Table: see text]

Algorithm-based histologic grade and tumor ratio for radical prostatectomy: Comparison with pathology reports.

e17096 Background: The histologic grade (Gleason score) as well as the tumor ratio of the resected specimen plays a significant role in assessing the clinical risk of prostate cancer patients who underwent radical prostatectomy. Gleason scoring is known to be prone to inter- and intra-observer discordance, and eyeballing measurement of tumor ratio is possibly coarse and inaccurate. Several deep learning-based tissue image analysis algorithms that perform prostate cancer diagnosis have been developed and are about to be applied clinically. We evaluated the utility of one of those algorithms by comparing its output with the pathology reports. Methods: A total of 29681 H&amp;E-stained tissue slides were collected for 1001 radical prostatectomy cases during 2010-2021 at Pusan National University Hospital and scanned at 40x magnification into whole-slide images. On each slide, we utilized a tissue detection algorithm to identify tissue regions and measure the area. A deep learning-based algorithm was used to identify prostate cancer lesions, measure the area, and determine the grades. The area measurement was converted into the volume figure assuming that the tissue slice thickness was 5mm. The slide-wise algorithm outputs were then aggregated for each case, resulting in the specimen volume, tumor ratio, and Gleason score. In the evaluation, the algorithm-based Gleason scores were compared with the ones in the hospital pathology reports on the ISUP grade group basis. The correlation analysis was performed for the tumor ratio. The specimen density values were calculated from the volume figures and the hospital weight measurement and utilized to exclude the cases with extreme density values. Results: The min, max, and average number of slides per case were 1, 67, and 29.7. For two cases with a single slide collected, both the algorithm and the expert pathologist found no cancer. The pathologist also confirmed that 7 had residual tumors among 15 cases where there was no Gleason score in the pathology reports while the algorithm found cancer. For the remaining 984 cases, the algorithm provided the grade groups equal to, higher than, and lower than the pathology reports for 482, 384, and 118 cases respectively, showing moderate agreement. The min, max, and mean values of the specimen volume (mL) were 0.01, 75.3, and 32.7, while the corresponding values of the specimen density (g/mL) were 0.11, 3001.79, and 4.38. The density values at the lower and upper 2.5% were 0.42 and 1.40 respectively, and the mean of the values between them (inner 95%) was 0.92. The degree of tumor ratio correlation between the algorithm and the pathology reports was high with the coefficient 0.813 (95% CI: 0.791-0.833), which went up to 0.826 (95% CI: 0.805-0.845) for the inner 95% density cases. Conclusions: Our findings support the usefulness of the algorithm-based analysis of prostatectomy specimens, which can benefit clinicians in the hospital.

Clinical characteristics and outcomes in febrile infants aged 29-90 days with urinary tract infections and cerebrospinal fluid pleocytosis.

Fever without a focus is a common reason for medical evaluations, hospitalizations, and the antimicrobial treatment of infants younger than 90 days. The presence of cerebrospinal fluid (CSF) pleocytosis could be challenge for clinicians who treat febrile young infants with urinary tract infection (UTI). We evaluated the factors associated with sterile CSF pleocytosis and the clinical outcomes of the patients. A retrospective review of patients aged 29-90 days with febrile UTIs who underwent a non-traumatic lumbar puncture (LP) at Pusan National University Hospital from January 2010 to December 2020 was conducted. CSF pleocytosis was defined as white blood cell (WBC) counts ≥9/mm3. A total of 156 patients with UTI were eligible for this study. Four (2.6%) had concomitant bacteremia. However, no patients had culture-proven bacterial meningitis. In correlation analysis, although weak strength, CSF WBC counts were positively correlated with C-reactive protein (CRP) level (Spearman r = 0.234; P = 0.003). Thirty-three patients had CSF pleocytosis [21.2%; 95% confidential interval (CI), 15.5-28.2]. The time from fever onset to the hospital visit, peripheral blood platelet counts, and CRP level at admission were statistically significant in patients with sterile CSF pleocytosis compared to those without CSF pleocytosis. In the multiple logistic regression, only CRP was independently associated with sterile CSF pleocytosis (cutoff, 3.425 mg/dl; adjusted odds ratio, 2.77; 95% CI, 1.19-6.88). The proportion of fever defervescence by hospital day 2 was 87.9% in patients with CSF pleocytosis and 89.4% in those without CSF pleocytosis (P = 0.759). There was no statistical difference in the fever defervescence curves between the two patient groups (P = 0.567). No patients had neurological manifestations or complications. Coexisting sterile CSF pleocytosis among febrile infants with UTIs suggest a systemic inflammatory response. However, the clinical outcomes between the two groups were similar. A selective LP should be considered in young infants with evidence of UTI, and inappropriate antibiotic therapy for sterile CSF pleocytosis should be avoided.

Review of the reasons for and effectiveness of switching biologics for psoriasis treatment in Korea.

Background Switching of biologics in patients has become common in clinical practice. Objectives This study investigated the reasons for and effectiveness of switching biologic agents during the treatment of psoriasis. Methods We retrospectively reviewed patients with psoriasis who were treated with biologics at Pusan National University Hospital and Chosun University Hospital from March 2012 to June 2020. We assessed their demographics and treatment characteristics (reasons for switching biologics and efficacy of the first- and second biologic agents). Results Of the 162 psoriatic patients treated with biologic agents for more than 52 weeks, 35 required a switch to another biologic agent. The reasons for switching biologic agents were inefficacy (n = 30), adverse events (n = 2) and others (n = 3). The mean psoriasis area and severity index (PASI) score was 12.1 at the start of the second biologic and 3.4 at 14-16 weeks later. Patients were more likely to switch to another biologic agent when they exhibited a high initial psoriasis area and severity index score and concomitant psoriatic arthritis. Limitations As a retrospective study, there were some limitations such as lack of a placebo control group and the time point of 14-16 weeks being somewhat early to judge the effect of the biologics. Conclusions The most common reason for switching biologic agents in Korea was treatment inefficacy, especially secondary failure. Despite the inefficacy of previous biologic agents, switching to a different agent may be an efficacious approach.

Tumor budding as a predictor of disease-free survival in patients with cholangiocarcinoma.

Background: Tumor budding is considered a prognostic factor in several solid cancer types. However, we lack comprehensive information on the importance of tumor budding in cholangiocarcinoma. Therefore, we aimed to assess the prognostic value of tumor budding in intrahepatic and extrahepatic cholangiocarcinomas and to evaluate its correlations with other clinicopathological parameters. Methods: We monitored 219 patients who underwent surgery for intrahepatic or extrahepatic cholangiocarcinoma at the Pusan National University Hospital between 2012 and 2021. Tumor budding was evaluated using the International Tumor Budding Consensus Conference scoring system. Tumor budding was classified into low (0-4), intermediate (5-9), and high (≥10). For statistical analysis, tumor budding was divided into two groups based on the cut-off value of 10 (lower: 0-9 vs. higher: ≥10). The correlations between clinicopathological parameters were examined using the chi-square and Fisher's exact test. The prognostic values of the variables were analyzed using the log-rank test and Cox regression analysis. Results: Low, intermediate, and high tumor buddings were identified in 135 (61.6%), 63 (28.8), and 21 (9.6%), patients, respectively. Higher tumor budding was related to the presence of lymphatic invasion (p = 0.017), higher tumor grade (p = 0.001), higher N category (p = 0.034). In the univariable and multivariable analyses, higher tumor budding was associated with shorter disease-free survival in 97 (44.3%) patients who underwent R0 resection (p < 0.001 and p = 0.011). Tumor budding did not significantly correlate with disease-specific survival in entire patients. Conclusion: Tumor budding may serve as a prognostic factor for intrahepatic and extrahepatic cholangiocarcinomas treated with R0 resection.

Is there association between thyroid stimulating hormone levels and the four phenotypes in polycystic ovary syndrome?

The aim of this study was to determine whether the incidence of subclinical hypothyroidism (SCH) is higher in polycystic ovary syndrome (PCOS) group than the control group. Additionally, the study investigated whether serum thyroid stimulating hormone (TSH) level is associated with various clinical parameters of PCOS regarding different phenotypes of the disease. This retrospective, case-control study included 329 PCOS patients and 162 control women who were aged between 20 and 42 years and visited the Gynecology outpatient clinic in Pusan National University Hospital from January 2014 to December 2017. PCOS patients were further classified according to their phenotypes: phenotype A as the combination of all hyperandrogenism (HA), ovulatory dysfunction (OD), and polycystic ovarian morphology (PCOM); phenotype B as the combination of HA and OD; phenotype C as the combination of HA and PCOM; and finally, phenotype D as the combination of OD and PCOM. Laboratory blood tests included follicle stimulating hormone (FSH), luteinizing hormone (LH), TSH and anti-mullerian hormone (AMH). The ovarian volume was calculated using three diameters by gynecologic ultrasonography. Serum TSH level was significantly higher in PCOS patients than in the control group after adjusting for age and body mass index (BMI). Serum TSH level was not related to HA and OD, but its significant association with PCOM was confirmed in comparative analysis in quartiles. The proportion of phenotype A patients increased as serum TSH level increased, while the proportion of phenotype B and D decreased. Phenotype C stayed relatively consistent with varying TSH levels. More numbers of patients showed elevated TSH level satisfying SCH diagnosis in PCOS group than the control group. In addition, a significant correlation between serum TSH level and different PCOS phenotypes has been observed; especially, PCOS patients with phenotype A, which displays all of HA, OD, and PCOM, tended to have the higher TSH levels than the PCOS patients with other phenotypes, requiring proper and thorough evaluation for potential endocrine disparity and according to management in such patient group.

Effect of delayed sample draw after blood collection for haemoglobin test in South Korea.

Our findings confirm that delays between blood collection and transfer can affect haemoglobin levels.

Analysis of Watson for oncology and clinicians' treatment recommendations for patients with breast cancer in Korea: A single center experience.

Various clinical applications have been attempted using artificial intelligence (AI) clinical decision support system (CDSS), and it has become a starting point for personalized cancer treatment. We aimed to identify the degree of agreement between the AI-CDSS, Watson for Oncology (WFO), and the clinician in treatment recommendations for Korean breast cancer patients and to provide guidelines for future improvement. One hundred and eighty-three breast cancer patients who underwent treatment at the Pusan National University Hospital between January 1, 2016 and May 31, 2017 were enrolled in this study. The concordance between WFO's and clinicians' treatment recommendations were examined according to various factors. WFO gave the same treatment option recommendations as clinicians in 74 (40.4%) of the cases. According to the logistic regression, the difference in recommendation concordance between stage I and stage III was statistically significant (P = 0.004), and there was no difference among other factors. The concordance of treatment recommendations was low overall. However, this is largely attributable to the differences of medical insurance system and healthcare environment between the United States and Korea. In the future, region-specific features should be considered or reflected during the development of AI-CDSS.

Eustachian Tube Function Test of Normal Ear in Patients with Unilateral Chronic Otitis Media

Purpose: The aim of this study is to observe the importance of normal ear Eustachian Tube Function Test (ETFT) for unilateral Chronic Otitis Media (COM) and essential date on ETFT through Williams test (Y-266 Hz).Methods: Williams test Y-226 Hz is a test that can evaluate the function of the Eustachian tube only by controlling the pressure, and we retrospectively analyzed 182 otitis media patients who underwent surgery in Pusan National University Hospital. Three results obtained through the Williams test (Y-226 Hz) were classified according to categories and descriptive analysis was performed.Results: In the 182 subjects, 89 did not show changes in static compliance (SC) or had result bias. 1~5 daPa change in 6 (3.3%), 6~10 daPa change 17 (9.3%), 11~15 daPa change 18 (9.9%), 16~20 daPa change 22 (12.1%), 21~25 daPa change 5 (2.7%), 26~30 daPa change 5 (2.7%), 31~40 daPa change 4 (2.2%), 41~50 daPa change 6 (3.3%), 51~100 daPa change changes in 6 (3.3%) and the remaining 4 (2.2%) showed a change greater than 100 daPa. The mean standard SC value of 93 subjects with change was -4.9 daPa, and the mean value measured at positive pressure +400 daPa was -27.4 daPa. Additionally, the mean value measured at negative pressure -400 daPa was +22.9 daPa.Conclusion: Even if the contralateral eardrum appeared normal in the subjects who underwent COM, there were more cases of problems with the Eustachian tube. Normal ear ETFT is necessary for unilateral COM patients, and the Williams test is suitable as a criterion-referenced assessment.

Which Areas Are Still Left in Biologics Responsive Korean Patients with Moderate to Severe Plaque Psoriasis.

Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat. To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics. The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment). A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%). This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.

Pigmented Fungiform Papillae of the Tongue: A Single-center Experience and Review of Literature.

Pigmented fungiform papillae of the tongue (PFPT) is a rare benign pigmentary disorder of the tongue. In dark-skinned individuals, PFPT appears to be relatively common. However, limited data exist on PFPT in Korean patients. We aimed to investigate the clinical characteristics of PFPT in Korean patients. Patients diagnosed with PFPT between 1995 and 2021 at the Pusan National University Hospital were included. Clinical characteristics of PFPT, dermoscopic findings, and comorbidities were reviewed. A total of 19 patients diagnosed with PFPT were enrolled. The male to female ratio was approximately 1:5. The mean age at diagnosis was 41.1 years (range, 8~67 years). According to Holzwanger's classification, Type I was the most common (89.5%). PFPT was commonly concomitant with pigmentary disorders, including mucosal melanotic macules, Laugier-Hunziker syndrome, melasma, and melanonychia (6/19, 31.6%). Preceding oral infection or inflammatory lesions were found in four patients (21.1%), and systemic diseases and infectious diseases existed in two patients (10.5%). Dermoscopic examination was performed in seven patients; pigmented border with dichotomized vessels (rose petal pattern, 71.4%) and diffuse pigmentation (cobblestone pattern, 71.4%) were common findings. Our study shows PFPT can coexist with pigmentary disorders. Concomitant pigmentary disorder shows an association with sex hormone or susceptibility to abnormal pigmentation may be a possible cause of PFPT.

Correlation of Sarcopenic Obesity on Various Cardiometabolic Risk Factors and Fracture Risk in Mid-Aged Korean Women.

This study aimed to investigate the correlation of sarcopenic obesity with various cardiometabolic risk factors and fracture risk in middle-aged Korean women. In this cross-sectional study, the medical records of 1,775 women who had visited Pusan National University Hospital for routine health screenings from 2010 to 2016 were reviewed. The patients were divided into four groups as follows: group 1, nonsarcopenic, nonobese (NS-NO); group 2, nonsarcopenic, obese (NS-O); group 3, sarcopenic, nonobese (S-NO); and group 4, sarcopenic, obese (S-O). Each patient was assessed based on self-reported questionnaires and individual interviews with a healthcare provider. The Fracture Risk Assessment Tool (FRAX) was used to assess bone fracture risk. Postmenopausal women accounted for 68.5% of the total patient population. The proportion of each group was as follows: NS-NO, 71.2%; NS-O, 17.9%; S-NO, 10.2%; and S-O, 0.7%. Statistical analysis of various parameters associated with metabolic and cardiovascular risks revealed that the S-O group had more patients with hypertension, diabetes, osteopenia, and metabolic syndrome. The FRAX scores were significantly higher in the S-O group than in other groups. Middle-aged women with obesity and reduced muscle mass, known as sarcopenic obesity, are at increased risk of hypertension, diabetes, and metabolic syndrome. Furthermore, sarcopenic obesity, individual cardiometabolic risks, and menopause can increase the bone fracture risk.

Clinical characteristics and risk factors for visual prognosis according to the types of infectious endophthalmitis.

Endophthalmitis is a fatal ophthalmological emergency that needs prompt diagnosis and treatment. This study aimed to evaluate the clinical characteristics and investigate risk factors for the visual prognosis of the different types of endophthalmitis. This retrospective study included 239 eyes diagnosed with endophthalmitis at the Pusan National University Hospital between January 2006 and December 2020. All patients were classified into six groups based on the etiology of endophthalmitis: post-cataract surgery, post-vitrectomy, post-glaucoma surgery, post-intravitreal injection, endogenous, and post-trauma. Demographics and clinical characteristics such as age, sex, laterality, initial symptoms, the interval between the primary causable event and diagnosis of endophthalmitis, initial and final visual acuity, management, and culture results were reviewed and statistically analyzed. Risk factors for poor visual prognosis were also analyzed according to the type of endophthalmitis. Of the 239 cases of endophthalmitis, the most common cause was post-cataract surgery, that occurs within two weeks post-surgery. Gram-positive Staphylococcus was cultured most frequently. Fusarium was characteristically cultured from delayed post-cataract surgery endophthalmitis (14 days-6 weeks post-surgery). Post-vitrectomy endophthalmitis occurred within 3.3 days post-surgery, but post-glaucoma surgery endophthalmitis developed a long period after surgery, averaging 2,742 days. Post-intravitreal injection endophthalmitis occurred most frequently following bevacizumab injection, and Staphylococcus was most commonly isolated. For endogenous endophthalmitis, the pyogenic liver abscess was the most common underlying disease, and Klebsiella was isolated most frequently. Post-traumatic endophthalmitis mostly occurred in young men. Advanced age and poor initial visual acuity were risk factors for poor visual prognosis (P = 0.041, odds ratio = 1.024 and P < 0.001, odds ratio = 3.904, respectively, using logistic regression analysis). Advanced age and initial visual acuity were risk factors for poor visual prognosis in cases of endophthalmitis caused by various etiologies. Early diagnosis and treatment of endophthalmitis are required, especially in older patients.

기계학습에 의한 후두 장애음성 식별기의 성능 비교*

This paper studies how to improve the identification rate of laryngeal disability speech data by convolutional neural network (CNN) and machine learning ensemble learning methods. In general, the number of laryngeal dysfunction speech data is small, so even if identifiers are constructed by statistical methods, the phenomenon caused by overfitting depending on the training method can lead to a decrease the identification rate when exposed to external data. In this work, we try to combine results derived from CNN models and machine learning models with various accuracy in a multi-voting manner to ensure improved classification efficiency compared to the original trained models. The Pusan National University Hospital (PNUH) dataset was used to train and validate algorithms. The dataset contains normal voice and voice data of benign and malignant tumors. In the experiment, an attempt was made to distinguish between normal and benign tumors and malignant tumors. As a result of the experiment, the random forest method was found to be the best ensemble method and showed an identification rate of 85%.