Wonju Severance Christian Hospital Research Articles

Thirty-day mortality after palliative radiotherapy in advanced cancer patients: Optimizing end-of-life care in Asia.

Evidence-based guidelines recommend hypofractionated palliative radiotherapy (PRT); nonetheless, many patients receive prolonged course of PRT. To identify patients with limited benefits from PRT in end-of-life care, we evaluated the pattern of PRT at an Asian institution and factors associated with 30-day mortality after PRT (30dM). We retrospectively reviewed 228 patients who died after PRT in Yonsei Wonju Severance Christian hospital between October 2014 and March 2022. The associations between clinical factors and survival were assessed using the Cox proportional hazards method. Survival was analysed using the existing models to evaluate their performance in our cohort. The median PRT duration was 13 (IQR, 7-15) days. Only 11.4% of the patients were treated with hypofractionated radiotherapy. One-third of the patients (32.9%) could not complete PRT and 39 (17.1%) died during PRT. The 30dM was 31.6%. The median time from PRT to death was 17 (IQR, 11-23) days for the patients who died within 30 days. The number of involved organs (≤2 vs. >2; P < 0.001), albumin level (<3.3 vs. ≥3.3; P = 0.016), admission during PRT (P < 0.001), admission 3 months before PRT (P = 0.036) and ICU care during PRT (P < 0.001) were prognostic factors. A comparison of survival based on the existing models yielded unsatisfactory results in our cohort. Almost one-third of the patients received PRT in the last 30 days of life. The use of hypofractionation for PRT was low in this Asian population. Further research is necessary to develop a predictive model of early mortality, allowing tailored end-of-life care for Asian patients.

Is chest tube omission safe for patients with primary spontaneous pneumothorax scheduled for video-assisted thoracoscopic surgery?

Primary spontaneous pneumothorax (PSP) is a sudden pleural disease predominantly affecting healthy adolescents and young adults, making it a prevalent thoracic disorder within this demographic. This study evaluated the necessity of preoperative chest tube insertion for PSP patients and reassessed current clinical practices. We conducted a retrospective analysis of medical records for individuals aged 14-30 years diagnosed with PSP who underwent video-assisted thoracoscopic surgery (VATS) at Wonju Severance Christian Hospital from January 2016 to December 2022. Patients were categorized retrospectively into two groups based on their initial treatment: Those who had a chest tube inserted and those who did not. We collected and compared clinical data, including demographics, treatment specifics, and outcomes. The study included 128 PSP cases. There was no difference in preoperative clinical data between the two groups, and there were no differences in operation time, number of wedge resections, and number of mechanical pleurodesis. However, the use of single-port surgery was significantly higher in the nonchest tube group (P = 0.001). The nonchest tube group had a significantly shorter hospital stay (P < 0.001), attributed to the absence of preoperative chest tube insertions. There were no significant differences in postoperative complications or recurrence rates between the groups. In young PSP patients, proceeding directly to VATS without prior chest tube insertion in stable individuals does not lead to serious complications or negatively affect outcomes. This approach may offer an effective alternative for PSP management.

Analysis of dental traumatic patterns in standing electric scooter-related accidents

BackgroundThere have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far. ObjectivesThe purpose of this study is to report the overall dental traumatic patterns, and compare the patterns of standing electric scooter-related dental trauma with other traumatic causes. Also, considerations about minimizing the risks of electric scooter-related trauma will be discussed. MethodsData on patients who visited Region Trauma Center of Wonju Severance Christian Hospital with dental emergency from January 2020 to December 2022 were collected. ResultsThe crown-root fracture and avulsion occurred significantly higher in electric scooter-related accidents than others. Furthermore, relatively minor dental injuries including concussion and subluxation showed higher percentage to be occurred as combined injuries in electric scooter-related accidents. The prevalence of traumatized posterior teeth was significantly higher in electric scooter-related trauma than others. Most of patients were teenagers and twenties. Also, the electric scooter-related accidents mostly occurred at evening and night. Furthermore, the number of patients wearing a helmet in electric scooter accidents was 1 out of 33. ConclusionThe standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.

Occult pneumothorax in patients with blunt chest trauma: key findings on supine chest radiography.

In patients with multiple trauma, a supine chest radiography [chest X-ray (CXR)] is preferred over a erect CXR. However, this method has limitations in detecting post-traumatic pneumothorax. The use of chest computed tomography (CT) to detect traumatic pneumothorax is well known. However, pneumothorax that is not detected before a chest CT scan is known as an occult pneumothorax (OP), and it can cause serious complications in the patient. This study sought to evaluate the frequency and risk factors for OP in trauma patients. Patients who suffered thoracic trauma at the Level 1 Regional Trauma Center of Wonju Severance Christian Hospital between 2015 and 2022 were included in this study. All patients were at least 18 years old. The study reviewed all patients' supine CXR and chest CT images and classified them into five radiographic diagnoses: pneumothorax, rib fracture, subcutaneous emphysema, lung contusion, and pneumomediastinum. The study included 1,284 patients, all with diagnoses of pneumothorax, rib fracture, subcutaneous emphysema, lung contusion, and pneumomediastinum following supine CXR and chest CT. The patient's average age was 58.3±15.2 years. Pneumothorax diagnosis on supine CXR had the lowest accuracy, at 46.7%, and the lowest sensitivity, at 12.7%. In univariate analysis, rib fracture, lung contusion, and subcutaneous emphysema on supine CXR were all found to be statistically significant regarding traumatic OP. In multivariate analysis, the risk factors for OP were lung contusion [odds ratio (OR), 1.440; 95% confidence interval (CI): 1.115-1.860; P=0.005] and subcutaneous emphysema (OR, 25.883; 95% CI: 13.155-50.928; P<0.001) on supine CXR. The lung contusion and subcutaneous emphysema in supine CXR of trauma patients indicate the presence of OP. Therefore, if chest CT cannot be performed immediately due to unstable vital signs or other circumstances, recognizing the above radiological findings of traumatic pneumothorax may be necessary.

CoAt-Mixer: Self-attention deep learning framework for left ventricular hypertrophy using electrocardiography.

Left ventricular hypertrophy is a significant independent risk factor for all-cause mortality and morbidity, and an accurate diagnosis at an early stage of heart change is clinically significant. Electrocardiography is the most convenient, economical, and non-invasive method for screening in primary care. However, the coincidence rate of the actual left ventricular hypertrophy and diagnostic findings was low, consequently increasing the interest in algorithms using big data and deep learning. We attempted to diagnose left ventricular hypertrophy using big data and deep learning algorithms, and aimed to confirm its diagnostic power according to the differences between males and females. This retrospective study used electrocardiographs obtained at Yonsei University Wonju Severance Christian Hospital, Wonju, Korea, from October 2010 to February 2020. Binary classification was performed for primary screening for left ventricular hypertrophy. Three datasets were used for the experiment: the male, female, and entire dataset. A cutoff for binary classification was defined as the meaningful as a screening test (<132 g/m2 vs. ≥132 g/m2, <109 g/m2 vs. ≥109 g/m2). Six types of input were used for the classification tasks. We attempted to determine whether electrocardiography had predictive power for left ventricular hypertrophy diagnosis. For the entire dataset, the model achieved an area under the receiver operating characteristic (AUROC) curve of 0.836 (95% CI, 0.833-838) with a sensitivity of 78.37% (95% CI, 76.79-79.95). For the male dataset, the AUROC was 0.826 (95% CI, 0.822-830) with a sensitivity of 76.73% (95% CI, 75.14-78.33). For the female dataset, the AUROC was 0.772 (95% CI, 0.769-775) with a sensitivity of 72.90% (95% CI, 70.33-75.46). Our model confirmed that left ventricular hypertrophy can be classified to some extent using electrocardiography, demographics, and electrocardiography features. In particular, a learning environment that considered gender differences was constructed. Consequently, the difference in diagnostic power between men and women was confirmed. Our model will help patients with suspected left ventricular hypertrophy to undergo screening tests at a low cost. In addition, our research and attempts will show the expected effect that gender-consideration approaches can help with various currently proposed diagnostic methods.

Prediction Model for Pre-Eclampsia Using Gestational-Age-Specific Serum Creatinine Distribution.

Pre-eclampsia (PE) is a pregnancy-related disease, causing significant threats to both mothers and babies. Numerous studies have identified the association between PE and renal dysfunction. However, in clinical practice, kidney problems in pregnant women are often overlooked due to physiologic adaptations during pregnancy, including renal hyperfiltration. Recent studies have reported serum creatinine (SCr) level distribution based on gestational age (GA) and demonstrated that deviations from the expected patterns can predict adverse pregnancy outcomes, including PE. This study aimed to establish a PE prediction model using expert knowledge and by considering renal physiologic adaptation during pregnancy. This retrospective study included pregnant women who delivered at the Wonju Severance Christian Hospital. Input variables, such as age, gestational weeks, chronic diseases, and SCr levels, were used to establish the PE prediction model. By integrating SCr, GA, GA-specific SCr distribution, and quartile groups of GA-specific SCr (GAQ) were made. To provide generalized performance, a random sampling method was used. As a result, GAQ improved the predictive performance for any cases of PE and triple cases, including PE, preterm birth, and fetal growth restriction. We propose a prediction model for PE consolidating readily available clinical blood test information and pregnancy-related renal physiologic adaptations.

PO-03-166 CLINICAL FEASIBILITY OF MINIMALIST APPROACH BY 3D PRINTED LEFT ATRIAL APPENDAGE (LAA) MODEL SIMULATION FOR PERCUTANEOUS LAA CLOSURE – A MULTI-CENTER CASE-CONTROL TRIAL

Because of wide anatomical variations of left atrial appendage (LAA), intra-procedural verification may prolong procedure time and increase the risk of complications. In order to minimize intraprocedural steps and manipulations, non-essential steps were replaced by ex vivo pre-procedural 3D LAA model simulations – minimalist approach. We tested clinical feasibility of minimalist approach. We reviewed clinical data and procedural images of LAA occlusion cases performed in Chung-Ang University Hospital, Seoul, Korea and Yonsei University Wonju Severance Christian Hospital, Wonju, Korea. LAA occlusion cases were categorized into 2 (conventional approach and minimalist approach). Within minimalist approach, device size and actually implanted location and orientation were determined before procedure by 3D LAA model based simulation. During procedure, we tried to reduce the number of angiography, the amount of contrast agent, the number of device deployment attempt, and radiation exposure. Then, we compared outcomes between conventional approach and minimalist approach. A total of 81 patients were reviewed and analysed (conventional approach N = 53, minimalist approach N = 28, mean age: 75.2 ± 10.7 years, 42 male (51.9 %). Procedural outcomes and complications were comparable and not significantly different. By applying minimalist approach, procedure time was reduced in number (108 ± 37,6 min vs. 88.7 ± 62.1 min, P = 0.141), radiation exposure time and dosage were significantly reduced (fluoroscopic time 20.6 ± 9.8 min vs. 10.2 ± 4.8 min, P < 0.001, dose area product 131.9 ± 128.8 mGy-cm2 vs. 44.0 ± 48.3 mGy-cm2, P = 0.001). The number of device implantation attempt was significantly reduced (2.8 ± 2.1 times vs. 1.6 ± 0.9, P < 0.001), and the number of LAA angiography was significantly reduced (5.7 ± 4.7 vs. 2.0 ± 1.3 times, P < 0.001), and the amount of contrast agent was significantly reduced (296.5 ± 155.8 ml vs. 150.9 ± 73.2 ml, P = 0.002). By applying minimalist approach, LAA occlusion procedure became shorter, safer and similarly effective without any trade-offs. Therefore, minimalist approach was feasible approach and further study is required.

Effect of Steroid Pulse Therapy on Ethambutol-induced Optic Neuropathy

Purpose: This study investigated the effects of high-dose steroid injections for ethambutol-induced optic neuropathy.Methods: A retrospective study examined 13 patients diagnosed with ethambutol-induced optic neuropathy at Wonju Severance Christian Hospital from December 2016 to November 2020. Methylprednisolone was injected at 1,000 mg/day for 3 days. The patients were evaluated before treatment; immediately after it; and at 1, 6, and 12 months. Visual acuity and visual fields were tested (Humphrey Field Analyzer, Carl Zeiss Meditec, Dublin, CA, USA) and the visual field index (VFI) and mean deviation (MD) were recorded.Results: We analyzed 26 eyes of 13 patients (6 males, 7 females; average age 68.7 years). Immediately after treatment, there was no significant improvement in visual acuity, but the VFI improved by 10% or more in 11 eyes and MD improved by 2 dB or more in 16 eyes. After the end of treatment, 13 of 26 eyes showed improved visual acuity of two lines or more in the Snellen table; VFI improved by more than 10% in 16 eyes and MD b y 2 dB or more in 20 eyes. The average differences in the final VFI and MD were 25.96 (standard deviation [SD] = 29.33) and 7.29 (SD = 7.09), respectively.Conclusions: When patients with ethambutol-induced optic neuropathy were treated with high-dose steroid injections, 60% (16/26) showed visual field improvement immediately after treatment and 77% (20/26) ultimately showed improvement. This suggests that steroids have a therapeutic effect in patients with optic neuropathy caused by ethambutol. Further studies are needed.

A Study of Congenitally Missing Permanent Teeth in Wonju Severance Christian Hospital

Congenitally missing teeth are one of the most prevalent dental anomalies in the oral cavity. In this study, the prevalence, distribution, and symmetry of congenitally missing permanent teeth among 1,865 patients aged 7 to 15 years who visited the Pediatric Dentistry Department of Wonju Severance Christian Hospital from March 2011 to May 2021 and took panoramic radiographs were investigated and analyzed. Most of the patients had one or two congenitally missing teeth, mainly in the second premolars and lateral incisors. Congenitally missing teeth occurred more in the mandible than in the maxilla, and there was no significant difference in prevalence between the left and right sides. Congenitally missing teeth tend to occur symmetrically on the left and right sides and in the maxilla and mandible, depending on the tooth. Early oral examination and radiological examination are required to prevent complications due to congenitally missing teeth, and appropriate interdisciplinary treatment is required.

Comparison of Clinical Characteristics of Traumatic Brain Injury Patients According to the Mechanism Before and After COVID-19.

This study investigated the change in the number of patients with head trauma according to the trauma mechanism among severely injured patients transferred to the emergency department of Wonju Severance Christian Hospital before and during the coronavirus disease 2019 (COVID-19) pandemic. Medical records (sex, age, diagnosis, trauma mechanism, and injury severity score) of patients referred to the emergency room between January 2018 and December 2019 and January 2020 and December 2021 were retrospectively reviewed, verified, and compared. Between 2020 and 2021, the number of patients with traumatic brain injury decreased by 251 (32%). No significant differences were observed in sex, age, or time of accident. From 2020 to 2021, among the trauma mechanisms, the number of cases involving rolling down slightly reduced compared with those involving other mechanisms. Furthermore, cerebral contusions among intracranial lesions significantly increased during the COVID-19 pandemic. Partial restrictions on social activities owing to COVID-19 are ongoing. Further investigation of the clinical characteristics of trauma patients over a longer period is required.

1081. Clinical Characteristics and Predictive Factors for the Development of Hypoxemia in SARS-CoV-2 Infected Women during Pregnancy

Abstract Background There is limited information describing the clinical characteristics and prognosis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and the predictive factors for development of hypoxemia were investigated in SARS-Cov-2 infected women during pregnancy. Methods From August 2020 to February 2022, 410 pregnant women were infected with SARS-CoV-2 who admitted to two hospitals, the National Health Insurance Service Ilsan Hospital in Goyang or the Wonju Severance Christian Hospital in Wonju, Korea. The clinical characteristics and prognosis were compared between pregnant women who required oxygen or not during hospitalization. Results The mean age of the patients was 33.3 years. The hospitalized pregnant women were categorized into two groups such as no oxygen group and oxygen group. Of 410 patients, 100 (24.4%) required oxygen therapy (81 low-flow, 15 high-flow oxygen and 4 mechanical ventilation including 2 extracorporeal membrane oxygenation). In oxygen group, the symptoms such as fever [163 (52.6%) vs 81 (81.0%), p&amp;lt; 0.001] and cough [172 (56.4%) vs 73 (73.0%), p=0.003] were frequently observed. In oxygen group, the frequency of whom were not vaccinated was more [264 (85.2%) vs 98 (98.0%), p=0.003], however, that of the SARS-CoV-2 omicron variant infected patients was lower [98 (31.6%) vs 18 (18.0%), p=0.009]. The risk for the development of hypoxemic respiratory difficulty was increased if the SARS-CoV-2 infection during third trimester (OR 5.083, 95% CI 1.095-23.593, p=0.038) and elevated C-reactive protein (≥1.0 mg/dL) at admission (OR 5.878, 95% CI 3.099-11.146, p&amp;lt; 0.001) in the SARS-CoV-2 infected pregnant women. However, the risk was decreased with vaccination (OR 0.186, 95% CI 0.041-0.838, p=0.028) and omicron variant infection (OR 0.498, 95% CI 0.258-0.961, p=0.038). Conclusion A quarter of SARS-CoV-2 infected women during pregnancy developed hypoxemic respiratory difficulty. The SARS-CoV-2 infection during third trimester and no vaccination increased the risk for the development of hypoxemic respiratory difficulty in pregnant women. Disclosures All Authors: No reported disclosures.

Comparative Analysis of the Molecular Characteristics of Group B Streptococcus Isolates Collected from Pregnant Korean Women Using Whole-genome Sequencing.

The incidence of early- and late-onset sepsis and meningitis in neonates due to maternal rectovaginal group B Streptococcus (GBS) colonization may differ with serotype distribution and clonal complex (CC). CC17 strains are associated with hypervirulence and poor disease outcomes. GBS serotypes are distinguished based on the polysaccharide capsule, the most important virulence factor. We determined the sequence type distribution of GBS isolates from pregnant women in Korea and validated whole-genome sequencing (WGS)-based prediction of antimicrobial susceptibility and capsular serotypes in GBS isolates. Seventy-five GBS isolates collected from pregnant Korean women visiting Wonju Severance Christian Hospital, Wonju, Korea between 2017 and 2019 were subjected to WGS using the NovaSeq 6000 system (Illumina, San Diego, CA, USA). Multilocus sequence types, serotypes, antimicrobial resistance genes, and hemolysin operon mutations were determined by WGS, and the latter three were compared with the results of conventional phenotypic methods. The predominant lineage was CC1 (37.3%), followed by CC19 (32.0%), CC12 (17.3%), and CC17 (4.0%). All isolates were cps typeable (100%, (75/75), and 89.3% of cps genotypes (67/75) were concordant with serotypes obtained using latex agglutination. The cps genotypes of the 75 isolates were serotypes III (24.0%), V (22.7%), and VIII (17.3%). All isolates harboring intact ermB and tet were non-susceptible to erythromycin and tetracycline, respectively. Three non-hemolytic strains had 1-bp frameshift insertions in cylE. The low prevalence of CC17 GBS colonization may explain the low frequency of neonatal GBS infections. WGS is a useful tool for simultaneous genotyping and antimicrobial resistance determination.

Delta neutrophil index as a prognostic factor for mortality in patients with Fournier's gangrene.

The delta neutrophil index represents the fraction of circulating immature granulocytes and is a marker of infection and sepsis. Our study aimed to evaluate the usefulness of the delta neutrophil index in predicting mortality in patients with Fournier's gangrene. We enrolled patients with Fournier's gangrene who were admitted to the Wonju Severance Christian Hospital (Wonju, Korea) between September 2010 and December 2021. We retrospectively analyzed the patients' characteristics, factors related to management, scoring systems such as the Fournier's Gangrene Severity Index, and laboratory data measured at initial presentation. There were 58 (68.2%) survivors and 27 (31.8%) non-survivors. The initial levels of serum lactate, hemoglobin, delta neutrophil index, albumin, international normalized ratio, creatinine, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and prognostic nutritional index differed between survivors and non-survivors. Age, international normalized ratio, and delta neutrophil index were independent predictors of mortality in Fournier's gangrene. In receiver operating characteristic curve analysis, delta neutrophil index on the day of admission was the best indicator of mortality (area under the curve, 0.804; 95% confidence interval [0.679-0.929]). The optimal cutoff for delta neutrophil index in predicting mortality was 11.25% (sensitivity, 74.1%; specificity, 91.4%). The initial delta neutrophil index was the best indicator of mortality (area under the curve, 0.804; 95% confidence interval 0.679-0.929). The delta neutrophil index can be useful for predicting mortality in patients with Fournier's gangrene. A delta neutrophil index >11.25% at initial presentation is a reliable predictor of Fournier's gangrene.

Gestational age-specific serum creatinine can predict adverse pregnancy outcomes

Serum creatinine level (SCr) typically decreases during pregnancy due to physiologic glomerular hyperfiltration. Therefore, the clinical practice of estimated glomerular filtration rate (eGFR) based on SCr concentrations might be inapplicable to pregnant women with kidney disease since it does not take into account of the pregnancy-related biological changes. We integrated the Wonju Severance Christian Hospital (WSCH)-based findings and prior knowledge from big data to reveal the relationship between the abnormal but hidden SCr level and adverse pregnancy outcomes. We analyzed 4004 pregnant women who visited in WSCH. Adverse pregnancy outcomes included preterm birth, preeclampsia, fetal growth retardation, and intrauterine fetal demise. We categorized the pregnant women into four groups based on the gestational age (GA)-unadjusted raw distribution (Q1–4raw), and then GA-specific (Q1–4adj) SCr distribution. Linear regression analysis revealed that Q1-4adj groups had better predictive outcomes than the Q1–4raw groups. In logistic regression model, the Q1–4adj groups exhibited a robust non-linear U-shaped relationship with the risk of adverse pregnancy outcomes, compared to the Q1–4raw groups. The integrative analysis on SCr with respect to GA-specific distribution could be used to screen out pregnant women with a normal SCr coupled with a decreased renal function.

Abstract P2-08-19: Prognostic significance of Hounsfield unit of tumor in patients with breast cancer

Abstract Background: Angiogenesis is known to be related with poor survival. However, previous clinical studies with anti-angiogenetic agents failed to show a clear overall survival benefit and one of the reasons was lack of appropriate biomarker. Therefore, the identification of biomarkers that may identify patients who might benefit from target agents against angiogenesis may be the key to determining which patients would benefit from these therapies. This study aimed to find biomarker which can reflect angiogenesis of the tumor and serve as a prognostic factor. Methods: Patients with stage I-III breast cancer who completed planned treatment were included. Data were retrospectively collected from the Wonju Severance Christian Hospital database of Yonsei University and the Korean National Cancer Center database. Results: 534 patients were enrolled in this study. Patients were divided into two groups according to the cut-off value (31.4) of proportional ratio between maximum Hounsfield unit (HU) of tumor and maximum HU of aortic arch (maximum tumor - aorta ratio, TAR), and analyzed with clinico-pathological factors. Tumor stage was significantly related with higher TAR [TI vs T2-T3, 29.5% vs 50.6%, p &amp;lt; 0.001]. While estrogen receptor positivity was not related with TAR. Human Epiermal growth factor Rceptor-2 showed higher frequency in high TAR [high TAR vs. low TAR, 17.6% vs. 28.1%, p = 0.006]. Kaplan-Meier curve with log rank test showed significantly worse distant recurrence free survival in high TAR group (p &amp;lt; 0.001) Cox proportional hazard model indicated that age, ER negativity, and high TAR were significant risk factors for distant relapse. Conclusion: TAR measured by CT performed before treatment can be used as a prognostic factor for overall and distant relapse-free survival in patients with breast cancer. We believe TAR could be a potential biomarker to select patients who will benefit from target agents based on anti-angiogenesis. Key words: breast neoplasms, computed tomography, Hounsfield unit, survival analysis. Table 1.Baseline characteristics of patientsCharacteristicsNumber (n = 534) (%)Age54.4 ± 11.5HistopathologyInfiltrating ductal carcinoma498 (93.3)Infiltrating lobular carcinoma19 (3.6)Others17 (3.2)T stageT025 (4.7)T1280 (52.4)T2198 (37.1)T331 (5.8)Tumor size (cm)2.4 ± 1.8N stageN0356 (66.5)N1116 (20.6)N249 (9.2)N319 (3.6)Unknown1 (0.2)ER (+) *297 (55.6)PR (+) **274 (51.3)HER 2 (+) ***128 (24.0)ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2; * Data were missing in 3 patients ** Data were missing in 2 patients *** Data were missing in 4 patients. Table 2.Relationship between TAR and clinico-histologic factorsClinico-pathologic factorsLower TAR(&amp;lt; 31.4 %) (n = 200)Higher TAR(≥ 31.4) (n = 334)p-valueAge56.2 ± 11.253.4 ± 11.60.007T stage (2 – 3)59 (29.5 %)169 (50.6 %)&amp;lt; 0.001Present lymph node metastasis62 (31.0 %)116 (34.7 %)0.395ER (+) *122 (61.3 %)175 (52.7 %)0.053PR (+) **109 (54.8 %)165 (49.5%)0.243HER – 2 (+) ***35 (17.6 %)93 (28.1 %)0.006TAR, Maximum Hounsfield unit of tumor aorta ratio; ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2* Data were missing in 3 patients ** Data were missing in 2 patients *** Data were missing in 4 patients Citation Format: Kwangmin Kim, In-Jeong Cho, Hany Noh, Hyangsook Choi, Seok Hahn, Seung Taek Lim, Jong-In Lee, Airi Han. Prognostic significance of Hounsfield unit of tumor in patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-08-19.

Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis.

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery.

A Deep Neural Network for Estimating Low-Density Lipoprotein Cholesterol From Electronic Health Records: Real-Time Routine Clinical Application.

BackgroundPreviously, we constructed a deep neural network (DNN) model to estimate low-density lipoprotein cholesterol (LDL-C).ObjectiveTo routinely provide estimated LDL-C levels, we applied the aforementioned DNN model to an electronic health record (EHR) system in real time (deep LDL-EHR).MethodsThe Korea National Health and Nutrition Examination Survey and the Wonju Severance Christian Hospital (WSCH) datasets were used as training and testing datasets, respectively. We measured our proposed model’s performance by using 5 indices, including bias, root mean-square error, P10-P30, concordance, and correlation coefficient. For transfer learning (TL), we pretrained the DNN model using a training dataset and fine-tuned it using 30% of the testing dataset.ResultsBased on 5 accuracy criteria, deep LDL-EHR generated inaccurate results compared with other methods for LDL-C estimation. By comparing the training and testing datasets, we found an overfitting problem. We then revised the DNN model using the TL algorithms and randomly selected subdata from the WSCH dataset. Therefore, the revised model (DNN+TL) exhibited the best performance among all methods.ConclusionsOur DNN+TL is expected to be suitable for routine real-time clinical application for LDL-C estimation in a clinical laboratory.

Determination of the radiologic findings for predicting failure of conservative management with observation for blunt renal injury patients: A single-centre experience over 13 years

PurposeMost blunt renal injuries (BRIs) are managed conservatively without complications. Because conservative management with observation (CMO) is widely conducted, failed CMO is frequent. Clarifying the role and indication of CMO is important to manage BRI patients. Therefore, this study was conducted to analyse factors related to failed CMO. MethodsBRI patients (aged >13 years) who were admitted via the emergency department in Wonju Severance Christian Hospital were analysed retrospectively between January 2008 and July 2020. Patient characteristics, including clinical data, laboratory findings, transfusion requirements, injury grade, initial CT findings, length of hospital stay, intensive care unit stay, and mortality, were investigated for all enrolled patients. ResultsKidney injury grade ≥ 4, perinephric haematoma rim distance (PHD), length of main laceration, intravascular contrast extravasation (ICE), Gerota's fascia discontinuity, multiple lacerations, dissociated renal fragment and complexity of laceration were statistically significantly different between the successful CMO and failed CMO groups in the comparative analysis.The multivariate analysis showed that perinephric haematoma rim distance [odds ratio (OR) 1.44 [95% confidence interval (CI) 1.09 – 1.90], p = 0.011] and ICE [OR 7.41 (95% CI 2.20 – 24.99), p = 0.001] were mutually independent risk factors associated with failed CMO.When the ROC curve of PHD and ICE was generated to predict the failure of CMO, the area under the curve (AUC) was 0.884 (95% CI, 0.826 – 0.942), p < 0.001), and the optimal cut-off value for PHD was 2.9 cm, and for ICE was presence of ICE on CT [sensitivity: 90.5% (95% CI, 0.70 – 0.99), specificity: 78.0% (95% CI, 0.73 – 0.83)]. ConclusionPHD and ICE may be useful factors to predict failed CMO for BRI patients. PHD > 2.9 cm and the presence of ICE may indicate who will require invasive procedures. Close observation is wise for patients with these risk factors.

Finding new indicators for operation and angiographic embolization in blunt renal injury patients: a single-center experience over 13 years.

PurposeTraumatic kidney injury can be treated surgically or nonsurgically. Nonsurgical treatment options include angiography, embolization, and conservative treatment. We aimed to identify factors that help in making clinical decisions on treatment plans for patients with traumatic kidney injury caused by blunt trauma.MethodsThe study included 377 patients aged ≥18 years with traumatic kidney injury caused by blunt abdominal trauma admitted to the emergency room of Wonju Severance Christian Hospital between January 2008 and July 2020. Medical records, laboratory test results, and computed tomography results were retrospectively reviewed.ResultsMultivariable logistic analysis showed diastolic blood pressure at admission and disruption of Gerota's fascia were significantly associated with surgical treatment, and that perinephric hematoma rim distance was the only significant indicator favoring embolization. Receiver operating characteristic curve analysis showed that angiography and embolization should be considered when hematoma size exceeds 2.97 cm.ConclusionWhen a patient with traumatic kidney injury due to blunt trauma visits an emergency room, even when vital signs are stable, Gerota's fascia should be checked by computed tomography prior to deciding on surgical treatment, and angiographic embolization should be considered if perinephric hematoma rim distance exceeds 2.97 cm.

Unplanned Reoperation Rate at a Government-Designated Regional Trauma Center in Gangwon Province

Purpose Determining appropriate ways to assess health care quality within the National Health Insurance System is of interest to both the Korean government and the medical community. However, in the trauma field, the number of indicators used to evaluate surgical quality is limited. Using data collected over 5 years at Wonju Severance Christian Hospital Trauma Center in Korea, this study aimed to determine whether the unplanned reoperation rate in the field of trauma surgery could be used to assess the quality of an institution’s surgical care. Methods In total, 665 general surgical procedures were performed at the Trauma Center in 453 patients with abdominopelvic injuries from January 2015 to December 2019. Data were collected from the Trauma Center’s data registry and medical records, and included information regarding patients’ demographic characteristics, the type of index operation, and the reason for unplanned reoperations. Results A total of 453 index operations were evaluated. The proportion of patients with an Injury Severity Score (ISS) >15 was 48–70% over the 5-year period, with an unplanned reoperation rate of 2.1–9.3%. Patients had an average ISS score of 17.5, while the average Abbreviated Injury Scale score was 2.87. Unplanned reoperations were required in about 7% of patients. The most common complications requiring reoperation were recurrent bleeding (26.9%), wound problems (26.9%), intestinal infarction (15.4%), and anastomosis site leakage (7.7%). The procedures most frequently requiring unplanned reoperations were bowel surgery (segmental resection, primary repair, enterostomy, etc.) (24.5%) and preperitoneal pelvic packing (10.6%). Conclusions The proportion of reoperations was confirmed to be affected by injury severity. Keywords: Wounds and injuries; Reoperation; Quality of health care