• Journal of Chest Surgery
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• v.57 no.1
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• pp.44-52
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• 2024

Background: Visceral pleural invasion (VPI) is a poor prognostic factor that contributes to the upstaging of early lung cancers. However, the preoperative assessment of VPI presents challenges. This study was conducted to examine intraoperative pleural carcinoembryonic antigen (pCEA) level and maximum standardized uptake value (SUVmax) as predictive markers of VPI in patients with clinical T1N0M0 lung adenocarcinoma. Methods: A retrospective review was conducted of the medical records of 613 patients who underwent intraoperative pCEA sampling and lung resection for non-small cell lung cancer. Of these, 390 individuals with clinical stage I adenocarcinoma and tumors ≤30 mm were included. Based on computed tomography findings, these patients were divided into pleural contact (n=186) and non-pleural contact (n=204) groups. A receiver operating characteristic (ROC) curve was constructed to analyze the association between pCEA and SUVmax in relation to VPI. Additionally, logistic regression analysis was performed to evaluate risk factors for VPI in each group. Results: ROC curve analysis revealed that pCEA level greater than 2.565 ng/mL (area under the curve [AUC]=0.751) and SUVmax above 4.25 (AUC=0.801) were highly predictive of VPI in patients exhibiting pleural contact. Based on multivariable analysis, pCEA (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.14-7.87; p=0.026) and SUVmax (OR, 5.25; 95% CI, 1.90-14.50; p=0.001) were significant risk factors for VPI in the pleural contact group. Conclusion: In patients with clinical stage I lung adenocarcinoma exhibiting pleural contact, pCEA and SUVmax are potential predictive indicators of VPI. These markers may be helpful in planning for lung cancer surgery.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.160-168
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• 2024

Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

• Journal of Veterinary Science
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• v.25 no.2
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• pp.20.1-20.15
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• 2024

Background: Avian influenza (AI) is a contagious disease that causes illness and death in poultry and humans. High pathogenicity AI (HPAI) H5N6 outbreaks commonly occur in Quang Ninh province bordering China. In June 2021, the first HPAI H5N8 outbreak occurred at a Quang Ninh chicken farm. Objectives: This study examined the risk factors associated with HPAI H5N6 and H5N8 outbreaks in Quang Ninh. Methods: A retrospective case-control study was conducted in Quang Ninh from Nov 2021 to Jan 2022. The cases were households with susceptible poultry with two or more clinical signs and tested positive by real-time reverse transcription polymerase chain reaction. The controls were households in the same village as the cases but did not show clinical symptoms of the disease. Logistic regression models were constructed to assess the risk factors associated with HPAI outbreaks at the household level. Results: There were 38 cases with H5N6 clade 2.3.4.4h viruses (n = 35) and H5N8 clade 2.3.4.4b viruses (n = 3). Compared to the 112 controls, raising poultry in uncovered or partially covered ponds (odds ratio [OR], 7.52; 95% confidence interval [CI], 1.44-39.27), poultry traders visiting the farm (OR, 8.66; 95% CI, 2.7-27.69), farms with 50-2,000 birds (OR, 3.00; 95% CI, 1.06-8-51), and farms with ≥ 2,000 birds (OR, 11.35; 95% CI, 3.07-41.94) were significantly associated with HPAI outbreaks. Conclusions: Combining biosecurity measures, such as restricting visitor entry and vaccination in farms with more than 50 birds, can enhance the control and prevention of HPAI in Quang Ninh and its spread across borders.

• Journal of the Korean Society of Radiology
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• v.84 no.6
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• pp.1350-1360
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• 2023

Purpose To evaluate the factors that predict symptomatic dislodgement of a percutaneous transhepatic biliary drainage (PTBD) catheter in patients with malignant biliary obstruction. Materials and Methods This retrospective study included 572 patients with malignant biliary obstruction who underwent 733 PTBD catheter insertions between January 2010 and February 2015. The duration of catheter placement, approach site, location of the catheter tip, insertion angle, presence of a closed-loop pigtail, and tube diameter were evaluated. Results During the follow-up period, 224 PTBD catheter dislodgements (30.56%) were observed in 157 patients. Among them, 146 (19.92%) were symptomatic. The mean duration from catheter insertion until dislodgement was 32 days (range: 1-233 days). Male (odds ratio [OR]: 1.636, 95% confidence interval [CI]: 1.131-2.367, p = 0.009), right-sided approach (OR: 1.567, 95% CI: 1.080-2.274, p = 0.018), increased insertion angle (OR: 1.015, 95% CI: 1.005-1.026, p = 0.005), and incomplete closed-loop pigtail formation (OR: 1.672, 95% CI: 1.098-2.545, p = 0.016) were independent factors predictive of symptomatic dislodgement of a PTBD catheter. Conclusion Factors predictive of symptomatic catheter dislodgement included male sex, a right-sided approach, increased insertion angle, and incomplete closed-loop pigtail formation.

• Journal of the Korean Society of Radiology
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• v.84 no.3
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• pp.627-637
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• 2023

Purpose To investigate the effect of patient positioning on tendinosis grade, visible range, and infraspinatus tendon (IST) thickness, and to determine the feasibility of internal rotation (IR) position to assess IST on ultrasound (US). Materials and Methods This study included 52 shoulders of 48 subjects who were evaluated for IST in three different positions: neutral position (N), IR, and position with the ipsilateral hand on the contralateral shoulder (HC). Two radiologists retrospectively graded IST tendinosis from grade 0 to grade 3 and the visible range from grade 1 to grade 4. The thickness of the IST was measured by another radiologist with a short-axis view. A generalized estimating equation was used for statistical analysis. Results The tendinosis grades were higher in the HC position than in the IR position, with a cumulative odds ratio of 2.087 (p = 0.004, 95% confidence interval [CI]: 1.268-3.433). The tendinosis grades in the HC position (p = 0.370) and IR position (p = 0.146) were not significantly different from those in the N position. The overall difference in IST thickness was significant (p < 0.001), but the visible range (p = 0.530) was not significantly different according to position. Conclusion Patient positioning significantly affected the grade of tendinosis and thickness but not the visible range of the IST. The IR position is a feasible position for assessing the IST on US.

• Nutrition Research and Practice
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• v.18 no.1
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• pp.149-164
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• 2024

BACKGROUND/OBJECTIVES: The economic recession caused by the coronavirus disease 2019 pandemic disproportionately affected poor and vulnerable populations globally. Better uunderstanding of vulnerability to shocks in food supply and demand in the Asia Pacific region is needed. SUBJECTS/METHODS: Using secondary data from rapid assessment surveys during the pandemic response (n = 10,420 in mid-2020; n = 6,004 in mid-2021) in India, Indonesia, Myanmar, and Vietnam, this study examined the risk factors for reported income reduction or job loss in mid-2021 and the temporal trend in food security status (household food availability, and market availability and affordability of essential items) from mid-2020 to mid-2021. RESULTS: The proportion of job loss/reduced household income was highest in India (60.4%) and lowest in Indonesia (39.0%). Urban residence (odds ratio [OR] range, 2.20-4.11; countries with significant results only), female respondents (OR range, 1.40-1.69), engagement in daily waged labor (OR range, 1.54-1.68), and running a small trade/business (OR range, 1.66-2.71) were significantly associated with income reduction or job loss in three out of 4 countries (all P < 0.05). Food stock availability increased significantly in 2021 compared to 2020 in all four countries (OR range, 1.91-4.45) (all P < 0.05). Availability of all essential items at markets increased in India (OR range, 1.45-3.99) but decreased for basic foods, hygiene items, and medicine in Vietnam (OR range, 0.81-0.86) in 2021 compared to 2020 (all P < 0.05). In 2021, the affordability of all essential items significantly improved in India (OR range, 1.18-3.49) while the affordability of rent, health care, and loans deteriorated in Indonesia (OR range, 0.23-0.71) when compared to 2020 (all P < 0.05). CONCLUSIONS: Long-term social protection programs need to be carefully designed and implemented to address food insecurity among vulnerable groups, considering each country's market conditions, consumer food purchasing behaviors, and financial support capacity.

• Journal of Nutrition and Health
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• v.57 no.1
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• pp.88-104
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• 2024

Purpose: High-sensitivity C-reactive protein (hs-CRP) is primarily synthesized in the liver upon stimulation of infectious disease cytokines, such as interleukin-6 (IL-6), and is used as a biological marker of systemic inflammation. Previous studies reported that hs-CRP is closely related to diet and abdominal obesity. Furthermore, a dietary score favoring the consumption of vegetables, fruits, and whole grains over meat and saturated fat reduced inflammation and decreased the prevalence of obesity and abdominal obesity. Nevertheless, no studies have examined whether hs-CRP mediates the relationship between dietary scores and abdominal obesity, and research on the Korean Healthy Eating Index (KHEI) is lacking. Therefore, the present study examined the association between the KHEI and abdominal obesity and the mediating effect of hs-CRP. Methods: In total, 17,770 adults aged ≥19 years were included in the study using the Korea National Health and Nutrition Examination Survey 2015-2018. KHEI was developed to assess the overall diet quality of Korean adults. Multivariable linear and logistic regression analyses assessed the relationship between KHEI, hs-CRP, and abdominal obesity. The mediation analysis with the bootstrapping method was performed using SAS MACRO. Results: Among women, the odds ratio (OR) of abdominal obesity prevalence was lower in the highest KHEI compared to the lowest KHEI after adjusting for age, body mass index, educational level, income level, occupational status, marital status, household type, region type, alcohol consumption, smoking status, physical activity, total energy intake, and hsCRP (OR 0.744, 95% confidence interval 0.598-0.926). The association between KHEI and abdominal obesity was partially mediated via hs-CRP, and the mediated proportion was 68.7% in men and 38.1% in women. Conclusion: A substantial relationship was observed between the KHEI and abdominal obesity among females. Moreover, according to the KHEI, abdominal obesity may be mediated partially by hs-CRP.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.28-36
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• 2024

Purpose: Recent advancements in interventional radiology have made angioembolization an invaluable modality in trauma care. Angioembolization is typically performed by interventional radiologists. In this study, we aimed to investigate the safety and efficacy of emergency angioembolization performed by trauma surgeons. Methods: We identified trauma patients who underwent emergency angiography due to significant trauma-related hemorrhage between January 2020 and June 2023 at Jeju Regional Trauma Center. Until May 2022, two dedicated interventional radiologists performed emergency angiography at our center. However, since June 2022, a trauma surgeon with a background and experience in vascular surgery has performed emergency angiography for trauma-related bleeding. The indications for trauma surgeon-performed angiography included significant hemorrhage from liver injury, pelvic injury, splenic injury, or kidney injury. We assessed the angiography results according to the operator of the initial angiographic procedure. The term "failure of the first angioembolization" was defined as rebleeding from any cause, encompassing patients who underwent either re-embolization due to rebleeding or surgery due to rebleeding. Results: No significant differences were found between the interventional radiologists and the trauma surgeon in terms of re-embolization due to rebleeding, surgery due to rebleeding, or the overall failure rate of the first angioembolization. Mortality and morbidity rates were also similar between the two groups. In a multivariable logistic regression analysis evaluating failure after the first angioembolization, pelvic embolization emerged as the sole significant risk factor (adjusted odds ratio, 3.29; 95% confidence interval, 1.05-10.33; P=0.041). Trauma surgeon-performed angioembolization was not deemed a significant risk factor in the multivariable logistic regression model. Conclusions: Trauma surgeons, when equipped with the necessary endovascular skills and experience, can safely perform angioembolization. To further improve quality control, an enhanced training curriculum for trauma surgeons is warranted.

• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.55-63
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• 2024

Purpose: A 2-dose varicella vaccination strategy has been introduced in many countries worldwide, aiming to increase vaccine effectiveness (VE) against varicella infection. In this network meta-analysis, we aimed to provide a comprehensive evaluation and an overall estimated effect of varicella vaccination strategies, via a Bayesian model. Methods: For each eligible study, we collected trial characteristics, such as: 1-dose vs. 2-dose, demographic characteristics, and outcomes of interest. For studies involving different doses, we aggregated the data for the same number of doses delivered into one arm. The preventive effect of 1-dose vs. 2-dose of varicella vaccine were evaluated in terms of the odds ratio (OR) and corresponding equal-tailed 95% confidence interval (95% CI). Results: A total of 903 studies were retrieved during our literature search, and 25 interventional or observational studies were selected for the Bayesian network meta-analysis. A total of 49,265 observed individuals were included in this network meta-analysis. Compared to the 0-dose control group, the OR of all varicella infections were 0.087 (95% CI, 0.046-0.164) and 0.310 (95% CI, 0.198-0.484) for 2-doses and one-dose, respectively, which corresponded to VE of 69.0% (95% CI, 51.6-81.2) and VE of 91.3% (95% CI, 83.6-95.4) for 1- and 2-doses, respectively. Conclusions: A 2-dose vaccine strategy was able to significantly reduce varicella burden. The effectiveness of 2-dose vaccination on reducing the risk of infection was demonstrated by sound statistical evidence, which highlights the public health need for a 2-dose vaccine recommendation.

• Korean Journal of Radiology
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• v.22 no.11
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• pp.1886-1893
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• 2021

Objective: To assess the feasibility of quantitatively assessing pancreatic steatosis using magnetic resonance imaging (MRI) and its correlation with obesity and metabolic risk factors in pediatric patients. Materials and Methods: Pediatric patients (≤ 18 years) who underwent liver fat quantification MRI between January 2016 and June 2019 were retrospectively included and divided into the obesity and control groups. Pancreatic proton density fat fraction (P-PDFF) was measured as the average value for three circular regions of interest (ROIs) drawn in the pancreatic head, body, and tail. Age, weight, laboratory results, and mean liver MRI values including liver PDFF (L-PDFF), stiffness on MR elastography, and T2^* values were assessed for their correlation with P-PDFF using linear regression analysis. The associations between P-PDFF and metabolic risk factors, including obesity, hypertension, diabetes mellitus (DM), and dyslipidemia, were assessed using logistic regression analysis. Results: A total of 172 patients (male:female = 125:47; mean ± standard deviation [SD], 13.2 ± 3.1 years) were included. The mean P-PDFF was significantly higher in the obesity group than in the control group (mean ± SD, 4.2 ± 2.5% vs. 3.4 ± 2.4%; p = 0.037). L-PDFF and liver stiffness values showed no significant correlation with P-PDFF (p = 0.235 and p = 0.567, respectively). P-PDFF was significantly associated with obesity (odds ratio 1.146, 95% confidence interval 1.006-1.307, p = 0.041), but there was no significant association with hypertension, DM, and dyslipidemia. Conclusion: MRI can be used to quantitatively measure pancreatic steatosis in children. P-PDFF is significantly associated with obesity in pediatric patients.