• Title/Summary/Keyword: internal risk

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Columnar variant of papillary carcinoma in the thyroglossal duct cyst with progression to lung metastasis

  • Yun, Yujung;Park, Hye Jung;Lee, Young Ki;Cho, Yongin;Kang, Beoduel;Kim, Hyun Ju;Lee, Jung-Hee;Jin, Moo-Nyun;Shin, Dong Yeob
    • Journal of Yeungnam Medical Science
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    • v.31 no.2
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    • pp.103-108
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    • 2014
  • Thyroglossal duct cyst (TGDC) carcinoma generally shows a favorable prognosis. If metastasis is present latently, it may not threaten the patient's life immediately. It has been shown, however, that larger than 1 cm papillary carcinoma (PC), level VI metastasis to the lymph node (LN), which is the nearest to the thyroid, independently predicts a worse prognosis. In the case presented herein, a 61-year-old female patient was diagnosed with an about 3 cm PC in the TGDC, particularly the columnar variant subtype, one of the aggressive variants. She had occult papillary thyroid microcarcinoma, but no LN metastasis. Even though she underwent the Sistrunk procedure and total thyroidectomy with central compartment neck dissection followed by high-dose radioactive iodine remnant ablation, however, the cancer cells spread to level IV neck LN, and finally to the lung. Therefore, when a patient is diagnosed with an aggressive histologic variant of PC in the TGDC, even without LN metastasis, the invasive surgical approach and close postoperative surveillance are necessary, with consideration of the risk of disease progression. Therefore, if it is possible to stratify the risk for patients, higher-risk patients can be offered a more invasive therapeutic approach.

A Development of Risk-Taking Behavior Forecasting Model of Taxi driver's Risk-Taking Propensity by Structural Analysis (택시운수업 종사자 위험성향 관련 변인들의 구조적 분석을 통한 위험감행 예측 모형 개발)

  • Park, Mi So;Yoon, Hyo Jin
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.32 no.4D
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    • pp.313-322
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    • 2012
  • This study analyzes taxi driver's risk-taking propensity with respect to risk-taking behaviour and traffic locus of control. In order to explore the traffic risk-taking, we present a predictive model by structural analysis of driver's risk-taking propensity. By applying this model to survey data from taxi drivers, we can observe that driver's risk-taking propensity has a significant impact on the traffic violation intention, and the higher perception of law and the lower lack of law-abiding drivers have, the more they tend to violate. Second, we test using multivariate analysis if the level of risk-taking propensity differs by the locus of control( external or internal). Drivers of external control shows higher risk-taking level compared to those of internal control so that the risk-taking propensity shows difference according to the locus of control for the responsibility of traffic accidents. The structural equation model of our study yielded ${\chi}^2$ = 279.7, ${\chi}^2$/df = 1.55, RMSEA = 0.44, GFI = 0.911, TLI = 0.916, CFI = 0.929.

Risk of Material Misstatement in the Stage of Audit Planning: Empirical Evidence from Vietnamese Listed Enterprises

  • NGUYEN, Hoan;NGO, Thi Kieu Trang;LE, Thi Tam
    • The Journal of Asian Finance, Economics and Business
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    • v.7 no.3
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    • pp.137-148
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    • 2020
  • The purpose of this study is to investigate factors influencing risk assessment of material misstatement in Vietnamese enterprises listed on stock market. Expert interview method was conducted to discover the scales for three variables including information system, trademark, and risk assessment of material misstatement. Survey method was used to examine the impacts of eight factors on risk assessment of material misstatement. Data is collected from 317 auditors who have excellent experience in auditing financial statements of companies listed on stock market. Then, data is processed by descriptive statistics, reliability analysis, factor extracted analysis, correlative regression analysis, and analysis variance of residual change. The research findings showed that business characteristic, stakeholder pressure, and economic environment have positive relationships with risk assessment of material misstatement. Three variables including operation control and monitor, control environment, and information system negatively affect to risk assessment. Specially, business characteristic and information system, which are elements in internal control, have strongest impact on risk assessment. One the other hand, assessment of internal control plays an important role not only in the audit plan stage but also throughout the stages of the audit implementation and ending. Therefore, appropriate solutions are proposed to carry out all audit stages.

Association of a genetic polymorphism of IL1RN with risk of acute pancreatitis in a Korean ethnic group

  • Park, Jin Woo;Choi, Ja Sung;Han, Ki Joon;Lee, Sang Heun;Kim, Eui Joo;Cho, Jae Hee
    • The Korean journal of internal medicine
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    • v.33 no.6
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    • pp.1103-1110
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    • 2018
  • Background/Aims: Several epidemiological studies have validated the association of interleukin gene polymorphisms with acute pancreatitis (AP) in different populations. However, there have been few studies in Asian ethnic groups. We aimed to investigate the relationships between inflammatory cytokine polymorphisms and AP as pilot research in a Korean ethnic group. Methods: Patients who had been diagnosed with AP were prospectively enrolled. DNA was extracted from whole blood, and DNA sequencing was subsequently performed. Single-nucleotide polymorphisms (SNPs) of the interleukin $1{\beta}$ (IL1B), interleukin 1 receptor antagonist (IL1RN), and tumor necrosis factor ${\alpha}$ (TNFA) genes of patients with AP were compared to those of normal controls. Results: Between January 2011 and January 2013, a total of 65 subjects were enrolled (40 patients with AP vs. 25 healthy controls). One intronic SNP (IL1RN -1129T>C, rs4251961) was significantly associated with the risk of AP (odds ratio, 0.304; 95% confidence interval, 0.095 to 0.967; p = 0.043). However, in our study, AP was not found to be associated with polymorphisms in the promoter regions of inflammatory cytokine genes, including IL1B (-118C>T, c47+242C>T, +3954C/T, and -598T>C) and TNFA (-1211T>C, -1043C>A, -1037C>T, -488G>A, and -418G>A). Conclusions: IL1RN -1129T>C (rs4251961) genotypes might be associated with a significant increase of AP risk in a Korean ethnic group.

The usefulness of newly developed R2CHA2DS2-VASc score and comparison with CHADS2 and CHA2DS2-VASc scores in atrial fibrillation patients (심방세동 환자에서 새로 개발된 R2CHA2DS2-VASc score 유용성 및 CHADS2, CHA2DS2-VASc scores와의 비교연구)

  • Kwak, Jae-Hoon;Yeo, Se-Hwan;Kim, Yeo-Un;Lee, Jin-Suk;Kim, Byong-Kyu;Chung, Jin-Wook;Bae, Jun-Ho;Nah, Deuk-Young;Lee, Kwan
    • Journal of Yeungnam Medical Science
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    • v.33 no.1
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    • pp.8-12
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    • 2016
  • Background: The decision to administer oral anticoagulation therapy depends on accurate assessment of stroke risk in patients with atrial fibrillation (AF). Various stroke risk stratification schemes have been developed to help inform clinical decision making. The CHADS2 and CHA2DS2-VASc scores have been used in estimating the risk of stroke in patients with AF. Recently R2CHA2DS2-VASc score was developed. The objective of the current study is to validate the usefulness of the R2CHA2DS2-VASc score and to compare the accuracy of the CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores in predicting a patient's risk of stroke. Methods: Based on medical records, we conducted a retrospective study of patients hospitalized with AF from March 2011 to July 2013. A total of 448 AF patients were included in this study. The receiver operating characteristic (ROC) curve analysis in MedCalc was used for comparison with respective diagnostic values. Results: The patient characteristics showed male predominance (60.9%). Among the 448 AF patients, 131 (29.2%) patients had strokes during the study. A R2CHA2DS2-VASc score of more than 5 is the optimal cut-off value for prediction of stroke. A risk score of three, the area under the ROC curve (AUC) of R2CHA2DS2-VASc score (AUC 0.631; 95% confidence interval, 0.585-0.679) was the highest. A significant difference was observed between AUC for R2CHA2DS2-VASc, CHADS2, and CHA2DS2-VASc scores, but no meaningful difference between CHADS2 and CHA2DS2-VASc scores. Conclusion: We determined the usefulness of the R2CHA2DS2-VASc score, which showed better association with stroke than the CHADS2 and CHA2DS2-VASc scores.

Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study

  • Ho-Young Yhim;Yong Park;Jeong-A Kim;Ho-Jin Shin;Young Rok Do;Joon Ho Moon;Min Kyoung Kim;Won Sik Lee;Dae Sik Kim;Myung-Won Lee;Yoon Seok Choi;Seong Hyun Jeong;Kyoung Ha Kim;Jinhang Kim;Chang-Hoon Lee;Ga-Young Song;Deok-Hwan Yang;Jae-Yong Kwak
    • The Korean journal of internal medicine
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    • v.39 no.3
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    • pp.501-512
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    • 2024
  • Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

End-stage Renal Disease and Risk of Active Tuberculosis: a Nationwide Population-Based Cohort Study

  • Min, Jinsoo;Kwon, Soon Kil;Jeong, Hye Won;Han, Joung-Ho;Kim, Yeonkook Joseph;Kang, Minseok;Kang, Gilwon
    • Journal of Korean Medical Science
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    • v.33 no.53
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    • pp.341.1-341.11
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    • 2018
  • Background: The converging epidemics of tuberculosis (TB) and end-stage renal disease (ESRD) have generated a significant public health burden, however, previous studies have been limited to a small number of patients. This nationwide cohort study aimed to assess the rate of developing active TB among patients receiving dialysis for ESRD. Methods: The Korean national health insurance database was used to identify patients receiving dialysis for new-onset ESRD during 2004-2013, who were propensity score matched to an equivalent number of non-dialysis subjects from the general population. The incidences of active TB in the ESRD and control cohorts were calculated for 2004-2013, and multivariable Cox proportional hazards model was used to evaluate the ESRD-related risk of active TB. Results: During 2004-2013, 59,584 patients received dialysis for newly diagnosed ESRD. In the dialysis and control cohorts, 457 (0.8%) and 125 (0.2%) cases of active TB were detected, respectively. Patients with ESRD were associated with a significantly higher risk of active TB compared to the controls (incidence rate ratio, 4.80). The ESRD cohort had an independently elevated risk of active TB (adjusted hazard ratio, 4.39; 95% confidence interval, 3.60-5.37). Conclusion: We found that patients receiving dialysis for ESRD had an elevated risk of active TB. These results highlight the need for detailed and well-organised guidelines for active TB screening among patients with ESRD.

Clinical Effect of Gyeongok-go: A Systematic Review of Randomized Controlled Trials (경옥고의 임상 효능 : 체계적 고찰)

  • Kang, Heekyung;Han, Changwoo
    • The Journal of Internal Korean Medicine
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    • v.43 no.3
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    • pp.423-435
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    • 2022
  • Purpose: The purpose of this study was to confirm the clinical efficacy of Gyeongok-go. Methods: Public/Publisher MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica dataBASE (EMBASE), Research Information Sharing Service (RISS), ScienceON, Korean Traditional Knowledge Portal (KTKP), and China National Knowledge Infrastructure (CNKI) were searched for randomized controlled clinical trials administering Gyeongok-go as an intervention, published from inception to December 31, 2021. The risk-of-bias of the included trials was assessed with the Cochrane risk-of-bias tool for randomized trials version 2. From the experimental and control groups of the selected trials, the mean value (or rate) of each outcome was extracted and statistically compared. Results: Statistically significant mean differences were in VO2max (MD 6.82), post-exercise heart rate (MD -8.76 at 5 min, -11.58 at 30 min, -14.6 at 60 min), senescence scale (MD -6.52), Th1 cells and Th2 cells in pulmonary tuberculosis (MD 2.79 and -1.64), yin-deficient and qi-deficient score (MD -9.64 and -9.76), and phlegm-dampness score (MD 5.56). Overall risk-of-bias was 20% low risk, 80% some concerns, and 0% high risk. There were no reports of adverse events. Conclusions: Gyeongok-go is likely to have the effect of improving cardiorespiratory endurance, increasing fatigue recovery ability, reducing senescence, and enhancing immune function in tuberculosis patients. Also, it is more suitable for those who are yin-deficient or qi-deficient, and those with phlegm-dampness probably need caution.