Eulji General Hospital

The optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR). In the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years. Among the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes. Among high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI. NCT03217877.

Introduction After immunologically standard-risk kidney transplantation, graft function is often not recovered to normal levels. We tried to find out what causes the insufficiency recovery of graft function and how it affects in the long-term outcome. Methods We analyzed the medical records of patient who received living-donor kidney transplantation (LDKT) between January 2006 and February 2014 in single institute. We excluded the immunologically high-risk transplantation; crossmatch positive, ABO type incompatible, PRA > 50% or multiple organ transplantation. Patient also was excluded who still on dialysis or rejection treatment at 1month. We divided patients into two groups according the highest glomerular filtration rate (GFR) within 1 month after transplant; GFR was 60 or more was defined as ‘standard group’ and less than 60 was defined as ‘suboptimal group’. Results Total 411 patients were analyzed and mean period of follow-up 11.3 years. Sixty-one patients (14.8%) were in suboptimal group.(Table 1) In suboptimal group, there were more male recipients, high Body mass index, more diabetes patients. There were more female (not significant) and older donor in suboptimal group. In donor relationship graft donation from parents or spouse were more common than standard group. We further analyzed about size mismatch between donor (graft) and recipients, graft weight was lower and donation from female to male was more common in suboptimal group. In long-term outcome analysis, there was no significance in graft survival and patient survival.(Figure 1) Conclusion In immunologically standard-risk LDKT, suboptimal graft function does not affect long-term outcome. Table 1. Recipients and donor characteristics (N=411) - Standard outcome(n=350) Suboptimal outcome(n=61) p-value Male 208 (59.4%) 47 (77.0%) 0.013 BMI 22.7 ± 3.4 24.7 ± 3.9 <0.001 DM 75 (21.4%) 22 (36.1%) 0.02 Donor age 40.4 ± 11.0 47.5 ± 9.4 <0.001 Donor - male 150 (42.9%) 20 (32.8%) 0.183 Donor BMI 23.8 ± 3.4 23.6 ± 3.0 0.731 Donor relationship 0.001 Parents 45 (12.9%) 12 (19.7%) Offsprings 67 (19.1%) 4 (6.6%) Siblings 128 (36.6%) 15 (24.6%) Spouse 74 (21.1%) 22 (36.1%) Non-related 19 (5.45%) 8 (13.1%) Distant family 17 (4.95%) 0 Graft weight 189.3 ± 34.4 168.2 ± 32.7 <0.001 Female to male KT 124 (35.4%) 35 (57.4%) 0.002

This study was performed to evaluate the efficacy and safety of lurasidone (160 mg/day) compared to quetiapine XR (QXR; 600 mg/day) in the treatment of acutely psychotic patients with schizophrenia. Patients were randomly assigned to 6 weeks of double-blind treatment with lurasidone 160 mg/day (n=105) or QXR 600 mg/day (n=105). Primary efficacy measure was the change from baseline to week 6 in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions severity (CGI-S) score. Adverse events, body measurements, and laboratory parameters were assessed. Lurasidone demonstrated non-inferiority to QXR on the PANSS total score. Adjusted mean±standard error change at week 6 on the PANSS total score was -26.42±2.02 and -27.33±2.01 in the lurasidone and QXR group, respectively. The mean difference score was -0.91 (95% confidence interval -6.35-4.53). The lurasidone group showed a greater reduction in PANSS total and negative subscale on week 1 and a greater reduction in end-point CGI-S score compared to the QXR group. Body weight, body mass index, and waist circumference in the lurasidone group were reduced, with significantly lower mean change compared to QXR. Endpoint changes in glucose, cholesterol, triglycerides, and low-density lipoprotein levels were also significantly lower. The most common adverse drug reactions with lurasidone were akathisia and nausea. Lurasidone 160 mg/day was found to be non-inferior to QXR 600 mg/day in the treatment of schizophrenia with comparable efficacy and tolerability. Adverse effects of lurasidone were generally tolerable, and beneficial effects on metabolic parameters can be expected.

Magnetically assisted capsule endoscopy (MACE) showed the feasibility for upper gastrointestinal examination. To further enhance the performance of conventional MACE, it is necessary to provide quality-improved and three-dimensional images. The aim of this clinical study was to determine the efficacy and safety of novel three-dimensional MACE (3D MACE) for upper gastrointestinal and small bowel examination at once. This was a prospective, single-center, non-randomized, and sequential examination study (KCT0007114) at Dongguk University Ilsan Hospital. Adult patients who visited for upper endoscopy were included. The study protocol was conducted in two stages. First, upper gastrointestinal examination was performed using 3D MACE, and a continuous small bowel examination was performed by conventional method of capsule endoscopy. Two hours later, an upper endoscopy was performed for comparison with 3D MACE examination. The primary outcome was confirmation of major gastric structures (esophagogastric junction, cardia/fundus, body, angle, antrum, and pylorus). Secondary outcomes were confirmation of esophagus and duodenal bulb, accuracy for gastric lesions, completion of small bowel examination, 3D image reconstruction of gastric lesion, and safety. Fifty-five patients were finally enrolled. The examination time of 3D MACE was 14.84 ± 3.02 minutes and upper endoscopy was 5.22 ± 2.39 minutes. The confirmation rate of the six major gastric structures was 98.6% in 3D MACE and 100% in upper endoscopy. Gastric lesions were identified in 43 patients during 3D MACE, and 40 patients during upper endoscopy (Sensitivity 0.97). 3D reconstructed images were acquired for all lesions inspected by 3D MACE. The continuous small bowel examination by 3D MACE was completed in 94.5%. 3D MACE showed better overall satisfaction (3D MACE 9.55 ± 0.79 and upper endoscopy 7.75 ± 2.34, p<0.0001). There were no aspiration or significant adverse event or capsule retention in the 3D MACE examination. Novel 3D MACE system is more advanced diagnostic modality than the conventional MACE. And it is possible to perform serial upper gastrointestinal and small bowel examination as a non-invasive and one-step test. It would be also served as a bridge to pan-endoscopy.

Introduction: Basicervical femoral neck fracture (FNF) is an uncommon type of femoral neck fracture and is associated with an increased risk of fixation failure due to its inherent instability. The purpose of this study was to compare the surgical parameters and reoperation rate between the use of a multiple cannulated screw (MCS) and fixed angle device (FAD) in treating basicervical FNFs. Methods: We retrospectively reviewed the records of 885 patients who underwent internal fixation between May 2004 and August 2019 to determine basicervical FNF with at least 12 months of follow-up. Among the identified 77 patients with basicervical FNF, 17 patients who underwent multiple cannulated screw (MCS) fixation and 36 patients who underwent fixed angle device (FAD) fixation were included. We compared the rates of fracture-site collapse and reoperations according to the fixation device. Results: Among the 53 patients with basicervical FNF, 13 patients (24.5%) sustained surgical complications (8 collapses of fracture site and 5 reoperations). The reoperation rate in the MCS group was significantly higher than that in the FAD group (23.5% vs. 2.8%, p = 0.016), without any significant difference in the collapse of the fracture site (11.8% vs. 16.7%, p = 0.642). Conclusions: Although basicervical FNF was rare among hip fractures, fracture site collapse was prevalent and prone to fixation failure. Surgeons should keep this in mind, and consider FAD for basicervical FNF.

To evaluate the efficacy of the head rotation test with bowing (B-HRT) in the sitting position in diagnosing lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). The efficacy outcomes of lateralization of 25 patients with LSC-BPPV were prospectively evaluated using B-HRT. Traditional head toration in the supine position (S-HRT) and the bow and lean test were also assessed for comparative effectiveness. Direction-changing nystagmus was detected in all patients with LSC-BPPV (100%) using B-HRT. The nystagmus direction (geotropic or apogeotropic) determined by B-HRT was consistent with that determined by S-HRT with a perfect level of agreement (Cohen κ = 1.0, p < 0.001**). In 76.0% of the cases, the determination of the affected ear was concordant between B-HRT and S-HRT (Cohen κ = 0.409, p = 0.037*). The concordance rate between B-HRT and bow and lean test showed a fair level of agreement (68.0%; Cohen κ = 0.286, p = 0.126) with no statistical significance. On comparing the peak slow-phase velocity (SPV), SPVs of positional nystagmus on the stronger side and weaker side did not differ statistically significantly between S-HRT and B-HRT. In 12 of the 25 cases, in which the peak SPV asymmetry was determined as less than 30% by S-HRT (average, 11.00 ± 6.87%), the asymmetry determined by B-HRT (average, 47.31 ± 34.78%) was significantly higher, facilitating lesion identification by performing B-HRT together ( p = 0.001*). B-HRT in the sitting position identified direction-changing nystagmus in LSC-BPPV. B-HRT is helpful in facilitating the diagnosis of LSC-BPPV in the sitting position and determination of the affected ears in cases with nonprominent differences in bilateral nystagmus intensity according to S-HRT.

BackgroundIt is necessary to develop a roadmap for antimicrobial usage monitoring in order to perform monitoring of antimicrobial use at the national level properly. Therefore, this study aimed to develop a roadmap for establishing surveillance and monitoring of antimicrobial use in medical institutions at the national level.Materials and MethodsA modified Delphi study was conducted, including 3 rounds of an online survey and a virtual meeting with 16 expert panels. The survey items were developed based on a literature review of the surveillance systems for antimicrobial use in 12 countries and interviews with experts. The questionnaire was designed to include both the surveillance and benchmarking systems.ResultsRegarding the scope of target institutions to be included in the surveillance system, medical institutions for sentinel surveillance had the highest proportion of agreement among the panels (75.0%, 9/12). For the benchmarking system, “tertiary- and secondary-care hospitals” were accepted as the scope of target institutions at the current moment. Furthermore, the National Health Insurance claims and prescription data of individual hospitals were considered appropriate data sources for the surveillance system. As for the measures to promote the participation of hospitals in the benchmarking system, “compensation through the establishment of antimicrobial management fees” and “set the participation in the program as a quality evaluation or accreditation index for hospital evaluation” were accepted.ConclusionThis study provides a roadmap for establishing an antimicrobial use monitoring and benchmarking system for medical institutions at a national level in Korea.