Pohang SeMyeong Christianity Hospital

ObjectivesTo explore the association between the degree of coronary artery calcium (CAC) and the progression of calcific aortic valve disease (CAVD).DesignA single-centre retrospective cohort study using a hospital-based database.ParticipantsA total of 2898 patients who underwent coronary CT angiography and serial echocardiograms at ≥6 months apart were included. Initial echocardiography was performed within 6 months from the time of CCTA.Outcome measuresCAC was divided into four groups: 0, 1–99, 100–399 and ≥400 (Agatston units, AU). The progression of CAVD was defined in two ways: progression 1 as at least one grade of progression, progression 2 as at least moderate aortic stenosis (AS) at follow-up.ResultsAt the initial CAVD grade, patients with at least mild AS tended to increase with increasing CAC (p<0.001). During a median follow-up of 3.2 years (IQR, 1.8–5.0 years), 101 patients (3.5%) experienced progression 1 and 24 patients (0.8%) suffered progression 2. There was a statistically significant increase in risk of progression 1 in CAC 100–399 and ≥400 groups than CAC 0 and 1–99 groups (p<0.001). In progression 2, the CAC≥400 group showed a higher progression rate than the other groups (p<0.001). In multivariable logistic regression, age (adjusted OR (aOR), 1.06; 95% CI, 1.02 to 1.09; p=0.001), CAC≥400 (aOR, 2.55 vs CAC 0 as a reference group; 95% CI, 1.19 to 5.46; p=0.016), body mass index (aOR, 1.09; 95% CI, 1.02 to 1.17; p=0.010) and initial peak aortic jet velocity (aOR, 1.21 per 0.1 m/s increase; 95% CI, 1.14 to 1.28; p<0.001) were associated with progression 1. In progression 2, CAC≥400 (aOR, 44.5 vs CAC 0 as a reference group; 95% CI, 1.09 to 1810; p=0.045), eGFR (aOR, 0.88; 95% CI, 0.80 to 0.97; p=0.007), left ventricular mass index (aOR, 1.05; 95% CI, 1.01 to 1.10; p=0.029) and initial peak aortic jet velocity (aOR, 4.21 per 0.1 m/s increase; 95% CI, 1.86 to 9.53; p=0.001) were significant determinants.ConclusionsCAC was significantly associated with the progression of CAVD. Particularly, CAC≥400 was linked to progression toward significant AS.

Atypical gastric lesions present diagnostic challenges, particularly when they mimic benign conditions. We report the case of a 76-year-old male who underwent esophagogastroduodenoscopy (EGD) during routine screening. The EGD revealed a 1-cm ulcerative lesion in the lesser curvature of the stomach. The initial endoscopic report simply described the lesion as a “gastric ulcer,” and the initial biopsy indicated a tubulovillous adenoma with low-grade dysplasia. However, follow-up endoscopy demonstrated an irregular, non-healing ulcer without a clean base, raising a strong possibility of deeper infiltration. A follow-up biopsy showed atypical findings, suggestive of malignancy, and prompting further evaluation. Abdominal computed tomography (CT) revealed a mass in the pancreatic body and tail that directly invaded the gastric wall, along with extensive peritoneal metastasis. Positron emission tomography-CT confirmed hypermetabolic activity in the pancreatic lesion. The final diagnosis was a pancreatic adenocarcinoma with gastric invasion. This case highlights the importance of correlating endoscopic findings with imaging and pathology findings, especially when endoscopic morphology appears atypical and inconsistent with biopsy results. Repeat evaluations and cross-sectional imaging may prevent unnecessary procedures and allow timely identification of extrinsic malignancies that present as primary gastric lesions.

Introduction: SB3 is a trastuzumab biosimilar approved in Australia, Brazil, Canada, the European Union, the Republic of Korea, Switzerland, and the USA. This real-world study evaluated safety and effectiveness of SB3 as part of the Korean post approval safety management system. Methods: This post-marketing surveillance in Korea included patients in line with approved indications, i.e., patients with early or metastatic breast cancer or metastatic gastric cancer. Safety outcomes were adverse events (AEs) and adverse drug reactions. Effectiveness outcomes were tumor response and event-free survival. Results: 424 patients were evaluated: 366 patients (86%) with early breast cancer, 53 patients (13%) with metastatic breast cancer, and 5 patients (1%) with metastatic gastric cancer. Among patients with breast cancer, AEs (mostly mild) and adverse drug reactions were reported by 158 (37.7%) and 57 (13.6%) patients, respectively. Most patients with an AE (141, 89.2%) had no change in treatment schedule. Treatment was temporarily suspended in 14 (8.9%) patients with an AE and completely discontinued in 7 (4.4%). Among patients with early and metastatic breast cancer who were evaluated for efficacy, objective response rates were 82.7% and 38.3%, respectively. Pathological complete response was 64.6% in patients with early breast cancer. Discussion/Conclusion: Safety and efficacy of SB3 demonstrated in this real-world study were comparable with previous studies of reference trastuzumab.

Objectives: The purpose of this study is to understand the effect of online health information orientation and e-health literacy on health behavior for patients with coronary artery disease.Methods: A cross-sectional and descriptive study design was used. Data collection was conducted from 130 patients with coronary artery disease who admitted to a general hospital in Pohang city between April and June 2020, and a self-administrated questionnaire was conducted. Data analysis was performed using the SPSS 22.0 program with descriptive statistics, Pearson’s correlation, and multiple regression analysis.Results: Online health information orientation and e-health literacy (r = 0.77, &lt;i&gt;p&lt;/i&gt;&lt; 0.001) showed a statistically significant positive correlation, but health behavior did not show any correlation with two variables. Online health information orientation and e-health literacy had a significant correlation with exercise out of health behavior (r = 0.22, &lt;i&gt;p&lt;/i&gt;= 0.013; r = 0.22, &lt;i&gt;p&lt;/i&gt;= 0.011). Multiple regression analysis for health behavior revealed that the significant predictors were smoking (β= 0.36), age ≤ 49 (β= -0.35), and 50-59 (β= -0.26). These factors explained 33.2% of the variance (F = 7.41, &lt;i&gt;p&lt;/i&gt;&lt; 0.001). Among the sub-areas of health behavior, it was e-health literacy that influenced the exercise area (β= 0.22, &lt;i&gt;p&lt;/i&gt;= 0.011).Conclusions: Online health information orientation and e-health literacy did not affect health behavior, but e-health literacy was found to be a significant variable in the exercise area among the lower areas of health behavior. Therefore, the higher the e-health literacy is, the higher the exercise behavior during health activities.

Introduction: Korea is one of the countries where liver transplantation (LT) operation is being performed most actively in the world. According to the most recent data, KONOS reported 11 year patient survival rate after LT as 71.6% and UNOS reported the 10 year graft survival rate as 66.4%. The authors investigated the short-term and long-term results of LT performed at a small volume center in Korea. Materials and Methods: From March 2002 to March 2019, 200 cases of adult LT were performed at Ulsan University Hospital. For these cases, the indications, operative data, early and late mortalities and long-term survival rates were investigated. Results: 114 cases were performed with graft from deceased donor, including 5 cases of split right graft. There were 3 cases of simultaneous liver-kidney transplantation. Among 86 living donor liver transplantation (LDLT), ABO incompatible LDLT was performed in 15 cases (17.5%). The most frequent indication was HBV, comprised of 115 cases (57.5%), of which 75 cases were complicated by HCC. Alcohol and HCV comprised 22.5% and 9%, respectively. There were 96 cases of HCC in total and 15 LT’s were performed as a salvage operation. During the operation, mean transfusion amounts were 10 pints of RBC, 15 pints of FFP and 7 pints of PC. 15.8% of the operation was performed without RBC transfusion. There was no intraoperative mortality. 3 cases of retransplantation were performed within 30 days after the primary operation and all were developed after ABO incompatible LT. 10 Cases of 90-days mortality happened. The causes were sepsis (4), graft versus host disease (3), fulminant viral (herpetic) hepatitis (1), primary nonfunction (1) and portal vein thrombosis (1). Late mortality (death after 90 days) developed in 14 cases. The causes were HCC recurrence (8), de novo cancer (2), graft dysfunction (2), HCV recurrence (1) and systemic aspergillosis (1). Long-term survival rates were 92.4%, 86.8%, and 83.7% at 1 year, 5 years and 10 years after LT, respectively. There was no significant difference in survival according to the indications (HBV vs. alcohol vs. HCC, Figure).10 year survival rates for HCC was 79.6% and was 83.6% for within Milan group (n=69) and 68.6% for beyond Milan group (n=27, p=0.183). Conclusion: In this era of widespread performance of liver transplantation in Korea, the short-term and long-term results were not influenced much from the volume of center. This may reflect through education of the transplant surgeons and other medical staves.

Nivolumab is an immune checkpoint inhibitor approved for the treatment of metastatic cancers. Here, we report the case of a 65-year-old male with recurrent renal cell carcinoma. After six cycles of nivolumab treatment, positron emission tomography/ computed tomography (PET/CT) was performed to evaluate the response. PET/CT revealed diffuse ground glass opacities in both lungs. He developed a cough, sputum, chills, and a febrile sense. After bronchoscopic bronchoalveolar lavage, pneumocystis pneumonia was finally diagnosed.

To the Editor, My colleagues and I would like to thank Drs. Ayubi and Safiri for their comments regarding our manuscript [3]. After reviewing their letter, we agree that our methods for calculating estimated odds ratios (ORs) and confidential internals (CI) were influenced by sparse-data bias, and, as the authors of the letter suggested, the data could be made more exact by performing a statistical compensation called penalization [1, 2]. We revised our estimated ORs and CIs using the penalization method, which we believe make our data more accurate, although our conclusions did not change. The ORs and CIs from chi square tests were reanalyzed using R statistical software, based on Bayesian logistic regression with penalization [1, 4]. We assumed prior 95% limits for all odds ratios to be 1/39 to 39, derived from a F(2,2) prior for the OR, as suggested by Greenland and Mansournia [1]. Next, we added the penalized ORs to Tables 1-3.Table 1.: Number of patients in isolated coronoid and isolated radial head fractures groups based on MRI findings and the results of chi square test, odds ratio, and penalized odds ratio.Table 2.: Number of patients in coronoid process fracture of isolated coronoid process and combined fractures and results of chi square and Fisher’s exact tests.Table 3.: Number of patients in isolated radial head fractures and combined coronoid and radial head fractures groups based on MRI findings and the results of chi square test and odds ratios.After reading your letter, and discussing your concerns with CORR’s Senior Editor, we agreed that the OR evaluations in Tables 1 and 3 showed something strange; for example, since complete rupture of the medial collateral ligament had an OR over 1, the OR for the lateral ulnar collateral ligament rupture (Table 1) should be below 1. We have modified and corrected the data with proper ORs using penalization as shown now in the revised Tables 1 and 3. We also found large sparse-data bias for the anteromedial facet fracture in isolated coronoid fracture and combined fracture. Accordingly, we have adjusted the ORs in Table 2 by using the penalization method. Drs. Safiri and Ayubi also suggested that we apply the penalization approach to the analysis on medial bone contusion (Table 3). We tried again, but found that the chi square test did not work because there was no occurrence of isolated radial-head fractures in patients with medial bone contusions. Furthermore, we did not perform the penalization method for the lateral bone contusion (Table 3) because that OR was correct.