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Long-Term Outcomes of COVID-19 and Risk Factors for Prolonged or Persistent COVID-19 in Lymphoma Patients: A Multicenter, Retrospective Cohort Study. 淋巴瘤患者 COVID-19 的长期疗效及 COVID-19 延长或持续存在的风险因素:一项多中心、回顾性队列研究。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.3346/jkms.2024.39.e263
Jung Ah Lee, Min Han, Sangmin Ahn, Yongseop Lee, Joon-Sup Yeom, Jun Yong Choi, Nam Su Ku, Su Jin Jeong, Jung Ho Kim, Jin Seok Kim, Haerim Chung, Hyunsoo Cho, Yu Ri Kim, Jin Young Ahn

Background: Patients with hematologic malignancies exhibit persistent severe acute respiratory syndrome coronavirus 2 positivity over long periods after coronavirus disease 2019 (COVID-19) diagnosis. However, the frequency of, risk factors for, and prognosis of prolonged COVID-19 in immunocompromised patients remain unclear. Therefore, we investigated the long-term outcomes of COVID-19 in lymphoma patients and identified the associated factors and impact of prolonged COVID-19 on mortality.

Methods: A multicenter retrospective cohort study of 583 lymphoma patients was conducted in 3 tertiary hospitals in South Korea. Patients receiving lymphoma treatment who were quarantined after obtaining a diagnosis of COVID-19 by polymerase chain reaction (PCR) or antigen test from August 2021 to September 2022 were examined.

Results: Overall, 115 patients (19.7%) were diagnosed with COVID-19. Among 77 patients with clinical data, 24 had prolonged COVID-19. Patients in the prolonged COVID-19 group showed higher rates of receiving rituximab maintenance therapy following bendamustine and rituximab (BR) treatment for follicular lymphoma. This group did not show significant differences in clinical presentation within 30 days of COVID-19 diagnosis; however, it showed higher rates of re-admission due to COVID-19 pneumonia compared with the non-prolonged COVID-19 group. BR treatment followed by rituximab maintenance therapy is one of the risk factors for persistent PCR positivity, delayed or persistent pneumonia, and COVID-19 related admission after quarantine period. Prolonged COVID-19 was an independent risk factor for 1-year mortality.

Conclusion: Prolonged COVID-19 was more frequent in lymphoma patients who received BR treatment followed by rituximab maintenance therapy and associated with unfavorable long-term outcomes and higher 1-year mortality.

背景:血液系统恶性肿瘤患者在确诊2019年冠状病毒病(COVID-19)后,会在很长一段时间内表现出持续的严重急性呼吸综合征冠状病毒2阳性。然而,免疫功能低下患者出现长期 COVID-19 的频率、风险因素和预后仍不清楚。因此,我们调查了淋巴瘤患者 COVID-19 的长期结局,并确定了相关因素以及 COVID-19 延长对死亡率的影响:方法:我们在韩国 3 家三级医院对 583 名淋巴瘤患者进行了多中心回顾性队列研究。研究对象为2021年8月至2022年9月期间通过聚合酶链反应(PCR)或抗原检测确诊为COVID-19后接受隔离治疗的淋巴瘤患者:共有 115 名患者(19.7%)被确诊为 COVID-19。在有临床数据的 77 名患者中,24 人的 COVID-19 病程较长。长期COVID-19组患者在接受苯达莫司汀和利妥昔单抗(BR)治疗滤泡性淋巴瘤后,接受利妥昔单抗维持治疗的比例较高。与非延长COVID-19组相比,该组在确诊COVID-19后30天内的临床表现无明显差异,但因COVID-19肺炎再次入院的比例较高。BR治疗后利妥昔单抗维持治疗是导致PCR持续阳性、肺炎延迟或持续存在以及隔离期后因COVID-19入院的风险因素之一。COVID-19延长是1年死亡率的独立风险因素:结论:COVID-19延长在接受BR治疗后再接受利妥昔单抗维持治疗的淋巴瘤患者中更为常见,与不利的长期预后和较高的1年死亡率有关。
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引用次数: 0
Healthcare Experts' Advisory Unit and Support (HAUS) Program for Medical Device Development in Korea: Introduction of Clinical Unmet Needs-Based Intended Use Establishment (CLUE) Templates. 韩国医疗器械开发的医疗专家咨询组和支持计划(HAUS):引入基于临床未满足需求的预期用途确定(CLUE)模板。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.3346/jkms.2024.39.e311
You Kyoung Lee, Eugene Lih, MinYoung Kim, Soo Young Kim, Ki Chang Nam, Jaesoon Choi, Il-Ho Park, Su-Kyoung Lee, Soe Ye Yint Tun, Ei Shwe Yi Phoo, Jin Woo Lee

Background: A clear and precise definition of the "intended use" in developing new medical devices can determine the success of entering the healthcare market. For this, practical collaboration between the clinical and engineering experts is necessary, and an appropriate tool is required for effective information collection and decision-making in the process.

Methods: The Korean Academy of Medical Sciences, in cooperation with the Korean Medical Device Development Fund, implemented the Healthcare Experts' Advisory Unit and Support (HAUS) program to match advisory clinical experts in medical device development projects. Three and five collaborative academic conferences were held in 2022 and 2023 to raise awareness of the HAUS program. In the consultation meeting, checklists were used to facilitate communications and satisfaction surveys were conducted afterward. Then, the results of the consultation meetings were compiled to build an integrated document.

Results: The HAUS program was conducted with a gradually increasing number of consultation sessions from 31 in 2021 to 128 in 2023. The medical device development teams (development teams) expressed a higher level of satisfaction (91.4% to 100%) compared to the advisors (clinical experts) (78.6% to 100%) across the survey items. Based on the experiences and observations of the HAUS consultation meetings, the "Clinical Unmet Needs-based Intended Use Establishment (CLUE) templates" were developed, which were purposes to improve communication efficiency and to support a systematic approach in establishing the intended use. The CLUE process comprises four main stages for processing: Stage 1, Initial Concept; Stage 2, Expert Consultation; Stage 3, Decision-making; and Stage 4, Intended Use.

Conclusion: The HAUS program seemed to be helpful for the development teams by providing opinions of clinical experts. And the resultant product, the CLUE templates have been proposed to facilitate collaboration between the development teams and the advisors and to define robust clinical intended use.

背景:在开发新的医疗设备时,对 "预期用途 "进行清晰而准确的定义可决定进入医疗市场的成败。为此,临床专家和工程专家之间必须开展切实的合作,并且需要一个适当的工具,以便在这一过程中有效地收集信息和做出决策:方法:韩国医学科学院与韩国医疗器械开发基金合作,实施了医疗专家咨询组和支持(HAUS)计划,为医疗器械开发项目中的临床咨询专家牵线搭桥。为提高人们对 HAUS 计划的认识,分别于 2022 年和 2023 年举办了三次和五次合作学术会议。在咨询会议上,使用了核对表以促进沟通,会后进行了满意度调查。然后,将咨询会议的结果汇编成一份综合文件:HAUS 计划的咨询会议次数从 2021 年的 31 次逐渐增加到 2023 年的 128 次。与顾问(临床专家)(78.6%-100%)相比,医疗器械开发团队(开发团队)在各调查项目中的满意度更高(91.4%-100%)。根据 HAUS 咨询会议的经验和观察结果,开发了 "基于临床未满足需求的预期用途确定(CLUE)模板",旨在提高沟通效率,并支持以系统化的方法确定预期用途。CLUE 流程包括四个主要处理阶段:第 1 阶段,初始概念;第 2 阶段,专家咨询;第 3 阶段,决策;第 4 阶段,预期用途:结论:HAUS 程序提供了临床专家的意见,似乎对开发团队很有帮助。结论:HAUS 程序提供了临床专家的意见,似乎对开发团队很有帮助,由此产生的产品 CLUE 模板也被提出来,以促进开发团队与顾问之间的合作,并确定稳健的临床预期用途。
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引用次数: 0
Efficacy of Bifidobacterium longum and Lactobacillus plantarum (NVP-1703) in Children With Allergic Rhinitis: A Randomized Controlled Trial. 长双歧杆菌和植物乳杆菌(NVP-1703)对过敏性鼻炎儿童的疗效:随机对照试验
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.3346/jkms.2024.39.e266
Kyunguk Jeong, Seok Won Jang, Se-Ah Jeon, Hei Ji Seo, Se-Hui Kang, Seung-Won Han, Dong In Suh, Sooyoung Lee

Background: There is increasing evidence that probiotics are effective in treating allergic rhinitis (AR), while some controversies remain. This study was performed to evaluate the therapeutic effect and safety of a mixture of Bifidobacterium longum and Lactobacillus plantarum (NVP-1703) in children with AR.

Methods: In a randomized, double-blind, placebo-controlled study, children aged 6 to 19 years with perennial AR were treated with NVP-1703 at a dose of 1 × 1010 CFU/day or placebo once a day for 4 weeks. Total nasal symptom score (TNSS), nasal symptom duration score (NSDS), quality of life (QoL), allergic inflammatory markers, and safety parameters were evaluated.

Results: After 4 weeks of treatment, the TNSS in the NVP-1703 group significantly decreased compared to that in the placebo group (P = 0.011), both in the morning and the evening (P = 0.031 and P = 0.004, respectively). The NSDS also significantly decreased in the NVP-1703 group compared to that in the placebo group (P = 0.018). QoL scores, particularly those related to mouth breathing and itchy nose, showed a significant improvement in the NVP-1703 group compared to the placebo group. The ratios of interleukin (IL)-4/IL-22 and IL-5/IL-22 were significantly reduced in the NVP-1703 group after the treatment compared to the baseline values. No notable adverse events were reported in the NVP-1703 group.

Conclusion: Oral administration of a mixture of B. longum and L. plantarum (NVP-1703) improved both AR symptoms and QoL in children with perennial AR, accompanied by decreases in the ratios of T helper 2 cytokines to IL-22.

Trial registration: Clinical Research Information Service Identifier: KCT0002661.

背景:越来越多的证据表明益生菌可有效治疗过敏性鼻炎(AR),但仍存在一些争议。本研究旨在评估长双歧杆菌和植物乳杆菌混合物(NVP-1703)对过敏性鼻炎儿童的治疗效果和安全性:在一项随机、双盲、安慰剂对照研究中,6至19岁的常年性AR患儿接受了NVP-1703治疗,剂量为1×1010 CFU/天或安慰剂,每天一次,持续4周。对鼻部症状总评分(TNSS)、鼻部症状持续时间评分(NSDS)、生活质量(QoL)、过敏性炎症指标和安全性参数进行了评估:治疗4周后,与安慰剂组相比,NVP-1703组的TNSS显著下降(P = 0.011),早晨和晚上的TNSS均显著下降(分别为P = 0.031和P = 0.004)。与安慰剂组相比,NVP-1703 组的 NSDS 也明显下降(P = 0.018)。与安慰剂组相比,NVP-1703 组的 QoL 评分,尤其是与口呼吸和鼻痒相关的评分有明显改善。与基线值相比,NVP-1703组治疗后的白细胞介素(IL)-4/IL-22和IL-5/IL-22比率明显降低。NVP-1703组未出现明显的不良反应:结论:口服龙杆菌和植物乳杆菌混合物(NVP-1703)可改善常年性AR患儿的AR症状和QoL,同时降低T辅助2细胞因子与IL-22的比率:试验注册:临床研究信息服务标识符:试验注册:临床研究信息服务标识符:KCT0002661。
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引用次数: 0
Estimating Excess Mortality During the COVID-19 Pandemic Between 2020-2022 in Korea. 估算 2020-2022 年 COVID-19 大流行期间韩国的超额死亡率。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.3346/jkms.2024.39.e267
Minjeong Jang, Soyoung Kim, Sunhwa Choi, Boyeong Ryu, So Young Choi, Siwon Choi, Misuk An, Seong-Sun Kim

Background: The persistent coronavirus disease 2019 (COVID-19) pandemic has had direct and indirect effects on mortality, making it essential to analyze excess mortality to fully understand the impact of the pandemic. In this study, we constructed a mathematical model using number of deaths from Statistics Korea and analyzed excess mortality between 2020 and 2022 according to age, sex, and dominant severe acute respiratory syndrome coronavirus 2 variant period.

Methods: Number of all-cause deaths between 2010 and 2022 were obtained from the annual cause-of-death statistics provided by Statistics Korea. COVID-19 mortality data were acquired from the Korea Disease Control and Prevention Agency. A multivariate linear regression model with seasonal effect, stratified by sex and age, was used to estimate the number of deaths in the absence of COVID-19. The estimated excess mortality rate was calculated.

Results: Excess mortality was not significant between January 2020 and October 2021. However, it started to increase monthly from November 2021 and reached its highest point during the omicron-dominant period. Specifically, in March and April 2022, during the omicron BA.1/BA.2-dominant period, the estimated median values for excess mortality were the highest at 17,634 and 11,379, respectively. Both COVID-19-related deaths and excess mortality increased with age. A notable increase in excess mortality was observed in individuals aged ≥ 65 years. In the context of excess mortality per 100,000 population based on the estimated median values in March 2022, the highest numbers were found among males and females aged ≥ 85 years at 1,048 and 910, respectively.

Conclusion: This study revealed that the prolonged COVID-19 pandemic coupled with its high transmissibility not only increased COVID-19-related deaths but also had a significant impact on overall mortality rates, especially in the elderly. Therefore, it is crucial to concentrate healthcare resources and services on the elderly and ensure continued access to healthcare services during pandemics. Establishing an excess mortality monitoring system in the early stages of a pandemic is necessary to understand the impact of infectious diseases on mortality and effectively evaluate pandemic response policies.

背景:2019年冠状病毒病(COVID-19)大流行对死亡率产生了直接和间接的影响,因此分析超额死亡率对充分了解大流行的影响至关重要。在这项研究中,我们利用韩国统计局提供的死亡人数构建了一个数学模型,并根据年龄、性别和冠状病毒2型严重急性呼吸综合征显性变异期分析了2020年至2022年期间的超额死亡率:方法:从韩国统计局提供的年度死因统计数据中获取 2010 年至 2022 年间全因死亡人数。COVID-19 死亡率数据来自韩国疾病预防控制机构。我们使用一个具有季节效应的多变量线性回归模型,按性别和年龄进行分层,以估算在没有 COVID-19 的情况下的死亡人数。计算出了估计的超额死亡率:结果:2020 年 1 月至 2021 年 10 月期间,超额死亡率并不明显。然而,从 2021 年 11 月起,超额死亡率开始逐月上升,并在奥米克龙主导期达到最高点。具体来说,在 2022 年 3 月和 4 月,即在 BA.1/BA.2 占主导地位的卵圆期间,超额死亡率的估计中值最高,分别为 17 634 人和 11 379 人。与 COVID-19 相关的死亡人数和超额死亡率都随着年龄的增长而增加。在年龄≥ 65 岁的人群中,超额死亡率明显增加。根据 2022 年 3 月的估计中位值计算的每 10 万人超额死亡率中,年龄≥ 85 岁的男性和女性的超额死亡率最高,分别为 1 048 人和 910 人:这项研究表明,COVID-19 大流行持续时间长,传播性强,不仅增加了与 COVID-19 相关的死亡人数,而且对总死亡率,尤其是老年人的总死亡率产生了重大影响。因此,将医疗保健资源和服务集中在老年人身上并确保他们在大流行期间能够持续获得医疗保健服务至关重要。为了了解传染病对死亡率的影响并有效评估大流行应对政策,有必要在大流行初期建立超额死亡率监测系统。
{"title":"Estimating Excess Mortality During the COVID-19 Pandemic Between 2020-2022 in Korea.","authors":"Minjeong Jang, Soyoung Kim, Sunhwa Choi, Boyeong Ryu, So Young Choi, Siwon Choi, Misuk An, Seong-Sun Kim","doi":"10.3346/jkms.2024.39.e267","DOIUrl":"10.3346/jkms.2024.39.e267","url":null,"abstract":"<p><strong>Background: </strong>The persistent coronavirus disease 2019 (COVID-19) pandemic has had direct and indirect effects on mortality, making it essential to analyze excess mortality to fully understand the impact of the pandemic. In this study, we constructed a mathematical model using number of deaths from Statistics Korea and analyzed excess mortality between 2020 and 2022 according to age, sex, and dominant severe acute respiratory syndrome coronavirus 2 variant period.</p><p><strong>Methods: </strong>Number of all-cause deaths between 2010 and 2022 were obtained from the annual cause-of-death statistics provided by Statistics Korea. COVID-19 mortality data were acquired from the Korea Disease Control and Prevention Agency. A multivariate linear regression model with seasonal effect, stratified by sex and age, was used to estimate the number of deaths in the absence of COVID-19. The estimated excess mortality rate was calculated.</p><p><strong>Results: </strong>Excess mortality was not significant between January 2020 and October 2021. However, it started to increase monthly from November 2021 and reached its highest point during the omicron-dominant period. Specifically, in March and April 2022, during the omicron BA.1/BA.2-dominant period, the estimated median values for excess mortality were the highest at 17,634 and 11,379, respectively. Both COVID-19-related deaths and excess mortality increased with age. A notable increase in excess mortality was observed in individuals aged ≥ 65 years. In the context of excess mortality per 100,000 population based on the estimated median values in March 2022, the highest numbers were found among males and females aged ≥ 85 years at 1,048 and 910, respectively.</p><p><strong>Conclusion: </strong>This study revealed that the prolonged COVID-19 pandemic coupled with its high transmissibility not only increased COVID-19-related deaths but also had a significant impact on overall mortality rates, especially in the elderly. Therefore, it is crucial to concentrate healthcare resources and services on the elderly and ensure continued access to healthcare services during pandemics. Establishing an excess mortality monitoring system in the early stages of a pandemic is necessary to understand the impact of infectious diseases on mortality and effectively evaluate pandemic response policies.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"39 40","pages":"e267"},"PeriodicalIF":3.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Barriers and Facilitators of Pediatric Obesity Prevention and Management (POPM) Programs in Korea: Focusing on the Questionnaire About the Linkage in Community Level. 韩国儿童肥胖症预防和管理计划(POPM)的障碍和促进因素:聚焦社区层面的联系问卷。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-21 DOI: 10.3346/jkms.2024.39.e261
Sujin Park, Hyo Seon Jeong, Young-Min Noh, Eungu Kang, Yong Hee Hong, Sochung Chung

Background: Recent global trends indicate a rise in pediatric obesity, reflecting patterns also observed in South Korea. Given its significant impact on chronic disease prevalence in adulthood, pediatric obesity poses potential societal challenges. For pediatric obesity-related prevention or management programs in community level to operate effectively, there needs to be a clear understanding of barriers and facilitators of the programs. This study aims to establish a foundation for policy implementation, contributing to pediatric obesity prevention and management (POPM) in Korea.

Methods: A survey was conducted among program providers involved in domestic POPM programs. A total of 577 individuals completed the survey, including those working in elementary and middle schools (n = 508) and public health centers (n = 69) nationwide. The questionnaire comprised 67 questions covering characteristics of respondents, purpose and contents of POPM programs, measurement of program outcome, level of inter- and intra-institutional linkage, difficulties in operating programs and factors that facilitate programs. A 5-point Likert scale was used for most questions. Descriptive statistics was employed to analyze characteristics of respondents in POPM programs. The level of linkage in POPM programs was assessed using perceived importance and actual degree of linkage. The difficulties in operating POPM programs were analyzed based on agreement responses, and facilitating factors of program activation were analyzed based on importance responses.

Results: The domestic POPM program showed low actual linkage compared to its perceived importance, both between institutions and among professions within institutions. Difficulties in operating the program included securing availability of students, encouraging participation of reluctant students and development of new programs. The survey suggested that schools require support from parents, guardians and family members, while public health centers need professional providers to facilitate such programs.

Conclusion: The study highlights the urgent need for strategies to address pediatric obesity in South Korea. Weak institutional linkages hinder effective programs. Challenges include student availability, participation, and the need for innovative programs. New approaches to build partnerships in harmony among institutions are necessary. Implementing findings into policy can help prevent obesity in Korean children and adolescents.

背景:最近的全球趋势表明,小儿肥胖症呈上升趋势,这也反映了在韩国观察到的模式。鉴于小儿肥胖症对成年后的慢性病发病率有重大影响,它对社会构成了潜在的挑战。要想在社区层面有效开展与小儿肥胖相关的预防或管理计划,就必须清楚地了解这些计划的障碍和促进因素。本研究旨在为政策实施奠定基础,为韩国儿科肥胖症预防和管理(POPM)做出贡献:方法:对参与国内儿童肥胖症预防与管理项目的项目提供者进行了调查。共有 577 人完成了调查,其中包括在全国中小学(508 人)和公共卫生中心(69 人)工作的人员。问卷由 67 个问题组成,涉及受访者的特征、持久性有机污染物项目的目的和内容、项目成果的衡量、机构间和机构内的联系水平、项目运作的困难以及促进项目的因素。大多数问题都采用了 5 点李克特量表。调查采用了描述性统计方法来分析民意调查项目受访者的特征。民研計劃的聯繫程度是以認知聯繫的重要性和實際聯繫程度來評估。根据同意度分析了 POPM 项目运作的困难,根据重要性分析了项目激活的促进因素:结果:国内持久性有机污染物管理计划在院校之间和院校内各专业之间的实际联系程度低于其认知重要性。项目运作的困难包括确保学生的可用性、鼓励不情愿的学生参与以及开发新项目。调查表明,学校需要家长、监护人和家庭成员的支持,而公共卫生中心则需要专业提供者来推动此类计划:这项研究强调,韩国急需制定策略来解决儿童肥胖问题。薄弱的机构联系阻碍了有效计划的实施。面临的挑战包括学生的可用性、参与度以及对创新计划的需求。有必要采取新方法,在各机构之间建立和谐的伙伴关系。将研究结果落实到政策中有助于预防韩国儿童和青少年肥胖。
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引用次数: 0
Identification of Preeclamptic Placenta in Whole Slide Images Using Artificial Intelligence Placenta Analysis. 利用人工智能胎盘分析鉴定全切片图像中的先兆子痫胎盘
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-14 DOI: 10.3346/jkms.2024.39.e271
Young Mi Jung, Seyeon Park, Youngbin Ahn, Haeryoung Kim, Eun Na Kim, Hye Eun Park, Sun Min Kim, Byoung Jae Kim, Jeesun Lee, Chan-Wook Park, Joong Shin Park, Jong Kwan Jun, Young-Gon Kim, Seung Mi Lee

Background: Preeclampsia (PE) is a hypertensive pregnancy disorder linked to placental dysfunction, often involving pathological lesions like acute atherosis, decidual vasculopathy, accelerated villous maturation, and fibrinoid deposition. However, there is no gold standard for the pathological diagnosis of PE and this limits the ability of clinicians to distinguish between PE and non-PE pregnancies. Recent advances in computational pathology have provided the opportunity to automate pathological analysis for diagnosis, classification, prediction, and prediction of disease progression. In this study, we assessed whether computational pathology could be used to identify PE placentas.

Methods: A total of 168 placental whole-slide images (WSIs) of patients from Seoul National University Hospital (comprising 84 PE cases and 84 normal controls) were used for model development and internal validation. For external validation of the model, 76 placental slides (including 38 PE cases and 38 normal controls) were obtained from the Boramae Medical Center (BMC). To establish standard criteria for diagnosing PE and distinguishing it from controls using placental WSIs, patch characteristics and quantification of terminal and intermediate villi were employed. In unsupervised learning, K-means clustering was conducted as a feature obtained through an Auto Encoder to extract the ratio of each cluster for each WSI. For supervised learning, quantitative assessments of the villi were obtained using a U-Net-based segmentation algorithm. The prediction model was developed using an ensemble method and was compared with a clinical feature model developed by using placental size features.

Results: Using ensemble modeling, we developed a model to identify PE placentas. The model showed good performance (area under the precision-recall curve [AUPRC], 0.771; 95% confidence interval [CI], 0.752-0.790), with 77.3% of sensitivity and 71.1% of specificity, whereas the clinical feature model showed an AUPRC 0.713 (95% CI, 0.694-0.732) with 55.6% sensitivity and 86.8% specificity. External validation of the predictive model employing the BMC-derived set of placental slides also showed good discrimination (AUPRC, 0.725; 95% CI, 0.720-0.730).

Conclusion: The proposed computational pathology model demonstrated a strong ability to identify preeclamptic placentas. Computational pathology has the potential to improve the identification of PE placentas.

背景:子痫前期(PE)是一种与胎盘功能障碍有关的妊娠高血压疾病,通常涉及急性动脉粥样硬化、蜕膜血管病变、绒毛成熟加速和纤维素沉积等病理病变。然而,目前尚无 PE 病理诊断的金标准,这限制了临床医生区分 PE 和非 PE 妊娠的能力。计算病理学的最新进展为诊断、分类、预测和疾病进展预测的病理分析自动化提供了机会。在本研究中,我们评估了计算病理学是否可用于识别 PE 胎盘:方法:共使用了 168 张首尔国立大学医院患者的胎盘全切片图像(WSI)(包括 84 例 PE 病例和 84 例正常对照)进行模型开发和内部验证。为了对模型进行外部验证,从 Boramae 医疗中心(BMC)获得了 76 张胎盘切片(包括 38 例 PE 病例和 38 例正常对照)。为了建立诊断 PE 的标准,并利用胎盘 WSI 将 PE 与对照组区分开来,我们采用了斑块特征以及末端绒毛和中间绒毛的定量方法。在无监督学习中,K均值聚类是通过自动编码器获得的特征,以提取每个WSI的每个聚类的比率。在监督学习中,使用基于 U-Net 的分割算法对绒毛进行定量评估。预测模型采用集合方法建立,并与利用胎盘大小特征建立的临床特征模型进行了比较:结果:利用集合建模法,我们建立了一个识别 PE 胎盘的模型。该模型显示出良好的性能(精确度-召回曲线下面积[AUPRC],0.771;95%置信区间[CI],0.752-0.790),灵敏度为77.3%,特异度为71.1%,而临床特征模型的精确度-召回曲线下面积[AUPRC]为0.713(95% CI,0.694-0.732),灵敏度为55.6%,特异度为86.8%。使用 BMC 导出的胎盘切片集对预测模型进行外部验证也显示出良好的区分度(AUPRC,0.725;95% CI,0.720-0.730):结论:所提出的计算病理学模型具有很强的识别子痫前期胎盘的能力。计算病理学有望改善对子痫前期胎盘的鉴定。
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引用次数: 0
Single-Center Experience With Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography for Diagnosing Lymphatic Disorders and Guiding Percutaneous Embolization. 动态对比增强磁共振淋巴管造影用于诊断淋巴管疾病和指导经皮栓塞的单中心经验。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-14 DOI: 10.3346/jkms.2024.39.e260
Yura Ahn, Hyun Jung Koo, Jooae Choe, Hee Ho Chu, Dong Hyun Yang, Joon-Won Kang, Ji Hoon Shin

Background: The pragmatic role of dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) needs to be evaluated and compared across distinct lymphatic disorders. We aimed to evaluate the performance of DCMRL for identifying the underlying causes of lymphatic disorders and to define the potential benefit of DCMRL for planning lymphatic interventions.

Methods: Patients who underwent DCMRL between August 2017 and July 2022 were included in this retrospective analysis. DCMRL was performed with intranodal injection of a gadolinium-based contrast medium through inguinal lymph nodes under local anesthesia. Technical success of DCMRL and feasibility of percutaneous embolization were assessed based on the lymphatic anatomy visualized by DCMRL. Based on the underlying causes, clinical outcomes were evaluated and compared.

Results: Seventy consecutive patients were included. The indications were traumatic chylothorax (n = 42), traumatic chylous ascites (n = 11), and nontraumatic lymphatic leak (n = 17). The technical success rate of DCMRL was the highest in association with nontraumatic lymphatic disorders (94.1% [16/17]), followed by traumatic chylothorax (92.9% [39/42]) and traumatic chylous ascites (81.8% [9/11]). Thirty-one (47.7%) patients among 65 patients who underwent technically successful DCMRL had feasible anatomy for intervention. Clinical success was achieved in 90.3% (28/31) of patients with feasible anatomy for radiologic intervention, while 62.5% (10/16) of patients with anatomical challenges showed improvement. Most patients with traumatic chylothorax showed improvement (92.9% [39/42]), whereas only 23.5% (4/17) of patients with nontraumatic lymphatic disorders showed clinical improvement.

Conclusion: DCMRL can help identify the underlying causes of lymphatic disorders. The performance of DCMRL and clinical outcomes vary based on the underlying cause. The feasibility of lymphatic intervention can be determined using DCMRL, which can help in predicting clinical outcomes.

背景:动态对比增强磁共振淋巴管造影术(DCMRL)的实际作用需要评估,并在不同的淋巴管疾病中进行比较。我们旨在评估动态对比增强磁共振淋巴管造影在确定淋巴管疾病潜在病因方面的性能,并确定动态对比增强磁共振淋巴管造影在规划淋巴管干预措施方面的潜在益处:本次回顾性分析纳入了2017年8月至2022年7月期间接受DCMRL的患者。DCMRL是在局部麻醉下通过腹股沟淋巴结在结节内注射钆基造影剂进行的。根据 DCMRL 观察到的淋巴解剖结构,评估了 DCMRL 的技术成功率和经皮栓塞的可行性。根据潜在病因,对临床结果进行评估和比较:结果:共纳入 70 例连续患者。适应症为外伤性乳糜胸(42 例)、外伤性乳糜腹水(11 例)和非外伤性淋巴漏(17 例)。DCMRL 的技术成功率在非创伤性淋巴系统疾病中最高(94.1% [16/17]),其次是创伤性乳糜胸(92.9% [39/42])和创伤性乳糜腹水(81.8% [9/11])。在 65 名接受 DCMRL 技术成功的患者中,有 31 名(47.7%)患者具有可行的介入解剖结构。90.3%(28/31)的患者具有可行的放射介入解剖结构,取得了临床成功,而 62.5%(10/16)的患者在解剖结构上有困难,病情有所改善。大多数外伤性乳糜胸患者的病情有所改善(92.9% [39/42]),而只有 23.5%(4/17)的非外伤性淋巴疾病患者的病情有临床改善:结论:DCMRL 可帮助确定淋巴系统疾病的潜在病因。结论:DCMRL 可帮助确定淋巴功能紊乱的根本原因,DCMRL 的性能和临床结果因根本原因而异。使用 DCMRL 可以确定淋巴干预的可行性,有助于预测临床结果。
{"title":"Single-Center Experience With Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography for Diagnosing Lymphatic Disorders and Guiding Percutaneous Embolization.","authors":"Yura Ahn, Hyun Jung Koo, Jooae Choe, Hee Ho Chu, Dong Hyun Yang, Joon-Won Kang, Ji Hoon Shin","doi":"10.3346/jkms.2024.39.e260","DOIUrl":"https://doi.org/10.3346/jkms.2024.39.e260","url":null,"abstract":"<p><strong>Background: </strong>The pragmatic role of dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) needs to be evaluated and compared across distinct lymphatic disorders. We aimed to evaluate the performance of DCMRL for identifying the underlying causes of lymphatic disorders and to define the potential benefit of DCMRL for planning lymphatic interventions.</p><p><strong>Methods: </strong>Patients who underwent DCMRL between August 2017 and July 2022 were included in this retrospective analysis. DCMRL was performed with intranodal injection of a gadolinium-based contrast medium through inguinal lymph nodes under local anesthesia. Technical success of DCMRL and feasibility of percutaneous embolization were assessed based on the lymphatic anatomy visualized by DCMRL. Based on the underlying causes, clinical outcomes were evaluated and compared.</p><p><strong>Results: </strong>Seventy consecutive patients were included. The indications were traumatic chylothorax (n = 42), traumatic chylous ascites (n = 11), and nontraumatic lymphatic leak (n = 17). The technical success rate of DCMRL was the highest in association with nontraumatic lymphatic disorders (94.1% [16/17]), followed by traumatic chylothorax (92.9% [39/42]) and traumatic chylous ascites (81.8% [9/11]). Thirty-one (47.7%) patients among 65 patients who underwent technically successful DCMRL had feasible anatomy for intervention. Clinical success was achieved in 90.3% (28/31) of patients with feasible anatomy for radiologic intervention, while 62.5% (10/16) of patients with anatomical challenges showed improvement. Most patients with traumatic chylothorax showed improvement (92.9% [39/42]), whereas only 23.5% (4/17) of patients with nontraumatic lymphatic disorders showed clinical improvement.</p><p><strong>Conclusion: </strong>DCMRL can help identify the underlying causes of lymphatic disorders. The performance of DCMRL and clinical outcomes vary based on the underlying cause. The feasibility of lymphatic intervention can be determined using DCMRL, which can help in predicting clinical outcomes.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"39 39","pages":"e260"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Suicide Rates and Subgroups With Elevated Suicide Risk Among Patients With Psychiatric Disorders: A Nationwide Cohort Study in Korea. 精神障碍患者中的自杀率和自杀风险较高的亚群:韩国全国队列研究》。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-14 DOI: 10.3346/jkms.2024.39.e264
Jiwon Kang, Jiseun Lim, Junhee Lee, Ji-Yeon Shin

Background: Despite the distinctly high risk of suicide among patients with psychiatric disorders, little is known regarding the nationwide rates and risk factors for suicide among individual subgroups of patients with psychiatric disorders. This study aimed to assess differences in suicide rates and identify risk factors for suicide across multiple psychiatric diseases using data from a nationally representative cohort in Korea.

Methods: Six groups of incident patients with psychiatric disorders, namely those with drug use disorder (DUD), alcohol use disorder (AUD), schizophrenia (SCZ), bipolar disorder (BD), depressive disorder (DD), or other affective disorders (OADs), were extracted from the National Health Information Database and followed up. Suicide rates and risk factors were then determined for each disease group.

Results: Patients with psychiatric disorders had higher suicide rates than did the general population, with standardized mortality ratios (SMRs) ranging from 2.5 to 16.6. In particular, patients with DUD showed markedly higher suicide rate (584.0 per 100,000 person-years [PYs]; SMR, 16.6) than did patients with affective disorders, including DD (119.8 per 100,000 PYs; SMR, 3.1). AUD, DUD, SCZ, and BD showed lower male/female suicide rate ratios (1.1-1.4) than did depressive and OADs (2.2-2.4). Old age increased the risk for suicide among those with DUD and OADs, while medical aid recipients exhibited the lowest suicide risk among those with the AUD and SCZ. Male sex and the presence of multiple psychiatric comorbidities were consistently identified as suicide risk factors across mental illness subgroups.

Conclusion: The current study observed substantial variations in suicide rates and risk factors across psychiatric disorders and patient characteristics, which have significant implications for suicide prevention strategies.

背景:尽管精神障碍患者的自杀风险明显较高,但人们对全国范围内各个精神障碍患者亚群的自杀率和自杀风险因素知之甚少。本研究旨在利用韩国具有全国代表性的队列数据,评估多种精神疾病患者自杀率的差异,并确定自杀的风险因素:方法:研究人员从国家健康信息数据库中提取了六组精神病患者,即药物使用障碍(DUD)、酒精使用障碍(AUD)、精神分裂症(SCZ)、双相情感障碍(BD)、抑郁障碍(DD)或其他情感障碍(OADs)患者,并对其进行了跟踪调查。然后确定每个疾病组的自杀率和风险因素:结果:精神障碍患者的自杀率高于普通人群,标准化死亡率(SMR)从 2.5 到 16.6 不等。其中,DUD 患者的自杀率(每 10 万人年 584.0 次;标准死亡率为 16.6)明显高于包括 DD 在内的情感障碍患者(每 10 万人年 119.8 次;标准死亡率为 3.1)。AUD、DUD、SCZ和BD的男女自杀率比(1.1-1.4)低于抑郁症和OAD(2.2-2.4)。高龄增加了 DUD 和 OAD 患者的自杀风险,而在 AUD 和 SCZ 患者中,接受医疗援助者的自杀风险最低。在不同的精神疾病亚群中,男性性别和多种精神疾病合并症一直被认为是自杀风险因素:本研究发现,不同精神疾病和患者特征的自杀率和自杀风险因素存在很大差异,这对自杀预防策略具有重要意义。
{"title":"Suicide Rates and Subgroups With Elevated Suicide Risk Among Patients With Psychiatric Disorders: A Nationwide Cohort Study in Korea.","authors":"Jiwon Kang, Jiseun Lim, Junhee Lee, Ji-Yeon Shin","doi":"10.3346/jkms.2024.39.e264","DOIUrl":"https://doi.org/10.3346/jkms.2024.39.e264","url":null,"abstract":"<p><strong>Background: </strong>Despite the distinctly high risk of suicide among patients with psychiatric disorders, little is known regarding the nationwide rates and risk factors for suicide among individual subgroups of patients with psychiatric disorders. This study aimed to assess differences in suicide rates and identify risk factors for suicide across multiple psychiatric diseases using data from a nationally representative cohort in Korea.</p><p><strong>Methods: </strong>Six groups of incident patients with psychiatric disorders, namely those with drug use disorder (DUD), alcohol use disorder (AUD), schizophrenia (SCZ), bipolar disorder (BD), depressive disorder (DD), or other affective disorders (OADs), were extracted from the National Health Information Database and followed up. Suicide rates and risk factors were then determined for each disease group.</p><p><strong>Results: </strong>Patients with psychiatric disorders had higher suicide rates than did the general population, with standardized mortality ratios (SMRs) ranging from 2.5 to 16.6. In particular, patients with DUD showed markedly higher suicide rate (584.0 per 100,000 person-years [PYs]; SMR, 16.6) than did patients with affective disorders, including DD (119.8 per 100,000 PYs; SMR, 3.1). AUD, DUD, SCZ, and BD showed lower male/female suicide rate ratios (1.1-1.4) than did depressive and OADs (2.2-2.4). Old age increased the risk for suicide among those with DUD and OADs, while medical aid recipients exhibited the lowest suicide risk among those with the AUD and SCZ. Male sex and the presence of multiple psychiatric comorbidities were consistently identified as suicide risk factors across mental illness subgroups.</p><p><strong>Conclusion: </strong>The current study observed substantial variations in suicide rates and risk factors across psychiatric disorders and patient characteristics, which have significant implications for suicide prevention strategies.</p>","PeriodicalId":16249,"journal":{"name":"Journal of Korean Medical Science","volume":"39 39","pages":"e264"},"PeriodicalIF":3.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medical Education Challenges in the Era of Internationalization and Digitization. 国际化和数字化时代的医学教育挑战。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-14 DOI: 10.3346/jkms.2024.39.e299
Yuliya Fedorchenko, Olena Zimba, Makhmadshokh K Gulov, Marlen Yessirkepov, Mykhailo Fedorchenko

Prior to the coronavirus disease 2019 (COVID-19) pandemic, Central Asia and Eastern Europe saw a significant rise in international medical student enrollment, driven by competitive tuition fees, prestigious institutions, and culturally diverse environments. The pandemic forced a rapid shift to online learning, disrupting student mobility and compromising clinical training quality. Online education for international medical students during the COVID-19 pandemic has proven beneficial, though low- and middle-income countries struggled with access to information infrastructure and resources. While 64% of students preferred online learning, challenges like limited internet access and lack of in-person interaction persisted, making a blended approach of online and traditional methods most effective. Despite a rebound in post-pandemic enrollment, persistent challenges such as linguistic obstacles, psychological stress, and cultural adaptation issues remain. Active research engagement during undergraduate studies is essential for skill development. Integrating research into education curricula and fostering motivation are crucial for enhancing academic outcomes. Critical thinking and cultural competence are vital, necessitating explicit instruction and collaborative learning strategies. Addressing language barriers through comprehensive support systems for both instructors and students is imperative. Tailored strategies and robust institutional support are essential to enhancing the educational experiences and success of international medical students.

在 2019 年冠状病毒病(COVID-19)大流行之前,中亚和东欧地区的国际医科学生入学率大幅上升,原因是学费具有竞争力、院校声誉卓著以及文化环境多样化。大流行迫使学生迅速转向在线学习,扰乱了学生的流动性,影响了临床培训质量。事实证明,在 COVID-19 大流行期间为国际医科学生提供在线教育是有益的,尽管中低收入国家在获取信息基础设施和资源方面存在困难。虽然 64% 的学生倾向于在线学习,但互联网访问受限和缺乏面对面互动等挑战依然存在,因此在线和传统方法的混合方法最为有效。尽管大流行后的入学率有所回升,但语言障碍、心理压力和文化适应问题等挑战依然存在。在本科学习期间积极参与研究对于技能培养至关重要。将研究融入教育课程和培养学习动机对于提高学习成绩至关重要。批判性思维和文化能力至关重要,需要明确的教学和协作学习策略。通过为教师和学生提供全面的支持系统来解决语言障碍问题势在必行。量身定制的策略和强有力的机构支持对于提升国际医学生的教育体验和成功至关重要。
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引用次数: 0
Validity and Reliability of the Korean Version of Reduced Morningness-Eveningness Questionnaire: Results From a General Population-Based Sample. 韩国版晨间活力降低问卷的有效性和可靠性:基于普通人群样本的结果。
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-07 DOI: 10.3346/jkms.2024.39.e257
Heewon Hwang, Taesic Lee, Wonwoo Lee, Kyung Min Kim, Kyoung Heo, Min Kyung Chu

Background: Chronotype refers to individual variations in diurnal preferences that manifest as everyday behaviors, including sleep patterns. Traditionally, the Horne & Östberg Morningness-Eveningness Questionnaire (MEQ), which comprises of 19 items, has been the standard for determining chronotype. However, its length makes it cumbersome for widespread application. To address this issue, the reduced MEQ (rMEQ), a concise version containing only five items from the MEQ, was developed for a more practical approach to chronotype assessment. This study aimed to evaluate the validity and reliability of Korean version of rMEQ in a sample from the general Korean population.

Methods: The Korean version of the rMEQ comprises of items 1, 7, 10, 18, and 19 of the original MEQ. The validity of the rMEQ was assessed by correlating its scores with those of the MEQ and Munich Chronotype Questionnaire (MCTQ). Its reliability was determined by calculating internal consistency.

Results: A total of 3,030 individuals participated in the study, yielding an average rMEQ score of 14.0 ± 3.4. There was a substantial positive correlation between the rMEQ and MEQ scores (r = 0.859, P < 0.001). Furthermore, the rMEQ scores were significantly negatively correlated with the midpoint of sleep on free days corrected for sleep debt as measured by the MCTQ (r = -0.388, P < 0.001), indicating a robust association with chronotype. The internal consistency of rMEQ, measured using Cronbach's alpha, was 0.609.

Conclusion: This study finds the Korean version of the rMEQ to be a valid and reliable instrument for assessing chronotype in the general population.

背景:时型是指个人在昼夜偏好方面的差异,表现为日常行为,包括睡眠模式。传统上,由 19 个项目组成的 Horne & Östberg Morningness-Eveningness Questionnaire (MEQ) 是确定时间型的标准。然而,由于其长度过长,在广泛应用时显得非常麻烦。为了解决这个问题,我们开发了简化版的 "快乐-幸福感问卷"(rMEQ),它只包含 "快乐-幸福感问卷 "中的五个项目,是一种更实用的时间型评估方法。本研究旨在评估韩国版 rMEQ 在韩国普通人群中的有效性和可靠性:韩文版 rMEQ 包括原版 MEQ 的第 1、7、10、18 和 19 个项目。通过将 rMEQ 的得分与 MEQ 和慕尼黑时间型问卷(MCTQ)的得分进行相关性分析,评估了 rMEQ 的有效性。通过计算内部一致性来确定其可靠性:共有 3,030 人参与了研究,rMEQ 平均得分为 14.0 ± 3.4。rMEQ 和 MEQ 分数之间存在显著的正相关(r = 0.859,P < 0.001)。此外,rMEQ 分数与根据 MCTQ 测量的睡眠欠缺校正后的空闲日睡眠中点呈显著负相关(r = -0.388,P < 0.001),这表明 rMEQ 与时间型有密切联系。用克朗巴赫α测量的rMEQ内部一致性为0.609:本研究发现,韩国版 rMEQ 是评估普通人群慢性型的有效、可靠的工具。
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引用次数: 0
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Journal of Korean Medical Science
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