Yonsei Medical Journal最新文献

Purpose: This study investigates the associations between various air pollutants and menstrual cycle irregularity.

Materials and methods: Data for premenopausal women were obtained from the Korea National Health and Nutrition Examination Survey (n=4478). We evaluated the associations of moving averages of five air pollutants over 90, 120, 150, 180, and 365 days with short-interval (menstruation occurring at least once every 3 months) and long-interval (menstruation skipped for ≥ 3 months) menstrual cycle irregularity using multinomial logistic regression models. The joint effects of air pollution mixtures were explored using the quantile g-computation method.

Results: Interquartile range increases in moving averages of nitrogen dioxide (NO₂) and sulfur dioxide (SO₂) over 90, 120, 150, and 180 days were associated with short-interval menstrual cycle irregularity [e.g., odds ratio (OR)=1.24, 95% confidence interval (CI): 1.03, 1.50 for NO₂ over 120 days; OR=1.07, 95% CI: 1.03, 1.12 for SO₂ over 150 days]. Each quintile increase in air pollution mixture (NO₂ over 120 days and SO₂ over 150 days) was also associated with short-interval menstrual cycle irregularity (OR=1.07, 95% CI: 1.00, 1.14).

Conclusion: Our results indicate associations between various exposure indices of NO₂ and SO₂ and short-interval menstrual cycle irregularity in a representative sample of Korean premenopausal women. This research represents one of the first investigations on this issue; therefore, further longitudinal studies are warranted to confirm these findings.

Purpose: Retinal vascular occlusive disease (RVOD) may occur as a consequence of systemic vascular dysfunction. Although RVOD has been associated with coronary artery disease, its incidence after acute coronary syndrome (ACS) and the influence of lipid control remain unclear.

Materials and methods: Using data from the Korean National Health Information Database (2002-2022), we conducted a nationwide retrospective cohort study including 55040 patients with newly diagnosed ACS [unstable angina (UA) or myocardial infarction (MI)] and age- and sex-matched controls. RVOD outcomes included retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Low-density lipoprotein-cholesterol (LDL-C) control was stratified into four categories (excellent, good, suboptimal, poor) based on guideline-recommended targets. Competing risk analysis was performed to estimate adjusted hazard ratios (aHRs).

Results: The risk of RVOD was higher in both the UA group [aHR=1.67, 95% confidence interval (CI): 1.56-1.79] and MI group (aHR=1.34, 95% CI: 1.15-1.56) compared with controls. Stratified analysis showed elevated risk in older patients (≥65 years) and males. Among LDL-C groups, poor LDL-C control (≥100 mg/dL) was associated with the highest RVOD risk (aHR = 2.27), compared with both the ACS-free control group and the excellent control group (<55 mg/dL).

Conclusion: ACS is independently associated with increased RVOD risk, particularly among patients with UA, older age, and poor LDL-C control. Intensive lipid-lowering therapy and ophthalmologic follow-up may reduce vision-threatening vascular events in this high-risk population.

Purpose: Endoscopically identifying eosinophilic esophagitis (EoE) is difficult due to its rare incidence and subtle morphology. We aimed to develop a robust and accurate convolutional neural network (CNN) model for EoE identification and classification in endoscopic images.

Materials and methods: We collected 548 endoscopic images from 81 patients with EoE and 297 images from 37 normal patients. These datasets were labeled according to the four eosinophilic esophagitis endoscopic reference score (EREFS) features: edema, rings, exudates, and furrows. A multi-task U-Net with an auxiliary classifier on various levels of skip connections (scaU-Net) was proposed. Then, scaU-Net was compared with VGG19, ResNet50, EfficientNet-B3, and a typical multi-task U-Net CNN. The performances of each model were evaluated quantitatively and qualitatively based on accuracy (ACC), area under the receiver operating characteristics (AUROC), and gradient-weighted class activation map (Grad-CAM), and were also compared with those of 25 human endoscopists.

Results: Our sca4U-Net with 4th-level skip connection showed the best performances in ACC (86.9%), AUROC (0.93), and outstanding Grad-CAM results compared to other models, reflecting the importance of utilizing the deepest skip connection. Moreover, the sca4U-Net showed generally better performance when compared with endoscopists with various levels of experience.

Conclusion: Our method showed robust performance compared to expert endoscopists and could assist endoscopists of all experience levels in the early detection of EoE-a rare but clinically important condition.

Purpose: To evaluate changes in cerebral interstitial fluid dynamics following whole-brain radiotherapy (WBRT) for brain metastases using the diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index, and to investigate the relationship between these changes and the subsequent development of radiation-induced leukoencephalopathy (LEP).

Materials and methods: A retrospective analysis was conducted on 50 patients who underwent WBRT for brain metastases. Baseline and post-WBRT DTI-ALPS indices were compared using paired t-tests. Univariate and multivariate linear regression analyses were performed to assess the relationship between changes in the DTI-ALPS index and clinical- and treatment-related factors. In a subset of 33 patients, univariate and multivariate logistic regression analyses were conducted to explore the association between the percentage change in the DTI-ALPS index and the development of LEP at 6-month follow-up, after adjustment for relevant clinical- and treatment-related factors.

Results: The mean DTI-ALPS index decreased significantly following WBRT (baseline: 1.487±0.257; post-WBRT: 1.353±0.229; p<0.001). A higher baseline DTI-ALPS index was significantly associated with a greater decline in the index post-WBRT (p=0.023). In the logistic regression analysis, a greater percentage reduction in the DTI-ALPS index was the only factor significantly associated with LEP development at 6 months (p=0.048).

Conclusion: WBRT is associated with impaired cerebral interstitial fluid dynamics, as reflected by a significant reduction in the DTI-ALPS index. A greater decline in the DTI-ALPS index was predictive of LEP development, suggesting its potential utility as a biomarker for early diagnosis of radiation-induced LEP.

Purpose: To investigate the clinical presentations and neuroimaging findings of patients with atypical visual field defects (VFDs).

Materials and methods: This retrospective cross-sectional study included 159 patients who underwent brain magnetic resonance imaging for evaluation of atypical VFDs between 2013 and 2022. Clinical characteristics were compared based on neuroimaging results, and logistic regression was performed to identify independent risk factors for significant findings.

Results: Twenty-nine patients (18.2%) exhibited significant findings responsible for their atypical VFDs, most commonly intracranial tumors and cerebrovascular accidents. Older age [odds ratio (OR) 1.049, 95% confidence interval (CI) 1.018-1.081, p=0.002], symptom of decreased visual acuity (OR 5.790, 95% CI 2.361-14.195, p<0.001), incomplete homonymous hemianopsia (OR 15.167, 95% CI 3.096-74.300, p=0.001), absence of peripapillary atrophy (PPA) (OR 0.353, 95% CI 0.136-0.919, p=0.033) and rapidly progressive VFDs (OR 4.385, 95% CI 1.266-15.189, p=0.020) were independently associated with significant findings. Subgroup analysis based on the presence of glaucoma revealed that, among glaucoma patients, incomplete homonymous hemianopsia (p=0.001) and absence of PPA (p=0.016) were more prevalent among those with significant neuroimaging results. Among non-glaucoma patients, those with significant findings had greater pattern standard deviation (p=0.003) and more frequent rapidly progressive VFDs (p=0.041).

Conclusion: Atypical VFDs may indicate lesions along the visual pathway. Neuroimaging is recommended for patients with atypical VFDs, particularly those of older age or presenting with decreased visual acuity, rapid progression or incomplete homonymous hemianopsia.

Purpose: Long bone overgrowth after pediatric skeletal injury or surgery is well recognized, whereas growth suppression without physeal injury is rare. This study aimed to evaluate the effects of creating multiple metaphyseal holes on bone growth and elucidate the underlying mechanisms in a rabbit model.

Materials and methods: Single and dual metaphyseal holes were created in the left tibiae of immature rabbits and filled with bone wax. In the one-hole group, a hole was drilled 10 mm below the physis. In the two-hole group, an additional hole was made 5 mm below the first. Rabbits were assigned to sham (n=8), one-hole (n=8), and two-hole (n=8) groups. Tibial lengths were measured radiographically. Histologic evaluation and CD31 immunofluorescence were used to assess new bone formation and angiogenesis. Growth change was calculated as the percentage difference between the operated and contralateral limbs.

Results: The one-hole group showed significantly greater overgrowth than the sham group (1.041±1.022 mm vs. 0.027±0.342 mm, p=0.021), while the two-hole group demonstrated significant growth suppression (-0.988±0.484 mm vs. 0.027±0.342 mm, p<0.001). Histologic analysis revealed increased new bone in the one-hole group and decreased new bone formation in the two-hole group. CD31 expression was reduced in the two-hole group, indicating impaired angiogenesis.

Conclusion: A single metaphyseal hole promotes overgrowth, whereas an additional hole suppresses growth, likely through vascular disruption. These findings provide insights into bone growth regulation and its underlying mechanisms.

Purpose: Infective endocarditis (IE) is a life-threatening disease with high morbidity and mortality rates. However, the risk factors for mortality in these patients require further study. This study aimed to evaluate the association of clinical outcomes of IE with patients' clinical characteristics and economic status and treatment center experience using nationwide data.

Materials and methods: Data were collected from the National Health Insurance System of South Korea. Patients diagnosed with IE between 2003 and 2018 were included. Baseline characteristics, treatment, and survival outcomes were analyzed.

Results: Among the 8487 patients included, 6617 (78.0%) had native valve IE, 1678 (19.8%) had prosthetic valve IE, and 192 (2.3%) had cardiac device-related IE (CDRIE). In-hospital mortality was 12.1±2.8% (121.3 deaths per 1000 IE case-years). In the multivariate analysis adjusted for variables significant in the univariate Cox regression, CDRIE, age ≥70 years, hypertension, diabetes, dialysis, cancer, immunosuppression, ischemic heart disease, atrial fibrillation, and complications such as hemorrhagic stroke, shock, and acute renal failure were independently associated with increased in-hospital mortality. Importantly, after multivariate adjustment, high-volume centers (≥20 IE cases/year) [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.50-0.70, p<0.001] and high economic status (HR, 0.83; 95% CI, 0.72-0.95; p=0.010) were significantly associated with lower mortality compared to low-volume centers and low economic status, respectively.

Conclusion: Mortality outcomes of IE were determined by multiple factors, including patients' clinical characteristics, economic status, and center experience. Support for those with low economic status and establishment of well-experienced multidisciplinary teams may help to lower the risk of death in patients with IE.

Purpose: Polypharmacy in older adults is a significant public health challenge. A hospital-based, multidisciplinary Polypharmacy Management Program (PMP) was initiated nationally. We evaluated this team-based program's initial performance, identifying factors associated with medication-related problems (MRPs) prompting prescription changes.

Materials and methods: We retrospectively analyzed 2021 PMP data from 1740 patients (33 hospitals). Medication review records, intervention outcome records, and patient demographics were examined. MRPs were identified, classified, and documented alongside prescription modifications. Multivariable logistic regression was used to determine factors associated with prescription modifications.

Results: MRPs were found in 73.5% of patients (average 2.7/patient). Common types were potentially inappropriate medications (PIMs, 58.7%), interactions (46.9%), and adverse drug reactions (ADRs, 26.2%). Pharmacists recommended modifications for 32.4% of MRPs, with 92.2% physician acceptance. Discontinuation (59.2%) was the most common modification, often due to lack of indication or ADRs. Significant predictors for modification included age ≥85 years [adjusted odds ratio (aOR)=2.34], ≥20 medications (aOR=2.46), and use of anticholinergics, multiple oral hypoglycemics, duplicate gastrointestinal agents/proton pump inhibitors or antidementia agents, and certain antidepressants/corticosteroids.

Conclusion: Hospital-based multidisciplinary teams effectively identify and rectify MRPs in older Korean adults with polypharmacy. Targeting interventions towards high-risk subgroups (very elderly, high medication count, specific drugs) could optimize PMP efficiency. Long-term clinical and economic outcome studies are needed.

Purpose: Recently, the steatosis-associated fibrosis estimator (SAFE) score was developed to predict significant fibrosis in primary care. We externally validated the SAFE score in Asian patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Materials and methods: We validated the SAFE score in 6229 patients who underwent transient elastography (TE) from 2012 to 2022. The sensitivities, specificities, negative predictive values, and positive predictive values of SAFE scores (two cutoffs: <0 and ≥100) for predicting fibrosis stage ≥2 were calculated.

Results: Based on TE results, the SAFE score had an area under the receiver operating characteristic curve of 0.753 (95% confidence interval 0.737-0.769), outperforming the Fibrosis-4 index (0.672) and the nonalcoholic fatty liver disease fibrosis score (0.663). Non-obese and obese patients had similar sensitivities (77.0% vs. 78.4%) and specificities (61.5% vs. 51.8%) for SAFE score <0, and similar sensitivities (50.0% vs. 50.0%) and specificities (90.1% vs. 85.4%) for SAFE score ≥100. Sensitivity of the SAFE score for ≥100 increased with age, from 16.1% (age 19-30) to 79.7% (age ≥61), whereas specificity for ≥100 decreased.

Conclusion: We externally validated the good performance of the SAFE score in Asian patients. The SAFE score has potential as an initial assessment to identify a low-risk population in a primary care setting.

Purpose: Takayasu arteritis (TAK) and extracranial large-vessel (LV) giant cell arteritis (GCA) share overlapping features, making differential diagnosis between the two diseases challenging. We aimed to identify LV involvement patterns that could accurately differentiate TAK and GCA.

Materials and methods: This retrospective cohort study included 181 patients (TAK, n=175; GCA, n=6). LV involvement patterns were assessed using computed tomography (CT) and/or ¹⁸F-fluorodeoxyglucose positron emission tomography/CT performed at diagnosis. A multivariable logistic regression model was used to identify LV involvement patterns that accurately distinguish TAK and GCA. Area under the curve (AUC) was estimated to determine the accuracy.

Results: The right subclavian artery (30.3% vs. 83.3%, p=0.013), aortic arch (13.7% vs. 83.3%, p<0.001), descending aorta (30.3% vs. 100.0%, p=0.001), and abdominal aorta (30.9% vs. 83.3%, p=0.015) were less commonly involved in TAK than in GCA. When categorized according to Hata's classification and clusters, type V (31.4% vs. 83.3%, p=0.016) and cluster 5 (2.3% vs. 83.3%, p<0.001) were less common in TAK than in GCA. Type V demonstrated an AUC of 0.760, whereas cluster 5 showed higher accuracy (AUC=0.905) in distinguishing TAK and GCA. A combination of right subclavian artery and aortic arch involvement (2.358 × right subclavian artery involvement+3.385 × aortic arch involvement; cut-off=2.872), derived from the multivariable logistic regression model, yielded the highest accuracy (AUC=0.925).

Conclusion: Distinct patterns of LV involvement, particularly aortic arch involvement, either alone or combined with right subclavian artery involvement, could accurately differentiate TAK and GCA.