Dual-isotope imaging method for Actinium-225 and Bismuth-213 using alpha imaging detector

Recently, 225Ac has received considerable attention for its use in targeted alpha therapy because it has a relatively long half-life and yields four more alpha-particles from the daughter nuclides. The performance evaluation should separately assess the distribution of 225Ac and 213Bi because daughter nuclides, including 213Bi, can cause renal toxicity, which may hinder the widespread use of 225Ac for targeted alpha therapy. In this study, we describe and validate a spectrum decomposition method for dual-isotope imaging of 225Ac and 213Bi using an alpha imaging detector. We implemented an experiment to demonstrate the feasibility of using the alpha imaging detector to obtain distribution images using therapeutic amounts of 225Ac. In addition, we designed and conducted a Monte Carlo simulation under realistic conditions based on the experimental results to evaluate the spectrum decomposition method for dual-isotope imaging. The alpha imaging detector exhibited a detection efficiency of 18.5% and an energy resolution of 13.4% at 5.5 MeV. In the simulation, the distributions of 225Ac and 213Bi were obtained in each region with a relative error of 5%. The results of this study confirmed the feasibility of the dual-isotope imaging method for discriminating alpha-emitters using small amounts of 225Ac.

Risk Stratification of Cardiovascular Disease according to Age Groups in New Prevention Guidelines: A Review

Age is a strong risk factor for cardiovascular disease. Accordingly, most cardiovascular risk prediction models have included age as an independent risk factor. There is much evidence that effective management of cardiovascular risk factors improves clinical outcomes even in older adults. However, there are concerns that intensive treatment for older adults increases the risk of adverse events. For hypertensive patients, intensive blood pressure reduction with combination therapy increases the risk of syncope, acute kidney injury, and falls. Intensive glucose-lowering therapy among older patients with diabetes increases the risk of hypoglycemia or cognitive impairment. These findings suggest that a balanced approach for older adults is required to increase the benefits and decrease the risk of side effects. In contrast to older people, the estimated 10-year cardiovascular risk in young and healthy individuals is low. However, the lifetime cardiovascular risk in these patients is actually high. The 2021 European Society of Cardiology guideline on cardiovascular disease prevention in clinical practice has been published. It proposed a different risk stratification and recommendation for treatment according to age group, based on the concept of avoiding undertreatment in young people and overtreatment in older persons. Although the guideline recommends age-dependent risk stratification, risk categories should not be applied to the mandatory initiation of drug treatment. In all age groups, other factors such as lifetime cardiovascular risk, treatment benefit and harm, comorbidities, frailty, and patient preferences should be considered when managing patients for primary prevention.

The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension

Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.

Impact of malnutrition evaluated by the mini nutritional assessment on the prognosis of acute hospitalized older adults

Background

Malnutrition is prevalent among hospitalized older patients. Therefore, this study aimed to investigate the association between nutritional status [assessed using the Mini Nutritional Assessment (MNA) and serum albumin levels] and adverse outcomes in hospitalized older patients. We also aimed to compare the predictive utility of our findings.

Methods

This retrospective cohort study was conducted between January 2016 and June 2020. In total, 808 older patients (aged ≥ 65 years, mean age 82.8 ± 6.70 years, 45.9% male) admitted to the acute geriatric unit were included in our sample. Comprehensive geriatric assessments, including the MNA, were performed. Malnutrition and risk of malnutrition were defined as MNA < 17, albumin < 3.5 g/dL and 17 ≤ MNA ≤ 24, 3.5 g/dL ≤ albumin < 3.9 g/dL, respectively. The primary outcome was that patients could not be discharged to their own homes. The secondary outcomes were overall all-cause mortality, 3-month all-cause mortality, and incidence of geriatric syndrome, including delirium, falls, and newly developed or worsening pressure sores during hospitalization.

Results

Poor nutritional status was associated with older age; female sex; admission from the emergency room; high risk of pressure sores and falls; lower physical and cognitive function; higher depressive score; and lower serum albumin, protein, cholesterol, and hemoglobin levels. In the fully adjusted model, malnutrition assessed using the MNA predicted discharge to nursing homes or long-term care hospitals [odds ratio (OR) 5.822, 95% confidence interval (CI): 2.092-16.199, P = 0.001], geriatric syndrome (OR 2.069, 95% CI: 1.007-4.249, P = 0.048), and 3-month mortality (OR 3.519, 95% CI: 1.254-9.872, P = 0.017). However, malnutrition assessed using albumin levels could only predict 3-month mortality (OR 3.848, 95% CI: 1.465-10.105, P = 0.006). The MNA predicted 3-month mortality with higher precision than serum albumin levels (P = 0.034) when comparing the areas under the receiver operating characteristic curve.

Conclusion

Nutritional risk measured by the MNA was an independent predictor of various negative outcomes in hospitalized older patients. Poor nutritional status assessed by serum albumin levels, the most widely used biochemical marker, could predict mortality, but not the development of geriatric syndrome or discharge location reflecting functional status.

Long-term cardiovascular events in hypertensive patients: full report of the Korean Hypertension Cohort

BACKGROUND/AIMS

This study evaluated the long-term cardiovascular complications among Korean patients with hypertension and compared them with that of controls without hypertension.

METHODS

The Korean Hypertension Cohort (KHC) enrolled 11,043 patients with hypertension and followed them for more than 10 years. Age- and sex-matched controls without hypertension were enrolled at a 1:10 ratio. We compared the incidence of cardiovascular events and death among patients and controls without hypertension.

RESULTS

The mean age was 59 years, and 34.8% and 16.5% of the patients belonged to the high and moderate cardiovascular risk groups, respectively. During the 10-year follow-up, 1,591 cardiovascular events (14.4%) with 588 deaths (5.3%) occurred among patients with hypertension and 7,635 cardiovascular events (6.9%) with 4,826 deaths (4.4%) occurred among controls. Even the low-risk population with hypertension showed a higher cardiovascular event rate than the population without hypertension. Although blood pressure measurements in the clinic showed remarkable inaccuracy compared with those measured in the national health examinations, systolic blood pressure (SBP) ≥ 150 mmHg was significantly associated with a higher risk of cardiovascular events.

CONCLUSION

This long-term follow-up study confirmed the cardiovascular event rates among Korean hypertensive patients were substantial, reaching 15% in 10 years. SBP levels ≥ 150 mmHg were highly associated with occurrence of cardiovascular event rates.

A randomized, double-blind, multicenter, phase III study on the efficacy and safety of a combination treatment involving fimasartan, amlodipine, rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy

Background

To assess the efficacy and safety of a combination therapy involving fimasartan, amlodipine, and rosuvastatin in patients with essential hypertension and dyslipidemia who fail to respond to fimasartan monotherapy.

Methods

This phase III, randomized, double-blind, multicenter study was conducted in adults aged 19–70 years. Patients who voluntarily consented were screened for eligibility to enroll in the study. Patients who failed to respond to 4 weeks of fimasartan monotherapy were randomized with a 1:1:1 ratio to the fimasartan 60 mg/amlodipine 10 mg + rosuvastatin 20 mg (FMS/ALD + RSV) as study group, fimasartan 60 mg/amlodipine 10 mg (FMS/ALD) as control 1 group, and fimasartan 60 mg + rosuvastatin 20 mg (FMS + RSV) as control 2 group. The primary efficacy endpoints were the change in the sitting systolic blood pressure and the rate of change in the low-density lipoprotein cholesterol (LDL-C) level from baseline to 8 weeks. The adverse events, adverse drug reactions, physical examination findings, laboratory test results, electrocardiograms, and vital signs were evaluated to assess safety in the study.

Results

Of 138 randomized patients, 131 were conducted efficacy analysis, and 125 completed the study. For the change in LDL-C and sitting SBP (SiSBP) as primary efficacy assessments, the change in LDL-C at week 8 was significantly reduce in the FMS/ALD + RSV group than in the control 1 group (P < 0.001). The change in SiSBP at week 8 were greater reduce in the FMS/ALD + RSV group than in the FMS + RSV group (both P < 0.001). For the safety evaluation, there were no differences among the treatment groups in the incidence of adverse drug reactions.

Conclusions

The fimasartan/amlodipine + rosuvastatin combination therapy can effectively and safely lower blood pressure and improve lipid levels in patients with essential hypertension and dyslipidemia who fail to respond adequately to fimasartan monotherapy.

Trial registration

NCT03156842, Registered 17 May 2017

Optimal blood pressure target in the elderly: rationale and design of the HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial

BACKGROUND/AIMS

The optimal systolic blood pressure (SBP) goal for elderly patients with hypertension, especially to reduce cardiovascular disease (CVD) incidence and improve outcome, is unclear. This study aimed to evaluate the beneficial effects of intensive treatment for hypertension on the incidence of CVD in elderly Korean patients.

METHODS

The HOW to Optimize eLDerly systolic Blood Pressure (HOWOLD-BP) trial is a multicenter, parallel-design, open-label, randomized controlled trial designed to evaluate whether intensive treatment (SBP ≤ 130 mmHg) will provide more benefits in lowering the incidence and mortality associated with CVD than standard treatment (SBP ≤ 140 mmHg) in elderly patients with hypertension aged ≥ 65 years. For this study, eleven university hospitals in Korea will enroll approximately 3,176 elderly patients with hypertension between 2019 and 2022. Patients will be requested to visit the clinic every 4 months for the first year and every 6 months thereafter for 36 months. Parameters, including clinic and home blood pressure, anthropometric and laboratory findings, and frailty assessments, will be collected according to the standardized protocol. The primary outcome is a composite of CVD (acute coronary syndrome, stroke, and heart failure) incidence and cardiovascular deaths.

RESULTS

As of December 2021, 1,655 participants had been enrolled in the study, including 831 patients in the standard group and 824 patients in the intensive group.

CONCLUSION

The HOWOLD-BP trial is the first study performed in Korea to evaluate the beneficial effects of intensive blood pressure treatment on CVD in elderly patients with hypertension. The results of this study will help clarify the appropriate target SBP for this population.

Blood Pressure Target in Type 2 Diabetes Mellitus

The prevalence of diabetes mellitus continues to increase worldwide, and it is a well-established cardiovascular risk factor. Hypertension is also an important cardiovascular risk factor to be controlled and is common among patients with diabetes mellitus. Optimal blood pressure (BP) goals have been the subject of great debate in the management of hypertension among patients with diabetes mellitus. This review provides detailed results from randomized controlled trials and meta-analyses of clinical outcomes according to the target BP in patients with type 2 diabetes mellitus. In addition, the target BP in patients with diabetes mellitus recommended by different guidelines was summarized and presented. A target BP of <140/90 mm Hg is recommended for patients with hypertension and diabetes mellitus, and BP should be controlled to <130/80 mm Hg in patients with diabetes mellitus who have high-risk clinical features. We hope that this review will be helpful to clinicians and patients by promoting the understanding and appropriate application of BP control in the comprehensive management of patients with diabetes mellitus.

Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea

BACKGROUND/AIMS

Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs.

METHODS

This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated.

RESULTS

Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS.

CONCLUSION

Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/ benefit relationship for their use should be considered.

Analysis of blood pressure and blood pressure variability pattern among older patients in long-term care hospitals: an observational study analysing the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) dataset

OBJECTIVES

There are limited data regarding blood pressure (BP) variability among older adults living in long-term care hospitals (LTCHs). We aimed to collect data from LTCH and analyse BP characteristics and its variability among these patients using a novel platform.

METHODS

The Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) platform was used to construct a daily BP dataset using data of 394 older patients from 6 LTCHs. BP variability was expressed as coefficient of variation (CV = standard deviation/mean of BP × 100). Physical frailty and cognitive function were evaluated using the K-FRAIL questionnaire and the Cognitive Performance Scale of the interRAI Long-Term Care Facilities tool, respectively.

RESULTS

From September 2019 to September 2020, 151,092 BP measurements, 346.5 (IQR 290.8-486.3) measurements per patient, were included. The mean BP was 123.4 ± 10.8/71.3 ± 6.5 mmHg. BP was significantly lower in frail patients (122.2 ± 11.3/70.4 ± 6.8 mmHg) than in pre-frail/robust patients (124.4 ± 10.4/72.1 ± 6.1 mmHg, P < 0.05). However, CV of systolic (10.7 ± 2.3% versus 11.3 ± 2.3%, P = 0.005) and diastolic (11.6 ± 2.3% versus 12.4 ± 2.4%, P < 0.001) BP was higher in frail patients. The mean BP was lower, but BP variability was higher in patients with cognitive impairment. The mean BP, but not BP variability, was higher in treated hypertensive patients, as the number of antihypertensive medications increased.

CONCLUSION

Older patients with physical or cognitive frailty had lower BP but higher BP variability. Relationship among frailty, increased BP variability and adverse clinical outcomes should be investigated.

Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-Angiotensin-Aldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.

Development of Health-RESPECT: An Integrated Service Model for Older Long-Term Care Hospital/Nursing Home Patients Using Information and Communication Technology

BACKGROUND

Korea, as one of the fastest-aging countries worldwide, requires an improved healthcare service model for older adults. We evaluated the current healthcare system and developed a service model based on information and communication technologies (ICT) for use in older patients in long-term care facilities (LTCF).

METHODS

We conducted a qualitative literature review, focus group interviews (FGIs), and structured survey to identify the current technology use and status of healthcare systems. We then developed a web-based platform with necessary, high-priority, and usable content for the care of older patients in LTCF.

RESULTS

We reviewed 60 (23 hypertension, 18 diabetes, and 19 heart failure) articles on information and communication technologies (ICT)-based disease management for clinical effectiveness and improved patient satisfaction. FGIs and structured surveys were used to evaluate the inconvenience in patient and medical information transfer between hospitals and cost and time required for its process. Accordingly, we confirmed the unmet need for an ICT-based service model for management, monitoring, and consultation among older patients and developed the Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT), a service platform for older patients residing in LTCF. The medical information exchange system was used to transfer medical information. Health-RESPECT includes an established algorithm for evidence-based comprehensive geriatric assessment and customized management; chronic disease management; management of potentially inappropriate medications; rehabilitation; and consultation and videoconferencing.

CONCLUSION

This study identified the current status and unmet needs of healthcare systems for older adults. We developed an ICT-based system to manage older institutionalized patients. However, the Health-RESPECT service model requires further validation.

Adaptive Information Visualization for Maritime Traffic Stream Sensor Data with Parallel Context Acquisition and Machine Learning

Excessive information significantly increases the mental burden on operators of critical monitoring services such as maritime and air traffic control. In these fields, vessels and aircraft have sensors that transmit data to a control center. Because of the large volume of collected data, it is infeasible for monitoring stations to display all of the information on monitoring screens that have limited sizes. This paper proposes a method for automatically selecting maritime traffic stream data for display from a large number of candidates in a context-aware manner. Safety is the most important concern in maritime traffic control, and special care must be taken to avoid collisions between vessels at sea. It presents an architecture for an adaptive information visualization system for a maritime traffic control service. The proposed system adaptively determines the information to be displayed based on the safety evaluation scores and expertise of vessel traffic service operators. It also introduces a method for safety context acquisition to assess the risk of collisions between vessels, using parallel and distributed processing of maritime stream data transmitted by sensors on the vessels at sea. It provides an information-filtering, knowledge extraction method based on the work logs of traffic service operators, using a machine learning technique to generate a decision tree. We applied the proposed system architecture to a large dataset collected at a port. Our results indicate that the proposed system can adaptively select traffic information according to port conditions and to ensure safety and efficiency.

ASSOCIATION BETWEEN GAIT SPEED MEASURED USING A WEARABLE DEVICE AND SARCOPENIA

As slow gait speed is a major feature of frailty and a diagnostic criterion of sarcopenia, gait speed measurement is widely used. Nowadays, with development of wearable devices, it is possible to measure daily-life gait speed without additional effort just by wearing the device. It is meaningful to measure daily-life gait speed and to analyze the association between the speed and sarcopenia. Participants were men over 50 years of age who visited the university hospital. Daily-life gait speed was checked using a smart belt (WELT) for 4 weeks. Afterwards, a survey about past medical history, usual gait speed measurement, handgrip strength measurement, and dual energy X-ray absorptiometry were performed. A total of 217,548 daily-life gait speed measurement data were analyzed for 106 participants. The mean daily-life gait speed was 1.23 ± 0.26 m/s. The mean age was 71.1 ± 7.6, and daily-life gait speed was significantly slower as people get older. (P<0.001) Additionally, weekday gait speed (1.23 ± 0.26 m/s) was significantly faster than weekend gait speed (1.22 ± 0.26 m/s). (P<0.001) Participants with sarcopenia (1.15 ± 0.25 m/s) had significantly slower mean daily-life gait speed than normal subjects (1.23 ± 0.26 m/s). (P<0.001) In analyzing factors related to gait speed, age and skeletal muscle mass of lower limbs were significantly associated with mean daily-life gait speed. Additional information about the gait speed can be obtained by measuring daily-life gait speed, and the daily-life gait speed has a significant association with the skeletal muscle mass of lower limbs.

MULTIDIMENSIONAL FRAILTY SCORE IS SUPERIOR TO PREDICT COMPLICATIONS AFTER SURGERY THAN CONVENTIONAL RISK FACTORS

Frail older adults are at increased risk for postoperative morbidity compared with their robust counterparts. We compared predictive utility of multidimensional frailty score (MFS) with physical performance parameters or conventional risk stratification indicators to identify postoperative complication in older surgical patients. From January 2016 to June 2017, 648 older surgical patients (age≥ 65) were included for analysis. The MFS was calculated through comprehensive geriatric assessment (CGA). Grip strength and gait speed were measured preoperatively. The primary outcome was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcome was 6-months all-cause mortality. Sixty-six (10.2%) patients experienced postoperative complications and 6-months mortality was 3.9% (n=25). Grip strength, gait speed, MFS and ASA classification could predict postoperative complication but only MFS (Hazard Ratio = 1.564, 95% CI, 1.283-1.905, p < 0.001) could predict 6-months mortality after full adjustment. MFS (C index = 0.747) had superior prognostic utility than age (0.638, p value = 0.008), grip strength (0.566, p value < 0.001) and ASA classification (0.649, p value = 0.004). MFS only had additive predictive value on both age (C-index of 0.638 (age) vs 0.754 (age +MFS), p = 0.001) and ASA classification (C index of 0.649 (ASA) to 0.762 (ASA + MFS), p < 0.001) for postoperative complication, but gait speed or grip strength had no statistical additive prognostic value on both age and ASA classification.

Immunogenicity of the Varicella-Zoster Vaccine in Community-Dwelling Non-robust Elderly Individuals Compared to Robust Elderly Individuals: A Prospective Cohort Study

To determine whether immunogenicity of the herpes zoster live-attenuated vaccine (ZVL) in elderly individuals is influenced by frailty status and cytokine levels, individuals aged at least 65 years were prospectively administered ZVL after their frailty status and cytokine levels were assessed. Humoral and cellular immunogenicity were assessed using enzyme-linked immunosorbent assays for the varicella-zoster virus–specific IgG antibody and varicella-zoster virus–specific enzyme-linked immunospot assays, before and 6 weeks after vaccination. We enrolled 69 participants (mean age, 74.3 years); 31 were non-robust. Thirty-seven participants had a greater than 2 geometric mean fold rise in IgG antibodies, 22 more participants had at least 10 spot-forming cells/106 peripheral blood mononuclear cells (from 35 to 57 participants), and 42 experienced a twofold geometric mean fold rise increase of spot-forming cells 6 weeks after vaccination. The geometric mean fold rises of the antibody titers were similar in the robust and non-robust groups; moreover, the baseline enzyme-linked immunospot assay geometric mean values were not significantly different before or 6 weeks after vaccination. We observed no significant correlations between baseline cytokine levels and immunogenicity. Approximately half of the community-dwelling elderly participants in this study experienced a twofold rise in antibodies and one-third more participants showed at least 10 spot-forming cells after ZVL administration, suggesting that the ZVL can boost immunity in non-robust (especially pre-frail) and robust elderly individuals.

Terminal Deoxynucleotidyl Transferase and T7 Exonuclease-Aided Amplification Strategy for Ultrasensitive Detection of Uracil-DNA Glycosylase

As one of the key initiators of the base excision repair process, uracil-DNA glycosylase (UDG) plays an important role in maintaining genomic integrity. It has been found that aberrant expression of UDG is associated with a variety of diseases. Thus, accurate and sensitive detection of UDG activity is of critical significance for biomedical research and early clinical diagnosis. Here, we developed a novel fluorescent sensing platform for UDG activity detection based on a terminal deoxynucleotidyl transferase (TdT) and T7 exonuclease (T7 Exo)-aided recycling amplification strategy. In this strategy, only two DNA oligonucleotides (DNA substrate containing one uracil base and Poly dT probe labeled with a fluorophore/quencher pair) are used. UDG catalyzes the removal of uracil base from the enclosed dumbbell-shape DNA substrate to give an apyrimidinic site, at which the substrate oligonucleotide is cleaved by endonuclease IV. The released 3'-end can be elongated by TdT to form a long deoxyadenine-rich (Poly dA) tail, which may be used as a recyclable template to initiate T7 Exo-mediated hybridization-digestion cycles of the Poly dT probe, giving a significantly enhanced fluorescence output. The proposed UDG-sensing strategy showed excellent selectivity and high sensitivity with a detection limit of 1.5 × 10^-4 U/mL. The sensing platform was also demonstrated to work well for UDG inhibitor screening and inhibitory activity evaluation, thus holding great potential in UDG-related disease diagnosis and drug discovery. The proposed strategy can be easily used for the detection of other DNA repair-related enzymes by simply changing the recognition site in DNA substrate and might also be extended to the analysis of some DNA/RNA-processing enzymes, including restriction endonuclease, DNA methyltransferase, polynucleotide kinase, and so on.

A natural infection by the red sea bream iridovirus-type Megalocytivirus in the golden mandarin fish Siniperca scherzeri

An outbreak of a Megalocytivirus infection was found in the golden mandarin fish Siniperca scherzeri during September and October 2016, in Korea. Phylogeny and genetic diversity based on the major capsid protein (MCP) and adenosine triphosphatase (ATPase) genes showed a new strain. Designated as GMIV, this strain derived from the golden mandarin fish was suggested to belong to the red sea bream iridovirus (RSIV)-subgroup I. Additionally, this train clustered with the ehime-1 strain from red sea bream Pagrus major in Japan and was distinguished from circulating isolates (RSIV-type subgroup II and turbot reddish body iridovirus [TRBIV] type) in Korea. The infection level, evaluated by qPCR, ranged from 8.18 × 102 to 7.95 × 106  copies/mg of tissue individually, suggesting that the infected fish were in the disease-transmitting stage. The diseased fish showed degenerative changes associated with cytomegaly in the spleen as general sign of Megalocytivirus infection. The results confirm that the RSIV-type Megalocytivirus might have crossed the environmental and species barriers to cause widespread infection in freshwater fish.

Real World Home Blood Pressure Variability in Over 56,000 Individuals With Nearly 17 Million Measurements

BACKGROUND

Using the data from 56,365 individuals, from 185 countries, and a Nokia Health Wireless blood pressure (BP) monitor, we investigated real-world characteristics of BP variability (BPV).

METHODS

All included individuals self-measured and uploaded their BP using Bluetooth at least 20 times over a period of ≥1 month at a frequency and duration of their choosing. In total, 16,904,844 BP measurements were analyzed, with a median of 146 measurements per person (interquartile range [IQR] 73-321) over a median of 14 months (IQR 7-31). SD, coefficient of variation, maximum BP, and maximum minus minimum BP difference were all calculated as measures of BPV.

RESULTS

BPV showed a distinct pattern, influenced by season of year, day of week, and time of day. BPV index was higher in females compared with males (P < 0.001) and increased with age (P < 0.001). Compared to the weekend, the weekday BPV index was significantly higher, and this finding was more prominent in females (P = 0.001). In multivariate analysis, BPV index were significantly associated with age, gender, geographic location, and mean BP values.

CONCLUSION

Using the largest BP data set we are aware of, with the benefits and limitations of real-world measurement, we could show the pattern of BPV and provide reference values that may be helpful in understanding the nature of BPV as self-measurement at home becomes more common, and help guide individualized management.

Comparison of mode of failure between primary and revision total knee arthroplasties

INTRODUCTION

Cognizance of common reasons for failure in primary and revision TKA, together with their time course, facilitates prevention. However, there have been few reports specifically comparing modes of failure for primary vs. revision TKA using a single prosthesis. The goal of the study was to compare the survival rates, modes of failure, and time periods associated with each mode of failure, of primary vs. revision TKA.

HYPOTHESIS

The survival rates, modes of failure, time period for each mode of failure, and risk factors would differ between primary and revision TKA.

MATERIAL AND METHODS

Data from a consecutive cohort comprising 1606 knees (1174 patients) of primary TKA patients, and 258 knees (224 patients) of revision TKA patients, in all of whom surgery involved a P.F.C^® prosthesis (Depuy, Johnson & Johnson, Warsaw, IN), was retrospectively reviewed. The mean follow-up periods of primary and revision TKAs were 9.2 and 9.8 years, respectively.

RESULTS

The average 10- and 15-year survival rates for primary TKA were 96.7% (CI 95%,±0.7%) and 85.4% (CI 95%,±2.0%), and for revision TKA 91.4% (CI 95%,±2.5%) and 80.5% (CI 95%,±4.5%). Common modes of failure included polyethylene wear, loosening, and infection. The most common mode of failure was polyethylene wear in primary TKA, and infection in revision TKA. The mean periods (i.e., latencies) of polyethylene wear and loosening did not differ between primary and revision TKAs, but the mean period of infection was significantly longer for revision TKA (1.2 vs. 4.8 years, P=0.003).

DISCUSSION

Survival rates decreased with time, particularly more than 10 years post-surgery, for both primary and revision TKAs. Continuous efforts are required to prevent and detect the various modes of failure during long-term follow-up. Greater attention is necessary to detect late infection-induced failure following revision TKA.

LEVEL OF EVIDENCE

Case-control study, Level III.

High prevalence of betanodavirus barfin flounder nervous necrosis virus as well as red-spotted grouper nervous necrosis virus genotype in shellfish

Using two serially executed PCRs, the discriminative multiplex two-step RT-PCR (DMT-2 RT-PCR) following the detection seminested two-step RT-PCR (DSN-2 RT-PCR), we found a high frequency presence of BFNNV genotype as well as RGNNV in various domestic and imported shellfish. This was definitely different from the previous reports of outbreaks and asymptomatic infection only by the RGNNV genotype in cultured finfish in Korea. Cultivation of NNV entrapped in shellfish was performed successfully by a blind passage. Thus, in an attempt to elucidate the epidemiology of betanodavirus, experiments conducted on 969 shellfish samples concluded that (i) distribution of NNV genotype, especially BFNNV, in shellfish is clearly different from that found in finfish of the world; (ii) unlike RGNNV, which showed a high rate in summer, BFNNV showed no seasonal variation and this result suggests BFNNVs in the marine environment remain fairly constant throughout the year; and (iii) the entrapped virus in shellfish was alive and culturable in vitro. These results are the first report of high level prevalence of in vitro culturable NNV in shellfish, for both BFNNV and RGNNV, which may present a potential risk in transmitting nodaviruses to host species in a marine environment.

Dual enzyme-assisted one-step isothermal real-time amplification assay for ultrasensitive detection of polynucleotide kinase activity

A novel, simple, one-step and one-tube detection method for polynucleotide kinase (PNK) activity based on isothermal real-time amplification assay was proposed.

Mid-term outcomes and complications of total knee arthroplasty in haemophilic arthropathy: A review of consecutive 131 knees between 2006 and 2015 in a single institute

INTRODUCTION

Although total knee arthroplasty (TKA) in haemophilic arthropathy can reduce severe joint pain and improve functional disability, it is technically demanding.

AIM

To evaluate mid-term outcomes and complications of TKA in haemophilic arthropathy.

METHODS

This study retrospectively reviewed 131 consecutive primary TKAs in a single institute. The mean age was 41.0 years old, and the mean follow-up period was 6.8 years. Clinical and radiographic results were evaluated. Complications were categorized according to the classification system of the Knee Society for TKA complications.

RESULTS

The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score improved from 66.0 to 24.2. The average flexion contracture significantly decreased from 17.3° to 4.7°, but the average pre- and postoperative maximum flexion did not differ (80.9° vs 85.6°, respectively). The average mechanical axis was varus 5.2° preoperatively and valgus 0.3° postoperatively. The coronal positions of the femoral and tibial components and the sagittal positions of these components were within ±3° in 83.2%, 89.3%, 63.4% and 73.3% of cases, respectively. Complications occurred in 17 knees (13.0%): hemarthrosis (n = 7), medial collateral ligament injury (n = 1), stiffness (n = 2), deep periprosthetic joint infection (PJI) (n = 3) and periprosthetic fracture (n = 4).

CONCLUSIONS

The mid-term results of TKA in haemophilic arthropathy were satisfactory in pain relief, improved function and decreased flexion contracture. Bleeding and PJI continue to be major concerns for TKA in haemophilic arthropathy, and risk of periprosthetic fracture must be taken into account for patient education and appropriate prevention.

Abstract P376: Impact of Selected Differences Between Automated versus Conventional Office Blood Pressure and Adherence on the Prevalence of SPRINT Eligibility in Korean Population

Background: For the applicability of Systolic Blood Pressure (BP) Intervention Trial (SPRINT) is controversial due to regional cardiovascular (CV) risk stratification system, AHM adherence, and the automated office BP (AOBP) methodology.

Method: General population aged 30 or more (n=205282) and 55208 hypertension subject in Korean National Health Insurance Service - National Sample Cohort (NHIS-NSC) 2010 data were analyzed. Three BP criteria 1, 2, and 3 according to the selected difference between office BP and AOBP of 0 mmHg, 5 mmHg, and 10 mmHg, respectively. Also according to the risk groups and adherence status, prevalence of SPRINT eligible subjects were investigated.

Results: SPRINT eligibility subjects were observed in 6.5[6.4~6.7]% vs 5.6[5.5~5.7]% in the general population 15.9[15.7~16.0]% vs 14.8[14.7~15.0]% in hypertension patients by KSH vs. FRS, respectively ([ ], 95% confidence interval). According to BP criteria 1 to 3, SPRINT eligibilities by KSH were different significantly in the general population (6.5[6.4~6.7]%, 4.0[3.9~4.1]%, and 2.7[2.6~2.7]%, respectively) and in hypertension patients (15.9[15.7~16.0]%, 11.8[11.7~12.0]%, and 9.9[9.8~10.0]%, respectively). When the SPRINT eligibility was allowed only in PDC >= 300 days per year in hypertension patients, the prevalence according to the BP criteria 1 to 3 were 8.0[7.7~8.2]%, 5.4[4.3~4.7]%, and 4.1[3.9~4.2]%, respectively by KSH and 8.1[7.8~8.3]%, 5.7[5.5~5.9]%, and 4.4[4.3~4.6]%, respectively by FRS.

Conclusion: SPRINT eligibility can be markedly differed not by the risk stratification systems but by the application of AOBP to conventional office BP and adherence.

Frailty as a Predictor of Acute Kidney Injury in Hospitalized Elderly Patients: A Single Center, Retrospective Cohort Study

BACKGROUND

Elderly patients have an increased risk for acute kidney injury (AKI). However, few studies have reported on predictors for AKI in geriatric patients. Therefore, we aimed at determining the effect of frailty as a predictor of AKI.

METHODS

We retrospectively enrolled 533 hospitalized elderly patients (aged ≥ 65 years) who had their creatinine levels measured (≥ 1 measurement) during admission for a period of 1 year (2013) and conducted a comprehensive geriatric assessment (CGA) within 1 year before the index hospitalization. We examined five variables (activity of daily living [ADL] and instrumental ADL dependence, dementia, nutrition, and polypharmacy) from CGA. We categorized the patients into 3 groups according to the tertile of aggregate frailty scores: Group 1, score 1-2; Group 2, score 3-4; Group 3, score 5-8).

RESULTS

Fifty-four patients (10.1%) developed AKI (median duration, 4 days). The frailest group (Group 3) showed an increased risk of AKI as compared to Group 1, (hazard ratio [HR] = 3.536, P = 0.002). We found that discriminatory accuracy for AKI improved with the addition of the tertile of aggregate frailty score to covariates (area under the receiver operator characteristics curves [AUROC] 0.641, AUROC 0.739, P = 0.004). Forty-six patients (8.6%) were transferred to nursing facilities and 477 patients (89.5%) were discharged home. The overall 90-day and 1-year mortality for elderly inpatients were 7.9% and 26.3%. The frailest group also demonstrated an increased risk of discharge to nursing facilities, and 90-day and 1-year mortality as compared to Group 1, independent of AKI severity (nursing facilities: odd ratio = 4.843, P = 0.002; 90-day mortality: HR = 6.555, P = 0.002; 1-year mortality: HR = 3.249, P = 0.001).

CONCLUSIONS

We found that frailty may independently predict the development of AKI and adverse outcomes in geriatric inpatients.

The Korean version of the FRAIL scale: clinical feasibility and validity of assessing the frailty status of Korean elderly

BACKGROUND/AIMS

The fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale is a screening tool for frailty status using a simple 5-item questionnaire. The aim of this study was to evaluate the clinical feasibility and validity of the Korean version of the FRAIL (K-FRAIL) scale.

METHODS

Questionnaire items were translated and administered to 103 patients aged ≥ 65 years who underwent a comprehensive geriatric assessment at the Seoul National University Bundang Hospital. In this cross-sectional study, the K-FRAIL scale was compared with the domains and the multidimensional frailty index of the comprehensive geriatric assessment. We also assessed the time required to complete the scale.

RESULTS

The participants' mean age was 76.8 years (standard deviation [SD], 6.1), and 55 (53.4%) were males. The mean overall frailty index was 0.19 (SD, 0.17). For K-FRAIL-robust, prefrail, and frail patients, the mean frailty indices were 0.09, 0.18, and 0.34, respectively (p for trend < 0.001). A higher degree of impairment in the K-FRAIL scale was associated with worse nutritional status, poor physical performance, functional dependence, and polypharmacy. The number of items with impairment in the K-FRAIL scale was positively associated with the frailty index (B = 3.73, p < 0.001). The K-FRAIL scale could differentiate vulnerability from robustness with a sensitivity of 0.90 and a specificity of 0.33. Of all patients, 75 (72.8%) completed the K-FRAIL scale within < 3 minutes.

CONCLUSIONS

The K-FRAIL scale is correlated with the frailty index and is a simple tool to screen for frailty in a clinical setting.

A New Equation to Estimate Muscle Mass from Creatinine and Cystatin C

Background

With evaluation for physical performance, measuring muscle mass is an important step in detecting sarcopenia. However, there are no methods to estimate muscle mass from blood sampling.

Methods

To develop a new equation to estimate total-body muscle mass with serum creatinine and cystatin C level, we designed a cross-sectional study with separate derivation and validation cohorts. Total body muscle mass and fat mass were measured using dual-energy x-ray absorptiometry (DXA) in 214 adults aged 25 to 84 years who underwent physical checkups from 2010 to 2013 in a single tertiary hospital. Serum creatinine and cystatin C levels were also examined.

Results

Serum creatinine was correlated with muscle mass (P < .001), and serum cystatin C was correlated with body fat mass (P < .001) after adjusting glomerular filtration rate (GFR). After eliminating GFR, an equation to estimate total-body muscle mass was generated and coefficients were calculated in the derivation cohort. There was an agreement between muscle mass calculated by the novel equation and measured by DXA in both the derivation and validation cohort (P < .001, adjusted R² = 0.829, β = 0.95, P < .001, adjusted R² = 0.856, β = 1.03, respectively).

Conclusion

The new equation based on serum creatinine and cystatin C levels can be used to estimate total-body muscle mass.

Aminoacyl-tRNA synthetase interacting multi-functional protein 1 attenuates liver fibrosis by inhibiting TGFβ signaling

The aminoacyl-tRNA synthetase interacting multi-functional protein 1 (AIMP1) participates in a variety of cellular processes, including translation, cell proliferation, inflammation and wound healing. Previously, we showed that the N-terminal peptide of AIMP1 (6-46 aa) induced ERK phosphorylation. Liver fibrosis is characterized by excessive deposition of extracellular matrix, which is induced by TGFβ signaling, and activated ERK is known to induce the phosphorylation of SMAD, thereby inhibiting TGFβ signaling. We assessed whether the AIMP1 peptide can inhibit collagen synthesis in hepatic stellate cells (HSCs) by activating ERK. The AIMP1 peptide induced phosphorylation of SMAD2 via ERK activation, and inhibited the nuclear translocation of SMAD, resulting in a reduction of the synthesis of type I collagen. The AIMP1 peptide attenuated liver fibrosis induced by CCl4, in a dose-dependent manner. Masson-Trichrome staining showed that the AIMP1 peptide reduced collagen deposition. Immunohistochemical staining showed that the levels of α-SMA, TGFβ and type I collagen were all reduced by the AIMP1 peptide. Liver toxicity analysis showed that the AIMP1 peptide improved the levels of relevant biological parameters in the blood. These results suggest that AIMP1 peptide may have potential for development as a therapeutic agent to treat liver fibrosis.

Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group

BACKGROUND/AIMS

The detection of white coat hypertension (WCH), treated normalized hypertension, and masked hypertension (MH) is important to improve the effectiveness of hypertension management. However, whether global cardiovascular risk (GCR) profile has any effect on the discordance between ambulatory blood pressure (ABP) and clinic blood pressure (CBP) is unknown.

METHODS

Data from 1,916 subjects, taken from the Korean Multicenter Registry for ABP monitoring, were grouped according to diagnostic and therapeutic thresholds for CBP and ABP (140/90 and 135/85 mmHg, respectively). GCR was assessed using European Society of Hypertension 2007 guidelines.

RESULTS

The mean subject age was 54.1 ± 14.9 years, and 48.9% of patients were female. The discordancy rate between ABP and CBP in the untreated and treated patients was 32.5% and 26.5%, respectively (p = 0.02). The prevalence of WCH or treated normalized hypertension and MH was 14.4% and 16.0%, respectively. Discordance between ABP and CBP was lower in the very high added-risk group compared to the moderate added-risk group (odds ratio [OR], 0.649; 95% confidence interval [CI], 0.487 to 0.863; p = 0.003). The prevalence of WCH or treated normalized hypertension was also lower in the very high added-risk group (OR, 0.451; 95% CI, 0.311 to 0.655).

CONCLUSIONS

Discordance between ABP and CBP was observed more frequently in untreated subjects than in treated subjects, and less frequently in the very high added-risk group, which was due mainly to the lower prevalence of WCH or treated normalized hypertension.

2013 Korean Society of Hypertension guidelines for the management of hypertension: part III-hypertension in special situations

Different treatment strategies are suggested for special situations. Hypertension is common in the elderly and frequently accompanied by or complicates other clinical conditions such as metabolic syndrome, coronary artery disease, heart failure, stroke, diabetes mellitus and chronic kidney disease.

Identification of metabolites produced by Phanerochaete chrysosporium in the presence of amlodipine orotate using metabolomics

Pharmaceuticals are very useful in treating human diseases but they are excreted to the environment sometimes in their original form or as byproducts of human metabolism. Pharmaceuticals and their metabolites have been proven by studies to be harmful to non-target ecological species and may be persistent in different water matrices. In this regard, there is an emergent need to eliminate these compounds to prevent their adverse effects on aquatic species. Biodegradation using white-rot fungi is a promising technology for the removal of recalcitrant compounds; however, products of fungal biodegradation can also be detrimental. In this novel study, we evaluated the ability of Phanerochaete chrysosporium to degrade amlodipine, an anti-hypertensive drug which was recently found in water systems. Analysis of amlodipine metabolites was done using quadrupole time-of-flight liquid chromatography mass spectrometry after the degradation set-up of 120 hours. Pharmaceutical degradation was seen using triple quadrupole liquid chromatography tandem mass spectrometry. Ninety-two significant metabolites (P-value ≤ 0.05) were significantly expressed after false discovery rate adjustment at a significance threshold of q = 0.05. Pyridine derivatives which were identified from samples became the basis of the proposed degradation pathway of amlodipine in this study.

Frailty status can predict further lean body mass decline in older adults

OBJECTIVES

To assess whether frailty is a risk factor for skeletal muscle mass decline in community-dwelling elderly people.

DESIGN

Prospective observational cohort study.

SETTING

Seongnam, Gyeongi Province, Korea.

PARTICIPANTS

Community-dwelling Koreans aged 65 and older (n = 341).

MEASUREMENTS

Bioimpedance analysis (BIA) was used to measure body composition at baseline and 5 years later. Laboratory examination and comprehensive geriatric assessment were performed at both times. Lean mass index (LMI) was defined as total body lean mass/height(2). A decrease of more than 5% in the LMI was considered to be significant. Frailty status was defined using the Cardiovascular Health Study criteria.

RESULTS

LMI decline occurred in 196 (54.1%) subjects during the follow-up period (5.0 ± 0.7 years). Baseline LMI was highest in robust (17.6 ± 1.8 kg/m(2), n = 126), lower prefrail (17.0 ± 1.7 kg/m(2), n = 185), and lowest in frail (16.7 ± 1.3 kg/m(2), n = 30) subjects (P < .001). Frailty status was associated with LMI decline at 5-year follow-up (robust 0.81 ± 0.78 kg/m(2), prefrail 1.00 ± 0.92 kg/m(2), frail 1.35 ± 0.85 kg/m(2), P < .001). This effect of frailty on LMI decline persisted after adjusting for covariables (P = .02). The risk of significant LMI decline was 2.9 times as great in frail elderly adults as in those who were robust even after adjusting for covariates (95% confidence interval = 1.01-8.55).

CONCLUSION

Frailty status was found to be independently associated with subsequent LMI decline in community-dwelling older adults.

U-shape relationship of white blood cells with acute kidney injury and mortality in critically ill patients

Low or high counts of white blood cells (WBCs) and WBC subtypes can be a predictor of morbidity and mortality in several clinical settings. However, the correlations of WBC and its subtypes with acute kidney injury (AKI) and mortality remain unresolved in critically ill patients. The counts of WBC and subtypes, such as neutrophil, lymphocyte, monocyte, and eosinophil, were measured in 2,079 patients admitted to the intensive care unit (ICU) from June 2004 through June 2010. The non-linear relationship between WBC counts and AKI risk was initially explored by a restricted cubic spline analysis. The odds ratios (ORs) for AKI and 1-year mortality were calculated after adjustment for multiple covariates. The relationship between WBC counts and AKI risk was U-shaped. Accordingly, we divided patients into quintiles according to the counts of WBC or subtypes. The 1(st) and 5(th) quintiles of WBC counts had greater ORs for AKI (1.42 and 2.05, respectively) and mortality (1.40 and 1.36, respectively) compared with the 3(rd) quintile. After stratification by WBC subtype, the 5(th) quintile of neutrophil counts and the 1(st) quintiles of lymphocyte and monocyte counts tended to have higher ORs for AKI (1.69, 1.40, and 1.77, respectively). For mortality, the 1(st) quintiles of neutrophil, lymphocyte, and eosinophil counts were associated with higher mortality compared with the 3(rd) quintile (the ORs were 1.48, 1.57, and 1.42, respectively). Both leukopenia and leukocytosis are associated with AKI and mortality risk in critically ill patients. This result may be attributable to the change in the subtype counts.

Multidimensional frailty score for the prediction of postoperative mortality risk

IMPORTANCE

The number of geriatric patients who undergo surgery has been increasing, but there are insufficient tools to predict postoperative outcomes in the elderly.

OBJECTIVE

To design a predictive model for adverse outcomes in older surgical patients.

DESIGN, SETTING, AND PARTICIPANTS

From October 19, 2011, to July 31, 2012, a single tertiary care center enrolled 275 consecutive elderly patients (aged ≥65 years) undergoing intermediate-risk or high-risk elective operations in the Department of Surgery.

MAIN OUTCOMES AND MEASURES

The primary outcome was the 1-year all-cause mortality rate. The secondary outcomes were postoperative complications (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission), length of hospital stay, and discharge to nursing facility.

RESULTS

Twenty-five patients (9.1%) died during the follow-up period (median [interquartile range], 13.3 [11.5-16.1] months), including 4 in-hospital deaths after surgery. Twenty-nine patients (10.5%) experienced at least 1 complication after surgery and 24 (8.7%) were discharged to nursing facilities. Malignant disease and low serum albumin levels were more common in the patients who died. Among the geriatric assessment domains, Charlson Comorbidity Index, dependence in activities of daily living, dependence in instrumental activities of daily living, dementia, risk of delirium, short midarm circumference, and malnutrition were associated with increased mortality rates. A multidimensional frailty score model composed of the above items predicted all-cause mortality rates more accurately than the American Society of Anesthesiologists classification (area under the receiver operating characteristic curve, 0.821 vs 0.647; P = .01). The sensitivity and specificity for predicting all-cause mortality rates were 84.0% and 69.2%, respectively, according to the model's cutoff point (>5 vs ≤5). High-risk patients (multidimensional frailty score >5) showed increased postoperative mortality risk (hazard ratio, 9.01; 95% CI, 2.15-37.78; P = .003) and longer hospital stays after surgery (median [interquartile range], 9 [5-15] vs 6 [3-9] days; P < .001).

CONCLUSIONS AND RELEVANCE

The multidimensional frailty score based on comprehensive geriatric assessment is more useful than conventional methods for predicting outcomes in geriatric patients undergoing surgery.

Treatment of distal femur fractures with locking plates: Comparison of periprosthetic fractures above total knee arthroplasty and non-periprosthetic fractures

The purpose of the present study was to compare the results and plate fit of periprosthetic and non-periprosthetic distal femur fractures fixed with locking plates. Twenty-one periprosthetic fractures above a TKA and 27 non-periprosthetic fractures were retrospectively reviewed. The primary healing rate, bone union time, clinical and radiographic results, complications, and additional surgeries were compared between the two groups. The quality of the plate fit on the bone was also compared. There were no differences in the primary healing rate, bone union time, clinical and radiographic results between the two groups. The incidence of overall complication and additional surgeries did not differ (3/21 vs. 5/27, 1/21 vs. 4/27). Plate fit trouble was observed more frequently in periprosthetic fractures (10/21 vs. 1/27, p = 0.004). Fixation of distal femur fractures with locking plates provided satisfactory results with a low risk of complications and additional surgeries in both periprosthetic and non-periprosthetic fractures.

Development of a swine bile duct dilation model using endoclips or a detachable snare under cap-assisted endoscopy

BACKGROUND

A reproducible large animal model of bile duct dilation for the preclinical testing of new biliary devices and for training endoscopic biliary intervention is required. Surgical methods are mainly used to produce large animal models of biliary obstruction.

OBJECTIVE

To develop an animal model of bile duct dilation using endoscopic methods and to compare the merits of endoclips and detachable snares for the obstruction of major duodenal papillae.

DESIGN

Proof of concept experimental study.

SETTINGS

Animal laboratory.

INTERVENTIONS

Endoscopic clipping of the major duodenal papilla or closure of the major duodenal papilla with a detachable snare.

MAIN OUTCOME MEASUREMENTS

Feasibility, efficacy, and safety of endoscopic methods to develop swine models with bile duct dilation were estimated by degree of dilation at the common bile duct (CBD), intrahepatic duct (IHD), and gallbladder (GB).

RESULTS

All animals survived until the end of the experiment. Clipping of the major duodenal papilla and closure of the major duodenal papilla with a detachable snare were performed successfully in all swine. No technical difficulty or adverse event occurred during the procedures. Biliary dilatations in all animals were observed on cholangiograms (mean Δ% of postprocedural and preprocedural maximum diameters: CBD, 301%; IHD, 223.5%; GB, 34.8%). Degree of bile duct dilation in the snare group tended to be greater (CBD, 367.3%; IHD, 298.3%; GB, 47.8%) than in the endoclip group (CBD, 234.7%; IHD, 148.7%; GB, 21.8%), but this difference was not significant. An analysis of degrees of dilation according to location in the biliary tree showed that the GB was not dilated as well as the CBD or IHD.

LIMITATIONS

Animal model.

CONCLUSION

The 2 endoscopic procedures described are effective and safe for creating a swine model of bile duct dilation and could be helpful for training biliary intervention and for endoscopic biliary studies.

Prevalence and outcomes of frailty in Korean elderly population: comparisons of a multidimensional frailty index with two phenotype models

BACKGROUND

Frailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model.

METHODS

We studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated.

RESULTS

The prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6 ± 0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04-4.35) and CHS index (OR = 2.24, 95% CI 1.05-4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68-3.01).

CONCLUSION

Prevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of frailty in the Korean elderly population.

Targeted inhibition of phosphatidyl inositol-3-kinase p110β, but not p110α, enhances apoptosis and sensitivity to paclitaxel in chemoresistant ovarian cancers

The phosphatidylinositol 3-kinase (PI3K) pathway is one of the critical signaling cascades playing important roles in the chemoresistance of human cancer cells, including ovarian cancer. In this study, we investigated the potential of targeting the PI3K p110β-isoform as a novel approach to overcome the chemoresistance in ovarian cancer. The effects on apoptosis, cell viability, proliferation and migration in chemoresistant ovarian cancer cell were determined following targeted p110β inhibition by small interfering RNA (siRNA). Seven paclitaxel (PTX)-resistant sublines (SKpacs and A2780pac) were produced from SKOV3 and A2780 ovarian cancer cell lines. We, first, evaluated the expression of PI3K p110 isoforms in chemosensitive and chemoresistant ovarian cancer cell lines and patient specimens, and found that p110β-isoform was significantly overexpressed both in a panel of ovarian cancer samples, and in PTX-resistant sublines compared with their parent cell lines. RNA interference-mediated p110β silencing augmented PTX-mediated apoptosis (31.15 ± 13.88 %) and reduced cell viability (67 %) in PTX-resistant cells, whereas targeting p110α did not show a significant change in cell viability and apoptosis. In addition, p110β silencing impaired cell proliferation (60 %) in PTX-resistant SKpac cells. We also found the combined treatment group with p110β siRNA and PTX showed a significant inhibition of tumor growth of SKpac cells compared to the PTX-only treated group in a xenograft nude mouse model. Thus, the siRNA-mediated silencing of PI3K p110β resensitizes PTX-resistant ovarian cancer cells, and may be a useful therapeutic strategy for PTX-resistant ovarian cancers.

Serum anion gap is predictive of mortality in an elderly population

An elevated serum anion gap is known to be associated with hypertension, low cardiorespiratory fitness, and decreased renal function. We evaluated whether serum AG might be predictive of elderly mortality in a community-based cohort in Korea. We analyzed the available data from 862 elderly people in the Korean Longitudinal Study on Health and Aging. Over a 5-year observational period, 151/862 (17.5%) participants died, and a high albumin-adjusted anion gap (SAAG) was associated with an increased risk of all-cause mortality in unadjusted analyses (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.41-2.71) and fully adjusted analyses (HR, 1.77; 95% CI, 1.24-2.52), compared with a low SAAG group. The population attributable fraction of death due to high SAAG was 38.2% (95% CI 20.7-58.2%). In particular, the participants with high SAAG had higher cardiovascular and infection-related mortality rates than those with low SAAG (HR, 2.11; 95% CI, 1.06-4.19, and HR, 9.69; 95% CI, 1.12-83.4, respectively). High SAAG may be an independent predictor of mortality and is associated with higher cardiovascular and infection related mortality in the elderly.

Efficacy and safety using autotransfusion system with postoperative shed blood following total knee arthroplasty in haemophilia

The purpose of this study was to evaluate the efficacy and safety of postoperative wound drain salvage and autotransfusion system in haemophilic patients undergoing elective total knee arthroplasty (TKA). No literature exists on reinfusing drained blood in patient with haemophilia undergoing TKA. Eighty-eight knees of 66 patients received cemented TKA due to end-stage haemophilic arthropathy (group I; with autotransfusion in 59 knees, group II; without autotransfusion in 29 knees). In group I, the postoperative shed blood was transfused within 6 h after surgery. The amount of blood drainage and reinfused blood, rate and amount of allogenic transfusion, postoperative change of haemoglobin level, prothrombin time (PT) and activated partial thromboplastin time were analysed. The mean postoperative blood drainage was 932 ± 479 mL in group I and 830 ± 492 mL in group II (P > 0.05). The mean volume of blood reinfused was 530 ± 265 mL in group I. Allogenic transfusion was needed in six knees (10.2%) of group I and eight knees (27.6%) of group II (P = 0.036). The mean volume of allogenic transfusion was 480 ± 49 mL in group I and 1041 ± 691 mL in group II (P > 0.05). Changes of all the laboratory results before and after TKA showed no statistically significant difference except PT was prolonged in group I (P = 0.008) at postoperative day 1. Moreover, there was no significant complication related to either reinfusion or allogenic transfusion in both groups. This study showed that reinfusion of drained blood is a simple, safe and efficacious method in patients with haemophilia undergoing TKA.

Comparison of chest digital tomosynthesis and chest radiography for detection of asbestos-related pleuropulmonary disease

AIM

To compare chest digital tomosynthesis (DTS) with digital radiography for the detection of asbestos-related pleuropulmonary disease.

MATERIALS AND METHODS

The institutional review board approved this study and all participants gave informed consent. Forty-five participants with a history of asbestos exposure were examined with DTS and radiography. Low-dose multidetector computed tomography (CT) in the prone position served as the reference. Two observers evaluated all images for the presence of pleural abnormalities and asbestosis. Interobserver agreement was analysed by using the k statistic. Diagnostic performance of the two imaging methods was compared using McNemar's test.

RESULTS

Interobserver agreement regarding DTS findings was moderate to very good (k = 0.544-0.846) and superior to the radiographic findings (k = 0.236-1.000). Overall, the diagnostic accuracy of DTS for the lesion detection was significantly better than with radiography (all p < 0.05, except that for the comparison of diagnostic accuracy of DTS versus radiographic detection of left diaphragmatic plaques and asbestosis). DTS was more sensitive than radiography for the detection of asbestosis (82% versus 27%, p = 0.031).

CONCLUSION

DTS is more accurate than radiography in the detection of pleural plaques and more sensitive than radiography in the detection of asbestosis. Interobserver agreements with respect to the DTS findings were superior to the radiographic findings.