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Objective: Intracerebral hemorrhage (ICH) accompanies higher mortality rates than other type of stroke. This study aimed to investigate the association between hospital volume and mortality for cases of ICH., Methods: We used nationwide data from 2013 to 2018 to compare high-volume hospitals (≥32 admissions/year) and low-volume hospitals (<32 admissions/year). We tracked patients' survival at 3-month, 1-year, 2-year, and 4-year endpoints. The survival of ICH patients was analyzed at 3-month, 1-year, 2-year, and 4-year endpoints using Kaplan-Meier survival analysis. Multivariable logistic regression analysis and Cox regression analysis were performed to determine predictive factors of poor outcomes at discharge and death., Results: Among 9086 ICH patients who admitted to hospital during 18-month period, 6756 (74.4%) and 2330 (25.6%) patients were admitted to high-volume and low-volume hospitals. The mortality of total ICH patients was 18.25%, 23.87%, 27.88%, and 35.74% at the 3-month, 1-year, 2-year, and 4-year, respectively. In multivariate logistic analysis, high-volume hospitals had lower poor functional outcome at discharge than low-volume hospitals (odds ratio, 0.80; 95% confidence interval, 0.72-0.91; p<0.001). In the Cox analysis, high-volume hospitals had significantly lower 3-month, 1-year, 2-year, and 4-year mortality than low-volume hospitals (p<0.05)., Conclusion: The poor outcome at discharge, short- and long-term mortality in ICH patients differed according to hospital volume. High-volume hospitals showed lower rates of mortality for ICH patients, particularly those with severe clinical status.

Pseudothrombocytopenia caused by platelet clumping (PC) can lead to unnecessary platelet transfusions or underdiagnosis of hematologic neoplasms. To overcome these limitations, we assessed the capacity of the Sysmex DI-60 digital morphology analyzer (Sysmex, Kobe, Japan) for detecting PC and determining an accurate platelet count in the presence of PC. For this purpose, 135 samples with or without PC (groups Y and N, respectively) were processed by an examiner (a hematologic specialist) using both the Sysmex XN-9000 and DI-60 analyzers. Although the platelet aggregate (PA) and giant platelet (GP) counts reported by the DI-60 and the examiner exhibited strong correlations, they proved inadequate as effective indicators for screening samples containing PC. Between the PA and GP counts and four platelet indices (the platelet distribution width [PDW], mean platelet volume [MPV], platelet large cell ratio [P&#95;LCR], and plateletcrit [PCT]) reported by the XN-9000, we observed statistically significant correlations (both overall and with group Y), but they were relatively weak. The platelet counts determined using the DI-60 and light microscopy in group Y showed substantial variations. Although the performance of the DI-60 was reliable for detecting PA and GP in smear images, such fixed areas are not representative of whole samples. Further, in the presence of PC, the resulting platelet counts determined using the DI-60 were not sufficiently accurate to be accepted as the final count.

Objectives: This study aimed to determine a definition for significant platelet clumping (PC) and evaluate the performance of the Sysmex XN instrument for detecting platelet clumps., Methods: For part 1, 372 specimens with a 'PLT&#95;clump?' flag in XN-9000 were classified into five groups according to the average number of PCs. We compared the initial platelet count (measured by XN-9000 using impedance method) and corrected platelet count (counted optically or re-analyzed by XN-9000 using vortexed or re-collected sample) of each group. For part 2, 1000 specimens with a PC flag divided into three subgroups {group N (PC = 0), Y (PC ≥ 1), and Z (microscopic fibrin clot)} and additional two groups {group S (PC(+) specimens without any flag and with flags of other categories) and group NC (negative control)} were collected. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of PC detection of XN-9000 were obtained and the platelet counts and four indices (PDW, MPV, P&#95;LCR, and PCT) of groups NC, N, Y, Z, and S were compared to detect PC more precisely., Results: In part 1, all groups showed significant difference between the initial and corrected platelet counts. In part 2, PPV, NPV, prevalence, sensitivity, and specificity were 41.5%, 56.5%, 43.4%, 2.18%, and 98.3%, respectively. The platelet counts and four indices showed statistical differences for detecting PCs, and especially PDW and P&#95;LCR were significantly smaller in group Z than group N or Y., Conclusions: We suggest the definition of significant PC by the presence of at least three platelets. In addition, utilizing platelet-related indices should be developed to improve the efficiency of the PC detection., (© 2024 The Author(s). International Journal of Laboratory Hematology published by John Wiley & Sons Ltd.)

Background and Objectives: With the global aging trend, the incidence of falls and hip fractures is projected to rise, leading to an increased associated burden. Over 90% of hip fractures result from falls, yet not all falls cause fractures, suggesting specific fall characteristics may contribute to hip fractures. This review provides insights into fragility hip fracture-related falls among the older adults, aiding in understanding and developing effective fall prevention strategies for this population., Methods: Searches encompassed PubMed, OVID, EMBASE, Cochrane Library, and Web of Science, supplemented by citation checks. We included non-randomized studies detailing characteristics of fragility hip fracture-related falls in the older individuals, with or without a non-hip fracture control. Evaluated fall characteristics included height, location, direction, time, mechanism, activity during the fall, hip impact, protective responses, walking aid use, and impact surface. Results were analyzed using a narrative synthesis approach. The quality of these studies was assessed using the revised Risk of Bias Assessment tool for Non-randomized Studies 2 (RoBANS2)., Results: A total of 30 articles were reviewed, comprising 23 non-case control and 7 case-control studies, with a mean age of 75.6 years. Studies presented varied details on fall characteristics. Hip-fracture related falls typically occur indoors at or around standing height during daytime, often involving sideways or backward motions with inadequate protective responses. Slipping is predominant, yet lost balance and weakness/collapse are notable. Walking precedes many falls, but stationary activities (lack of forward motion, changing positions, sitting or standing still, transfer) also contribute. Low usage of walking aids and impact on hard surfaces are common features of these falls., Conclusions: This review underscores fall characteristics associated with fragility hip fractures in older adults, highlighting features more aligned with age-related physical frailty than general falls. Such insights can guide healthcare providers in implementing tailored interventions to reduce hip fractures and related challenges., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

It has been reported that a scenario-based cognitive behavioral therapy mobile app including Todac Todac was effective in improving depression in the general public. However, no study has been conducted on whether Todac Todac is effective in dialysis patients. Therefore, this study was intended to determine whether the use of this app was effective in improving depression in dialysis patients. Sixty-five end-stage kidney disease patients receiving dialysis at Soonchunhyang University Cheonan Hospital were randomly assigned to the Todac Todac app program (experimental group) or an E-moods daily mood chart app program (control group) for 3 weeks. The degree of depression was measured before and after using the app.After the end of the 3-week program, a small but significant improvement was observed in the Trait anxiety (p < 0.05) and Beck depression index (p < 0.05) in E-moods group and DAS-K scores (p < 0.05) in Todac Todac group. However, no differences were seen in any parameters between the two groups. In addition, Todac Todac was not statistically more effective than the control intervention in the subgroup analysis. The Todac Todac, a scenario-based cognitive behavioral therapy mobile app, seemed to have a limited effect on improving depression in dialysis patients. Therefore, it is necessary to develop new tools to improve depression in dialysis patients., (© 2024. The Author(s).)

Objective: This study aimed to identify predictive biomarkers for unscheduled emergency department (ED) revisits within 24 hours of discharge in infants diagnosed with acute bronchiolitis (AB)., Methods: A retrospective observational study was conducted on infants diagnosed with AB who visited 3 emergency medical centers between January 2020 and December 2022. The study excluded infants with comorbidities, congenital diseases, and prematurity and infants who revisited the ED after 24 hours of discharge. Demographic data, vital signs, and laboratory results were collected from the medical records. Univariable and multivariable logistic regression analyses were performed on factors with P of less than 0.1 in univariable analysis. Receiver operator curve analysis was used to assess the accuracy of lactate measurements in predicting ED revisits within 24 hours of discharge., Results: Out of 172 participants, 100 were in the revisit group and 72 in the discharge group. The revisit group was significantly younger and exhibited higher lactate levels, lower pH values, and higher pCO 2 levels compared to the discharge group. Univariable logistic regression identified several factors associated with revisits. Multivariable analysis found that only lactate was a variable correlated with predicting ED revisits (odds ratio, 18.020; 95% confidence interval [CI], 5.764-56.334). The receiver operator curve analysis showed an area under the curve of 0.856, with an optimal lactate cutoff value of 2.15., Conclusion: Lactate value in infants diagnosed with AB were identified as a potential indicator of predicting unscheduled ED revisits within 24 hours of discharge. The predictive potential of lactate levels holds promise for enhancing prognosis prediction, reducing health care costs, and alleviating ED overcrowding. However, given the study's limitations, a more comprehensive prospective investigation is recommended to validate these findings., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The perovskite quantum dots (QDs) of CsPbX 3 (X = Cl, Br, I) exhibit exceptional photoluminescent properties, but their sensitivity to moisture and heat poses a challenge. This study presents a solvent-free synthesis approach for incorporating CsPbBr 3 perovskite QDs into zeolite A. The introduction of [Cs 8 PbBr 6 ] 4+ perovskite QDs into the zeolite framework resulted in a highly stable configuration, maintaining its initial luminescence properties even after being underwater or exposed to heat. The structure is determined by 3-dimensional single-crystal crystallography. Each octahedral PbBr 6 4- ion is surrounded by Cs + ions and [Cs 8 PbBr 6 ] 4+ perovskite QDs being formed at the 32% of the center of a large cavity. Further, [Na 12 CsBr 8 ] 5+ QDs are formed at the very center of another 46% large cavities by combining Cs + , Na + , and Br - ions. The peak in the emission spectrum of Pb,Br,Cs,Na-A is similar to those of the CsPbBr 3 nanocrystal, Cs 4 PbBr 6 0-dimensional perovskite QDs, and Pb,Br,H,Cs,Na-FAU(X and Y). This work demonstrates that Pb,Br,Cs,Na-A can be produced using a simplified solvent-free synthesis procedure, which exhibits excellent stability against moisture and heat. Moreover, through a straightforward process, various quantum dots (QDs) can be incorporated into zeolite cavities to develop materials with variety photoluminescent properties.

Objectives: This study aimed to compare the analgesic efficacy and safety of the femoral branch block of the genitofemoral nerve (FBB) versus local infiltration anesthesia (LIA) for femoral arterial access gain and closure., Methods: Eighty-two patients (age, 64.8 ± 10.9 years; female, 30.5%) undergoing endovascular procedures using 5-Fr femoral sheath were assigned to either FBB (n = 41) or LIA (n = 41). In both groups, 2% lidocaine HCL with 1:100,000 epinephrine was used as an anesthetic solution. Pain scores during access gain and closure were evaluated using a visual analog scale (score 0-10), patient satisfaction levels with the quality of anesthesia were scored on a 7-point Likert scale, and adverse events were recorded., Results: The primary endpoint, pain scores during access closure, was significantly lower in the FBB group than in the LIA group (0.1 ± 0.37 vs 1.73 ± 0.92; p < 0.001). The FBB group also had significantly lower pain scores during access gain compared to the LIA group (0.83 ± 0.83 vs 2.78 ± 1.26; p < 0.001). There was an inverse relationship between pain scores and FBB after adjustment for age, gender, and body mass index (p < 0.001). FBB group reported significantly higher satisfaction with anesthesia quality compared to the LIA group (6.49 ± 0.64 vs 4.05 ± 1.05; p < 0.001). No complications were recognized in either group., Conclusions: Ultrasound-guided genitofemoral nerve blocks offered better acute pain relief and higher patient satisfaction than LIA during femoral arterial access gain and closure., Clinical Relevance Statement: In this prospective randomized controlled trial, ultrasound-guided genitofemoral nerve blocks offered better acute pain relief than local infiltration anesthesia, resulting in enhanced patient satisfaction., Key Points: • FBB provided better pain relief during access gain and closure than LIA. • FBB offered higher patient satisfaction with the quality of anesthesia than LIA. • No anesthesia-related or access site complications were recognized in either treatment group., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Background: In patients with type 2 diabetes mellitus (T2DM), diabetic kidney disease (DKD) is diagnosed based on clinical features. A kidney biopsy is used only in selected cases. This study aimed to reconsider the role of a biopsy in predicting renal outcomes., Methods: Clinical and laboratory parameters and renal biopsy results were obtained from 237 patients with T2DM who underwent renal biopsies at Soonchunhyang University Cheonan Hospital between January 2000 and March 2020 and were analyzed., Results: Of 237 diabetic patients, 29.1% had DKD only, 61.6% had non-DKD (NDKD), and 9.3% had DKD with coexisting NDKD (DKD/NDKD). Of the patients with DKD alone, 43.5% progressed to end-stage kidney disease (ESKD), while 15.8% of NDKD patients and 36.4% of DKD/NDKD patients progressed to ESKD (p < 0.001). In the DKD-alone group, pathologic features like ≥50% global sclerosis (p < 0.001), tubular atrophy (p < 0.001), interstitial fibrosis (p < 0.001), interstitial inflammation (p < 0.001), and the presence of hyalinosis (p = 0.03) were related to worse renal outcomes. The Cox regression model showed a higher risk of progression to ESKD in the DKD/NDKD group compared to the DKD-alone group (hazard ratio [HR], 2.73; p = 0.032), ≥50% global sclerosis (HR, 3.88; p < 0.001), and the degree of mesangial expansion (moderate: HR, 2.45; p = 0.045 and severe: HR, 6.22; p < 0.001)., Conclusion: In patients with T2DM, a kidney biopsy can help in identifying patients with NDKD for appropriate treatment, and it has predictive value.

Background: This study aimed to analyze differential radiotherapy (RT) responses according to the pathological type of lung cancer to see the possibility of applying adaptive radiotherapy (ART)., Methods: ART planning with resampled-computed tomography was conducted for a total of 30 patients (20 non-small-cell lung cancer patients and 10 small-cell lung cancer patients) using a deformable image registration technique to reveal gross tumor volume (GTV) changes according to the duration of RT., Results: The small-cell lung cancer group demonstrated an average GTV reduction of 20.95% after the first week of initial treatment ( p = 0.001), whereas the adenocarcinoma and squamous cell carcinoma groups showed an average volume reduction of 20.47% ( p = 0.015) and 12.68% in the second week. The application of ART according to the timing of GTV reduction has been shown to affect changes in radiation dose irradiated to normal tissues. This suggests that ART applications may have to be different depending on pathological differences in lung cancer., Conclusion: Through these results, the present study proposes the possibility of personalized treatment options for individual patients by individualizing ART based on specific radiation responses by pathologic types of lung cancer.

Background: With the prevalence of non-alcoholic fatty liver disease (NAFLD) increasing worldwide, many noninvasive techniques have been used to improve its diagnosis. Recently, the serum uric acid/creatinine (sUA/sCr) ratio was identified as an indicator of fatty liver disease. Therefore, we examined the relationship between sUA/sCr levels and ultrasound-diagnosed NAFLD in Korean adults., Methods: This study included 16,666 20-year-olds or older who received health checkups at a university hospital's health promotion center from January to December 2021. Among them, 11,791 non-patients with and without NAFLD were analyzed, excluding those without abdominal ultrasound, those without data on fatty liver, cancer, or chronic kidney disease severity, those with a history of alcohol abuse, and those with serum hs-CRP <5 mg/L. The odds ratio (OR) and 95% confidence interval (CI) of the sUA/sCr ratio according to the presence or absence of fatty liver disease and severity were calculated after correcting for confounding variables using logistic regression analysis. The receiver operating characteristic (ROC) curve and area under the curve (AUC) of the sUA/sCr ratio confirmed and compared the sensitivity and specificity of NAFLD and serum uric acid., Results: sUA/sCr increased with fatty liver severity, and the post-correction OR in the NAFLD group was 1.183 (95% CI: 1.137-1.231) compared to the group without NAFLD. Concerning the fatty liver severity, the post-correction OR in the mild NAFLD group increased to 1.147 (95% CI: 1.099-1.196), and that in the moderate-to-severe NAFLD group increased to 1.275 (95% CI: 1.212-1.341) compared to the group without NAFLD. The sensitivity of sUA/sCr to fatty liver severity was 57.9% for the non-NAFLD group, 56.7% for the mild NAFLD group, and 59.0% for the moderate-to-severe NAFLD group; the specificity of sUA/sCr to fatty liver severity 61.4% for the non-NAFLD group, 57.3% for the mild NAFLD group, and 65.2% for the moderate-to-severe NAFLD group., Conclusion: NAFLD severity is associated with sUA/sCR., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Choi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Clinically, flatfoot, known as pes planus, is quite prevalent. It is classified into 2 types: flexible and rigid, both of which may or may not have symptoms. If a flexible flatfoot is symptomatic, it must be treated to prevent subsequent complications. In principle, most physicians initially use conservative methods, such as foot insoles. This study aimed to demonstrate the effect of long term use of a foot insole using plain radiography as an objective measurement in children with symptomatic flexible flatfoot (SFFF) in large samples. This study analyzed the medical records of 292 children aged < 18 years who were diagnosed with SFFF. Of these, 200 children (62 boys and 138 girls, mean age: 6.49 ± 2.96 years) were selected and conservatively treated with foot insoles. They were periodically followed up within 3 to 4 months to modify the foot insole and perform radiologic evaluations, such as foot radiography. The calcaneal pitch angle (CPA) and talo first metatarsal angle were measured and compared individually using foot lateral radiographs, which were pictured in a bilateral barefoot state. The treatment was terminated by repeating the same procedure until the symptoms disappeared. A significant improvement (P < .001) was observed in the radiological indicators, both CPA and talo first metatarsal angle, regardless of age, after the application of soft foot insoles. However, the right foot CPA in the group with valgus deformity was an exception (P = .078). This study showed that in children diagnosed with SFFF under 18 years of age, wearing a periodically revised foot insole as conservative treatment could not only decrease the symptoms, but also improve the radiologic indices., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To investigate added value of late portal venous phase (LPVP) for identification of enhancing capsule (EC) on gadoxetate disodium-enhanced MRI (GD-MRI) for diagnosing hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD)., Methods: This retrospective study comprised 116 high-risk patients with 128 pathologically proven HCCs who underwent GD-MRI including arterial phase, conventional portal venous phase (CPVP, 60 s), LPVP (mean, 104.4 ± 6.7 s; range, 90-119 s), and transitional phase (TP, 3 min). Two independent radiologists assessed the presence of major HCC features, including EC on CPVP and/or TP (CPVP/TP) and EC on LPVP. The frequency of EC was compared on GD-MRI between with and without inclusion of LPVP. The radiologists assigned Liver Imaging Reporting and Data System (LI-RADS) v2018 categories before and after identifying EC on LPVP., Results: Of the total 128 HCCs, 74 and 73 revealed EC on CPVP/TP for reviewer 1 and 2, respectively. After inclusion of LPVP, each reviewer identified seven more EC [Reviewer 1, 57.8% (74/128) vs. 63.3% (81/128); Reviewer 2, 57.0% (73/128) vs. 62.5% (80/128); P = 0.016, respectively]. Sensitivities of LR-5 assignment for diagnosing HCCs were not significantly different in GD-MRI with or without LPVP for EC identification [Reviewer 1, 71.9% (92/128) vs. 72.7% (93/128); Reviewer 2, 75.0% (96/128) vs. 75.8% (97/128); P = 1.000, respectively]., Conclusion: Including the LPVP in GD-MRI may improve identification of EC of HCC in patients with CLD. However, LI-RADS v2018 using GD-MRI showed comparable sensitivity for diagnosing HCC regardless of applying LPVP for EC., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Advances in the diagnosis and management of acute ischemic stroke (AIS) and the increased use of mechanical thrombectomy (MT) have improved the quality of care and prognosis of patients with AIS since 2015. We investigated the changing trends in mortality of patients with AIS in Korea before and after 2015., Materials and Methods: A retrospective cohort study was conducted using combined anonymized data from the Acute Stroke Assessment Registry of Korea and the Health Insurance Review & Assessment Service database. Patients with ischemic stroke with precise onset time and initial National Institute of Health Stroke Scale records were included., Results: Patients receiving MT treatment increased from 256 (2.7%) pre-2015 to 1,037 (3.9%) post-2015 ( p < 0.001). Overall mortality significantly decreased from pre-2015 to post-2015. In pre-2015, intravenous thrombolysis (IVT) administered within 2 h significantly reduced 3-month mortality when compared with non-IVT. While, in post-2015, IVT administered within 2 h significantly reduced the 3-month, 1-year, 2-year, and 4-year mortality ( p < 0.05). MT only reduced 1-year mortality pre-2015; however, MT significantly reduced the 3-month, 1-year, and 2-year mortality post-2015 ( p < 0.05). Post-stroke antiplatelet and anticoagulant drugs significantly reduced the 3-month, 1-year, 2-year, and 4-year mortality post-2015., Discussion: Since 2015, faster IVT has significantly reduced the short- and long-term mortality in patients with AIS; MT reduced the 3-month, 1-year, and 2-year mortality. Post-stroke antithrombotic medication has significantly lowered the 2- and 4-year mortality since 2015., Conclusions: Changing trends in AIS management since 2015 have improved the prognosis of patients with AIS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Park, Lee, Heo, Han, Lee, Hong, Lee, Lee, Lim, Kim, Lee and Oh.)

Introduction: Recent improvements in treatment for subarachnoid hemorrhage (SAH) have decreased the mortality rates; however, the outcomes of SAH management are dependent on many other factors. In this study, we used nationwide, large-scale, observational data to investigate short- and long-term mortality rates after SAH treatment and the influence of patient severity and hospital volume., Patients and Methods: We selected patients with SAH treated with clipping and coiling from the South Korean Acute Stroke Assessment Registry. High- and low-volume hospitals performed ≥20 clipping and coiling procedures and <20 clipping and coiling procedures per year, respectively. Short- and long-term mortality were tracked using data from the Health Insurance Review and Assessment Service., Results: Among 2,634 patients treated using clipping and coiling, 1,544 (58.6%) and 1,090 (41.4%) were hospitalized in high- and low-volume hospitals, respectively, and 910 (34.5%) and 1,724 (65.5%) were treated with clipping and coiling, respectively. Mortality rates were 13.5, 14.4, 15.2, and 16.1% at 3 months, 1, 2, and 4 years, respectively. High-volume hospitals had a significantly lower 3-month mortality rate. Patients with mild clinical status had a significantly lower 3-month mortality rate in high-volume hospitals than in low-volume hospitals. Patients with severe clinical status had significantly lower 1- and 2-year mortality rates in high-volume hospitals than in low-volume hospitals., Conclusion: Short- and long-term mortality in patients with SAH differed according to hospital volume. In the modern endovascular era, clipping and coiling can lead to better outcomes in facilities with high stroke-care capabilities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Park, Lee, Heo, Han, Lee, Hong, Lee, Lee and Oh.)

Necrotising fasciitis (NF) is a rapidly progressing fatal disease. Craniofacial necrotising fasciitis (CNF) is limited to the region above the mandibular margin, and early diagnosis is particularly difficult in the absence of related studies. Ten-year data of patients with craniofacial infection were collected from four separate hospitals. Based on the diagnostic criteria, patients were classified into abscess and CNF. The risk factors for early diagnosis were analysed by comparing the two groups. Simple abscess was found in 176 patients, and CNF was detected in 25 patients. The risk factors associated with CNF include old age, presence of odontogenic infection, elevated white blood cell count (WBC), increased C-reactive protein (CRP), high levels of creatinine (Cr) and glucose (Glu) and low levels of haemoglobin (Hb) and albumin (Alb). In addition, fever above 38°C and sinusitis at the time of admission and progressive sepsis after admission were also risk factors. Among the statistically significant risk factors, low Alb level showed the greatest association with CNF progression. Appropriate management of CNF via early diagnosis and extensive surgical intervention based on identified risk factors can reduce the mortality rate, complications and unnecessary medical expenses. Clinical question/level of evidence: Diagnostic, III., (© 2021 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.)

Background: Rosacea is a chronic inflammatory skin disease with a multifactorial etiology. Recently, associations between serum homocysteine (Hcy) levels and inflammatory skin diseases, such as psoriasis and hidradenitis suppurativa, have been reported. However, no study has explored the levels of serum Hcy, folic acid, and vitamin B 12 in patients with rosacea., Objective: To investigate serum Hcy, vitamin B 12 , and folic acid levels in patients with papulopustular rosacea (PPR), we characterized the association of these levels with PPR severity., Methods: This case-control study included 138 PPR patients and 58 healthy controls. The serum levels of Hcy, vitamin B 12 , and folic acid were measured. A correlation was assessed between disease severity and serum levels of Hcy, vitamin B 12 , and folic acid., Results: Serum vitamin B 12 and folic acid levels were significantly lower in PPR patients than in the healthy controls ( p = 0.011 and p = 0.0173, respectively). Although serum Hcy levels did not significantly differ between PPR patients and healthy controls, PPR severity was positively correlated with serum Hcy levels ( p < 0.001)., Conclusions: Our results suggest a possible association between hyperhomocysteinemia and vitamin B 12 deficiency in patients with PPR., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Bo Young Chung et al.)

Purpose: The aim of this study was to compare out-of-hospital cardiac arrest (OHCA) outcomes before and after implementation of Smart Advanced Life Support (SALS) protocol incorporating changes in cardiopulmonary resuscitation (CPR) assistance and coaching by physicians via real-time video calls., Methods: A prospective before-and-after multi-regional observational study was conducted between January 2014 and December 2018. In January 2016, emergency medical service (EMS) providers adopted an integrated CPR coaching by physicians via real-time video call via SALS to treat patients with OHCA focusing on high-quality cardiopulmonary resuscitation. Propensity score matching was performed to match patients. Patients' outcomes using conventional protocol were then compared with those of patients using the SALS protocol., Results: Among 26,349 OHCA cases, 2351 patients and 7261 patients were enrolled during the pre-intervention and the post-intervention periods, respectively. Multivariate analysis showed that SALS was independently associated with favorable neurological outcomes [odds ratio (OR): 2.20; 95% confidence interval (CI): 1.62-2.99]. A total of 2096 patients were propensity score-matched and the two groups were well balanced. In the matched cohort, the use of SALS protocol was still associated with increased prehospital return of spontaneous circulation (ROSC) (OR: 3.83, 95% CI: 2.80-5.26), survival to discharge (OR: 1.68; 95% CI: 1.20-2.34), and favorable neurological outcomes (OR: 1.83; 95% CI: 1.19-2.82)., Conclusion: A multidisciplinary SALS protocol for the resuscitation of patients with OHCA was associated with increased prehospital ROSC, survival to discharge, and good neurologic outcomes compared with traditional resuscitation protocol., Competing Interests: Declaration of Competing Interest The content, findings, and conclusions of this report are solely the authors' responsibility and do not necessarily represent the official views of the Ministry of Health and Welfare of Republic of Korea. No author has any conflict of interest with the content of this study., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Albuminuria is a well-known risk factor for end-stage kidney disease, all-cause mortality, and cardiovascular mortality, even when the albumin-to-creatinine ratio is <30 mg/g. However, the association between transiently observed trace albuminuria and these major adverse outcomes has not yet been reported. This study aimed to examine the effect of transient albuminuria on these major adverse outcomes using the National Health Insurance Service data in Korea., Methods and Results: The National Health Insurance Service-National Sample Cohort from Korea, followed from 2002 to 2015, consisted of 1,025,340 individuals, accounting for 2.2% of the total Korean population. We analyzed the effect of transient albuminuria on all-cause death, cardiovascular death, and incident chronic kidney disease (CKD) and compared it with the group without albuminuria. Among 1,025,340 individuals, 121,876 and 2,815 had transient albuminuria and no albuminuria, respectively. Adjusted hazard ratios of the transient albuminuria group for cardiovascular death and incident CKD were 1.76 (1.01-3.08) and 1.28 (1.15-1.43), respectively. There were significant differences in all-cause death, cardiovascular death, and incident CKD between the two groups after propensity score matching ( p = 0.0037, p = 0.015, and p < 0.0001, respectively). Propensity score matching with bootstrapping showed that the hazard ratios of the transient albuminuria group for all-cause death and cardiovascular death were 1.39 (1.01-1.92) and 2.18 (1.08-5.98), respectively., Conclusions: In this nationwide, large-scale, retrospective cohort study, transient albuminuria was associated with all-cause death, cardiovascular death, and incident CKD, suggesting that transient albuminuria could be a risk marker for adverse outcomes in the future, and that its own subclinical phenotype could play an important role during the course of CKD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Park, Woo, Leem, Heo, Cho, Gil, Kim and Lee.)

Objective: This study investigated the predictive values of computed tomography (CT)-attenuation and fluorine-18-fluorodeoxyglucose ( 18 F-FDG) uptake in the liver for the hepatic recurrence of colorectal cancer., Subject and Methods: This study retrospectively included 257 colorectal cancer patients who underwent staging 18 F-FDG positron emission tomography (PET)/CT and were subsequently treated with curative surgical resection. Using non contrast-enhanced CT images in PET/CT, the liver-spleen ratio and liver-spleen difference of CT-attenuation and CT-attenuation of the liver were calculated. The maximum and mean 18 F-FDG uptake in the liver was measured using the PET images. The relationship of these five liver parameters to recurrence-free survival (RFS), hepatic RFS, and extrahepatic RFS was assessed., Results: In univariate survival analysis, the liver-spleen ratio, liver-spleen difference, and maximum 18 F-FDG uptake of the liver were significant predictors of both RFS and hepatic RFS (P<0.05), whereas none of the five liver parameters were significantly associated with extrahepatic RFS (P>0.05). Patients with a low liver-spleen ratio and liver-spleen difference and a high maximum 18 F-FDG uptake showed better hepatic RFS than those with a high liver-spleen ratio and liver-spleen difference and a low maximum 18 F-FDG uptake. In multivariate analysis, the liver-spleen ratio, liver-spleen difference, and maximum 18 F-FDG uptake of liver remained significant predictors for hepatic RFS after adjusting for age, sex, obesity, andstage (P<0.05)., Conclusion: Computed tomography-attenuation and maximum 18 F-FDG uptake in the liver on 18 F-FDG PET/CT were significant predictive factors for hepatic RFS in patients with colorectal cancer after curative resection.

Although periodic limb movement during sleep (PLMS) and restless legs syndrome (RLS) are common in children and adolescents, they are relatively overlooked as a target of treatment. PLMS has been evaluated as having a lower clinical significance than RLS. This study examined the relationship of socio-behavioral factors of PLMS in Korean adolescents and checked whether PLMS is associated with excessive daytime sleepiness (EDS), depending on whether restless legs symptoms accompany it. In a cross-sectional study, 25,789 adolescents between 12 and 18 years of age (15.76 ± 1.73 years; female 51.49%) were evaluated using an online survey. Various self-report questionnaires were used to assess PLMS and RLS symptoms, EDS, sleep habits, and various socio-behavioral factors. The prevalence of self-perceived PLMS and restless legs symptoms were 903 (3.50%) and 1311 (5.08%), respectively. Of the 1311 participants, 399 had self-perceived PLMS. The odds ratios (ORs) for self-perceived PLMS in participants with restless legs symptoms were: males (OR = 1.528; 95% CI: 1.145-2.040), usually/always experienced apnea apnea (OR, 3.006; 95% CI, 1.954-4.624), increased proneness to Internet addiction (OR = 1.013; 95% CI: 1.001-1.025), sometimes/often consuming coffee (OR = 1.312; 95% CI: 1.015-1.695), EDS (OR = 0.826; 95% CI: 0.488-1.398), and perceived insufficient sleep (OR = 1.143; 95% CI: 0.835-1.565). The male gender, witness apnea, consuming coffee, and being prone to Internet addiction were identified as factors significantly associated with self-perceived PLMS in participants with restless legs symptoms. However, EDS and insufficient sleep were associated with self-perceived PLMS in the absence of restless legs symptoms.

Background: We investigated the importance of lupus anticoagulant (LA) in patients with SARS-CoV-2. Methods: Medical records of 41 SARS-CoV-2 infected patients were reviewed. Patients were classified into two groups according to the frequency of positive LA test results: "LA (-)" and "LA (+) ≥1" (LA positive at least once). Statistical analysis was performed to determine the association between LA presence and change in LA test results and disease course according to both hospital days (HD) and days after diagnosis (DD). Results: The prevalence of LA was 51.2%. Averagely, the first change in LA test result occurred during DD 12-13 and between HD 9-10. The second change occurred on DD 15-16 and HD 13-14. The presence of LA was associated with severe disease ( P  = .004) but was not associated with thrombotic complications or mortality. The change of results from negative to positive or vice versa or the frequency of the changes was not associated with disease severity, thrombotic complications, or mortality. Conclusions: LA positivity can be regarded as one of the findings suggesting more serious SARS-CoV-2 infection.

Background: The rationale behind left renal vein division (LRVD) is the assumption that adequate collateral draining channels will develop., Purpose: To describe computed tomography (CT) findings after LRVD during aortic surgery., Material and Methods: Among 61 consecutive patients who underwent LRVD during aneurysm repair or revascularization for aortic occlusive disease between January 2003 and December 2017, 51 patients (40 men, mean age 71.4 ± 8.4 years) were enrolled. Contrast-enhanced CT images were analyzed to evaluate collateral drainage, patency, left renal vein diameter, and left renal parenchymal thickness. A total of 115 radiologic reports were reviewed to check whether these findings were accurately mentioned., Results: The median time period of the first postoperative follow-up CT was 36 days (range 7-1351 days). The gonadal vein (n = 47) was the most common collateral draining channel, followed by the retroperitoneal veins (n = 42) and adrenal vein (n = 33). Thrombosis occurred in five patients between postoperative days 7 and 17 in the remnant renal vein (n = 3), remnant renal vein plus gonadal and adrenal veins (n = 1), and gonadal vein (n = 1). There was a significant decrease in renal vein diameter (-0.48 ± 2.12 mm, P  = 0.006). There was no significant difference in parenchymal thickness (-0.25 ± 1.27 mm, P  = 0.193). Neither LRVD nor any associated findings were correctly stated on radiologic reports., Conclusion: Postoperative contrast-enhanced CT can delineate collateral draining channels and complications following LRVD. However, these findings tend to be either missed or misinterpreted.

Objectives: To assess the efficacy of an endothelin receptor antagonist (ERA) and phosphodiesterase type5 inhibitors (PDE5is) for treating SSc-related digital ulcers (DUs)., Methods: This prospective, multicentre, observational cohort study recruited patients with active SSc-related DUs from 13 medical centres in South Korea. The primary outcome was time to cardinal ulcer (CU) healing. A secondary outcome was time to new DU occurrence. Patients were followed up 4, 8, 12 and 24 weeks after treatment initiation., Results: Sixty-three patients were analysed. Their mean age was 49.9 years (s.d. 11.4) and 49 were female. Twenty-eight had limited SSc. Forty-nine patients received ERA, 11 received a PDE5i (9 sildenafil, 1 udenafil and 1 tadalafil) and 3 received other medication. The hazard ratio (HR) for time to CU healing in the ERA group vs the PDE5i group was 0.75 (95% CI 0.35, 1.64; P = 0.47) in an unadjusted model and 0.80 (95% CI 0.36, 1.78; P = 0.59) in a model adjusted for age, sex, use of calcium channel blockers (CCBs), total DU number and initial CU area. The HR for new DU development in the ERA group vs the PDE5i group was 0.39 (95% CI 0.16, 0.93; P = 0.03) in an unadjusted model and 0.32 (95% CI 0.13, 0.81; P = 0.02) in an adjusted model. No patients receiving CCBs developed new DUs at 24 weeks., Conclusion: Time to CU healing is comparable for ERA and PDE5i. ERAs are more effective in reducing new DU occurrence than PDE5is. CCBs may be effective as a background medication., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To report the prevalence, related factors, and characteristics of birth-related retinal hemorrhages (RHs) according to their severity in healthy newborns using a telemedicine network and wide-field digital retinal imaging (WFDRI)., Methods: Newborns who underwent WFDRI at 61 obstetrics/gynecology hospitals between January 2017 and December 2019 were enrolled. Demographics and related factors were compared among newborns with and without RHs. The newborns' eyes were divided into the minimal, mild, moderate, and severe groups according to the number of RHs, and characteristics like bilaterality, laterality, involved retinal layer, involved zone, macular and/or optic nerve (ON) involvement were compared., Results: Among 56247 newborns, 13026 had birth-related RHs (23.2%). Normal spontaneous vaginal delivery (NSVD) showed the highest association with RHs (odds ratio, 19.774; 95% confidence interval, 18.277-21.393; P < 0.001) on multivariate analysis. Bilateral RHs (8414/13026; 64.59%) were more common than unilateral RHs (4612/13026; 35.41%); however, unilateral RHs (2383/4217; 56.51%) were more common than bilateral RHs (1834/4217; 43.49%) in the minimal group. RHs showed no laterality differences between the two eyes (P = 0.493). Most RHs were intraretinal (18678/21440; 87.12%), and 2328 (31.65%) eyes with preretinal hemorrhage were observed in the severe group. Zone I RHs were common in the minimal (7072/7090; 99.75%), mild (4953/4960; 99.86%), and moderate (2013/2035; 98.92%) groups; zone I and II RHs were common in the severe group (4843/7355; 65.85%); and RHs in zone III were rare (7/21440; 0.03%). Most RHs showed no macular and/or ON involvement in the minimal and mild group; however, this was common in the severe group (7111/7355; 96.68%)., Conclusions: Birth-related RHs were common in healthy newborns and were significantly associated with NSVD. RHs were usually bilateral, intraretinal, and distributed posterior to the retina, but severe RHs had unique characteristics. Future long-term and longitudinal studies are required to elucidate the prognosis of severe RHs., Competing Interests: The authors have declared that no competing interests exist.

Abstract: It remains unknown whether intravenous thrombolysis (IVT), thrombectomy, or poststroke antithrombotic medication lower short- and long-term mortality in acute ischemic stroke (AIS). This study aimed to investigate the efficacy of IVT in AIS using propensity score matching, to determine whether IVT could reduce short- and long-term mortality, and to identify risk factors influencing short- and long-term mortality in AIS.During 2013 to 2014, the nationwide Korea Acute Stroke Assessment registry enrolled 14,394 patients with first-ever recorded ischemic stroke. Propensity score matching was used to match IVT and control cases with a 1:1 ratio. The primary outcome was survival up to 3 months, 1 year, and 5 years, as assessed using Kaplan-Meier estimates and Cox proportional hazards.In total, 1317 patients treated with IVT were matched with 1317 patients not treated with IVT. Survival was higher in the IVT group (median, 3.53 years) than in the non-IVT group (median, 3.37 years, stratified log-rank test, P < .001). Compared with the non-IVT group, thrombolysis performed within 2 hours significantly reduced the risk of 3-month mortality by 37%, and thrombolysis performed between 2 and 4.5 hours significantly reduced the risk of 3-month mortality by 26%. Thrombectomy significantly reduced the risk of 3-month mortality by 28%. Compared with no poststroke medication, poststroke antiplatelet medication was associated with 51%, 55%, and 52% decreases in 3-month, 1-year, and 5-year mortality risk, respectively. Poststroke anticoagulant medication was associated with 51%, 54%, and 44% decreases in the risk of 3-month, 1-year, and 5-year mortality, respectively.IVT and mechanical thrombectomy showed improvement in short-term survival. To improve long-term outcomes, the use of poststroke antithrombotic medication is important in AIS., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps., Methods: In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups., Results: The mean operative time for reconstruction was 115 minutes (interquartile range, 85-150 minutes) and 142 minutes (interquartile range, 95-180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18-30 days) and 27 days (interquartile range, 20-41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15-21 days) and 18 days (interquartile range, 15-34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases., Conclusion: The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.

Purpose: The aim of this study was to evaluate the association of contrast-enhanced ultrasound (CEUS) features using Sonazoid for liver nodules with Liver Imaging Reporting and Data System (LI-RADS) categories and to identify the usefulness of Kupffer-phase images., Methods: This retrospective study was conducted in 203 patients at high risk of hepatocellular carcinoma (HCC) who underwent CEUS with Sonazoid from 2013 to 2016. Nodule enhancement in the arterial, portal venous, late, and Kupffer phases; CEUS LI-RADS major features; and Kupffer-phase defects were evaluated. According to the computed tomography/magnetic resonance imaging (CT/MRI) LI-RADS v2018, all nodules were assigned an LR category (n=4/33/99/67 for LR-M/3/4/5) and comparisons across LR categories were made. We defined modified CEUS LI-RADS as using Kupffer-phase defects as an alternative to late and mild washout in CEUS LI-RADS and compared the diagnostic performance for HCC., Results: On CEUS of 203 nodules, 89.6% of CT/MRI LR-5 and 85.9% of LR-4 nodules showed hyperenhancement in the arterial phase, while 57.6% of LR-3 nodules showed hyperenhancement. Among the CT/MRI LR-5 nodules that showed arterial phase hyperenhancement or isoenhancement, 59.7% showed hypoenhancing changes from the portal venous phase, 23.9% from the late phase, and 13.4% additionally in the Kupffer phase. The modified CEUS LI-RADS showed higher sensitivity than CEUS LI-RADS (83.2% vs. 74.2%, P=0.008) without compromising specificity (63.6% vs. 69.7%, P=0.500)., Conclusion: The Kupffer phase best shows hypoenhancing changes in LR-5 lesions and is expected to improve the sensitivity for HCC in high-risk patients.

Background The relationship between vascular calcification and chronic kidney disease is well known. However, whether vascular calcification affects renal function deterioration remains unclear. We investigated whether kidney function deteriorated more rapidly in individuals with higher vascular calcification indicated by the coronary artery calcium score (CACS). Methods and Results Individuals with a normal estimated glomerular filtration rate (>60 mL/min per 1.73 m 2 ) who underwent cardiac computed tomography in our institution (a tertiary teaching hospital in Cheonan, Korea) from January 2010 to July 2012 were retrospectively reviewed. All participants were aged 20 to 65 years. Among 739 patients, 447, 175, and 117 had CACSs of 0, 1 to 99, and ≥100 units, respectively. The participants were followed for 7.8 (interquartile range, 5.5-8.8) years. The adjusted annual estimated glomerular filtration rates declined more rapidly in patients in the CACS ≥100 group compared with those in the CACS 0 group (adjusted-β, -0.40; 95% CI, -0.80 to -0.03) when estimated using a linear mixed model. The adjusted hazard ratio in the CACS ≥100 group for Kidney Disease: Improving Global Outcomes criteria (a drop in estimated glomerular filtration rate category accompanied by a 25% or greater drop in estimated glomerular filtration rate) was 2.52 (1.13-5.61). After propensity score matching, more prevalent renal outcomes (13.2%) were observed in patients with a CACS of ≥100 compared with those with a CACS of 0 (1.9%), with statistical significance ( P =0.004). Conclusions Our results showed that renal function declined more rapidly in patients with higher CACSs, suggesting that vascular calcification might be associated with chronic kidney disease progression.

Background: Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and short- and long-term mortality in patients treated with subarachnoid hemorrhage., Methods: We selected subarachnoid hemorrhage patients treated with clipping and coiling from March-May 2013 to June-August 2014 using data from Acute Stroke Registry, and the selected subarachnoid hemorrhage (SAH) patients were tracked in connection with data of Health Insurance Review and Assessment Service to evaluate the short-term and long-term mortality., Results: A total of 625 subarachnoid hemorrhage patients were admitted to high-volume hospitals (n = 355, 57%) and low-volume hospitals (n = 270, 43%) for six months. The mortality of SAH patients treated with clipping and coiling was 12.3%, 20.2%, 21.4%, and 24.3% at 14 days, three months, one year, and five years, respectively. The short-term and long-term mortality in high-volume hospitals was significantly lower than that in low-volume hospitals. On Cox regression analysis of death in patients with severe clinical status, low-volume hospitals had significantly higher mortality than high-volume hospitals during short-term follow-up. On Cox regression analysis in the mild clinical status group, there was no statistical difference between high-volume hospitals and low-volume hospitals., Conclusion: In subarachnoid hemorrhage patients treated with clipping and coiling, low-volume hospitals had higher short-term mortality than high-volume hospitals. These results from a nationwide database imply that acute SAH should be treated by a skilled neurosurgeon with adequate facilities in a high-volume hospital., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2021 The Korean Academy of Medical Sciences.)

Background: The aryl hydrocarbon receptor (AHR) and autophagy are both important to maintain skin homeostasis. However, they are also involved in skin disorders. So far, their roles in psoriasis pathogenesis are unknown., Objective: We studied the immunohistochemical and gene expression of AHR, CYP1A1, and microtubule-associated protein light chain 3 (LC3) in lesional skin of psoriasis patients to determine correlations among them., Methods: We included 24 psoriasis patients and ten healthy volunteers. Skin biopsies were collected. AHR, CYP1A1, and LC3 protein expression was examined by immunohistochemistry, immunofluorescence, and western blotting. AHR , CYP1A1 , LC3 , ATG5 , BECN1 and Nrf2 mRNA levels were measured by quantitative polymerase chain reaction., Results: AHR and CYP1A1 protein expression were higher in psoriasis lesional skin than in normal skin. LC3 protein expression was lower in psoriasis lesions than in normal controls. AHR and CYP1A1 protein expression in psoriasis lesions showed significant positive correlations with mean epidermal thickness and inflammatory cell density. Significant negative correlations were noted between LC3 protein expression in psoriasis lesions and the mean epidermal thickness or inflammatory cell density. A significant negative correlation was found between AHR and LC3 expression in psoriatic skin. AHR, CYP1A1 and Nrf2 mRNA expression were upregulated while LC3, ATG5, and BECN1 mRNA were down-regulated, in psoriatic lesional skin compared with normal controls., Conclusion: AHR and autophagy could play a role in psoriasis pathogenesis by modifying epidermal hyperproliferation and inflammation. AHR and autophagy regulation are potential therapeutic targets in chronic inflammatory skin diseases., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose., (Copyright © 2021 The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)

Purpose: To define and weight the preoperative CT findings for ovarian torsion and to develop an integrated nomogram for estimating the probability of ovarian torsion in women with ovarian lesion and pelvic pain., Methods: This retrospective study included 218 women with surgically resected ovarian lesions who underwent preoperative contrast-enhanced CT for pelvic pain from January 2014 to February 2019. Significant imaging findings for torsion were extracted using regression analyses and a regression coefficient-based nomogram was constructed. The diagnostic performance with sensitivity, specificity, and accuracy of the significant imaging findings and the nomogram were assessed., Results: A total of 255 ovarian lesions (123 lesions with torsion and 132 lesions without torsion) were evaluated. Multivariable regression analysis showed that whirl sign (odds ratio [OR] 11.000; p < 0.001), tubal thickening (OR 4.621; p = 0.001), unusual location of ovarian lesion (OR 2.712; p = 0.020), and hemorrhagic component within adnexal lesion (OR 2.537; p = 0.028) were independent significant parameters predicting ovarian torsion. Tubal thickening showed the highest sensitivity (91.1%) and whirl sign showed the highest specificity (94.7%). When probabilities of ovarian torsion of 0.5 or more in the nomogram were diagnosed as ovarian torsion, sensitivity, specificity, and accuracy of the nomogram were 78.1%, 91.7%, and 85.1%, respectively., Conclusion: The whirl sign, tubal thickening, unusual location of ovarian lesion, and hemorrhagic component within adnexal lesion, and an integrated nomogram derived from these significant findings can be useful for predicting ovarian torsion.

Objectives: Neuron-specific enolase (NSE) is frequently used to predict neurological outcomes in patients with hypoxic brain injury. Hanging can cause hypoxic brain damage, and survivors can suffer from neurological deficits that may impair daily activities. Here, we investigated the utility of the initial serum NSE level as a predictor of neurological outcomes in near-hanging patients with decreased consciousness., Methods: This retrospective multicenter study was conducted in patients who visited the emergency department due to near-hanging injury from October 2013 to February 2019 at three university hospitals in Korea. They were divided into two groups according to the presence of out-of-hospital cardiac arrest. The neurological outcome was determined using the Cerebral Performance Category (CPC) measured at the time of discharge. Multivariate analysis was performed to determine whether initial serum NSE is an independent predictor of neurological outcome., Results: Of the 70 patients included in the study, 44 showed a poor neurological outcome (CPC score = 3-5). Among the 52 patients with cardiac arrest, only 10 (19.2%) were discharged with good neurological outcome (CPC score = 1-2). In the whole cohort, a high serum NSE level was a significant predictor of poor neurological outcome (odds ratio [OR], 1.343; 95% confidence interval [CI], 1.003-1.800, p = 0.048). Among the patients with cardiac arrest, a high serum NSE level was a significant predictor of poor neurological outcome (OR, 1.138; 95% CI, 1.009-1.284, p = 0.036)., Conclusions: In near-hanging patients, a high initial serum NSE level is an independent predictor of poor neurological outcome., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Although there is no comparison study about the learning curves for holmium laser enucleation and other surgical modalities to treat benign prostatic hyperplasia (BPH), beginner urologists are hesitant to perform holmium laser enucleation because of its steep learning curve. Therefore, we investigated the degree of surgical difficulty of holmium laser enucleation by comparing its learning curve with that of transurethral resection. Patients and Methods: Two beginner urologists performed surgery for BPH: H.J.Y. performed holmium laser enucleation and K.H.K. performed transurethral resection. Of 141 patients, 72 were enrolled in the holmium laser enucleation group and 69 in the transurethral prostate resection group. After retrospectively reviewing medical records, we performed a cumulative sum analysis of resection speed (RS) and resected ratio (RR) to compare the learning curves of holmium laser enucleation and transurethral resection. Results: Both surgeons achieved RS competency with a speed <0.13 g/min. The surgeon who performed holmium laser enucleation achieved RR competency with a ratio <0.40, whereas the surgeon who performed transurethral resection achieved competency with a ratio <0.35. To achieve RS competency of 0.13 g/mL, the holmium laser enucleation and transurethral resection groups required 12 and 23 cases, respectively. To achieve RR competency of 0.35, the holmium laser enucleation and transurethral resection groups required 12 and 5 cases, respectively. Conclusions: Holmium laser enucleation is not a difficult procedure compared with transurethral resection in beginner urologists. Therefore, it is unnecessary to avoid holmium laser enucleation because the concerns that it may be difficult are unfounded.

Backgrounds and Aim: Multiple insertions of self-expandable metal stents (SEMS) for advanced malignant hilar obstruction (MHO) are now considered to be an effective palliative method for adequate drainage of liver volume. However, the efficacy of endoscopic reintervention in technically and clinically successful bilateral SEMS is limited. This study investigated the endoscopic revision efficacy in patients who underwent bilateral SEMS in MHO., Methods: Primary endoscopic revision using plastic or metal stents or an alternative percutaneous approach followed by secondary endoscopic revision was performed in patients who underwent clinically successful deployment of bilateral SEMS. The primary outcome was a technical success. Secondary outcomes were clinical success, adverse events, and patency duration after reintervention., Results: A total of 55 patients (83.3%) out of 66 enrolled patients underwent reintervention: primary endoscopic reintervention (n = 47) and secondary endoscopic revision following percutaneous drainage (n = 8). Intended technical success rates of primary and secondary endoscopic reintervention were 93.6% (44/47) and 87.5% (7/8), respectively (P = 0.47). Clinical success rates were 72.3% and 50%, respectively (P = 0.23). Stent malfunction rate after reintervention was 48.9% (23/47) and 37.5% (3/8) (P = 0.70) during follow up, and median cumulative stent patency duration was 119 and 55 days, respectively (log-rank P = 0.68). Stent patent rate after reintervention was not different according to the time interval. In univariate and multivariate analysis for stent patency duration-related factors after reintervention, there were no meaningful factors., Conclusion: Primary endoscopic reintervention for bilateral SEMS in MHO was feasible technically and clinically. However, there were no statistically meaningful factors for stent patency duration after reintervention., (© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Objectives: To evaluate the effect of superselective renal artery embolization in terms of renal function and blood pressure, to compare the results between groups with different embolization extents, and to analyze risk factors of entire study population for postprocedural acute kidney injury (AKI)., Materials and Methods: The inclusion criteria were patients who underwent renal artery embolization from January 2009 to December 2019, with available serum creatinine and blood pressure data. The exclusion criteria were non-selective embolization of main renal artery, AKI before embolotherapy, and follow-up of less than one month. According to the extent of embolization, the patients were divided into two groups: Group A (1 segment) and Group B (2-4 segments)., Results: A total of 48 patients were enrolled. There was a significant difference between pre- and postprocedural estimated glomerular filtration rate ( p = 0.030). There were no significant difference between pre- and postprocedural blood pressure. The incidence of postprocedural AKI in group B was significantly higher than that in group A ( p = 0.044). There was no significant difference in the incidence of the worsening of hypertension between the two groups. Chronic kidney disease and high embolization grade were predictive for postprocedural AKI ( p = 0.012, 0.021)., Conclusion: Superselective embolization appears to be a safe procedure, but meticulous attention for AKI is required for patients who underwent embolization of more than one segmental artery. An attempt to minimize the extent of devascularization should be pursued to avoid postprocedural complications., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Objective: To compare the relationship of the Bayley Scales of Infant and Toddler Development 3rd Edition (K-BSID-III) language score and the Sequenced Language Scale for Infant (SELSI) score and evaluate the sensitivity and specificity of K-BSID-III language score and optimal cutoff value with receiver operator characteristic (ROC) curve analysis in infants and toddlers with delayed language development., Methods: A total of 104 children with suspected language developmental delay were included in this retrospective study. Subjects were tested using the K-BSID-III and SELSI and subdivided into several groups according to the severity of language scores. ROC curve analysis was performed to assess K-BSID-III for delayed language development., Results: Receptive and expressive language subscales of the K-BSID-III showed markedly significant correlation with the SELSI scores (p<0.001). ROC analysis showed an area under the curve of 0.877 (p<0.001) in SELSI receptive score and 0.935 (p<0.001) in SELSI expressive score. The optimal cutoff value where sensitivity of 85% and specificity of 81% were achieved with the K-BSID-III receptive score was 1.50 (between average and low average) in the SELSI receptive score. The optimal cutoff value where sensitivity of 96% and specificity of 82% were achieved with the K-BSID-III expressive score was also 1.50 in the SELSI expressive score., Conclusion: In this study, the correlations between K-BSID-III and SELSI language scores were statistically significant. However, the interpretation should be considered carefully in low average group due to tendency of underestimation of delayed language development.

Background: Proteinuria is a significant risk factor for progression of IgA nephropathy (IgAN) and has a positive correlation with severity of foot process effacement (FPE). We evaluated the relationship of FPE with proteinuria and histologic characteristics, including the Oxford classification., Methods: Patients who underwent renal biopsy and were diagnosed with IgAN at a single center were retrospectively reviewed. Patients aged less than 18 years and those with the possibility of secondary causes were excluded from the study. Subsequently, we evaluated the association between degree of proteinuria, severity of FPE, and histologic characteristics, including the Oxford classification and other immunofluorescence stains., Results: A total of 805 cases of renal biopsy was performed at our institution, and 327 patients were diagnosed with IgAN. Among them, 82 patients were excluded. Severity of FPE had an impact on the degree of proteinuria. Notably, the group with diffuse FPE had more than about 1.3 g/day of urine protein compared to those with rare FPE. Among the histologic characteristics, M1 score and immune deposition of IgG affected severity of FPE (hazard ratios [95% confidence interval], 1.90 [1.10 to 3.26], and 3.77 [1.66 to 8.54], respectively)., Conclusion: Severity of FPE had an impact on the degree of proteinuria and may be associated with the pathogenesis of IgAN.

Purpose: To investigate the added value of considering hypointensity on late portal venous phase (LPVP) images as washout for diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in patients with chronic liver disease (CLD)., Methods: This retrospective study comprised 97 patients at high risk for HCC who underwent Gd-EOB-MRI including unenhanced, multi-arterial phase, conventional portal venous phase (CPVP, 60 s), and LPVP (mean, 99.9 ± 9.1 s; range, 90-119 s) images. A total of 115 hepatic lesions were identified by histopathological or clinical diagnosis. Three independent radiologists assessed the MRI images by consensus. Diagnosis of HCC was made using criteria of arterial hyperenhancement and hypointensity relative to the surrounding liver parenchyma (1) on CPVP or (2) on CPVP and/or LPVP images. The generalized estimating equation was used to compare diagnostic performance for HCC between Criterion 1 and 2., Results: In 82 HCCs, the frequency of hypointensity differed significantly between the CPVP and LPVP images (64.6% [53/82] vs. 84.1% [69/82], P < 0.001). Among 33 non-HCCs, two cHCC-CCs showed additional hypointensity on LPVP than CPVP images (33.3% [11/33] vs. 39.4% [13/33], P = 0.500). Criterion 2 provided significantly greater sensitivity for diagnosing HCC than Criterion 1 (54.9% [45/82] vs. 74.4% [61/82], P < 0.001), with relatively little reduction in specificity (90.9% [30/33] vs. 84.8% [28/33], P = 0.145)., Conclusion: Additional use of LPVP hypointensity as washout could significantly improve sensitivity for HCC diagnosis when utilizing Gd-EOB-MRI in patients with CLD, without a significant decrease in specificity.

Objective: To analyze the differences in characteristics and outcomes between public bath (PB)-related and non-PB-related out-of-hospital cardiac arrest (OHCA) patients in South Korea., Methods: We performed a retrospective observational analysis of collected data from the Smart Advanced Cardiac Life Support (SALS) registry between September 2015 and December 2018. We included adult OHCA patients (aged >18 years) with presumed OHCA of non-traumatic etiology who were attended by dispatched emergency medical services. SALS is a field advanced life support with smartphone-based direct medical direction. The primary outcome was the survival to discharge rate measured at the time of discharge., Results: Of 38,995 cardiac arrest patients enrolled in the SALS registry, 11,889 were included in the final analysis. In total, 263 OHCAs occurred in PBs. Male sex and bystander cardiopulmonary resuscitation proportions appeared to be higher among PB patients than among non-PB patients. Percentages for shockable rhythm, witnessed rate, and number of underlying disease were lower in the PB group than in the non-PB group. Prehospital return of spontaneous circulation (11.4% vs. 19.5%, P=0.001), survival to discharge (2.3% vs. 9.9%, P<0.001), and favorable neurologic outcome (1.9% vs. 5.8%, P=0.007) in PB patients were significantly poorer than those in non-PB patients., Conclusion: Patient characteristics and emergency medical services factors differed between PB and non-PB patients. All outcomes of PB-related OHCA were poorer than those of non-PB-related OHCA. Further treatment strategies should be developed to improve the outcomes of PB-related cardiac arrest.

Nanocrystals (NCs) of CsPbX 3 , X = Cl, Br, or I, have excellent photoluminescent properties: high quantum yield, tunable emission wavelengths (410-700 nm), and narrow emission band widths. CsPbBr 3 NCs show high promise as a green-emitting material for use in wide color gamut displays. CsPbBr 3 NCs have, however, not been commercialized because they are sensitive to moisture and heat. To avoid these problems, this work attempts to introduce CsPbBr 3 into five zeolites. The zeolite X product, Pb,Br,H,Cs,Na-X, shows superior stability toward moisture, maintaining its initial luminescence properties after being under water for more than a month. Its structure, determined using single-crystal X-ray crystallography, shows that quantum dots (QDs) of [Na 4 Cs 6 PbBr 4 ] 8+ (not of CsPbBr 3 ) have formed. They are tetrahedral PbBr 4 2- ions (Pb-Br = 3.091(11) Å) surrounded by Na + and Cs + ions. Each fills the zeolite's supercage with its Pb 2+ ion precisely at the center, a position of high symmetry. The peaks in the emission spectra of Pb,Br,H,Cs,Na-X and the CsPbBr 3 NCs are both at about 520 nm. The FWHM of Pb,Br,H,Cs,Na-X, however, is narrower than any previously reported for any of the CsPbBr 3 NCs, and for zeolite Y and the various mesoporous materials treated with CsPbBr 3 ., (© 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: To clarify the pre-operative imaging and clinical features differentiating malignant from benign intraductal papillary mucinous neoplasm (IPMN) of the pancreas and develop a nomogram for estimating the individualized risk of malignant IPMN., Methods: One hundred twenty-six patients with IPMN (72 benign and 54 malignant) who underwent pre-operative contrast-enhanced CT or MRI from 2010 to 2018 were retrospectively evaluated in two tertiary institutions. All lesions were pathologically proven by surgery or biopsy. Significant imaging and clinical findings for malignancy were assessed by univariate and multivariable logistic regression analyses. Based on the significant variables in the multivariable analysis, we developed a nomogram to predict malignant potential in patients with IPMNs, and the area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic value., Results: Multivariable analysis revealed that enhancing mural nodule ≥ 5 mm (odds ratio (OR), 48.30; 95% confidence interval (CI), 11.69-199.49), increased serum carbohydrate antigen 19-9 (CA19-9) (OR, 8.69; 95% CI, 2.04-36.92), main pancreatic duct (MPD) diameter ≥ 10 mm (OR, 6.34; 95% CI, 1.21-33.30), and acute pancreatitis (OR, 4.77; 95% CI, 1.12-20.36) were independent significant parameters to predict malignant IPMN. Among them, enhancing mural nodule ≥ 5 mm showed the highest OR and predictor point on the nomogram. The AUC for the nomogram was 0.955 (95% CI, 0.903-0.984)., Conclusions: Pre-operative imaging findings could aid in predicting malignant potential of IPMN using the significant findings of enhancing mural nodule ≥ 5 mm, increased serum CA19-9, MPD diameter ≥ 10 mm, and acute pancreatitis., Key Points: • Among pre-operative imaging and clinical features, enhancing mural nodule ≥ 5 mm, increased serum CA19-9, main pancreatic duct diameter ≥ 10 mm, and acute pancreatitis were independent significant parameters to predict malignant IPMN. • Enhancing mural nodule ≥ 5 mm was a single predictor for malignant IPMN, with the highest diagnostic values compared to other significant parameters. • A constructed nomogram using these parameters could aid in predicting malignant potential in patients with IPMN of the pancreas.

Background: The objective of this study was to investigate the prognostic value of 2-Deoxy-2-[ 18 F]fluoro-D-glucose ([ 18 F]FDG) uptake of bone marrow (BM) and metabolic parameters of primary tumor on positron emission tomography/computed tomography (PET/CT) for predicting distant recurrence in patients with breast cancer., Methods: Pretreatment [ 18 F]FDG PET/CT images of 345 breast cancer patients were retrospectively evaluated. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of primary breast cancer and bone marrow-to-liver uptake ratio (BLR) on PET/CT were measured. A Cox proportional hazard regression model was used to evaluate the prognostic potential of parameters for predicting recurrence-free survival (RFS) and distant RFS. For Kaplan-Meier analysis, the specific cutoff values pf BLR and TLG were determined by the maximal chi-square method., Results: The median follow-up duration of the enrolled patients was 48.7 months, and during follow-up, 36 patients (10.4%) experienced the cancer recurrence. BLR was significantly correlated with T stage, serum inflammatory markers, and recurrence pattern (p < 0.05). Patients with high BLR and TLG showed worse RFS and distant RFS than those with low BLR and TLG. On multivariate analysis, BLR was significantly associated with both RFS and distant RFS after adjusting for T stage, estrogen receptor status, and TLG (p = 0.001 for both). Only 0.5% of patients with TLG < 9.64 g and BLR < 0.91 experienced distant recurrence. However, patients with TLG ≥ 9.64 g and BLR ≥ 0.91 had a distant recurrence rate of 40.7%., Conclusions: BLR on pretreatment [ 18 F]FDG PET/CT were significant predictors for RFS and distant RFS in patients with breast cancer. By combining [ 18 F]FDG uptake of BM and volumetric PET/CT index of breast cancer, the risk of distant recurrence could be stratified.

The Oxford classification was developed to predict the outcome of IgA nephropathy (IgAN). Based on the upper reference limit (95 th percentile) for the number of globally sclerotic glomeruli (GSG) expected on biopsy according to age, we evaluated whether the prognosis of IgAN was affected by the age-calibrated numbers of GSG independent of the Oxford classification. Patients diagnosed with IgAN on renal biopsy in a single center from January 2011 to December 2018 were analyzed retrospectively. Patients with more GSG number than the upper reference limit expected on biopsy according to age were categorized in a group of GSG abnormal for age. We analyzed in two ways, calculating the median rate of decline in estimated glomerular filtration rate (eGFR) and time-to-event defined as a decline of eGFR level to 40% lower than the baseline. There were 111 patients in the group of GSG abnormal for age. In this group, the rate of eGFR decline was faster by 1.85 (3.68-0.03) ml/min/1.73 m 2 per year in the fully-adjusted robust regression model. The adjusted hazard ratio for eGFR decline for renal outcome was 29.10 (2.18-388.49). The cumulative incidence of CKD progression was significantly higher, especially for those with T score of 0 in the Oxford classification. We suggest that GSG abnormal for age is an independent risk factor in predicting the renal outcome of IgAN.

Background: Hypervascular hyperplastic nodules (HHNs) occasionally develop in patients with alcoholic liver cirrhosis (ALC) and show arterial enhancement, thus mimicking hepatocellular carcinoma (HCC). Importantly, HHN as a benign lesion should be distinguished from HCC., Purpose: To evaluate the value of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) in distinguishing HHN from small (<3 cm) hypervascular HCC (hHCC) in patients with ALC., Study Type: Retrospective case-control study., Field Strength/sequence: 3.0T/in- and out-of-phase, T 1 -weighted, T 2 -weighted, diffusion-weighted, apparent diffusion coefficient, and dynamic gadoxetic acid-enhanced images., Population: Among 560 patients with ALC who underwent Gd-EOB-MRI and DWI, 12 patients with 28 HHNs and 22 patients with 29 hHCCs smaller than 3 cm were included., Assessment: The following MRI features were evaluated by three independent radiologists: signal intensity (SI) on T 1 -weighted, T 2 -weighted, diffusion-weighted, and hepatobiliary phase (HBP) images; shape, homogeneity, and margin on HBP; diffusion restriction; intralesional fat; necrosis; hemorrhage; washout on portal venous phase (PVP) and/or transitional phase (TP); and capsular enhancement. Quantitative analysis was also conducted., Statistical Tests: Univariate and multivariate analyses were performed to determine the significant MRI findings, and their diagnostic performance for the prediction of HHN was analyzed., Results: Lesion size of ≤16 mm (odds ratio [OR], 24.41; P = 0.007), low-to-iso SI on DWI (OR, 26.92; P = 0.007), and absence of washout on PVP and/or TP (OR, 31.84; P = 0.009) were significant independent factors for predicting HHN. When all three criteria were satisfied, the specificity was 100%. Compared with hHCCs, HHNs showed significantly smaller size (mean, 13.8 mm vs. 19.9 mm; P < 0.001) and higher mean SI value (994.0 vs. 669.5) and lesion-to-liver SI ratio (1.045 vs. 0.806) on HBP (P < 0.001, respectively)., Data Conclusion: Gd-EOB-MRI and DWI may be helpful in differentiating HHN from small hHCC in patients with ALC., Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:70-80., (© 2019 International Society for Magnetic Resonance in Medicine.)

Purpose: Emergency medical services (EMS) response time is one of prehospital factors associated with survival rate of patients with out-of-hospital cardiac arrest (OHCA). The objective of this study was to determine whether short EMS response time was associated with improved neurologic outcome of patients with OHCA through prospective analysis., Methods: We performed a prospective observational analysis of collected data from KoCARC registry between October 2015 and December 2016. OHCA patients aged 18 years or older with presumed cardiac etiology by emergency physicians in emergency department were included in this study., Results: Of 3187 cardiac arrest patients enrolled in the KoCARC registry, 2309 patients were included in the final analysis. Response time threshold was 11.5 min for prehospital return of spontaneous circulation and 7.5 min for survival to discharge and favorable neurologic outcome. Patients in the ≤7.5 min response time group showed increased odds of survival to discharge (OR: 1.54, 95% CI: 1.13-2.10, p = .006) and favorable neurologic recovery (OR: 2.01, 95% CI: 1.36-2.99, p = .001). When response time was decreased by 1 min, all outcomes were improved (survival to discharge, OR: 1.08; 95% CI: 1.04-1.12, p < .001; favorable neurological outcome, OR: 1.14, 95% CI: 1.07-1.21, p < .001)., Conclusion: We found that shorter EMS response time could lead to favorable neurologic outcome in patients with OHCA of presumed cardiac origin. EMS response time threshold associated with improved favorable outcome was ≤7.5 min., (Copyright © 2019. Published by Elsevier Inc.)

This study aimed to identify whether a new method using heart rate variability (HRV) could predict intradialytic hypotension (IDH) for one month in advance for patients undergoing prevalent hemodialysis. A total 71 patients were enrolled, and baseline clinical characteristics and laboratory results were collected when HRV was measured, then, the frequency of IDH was collected during the observation period. HRV parameters included heart rate, R-R interval, the standard deviation of N-N interval, the square root of the mean squared differences of successive NN intervals, very low frequency, low frequency, high frequency, total power, and low frequency/high frequency ratio. During the one-month observation period, 28 patients experienced 85 cases of IDH (10.0% of a total 852 dialysis sessions). Among the clinical and laboratory parameters, ultrafiltration rate, prior history of diabetes, coronary artery disease, or congestive heart failure, age, intact parathyroid hormone level, and history of antihypertensive drug use were integrated into the multivariate model, referred to as a basic model, which showed significant ability to predict IDH (the area-under-curve [AUC], 0.726; p = 0.002). In HRV parameters, changes between the early and middle phases of hemodialysis (referred to Δ) were identified as significant independent variables. New models were built from the combination of Δ values with the basic model. Among them, a model with the highest AUC value (AUC, 804; p < 0.001) was compared to the basic model and demonstrated improved performance when HRV parameters were used (p = 0.049). Based on our results, it is possible that future IDH might be predicted more accurately using HRV.

Objectives: To compare the sensitivity of Liver Imaging Reporting and Data System (LI-RADS) v2017 for diagnosis of hepatocellular carcinoma (HCC) using multiphasic computed tomography (CT) between patients with and without moderate to severe fatty liver (MSFL)., Methods: This retrospective study included a total of 106 high-risk patients with 112 pathologically proven HCCs who underwent multiphasic CT. Patients were classified as MSFL (24 men, 2 women; mean age, 59.5 years [range, 38-79 years]) and non-MSFL (64 men, 16 women; mean age, 62.9 years [range, 40-89 years]) groups according to unenhanced CT liver and spleen parenchymal attenuation. Two independent radiologists assigned LI-RADS categories and accessed HCC features on CT. Sensitivities for LR-5 assignment and frequencies of HCC features were compared between the two groups., Results: Sensitivities of LR-5 assignment for diagnosing HCCs were not significantly different between MSFL and non-MSFL groups (65.4% [17/26] vs. 76.7% [66/86] for reviewer 1, p = 0.247; 73.1% [19/26] vs. 76.74% [66/86] for reviewer 2, p = 0.702). No significant differences in the frequencies of arterial hyperenhancement, washout, and capsule were observed between the two groups (96.2% [25/26] vs. 98.8% [85/86], p = 0.412; 80.8% [21/26] vs. 89.5% [77/86], p = 0.308; and 53.8% [14/26] vs. 57% [49/86], p = 0.778, respectively)., Conclusions: LI-RADS v2017 using CT showed comparable sensitivity for diagnosing HCC regardless of MSFL., Key Points: • Using LI-RADS v2017 with CT, diagnosis of HCC in patients with MSFL showed similar sensitivity to that in patients without MSFL. • Frequencies of major HCC features (arterial hyperenhancement, washout, and capsule) on CT between the MSFL and non-MSFL groups were not significantly different. • LI-RADS using CT may be feasible for diagnosing HCC in patients with fatty liver.