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Group B Streptococcus (GBS) colonization in pregnant women is a risk factor for causing infection in neonates; therefore, GBS screening tests are performed on them. Culture methods and molecular diagnostics are mainly performed for GBS detection; however, culture methods differ in the detection rate for GBS depending on the procedure of culture. The authors intended to confirm the difference in GBS colonization rate in the conventional culture method, enrichment culture method, and molecular genetic test as screening tests for GBS.Duplicate vagino-rectal swabs were collected from 371 pregnant women between the 35th and 37th week of gestation; one was used for conventional culture method and the other was frozen at -80℃, followed by enrichment culture method and molecular genetic test.The prevalence of GBS colonization identified by conventional culture, enrichment culture, and molecular genetic test was 4.35% (17/391), 8.95% (35/391), and 22.25% (87/391), respectively. The detection rate by enrichment culture method was 2.06 times higher (17/391 vs. 35/391) than that by conventional culture method. It was identified that there was a significant difference in the detection rates of GBS between the two methods (p0.001). The detection rate identified in molecular genetic test was much higher at 22.25% (87/391). The concordance rate of the results from three detection methods for GBS was 80.05% (313/391). All pregnant women colonized with GBS were given intrapartum antibiotic prophylaxis using cefazolin and their neonates were confirmed not to be infected with GBS.Prevalence of GBS colonization in pregnant women is shown to vary depending on detection method. Particularly, it differs greatly depending on the use of enrichment media in the culture method. Therefore, it is necessary that the microbiological laboratory implements the culture method with supplementary procedures such as selective or enrichment media in order to improve the detection rate of GBS.

We compared the clinical course of pregnant women with coronavirus disease 2019 (COVID-19) before and after the emergence of the omicron variant and based on vaccination status. We retrospectively reviewed the electronic medical charts of 224 patients and 82 deliveries from November 1, 2020, to March 7, 2022; of these, 42% were diagnosed during the omicron dominance period. Disease severity and morbidity of COVID-19 were significantly decreased during the omicron era. The vaccination rates among the patients were higher after omicron emergence (31.9%) than before (6.9%). Overall, 4.1% and 25% of patients had severe symptoms, and 2.6% and 16.2% required oxygen therapy in the vaccination and non-vaccination groups, respectively. Overall, patients had a more favorable clinical course in the omicron era; moreover, vaccinated patients were better protected than non-vaccinated patients, indicating the importance of vaccination against COVID-19.

This study aimed to compare the clinical and laboratory characteristics of two groups of women (favorable and adverse outcome groups) in the third trimester of pregnancy with coronavirus disease 2019 (COVID-19) and to investigate the predictors of specific adverse outcomes.We retrospectively reviewed the medical records of patients hospitalized with COVID-19 between November 2020 and October 2021 at Kyungpook National University Chilgok Hospital. Adverse outcomes were clinically defined using the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team criteria. The group without adverse outcomes was defined as the "favorable outcome" group and the rest as the "adverse outcome" group. We compared the clinical characteristics between the two groups and examined the correlation between their laboratory results and adverse outcomes.Of the 70 pregnant women included, 37 were in their third trimester. No significant differences in clinical characteristics, except the length of hospitalization, were noted between the groups. In laboratory tests conducted immediately after hospitalization, C-reactive protein (CRP) (1.0 [0.3 - 1.4]CRP and ferritin levels are associated with poor prognosis and can predict adverse outcomes in women with COVID-19 in the third trimester of pregnancy.

Background Unilateral pulmonary artery discontinuity is a rare malformation that is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. The prenatal diagnosis of isolated unilateral pulmonary artery discontinuity can also be delayed. However, undiagnosed this malformation would have an effect on further prognosis. We report our case of a prenatal diagnosis of pulmonary atresia with ventricular septal defect and left pulmonary artery discontinuity. Case presentation A 33-year-old Asian woman visited our institution at 24 weeks of gestation because of suspected fetal congenital heart disease. Fetal echocardiography revealed a small atretic main pulmonary artery giving rise to the right pulmonary artery without bifurcation and the left pulmonary artery arising from the ductus arteriosus originating from the left subclavian artery. The neonate was delivered by cesarean section at 376/7 weeks of gestation. Postnatal echocardiography and multidetector computed tomography showed a right aortic arch, with the small right pulmonary artery originating from the atretic main pulmonary artery and the left pulmonary artery originating from the left subclavian artery. Patency of the ductus arteriosus from the left subclavian artery was maintained with prostaglandin E1. Right ventricular outflow tract reconstruction and pulmonary angioplasty with Gore-Tex graft patch was performed 25th day after birth. Unfortunately, the neonate died because of right heart failure 8 days postoperation. Conclusion There is a possibility that both pulmonary arteries do not arise from the same great artery (main pulmonary artery or common arterial trunk). Therefore, clinicians should check the origin of both pulmonary arteries.

Hepatic estrogen signaling, which is important in liver injury/recovery, is determined by the level of systemic estrogen and hepatic estrogen receptor. We aimed to evaluate whether females' advantage in the tolerance of hepatic ischemia-reperfusion injury decreases according to the age of 40 y (systemic estrogen decrease) and macrosteatosis (hepatic estrogen receptor decrease).We included 358 living liver donors (128 female and 230 male individuals). The tolerance of hepatic ischemia-reperfusion injury was determined by the slope of the linear regression line modeling the relationship between the duration of intraoperative hepatic ischemia and the peak postoperative transaminase level. Estrogen receptor content was measured in the biopsied liver samples using immunohistochemistry.In the whole cohort, the regression slope for aspartate transaminase was comparable between female and male individuals (P = 0.940). Within the subgroup of donors aged ≤40 y, the regression slope was significantly smaller in female individuals (P = 0.031), whereas it was comparable within donors aged40 y (P = 0.867). Within the subgroup of nonmacrosteatotic donors aged ≤40 y, the regression slope was significantly smaller in female individuals in univariable (P = 0.002) and multivariable analysis (P = 0.006), whereas the sex difference was not found within macrosteatotic donors aged ≤40 y (P = 0.685). Estrogen receptor content was significantly greater in female individuals within nonmacrosteatotic donors aged ≤40 y (P = 0.021), whereas it was not different in others of age40 y or with macrosteatosis (P = 0.450).The tolerance of hepatic ischemia-reperfusion injury was greater in female individuals than in male individuals only when they were40 y and without macrosteatosis. The results were in agreement with the hepatic estrogen receptor immunohistochemistry study.

With the continued fight against coronavirus disease 2019 (COVID-19), new guidelines on its management are emerging; however, information on COVID-19 and pregnancy remains limited. Therefore, this study aimed to review the guidelines of the American College of Obstetricians and Gynecologists, Society for Maternal Fetal Medicine, and Royal College Obstetrics and Gynecology and International Society of Ultrasound in Obstetrics and Gynecology.

Imperforate anus is an anomaly caused by a defect in the development of the hindgut during early pregnancy. It is a relatively common congenital malformation and is more common in males. Although there are cases of a solitary imperforate anus, the condition is more commonly found as a part of a wider spectrum of other congenital anomalies. Although urgent reconstruc tive anorectal surgery is not necessary, immediate evaluation is important and urgent decom pressive surgery may be required. Moreover, as there are often other anomalies that can affect management, prenatal diagnosis can help in optimizing perinatal care and prepare parents through prenatal counseling. In the past, imperforate anus was diagnosed by prenatal ultraso nography based on indirect signs such as bowel dilatation or intraluminal calcified meconium. Currently, it is diagnosed by directly checking the perineum with prenatal ultrasonography. De spite advances in ultrasound technology, accurate prenatal diagnosis is impossible in most cases and imperforate anus is detected after birth. Here, we present two cases of imperforate anus in female fetuses that were not diagnosed prenatally.

This study aimed to determine the relationship between estimated fetal weight discordance by ultrasonography and maternal and neonatal outcomes in dichorionic diamniotic twin pregnancies. We conducted a retrospective review of the medical records of 106 twin pregnancies delivered at a single tertiary center between January 2011 and February 2020. At 20–24 and 28–32 weeks of gestation, participants were divided into two groups: discordant twins with an estimated fetal weight difference of more than 20% and concordant twins with a weight difference of less than 20%. Maternal complications and neonatal outcomes were compared between the two groups. Although the incidences of preeclampsia and placenta previa were significantly higher in discordant twins measured between 20 and 24 weeks, no statistical significance was found in neonatal outcomes. Delivery times were earlier, and neonatal weights were lower in discordant twins measured between 28 and 32 weeks. Neonatal outcomes such as ventilator use and neurodevelopment were also significantly different. Discordance in estimated fetal weight measured using ultrasonography between 20 and 24 weeks can be a risk factor for maternal preeclampsia and placenta previa, whereas discordance at 28–32 weeks may predict poor neonatal outcomes.

Background: This study aimed to determine the correlation between maternal weight gain in each trimester and fetal growth according to pre-pregnancy maternal body mass index in twin pregnancies.Methods: We conducted a retrospective review of the medical records of 500 twin pregnancies delivered at 28 weeks’ gestation or greater at a single tertiary center between January 2011 and December 2020. We measured the height, pre-pregnant body weight, and maternal body weight of women with twin pregnancies and evaluated the relationship between the maternal weight gain at each trimester and fetal growth restriction according to pre-pregnancy body mass index.Results: The overweight pregnant women were older than the normal or underweight pregnant women, and the risk of gestational diabetes was high. The underweight pregnant women were younger, and the incidences of preterm labor and short cervical length during pregnancy was high. Especially in normal weight pregnant women, the heavier the weight of the newborn babies as the second trimester of pregnancy weight gain, the less significant the weight gain in the first trimester of pregnancy and fetal growth. The most predictive single factor for the prediction of small neonates was weight gain during 24-28 weeks and 15-18 weeks, and the cutoff value was 6.2 kg. (area under the curve 0.592, p < 0.001).Conclusions: In twin pregnancy, regardless of the pre-pregnant body mass index, maternal weight gain affected fetal growth. Furthermore, weight gain in the second trimester of pregnancy is considered a powerful indicator of fetal growth, especially in normal weight pregnancies.

Purpose: The aim of this study was to determine the relationships between the estimated fetal weight discordancy, which was measured by ultrasound during pregnancy, and maternal pregnancy complications and neonatal outcomes in dichorionic diamniotic twin pregnancies.Methods: We conducted a retrospective review of the medical records of 320 twin pregnancies delivered at Chilgok Kyungpook National University Hospital between January 2011 and February 2020. This study included dichorionic diamniotic twin mothers who delivered between 32+1 and 38+0 weeks of gestation. Mothers who had one fetal demise, a major anomaly, or twin-specific complications were excluded. At 20–24 weeks and 28–32 weeks of gestation, participants were divided into 2 groups: discordant twins with an estimated fetal weight difference of more than 20% and concordant twins with a weight difference of less than 20%. The maternal complications and neonatal outcomes were compared between the two groups. Results: The incidences of preeclampsia and placenta previa were significantly higher in discordant twins measured between 20 and 24 weeks compared with concordant twins, but no statistical significance was found in the neonatal outcomes between the two groups. Delivery times were earlier and neonatal weights were lower in discordant twins measured between 28 and 32 weeks. Neonatal outcomes such as ventilator use and neurodevelopment were also significantly different. Conclusion: Discordance in estimated fetal weight measured by ultrasound between 20 and 24 weeks is a risk factor for maternal preeclampsia and placenta previa, whereas discordancy at 28–32 weeks can predict poor neonatal outcomes.

We aimed to evaluate the changes in plasma membrane Ca2+-ATPase (PMCA) and sarcoendoplasmic reticulum CA2+-ATPase (SERCA-2) according to the antepartal magnesium sulfate (MgSO4) administration in the placentas from pregnancies with pre-eclampsia (PE) or fetal growth restriction (FGR). Pregnant women were classified as follows: (group 1) pregnancies without PE or FGR (n=16), (group 2) pregnancies with PE or FGR but without MgSO4 administration (n=14), and (group 3) pregnancies with PE or FGR and with MgSO4 administration (n=28). We observed the localization of PMCA and SERCA-2 in placentas and compared its expression among 3 groups. And we observed its expression in BeWo cells following treatment with MgSO4 and CoCl2. PMCA staining was more observed in the basal membrane, whereas SERCA-2 staining was observed predominantly under the microvillous membrane. SERCA-2 expression was significantly increased in group 3 compared with that in group 1. Considering the gestational age at delivery, PMCA expression was increased in group 2 and group 3 compared with that in group 1 after 36 weeks of gestation. SERCA-2 was increased in group 3, but not in group 2 compared with that in group 1 after 36 weeks of gestation. In BeWo cells, MgSO4 treatment increased PMCA and SERCA-2 expression. PMCA expression was influenced by gestational age at delivery, and SERCA-2 expression was increased in the presence of PE and antepartal MgSO4 administration. This indicates that antepartal MgSO4 administration has a greater influence on SERCA-2 than PMCA.

We aimed to determine the upper and lower cutoff values to simplify the diagnosis of gestational diabetes mellitus (GDM). We investigated the 50-g oral glucose tolerance test (OGTT) results from 1441 pregnancies and identified 423 gravidas who underwent the 100-g OGTT from 2011 to 2019. We collected the results of 50- and 100-g OGTTs. Moreover, we obtained the sum of the 50-g OGTT and 0-hour values, and the sum of those levels and 1-hour values. We determined the upper cutoff at 50-g OGTT, 0-, 1-hour, sum of 50-g OGTT and 0-hour results, and sum of those levels and 1-hour results for the confirmation of GDM. Also, we determined the lower cutoff at these tests for the exclusion of GDM. The upper cutoffs in 50-g OGTT, 0-, 1-hour, the sum of 50-g OGTT and 0-hour were 222, 115, 212, and 315 mg/dL, respectively. The lower cutoffs in 50-g OGTT, 0-, 1-hour, the sum of 50-g OGTT and 0-hour were 131, 65, 151, and 208 mg/dL, respectively. In addition, we discovered that the upper and lower cutoffs in the sum of 50-g OGTT, 0- and 1-hour values were516 and373 mg/dL, respectively. We implemented these cutoffs to our study group at 50-g OGTT and 0-, 1-hour of 100-g OGTT. It could omit 2- and 3-hour sampling in 216 gravidas (51.1%). Our approach was able to simplify GDM diagnostic steps in half of our study group.

Unilateral pulmonary artery discontinuity (UPAD) is a rare malformation which is associated with other intracardiac abnormalities. Cases accompanied by other cardiac abnormalities are often missed on prenatal echocardiography. We reported our case which was prenatally diagnosed as pulmonary atresia with ventricular septal defect (PAVSD) and left pulmonary artery (LPA) discontinuity.

Background Posttransplant liver graft failure occurs most often in male recipients of livers from female donors. The respective role of donor sex itself and the size disparity in graft vessels/bile ducts according to donor sex are unclear. Thus, we aimed to evaluate the importance of donor sex with adjustment for anastomotic size disparity between female and male donor grafts. Methods A total of 309 male patients without hepatic tumors who underwent living donor liver transplantation were analyzed (109 female donors and 200 male donors). The primary outcome was posttransplant graft failure (ie, retransplantation or death). Survival analysis was performed using the Cox model. Analyzed anastomosis-related factors comprised graft weight, number and size of hepatic vessels/bile ducts, and anastomosis techniques. Results Graft failure probabilities at 1, 6, 12, 24, and 60 months posttransplantation were 9.1%, 19.5%, 20.2%, 23.0%, and 27.0%, respectively, with female donors and 2.0%, 5.5%, 8.1%, 10.1%, and 13.5% with male donors (hazards ratio [HR], 2.29; 95% confidence interval [CI], 1.35-3.88; P = 0.002). Multivariable analysis confirmed the significance of donor sex (HR, 2.30; 95% CI, 1.14-4.67; P = 0.021) after adjustment for anastomosis-related factors. All analyzed anastomosis-related factors showed no significant association with graft failure, although size of the graft hepatic artery showed marginal significance (HR, 0.50; 95% CI, 0.25-1.01; P = 0.053). The significance of donor sex was lost when donor was older than 36 to 40 years (age of poor ovarian reserve and the end of female fertility). Our institutional pediatric recipient cohort validated the inferiority of female-to-male donation. Conclusions Donor sex appears to be an independent factor modulating graft failure risk in male liver transplant recipients.

Background:Many studies have shown a link between gout and metabolic syndrome (MetS). It is well known that lifestyle modifications such as weight reduction and abstinence from alcohol are effective in the treatment of gout, but data are lacking on how exactly the change of metabolic parameters affects gout.Objectives:The purpose of this study was to investigate the relationship between gout risk and metabolic parameters in a nationwide population based young adult cohort, and to determine whether changes in metabolic parameters affect gout risk changes.Methods:Among adults aged 20-39 years who participated in national health check-up programs from 2009 to 2012, a total of 6,290,914 subjects were included in the study, excluding subjects who were previously diagnosed with gout. To determine the effect of changes in metabolic parameters on gout incidence, 2,701,138 subjects who participated in the health examination once more 2 years later were used for the analysis. Outcome was defined as the occurrence of gout, when the ICD-10 code (M10) was registered twice in the claim database. The Cox proportional hazard model and Kaplan Meier curve were used for the analysis.Results:The incidence rate of gout was higher in those with MetS compared to those without (10.1 vs. 3.6 per 1,000 person-years). The risk of gout in people with MetS was 85% higher (adjusted HR 1.85, 95% CI 1.83-1.87) and was more significant in men than in women (adjusted HR 1.88 in male and 1.56 in female). Each component of MetS was also associated with increased gout risk, and hypertriglyceridemia showed the highest adjusted HR. The greater the number of MetS components, the higher the gout risk. The risk of gout was 70% higher in those who had MetS consistently (adjusted HR 1.71, 95% CI 1.67-1.75) and 44% higher in those with newly developed MetS (adjusted HR 1.47, 95% CI 1.40-1.48) than those who did not have MetS at the two health examinations. Similar risk patterns were observed according to the change of each metabolic parameter. Among the metabolic parameters, the change in hypertriglyceridemia was associated with the greatest difference in the change in gout risk.Conclusion:In young adults, MetS was associated with a higher risk of gout, especially with more components, the higher the risk. Since the occurrence of MetS is associated with an increased risk of gout, prevention of MetS would be important to reduce gout incidence.Disclosure of Interests:None declared

Background:Previous studies using cluster analysis technique in ankylosing spondylitis (AS) patients have consistently identified distinct groups of patients in terms of their clinical characteristics: those with pure axial symptoms and those with a high frequency of peripheral manifestations [1,2]. Due to the cross-sectional nature of these studies, however, prognostic information such as drug survival of anti-TNF agents in these group were not provided.Objectives:Using the data retrieved from Korean College of Rheumatology Biologics (KOBIO) registry, which includes longitudinal data of AS patients using anti-TNF agents, this study aims to perform cluster analysis to differentiate AS patients in terms of clinical phenotypes and to examine the differential drug survival of anti-TNF agents in these groups.Methods:Clinical characteristics and demographic data of AS patients in KOBIO registry were analyzed using hierarchical clustering analysis. After clustering, drug survivals of anti-TNF agents were compared between these groups.Results:1,046 patients were included in the study with no missing data. The hierarchical cluster analysis classified patients in two groups; one with predominant isolated axial manifestations (axial group, n=823) and the other with more frequent extra-axial symptoms (extra-axial group, n=223). Almost all extra-axial symptoms (peripheral arthritis, enthesitis, uveitis, dactylitis, and psoriasis) were more frequently observed in extra-axial group than axial group. In addition, patients with shorter disease duration, late disease onset, and high disease activity were classified in extra-axial group (Table 1). Interestingly, the extra-axial group had lower drug survival probability than the axial group (p=0.008, Figure 1).Conclusion:Cluster analysis of AS patients using anti-TNF agents classified two distinct groups of patients in terms of their clinical phenotypes and revealed that the patients with prominent extra-axial manifestations had lower drug survival with anti-TNF agents.References:[1]Costantino F, et al. Two Phenotypes Are Identified by Cluster Analysis in Early Inflammatory Back Pain Suggestive of Spondyloarthritis: Results From the DESIR Cohort. Arthritis Rheumatol. 2016 Jul;68(7):1660-8.[2]Porcher R, et al. Two major spondylarthropathy phenotypes are distinguished by pattern analysis in multiplex families. Arthritis Rheum. 2005 Apr 15;53(2):263-71.Table 1.Clinical characteristics of divided groupsGroup1 (axial group)2 (extra-axial group)pNumber of patients823223Age at start of TNFi (yr)38.21 (12.78)38.58 (14.17)0.713Disease duration (yr)3.95 (5.26)2.29 (4.32)Age at diagnosis34.27 (13.05)36.29 (14.11)0.044Sex (male) (%)645 (78.4)152 (68.2)0.002HLA-B27 positivity (%)736 (89.4)197 (88.3)0.732Inflammatory back pain (%)699 (84.9)191 (85.7)0.872Peripheral arthritis (%)201 (24.4)191 (85.7)Enthesitis (%)65 (7.9)154 (69.1)Uveitis (%)163 (19.8)59 (26.5)0.039Dactylitis (%)12 (1.5)13 (5.8)Psoriasis (%)15 (1.8)12 (5.4)0.006Good response to NSAIDs (%)205 (24.9)155 (69.5)Family history (%)88 (10.7)27 (12.1)0.632Smoking (%)408 (49.6)102 (45.7)0.347CRP (mg/dl)2.10 (2.74)2.89 (3.57)ESR (mm/hr)35.52 (28.73)46.33 (32.94)BASDAI5.93 (1.92)6.41 (1.80)0.001BASF3.42 (2.56)3.64 (2.58)0.255Drug change after one year (%)160 (19.4)61 (27.4)0.013Disclosure of Interests:None declared.

Background:Behcet’s disease (BD) is an immune-mediated systemic vasculitis affecting any size of blood vessels. Previous studies showed that BD may involve large arterial vessels [1] but the radiographic outcome has not been well known due to its low prevalence.Objectives:To evaluate the radiographic outcome of vascular BD involving aorta and its major branches and the clinical characteristics of each prognosis group.Methods:We retrospectively analyzed the medical records of patients who visited a single-center tertiary hospital in Seoul, Korea, across a 19-year period (Jan 2002 to Dec 2020). All patients fulfilled the International Criteria for Behcet’s Disease. The patients included in this study had undergone CT angiography (CTA) of the aorta and its major branches at least twice in a 2–5 year interval and showed characteristic vascular involvements (aneurysm, stenosis, occlusion, vessel wall thickening, and thrombosis). Due to lack of the validated definition of radiographic progression of large vessel vasculitis in BD, we defined 20% changes of existing lesions or occurrence of new lesions as a radiographic progression.Results:22 patients with BD met the inclusion criteria. 5 patients (22.7%) progressed radiographically between the initial and follow-up CTA despite low acute phase reactant levels (AUC of ESR and CRP were 13.94 mm/h and 0.32 mg/dl, respectively). Aneurysm was the most frequent form of vascular involvement followed by thrombosis (21 [95.5%] and 11 [50.0%] patients, respectively, Table 1). Patients with radiographically progressive disease had longer disease duration (1.63 vs. 6.61 years, p=0.010) at initial CTA evaluation. Other clinical characteristics, including ESR, CRP, medication use, and follow up duration, were not different between two groups (Table 2).Table 1.Radiographic characteristics of the cohort.OverallNot progressedProgressedpn22175Aneurysm (%)21 (95.5)16 (94.1)5 (100.0)>0.999Stenosis (%)5 (22.7)4 (23.5)1 (20.0)>0.999Occlusion (%)5 (22.7)5 (29.4)0 (0.0)0.440Wall thickening (%)4 (18.2)4 (23.5)0 (0.0)0.589Thrombosis (%)11 (50.0)9 (52.9)2 (40.0)>0.999Conclusion:A considerable number of vascular BD patients involving aorta and its major branches progressed radiographically despite low disease activity. Radiographically progressed patients had longer disease duration, but other clinical characteristics were not significantly different whether progressed or not.References:[1]Kural-Seyahi, Emire MD et al. The Long-Term Mortality and Morbidity of Behçet Syndrome. Medicine. 2003 Jan;82(1):60-76.Table 2.Clinical characteristics of the cohort.OverallNot progressedProgressedpn22175Sex (Male) (%)22 (100.0)17 (100.0)5 (100.0)NAAge (yr)46.43 (7.71)45.06 (8.06)51.10 (4.03)0.126Disease duration (yr)2.77 (3.99)1.63 (2.66)6.61 (5.61)0.01HTN (%)5 (22.7)4 (23.5)1 (20.0)>0.999DM (%)1 (4.5)1 (5.9)0 (0.0)>0.999Dyslipidemia (%)6 (27.3)5 (29.4)1 (20.0)>0.999CKD (%)7 (31.8)4 (23.5)3 (60.0)0.321BMI (kg/m2)42.91 (91.28)48.23 (103.94)24.82 (1.69)0.626AUC of CRP (mg/dl)0.32 (0.37)0.31 (0.41)0.37 (0.12)0.758AUC of ESR (mm/h)13.94 (11.40)13.30 (12.77)16.12 (4.66)0.638Immunosuppressive agent use (%)18 (81.8)14 (82.4)4 (80.0)>0.999Steroid use (%)22 (100.0)17 (100.0)5 (100.0)NAf/u duration (yr)3.54 (0.80)3.56 (0.79)3.50 (0.92)0.885Data are presented as mean (SD) unless otherwise specifiedDisclosure of Interests:None declared

Uterine fibroids are common benign tumors that may cause an umbilical hernia in patients with increased intra-abdominal pressure due to pregnancy, obesity, ascites, and intra-abdominal tumors. However, the simultaneous occurrence of uterine fibroids and umbilical hernias, or fibroids and an associated umbilical hernia, during pregnancy has rarely been reported. Here, we present the case of a fibroid presenting as an incarcerated umbilical hernia in a menopausal patient.

Background The prediction of preterm birth (PTB) is important in the management of symptomatic preterm labour women. We evaluated the effectiveness of the foetal fibronectin (fFN) test for predicting PTB in symptomatic preterm labour women with consideration of physiologic changes in cervical length (CL) during pregnancy. Methods This prospective study included 85 women with symptomatic preterm labour of a singleton pregnancy. Positive fFN was defined as a fFN level of > 50 ng/mL in cervicovaginal secretion, while a short CL was defined as that below 25th percentile at the corresponding gestational age. We evaluated effectiveness of the fFN test, CL, and the combination of these two tests, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR−) to predict the PTB within 7 and 14 days of testing and PTB at

Background: Preterm birth is strongly associated with increasing mortality, incidence of disability, intensity of neonatal care required, and consequent costs. We examined the clinical utility of the potential preterm birth risk factors from admitted pregnant women with symptomatic preterm labor and developed prediction models to obtain information for prolonging pregnancies. Methods: This retrospective study included pregnant women registered with the KOrean Preterm collaboratE Network (KOPEN) who had symptomatic preterm labor, between 16 and 34 gestational weeks, in a tertiary care center from March to November 2016. Demographics, obstetric and medical histories, and basic laboratory test results obtained at admission were evaluated. The preterm birth probability was assessed using a nomogram and decision tree according to birth gestational age: early preterm, before 32 weeks; late preterm, between 32 and 37 weeks; and term, after 37 weeks. Results: Of 879 registered pregnant women, 727 who gave birth at a designated institute were analyzed. The rates of early preterm, late preterm, and term births were 18.16%, 44.02%, and 37.83%, respectively. With the developed nomogram, the concordance index for early and late preterm births was 0.824 (95% CI: 0.785-0.864) and 0.717 (95% CI: 0.675-0.759) respectively. Preterm birth was significantly more likely among women with multiple pregnancy and had water leakage due to premature rupture of membrane. The prediction rate for preterm birth based on decision tree analysis was 86.9% for early preterm and 73.9% for late preterm; the most important nodes are watery leakage for early preterm birth and multiple pregnancy for late preterm birth. Conclusion: This study aims to develop an individual overall probability of preterm birth based on specific risk factors at critical gestational times of preterm birth using a range of clinical variables recorded at the initial hospital admission. Therefore, these models may be useful for clinicians and patients in clinical decision-making and for hospitalization or lifestyle coaching in an outpatient setting.

The study aims to evaluate the rate of transition to osteoporosis in 360 RA patients and estimate the rescreening intervals of bone mineral density (BMD) testing. Osteoporosis was newly developed in 24.8 % during mean follow-up of 7.4 years. The estimated time of a BMD testing interval was dependent on the baseline T-score in RA patients. Although BMD testing is routinely performed in RA patients, the interval between BMD tests has not been determined. We retrospectively recruited 360 consecutive female patients with RA, who underwent repeated BMD testing, with a mean age of 53.7 ± 10.2 years and a mean follow-up duration of 7.4 ± 5.0 years. We stratified the study participants into five groups based on their baseline T-score range. The testing interval was defined as the estimated time for 10 % of patients in each subgroup to transition to osteoporosis. Competing-risk analyses were performed with sensitivity analysis by menopausal status and risk factors for transition to osteoporosis. At baseline, 15 % of screened patients had osteoporosis, and during follow-up, that proportion increased to 24.8 %. The estimated BMD testing interval for 10 % of patients to develop osteoporosis was 9.6 years for those with normal BMD, 7.6 years for those with mild osteopenia, 4.7 years for those with moderate osteopenia, and 2.1 years for those with severe osteopenia. No significant risk factor for transition to osteoporosis was identified in this cohort. Our data indicate that osteoporosis will develop in less than 10 % of female RA patients during rescreening intervals of approximately 9 years for those with normal bone density at baseline, 7 years for those with mild osteopenia, 4 years for those with moderate osteopenia, and 2 years for those with severe osteopenia at baseline. BMD interval in RA patients could be adjusted according to their baseline BMD T-scores.

Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.

Background:Osteoarthritis (OA) and osteoporosis (OP) are both high prevalence at old age, and there are various reports on the association between the two diseases. Some studies have shown that high bone mineral density (BMD) is a risk factor for OA incidence, while others have mentioned the possibility of OP contributing to onset of hip OA. Recent study described that higher BMD reduce the risk of hip OA and raise the risk of knee OA. So, the relationship between BMD and OA or the effects of BMD on different OA site are not clear yet.Objectives:In this study, we investigated the association between BMD and radiographic OA using representative sample data of Korean adults.Methods:The study included 6345 subjects aged 50 years or older who underwent BMD measurements using dual-energy X-ray absorptiometry and X-rays of at least one site of the spine, hip, and knee in the Korean National Health and Nutrition Examination Survey conducted in 2010-2011. OA was defined according to radiographic finding (KL grade ≥ 2). Weighted multivariable logistic regression was used to analyze the association between BMD and OA. Since gender differences are evident, men and women were analyzed separately.Results:Spine OA was about 60% in both men and women, and hip OA was about 35% in men but only 1% in women. Knee OA was 76% in women and 58% in men. In men, the risk of OA increased 1.24 times as BMD increased by 1 g/cm2. By site, knee and spine OA were statistically significant in relation to BMD, but hip OA was not statistically significant. In women, the association between BMD and knee and hip OA was insignificant. In spine OA, the risk of OA increased 1.2 times when BMD increased by 1 g/cm2.Conclusion:In conclusion, high BMD increased the risk of knee and spine OA in men, but did not affect hip OA. In women, high BMD increased the risk of spine OA. Differences in the mechanism of OA development by site are thought to be possible explanations for the differences in the association between BMD and OA.Disclosure of Interests:None declared

Background:Tumor necrosis factor (TNF) inhibitors are important drugs in treating patients with ankylosing spondylitis (AS). However, they are not used as a first-line treatment for AS. There is an insufficient treatment response to the first-line treatment, non-steroidal anti-inflammatory drugs (NSAIDs), in over 40% of patients. If we can predict who will need TNF inhibitors at an earlier phase, adequate treatment can be provided at an appropriate time and potential damages can be avoided. There is no precise predictive model at present. Recently, various machine learning methods show great performances in predictions using clinical data.Objectives:We aim to generate an artificial neural network (ANN) model to predict early TNF inhibitor users in patients with ankylosing spondylitis.Methods:The baseline demographic and laboratory data of patients who visited Samsung Medical Center rheumatology clinic from Dec. 2003 to Sep. 2018 were analyzed. Patients were divided into two groups: early TNF inhibitor users treated by TNF inhibitors within six months of their follow-up (early-TNF users), and the others (non-early-TNF users). Machine learning models were formulated to predict the early-TNF users using the baseline data. Additionally, feature importance analysis was performed to delineate significant baseline characteristics.Results:The numbers of early-TNF and non-early-TNF users were 90 and 509, respectively. The best performing ANN model utilized 3 hidden layers with 50 hidden nodes each; its performance (area under curve (AUC) = 0.75) was superior to logistic regression model, support vector machine, and random forest model (AUC = 0.72, 0.65, and 0.71, respectively) in predicting early-TNF users. Feature importance analysis revealed erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and height as the top significant baseline characteristics for predicting early-TNF users. Among these characteristics, height was revealed by machine learning models but not by conventional statistical techniques.Conclusion:Our model displayed superior performance in predicting early TNF users compared with logistic regression and other machine learning models. Machine learning can be a vital tool in predicting treatment response in various rheumatologic diseases.Disclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect any organ of the body. Nervous system involvement of SLE lead to a variety of neurologic and psychiatric manifestations, which are called neuropsychiatric lupus. Cognitive dysfunction may appear as part of neuropsychiatric lupus. There are several papers on the increase in dementia risk in SLE patients, but data are not sufficient and there is little data on whether SLE affects dementia differently depending on the dementia subtype.Objectives:We evaluate dementia incidence and risk in SLE patients in a nationwide population-based cohort and determine whether the risk is different for each dementia subtype.Methods:We identified patients aged 40 years or more, with systemic lupus erythematosus between 2008 and 2014 using the database of the National Health Insurance Service (NHIS) of south Korea. Patients who had previously been diagnosed with dementia were excluded from the study. A total of 11,288 SLE patients and 56,440 control subjects with a 1:5 age- and sex-matching were included in the study. The primary outcome of the study was incident dementia, which was defined by an ICD-10 code and the use of dementia medications. Kaplan-Meier curves and Cox proportional hazards regression analysis were used for the analysis.Results:The incidence rate of dementia was higher in SLE cohort (3.90 per 1,000 person-years) than control cohort (2.73 per 1,000 person-years). Incidence rates of Alzheimer disease and vascular dementia were also higher in SLE cohort than control. SLE patients had a higher risk of dementia compared to control cohorts without SLE (crude hazard ratio 1.43, 95% CI 1.25-1.63). In patients with SLE, the risk of Alzheimer’s disease was 1.4 times higher and the risk of vascular dementia 1.6 times higher than non-SLE control.Conclusion:In this nationwide population-based cohort study, SLE patients had a 1.4-fold higher risk of incident dementia compared to patients without SLE. Further studies are warranted to identify mechanisms of increased risk of dementia in SLE patients. Monitoring of dementia incidence in SLE patients is needed in clinical practice.Disclosure of Interests:None declared