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Background/Aims: There are no definite guidelines for the management of gastric lesions diagnosed as indefinite for dysplasia (IND) by endoscopic forceps biopsy (EFB). Therefore, this study aimed to evaluate the clinical outcomes of gastric IND and predictive factors for gastric neoplasm.Methods: This study included 457 patients with a first diagnosis of gastric IND by EFB between January 2005 and December 2013. Patient characteristics and endoscopic and pathological data were reviewed and compared.Results: Of the 457 gastric IND patients, 128 (28%) were diagnosed with invasive carcinoma, 21 (4.6%) with high-grade dysplasia, 31 (6.8%) with low-grade dysplasia, and 277 (60.6%) as negative for dysplasia. Of lesions observed, 180 (39.4%) showed upgraded histology. Multivariate analysis revealed that surface erythema (odds ratio [OR], 2.804; 95% confidence interval [CI], 1.741 to 4.516), spontaneous bleeding (OR, 2.618; 95% CI, 1.298 to 5.279), lesion size ≥ 1 cm (OR, 5.762; 95% CI, 3.459 to 9.597), and depressed morphology (OR, 2.183; 95% CI, 1.155 to 4.124) were significant risk factors for high-grade dysplasia or adenocarcinoma. The ORs associated with 2 and ≥ 3 risk factors were 7.131 and 34.86, respectively.Conclusions: Precautions should be taken in the management of gastric IND patients, especially when risk factors, including surface erythema, spontaneous bleeding, lesion size ≥ 1 cm, and depressed morphology are present. Considering the combined effect of the presence of multiple risk factors on the incidence of high-grade dysplasia or adenocarcinoma, endoscopic resection should be recommended if a gastric IND patient has at two or more of these factors. more...

Objective Dementia affects over 47 million people worldwide. Olfactory impairment (OI) is a well-established predictive marker of conversion to dementia among those with mild cognitive impairment. This systematic review aims to describe the predictive value of OI for future cognitive decline among cognitively normal adults. Methods A literature search encompassing PubMed, EMBASE, and Cochrane for longitudinal cohort studies following cognitively normal adults with baseline OI in comparison to those without OI reporting incident cognitive impairment or dementia was included. Study design, participant demographics, olfactory testing method, and incidence of cognitive decline or dementia were abstracted. Two investigators independently reviewed all articles. Results The search yielded 964 nonduplicate abstracts and titles, from which 19 full-text articles were reviewed and 10 were included. Studies included were all good quality (mean score 8.7 of 9), and all studies (100%) found a statistically significant association between baseline OI and incident cognitive decline compared with normosmic controls. Conclusion The existing literature suggests that OI predicts future cognitive decline among cognitively normal adults, supporting olfactory evaluation as a low-cost, minimally invasive, and widely available screening tool to be used in combination with other tests to identify adults at early risk of dementia. Level of evidence NA Laryngoscope, 130:840-847, 2020. more...

Objectives Postoperative hemorrhage is a serious complication of tonsillectomy, with secondary bleeding rates affecting up to 0.8% to 3% of patients. Although these bleeds are anecdotally perceived as occurring more frequently at night, the occurrence of hemorrhage relative to the time of day has not been investigated. We measured the frequency of post-tonsillectomy hemorrhage onset relative to the time of day. Methods We reviewed electronic medical records of all patients who experienced postprocedural hemorrhage (International Classification of Disease, Ninth Edition [ICD-9] 998.11, ICD-10 J95.830 at two hospitals within a tertiary academic health system in a 10-year period). Patient demographics, time of bleed onset, emergency room [ED] arrival time, and management (operating room vs. observation) were abstracted. Patients without a recorded bleeding time were excluded. Time of bleed onset was categorized as morning (6:01 am-12 pm), afternoon (12:01 pm-6 pm), evening (6:01 pm-12 am), or overnight (12:01 am-6 am). Chi-square goodness of fit test was used to assess the distribution of hemorrhage timing (P ≤ 0.05). Results A total of 7,396 patients underwent tonsillectomy May 2008 through May 2018, among whom 121 (2%) post-tonsillectomy hemorrhage patients were identified. Among the 104 patients with ED arrival times, 29 (28%) arrived in the morning; 15 (14%) arrived in the afternoon; 40 (38%) arrived in the evening; and 20 (19%) arrived overnight (P = 0.003). Sixty patients (mean age 17.1 years, standard deviation 16.6) had a recorded timing of bleed onset. Bleed onset occurred most commonly overnight (24, 40%), followed by evening (21, 35%), afternoon (11, 18%), and morning (4, 7%) (P = 0.0007). Conclusion In this cohort, post-tonsillectomy hemorrhage occurred most frequently between midnight and 6 am. Our findings confirm anecdotal experience and provide data in setting caregiver expectations. Level of evidence 4 Laryngoscope, 130:1823-1827, 2020. more...

현전하는 신라의 문헌자료에는 혁거세를 국조로 하는 건국신화가 실려 있다. 신라는 사로국을 모체로 주변 진한 여러 나라를 병합하면서 성장하였다. 신라 문헌자료에 보이는 초기 기록은 사로국과 관련된 것으로 이해하고 있다. 그러므로 혁거세는 신라 초기 왕실인 소위 ‘박씨’의 시조이자 사로국의 국가시조로 이해해 왔다. 그런데 혁거세 신화에서는 역사적 인격으로서의 성격이 강하게 나타나지 않았다. 혁거세 신화는 건국과 관련된 활동이나 정치적 행적이 전혀 보이지 않는다. 또한 혁거세는 고대 건국신화에 보이는 선민의식이나 영웅전승적 모습도 보이지 않는다. 반면 신격으로서 광명신, 천신의 성격이 두드러졌다. 이는 혁거세가 사로국 형성과 관계가 있는 역사적 시조가 아니라, 관념적으로 만들어진 시조였을 가능성을 보여준다. 혁거세 신화는 알영 전승, 6촌장 전승과 유기적으로 연결되어 있다. 혁거세를 국조로 하는 신화가 6촌의 형성을 배경으로 만들어졌음을 보여준다. 또한 혁거세 신화의 신화소를 바탕으로 혁거세 신화는 김씨가 신라 왕위를 독점하는 마립간시기에 만들어졌던 것으로 보았다. 혁거세는 사로국이 아닌 신라 국가의 국조였던 것으로 이해할 수 있다. 사로국 단계에서는 조상신과 천신 두 가지 계통의 제사가 있었다. 혁거세는 천신 신앙과 관련이 있었다. 천신과 별도로 조상신 제사가 있었는데, 사로국에서 조상신, 시조로 인식되었던 존재는 알영으로 이해했다. 그런데 사로국이 주변 소국들을 병합해 가면서 신라 국가로 변화된 뒤 혁거세를 국조로 하는 건국신화가 형성되었다. 마립간기에 설립된 신궁은 혁거세 국조 형성과 관련이 있었다. 그러므로 혁거세는 ‘박씨’ 표현되었던 초기 왕실과 관련이 없는 것으로 이해했다. 혁거세의 신화적 속성은 천강신화이며, ‘알지거서간’이라는 표현 등을 볼때 오히려 혁거세는 김씨의 시조인 알지 전승과 유사했다. 이는 혁거세의 국조신화의 형성이 사로국 단계의 초기 왕계가 아닌 김씨 족단과 관련을 가지고 있음을 보여준다. 마립간기 이후 김씨들이 왕위를 독점하면서 새로운 국조 신화체계를 모색하게 되었다. 김씨 족단은 알지를 시조로 하는 전승이 있지만, 신라 전체의 국조로 내세우기에는 한계가 있었다. 국가 체제로 성장하면서 원시적인 족단별 시조신화를 흡수하면서, 사상적 통일을 이룰 수 있는 국가 시조가 필요하였다. 이 과정에서 사로국 단계에 천신이 인격화되어 신라의 국조로 자리매김하게 되었다. 또한 사로국 단계에 시조로 인식되었던 알영은 시조비로 재편되었다. more...

Purpose The clinical significance of margin status in pancreatic head cancer is still controversial due to the nonstandardized definition of R status and pathologic reporting. This study aims to evaluate the impact of the margin status including location and the role of radiation therapy in pancreatic head cancer. Methods A total of 314 patients who underwent curative-intent surgery for pancreatic head cancer between 2010 and 2017 were analyzed. Demographics, survival, and local recurrences were compared according to 2 definitions: 0-mm R1 as direct involvement and 1-mm R1 as close resection margin less than 1 mm. The specific margins were divided into 4 groups according to the location around the pancreas: pancreas transection, anterior surface, posterior surface, and vessel (superior mesenteric artery/superior mesenteric vein) margin. Results The 0-mm R1-rate was 15.6%, and increased to 36.3% in 1-mm R1. The median overall survival rate of 0-mm R0 vs. R1 was 26 months vs. 16 months (P = 0.052) and that of 1-mm R0 vs. R1 was 27 months vs. 18 months, respectively (P = 0.016). In individual margins, posterior, anterior surface, and pancreas transection margin involvement were associated with poor outcome, and the 1 mm posterior surface involvement was an independent risk factor for disease-free survival (hazard ratio, 1.63). Adjuvant radiation therapy had oncologic benefits, especially in R1 patients (P = 0.011) compared to R0 patients (P = 0.088). Conclusion Margin status, especially 1-mm R1 status is an important predictive factor, and involved posterior surface has a clinical impact. Patients with positive margins should be considered adjuvant radiation therapy. more...

Background: To analyse regional corneal epithelial and stromal remodelling after epithelium-off (epi-off) continuous accelerated corneal collagen cross-linking (CXL) for keratoconus (KC).Methods: In this retrospective study, 20 patients (33 eyes) who were treated with epi-off continuous accelerated CXL (KXL system; Avedro, Inc., Waltham, MA, USA). All treatments were performed with ultraviolet-A (UVA) (energy, 7.2 J/cm2; irradiance, 30 mW/cm2), using continuous (4 min) illumination. The postoperative changes in corneal biometric and visual outcomes were compared. The corneal thickness changes were evaluated using anterior segment optical coherence tomography (Optovue). All patients were followed up for 12 months postoperatively.Results: Uncorrected distance visual acuity significantly improved from 1.06 ± 0.49 logarithm of the minimum angle resolution (logMAR) to 0.71 ± 0.37 logMAR at 3 months after epi-off continuous accelerated CXL (pConclusions: Significant regional epithelial remodelling occurs after epi-off continuous accelerated CXL; a more regular corneal thickness profile and keratometric variations were observed after treatment. more...

This article examines the relationship between human emotions and slavery in Chosŏn Korea (1392–1910) by examining legislative processes as well as private practices concerning the status of the of... more...

OBJECTIVES Collaboration and diversity of expertise are increasingly emphasized in the production of successful research. However, the degree of cross-disciplinary collaboration in otolaryngology research is unknown. In this study, we quantify cross-disciplinary collaboration in otolaryngology publications. METHODS We retrospectively analyzed authorship and study characteristics for all original articles published from January 2014 to December 2016 in three key peer-reviewed otolaryngology journals: Laryngoscope, Otolaryngology-Head & Neck Surgery, and JAMA Otolaryngology-Head & Neck Surgery. Author affiliations and online searches were used to determine author's primary discipline. Subspecialty topic of article, study design, and funding sources were also recorded. Fisher exact test was used to compare characteristics of articles with and without cross-disciplinary authorship. RESULTS A total of 2,378 articles were reviewed, of which 1,312 (55%) articles had one or more cross-disciplinary collaborators. Among articles with cross-disciplinary collaboration, the greatest representation of disciplines was from other medical specialties (1,109, 50.9%), epidemiology/biostatistics (266, 12.2%), pathology/histology (175, 8.0%), biologic sciences (168, 7.7%), and radiology/imaging (144, 6.6%). Cross-disciplinary studies had a significantly greater proportion of articles on the topic of head and neck compared to studies without collaboration (P < 0.0001). The proportion of funded studies was significantly greater among articles with collaboration compared to articles without collaboration (P < 0.0001). CONCLUSION The majority of articles published during a 3-year period in three influential otolaryngology journals had cross-disciplinary collaboration. There is potential opportunity for further leveraging expertise, funding opportunities, and dissemination of key findings through collaborative research. LEVEL OF EVIDENCE NA Laryngoscope, 129:1800-1805, 2019. more...

The factors associated with recurrence of colonic neoplasm after endoscopic resection with a positive lateral margin are not well known. Thus, we evaluate the relationship between recurrence and positive lateral margin after endoscopic en bloc resection of colorectal neoplasm.A retrospective review of 9302 patients who underwent colonic endoscopic resection from January 2008 to January 2015. Of these, a total of 76 patients with positive lateral margins with clear evidence of the its location on endoscopic picture after endoscopic en bloc resection of colorectal neoplasm (10 mm) were included.Ten of 76 (13.2%) patients experienced recurrence during the follow-up period (mean f/u month, 21.7 ± 15.6). In cases with positive lateral margins, the 3- and 5-year local recurrence rate of colorectal neoplasm was 28.1% and 40.1%, respectively. The histological features of the recurrence group were as follows: one case of adenocarcinoma [from low-grade adenoma (LGA)]; two cases of high-grade adenoma (HGA) (one from HGA and one from LGA); and seven cases of LGA (four from adenocarcinoma, two from LGA, and one from HGA). The mean age of patients, locations of the lesions, and histologic type were not significantly associated with local recurrence. In multivariate Poisson regression analyses, total length of lateral margin involvement ≥8 mm (relative risk 12.51; 95% CI 1.11-140.34, p = .040) was a significant predictor of local recurrence.Positive lateral margins ≥8 mm may be a reliable predictor of local recurrence after endoscopic en bloc resection of colorectal neoplasm. more...