BackgroundGestational diabetes mellitus (GDM) affects women with diverse pathological phenotypes, but little is known about the effects of this variation on perinatal outcomes. We explored the metabolic phenotypes of GDM and their impact on adverse pregnancy outcomes. MethodsWomen diagnosed with gestational glucose intolerance or GDM were categorized into subgroups according to their prepregnancy body mass index (BMI) and the median values of the gestational Matsuda and Stumvoll indices. Logistic regression analysis was employed to assess the odds of adverse pregnancy outcomes, such as large-for-gestational age (LGA), small-for-gestational age, preterm birth, low Apgar score, and cesarean section. ResultsA total of 309 women were included, with a median age of 31 years and a median BMI of 22.3 kg/m2. Women with a higher pre-pregnancy BMI had a higher risk of LGA newborns (adjusted odds ratio [aOR] for pre-pregnancy BMI ≥25 kg/m2 compared to 20–23 kg/m2, 4.26; 95% confidence interval [CI], 1.99 to 9.12; P<0.001; P for trend=0.001), but the risk of other adverse pregnancy outcomes did not differ according to pre-pregnancy BMI. Women with insulin resistance had a higher risk of LGA (aOR, 1.88; 95% CI, 1.02 to 3.47; P=0.043) and cesarean section (aOR, 2.12; 95% CI, 1.29 to 3.50; P=0.003) than women in the insulin-sensitive group. In contrast, defective β-cell function did not affect adverse pregnancy outcomes. ConclusionDifferent metabolic phenotypes of GDM were associated with heterogeneous pregnancy outcomes. Women with obesity and those with insulin resistance are at greater risk of adverse outcomes and might need strict glycemic management during pregnancy.
Predicting food allergy resolution is essential to minimize the number of restricted foods in children. However, there have been no studies on the natural history of peanut allergy (PA) in Korea.This study aimed to evaluate the natural course and prognostic factors of immediate-type PA in children till the age of 10 years.We retrospectively collected data of 122 children who developed PA before 60 months of age from 3 tertiary hospitals in Korea. Diagnosis and resolution of PA was defined as an oral food challenge test or a convincing history of symptoms within 2 h after peanut ingestion. The prognostic factors for resolution of PA were identified using the Cox proportional hazard model.The median (interquartile range) age at diagnosis was 2.0 (1.3-3.0) years. Among the 122 children, PA resolved in 18 (14.8%) children. The level of peanut-specific IgE (sIgE) at diagnosis in the persistence group was significantly higher than that in the resolution group (p = 0.026). The probabilities of resolution of PA were 10.3% and 32.8% at the ages of 6 and 10 years, respectively. A peanut-sIgE level ≥1 kU/L at diagnosis was significantly associated with persistent PA (hazard ratio, 5.99; 95% confidence interval, 1.89-18.87).Only 10.3% of our patients had a probability of developing spontaneous resolution of PA by 6 years of age. Peanut-sIgE levels ≥1 kU/L at diagnosis were associated with the persistence of PA.
To compare the diagnostic performance of non-contrast liver MRI to whole MRI using gadoxetic acid for detection of recurrent hepatocellular carcinoma (HCC) after hepatectomy.This retrospective study analyzed 483 patients who underwent surveillance with liver MRI after hepatectomy for HCC (median time interval, 7.7 months). Non-contrast MRI set (T1- and T2 weighted and diffusion-weighted images) and whole MRI set (gadoxetic acid-enhanced and non-contrast MRI) were analyzed independently by two observers. Receiver operating characteristic analysis was used (with the observers' individual observations and consensus) to detect recurrent HCC. The accuracy, sensitivity, and specificity were calculated.A total of 113 patients had 197 recurrent HCCs on first follow-up MRI. Although non-contrast MRI had fairly high sensitivity for recurrent HCC, there were significant differences in sensitivity (94.7% vs 99.1%, p = 0.025) and accuracy (97.5% vs 99.2%, p = 0.021) between the two image sets (per-patients base analysis). However, in patients followed for ≥1 year after surgery, the diagnostic performance of non-contrast MRI and whole MRI were not significantly different (p > 0.05).Non-contrast MRI may serve as an alternative follow-up method which can potentially replace whole MRI at least in selected patients followed up ≥1 year after surgery who have relatively lower risk of HCC recurrence.There is no consensus regarding the ideal imaging modality or follow-up interval after resection of HCC. Non-contrast MRI had comparable performance to that of gadoxetic acid-enhanced MRI in the detection of HCC recurrence during surveillance ≥1 year after surgery.
Patients diagnosed with low-risk papillary thyroid microcarcinoma (PTMC) face the decision between thyroid lobectomy and active surveillance (AS). This study aimed to investigate the factors influencing treatment decisions in low-risk PTMC and to compare the quality of life (QoL) according to the treatment plan.
ObjectivesWe evaluated the effects of a comprehensive antimicrobial stewardship program (ASP) in a surgical intensive care unit (SICU).MethodsThe ASP was implemented from March 2018 to February 2019 at an SICU in a teaching hospital. An infectious disease physician and a pharmacist visited the SICU 3 times per week for prospective audit and feedback. Outcomes were compared between the ASP period and the same months in the preceding year (pre-ASP period). The primary outcome measure was the use of anti-pseudomonal beta-lactams (APBL). Appropriate antimicrobial de-escalation and ICU mortality rates were also compared.ResultsA total of 182 and 149 patients were included in the study for the pre-ASP and ASP periods, respectively. Although disease severity was higher in the ASP group (septic shock 39.0% in pre-ASP vs 65.1% in ASP group, P < 0.001), the use of APBL as a definitive treatment was lower during ASP (68.7% vs 57.7%, OR 0.62, 95% CI 0.40–0.98). Appropriate antimicrobial de-escalation improved (63.2% vs 94.6%, P < 0.001). ICU mortality was comparable (7.7% vs 7.4%) and significantly lower during the ASP, after adjustment (adjusted OR 0.41, 95% CI 0.18–0.92, P = 0.032).ConclusionsA comprehensive ASP decreased the use of APBL and was associated with improved patient outcomes.
Clinical decision support tools (CDST) were developed to predict drug response to various biological treatments for Crohn's disease (CD). This study investigated whether CDSTs for vedolizumab (V-CDST) and ustekinumab (U-CDST) can be used as prognostic or drug-specific markers to predict response.A hypothetical scenario involving 872 patients with CD who were exposed to the first biological therapy at Samsung Medical Center between 1995 and 2020 is presented. V-CDST & U-CDST were calculated based on clinical and laboratory data immediately before the first biologic was initiated. The Cumulative Link Mixed Model (CLMM) test, weighted Kappa and plot, and Spearman's correlation was used to determine the degree of agreement and difference between the two tools.25% of all patients diagnosed with biologically naïve CD were categorized into different probability groups using V-CDST and U-CDST. The difference between the two tools was significantly based on a two-sample paired ordinal test with Cumulative Link Mixed Model (CLMM) (p-value < .001). Concordance between the two tools with a total of 654 subjects (75% of all patients) showed a similar probability (weighted Kappa: 0.47, 95% CI: 0.41-0.52).V-CDST and U-CDST are useful in selecting vedolizumab or ustekinumab in 25% of biologically naïve CD patients in our hypothetical scenario.
This study aimed to evaluate the efficacy of post-operative oral nutrition supplementation after major gastrointestinal surgery.A prospective randomized controlled trial was conducted to evaluate 174 subjects who were discharged within 2 weeks after major gastrointestinal surgery. The subjects in the study group were prescribed 400 ml/day of Encover® from the day of discharge for 8 weeks, but no supplementation was allowed in the control group. The primary endpoint was the weight loss rate at 8 weeks after discharge compared with the pre-operative weight, and the secondary endpoints included changes in body weight, body mass index, Patient-Generated Subjective Global Assessment score/grade, hematological/ biochemical parameters, and adverse events evaluated at 2, 4, and 8 weeks after discharge.The weight loss rate at 8 weeks after discharge did not differ between two groups (4.23±5.49% vs 4.80±4.84%, p=0.481). The total lymphocyte count, the level of total cholesterol, total protein, and albumin were significantly higher in the study group after discharge. Diarrhea was the most frequent adverse event, and the incidence of adverse events with a severity score of >=3 did not differ between groups (2.3% vs 1.2%).The utility of routine oral nutritional support after major gastrointestinal surgery was not proven in terms of weight loss at 8 weeks after discharge. However, it can be beneficial for early recovery of biochemical parameters.
Introduction : This study aimed to evaluate of the efficacy of postoperative oral nutrition supplement after major gastrointestinal surgery.Methods : A prospective randomized controlled trial was conducted for 174 subjects who were discharged within 2 weeks after major gastrointestinal surgery. Subjects in study group were prescribed to take 400 ml/day of Encover® from the day of discharge for 8 weeks. The primary endpoint was the weight loss rate at 8 weeks after discharge compared with the pre-operative weight, and the secondary endpoints included the changes in body weight, body mass index, Patient-Generated Subjective Global Assessment, hematology/biochemistry tests, and adverse events evaluated at 2, 4, and 8 weeks after discharge.Results : The weight loss rate at 8 weeks after discharge was not different between two groups. (4.23±5.49% vs. 4.80±4.84%, p=0.4810). The level of lymphocyte count, cholesterol, protein, and albumin were significantly higher in study group after discharge. The incidence of adverse events with a severity score ≥ 3 was not different between two groups. (2.3% vs. 1.2%)Conclusions : Usefulness of routine oral nutritional support after major gastrointestinal surgery was not proven in terms of weight loss at 8 weeks after discharge. However, it can be beneficial for early recovery of biochemical parameters.
'%3e%3cg id='b'%3e%3cpath id='a' stroke='%23000' stroke-width='2' d='M-6-25H6m-12 3H6m-12 3H6'/%3e%3cuse xlink:href='%23a' y='44'/%3e%3c/g%3e%3cpath stroke='%23fff' d='M0 17v10'/%3e%3ccircle r='12' fill='%23cd2e3a'/%3e%3cpath fill='%230047a0' d='M0-12A6 6 0 0 0 0 0a6 6 0 0 1 0 12 12 12 0 0 1 0-24z'/%3e%3c/g%3e%3cg transform='rotate(-123.69)'%3e%3cuse xlink:href='%23b'/%3e%3cpath stroke='%23fff' d='M0-23.5v3M0 17v3.5m0 3v3'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3ccircle r='120' fill='%230f47af'/%3e%3cg id='a'%3e%3cpath fill='%23fcdd09' d='m0-96-4.206 12.944 17.348 53.39h-23.13l-2.599 8h74.163l11.011-8H21.553z'/%3e%3cpath stroke='%23fcdd09' stroke-width='4' d='m25.863-35.597 30.564-42.069'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(72)'/%3e%3cuse xlink:href='%23a' transform='rotate(144)'/%3e%3cuse xlink:href='%23a' transform='rotate(216)'/%3e%3cuse xlink:href='%23a' transform='rotate(288)'/%3e%3c/g%3e%3c/svg%3e)
