[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer (CRC) is among the leading causes of cancer deaths and can be caused by environmental factors as well as genetic factors. Therefore, we developed a prediction model of CRC using genetic risk scores (GRS) and evaluated the effects of conventional risk factors, including family history of CRC, in combination with GRS on the risk of CRC in Koreans. This study included 187 cases (men, 133; women, 54) and 976 controls (men, 554; women, 422). GRS were calculated with most significantly associated single-nucleotide polymorphism with CRC through a genomewide association study. The area under the curve (AUC) increased by 0.5% to 5.2% when either counted or weighted GRS was added to a prediction model consisting of age alone (AUC 0.687 for men, 0.598 for women) or age and family history of CRC (AUC 0.692 for men, 0.603 for women) for both men and women. Furthermore, the risk of CRC significantly increased for individuals with a family history of CRC in the highest quartile of GRS when compared to subjects without a family history of CRC in the lowest quartile of GRS (counted GRS odds ratio [OR], 47.9; 95% confidence interval [CI], 4.9 to 471.8 for men; OR, 22.3; 95% CI, 1.4 to 344.2 for women) (weighted GRS OR, 35.9; 95% CI, 5.9 to 218.2 for men; OR, 18.1, 95% CI, 3.7 to 88.1 for women). Our findings suggest that in Koreans, especially in Korean men, GRS improve the prediction of CRC when considered in conjunction with age and family history of CRC.
[Show abstract][Hide abstract] ABSTRACT: Background/aims:
We examined whether the insertion time for colonoscopies performed after left-sided resection was different in patients with a colostomy from that in patients without a colostomy and identified factors that could impact colonoscopy performance.
We included consecutive patients who underwent colonoscopy between July 2005 and March 2011 after left-sided colorectal resection for colorectal cancer. We classified surgical methods according to the presence or absence of a colostomy and evaluated colonoscope insertion time retrospectively. Furthermore, we analyzed factors that might affect insertion time.
A total of 1,041 patients underwent colonoscopy after left-sided colorectal resection during the study period. The colonoscopy completion rate was 98.6 %, and the mean insertion time was 6.1 ± 4.6 min (median 4.7 min, range 0.3-35.8 min). A shorter resection length of colon, the presence of a colostomy, and a lower endoscopist case volume were found to be independent factors associated with prolonged insertion time in patients with left-sided colorectal resection. Among experienced colonoscopists, no colonoscopy-associated or clinical factors were found to affect insertion time. However, a shorter resection length of colon, the presence of a colostomy, and poor bowel preparation were associated with prolonged insertion time among inexperienced endoscopists.
We identified three factors that affect colonoscope insertion time after left-sided colorectal resection, including the presence of a colostomy. Inexperienced endoscopists were much more affected by the presence of a colostomy after left-sided colorectal resection. These findings have implications for the practice and teaching of colonoscopy after left-sided colorectal resection.
No preview · Article · Jun 2012 · Digestive Diseases and Sciences
[Show abstract][Hide abstract] ABSTRACT: To determine which Breast Imaging Reporting and Data System (BI-RADS) descriptors for ultrasound are predictors for breast cancer using logistic regression (LR) analysis in conjunction with interobserver variability between breast radiologists, and to compare the performance of artificial neural network (ANN) and LR models in differentiation of benign and malignant breast masses. Five breast radiologists retrospectively reviewed 140 breast masses and described each lesion using BI-RADS lexicon and categorized final assessments. Interobserver agreements between the observers were measured by kappa statistics. The radiologists' responses for BI-RADS were pooled. The data were divided randomly into train (n = 70) and test sets (n = 70). Using train set, optimal independent variables were determined by using LR analysis with forward stepwise selection. The LR and ANN models were constructed with the optimal independent variables and the biopsy results as dependent variable. Performances of the models and radiologists were evaluated on the test set using receiver-operating characteristic (ROC) analysis. Among BI-RADS descriptors, margin and boundary were determined as the predictors according to stepwise LR showing moderate interobserver agreement. Area under the ROC curves (AUC) for both of LR and ANN were 0.87 (95% CI, 0.77-0.94). AUCs for the five radiologists ranged 0.79-0.91. There was no significant difference in AUC values among the LR, ANN, and radiologists (p > 0.05). Margin and boundary were found as statistically significant predictors with good interobserver agreement. Use of the LR and ANN showed similar performance to that of the radiologists for differentiation of benign and malignant breast masses.
No preview · Article · Jan 2012 · Journal of Digital Imaging
[Show abstract][Hide abstract] ABSTRACT: The lack of epidemiologic information on osteoporotic hip fractures hampers the development of preventive or curative measures against osteoporosis in South Korea. We conducted a population-based study to estimate the annual incidence of hip fractures. Also, we examined factors associated with post-fracture mortality among Korean elderly to evaluate the impact of osteoporosis on our society and to identify high-risk populations.
The Korean National Health Insurance (NHI) claims database was used to identify the incidence of hip fractures, defined as patients having a claim record with a diagnosis of hip fracture and a hip fracture-related operation during 2003. The 6-month period prior to 2003 was set as a 'window period,' such that patients were defined as incident cases only if their first record of fracture was observed after the window period. Cox's proportional hazards model was used to investigate the relationship between survival time and baseline patient and provider characteristics available from the NHI data.
The age-standardized annual incidence rate of hip fractures requiring operation over 50 years of age was 146.38 per 100,000 women and 61.72 per 100,000 men, yielding a female to male ratio of 2.37. The 1-year mortality was 16.55%, which is 2.85 times higher than the mortality rate for the general population (5.8%) in this age group. The risk of post-fracture mortality at one year is significantly higher for males and for persons having lower socioeconomic status, living in places other than the capital city, not taking anti-osteoporosis pharmacologic therapy following fracture, or receiving fracture-associated operations from more advanced hospitals such as general or tertiary hospitals.
This national epidemiological study will help raise awareness of osteoporotic hip fractures among the elderly population and hopefully motivate public health policy makers to develop effective national prevention strategies against osteoporosis to prevent hip fractures.