Deep learning-based optic disc classification is affected by optic-disc tilt

We aimed to determine the effect of optic disc tilt on deep learning-based optic disc classification. A total of 2507 fundus photographs were acquired from 2236 eyes of 1809 subjects (mean age of 46 years; 53% men). Among all photographs, 1010 (40.3%) had tilted optic discs. Image annotation was performed to label pathologic changes of the optic disc (normal, glaucomatous optic disc changes, disc swelling, and disc pallor). Deep learning-based classification modeling was implemented to develop optic-disc appearance classification models with the photographs of all subjects and those with and without tilted optic discs. Regardless of deep learning algorithms, the classification models showed better overall performance when developed based on data from subjects with non-tilted discs (AUC, 0.988 ± 0.002, 0.991 ± 0.003, and 0.986 ± 0.003 for VGG16, VGG19, and DenseNet121, respectively) than when developed based on data with tilted discs (AUC, 0.924 ± 0.046, 0.928 ± 0.017, and 0.935 ± 0.008). In classification of each pathologic change, non-tilted disc models had better sensitivity and specificity than the tilted disc models. The optic disc appearance classification models developed based all-subject data demonstrated lower accuracy in patients with the appearance of tilted discs than in those with non-tilted discs. Our findings suggested the need to identify and adjust for the effect of optic disc tilt on the optic disc classification algorithm in future development.

Impact of preserved ratio impaired spirometry on coronary artery calcium score progression: a longitudinal cohort study

Background

Preserved ratio impaired spirometry (PRISm) is associated with increased cardiovascular disease (CVD) risk and mortality. However, a causal relationship between PRISm and CVD remains unclear. We investigated the progression of coronary artery calcium (CAC) scores based on the presence of PRISm and reduced forced vital capacity (FVC).

Methods

This retrospective cohort study included 11 420 participants aged ≥40 years with forced expiratory volume in 1 s (FEV1)/FVC ≥0.7 who underwent at least two health screening examinations with coronary computed tomography scan between 2003 and 2020, and were without a history of CVD or interstitial lung disease. Participants with PRISm, defined as FEV1/FVC ≥0.7 and FEV1 <80% predicted, were further divided by low FVC (FVC <80% predicted). We estimated the 5-year progression rates of CAC by comparing participants with and without PRISm at baseline using mixed linear models.

Results

Of the 11 420 participants, 8536 (75%), 811 (7%) and 2073 (18%) had normal spirometry, PRISm with normal FVC and PRISm with low FVC, respectively. During the mean (range) follow-up of 6.0 (0.5-17.2) years, the multivariable adjusted ratio of 5-year CAC progression rates comparing participants with PRISm to those with normal spirometry was 1.08 (95% CI 1.04-1.13). This rate was higher in participants with PRISm with low FVC (1.21 (95% CI 1.12-1.30)) than in those with normal FVC.

Conclusion

In this longitudinal cohort study of subjects without a history of CVD, PRISm was significantly associated with CAC progression, which was more evident in the group with PRISm and low FVC.

Exercise capacity and risk of incident atrial fibrillation in healthy adults

BACKGROUND/AIMS

Atrial fibrillation (AF) is a common arrhythmia and is associated with cardiovascular morbidity and mortality. It is important to identify and control the modifiable risk factors of AF. We aimed to examine the association of exercise capacity with the risk of incident AF within 3 years in healthy subjects.

METHODS

We evaluated asymptomatic adults who had undergone more than two consecutive health checkups. We included subjects who exhibited normal sinus rhythm on the first health examination and who developed AF on the second or subsequent health examinations. Subjects who underwent cardiopulmonary exercise testing within 3 years before the diagnosis of AF were examined.

RESULTS

The study population in the analyses included 428 cases (mean age 58.4 ± 7.6 yr, male 95.6%). There were significant differences in maximal systolic blood pressure (SBP; case 169.4 ± 24.2 vs. control 173.9 ± 22.3 mmHg), peak VO2 (29.5 ± 5.4 vs. 30.4 ± 4.8 mL/kg per minute), and maximal metabolic equivalents (METs; 8.5 ± 1.6 vs. 8.7 ± 1.4) between the two groups. In the multivariable logistic models, adjusted odds ratios were 0.99 for maximal SBP (95% confidence interval [CI] 0.98-0.99), 0.97 for peak VO2 (95% CI 0.95-0.99), and 0.91 for maximal METs (95% CI 0.83-0.98).

CONCLUSION

We demonstrated that poorer exercise capacity was associated with the development of AF in a healthy population. A prospective, systematic trial is necessary to confirm that appropriate exercise training will be beneficial in preventing the development of AF in such patients.

Development and validation of multivariable quantitative ultrasound for diagnosing hepatic steatosis

This study developed and validated multivariable quantitative ultrasound (QUS) model for diagnosing hepatic steatosis. Retrospective secondary analysis of prospectively collected QUS data was performed. Participants underwent QUS examinations and magnetic resonance imaging proton density fat fraction (MRI-PDFF; reference standard). A multivariable regression model for estimating hepatic fat fraction was determined using two QUS parameters from one tertiary hospital (development set). Correlation between QUS-derived estimated fat fraction(USFF) and MRI-PDFF and diagnostic performance of USFF for hepatic steatosis (MRI-PDFF ≥ 5%) were assessed, and validated in an independent data set from the other health screening center(validation set). Development set included 173 participants with suspected NAFLD with 126 (72.8%) having hepatic steatosis; and validation set included 452 health screening participants with 237 (52.4%) having hepatic steatosis. USFF was correlated with MRI-PDFF (Pearson r = 0.799 and 0.824; development and validation set). The model demonstrated high diagnostic performance, with areas under the receiver operating characteristic curves of 0.943 and 0.924 for development and validation set, respectively. Using cutoff of 6.0% from development set, USFF showed sensitivity, specificity, positive predictive value, and negative predictive value of 87.8%, 78.6%, 81.9%, and 85.4% for diagnosing hepatic steatosis in validation set. In conclusion, multivariable QUS parameters-derived estimated fat fraction showed high diagnostic performance for detecting hepatic steatosis.

Intact Chorionic Vesicle in Very Early Products of Conception Specimens: Clinicopathologic Features of 26 Cases That May Mimic Complete Hydatidiform Mole

Among the morphologic mimics of hydatidiform moles, the chorionic vesicle of early first-trimester pregnancy has received scant attention. The chorionic vesicle is the stage of the implanted blastocyst in which the cytotrophoblastic shell is circumferentially lined by primary and secondary villi and envelops the notochord stage embryo, yolk sac, and amniotic sac, ∼5 to 6 weeks since the last menstrual period. Miscarriage specimens at this early gestational age that contain an intact chorionic vesicle may be misinterpreted as a complete hydatidiform mole because of its large size, cistern-like cavity, and circumferentially radiating villi and trophoblast, particularly so when embryonic tissue is absent. We present the clinicopathologic features of 26 products of conception specimens containing a chorionic vesicle, some of which were submitted for consultation as a possible complete mole. The median gestational age was 6 weeks. The majority were free-floating in the specimen, unattached to endometrium. The median diameter was 6.3 mm and ranged up to 11.3 mm. The embryo was absent in 81% of cases, leaving an empty cavity resembling the cistern of a complete mole in all but 2 cases. Most cases exhibited circumferential villi and variable degrees of proliferating polarized villous trophoblast and extravillous trophoblast but trophoblast atypia was absent. Villous stromal karyorrhexis and blue-gray myxoid extracellular stromal matrix were observed in the majority of cases. A minority exhibited focal abnormal villous morphology concerning for early molar pregnancy, including irregular projections (27%), invaginations (12%), or bulbous shapes (4%) of the villous contours and trophoblast pseudoinclusions (15%). In contrast, orderly hierarchical branching of the secondary villi occurred in 31%. p57 immunoexpression was intact in all 25 cases tested. Short tandem repeat genotype testing confirmed a biparental diploid genotype in both of 2 cases tested. Although uncommonly observed in early first-trimester products of conception specimens, the normal chorionic vesicle merits awareness as a potential diagnostic pitfall. While some morphologic features resemble those of a well-developed complete mole, at this early gestational age such features are not expected in a very early complete mole. Attention to the reported gestational age, if available, and presence of embryonic tissues will mitigate against misclassification as complete mole. As with the workup of any potential gestational trophoblastic disease, partnering the clinical and morphologic evaluation with molecular evaluation (intact p57 immunoexpression and lack of any of the characteristic molar genotypes) offers the most precise classification.

T1 values and extracellular volume fraction in asymptomatic subjects: variations in left ventricular segments and correlation with cardiovascular risk factors

To evaluate variations in pre-contrast (preT1) and post-contrast (postT1) myocardial T1 values and extracellular volume fraction (ECV) according to left ventricular (LV) segments and to find correlations between them and cardiovascular risk factors. The 233 asymptomatic subjects (210 men, 23 women; aged 54.1 ± 6.0 years) underwent cardiac magnetic resonance imaging with preT1 and postT1 mapping on a 1.5-T scanner. T1 values and ECVs were evaluated according to LV segments, age, sex, and estimated glomerular filtration rate (eGFR). Based on the presence of hypertension (HTN) and diabetes mellitus (DM), subjects were subdivided into the control, HTN, DM, and HTN and DM (HTN-DM) groups. T1 values and ECV showed significant differences between septal and lateral segments at the mid-ventricular and basal levels (p ≤ 0.003). In subgroup analysis, the HTN-DM group showed a significantly higher ECV (0.260 ± 0.023) than the control (0.240 ± 0.021, p = 0.011) and HTN (0.241 ± 0.024, p = 0.041) groups. Overall postT1 and ECV of the LV had significant correlation with eGFR (r = 0.19, p = 0.038 for postT1; r =  − 0.23, p = 0.011 for ECV). Septal segments show higher preT1 and ECV but lower postT1 than lateral segments at the mid-ventricular and basal levels. ECV is significantly affected by HTN, DM, and eGFR, even in asymptomatic subjects.

Li-Ion Intercalation, Rectification, and Solid Electrolyte Interphase in Molecular Tunnel Junctions

This paper describes Li-ion intercalation into a pyrenyl-terminated self-assembled monolayer (SAM) on gold, inspired by the graphite anode in a Li-ion battery, and its effect on tunneling performance in a molecular junction incorporating the SAM. As the concentration of the Li-ion precursor ([LiPF₆]) increased from 0 to 10^-2 M, the rectification ratio increased to ∼10². Further experiments revealed that the intercalation-induced changes in the orientation of PYR group and in the HOMO energy level account for the enhanced rectification. Treatment with high concentrations of LiPF₆ (from 10^-2 to 10⁰ M) yielded a considerable solid electrolyte interphase (SEI), mainly composed of LiF, on the surface of the SAM, resulting in the disappearance of rectification. This was attributed to renormalization of the HOMO level back to that of the intact SAM, caused by the SEI layer. Our work demonstrates the interplay among Li-ion intercalation, SEI, and tunneling in the molecular junction, benefiting the research of molecular electronics as well as SAM-based batteries.

Prediction Algorithms for Blood Pressure Based on Pulse Wave Velocity Using Health Checkup Data in Healthy Korean Men: Algorithm Development and Validation

BACKGROUND

Pulse transit time and pulse wave velocity (PWV) are related to blood pressure (BP), and there were continuous attempts to use these to predict BP through wearable devices. However, previous studies were conducted on a small scale and could not confirm the relative importance of each variable in predicting BP.

OBJECTIVE

This study aims to predict systolic blood pressure and diastolic blood pressure based on PWV and to evaluate the relative importance of each clinical variable used in BP prediction models.

METHODS

This study was conducted on 1362 healthy men older than 18 years who visited the Samsung Medical Center. The systolic blood pressure and diastolic blood pressure were estimated using the multiple linear regression method. Models were divided into two groups based on age: younger than 60 years and 60 years or older; 200 seeds were repeated in consideration of partition bias. Mean of error, absolute error, and root mean square error were used as performance metrics.

RESULTS

The model divided into two age groups (younger than 60 years and 60 years and older) performed better than the model without division. The performance difference between the model using only three variables (PWV, BMI, age) and the model using 17 variables was not significant. Our final model using PWV, BMI, and age met the criteria presented by the American Association for the Advancement of Medical Instrumentation. The prediction errors were within the range of about 9 to 12 mmHg that can occur with a gold standard mercury sphygmomanometer.

CONCLUSIONS

Dividing age based on the age of 60 years showed better BP prediction performance, and it could show good performance even if only PWV, BMI, and age variables were included. Our final model with the minimal number of variables (PWB, BMI, age) would be efficient and feasible for predicting BP.

Disability and Economic Loss Caused by Headache among Information Technology Workers in Korea

Background and Purpose

Headache disorders are a leading cause of disability globally. However, there is inadequate information available about these disorders and the related economic loss in the workplace in Asian countries. Information technology (IT) jobs are intellectually and cognitively challenging, and hence IT workers are a suitable population for assessing headache disorders and related economic loss.

Methods

We sent invitation emails to all employees of selected IT companies. A comprehensive Web-based questionnaire regarding headache characteristics, disability, quality of life, and economic loss was completed by 522 participants from 8 companies.

Results

The participants included 450 (86.2%) who had experienced headache more than once during the previous year. The frequencies of migraine, probable migraine (PM), and tension-type headache (TTH) were 18.2%, 21.1%, and 37.0%, respectively. The Migraine Disability Assessment score was higher for participants with migraine [median and interquartile range, 3.0 (0.0–6.0)] than for those with PM [0.0 (0.0–2.0), p<0.001] and TTH [0.0 (0.0–1.0), p<0.001]. The estimated annual economic losses caused by migraine per person associated with absenteeism and presenteeism were USD 197.5±686.1 and USD 837.7±22.04 (mean±standard deviation), respectively. The total annual economic loss per person caused by migraine (USD 1,023.3±1,972.7) was higher than those caused by PM (USD 424.8±1,209.1, p<0.001) and TTH (USD 197.6±636.4, p<0.001).

Conclusions

Migraine, PM, and TTH were found to be prevalent among IT workers in Korea. Disability and economic loss were significantly greater in participants with migraine than in those with PM or TTH.

Risk of hepatocellular carcinoma in individuals without traditional risk factors: development and validation of a novel risk score

BACKGROUND

Although hepatocellular carcinoma (HCC) occurs mostly in patients with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection or heavy alcohol use or cirrhosis, some patients develop HCC without these risk factors. Our objective in this study was to develop and validate a new HCC risk score that could stratify HCC risk in patients who develop HCC without known risk factors.

METHODS

A new HCC risk score was developed using a nationwide, population-based cohort among individuals without chronic HBV infection, chronic HCV infection, heavy alcohol use or cirrhosis (n = 467 206, derivation cohort). The performance of the HCC risk score was validated using an independent Samsung Medical Center Health Promotion Center cohort (n = 91 357, validation cohort).

RESULTS

Multivariable Cox regression analysis identified six independent risk factors: age, sex, smoking, diabetes, total cholesterol level and serum alanine aminotransferase level. A 19-point scale for HCC risk score was developed, with 10-year risk of HCC ranging from 0.0% to 6.16% for the lowest and highest risk scores, respectively. The area under the receiver operating characteristics curve values (AUROCs) to predict HCC development were 0.83 [95% confidence interval (CI): 0.77, 0.88)] and 0.92 (95% CI: 0.89, 0.95) at 10 years in the derivation and validation cohorts, respectively. Predicted risk was well correlated with the Kaplan-Meier observed HCC risk.

CONCLUSIONS

A simple-to-use, novel HCC risk score was developed for predicting HCC development in individuals without alleged risk factors. It can be used to assess the risk of HCC in this population so that decisions about their clinical management, including risk reduction interventions, can be subsequently made.

Smoking History and Clinical Features of Cluster Headache: Results from the Korean Cluster Headache Registry

Background and Purpose

Epidemiologic data suggest that cluster headache (CH) is significantly associated with cigarette smoking. The aim of this study was to determine differences in features between patients with a smoking history and those who are never-smokers, using data from a prospective multicenter registry.

Methods

Data used in this study were obtained from the Korean Cluster Headache Registry that collected data from consecutive patients diagnosed with CH. We compared clinical and demographic features between ever-smokers (current or former smokers) and never-smokers.

Results

This study enrolled 250 patients who were diagnosed with CH, of which 152 (60.8%) were ever-smokers and 98 (39.2%) were never-smokers. The age at CH onset was significantly lower in the never-smoker group than in the ever-smoker group [27.1±12.9 years vs. 30.6±10.9 years (mean±standard deviation), p=0.024]. Seasonal rhythmicity (58.1% vs. 44.7%, p=0.038) and triptan responsiveness (100% vs. 85.1%, p=0.001) were higher in never-smokers, while other clinical features such as pain severity, duration, attack frequency, and associated autonomic symptoms did not differ significantly between the groups. The male-to-female ratio was markedly higher in ever-smokers (29.4:1) than in never-smokers (1.7:1).

Conclusions

Most of the clinical features did not differ significantly between patients with a smoking history and never-smokers. However, the age at CH onset, sex ratio, and seasonal rhythmicity were significantly associated with smoking history.

Achieving Ultralow, Zero, and Inverted Tunneling Attenuation Coefficients in Molecular Wires with Extended Conjugation

Molecular tunnel junctions are organic devices miniaturized to the molecular scale. They serve as a versatile toolbox that can systematically examine charge transport behaviors at the atomic level. The electrical conductance of the molecular wire that bridges the two electrodes in a junction is significantly influenced by its chemical structure, and an intrinsically poor conductance is a major barrier for practical applications toward integrating individual molecules into electronic circuitry. Therefore, highly conjugated molecular wires are attractive as active components for the next-generation electronic devices, owing to the narrow highest occupied molecular orbital-lowest occupied molecular orbital gaps provided by their extended π-building blocks. This article aims to highlight the significance of highly conductive molecular wires in molecular electronics, the structures of which are inspired from conductive organic polymers, and presents a body of discussion on molecular wires exhibiting ultralow, zero, or inverted attenuation of tunneling probability at different lengths, along with future directions.

Prevalence, Disability, and Management Patterns of Migraine in Korea: Nationwide Survey Data from 2009 and 2018

Background and Purpose

Identifying changes in the prevalence, disability, and management patterns of migraine is important for reducing the burden of this disease. However, data on the changes in these variables are scarce.

Methods

We compared data obtained in the 2009 Korean Headache Survey and the 2018 Korean Sleep-Headache Survey.

Results

The 1-year migraine prevalence did not differ significantly between 2018 and 2009 [5.2% (114/2,200) vs. 6.0% (91/1,507), p=0.492]. The number of days with missed activity due to headache during the previous 3 months was larger in the 2018 survey than in the 2009 survey [1.1±2.9 vs. 0.3±1.0 days (mean±standard deviation), p=0.013]. The number of days with reduced productivity during the previous 3 months did not differ significantly between the two surveys (0.8±2.8 vs. 1.4±1.4 days, p=0.679). The proportion of subjects with a substantial-to-severe headache impact (Headache Impact Test-6 score ≥56) was marginally larger in the 2018 survey than in the 2009 survey [42.1% (48/114) vs. 29.7% (27/91), p=0.066]. The rate of lifetime medical consultations did not differ between the 2018 and 2009 surveys [34.2% (39/114) vs. 30.8% (28/91), p=0.615].

Conclusions

Migraine prevalence was stable over the 9-year period between the surveys, but disability due to missed activity was greater in 2018 than in 2009 in Korea.

Diagnostic Accuracy of MRI-Based Morphometric Parameters for Detecting Olfactory Nerve Dysfunction

BACKGROUND AND PURPOSE

Although olfactory dysfunction is a common cranial nerve disorder, there are no simple objective morphometric criteria to assess olfactory dysfunction. The aim of this study was to evaluate the diagnostic performance of MR imaging morphometric parameters for detecting olfactory dysfunction.

MATERIALS AND METHODS

This prospective study enrolled patients from those presenting with olfactory symptoms who underwent both an olfactory function test and MR imaging. Controls without olfactory dysfunction were recruited during the preoperative work-up for pituitary adenoma. Two independent neuroradiologists measured the olfactory bulb in 3D and assessed olfactory bulb concavity on MR imaging while blinded to the clinical data. Diagnostic performance was assessed using receiver operating characteristic curve analysis.

RESULTS

Sixty-four patients and 34 controls were enrolled. The patients were significantly older than the controls (mean age, 57.8 ± 11.9 years versus 47.1 ± 12.1 years; P < .001). Before age adjustment, the olfactory bulb height was the only olfactory bulb parameter showing a significant difference between patients and controls (1.6 ± 0.3 mm versus 2.0 ± 0.3 mm, P < .001). After age adjustment, all parameters and olfactory bulb concavity showed significant intergroup differences, with the olfactory bulb height having the highest area under the curve (0.85). Olfactory bulb height was confirmed to be the only significant parameter showing a difference in the detection of olfactory dysfunction in 22 pairs after matching for age and sex (area under the curve = 0.87, P < .001). Intraclass correlation coefficients revealed moderate-to-excellent degrees of inter- and intrareader agreement.

CONCLUSIONS

MR imaging morphometric analysis can differentiate patients with olfactory dysfunction, with the olfactory bulb height having the highest diagnostic performance for detecting olfactory dysfunction irrespective of age.

Non-alcoholic fatty liver disease and the incidence of myocardial infarction: A cohort study

BACKGROUND AND AIM

Non-alcoholic fatty liver disease (NAFLD) is a multisystem disease associated with an increased risk of cardiovascular disease (CVD), diabetes, and chronic kidney disease. Indeed, CVD is the most common cause of death in NAFLD patients. This study aimed to evaluate the association between NAFLD and the risk of incident myocardial infarction.

METHODS

This is a retrospective cohort study involving 111 492 adults over 40 years old without history of CVD, liver disease, or cancer at baseline who participated in a regular health screening exam between 2003 and 2013. Fatty liver was diagnosed by ultrasonography.

RESULTS

During 725 706.9 person-years of follow-up, 183 participants developed myocardial infarction (incidence rate 0.3 cases per 1000 person-years). The age, sex, and year of visit-adjusted hazard ratio (HR) for incident myocardial infarction comparing participants with NAFLD with those without it was 2.14 (95% confidence interval 1.59, 2.89). This association remained significant in fully adjusted models (HR 1.54; 95% confidence interval 1.11, 2.14). Compared with participants without NAFLD, in participants with low NAFLD fibrosis score (NFS) (< -1.455) and with intermediate-to-high NFS (≥ -1.455), the fully adjusted HRs for incident myocardial infarction were 1.70 (1.22, 2.36) and 1.88 (1.24, 2.87), respectively.

CONCLUSION

In this large cohort study, NAFLD was associated with an increased incidence of myocardial infarction independently of established risk factors. In addition, this association was similar in participants with and without evidence of more advanced NAFLD as indicated by the NFS. NAFLD patients may need to be carefully monitored and managed early to prevent myocardial infarction.

Diagnostic performance of MRI to detect metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis

AIM

To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of metastatic cervical lymph nodes.

MATERIALS AND METHODS

Ovid-MEDLINE and EMBASE databases were searched up until 12 June 2018. Eleven articles were included in the qualitative systematic review and nine of the 11 in the quantitative analysis. Two radiologists independently performed data extraction and methodological quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A qualitative systematic review and quantitative analysis were performed, followed by a meta-regression analysis to determine factors causing heterogeneity.

RESULTS

The pooled sensitivity and specificity in the diagnosis of metastatic cervical lymph nodes were 80% (95% confidence interval [CI]: 68-88%) and 85% (95% CI: 63-95%), respectively. The sensitivity and false-positive rate (correlation coefficient, 0.655) showed a positive correlation due to a threshold effect, which was responsible for heterogeneity across the studies, as indicated by a Q-test (p<0.01) and Higgins I² statistic (sensitivity, I²=90.11%; specificity, I²=92.49%). In the meta-regression analysis, fat-suppressed imaging, and the analysis method were significant factors influencing the heterogeneity in diagnostic performance.

CONCLUSIONS

MRI shows moderate diagnostic performance in the diagnosis of metastatic lymph nodes in patients with thyroid cancer in the neck. MRI may be an optional or complementary imaging method to ultrasound or computed tomography (CT) in thyroid cancer patients.

Weight Change and Development of Subclinical Carotid Atherosclerosis Among Metabolically Healthy Adults: A Cohort Study

BACKGROUND

The benefit of weight loss for reducing cardiovascular disease (CVD) risk in metabolically healthy obese people is unknown.

OBJECTIVES

We evaluated the association between weight change and incident subclinical carotid atherosclerosis (SCA) in metabolically healthy but overweight or obese subjects.

METHODS

Cohort study of 3117 metabolically healthy overweight or obese adults who did not have any metabolic syndrome components or insulin resistance at baseline. SCA was assessed using carotid artery ultrasonography. The study outcome was the development of incident SCA among participants free of the disease at baseline.

RESULTS

During 12 248 person-years of follow-up (median 3.42 years), 747 participants developed SCA. The proportions of participants with no reduction or increased weight, reduction in weight from 0.1% to 4.9%, and reduction in weight ≥ 5% during follow-up were 47.0%, 44.4%, and 8.6%, respectively. The fully-adjusted hazard ratios (HRs) for incident SCA in participants with a reduction in weight of 0.1% to 4.9% and ≥ 5% compared with those with no reduction or increased weight were 0.84 (95% CI, 0.72-0.98) and 0.66 (95% CI, 0.50-0.87), respectively.

CONCLUSIONS

In a large cohort study of metabolically healthy but overweight or obese adult men and women, weight reduction was associated with a lower incidence of SCA. Our findings suggest that metabolically healthy overweight or obese subjects may benefit from weight reduction in terms of CVD risk.

CT and MRI Findings of Glomangiopericytoma in the Head and Neck: Case Series Study and Systematic Review

Glomangiopericytoma is a rare sinonasal mesenchymal tumor of borderline or low malignant potential. We reviewed the CT and MR imaging findings of head and neck glomangiopericytoma via a retrospective case series study and systematic review. Our study revealed that glomangiopericytoma is a well-defined lobulated avidly enhancing soft-tissue mass with erosive bony remodeling that is most commonly found in the sinonasal cavity. Typically, it is hyperintense on T2-weighted images with vascular signal voids, has a high mean ADC value, and a wash-in and washout pattern on dynamic contrast-enhanced MR imaging. Although the CT findings are nonspecific, typical MR imaging findings, including those on the ADC map and dynamic contrast-enhanced MR imaging, may be helpful for differentiating glomangiopericytomas from other hypervascular tumors in the head and neck.

Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients

Background and Purpose

Deciding whether or not to perform neuroimaging in primary headache is a dilemma for headache physicians. The aim of this study was to identify clinical predictors of incidental neuroimaging abnormalities in new patients with primary headache disorders.

Methods

This cross-sectional study was based on a prospective multicenter headache registry, and it classified 1,627 consecutive first-visit headache patients according to the third edition (beta version) of the International Classification of Headache Disorders (ICHD-3β). Primary headache patients who underwent neuroimaging were finally enrolled in the analysis. Serious intracranial pathology was defined as serious neuroimaging abnormalities with a high degree of medical urgency. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with incidental neuroimaging abnormalities.

Results

Neuroimaging abnormalities were present in 170 (18.3%) of 927 eligible patients. In multivariable analysis, age ≥40 years [multivariable-adjusted odds ratio (aOR)=3.37, 95% CI=2.07–6.83], male sex (aOR=1.61, 95% CI=1.12–2.32), and age ≥50 years at headache onset (aOR=1.86, 95% CI=1.24–2.78) were associated with neuroimaging abnormalities. In univariable analyses, age ≥40 years was the only independent variable associated with serious neuroimaging abnormalities (OR=3.37, 95% CI=1.17–9.66), which were found in 34 patients (3.6%). These associations did not change after further adjustment for neuroimaging modality.

Conclusions

Incidental neuroimaging abnormalities were common and varied in a primary headache diagnosis. A small proportion of the patients incidentally had serious neuroimaging abnormalities, and they were predicted by age ≥40 years. These findings can be used to guide the performing of neuroimaging in primary headache disorders.

Frequency and Clinical Associating Factors of Valvular Heart Disease in Asymptomatic Korean Adults

Limited information is available on the prevalence and clinical determinants of valvular heart disease (VHD) in apparently healthy people. This study sought to assess the frequency and clinical associating factors of aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS), mitral regurgitation (MR), tricuspid regurgitation (TR) in asymptomatic individuals with health check-up examination. We included 23,254 subjects ≥50 years of age who underwent a health check-up examination with transthoracic echocardiography (TTE) between 2012 and 2016 in a single tertiary-care hospital in Korea. Among a total of 23,254 subjects, 15,358 men (66.0%) and 7,896 women (34.0%) underwent TTE. Newly identified (predominantly mild) VHD was detected in 9.4% of subjects. The most common VHD were TR (4.6%), AR (3.0%) and MR (2.4%). Clinically significant (more than moderate) VHD was identified in 176 subjects (0.8%). Age ≥75 years was associated with all clinically significant VHD, and female gender was associated with AR, MS and TR. Korea has been very active in the health check-up examination including echocardiography. We find that VHD in apparently healthy people is not uncommon than believed; all VHD except MS were more frequent in elderly over 75 years of age in a large population-based study.

Lack of Association between Past Helicobacter pylori Infection and Diabetes: A Two-Cohort Study

Helicobacter pylori (H. pylori) may be involved in diabetes and other insulin-related processes. This study aimed to investigate the associations between H. pylori infection and the risks of type 2 diabetes, impaired glucose tolerance (IGT), diabetic nephropathy, and poor glycemic control. We retrospectively evaluated 16,091 subjects without diabetes at baseline who underwent repeated health examinations. Subjects were categorized according to whether they were seropositive and seronegative for H. pylori infection. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models. The serological results were validated using an independent cohort (n = 42,351) based on a histological diagnosis of H. pylori infection. During 108,614 person-years of follow-up, 1338 subjects (8.3%) developed newly diagnosed diabetes, although the cumulative incidence of diabetes was not significantly related to serological H. pylori status. The multivariate Cox proportional-hazards regression models revealed that H. pylori seropositivity was not significantly associated with diabetes (HR: 1.01, 95% CI: 0.88–1.16; p = 0.854), IGT (HR: 0.98, 95% CI: 0.93–1.04; p = 0.566), diabetic nephropathy (HR: 0.99, 95% CI: 0.82–1.21; p = 0.952), or poor glycemic control (HR: 1.05, 95% CI: 0.90–1.22; p = 0.535). Similarly, histopathological findings of H. pylori infection were not significantly associated with diabetes (p = 0.311), diabetic nephropathy (p = 0.888), or poor glycemic control (p = 0.989). The findings from these large Korean cohorts indicate that there does not appear to be a role for past H. pylori infection in the development of diabetes, IGT, diabetic nephropathy, or poor glycemic control.

Lean non-alcoholic fatty liver disease and development of diabetes: a cohort study

OBJECTIVE

Non-alcoholic fatty liver disease (NAFLD), a condition associated with multiple metabolic abnormalities, is frequently observed in normal weight individuals (lean NAFLD). The metabolic consequences of lean NAFLD, however, are not well characterized. Thus, this study aimed to evaluate the risk of incident diabetes in lean NAFLD.

METHODS

This is a cohort study of 51,463 adults without diabetes, history of liver disease or cancer at baseline who participated in a regular health screening exam. Fatty liver was diagnosed by ultrasonography. The study outcome was the development of diabetes during follow-up.

RESULTS

During 236,446.6 person-years of follow-up (median follow-up of 4.0 years), 5370 participants developed diabetes. In fully adjusted models, the hazard ratios (HRs) for incident diabetes comparing lean participants with NAFLD, overweight/obese participants without NAFLD and overweight/obese participants with NAFLD to lean participants without NAFLD, were 1.18 (95% CI: 1.03-1.35), 1.06 (0.98-1.14) and 1.45 (1.34-1.57), respectively. The fully adjusted HR for incident diabetes for lean NAFLD participants with low NAFLD fibrosis score (NFS) (<-1.455) and with intermediate-to-high NFS (≥-1.455) compared to lean participants without NAFLD were 1.32 (1.14-1.53) and 2.73 (2.10-3.55), respectively.

CONCLUSIONS

In this large cohort study, the presence and severity of NAFLD in normal weight adults was associated with an increased incidence of diabetes independently of established risk factors. Indeed, isolated lean NAFLD was a stronger risk factor for incident diabetes than the presence of overweight/obesity without NAFLD. Subjects with lean NAFLD require careful monitoring for the development of metabolic abnormalities.

A Multicenter, Randomized Clinical Trial to Assess the Efficacy of a Therapeutic Intervention Program for Caregivers of People with Dementia

BACKGROUND AND PURPOSE

Caregivers experience tremendous social, financial, physical, and psychological burdens in caring for people with dementia. This study aimed to determine the efficacy of a multicomponent therapeutic intervention program for the caregivers of people with dementia (CGPWD) through a multicenter clinical trial: the intervention program-caregivers of people with dementia study.

METHODS

The 38 caregivers of dementia patients at 8 sites were randomized into 2 groups: treatment (n=19) and control (n=19). The treatment group received the intervention program for 8-10 weeks, including one group session for dementia education and three individual sessions (on cognitive behavioral therapy, coping with stress, and stress management) and single targeted training for daily activities. The Korean version of the Zarit Burden Interview (ZBI-K) and the Geriatric Depression Scale (GDS) were evaluated at pre- and postintervention as primary efficacy measures.

RESULTS

The treatment group displayed significant improvements in scores on the ZBI-K and GDS. The ZBI-K score at postintervention was significantly reduced in the treatment group compared to that in the control group [6.2-point decrease vs. 3.7-point increase, t(37)=-2.9, p<0.01]. There was a significant difference in the GDS score between the treatment and control groups [2.2-point decrease vs. 1.3-point increase, t(18)=2.5, p<0.05].

CONCLUSIONS

The findings of this study imply that a multicomponent therapeutic intervention program is effective in reducing the burden experienced by and depression among CGPWD. Further research is warranted to investigate the long-term effects of the intervention program for CGPWD.

Molecularly Controlled Stark Effect Induces Significant Rectification in Polycyclic-Aromatic-Hydrocarbon-Terminated n-Alkanethiolates

The variation of the electronic structure of individual molecules as a function of the applied bias matters for the performance of molecular and organic electronic devices. Understanding the structure-electric-field relationship, however, remains a challenge because of the lack of in-operando spectroscopic technique and complexity arising from the ill-defined on-surface structure of molecules and organic-electrode interfaces within devices. We report that a reliable and reproducible molecular diode can be achieved by control of the conjugation length in polycyclic-aromatic-hydrocarbon (PAH)-terminated n-alkanethiolate (denoted as SC₁₁PAH), incorporated into liquid-metal-based large-area tunnel junctions in the form of a self-assembled monolayer. By taking advantage of the structural simplicity and tunability of SC₁₁PAH and the high-yielding feature of the junction technique, we demonstrate that the increase in the conjugation length of the PAH terminal group leads to a significant rectification ratio up to ∼1.7 × 10² at ±740 mV. Further study suggests that the Stark shift of the molecular energy resonance of the PAH breaks the symmetry of the energy topography across the junction and induces rectification in a temperature-independent charge-transport regime.

Application of Efficient Data Cleaning Using Text Clustering for Semistructured Medical Reports to Large-Scale Stool Examination Reports: Methodology Study

Background

Since medical research based on big data has become more common, the community’s interest and effort to analyze a large amount of semistructured or unstructured text data, such as examination reports, have rapidly increased. However, these large-scale text data are often not readily applicable to analysis owing to typographical errors, inconsistencies, or data entry problems. Therefore, an efficient data cleaning process is required to ensure the veracity of such data.

Objective

In this paper, we proposed an efficient data cleaning process for large-scale medical text data, which employs text clustering methods and value-converting technique, and evaluated its performance with medical examination text data.

Methods

The proposed data cleaning process consists of text clustering and value-merging. In the text clustering step, we suggested the use of key collision and nearest neighbor methods in a complementary manner. Words (called values) in the same cluster would be expected as a correct value and its wrong representations. In the value-converting step, wrong values for each identified cluster would be converted into their correct value. We applied these data cleaning process to 574,266 stool examination reports produced for parasite analysis at Samsung Medical Center from 1995 to 2015. The performance of the proposed process was examined and compared with data cleaning processes based on a single clustering method. We used OpenRefine 2.7, an open source application that provides various text clustering methods and an efficient user interface for value-converting with common-value suggestion.

Results

A total of 1,167,104 words in stool examination reports were surveyed. In the data cleaning process, we discovered 30 correct words and 45 patterns of typographical errors and duplicates. We observed high correction rates for words with typographical errors (98.61%) and typographical error patterns (97.78%). The resulting data accuracy was nearly 100% based on the number of total words.

Conclusions

Our data cleaning process based on the combinatorial use of key collision and nearest neighbor methods provides an efficient cleaning of large-scale text data and hence improves data accuracy.

Tunneling and thermoelectric characteristics of N-heterocyclic carbene-based large-area molecular junctions

Tunneling and thermoelectric characteristics of NHC-based large-area junctions were demonstrated for the first time.

Differences in Characteristics and Comorbidity of Cluster Headache According to the Presence of Migraine

Background and Purpose

Cluster headache (CH) can present with migrainous symptoms such as nausea, photophobia, and phonophobia. In addition, an overlap between CH and migraine has been reported. This study aimed to determine the differences in the characteristics of CH according to the presence of comorbid migraine.

Methods

This study was performed using data from a prospective multicenter registry study of CH involving 16 headache clinics. CH and migraine were diagnosed by headache specialists at each hospital based on third edition of the International Classification of Headache Disorders (ICHD-3). We interviewed patients with comorbid migraine to obtain detailed information about migraine. The characteristics and psychological comorbidities of CH were compared between patients with and without comorbid migraine.

Results

Thirty (15.6%) of 192 patients with CH had comorbid migraine, comprising 18 with migraine without aura, 1 with migraine with aura, 3 with chronic migraine, and 8 with probable migraine. Compared to patients with CH without migraine, patients with CH with comorbid migraine had a shorter duration of CH after the first episode [5.4±7.4 vs. 9.0±8.2 years (mean±standard deviation), p=0.008], a lower frequency of episodic CH (50.0% vs. 73.5%, p=0.010), and a higher frequency of chronic CH (13.3% vs. 3.7%, p=0.033). Psychiatric comorbidities did not differ between patients with and without comorbid migraine. The headaches experienced by patients could be distinguished based on their trigeminal autonomic symptoms, pulsating character, severity, and pain location.

Conclusions

Distinct characteristics of CH remained unchanged in patients with comorbid migraine with the exception of an increased frequency of chronic CH. The most appropriate management of CH requires clinicians to check the history of preceding migraine, particularly in cases of chronic CH.

Development and Validation of the Cluster Headache Screening Questionnaire

Background and Purpose

Cluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ).

Methods

Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed.

Results

Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p<0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively.

Conclusions

The CHSQ is a reliable screening tool for the rapid identification of CH.

Relationship between fitness and arterial stiffness according to hypertensive state

Background: There is a well-established relationship between cardiorespiratory fitness (CRF) and arterial stiffness. However, it is unclear whether this relationship differs significantly between hypertensive and non-hypertensive patients.Methods: Adults without a history of ischemic heart disease or stroke and normal exercise test results who underwent health screening were included. Cardiopulmonary function test was performed using the Bruce protocol. Peak oxygen consumption (VO2peak) was measured. Arterial stiffness was evaluated using the brachial-ankle pulse wave velocity (baPWV).Results: Study subjects were 9232 participants (M:F = 71:29%) with a mean age of 53 ± 6 years. Thirty-four percent had hypertension. There was an inverse relationship between the peak oxygen consumption and baPWV (r = - 0.21, p < 0.001) This relationship persisted after adjusting for age, gender, body mass index, smoking, diabetes mellitus, hemoglobin A1c, LDL-cholesterol, mean blood pressure, and hypertension (p < 0.0001). The regression coefficient of VO2peak was significantly more negative among hypertensive subjects than it was in non-hypertensive subjects in the regression coefficient (-9.2 vs. -4.2, p for interaction <0.001). The difference in arterial stiffness between hypertensive and non-hypertensive groups decreased as the CRF increased.Conclusion: Arterial stiffness decreased as CRF increased among participants without overt cardiovascular disease. The effect of hypertension on arterial stiffness also decreased as the CRF increased.

Unrecognized myocardial infarction detected on cardiac magnetic resonance imaging: Association with coronary artery calcium score and cardiovascular risk prediction scores in asymptomatic Asian cohort

Background

To investigate the association between unrecognized myocardial infarction (UMI) assessed with cardiac magnetic resonance (CMR) and coronary artery calcium (CAC) and cardiovascular risk prediction scores in asymptomatic Asian subjects.

Materials and methods

Total 872 asymptomatic subjects without prior cardiovascular event (male:female, 817:55; age, 53.88 ± 5.91) who underwent both CMR and CAC scoring CT were included. UMI were accessed and framingham risk score (FRS) and ASCVD (atherosclerotic cardiovascular disease) risk score by ACC/AHA were calculated.

Results

Late gadolinium enhancement indicating UMI was noted in 23 of 872 subjects (2.64%), but only three of them showed ECG abnormality (13.04%). Subjects with UMI showed higher CAC scores, FRS, and ASCVD scores than those without UMI (p < .001, p = .011 and p = .024, respectively). The prevalence of UMI differed significantly according to the CAC scores as follows: 1% in CAC = 0 (4/403), 1% in 1 ≤ CAC <100 (2/293), 6.1% in 100 ≤ CAC < 400 (7/114) and 14.5% in CAC ≥ 400 (9/62), respectively (p < .001). Receiver operating characteristics (ROC) analysis by using CAC score demonstrated an area under the curve (AUC) of 0.816 (95% confidence interval (CI), 0.780–0.848; p < .0001) for predicting UMI, which is superior to FRS [AUC, 0.712; 95% CI, 0.671–0.751; p = .009] and ASCVD risk score [AUC, 0.689; 95% CI, 0.648–0.729; p = .036].

Conclusion

The prevalence of UMI increases with increasing burden of CAC and FRS. CAC score is a good discriminator for UMI, superior to FRS and ASCVD score, in asymptomatic population.

Understanding Keesom Interactions in Monolayer-Based Large-Area Tunneling Junctions

Charge transport across self-assembled monolayers (SAMs) has been widely studied. Discrepancies of charge tunneling data that arise from various studies, however, call for efforts to develop new statistical analytical approaches to understand charge tunneling across SAMs. Structure-property studies on charge tunneling across SAM-based junctions have largely been through comparison of average tunneling rates and associated variance. These early moments (especially the average) are dominated by barrier width-a static property of the junction. In this work, we show that analysis of higher statistical moments (skewness and kurtosis) reveals the dynamic nature of the tunnel junction. Intramolecular Keesom (dipole-dipole) interactions dynamically fluctuate with bias as dictated by stereoelectronic limitations. Analyzing variance in the distribution of tunneling data instead of the first statistical moment (average), for a series of n-alkanethiols containing internal amide and aromatic terminal groups, we observe that the direction of dipole moments affects molecule-electrode coupling. An applied bias induces changes in the tunneling probability, affecting the distribution of tunneling paths in large-area molecular junctions.

Non-alcoholic fatty liver disease and the development of reflux esophagitis: A cohort study

BACKGROUND AND AIM

Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, is associated with gastroesophageal reflux disease in cross-sectional studies, but a prospective association has not been evaluated. The current study aimed to determine whether NAFLD increases the risk of incident reflux esophagitis in a large cohort study.

METHODS

We conducted a cohort study of 34 063 men and women without reflux esophagitis or other upper gastrointestinal disease at baseline who underwent health checkup examinations between January 2003 and December 2013. Fatty liver was diagnosed by ultrasound based on standard criteria. Reflux esophagitis was defined by the presence of at least grade A mucosal break on esophagogastroduodenoscopy.

RESULTS

The prevalence of NAFLD at baseline was 33.2%. During 153 520.2 person-years of follow-up, the cumulative incidences of reflux esophagitis for participants without and with NAFLD were 9.6% and 13.8%, respectively (P < 0.001). The age-adjusted and sex-adjusted hazard ratio for the risk of reflux esophagitis development in participants with NAFLD compared with those without NAFLD was 1.15 (95% confidence interval 1.07-1.23; P < 0.001). However, this association disappeared after adjusting for body mass index and other metabolic factors (hazard ratio 1.01, 95% confidence interval 0.94-1.09; P = 0.79). Similarly, in multivariable-adjusted models, there was no significant association between NAFLD severity and the risk of developing reflux esophagitis.

CONCLUSIONS

Non-alcoholic fatty liver disease is not independently associated with the risk of the development of reflux esophagitis, but rather, reflux esophagitis is primarily the consequence of increased body mass index commonly associated with NAFLD.

Nonalcoholic fatty liver disease accelerates kidney function decline in patients with chronic kidney disease: a cohort study

This study aimed to investigate the association of nonalcoholic fatty liver disease (NAFLD) and its severity with the decline in kidney function in patients with chronic kidney disease (CKD). We conducted a cohort study of 1,525 CKD patients who underwent repeated health check-up examinations from January 2003 through December 2013. NAFLD was diagnosed by ultrasonography and its severity was assessed by the NAFLD fibrosis score. At baseline, the prevalence of NAFLD was 40.9%, and the mean estimated glomerular filtration rate (eGFR) was 59.1 ml/min/1.73 m2. The average follow-up was 6.5 years. The age- and sex-adjusted decline in eGFR was greater in patients with NAFLD (-0.79% per year, 95% CI -1.31%, -0.27%) compared to those without it (0.30%, 95% CI -0.14%, 0.76%; p = 0.002). In multivariable adjusted models, the average difference in annual percent change in decline in eGFR comparing patients with NAFLD to those without NAFLD was -1.06% (-1.73%, -0.38%; p = 0.002). The decline in eGFR associated with NAFLD was greater in patients with higher NAFLD fibrosis score, in those with proteinuria or with low eGFR at baseline ( <45 ml/min/1.73 m2), and in those who were smokers and hypertensive. Therefore, NAFLD is independently associated with CKD progression.

Effect of Vitamin D Deficiency on the Frequency of Headaches in Migraine

Background and Purpose

The risk of vitamin D deficiency varies with the season. The frequency of vitamin D deficiency in migraine patients and its association with migraine are unclear.

Methods

We retrospectively evaluated first-visit migraine patients between January 2016 and May 2017, and investigated the demographics, season, migraine subtypes, frequency, severity, and impact of migraine, psychological and sleep variables, climate factors, and vitamin D levels. The nonfasting serum 25-hydroxyvitamin D concentration was measured to determine the vitamin D level, with deficiency of vitamin D defined as a concentration of <20 ng/mL.

Results

In total, 157 patients with migraine aged 37.0±8.6 years (mean±standard deviation) were analyzed. Their serum level of vitamin D was 15.9±7.4 ng/mL. Vitamin D deficiency was present in 77.1% of the patients, and occurred more frequently in spring and winter than in summer and autumn (89.1%, 85.7%, 72.4%, and 61.7%, respectively; p=0.008). In multivariate Poisson regression analysis, monthly headache was 1.203 times (95% confidence interval=1.046–1.383, p=0.009) more frequent in patients with vitamin D deficiency than in those without deficiency after adjusting for demographics, season, migraine subtype, depression, anxiety, and sleep quality. These associations were consistently noted in subgroup analysis of episodic migraine (odds ratio=1.266, p=0.033) and chronic migraine (odds ratio=1.390, p=0.041).

Conclusions

Our study found that a larger number of monthly days with headache was related to vitamin D deficiency among migraineurs. Future studies should attempt to confirm the causal relationship between vitamin D deficiency and migraine.

Insufficient Sleep in Tension-Type Headache: A Population Study

Background and Purpose

Sufficient sleep is an essential part of good health and well-being. Tension-type headache (TTH) is the most common type of primary headache and has negative impacts on the quality of life and work performance. We aimed to determinethe relationship between TTH and insufficient sleep in the general population.

Methods

This study used data from the Korean Headache Sleep Study, which was a population-based survey about headache and sleep among Korean adults. Insufficient sleep was defined when the discrepancy between sleep need and average sleep duration was at least 1 hour.

Results

Among the 2,695 included subjects, 570 (21.2%) and 727 (27.0%) were classified as having TTH and insufficient sleep, respectively. The prevalence of insufficient sleep was significantly higher among subjects with TTH than among those without headaches (28.8% vs. 20.4%). For subjects with TTH, the scores on a visual analogue scale (4.7±1.8 vs. 4.3±1.9, mean±SD) and the Headache Impact Test-6 (44.9±7.0 vs. 43.6±6.1) were much higher in subjects with insufficient sleep than in those without insufficientsleep. Multivariable analyses revealed that insomnia [odds ratio (OR)=2.1], poor sleep quality (OR=1.7), and short sleep duration (OR=6.9) were significantly associated with insufficient sleep in subjects with TTH.

Conclusions

Our findings suggest that insufficient sleep is prevalent among subjects with TTH and is linked to an exacerbation of TTH. Therefore, the proper evaluation and management of sleep may lead to the better management of TTH.

The Association between Facial Fracture Patterns and Traumatic Head Injury in Injured Motorcycle Riders According to Helmet Use Status

Objective

This study was undertaken to identify the association between facial fracture patterns and traumatic head injury in injured motorcycle riders.

Methods

Retrospective study design. We reviewed the medical records of patients who underwent facial bone computed tomography (CT) and brain CT simultaneously among the injured motorcycle riders between May 2009 and July 2011. Data collected included age, sex, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), facial fracture patterns, head protective device (helmet) use, alcohol intake, time of accident and seat position. Facial fracture patterns were grouped as upper, mid, and lower face. Traumatic head injury (THI) included skull fracture, brain haemorrhage and diffuse axonal injury.

Results

Of the 154 patients included, 138 (89.6%) were male, 57 (37%) had facial fracture, 69 (44.8%) wore helmets and 30 (19.5%) had THI. Their mean age was 29.0+15.0 years. After multivariate logistic regression analysis, THI was associated with GCS, seat position of riders and accident time. THI was correlated with the combination of upper and midfacial fractures in helmeted group and isolated upper facial fracture or the combination of upper and midfacial fractures in unhelmeted group. The rest of facial fracture patterns were not correlated with THI regardless of helmet.

Conclusions

The combination of upper and midfacial fractures are the risk factor of THI regardless of helmet. The patients with the combination of upper and midfacial fractures should be further evaluated for head injury regardless of helmet.

Development of chronic kidney disease in patients with non-alcoholic fatty liver disease: A cohort study

BACKGROUND & AIMS

Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD.

METHODS

We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS).

RESULTS

The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60ml/min/1.73m². During 200,790 person-years of follow-up (median follow-up of 4.15years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04-1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS <-1.455 and those with NFS ≥-1.455 to participants without NAFLD were 1.09 (95% CI 0.91-1.32) and 1.58 (95% CI 1.30-1.92), respectively. The association was consistent across clinically relevant subgroups.

CONCLUSION

In a large cohort of adult men and women without CKD, NAFLD was associated with an increased risk of CKD development. NAFLD may adversely affect renal function and patients may need to be carefully monitored for an increased risk of CKD.

LAY SUMMARY

The presence of fatty liver is associated with the future decline of renal function. Thus, fatty liver patients need to be monitored regularly for renal function.

Clinical Features of Cluster Headache Patients in Korea

Cluster headache (CH) is a rare underdiagnosed primary headache disorder with very severe unilateral pain and autonomic symptoms. Clinical characteristics of Korean patients with CH have not yet been reported. We analyzed the clinical features of CH patients from 11 university hospitals in Korea. Among a total of 200 patients with CH, only 1 patient had chronic CH. The average age of CH patients was 38.1 ± 8.9 years (range 19-60 years) and the average age of onset was 30.7 ± 10.3 years (range 10-57 years). The male-to-female ratio was 7:1 (2.9:1 among teen-onset and 11.7:1 among twenties-onset). Pain was very severe at 9.3 ± 1.0 on the visual analogue scale. The average duration of each attack was 100.6 ± 55.6 minutes and a bout of CH lasted 6.5 ± 4.5 weeks. Autonomic symptoms were present in 93.5% and restlessness or agitation was present in 43.5% of patients. Patients suffered 3.0 ± 3.5 (range 1-25) bouts over 7.3 ± 6.7 (range 1-30) years. Diurnal periodicity and season propensity were present in 68.5% and 44.0% of patients, respectively. There were no sex differences in associated symptoms or diurnal and seasonal periodicity. Korean CH patients had a high male-to-female ratio, relatively short bout duration, and low proportion of chronic CH, unlike CH patients in Western countries.

Non-alcoholic fatty liver disease and progression of coronary artery calcium score: a retrospective cohort study

BACKGROUND AND AIM

Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, was associated with subclinical atherosclerosis in many cross-sectional studies, but the prospective association between NAFLD and the progression of atherosclerosis has not been evaluated. This study was conducted to evaluate the association between NAFLD and the progression of coronary atherosclerosis.

METHODS

This retrospective cohort study included 4731 adult men and women with no history of cardiovascular disease (CVD), liver disease or cancer at baseline who participated in a repeated regular health screening examination between 2004 and 2013. Fatty liver was diagnosed by ultrasound based on standard criteria, including parenchymal brightness, liver-to-kidney contrast, deep beam attenuation and bright vessel walls. Progression of coronary artery calcium (CAC) scores was measured using multidetector CT scanners.

RESULTS

The average duration of follow-up was 3.9 years. During follow-up, the annual rate of CAC progression in participants with and without NAFLD were 22% (95% CI 20% to 23%) and 17% (16% to 18%), respectively (p<0.001). The multivariable ratio of progression rates comparing participants with NAFLD with those without NAFLD was 1.04 (1.02 to 1.05; p<0.001). The association between NAFLD and CAC progression was similar in most subgroups analysed, including in participants with CAC 0 and in those with CAC >0 at baseline.

CONCLUSIONS

In this large cohort study of adult men and women with no history of CVD, NAFLD was significantly associated with the development of CAC independent of cardiovascular and metabolic risk factors. NAFLD may play a pathophysiological role in atherosclerosis development and may be useful to identify subjects with a higher risk of subclinical disease progression.

Persistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis

BACKGROUND & AIMS

Nonalcoholic fatty liver disease (NAFLD) has been associated with subclinical atherosclerosis in cross-sectional studies. We investigated the longitudinal association of NAFLD with the development of subclinical carotid atherosclerosis.

METHODS

We performed a retrospective cohort study of 8020 adult men (average age, 49.2 y) without carotid atherosclerosis at baseline who underwent repeated health check-up examinations from January 1, 2005, through December 31, 2013. NAFLD status was diagnosed by ultrasonography and classified into 4 groups based on baseline and follow-up findings: none, developed, regressed, or persistent NAFLD. Subclinical carotid atherosclerosis was measured by ultrasound.

RESULTS

The age-adjusted hazard ratio for subclinical carotid atherosclerosis development comparing participants with persistent NAFLD with those without NAFLD was 1.23 (95% confidence interval [CI], 1.13-1.35; P < .001). The association persisted after adjustment for smoking, alcohol, body mass index, and weight change (hazard ratio, 1.13; 95% CI, 1.03-1.25; P = .014), but disappeared after adjustment for metabolic variables. The hazard ratio, comparing subjects with regression of NAFLD vs those with persistent NAFLD, was 0.82 (95% CI, 0.69-0.96; P = .013). The risk of subclinical carotid atherosclerosis development also was higher among participants with a high NAFLD fibrosis score, fibrosis-4 scores, or levels of γ-glutamyl transferase at baseline.

CONCLUSIONS

In a large cohort study, persistent NAFLD was associated with an increased risk of subclinical carotid atherosclerosis development. This association was explained by metabolic factors that could be potential mediators of the effect of NAFLD. Markers of liver fibrosis also were associated with subclinical carotid atherosclerosis development. Prospective studies are needed to determine whether treatment of NAFLD can reduce this risk.

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study

Background and Purpose

Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea.

Methods

Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator.

Results

Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals.

Conclusions

The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.

Prehypertension and Left Ventricular Diastolic Dysfunction in Middle-Aged Koreans

Background and Objectives

Left ventricular diastolic dysfunction is known to be a marker of myocardial damage, in particular myocardial fibrosis resulting from hypertension (HT). However, few studies have shown an association between the grade of diastolic dysfunction and blood pressure classification. We investigated the association between diastolic dysfunction and prehypertension (preHT) in apparently healthy adults who underwent routine health examinations.

Subjects and Methods

The study sample included 4261 Koreans, 45 to 64 years of age with no previous history of HT, diabetes mellitus, malignancy, proven coronary artery disease, or valvular heart disease based on echocardiography, who underwent routine health examinations including echocardiography. The subjects were classified into three groups based on resting blood pressure: prehypertensive, hypertensive, and normotensive.

Results

The prevalence of preHT in our study was 42.1%. After adjusting for age, gender, smoking status, alcohol consumption, fasting blood sugar, serum lipid profile, and body mass index, left ventricular diastolic dysfunction grades 1 and 2 were significantly more frequent in subjects with preHT (odds ratio [OR] 1.66 [95% confidence interval {CI} 1.40-1.96] and 1.37 [95% CI 0.95-1.97], respectively). When analyzed according to gender, the increased OR was especially notable in males.

Conclusion

Left ventricular diastolic dysfunction appears to be significantly associated with preHT in Korean middle-aged males.

Observational scores of dampness and mold associated with measurements of microbial agents and moisture in three public schools

We examined associations between observational dampness scores and measurements of microbial agents and moisture in three public schools. A dampness score was created for each room from 4-point-scale scores (0-3) of water damage, water stains, visible mold, moldy odor, and wetness for each of 8 room components (ceiling, walls, windows, floor, ventilation, furniture, floor trench, and pipes), when present. We created mixed microbial exposure indices (MMEIs) for each of 121 rooms by summing decile ranks of 8 analytes (total culturable fungi; total, Gram-negative, and Gram-positive culturable bacteria; ergosterol; (1→3)-β-D-glucan; muramic acid; and endotoxin) in floor dust. We found significant (P ≤ 0.01) linear associations between the dampness score and culturable bacteria (total, Gram-positive, and Gram-negative) and the MMEIs. Rooms with dampness scores greater than 0.25 (median) had significantly (P < 0.05) higher levels of most microbial agents, MMEIs, and relative moisture content than those with lower scores (≤0.25). Rooms with reported recent water leaks had significantly (P < 0.05) higher dampness scores than those with historical or no reported water leaks. This study suggests that observational assessment of dampness and mold using a standardized form may be valuable for identifying and documenting water damage and associated microbial contamination.

Characteristics of Elderly-Onset (≥65 years) Headache Diagnosed Using the International Classification of Headache Disorders, Third Edition Beta Version

Background and Purpose

New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups.

Methods

We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version.

Results

In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040).

Conclusions

Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.