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Concordance rate in Cervicography Interpretation
( Kidong Kim ),( Won Moo Lee ),( Yong Jung Song ),( Kibbeum Doh ),( Soyeon Ahn ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective: To estimate the concordance rate in interpretation of cervicography. Methods: Three reviewers who practiced as a gynecologic oncologist over 5 years independently reviewed 392 cervicography images from patients with confirmed Cervical Intraepithelial Neoplasia (CIN) diagnosis (low grade squamous intraepithelial lesion (LSIL) in 47, high grade squamous intraepithelial lesion (HSIL) in 345). Reviewers were blinded to the diagnosis of each case and the composition of diagnosis in 392 cervicography images. After evaluating the quality of cervicography images, reviewers graded cervicography images as LSIL vs HSIL based on the first impression. Then, reviewers determined the presence or absence of findings: acetowhite lesion, mosaicism, punctuation, atypical vessels, cancerous mass, ulceration. Finally, reviewers graded again the cervicography images as LSIL vs HSIL. The concordance rate between reviewers was defined as portion of cases in which all three reviewers graded same diagnosis (LSIL vs HSIL). Results: Over two of three reviewers evaluated 67 cervicography images as not evaluable (67/392, 17%) and excluded from the further analysis. The sensitivity and specificity of reviewers were poor but compatible to numbers in literatures (sensitivity 0.48 0.56, specificity 0.55 0.76 by first impression; sensitivity 0.52 0.56, specificity 0.55 0.74 by final impression). However, the concordance rate is only 0.57 based on the first and final impression. Conclusion: In interpreting cervicography, the concordance rate between reviewers is poor. Novel technology with more Objective interpretation is necessary. Acknowledgements: This work was supported by the Technology Innovation Program funded By the Ministry of Trade, Industry and Energy (MOTIE) of Korea (10049785, Developm)
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( Sejoong Kim ),( Jong Cheol Jeong ),( Shin Young Ahn ),( Kibbeum Doh ),( Dong-chan Jin ),( Ki Young Na ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.1
Background: Unlike patterns observed in the general population, obesity is associated with better survival among hemodialysis patients, which could be explained by reverse causation or illness-related weight loss. However, the time-varying effect of body mass index (BMI) on hemodialysis survival has not been investigated. Therefore, this study investigated the time-varying effect of BMI on mortality after starting hemodialysis. Methods: In the present study, we examined Korean Society of Nephrology data from 16,069 adult patients who started hemodialysis during or after the year 2000. Complete survival data were obtained from Statistics Korea. Survival analysis was performed using Cox regression and a non-proportional hazard fractional polynomial model. Results: During the median follow-up of 8.6 years, 9,272 patients (57.7%) died. Compared to individuals with normal BMI (18.5-24.9 kg/m2), the underweight group (< 18.5 kg/m2) had a higer mortality hazard ratio (HR, 1.292; 95% confidence interval [CI], 1.203-1.387; P < 0.001) and the overweight group (25.0-29.9 kg/m2) had a lower mortality HR (0.904; 95% CI, 0.829-0.985; P = 0.022). The underweight group had increasing HRs during the first 3 to 7 years after starting hemodialysis, which varied according to age group. The young obese group (< 40 years old) had a U-shaped temporal trend in their mortality HRs, which reflected increased mortality after 7 years. Conclusion: The obese hemodialysis group had better survival during the early post-dialysis period, although the beneficial effect of obesity disappeared 7 years after starting hemodialysis. The young obese group also had an increased mortality HR after 7 years.
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