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Background/aims: Compared with Western countries, chronic lymphocytic leukemia (CLL) rarely occurs in Asia and has different clinical characteristics. Thus, we aimed to evaluate the clinical characteristics, treatment outcomes, and prognostic significance of Korean patients with CLL., Methods: We retrospectively analyzed 90 patients with CLL who had received chemotherapy at 6 centers in Korea between 2000 and 2012., Results: Compared with Western patients with CLL, Korean patients with CLL express lambda (42.0%) and atypical markers such as CD22 and FMC7 (76.7% and 40.0%, respectively) more frequently. First-line chemotherapy regimens included chlorambucil (n = 43), fludarabine and cyclophosphamide (FC) (n = 20), fludarabine (n = 13), rituximab-FC (n = 4). The remaining patients were treated with other various regimens (n = 10). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 79.3% and 28.1%, respectively. Multivariate analyses showed that hyperleukocytosis (≥ 100 × 103/μL), extranodal involvement, and the Binet C stage were significant negative prognostic factors for OS (hazard ratio [HR] 4.75, p = 0.039; HR 21.6, p = 0.002; and HR 4.35, p = 0.034, respectively). Cytogenetic abnormalities including complex karyotypes (≥ 3), del(11q), and del(17) had a significantly adverse impact on both OS and PFS (p < 0.001 and p = 0.010, respectively)., Conclusion: Initial hyperleukocytosis, extranodal involvement, complex karyotype, del(17) and del(11q) need to be considered in the risk stratification system for CLL.

Background: Multidrug-resistant Shigella isolates have recently emerged as a serious public health threat worldwide. In particular, overseas travel is a risk factor for acquisition of antimicrobial-resistant Shigella strains. To explore the role of travel in the spread of cefotaxime-resistant Shigella sonnei in Korea, we screened 751 Shigella spp. isolates from 2007 to 2016 through the National Surveillance system, and 28 cephalosporin-resistant S. sonnei isolates were identified., Methods: For cephalosporin-resistant S. sonnei isolates, epidemiological and molecular analyses (plasmid structure analysis, pulsed-field gel electrophoresis (PFGE) and high-quality single-nucleotide polymorphisms (hqSNPs) based on whole-genome sequencing (WGS)) were conducted to investigate the source of infection and transmission route., Results: Among the 28 cefotaxime-resistant S. sonnei strains, 18 were isolated from travellers returning from Asia, including Vietnam (n=11). Molecular analysis of 18 bla CTX-M -type isolates revealed that 15 contain CTX-M-15; 50% of isolates from domestic patients contain CTX-M-14. Analysis of the genetic environments of the bla CTX-M-14 and bla CTX-M-15 genes revealed different genetic organization surrounding the bla CTX-M genes. Additionally, PFGE and hqSNP results suggested a large phylogenetic distance between the S. sonnei isolates related to overseas travel and those acquired domestically in Korea., Conclusion: Our study data demonstrates that two prevalent bla CTX-M genes, bla CTX-M-14 and bla CTX-M-15 , have been circulating in S. sonnei in Korea over the last 10 years. Recently, international travellers are at a high risk for acquisition of CTX-M-15-producing S. sonnei in Korea., (Copyright © 2019. Published by Elsevier Ltd.)

Previous studies have identified microplastics (MPs) in commercial table salts but could not exactly address the origin of the MPs because of several limitations. The present study is based on the hypothesis that commercial sea salts can act as an indicator of MP pollution in the surrounding environment unless the MPs are filtered out during the manufacturing process. A total of 39 different salt brands produced at geospatially different sites, including 28 sea salt brands from 16 countries/regions on six continents, were investigated. A wide range of MP content (in number of MPs per kg of salt; n/kg) was found: 0-1674 n/kg (excluding one outlier of 13 629 n/kg) in sea salts, 0-148 n/kg in rock salt, and 28-462 n/kg in lake salt. Relatively high MP content was identified in sea salts produced in Asian countries/regions. The abundance of MPs in unrefined sea salts ( n = 25) exhibited significant linear correlations with plastic emissions from worldwide rivers ( r 2 = 0.33; p = 0.003) and with the MP pollution levels in surrounding seawater ( r 2 = 0.46; p = 0.021) in the published literature. The results indicate that not only is Asia a hot spot of global plastic pollution, as previous studies have suggested, but also that sea salt can be a good indicator of the magnitude of MP pollution in the surrounding marine environment.

Although stroke is a world-wide problem, the burden of stroke is particularly serious in Asia; its mortality is higher than in Europe or North America. The situation in Asia is dichotomized. Stroke mortality and case fatality has been declining in northern-eastern countries such as Korea, Japan, Taiwan, and urbanized areas of China. This is attributed to both the risk factor control and stroke care improvement. However, declining stroke incidence is rarely observed, which is in part due to rapidly aging population. As a result, there is an increase in the number of stroke survivors who require long-term, costly care. The extremely low birth rate and relatively insecure social health system markedly increases the caregiver burden. The problem in southern Asian countries, such as India, Pakistan, Bangladesh, and Indonesia is more fundamental. With the improving control of infectious diseases, life expectancy is prolonged. However, risk factors such as hypertension, diabetes, obesity and cigarette smoking become prevalent, and are poorly controlled. Stroke neurologists, organized stroke centers, and diagnostic tools are insufficient, which has resulted in high stroke fatality and mortality. Throughout Asia, the most urgent priority should be the primary stroke prevention through promoting a healthy lifestyle, e.g. low salt intake, regular physical exercise, stopping smoking, government sectors should take a stronger initiative to accomplish this. The rapidly aging populations and stroke burden will shrink the economy and destabilize the society, not only in Asia but also globally unless appropriate efforts are promptly initiated, this may result in a global disaster., (© 2014 World Stroke Organization.)

Relevant for various areas of human genetics, Y-chromosomal short tandem repeats (Y-STRs) are commonly used for testing close paternal relationships among individuals and populations, and for male lineage identification. However, even the widely used 17-loci Yfiler set cannot resolve individuals and populations completely. Here, 52 centers generated quality-controlled data of 13 rapidly mutating (RM) Y-STRs in 14,644 related and unrelated males from 111 worldwide populations. Strikingly, >99% of the 12,272 unrelated males were completely individualized. Haplotype diversity was extremely high (global: 0.9999985, regional: 0.99836-0.9999988). Haplotype sharing between populations was almost absent except for six (0.05%) of the 12,156 haplotypes. Haplotype sharing within populations was generally rare (0.8% nonunique haplotypes), significantly lower in urban (0.9%) than rural (2.1%) and highest in endogamous groups (14.3%). Analysis of molecular variance revealed 99.98% of variation within populations, 0.018% among populations within groups, and 0.002% among groups. Of the 2,372 newly and 156 previously typed male relative pairs, 29% were differentiated including 27% of the 2,378 father-son pairs. Relative to Yfiler, haplotype diversity was increased in 86% of the populations tested and overall male relative differentiation was raised by 23.5%. Our study demonstrates the value of RM Y-STRs in identifying and separating unrelated and related males and provides a reference database., (© 2014 The Authors. **Human Mutation published by Wiley Periodicals, Inc.)

The incidence of multiple myeloma (MM) is known to be variable according to ethnicity. However, the differences in clinical characteristics between ethnic groups are not well-defined. In Asian countries, although the incidence of MM has been lower than that of Western countries, there is growing evidence that MM is increasing rapidly. The Asian Myeloma Network decided to initiate the first multinational project to describe the clinical characteristics of MM and the clinical practices in Asia. Data were retrospectively collected from 23 centers in 7 countries and regions. The clinical characteristics at diagnosis, survival rates and initial treatment of 3,405 symptomatic MM patients were described. Median age was 62 years (range, 19-106), with 55.6% of being male. Median overall survival (OS) was 47 months (95% CI 44.0-50.0). Stem cell transplantation was performed in 666 patients who showed better survival rates (79 vs. 41 months, P < 0.001). The first-line treatments of 2,970 patients were analyzed. The overall response rate was 71% including very good partial response or better in 31% of the 2,660 patients those were able to be evaluated. New drugs including bortezomib, thalidomide, and lenalidomide were used in 36% of 2,970 patients and affected OS when used as a first-line treatment., (© 2014 Wiley Periodicals, Inc.)

Background: Hepatitis B virus (HBV) reactivation is increasing, as rituximab has become widely used for B-cell lymphoma. Thus, prevention and management of HBV reactivation are important in HBV-endemic areas., Methods: Hepatitis B virus (HBV) reactivation in HBV surface antigen (HBsAg)-positive patients and HBsAg-negative/HBV core antibody (HBcAb)-positive patients who received rituximab-containing chemotherapy was investigated by the Asia Lymphoma Study Group via retrospective (n=340), and the results were compared to cross-sectional analysis with patients who were prospectively monitored in a single institute (n=127). The goal of the study was to define the frequency of HBV reactivation and the efficacy of antiviral prophylaxis., Results: HBV reactivation was found in 27.8% of HBsAg-positive patients (45/162) in the retrospective analysis, being significantly less frequent in patients receiving antiviral prophylaxis than those not (22.9%, 32/140 versus 59.1%, 13/22; p<0.001). Lamivudine was most commonly used (96/162, 59.3%), but more than 20% of HBsAg-positive patients showed breakthrough HBV reactivation. In the cross-sectional analysis, a reduced rate of HBV reactivation occurred for entecavir as compared with lamivudine prophylaxis (6.3% versus 39.3%; p<0.05). HBV DNA monitoring of HBsAg-negative/HBcAb-positive patients in the cross-sectional analysis showed HBV reactivation in only 2.4% of cases., Conclusions: This is the largest study of HBV reactivation in patients receiving rituximab-containing chemotherapy to date, and we defined the probability of HBV reactivation in an HBV-endemic region., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A recent genome-wide association study (GWAS) of subjects from Japan and South Korea reported a novel association between the TP63 locus on chromosome 3q28 and risk of lung adenocarcinoma (p = 7.3 × 10(-12)); however, this association did not achieve genome-wide significance (p ≤ 10(-7)) among never-smoking males or females. To determine if this association with lung cancer risk is independent of tobacco use, we genotyped the TP63 SNPs reported by the previous GWAS (rs10937405 and rs4488809) in 3,467 never-smoking female lung cancer cases and 3,787 never-smoking female controls from 10 studies conducted in Taiwan, Mainland China, South Korea, and Singapore. Genetic variation in rs10937405 was associated with risk of lung adenocarcinoma [n = 2,529 cases; p = 7.1 × 10(-8); allelic risk = 0.80, 95% confidence interval (CI) = 0.74-0.87]. There was also evidence of association with squamous cell carcinoma of the lung (n = 302 cases; p = 0.037; allelic risk = 0.82, 95% CI = 0.67-0.99). Our findings provide strong evidence that genetic variation in TP63 is associated with the risk of lung adenocarcinoma among Asian females in the absence of tobacco smoking.

The current status and challenges associated with the production and utilization of cellulosic ethanol in Korea are reviewed in this paper. Cellulosic ethanol has emerged as a promising option for mitigating Korea's CO(2) emissions and enhancing its energy security. Korea's limited biomass resources is the most critical barrier to achieving its implementation targets for cellulosic ethanol. Efforts to identify new suitable biomass resources for cellulosic ethanol production are ongoing and intensive. Aquatic biomasses including macroalgae and plantation wastes collected in the Southeast Asia region have been found to have great potential as feedstocks for the production of cellulosic ethanol. R&D explorations into the development of technologies that can convert biomass materials to ethanol more efficiently also are underway. It is expected that cellulosic ethanol will be in supply from 2020 and that, by 2030, its use will have effectively reduced Korea's total gasoline consumption by 10%., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Stroke is a major cause of morbidity and mortality in Asia, and its pattern is changing. The incidence of haemorrhagic stroke is declining while the incidence of ischaemic stroke caused by large artery atherothromboembolism is increasing secondary to an increase in the prevalence of hypercholesterolaemia. The Working Group on Stroke and Lipids Management in Asia Consensus Panel assembled leading experts from the region to reach a consensus on how to address this challenge. The group discussed the observational epidemiology of the relationship between cholesterol and risk of stroke, the clinical trial evidence base for cholesterol-lowering for stroke prevention, and issues specific to stroke and lipid management for Asian doctors and patients. Stroke guidelines from many of the Asian countries have recently recommended consideration of statins for recurrent stroke prevention in patients with previous ischaemic stroke or transient ischaemic attack. However, because these recommendations have yet to be implemented widely, there is a need to educate Asian physicians and patients about the importance of adequate control of hypercholesterolaemia. Further trials of statins in Asian patients are also needed, particularly in those with intracranial stenosis.

To enhance the detection of bacterial meningitis in an East Asian surveillance study, we employed cerebrospinal fluid (CSF) bacterial culture, latex agglutination (LA) and polymerase chain reaction-enzyme immunoassay (PCR-EIA) testing for Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Sp). The sensitivity and specificity of CSF PCR-EIA testing was compared to LA and culture. A meningitis case was defined by one positive result for any of the three tests. The sensitivity of H. influenzae CSF PCR-EIA, LA, and culture was 100%, 40% and 57.5% respectively; and for Sp CSF PCR-EIA, LA and culture, the sensitivity was 100%, 58.3% and 66.7%, respectively. Hib and Sp specificity was 100% by each method. CSF PCR-EIA was more sensitive than culture or LA for the detection of Hib and Sp meningitis cases increasing their incidence by 74% and 50% compared to culture respectively. CSF PCR-EIA should be included for the detection of bacterial meningitis in surveillance studies.

Rotavirus remains the most common cause of severe, dehydrating diarrhea among children worldwide. Several rotavirus vaccines are under development. Decisions about new vaccine introduction will require reliable data on disease impact. The Asian Rotavirus Surveillance Network, begun in 2000 to facilitate collection of these data, is a regional collaboration of 36 hospitals in nine countries or areas that conduct surveillance for rotavirus hospitalizations using a uniform World Health Organization protocol. We summarize the Network's organization and experience from August 2001 through July 2002. During this period, 45% of acute diarrheal hospitalizations among children 0-5 years were attributable to rotavirus, higher than previous estimates. Rotavirus was detected in all sites year-round. This network is a novel, regional approach to surveillance for vaccine-preventable diseases. Such a network should provide increased visibility and advocacy, enable more efficient data collection, facilitate training, and serve as the paradigm for rotavirus surveillance activities in other regions.

In Korea the system of medical management has been bifurcated into two parts since the restoration of nation from Japanese after World War II. One is 'Western Medicine' and the other is 'Oriental Medicine' like Chinese but not like Japanese. The authors attempted to study on the unification of both medicines to prevent the confusion of medicare for people. The major part of medical care is accomplished by Western medicine among people in Korea and China. However, Oriental medicine is still present as well as college of Oriental medicine in small number. There have been long struggles between two parts of medicine because of each assertions for the theories. The ancient medicine has been likely to have its characteristics either in Western or Oriental medicine although in many countries were succeeded by Western medicine except a few Asian countries such as Korea and China. In Japan since the license of Oriental(herb) medicine was ceased about one hundred years ago, the Western medicine has been authorized by law until today and the herb is the secondary medicine as a kind of folk treatment as well as continuous and enormous study for scientification. In only China and Korea this herb medicine has been kept to use as a part of medicine by law though China has developed combined medicine to use both Western and Oriental medicine by one physician since previous prime minister Chou En-Lai around the year 1950 who made a recommendation to the two medical societies, Western and Oriental. This fact has a big sense to establish the unification of two medicines in near future in Korea as well as China. For this accomplishment of medical unification both parts of medicine require sincere and enormous efforts to study the theory and practice of herb medicine even from now on. This unification of two medicines will provide the best medicare in most convenient way to the people in the world creating new world medicine like the third medicine including alternative medicine. The acupuncture is changing to a new method in Western medicine especially applying into anesthesia and pain clinic in even USA and Western countries at this time. In conclusion the unification of the Western and Oriental medicine will provide the most reasonable and practical medicare including alternative medicine to people in the world. Because the Oriental medicine will be used at least separately to supplement the Western medicine by one physician.

Place of residence has traditionally been an important factor in Korea in mate selection. This study examines the local marriage network in Korean society, its variation by year of marriage, and general characteristics of the married women. Data are drawn from the 1986 national sample survey on the family life cycle implemented by the Korea Institute for Population and Health. Questionnaires were administered to 3013 wives aged 15-64. Major study findings follow. 1) The local marriage rate within the same region by birthplace is strikingly high in Kyongsangdo and Chonla-do. Local marriage rates are 79.5% in both of these regions, 33.5% in Seoul, 35.2% in Busan, 50% in Kyonggi-do, 48.1% in Kangwon-do, and 60.7% in Chungchung-do. 2) The local marriage rate within the same county or the same city be residence before marriage has rapidly been declining in rural areas since 1960. This is largely due to industrialization, urbanization, and better transportation. The marriage rate in rural areas was 62% among marriages in the 1940s, 47.1% in the 1960s, 43% in the 1980s, and 70.9%, 88.4%, and 70.7% respectively in urban areas. 3) The proportion of local marriages within the same city or county is 55.1% among arranged marriages and 72.3% among romantic marriages. 4) Pre-marital employment seems to have some effects on the extent of mate-selection. Wives who worked before marriage were more likely to marry men in the same city or county. The local marriage rate within the same city or county is 63.2% among wives with work experience, and 58.5% among wives without work experience. 5) The more educated the woman, the higher the local marriage rate within the same city or county. 56.6% of those who attended middle school married men in the same city or county as theirs, 61.4% of wives with a high school education, and 76.6% of wives with college or more education. 63.8% of wives who never attended school married men in the same city or county. In summary, restrictions on marriage between couples of different status has been diminishing due to introduction of democratic thought based on freedom and equality; the marriage network has also narrowed due to industrialization, urbanization, migration, and women's higher educational attainment.