Search

Despite several screening levels for NDMA reported in water, soil, air, and drugs, the human risk assessment using biomonitoring concentrations has not been performed. In this study, gender-specific exposure guidance values were determined in humans, then biomonitoring measurements in healthy Korean subjects (32 men and 40 women) were compared to the exposure guidance values to evaluate the current exposure level to NDMA. For the human risk assessment of NDMA, the gender-specific physiologically based pharmacokinetic (PBPK) model was developed in humans using proper physiological parameters, partition coefficients, and biochemical parameters. Using the PBPK model, a Monte Carlo simulation was performed to describe the magnitudes of inter-individual variability and uncertainty on the single model predictions. The PBPK modeling and Monte Carlo simulation allowed the estimation of the relationship between external dose and blood concentration for the risk assessment. The procedure for the human risk assessment was summarized as follows: (1) estimating a steady-state blood concentration (C avg ) corresponding to the daily no observed adverse effect level (NOAEL) administration in rats; (2) applying uncertainty factors (UFs) for deriving the human C avg ; (3) determining the exposure guidance values as screening criteria; (4) interpreting the human biomonitoring measurements by forward and reverse dosimetry approaches. Using the biomonitoring concentrations, current daily exposures to NDMA were estimated to be 3.95 μg/day/kg for men and 10.60 μg/day/kg for women, respectively. The result of the study could be used as a basis for implementing further risk management and regulatory decision-making for NDMA., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Postpartum depression (PPD) can negatively affect infant well-being and child development. Although the frequency and risk factors of PPD symptoms might vary depending on the country and culture, there is limited research on these risk factors among Korean women. This study aimed to elucidate the potential risk factors of PPD throughout pregnancy to help improve PPD screening and prevention in Korean women., Methods: The pregnant women at 12 gestational weeks (GW) were enrolled from two obstetric specialized hospitals from March 2013 to November 2017. A questionnaire survey was administered at 12 GW, 24 GW, 36 GW, and 4 weeks postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and PPD was defined as a score of ≥ 10., Results: PPD was prevalent in 16.3% (410/2,512) of the participants. Depressive feeling at 12 GW and postpartum factors of stress, relationship with children, depressive feeling, fear, sadness, and neonatal intensive care unit admission of baby were significantly associated with a higher risk of PPD. Meanwhile, high postpartum quality of life and marital satisfaction at postpartum period were significantly associated with a lower risk of PPD. We developed a model for predicting PPD using factors as mentioned above and it had an area under the curve of 0.871., Conclusion: Depressive feeling at 12 GW and postpartum stress, fear, sadness, relationship with children, low quality of life, and low marital satisfaction increased the risk of PPD. A risk model that comprises significant factors can effectively predict PPD and can be helpful for its prevention and appropriate treatment., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)

We aimed to evaluate the clinical impact of shift patterns at work on gynecologic problems and the healthcare behavior of Korean nursing staff. We conducted a web-based survey for over two weeks in September 2021, involving female nursing staff, including nurses, nurses' aides, and nursing assistants, working in five medical centers. The questionnaire included 40 questions on baseline characteristics, working information, and experiences with gynecologic problems and medical approaches. Overall, 885 nursing staffs participated in the survey, of the 1,904 who received the invitation with an online link of the survey. The response rate was 46.5%. Among the participants responding to all questions, 569 (64.4%) worked two or three shifts and 305 (34.5%) worked full-time. In women rotating two or three-shift patterns, irregular menstrual cycles (21.6% vs. 13.8%, p = 0.005), abnormal menstrual cycles (40.9% vs. 33.8%, p = 0.038), and dysmenorrhea (48.0% vs. 38.4%, p = 0.006) were more frequent than in those who worked full-time. The experience of visiting gynecologic clinics (47.5% vs. 44.1%, p = 0.332) and treating gynecologic conditions (33.4% vs. 29.3%, p = 0.211) did not differ according to the working patterns. However, diagnosis of gynecologic diseases was more frequent in women working full-time (36.4% vs. 29.7%, p = 0.043). The rates of screening (76.1% vs. 57.8%, p<0.001) and human papillomavirus vaccination (55.7% vs. 39.9%, p<0.001) for cervical cancer prevention were higher in women working full-time than in two-three shifts. This study showed that rotating shift work may be related to an increase in gynecologic problems and a decrease in cancer prevention activity among female nursing staff., Competing Interests: The authors have declared that no competing interests exist.

Background: Due to its abuse potential, propofol has been classified as a controlled substance since February 2011 in South Korea. Healthcare workers are exposed to propofol abuse considering their easy access to this substance in hospitals. Therefore, we aimed to investigate propofol abuse among healthcare workers through the database of the Supreme Court in South Korea., Methods: We retrospectively analyzed adjudicated criminal cases related to propofol abuse among healthcare workers from January 1, 2013, to December 31, 2020, using the database of the Supreme Court of South Korea's judgments. We collected the clinical characteristics and punishment-related information of healthcare workers who abused propofol., Results: Of the 194 cases collected using the search term 'propofol,' 20 were included in the final analysis. The most common healthcare workers who abused propofol were nursing aides (n = 15). Among them, 40% (n = 8) of the defendants had previously been punished for substance abuse, and 35% (n = 7) had a history of psychological disease. Of the defendants, 65% (n = 13) self-administered propofol more than twice, and the median number of self-administrations was three. Except for two, the defendants were sentenced to imprisonment, including suspended sentences, and the median values of their duration of prison and probation were 9 months and 24 months., Conclusions: Despite propofol being strongly regulated as a controlled substance in South Korea, its abuse among healthcare workers remains. Healthcare workers should be vigilant against its abuse among themselevs.

Recurrent pregnancy loss (RPL) is the loss of two or more consecutive pregnancies before 20 weeks of gestational age. Our study investigated whether mucin 4 (MUC4) polymorphisms are associated with RPL. MUC polymorphisms (rs882605 C>A, rs1104760 A>G, rs2688513 A>G, rs2258447 C>T, and rs2291652 A>G) were genotyped in 374 women with RPL and 239 controls of Korean ethnicity using polymerase chain reaction-restriction fragment length polymorphism analysis and the TaqMan probe SNP genotyping assay. Differences in genotype frequencies between cases of RPL and the controls were compared. MUC4 rs882605 C>A and rs1104760 A>G polymorphisms were associated with increased incidence of RPL in three and four or more pregnancy loss patients. The haplotype analyses showed a tendency for the allelic effect including the association of MUC4 rs882605 A and rs1104760 G alleles with increased incidence of RPL. In addition, the MUC4 rs882605 CA/MUC4 rs2258447 CC genotype combination was associated with increased RPL prevalence. The two exonic polymorphisms lead to amino acid changes of protein and may act as pathogenic variants for RPL. In conclusion, the MUC4 rs882605 C>A and MUC4 rs1104760 A>G polymorphisms were associated with the susceptibility of RPL and we considered them as potential biomarkers for RPL.

Background: Medical malpractice during endotracheal intubation can result in catastrophic complications. However, there are no reports on these severe complications in South Korea. We aimed to investigate the severe complications associated with endotracheal intubation occurring in South Korea, via medicolegal analysis., Methods: We retrospectively analyzed the closed judicial precedents regarding complications related to endotracheal intubation lodged between January 1994 and June 2020, using the database of the Supreme Court of Korea. We collected clinical and judicial characteristics from the judgments and analyzed the medical malpractices related to endotracheal intubation., Results: Of 220 potential cases, 63 were included in the final analysis. The most common event location was the operating room (n = 20, 31.7%). All but 3 cases were associated with significant permanent or more severe injury, including 31 deaths. The most common problems were failed or delayed intubation (n = 56, 88.9%). Supraglottic airway device was used in 5.2% (n = 3) cases of delayed or failed intubation. Fifty-one (81%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of Korean Won 133,897,845 (38,000,000, 308,538,274). The most common malpractice recognized by the court was that of not attempting an alternative airway technique (n = 32, 50.8%), followed by violation of the duty of explanation (n = 10, 15.9%)., Conclusions: Our results could increase physicians' awareness of the major complications related to endotracheal intubation and help ensure patient safety.

Background: People are generally considered overweight and obese if their body mass index (BMI) is above 25 kg/m² and 30.0 kg/m², respectively. The World Health Organization proposed stricter criteria for Asians (≥ 23 kg/m²: overweight, ≥ 25 kg/m²: obese). We aimed to verify whether this criteria could predict adverse pregnancy outcomes in Korean women., Methods: We included 7,547 Korean women from 12 institutions enrolled between June 2016 and October 2018. Women with no pre-pregnancy BMI data, not Korean, or lost to follow-up were excluded, leaving 6,331. The subjects were categorized into underweight, normal, overweight, class I obesity, and class II/III obesity based on a pre-pregnancy BMI of < 18.5, 18.5-22.9, 23.0-24.9, 25.0-29.9, and ≥ 30.0 kg/m², respectively., Results: Overall, 13.4%, 63.0%, 11.8%, 9.1%, and 2.6% of women were underweight, normal, and overweight and had class I obesity and class II/III obesity, respectively. In the multivariable analysis adjusted for maternal age, a higher BMI significantly increased the risk of preeclampsia, gestational diabetes, preterm delivery caused by maternal-fetal indications, cesarean section, large for gestational age, and neonatal intensive care unit admission., Conclusion: Adverse pregnancy outcomes started to increase in those with a pre-pregnancy BMI ≥ 23.0 kg/m² after adjusting for maternal age. The modified obesity criteria could help predict adverse pregnancy outcomes in Koreans., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2021 The Korean Academy of Medical Sciences.)

Objective: To determine the association between insufficient sleep in the prenatal period and postpartum depression (PPD), and whether changes in sleep patterns during pregnancy increase the risk of PPD., Methods: A prospective cohort study was conducted between March 2013 and November 2017. Participants completed a sleep questionnaire pre-pregnancy and at 12, 24 and 36 gestational weeks (GW). Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum, and the cut-off score for PPD was 10 or more., Results: Of 2512 participants, 410 (16.3%) were identified as having PPD. Only insufficient sleep at 36 GW was significantly associated with PPD after adjusting for confounding factors (odds ratio 1.79, 95% confidence interval 1.40-2.27, P < 0.001). Both Group 1 (change from sufficient to insufficient) and Group 3 (sustained insufficient) demonstrated a significant risk of PPD at all starting time-points in the multivariate analysis, but no significant association was evident between Group 2 (change from insufficient to sufficient) and PPD., Conclusion: Insufficient sleep at 36 GW was associated with a significant risk of developing PPD. Additionally, regardless of whether women had sufficient sleep, a shift towards worsening sleep at 36 GW was highly associated with PPD., (© 2021 International Federation of Gynecology and Obstetrics.)

Banhahoobak-tang is the most prescribed herbal drug in East Asia when individuals experience sudden symptoms such as sore throat or neurological symptoms. The low toxicity and high in-vivo safety of this herbal medicine has made it more attractive to patients, and it has recently been formulated as tablets. In addition, Banhahoobak-tang tablets are registered as health insurance drugs in South Korea, and clinical prescriptions and demand are increasing. However, there are very few clinical trial data as well as very little accurate content analysis and results for Banhahoobak-tang tablets. The purpose of this study was to perform in-vitro and in-vivo studies on Banhahoobak-tang tablets, including content analysis, pharmacokinetics in humans, and plasma protein binding. For this study, a UPLC-ESI-MS/MS method with polarity switching was developed for simultaneous analysis of 18 components of Banhahoobak-tang. To separate the analytes, a C 8 reverse-phase column was used as the stationary phase, 0.1 % aqueous formic acid and acetonitrile as the mobile phase, and ionization and multiple reaction monitoring for quantification. The developed method was able to isolate and quantify the 18 components with good sensitivity and selectivity and was fully validated according to international analytical standards. Stability tests were also conducted on the analytes. Finally, the method was applied to in-vitro and in-vivo studies of Banhahoobak-tang tablets, and the tablet components were 52.49 ng/g to 91.00 μg/g on average. The detected components showed rapid oral absorption in humans as well as high plasma protein binding ratio overall. These results and methods can be useful not only for effectiveness and safety evaluation but also for quality control of Banhahoobak-tang tablets., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The positive effects of graphic health warnings (GHWs) on quitting smoking have been widely demonstrated in the literature on cigarette warning. However, recent findings of smoker reactance to GHWs demand investigations of factors that may constrain the effects of GHWs. The current study sought to identify conditions in which GHWs do not have a positive impact on smokers' desire to quit with a focus on smokers' perceived stress. Two hundred and forty-four smokers in South Korea were exposed to either a text-only or a GHW cigarette pack in a between-subjects experiment. Results from this study suggest that the GHW condition is effective in increasing attention to the GHW, enhancing perceived usefulness of information, and desire to quit only among those with low (vs. high) perceived stress. In addition, an interaction effect between warning type and perceived stress on the desire to quit was sequentially mediated by attention and perceived information effectiveness. Based on the results, we suggest that GHWs were less effective for smokers with high levels of perceived stress because their stress appeared to exhaust the cognitive resources necessary to process the information.

Background: Pediatric as well as adult patients with chronic kidney disease (CKD) are susceptible to cardiovascular disease (CVD) events, which increase their mortality. Dyslipidemia is thought to be one of the most important contributing risk factors for developing CVD. This study aimed to evaluate the prevalence of dyslipidemia and assess clinical and laboratory risk factors associated with dyslipidemia in East Asian pediatric patients with CKD., Methods: From April 2011 to April 2016, 469 patients with CKD aged < 20 years were enrolled in KNOW-PedCKD (the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease); 356 patients were included in the final analysis. Using the baseline data of the cohort cross-sectionally, a multivariable logistic regression analysis was performed to assess the risk factors for dyslipidemia; a subanalysis for each lipid abnormality was also done., Results: The prevalence of dyslipidemia was 61.5% (n = 219). For dyslipidemia, nephrotic range proteinuria and 25-hydroxyvitamin D deficiency significantly increased the adjusted odds ratio. In the subanalysis, glomerulonephropathy as the origin of CKD and nephrotic range proteinuria significantly increased the risks for high total cholesterol and high low-density lipoprotein cholesterol. Overweight or obese body mass index z-score, elevated proteinuria, hypocalcemia, and 1,25-dihydroxyvitamin D deficiency were significantly associated with low high-density lipoprotein cholesterol. Glomerular filtration rate stage 3b or higher and hyperphosphatemia significantly increased the risk for high triglycerides., Conclusions: Long-term data accumulation and prospective analysis are needed to clarify the relationship between CKD progression and dyslipidemia and to find additional risk factors for dyslipidemia.

Background : Preterm birth is strongly associated with increasing mortality, incidence of disability, intensity of neonatal care required, and consequent costs. We examined the clinical utility of the potential preterm birth risk factors from admitted pregnant women with symptomatic preterm labor and developed prediction models to obtain information for prolonging pregnancies. Methods: This retrospective study included pregnant women registered with the KOrean Preterm collaboratE Network (KOPEN) who had symptomatic preterm labor, between 16 and 34 gestational weeks, in a tertiary care center from March to November 2016. Demographics, obstetric and medical histories, and basic laboratory test results obtained at admission were evaluated. The preterm birth probability was assessed using a nomogram and decision tree according to birth gestational age: early preterm, before 32 weeks; late preterm, between 32 and 37 weeks; and term, after 37 weeks. Results: Of 879 registered pregnant women, 727 who gave birth at a designated institute were analyzed. The rates of early preterm, late preterm, and term births were 18.16%, 44.02%, and 37.83%, respectively. With the developed nomogram, the concordance index for early and late preterm births was 0.824 (95% CI: 0.785-0.864) and 0.717 (95% CI: 0.675-0.759) respectively. Preterm birth was significantly more likely among women with multiple pregnancy and had water leakage due to premature rupture of membrane. The prediction rate for preterm birth based on decision tree analysis was 86.9% for early preterm and 73.9% for late preterm; the most important nodes are watery leakage for early preterm birth and multiple pregnancy for late preterm birth. Conclusion: This study aims to develop an individual overall probability of preterm birth based on specific risk factors at critical gestational times of preterm birth using a range of clinical variables recorded at the initial hospital admission. Therefore, these models may be useful for clinicians and patients in clinical decision-making and for hospitalization or lifestyle coaching in an outpatient setting., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

An aerobic, Gram-stain-negative, polar-flagellated, rod-shaped bacterium, designated as SC2-7 T , was isolated from the dust collector at a pig farm located in Wanju-gun, Jeollabuk-do, Republic of Korea. Growth occurred at 10-37 °C (optimum, 28-30 °C), pH 6.0-10.0 (optimum, 7.0-8.0) and in the presence of 0-3 % (w/v) NaCl (optimum, 0 %) on Reasoner's 2A medium. The phylogenetic tree based on the 16S rRNA gene sequences revealed that strain SC2-7 T was a member of the family Comamonadaceae, forming a robust cluster with the genera Alicycliphilus, Oryzisolibacter and Melaminivora. The 16S rRNA gene sequences of strain SC2-7 T showed the highest sequence similarities to Alicycliphilus denitrificans K601 T (97.2 %), Oryzisolibacter propanilivorax EPL6 T (97.0 %), Melaminivora alkalimesophila CY1 T (96.9 %), Diaphorobacter polyhydroxybutyrativorans SL-205 T (96.6 %), Diaphorobacter nitroreducens NA10B T (96.6 %) and Melaminivora jejuensis KBB12 T (96.5 %). The tree based on the gyrA gene sequences also showed that strain SC2-7 T fell into a phylogenetic position similar to that based on the 16S rRNA gene sequences. The polar lipids present were phosphatidylethanolamine, diphosphatidylglycerol, phosphatidylglycerol, an unidentified aminolipid and an unidentified phospholipid. The predominant quinone was ubiquione-8. The major fatty acids were summed feature 3 (including C16 : 1ω6c and/or C16 : 1ω7c), C16 : 0 and summed feature 8 (including C18 : 1ω6c and/or C18 : 1ω7c). The genomic DNA G+C content was 69.1 mol%. On the basis of the phenotypic, phylogenetic and chemotaxonomic data presented here, strain SC2-7 T represents a novel species of a new genus, for which the name Pulveribacter suum gen. nov., sp. nov., is proposed. The type strain of Pulveribacter suum is SC2-7 T (=KACC 19309 T =NBRC 113102 T ).

A Gram-stain-negative, strictly aerobic, non-motile, non-spore-forming, coccoid- or short rod-shaped bacterial strain, designated SC2-6 T , was isolated from a dust collector of a pig farm located in Wanju-gun, Jeollabuk-do, Republic of Korea. Strain SC2-6 T grew within the ranges of 10-37 °C (28-30 °C, optimally), pH 6.0-10.0 (pH 7.0-8.0, optimally) and 0-3% NaCl (w/v). The 16S rRNA gene sequence similarity of strain SC2-6 T showed the highest values to Paracoccus kondratievae GBT (96.3%), Paracoccus denitrificans DSM 413 T (96.3%) and Paracoccus sanguinis 5503 T (96.1%). The phylogenetic tree based on the 16S rRNA gene sequences revealed that strain SC2-6 T belonged to the genus Paracoccus and clustered with Paracoccus pacificus F14 T . The phylogenetic tree based on the rpoD gene sequences also demonstrated that strain SC2-6 T fell into the clade of the genus Paracoccus. The DNA G+C content was 66.9 mol%. The major respiratory quinone was ubiquinone-10 and the major fatty acids (> 10% of the total fatty acids) were summed feature 8 (comprising C18 : 1 ω6c and/or C18 : 1 ω7c). The polar lipids were composed of diphosphatidylglycerol, phosphatidylcholine, an unidentified glycolipid, two unidentified aminolipids and two unidentified lipids. On the basis of phenotypic, phylogenetic and genomic data, strain SC2-6 T was classified in the genus Paracoccus as a member of a novel species, for which the name Paracoccus suum sp. nov. is proposed. The type strain is SC2-6 T (=KACC 19328 T =NBRC 113110 T ).

Aim: This study was designed to investigate the impact of paediatric end-stage renal disease (ESRD) on parents, based on the PedsQL Family Impact Module (FIM), and the relationship to the quality of life (QOL) of paediatric ESRD patients measured by PedsQL 3.0 ESRD module., Methods: We performed a cross-sectional study using Korean translations of the PedsQL FIM and the PedsQL 3.0 ESRD module. In all, 79 patients were enrolled, including 47 children receiving dialysis and 32 children who underwent renal transplant., Results: FIM scores, analyzed for every category according to treatment modality, were significantly lower in haemodialysis (HD) than in peritoneal dialysis (PD) or renal transplant patients. Mother's age, duration since diagnosis of ESRD and the existence of comorbidity were variables to have significant effects on FIM scores. The correlation between total FIM and QOL scores of paediatric patients were significant, in both parent-proxy and child-self report., Conclusions: The PedsQL FIM appears to be a useful tool for the assessment of family impact on children with ESRD. Further prospective studies focused on the QOL of parents and caregivers should be performed with the goal of improving clinical outcomes for paediatric ESRD patients., (© 2017 Asian Pacific Society of Nephrology.)

Background: Among the non-invasive screening methods for the identification of fetal aneuploidy, NIPT (non-invasive prenatal testing) shows the highest sensitivity and specificity in high-risk pregnancies. Due to the low false positive rate of NIPT, it is assumed that the implementation of NIPT as a primary screening method may reduce the number of invasive fetal tests and result in a similar or lowered cost in the overall detection of Down syndrome. However, most previous studies are based on theoretical economic analysis. This study aims to determine the cost effectiveness of various prenatal test strategies, including NIPT, in real clinical settings in both low risk and high risk pregnancies., Methods/design: In this prospective observational study, women (< 24 weeks) with singleton or twin pregnancies will be enrolled in 12 different healthcare institutions. The participants will be grouped based on the risks of fetal chromosomal abnormalities and will be counseled on the various screening or diagnostic methods, including NIPT, according to the aneuploidy risk. The final decision on screening or diagnostic methods will be made by patients after counseling. Questionnaires regarding factors affecting the decision on prenatal test will be answered by the participants and physicians. The economic analysis on final total costs will be compared according to the various prenatal test strategies., Discussion: The results of present study are expected to have a significant impact on national policies in determining Korean prenatal screening test strategies and to help in developing novel and effective prenatal screening tests in the future.

Purpose: The aim of this study was to confirm the applicability of YouTube as a delivery platform of lecture videos for dental students and to assess their learning attitudes towards the flipped classroom model., Methods: Learning experiences after using the YouTube platform to deliver preliminary video lectures in a flipped classroom were assessed by 69 second-year students (52 males, 17 females) at Dankook College of Dentistry, Korea, who attended periodontology lectures during 2 consecutive semesters of the 2016 academic year. The instructor uploaded the lecture videos to YouTube before each class. At the end of the second semester, the students were surveyed using a questionnaire devised by the authors., Results: Of the students, 53 (76.8%) always watched the lecture before the class, 48 (69.6%) used their smartphones, and 66 (95.7%) stated that they watched the lectures at home. The majority of the students replied that the video lectures were easier to understand than in-person lectures (82.6%) and that they would like to view the videos again after graduation (73.9%)., Conclusion: Our results indicate that YouTube is an applicable platform to deliver video lectures and to expose students to increased learning opportunities.

The objective of this study was to perform population pharmacokinetic (PK) analysis of gabapentin in healthy Korean subjects and to investigate the possible effect of genetic polymorphisms (1236C > T, 2677G > T/A, and 3435C > T) of ABCB1 gene on PK parameters of gabapentin. Data were collected from bioequivalence studies, in which 173 subjects orally received three different doses of gabapentin (300, 400, and 800 mg). Only data from reference formulation were used. Population pharmacokinetics (PKs) of gabapentin was estimated using a nonlinear mixed-effects model (NONMEM). Gabapentin showed considerable inter-individual variability (from 5.2- to 8.7-fold) in PK parameters. Serum concentration of gabapentin was well fitted by a one-compartment model with first-order absorption and lag time. An inhibitory Emax model was applied to describe the effect of dose on bioavailability. The oral clearance was estimated to be 11.1 L/h. The volume of distribution was characterized as 81.0 L. The absorption rate constant was estimated at 0.860 h -1 , and the lag time was predicted at 0.311 h. Oral bioavailability was estimated to be 68.8% at dose of 300 mg, 62.7% at dose of 400 mg, and 47.1% at dose of 800 mg. The creatinine clearance significantly influenced on the oral clearance (P < 0.005) and ABCB1 2677G > T/A genotypes significantly influenced on the absorption rate constant (P < 0.05) of gabapentin. However, ABCB1 1236C > T and 3435C > T genotypes showed no significant effect on gabapentin PK parameters. The results of the present study indicate that the oral bioavailability of gabapentin is decreased when its dosage is increased. In addition, ABCB1 2677G > T/A polymorphism can explain the substantial inter-individual variability in the absorption of gabapentin.

Background: The goal of this study was to evaluate the quality of life (QOL) of Asian children with pre-dialysis chronic kidney disease (CKD) and to reveal the factors influencing the QOL of children with CKD., Methods: We performed a cross-sectional study of the PedsQL 4.0 Generic Core Scale Module in the KNOW-PedCKD (KoreaN cohort study for Outcome in patients with Pediatric Chronic Kidney Disease) cohort, and compared the child self-reported and parent proxy-reported QOL of the pediatric cohort. From 2011 through 2016, a total of 376 children with CKD were enrolled after informed consent was obtained from parents or caregivers in seven pediatric nephrology centers., Results: In parent proxy-reports, male patients had a better QOL than female patients in the Physical Functioning category. In child self-reports, male patients had better QOL than female patients in the Physical, Emotional, and School Functioning categories. According to CKD stage, there were significant differences in the QOL score in all categories of parent proxy-reports, and patients with higher CKD stage (lower glomerular filtration rate) had a worse QOL. Growth parameters showed a significantly positive correlation with the QOL score in all categories., Conclusions: The QOL of children with predialysis CKD is affected by various factors, including sex, glomerular filtration rate (GFR), socio-economic status, existence of co-morbidities, anemia, growth retardation, and behavioral disorders. To improve their QOL, it is important to objectively understand the respective effects of these factors and attempt early intervention.

Gestational diabetes mellitus (GDM) is a common disease in pregnancy causing maternal and fetal complications. To prevent these adverse outcomes, optimal screening and diagnostic criteria must be adequate, timely, and efficient. This study suggests a novel approach that is practical, efficient, and patient- and clinician-friendly in predicting adverse outcomes of GDM. The authors conducted a retrospective cohort study via medical record review of patients admitted between March 2001 and April 2013 at the Severance Hospital, Seoul, South Korea. Patients diagnosed by a conventional 2-step method were evaluated according to the presence of adverse outcomes (neonatal hypoglycemia, hyperbilirubinemia, and hyperinsulinemia; admission to the neonatal intensive care unit; large for gestational age; gestational insulin therapy; and gestational hypertension). Of 802 women who had an abnormal 50-g, 1-hour glucose challenge test, 306 were diagnosed with GDM and 496 did not have GDM (false-positive group). In the GDM group, 218 women (71.2%) had adverse outcomes. In contrast, 240 women (48.4%) in the false-positive group had adverse outcomes. Women with adverse outcomes had a significantly higher body mass index (BMI) at entry (P = 0.03) and fasting blood glucose (FBG) (P = 0.03). Our logistic regression model derived from 2 variables, BMI at entry and FBG, predicted GDM adverse outcome with an area under the curve of 0.642, accuracy of 61.3%, sensitivity of 57.2%, and specificity of 66.9% compared with the conventional 2-step method with an area under the curve of 0.610, accuracy of 59.1%, sensitivity of 47.6%, and specificity of 74.4%. Our model performed better in predicting GDM adverse outcomes than the conventional 2-step method using only BMI at entry and FBG. Moreover, our model represents a practical, inexpensive, efficient, reproducible, easy, and patient- and clinician-friendly approach.

This study is a multi-center clinical study, which aimed to compare CA125, HE4, and risk of ovarian malignancy algorithm (ROMA) in predicting epithelial ovarian cancer of Korean women with a pelvic mass. Prospectively, serum from 90 Korean women with ovarian mass was obtained prior to surgery. For control group, serum from 79 normal populations without ovarian mass was also obtained. The HE4 and CA125 data were registered and evaluated separately and ROMA was calculated for each sample. Total 67 benign tumors and 23 ovarian cancers were evaluated. Median serum levels of HE4 and CA125, and ROMA score were significantly higher in patients with ovarian cancer than those with benign ovarian tumor and normal population (P < 0.001). In ROC curve analysis for women with a pelvic mass, area under the curve (AUC) for HE4 and ROMA was higher than CA125. Statistical differences in each study compared to CA125 were marginal (P compared to CA125; 0.082 for HE4 and 0.069 for ROMA). Sub-analysis revealed that AUC for HE4 and ROMA was higher than AUC for CA125 in post-menopausal women with a pelvic mass, but there were no statistically significant differences (P compared to CA125; 0.160 for HE4 and 0.127 for ROMA). Our data suggested that both HE4 and ROMA score showed better performance than CA125 for the detection of ovarian cancer in women with a pelvic mass. HE4 and ROMA can be a useful independent diagnostic marker for epithelial ovarian cancer in Korean women.

Impaired wound healing is a common complication of diabetes mellitus and a major morbidity that leads to pain and severely diminished quality of life. Diabetic wounds are commonly associated with defective immune cell responses or abnormality of extracellular matrix. Various types of electrical stimulation interventions have been used to promote tissue healing. However, it is unclear whether high-voltage pulsed current stimulation (HVPCS) enhances diabetic wound healing. In this study, the effects of HVPCS on wound healing were investigated in diabetic rats. Three groups of rats (10 per group) were used: non-diabetic control, diabetic control, and diabetic rats that were administered HVPCS for 40 minutes daily for 1 week. Rats from control groups were administered sham interventions. Dorsal incision wounds were generated in all animals, and wound-healing rate was determined during one-week intervention. After interventions, we measured the relative expression levels of collagen type I (collagen-I), α-smooth muscle actin (α-SMA), and transforming growth factor-β1 (TGF-β1) mRNAs in the wounded skin. Wound closure was delayed in diabetic control rats compared to the non-diabetic control rats, and the diabetic control rats showed the reduced expression levels of collagen-I, α-SMA and TGF-β1 mRNAs. Importantly, compared to diabetic control rats, rats with HVPCS showed accelerated wound closure and healing (p < 0.01) and restored expression levels of collagen-I (p = 0.02), α-SMA (p = 0.04), and TGF-β1 (p = 0.01) mRNAs. In conclusion, HVPCS may be beneficial for enhancing the healing of diabetic wounds by restoring the expression levels of TGF-β1, collagen-I, and α-SMA.

Purpose: To identify the clinical features, treatment outcomes, and prognostic factors of endogenous endophthalmitis in multiple tertiary referral centers of South Korea over a 6-year period., Methods: The authors conducted a retrospective review of medical records of 57 eyes of 43 patients diagnosed with endogenous endophthalmitis from January 2005 to December 2011, which was referred to tertiary referral centers., Results: Fifty-seven cases of 43 patients were followed for a mean of 18.7 months (range, 0.5-50 months). The common underlying diseases were diabetes mellitus (46.5%) and liver cirrhosis (20.93%). Liver abscess (39.5%) was the most common infection source. Among prognostic factors, the initial visual acuity was associated with favorable visual outcome significantly (P < 0.001). Endogeneous endophthalmitis with gram-negative bacteria had worse visual outcomes than gram-positive bacteria or fungus (P = 0.014)., Conclusion: Similar to the findings of previous East Asian studies, this study showed that Klebsiella pneumoniae was the most common causative organism of endogenous endophthalmitis and liver abscess was the most common infection focus. Although endogenous endophthalmitis is generally associated with poor visual acuity outcomes, the prognosis depends mainly on the initial visual acuity and the pathogen.

Severe upper limb paresis is a major contributor to disability after stroke. This study investigated the efficacy of task-related training (TRT) with transcutaneous electrical nerve stimulation (TENS) on recovery of upper limb motor function in chronic-stroke survivors. Thirty patients with chronic stroke were randomly allocated two groups: the TRT+TENS group (n = 15) and the TRT+placebo (TRT+PLBO) group (n = 15). Patients in the TRT+TENS group received TENS stimulation (two to three times the sensory threshold), while subjects in the TRT+PLBO group received TENS without real electrical stimulation. TENS was applied to muscle belly of triceps and wrist extensors, while placebo (PLBO) stimulation was administrated without real electrical stimulation. Both interventions were given for 30 minutes per day, 5 days per week, for a period of 4 weeks. The primary outcomes were assessed with Fugl-Meyer assessment scores (FMA), Manual function test (MFT), Box and block test (BBT), and Modified Ashworth scale (MAS), each of which was performed one day before and one day after intervention. Both groups showed significant improvements in FMA, MFT, and BBT after intervention. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvements in FMA (p = 0.034), MFT (p = 0.037), and BBT (p = 0.042). In MAS score, significant improvement was observed only in the TRT+TENS group (p = 0.011). Our findings indicate that TRT with TENS can reduce motor impairment and improve motor activity in stroke survivors with chronic upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS.

Objectives: To investigate the effects of motor imagery training on the balance and gait abilities of post-stroke patients., Design: Randomized controlled trial., Setting: Outpatient rehabilitation centre., Subjects: Twenty-eight individuals with chronic stroke., Interventions: The experimental group (n = 15) performed motor imagery training involving imagining normal gait movement for 15 minutes embedded in gait training for 30 minutes (45 minutes/day, 3 times/week); the control group (n = 13) performed gait training only (30 minutes/day, 3 times/week)., Main Measures: Balance and gait abilities were measured by the Functional Reach Test, Timed Up-and-Go Test, 10-m Walk Test and Fugl-Meyer assessment before and after interventions., Results: All measurements improved significantly compared with baseline values in the experimental group. In the control group, there were significant improvements in all parameters except the Fugl-Meyer assessment. All parameters of the experimental group increased significantly compared to those of the control group as follows: Functional Reach Test (control vs. experimental: 28.1 ± 3.1 vs. 37.51 ± 3.0), Timed Up-and-Go Test (20.7 ± 4.0 vs. 13.2 ± 2.2), 10-m Walk Test (17.4 ± 4.6 vs. 16.0 ± 2.7) and Fugl-Meyer assessment (12.0 ± 2.9 vs. 17.6 ± 1.3)., Conclusions: Gait training with motor imagery training improves the balance and gait abilities of chronic stroke patients significantly better than gait training alone.

Purpose: To study choroidal thickness and its topographic profile in normal eyes using 3D OCT-1000 spectral domain optical coherence tomography and the correlation with age and refractive error., Methods: Fifty-seven eyes (45 individuals) with no visual complaints or ocular disease underwent horizontal and vertical line scanning using 3D OCT-1000. The definition of choroidal thickness was the vertical distance between the posterior edge of the hyper-reflective retinal pigment epithelium and the choroid/sclera junction. Choroidal thickness was measured in the subfoveal area at 500 µm intervals from the fovea to 2,500 µm in the nasal, temporal, superior, and inferior regions. The spherical equivalent refractive error was measured by autorefractometry. Statistical analysis was used to confirm the correlations of choroidal thickness with age and refraction error., Results: The mean age of the 45 participants (57 eyes) was 45.28 years. Detailed visualization of the choroid for measuring its thickness was possible in 63.3% of eyes. The mean subfoveal choroidal thickness was found to be 270.8 µm (standard deviation [SD], ±51 µm), in horizontal scanning and 275.0 µm (SD, ±49 µm) in vertical scanning. The temporal choroidal thickness was greater than any 500 µm interval in corresponding locations, and there was no significant difference between the superior and inferior choroid as far as 2,000 µm from the fovea. Age and refractive error were associated with subfoveal choroidal thickness in terms of regression (p < 0.05)., Conclusions: Choroidal thickness in normal Korean eyes can be measured using 3D OCT-1000 with high resolution line scanning. The topographical profile of choroidal thickness varies depending on its location. Age and refractive error are essential factors for interpretation of choroidal thickness.

Background: Health-related quality of life is a very important issue in children with end-stage renal disease and their family. Moreover, this can be a lifelong problem. In this study, we performed a cross-sectional investigation of the health-related quality of life in Korean children, undergoing renal replacement therapies, such as dialysis and renal transplantation., Findings: We validated the Korean version of the PedsQL 3.0 End-Stage Renal Disease Module by comparing with the PedsQL 4.0 Generic Core Scales. A total of 92 pediatric patients with end-stage renal disease, aged 2-18 year old, were enrolled in four teaching hospitals in Korea. The module was acceptable for both parent proxy-report and child self-report. The response rate was acceptable, since no reminders were delivered. A large proportion of the responders answered > 90% of the items, which suggests a good face validity. The PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 End-Stage Renal Disease Module showed minimal missing values in the current study, which supported feasibility. The validation analyses revealed acceptable floor and ceiling effects and an acceptable construct validity., Conclusions: The PedsQL 3.0 End-stage Renal Disease Module may be useful as an end-stage renal disease -specific instrument in the evaluation of the health-related quality of life in Korean children; however, a larger, longitudinal prospective study is needed.

Background: Bartter syndrome (BS) is clinically classified into antenatal or neonatal BS (aBS) and classic BS (cBS) as well as five subtypes based on the underlying mutant gene; SLC12A1 (BS I), KCNJ1 (BS II), CLCNKB (BS III), BSND (BS IV) and CASR (BS V)., Methods: Clinico-genetic features of a nationwide cohort of 26 Korean children with BS were investigated., Results: The clinical diagnosis was aBS in 8 (30.8%), cBS in 15 (57.7%) and mixed Bartter-Gitelman phenotype in 3 cases (11.5%). Five of eight patients with aBS and all 18 patients with either cBS or mixed Bartter-Gitelman phenotype had CLCNKB mutations. Among the 23 patients (46 alleles) with CLCNKB mutations, p.W610X and large deletions were detected in 25 (54.3%) and 10 (21.7%) alleles, respectively. There was no genotype-phenotype correlation in patients with CLCNKB mutations., Conclusions: Twenty-three (88.5%) of the 26 BS patients involved in this study had CLCNKB mutations. The p.W610X mutation and large deletion were two common types of mutations in CLCNKB. The clinical manifestations of BS III were heterogeneous without a genotype-phenotype correlation, typically manifesting cBS phenotype but also aBS or mixed Bartter-Gitelman phenotypes. The molecular diagnostic steps for patients with BS in our population should be designed taking these peculiar genotype distributions into consideration, and a new more clinically relevant classification including BS and Gitelman syndrome is required.

We investigated the prevalence and risk factors of vertebral fractures in Korea. In a community-based prospective epidemiology study, 1,155 men and 1,529 women (mean age 59 years, range 43-74) were recruited from Ansung, a rural Korean community. Prevalent vertebral fractures were identified on the lateral spinal radiographs at T11 to L4 using vertebral morphometry. Bone mineral density (BMD) was measured at the lumbar spine, femur neck and total hip. Of the 2,684 subjects, 137 (11.9%) men and 227 (14.8%) women had vertebral fractures and the standardized prevalence for vertebral fractures using the age distribution of Korean population was 8.8% in men and 12.6% in women. In univariate analysis, older age, low hip circumference, low BMD, low income and education levels in both sexes, previous history of fracture in men, high waist-to-hip circumference ratio, postmenopausal status, longer duration since menopause, and higher number of pregnancies and deliveries in women were associated with an increased risk of vertebral fractures. However, after adjusting for age, only low BMD in both sexes and a previous history of fracture in men were significantly associated with an increased risk of vertebral fractures. Vertebral fractures are prevalent in Korea as in other countries. Older age, low BMD and a previous history of fracture are significant risk factors for vertebral fractures.

This study characterized the adverse events following immunization (AEFI) with the novel influenza A (H1N1) 2009 vaccine in Korea. Data on immunization and AEFI were collected between October 27, 2009 and March 15, 2010 through the national immunization registry and passive surveillance systems. The frequency of AEFI and serious adverse events (SAEs) were calculated according to age, sex, priority group, and vaccine type. In 13,758,527 vaccine recipients aged 6 months or older, 2,530 AEFI were reported (18.4 per 100,000 immunizations). The AEFI reporting rate was highest among people aged 10-19 years (29.6 per 100,000 immunizations) and was higher in female recipients than in male recipients (20.0 versus 16.7 per 100,000 immunizations). Most AEFIs were nonspecific systematic reactions that occurred within 24 h (77.4%) after vaccine administration. A total of 178 vaccine-related SAEs were identified, and vaccine-related mortalities were not reported. This study showed that the AEFI reporting rate after influenza A (H1N1) 2009 vaccinations was relatively high, especially in the younger population. Mild systemic reactions accounted for the majority of reported AEFI, and fatal SAEs were rare. This study also implied that passive surveillance might be an efficient safety monitoring system that can detect relatively rare AEFI.

Purpose: The purpose of this study was to develop a population pharmacokinetic (PPK) model of glimepiride and to investigate the influence of genetic polymorphisms in CYP2C9 on the PPK of glimepiride in healthy Korean subjects., Methods: Serum data after a single oral dose of 2 mg of glimepiride in 177 healthy male Korean subjects (CYP2C9*1*1: 163 subjects, *1/*3: 14 subjects) were used. We estimated the PPK of glimepiride using a nonlinear mixed effects modeling (NONMEM) method and explored the possible influence of genetic polymorphisms in CYP2C9 on the PPK of glimepiride., Results: The disposition of glimepiride was best described with a two-compartment model with a Weibull-type absorption and first-order elimination. The visual predictive check indicated that the pharmacokinetic profile of glimepiride was adequately described by the proposed PPK model. The CYP2C9 genotypes as covariate significantly (P < 0.001) influenced the apparent oral clearance (CL/F) of glimepiride. The estimated CL/F of glimepiride was higher (1.60-fold) in CYP2C9*1/*1 subjects than in CYP2C9*1/*3 subjects., Conclusions: This study indicates that genetic polymorphisms of CYP2C9 influence the substantial interindividual variability in the disposition of glimepiride, and these polymorphisms may affect the clinical response to glimepiride therapy.

Purpose: Accumulating evidence has shown a close connection between hematopoiesis and bone formation. Our aim was to evaluate the association between peripheral blood cell counts and bone mineral density (BMD) in a sample of postmenopausal women., Materials and Methods: Three hundreds thirty eight healthy postmenopausal women who underwent BMD measurement during their health check-up were investigated. BMD was measured by dual energy X-ray asorptiometry at L1-L4 spine, femoral neck and total proximal femur. BMD was expressed as a T-score: among T-scores obtained from three different sites (L1-L4 spine, femoral neck and total proximal femur), the lowest T-score was considered to be the subject's T-score., Results: The prevalence of osteopenia and osteoporosis diagnosed by T-score in the study participants were 49.4% (167/338) and 5.0% (17/338), respectively. Peripheral blood white blood cell (WBC), red blood cell (RBC) and platelet counts had significant positive correlations with T-scores (p<0.001) upon simple linear regression analysis. A multiple linear regression analysis, after controlling of confounders including age, body weight, systolic blood pressure, alkaline phosphatase and creatinine, showed that WBC (β=0.127; standard error=0.043; p=0.014), RBC (β=0.192; standard error=0.139; p<0.001) and platelet (β=0.097; standard error=0.001; p=0.050) counts still had significant positive association with T-scores., Conclusion: The study results showed a positive relationship between blood cell counts and bone mineral density in postmenopausal women, supporting the idea of a close connection between hematopoiesis and bone formation. The study results also suggest that blood cell counts could be a putative marker for estimating BMD in postmenopausal women.

The purposes of this study were to clarify the involvement of P-glycoprotein in the absorption of levosulpiride in knockout mice that lack the Abcb1a/ 1b gene, and to evaluate the relationship between genetic polymorphisms in ABCB1 (exon 12, 21 and 26) and levosulpiride disposition in healthy subjects. The plasma and brain samples were obtained after oral administration (10 microg/g) of levosulpiride to abcb1a/1b(-/-) and wild-type mice (n=3 approximately 6 at each time point). The average brain-to-plasma concentration ratio and blood-brain barrier partitioning of levosulpiride were 2.3- and 2.0-fold higher in Abcb1a/1b(-/-) mice than in wild-type mice, respectively. A total of 58 healthy Korean volunteers receiving a single oral dose of 25 mg levosulpiride participated in this study. The subjects were evaluated for polymorphisms of the ABCB1 exon 12 C1236T, exon 21 G2677A/T (Ala893Ser/Thr) and exon 26 C3435T using polymerase chain reaction restriction fragment length polymorphism. The PK parameters (AUC(0-4h), AUC(0-infinity) and C(max.)) of ABCB1 2677TT and 3435TT subjects were significantly higher than those of subjects with at least one wild-type allele (P<0.05). The results indicate that levosulpiride is a P-glycoprotein substrate in vivo, which is supported by the effects of SNPs 2677G>A/T in exon 21 and 3435C>T in exon 26 of ABCB1 on levosulpiride disposition., (Copyright (c) 2010 IBRO. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate bone mineral density (BMD) profiles, osteoporosis prevalence and risk factors in a community-based cohort in Korea., Methods: The present study is a cross-sectional study. The study population consisted of 1,547 men and 1991 women aged 40 years and older with BMD measurements using central dual energy X-ray absorptiometry from a prospective community-based cohort. The data were compared with other ethnic groups. Risk factors related to osteoporosis were analyzed., Results: Crude prevalence of osteoporosis in the whole subjects (40-79 years old) was 13.1% for men and 24.3% for women by WHO criteria, at any site among lumbar spine, femoral neck or total hip. Standardized prevalence of osteoporosis between age of 50 and 79 at lumbar spine, femoral neck and total hip was 12.9%, 1.3% and 0.7% in men and 24.0%, 5.7% and 5.6% in women, respectively. The mean BMD of studied female subjects after age of 50 was not significantly different from that of Chinese but significantly lower than that of Japanese, non-Hispanic whites, non-Hispanic blacks and Mexican Americans. Risk of osteoporosis was significantly associated with the presence of past fracture history (OR, 1.45; 95% CI, 1.08-1.94), smoking> or =1 pack/day (OR, 1.63; 95% CI, 1.01-2.62), menarche after age of 16 (OR, 1.46; 95% CI, 1.14-1.87), last delivery after age of 30 (OR, 1.58; 95% CI, 1.20-2.09), more than three offspring (OR, 1.42; 95% CI, 1.07-1.89), post-menopause status (OR, 7.32; 95% CI, 3.05-17.6), more than 17 years since menopause (OR, 1.53; 95% CI, 1.10-2.14), regular exercise of two to three times per week (OR, 0.40; 95% CI, 0.18-0.89), monthly income above 500,000 won per household (OR, 0.64; 95% CI, 0.45-0.92), college graduate (OR, 0.29; 95% CI, 0.13-0.63) and calcium intake> or =627.5 mg/day (OR, 0.65; 95% CI, 0.43-0.98) after adjusting for age and BMI., Conclusion: The BMD and osteoporosis prevalence of Koreans are presented. Risk of osteoporosis was significantly associated with fracture history, smoking, reproductive history, regular exercise, income level, education background and calcium intake., (Copyright 2010 Elsevier Inc. All rights reserved.)

The Korea Advisory Committee on Immunization Practices (KACIP), established by law in the early 1990s, makes recommendations on a range of issues related to the National Immunization Program. The Committee consists of 15 members and always includes the two government officials who belong to the Korea Centers for Disease Control and Prevention and the Korea Food and Drug Administration. Other members usually come from affiliated organizations and serve for 2-year terms. The KACIP depends on special-topics sub-committees or temporary advisory committees to gather and analyze data and to make recommendations which are normally reached by consensus and implemented by public sector health providers and private providers., (Copyright © 2010 Elsevier Ltd. All rights reserved.)