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Background: This retrospective observational matched-cohort study of 2,151,216 individuals from the Korean coronavirus disease 2019 (COVID-19) vaccine effectiveness cohort aimed to evaluate the comparative effectiveness of the COVID-19 bivalent versus monovalent vaccines in providing additional protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, critical infection, and death in Korea., Methods: Among individuals, those vaccinated with COVID-19 bivalent vaccines were matched in a 1:1 ratio with those who were vaccinated with monovalent vaccines (bivalent vaccines non-recipients) during the observation period. We fitted a time-dependent Cox proportional-hazards model to estimate hazard ratios (HRs) of COVID-19 outcomes for infection, critical infection, and death, and we defined vaccine effectiveness (VE) as 1-HR., Results: Compared with the bivalent vaccination group, the incidence proportions in the monovalent vaccination group were approximately three times higher for infection, nine times higher for critical infection, and 11 times higher for death. In the early stage of bivalent vaccination, relative VE of bivalent vaccine against monovalent vaccine was 42.4% against SARS-CoV-2 infection, 81.3% against critical infection, and 85.3% against death. In addition, VE against critical infection and death according to the elapsed period after bivalent vaccination was maintained at > 70%., Conclusion: The bivalent booster dose provided additional protection against SARS-CoV-2 infections, critical infections, and deaths during the omicron variant phase of the COVID-19 pandemic., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

Purpose: This study aimed to verify whether bioelectrical impedance vector analysis (BIVA) can support the clinical evaluation of sarcopenia in elderly individuals and evaluate the relationships between phase angle (PhA), physical performance, and muscle mass., Methods: The sample comprised 134 free-living elderly individuals of both sexes aged 69-91 years. Anthropometric parameters, grip strength, dual-energy X-ray absorptiometry findings, bioimpedance analysis results, and physical performance were also measured. The impedance vector distributions were evaluated in elderly individuals using BIVA., Results: BIVA revealed significant differences between the sarcopenia and non-sarcopenia groups (both sexes). The sarcopenia group had a significantly lower PhA than the non-sarcopenia group in both sexes ( p < 0.05). PhA was significantly correlated with age, appendicular skeletal muscle (ASM), handgrip strength (HGS), and muscle quality in both sexes and significantly correlated with ASM/Height 2 and physical performance in males., Conclusion: BIVA can be used as a field assessment method in elderly Koreans with sarcopenia. PhA is a good indicator of muscle strength, muscle quality, and physical performance in males. These methods can help diagnose sarcopenia in elderly individuals with reduced mobility.

Sonazoid, a second-generation ultrasound contrast agent, was introduced for the diagnosis of hepatic nodules. To clarify the issues with Sonazoid contrast-enhanced ultrasonography for the diagnosis of hepatocellular carcinoma (HCC), the Korean Society of Radiology and Korean Society of Abdominal Radiology collaborated on the guidelines. The guidelines are de novo, evidence-based, and selected using an electronic voting system for consensus. These include imaging protocols, diagnostic criteria for HCC, diagnostic value for lesions that are inconclusive on other imaging results, differentiation from non-HCC malignancies, surveillance of HCC, and treatment response after locoregional and systemic treatment for HCC., Competing Interests: Min Woo Lee, Jung Hoon Kim, Ijin Joo, So Yeon Kim, Yong Eun Chung, Jeong Min Lee, contributing editors of the Korean Journal of Radiology, were not involved in the editorial evaluation or decision to publish this article. Woo Kyoung Jeong received honorarium from GE Healthcare and Bayer; Hyo-Jin Kang received honorarium from GE Healthcare; Mi-Suk Park received grant from GE Healthcare and Guerbet; Bohyun Kim was a consultant for Samsung Medison; Min Woo Lee received honorarium from Bracco, Starmed, Bonston Scientific, and Medtronic, and was a consultant for Starmed and Medtronic; Jeong Ah Hwang received honorarium from GE Healthcare; Jae Young Lee received grant from Canon Healthcare, Siemens Healthcare, Alpinion Medical System, and GE Healthcare and received honorarium from Philips, Canon Healthcare, GE Healthcare, Alpinion Medical System, and Siemens Healthcare; Jung Hoon Kim received honorarium from GE Healthcare; Ijin Joo received honorarium from Samsung Medison; So Yeon Kim received grant from Bayer Healthcare and Canon Healthcare; Jeong Min Lee received grant from Bayer Healthcare, Canon Healthcare, Siemens Healthcare, GE Healthcare, CMS, Guerbet, Samsung Medison, Starmed, RF medical, Clarify, and Dongkuk Pharma and received honorarium from Samsung Medison, Philips, GE Healthcare, Bayer, Guerbet, and Clarify. The funders had no role in the data analysis, or the decision to publish. All remaining authors have declared no conflicts of interest., (Copyright © 2023 The Korean Society of Radiology.)

Dysphagia is one of the main serious issues for amyotrophic lateral sclerosis (ALS) patients because of causing malnutrition and aspiration pneumonia. Early detection and management of dysphagia are essential for the long-term survival. In this study, videofluoroscopic swallowing study (VFSS) results of bulbar and spinal onset ALS patients were compared. VFSS results and revised ALS Functional Rating Scale (ALSFRS-R) score were also analyzed to assess the correlation between dysphagia and functional status of patients. ALS patients with swallowing difficulties who underwent VFSS were recruited retrospectively. Two oral, seven pharyngeal, and two esophageal components of VFSS were evaluated. An ALSRFRS-R bulbar subtype score < 9 was used to divide the groups with severe bulbar symptoms. Total 109 Korean ALS patients (39 bulbar vs 70 spinal) were included. Bulbar ALS patients exhibited a significantly longer oral transit time (OTT) then spinal ALS patients, especially in severe bulbar patients with low ALSRFRS-R bulbar subscale. In bulbar ALS patients, penetration (thick liquid), aspiration, OTT, and Penetration-Aspiration Scale (PAS) were significantly correlated with ALSFRS-R bulbar subscale score. However, in spinal ALS patients, only OTT (thin liquid) and aspiration (thick liquid) were significantly correlated with ALSFRS-R bulbar subscale score. Bulbar ALS patients demonstrated significantly longer OTT than spinal ALS patients, and ALSFRS-R bulbar subscale score also correlated well with bulbar ALS patients. Therefore, high vigilance and aggressive treatment for dysphagia especially in bulbar ALS patients rather than spinal ALS patients are mandatory., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The objective of this case/non-case study was to detect rebamipide-related pulmonary adverse events (AE) compared with other drugs for acid-related disorders based on population-level data., Methods: From 2009 to 2018, AE reports on drugs for acid-related disorders, which are anatomical therapeutic chemical code A02B drugs, in the Korea Adverse Events Reporting System (KAERS) database were examined. The reporting odds ratio (ROR) was calculated, and the odds of reporting pulmonary AE for rebamipide and all other A02B drugs were compared. Furthermore, a stratified analysis according to patients' age and sex was conducted., Results: Altogether 13 (0.05%) and 157 (0.11%) cases of pulmonary AE were reported for rebamipide and all other A02B drugs, respectively. The risk of reporting pulmonary AE was significantly lower for rebamipide than for all other A02B drugs (ROR 0.49, 95% confidence interval [CI] 0.28-0.87). The number of reports of pulmonary AE for rebamipide was significantly higher among patients aged ≥65 years than those aged <65 years (ROR 19.36, 95% CI 2.50-149.97)., Conclusions: Rebamipide was less often reported for pulmonary AE. However, healthcare professionals need to be aware of the risk of pulmonary AE in elderly patients., (© 2021 The Authors. Journal of Digestive Diseases published by Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Background Nonalcoholic fatty liver disease (NAFLD) is common in the general population but identifying patients with high-risk nonalcoholic steatohepatitis (NASH) who are candidates for pharmacologic therapy remains a challenge. Purpose To develop a score to identify patients with high-risk NASH, defined as NASH with an NAFLD activity score (NAS) of 4 or greater and clinically significant fibrosis (stage 2 [F2] or higher). Materials and Methods This was a cross-sectional secondary analysis of data prospectively collected between April 2017 and March 2019 for a group of patients with NAFLD in Japan (Japan NAFLD, the derivation data set) with contemporaneous two-dimensional shear-wave elastography and biopsy-proven NAFLD (age range, 20-89 years). Three US markers (liver stiffness [LS, measured in kilopascals], attenuation coefficient [AC, measured in decibels per centimeter per megahertz], and dispersion slope [DS, measured in meters per second per kilohertz]) were determined, together with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and the AST-to-ALT ratio. The best-fit multivariate logistic regression model for identifying patients with high-risk NASH was determined. Diagnostic performance was assessed by using the area under the receiver operating characteristic curve (AUC). The findings were validated in an independent data set (Korea NAFLD; age range, 20-78 years). Results The Japan NAFLD data set included 111 patients (mean age, 53 years ± 18 [standard deviation]; 57 men), 84 (76%) with NASH. The Korea NAFLD data set included 102 patients (mean age, 48 years ± 18; 43 men), 55 (36%) with NASH. The most predictive model (LAD NASH score) combined LS, AC, and DS. Performance was satisfactory in both the derivation sample (AUC, 0.86; 95% CI: 0.79, 0.93) and the validation sample (AUC, 0.88; 95% CI: 0.80, 0.95). The LAD NASH score showed a positive predictive value of 86.5% and a negative predictive value of 87.5% for high-risk NASH in the derivation sample. Conclusion A score combining three US markers may be useful for noninvasive identification of patients with high-risk nonalcoholic steatohepatitis for inclusion in clinical trials and pharmacologic therapy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lockhart in this issue.

We examined the relationship between resource abundance and the feeding activity of phytophagous insects on three common island plants. The aim was to investigate the correlation between phytophagous insects' abundance and availability of food and island geography. We collected 30,835 leaves from three tree species groups (Mallotus japonicus, Prunus species, and Quercus species) on 18 islands in southwest Korea. The number of plant resources for herbivores varied: the number of leaves per shoot was the highest in Mallotus, leaf weight and the water content per leaf was significantly lower in Quercus species. External feeding was higher for Prunus and Quercus species, whereas the internal feeding type was significantly higher for Quercus species. Geography (area and distance), elevation and food resource (elevation, number of plant species, and the forest cover rate) had a variable effect on phytophagous insects feeding activities: distance and the number of plant species were more explainable to the external feeding guild. In contrast, area and forest cover were more to the internal feeding guild., Competing Interests: No authors have competing interests.

This study presents a novel method for estimating the heat-attributable fractions (HAF) based on the cross-validated best temperature metric. We analyzed the association of eight temperature metrics (mean, maximum, minimum temperature, maximum temperature during daytime, minimum temperature during nighttime, and mean, maximum, and minimum apparent temperature) with mortality and performed the cross-validation method to select the best model in selected cities of Switzerland and South Korea from May to September of 1995-2015. It was observed that HAF estimated using different metrics varied by 2.69-4.09% in eight cities of Switzerland and by 0.61-0.90% in six cities of South Korea. Based on the cross-validation method, mean temperature was estimated to be the best metric, and it revealed that the HAF of Switzerland and South Korea were 3.29% and 0.72%, respectively. Furthermore, estimates of HAF were improved by selecting the best city-specific model for each city, that is, 3.34% for Switzerland and 0.78% for South Korea. To the best of our knowledge, this study is the first to observe the uncertainty of HAF estimation originated from the selection of temperature metric and to present the HAF estimation based on the cross-validation method.

Although the presence of prosthetic restorations has been associated with plaque accumulation, gingivitis, and periodontitis, there is a lack of large epidemiological investigations providing evidence on the association of prosthetic crowns with periodontitis. This study aimed to analyze the association between the number of prosthetic crowns and the presence of periodontitis. This study was based on the Seventh Korea National Health and Nutrition Examination Survey (2016-2018). A total of 12,689 participants over the age of 19 years were surveyed. Multivariate logistic regression analyses were used to identify the association between the number of prosthetic crowns and periodontitis after adjusting for potential confounders, including demographic variables, socio-economic characteristics, oral health-related variables, and oral and systemic clinical variables. The odds ratio of periodontitis showed statistically significant differences in the anterior and posterior regions, and the prevalence of periodontal disease increased as the number of crown prostheses increased. Participants with 6-10 and 11 prosthetic crowns had 1.24 and 1.28 times higher prevalence of periodontitis, respectively, than patients with no prosthetic crown. The results of this study show that the number of prosthetic crowns present in adults is related to the prevalence of periodontitis.

Objective: To evaluate the efficacy and safety of transvaginal high-intensity focused ultrasound (vHIFU) therapy in women with symptomatic uterine leiomyomas., Methods: This first-in-human, two-center, prospective, unblinded, single-arm trial was performed in the Republic of Korea from December 2017 to February 2019. Premenopausal women with symptomatic, contrast-enhanced uterine leiomyomas with a diameter ≤5 cm were eligible. Under sedation or monitored anesthesia, leiomyomas were ablated with vHIFU under ultrasound guidance. The primary endpoint was the non-perfused volume (NPV) ratio measured immediately after therapy. Secondary endpoints were changes in Uterine Fibroid Symptom-Quality of Life (UFS-QOL) scores, dysmenorrhea visual analog scale (VAS), uterine leiomyoma volume, rate of subsequent therapy, and treatment-emergent adverse events (TEAE)., Results: Thirty-five women were screened; 13 women were enrolled and underwent vHIFU therapy for 33 uterine leiomyomas. NPV ratios were 0.76 ± 0.27 (mean ± SD); the lower limit of a one-sided 97.5 % confidence interval was 0.67, surpassing the non-inferiority cut-off of 0.50. UFS-QOL scores (symptom severity score, median, baseline: 66.60, 3-month follow-up: 32.85; p = 0.0010; health related quality of life score, median, baseline: 41.40, 3-month follow-up: 73.30; p = 0.0010) and dysmenorrhea VAS (mean, baseline: 50.92, 3-month follow-up: 20.67; p = 0.0019) improved significantly. Volume of uterine leiomyoma was reduced (median, baseline: 8.10 cm 3 , 3-month follow=-up: 5.30 cm 3 ; p < 0.0001), and none received subsequent therapy. Twenty-six TEAEs from 8 participants were observed, and all TEAEs were resolved without sequelae., Conclusion: vHIFU therapy exhibited promising efficacy and safety and might be considered as a treatment option for women with symptomatic uterine leiomyomas. Registration: This trial was registered at: www.clinicaltrial.gov (NCT03328260)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

As climate change progresses, understanding the impact on human health associated with the temperature and air pollutants has been paramount. However, the predicted effect on temperature associated with particulate matter (PM 10 ) is not well understood due to the difficulty in predicting the local and regional PM 10 . We compared temperature-attributable mortality for the baseline (2003-2012), 2030s (2026-2035), 2050s (2046-2055), and 2080s (2076-2085) based on a distributed lag non-linear model by simultaneously considering assumed levels of PM 10 on historical and projected temperatures under representative concentration pathway (RCP) scenarios. The considered projected PM 10 concentrations of 35, 50, 65, 80, and 95 μg/m 3 were based on historical concentration quantiles. Our findings confirmed greater temperature-attributable risks at PM 10 concentrations above 65 μg/m 3 due to the modification effect of the pollutants on temperature. In addition, this association between temperature and PM 10 was higher under RCP8.5 than RCP4.5. We also confirmed regional heterogeneity in temperature-attributable deaths by considering PM 10 concentrations in South Korea with higher risks in heavily populated areas. These results demonstrated that the modification association of air pollutants on health burdens attributable to increasing temperatures should be considered by researchers and policy makers.

This study aims to investigate the association between family dinners involving the participation of both mother and her adolescent child and depressive symptoms within the adolescents. Data from 2183 mother-child pairs obtained from the Korea National Health and Nutrition Examination Survey IV-VI (2010-2013, and 2015) were employed in the analysis. The dependent variable of this study was depressive symptom of adolescents. Maternal accompaniment at family dinners was the variable of interest. Logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CI) to analyze the association between family dinners including both mother and adolescent and depressive symptoms within the adolescent. According to the results, maternal absence in family dinners was significantly associated with higher odds of depressive symptoms in adolescents (OR = 1.42, 95%CI: 1.01-1.99). In particular, the association was strong among adolescents aged 12-15, female adolescents, those with mothers without depressive symptoms, and city dwellers. This study showed that maternal absence at family dinners was strongly associated with depressive symptoms of adolescents. For the sake of adolescent mental health, it may be necessary to consider the implementation of policies that emphasize the importance of maternal accompaniment at family dinners and encourage the presence of mothers at the dinner table.

Background: The purpose of this study was to evaluate the mitigating effect of the use of interdental brushes on periodontal health inequality., Methods: This study was based on the data acquired in the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI; 2013-2015). A total of 17,583 participants (7,633 males and 9,950 females)) aged 19 years or older completed the KNHANES VI between 2013 and 2015. Multivariable logistic regression analysis was performed using socioeconomic characteristics (sex, age, level of education, individual income), personal health practice (smoking, toothbrushing, dental flossing, interdental brushing, dental clinic visiting), systematic medical factors (diabetes mellitus, hypercholesterolemia, hypertension, obesity) and the community periodontal index. We confirmed differences in the prevalence of periodontal disease with the use of an interdental brushes stratified according to individual income., Results: Three logistic regression models adjusted for covariates hierarchically. In all models, individuals who used an interdental brush were not significantly different from individuals who did not use an interdental brush. The adjusted odds ratio (OR) for interdental brushing was 0.918 with a 95% confidence intervals (CIs) of 0.797-1.057. When periodontal disease was the outcome of the model, the lowest income group had 1.266 (95% CIs 1.066 to 1.502) times the odds of having periodontal disease than the highest income group. In interdental brush nonusers, the lowest income group had 1.276 (95% CI 1.061-1.533) times the odds of having periodontal diseases than the highest income group. However, in the interdental brush users, there were no significant differences in periodontal disease prevalence among income groups., Conclusions: The results suggest that the use of interdental brushes could alleviate periodontal health inequality.

The aim of this study was to determine and evaluate the association between potassium intake and hearing thresholds in the Korean adult population. Data from the Korean National Health and Nutrition Examination Survey were analyzed. Participants were divided into tertiles on the basis of their potassium intake as follows: low, middle, and high. Pure-tone audiometry was performed using an automated audiometer. We calculated as the average threshold at the low-frequency pure-tone average (0.5 and 1 kHz), mid-frequency pure-tone average (2 and 3 kHz), and high-frequency pure-tone average (4 and 6 kHz). The average hearing threshold (AHT) was calculated as the pure-tone average of the thresholds at 0.5~3 kHz. Hearing loss (HL) was defined as an AHT of >40 dB in the better ear. There were 1975 participants each in the low, middle, and high tertile groups. The four different average hearing thresholds significantly decreased with an increase in the potassium intake tertile. Multivariate analysis revealed that the four different average hearing thresholds were significantly lower in the high tertile group than in the other two groups. In addition, univariate and multivariate linear regression analyses showed that the potassium intake level was inversely associated with each of the four different average hearing thresholds. Analyses of participants matched based on propensity scores and participants not matched based on propensity scores yielded similar results. The results of this study suggest that high potassium intake levels were associated with a lower prevalence of HL and lower hearing thresholds in the Korean adult population.

Background: Colon perforation is the most serious complication associated with colonoscopic procedures. We performed a novel purse-string suture technique to close the iatrogenic colonic perforation using dual-channel endoscope with an endoloop and clips., Methods: Iatrogenic colon perforations developed during diagnostic colonoscopy referred to a tertiary hospital over 10 years were considered for this endoscopic closure. An endoloop was inserted through the left channel of the endoscope and placed around the defect. The first clip was placed at the proximal site of the defect through the other channel of the endoscope, and the endoloop was anchored on the mucosa around the defect. Then, subsequent clips were placed next to previous clips and the endoloop was fixed. After the defect was encircled by the endoloop and clips, the rim of the opening was approximated by fastening the endoloop with a purse-string technique., Results: A total of 8 patients were admitted to our hospital because of iatrogenic colon perforations during diagnostic colonoscopy. Of these, 2 underwent laparoscopic surgery and 6 underwent endoscopic closure by this novel purse-string suture technique. The estimated diameters of the perforations were 20 mm. All cases were successfully treated in the endoscopy unit without sedation or general anesthesia, and recovered without any complication or subsequent operation. Abdominal pain had nearly resolved within 3 days after the procedure in all patients, and only mild peritonitis was observed., Conclusions: Iatrogenic colon perforation can be treated with a purse-string suture technique using dual-channel endoscope with an endoloop and clips. This technique can be useful for relatively large colon perforations associated with diagnostic colonoscopy.

Projections of the magnitude and pattern of possible health risks from climate change should be based on multiple climate and development scenarios to describe the range of uncertainties, to inform effective and efficient policies. For a better understanding of climate change-related risks in seven metropolitan cities of South Korea, we estimated temperature-related summer (June to August) mortality until 2100 using projected changes in climate, population, and adaptation. In addition, we extracted the variations in the mortality estimates associated with uncertainties in climate, population, and adaptation scenarios using 25 climate models, two Representative Concentration Pathways (RCP 4.5 and 8.5), three population scenarios (high, medium and low variants), and four adaptation scenarios (absolute threshold shift, slope reduction in the temperature-mortality relationship, a combination of slope reduction and threshold shift, and a sigmoid function based on the historical trend). Compared to the baseline period (1991⁻2015), temperature-attributable mortality in South Korea during summer in the 2090s is projected to increase 5.1 times for RCP 4.5 and 12.9 times for RCP 8.5 due to climate and population changes. Estimated future mortality varies by up to +44%/-55%, -80%, -60%, and +12%/-11% associated with the choice of climate models, adaptation, climate, and population scenarios, respectively, compared to the mortality estimated for the median of the climate models, no adaptation, RCP 8.5, and medium population variant. Health system choices about adaptation are the most important determinants of future mortality after climate projections. The range of possible future mortality underscores the importance of flexible, iterative risk management.

Background: There are many types of disabilities, and each type has a variety related to socioeconomic factors. Such factors affect to many health problems of the disabled. However, surveys of the oral health status of the disabled in Korea are rare., Objective: The purpose of this study was to estimate oral health disparity through comparing oral health status of the disabled to the non-disabled, adjusted for the net effect of the disability on oral health status., Methods: A cross-sectional study was conducted among the disabled in urban and suburban areas in Korea from June to September 2016. People with physical, mental, and multiple disabilities took part in this survey. The clinical examinations were carried out by trained dentists. Statistical analysis was performed to quantify the association between oral health and socioeconomic status after restricting the analysis using a propensity score matching method., Results: The disabled had more DMFT, DT, and MT, fewer FT, and fewer teeth than the non-disabled based on entire groups (P<0.01). No difference in the ratio of periodontitis was observed. The subjects with mental disabilities (MD) scored 3.09 (95% CI, 1.07-8.97), and those with multiple disabilities scored 4.37 (95% CI, 1.16-16.37) for edentulous status. The MD had an odds ratio of 1.34 (95% CI, 1.03-1.74), and those with multiple disabilities had an odds ratio of 1.75 (95% CI, 1.11-2.76) for the DMFT index., Conclusions: These results represent poor oral health status of the disabled compared to the non-disabled. Consequentially, we can verify that not only the existence of disability but also the type of disability has a decisive effect on oral health condition. This comparison is necessary to widen our approach to evaluate the actual status condition of the disabled., Competing Interests: The authors have declared that no competing interests exist.

Investigating how well people adapt to heat waves and cold spells has been an important issue under climate change. Also, most of previous studies focused only on the mortality risks for heat waves or cold spells for certain time period not considering its temporal changes and increasing frequencies. This study investigated the change in risks of mortality from heat waves and cold spells over time, and estimated the temporal changes in mortality burden attributed to heat waves and cold spells in Korea and Japan. We collected time-series data covering mortality and weather variables from 53 communities in the two countries from 1992 to 2015. Two-stage time-series regression with a time-varying distributed lag model and meta-analysis was used to assess the impacts of heat waves and cold spells by period (1990s, 2000s, and 2010s). In total population, the risks of heat waves have decreased over time; however their mortality burden increased in the 2010s compared to the 2000s with increasing frequency. On the other hand, the risk and health burden of cold spells have increased over the decades. Our findings showed that the future mortality burden of heat waves and cold spells might not decrease, when considering their changes in risks and frequencies., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The Paris Agreement aims to limit the global temperature increase to below 2 &deg;C above pre-industrial levels and to pursue efforts to limit the increase to even below 1.5 &deg;C. Now, it should be asked what benefits are in pursuing these two targets. In this study, we assessed the temperature⁻mortality relationship using a distributed lag non-linear model in seven major cities of South Korea. Then, we projected future temperature-attributable mortality under different Representative Concentration Pathway (RCP) and Shared Socioeconomic Pathway (SSP) scenarios for those cities. Mortality was projected to increase by 1.53 under the RCP 4.5 (temperature increase by 2.83 &deg;C) and 3.3 under the RCP 8.5 (temperature increase by 5.10 &deg;C) until the 2090s, as compared to baseline (1991⁻2015) mortality. However, future mortality is expected to increase by less than 1.13 and 1.26 if the 1.5 &deg;C and 2 &deg;C increase targets are met, respectively, under the RCP 4.5. Achieving the more ambitious target of 1.5 &deg;C will reduce mortality by 12%, when compared to the 2 &deg;C target. When we estimated future mortality due to both temperature and population changes, the future mortality was found to be increased by 2.07 and 3.85 for the 1.5 &deg;C and 2 &deg;C temperature increases, respectively, under the RCP 4.5. These increases can be attributed to a growing proportion of elderly population, who is more vulnerable to high temperatures. Meeting the target of 1.5 &deg;C will be particularly beneficial for rapidly aging societies, including South Korea.

The global diversity of airborne bacteria has not yet been studied, despite its importance in human health and climate change. Here, we focused on the diversity of airborne bacteria and their correlations with meteorological/environmental conditions in China, South Korea, and Japan. Beijing (China) had more diverse airborne bacteria, followed by Seoul (South Korea) and Nagasaki (Japan), and seasonal variations were observed. Beijing and Seoul had more diverse airborne bacteria during the winter, whereas Nagasaki showed greater diversity during the summer. According to principal component analysis and Bray-Curtis similarity, higher similarity was observed between Beijing and Seoul than between Seoul and Nagasaki during all seasons except summer. Among meteorological/environmental variables, temperature and humidity were highly correlated with the diversity of airborne bacteria on the measurement day, whereas wind speeds and the frequency of northwest winds were highly correlated for 2-3-day moving averages. Thus, proximity and resuspension could enhance bacterial diversity in East Asian cities.

Background: Prevalence of anaphylaxis is increasing steadily, but there is scant information about anaphylaxis., Objective: To identify the prevalence of anaphylaxis and evaluate the cause and features of anaphylaxis according to age., Method: The relevance of gender, age, history of allergic diseases, causes and clinical symptoms in the treatment and prognosis of anaphylaxis were retrospectively evaluated in patients diagnosed with anaphylaxis in Pusan National University Hospital from January 2009 to June 2014., Results: The 161 patients included 30 children and 131 adults. The prevalence of anaphylaxis in both children and adults increased during the study period. The most common triggers were food in children, especially in those <5 years of age, and drugs in adults. All of the children with episodes of anaphylaxis presented with cutaneous symptoms and 90% had respiratory symptoms. For adults, cardiovascular symptoms were more common., Conclusions: The prevalence of anaphylaxis increased in both children and adults, with a higher rate in children. The causes and symptoms of anaphylaxis may differ depending on age. Clinicians should understand the characteristics of anaphylaxis by age.

Background: Vascularized bone grafts for the treatment of Kienböck's disease may facilitate revascularization and remodeling of the avascular lunate. The aim of this study was to evaluate the radiological and clinical results obtained when a fourth extensor compartmental artery (ECA) bone graft was used to treat Kienböck's disease., Methods: Between May 2009 and June 2012, 13 patients (6 men, 7 women) with Kienböck's disease were treated with placement of fourth ECA vascularized bone grafts. The mean patient age was 39.2 (20-58) years, and the mean follow-up period was 32.5 (12-72) months. At the time of surgery, One patient had Lichtman's stage II Kienböck's disease, 11 stage IIIA disease, and one stage IIIB disease. We measured the pre- and post-operative ranges of motion, pain, grip strength, and radiological parameters, including the carpal height ratio and the radioscaphoid angle., Results: At the last follow-up, pain was significantly reduced, and grip strength had improved from 60.5% to 87.8% relative to that of the contralateral side. The mean range of motion for flexion had improved from 39° to 53° while that of wrist joint extension improved from 41° to 56°. There were little or no changes in either the carpal height ratio or the radioscaphoid angle (both p values > 0.05)., Conclusions: Placing of a fourth ECA vascularized bone graft is a reliable alternative to other revascularization procedures for treatment of Kienböck's disease. Such grafting is effective, minimally invasive, and associated with a low risk of pedicle kinking., Type of Study/level of Evidence: Therapeutic/IV., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Wastewater treatment plants at petroleum refineries often produce substantial quantities of sludge with relatively high concentrations of oil. Disposal of this waste is costly, in part because the high oil content requires use of secure disposal methods akin to handling of hazardous wastes. This article examines the properties of oily sludge and evaluates optional methods for reducing the oil content of this sludge to enable use of lower cost disposal methods. To reduce the oil content or break the structure of oily sludge, preliminary lab-scale experiments involving mechanical treatment, surfactant extraction, and oxidation are conducted. By applying surfactants, approximately 36% to 45% of oils are extracted from oily sludge. Of this, about 33% of oils are rapidly oxidised via radiation by an electron beam within 10 s of exposure. The Fenton reaction is effective for destruction of oily sludge. It is also found that 56% of oils were removed by reacting oily sludge with water containing ozone of 0.5 mg l(-1) over a period of 24 h. Oxidation using ozone thus can also be effectively used as a pretreatment for oily sludge., (© The Author(s) 2015.)

This study aimed to determine whether primary surgical closure of patent ductus arteriosus (PDA) is a risk factor for morbidity and mortality compared with secondary surgical ligation. The study enrolled 178 very-low-birth-weight infants. The surgical group included 34 patients who did not respond to pharmacologic intervention and eventually required ligation of their PDA as well as 35 patients who underwent direct ligation because of contraindications to the use of oral ibuprofen. The overall outcomes for the primary and secondary ligation groups were compared. The outcome during hospitalization showed no statistically significant difference in terms of morbidity and mortality between the two groups. The group that had primary ligation for PDA experienced more complications associated with premature birth such as lower gestational age and birth weight. The two groups did not differ significantly in terms of overall outcomes.

Aim: The problems of youth social withdrawal (or hikikomori) became a hot-button social issue in Japan in the 1990s. Unfortunately, current nosology in the DSM-IV may not adequately capture the concept of socially withdrawn youth (SWY) or hikikomori. This study aimed to investigate core SWY issues, evaluate SWY's psychopathologies, and approach them therapeutically through a home visitation program., Methods: Participants were 65 youth referred by community mental health centers and psychiatric clinics around Seoul and Kyongki-Do province. Among them, only 41 participants (31 male, 10 female, mean age 15 ± 3.6 years) fit our SWY criteria. In addition, 248 middle and high school students in Seoul were recruited as a baseline control group. Caseworkers interviewed the SWY participants and their parents in their homes, using our structured interview manual and a number of psychiatric scales. Caseworkers also approached the participants therapeutically., Results: Participants' Depression Inventory, Trait Anxiety Inventory, Social Anxiety Scale, and Internet Addiction Scale scores were significantly higher than those of baseline controls. Participants' mean number of psychotherapeutic sessions was 2.8, and the mean number of parental interview sessions was 3.4. After the therapeutic sessions, Global Assessment Functioning scores and social activities had improved somewhat in 68.3% of participants., Conclusion: These findings suggest that SWY is a complex phenomenon, so an individual psychopathologic process is very important for treatment. The most difficult problem in SWY treatment was therapeutic access. Hence, the home visit approach with a structured manual may be a good gateway for solving this problem., (© 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.)

Aim: The aim of this study was to observe whether our patient selection maximized the benefits of PDA ligation by comparing the outcomes in a surgically ligated group of PDA to a medically closed group., Study Design: If a hemodynamically significant ductus arteriosus (HSDA) was found to meet both clinical and echocardiographic criteria (stage≥3), as proposed by NcNamara and Hellman, medical treatment was initiated with oral ibuprofen (maximum 2 courses). If the PDA of these patients failed to close medically, timed surgical closure was performed., Result: Medical treatment was effective in 75 (72%) cases, and 29 (28%) patients required surgical ligation. The mean gestational age and birth weight were each significantly lower and the initial PDA shunt size was significantly larger in the surgically treated group. Additionally, the mean durations of mechanical ventilation, oxygen dependence and hospital admission were significantly longer in the surgically ligated group. However, our logistic regression analysis demonstrated no statistically significant difference in the outcomes of hospitalization (CLD, NEC, ARF, sepsis, IVH, ROP, PVL and death) between the two groups., Conclusion: Comprehensive HSDA patient selection may maximize the benefits of timed PDA ligation without adverse outcomes in very low birth weight infants., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The present study evaluated 168 childcare facilities from 6 cities in South Korea to assess exposure to organophosphorus pesticides (OPs) in children through 4 major pathways (indoor air, indoor dust, surface wipe of indoor objects, and hand wash water of children). The Excess Cancer Risk (ECR) was calculated based on the Cancer Potency Factor (CPF) and Age Dependent Adjustment Factor (ADAF) in adults. Dichlorvos residues were detected in the indoor air, indoor dust, surface wipes of indoor objects, and the hand wash water of children at frequencies of 47.4, 90, 100, and 100%, respectively. After revision based on the ADAF, total cancer risk in the 50th percentile was 3.99×10(-3) for inhalation, oral intake, and dermal contact in children ages 3 to 4 and 4.63×10(-4) in kindergarteners ages 5 to 6. Inhalation was the primary pathway of pesticide exposure in children in childcare facilities. Children ages 3 to 4 in daycare centers had a Hazard Quotient (HQ) of 0.5 for dichlorvos, which was 50% lower than the risk criterion level of 1 but was higher than the 95% percentile with a HQ of 1.9. This study postulates that children in childcare facilities may be exposed to specific OPs., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background/aims: There is a need for new anti-asthmatic medications with fewer side effects. NDC-052, an extract of the medicinal herb Magnoliae flos, which has a long history of clinical use, was recently found to have anti-inflammatory effects. Herein, we evaluated the effects of NDC-052 as an add-on therapy in patients with mild to moderate asthma using inhaled corticosteroids (ICS)., Methods: In a non-comparative, multi-center trial, 148 patients taking ICS received NDC-052 for eight weeks. We evaluated their forced expiratory volume in one second (FEV1), morning and evening peak expiratory flow rate (AM and PM PEFR), AM/PM asthma symptom scores, visual analogue symptom (VAS) scores, night-time wakening, frequency of short-acting β2-agonist usage, and adverse events., Results: After eight weeks, both AM and PM PEFRs were significantly improved. Asthma symptom scores, VAS scores, the frequency of nights without awakening, and the frequency of β2-agonist use were also reduced. Most of the adverse drug reactions were mild and resolved spontaneously., Conclusions: The addition of NDC-052 to ICS had a beneficial effect on asthma control in patients with mild to moderate asthma, with good tolerability and fewer side effects. Further studies are necessary to evaluate the effects of NDC-052 in patients with severe and/or refractory asthma.

Background and Aim: Patients with persistently active hepatitis B virus (HBV) replication are at high risk for progression to liver cirrhosis and hepatocellular carcinoma (HCC). The influence of the viral load of HBV on intrahepatic recurrence after local ablation therapy in patients with HBV-related HCC has not been elucidated. We aimed to evaluate predictors of intrahepatic recurrence and clarify the correlation between viral load and intrahepatic recurrence after percutaneous ablation., Methods: Patients with HBV-related, solitary HCC undergoing radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), between October 2004 and December 2008 were prospectively enrolled. Statistical analyses were performed using the Kaplan-Meier method and Cox regression model to identify risk factors for intrahepatic recurrence., Results: A total of 145 patients (male, 81.4%; mean age, 55.3 years) were included. Ninety patients (62.1%) had serum HBV DNA ≥2000 IU/mL. The median follow-up duration was 28.9 months (range, 12.0-57.0) and 63 patients (43.4%) experienced intrahepatic tumor recurrence. Multivariate analysis indicated that seropositivity for hepatitis B envelope antigen (HBeAg) was an independent negative predictor of intrahepatic recurrence (hazard ratio, 0.473; P=0.026) and late (≥1 year) recurrence (HR, 0.288; P=0.012). The serum alpha fetoprotein (AFP) level also significantly predicted late recurrence (HR, 1.001; P=0.005). However, neither the ablation method nor serum HBV DNA titers were correlated with intrahepatic recurrence., Conclusions: These findings show that HBeAg-negativity and serum AFP levels were associated with late intrahepatic recurrence of HCC, implicating HBeAg-negativity as a risk factor for de novo recurrence after percutaneous ablation in HBV-related HCC., (© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.)

Aspirin-intolerant asthma (AIA) is an asthma phenotype characterized by the development of bronchoconstriction following ingestion of aspirin. Despite the well-defined pathological trigger, the underlying mechanisms of AIA are still unclear. With the biophysical characteristics of the human EMI domain-containing protein 2 (EMID2) gene in relation to the extracellular matrix deposition and epithelial-mesenchymal transition as pivotal characteristics of airway remodeling in asthma, we hypothesized that genetic polymorphisms of EMID2 might affect the development of AIA. In this study, the allelic associations of 49 single-nucleotide polymorphisms (SNPs) of the human EMID2 gene were evaluated from 163 AIA patients and 429 aspirin-tolerant asthma (ATA) subjects as controls in a Korean population. Logistic analysis showed that five SNPs (P = 0.01-0.04, but P (corr) > 0.05) and EMID2&#95;BL2&#95;ht2 haplotype (unique to the minor alleles of rs4727494 and rs13233066; P = 0.02; P (corr) = 0.02) were significantly associated with AIA. More interestingly, regression analysis of the decline of forced expiratory volume in one second (FEV(1)) by aspirin provocation revealed that 10 SNPs (P = 0.003-0.04) and four relevant haplotypes (P = 0.002-0.02) were significantly associated with the fall rate of FEV(1) by aspirin provocation, indicating that genetic polymorphisms of EMID2 could cause meaningful deficits in the upper and lower airways among AIA patients. These findings provide evidence that EMID2 may be a susceptible genetic factor for aspirin hypersensitivity among asthmatics in Korean population.

Aspirin-intolerant asthma (AIA) is characterized by severe asthmatic attack after ingestion of aspirin and/or non-steroidal anti-inflammatory drugs. In this study, we investigated the relationship between Prostaglandin E2 receptor (PTGER) gene family polymorphisms and AIA in 243 AIA patients and 919 aspirin-tolerant asthma (ATA) controls of Korean ethnicity in two separate study cohorts. After genotyping 120 SNPs of the PTGER gene family for the 1(st) cohort study, four SNPs in PTGER1, ten in PTGER3, six in PTGER3, and a haplotype of PTGER2 showed association signals with decreased or increased risk of AIA. Among the positively associated SNPs, one in PTGER1 and four in PTGER3 were analyzed in the 2(nd) cohort study. The results show that rs7543182 and rs959 in PTGER3 retained their effect, although no statistical significance was retained in the 2(nd) cohort study. Our findings provide further evidence that polymorphisms in PTGER3 might play a significant role in aspirin hypersensitivity among Korean asthmatics.