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Background: The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis. Methods: Data were collected retrospectively at five hospitals for patients aged =18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models. Results: The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3-7) and the median PNI score was 39.6 (IQR, 33.8-46.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5-8; PNI: 35-38) or severe (CONUT: 9-12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0-1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24-1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95-3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09-1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67-2.12; P<0.001). Conclusions: The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days. [ABSTRACT FROM AUTHOR]

Purpose: To understand the current practice of radiation oncologists (ROs) and orthopedic surgeons (OSs) regarding spine metastasis. Methods: In 2022, an internet-based survey was conducted for ROs and OSs who treat spinal metastasis in Korea. Respondents were asked to choose the treatment option for two clinical scenarios. Scenario 1 involved a case displaying symptoms of leg weakness due to spinal cord compression and Scenario 2 involved a case with back pain due to pathologic compression fracture. The survey also included a question that required respondents to rank the importance of 11 clinical factors that affect treatment decisions. Results: Forty-nine ROs and 30 OSs responded to the survey. There were significant differences in treatment choices between two groups for both scenarios (P = 0.001). In Scenario 1, more OSs chose surgical resection than ROs (43.3% vs. 16.7%), while more ROs chose radiotherapy than OSs (83.3% vs. 53.3%). In Scenario 2, a similar proportion of OSs and ROs chose radiotherapy (OSs, 71.4% vs. ROs, 67.3%), while more OSs opted for prophylactic fixation after radiotherapy than ROs (95.0% vs. 42.4%). The top three factors influencing treatment decisions were general performance status, life expectancy, and spinal instability for both ROs and OSs. In both Scenarios 1 and 2, the treatment decisions of ROs changed significantly when clinical conditions related to these top three factors were altered. Conclusion: Although ROs and OSs share the same factors influencing treatment decisions for spinal metastases, notable differences exist in their actual [ABSTRACT FROM AUTHOR]

Caseous lymphadenitis (CLA) caused by Corynebacterium pseudotuberculosis is a chronic disease that affects goats. The Korean native goat (KNG) is the most popular goat breed raised in Korea. In this study, the distribution of CLA in the KNG population and the relevance of sex and age in disease development were determined. From March 2020 to February 2021, 1,177 KNGs from 110 farms were assessed. The distribution of CLA in animals was determined by a veterinary inspector who performed gross examinations of goat carcasses and confirmed diagnoses via polymerase chain reaction and bacteriological examination. The CLA detection rate in the KNG population was 19.80%, and more than half of the farms were affected by the disease (56.36%). A statistically significant difference was observed among the sex groups, with castrated males (13.98%) having the lowest detection rate, followed by intact males (22.48%) and females (24.09%), suggesting that castration has a positive effect on reducing the risk of CLA (p  <  0.05). In terms of age groups, an increased detection rate of 28.16% was observed in the late adult (>2  years) group. Phylogenetic analysis indicated that the RNA polymerase beta subunit-encoding gene can effectively differentiate biovar ovis from biovar equi and can be used for further epidemiological studies of C. pseudotuberculosis. This is the first nationwide surveillance study of CLA distribution to confirm the continuous occurrence of CLA in Korean goat farms. Future studies should include risk factor analyses of CLA based on herd levels to prevent and control this disease in Korea. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the association between type 2 diabetes mellitus (T2DM) and shoulder adhesive capsulitis (AC) using a large-scale, nationwide, population-based cohort in the Republic of Korea. Methods: A total of 3,471,745 subjects aged over 20 years who underwent a National Health Insurance Service medical checkup between 2009 and 2010 were included in this study, and followed from the date of their medical checkup to the end of 2018. Subjects were classified into the following four groups based on the presence of dysglycemia and history of diabetes medication: normal, prediabetes, newly diagnosed T2DM (new-T2DM), and T2DM (claim history for antidiabetic medication). The endpoint was new-onset AC during follow-up. The incidence rates (IRs) in 1,000 person-years and hazard ratios (HRs) of AC for each group were analyzed using Cox proportional hazard regression models. Results: The IRs of AC were 9.453 (normal), 11.912 (prediabetes), 14.933 (new-T2DM), and 24.3761 (T2DM). The adjusted HRs of AC in the prediabetes, new-T2DM, and T2DM groups were 1.084 (95% confidence interval [CI], 1.075 to 1.094), 1.312 (95% CI, 1.287 to 1.337), and 1.473 (95% CI, 1.452 to 1.494) compared to the normal group, respectively. This secular trend of the HRs of AC according to T2DM status was statistically significant (P<0.0001). Conclusion: This large-scale, longitudinal, nationwide, population-based cohort study of 3,471,745 subjects confirmed that the risk of AC increases in prediabetic subjects and is associated with T2DM status. [ABSTRACT FROM AUTHOR]

Background: Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking. Methods: We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed. Results: The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00–1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02–1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26–13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07–0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival. Conclusions: Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant. [ABSTRACT FROM AUTHOR]

Background/Aims: There are few reports regarding mixed carcinoma, defined as a mixture of glandular and poorly cohesive components, in patients with gastric cancer (GC). The aim of this study was to evaluate the proportion and characteristics of mixed carcinoma in GC patients. Methods: A total of 7,215 patients diagnosed with GC at Seoul National University Bundang Hospital were enrolled from March 2011 to February 2020. GC was divided into four groups (wellmoderately differentiated GC, poorly differentiated GC, poorly cohesive carcinoma, and mixed carcinoma). The proportion of each GC type and the clinicopathological features were analyzed and divided into early GC and advanced GC. Results: The proportion of mixed carcinoma was 10.9% (n=787). In early GC, submucosal invasion was the most common in poorly differentiated (53.7%), and mixed carcinoma ranked second (41.1%). Mixed carcinoma showed the highest proportion of lymph node metastasis in early GC (23.0%) and advanced GC (78.3%). In advanced GC, the rate of distant metastasis was 3.6% and 3.9% in well-moderately differentiated GC and mixed carcinoma, respectively, lower than that in poorly differentiated GC (6.4%) and poorly cohesive carcinoma (5.7%), without statistical significance. Conclusions: Mixed carcinoma was associated with lymph node metastasis compared to other histological GC subtypes. And it showed relatively common submucosal invasion in early GC, but the rates of venous invasion and distant metastasis were lower in advanced GC. Further research is needed to uncover the mechanism underlying these characteristics of mixed carcinoma. [ABSTRACT FROM AUTHOR]

Decapod iridescent virus 1 (DIV1) is a dangerous new virus that causes mortality to shrimp and crayfish. This virus has been reported in China, which is a major exporter of decapods to South Korea and its neighboring countries, Taiwan and Thailand. This virus can be regarded as a pathogen with a high risk of entry into Korea. Therefore, South Korea has been conducting emergency quarantine for DIV1 since 2020, and in this study, an import risk analysis was performed following the World Organization of Animal Health and domestic laws and regulations to present scientific grounds and validity for South Korea's DIV1 emergency quarantine. Import risk analysis was performed by hazard identification, entry assessment, exposure assessment, and consequence assessment. As a result of the import risk analysis, it was confirmed that the current DIV1 quarantine can significantly reduce the import risk. However, it was also established that the management of prawns and polychaetes intended for animal feed or bait and currently not subjected to quarantine is also required. Additionally, two species of crabs that would meet the criteria for a completely susceptible species and two species of crayfish that required surveillance of the import amount or route of exposure were also identified. In conclusion, these uses and susceptible species were designated as quarantine targets for nonhuman consumption requiring risk management and import sanitary conditions to be performed before export and after import. Finally, alternatives to reduce the cost burden of stakeholders following the introduction of the system were also presented. [ABSTRACT FROM AUTHOR]

Porcine epidemic diarrhea virus (PEDV) has posed significant financial threats to the domestic pig industry over the last three decades in South Korea. PEDV infection will mostly result in endemic persistence in the affected farrow-to-finish (FTF) herds, leading to endemic porcine epidemic diarrhea (PED) followed by year-round recurrent outbreaks. This review aims to encourage collaboration among swine producers, veterinarians, and researchers to offer answers that strengthen our understanding of PEDV in efforts to prevent and control endemic PED and to prepare for the next epidemics or pandemics. We found that collaboratively implementing a PED risk assessment and customized four-pillar-based control measures is vital to interrupt the chain of endemic PED in affected herds: the former can identify on-farm risk factors while the latter aims to compensate for or improve weaknesses via herd immunity stabilization and virus elimination. Under endemic PED, long-term virus survival in slurry and asymptomatically infected gilts (“Trojan Pigs”) that can transmit the virus to farrowing houses are key challenges for PEDV eradication in FTF farms and highlight the necessity for active monitoring and surveillance of the virus in herds and their environments. This paper underlines the current knowledge of molecular epidemiology and commercially available vaccines, as well as the risk assessment and customized strategies to control PEDV. The intervention measures for stabilizing herd immunity and eliminating virus circulation may be the cornerstone of establishing regional or national PED eradication programs. [ABSTRACT FROM AUTHOR]

Background/Aims: Low-volume preparations for colonoscopy are gaining attention for their higher acceptability. However, the efficacy and safety of oral sulfate solution (OSS) preparations in patients with ulcerative colitis (UC) has not been well known. Therefore, we aimed to compare OSS and 2-L polyethylene glycol with ascorbic acid (PEG+Asc) for bowel preparation in inactive UC. Methods: A multicenter, randomized, single-blind study was conducted at six tertiary referral hospitals in Korea. Outpatients with UC who had stable disease activity were randomly allocated to the OSS group or the 2-L PEG+Asc group for bowel preparation before colonoscopy. The study outcomes included treatment efficacy, safety, tolerability, and acceptability. Bowel cleansing was assessed using the Boston Bowel Preparation Scale and rated as successful cleansing if the score was ≥6. Patient acceptance and tolerability were assessed using a 4-point ordinal scale. Additionally, disease activity and laboratory data before and after colonoscopy were evaluated to check for safety. Results: The OSS and 2-L PEG+Asc groups included 92 and 93 participants, respectively. No significant between-group difference was noted in successful cleansing (OSS [96.7%] vs 2-L PEG+Asc [97.8%], p=0.64). Moreover, the safety, acceptance, and tolerability were not significantly different (all p>0.05). Furthermore, no significant changes were found in serum electrolytes or disease activity in either group. Conclusions: OSS is effective for colonoscopy cleansing, has acceptable tolerability, and does not affect disease activity; thus, it can be used safely for bowel preparation in patients with inactive UC. [ABSTRACT FROM AUTHOR]

This study aims to analyze the gap between the level of heat wave adaptation policies and heat wave effects in South Korean municipalities. First, the types of industries in municipalities were classified using factor analysis and cluster analysis. Second, the level of heat wave adaptation policy in the municipalities was assessed using a fuzzy analytic hierarchy process analysis. Third, the gap between the level of heat wave adaptation policy and the heat wave effect was analyzed. The results show that the heat wave adaptation policies were established in accordance with the heat wave effects to at least some degree. However, closer to the long-term future (2095), the policies have not sufficiently matched the level of heat wave effects. The proportion of municipalities with insufficient levels of heat wave adaptation policies against the heat wave effects was higher among urban-type municipalities. The analysis results suggest two policy implications. First, the heat wave adaptation policies of municipalities should be established through continuous feedback on the predictions of future heat wave effects. Second, urban-type municipalities should strengthen their planning authority and competence by securing a professional workforce and budgets for the establishment of heat wave adaptation policies. [ABSTRACT FROM AUTHOR]

Purpose: Oxaliplatin, a component of the capecitabine plus oxaliplatin (XELOX) regimen, has a more favorable toxicity profile than cisplatin in patients with advanced gastric cancer (GC). However, oxaliplatin can induce sensory neuropathy and cumulative, dose-related toxicities. Thus, the capecitabine maintenance regimen may achieve the maximum treatment effect while reducing the cumulative neurotoxicity of oxaliplatin. This study aimed to compare the survival of patients with advanced GC between capecitabine maintenance and observation after 1st line XELOX chemotherapy. Materials and Methods: Sixty-three patients treated with six cycles of XELOX for advanced GC in six hospitals of the Catholic University of Korea were randomized 1:1 to receive capecitabine maintenance or observation. The primary endpoint was progression-free survival (PFS), analyzed using a two-sided log-rank test stratified at a 5% significance level. Results: Between 2015 and 2020, 32 and 31 patients were randomized into the maintenance and observation groups, respectively. After randomization, the median number of capecitabine maintenance cycles was 6. The PFS was significantly higher in the maintenance group than the observation group (6.3 vs. 4.1 months, P=0.010). Overall survival was not significantly different between the 2 groups (18.2 vs. 16.5 months, P=0.624). Toxicities, such as hand-foot syndrome, were reported in some maintenance group patients. Maintenance treatment was a significant factor associated with PFS in multivariate analysis (hazard ratio, 0.472; 95% confidence interval, 0.250–0.890; P=0.020). Conclusions: After 6 cycles of XELOX chemotherapy, capecitabine maintenance significantly prolonged PFS compared with observation, and toxicity was manageable. Maintenance treatment was a significant prognostic factor associated with PFS. [ABSTRACT FROM AUTHOR]

Background Owing to antiretroviral therapy (ART), acquired immune deficiency syndrome (AIDS)-related mortality has significantly decreased. Retaining in care is an essential step for human immunodeficiency virus (HIV) care cascade. This study investigated the incidence of and risk factors for loss to follow-up (LTFU) in Korean people living with HIV (PLWH). Materials and Methods Data from the Korea HIV/AIDS cohort study (including prospective interval cohort and retrospective clinical cohort) were analyzed. LTFU was defined as not visiting the clinic for more than 1 year. Risk factors for LTFU were identified using the Cox regression hazard model. Results The study enrolled 3,172 adult HIV patients (median age, 36 years; male 92.97%). The median CD4 T cell count at enrollment was 234 cells/mm³ (interquartile range [IQR]: 85 - 373) and the median viral load at enrollment was 56,100 copies/mL (IQR: 15,000 - 203,992). The total follow-up duration was 16,487 person-years, and the overall incidence rate of LTFU was 85/1,000 person-years. In the multivariable Cox regression model, subjects on ART were less likely to have LTFU than subjects not on ART (hazard ratio [HR] = 0.253, 95% confidence interval [CI]: 0.220 - 0.291, P <0.0001). Among PLWH on ART, female sex (HR = 0.752, 95% CI: 0.582 - 0.971, P = 0.0291) and older age (>50: HR = 0.732, 95% CI: 0.602 - 0.890; 41 - 50: HR = 0.634, 95% CI: 0.530 - 0.750; 31 - 40: HR = 0.724, 95% CI: 0.618 - 0.847; ≤30: reference, P <0.0001) were associated with high rate of retention in care. The viral load at ART initiation ≥1,000,001 (HR = 1.545, 95% CI: 1.126 - 2.121, ≤10,000: reference) was associated with a higher rate of LTFU. Conclusion Young and male PLWH may have a higher rate of LTFU, and an increased rate of LTFU may induce virologic failure. [ABSTRACT FROM AUTHOR]

Background/Aims: The incidence and prognosis of gastric cancer (GC) shows sex difference. This study aimed to evaluate the effect of body mass index (BMI) on GC survival depending on sex. Methods: The sex, age, location, histology, TNM stages, BMI, and survival were analyzed in GC patients from May 2003 to February 2020 at the Seoul National University Bundang Hospital. Results: Among 14,688 patients, there were twice as many males (66.6%) as females (33.4%). However, under age 40 years, females (8.6%) were more prevalent than males (3.1%). Cardia GC in males showed a U-shaped distribution for underweight (9.6%), normal (6.4%), overweight (6.1%), obesity (5.6%), and severe obesity (9.3%) but not in females (p=0.003). Females showed decreased proportion of diffuse-type GC regarding BMI (underweight [59.9%], normal [56.8%], overweight [49.5%], obesity [44.8%], and severe obesity [41.7%]), but males did not (p<0.001). Both sexes had the worst prognosis in the underweight group (p<0.001), and the higher BMI, the better prognosis in males, but not females. Sex differences in prognosis according to BMI tended to be more prominent in males than in females in subgroup analysis of TNM stages I, II, and III and the operative treatment group. Conclusions: GC-specific survival was affected by BMI in a sex-dependent manner. These differences may be related to genetic, and environmental, hormonal factors; body composition; and muscle mass (Trial registration number: NCT04973631). [ABSTRACT FROM AUTHOR]

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline. [ABSTRACT FROM AUTHOR]

To provide information on the identification and quality evaluation of Q. variabilis virgin cork from Korea, the qualitative anatomical characteristics of the virgin cork were observed by optical and scanning electron microscopy and compared with those of Q. suber reproduction cork from Portugal. Q. variabilis showed a narrower growth ring than Q. suber. A dark-brown zone with sclereids was found only in Q. variabilis cork. The lenticular channel in Q. variabilis is larger than that in Q. suber. Q. variabilis virgin cork showed a distinct growth ring boundary and an abrupt transition from earlycork to latecork with a few rows of latecork cells. Q. suber reproduction cork showed an indistinct growth ring with a gradual transition from one to two rows of latecork cells. In the earlycork, Q. suber showed mild corrugation, while Q. variabilis displayed significant corrugation with collapsed and distorted cork cells. The lenticular channel in Q. variabilis virgin cork was surrounded by thick-walled cells filled with compact lenticular filling tissue. Q. suber reproduction cork had an opening with loose lenticular filling tissue surrounded by thick-walled cells. Prismatic crystals, thick-walled sclereid cells, and fiber-sclereids were found only in Q. variabilis. A few trabeculae were found in both cork samples. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Proteinuria is widely used to predict cardiovascular risk. However, there is insufficient evidence to predict how changes in proteinuria may affect the incidence of cardiovascular disease. METHODS: The study included 265,236 Korean adults who underwent health checkups in 2003-2004 and 2007-2008. They were categorized into 4 groups based on changes in proteinuria (negative: negative - negative; resolved: proteinuria =1+ - negative; incident: negative - proteinuria =1+; persistent: proteinuria =1+ - proteinuria =1+). We conducted 6 years of follow-up to identify the risks of developing ischemic heart disease (IHD), acute myocardial infarction (AMI), and angina pectoris according to changes in proteinuria. A multivariate Cox proportional-hazards model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident IHD, AMI, and angina pectoris. RESULTS: The IHD risk (expressed as HR [95% CI]) was the highest for persistent proteinuria, followed in descending order by incident and resolved proteinuria, compared with negative proteinuria (negative: reference, resolved: 1.211 [95% CI, 1.104 to 1.329], incident: 1.288 [95% CI, 1.184 to 1.400], and persistent: 1.578 [95% CI, 1.324 to 1.881]). The same pattern was associated with AMI (negative: reference, resolved: 1.401 [95% CI, 1.048 to 1.872], incident: 1.606 [95% CI, 1.268 to 2.035], and persistent: 2.069 [95% CI, 1.281 to 3.342]) and angina pectoris (negative: reference, resolved: 1.184 [95% CI, 1.065 to 1.316], incident: 1.275 [95% CI, 1.160 to 1.401], and persistent: 1.554 [95% CI, 1.272 to 1.899]). CONCLUSIONS: Experiencing proteinuria increased the risks of IHD, AMI, and angina pectoris even after proteinuria resolved. [ABSTRACT FROM AUTHOR]

Context: Several factors, such as balance and respiration training programs, have been identified as contributing to a shooting performance. However, little is known about the benefits of these programs on the shooting records of adolescent air rifle athletes. Objective: The purpose of this study was to investigate whether balance and respiration training can contribute to the shooting performance required for adolescent air rifle shooting athletes. Design: Case-control study. Setting: Shooting range. Participants: A total of 21 adolescent air rifle athletes were recruited from the local school community and assigned to an experimental (n = 11; EG) or control (n = 10; CG) group. Intervention: The EG performed respiration and balance training for 30 minutes 3 times a week for 6 weeks, and the CG performed balance training only. Main Outcome Measures: Data were collected on the respiratory function, muscle activity, and shooting record before and after the 6-week intervention. Results: The forced vital capacity (FVC), forced expired volume in 1 second (FEV1 ), FEV1 as a percentage of FVC, peak expiratory flow, and maximum voluntary ventilation were significantly increased in the EG, and FEV1 as a percentage of FVC was significantly increased in the CG (P < .05). The FVC and peak expiratory flow postintervention were significantly different between the groups (P< .05). The activity of the right internal oblique (IO) and left IO muscles of the FVC were significantly different in the EG (P < .05). Within-group changes in right external oblique, right 10, and left IO of the maximum voluntary ventilation were significantly increased in the EG (P< .05). The right IO and left IO activity improved more significantly in the EG than CG (P < .05). There was no difference between the groups with respect to the shooting records. Conclusions: The clinical significance of this study is the balance and respiration training affected the respiration function capacity and muscle activity, but did not affect the shooting record. Nevertheless, these training are a potential approach method to improve athletes' shooting record. [ABSTRACT FROM AUTHOR]

Background/Aims: The long-term course of Crohn’s disease (CD) has never been evaluated in non-Caucasian population-based cohorts. The aim of the present study was to evaluate the longterm prognosis of Korean CD patients in the well-defined population-based Songpa-Kangdong inflammatory bowel disease cohort. Methods: Outcomes of disease and their predictors were evaluated for 418 patients diagnosed with CD between 1986 and 2015. Results: During a median of 123 months, systemic corticosteroids, thiopurines, and anti-tumor necrosis factor (TNF) agents were administered to 58.6%, 81.3%, and 37.1% of patients, respectively. Over time, the cumulative probability of starting corticosteroids significantly decreased (p=0.001), whereas that of starting thiopurines and anti-TNFs significantly increased (both p<0.001). The cumulative probability of behavioral progression was 54.5% at 20 years, and it significantly decreased during the anti-TNF era. Intestinal resection was required for 113 patients (27.0%). The cumulative probabilities of intestinal resection at 1, 5, 10, 20, and 25 years after CD diagnosis were 12.7%, 16.5%, 23.8%, 45.1%, and 51.2%, respectively. Multivariable Cox regression analysis identified stricturing behavior at diagnosis (adjusted hazard ratio [aHR], 2.70; 95% confidence interval [CI], 1.55 to 4.71), penetrating behavior at diagnosis (aHR, 11.15; 95% CI, 6.91 to 17.97), and diagnosis of CD during the anti-TNF era (aHR, 0.51; 95% CI, 0.35 to 0.76) as independently associated with intestinal resection. The standardized mortality ratio among CD patients was 1.36 (95% CI, 0.59 to 2.68). Conclusions: The long-term prognosis of Korean patients with CD is at least as good as that of Western CD patients, as indicated by the low intestinal resection rate. Moreover, behavioral progression and intestinal resection rates have decreased over the past 3 decades. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioral therapy for adherence and depression (CBT-AD) performed by clinical psychologists is an effective treatment for improving the depression in people living with HIV (PLWH). However, because access to clinical psychologists is limited in most clinics, CBT-AD is rarely performed for PLWH in Korea. This pilot study evaluates whether CBT-AD can be effectively performed by a nurse trained and supervised by a clinical psychologist, with a view to the wider provision of CBT-AD. Materials and Methods: One clinical psychologist developed manuals, educated and supervised one nurse. PLWH with depression or adherence to self-reported antiretroviral therapy <90% were enrolled, and CBT-AD was conducted once weekly for 12 sessions. PLWH were assessed for adherence by visual analog scale, Beck depression inventory (BDI) for depression, PozQoL for quality of life, and Berger’s 40-item stigma scale for stigma at baseline, after the 6th, 12th session, at 4-, and 8-months after CBT-AD. Acceptability for PLWH and feasibility for providers were evaluated through surveys. Results: Five male PLWH have completed the study protocols (mean age 29.2 years). All study participants showed improving depression (mean BDI at baseline 33.0 ± 7.0, and after the 12th session 13.4 ± 3.5), and the effect was maintained at the 8-month follow-up (BDI 15.4 ± 6.4). Quality of life showed a tendency to improve (mean PozQoL at baseline 28.0 ± 7.7, after 12th session 36.8 ± 4.4, and at the 8-month follow-up 38.2 ± 7.9), but stigma did not show clear improvement (Berger’s 40-item stigma scale at baseline 121.0 ± 3.9, after 12th session 107.6 ± 8.8. and at the 8-month follow-up 107.6 ± 5.0). All study participants received great help from CBT-AD and expressed their desire to continue. All providers agreed that nursedelivered CBT-AD could be implemented in routine clinical practice. Conclusion: Our findings suggest that a nurse-delivered CBT-AD could be feasible and acceptable for PLWH through structured interventions. It has been shown to have the potential to help PLWH, especially for their depression and quality of life. [ABSTRACT FROM AUTHOR]

배경: Infective endocarditis (IE) remains a major medical problem with high morbidity and mortality. Appropriate antibiotic treatment lowers the risk of embolism, recurrence, and long-term mortality. However, there are concerns about adverse drug reactions and resistant strains due to long-term use of antibiotics. Therefore, we compared the difference in overall mortality according to the duration of postoperative antibiotics therapy in patients with IE. 방법: From 2005 to 2017, we retrospectively reviewed 416 patients with IE at a 2400-bed tertiary hospital in South Korea. A total of 234 IE patients who underwent valve surgery and appropriate duration of antibiotics were enrolled. They were divided into two groups based on the 2 weeks of postoperative antibiotic therapy. The primary outcome was long-term overall all-cause mortality. The secondary outcomes were reoperation rate, recurrence rate, and postoperative complications. 결과: The median follow-up duration was 71 (interquartile range [IQR], 46–109) months. The duration of postoperative antibiotic therapy was less than 2 weeks in 62 patients (26.5%) and more than 2 weeks in 172 patients (73.5%). The median age was 53 ([IQR], 39–63) years. The overall mortality was 12.8% (30/234). There were no statistical differences in overall mortality (12.9% vs. 12.8%, p=0.982), reoperation (6.5% vs. 4.1%, p=0.488), and recurrence (8.1% vs. 2.9%, p=0.135) between patients with postoperative antibiotic therapy less than 2 weeks and for ≥2 weeks, respectively. The duration of postoperative antibiotic therapy based on 2 weeks in the Kaplan-Meier curve was not associated with overall mortality (log-rank test, p=0.877). 결론: In conclusion, there was no statistically significant difference in the overall mortality, recurrence, and reoperation rate according to the duration of postoperative antibiotic therapy. If surgery and recommended total antibiotic duration are properly performed, a shorter duration of postoperative antibiotics might be considered. [ABSTRACT FROM AUTHOR]

배경: Computed tomography (CT) is a very useful tool for evaluating the etiology of patients with sepsis or septic shock. However, it is difficult to obtain contrast-enhanced CT images due to concerns about nephrotoxicity caused by contrast media, especially in patients with septic acute kidney injury (AKI). In this study, we aim to investigate the relationship between contrast media administration and long-term mortality and chronic kidney disease in patients with septic AKI. 방법: A total of 1,521 patients with septic shock admitted to a tertiary hospital in South Korea from July 2008 to November 2019 were retrospectively reviewed. A total of 609 adult septic shock patients with AKI who underwent contrast or non-contrast CT scans were enrolled. The primary outcome was 90-day mortality rate. The secondary outcomes were worsening AKI, 28-day mortality rate, chronic kidney disease, and maintain dialysis at 90 days between contrast CT group and non-contrast CT group. 결과: Of 609 septic AKI patients, 220 patients (36.1%) underwent contrast CT and 389 patients (63.9%) underwent non-contrast CT. The median age was 70.9 years, and 305 (50.1%) were male. There were no statistically significant differences in the outcomes between the contrast and non-contrast CT groups: 90-day mortality, 55.3% vs. 57.4%, p=0.682; worsening AKI, 1.8% vs. 2.1%, p=0.999; 28-day mortality, 41.4% vs. 42.3%, p=0.898; chronic kidney disease, 13.2% vs. 15.3%, p=0.73; and maintain dialysis at 90day, 0.0% vs. 0.8%, p=0.482. 결론: In conclusion, intravenous contrast media administration was not associated with long-term mortality, chronic renal impairment, and dialysis in patients with septic AKI. [ABSTRACT FROM AUTHOR]

배경: This study aimed to investigate the prognosis and prognostic factors for mortality in progressive multifocal leukoencephalopathy (PML) patients through a long observation period. 방법: This retrospective study was conducted in two tertiary hospitals in South Korea from 1999 to 2021. Patients diagnosed with PML were reviewed according to the American Academy of Neurology diagnostic criteria. The primary endpoint was long-term overall mortality. Each patient was followed up till death or the end of the study period. 결과: Total of 47 PML patients were included. Of 27 patients (57.4%) were diagnosed with HIV. Median last follow-up modified Rankin Scale (mRS) score was higher in the non-HIV PML group than that in the HIV group (5 vs. 4, p=0.020). Median survival duration was lower in the non-HIV group (184 vs. 1,564 days). The 1-year and overall mortality rates of PML patients were significantly higher in the non-HIV group than that in HIV group (60.0% vs. 25.9%, p=0.019; 80.0% vs. 40.7%, p=0.007). Initial mRS score (HR 1.685, p=0.038) and highly active antiretroviral therapy (HAART) in HIV patients (HR 0.374, p=0.013) had a significant effect on overall mortality. 결론: Survival duration of HIV-positive PML patients receiving HAART improved; however, the mortality rate is still high. Introduction of HAART in HIV patients and initial mRS score are significant prognostic factors for overall mortality in PML patients. [ABSTRACT FROM AUTHOR]

배경: Dagnosis of invasive aspergillosis (IA) is often difficult due to need for invasive procedures. Next-generation sequencing of plasma microbial cell free DNA (cfDNA) can be a novel non-invasive diagnostic method. We evaluated the clinical accuracy and utility of microbial cfDNA whole genome sequencing (WGS) for diagnosis of IA in patients with hematologic malignancy (HM) or coronavirus disease (COVID-19). 방법: A single-center prospective cohort study was conducted in a tertiary hospital in Korea. We enrolled adult patients with HM or severe COVID-19, who suspected of IA and collected plasma samples. cfDNA was extracted from plasma and WGS was performed. IA diagnosis was retrospectively confirmed according to EORTC/MSG definitions in patients with HM, and modified AspICU criteria in patients with severe COVID-19. The final diagnosis of IA was compared to the results of microbial cfDNA WGS. 결과: Between Mar 2021 and Feb 2022, a total of 64 microbial cfDNA WGS was performed on the plasma samples from 37 participants (19 with HM and 19 with COVID-19) and 7 controls who didn’t have any evidence of fungal infection. In participants with HM, aspergillus cfDNA was detected in 100% (1/1) of proven and 84.6% (11/13) of probable IA cases. In participants with COVID-19, 46.7% (7/15) of probable IA showed positive aspergillus cfDNA. Positive agreement of detection of aspergillus cfDNA versus conventional diagnosis of proven/probable IA was significantly higher in participants with HM compared to COVID-19 (85.7% vs. 46.7%, p=0.011). Fifteen of 19 (78.9%) participants with positive aspergillus cfDNA had exposure to antifungal agents. In 7 participants, non-aspergillus pathogens detected by microbial cfDNA WGS were in accordance with those identified through conventional culture. 결론: Detection of aspergillus cfDNA showed high concordance with conventional diagnostic methods of proven/probable IA in patients with HM and could be a helpful non-invasive approach to IA diagnosis in those populations. [ABSTRACT FROM AUTHOR]

Background/Aims: The prospective Crohn’s Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn’s disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD. Methods: Patients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis: cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019). Results: A total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35; 95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection. Conclusions: The prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection. [ABSTRACT FROM AUTHOR]

Background/Aims: We aimed to evaluate the clinical characteristics and long-term prognosis of elderly-onset ulcerative colitis (EOUC) in Korean patients over a 30-year period using a well-established population-based cohort in the Songpa-Kangdong district of Seoul, Korea. Methods: Clinical characteristics and prognosis were compared between two groups: EOUC, defined as UC diagnosed in individuals aged ≥60 years and non-EOUC (N-EOUC), defined as UC diagnosed in individuals aged 18 to 59 years. Results: We identified 99 patients with EOUC (10.3%) and 866 patients with N-EOUC (89.7%) between 1986 and 2015. During the median follow-up of 104.5 months, the overall exposure to medications was comparable between patients with EOUC and N-EOUC (p=0.091 for corticosteroids, p=0.794 for thiopurines, and p=0.095 for anti-tumor necrosis factor agents). The cumulative risks of disease outcomes were also comparable between patients with EOUC and N-EOUC (22.4% vs 30.4% for proximal disease extension [p=0.351], 11.9% vs 18.1% for hospitalization [p=0.240], and 2.3% vs 1.8% for colectomy [p=0.977]) at 10 years after diagnosis. Multivariate Cox regression analysis revealed that corticosteroid use at diagnosis was an independent predictor of proximal disease extension (hazard ratio [HR], 6.216; 95% confidence interval [CI], 1.314 to 28.826) and hospitalization (HR, 11.241; 95% CI, 3.027 to 41.742) in patients with EOUC. Conclusions: In this population-based study from Korea, the pattern of medication use seemed comparable between the EOUC and N-EOUC groups. Moreover, patients with EOUC and those with N-EOUC have a similar disease course in terms of proximal disease extension, hospitalization, and colectomy. [ABSTRACT FROM AUTHOR]

Background: Since 2013, the number of requests for diagnosis for horses based on neurological symptoms has increased rapidly in South Korea. The affected horses have commonly exhibited symptoms of acute seasonal hindlimb ataxia. A previous study from 2015–2016 identified Setaria digitata as the causative agent. Objectives: This study is an epidemiological investigation to find out risk factors related to the rapid increase in hindlimb ataxia of horses due to aberrant parasites in South Korea. Methods: An epidemiological investigation was conducted on 155 cohabiting horses in 41 horse ranches where the disease occurred. The surrounding environment was investigated at the disease-causing horse ranches (n = 41) and 20, randomly selected, non-infected ranches. Results: Hindlimb ataxia was confirmed in nine cohabiting horses; this was presumed to be caused by ectopic parasitism. Environments that mosquitoes inhabit, such as paddy fields within 2 km and less than 0.5 km from a river, had the greatest association with disease occurrence. Conclusions: Most horse ranches in South Korea are situated in favorable environments for mosquitoes. Moreover, the number of mosquitoes in the country has increased since 2013 due to climate change. Additional research is required; however, these data show that it is necessary to establish guidelines for the use of anthelmintic agents based on local factors in South Korea and disinfection of the environment to prevent disease outbreaks. [ABSTRACT FROM AUTHOR]

Renal insufficiency is one of the common issues in people living with human immunodeficiency virus (PLHIV). We studied the incidence and risk factors for renal insufficiency in male PLHIV using the Korea HIV/acquired immunodeficiency syndrome (AIDS) Cohort Study. Among the 830 enrolled patients, 32 (3.9%) cases of renal insufficiency occurred over 9576 patient-years of follow-up. The incidence of renal insufficiency in HIV-[infected men in this study was 3.3 per 1000 patient-years. Diabetes mellitus, dyslipidemia, tenofovir or non-nucleoside reverse transcriptase inhibitor exposure for >1 year, and AIDS-defining illness were risk factors for renal insufficiency. [ABSTRACT FROM AUTHOR]

배경 Patients with cancer are at greater risk of severe COVID-19 and have been prioritized for COVID-19 vaccination including booster doses. We aimed to assess the immunogenicity and safety of COVID-19 vaccination and analyze factors associated with the immunogenicity of the vaccine among actively treat- ed solid cancer patients (CPs) in Korea. 방법 A prospective cohort was established among CPs undergoing anticancer treatment in a tertiary hospital in Korea. Patients in this cohort had no history of previous SARS-CoV-2 infection confirmed by baseline serological testing and received at least one dose of COVID-19 vaccine in accordance with the vaccine strategy. Blood samples were collected before prime vaccination, and beyond 2 weeks for each dose of vaccine administration. Spike (S)- specific IgG antibodies were analyzed on each sample. Adverse events (AEs) within 7 days following each vaccine dose were collected. Data from age-matched healthcare workers (HCWs) recruited into a separate study are included as a comparison cohort. 결과 Between April 2021 to November 2021, we enrolled 134 CPs; 118 were eligible for analysis. The demographics of CPs and HCWs are described in Table 1. CPs were treated with cytotoxic agents (78.8%), immunotherapy (16.9%), target therapy (18.6%), and others (5.9%), that were given either alone or in combinations. The rate of seroconversion after 1st vaccination in CPs was significantly lower than in HCWs (p value=0.001), however, all CPs and HCWs revealed seroconversion after 2nd vaccination (Figure 1). Antibody response was significantly increased following each dose of vaccination in both CPs and HCWs (Figure 2A). The geometric mean titer (GMT) of S-specific IgG antibodies after 2nd vaccination in CPs who received a primary set of adenovirus vector vaccine were significantly lower than that in HCWs, whereas CPs who received a primary set of mRNA vaccines showed comparable GMT with HCWs after 2nd vaccination (Figure 2B). After the 3rd vaccination, there was no statistical difference in GMT of S-specific antibodies between CPs and HCWs regardless of the type of primary vaccine. In age-matched analysis between good responders (defined as those with higher antibody titers after 2nd vaccination than the mean of age-stratified HCW cohort) and poor responders (defined as those with lower titers) among CPs, there was no significant difference in other factors including the type of vaccine, cancer or anticancer treatment except lower leukocyte counts in poor responders treated with cytotoxic agents. The incidence and severity of AEs were similar between CPs and HCWs without any severe vaccine-related AEs. 결론 Patients with solid cancer had delayed antibody response compared to HCWs after the 1st vaccination but all CPs showed seroconversion after 2nd vaccination. Antibody responses similar to that of HCWs were achieved after the 3rd dose of vaccination in actively treated CPs in this study. [ABSTRACT FROM AUTHOR]

Next-generation sequencing (NGS) is becoming essential in the fields of precision oncology. With implementation of NGS in daily clinic, the needs for continued education, facilitated interpretation of NGS results and optimal treatment delivery based on NGS results have been addressed. Molecular tumor board (MTB) is multidisciplinary approach to keep pace with the growing knowledge of complex molecular alterations in patients with advanced solid cancer. Although guidelines for NGS use and MTB have been developed in western countries, there is limitation for reflection of Korea's public health environment and daily clinical practice. These recommendations provide a critical guidance from NGS panel testing to final treatment decision based on MTB discussion. [ABSTRACT FROM AUTHOR]

배경: Interest in complications and sequelae following COVID-19 is increasing. Several articles have reported COVID-19-associated autoimmune diseases and the association of autoantibodies with the severity of COVID-19. Thromboembolic complications frequently occur in COVID-19 patients, and the anti-phospholipid antibody (aPL) is frequently detected. We conducted this study to investigate the prevalence, clinical significance, and persistence of anti-nuclear antibody (ANA) and aPL in COVID-19. 방법: This study enrolled the patients diagnosed with COVID-19 with oxygen demand, admitted to Severance Hospital, running a critical care unit for COVID-19 in South Korea from July 2020 to March 2022. ANA and aPLs were assessed using the immuno-assay kit. 결과: A total of 250 patients were enrolled during the study period. Among them, five patients showed ANA-positive, and 41 showed aPL-positive (IgM anti-Cardiolipin (aCL) antibody for seven patients, IgG aCL for seven patients, IgM anti-β2Glycoprotein1 antibody (aβ2-GPI) for 32 patients, and IgG aβ2-GPI for one patient). Two of the five ANA-positive patients, 13 of the 32 IgM aβ2-GPI-positive patients, 5 of the 7 IgM aCL-positive patients, and 2 of the 7 IgG aCL-positive patients were eligible for follow-up analysis, and 100%, 69.2%, 40%, and 50% of the patients remained autoantibody-positive, respectively. Except for the IgG aCL group, there were no differences in clinical outcomes, including thromboembolic complications, between the autoantibody-positive and negative groups. 결론: Our study demonstrated that a significant proportion of COVID-19 patients with oxygen demand showed autoantibody-positive and persisted several months after symptom onset. Whether these autoantibodies are related to long-term sequelae in COVID-19 patients requires further research. [ABSTRACT FROM AUTHOR]

The outbreak of human toxoplasmosis can be attributed to ingestion of food contaminated with Toxoplasma gondii. Toxoplasmosis recently increased in domestic and stray dogs and cats. It prompted studies on the zoonotic infectious diseases transmitted via these animals. Sero- and antigen prevalences of T. gondii in dogs and cats were surveyed using ELISA and PCR, and B1 gene phylogeny was analyzed in this study. Toxoplasmosis antibodies were measured on sera of 403 stray cats, 947 stray dogs, 909 domestic cats, and 2,412 domestic dogs collected at nationwide regions, Korea from 2017 to 2019. In addition, whole blood, feces, and tissue samples were also collected from stray cats (1,392), stray dogs (686), domestic cats (3,040), and domestic dogs (1,974), and T. gondii-specific B1 gene PCR was performed. Antibody prevalence of stray cats, stray dogs, domestic cats, and domestic dogs were 14.1%, 5.6%, 2.3%, and 0.04%, respectively. Antigen prevalence of these animals was 0.5%, 0.2%, 0.1%, and 0.4%, respectively. Stray cats revealed the highest infection rate of toxoplasmosis, followed by stray dogs, domestic cats, and domestic dogs. B1 gene positives were 5 of stray cats, and identified to high/moderate pathogenic Type I/III group. These findings enforce that preventive hygienic measure should be strengthened at One Health level in dogs and cats, domestic and stray, to minimize human toxoplasmosis infections. [ABSTRACT FROM AUTHOR]

In preparation for the surge of coronavirus disease 2019 (COVID-19), it is crucial to allocate medical resources efficiently for distinguishing people who remain asymptomatic until the end of the disease. Between January 27, 2020, and April 21, 2020, 517 COVID-19 cases from 13 healthcare facilities in Gyeonggi province, Korea, were identified out of which the epidemiologic and clinical information of 66 asymptomatic patients at the time of diagnosis were analyzed retrospectively. An exposure-diagnosis interval within 7 days and abnormal aspartate aminotransferase levels were identified as characteristic symptom development in asymptomatic COVID-19 patients. If asymptomatic patients without these characteristics at the time of diagnosis could be differentiated early, more medical resources could be secured for mild or moderate cases in this COVID-19 surge. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to conduct metabolic profiling of dairy cattle serum and urine using proton nuclear magnetic resonance (1H-NMR) spectroscopy and to compare the results obtained with those of other dairy cattle herds worldwide so as to provide a basic dataset to facilitate research on metabolites in serum and urine. Methods: Six dairy cattle were used in this study; all animals were fed the same diet, which was composed of total mixed ration; the fed amounts were based on voluntary intake. Blood from the jugular neck vein of each steer was collected at the same time using a separate serum tube. Urine samples were collected by hand sweeping the perineum. The metabolites were determined by 1H-NMR spectroscopy, and the obtained data were statistically analyzed by performing principal component analysis, partial least squares-discriminant analysis, variable importance in projection scores, and metabolic pathway data using Metaboanalyst 4.0. Results: The total number of metabolites in the serum and urine was measured to be 115 and 193, respectively, of which 47 and 81, respectively were quantified. Lactate (classified as an organic acid) and urea (classified as an aliphatic acylic compound) exhibited the highest concentrations in serum and urine, respectively. Some metabolites that have been associated with diseases such as ketosis, bovine respiratory disease, and metritis, and metabolites associated with heat stress were also found in the serum and urine samples. Conclusion: The metabolites measured in the serum and urine could potentially be used to detect diseases and heat stress in dairy cattle. The results could also be useful for metabolomic research on the serum and urine of ruminants in Korea. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to test the hypothesis that the fundamentals of the supply chain relationships have not changed during the digital transformation period in Korea between 2006 and 2018. Design/methodology/approach - The data for this study were collected through a questionnaire-based survey during two different time periods in Korea, 2006 and 2018. Findings - This study reveals that supply chain professionals in 2006 regarded trust building process as the most important construct for the successful supply chain operations while in the 2018 survey, trust-based commitment became the most important construct. This paper concludes that supply chain sustainability will be enhanced based on strong supply chain relationship framework. Originality/value - This study reaffirmed that a supply chain relationship built on a trust-based commitment is still the pathway to successful supply chain implementation. As far as we know, no studies have been published in examining supply chain relationships during the digital transformation in two time periods. [ABSTRACT FROM AUTHOR]

Purpose The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) has increased, and staging and optimal therapeutic approaches are challenging. A questionnaire survey was conducted to investigate the controversial treatment policy of stage T2 OPC according to the N category and determine the opinions of multidisciplinary experts in Korea. Materials and Methods Five OPC scenarios were developed by the Subcommittee on Oropharyngeal Treatment Guidelines of the Korean Society for Head and Neck Oncology and distributed to experts of multidisciplinary treatment hospitals. Results Sixty-five experts from 45 institutions responded. For the HPV-positive T2N0M0 scenario, 67.7% of respondents selected surgery followed by definitive concurrent chemoradiotherapy (CCRT) or radiotherapy alone. For the T2N1M0 HPV-positive scenario, there was a notable difference in the selection of primary treatment by expert specialty; 53.9% of respondents selected surgery and 39.8% selected definitive CCRT as the primary treatment. For the T2N3M0 advanced HPV-positive scenario, 50.0% of respondents selected CCRT and 33.3% considered induction chemotherapy (IC) as the primary treatment. CCRT and IC were significantly more frequently selected for the HPV-related OPC cases (p=0.010). The interdepartmental variability showed that the head and neck surgeons and medical oncologists favored surgery, whereas the radiation oncologists preferably selected definitive CCRT (p < 0.001). Conclusion In this study, surgery was preferred for lymph node-negative OPC, and as lymph node metastasis progressed, CCRT tended to be preferred, and IC was administered. Clinical practice patterns by stage and HPV status showed differences according to expert specialty. Multidisciplinary consensus guidelines will be essential in the future. [ABSTRACT FROM AUTHOR]

Purpose: Studies on de-escalation in radiation therapy (RT) for human papillomavirus-positive (HPV(+)) oropharyngeal cancer (OPC) are currently ongoing. This study investigated the current practice regarding the radiation dose and field in the treatment of HPV(+) OPC. Materials and Methods: The Korean Society for Head and Neck Oncology conducted a questionnaire on the primary treatment policy. Among them, for HPV(+) OPC scenarios, radiation oncologists were questioned regarding the field and dose of RT. Results: Forty-two radiation oncologists responded to the survey. In definitive concurrent chemoradiotherapy (CCRT) treatment for stage T2N1M0 OPC, most respondents prescribed a dose of >60 Gy to the primary tonsil and involved ipsilateral lymph nodes. However, eight of the respondents prescribed a relatively low dose of =54 Gy. For stage T2N1M0 OPC, postoperative adjuvant RT was prescribed by eight and nine respondents with a lower dose of =50 Gy for the ipsilateral tonsil and involved neck, respectively. In definitive CCRT in complete remission after induction chemotherapy for initial stage T2N3M0 OPC, de-escalation of the tonsil and involved neck were performed by eight and seven respondents, respectively. Regarding whether de-escalation is applied in radiotherapy for HPV(+) OPC, 27 (64.3%) did not do it at present, and 15 (35.7%) were doing or considering it. Conclusion: The field and dose of prescribed treatment varied between institutions in Korea. Among them, dose de-escalation of RT in HPV(+) OPC was observed in approximately 20% of the respondents. Consensus guidelines will be set in the near future after the completion of ongoing prospective trials. [ABSTRACT FROM AUTHOR]

PM2.5 is a WHO-designated first-class carcinogen and coping with high-concentration situations with high human risk is becoming more important. In particular, Korea has a high concentration of PM2.5 in winter due to its geographical characteristics, which can be largely divided into foreign inflows and domestic atmospheric stability. To determine this, wind patterns and air pressure data were analyzed representatively and episodes about high concentration phenomena were classified. In this study, high-concentration PM2.5 episodes, where the daily average PM2.5 concentration in Seoul exceeded 35 µg/m³ between October 2019 to March 2020, were analyzed case-by-case. The criteria for the separation of consecutive episodes were established. Then, the designated episodes were classified into four categories based on cause: atmospheric stagnation, combination of causes, penetration from abroad, and accumulation. To identify the causes of the episodes, wind direction, wind speed data, wind roses, and air quality forecast modeling data obtained from "Air Korea" were studied. Fifteen episodes were identified and analyzed and each were given a classification type. Furthermore, the phenomenon of high-concentration episodes was summarized after detailed individual analysis of the episodes. As a result of case analysis, just before there was an inflow from abroad due to strong wind speed, a characteristic of low PM2.5 concentration of air quality as a kind of cleaning effect could be found. In addition, alarm-level PM2.5 concentrations of 75 µg/m³ or higher were often made by external inflow. This will contribute towards identifying the main causes of high PM2.5 concentration episodes in Korea when it is applied over a longer time period. [ABSTRACT FROM AUTHOR]

There have been no epidemiological studies identifying associations between systemic inflammatory diseases and actinic keratosis. This study used a large nationwide database to investigate the associations between actinic keratosis and systemic inflammatory diseases. Records of patients over 20 years of age newly diagnosed with actinic keratosis (n = 64,659) from 2012 to 2017 were analysed. A control population of individuals without actinic keratosis, matched for age, sex, and year of claim, who visited an outpatient clinic, was sampled at a ratio of 1:1 (n = 64,659). Both cohorts were analysed for the presence of systemic inflammatory diseases within at least 5 years prior to diagnosis of actinic keratosis. Patients with actinic keratosis exhibited higher odds ratios for rheumatoid arthritis (1.336; 95% confidence interval (95% CI) 1.161-1.537)) and psoriasis (1.513; 95% CI 1.435-1.595) compared with the control group on multivariate analysis. However, the proportions of Behçet's disease, Crohn's disease, ulcerative colitis, and multiple sclerosis in the actinic keratosis group were not statistically significant. [ABSTRACT FROM AUTHOR]

배경 The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving. 방법 This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021. 결과 During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified. Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the en- hanced environmental cleaning using sodium hypochlorite (NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. 결론 Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning [ABSTRACT FROM AUTHOR]

Equine piroplasmosis (EP) is caused by Babesia caballi and Theileria equi infection. We investigated antigen and antibody of EP in horses in the Republic of Korea during 2016- 2017. Antigen and antibody of T. equi was detected 0.06% (1/1,650). Phylogenetic analysis of 18S rRNA revealed that the T. equi was highly homologous with the strains from China, Mongolia, and Spain. Two Theileria spp. were also detected and highly homologous with T. buffeli, T. luwenshuni, and T. orientalis. [ABSTRACT FROM AUTHOR]

Objective: The metabolites that constitute the rumen fluid and milk in dairy cattle were analyzed using proton nuclear magnetic resonance (1H-NMR) spectroscopy and compared with the results obtain for other dairy cattle herds worldwide. The aim was to provide basic dataset for facilitating research on metabolites in rumen fluid and milk. Methods: Six dairy cattle were used in this study. Rumen fluid was collected using a stomach tube, and milk was collected using a pipeline milking system. The metabolites were determined by 1H-NMR spectroscopy, and the obtained data were statistically analyzed by principal component analysis, partial least squares discriminant analysis, variable importance in projection scores, and metabolic pathway data using Metaboanalyst 4.0. Results: The total numbers of metabolites in rumen fluid and milk were measured to be 186 and 184, and quantified as 72 and 109, respectively. Organic acid and carbohydrate metabolites exhibited the highest concentrations in rumen fluid and milk, respectively. Some metabolites that have been associated with metabolic diseases (acidosis and ketosis) in cows were identified in rumen fluid, and metabolites associated with ketosis, somatic cell production, and coagulation properties were identified in milk. Conclusion: The metabolites measured in rumen fluid and milk could potentially be used to detect metabolic diseases and evaluate milk quality. The results could also be useful for metabolomic research on the biofluids of ruminants in Korea, while facilitating their metabolic research. [ABSTRACT FROM AUTHOR]

Objective: The treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.Methods: A 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.Results: We included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).Conclusions: The incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE. [ABSTRACT FROM AUTHOR]

We estimated the production of the copepod Calanus sinicus, including somatic production of copepodite stage 1 (CI) to copepodite stage 5 (CV) and egg production of adult females, to elucidate the role of C. sinicus during spring in the northern East China Sea, including the southern waters of Korea. To estimate the somatic production of the copepodites, an empirical equation for broadcasters (Hirst & Bunker 2003) was used. The total biomass of the C. sinicus population, including CI to adult males and females, ranged from 0.11 to 30.23 mg C m−3 , with a mean of 8.69 mg C m−3 . The egg production rate (EPR) of adult females of C. sinicus, measured over 24 h of shipboard incubation, ranged from 0 to 14.9 eggs female−1 day−1 (mean 5.8 eggs female−1 day−1 ), equivalent to mean 33.6 µg C m−3 day−1 . The weight-specific EPR (WSEPR) of adult females averaged 0.023 day−1, and significantly increased with increasing water temperature at 5 m depth and surface chlorophyll a concentration, respectively. WSEPR decreased with increasing body mass of individual adult females. The total production of the C. sinicus population ranged from 0.02 to 3.67 mg C m−3 day−1 (mean 0.91 mg C m−3 day−1 ) and the depth-integrated mean total production was estimated to be 52.72 mg C m−2 day−1 . CV production accounted for 54% of the total production. By contrast, EPR contributed on average only 3.7% of the total production rate. Our estimate of the production of C. sinicus can be applied for potential comparisons of region-specific copepod production. [ABSTRACT FROM AUTHOR]

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis in China, the Republic of Korea (ROK), and Japan. The presence of the SFTS virus (SFTSV) in companion, livestock, and wild animals has been reported. Recently, human SFTS-like clinical symptoms in cats and cheetahs have been reported in Japan. Therefore, the prevalence of the SFTSV gene or antibody in cats is important for public health as well as veterinary medicine. Materials and Methods: Sera were collected from 201 feral and house cats in the ROK in 2017. Samples were analyzed for the presence of the SFTSV gene after RT-nested PCR amplification and for anti-SFTSV antibodies after enzyme linked immunosorbent assay. Results: Eight (4.0%) and nine (4.5%) of 201 cat sera were found to be positive for the SFTSV gene and anti- SFTSV nucleocapsid protein antibodies, respectively. Specifically, 5.9% feral and 2.0% house cats were positive for the SFTSV gene, and 6.9% feral and 2.0% house cats were positive for anti-SFTSV antibodies. All sequences of the SFTSV S segment obtained were included in Japanese/Korean SFTSV clades, as opposed to the Chinese clade. Conclusions: This study constitutes the first serological study of SFTSV in house and feral cats in the ROK. Evidence of SFTSV in companion animals indicates that SFTSV can circulate in homes and that more intensive precautions and education measures are needed for companion animal guardians and veterinarians. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and Methods: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion: Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered. [ABSTRACT FROM AUTHOR]

Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. Conclusion: Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting. [ABSTRACT FROM AUTHOR]

Background: Although the existence of proteasomes in human blood, termed circulating proteasomes (c-proteasomes), has been reported previously, their origin and pathophysiological functions remain largely unknown.Objective: Given that c-proteasome activity was significantly reduced in Alzheimer's disease model mice and relatively high frequency of mild cognitive impairment (MCI) is accompanied by chronic tinnitus in aged patients, we examined whether c-proteasome activity in human plasma was associated with cognitive function in patients with chronic tinnitus.Methods: c-Proteasome activity in the plasma of tinnitus patients (N = 55) was measured with fluorogenic reporter substrate, suc-LLVY-AMC. To assess MCI, the Montreal Cognitive Assessment was conducted with a cut-off score of 22/23. All patients underwent audiological and psychoacoustic analyses. Levels of c-proteasomes, Aβ42, and Aβ40 were measured using ELISA, and their association with c-proteasome activity was evaluated.Results: The activity of circulating proteasomes was significantly lower in patients with chronic tinnitus and MCI (p = 0.042), whereas activities of other plasma enzymes showed little correlation. In addition, c-proteasome activity was negatively associated with the level of plasma Aβ and was directly dependent on its own concentration in the plasma of patients with chronic tinnitus.Conclusion: Our current work provides a new perspective for understanding the potential relationship between circulating proteasomes in the plasma and cognitive dysfunction, suggesting a novel, non-invasive biomarker in the context of MCI diagnosis. [ABSTRACT FROM AUTHOR]

Cypripedium japonicum is known to be the indigenous plant to Korea, Japan, and China. However, C. japonicum represents the most critically endangered plant species in South Korea. The plant is esthetically pleasing due to its flower, which is larger than any other orchidaceous species. Disease symptoms relating to gray mold were observed on C. japonicum in May 2019. The suspected pathogen was successfully isolated from the symptomatic leaf tissue and conducted a pure culture of the fungi. The conidia formed consisted of a colorless or light brown single cell, which was either egg or oval-shaped with a size of 7.1 to 13.4x5.2 to 8.6 lm. Molecular phylogenetic relationship analysis was also confirmed that the pathogen concerned belonging to the family of Botrytis cinerea. Therefore, the findings confirmed that the pathogen isolated from C. japonicum was consistent with the unique properties of B. cinerea. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate the effects of meteorological factors and air pollutants on out-of-hospital cardiac arrest (OHCA) according to seasonal variations because the roles of these factors remain controversial to date.Methods: A total of 38 928 OHCAs of cardiac origin that occurred within eight metropolitan areas between 2012 and 2016 were identified from the Korean nationwide emergency medical service database. A time series multilevel approach based on Poisson analysis following a Granger causality test was used to analyse the influence of air pollution and 13 meteorological variables on OHCA occurrence.Results: Particulate matter (PM) ≤2.5 µm (PM2.5), average temperature, daily temperature range and humidity were significantly associated with a higher daily OHCA risk (PM2.5: 1.59%; 95% CI: 1.51% to 1.66% per 10µg/m3, average temperature 0.73%, 95% CI: 0.63% to 0.84% per 1°C, daily temperature range: 1.05%, 95% CI: 0.63% to 1.48% per 1°C, humidity -0.48, 95% CI: -0.40 to -0.56 per 1%) on lag day 1. In terms of the impact of these four risk factors in different seasons, average temperature and daily temperature range were highly associated with OHCA in the summer and winter, respectively. However, only PM2.5 elevation (to varying extents) was an independent and consistent OHCA risk factor irrespective of the season.Conclusions: PM2.5, average temperature, daily temperature range and humidity were independently associated with OHCA occurrence in a season-dependent manner. Importantly, PM2.5 was the only independent risk factor for OHCA occurrence irrespective of seasonal changes. [ABSTRACT FROM AUTHOR]