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To track stepwise changes in genetic diversity and antimicrobial resistance in rapidly evolving OXA-232-producing Klebsiella pneumoniae ST14, an emerging carbapenem-resistant high-risk clone, in clinical settings. Twenty-six K. pneumoniae ST14 isolates were collected by the Korean Nationwide Surveillance of Antimicrobial Resistance system over the course of 1 year. Isolates were subjected to whole-genome sequencing and MIC determinations using 33 antibiotics from 14 classes. Single-nucleotide polymorphism (SNP) typing identified 72 unique SNP sites spanning the chromosomes of the isolates, dividing them into three clusters (I, II and III). The initial isolate possessed two plasmids with 18 antibiotic-resistance genes, including bla OXA-232 , and exhibited resistance to 11 antibiotic classes. Four other plasmids containing 12 different resistance genes, including bla CTX-M-15 and strA/B , were introduced over time, providing additional resistance to aztreonam and streptomycin. Moreover, chromosomal integration of insertion sequence Ecp1 - bla CTX-M-15 mediated the inactivation of mgrB responsible for colistin resistance in four isolates from cluster III. To the best of our knowledge, this is the first description of K. pneumoniae ST14 resistant to both carbapenem and colistin in South Korea. Furthermore, although some acquired genes were lost over time, the retention of 12 resistance genes and inactivation of mgrB provided resistance to 13 classes of antibiotics. We describe stepwise changes in OXA-232-producing K. pneumoniae ST14 in vivo over time in terms of antimicrobial resistance. Our findings contribute to our understanding of the evolution of emerging high-risk K. pneumoniae clones and provide reference data for future outbreaks. Image 1 [ABSTRACT FROM AUTHOR]

Background and purpose: We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation. Methods: The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K‐ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31 days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence. Results: Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9 ± 8.3 years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA2DS2‐VASc score were not significantly different between patients with and without recurrent stroke. Conclusions: A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the association between periodontal disease status and metabolic syndrome (MetS) and its individual components in Korean adults over 50 years old. Material and Methods: In the Dong‐gu study, 5078 men and women aged over 50 years were included. They underwent a questionnaire survey, physical assessment, biochemical assessment and periodontal assessment. The percentages of sites with periodontal probing depth ≥4 mm, and clinical attachment loss ≥4 mm were recorded for each participant. Periodontal disease was also classified by the Centers for Disease Control and Prevention/American Academy of Periodontology definition of periodontitis and the American Academy of Periodontology definition (1999). MetS was defined by the 2009 guidelines of the International Diabetes Federation. This study used multivariate negative binominal regression analysis to assess the association between the severity of periodontitis and MetS, after age, smoking habits, alcohol consumption and physical activity related factors were adjusted for. Results: Prevalence of MetS was 32.3%, 36.2% and 45.9% among men with no or mild, moderate and severe periodontitis, respectively. The severity of periodontitis was positively associated with the prevalent MetS in men but not in women. In men, severe periodontitis showed a higher risk of MetS than those with no or mild periodontitis (relative risk 1.43, 95% confidence interval 1.17‐1.73) after adjusting for confounders. Periodontal probing depth was positively associated with the prevalence of MetS in both genders. In the analysis separated by individual MetS components, periodontitis severity was positively associated with hypertriglyceridemia and low high‐density lipoprotein cholesterol in men, while positively associated with low high‐density lipoprotein cholesterol and abdominal obesity in women. Conclusion: Increasing the severity of periodontitis was associated with the risk of prevalent MetS in Korean adults. This result confirmed that periodontal inflammation might be a contributive factor of MetS. [ABSTRACT FROM AUTHOR]

Aims The purpose of this study was to identify gender differences in chewing discomfort among elderly Koreans. Methods This study used data from 56 616 (weighted sample: 5 638 394) subjects aged over 65 years who participated in the 2011 Community Health Survey in Korea. Of them, 23 059 (weighted sample: 2 368 200, 42.0%) were men and 33 357 (weighted sample: 3 270 194, 58.0%) were women. Data were analysed using chi-square tests and hierarchical logistic regression analyses, with SPSS 20.0. Chewing discomfort was set as the dependent variable, and independent variables were divided into socio-economic factors (place of residence, age, education, monthly household income, basic living security stipend, private insurance, economic activity, living arrangements), general health factors (hypertension, diabetes) and oral health factors (tooth defects, denture use, subjective periodontal health status). Results A greater proportion of women (50.2%) than men (42.6%) exhibited chewing discomfort ( P < 0.001). In men, place of residence, monthly household income, private health insurance, tooth defects and periodontal health were associated with chewing discomfort ( P < 0.05). In women, age, education level, basic living security stipend and denture use were associated with chewing discomfort ( P < 0.05). Conclusions Elderly Korean women experience more severe chewing discomfort than their male counterparts. The factors associated with chewing also differ by gender. [ABSTRACT FROM AUTHOR]

The largest epidemic of foot-and-mouth disease ( FMD) in Korea since the first record in 1911 occurred between November 2010 and April 2011. The outbreak was confirmed in 153 farms, and more than three million animals were destroyed. This study presents the temporal and spatial distribution patterns, epidemiological investigation and the control measures for the 2010/2011 epidemic in Korea. The index case of this 2010/2011 FMD epidemic was reported in a pig-farming complex with five piggeries in Andong, GyeongBuk Province, on 28 November 2010, and the outbreak lasted 145 days. The largest number of new detection of the infected farms per day was recorded in mid-January. Epidemiological investigation revealed that the FMD virus had spread from farm to farm through routine movements associated with animal husbandry operations. In contrast to FMD epidemics in other countries in which movement of the infected animals largely contributed to the spread of the disease, human behaviours were major factors in the spread of the FMD virus in the Korean epidemic. The 2010/2011 epidemic was first confirmed in a local small and medium city where share of smallholder producers is higher than that of other provinces. Although Korea had a well-developed emergent response system with the experience of controlling infection and re-obtaining FMD-free status after the previous epidemics, Korea was prompted to revise their contingency plan by tailoring it to its unique livestock environment. Practical contingency plans tailored to Korea for control of FMD can be fully effective when farmers, livestock-related agencies, veterinary service providers and the general public work together. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the prevalence of carotid artery calcification (CAC) detected on panoramic radiographs and peripheral arterial disease (PAD), and to evaluate the difference in the prevalence of PAD between patients with CAC and patients without CAC detectable by panoramic radiograph. Methods: The surveyed population consisted of 4078 subjects aged 50 years and older (1410 males and 2668 females) who underwent medical and dental examination in Gwangju city, South Korea. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. A trained research technician measured the ankle-brachial index (ABI). An ABI <0.9 in either leg was considered evidence of PAD. Results: The prevalence of CAC on panoramic radiographs was 6.2% and that of PAD was 2.6%. Subjects with CAC had a significantly higher prevalence of PAD than those without CAC (5.5% vs 2.4%, respectively). The presence of CAC on panoramic radiographs was associated with PAD (odds ratio 1.84; 95% confidence interval 1.01-3.36) after adjusting for potential confounders. Conclusion: CACs detected on panoramic radiographs were positively associated with PAD in middle-aged and older Korean adults. [ABSTRACT FROM AUTHOR]

We reviewed the clinical signs of the foot-and-mouth disease (FMD) incidences in the Republic of Korea occurring from November 2010 to April 2011. Profuse salivation, vesiculation, lameness or ataxia, and ulceration were the most commonly observed clinical signs of FMD among the infected animals, irrespective of the species. The clinical signs of FMD manifested more clearly in the dairy cattle and pigs compared to the beef cattle, deer and goats on infected farms. About 54% of the infected dairy farms reported vesicles on the teats as the primary clinical sign, while vesiculation on the nose, including the snout and muzzle, was the major lesion observed in infected beef cattle and pig farms. The teat and feet were the second most frequently vesiculated body parts on infected pigs. Although the average age of the first-to-appear clinical lesion in the animals in the beef and dairy cattle farms subjected to vaccination was higher than that observed in the animals in the farms not subjected to vaccination, a reverse pattern was observed in the pig farms. In this study, the clinical signs of FMD were described on the basis of the subjective observations by the farm workers. The present results highlight the clinical signs expected on specific body parts of different types of susceptible animals, and therefore, they may be useful for generating public awareness, particularly among farm workers, as well as for early detection of future FMD outbreaks. [ABSTRACT FROM AUTHOR]

In order to better understand the characteristics of atmospheric carbonaceous aerosol at a background site in Northeast Asia, semicontinuous organic carbon (OC) and elemental carbon (EC), and time-resolved water-soluble organic carbon (WSOC) were measured by a Sunset OC/ EC and a PILS-TOC (particle-into-liquid sampler coupled with an online total organic carbon) analyzer, respectively, at the Gosan supersite on Jeju Island, Korea, in the summer (May 28-June 17) and fall (August 24-September 30) of 2009. Hourly average OC concentration varied in the range of approximately 0.87-28.38 µgC m-3, with a mean of 4.07 ± 2.60 µgC m-3, while the hourly average EC concentration ranged approximately from 0.04 to 8.19 µgC m-3, with a mean of 1.35 ± 0.71 µgC m-3, from May 28 to June 17, 2009. During the fall season, OC varied in the approximate range 0.9-9.6 µgC m-3, with a mean of 2.30 ± -0.80 µgC m-3, whereas EC ranged approximately from 0.01 to 5.40 µgC m-3, with a mean of 0.66 ± 0.38 µgC m-3. Average contributions of EC to TC and WSOC to OC were 26.0% ± 9.7% and 20.6% ± 7.4%, and 37.6% ± 23.5% and 57.2% ± 22.2% during summer and fall seasons, respectively. As expected, clear diurnal variation of WSOC/OC was found in summer, varying from 0.22 during the nighttime up to 0.72 during the daytime, mainly due to the photo-oxidation process. In order to investigate the effect of air mass pathway on the characteristics of carbonaceous aerosol, 5-day back-trajectory analysis was conducted using the HYSPLIT model. The air mass pathways were classified into four types: Continental (CC), Marine (M), East Sea (ES) and Korean Peninsula (KP). The highest OC/EC ratio of 3.63 was observed when air mass originated from the Continental area (CC). The lowest OC/EC ratio of 0.79 was measured when air mass originated from the Marine area (M). A high OC concentration was occasionally observed at Gosan due to local biomass burning activities. The contribution of secondary OC to total OC varied approximately between 8.4% and 32.2% and depended on air mass type. [ABSTRACT FROM AUTHOR]

Clinicians sometimes experience treatment failure in the initial empirical antibiotics treatment using cephalosporins in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Enterococcus, which is intrinsically resistant to cephalosporins, may be one of the causes of treatment failure. The aim of this study was to evaluate the clinical importance and the clinical characteristics of spontaneous enterococcal peritonitis (SEP). This was a retrospective cohort study of 359 patients with SBP treated in a single tertiary care center in South Korea from January 2000 through December 2004. We evaluated the clinical manifestation and the treatment results of SBP patients with enterococci identified from ascites culture. During the observation period, 13 of 359 patients (3.6%) diagnosed with culture-positive SBP had enterococcal peritonitis. For the initial empirical treatment, third-generation cephalosporins were administered to the 13 patients, ten of whom (76.9%) did not improve in the first 48 h. An in vitro antibiotic sensitivity test showed that the identified enterococci were susceptible to ampicillin plus gentamycin in eight patients (61.5%) and there was no vancomycin-resistant enterococcus. Although antibiotics were changed to antienterococcal antibiotics in 11 patients, only five patients improved. As a result, eight of the 13 patients (61.5%) with enterococcal SBP died during the observation period, and the one-month mortality was significantly higher from enterococcal SBP than from nonenterococcal SBP ( P = 0.038). We conclude that enterococcal SBP has poor prognosis and it is reasonable to use antienterococcal antibiotics when enterococcus is identified from ascites culture of patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

To understand patients' perceptions of clinical trials (CTs) is the principal step in the enrollment of patients to CTs. However, these perceptions in eastern countries are very rare. From 12 February 2007 to 13 April 2007, we consecutively distributed the questionnaire to 842 cancer patients who initiated a first cycle of chemotherapy regardless of each treatment step in the Seoul National University Hospital. Younger age, higher educational degree, higher economic status, and possession of private cancer insurance were related with significantly higher awareness of CTs (P=0.001, P=0.006, P=0.002, and P=0.009, respectively). However, unlike awareness, perceptions on benefits of CTs were not changed according to age, educational degree, and economic status (P=0.709, P=0.920, and P=0.847, respectively). Willingness was also not changed according to age, educational degree, economic status, and private cancer insurance (P=0.381, P=0.775, P=0.887, and P=0.392, respectively). Instead, males and heavily treated patients had more positive perceptions on benefits (P=0.002 and P=0.001, respectively) and more willingness to participate in CTs (OR=1.17, 1.14-2.75: OR=1.59, 1.01-2.51, respectively). In summary, cancer patients' awareness of CTs, perceptions on the benefit in CTs, and willingness to participate are differently influenced by diverse medical and social conditions. This information would be very helpful for investigators to properly conduct CTs in eastern cancer patients. [ABSTRACT FROM AUTHOR]

The article addresses impacts on beef exporting nations of the privatization of beef importation in South Korea. A model of beef imported through the simultaneous buy-sell system (SBS), differentiated by countries of origin and the specific SBS importing firms, is estimated based on firm-specific monthly import and price data for the period of 1995 through 1999. The econometric model focuses on the source preferences of importers. The results suggest that Korean import demand for U.S. beef is highly price-inelastic.

Summary¶Daily global and diffuse radiation measurements have been used to characterize the atmosphere optical conditions at Kwangju (Lat.35.13N, Long.126.53E) and Seoul (Lat.37.57N, Long.126.98E) in South Korea and Ile-Ife (Lat.7.14N, Long.4.56E) in Nigeria. The clearness index, (CI) which gives the percentage depletion by the sky of the incoming global radiation and the diffuse ratio, (DR) which represents the effectiveness of the sky in scattering incoming radiation have been analyzed in this study. Results show an average clearness index value of 0.57 for the year 1999 with maximum values occurring during the wet seasons at Ile-Ife. The average clearness indexes for Kwangju and Seoul from 1998–2000 was 0.48 and 0.34, respectively, with both stations having maximum clearness indexes in the winter seasons. The diffuse ratio was higher at Kwangju and Seoul than at Ile-Ife due to heavy dust pollution from the Gobi desert in the Korea peninsula in spring, and high biomass burning at Kwangju in the fall. [ABSTRACT FROM AUTHOR]

Presents polymerase chain reaction amplification and sequence analysis of irido-like virus infecting fish in South, Korea. Report of large-scale mortality among cultured fishes; Revelation of two groups of virus; Presence of slight variation in the DNA sequences among virus strains.

Although there have been growing concerns about the adverse effects of air pollution on preterm birth, little is known about whether air pollutants contribute to preterm birth. This study aims to evaluate the association between prenatal exposure to air pollutants and preterm birth.We obtained birth data in Seoul between January 1, 1998 and December 31, 2000 from the Korean National Birth Register. The last menstrual period and ultrasound assessment were used to estimate gestational age. Preterm birth was defined as less than 37 weeks completed gestation. Using the air pollution data, we estimated the exposure during each trimester and also during each month of pregnancy on the basis of the gestational age and birth date of each newborn. Both of logistic regression analysis in SAS and generalized additive logistic regression analyses in SPLUS were conducted considering infant sex and order, parental age, marriage status, parity, live birth, maternal occupation, educational level of father and season.Using logistic regression model, the adjusted odds ratio (AOR) of an interquartile range (IQR) of PM10 for preterm birth was 1.06 (95% CI, 0.97-1.15) in third trimester. The highest risk for PM10 was observed in 7 month (OR = 1.07, 95% CI = 1.01-1.14). The monthly analyses suggested that the risks for preterm birth tended to increase with PM10 exposure between the sixth and ninth months of pregnancy. Using generalized additive model (GAM), we observed similar results with logistic regression model. However, the effect size from GAM was larger than that from logistic regression.We found that prenatal exposure to PM10 was associated with preterm birth. The monthly analyses suggested that exposure to PM10 during mid to late pregnancy contributes to risks for preterm birth. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied. METHODS: In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes. RESULTS: A total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the highertarget group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P=0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups. CONCLUSIONS: After an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.). [ABSTRACT FROM AUTHOR]