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BACKGROUND: The contribution of the metal components of particulate pollutants to acute respiratory effects has not been adequately evaluated. Moreover, little is known about the effects of genetic polymorphisms of xenobiotic metabolism on pulmonary function. OBJECTIVES: This study was conducted to assess lung function decrement associated with metal components in particulate pollutants and genetic polymorphisms of glutathione S-transferase M1 and T1. METHODS: We studied 43 schoolchildren who were in the 3rd to 6th grades. Each student measured peak expiratory flow rate three times a day for 42 days. Particulate air concentrations were monitored every day, and the concentrations of iron, manganese, lead, zinc, and aluminum in the particles were measured. Glutathione S-transferase M1 and T1 genetic polymorphisms were determined using DNA extracted from participant buccal washings. We used a mixed linear regression model to estimate the association between peak expiratory flow rate and particulate air pollutants. RESULTS: We found significant reduction in the peak expiratory flow rate after the children's exposure to particulate pollutants. The effect was shown most significantly 1 day after exposure to the ambient particles. Manganese and lead in the particles also reduced the peak expiratory flow rate. Genetic polymorphisms of glutathione S-transferase M1 and T1 did not significantly affect peak expiratory flow rate. CONCLUSIONS: This study demonstrated that particulate pollutants and metals such as manganese and lead in the particles are associated with a decrement of peak expiratory flow rate. These effects were robust even with consideration of genetic polymorphisms of glutathione S-transferase. [ABSTRACT FROM AUTHOR]

OBJECTIVE--This study aimed to assess the correlation between abdominal subcutaneous adipose tissue (SAT) and metabolic syndrome (MetS) in Korean adults after adjusting for the effects of visceral adipose tissue (VAT). RESEARCH DESIGN AND METHODS--The SAT/VAT ratio (SVR) was calculated using abdominal computed tomography in 2,655 subjects. We used regression analyses to assess whether the SVR predicted MetS. RESULTS--For both sexes, the prevalence of elevated triglycerides, reduced HDL, and elevated fasting glucose significantly decreased with increasing quintiles of SVR (P for trend < 0.05). The prevalence and odds ratios of MetS significantly decreased as the SVR increased (men: odds ratio 0.5 [95% CI 0.3-0.71; women: 0.2 [0.1-0.5] for comparisons of lowest vs. highest quintile; P for trend < 0.05). CONCLUSIONS--After adjustment for VAT, abdominal SAT was inversely correlated with the occurrence of MetS. [ABSTRACT FROM AUTHOR]

The article discusses the features of the Korean Supreme Court's decision regarding efforts of epidemiologists and others involved in public health to raise awareness of the dangers of smoking. It notes how the decision improved the profitability of selling cigarettes in Korea, how the distinction between specific and non-specific diseases did not bear the weight that the judgment placed on it and a resistance to acknowledge any link between epidemiological evidence and an individual case.

Problem The surge in coronavirus disease 2019 (COVID-19) cases overwhelmed the health system in the Republic of Korea. Approach To help health-care workers prioritize treatment for patients with more severe disease and to decrease the burden on health systems caused by COVID-19, the government established a system to classify disease severity. Health-care staff in city- and provincial-level patient management teams classified the patients into the different categories according to the patients' pulse, systolic blood pressure, respiratory rate, body temperature and level of consciousness. Patients categorized as having moderate, severe and very severe disease were promptly assigned to beds or negative-pressure isolation rooms for hospital treatment, while patients with mild symptoms were monitored in 16 designated facilities across the country. Local setting The case fatality rate was higher in the city of Daegu and the Gyeongsangbuk-do province (1.6%; 124/7756) than the rest of the country (0.5%; 7/1485). Relevant changes From 25 February to 26 March 2020, the ratio of negative-pressure isolation rooms per COVID-19 patient was below 0.15 in the city of Daegu and the Gyeongsangbuk-do province. In the rest of the country, this ratio decreased from 5.56 to 0.63 during the same period. Before the classification system was in place, eight (15.7%) out of the 51 deaths occurred at home or during transfer from home to health-care institutions. Lessons learnt Categorizing patients according to their disease severity should be a prioritized measure to ease the burden on health systems and reduce the case fatality rate. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweight and obesity are well known risk factors of atherosclerotic cardiovascular disease (ASCVD). We aimed to examine the association between body mass index (BMI) and ASCVD over a 23-year follow-up in young adults. We also qualified how much of the effects of obesity on ASCVD were mediated through blood pressure, cholesterol, and glucose. Methods: Data are from the Korean Life Course Health Study, a cohort study of 226,955 Korean young adults aged 20–39. At baseline, the participants undertook routine health assessments where their BMI was measured in 1992–1994; and the metabolic mediators including systolic blood pressure (SBP), fasting serum glucose (FSG), and total cholesterol (TC) were re-measured in 2002–2004. The main outcomes of the study include incident events of ischemic heart disease (IHD), stroke, and ASCVD between 2005 and 2015. Cox proportional model was used to calculate adjusted hazard ratios (HRs) for ASCVD. Results: In both men and women, the direct effect of BMI on ASCVD was greater than the indirect effect. The percentage of excess HR of BMI mediated by all of the metabolic mediators, including SBP, FSG, and TC, was 45.7% for stroke and 18.7% for IHD in men and 27.5% for stroke and 17.6% for IHD in women. Conclusion: High BMI in young adults increases the risk of metabolic mediators in their middle age, and metabolic mediators explain the adverse effects of high BMI on stroke risk than IHD risk.

Background: The prevalence of obesity in children and adolescents is increasing worldwide, which is of concern because obesity can lead to various complications such as metabolic syndrome (MS). Waist circumference (WC) and waist-height ratio (WHtR) are useful indicators of abdominal obesity and MS. In this study, we investigate trends in the prevalence of abdominal obesity and MS using two different references. Methods: Data from the Korea National Health and Nutrition Examination Survey (2007 to 2020) were used. In total, 21,652 participants aged 2 to 18 years and 9,592 participants aged 10 to 18 years were analyzed for abdominal obesity and MS, respectively. The prevalence of abdominal obesity and that of MS were compared using the Korean National Growth Chart in 2007 (REF2007) and the newly published WC and WHtR reference values in 2022 (REF2022). Results: Both WC and WHtR showed an increasing trend. The prevalence of abdominal obesity was 14.71% based on REF2022, 5.85% points higher than that of 8.86% based on REF2007. MS based on REF2022 had a higher prevalence for both the National Cholesterol Education Program definition (3.90% by REF2007, 4.78% by REF2022) and the International Diabetes Federation definition (2.29% by REF2007, 3.10% by REF2022). The prevalence of both abdominal obesity and MS increased over time. Conclusion: The prevalence of abdominal obesity and MS increased in Korean children and adolescents from 2007 to 2020. When analyzed by REF2022, both abdominal obesity and MS showed higher prevalence rates than when using REF2007, indicating that previous reports were underestimated. Follow-up for abdominal obesity and MS using REF2022 is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND Insulin resistance is a core feature of polycystic ovary syndrome (PCOS). Phosphatidylinositol (PI) 3-kinase is an important enzyme in the early insulin signaling cascade and plays a key role in insulin-mediated glucose transport. In its regulatory subunit, p85α, there is a common amino acid substitution (the Met326Ile polymorphism), and this amino acid may be crucial for the function of the p85α regulatory subunit and PI3-kinase. METHODS Analysis of the Met326Ile polymorphism was carried out on DNA samples from 256 PCOS patients and 283 controls. Clinical and biochemical profiles of participants were also compared. RESULTS The genotype distribution of the Met326Ile polymorphism in the PCOS group was not different from that of the controls (Met326Met/Met326Ile/Ile326Ile rates were 73.4%/23.4%/3.2% and 70.3%/26.1%/3.6% for the PCOS and control groups, respectively, P = 0.72). The PCOS group was divided into two subgroups according to the presence of the variant 326Ile allele. Compared with those carrying at least one variant 326Ile allele, carriers with the Met326Met genotype had higher serum 17-hydroxyprogesterone (17-OHP) {1.1 [95% confidence interval (CI) 1.1–1.3] ng/ml in those with the Met326Met genotype versus 0.8 (95% CI 0.7–1.0) ng/ml in those with Ile326Ile and Met326Ile genotypes, P = 0.0073} and free testosterone levels [1.2 (95% CI 1.1–1.4) pg/ml for Met326Met genotype versus 0.9 (95% CI 0.6–1.3) pg/ml for Ile326Ile and Met326Ile genotypes, P = 0.038]. CONCLUSIONS Our results suggest that the PI3-kinase gene Met326Ile polymorphism may not be a major determinant for the development of PCOS, but it may modulate the concentrations of serum 17-OHP or free testosterone in PCOS patients. [ABSTRACT FROM AUTHOR]

Background Patients undergoing hemodialysis are susceptible to sarcopenia. As intracellular reservoirs of water, skeletal muscles are important contributors to intradialytic hypotension. This study was designed to determine the role of skeletal muscle mass in intradialytic hypotension. Methods In a cross-sectional study, the body composition of 177 patients was measured immediately after hemodialysis using bioelectrical impedance analysis. The parameters measured were skeletal muscle mass, intracellular and extracellular water contents, total body water, and cell-membrane functionality (in phase angle at 50 kHz). Data from laboratory tests, chest radiography, measurements of handgrip strength and mid-arm circumference, and questionnaires were collected. The main outcome was intradialytic hypotension, defined as more than two episodes of hypotension (systolic blood pressure of

Purpose This study aimed to provide the clinical characteristics, prognostic factors, and 5-year relative survival rates of lung cancer diagnosed in 2015. Materials and Methods The demographic risk factors of lung cancer were calculated using the KALC-R (Korean Association of Lung Cancer Registry) cohort in 2015, with survival follow-up until December 31, 2020. The 5-year relative survival rates were estimated using Ederer II methods, and the general population data used the death rate adjusted for sex and age published by the Korea Statistical Information Service from 2015 to 2020. Results We enrolled 2,657 patients with lung cancer who were diagnosed in South Korea in 2015. Of all patients, 2,098 (79.0%) were diagnosed with non–small cell lung cancer (NSCLC) and 345 (13.0%) were diagnosed with small cell lung cancer (SCLC), respectively. Old age, poor performance status, and advanced clinical stage were independent risk factors for both NSCLC and SCLC. In addition, the 5-year relative survival rate declined with advanced stage in both NSCLC (82%, 59%, 16%, 10% as the stage progressed) and SCLC (16%, 4% as the stage progressed). In patients with stage IV adenocarcinoma, the 5-year relative survival rate was higher in the presence of epidermal growth factor receptor (EGFR) mutation (19% vs. 11%) or anaplastic lymphoma kinase (ALK) translocation (38% vs. 11%). Conclusion In this Korean nationwide survey, the 5-year relative survival rates of NSCLC were 82% at stage I, 59% at stage II, 16% at stage III, and 10% at stage IV, and the 5-year relative survival rates of SCLC were 16% in cases with limited disease, and 4% in cases with extensive disease. [ABSTRACT FROM AUTHOR]

Background: Abdominal obesity, which is a strong indicator of cardiometabolic risk, is widely evaluated using waist circumference (WC) and waist-height ratio (WHtR). In Korea, the reference values for WC for children and adolescents were published in 2007 and need to be revised. Moreover, there is no reference for WHtR. The aim of this study was to establish new reference values for WC and WHtR in Korean children and adolescents. Methods: Data of 20,033 subjects from the Korea National Health and Nutrition Examination Survey (2007-2019) were used. Tables for reference values and the graphs of smoothed percentile curves of WC and WHtR for children and adolescents aged 2-18 years by sex were generated using the LMS method and locally estimated scatterplot smoothing regression analysis after removing extreme values. Results: Sex-specific reference tables and percentile curves for WC and WHtR were developed. In the new WC curves, the 10th, 50th, and 90th percentile lines were lower than the corresponding lines of the 2007 reference for both sexes. The WHtR curves showed sex-specific differences, although they demonstrated a relative plateau among those aged ≥10 years in both sexes. In the logistic regression analysis, the WC and WHtR z-scores showed higher odds ratios for predicting cardiometabolic risk factors than the body mass index z-score. Conclusion: New WC and WHtR reference values for Korean children and adolescents aged 2-18 years were developed using the latest statistical methods. These references will help monitor and track WC and WHtR for evaluating abdominal obesity among at-risk children and adolescents in Korea. [ABSTRACT FROM AUTHOR]

Lower potassium intake is considered to be correlated with diabetes incidence. However, few studies have investigated the effect of potassium intake on metabolic syndrome (MetS). Data was taken from the Korean National Health and Nutritional Examination Survey (2008-2010) using weighted adjustment. MetS was defined as per the revised National Cholesterol Education Program criteria. Homeostasis model assessment indices were calculated to diagnosis insulin resistance (IR). A total of 16,637 participants (44±0.25 years) were included. Women ingested lower amounts of potassium (2.71±0.02 g/day) than men (3.45±0.03 g/day). A curvilinear association between potassium intake and MetS prevalence was found among women. Women with less than the Adequate Intake (4.7 g/day) of potassium had an 11% risk reduction for MetS (adjusted odds ratio [OR], 0.89; 95% confidence interval [CI], 0.82-0.96; P = 0.004) and a 10% risk reduction for IR (OR, 0.90; 95% CI, 0.82-0.99; P = 0.026) for every 1 g/day potassium increase. Compared with the reference group (3.5-4.5 g/day), potassium intake was inversely associated with an increased risk of MetS (1.5-2.5 g/day; OR, 1.29; 95% CI, 1.02-1.63; P = 0.035; <1.5 g/ day; OR, 1.40; 95% CI, 1.06-1.85; P = 0.017) and IR (<1.5 g/day; OR, 1.36; 95% CI, 1.05-1.76; P = 0.021). This relationship was more prominent in postmenopausal women, but not observed among men. Higher potassium intake is significantly associated with a lower MetS prevalence in women, and IR is believed to be connected. [ABSTRACT FROM AUTHOR]

Objective This study aimed to describe the conceptualization, development, and implementation processes of the newly established Korean Cardiac Arrest Resuscitation Consortium (KoCARC) to improve out-of-hospital cardiac arrest (OHCA) outcomes. Methods The KoCARC was established in 2014 by recruiting hospitals willing to participate voluntarily. To enhance professionalism in research, seven research committees, the Epidemiology and Preventive Research Committee, Community Resuscitation Research Committee, Emergency Medical System Resuscitation Research Committee, Hospital Resuscitation Research Committee, Hypothermia and Postresuscitation Care Research Committee, Cardiac Care Resuscitation Committee, and Pediatric Resuscitation Research Committee, were organized under a steering committee. The KoCARC registry was developed with variables incorporated in the currently existing regional OHCA registries and Utstein templates and were collected via a web-based electronic database system. The KoCARC study population comprises patients visiting the participating hospitals who had been treated by the emergency medical system for OHCA presumed to have a cardiac etiology. Results A total of 62 hospitals volunteered to participate in the KoCARC, which captures 33.0% of the study population in Korea. Web-based data collection started in October 2015, and to date (December 2016), there were 3,187 cases compiled in the registry collected from 32 hospitals. Conclusion The KoCARC is a self-funded, voluntary, hospital-based collaborative research network providing high level evidence in the field of OHCA and resuscitation. This paper will serve as a reference for subsequent KoCARC manuscripts and for data elements collected in the study.

Objective Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. Methods The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. Results and Conclusion Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.

Objective Pulmonary edema is frequently observed after a successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. Currently, its risk factors and prognostic implications are mostly unknown. Methods Adult OHCA patients with a presumed cardiac etiology who achieved sustained return of spontaneous circulation (ROSC) in emergency department were retrospectively analyzed. The patients were grouped according to the severity of consolidation on their initial chest X-ray (group I, no consolidation; group II, patchy consolidations; group III, consolidation involving an entire lobe; group IV, total white-out of any lung). The primary objective was to identify the risk factors of developing severe pulmonary edema (group III or IV). The secondary objective was to evaluate the association between long-term prognosis and the severity of pulmonary edema. Results One hundred and seven patients were included. Total duration of cardiopulmonary resuscitation (CPR) and initial pCO2 level were both independent predictors of developing severe pulmonary edema with their odds ratio (OR) being 1.02 (95% confidence interval [CI], 1.00 to 1.04; per 1 minute) and 1.04 (95% CI, 1.01 to 1.07; per 1 mmHg), respectively. The long term prognosis was significantly poor in patients with severe pulmonary edema with a OR for good outcome (6-month cerebral performance category 1 or 2) being 0.22 (95% CI, 0.06 to 0.79) in group III and 0.16 (95% CI, 0.04 to 0.63) in group IV compared to group I. Conclusion The duration of CPR and initial pCO2 level were both independent predictors for the development of severe pulmonary edema after resuscitation in emergency department. The severity of the pulmonary edema was significantly associated with long-term outcome.

OBJECTIVE: To determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs. METHODS: Cohort study of a 3% random sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010. RESULTS: In primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003-2004 compared to those who did not were 0.58 (95% CI: 0.53-0.63), 0.62 (95% CI: 0.60-0.64), 0.82 (95% CI: 0.78-0.85), 0.84 (95% CI: 0.75-0.93), 0.84 (95% CI: 0.79-0.89), and 0.73 (95% CI: 0.67-0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders. CONCLUSIONS: Participation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs. [ABSTRACT FROM AUTHOR]

Purpose. The one-year effectiveness of transdermal nicotine patches versus placebo patches for smoking cessation based on continuous or sustained abstinence was studied. Methods. A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials up to April 2006 was conducted. Articles containing relevant keywords were reviewed by two evaluators independently. To be consideredfor inclusion in the meta-analysis, studies had to be randomized clinical trials with a transdermal nicotine patch group and a placebo patch group, had to include at least one year of follow-up, had to have abstinence biochemically verified, and had to include the odds ratio (OR) as an outcome measure. Results. Sixteen trials met the selection criteria. The total number of subjects was 9457 (6084 in the nicotine patch group and 3373 in the placebo patch group). The pooled OR for smoking abstinence at one year for the nicotine patch group versus the placebo patch group was 1.79 (95% confidence interval [Cl], 1.55-2.08). The pooled OR for one-year continuous or sustained abstinence for the nicotine patch compared with placebo, excluding four studies reporting only point-prevalence abstinence, was 1.75 (95% Cl, 1.49-2.05). Conclusion. A meta-analysis of trials of transdermal nicotine patch therapy versus placebo for smoking cessation yielded ORs for smoking abstinence of about 1.8 at one year after the start of therapy. ORs were similar whether the endpoint was point-prevalence abstinence, continuous or sustained abstinence, or both. [ABSTRACT FROM AUTHOR]

Purpose: Minimal (< 10 mm thick) pleural effusion (PE) may represent an early phase of malignant PE, but its clinical relevance has rarely been studied. Therefore, we examined the proportion of minimal PE in patients with non-small-cell lung cancer (NSCLC) and its impact on survival. We also considered possible accumulation mechanisms in our data set., Patients and Methods: On the basis of PE status from chest computed tomography scans at diagnosis, 2,061 patients were classified into three groups: no PE, minimal PE, and malignant PE. Twenty-one variables associated with four factors-patient, stage migration, tumor, and treatment-were investigated for correlation with survival., Results: Minimal PE presented in 272 patients (13.2%). Of 2,061 patients, the proportion of each stage was the following: 5.2% stage I, 10.9% stage II, 13.2% stage IIIA, 23.8% stage IIIB, and 13.9% stage IV. Minimal PE correlated significantly with shorter survival time than did no PE (median survival time, 7.7 v 17.7 months; log-rank P < .001), even after full adjustment with all variables (adjusted hazard ratio, 1.40; 95% CI, 1.21 to 1.62). Prognostic impact of minimal PE was higher in early versus advanced stages (Pinteraction = .001). In 237 patients (87.8%) with minimal PE, pleural invasion or attachment as a direct mechanism was observed, and it was an independent factor predicting worse survival (P = .03)., Conclusion: Minimal PE is a commonly encountered clinical concern in staging NSCLCs. Its presence is an important prognostic factor of worse survival, especially in early-stage disease.