Objectives: . This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. Methods: . The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. Results: . The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. Conclusion . RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Background/Aims: Plug-assisted retrograde transvenous obliteration (PARTO) is widely used to manage gastric varices with a portosystemic shunt. It is not clear whether portal pressure and the incidence of complications increase after PARTO. The aim of this study was to determine the changes in portal pressure and the associated changes in liver func-tion, ascites, hepatic encephalopathy, and especially esopha-geal varix (EV) after PARTO. Methods: From March 2012 to February 2018, 54 patients who underwent PARTO were analyzed retrospectively. The parameters collected included liver function and episodes of cirrhotic complications before and at 1 and 6 months after PARTO. Results: The analysis of 54 patients showed improvement in liver function during the 6-month follow-up period (Model for End-Stage Liver Disease score: change from 11.46±4.35 to 10.33±2.96, p=0.021).Among these 54 patients, 25 patients were evaluated for their hepatic venous pressure gradient (HVPG) before and after PARTO (change from 12.52±3.83 to 14.68±5.03 mm Hg; p<0.001). Twenty-five patients with portal pressure mea-sured before and after PARTO were evaluated for risk factors affecting liver function improvement and EV deterioration. No factor associated with portal pressure was affected by liver function improvement. Post-PARTO portal pressure was a risk factor affecting EV deterioration (HVPG-post: odds ratio, 1.341; 95% confidence interval, 1.017 to 1.767; p=0.037). Conclusions The artificial blockade of the portosystemic shunt evidently leads to an increase in HVPG. Liver function was improved over the 6-month follow-up period. Portal pres-sure after PARTO was a significant risk factor for EV deterioration. Portal pressure measurement is helpful for predicting the patient’s clinical outcome.

BACKGROUND/AIMS: This study was conducted to clarify the sustained virological response (SVR) prediction ability of baseline and treatment-related factors in patients with chronic hepatitis C virus (HCV) infection. METHODS: This retrospective study collected data at four tertiary referral hospitals between June 2004 and July 2012. Out of 476 patients, 330 treatment-naïve patients with chronic HCV infection were recruited. Pegylated interferon α-2a/-2b plus ribavirin was administered for either 24 or 48 weeks depending on the HCV genotype. The baseline and treatment-related predictive factors of SVR were evaluated by analyzing data measured before treatment (i.e., baseline) and during treatment. RESULTS: SVR rates for genotypes 1 and 2 were 63% (97/154) and 79.5% (140/176), respectively (p = 0.001). Multivariate analysis for baseline factors revealed that young age (p = 0.009), genotype 2 (p = 0.001), HCV RNA level of < 800,000 IU/mL (p < 0.001), and a baseline platelet count of > 150 × 10³/µL (p < 0.001) were significant SVR predictors, regardless of the genotype. In particular, predictive accuracy for achievement of SVR was 87.3% for a baseline platelet count of > 150 × 10³/µL. In multivariate analysis for treatment-related factors, SVR was associated with achievement of a rapid virological response (RVR; p < 0.001), treatment adherence of ≥ 80/80/80 (p < 0.001). CONCLUSIONS Young age, genotype 2, low HCV RNA level, RVR, and treatment adherence were significantly associated with SVR. In addition, platelet count was an independent predictive factor for SVR. Therefore, platelet count could be used to develop individualized treatment regimens and to optimize treatment outcomes in patients with chronic HCV infection.

PURPOSE: To study the usefulness of the procalcitonin (PCT) test in young febrile infants between 1 and 3 months of age. METHODS: We evaluated the medical records of 336 febrile infants between 1 and 3 months of age who visited the Emergency Department or outpatient department of Samsung Changwon Hospital from May 2015 to February 2017, and analyzed the clinical characteristics between infants in the serious bacterial infection (SBI) group and non-SBI group. RESULTS: Among the 336 infants, 38 (11.3%) had definitive SBI (bacteremia, n=3; meningitis, n=1; urinary tract infection, n=34). The mean PCT (6.4±11.9 ng/mL) and C-reactive protein (CRP) level (3.8±2.6 mg/dL), and the absolute neutrophil count (ANC) (6,984±4,675) for patients in the SBI group were significantly higher than those for patients in the non-SBI group (PCT, 0.3±1.2 ng/mL; CRP, 1.3±1.6 mg/dL; ANC, 4,888±3,661). PCT had lower sensitivity (43.6%), but higher specificity (92.6%) and accuracy (86.9%) than CRP (92.3%, 25.3%, and 33.0%) for identifying SBI. The area under the receiver operating characteristic curves (AUCs) for definitive SBI were PCT 77.0%, CRP 80.8%, WBC 56.8%, ANC 67.8%, and PLT 48.1%. The AUCs for definitive SBI were PCT+CRP 85.4%, PCT+WBC 77.2%, PCT+ANC 81.3%, CRP+WBC 80.1%, and CRP+ANC 81.6%. CONCLUSION: Our results suggest that the PCT test or a combination of PCT and CRP tests is a more accurate and specific biomarker to detect and rule out SBIs.
Area Under Curve ; Bacterial Infections ; C-Reactive Protein ; Emergency Service, Hospital ; Fever ; Gyeongsangnam-do ; Humans ; Infant* ; Medical Records ; Meningitis ; Neutrophils ; Outpatients ; ROC Curve ; Sensitivity and Specificity ; Urinary Tract Infections

We performed a nationwide epidemiological study to evaluate the prevalence and characteristics of nocturnal enuresis (NE) in Korean adolescents and adults. A questionnaire was sent via e-mail to 51,073 people aged 16-40 yr by stratified sampling according to age, sex, and region among a 200,000 internet survey panel pool. The questionnaire included following information; presence or absence of NE, frequency of NE, possible risk factors for NE, self-esteem scale score and depression score results, and measures for the treatment of NE. Among the 2,117 responders, 54 (2.6%) had NE (> or =1 enuretic episode within 6 months). Of 54 bedwetters, 9.3% wet > or =1 night per week and 20.5% wet > or =1 per month. The prevalence rates remained relatively stable with no apparent trend of reduction with age. The presence of sleep disturbance, family history, urgency, or urge incontinence increased the probability of NE episode significantly. The self-esteem score was lower (P=0.053) and the depression scale score was higher (P=0.003) in bedwetters compared with non-bedwetters. Overall 2.6% of Korean aged 16-40 yr have NE. The higher rate of urgency and urge incontinence in adolescent and adult enuretics suggests that bladder function has an important role in adolescent and adult NE.
Adolescent ; Adult ; Cross-Sectional Studies ; Female ; Humans ; Male ; Nocturnal Enuresis/*epidemiology ; Prevalence ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors ; Sleep Disorders ; Urinary Incontinence/epidemiology ; Young Adult

PURPOSE: Lactobacilli are probiotic bacteria that are effective in the management of allergic diseases or gastroenteritis. It is hypothesized that such probiotics have immunoregulatory properties and promote mucosal tolerance. Our goal was to investigate whether Lactobacillus casei rhamnosus Lcr35 could inhibit airway inflammation in an ovalbumin (OVA)-induced murine model of asthma. METHODS: BALB/c mice aged 6 weeks were used in the present study. Lactobacillus casei rhamnosus Lcr35 was administered daily, starting 1 week prior to the first OVA sensitization (group 1) and 2 days before the first 1% OVA airway challenge (group 2). Mice that received only saline at both sensitization and airway challenge time points were used as negative controls (group 3), and those that had OVA-induced asthma were used as positive controls (group 4). Airway responsiveness to methacholine was assessed, and bronchoalveolar lavage (BAL) was performed. At the endpoint of the study, total IgE as well as OVA-specific IgE, IgG1 and IgG2a in serum was measured by enzyme-linked immunosorbent assay. Lung pathology was also evaluated. RESULTS: Airway hyperresponsiveness, total cell counts and the proportion of eosinophils in BAL fluid were significantly decreased in group 1 compared with group 4 (P<0.05). Total serum IgE levels were also significantly decreased in group 1 compared with group 4. Serum levels of OVA-specific IgE, IgG1 and IgG(2a) were not significantly influenced by treatment with Lcr35. There was significantly less peribronchial and perivascular infiltration of inflammatory cells in group 1 compared with group 4; however, there were no significant differences in methacholine challenge, BAL, serology or histology between groups 2 and 4. CONCLUSIONS: Oral treatment with Lcr35 prior to sensitization can attenuate airway inflammation and hyperreactivity in a mouse model of allergic airway inflammation. These results suggest that Lcr35 may have potential for preventing asthma.
Aged ; Animals ; Asthma ; Bacteria ; Bronchoalveolar Lavage ; Cell Count ; Disease Models, Animal ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Gastroenteritis ; Humans ; Immunoglobulin E ; Immunoglobulin G ; Inflammation ; Lactobacillus ; Lactobacillus casei ; Lactobacillus rhamnosus ; Lung ; Methacholine Chloride ; Mice ; Ovalbumin ; Ovum ; Primary Prevention ; Probiotics

PURPOSE: With increasing frequency, Yersinia enterocolitica is being recognized as an important bacterial cause of acute gastrointestinal infection with abdominal pain. In addition, the association of Y. enterocolitica infections with acute appendicitis has been suggested. This study was undertaken to ascertain whether Y. enterocolitica is a possible infectious agent in acute appendicitis. METHODS: Between December 2007 and April 2008, 162 patients who underwent appendectomy for presumed appendicitis, enrolled in this prospective study. After surgical excision of appendix, a portion of each specimen was cultured for Y. enterocolitica with highly selective media (Cefsulodin-Irgasan-Novobiocin agar). RESULTS: Pathologically, 150 of the patients had appendicitis and 12 patients had normal appendices. Only one of the 150 patients (0.7%) with appendicitis was found to be culture positive for Y. enterocolitica, while it was not detected from normal appendices. CONCLUSION: The authors were unable to implicate Y. enterocolitica as a major pathogen in acute appendicitis within the Seoul area. However, we thought there to be more need for investigation for association of Y. enterocolitica with acute appendicitis over a broader area and season.
Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Humans ; Prospective Studies ; Seasons ; Yersinia ; Yersinia enterocolitica

Since the development of sophisticated molecular carriers such as octereotides for peptide receptor targeting and monoclonal antibodies against various antigens associated with specific tumor types, radionuclide therapy (RNT) employing open sources of therapeutic agents is promising modality for treatment of tumors. Furthermore, the emerging of new therapeutic regimes and new approaches for tumor treatment using radionuclide are anticipated in near future. In targeted radiotherapy using peptides and other receptor based carrier molecules, the use of radionuclide with high specific activity in formulating the radiopharmaceutical is essential in order to deliver sufficient number of radionuclides to the target site without saturating the target. In order to develop effective radiopharmaceuticals for therapeutic applications, it is crucial to carefully consider the choice of appropriate radionuclides as well as the carrier moiety with suitable pharmacokinetic properties that could result in good in vivo localization and desired excretion. Up to date, only a limited number of radionuclides have been applied in radiopharmaceutical development due to the constraints in compliance with their physical half-life, decay characteristics, cost and availability in therapeutic applications. In this review article, we intend to provide with the improved understanding of the factors of importance of appropriate radionuclide for therapy with respect to their physical properties and therapeutic applications.
Antibodies, Monoclonal ; Compliance ; Half-Life ; Peptides ; Radioisotopes* ; Radiopharmaceuticals ; Radiotherapy ; Receptors, Peptide

PURPOSE: Recently established in 1997, Sungkyunkwan University School of Medicine was the first medical school in Korea to adopt problem-based learning (PBL) as a core curriculum from the very beginning. The purpose of this study was to evaluate the PBL curriculum from the viewpoint of the medical students. METHODS: This study used a qualitative approach to understand students' perceptions of the positive aspects of PBL. A total of 22 second-year medical students at Sungkynkwan medical school were surveyed. Student perceptions were obtained from questionnaires and face-to-face interviews. The interview was designed to evoke more personal and in-depth responses. RESULTS: Students' perceptions of the effects of PBL were found to be very favorable. Most students showed positive responses on the issues of more active learning attitude, self-directed learning, motivation to study, improved problem solving, and integrated learning. CONCLUSION: The results of this study demonstrated that the students had a good understanding of PBL and experienced its positive aspects of PBL approach. It might be concluded that PBL was successfully implemented into the curriculum and specific and expected effects of PBL accomplished.
Curriculum* ; Evaluation Studies as Topic* ; Humans ; Korea ; Learning ; Motivation ; Problem Solving ; Problem-Based Learning* ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

BACKGROUND: Since the introduction of HAART (Highly Active Anti-Retroviral Therapy), metabolic com- plications have been reported with varying prevalence. We performed a retrospective study to evaluate the incidence and risk factors of metabolic complications arising in Korean HIV/AIDS patients. MATERIALS AND METHODS: 66 HIV positive patients on combination therapy between 1998 June to 2002 June with at least 1 protease inhibitor (PI) or/and Non-nucleoside reverse transcriptase inhibitors (NNRTI) were reviewed. Hyperglycemia was defined as serum glucose >140 mg/dL on 2 or more occasions; diabetes as any random serum glucose >200 mg/dl; hypercholesterolemia as serum cholesterol >240 mg/dL; hypertriglyceridemia as serum triglyceride >200 mg/dL. We used SPSS version 9.0 for statistical analysis. One way ANOVA was used to compare the treatment groups. Multinominal logistic regression analysis was used for risk factor analysis. RESULTS: 66 patients were analyzed and total duration of follow up was 138 patient-years. The incidence of metabolic complication was 20.3%. Incidence of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, and diabetes were 12.3%, 5.8%. 1.4%, 4.3% respectively. On risk factor analysis, factors contributing to the development of metabolic complication were age>35 years (P= 0.020) and baseline serum triglyceride >140 mg/dL (P=0.001). Baseline CD4 count <170/mm3 (P= 0.054) and use of stavudine >6 months (P=0.055) were associated with development of metabolic complications with borderline significance. CONCLUSION: The incidence of metabolic complication among Korean HIV/AIDS patients receiving HAART is 20.3%. Older age and high baseline triglyceride were risk factors for development of metabolic complications.
Antiretroviral Therapy, Highly Active ; Blood Glucose ; CD4 Lymphocyte Count ; Cholesterol ; Follow-Up Studies ; HIV ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hypertriglyceridemia ; Incidence ; Logistic Models ; Prevalence ; Protease Inhibitors ; Retrospective Studies ; Reverse Transcriptase Inhibitors ; Risk Factors ; Stavudine ; Triglycerides