Despite the availability of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection in Korea, need remains for pangenotypic regimens that can be used in the presence of hepatic impairment, comorbidities, or prior treatment failure. We investigated the efficacy and safety of sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir for 12 weeks in HCV-infected Korean adults. Methods: This Phase 3b, multicenter, open-label study included 2 cohorts. In Cohort 1, participants with HCV genotype 1 or 2 and who were treatment-naive or treatment-experienced with interferon-based treatments, received sofosbuvir–velpatasvir 400/100 mg/day. In Cohort 2, HCV genotype 1 infected individuals who previously received an NS5A inhibitor-containing regimen ≥ 4 weeks received sofosbuvir–velpatasvir–voxilaprevir 400/100/100 mg/day. Decompensated cirrhosis was an exclusion criterion. The primary endpoint was SVR12, defined as HCV RNA < 15 IU/mL 12 weeks following treatment. Results: Of 53 participants receiving sofosbuvir–velpatasvir, 52 (98.1%) achieved SVR12. The single participant who did not achieve SVR12 experienced an asymptomatic Grade 3 ASL/ALT elevation on day 15 and discontinued treatment. The event resolved without intervention. All 33 participants (100%) treated with sofosbuvir–velpatasvir–voxilaprevir achieved SVR 12. Overall, sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir were safe and well tolerated. Three participants (5.6%) in Cohort 1 and 1 participant (3.0%) in Cohort 2 had serious adverse events, but none were considered treatment-related. No deaths or grade 4 laboratory abnormalities were reported. Conclusions: Treatment with sofosbuvir–velpatasvir or sofosbuvir–velpatasvir–voxilaprevir was safe and resulted in high SVR12 rates in Korean HCV patients.

PURPOSE: Peritoneal carcinomatosis (PC) has been considered a terminal condition and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIEPC) is regarded as an alternative therapeutic option. This study aimed to evaluate the 30-day clinical outcomes of CRS/HIPEC and the feasibility of the surgery by investigating the morbidity and mortality in Inje University Hospital.METHODS: Data were retrospectively collected from 19 patients with PC who underwent CRS/HIPEC at Inje University Hospital in 2018. We evaluated pre-, intra-operative parameters and postoperative clinical outcomes and early complications.RESULTS: The mean operating time was 506.95 minutes and the mean blood loss was 837.11 mL. Six cases (31.58%) had morbidity of grade III or above. A longer operating time (≥560 minutes, P=0.038) and large blood loss (≥700 mL, P=0.060) were positively correlated with grade III or worse postoperative complications.CONCLUSION: Our early experience with CRS/HIPEC resulted in a 31.58% morbidity rate of grade III and above, with risk factors being longer operating time and greater intraoperative blood loss. As the surgical team's skills improve, a shorter operating time with less intraoperative blood loss could result in better short-term outcomes of CRS/HIPEC.
Carcinoma ; Drug Therapy ; Humans ; Korea ; Mortality ; Postoperative Complications ; Retrospective Studies ; Risk Factors

OBJECTIVES: This research was carried out to identify the synergistic effect of dexmedetomidine and ketorolac on neuropathic pain alleviation. METHODS: The anti-allodynic effect of intrathecal dexmedetomidine and ketorolac was investigated in rats after L5 spinal nerve ligation (SNL). Mechanical allodynia was assessed using Von Frey filaments. Every day for 3 consecutive days, beginning on the 10th day after SNL, behavioral tests were carried out at 1, 2, and 4 hr after drug injection. RESULTS: Significant increases in ipsilateral paw withdrawal thresholds (PWTs) were observed 1, 2, and 4 hr after drug injection in the groups of rats which received intrathecal injection of either dexmedetomidine (group D) or ketorolac (group K), compared to group S (P < 0.05). And group DK, which received simultaneous intrathecal injection of both dexmedetomidine and ketorolac, showed statistically significantly higher ipsilateral PWTs than groups D and K, which received only one of them (P < 0.05). CONCLUSIONS: The results of this research demonstrated the anti-allodynic effect of dexmedetomidine and ketorolac on neuropathic pain induced by SNL in rats. They also suggest that synergistic analgesia can be induced by the simultaneous injection of dexmedetomidine and ketorolac, and that combination therapy is an effective approach to treating chronic neuropathic pain syndrome.
Analgesia ; Animals ; Behavior Rating Scale ; Dexmedetomidine* ; Hyperalgesia* ; Injections, Spinal ; Ketorolac* ; Ligation* ; Neuralgia ; Rats* ; Spinal Nerves*

The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Cholestasis/epidemiology/etiology ; Demography ; Hepatitis A/complications/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/epidemiology/etiology ; Liver Transplantation ; Middle Aged ; Morbidity ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Young Adult

Erectile dysfunction (ED) is a highly prevalent disorder that affects millions of men worldwide. ED is now considered an early manifestation of atherosclerosis, and consequently, a precursor of systemic vascular disease. This study was designed to investigate the effects of male silkworm pupa powder (SWP) on the levels of nitric oxide synthase (NOS) expression, nitrite, and glutathione (GSH); lipid peroxidation; libido; and erectile response of the corpus cavernosum of the rat penis. We induced ED in the study animals by oral administration of 20% ethanol over 8 weeks. The SWP-treated male rats were divided into 3 groups that were orally administered 200, 400, and 800 mg/kg. The libido of the SWP-administered male rats was higher than that of the ethanol control group. In addition, the erectile response of the corpus cavernosum was restored in males on SWP administration, to a level similar to that of the normal group without ED. The testosterone concentration did not increase significantly. The lipid peroxidation in the corpus cavernosum of the male rats administered SWP decreased significantly. In contrast, compared to the ethanol group, SWP-administered male rats showed increased GSH levels in the corpus cavernosum. The level of nitrite and NOS expression in the corpus cavernosum of SWP-administered male rats increased significantly. These results indicated that SWP effectively restored ethanol-induced ED in male rats.
Administration, Oral ; Animals ; Atherosclerosis ; Bombyx ; Erectile Dysfunction ; Ethanol ; Glutathione ; Humans ; Libido ; Lipid Peroxidation ; Male ; Nitric Oxide Synthase ; Penis ; Pupa ; Rats ; Testosterone ; Vascular Diseases

BACKGROUND: Accurate recognition of stroke victims by ambulance paramedics is necessary to ensure the rapid transfer of these patients to the hospital. We carried out a prospective study to characterize the cause of prehospital delays after stroke by the emergency medical service (EMS) and to determine the accuracy of identifying acute stroke by paramedics. METHODS: All paramedics in the Busan Metropolitan 119 EMS were asked to record the clinical presentations and time intervals from symptom onset to various points along the patients' prehospital course on the ambulance admission sheets for suspected stroke patients during a month (February 1, 2010 to February 28, 2010). Neurologists in twenty four hospitals reviewed the hospital records for the patients who were given a diagnosis of stroke or transient ischemic attack by the paramedics. RESULTS: Of the EMS on-scene evaluations, the diagnosis of stroke by ambulance paramedics was correct for 79 of the 186 (43%) patients. Positive predictive values for main suspected stroke symptoms were 95% in hemiparesis, 88% in speech disturbance and 44% in impaired consciousness. The prehospital personnel transferred the suspected stroke patients to each hospital at a mean of 25 minutes after the emergency 119 call. However, only 62% of the stroke patients called EMS within the first 2 hours of stroke. CONCLUSIONS: Public education for the need to seek EMS promptly after stroke as a medical emergency, and strokespecific training for EMS personnel are essential so that stroke patients receive effective acute treatment.
Allied Health Personnel ; Ambulances ; Consciousness ; Dietary Sucrose ; Emergencies ; Emergency Medical Services ; Hospital Records ; Humans ; Ischemic Attack, Transient ; Paresis ; Prospective Studies ; Stroke

BACKGROUND: There are many causes for the failure of aspirin therapy in patients with acute ischemic stroke. Laboratory aspirin resistance (AR) might be involved in clinical aspirin non-response. The PFA-100 is a laboratory method to evaluate AR in the clinical setting. However, there has been limited data regarding concordance with optical platelet aggregometry, which is considered the gold standard for detecting AR. We retrospectively analyzed platelet function tests using the PFA-100 and an optical platelet aggregometer in 86 patients with acute ischemic stroke. METHODS: Eighty six patients were enrolled in the study and were evaluated the platelet function test by optical aggregometer and a PFA-100. We determined the variability in the prevalence of AR and the kappa value between the two tests in patients with acute ischemic stroke. RESULTS: Among 86 patients, 27 (31.4%) were detected as AR by the optical aggregometer and 31 (36.0%) by the PFA-100. There were 13 cases of AR (15.1%) in both laboratory methods. The optical platelet aggregometer results showed that female gender (P=0.03), aspirin monotherapy (P =0.05), and NIHSS at baseline (P=0.04) were related with AR in acute ischemic stroke. Multiple logistic regression analysis showed that NIHSS was independently associated with AR of the optical platelet aggregometer (OR=1.12 95%, CI: 1.00-1.25, P=0.05). CONCLUSION: The prevalence of AR was similar between the PFA-100 and the optical platelet aggregometer in patients with acute ischemic stroke. However, the concordance rate of these two tools is low.
Aspirin ; Blood Platelets ; Female ; Humans ; Logistic Models ; Platelet Aggregation ; Platelet Function Tests ; Prevalence ; Retrospective Studies ; Stroke

The cause of IgA nephropathy is unknown, but a mesangial deposition of IgA immune complexes containing antigens from a putative pathogen might be involved in its pathogenesis. We report a case of IgA nephropathy associated with disseminated tuberculosis. A 32-year-old man was presented with sudden onset of edema of both lower legs. The chest X-ray revealed extensive active pulmonary tuberculosis in both lung fields. The abdominal CT, cystoscopy and IVP were compatible with renal tuberculosis and tuberculous cystitis. Besides, the colonoscopic findings with biopsy showed tuberculous colitis. The laboratory data revealed a positive culture for tuberculous bacilli from sputum, 2.7 g of 24-hour urinary protein, and microscopic hematuria. A renal biopsy showed mesangial and segmental endocapillary proliferative glomerulonephritis, consistent with IgA nephropathy. Intense positive stainings for IgA and C3 in the mesangium by Immunofluorescence microscopy. Electron microscopic examination demonstrates segmental endocapillary proliferation, necrosis and mesangiolysis with mild mesangial electron-dense deposits. Treatment with anti-tuberculous medications resulted in gradual disappearance of proteinuria and other various manifestations of the disseminated tuberculosis. Therefore we suggest that IgA nephropathy may be associated with active disseminated tuberculosis.
Adult ; Antigen-Antibody Complex ; Biopsy ; Colitis ; Cystitis ; Cystoscopy ; Edema ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Leg ; Lung ; Microscopy, Fluorescence ; Necrosis ; Proteinuria ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Tuberculosis, Renal

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are thought to be associated with increased airway inflammation, and the NF-kappa B is known to be an indicator of cellular activation and of inflammatory mediator production. This study was undertaken to investigate the change of cytokine characteristics and NF-kappa B activity in induced sputum of COPD patients during exacerbation and recovery of the disease. METHODS: Sputum induction was performed in 37 patients with COPD during exacerbation and during recovery and in 15 healthy subjects. Cell counts, levels of IL-6, IL-8 and TNF-alpha in induced sputum and NF-kappa B activity in macrophage of induced sputum were measured. RESULTS: Patients with COPD showed significantly increased levels of IL-6, IL-8 and TNF-alpha(p<0.01) and increased NF-kappa B activity in induced sputum(p<0.05) as compared with control subjects. Level of IL-8 during exacerbation of COPD decreased significantly during recovery(p<0.05). NF-kappa B activity and levels of IL-6 and TNF-alpha tended to be decreased during recovery, but not siginificantly. CONCLUSION: Activation of NF-kappa B and increased levels of IL-6, IL-8 and TNF-alpha were thought to be associated with pathogenesis and exacerbations of COPD.
Cell Count ; Humans ; Inflammation ; Interleukin-6* ; Interleukin-8* ; Macrophages ; NF-kappa B ; Pulmonary Disease, Chronic Obstructive* ; Sputum* ; Tumor Necrosis Factor-alpha*

Gastric MALT lymphoma usually presents with various endoscopic morphologic characteristics. The majority of gross findings reveal multiple and superficial erosions or ulcerations. However gastric MALT lymphoma, presenting as a submucosal tumor, is very rare. We recently experienced a case of low-grade gastric MALT lymphoma, presenting as a submucosal tumor-like lesion without definite mucosal lesion, confirmed by endoscopic mucosal resection. So we report this case with a review of the related literatures.
Lymphoma, B-Cell, Marginal Zone* ; Ulcer