During the Middle East respiratory syndrome (MERS) outbreak in 2015, the Ministry of Health and Welfare (MOHW) of the Republic of Korea provided outbreak information targeting international visitors and foreign residents through multiple channels. The MOHW created a MERS portal website in Korean and English on 10 June 2015; in addition, the existing MOHW website provided English-language press releases beginning 28 May. A toll-free telephone hotline also started service in English on 12 June; it expanded to include 18 other foreign languages on 15 June. This report describes the usage of these multi-language communication channels during this MERS outbreak.

The 2015 Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea, which started with an imported case and spread throughout the country with a total of 186 cases, revealed the vulnerabilities of the health-care system of the country. The situation was compounded by the unique health-care settings in the Republic of Korea, including crowded emergency departments and large numbers of hospital visitors seeking care at multiple hospitals. To assist with the outbreak response, the Ministry of Health and Welfare of the Republic of Korea hosted several international joint missions that provided valuable information and recommendations for MERS control and prevention of future outbreaks. This report briefly summarizes the missions’ outcomes and discusses their positive impacts.

Unenhanced echocardiography (UE), commonly used in veterinary practice, is limited by left ventricular (LV) foreshortening and observer dependency. Contrast echocardiography (CE) was used to compare two-dimensional (2D) LV measurements made using UE and 256-row multi-detector computed tomography (MDCT) as a reference standard. Seven healthy beagle dogs were evaluated in this study. Measurements obtained using CE, including LV wall thickness, internal diameter, and longitudinal and transverse length, were significantly greater than those obtained using UE. Measurements of LV internal dimension in diastole (LVIDd) and systole (LVIDs) were significantly larger with CE compared UE. Regardless of the cardiac cycle, LV longitudinal (LVLd and LVLs) and transverse diameter (LVTDd and LVTDs) measurements were significantly different with CE and approximated values from MDCT. Among automatically calculated parameters, LV end-systolic volume and the relative wall thickness were significantly different between UE and CE. In CE, the correlation coefficients of 4 major parameters (r = 0.87 in LVIDd; 0.91 in LVIDs; 0.87 in LVLd; and 0.81 in LVLs) showed higher values compared to the UE (r = 0.68 in LVIDd, 0.71 in LVIDs, 0.69 in LVLd, and 0.35 in LVLs). Inter-observer agreement was highest for MDCT and higher for CE than UE. In conclusion, CE is more accurate and reproducible than UE in assessing 2D LV measurements and can overcome the limitations of UE including LV foreshortening and high observer dependency.
Animals ; Diastole ; Dogs ; Echocardiography ; Multidetector Computed Tomography ; Systole

Simvastatin reduces plasma cholesterol by inhibiting HMG-CoA reductase (HMGR) and is widely used in the treatment of hypercholesterolemia. To screening the possible genetic factors affecting the pharmacokinetics (PK) of simvastatin, 35 male Korean volunteers were enrolled from two separate bioequivalence studies. Each subject was administered 20 mg simvastatin and reference drug PK parameters were used. We used Illumina Human610Quad v1.0 DNA Analysis BeadChip for whole genome SNPs analysis and whole genome genotyping data was processed by linear regression analysis for PK parameters of drug metabolizing enzymes and transporters. We found 145 significant SNPs (P < 0.01) in C(max), 135 significant SNPs (P < 0.01) in T(max) and 85 significant SNPs (P < 0.01) in AUC(inf) from whole genome analysis. In particular, we found that the ABCC2 gene had a significant effect on C(max) and AUC(inf). These results could provide information of possible candidate genes for personalized simvastatin therapy.
Cholesterol ; DNA ; Genome ; Humans ; Hypercholesterolemia ; Linear Models ; Male ; Mass Screening* ; Oxidoreductases ; Pharmacogenetics ; Pharmacokinetics* ; Plasma ; Polymorphism, Genetic* ; Polymorphism, Single Nucleotide ; Simvastatin* ; Therapeutic Equivalency ; Volunteers

In 2016, 13 topics were selected as major research advances in gynecologic oncology. For ovarian cancer, study results supporting previous ones regarding surgical preventive strategies were reported. There were several targeted agents that showed comparable responses in phase III trials, including niraparib, cediranib, and nintedanib. On the contrary to our expectations, dose-dense weekly chemotherapy regimen failed to prove superior survival outcomes compared with conventional triweekly regimen. Single-agent non-platinum treatment to prolong platinum-free-interval in patients with recurrent, partially platinum-sensitive ovarian cancer did not improve and even worsened overall survival (OS). For cervical cancer, we reviewed robust evidences of larger-scaled population-based study and cost-effectiveness of nonavalent vaccine for expanding human papillomavirus (HPV) vaccine coverage. Standard of care treatment of locally advanced cervical cancer (LACC) was briefly reviewed. For uterine corpus cancer, new findings about appropriate surgical wait time from diagnosis to surgery were reported. Advantages of minimally invasive surgery over conventional laparotomy were reconfirmed. There were 5 new gene regions that increase the risk of developing endometrial cancer. Regarding radiation therapy, Post-Operative Radiation Therapy in Endometrial Cancer (PORTEC)-3 quality of life (QOL) data were released and higher local control rate of image-guided adaptive brachytherapy was reported in LACC. In addition, 4 general oncology topics followed: chemotherapy at the end-of-life, immunotherapy with reengineering T-cells, actualization of precision medicine, and artificial intelligence (AI) to make personalized cancer therapy real. For breast cancer, adaptively randomized trials, extending aromatase inhibitor therapy, and ribociclib and palbociclib were introduced.
Aromatase ; Artificial Intelligence ; Brachytherapy ; Breast Neoplasms ; Diagnosis ; Drug Therapy ; Endometrial Neoplasms ; Female ; Genital Neoplasms, Female ; Humans ; Immunotherapy ; Laparotomy ; Minimally Invasive Surgical Procedures ; Ovarian Neoplasms ; Precision Medicine ; Quality of Life ; Standard of Care ; T-Lymphocytes ; Uterine Cervical Neoplasms

Ten topics were chosen among major clinical research achievements in gynecologic oncology in 2012. For ovarian cancer, comprehensive review of the history of bevacizumab studies was followed by poly adenosine diphosphate [ADP]-ribose polymerase (PARP) inhibitors and other molecular targeted agents such as epidermal growth factor receptor tyrosine kinase inhibitor and AMG 386. For the development of genomic study in gynecologic cancers, BRCA and DICER1 mutations were covered in epithelial and nonepithelial ovarian cancer, respectively. For endometrial cancer, targeted agents including mammalian target of rapamycin (mTOR) inhibitors and bevacizumab were discussed. Radiation therapy "sandwiched" between combination chemotherapy schedules for the treatment of uterine papillary serous carcinoma was also reviewed. Preoperative prediction of lymph node metastasis, definition of low-risk group, and recurrence and survival outcomes of laparoscopic approaches were addressed. For cervical cancer, we reviewed long-term benefit of human papillomavirus test and efficacy of paclitaxel/carboplatin versus paclitaxel/cisplatin in stage IVB, persistent or recurrent disease. In addition, the effect of three dimensional image-based high-dose rate brachytherapy was also reviewed. For vulvar cancer, the diagnostic value of sentinel lymph node biopsy was discussed. For breast cancer, positive results of three outstanding phase III randomized clinical trials, CLEOPATRA, EMILIA, and BOLERO-2 were introduced. Lastly, updates of major practice guidelines were summarized.
Achievement ; Adenosine Diphosphate ; Antibodies, Monoclonal, Humanized ; Appointments and Schedules ; Bevacizumab ; Brachytherapy ; Breast Neoplasms ; Drug Therapy, Combination ; Endometrial Neoplasms ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Nitriles ; Ovarian Neoplasms ; Protein-Tyrosine Kinases ; Pyrethrins ; Receptor, Epidermal Growth Factor ; Recombinant Fusion Proteins ; Recurrence ; Sentinel Lymph Node Biopsy ; Sirolimus ; Uterine Cervical Neoplasms ; Vulvar Neoplasms

In 2014, 9 topics were selected as major advances in clinical research for gynecologic oncology: 2 each in cervical and corpus cancer, 4 in ovarian cancer, and 1 in breast cancer. For cervical cancer, several therapeutic agents showed viable antitumor clinical response in recurrent and metastatic disease: bevacizumab, cediranib, and immunotherapies including human papillomavirus (HPV)-tumor infiltrating lymphocytes and Z-100. The HPV test received FDA approval as the primary screening tool of cervical cancer in women aged 25 and older, based on the results of the ATHENA trial, which suggested that the HPV test was a more sensitive and efficient strategy for cervical cancer screening than methods based solely on cytology. For corpus cancers, results of a phase III Gynecologic Oncology Group (GOG) 249 study of early-stage endometrial cancer with high-intermediate risk factors are followed by the controversial topic of uterine power morcellation in minimally invasive gynecologic surgery. Promising results of phase II studies regarding the effectiveness of olaparib in various ovarian cancer settings are summarized. After a brief review of results from a phase III study on pazopanib maintenance therapy in advanced ovarian cancer, 2 outstanding 2014 ASCO presentations cover the topic of using molecular subtypes in predicting response to bevacizumab. A review of the use of opportunistic bilateral salpingectomy as an ovarian cancer preventive strategy in the general population is presented. Two remarkable studies that discussed the effectiveness of adjuvant ovarian suppression in premenopausal early breast cancer have been selected as the last topics covered in this review.
Biomedical Research/*trends ; Endometrial Neoplasms/drug therapy/pathology/surgery ; Female ; Genital Neoplasms, Female/diagnosis/*therapy ; Humans ; Ovarian Neoplasms/drug therapy/pathology/surgery ; Uterine Cervical Neoplasms/drug therapy/pathology/surgery

Tracheal ultrasonography was performed to measure the width of the tracheal ring shadow and to assess the clinical relevance of these measurements for identifying tracheal collapse. The first tracheal ring width (FTRW) and thoracic inlet tracheal ring width (TITRW) were measured on both expiration and inspiration. The mean of the FTRW width (129 dogs) was greater in expiration (10.97 +/- 1.02 mm, p = 0.001) than that in inspiration (9.86 +/- 1.03 mm). For 51 normal dogs, the mean of the TITRW width was greater in expiration (9.05 +/- 1.52 mm, p = 0.001) than in inspiration (8.02 +/- 1.43 mm). For 78 tracheal collapse dogs, the mean of the TITRW width was greater in expiration (15.89 +/- 1.01 mm, p = 0.001) than in inspiration (14.85 +/- 1.17 mm). The TITRW/FTRW ratio of the normal dogs was higher (p = 0.001) in expiration (0.81 +/- 0.09) than that in inspiration (0.79 +/- 0.10). When compared between the normal and tracheal collapse dogs, the TITRW/FTRW ratio was also increased (p = 0.001) both in expiration (1.54 +/- 0.09) and inspiration (1.47 +/- 0.08), respectively. Based on these results, the cutoff level of the TITRW/FTRW ratio was statistically analyzed according to the receiver operating characteristic curve and it could be set at 1.16 in expiration and at 1.13 in inspiration. We have demonstrated that tracheal ultrasonography is a useful technique for the evaluation of tracheal collapse and it can be a supportive tool together with the radiographic findings for making the correct diagnosis.
Animals ; Dog Diseases/diagnosis/pathology/*ultrasonography ; Dogs ; Female ; Male ; Radiography, Thoracic/*veterinary ; Sensitivity and Specificity ; Trachea/*pathology/radiography ; Tracheal Stenosis/diagnosis/pathology/veterinary

PURPOSE: Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. MATERIALS AND METHODS: We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. RESULTS: We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). CONCLUSION: In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.
Diagnosis ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Propensity Score ; Uterine Cervical Neoplasms

BACKGROUND: Because of their large size and excellent computerized records of illness and services rendered, the importance of national insurance program is getting much attentions from the public health researchers and the national and local health authorities. In reality, however, most health records from medical insurance program suffer very much from inaccurate disease coding, and therefore, they are practically in no use. METHODS: Pattern of incorrect disease coding of 6 Notifiable Acute Communicable Diseases that believed not to have been occurred in Korea lately was reviewed. The reasons of such incorrect codings in different level of medical institutions were studied. This study also attempted to see how an official intervention asking the medical institutions to correct their coding behavior works by comparing the frequencies of incorrect disease coding before and after the intervention. RESULTS: Study results showed that more incorrect disease codings came from clinics than hospitals, and non-physician personnel in clinics and hospitals seemed to be responsible for most of the incorrect disease codings. Most frequent diseases coded incorrectly such as cholera and poliomyelitis were the ones that physicians and non-physician personnel in the clinics and hospitals had been familiar with for a long time period. CONCLUSION: Even a simple official intervention asking the clinics and hospitals to correct their coding behavior was very effective : total number of incorrect disease codings before intervention (398 cases from 144 institutions) dramatically decreased (14 cases from 8 institutions) after intervention. Significant decrease in incorrect disease coding was found more in small institutions such as clinics and public health facilities than large institutions.
Attention ; Cholera ; Clinical Coding* ; Communicable Diseases* ; Insurance* ; Korea ; Poliomyelitis ; Public Health