Background: The distribution of species and characteristics of non-tuberculous mycobacteria (NTM) differ, and surveillance data for changes in antimicrobial susceptibilities of NTM is insufficient. This study analyzed the changes in antimicrobial susceptibility trends across NTM species and assessed the appropriateness of empirical antimicrobial drugs for NTM. Materials and Methods: We retrospectively analyzed the clinical characteristics, including demographics, distribution of NTM species, antimicrobial drug susceptibilities, and outcomes, at a teaching hospital in Jeju Island from 2009 - 2022. Results: Overall, 342 patients were included in the analysis; 93.0% were classified into the pulmonary group (PG) and 7.0% into the extrapulmonary group (EPG). The isolation rate of Mycobacterium avium was significantly higher in PG (36.8% vs. 0%, P = 0.001), while that of Mycobacterium fortuitum was significantly higher in EPG (4.5% vs.31.3%, P = 0.001). The antimicrobial susceptibility rate is higher against clarithromycin (89.9%) and amikacin (83.3%) and lower against rifampin (54.7%) and ethambutol (28.1%). The susceptibility rate to clarithromycin was over 80%, but those to rifampin and ethambutol showed decreasing annual trends. Of the 162 patients who received empirical antimicrobial therapy, actual antimicrobial susceptibility rates were high (90.1%) using empirical macrolide, and relatively low using ethambutol and rifampin (28.0% and 58.8%, respectively). Conclusion This is the first study of analysis of the distribution, baseline characteristics, and antimicrobial susceptibility of isolated NTM species in pulmonary and extrapulmonary patients in Jeju Island over 10 years. Policies that continuously monitor changes in susceptibility rate are required to ensure effective treatment strategies.

Purpose: We conducted a randomized prospective trial (KLASS-07 trial) to compare laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. In this interim report, we describe short-term results in terms of morbidity and mortality. Methods: and Methods: The sample size was 442 participants. At the time of the interim analysis, 314 patients were enrolled and randomized. After excluding patients who did not undergo planned surgeries, we performed a modified per-protocol analysis of 151 and 145 patients in the LADG and TLDG groups, respectively. Results: The baseline characteristics, including comorbidity status, did not differ between the LADG and TLDG groups. Blood loss was somewhat higher in the LADG group, but statistical significance was not attained (76.76±72.63 vs. 62.91±65.68 mL; P=0.087). Neither the required transfusion level nor the operation or reconstruction time differed between the 2 groups. The mini-laparotomy incision in the LADG group was significantly longer than the extended umbilical incision required for specimen removal in the TLDG group (4.79±0.82 vs. 3.89±0.83 cm; P<0.001). There were no between-group differences in the time to solid food intake, hospital stay, pain score, or complications within 30 days postoperatively. No mortality was observed in either group. Conclusions Short-term morbidity and mortality rates did not differ between the LADG and TLDG groups. The KLASS-07 trial is currently underway.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

OBJECTIVE: Empathy is important in the education of medical students. Many psychosocial variables are related to empathy. The aim of the study was to investigate the relationship between empathy and psychosocial factors such as burnout, personality, self-esteem, and resilience. METHODS: The participants completed a set of self-reporting questionnaires, including questions related to socio-demographic characteristics, the Korean edition of the Jefferson Scale of Empathy, student version (JSE-S-K), Maslach Burnout Inventory General Survey (MBI-GS), NEO Five-Factor Inventory (NEO-FFI), Rosenberg Self-esteem Scale (R-SES), and Connor-Davidson Resilience Scale (CD-RISC). Partial correlation and regression analyses were performed. RESULTS: In male students, there were positive correlations between JSE-S-K and R-SES (r=0.229, p=0.002); conscientiousness of the NEO-FFI (r=0.153, p=0.037) and negative correlations, specifically between JSE-S-K and depersonalization of MBI (r=-0.206, p=0.005). In female students, there was positive correlations between JSE-S-K and personal accomplishment of MBI (r=0.384, p=0.004). In the multiple regression model, the JSE-S-K was affected by conscientiousness of the NEO-FFI (adjusted R² =0.245, β=0.201, p=0.001); depersonalization, personal accomplishment of the MBI-GS (β=-0.188, p=0.001, β=0.143, p=0.017); R-SES (β=0.176, p=0.004); sex (β=0.117, p=0.029). CONCLUSION: The present findings suggested that conscientiousness, depersonalization, personal accomplishment, self-esteem and sex have an influence on empathy. Therefore, these must be considered in medical education and can be helpful to nurture more empathetic doctors.
Cross-Sectional Studies ; Depersonalization ; Education ; Education, Medical ; Empathy ; Female ; Humans ; Male ; Psychology ; Students, Medical

Mycobacterium szulgai is a rare nontuberculous mycobacterium found in Korea. It is an opportunistic pathogen and is usually isolated from patients with a history of alcoholism, chronic pulmonary disease, or an immunocompromising condition. We present here a case of M. szulgai isolated from a patient with a history of pulmonary tuberculosis. A 54-year-old man was admitted with dyspnea and febrile sensation. He had a history of pulmonary tuberculosis which occurred 30 years earlier and treatment with anti-tuberculosis medication. His chest computed tomography scan showed cavitary consolidation in both upper lungs. A sputum acid-fast bacilli (AFB) smear was positive and anti-tuberculous medication was started. However, a polymerase chain reaction for mycobacterium tuberculosis was negative and anti-tuberculous medication was stopped. M. szulgai was isolated on 3 separate sputum and bronchial wash fluid AFB cultures. He was treated with clarithromycin, rifampicin, and ethambutol. After 1 month, a sputum AFB smear and culture became negative and no additional M. szulgai were isolated during a 16-month treatment.
Alcoholism ; Clarithromycin ; Dyspnea ; Ethambutol ; Humans ; Invasive Pulmonary Aspergillosis ; Korea ; Lung ; Lung Diseases ; Middle Aged ; Mycobacterium ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Rifampin ; Sensation ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Though leptin, the adipocytes-derived hormone, plays an important role in obesity, it can act as a growth factor for several cancers including gastrointestinal malignancies. Based on this background, we investigated whether leptin expression correlated with the clinicopathological characteristics or disease outcome in patients with colon cancer. We immunohistochemically analyzed the expression of leptin in a "colon adenoma-carcinoma sequence" in the normal colon mucosa, an adenomatous polyp and adenocarcinoma tissue, from a surgical resection for each patient. METHODS: We collected samples from 24 patients with a colorectal adenocarcinoma that was removed in either a total colectomy or hemicolectomy, and who presented with an adenomoatous polyp and an adenocarcinoma in the same surgical specimen. Leptin expression was assessed using immunohistochemical methods and was evaluated by grading the staining intensity as 0, +1, +2, +3. RESULTS: Whereas leptin expression was observed in 4.2% (1/24) of the normal colon mucosa, adenomatous polyps and adenocarcinomas showed 33.3% (8/24) and 50.0% (12/24) expression of leptin, respectively (p<0.05), suggesting that leptin expression in the adenomatous polyps and adenocarcinomas was higher than in the normal colon mucosa (p<0.05). There was no significant difference in leptin expression between the adenomatous polyps and adenocarcinomas, statistically. There was no relationship between leptin expression and patients age, sex, BMI (body mass index), cancer stage, and lymph node metastasis. However, the tumor size in the positive leptin expression group was larger than in the negative leptin expression group (5.6+/-2.2 cm vs 3.9+/-1.4 cm; p<0.05) CONCLUSIONS: Since leptin expression in adenomatous polyps and adenocarcinomas was higher than in the normal colon mucosa and leptin expression significantly correlated with the tumor size, leptin might play a role in the development of an adenomatous polyp and an adenocarcinoma in the colon. However, leptin does not contribute to the progression of colon adenoma, and further evaluation studies will be required.
Adenocarcinoma* ; Adenoma ; Adenomatous Polyps* ; Colectomy ; Colon* ; Colonic Neoplasms* ; Humans ; Leptin* ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Obesity ; Polyps

PURPOSE: The etiology of febrile seizures is not yet ascertained but it is known that genetic factors, cytokines or trace elements are associated with pathogenesis of febrile seizures. Among them, zinc deficiency is known to play some role of pathogenesis of febrile seizures. We purposed to know the relation between recurrence of febrile seizures and serum zinc level. METHODS: The subjects were recurrent febrile seizures group who were admitted to our hospital from June 2003 to July 2005 because of more than 3 times febrile seizures. The other two control groups were simple febrile seizures and acute febrile illness groups admitted to our hospital in same period. Simple febrile seizures group showed no more seizure over 1 year after first onset. We investigated serum zinc level in each group. RESULTS: The number of patient in each group is 33 children. Recurrent febrile seizures group was composed of 20 boys and 13 girls (the ratio of 1.5:1) with an average age 30 months old. The mean serum zinc levels in the recurrent febrile seizures group (123.7+/-9.6 microgram/dL) were not statistically different from those of the simple febrile seizures group(112.5+/-8.9 microgram/dL). Both of the recurrent and simple febrile seizures groups had significantly lower serum zinc levels than the febrile illness group(154.1+/-6.8 microgram/dL). CONCLUSION: We suggested that serum zinc level is not relationship with recurrence of febrile seizures. Nevertheless, the fact remains that serum zinc level was decreased in recurrent and simple febrile seizures groups compared with acute febrile illness group.
Child ; Child, Preschool ; Cytokines ; Female ; Humans ; Recurrence* ; Seizures ; Seizures, Febrile* ; Trace Elements ; Zinc*