Objectives: We described the trends and epidemiological characteristics of varicella outbreaks from 2016 to 2020 in the Republic of Korea. Methods: We investigated variables such as the outbreak setting, age of patients, vaccination status, and lesion count. The collected data were analyzed with the Cochrane-Armitage trend test and Kruskal-Wallis test. These statistical tests were performed using R ver. 4.0.3. Results: The number of varicella outbreaks increased from 2016 to 2018; however, after a slight decrease in the number of outbreaks in 2019, the number fell sharply in 2020. The median size of outbreaks decreased from 8 to 9 cases during 2016−2019 to 6 cases in 2020. The median duration of outbreaks was 18 days during 2016−2017, 28 days in 2018, 29 days in 2019, and 15 days in 2020. Varicella outbreaks occurred most frequently in elementary schools, and vaccination coverage of patients increased from 89.4% in 2016 to 97.2% in 2019. The median age of patients with outbreak-related varicella decreased from 8 years in 2016 to 6 years in 2020. Conclusion Significant changes were observed in the age of patients with outbreak-related varicella. Ongoing monitoring of varicella outbreaks should be conducted. Further research will be needed to measure the disease burden of varicella and enable evidence-based policy decisions.

BACKGROUND/AIMS: Fibromyalgia (FM) is a common rheumatologic disease characterized by chronic widespread pain, along with various clinical manifestations including atypical autoimmune characteristics. Despite its high prevalence, there remain no approved laboratory tests to identify specific manifestations of FM, or to rule out FM from other rheumatic diseases. Anti-dense fine speckled 70 (anti-DFS70) antibodies were initially identified as a form of anti-nuclear antibodies in a patient with interstitial cystitis. Anti-DFS70 antibodies are found in ≤ 10% of healthy individuals, but have suggestive negative association with autoimmune diseases; however, the clinical significance of these autoantibodies in FM patients remains poorly understood. METHODS: We examined 39 patients with FM, along with 17 patients with systemic lupus erythematosus (SLE), and 19 healthy individuals (HI). Patients were compared based on physical measurements, disease duration, tender point counts, FM Impact Questionnaire (FIQ) scores, visual analog scale (VAS) for pain, somatic symptoms, and anti-DFS70 antibodies. RESULTS: Levels of anti-DFS70 antibodies were significantly higher in the FM and HI groups than in those with SLE. Both anti-DFS70 antibodies and VAS scores were positively correlated with FM. Within the FM group, patients with arthralgia had higher anti-DFS70 antibody values compared to those without arthralgia (p = 0.024); antibody levels were also higher in patients with sleep disturbances relative to those without sleep issues (p = 0.024). In contrast, there were no correlations between anti-DFS70 antibodies and age, body mass index, disease duration, tender point counts, FIQ, short-form health survey results, or other clinical manifestations. CONCLUSIONS Anti-DFS70 antibodies may represent a useful biomarker for differentiating between FM and other autoimmune diseases. The levels of anti-DFS70 antibodies were also significantly higher among patients with arthralgia and sleep disturbances. Further investigations are necessary to evaluate the relationships between anti-DFS70 antibodies and other cytokines as a predictive marker for pain.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) and the associated social distancing, limited freedom, and fear of an uncertain future are expected to have substantial mental health effects. We investigated mental health responses in the community during the first year of the COVID-19 pandemic in Korea. METHODS: We used 2016-2019 and 2020 data from the Korea National Health and Nutrition Examination Survey (KNHANES) to assess pre-pandemic and pandemic mental health status, respectively, in terms of perceived severe stress, depression, and suicidal plans. All analyses were gender-stratified. Pre-specified subgroup analyses were performed according to age, employment status, and household income. RESULTS: The percentage of Korean adults with suicidal plans increased significantly from 1.3%p (95% confidence interval [CI], 1.1 to 1.5) in 2016-2019 to 1.8%p (95% CI, 1.4 to 2.1) in 2020. Individuals in their 20s and 40s showed a marked increase in suicidal plans (1.2%p; 95% CI, 0.0 to 2.3 and 0.9%p; 95% CI, 0.0 to 1.8, respectively). In men, depression and perceived severe stress increased significantly from pre-COVID-19 to 2020. There was a 2.4%p (95% CI, 0.8 to 4.0) increase in depression among standard workers and a 2.9%p increase in depression in individuals in the second-highest quintile of household income from 2016 and 2018 to 2020. CONCLUSIONS As COVID-19 continued, mental health issues such as suicidal plans, depression, and severe stress increased significantly in young men and people in the second-highest quintile of household income. Proactive community mental health efforts are needed to prevent increases in the suicide rate resulting from prolonged exposure to the COVID-19 pandemic.

Background: Measurement of ABO isoagglutinin titers is important for patients who have received an ABO-incompatible organ transplant. Specifically, IgG isoagglutinin is essential for predicting graft outcomes in kidney transplantation, but many laboratories measure only the total isoagglutinin taking into consideration time and labor efficiency. In this study, we propose a useful method for predicting IgG isoagglutinin by analyzing the mathematical relationship between total and IgG isoagglutinin titers. Furthermore, the effects of patients’ characteristics of isoagglutinin were also analyzed. Methods: From January 2017 to April 2022, the results of 3,676 total/IgG isoagglutinin titers of 65 patients who underwent liver and kidney transplantation were analyzed. Isoagglutinin titration was performed using the column agglutination technique with serially diluted serum samples and dithiothreitol was added for measuring IgG isoagglutinin. A generalized estimation equation (GEE) and the Deming regression were used to analyze the relationship and agreement of total/IgG isoagglutinin titers. Results: In A, B, and O types, total isoagglutinin titers were 1.6 (2^67.1×10–2 ), 1.9 (2^95.1×10–2 ), and 2.0 (2^98.5×10–2 ) times higher than IgG isoagglutinin, respectively, and the agreement between the two tests was high in all blood types. The blood types affected total/IgG isoagglutinin titers (P＜0.05, GEE), but age, sex, and the type of transplanted organs did not have a statistically significant effect. Conclusion We concluded that if measuring IgG isoagglutinin titers in ABO-incompatible organ transplant patients is not feasible, the relationship between total and IgG isoagglutinin, viz. total isoagglutinin titers=1.6, 1.9 or 2.0×IgG isoagglutinin for the A, B, and O type blood groups respectively can be used as an auxiliary means of prediction.

OBJECTIVES: This study aimed to analyze the changes in chronic disease management indicators, including hypertension, diabetes mellitus, and hypercholesteremia, from 2010-2020 and before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This study included 58,504 individuals aged ≥30 years who participated in the Korea National Health and Nutrition Examination Survey 2010-2020. Trends in the prevalence, awareness, treatment, and control of chronic diseases and the difference in those between before and during the COVID-19 pandemic were analyzed using the SAS program PROC SURVEYREG. RESULTS: From 2010-2020, the awareness, treatment, and control in adults aged ≥30 years for hypertension and hypercholesterolemia continuously improved, whereas no significant change in the management indicators of diabetes mellitus was observed. The prevalence of hypertension, diabetes mellitus, and hypercholesterolemia in men increased from before to during the COVID- 19 pandemic. However, there was no significant change in the management indicators of hypertension and diabetes mellitus in men and women, and the awareness, treatment, and control rates for hypercholesterolemia increased by 5.5%p, 6.9%p, and 4.1%p respectively. CONCLUSIONS In 2020, the first year of the COVID-19 pandemic, the prevalence of hypertension, diabetes mellitus, and hypercholesterolemia increased, but the management indicators of the chronic diseases did not significantly deteriorate. Considering the ongoing COVID-19 pandemic, it is necessary to monitor changes in chronic disease management indicators and to develop efficient and accessible chronic disease prevention and management programs.

A 31-year-old man presented with a dry cough and exertional dyspnea. The chest X-ray showed multiple nodular opacities throughout the entire lung field. Chest computed tomography (CT) revealed variable-sized nodules with a peribronchiolar or centrilobular distribution, some of which revealed thick-walled cavitary change. Based on the chest CT findings, it was initially assumed that metastatic lung nodules with hematogenous spread were present; therefore, we performed an open lung biopsy. On microscopic examination, several compact cellular interstitial infiltrates composed of Langerhans' cells, eosinophils, and lymphocytes were observed. Immunochemically, the Langerhans' cells showed strong cytoplasmic staining for S-100 protein. Based on these findings, the patient was diagnosed with Langerhans' cell histiocytosis of the lung. High-resolution CT of the chest is a useful, sensitive tool in the diagnosis of pulmonary Langerhans' cell histiocytosis (PLCH). A typical radiologic finding of PLCH is irregularly shaped cysts. The radiological finding in this case of nodular opacities throughout the lung fields only without cysts is rare in PLCH. We report a case of PLCH with atypical multiple nodules mimicking hematogenous metastatic lung nodules.
Adult ; Diagnosis, Differential ; Histiocytosis, Langerhans-Cell/*diagnosis/etiology/pathology/radiography ; Humans ; Lung Neoplasms/*diagnosis/*secondary ; Male ; Radiography, Thoracic ; Tomography, X-Ray Computed

BACKGROUND: Dust clouds blown by the wind from the arid deserts of Mongolia and Northeast China are known as Asian dust storms. Ambient particulate matter with a diameter <10 micrometer (PM(10)) is associated with the exacerbation of respiratory diseases and increased mortality of heart and lung disease patients. The fibrotic effects of PM(10) of Asian dust to pulmonary fibroblast cells are unknown. This study examined the production of reactive oxygen species (ROS), TGF-beta, NF-kappaB, PDGF-alpha and Fibronectin in fibroblasts exposed to Asian dust particles. METHODS: Air samples were collected using a high volume air sampler (Sibata model HV500F) with an air flow of 500 L/min for at least 6 hours. The MRC-5 cells were exposed to 0, 50 and 100 microgram/mL of PM(10) for 24 hours. ROS was detected by measuring the level of oxidized DCF using FACS. TGF-beta, NF-kappaB, PDGF-alpha and fibronectin were detected by western blotting. RESULTS: There was no increase in the ROS, TGF-beta and PDGF-alpha levels in the MRC-5 cells exposed to PM(10). The NF-kappaB level was higher in the MRC-5 cells exposed to 50 and 100 microgram/mL of PM(10) for 24 hours. The fibronectin level in the MRC-5 cells after 24 hours incubation with 50 microgram/mL PM(10) was significantly higher than the control group (PM(10) 50 microgram/mL 113.27+/-8.65 of control, p=0.005). CONCLUSION: PM(10) from Asian dust increases the activation of NF-kappaB and fibronectin expression in MRC-5 fibroblast cells.
Asian Continental Ancestry Group ; Blotting, Western ; China ; Dust ; Fibroblasts ; Fibronectins ; Heart ; Humans ; Lung Diseases ; Mongolia ; NF-kappa B ; Particulate Matter ; Pulmonary Fibrosis ; Reactive Oxygen Species ; Transforming Growth Factor beta ; Wind

BACKGROUND: Delayed hypersensitivity plays a large role in the pathogenesis of tuberculous pleural effusion (TPE). Macrophages infected with live Mycobacterium tuberculosis (MTB) increase the levels of adenosine deaminase2 (ADA2) in the pleural fluid of TPE patients. However, it is as yet unclear whether ADA2 can be produced by macrophages when challenged with MTB antigens alone. This study therefore evaluated the levels of ADA2 mRNA expression, using monocyte-derived macrophages (MDMs) stimulated with MTB antigens. METHODS: Purified monocytes from the peripheral blood mononuclear cells of healthy volunteers were differentiated into macrophages using granulocyte-macrophage colony-stimulating factor (GM-CSF) or macrophage colony-stimulating factor (M-CSF). The MDMs were stimulated with early secretory antigenic target protein 6 (ESAT6) and culture filtrate protein 10 (CFP10). The mRNA expression levels for the cat eye syndrome chromosome region, candidate 1 (CECR1) gene encoding ADA2 were then measured. RESULTS: CECR1 mRNA expression levels were significantly higher in MDMs stimulated with ESAT6 and CFP10, than in the unstimulated MDMs. When stimulated with ESAT6, M-CSF-treated MDMs showed more pronounced CECR1 mRNA expression than GM-CSF-treated MDMs. Interferon-γ decreased the ESAT6- and CFP10-induced CECR1 mRNA expression in MDMs. CECR1 mRNA expression levels were positively correlated with mRNA expression of tumor necrosis factor α and interleukin 10, respectively. CONCLUSION: ADA2 mRNA expression increased when MDMs were stimulated with MTB antigens alone. This partly indicates that pleural fluid ADA levels could increase in patients with culture-negative TPE. Our results may be helpful in improving the understanding of TPE pathogenesis.
Adenosine Deaminase* ; Adenosine* ; Animals ; Cats ; Granulocyte-Macrophage Colony-Stimulating Factor ; Healthy Volunteers ; Humans ; Hypersensitivity, Delayed ; Interleukin-10 ; Macrophage Colony-Stimulating Factor ; Macrophages* ; Monocytes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Pleural Effusion ; RNA, Messenger* ; Tumor Necrosis Factor-alpha

BACKGROUND: The facilitator effects of steroids on neuromuscular transmission may cause resistance to neuromuscular blocking agents. Additionally, steroids may hinder sugammadex reversal of neuromuscular blockade, but these findings remain controversial. Therefore, we explored the effect of dexamethasone and hydrocortisone on rocuronium-induced neuromuscular blockade and their inhibitory effect on sugammadex. METHODS: We explored the effects of steroids, dexamethasone and hydrocortisone, in vitro using a phrenic nerve-hemidiaphragm rat model. In the first phase, an effective dose of rocuronium was calculated, and in the second phase, following sugammadex administration, the recovery of the train-of-four (TOF) ratio and T1 was evaluated for 30 minutes, and the recovery index was calculated in dexamethasone 0, 0.5, 5, and 50 μg/ml, or hydrocortisone 0, 1, 10, or 100 μg/ml. RESULTS: No significant effect of steroids on the effective dose of rocuronium was observed. The TOF ratios at 30 minutes after sugammadex administration were decreased significantly only at high experimental concentrations of steroids: dexamethasone 50 μg/ml and hydrocortisone 100 μg/ml (P < 0.001 and P = 0.042, respectively). There were no statistical significances in other concentrations. No differences were observed in T1. Recovery index was significantly different only in 100 μg/ml of hydrocortisone (P = 0.03). CONCLUSIONS Acute exposure to steroids did not resist the neuromuscular blockade caused by rocuronium. And inhibition of sugammadex reversal on rocuronium-induced neuromuscular blockade is unlikely at typical clinical doses of dexamethasone and also hydrocortisone. Conclusively, we can expect proper effects of rocuronium and sugammadex when dexamethasone or hydrocortisone is used during general anesthesia.

Background/Aims: The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested.This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy. Methods: We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR. Results: A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001). Conclusions The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.