Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Spinal muscular atrophy (SMA) is an autosomal recessive disease characterized by progressive proximal muscle weakness and atrophy. Given the recent introduction of gene therapies, knowledge of the SMA carrier frequency in various populations has become important for developing screening programs for this disease. In total, 1,581 anonymous DNA samples from an umbilical cord blood bank were tested for SMN1 and SMN2 gene copies using a multiplex ligation-dependent probe amplification assay. Twenty-nine of the 1,581 newborns [1.83%; 95% confidence interval (CI), 1.25–2.66%] were SMA carriers with one copy of SMN1, and no homozygous SMN1 deletion was detected. The carrier frequency in this population was estimated to be 1,834 per 100,000 (95% CI, 1,254–2,659) or 1 in 55 (95% CI, 1/79–1/38). Our data indicate that SMA carriers are not uncommon in the Korean population and may serve as a reference for designing a population screening program in Korea.

PURPOSE: The tertiary lymphoid structure (TLS) is an important source of tumor-infiltrating lymphocytes (TILs), which have a strong prognostic and predictive value in triple-negative breast cancer (TNBC). A previous study reported that the levels of CXCL13 mRNA expression were associated with TLSs, but measuring the gene expression is challenging in routine practice. Therefore, this study evaluated the MECA79-positive high endothelial venule (HEV) densities and their association with the histopathologically assessed TLSs in biopsy samples. In addition, the relationship of TLSs with the CXCL13 transcript levels and clinical outcomes were examined. MATERIALS AND METHODS: A total of 108 TNBC patients treated with neoadjuvant chemotherapy (NAC) were studied. The amounts of TILs and TLSs were measured histopathologically using hematoxylin and eosin–stained slides. The HEV densities and TIL subpopulations were measured by immunohistochemistry for MECA79, CD3, CD8, and CD20. CXCL13mRNA expression levels using a NanoString assay (NanoString Technologies). RESULTS: The mean number of HEVs in pre-NAC biopsies was 12 (range, 0 to 72). The amounts of TILs and TLSs, HEV density, and CXCL13 expression showed robust correlations with each other. A lower pre-NAC clinical T stage, higher TIL and TLS levels, a higher HEV density, CD20-positive cell density, and CXCL13 expression were significant predictors of a pathologic complete response (pCR). Higher CD8-positive cell density and levels of CXCL13 expression were significantly associated with a better disease-free survival rate. CONCLUSION: MECA79-positive HEV density in pre-NAC biopsies is an objective and quantitative surrogate marker of TLS and might be a valuable tool for predicting pCR of TNBC in routine pathology practice.
Biomarkers ; Biopsy ; Cell Count ; Disease-Free Survival ; Drug Therapy ; Gene Expression ; Hematoxylin ; Humans ; Immunohistochemistry ; Lymphocytes, Tumor-Infiltrating ; Pathology ; Polymerase Chain Reaction ; Prognosis ; RNA, Messenger ; Triple Negative Breast Neoplasms* ; Venules*

OBJECTIVES: The aim of this study is to develop Treatment Guidelines for Alcohol Use Disorder-the Korean Addiction Treatment Guidelines-using the Adaptation method. METHODS AND PROCEDURES: As the Adaptation method of Guidelines, the ADAPTE Manual, which is developed by ADAPTE collaboration is applied. In Part 1 : preparatory work prior to the beginning of Adaptation is performed. In Part 2 : the core phase of the Adaptation in which we searched the guidelines and performed a systematic review of the literature. The two guidelines (of the AU and the UK) are selected by gone through the methodological quality and currency evaluation for guidelines. And, in order to choose the proper recommendations, the contents were evaluated with regard to the applicability and acceptability of guidelines to the domestic. Finally, in Part 3 : the adapted guideline is reviewed externally, with review and plan update. Therefore, in this way, the Korean Guidelines for Treatment of Alcohol Use Disorder, comprised of 55 recommendations, was developed. CONCLUSION: In this study, Korean Guidelines for Treatment of Alcohol Use Disorder were developed by application of the Adaptation method of ADAPTE. These are the first evidence-based Korean Guidelines for Treatment of Alcohol Use Disorder, which were modified and accepted in accordance with Korean circumstances within the range not damaging the validity of the treatment worth, and it is expected to contribute to improvement in quality and efficiency enhancement of Korean treatment of Alcohol Use Disorder.
Cooperative Behavior

BACKGROUND/AIMS: Benign colon 18F-fluorodeoxyglucose (FDG) uptake is frequently observed in asymptomatic individuals. Aims of this study were to investigate the benign colon uptake by whole body FDG-positron emission tomography (PET) in asymptomatic adults and to correlate those results with colonoscopic and histologic findings. METHODS: Among 3,540 subjects who had undergone FDG-PET, 43 subjects who were diagnosed to have benign colon uptake in FDG-PET and underwent colonoscopy were retrospectively reviewed. Subjects were classified as diffuse or focal groups based on their FDG uptake patterns. PET results were analyzed together with colonoscopic and histologic findings. RESULTS: Forty-three subjects showed benign colon uptake in FDG-PET; 28 of them were shown as the diffuse group, while other 15 subjects were classified as the focal group. Five subjects among those showed diffuse uptake were diagnosed as adenoma. Seven among 15 subjects who showed focal uptake were diagnosed as adenocarcinoma (n=2), adenoma (n=3), or non-neoplastic polyp (n=2). Positive predictive values were 25% in the diffuse group and 47% in the focal group. CONCLUSIONS: We recommend that patients showing benign FDG uptake in the colon should be further evaluated by colonoscopy, especially for patients with focal FDG uptake.
Adenocarcinoma ; Adenoma ; Adult ; Colon ; Colonoscopy ; Fluorodeoxyglucose F18 ; Humans ; Polyps ; Retrospective Studies

BACKGROUND/AIMS: It has been known that elderly patients with gastric cancer show worse general condition and higher comorbidities. Therefore, few elderly patients undergo surgery. This study was designed to determine clinicopathological characteristics of gastric cancer in elderly patients and evaluate their survival improvements by the surgical treatment. METHODS: Gastric cancer patients, diagnosed at Ewha Womans University Mokdong Hospital between 2000 to 2004, were divided into two groups those aged > or =65 years vs. <65 years. Clinicopathological characteristics, incidence of postoperative complications, and survival time of patients in each group were analyzed. RESULTS: Total 370 patients were subjected and divided into the elderly and the younger group (55.4% vs. 44.6%). The elderly group showed higher incidences of hypertension and cardiovascular disease. Well differentiated adenocarcinoma was more frequently found in the elderly group (19.0% vs. 10.0%, p=0.025). There were no differences of operation time (242.6+/-70.7 vs. 257.3+/-83.8 min, p=0.115), postoperative hospital stays (15.8+/-10.6 vs. 14.7+/-9.8 days, p=0.361), and incidence of any complications (6.7% vs. 9.9%, p=0.309) between the two subgroups. The significant factors related with the elderly patient's survival were the tumor-node-metastasis (TNM) stage (stage I, hazard ratio [HR] 1.00; stage II, HR 1.28, 95% confidence interval [CI] 0.44-3.72; stage III, HR 4.06, 95% CI 2.08-7.92, stage IV, HR 9.78, 95% CI 4.97-19.26;p<0.001) and the treatment modality (laparoscopy, HR 1.00; open surgery, HR 3.90, 95% CI 2.43-6.26;p<0.001). The elderly patients who underwent gastric cancer surgery showed prolonged survival on TNM stage I, II, and III than those who were treated conservatively. CONCLUSIONS: In the elderly patients with gastric cancer, those who had received surgical treatments showed significantly higher survival rate than those who had treated conservatively. Therefore, aggressive surgical treatments should be seriously considered even for the elderly patients with gastric cancer.
Adenocarcinoma/mortality/*pathology/surgery ; Adult ; Aged, 80 and over ; *Aging ; Carcinoembryonic Antigen/analysis ; Cardiovascular Diseases/complications/epidemiology ; Female ; Humans ; Hypertension/complications/epidemiology ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms/mortality/*pathology/surgery

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) may contribute to the development of sleep disturbance, which may, in turn, provoke or worsen GERD. We evaluated the prevalence of GERD, non-erosive reflux disease (NERD), and extra-esophageal syndrome in subjects with self-reported sleep disturbance. METHODS: Subjects presenting for a health check-up were enrolled. Valid self-administered questionnaires provided information about reflux symptoms and sleep disturbances. We defined insomnia as self-reported sleep disturbance that occurred at least twice a week. GERD was defined as at least weekly symptoms of heartburn or acid regurgitation. Factors affecting sleep disturbance were revealed by a logistic regression analysis. RESULTS: We recruited 1,701 subjects (men 57.5%; mean age 45.0 +/- 15.0 years). The prevalence of sleep disturbance was 16.3%. GERD was reported in 14.8% of the subjects with insomnia and 7.1% of controls (p < 0.001). The prevalence of NERD was 13.7% in subjects with insomnia and 6.2% in controls (p < 0.001). The prevalence of extra-esophageal symptoms was higher in the insomniacs than controls. There was a significant correlation between the number of extra-esophageal symptoms and the frequency of sleep disturbance. Multivariate analysis showed that having GERD, NERD, extra-esophageal symptoms, and high depression and anxiety scores were predictors of sleep disturbance. CONCLUSIONS: The prevalence of GERD is higher in subjects with sleep disturbance. The number of extra-esophageal symptoms was correlated with the severity of poor sleep quality, regardless of the presence of erosive change. These findings have therapeutic implications for GERD, NERD, and extra-esophageal syndrome in patients with sleep disturbance, and future trials are warranted.
Anxiety ; Depression ; Gastroesophageal Reflux ; Heartburn ; Humans ; Logistic Models ; Multivariate Analysis ; Prevalence ; Surveys and Questionnaires ; Sleep Initiation and Maintenance Disorders

BACKGROUND/AIMS: Attempts to increase colonoscopy withdrawal time have been the topic of several recent publications. We assessed whether the real-time measurement of withdrawal time affected the withdrawal time and polyp detection rate. METHODS: Real-time colonoscopy withdrawal time was measured in 197 subjects in a study group and 184 subjects comprised a control group without real-time measurements. Colonoscopies were performed by four endoscopy specialists and three fellows during their first year of training. Withdrawal time, clinical features, bowel preparation, and polyp detection rates were comparatively analyzed. RESULTS: No significant differences in age, gender, bowel preparation, or polyp history were found in the two groups. Withdrawal time was significantly higher in the study group than that in the control group when a fellow performed the withdrawal. However, polyp detection rate did not significantly increase in the study group, regardless of physician. CONCLUSIONS: Real-time measurement of colonoscopy withdrawal time did not increase polyp detection rate, but the withdrawal time was significantly higher when a fellow performed the withdrawal phase than when a specialist performed withdrawal. Therefore, the real-time measurement of colonoscopy withdrawal time seems to be a useful tool for fellow training.
Colonoscopy ; Endoscopy ; Polyps ; Quality Control ; Specialization

Infectious esophagitis usually occurs in immunocompromised patients with AIDS, malignancy and those receiving immunosuppresive therapy. Common pathogens causing esophagitis include Candida, Herpes simplex virus and Cytomegalovirus. However simultaneous esophageal infection with both Candida and Herpes simplex virus has rarely been reported. The endoscopic findings of Herpes simplex esophagitis combined with Candida infection does not show typical findings due to diffuse whitish or yellowish plaques; hence, accurate diagnosis can be delayed. We observed concomitant infection of Herpes simplex virus and Candida causing esophagitis in a 45-year-old renal transplant patient who had been receiving immunosuppressive therapy. The patient showed marked reductions in clinical symptoms and in endoscopic findings after anti-fungal and acyclovir therapy.
Acyclovir ; Candida ; Cytomegalovirus ; Esophagitis ; Herpes Simplex ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Methylmethacrylates ; Middle Aged ; Polystyrenes ; Simplexvirus ; Transplants