Objective: To evaluate the efficacy and safety of Daewoong botulinum toxin type A (NABOTA) after its launch in South Korea. Methods: This prospective, multicenter, open-label phase IV clinical trial included 222 patients with stroke. All patients visited the clinic at baseline and at weeks 4, 8, and 12 after injection of upto 360 units of NABOTA into the wrist, elbow, and finger flexor muscles at the first visit. The primary outcome was the change in Modified Ashworth Scale (MAS) score for the wrist flexor muscles between baseline and week 4. The secondary outcomes were the changes in MAS, Disability Assessment Scale (DAS), and Caregiver Burden Scale (CBS) scores between baseline and each visit, and the Global Assessment Scale (GAS) score at week 12. Results: There was a statistically significant decrease in the MAS score for the wrist flexors between baseline and week 4 (-0.97±0.66, p<0.001). Compared with baseline, the MAS, DAS and CBS scores improved significantly during the study period. The GAS was rated as very good or good by 86.8% of physicians and by 60.0% of patients (or caregivers). The incidence of adverse events was 14.4%, which is smaller than that in a previous trial. Conclusion NABOTA showed considerable efficacy and safety in the management of upper limb spasticity in stroke patients.

Background: Previous studies have reported an association between pneumonia risk and the use of certain drugs. We investigated the relationship between antihypertensive drugs and pneumonia in the general population. Methods: This case-crossover study utilized the nationwide data of South Korea. We included participants who were hospitalized for pneumonia. A single case period was defined as 30 days before pneumonia onset, and two control periods were established (90–120 and 150–180 days before pneumonia onset). Further, we performed sensitivity and subgroup analyses (according to the presence of diabetes, documented disability, and whether participants were aged ≥ 70 years). We used conditional logistic regression models adjusted for covariates, such as angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), other antihypertensives, statins, antipsychotics, benzodiazepine, and the number of outpatient visits. Results: In total, 15,463 subjects were included in this study. ACE inhibitors (adjusted odds ratio [aOR], 0.660; 95% confidence interval [CI], 0.558–0.781), ARBs (aOR, 0.702; 95% CI, 0.640–0.770), and other antihypertensive drugs (aOR, 0.737; 95% CI, 0.665–0.816) were significantly associated with reduced pneumonia risk. Subgroup analyses according to the presence of diabetes mellitus, documented disability, and whether participants were aged ≥ 70 years consistently showed the association of antihypertensives with a reduced risk of hospitalization for pneumonia. Conclusion All antihypertensive drug types were related to a lower risk of hospitalization for pneumonia in the general population. Our results implied that frequent medical service usage and protective immunity were primarily related to a reduced risk of pneumonia in the general population of South Korea.

Background: Early-onset dementia (EOD) is still insufficiently considered for healthcare policies. We investigated the effect of socio-environmental factors on the long-term survival of patients with EOD. Methods: This retrospective cohort study utilized the Korean National Health Insurance Database from 2007 to 2018. We enrolled 3,825 patients aged 40 to 65 years old with all types of dementia newly diagnosed in 2009 as EOD cases. We defined socioeconomic status using the national health insurance premium (NHIP) levels. Residential areas were classified into capital, metropolitan, city, and county levels. All-cause mortality was the primary outcome. Kaplan-Meier curves and log-rank tests were employed. Further, Cox-proportional hazards models were established. Results: The mean survival of the fourth NHIP level group was 96.31 ± 1.20 months, whereas that of the medical-aid group was 85.53 ± 1.30 months (P < 0.001). The patients living in the capital had a mean survival of 95.73 ± 1.34 months, whereas those living in the county had 89.66 ± 1.75 months (P = 0.035). In the Cox-proportional hazards model, the medical-aid (adjusted hazard ratio [aHR], 1.67; P < 0.001), first NHIP level (aHR, 1.26; P = 0.012), and second NHIP level (aHR, 1.26; P = 0.008) groups were significantly associated with a higher long-term mortality risk. The capital residents exhibited a significantly lower long-term mortality risk than did the county residents (aHR, 0.82; P = 0.041). Conclusion Socioeconomic status and residential area are associated with long-term survival in patients with EOD. This study provides a rational basis for establishing a healthcare policy for patients with EOD.

Purpose: The effect of prebiotics intake after administration of a synbiotics mixture (a probiotic, Bifidobacterium longum, and a prebiotic, xylooligosaccharide containing sugar [XOS]) on human intestinal microflora and defecation characteristics was investigated in a randomized controlled trial. Methods: Twenty-five healthy young volunteers (11 males and 14 females) were randomly assigned to 2 groups (BL2XO2 and BL2XO6). The synbiotics mixture was orally administered to both groups for 2 weeks, and the prebiotics were subsequently administered to the BL2XO6 group for 4 additional weeks. The daily dose of the synbiotics mixture comprised 1010 colony-forming unit of Bifidobacterium longum and 10 g of XOS, and during the prebiotics period, the daily dose of prebiotics comprised only 10 g of XOS. The fecal pH, microflora, and defecation characteristics were analyzed at baseline and at weeks 1, 2, 4, and 6. Results: The counts of B. longum and Bifidobacterium spp. in the BL2XO6 group exhibited a steady, increasing trend during the synbiotics and prebiotics periods, whereas those of the BL2XO2 group exhibited considerable variation in each week of the study period. Although there was no significant difference, the counts of fecal Bifidobacterium in the BL2XO6 group tended to be higher than those of the BL2XO2 group at week 6. The growth of Lactobacillus spp. exhibited a time-dependent variation, peaking at week 6 in both groups. Low counts of Clostridium spp. were observed after treatment with the synbiotics and prebiotics in the BL2XO6 group (p < 0.05) throughout the study, whereas the inhibitory effect on Clostridium spp. was maintained only during the synbiotics period in the BL2XO2 group. The defecation characteristics did not differ between the two groups. Conclusion Administration of XOS after a synbiotics mixture containing B. longum and XOS can exert a prebiotic effect in healthy young volunteers by stimulating Bifidobacteriun spp.growth and inhibiting growth of Clostridium spp.

PURPOSE: Dexrazoxane has been used as an effective cardioprotector against anthracycline cardiotoxicity. This study intended to analyze cardioprotective efficacy and secondary malignancy development, and elucidate risk factors for secondary malignancies in dexrazoxane-treated pediatric patients. MATERIALS AND METHODS: Data was collected from 15 hospitals in Korea. Patients who received any anthracyclines, and completed treatment without stem cell transplantation were included. For efficacy evaluation, the incidence of cardiac events and cardiac event-free survival rates were compared. Data about risk factors of secondary malignancies were collected. RESULTS: Data of total 1,453 cases were analyzed; dexrazoxane with every anthracyclines group (D group, 1,035 patients) and no dexrazoxane group (non-D group, 418 patients). Incidence of the reported cardiac events was not statistically different between two groups; however, the cardiac event-free survival rate of patients with more than 400 mg/m2 of anthracyclines was significantly higher in D group (91.2% vs. 80.1%, p=0.04). The 6-year cumulative incidence of secondary malignancy was not different between both groups after considering follow-up duration difference (non-D, 0.52%±0.37%; D, 0.60%±0.28%; p=0.55). The most influential risk factor for secondary malignancy was the duration of anthracycline administration according to multivariate analysis. CONCLUSION: Dexrazoxane had an efficacy in lowering cardiac event-free survival rates in patients with higher cumulative anthracyclines. As a result of multivariate analysis for assessing risk factors of secondary malignancy, the occurrence of secondary malignancy was not related to dexrazoxane administration.
Anthracyclines ; Cardiotoxicity ; Dexrazoxane ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Neoplasms, Second Primary ; Risk Factors* ; Stem Cell Transplantation

OBJECTIVES: This study aimed to compare the quality of life reported by patients with attention-deficit/hyperactivity disorder (ADHD) to the patients' quality of life as reported by their caregivers. In addition, it aimed to examine how emotional problems, including depression and anxiety, and the severity of the symptoms affect the quality of life reported by the patients and their caregivers. METHODS: The patients' quality of life and their degree of depression and anxiety were measured using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Child Self-Report, the Children's Depression Inventory (CDI), and the Revised Children's Manifest Anxiety Scale, respectively. The caregivers' perception of the patients' quality of life and severity of the ADHD symptoms were measured using the PedsQL 4.0 Parent Proxy Report and the Conners' Parent Rating Scale (CPRS), respectively. A total of 66 participants completed the survey. The independent-samples t-test, Pearson's correlation analysis, and multiple regression analysis were conducted. RESULTS: The mean score of the PedsQL 4.0 Child Self-Report was significantly higher than the mean score of the PedsQL 4.0 Parent Proxy Report. However, for school function, the PedsQL 4.0 Child Self-Report score was significantly lower than that of Parent Proxy Report. The correlation between the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores was significant only for emotional function and social function. The multiple regression analysis showed that the PedsQL 4.0 Child Self-Report and PedsQL 4.0 Parent Proxy Report scores were significantly predicted by the CDI and CPRS scores, respectively. CONCLUSION: Our results demonstrate that there are clear differences between the quality of life reported by the patient themselves and that reported by their caregivers. In addition, the findings suggest that it is critical to treat the patients' accompanying depressive symptoms.
Adolescent ; Anxiety ; Cardiopulmonary Resuscitation ; Caregivers ; Child ; Depression ; Humans ; Manifest Anxiety Scale ; Parents ; Proxy ; Quality of Life

PURPOSE: We evaluate the influence of the types of coffee beverage on obesity and abdominal obesity in Korean adults who were aged 19 years or over by using the 2013 ~ 2016 Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: Specific questions were asked about frequency of coffee intake, the type of coffee beverage, the addition of milk and/or sugar to coffee by using the food frequency questionnaire of the 2013 ~ 2016 KNHANES. RESULTS: We found that coffee intake increased the prevalence of obesity and abdominal obesity. After multivariable adjustment, coffee consumption increased the risk of obesity by 1.30 (95% CI: 1.08 ~ 1.57) in the group that drank coffee twice a day, and 1.33 (95% CI: 1.11 ~ 1.60) in the people who drank coffee ≥3 times a day as compared to that of the non-coffee intake group. The risk of abdominal obesity increased to 1.27 (95% CI: 1.02 ~ 1.57) in the < 1 time/day coffee drinking group, 1.34 (95% CI: 1.08 ~ 1.66) in the 1 time/day coffee drinking group, 1.35 (95% CI: 1.09 ~ 1.67) in the 2 times/day coffee drinking group, and 1.40 (95% CI: 1.14 ~ 1.72) in the ≥ 3 times/day coffee drinking group as compared to that of the non-coffee drinking group. The influence of black coffee intake was different according to gender: males showed a high prevalence of abdominal obesity and females showed a high prevalence of obesity. Mixed coffee consumption increased the risk of obesity and abdominal obesity by more than 34% in men who consumed coffee more than 3 times a day and in women who consumed coffee more than 2 times per day. CONCLUSIONS: We found that coffee intake, regardless of the type of coffee, increased the prevalence of obesity and abdominal obesity. It is necessary to refrain from drinking coffee to prevent obesity.
Adult ; Beverages ; Coffee ; Drinking ; Female ; Humans ; Korea ; Male ; Milk ; Nutrition Surveys ; Obesity ; Obesity, Abdominal ; Prevalence

PURPOSE: This study examined the relationship between caffeine intake and metabolic syndrome in Korean adults using the 2013 ~ 2016 Korea National Health and Nutrition Examination Survey data (KNHANES). METHODS: The caffeine database (DB) developed by Food and Drug Safety Assessment Agency in 2014 was used to estimate the caffeine consumption. The food and beverage consumption of the 24 hr recall data of 2013 ~ 2016 KNHANES were matched to items in the caffeine DB and the daily caffeine intakes of the individuals were calculated. The sample was limited to non-pregnant healthy adults aged 19 years and older, who were not taking any medication for disease treatment. RESULTS: The average daily caffeine intake was 41.97 mg, and the daily intake of caffeine of 97% of the participants was from coffee, teas, soft drinks, and other beverages. Multivariate analysis showed that the caffeine intake did not affect metabolic syndrome, hypertension, low HDL-cholesterol, and abdominal obesity. Diabetes and hypertriglyceridemia, however, were 0.76 (95% CI: 0.63 ~ 0.93), and 0.87 (95% CI: 0.77 ~ 0.98) in third quintile (Q3), and 0.66 (95% CI: 0.53 ~ 0.82) and 0.83 (95% CI: 0.73 ~ 0.94) in fourth quintile (Q4) compared to Q1, respectively. Therefore, caffeine intake of 3.66 ~ 45.81 mg per day is related to a lower risk of diabetes and hypertriglyceridemia. CONCLUSION: The study showed that adequate caffeine intake (approximately 45 mg) was associated with a lower prevalence of diabetes and hypertriglyceridemia. Therefore, it can be used as a guideline for the adequate level of caffeine intake for maintaining health.
Adult ; Beverages ; Caffeine ; Carbonated Beverages ; Coffee ; Humans ; Hypertension ; Hypertriglyceridemia ; Korea ; Multivariate Analysis ; Nutrition Surveys ; Obesity, Abdominal ; Prevalence ; Tea

PURPOSE: In this study, anaplastic lymphoma kinase (ALK) mutation and amplification, ALK protein expression, loss of the nuclear alpha thalassemia/mental retardation syndrome X-linked (ATRX) protein, and telomerase reverse transcriptase (TERT) protein expressionwere studied to investigate potential correlations between these molecular characteristics and clinical features or outcomes in neuroblastoma. MATERIALS AND METHODS: Seventy-two patients were enrolled in this study. Polymerase chain reaction amplification and direct sequencing were used for mutation analysis. ALK and MYCN amplifications were detected by fluorescence in situ hybridization. Protein expressionwas evaluated by immunohistochemical (IHC) staining. RESULTS: ALK mutation was found in only two patients (4.1%); ALK amplification was not detected. ALK positivity, loss of nuclear ATRX protein, TERT positivity by IHC were detected in 40 (55.6%), nine (13.0%), and 42 (59.2%) patients, respectively. The incidence of ALK expression increased in accordance with increasing tumor stage (p=0.001) and risk group (p < 0.001). The relapse rate was significantly higher in ALK+ patients compared to that of other patients (47.5% vs. 11.3%, p=0.007). However, there was no significant difference in relapse rate when the survival analysis was confined to the high-risk patients. CONCLUSION: Although ALK mutation was rare and no amplification was observed, ALK protein expression was found in a significant number of patients and was correlated with advanced stage and high-risk neuroblastoma. ALK protein expression could be considered as a marker related to the aggressive neuroblastoma, but it was not the independent prognostic factor for the outcome.
Fluorescence ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Incidence ; Lymphoma ; Neuroblastoma* ; Phosphotransferases ; Polymerase Chain Reaction ; Recurrence ; Telomerase ; Telomere

Catheter ablation of atrial fibrillation (AF) is one of the most complex interventional electrophysiological procedures. The success of AF ablation is based in large part on freedom from AF recurrence based on electrocardiography (ECG) monitoring. Arrhythmia monitoring can be performed with the use of noncontinuous or continuous ECG monitoring tools. AF ablation is an invasive procedure that entails risks, most of which are present during the acute procedural period. However, complications can also occur in the weeks or months following ablation. Recognizing common symptoms after AF ablation and distinguishing those that require urgent evaluation and referral to an electrophysiologist is an important part of follow-up after AF ablation. This section reviews the complications associated with catheter ablation procedures performed to treat AF. The types and incidence of complications are presented, their mechanisms are explored, and the optimal approach to prevention and treatment is discussed. Finally, surgical and hybrid AF ablation technology and the indications for concomitant open or closed surgical ablation of AF, stand-alone and hybrid surgical ablation of AF are covered in this section.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Catheter Ablation ; Catheters ; Electrocardiography ; Follow-Up Studies ; Freedom ; Incidence ; Recurrence ; Referral and Consultation