PURPOSE: We investigated whether irinotecan plus capecitabine improved progression-free survival (PFS) compared with capecitabine alone in patients with human epidermal growth factor 2 (HER2) negative and anthracycline and taxane pretreated metastatic breast cancer (MBC). MATERIALS AND METHODS: A total of 221 patients were randomly assigned to irinotecan (80 mg/m2, days 1 and 8) and capecitabine (1,000 mg/m2 twice a day, days 1-14) or capecitabine alone (1,250 mg/m2 twice a day, days 1-14) every 3 weeks. The primary endpoint was PFS. RESULTS: There was no significant difference in PFS between the combination and monotherapy arm (median, 6.4 months vs. 4.7 months; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.63 to 1.11; p=0.84). In patients with triple-negative breast cancer (TNBC, n=90), the combination significantly improved PFS (median, 4.7 months vs. 2.5 months; HR, 0.58; 95% CI, 0.37 to 0.91; p=0.02). Objective response rate was numerically higher in the combination arm, though it failed to reach statistical significance (44.4% vs. 33.3%, p=0.30). Overall survival did not differ between arms (median, 20.4 months vs. 24.0 months; p=0.63). While grade 3 or 4 neutropenia was more common in the combination arm (39.6% vs. 9.0%), hand-foot syndrome was more often observed in capecitabine arm. Quality of life measurements in global health status was similar. However, patients in the combination arm showed significantly worse symptom scales especially in nausea/vomiting and diarrhea. CONCLUSION: Irinotecan plus capecitabine did not prove clinically superior to single-agent capecitabine in anthracycline- and taxane-pretreated HER2 negative MBC patients. Toxicity profiles of the two groups differed but were manageable. The role of added irinotecan in patients with TNBC remains to be elucidated.
Arm ; Breast Neoplasms* ; Breast* ; Capecitabine* ; Diarrhea ; Disease-Free Survival ; Epidermal Growth Factor ; Global Health ; Hand-Foot Syndrome ; Humans ; Neutropenia ; Quality of Life ; Triple Negative Breast Neoplasms ; Weights and Measures

PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of severe cutaneous adverse reactions (SCARs). The present study aimed to investigate the characteristics of SCARs induced by NSAIDs in the Korean SCAR registry. METHODS: A retrospective survey of NSAID-induced SCARs recorded between 2010 and 2015 at 27 university hospitals in Korea was conducted. Clinical phenotypes of SCARs were classified into Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS). Causative NSAIDs were classified into 7 groups according to their chemical properties: acetaminophen, and propionic, acetic, salicylic, fenamic and enolic acids. RESULTS: A total of 170 SCARs, consisting of 85 SJS, 32 TEN, 17 SJS-TEN overlap syndrome and 36 DRESS reactions, were induced by NSAIDs: propionic acids (n=68), acetaminophen (n=38), acetic acids (n=23), salicylic acids (n=16), coxibs (n=8), fenamic acids (n=7), enolic acids (n=5) and unclassified (n=5). Acetic acids (22%) and coxibs (14%) accounted for higher portions of DRESS than other SCARs. The phenotypes of SCARs induced by both propionic and salicylic acids were similar (SJS, TEN and DRESS, in order). Acetaminophen was primarily associated with SJS (27%) and was less involved in TEN (10%). DRESS occurred more readily among subjects experiencing coxib-induced SCARs than other NSAID-induced SCARs (62.5% vs. 19.7%, P = 0.013). The mean time to symptom onset was longer in DRESS than in SJS or TEN (19.1 ± 4.1 vs. 6.8 ±1.5 vs. 12.1 ± 3.8 days). SCARs caused by propionic salicylic acids showed longer latency, whereas acetaminophen- and acetic acid-induced SCARs appeared within shorter intervals. CONCLUSIONS: The present study indicates that the phenotypes of SCARs may differ according to the chemical classifications of NSAIDs. To establish the mechanisms and incidences of NSAID-induced SCARs, further prospective studies are needed.
Acetaminophen ; Acetates ; Acetic Acid ; Anti-Inflammatory Agents, Non-Steroidal ; Cicatrix ; Classification ; Cyclooxygenase 2 Inhibitors ; Diethylpropion ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome ; Hospitals, University ; Incidence ; Korea ; Phenotype ; Propionates ; Prospective Studies ; Retrospective Studies ; Salicylates ; Salicylic Acid ; Stevens-Johnson Syndrome

BACKGROUND/OBJECTIVES: Excessive sugar consumption may increase the risk for development of several diseases. Although average dietary sugar intake of Koreans is within the recommended level, an increasing trend has been found in all age groups. This study aimed to evaluate the population attributable fractions (PAF) to dietary sugar for disease and death in Korea, and to estimate the socioeconomic effects of a reduction in dietary sugar. MATERIALS/METHODS: The prevalence of sugar-sweetened beverages (SSB) overconsumption (≥ 20 g of sugar from beverages) was analyzed using the Korean National Health and Nutrition Examination Survey 2015. Disease-specific relative risks of excessive SSB consumption were obtained through reviewing previous studies. Using the prevalence of SSB overconsumption and each relative risk, PAFs for morbidity and mortality were calculated. Socioeconomic costs of diseases and death attributable to SSB overconsumption were estimated by using representative data on national medical expenditures, health insurance statistics, employment information, and previous reports. RESULTS: Disease-specific PAF to SSB consumption ranged from 3.11% for stroke to 9.05% for obesity and dental caries, respectively. Costs from disease caused by SSB overconsumption was estimated at 594 billion won in 2015. About 39 billion won was estimated to be from SSB consumption-related deaths, and a total of 633 billion won was predicted to have been saved through preventing SSB overconsumption. CONCLUSIONS: Sugars overconsumption causes considerable public burdens, although the cost estimates do not include any informal expenditure. Information on these socioeconomic effects helps both health professionals and policy makers to create and to implement programs for reducing sugar consumption.
Administrative Personnel ; Beverages ; Carbohydrates ; Dental Caries ; Dietary Sucrose ; Employment ; Health Expenditures ; Health Occupations ; Humans ; Insurance ; Korea ; Mortality ; Nutrition Surveys ; Obesity ; Prevalence ; Public Health ; Stroke

BACKGROUND: The titer of influenza vaccine-induced antibodies declines over time, and younger children have lower immunogenicity and shorter duration of immunity. This study aimed to compare persistence of antibody at 6 months after influenza vaccination according to influenza virus strains, vaccine type, antigen dose, and primed status in children aged 6 to 35 months. METHODS: A total 124 healthy children aged 6 to 35 months were enrolled from September to December 2016 at 10 hospitals in Korea and randomly assigned to either a full dose of quadrivalent influenza vaccine or a half dose of trivalent influenza vaccine with Victoria B strain group. Hemagglutination inhibition antibody titers (that measure the seroprotection rates) were assessed for the recommended influenza strains at 6 months post vaccination. RESULTS: The seroprotection rates at 6 months for strains A (H1N1), A (H3N2), B/Yamagata, and B/Victoria were 88.7%, 97.4%, 36.6%, and 27.6%, respectively. The seroprotection rates for A (H1N1), A (H3N2) and B (Victoria) were 91.4%, 98.7% and 27.5% in a full dose of quadrivalent vaccine vs. 83.7%, 94.6% and 27.9% in a half dose trivalent vaccine, respectively. The seroprotection rate for the B (Yamagata) strain was 23.8% in the quadrivalent group and 14.0% in the trivalent group. CONCLUSION: Persistence of antibodies at 6 months was more favorable against the influenza A strains than against the B strains. Persistence of antibodies to additional B strain at 6 months was superior in the quadrivalent vaccine group. The immunity of primed children with different B strains was not superior to that of the unprimed group with another B strain.
Antibodies ; Child ; Hemagglutination ; Humans ; Influenza Vaccines ; Influenza, Human ; Korea ; Orthomyxoviridae ; Vaccination ; Victoria

OBJECTIVE: It is unclear whether the decline in dopamine transporters (DAT) differs among idiopathic rapid eye movement sleep behavior disorder (iRBD) patients with different levels of olfactory impairment. This study aimed to characterize DAT changes in relation to nonmotor features in iRBD patients by olfactory loss. METHODS: This prospective cohort study consisted of three age-matched groups: 30 polysomnography-confirmed iRBD patients, 30 drug-naïve Parkinson's disease patients, and 19 healthy controls without olfactory impairment. The iRBD group was divided into two groups based on olfactory testing results. Participants were evaluated for reported prodromal markers and then underwent 18F-FP-CIT positron emission tomography and 3T MRI. Tracer uptakes were analyzed in the caudate, anterior and posterior putamen, substantia nigra, and raphe nuclei. RESULTS: Olfactory impairment was defined in 38.5% of iRBD patients. Mild parkinsonian signs and cognitive functions were not different between the two iRBD subgroups; however, additional prodromal features, constipation, and urinary and sexual dysfunctions were found in iRBD patients with olfactory impairment but not in those without. Tracer uptake showed significant group differences in all brain regions, except the raphe nuclei. The iRBD patients with olfactory impairment had uptake reductions in the anterior and posterior putamen, caudate, and substantia nigra (p < 0.016 in all, adjusted for age), which ranged from 0.6 to 0.8 of age-normative values. In contrast, those without olfactory impairment had insignificant changes in all regions ranging above 0.8. CONCLUSION: There was a clear distinction in DAT loss and nonmotor profiles by olfactory status in iRBD.
Brain ; Cognition ; Cohort Studies ; Constipation ; Dopamine Plasma Membrane Transport Proteins ; Dopamine ; Humans ; Magnetic Resonance Imaging ; Parkinson Disease ; Positron-Emission Tomography ; Prospective Studies ; Putamen ; Raphe Nuclei ; REM Sleep Behavior Disorder ; Sleep, REM ; Smell ; Substantia Nigra

PURPOSE: Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. METHODS: A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. RESULTS: Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs (P< 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs (P= 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P= 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. CONCLUSION: This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.
Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Epidemiologic Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Length of Stay ; Mortality ; Referral and Consultation ; Risk Factors ; Stevens-Johnson Syndrome ; Thrombocytopenia ; Valproic Acid

Myxomas can be divided into two groups: those derived from the facial skeleton, and those derived from external skeletal soft tissue. Soft tissue myxomas of the head and neck are uncommon, with fewer than 50 cases reported. In any form and location, myxoma of parotid gland is rare. We report a case of myxoma arising from the left superficial lobe of the parotid gland with good long-term follow-up after superficial parotidectomy with tumor excision. A 49-year-old man was referred to our department of plastic and reconstructive surgery with a painless palpable mass that had persisted in the left mandible angle region for 2 years. Excision of the facial mass and superficial parotidectomy with facial nerve preservation were performed. The biopsy result was myxoma. Long-term follow-up for 22 months showed favorable results without evidence of recurrence but with temporary facial nerve weakness right after the surgery. Myxoma should be considered as a differential diagnosis when benign tumor of the parotid gland is being considered.
Biopsy ; Diagnosis, Differential ; Facial Nerve ; Follow-Up Studies ; Head ; Humans ; Mandible ; Middle Aged ; Myxoma ; Neck ; Parotid Gland ; Plastics ; Recurrence ; Skeleton ; Soft Tissue Neoplasms

Adult ; Alzheimer Disease ; Depression ; Depressive Disorder ; Humans ; Korea ; Logistic Models ; Long-Term Care ; Mental Health ; Prevalence ; Risk Factors ; Seoul ; Social Isolation ; Suicidal Ideation

Primary malignant melanoma (PMM) of the gastrointestinal tract is rare. Reported cases of PMM of the lower gastrointestinal tract typically describe anal and rectal involvement rather than colonic lesions. This report describes a rare case of a 50-year-old woman with PMM originating in the colon. The patient presented to Inje University Busan Paik Hospital with a 3-day history of blood-tinged stools. She underwent colonoscopy for a diagnosis of hematochezia. The colonoscopic examination revealed a large-sized semi-pedunculated sigmoid colon polyp with a reddish-colored mucosal surface. Endoscopic mucosal resection was performed, and the final histopathological findings were consistent with a diagnosis of malignant melanoma. Systemic work-up was performed for assessment of metastasis and to identify the primary tumor considering the high metastatic rate of gastrointestinal malignant melanoma; however, no other malignant lesion was detected. Thus, she was diagnosed with colonic PMM. She underwent laparoscopic low anterior resection and lymph node dissection and has been recurrence-free for > 2 years.
Busan ; Colon ; Colon, Sigmoid ; Colonoscopy ; Diagnosis ; Female ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans ; Lower Gastrointestinal Tract ; Lymph Node Excision ; Melanoma ; Melanosis ; Middle Aged ; Neoplasm Metastasis ; Polyps

PURPOSE: Physician competency in end-of-life (EOL) care is becoming increasingly important. This study investigated the EOL care curricula in Korean medical schools.METHODS: Questionnaires were issued to the faculty members responsible for the EOL care curricula at each of the medical schools. These included questions on the structure and content of the curricula, teaching methods, and faculty members' attitudes to the curricula.RESULTS: Characteristics of the EOL care curricula were compiled from 27 (66%) of the 41 medical schools. All of the medical schools taught essential aspects of the EOL care curriculum either as a separate course or embedded within other medical education courses. The mean time spent on EOL care teaching was 10 hrs (range, 2~32 hrs). The most frequently taught topics were delivering bad news (100%) and symptom management (74%). When the palliative care education assessment tool (PEAT) was used to evaluate the curricula, a median of 11 PEAT objectives was met (range, 2~26; maximum, 83). More than two teaching methods were used in most of the curricula. However, lectures were the only teaching method used by three medical schools. 78% of faculty members who were responsible for curriculum reported dissatisfaction with it, whereas 18% believed that the time allotted to it was adequate. Only 7% of these faculty members believed that their students were adequately prepared to practice EOL care.CONCLUSION: There is a need to improve EOL care education in basic medical curricula and to take a more systematic approach to achieving learning outcomes.
Curriculum ; Education ; Education, Medical ; Hospice Care ; Humans ; Learning ; Lectures ; Palliative Care ; Schools, Medical ; Soil ; Teaching ; Terminal Care