OBJECTIVES: This study developed an algorithm for identifying pregnancy episodes and estimating the last menstrual period (LMP) in an administrative claims database and applied it to investigate the use of pregnancy-incompatible immunosuppressants among pregnant women with systemic lupus erythematosus (SLE). METHODS: An algorithm was developed and applied to a nationwide claims database in Korea. Pregnancy episodes were identified using a hierarchy of pregnancy outcomes and clinically plausible periods for subsequent episodes. The LMP was estimated using preterm delivery, sonography, and abortion procedure codes. Otherwise, outcome-specific estimates were applied, assigning a fixed gestational age to the corresponding pregnancy outcome. The algorithm was used to examine the prevalence of pregnancies and utilization of pregnancy-incompatible immunosuppressants (cyclophosphamide [CYC]/mycophenolate mofetil [MMF]/methotrexate [MTX]) and non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy in SLE patients. RESULTS: The pregnancy outcomes identified in SLE patients included live births (67%), stillbirths (2%), and abortions (31%). The LMP was mostly estimated with outcome-specific estimates for full-term births (92.3%) and using sonography procedure codes (54.7%) and preterm delivery diagnosis codes (37.9%) for preterm births. The use of CYC/MMF/MTX decreased from 7.6% during preconception to 0.2% at the end of pregnancy. CYC/MMF/MTX use was observed in 3.6% of women within 3 months preconception and 2.5% during 0-7 weeks of pregnancy. CONCLUSIONS This study presents the first pregnancy algorithm using a Korean administrative claims database. Although further validation is necessary, this study provides a foundation for evaluating the safety of medications during pregnancy using secondary databases in Korea, especially for rare diseases.

Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

BACKGROUND: In chemical pleurodesis for managing pulmonary air leak, tetracycline derivatives are commonly used, and their effectiveness has been established in many studies. Recently, a Viscum album extract was used in chemical pleurodesis. We compared the effects of V. album with those of a tetracycline derivative (doxycycline) to demonstrate the therapeutic effectiveness of the V. album extract in chemical pleurodesis for managing pulmonary air leak. METHODS: Between October 2010 and October 2016, chemical pleurodesis was performed using doxycycline in 40 patients and the V. album extract in 37 patients. Thirty-three patients were in the postoperative state after pulmonary resection, and 44 patients suffered from spontaneous pneumothorax. RESULTS: No statistically significant difference in the success rate was observed between the 2 groups (V. album extract and doxycycline). In both groups, chest pain was the most common complication. More patients in the doxycycline group complained of severe chest pain (42.1% vs. 13.5%, p=0.006). In the V. album extract group, 24.3% of the patients required a chest tube to drain the pleural effusion after cessation of the air leak (doxycycline group: 5%, p=0.022). Further, the amount of pleural effusion drained on the day after the last chemical pleurodesis in the V. album extract group was greater than that in the doxycycline group (162.2±170.2 mL vs. 97.0±77.2 mL, p=0.032). All patients were discharged from the hospital without complications after pleural effusion drainage. CONCLUSION: Considering that treatment using the V. album extract was less painful, V. album might be a feasible option for chemical pleurodesis. However, pleural effusion should be monitored carefully when using V. album extract for treating patients suffering from air leak.
Chest Pain ; Chest Tubes ; Doxycycline* ; Drainage ; Humans ; Pleural Effusion ; Pleurodesis* ; Pneumothorax ; Tetracycline ; Viscum album* ; Viscum*

Pulmonary benign metastasizing leiomyoma (PBML) is defined as metastasis of a leiomyoma to lung tissue. It was first reported in 1937. P BML is known as a benign disease, but can undergo malignant transformation. Only 1 case of the malignant transformation of PBML to leiomyosarcoma has been reported previously. In this report, we present a case of malignant transformation of PBML.
Leiomyoma* ; Leiomyosarcoma ; Lung ; Lung Neoplasms ; Neoplasm Metastasis

PURPOSE: Allergic diseases have been increased in Korea. The aim of this study was to investigate the changes of sensitization rate to inhalant allergens over 10 years in children with allergic diseases from a tertiary referral hospital. METHODS: Skin prick tests were done in total 2,225 children in 2000, 2005, and 2010. Changes of skin reactivity to 12 major inhalant allergens, including Tree pollen mixture I (Alder, Elm, Hazel, Poplar, Willow), Tree pollen mixture II (Beech, Birch, Oak, Plane tree), Dermatophagoides pteronyssinus, Dermatophagoides farina, Alternaria, cat dander, and dog dander were investigated. RESULTS: The sensitization rates to Tree pollen mixture I and II were increased as 5.0%, 6.8% in 2000, 8.5%, 9.8% in 2005, and 14.8%, 17.3% in 2010, respectively (trend P<0.001, P<0.001, respectively). And the sensitization rates to D. pteronyssinus cat dander and dog dander were changed as 55%, 4.8%, 4.8% in 2000, 62.2%, 11.9%, 28% in 2005, and 63.1%, 12.7%, 16.7% in 2010, respectively. The distribution of sensitized pollens was oak (12.8%), beech (12.4%), pine (10.3%), birch (10%), hazel (9.6%), alder (8%), elder (6.9%), elm (5.4%) in the study of 2010. When allergen/histamine ratio was compared, rates of strong sensitization over 4+ to tree pollen were increased. CONCLUSION: The sensitization rates to inhalant allergens were increased in children with asthma or allergic rhinitis from a tertiary referral hospital in Seoul over last 10 years. Especially, an increase in the degree of skin reactivity was observed in cat dander, dog dander, and tree pollens. The studies to investigate the etiology of this increase and prevention will be needed.
Allergens ; Alnus ; Alternaria ; Animals ; Asthma* ; Betula ; Cats ; Child* ; Dander ; Dermatophagoides pteronyssinus ; Dogs ; Fagus ; Humans ; Hypersensitivity ; Korea ; Pollen ; Pyroglyphidae ; Rhinitis* ; Seoul ; Skin ; Tertiary Care Centers*

BACKGROUND/AIMS: A self-report questionnaire is frequently used to measure symptoms reliably and to distinguish patients with functional gastrointestinal disorders (FGIDs) from those with other conditions. We produced and validated a cross-cultural adaptation of the Rome III questionnaire for diagnosis of FGIDs in Korea. METHODS: The Korean version of the Rome III (Rome III-K) questionnaire was developed through structural translational processes. Subsequently, reliability was measured by a test-retest procedure. Convergent validity was evaluated by comparing self-reported questionnaire data with the subsequent completion of the questionnaire by the physician based on an interview and with the clinical diagnosis. Concurrent validation using the validated Korean version of the Short Form-36 Health Survey (SF-36) was adopted to demonstrate discriminant validity. RESULTS: A total of 306 subjects were studied. Test-retest reliability was good, with a median Cronbach's alpha value of 0.83 (range, 0.71-0.97). The degree of agreement between patient-administered and physician-administered questionnaires to diagnose FGIDs was excellent; the kappa index was 0.949 for irritable bowel syndrome, 0.883 for functional dyspepsia and 0.927 for functional heartburn. The physician's clinical diagnosis of functional dyspepsia showed the most marked discrepancy with that based on the self-administered questionnaire. Almost all SF-36 domains were impaired in participants diagnosed with one of these FGIDs according to the Rome III-K. CONCLUSIONS: We developed the Rome III-K questionnaire though structural translational processes, and it revealed good test-retest reliability and satisfactory construct validity. These results suggest that this instrument will be useful for clinical and research assessments in the Korean population.
Dyspepsia ; Gastrointestinal Diseases* ; Health Surveys ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Surveys and Questionnaires*

Transmissible gastroenteritis (TGE) is sporadic in South Korea. Since porcine respiratory coronavirus (PRCV) infection was identified in South Korea in 1996, the TGE infection has decreased with the PRCV occurrence. In this study, we described the sero-surveillance of TGE/PRCV infection by using a commercially available ELISA kit. A total of 1,295 sera from slaughtered pigs and 69 sera from wild boars were collected in years 2009 and 2010 throughout the country and tested for antibodies against TGE and PRCV. Although there was no clinical sign observed for TGE and vaccination had not been done for TGEV, 4.9% of sera showed positive for antibody against TGEV. Furthermore, 63.7% of finisher and 8.7% of wild boars were positive for antibody against PRCV. Our result suggests that the TGEV infection might still be present in some farms in South Korea.
Antibodies ; Enzyme-Linked Immunosorbent Assay ; Gastroenteritis ; Porcine Respiratory Coronavirus ; Republic of Korea ; Sus scrofa ; Swine ; Transmissible gastroenteritis virus ; Vaccination

PURPOSE: To report the anti-inflammatory effect and best-corrected visual acuity (BCVA) response after oral glucosamine (Glucosamine Sulfate 750(R), General Nutrition Companies, Inc.) and aspirin (Aspirin protect(R), Bayer) therapy in patients with uveitis. METHODS: Twenty-seven patients (43 eyes) with uveitis, not easily managed with conventional therapy, were treated with oral glucosamine 750 mg and aspirin 100 mg daily, and underwent BCVA testing and slit-lamp examination of anterior chamber inflammation. Changes in the dose of previously-used oral steroids and immunosuppressants were recorded at baseline, every 2 weeks for the first 2 months, and once every month thereafter. RESULTS: The mean follow-up period was 15.0+/-3.69 weeks and inflammation started to improve within 4.6 weeks. The change in visual acuity was not statistically significant, but grade of inflammation decreased by as much as 1.02+/-1.28, significantly (p<0.01) after treatment. In 12 patients (19 eyes, 44.2%) the dosage of systemic steroids and immunosuppressants could be Reduced. 7 patients (10 eyes, 23.3%) experienced aggravation of uveitis and the dosage of glucosamine and aspirin was increased. CONCLUSIONS: Concurrent oral administration of glucosamine and aspirin could not completely inhibit the recurrence of inflammation nor control it, but consistent use of these drugs may help to reduce inflammation without serious side effects. A longer prospective control study with larger sample size is required to further evaluation of the efficacy of the medication.
Administration, Oral ; Anterior Chamber ; Aspirin ; Eye ; Follow-Up Studies ; Glucosamine ; Humans ; Immunosuppressive Agents ; Inflammation ; Recurrence ; Sample Size ; Steroids ; Uveitis ; Visual Acuity

OBJECTIVE: beta ig-h3 is an extracellular matrix protein, which is overexpressed in synovial tissues of rheumatoid arthritis (RA) similar to adhesive glycoproteins. We sought to evaluate the compensatory role of beta ig-h3 with adhesive glycoproteins in mediating the adhesion of fibroblast- like synoviocytes (FLS) and to confirm the inhibitory effect of YH18 peptide of the 2nd fas-1 domain in beta ig-h3-mediated adhesion. METHODS: The adhesion of FLS isolated from synovial tissues of RA, was evaluated in 96 well microtiter plate coated with matrix proteins. Inhibitory effect of YH18 peptides from the 2nd and 4th fas-1 domains was estimated in beta ig-h3-mediated adhesion of FLS. RESULTS: The adhesion of FLS on beta ig-h3 was weaker than that of fibronectin and vitronectin. The beta ig-h3-mediated adhesion was enhanced by the stimulation with phorbol myristate acetate (PMA), but not by cytokines and growth factors. Combination of fibronectin with beta ig-h3 synergistically enhanced the adhesion of FLS, in contrast to the additive effect of vitronectin combined with beta ig-h3. YH18 peptide of the 2nd fas-1 domain did not block the beta ig-h3-mediated adhesion of FLS. CONCLUSION: Our results reveal that beta ig-h3 may regulate the adhesion of FLS through the interaction with adhesive glycoproteins and confirm that the essential motifs mediating adhesion on beta ig-h3 are different according to the type of cells.

BACKGROUND: Intravenous hypnotics are used in pregnancy, labor and delivery. The aim of the present study was to investigate and compare the relaxant effects of propofol, thiopental, ketamine, and etomidate on isolated rat uterine smooth muscles. METHODS: Uterine smooth muscle preparations were obtained from non-pregnant female rats. The uterus of the rat was dissected and cut into 10 mm strips. The muscle strips were bathed in Krebs solution. After spontaneous uterine contractile activity had been accomplished, propofol, ketamine, thiopental, and etomidate in various concentrations were added cumulatively to the baths and resting tension, active tension, and frequency of contration were recorded at each concentration of agents. EC(5), EC(25), EC(50), EC(75), and EC(95) of each drug on active tension and frequency of contraction were calculated using a probit model. RESULTS: Propofol, thiopental, and etomidate reduced uterine contractions in a concentration-dependent manner. Ketamine concentrations of 10(-7) to 10(-5) M augmented uterine contractions but ketamine concentrations of 10(-4) to 10(-3) M attenuated uterine contractions. The EC(50)'s of propofol, thiopental, ketamine, and etomidate on active tension were 1.56 x 10(-5) M, 4.97 x 10(-5) M, 3.52 x 10(-4) M, and 2.73 x 10(-5) M, respectively. CONCLUSIONS: All four intravenous hypnotics relaxed the uterine smooth muscle of rats except for ketamine in low concentrations (10(-7) to 10(-5) M). Propofol had the greatest relaxant effects on isolated rat uterine smooth muscle among these hypnotics. It seems that ketamine is a suitable obstetric hypnotic agent for hypovolemic parturients and propofol is a useful hypnotic agent for uterine relaxation during pregnancy.
Animals ; Baths ; Contracts ; Etomidate ; Female ; Humans ; Hypnotics and Sedatives ; Hypovolemia ; Isotonic Solutions ; Ketamine ; Muscle, Smooth ; Muscles ; Pregnancy ; Propofol ; Rats ; Relaxation ; Thiopental ; Uterine Contraction ; Uterus