BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients.METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death.RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6–2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19–0.85), major bleeding (HR, 0.43; 95% CI, 0.23–0.81), primary (HR, 0.50; 95% CI, 0.29–0.84) and secondary (HR, 0.45; 95% CI, 0.28–0.74) net-clinical outcomes, whereas mean INR 2.0–3.0 did not. Simultaneous satisfaction of mean INR 1.6–2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes.CONCLUSIONS: Mean INR 1.6–2.6 was better than mean INR 2.0–3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6–2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0–3.0 and TTR ≥70% in Korean patients with non-valvular AF.
Atrial Fibrillation ; Follow-Up Studies ; Hemorrhage ; Humans ; International Normalized Ratio ; Prothrombin Time ; Risk Reduction Behavior ; Stroke ; Thromboembolism ; Warfarin

PURPOSE: Head and neck squamous cell carcinoma (HNSCC) is a deadly disease in which precision medicine needs to be incorporated. We aimed to implement next-generation sequencing (NGS) in determining actionable targets to guide appropriate molecular targeted therapy in HNSCC patients. MATERIALS AND METHODS: Ninety-three tumors and matched blood samples underwent targeted sequencing of 244 genes using the Illumina HiSeq 2500 platform with an average depth of coverage of greater than 1,000×. Clinicopathological data from patients were obtained from 17 centers in Korea, and were analyzed in correlation with NGS data. RESULTS: Ninety-two of the 93 tumors were amenable to data analysis. TP53 was the most common mutation, occurring in 47 (51%) patients, followed by CDKN2A (n=23, 25%), CCND1 (n=22, 24%), and PIK3CA (n=19, 21%). The total mutational burden was similar between human papillomavirus (HPV)–negative vs. positive tumors, although TP53, CDKN2A and CCND1 gene alterations occurred more frequently in HPV-negative tumors. HPV-positive tumors were significantly associated with immune signature-related genes compared to HPV-negative tumors. Mutations of NOTCH1 (p=0.027), CDKN2A (p < 0.001), and TP53 (p=0.038) were significantly associated with poorer overall survival. FAT1 mutations were highly enriched in cisplatin responders, and potentially targetable alterations such as PIK3CA E545K and CDKN2A R58X were noted in 14 patients (15%). CONCLUSION: We found several targetable genetic alterations, and our findings suggest that implementation of precision medicine in HNSCC is feasible. The predictive value of each targetable alteration should be assessed in a future umbrella trial using matched molecular targeted agents.
Biomarkers ; Carcinoma, Squamous Cell* ; Cisplatin ; Epithelial Cells* ; Head* ; Humans ; Korea ; Molecular Targeted Therapy ; Neck* ; Precision Medicine ; Statistics as Topic

PURPOSE: The purpose of this study is to evaluate the prognostic value of preoperative serum CA 19-9 levels in colorectal cancer patients. METHODS: Between 2008 and 2011, 4,794 consecutive patients who underwent curative resection for colorectal cancer were analyzed. These patients were classified into 2 groups according to preoperative CA 19-9 (high CA 19-9: ≥37 ng/mL, n = 440; normal CA 19-9: <37 ng/mL, n = 4,354). We used 1:20 propensity score matching to adjust for potential baseline confounders between groups. RESULTS: After matching, 424 patients (10.5%) among 4,021 patients with colorectal cancer showed a high pre-CA 19-9 level (≥37 ng/mL). There were no significant differences between these 2 groups in age, sex, preoperative CEA level, or T, N, and M stage after matching. Of the 424 patients with high pre-CA 19-9, 141 (33.3%) exhibited cancer recurrence more frequently than patients with normal preoperative CA 19-9 (18.5%). Patients with an elevated preoperative CA 19-9 level showed significantly poorer survival than those with normal levels. The 5-year overall survival rate was 79.7% in the high preoperative CA 19-9 group and 91.9% in the normal preoperative CA 19-9 group (P < 0.001). The 5-year disease-free survival rate was 70.2% in the high preoperative CA 19-9 group and 82.7% in the normal preoperative CA 19-9 group (P < 0.001). CONCLUSION: Patients with an elevated preoperative CA 19-9 level in colorectal cancer have a significantly poorer prognosis than those with normal levels of CA 19-9. We therefore suggest preoperative CA 19-9 level can be used as an additional prognostic indicator of poor outcomes in colorectal cancer.
CA-19-9 Antigen ; Colorectal Neoplasms ; Disease-Free Survival ; Humans ; Prognosis ; Propensity Score ; Recurrence ; Survival Rate

The ginsenoside content was compared with wild simulated ginseng (Panax ginseng) collected every season at 11 wild simulated ginseng plantations in Korea. As a result, the total saponin of 7 years old wild simulated ginseng showed the highest content of 4.5% in spring sampling wild simulated ginseng, 2.0% in summer sampling wild simulated ginseng, 1.2% in winter sampling wild simulated ginseng and 1.0% in autumn sampling wild simulated ginseng. And also, the total saponin of 10 years old wild simulated ginseng showed the highest content of 3.9% in spring sampling wild simulated ginseng, summer sampling wild simulated ginseng (1.8%), winter sampling wild simulated ginseng (1.6%) and autumn sampling wild simulated ginseng (0.6%). Therefore, the total saponin of spring sampling wild simulated ginseng was about 4.5 – 6.5 times higher than that of autumn sampling wild simulated ginseng regardless of cultivation period.
Korea ; Panax ; Saponins ; Seasons

The authors regret that one co-author (Kyung-Hyo Kim) was missing in the article.

BACKGROUND: Fabry disease is an X-linked recessive disorder caused by deficiency of the lysosomal enzyme α-galactosidase A (α-Gal A). Previous studies identified many cases of Fabry disease among men with left ventricular hypertrophy (LVH). The purpose of this study was to define the frequency of Fabry disease among Korean men with LVH. METHODS: In this national prospective multicenter study, we screened Fabry disease in men with LVH on echocardiography. The criterion for LVH diagnosis was a maximum LV wall thickness 13 mm or greater. We screened 988 men with LVH for plasma α-Gal A activity. In patients with low α-Gal A activity (< 3 nmol/hr/mL), we searched for mutations in the α-galactosidase gene. RESULTS: In seven men, α-Gal A activity was low. Three had previously identified mutations; Gly328Arg, Arg301Gln, and His46Arg. Two unrelated men had the E66Q variant associated with functional polymorphism. In two patients, we did not detect GLA mutations, although α-Gal A activity was low on repeated assessment. CONCLUSION: We identified three patients (0.3%) with Fabry disease among unselected Korean men with LVH. Although the prevalence of Fabry disease was low in our study, early treatment of Fabry disease can result in a good prognosis. Therefore, in men with unexplained LVH, differential diagnosis of Fabry disease should be considered.
Diagnosis ; Diagnosis, Differential ; Echocardiography ; Fabry Disease ; Humans ; Hypertrophy, Left Ventricular ; Male ; Plasma ; Prevalence ; Prognosis ; Prospective Studies

PURPOSE: There is substantial need for optimizing radiation protection in nuclear medicine imaging studies. However, the diagnostic reference levels (DRLs) have not yet been established for nuclear medicine imaging studies in Korea.MATERIALS AND METHODS: The data of administered activity in 32 nuclear medicine imaging studies were collected from the Korean Society of Nuclear Medicine (KSNM) dose survey database from 2013 and 2014. Through the expert discussions and statistical analyses, the 75th quartile value (Q3) was suggested as the preliminary DRL values. Preliminary DRLs were subjected to approval process by the KSNM Board of Directors and KSNM Council, followed by clinical applications and performance rating by domestic institutes.RESULTS: DRLs were determined through 32 nuclear medicine imaging studies. The Q3 value was considered as appropriate selection as it was generally consistent with the most commonly administered activity. In the present study, the final version of initial DRL values for nuclear medicine imaging in Korean adults is described including various protocols of the brain and myocardial perfusion imaging.CONCLUSION: The first DRLs for nuclear medicine imaging in Korean adults were confirmed. The DRLs will enable optimized radiation protection in the field of nuclear medicine imaging in Korea.
Academies and Institutes ; Adult ; Brain ; Humans ; Korea ; Myocardial Perfusion Imaging ; Nuclear Medicine ; Radiation Protection

BACKGROUND: Diabetic patients are known to have unusually high mean intraocular pressure (IOP); attributable to autonomic dysfunction and genetic factors. A recent study reported that diabetic complications occur in not only diabetes but also prediabetes. We performed this study to analyze the relationship between glycated hemoglobin A1c (HbA1c) levels and IOP in non-diabetics using electronic medical records at the health screening center of Soon Chun Hyang University Seoul Hospital.METHODS: We considered 16,643 individuals who visited the health screening center of Soon Chun Hyang University Seoul Hospital between November 2015 and September 2017. In total, 3,029 subjects were included in the study. Exclusion criteria included a history of hypertension, diabetes, stroke, cardiovascular disease, hepatitis (A-C), cancer, other disease, fasting blood glucose of 126 mg/dL or higher, HbA1c of 6.5% or higher, and individuals whose binocular IOP could not be measured. We categorized subjects into two groups; those with HbA1c less than or equal to 5.6%, and those with HbA1c greater than 5.6% and less than 6.5%. The mean IOP of each group was compared by gender.RESULTS: After adjusting for factors affecting IOP, analysis of variance was performed to analyze the relationship between HbA1c and IOP. There was no statistically significant difference between the HbA1c groups in males. However, there was a significant difference in IOP between females in the the higher and lower HbA1c groups.CONCLUSION: There was a statistically significant relationship between mean IOP and HbA1c in females without diabetes. Further research is needed with prospective and extensive data collection.
Blood Glucose ; Data Collection ; Diabetes Complications ; Diabetes Mellitus ; Electronic Health Records ; Fasting ; Female ; Health Promotion ; Hemoglobin A, Glycosylated ; Hepatitis ; Humans ; Hypertension ; Intraocular Pressure ; Male ; Mass Screening ; Myocardial Infarction ; Prediabetic State ; Prospective Studies ; Seoul ; Telescopes

BACKGROUND: The frequency with which the 2 B lineages have been found to cocirculate in a season has been on the rise, which has spurred the need for a quadrivalent influenza vaccine (QIV) to protect against both B lineages. The World Health Organization (WHO) recommended that QIV include both B lineages beginning in the 2013–2014 flu season. This study was conducted to evaluate the immunogenicity and safety of an egg-cultivated QIV in healthy Korean children and adolescents aged ≥ 6 months to < 19 years. METHODS: A total of 528 subjects were randomized 4:1 to receive either a QIV (GC3110A) or a trivalent influenza vaccine. Hemagglutination inhibition antibody responses were assessed 28 days after the last dose. Safety was also evaluated. RESULTS: The proportion of subjects in the GC3110A group who achieved seroconversion was confirmed to exceed 40% across all age groups. The proportion of subjects aged ≥ 6 months to < 3 years in the GC3110A group who achieved seroprotection failed to meet the Ministry of Food and Drug Safety (MFDS) standard of 70%. Potential causes may include the small number of subjects, as well as the small dosage. However, results pertaining to the other age groups satisfied the MFDS standard. The safety profile was also comparable to that of the control. CONCLUSION: The new quadrivalent split influenza vaccine may offer broader protection to children and adolescents aged ≥ 3 years to < 19 years of age against both influenza B lineages than the existing trivalent influenza vaccines (Registered at the ClinicalTrials.gov NCT02541253).
Adolescent ; Antibody Formation ; Child* ; Hemagglutination ; Humans ; Influenza Vaccines* ; Influenza, Human* ; Seasons ; Seroconversion ; World Health Organization

PURPOSE: There are patients who do not undergo surgery, regardless of tumor response for neoadjuvant chemoradiotherapy (nCRT) in rectal cancer. However, there have been few reports focused on how oncologic outcomes are worse in these patients. We sought to investigate oncologic outcomes for these non-operated patients with rectal cancer after nCRT. MATERIALS AND METHODS: A total of 1,063 records of patients with rectal cancer who were treated with nCRT from January 2002 to December 2013 were retrospectively reviewed. We categorized patients into the non-operated group (n=77), transanal local excision (TLE) group (n=54), ortotal mesorectal excision (TME) group (n=932) and compared each group using propensity score matching. RESULTS: In the non-operated group, the most common reason for no surgery was patient refusal (n=64). Eleven patients were considered to have achieve clinical complete response (cCR), which was an independent prognostic factor of progression-free survival (p=0.045). In patients with disease progression in the non-operated group, the overall survival did not improved according to salvage treatments (p=0.451). The non-operated group showed worse survivals compared to the TLE or TME group before and after matching (p < 0.001). This finding was also noted in the analysis of survival only in patients with cCR. CONCLUSION: In this study, non-operated patients did not secure oncologic safety regardless of cCR after nCRT. Our results suggest that a non-operative management must be carefully considered even if cCR is achieved.
Chemoradiotherapy* ; Disease Progression ; Disease-Free Survival ; Humans ; Neoadjuvant Therapy ; Propensity Score ; Rectal Neoplasms* ; Retrospective Studies ; Salvage Therapy