Background: The distribution of species and characteristics of non-tuberculous mycobacteria (NTM) differ, and surveillance data for changes in antimicrobial susceptibilities of NTM is insufficient. This study analyzed the changes in antimicrobial susceptibility trends across NTM species and assessed the appropriateness of empirical antimicrobial drugs for NTM. Materials and Methods: We retrospectively analyzed the clinical characteristics, including demographics, distribution of NTM species, antimicrobial drug susceptibilities, and outcomes, at a teaching hospital in Jeju Island from 2009 - 2022. Results: Overall, 342 patients were included in the analysis; 93.0% were classified into the pulmonary group (PG) and 7.0% into the extrapulmonary group (EPG). The isolation rate of Mycobacterium avium was significantly higher in PG (36.8% vs. 0%, P = 0.001), while that of Mycobacterium fortuitum was significantly higher in EPG (4.5% vs.31.3%, P = 0.001). The antimicrobial susceptibility rate is higher against clarithromycin (89.9%) and amikacin (83.3%) and lower against rifampin (54.7%) and ethambutol (28.1%). The susceptibility rate to clarithromycin was over 80%, but those to rifampin and ethambutol showed decreasing annual trends. Of the 162 patients who received empirical antimicrobial therapy, actual antimicrobial susceptibility rates were high (90.1%) using empirical macrolide, and relatively low using ethambutol and rifampin (28.0% and 58.8%, respectively). Conclusion This is the first study of analysis of the distribution, baseline characteristics, and antimicrobial susceptibility of isolated NTM species in pulmonary and extrapulmonary patients in Jeju Island over 10 years. Policies that continuously monitor changes in susceptibility rate are required to ensure effective treatment strategies.

Purpose: We conducted a randomized prospective trial (KLASS-07 trial) to compare laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. In this interim report, we describe short-term results in terms of morbidity and mortality. Methods: and Methods: The sample size was 442 participants. At the time of the interim analysis, 314 patients were enrolled and randomized. After excluding patients who did not undergo planned surgeries, we performed a modified per-protocol analysis of 151 and 145 patients in the LADG and TLDG groups, respectively. Results: The baseline characteristics, including comorbidity status, did not differ between the LADG and TLDG groups. Blood loss was somewhat higher in the LADG group, but statistical significance was not attained (76.76±72.63 vs. 62.91±65.68 mL; P=0.087). Neither the required transfusion level nor the operation or reconstruction time differed between the 2 groups. The mini-laparotomy incision in the LADG group was significantly longer than the extended umbilical incision required for specimen removal in the TLDG group (4.79±0.82 vs. 3.89±0.83 cm; P<0.001). There were no between-group differences in the time to solid food intake, hospital stay, pain score, or complications within 30 days postoperatively. No mortality was observed in either group. Conclusions Short-term morbidity and mortality rates did not differ between the LADG and TLDG groups. The KLASS-07 trial is currently underway.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

OBJECTIVE: Empathy is important in the education of medical students. Many psychosocial variables are related to empathy. The aim of the study was to investigate the relationship between empathy and psychosocial factors such as burnout, personality, self-esteem, and resilience. METHODS: The participants completed a set of self-reporting questionnaires, including questions related to socio-demographic characteristics, the Korean edition of the Jefferson Scale of Empathy, student version (JSE-S-K), Maslach Burnout Inventory General Survey (MBI-GS), NEO Five-Factor Inventory (NEO-FFI), Rosenberg Self-esteem Scale (R-SES), and Connor-Davidson Resilience Scale (CD-RISC). Partial correlation and regression analyses were performed. RESULTS: In male students, there were positive correlations between JSE-S-K and R-SES (r=0.229, p=0.002); conscientiousness of the NEO-FFI (r=0.153, p=0.037) and negative correlations, specifically between JSE-S-K and depersonalization of MBI (r=-0.206, p=0.005). In female students, there was positive correlations between JSE-S-K and personal accomplishment of MBI (r=0.384, p=0.004). In the multiple regression model, the JSE-S-K was affected by conscientiousness of the NEO-FFI (adjusted R² =0.245, β=0.201, p=0.001); depersonalization, personal accomplishment of the MBI-GS (β=-0.188, p=0.001, β=0.143, p=0.017); R-SES (β=0.176, p=0.004); sex (β=0.117, p=0.029). CONCLUSION: The present findings suggested that conscientiousness, depersonalization, personal accomplishment, self-esteem and sex have an influence on empathy. Therefore, these must be considered in medical education and can be helpful to nurture more empathetic doctors.
Cross-Sectional Studies ; Depersonalization ; Education ; Education, Medical ; Empathy ; Female ; Humans ; Male ; Psychology ; Students, Medical

Mycobacterium szulgai is a rare nontuberculous mycobacterium found in Korea. It is an opportunistic pathogen and is usually isolated from patients with a history of alcoholism, chronic pulmonary disease, or an immunocompromising condition. We present here a case of M. szulgai isolated from a patient with a history of pulmonary tuberculosis. A 54-year-old man was admitted with dyspnea and febrile sensation. He had a history of pulmonary tuberculosis which occurred 30 years earlier and treatment with anti-tuberculosis medication. His chest computed tomography scan showed cavitary consolidation in both upper lungs. A sputum acid-fast bacilli (AFB) smear was positive and anti-tuberculous medication was started. However, a polymerase chain reaction for mycobacterium tuberculosis was negative and anti-tuberculous medication was stopped. M. szulgai was isolated on 3 separate sputum and bronchial wash fluid AFB cultures. He was treated with clarithromycin, rifampicin, and ethambutol. After 1 month, a sputum AFB smear and culture became negative and no additional M. szulgai were isolated during a 16-month treatment.
Alcoholism ; Clarithromycin ; Dyspnea ; Ethambutol ; Humans ; Invasive Pulmonary Aspergillosis ; Korea ; Lung ; Lung Diseases ; Middle Aged ; Mycobacterium ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Rifampin ; Sensation ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The purpose of this study was to assess the interrelationship of maximal step length (MSL) measurement as protective strategies and risk factors of falls. METHODS: The study population consisted of 149 community-dwelling people (> or = 60 yrs). Demographic data, depression degree (GDS-short form), fatigue degree (revised Chalder's fatigue scale) were reviewed by self-recorded questionnaire. K-MMSE, MSL, US and TUG were done when they visited our clinic. We examined whether MSL was correlated with the six leg-directions and was related to other measures to evaluate fall risk. To examine the association between MSL and other variables, we analyzed data by T-test, ANOVA and multiple regressions. RESULTS: The MSLmean correlated highly with each leg- direction MSL (correlation coefficient, r=0.771~0.941, P<0.01), US (r=0.392, P<0.01) and TUG (r=-0.608, P<0.01). The MSL(mean/L) (MSL(mean), leg length adjusted) correlated strongly with frequent fall (P=0.005). Also, the MSL(mean/L) had a tendency to be low in the elderly, females, in those with regular exercise, widowed or divorced, DM, stroke, dementia suspicion, inclination toward depression, arthritis and frequent falls, but higher score on fatigue groups. Age (P<.001), sex (P=0.001), DM (P<.001), frequent falls (P= 0.017), dementia suspicion (P=0.016), and arthritis (P= 0.024) variables were related with MSL(mean/L) when we examined these variables by multiple regression analysis. CONCLUSION: MSL was correlated highly with other functional performance test and DM, age, sex, frequent fall, dementia suspicion, and arthritis variables for fall risk.
Adult ; Aged ; Arthritis ; Dementia ; Depression ; Divorce ; Fatigue ; Female ; Humans ; Leg ; Risk Factors ; Stroke ; Widowhood ; Surveys and Questionnaires

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The purpose of this study was to assess the interrelationship of maximal step length (MSL) measurement as protective strategies and risk factors of falls. METHODS: The study population consisted of 149 community-dwelling people (> or = 60 yrs). Demographic data, depression degree (GDS-short form), fatigue degree (revised Chalder's fatigue scale) were reviewed by self-recorded questionnaire. K-MMSE, MSL, US and TUG were done when they visited our clinic. We examined whether MSL was correlated with the six leg-directions and was related to other measures to evaluate fall risk. To examine the association between MSL and other variables, we analyzed data by T-test, ANOVA and multiple regressions. RESULTS: The MSLmean correlated highly with each leg- direction MSL (correlation coefficient, r=0.771~0.941, P<0.01), US (r=0.392, P<0.01) and TUG (r=-0.608, P<0.01). The MSL(mean/L) (MSL(mean), leg length adjusted) correlated strongly with frequent fall (P=0.005). Also, the MSL(mean/L) had a tendency to be low in the elderly, females, in those with regular exercise, widowed or divorced, DM, stroke, dementia suspicion, inclination toward depression, arthritis and frequent falls, but higher score on fatigue groups. Age (P<.001), sex (P=0.001), DM (P<.001), frequent falls (P= 0.017), dementia suspicion (P=0.016), and arthritis (P= 0.024) variables were related with MSL(mean/L) when we examined these variables by multiple regression analysis. CONCLUSION: MSL was correlated highly with other functional performance test and DM, age, sex, frequent fall, dementia suspicion, and arthritis variables for fall risk.
Adult ; Aged ; Arthritis ; Dementia ; Depression ; Divorce ; Fatigue ; Female ; Humans ; Leg ; Risk Factors ; Stroke ; Widowhood ; Surveys and Questionnaires