BACKGROUND: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. METHODS: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, ex-smokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. RESULTS: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. CONCLUSION The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.

Asthma ; Bronchitis ; Cohort Studies ; Cough ; Diagnosis ; Disease Management ; Eosinophils ; Epidemiology ; Female ; Gastroesophageal Reflux ; Humans ; Korea ; Lung Diseases ; Multivariate Analysis ; Observational Study ; Pregnant Women ; Retrospective Studies ; Tuberculosis

BACKGROUND: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. METHODS: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, ex-smokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. RESULTS: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. CONCLUSION The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.

PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation.
Aged ; Anesthetics, Intravenous/*administration & dosage/therapeutic use ; *Consciousness Monitors ; Endoscopy/methods ; Female ; Humans ; Intraoperative Complications/*prevention & control ; Male ; Middle Aged ; Monitoring, Physiologic/methods ; Piperidines/*administration & dosage/adverse effects/therapeutic use ; Propofol/*administration & dosage/adverse effects/therapeutic use

BACKGROUND: Discontinuation of antiepileptic drug (AED) is valuable in patients of epilepsy who have been seizure free for a considerable time. However, there are few established methods to successfully stop AED. The purpose of study was to find the prognostic factors and the method of desirable AED withdrawal. METHODS: Seventy-eight patients who were seizure free for more than 18 months were enrolled in this retrospective study. The patients were followed for more than 2 years after starting withdrawal, or until seizure recurrence within 2 years. To clarify the prognostic factors affecting the seizure recurrence related to the withdrawal, statistical analyses were done about AED types, EEG before withdrawal, sex, age, onset age of seizure, febrile convulsion, family history, brain CT/MRI, trauma history, loss of consciousness history, seizure nature, and duration of seizure free. Furthermore, survival analysis between groups over the duration of withdrawal period and AED decrement rate was done to elucidate the most successful methods of AED withdrawal. RESULTS: Fifty-seven patients (73%) experienced seizure recurrence after starting withdrawal within 2 years. Over 12 months of withdrawal duration (p=0.037) and under 20 percent per month of the decrement rate of carbamazepine (p=0.019) were related to reduce the seizure recurrence. These were also confirmed via survival curve analysis. CONCLUSIONS: This study is a new attempt to apply reduction rate in withdrawal. AED withdrawal duration and decrement rate are important factor to prognostic factors of desirable AED withdrawal and minimize the recurrence after withdrawal.
Age of Onset ; Anticonvulsants ; Brain ; Carbamazepine ; Electroencephalography ; Epilepsy ; Humans ; Recurrence ; Retrospective Studies ; Seizures ; Seizures, Febrile ; Unconsciousness

Although the genetic component in the etiology of rheumatoid arthritis (RA) has been consistently suggested, many novel genetic loci remain to uncover. To identify RA risk loci, we performed a genome-wide association study (GWAS) with 100 RA cases and 600 controls using Affymetrix SNP array 5.0. The candidate risk locus (APOM gene) was re-sequenced to discover novel promoter and coding variants in a group of the subjects. Replication was performed with the independent case-control set comprising of 578 RAs and 711 controls. Through GWAS, we identified a novel SNP associated with RA at the APOM gene in the MHC class III region on 6p21.33 (rs805297, odds ratio (OR) = 2.28, P = 5.20 x 10(-7)). Three more polymorphisms were identified at the promoter region of the APOM by the re-sequencing. For the replication, we genotyped the four SNP loci in the independent case-control set. The association of rs805297 identified by GWAS was successfully replicated (OR = 1.40, P = 6.65 x 10(-5)). The association became more significant in the combined analysis of discovery and replication sets (OR = 1.56, P = 2.73 +/- 10(-10)). The individuals with the rs805297 risk allele (A) at the promoter region showed a significantly lower level of APOM expression compared with those with the protective allele (C) homozygote. In the logistic regressions by the phenotype status, the homozygote risk genotype (A/A) consistently showed higher ORs than the heterozygote one (A/C) for the phenotype-positive RAs. These results indicate that APOM promoter polymorphisms are significantly associated with the susceptibility to RA.
Apolipoproteins/*genetics ; Arthritis, Rheumatoid/*genetics ; Case-Control Studies ; DNA/genetics ; Female ; *Genetic Predisposition to Disease ; Genome-Wide Association Study ; Genotype ; Heterozygote ; Homozygote ; Humans ; Lipocalins/*genetics ; Luciferases/metabolism ; Male ; Middle Aged ; Polymorphism, Single Nucleotide/*genetics ; Promoter Regions, Genetic/*genetics ; Real-Time Polymerase Chain Reaction ; Risk Factors

BACKGROUND: The present study tested the effect of midazolam administration after sevoflurane anesthesia against emergence agitation in children in the recovery phase. METHODS: A total of 60 children presenting for ophthalmic surgery under sevoflurane anesthesia were randomly placed in four groups from Group I to Group IV. Before the end of the surgery, we injected normal saline 2 ml in Group I and Group IV. We administered a 2-ml mixture of midazolam 0.025 mg/kg and midazolam 0.050 mg/kg to Group II and Group III respectively. Among the patients with agitation scores 4 or 5 in the peostanesthesia care unit (PACU), Group IV patients were intravenously given a 1-ml mixture of midazolam 0.025 mg/kg and normal saline up to 3 times. Agitation parameters, anesthesia recovery times, and the total administration amounts of midazolam were measured. RESULTS: Extubation time was significantly longer and maximum agitation scores higher in Group III than in Group I. The rate of the length of the period when the agitation score was 4 or 5 out of the length of stay in the PACU was significantly lower in Group II, Group III, and Group IV than in Group I. The length of stay in the PACU was significantly longer in Group III, and Group IV than in Group I. CONCLUSIONS: For pediatric patients under sevoflurane anesthesia, postoperative midazolam administration slightly prolonged the length of stay in the PACU. But it effectively reduced emergence agitation without any side effects.
Anesthesia ; Child ; Dihydroergotamine ; Humans ; Length of Stay ; Methyl Ethers ; Midazolam ; Strabismus

Fundoplication is a common surgical procedure for gastroesophageal reflux disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to review our 11 years experience with fundoplication in infants and children. From October 1994 to December 2005, 59 fundoplications in 55 patients were performed at Sungkyunkwan University Samsung Medical Center. Medical records and laboratory results of these children were retrospectively reviewed for sex, age, symptoms and signs, coexisting disease, diagnostic methods, treatment modalities and length of operative time. Open fundoplication was performed in 41 cases and laparoscopic fundoplication in 18 cases. Simultaneous gastrostomy was done in 27 cases. Recurrent GERD symptom occurred in four patients (7.2 %) within 2 years after first fundoplication and all 4 patients had re-do fundoplication. There were no intra- and immediate post-operative complications. Gastrointesitnal symptoms were the most common indication for fundoplication in neurologically normal patients. The most frequent diagnostic studies were upper gastrointestinal series (76.3 %) and 24 hour esophageal pH monitoring (78.2 %). Fundoplication had been increased since 2004 and mostly done laparoscopically. In conclusion, our 11 years' practice of open and laparoscopic fundoplication indicates that both approaches are safe and effective in the treatment of GERD for infants and children.
Child ; Esophageal pH Monitoring ; Fundoplication ; Gastroesophageal Reflux ; Gastrostomy ; Humans ; Infant ; Medical Records ; Operative Time ; Retrospective Studies

Even though there is no direct evidence to prove the cellular and molecular changes induced by radiofrequency (RF) radiation itself, we cannot completely exclude the possibility of any biological effect of mobile phone frequency radiation. We established a carousel-type exposure chamber for 849 MHz or 1763 MHz of mobile phone RF radiation to expose RF to the heads of C57BL mice. In this chamber, animals were irradiated intermittently at 7.8 W/kg for a maximum of 12 months. During this period, the body weights of 3 groups-sham, 849 MHz RF, and 1763 MHz RF-did not show any differences between groups. The brain tissues were obtained from 3 groups at 6 months and 12 months to examine the differences in histology and cell proliferation between control and RF exposure groups, but we could not find any change upon RF radiation. Likewise, we could not find changes in the expression and distribution of NeuN and GFAP in hippocampus and cerebellum, or in cell death by TUNEL assay in RF exposure groups. From these data, we conclude that the chronic exposure to 849 MHz and 1763 MHz RF radiation at a 7.8 W/kg specific absorption rate (SAR) could not induce cellular alterations such as proliferation, death, and reactive gliosis.
Animals ; Apoptosis/*radiation effects ; Body Weight/radiation effects ; Brain/pathology/*radiation effects ; Cell Proliferation/*radiation effects ; *Cellular Phone ; Dose-Response Relationship, Radiation ; Gliosis/etiology/pathology ; In Situ Nick-End Labeling ; Mice ; Mice, Inbred C57BL ; Nerve Tissue Proteins/biosynthesis/genetics ; Proliferating Cell Nuclear Antigen/biosynthesis/genetics ; Radio Waves/*adverse effects