Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder characterized by uncontrolled terminal complement activation. Eculizumab, a monoclonal antibody C5 inhibitor was introduced in Korea in 2009 and has been the standard treatment option for PNH. Methods: This study assessed the long-term efficacy/safety of eculizumab in PNH using real-world data from the Korean Health Insurance Review and Assessment Service. Eighty patients who initiated eculizumab from 2009–2020 were enrolled. Results: At eculizumab initiation, the median age was 51.5 years, lactate dehydrogenase (LDH) 6.8 × upper limit of normal, and granulocyte clone size 93.0%. All patients had at least one PNH-related complication before eculizumab initiation, including renal failure (n = 36), smooth muscle spasm (n = 24), thromboembolism (n = 20), and pulmonary hypertension (n = 15). The median (range) duration of eculizumab treatment was 52.7 (1.0, 127.3) months (338.6 total treated patient-years). Despite high disease activity in the study population before treatment initiation, overall survival was 96.2% and LDH levels were stabilized in most patients during treatment. PNH-related complications at treatment initiation were resolved in 44.4% of patients with renal failure, 95.8% with smooth muscle spasm, 70.0% with thromboembolism, and 26.7% with pulmonary hypertension. Extravascular hemolysis occurred in 28.8% of patients (n = 23; 0.09 per patient-year) and breakthrough hemolysis in 18.8% (n = 15; 0.06 per patient-year). No treatment discontinuation cases related to eculizumab were observed. Conclusion These data provided evidence for the long-term efficacy and safety of eculizumab in Korean PNH patients with high disease burdens.

Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

Venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis, is a condition characterized by abnormal blood clot formation in the pulmonary arteries and the deep venous vasculature. It is often serious and sometimes even fatal if not promptly and appropriately treated. Moreover, the later consequences of VTE may result in reduced quality of life. The treatment of VTE depends on various factors, including the type, cause, and patient comorbidities. Furthermore, bleeding may occur as a side effect of VTE treatment. Thus, it is necessary to carefully weigh the benefits versus the risks of VTE treatment and to actively monitor patients undergoing treatment. Asian populations are known to have lower VTE incidences than Western populations, but recent studies have shown an increase in the incidence of VTE in Asia. A variety of treatment options are currently available owing to the introduction of direct oral anticoagulants.The current VTE treatment recommendation is based on evidence from previous studies, but it should be applied with careful consideration of the racial, genetic, and social characteristics in the Korean population.

PURPOSE: The aim of this study was to investigate the influence of nurses' awareness of healthcare accreditation on their job stress and turnover intention. METHODS: Across-sectional correlation study design was used. Participants consisted of 143 nurses from two tertiary hospitals in Seoul and Gyunggido, South Korea. Data were collected in October 2016 using self-report questionnaires and analyzed using descriptive statistics, t-test, an ANOVA, Pearson's correlation coefficient, and multiple regression in SPSS/WIN 21.0. RESULTS: Awareness of health care accreditation correlated negatively with job stress (r=−63, p < .001) and turn over intention (r=−.50, p < .001). Awareness of health care accreditation was the factor that most influenced job stress, explaining 38% of the variance (F=23.10, p < .001). Awareness of health care accreditation and duty pattern were the factors that most influenced intention to leave, explaining 32% of the variance (F=10.35, p < .001). CONCLUSION: These findings suggest raising nurses' awareness of certification systems to reduce their job stress and turnover intentions. It will be necessary to provide support for the aggressive work nurses do and improve their work structure, highlighting the need for both manpower and institutional support. Accordingly, providing regular education programs and appropriate compensation schemes, by raising nurses' awareness of medical institutions' certification systems, is necessary.
Accreditation ; Certification ; Compensation and Redress ; Delivery of Health Care ; Education ; Intention ; Korea ; Personnel Turnover ; Seoul ; Statistics as Topic ; Tertiary Care Centers

PURPOSE: The aim of this study was to investigate the influence of nurses' awareness of healthcare accreditation on their job stress and turnover intention. METHODS: Across-sectional correlation study design was used. Participants consisted of 143 nurses from two tertiary hospitals in Seoul and Gyunggido, South Korea. Data were collected in October 2016 using self-report questionnaires and analyzed using descriptive statistics, t-test, an ANOVA, Pearson's correlation coefficient, and multiple regression in SPSS/WIN 21.0. RESULTS: Awareness of health care accreditation correlated negatively with job stress (r=−63, p < .001) and turn over intention (r=−.50, p < .001). Awareness of health care accreditation was the factor that most influenced job stress, explaining 38% of the variance (F=23.10, p < .001). Awareness of health care accreditation and duty pattern were the factors that most influenced intention to leave, explaining 32% of the variance (F=10.35, p < .001). CONCLUSION These findings suggest raising nurses' awareness of certification systems to reduce their job stress and turnover intentions. It will be necessary to provide support for the aggressive work nurses do and improve their work structure, highlighting the need for both manpower and institutional support. Accordingly, providing regular education programs and appropriate compensation schemes, by raising nurses' awareness of medical institutions' certification systems, is necessary.

During a biodiversity survey of undiscovered taxa in Korea, two zygomycetous fungal strains were isolated. The first strain, EML-FSDY6-1 was isolated from a soil sample collected at Dokdo Island in the East Sea of Korea in 2013, and the second strain, EML-DG-NH3-1 was isolated from a rat dung sample collected at Chonnam National University garden, Gwangju, Korea in 2014. Based on the morphological characteristics and phylogenetic analysis of the internal transcribed spacer, 18S and 28S rDNA, actin and translation elongation factor-1α genes. EML-FSDY6-1 and EML-DG-NH3-1 isolates were confirmed as zygomycete species, Absidia pseudocylindrospora and Absidia glauca, respectively. Neither species has previously been described in Korea.
Absidia ; Actins ; Animals ; Biodiversity ; DNA, Ribosomal ; Gwangju ; Jeollanam-do ; Korea* ; Rats ; Soil

The purpose of this study was to investigate the intakes and perceptions of convenient breakfast related to age and family type. The survey included 545 men and women living in Seoul from June to July. Questionnaire items covered their age, gender, family types, breakfast intakes and preference for convenient breakfast menu. As a result, there were significant differences in the number of breakfast intakes per week according to family types; large families recorded the highest frequency in "I have breakfast everyday" and the couple-only families and nuclear families scored relatively high numbers. In terms of the type of breakfast, the first choice was "rice and side dishes" across all the age groups (69.3%). There were differences in the preference of convenient breakfast in "bread", "cereal", "rice cake", "sunsik", and "rice gruel" by different age. The teens exhibited the highest preference of bread (5.63), and cereal (5.53) for breakfast; those who were in their fifties for rice cake (5.42). Both forties and fifties showed the higher preference of sunsik (4.58, 4.76) and rice gruel (5.89, 5.77) than other age groups. As for the preference for convenient breakfast according to family types, single person families displayed the highest preference of bread (5.42) and cereal (5.75). Couple families showed higher preference of rice gruel (5.82) than other family groups. The preference level for "rice cake" was similar among all the family types. As a result, it is suggested that the development of various breakfast menus considering age groups and family types is needed so that modern people can enjoy breakfast in terms of quality and quantity in their busy daily life.
Adolescent ; Bread ; Breakfast ; Edible Grain ; Female ; Humans ; Male ; Nuclear Family ; Surveys and Questionnaires ; Single Person

PURPOSE: Stage-related treatment has been recommended for gallbladder cancer (GBC). When patients with T2 tumors undergo an extended cholecystectomy, the 5-year survival rates have been reported to be 64~100%. But when patients with T2 tumors undergo simple cholecystectomy, the 5-year survival rates have been reported to be only 20~40%. The question may rise as to which patients benefit from simple cholecystectomy among patients with T2 GBC. We investigated the survivals and the facts leading to death or recurrence after simple cholecystectomy for T2 GBC. METHODS: Between Mar. 2001 and Dec. 2007, 13 patients had refused second radical operation for T2 GBC incidentally discovered after simple cholecystectomy. Survival analyses were evaluated by clinopathological factors. RESULTS: The 1-, 3- and 4-year overall survival rates were 84.6%, 76.2% and 38.1% and 1- and 3-year disease-free survival rates were 69.2%, 51.3%. The factors affected survival rates were low serum albumin titer and R1 resection (Lymph node metastasis or cystic duct involvement in microscopic finding) (P<0.05). CONCLUSION: Simple cholecystectomy is not a curative method of T2 GBC, because it reveals lower 5-year survival rates compared to those of extended cholecystectomy or radical surgery. But in the case when the patient refuses reoperation or it is difficult to undergo reoperation because of severe underlying disease, simple cholecystectomy with normal albumin titer or the absence of lymph node metastasis and absence of cystic duct involvement in microscopic findings may help the long-term survivals after simple cholecystectomy.
Cholecystectomy ; Cystic Duct ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Reoperation ; Serum Albumin ; Survival Rate

BACKGROUND/AIMS: The aim of this study was to investigate the value of expression of COX-2 and p53 protein in colonic adenoma with or without malignant change. METHODS: We studied twenty-five cases of colonic adenoma with malignant change and twenty-five cases of colonic adenoma without malignant change treated by colonoscopic polypectomy in Chungnam National University Hospital from January, 1999 to July, 2002. We compared the expression of COX-2 and p53 protein by immunohistochemical stain in both group. RESULTS: In immunohistochemical staining, the expression of COX-2 was demonstrated 68.0% (17 of 25) of colonic adenoma with malignant change and not different with that of colonic adenoma without malignant change. The overexpression of p53 protein was detected immunohistochemically in 88.0% (22 of 25) of colonic adenoma with malignant change and 32% (8 of 25) of colonic adenoma only (p <0.05). CONCLUSIONS: The degree of COX-2 expression was similar in colonic adenoma and colonic adenoma with malignant change, but the expression of p53 in colonic adenoma with malignant change was significantly higher (p <0.05). These results suggest COX-2 might operate on early step of adenoma-carcinoma sequence. Also these results remind us that mutation of p53 gene operates on the late step of adenoma-carcinoma sequence.
Adenoma* ; Chungcheongnam-do ; Colon* ; Cyclooxygenase 2* ; Genes, p53

BACKGROUND/AIMS: Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC. METHODS: We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size. RESULTS: One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively. CONCLUSIONS: We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.
Adult ; Aged ; Carcinoma, Hepatocellular/complications/*diagnosis/virology ; English Abstract ; Female ; Hepatitis B Surface Antigens/*blood ; Humans ; Liver Cirrhosis/*complications/virology ; Liver Neoplasms/complications/*diagnosis/virology ; Male ; Middle Aged ; Sensitivity and Specificity ; Tumor Markers, Biological/analysis ; alpha-Fetoproteins/*analysis