Stroke causes systemic immunosuppression. T lymphocytes are involved in infarct size in the early stages of stroke. However, the phenotypes of T lymphocytes and their functions in peripheral immune organs and the brain have not been well analyzed in the acute and chronic phases of stroke. Here, we investigated pathological phenotypic alterations in the systemic immune response, especially changes in T lymphocytes, from one day to six months after ischemic stroke in mice. Impairment in thymocyte numbers, development, proliferation, and apoptosis were observed for up to two weeks. The number of mature T cells in the spleen and blood decreased and showed reduced interferon-γ production. Increased numbers of CD4-CD8-CD3+ double-negative T cells were observed in the mouse brain during the early stages of stroke, whereas interleukin (IL)-10+Foxp3+ regulatory T lymphocytes increased from two weeks during the chronic phase. These phenotypes correlated with body weight and neurological severity scores. The recovery of T lymphocyte numbers and increases in IL-10+Foxp3+ regulatory T lymphocytes may be important for long-term neurological outcomes. Dynamic changes in T lymphocytes between the acute and chronic phases may play different roles in pathogenesis and recovery. This study provides fundamental information regarding the T lymphocyte alterations from the brain to the peripheral immune organs following stroke.

Stroke causes systemic immunosuppression. T lymphocytes are involved in infarct size in the early stages of stroke. However, the phenotypes of T lymphocytes and their functions in peripheral immune organs and the brain have not been well analyzed in the acute and chronic phases of stroke. Here, we investigated pathological phenotypic alterations in the systemic immune response, especially changes in T lymphocytes, from one day to six months after ischemic stroke in mice. Impairment in thymocyte numbers, development, proliferation, and apoptosis were observed for up to two weeks. The number of mature T cells in the spleen and blood decreased and showed reduced interferon-γ production. Increased numbers of CD4-CD8-CD3+ double-negative T cells were observed in the mouse brain during the early stages of stroke, whereas interleukin (IL)-10+Foxp3+ regulatory T lymphocytes increased from two weeks during the chronic phase. These phenotypes correlated with body weight and neurological severity scores. The recovery of T lymphocyte numbers and increases in IL-10+Foxp3+ regulatory T lymphocytes may be important for long-term neurological outcomes. Dynamic changes in T lymphocytes between the acute and chronic phases may play different roles in pathogenesis and recovery. This study provides fundamental information regarding the T lymphocyte alterations from the brain to the peripheral immune organs following stroke.

Medical ethics, autonomy, and self-regulation form the core of medical professionalism. Therefore, codes and guidelines regarding ethics are key documents that demonstrate the identity of physicians as a professional group in a society. In Korea, foreign declarations such as the Hippocratic Oath and the Geneva Declaration have been translated and introduced, while medical ethics guidelines have been introduced from developed countries. In 1961, 1965, and 1979, the Code of Medical Ethics was created and revised, but only in 1997 did Korean doctors develop their own ethics guidelines and codes reflecting their identity in Korean society. In order for these guidelines and codes to be effective living documents, they should be regularly modified to reflect changes in the medical environment and the field of medicine. In response to the urgent need to establish strict norms of medical professionalism in the 21st century due to internal and external problems in Korean society, the Korean Medical Association worked to revise the Ethics Code and Guidelines in 2016. This article reviews the history of how the Korean Code of Ethics and Guidelines has changed and examines the contents of the Code of Ethics and Guidelines as amended in 2016.
Codes of Ethics ; Developed Countries ; Ethics ; Ethics, Medical* ; Hippocratic Oath ; Korea* ; Professionalism ; Self-Control

Ciliary rootlet coiled coil protein (CROCC), the structural component that originates from the basal body at the proximal end of the ciliary rootlet, plays a crucial role in maintaining the cellular integrity of ciliated cells. In the current study, we cloned Xenopus CROCC and performed the expression analysis. The amino acid sequence of Xenopus laevis was related to those of Drosophila, cow, goat, horse, chicken, mouse and human. Reverse transcription polymerase chain reaction analysis revealed that CROCC mRNA encoding a coiled coil protein was present maternally, as well as throughout early development. In situ hybridization indicated that CROCC mRNA occurred in the animal pole of embryo during gastrulation and subsequently in the presumptive neuroectoderm at the end of gastrulation. At tailbud stages, CROCC mRNA expression was localized in the anterior roof plate of the developing brain, pharyngeal epithelium connected to gills, esophagus, olfactory placode, intestine and nephrostomes of the pronephric kidney. Our study suggests that CROCC may be responsible for control of the development of various ciliated organs.
Amino Acid Sequence ; Animals ; Basal Bodies ; Brain ; Chickens ; Clone Cells ; Drosophila ; Embryonic Structures ; Epithelium ; Esophagus ; Gastrulation ; Gills ; Goats ; Horses ; Humans ; In Situ Hybridization ; Intestines ; Kidney ; Mice ; Neural Plate ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger* ; Xenopus laevis ; Xenopus*

PURPOSE: We evaluated the characteristics of and treatment outcomes in patients with benign tracheobronchial tumors. MATERIALS AND METHODS: We reviewed the records of patients with benign tracheobronchial tumors who underwent bronchoscopic intervention with mechanical removal and Nd: YAG laser cauterization, and evaluated the characteristics and treatment outcomes of 55 patients with hamartomas, leiomyomas, papillomas, typical carcinoids, or schwannomas seen between April 1999 and July 2012. RESULTS: The most common tumors were hamartoma (n=24), leiomyoma (n=16), papilloma (n=7), typical carcinoid (n=5), and schwannoma (n=3). Forty-one patients (75%) had symptoms. On chest computed tomography, 35 patients (64%) had round or ovoid lesions, accompanied by atelectasis (n=26, 47%) or obstructive pneumonia (n=17, 31%). Fatty components (n=9, 16%) and calcifications (n=7, 13%) were observed only in hamartomas, leiomyomas, and typical carcinoids. At bronchoscopy, the typical findings were categorized according to tumor shape, surface, color, and visible vessels. Fifty (91%) patients underwent complete resection. Forty patients (73%) achieved successful bronchoscopic removal defined as complete resection without complications or recurrence. Recurrences occurred in four papillomas, one leiomyoma, and one typical carcinoid. The proportions of tumor types (p=0.029) differed between the successful and unsuccessful removal groups, and a pedunculated base (p<0.001) and no spontaneous bleeding (p=0.037) were more frequent in the successful removal group. CONCLUSION: We described clinical, radiological, and typical bronchoscopic findings in patients with benign tracheobronchial tumors; these findings might help to differentiate such tumors. Bronchoscopic intervention was a useful treatment modality, and tumor type, pedunculated base, and vascularity may influence successful tumor removal.
Adolescent ; Adult ; Aged ; Bronchi/pathology/*surgery ; Bronchoscopy ; Carcinoid Tumor/pathology/surgery ; Female ; Hamartoma/pathology/surgery ; Humans ; Leiomyoma/pathology/surgery ; Male ; Middle Aged ; Neurilemmoma/pathology/surgery ; Papilloma/pathology/surgery ; Young Adult

We evaluated whether sonographic findings can provide additional diagnostic yield in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and can more accurately predict nodal metastasis than chest computed tomography (CT) or positron emission tomography (PET)/CT scans. EBUS-TBNA was performed in 146 prospectively recruited patients with suspected thoracic lymph node involvement on chest CT and PET/CT from June 2012 to January 2013. Diagnostic yields of EBUS finding categories as a prediction model for metastasis were evaluated and compared with findings of chest CT, PET/CT, and EBUS-TBNA. In total, 172 lymph nodes were included in the analysis: of them, 120 were malignant and 52 were benign. The following four EBUS findings were predictive of metastasis: nodal size > or =10 mm, round shape, heterogeneous echogenicity, and absence of central hilar structure. A single EBUS finding did not have sufficient diagnostic yield; however, when the lymph node had any one of the predictive factors on EBUS, the diagnostic yields for metastasis were higher than for chest CT and PET/CT, with a sensitivity of 99.1% and negative predictive value of 83.3%. When any one of predictive factors is observed on EBUS, subsequent TBNA should be considered, which may provide a higher diagnostic yield than chest CT or PET/CT.
Aged ; Bronchi ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/*methods ; Endosonography/*methods ; Female ; Humans ; Lymph Nodes/*pathology/ultrasonography ; Lymphatic Diseases/*pathology/ultrasonography ; Lymphatic Metastasis ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Thoracic Neoplasms/*pathology/*secondary/ultrasonography

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Community-Acquired Infections/*mortality ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pneumonia/*mortality ; Prospective Studies ; Republic of Korea ; *Severity of Illness Index ; Young Adult

PURPOSE: This study was designed to validate the usefulness of the Acute Physiology and Chronic Health Evaluation (APACHE) II for predicting hospital mortality of critically ill Korean patients. MATERIALS AND METHODS: We analyzed data on 826 patients who had been admitted to nine intensive care units and were included in the Fever and Antipyretics in Critical Illness Evaluation study cohort. RESULTS: Among the patients enrolled, 62% (512/826) were medical and 38% (314/826) were surgical patients. The median APACHE II score was 17 (11 to 23 interquartile range), and the hospital mortality rate was 19.5%. Age, underlying diseases, medical patients, mechanical ventilation, and renal replacement therapy were independently associated with hospital mortality. The calibration of APACHE II was poor (H=57.54, p<0.0001; C=55.99, p<0.0001), and the discrimination was modest [area under the receiver operating characteristic (aROC)=0.729]. Calibration was poor for both medical and surgical patients (H=63.56, p<0.0001; C=73.83, p<0.0001, and H=33.92, p<0.0001; C=33.34, p=0.0001, respectively), while discrimination was poor for medical patients (aROC=0.651) and modest for surgical patients (aROC=0.704). At the predicted risk of 50%, APACHE II had a sensitivity of 36.6% and a specificity of 87.4% for hospital mortality. CONCLUSION: For Koreans, the APACHE II exhibits poor calibration and modest discrimination for hospital mortality. Therefore, a new model is needed to accurately predict mortality in critically ill Korean patients.
*APACHE ; Aged ; Cohort Studies ; Critical Illness/mortality ; Hospital Mortality ; Humans ; *Intensive Care Units ; Middle Aged ; Risk Factors

PURPOSE: The purpose of this study is to present our preliminary experience of the temporary endovascular bypass (TEB) technique using an Enterprise stent for recanalization of acute intracranial artery (IA) occlusion. MATERIALS AND METHODS: Patients treated by TEB were enrolled in this retrospective study from January 2009 to May 2010. All the procedures consist of temporary partial deployment and subsequent retrieval of Enterprise stent, supplemented by intra-arterial infusion of urokinase (UK) and/or tirofiban. According to the thrombolysis in cerebral infarction (TICI) classification, recanalization was evaluated with initial and postprocedural angiography. Safety was evaluated related to the procedure and clinical outcomes were assessed by National Institute of Health Stroke Scale (NIHSS) score at discharge and modified Rankin scale (mRS) score at 3 months. RESULTS: Eleven patients (median NIHSS 12.8, mean age 61.6 years, male: female = 8:3) with acute IA occlusion were treated with TEB. All the patients presented with TICI 0, and the occluded vessel was the middle cerebral artery (n=7), the basilar artery (n=1), and the distal ICA occlusion (n = 3). IV infusion of tissue plasminogen activator (tPA) was done in 4 patients and mechanical thrombolysis with intra-arterial UK was performed in 9. Recanalization was achieved in 73% (8 patients; TICI > or = 2). There were no procedure-related complications except for two asymptomatic intracranial hemorrhages. Improvement (> or = 4 points on the NIHSS) and good outcome (mRS < or =2) after 90 days was shown in six patients (55%). One patient died 6 days after procedure. CONCLUSION: TEB may be a valuable treatment option in acute thromboembolic IA occlusion without stent implantation.
Angiography ; Arteries ; Basilar Artery ; Cerebral Infarction ; Female ; Glycosaminoglycans ; Humans ; Infusions, Intra-Arterial ; Intracranial Hemorrhages ; Mechanical Thrombolysis ; Middle Cerebral Artery ; Retrospective Studies ; Stents ; Stroke ; Tissue Plasminogen Activator ; Tyrosine ; Urokinase-Type Plasminogen Activator

PURPOSE: To assess the clinical features associated with the direction of deviation in sensory strabismus and postoperative stability of strabismus angles. METHODS: The authors retrospectively reviewed the medical records of 98 patients diagnosed with sensory strabismus who were treated surgically. Among the factors analyzed were sex, age, direction of strabismus, preoperative visual acuity, age at onset of visual loss, cause of primary sensory deficit, refractive error, age at operation, deviation angle at 1 and 6 months postoperatively and after at least 5 years. RESULTS: At baseline, 20 patients (20.4%) had esotropia and 78 (79.6%) had exotropia. Common causes of primary sensory deficit were corneal opacity (25.5%), vitreoretinal disorder (23.5%), and congenital cataracts (16.3%). The proportion of esotropia increased significantly as the refractive error of the sound eye became more hyperopic. The older the patients were when they lost their vision, the higher the proportion of exotropia. Patients with longer duration of vision loss were more likely to have a larger deviation angle with exotropia, but the association was not significant with esotropia. CONCLUSIONS: Patients with sensory strabismus tend to develop exotropia. Refractive error of the sound eye and age at onset of vision loss were associated with the direction of strabismus. Despite poor sensory fusion even after surgery, more than 50% of patients maintained a stable eye position.
Cataract ; Corneal Opacity ; Esotropia ; Exotropia ; Eye ; Humans ; Medical Records ; Refractive Errors ; Retrospective Studies ; Strabismus ; Vision, Ocular ; Visual Acuity