Despite the availability of direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection in Korea, need remains for pangenotypic regimens that can be used in the presence of hepatic impairment, comorbidities, or prior treatment failure. We investigated the efficacy and safety of sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir for 12 weeks in HCV-infected Korean adults. Methods: This Phase 3b, multicenter, open-label study included 2 cohorts. In Cohort 1, participants with HCV genotype 1 or 2 and who were treatment-naive or treatment-experienced with interferon-based treatments, received sofosbuvir–velpatasvir 400/100 mg/day. In Cohort 2, HCV genotype 1 infected individuals who previously received an NS5A inhibitor-containing regimen ≥ 4 weeks received sofosbuvir–velpatasvir–voxilaprevir 400/100/100 mg/day. Decompensated cirrhosis was an exclusion criterion. The primary endpoint was SVR12, defined as HCV RNA < 15 IU/mL 12 weeks following treatment. Results: Of 53 participants receiving sofosbuvir–velpatasvir, 52 (98.1%) achieved SVR12. The single participant who did not achieve SVR12 experienced an asymptomatic Grade 3 ASL/ALT elevation on day 15 and discontinued treatment. The event resolved without intervention. All 33 participants (100%) treated with sofosbuvir–velpatasvir–voxilaprevir achieved SVR 12. Overall, sofosbuvir–velpatasvir and sofosbuvir–velpatasvir–voxilaprevir were safe and well tolerated. Three participants (5.6%) in Cohort 1 and 1 participant (3.0%) in Cohort 2 had serious adverse events, but none were considered treatment-related. No deaths or grade 4 laboratory abnormalities were reported. Conclusions: Treatment with sofosbuvir–velpatasvir or sofosbuvir–velpatasvir–voxilaprevir was safe and resulted in high SVR12 rates in Korean HCV patients.

Background: We hypothesized that concurrent temporary fixation of scapholunate ligament (SL) injury during volar locking plate (VLP) fixation of distal radius fractures (DRFs) would improve restoration outcomes based on both radiological and clinical results.Here, we performed a prospective, comparative study investigating the effectiveness of temporary percutaneous reduction/pinning during VLP fixation in DRFs. Methods: The first 43 consecutive SL injuries were treated concurrently after VLP fixation by closed pinning (group 1); the next 36 consecutive injuries were treated nonoperatively (group 2). Patients were followed up for at least 5 years after treatment. Basic demographic data, radiological measurements, arthroscopic findings of SL injury, and other clinical outcomes were evaluated. Results: The mean follow-up period was 7.2 years. No significant differences in basic demographic data were evident between groups. Fracture patterns were not distinctively different between groups. The initial scapholunate angle measured immediately after surgery was 23° ± 3° in group 1 and 38° ± 13° in group 2, indicating a significantly hyperextended scaphoid position in group 1.The final scapholunate angles were also significantly different between groups although the final angle in group 2 (58° ± 11°) was within normal limits. Final visual analog scale scores, Disabilities of the Arm, Shoulder and Hand scores, Gartland and Werley system scores, and wrist motions were not different between groups; however, grip strength at the time of final follow-up was closer to that of the contralateral uninjured wrist in group 1. Arthrosis was less advanced in group 1. Conclusions Temporary fixation for SL injury with a DRF can be an effective option for the maintenance of scapholunate angle.The non-fixed group exhibited a more pronounced collapse of the scapholunate angle although the angle was still within normal limits, and clinical outcomes were similar between groups regardless of the fixation status.

Background: We hypothesized that concurrent temporary fixation of scapholunate ligament (SL) injury during volar locking plate (VLP) fixation of distal radius fractures (DRFs) would improve restoration outcomes based on both radiological and clinical results.Here, we performed a prospective, comparative study investigating the effectiveness of temporary percutaneous reduction/pinning during VLP fixation in DRFs. Methods: The first 43 consecutive SL injuries were treated concurrently after VLP fixation by closed pinning (group 1); the next 36 consecutive injuries were treated nonoperatively (group 2). Patients were followed up for at least 5 years after treatment. Basic demographic data, radiological measurements, arthroscopic findings of SL injury, and other clinical outcomes were evaluated. Results: The mean follow-up period was 7.2 years. No significant differences in basic demographic data were evident between groups. Fracture patterns were not distinctively different between groups. The initial scapholunate angle measured immediately after surgery was 23° ± 3° in group 1 and 38° ± 13° in group 2, indicating a significantly hyperextended scaphoid position in group 1.The final scapholunate angles were also significantly different between groups although the final angle in group 2 (58° ± 11°) was within normal limits. Final visual analog scale scores, Disabilities of the Arm, Shoulder and Hand scores, Gartland and Werley system scores, and wrist motions were not different between groups; however, grip strength at the time of final follow-up was closer to that of the contralateral uninjured wrist in group 1. Arthrosis was less advanced in group 1. Conclusions Temporary fixation for SL injury with a DRF can be an effective option for the maintenance of scapholunate angle.The non-fixed group exhibited a more pronounced collapse of the scapholunate angle although the angle was still within normal limits, and clinical outcomes were similar between groups regardless of the fixation status.

Background/Aims: This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex. Methods: We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex. Results: During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female. Conclusions QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.

BACKGROUND AND PURPOSE: Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. METHODS: Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38℃ accompanied by a cough and/or a sore throat. RESULTS: Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). CONCLUSIONS: The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
Autoimmune Diseases ; Common Cold ; Cough ; Fever ; Follow-Up Studies ; Humans ; Influenza Vaccines ; Influenza, Human* ; Male ; Muscle Weakness ; Myasthenia Gravis* ; Pharyngitis ; Vaccination*

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Advisory Committees ; Consensus ; Counseling ; Drug Therapy ; Glottis ; Humans ; Laryngeal Neoplasms* ; Neck*

PURPOSE: This study aimed at evaluation of the learning curve for laparoscopic colorectal surgery with varied operative procedures. METHODS: From June 2004 to May 2010, 269 consecutive patients underwent laparoscopic colorectal surgery. Patients were divided into four groups according to operative methods: right-side colectomy, left-side colectomy, rectal resection, and total colectomy group. Each group was divided into three-early, middle, and late-groups according to operation numbers. Learning curves were generated for each group using moving average methods. Prospective collection and retrospective review of data on operative outcomes, including open conversion, operation time, intra-operative blood loss, postoperative hospital stay, and postoperative complication were performed. RESULTS: Operations included 75 right-side colectomies, 12 left-side colectomies, 178 rectal resections, four total colectomies, and seven open conversions (2.6%). The mean operative time for right-side colectomy and rectal resection showed a significant decline from the early group to the middle and late groups, while the left-side colectomy group showed no significant difference. Operation time was platitude after 50 cases of whole laparoscopic colorectal surgery, 11 cases in the right-side colectomy group, eight cases in the left-side colectomy group, and 34 cases in the recto-sigmoid resection group. CONCLUSION: For the surgeon, laparoscopic colorectal surgery can be performed more independently after 50 cases. The learning curve may be determined according to the general skill of laparoscopic colorectal surgery. The question of whether the learning curve is determined by varied operative procedures has not yet been resolved.
Colectomy ; Colorectal Surgery ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Operative Time ; Postoperative Complications ; Postoperative Hemorrhage ; Prospective Studies ; Retrospective Studies ; Surgical Procedures, Operative

PURPOSE: A 70-gene prognostic signature has prognostic value in patients with node-negative breast cancer in Europe. This diagnostic test known as "MammaPrint(TM) (70-gene prognostic signature)" was recently validated and implementation was feasible. Therefore, we assessed the 70-gene prognostic signature in Korean patients with breast cancer. We compared the risk predicted by the 70-gene prognostic signature with commonly used clinicopathological guidelines among Korean patients with breast cancer. We also analyzed the 70-gene prognostic signature and clinicopathological feature of the patients in comparison with a previous validation study. METHODS: Forty-eight eligible patients with breast cancer (clinical T1-2N0M0) were selected from four hospitals in Korea. Fresh tumor samples were analyzed with a customized microarray for the 70-gene prognostic signature. Concordance between the risk predicted by the 70-gene prognostic signature and risk predicted by commonly used clinicopathological guidelines (St. Gallen guidelines, National Institutes of Health [NIH] guideline, and Adjuvant! Online) was evaluated. RESULTS: Prognosis signatures were assessed in 36 patients. No significant differences were observed in the clinicopathological features of patients compared with previous studies. The 70-gene prognosis signature identified five (13.9%) patients with a low-risk prognosis signature and 31 (86.1%) patients with a high-risk prognosis signature. Clinical risk was concordant with the prognosis signature for 29 patients (80.6%) according to the St. Gallen guidelines; 30 patients (83.4%) according to the NIH guidelines; and 23 patients (63.8%) according to the Adjuvant! Online. Our results were different from previous validation studies in Europe with about a 40% low-risk prognosis and about a 60% high-risk prognosis. The high incidence in the high-risk group was consistent with data in Japan. CONCLUSION: The results of 70-gene prognostic signature of Korean patients with breast cancer were somewhat different from those identified in Europe. This difference should be studied as whether there is a gene disparity between Asians and Europeans. Further large-scale studies with a follow-up evaluation are required to assess whether the use of the 70-gene prognostic signature can predict the prognosis of Korean patients with breast cancer.
Asian Continental Ancestry Group ; Breast ; Breast Neoplasms ; Diagnostic Tests, Routine ; Europe ; Follow-Up Studies ; Gene Expression Profiling ; Genes, vif ; Humans ; Incidence ; Korea ; National Institutes of Health (U.S.) ; Prognosis

PURPOSE: To investigate the practice and attitude of healthcare professionals toward the sexuality of cancer patients. MATERIALS AND METHODS: The subjects were comprised of doctors and nurses who served at two medical centers. Questionnaires consisted of five domains and fourteen questions were disseminated via emails in March 2009. The first domain (3 questions) pertained the recognition of sexual dysfunction in cancer patients, the second (2 questions) pertained cancer patients' experience of sexual dysfunction, the third (3 questions) pertained the attitude to cancer patients with sexual dysfunction, the fourth (3 questions) pertained capacity for sexual dysfunction treatment, and the fifth (3 questions) pertained problems or difficulties encountered when facing cancer patients' sexual dysfunction. RESULTS: Three hundred and twenty-six men and women completed the questionnaires, giving a response rate of 85.4%. The mean age was 33.6 years. The proportion of doctors and nurses were respectively 48.2% and 51.8%. The proportion of males and females were 29.8%, and 70.2%, respectively. Ninety point five per cent (90.5%) of respondents answered that cancer patients' sexual dysfunction is important to quality of life. However, fewer medical professionals (27.4%) give an affirmative answer that patients requested sexual dysfunction therapy. The occurred particularly less frequently in physicians (13.2%) than in surgeons (55.6%). Fifty-four point six (54.6%) percent of respondents said that they tried to resolve the problem when patients asking for treatment of sexual dysfunction. Only 38.3% of respondents experienced little or no difficulty in behaving naturally when counseling cancer patients about their sexual dysfunction. Female doctors and nurses more often experience embarrassment when addressing sexuality with patients. In addition, most respondents (84.0%) felt that theoretical knowledge on cancer patients' problems is needed. CONCLUSIONS: Most healthcare professionals agreed that sexual problems of cancer patients were important for quality of life. However, they frequently felt a lack of communicating skills and theoretical knowledge. Education programs on this issue and an appropriate contact system with specialists should be established.
Counseling ; Surveys and Questionnaires ; Delivery of Health Care ; Electronic Mail ; Female ; Humans ; Male ; Quality of Life ; Republic of Korea ; Sexuality ; Specialization

BACKGROUND: There is no accepted landmark for the mechanical axis of the femoral axis in sagittal plane in conventional total knee arthroplasty. METHODS: As palpable anatomic landmarks of the femur, lateral epicondyle, and anterior margin of the greater trochanter were identified. The line connecting these two landmarks was defined as the "palpable sagittal axis". The mechanical axis of the femur was compared with the palpable sagittal axis and the distal femoral anterior cortex axis. These axes were also compared with sagittal bowing of the femur. RESULTS: The distal femoral anterior cortex axis and the palpable sagittal axis were flexed by 4.1degrees and 2.4degrees more than the sagittal mechanical axes, respectively (p < 0.05). However, the palpable sagittal axis was not correlated with sagittal bowing of the femur (Spearman's rs, 0.17; p = 0.14). CONCLUSIONS: The palpable sagittal axis showed a consistent relationship with the sagittal mechanical femoral axes regardless of the severity of the sagittal bowing of the femur.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*methods ; Biomechanics ; Female ; Femur/anatomy & histology/*surgery ; Humans ; Knee Joint/anatomy & histology/surgery ; Male ; Middle Aged