Objective: To establish the reference standard of the median nerve conduction study (NCS) in Korea. Methods: A total of 648 median motor and 602 median sensory NCSs from 349 Korean healthy volunteers were tested and analyzed prospectively. Equipment calibration, assessment of intraand inter-rater reliability, and the NCSs per se were conducted according to a predetermined protocol. A reference standard was established from uncertainty components for the following parameters: the onset and peak latencies; the baseline-to-peak and peak-to-peak amplitudes; the area and duration of the negative wave; and the nerve conduction velocity. The effects of sex, age and stimulation intensity were analyzed. Results: Each measured value of 648 median motor and 602 median sensory nerves were obtained and presented with both mean and expanded uncertainties, as well as mean and standard deviations. The cut-off values with expanded uncertainty were determined for different age and sex groups. After adjusting for anthropometric covariates, all parameters except duration were affected by age, and sex appeared to influence both duration and area. While stimulation intensity significantly affected some parameters including latencies, the effect sizes were negligible. Conclusion We propose the median NCS reference standard using the largest Korean dataset ever available. The use of the traceable and reliable reference standard is anticipated to promote more accurate and dependable diagnosis and appropriate management of median neuropathies in Korea.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Background: Nilotinib is a tyrosine kinase inhibitor approved by the Ministry of Food and Drug Safety for frontline and 2nd line treatment of Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML). This study aimed to confirm the safety and efficacy of nilotinib in routine clinical practice within South Korea. Methods: An open-label, multicenter, single-arm, 12-week observational post-marketing surveillance (PMS) study was conducted on 669 Korean adult patients with Ph + CML from December 24, 2010, to December 23, 2016. The patients received nilotinib treatment in routine clinical practice settings. Safety was evaluated by all types of adverse events (AEs) during the study period, and efficacy was evaluated by the complete hematological response (CHR) and cytogenetic response. Results: During the study period, AEs occurred in 61.3% (410 patients, 973 events), adverse drug reactions (ADRs) in 40.5% (271/669 patients, 559 events), serious AEs in 4.5% (30 patients, 37 events), and serious ADRs in 0.7% (5 patients, 8 events). Furthermore, unexpected AEs occurred at a rate of 6.9% (46 patients, 55 events) and unexpected ADRs at 1.2% (8 patients, 8 events). As for the efficacy results, CHR was achieved in 89.5% (442/494 patients), and minor cytogenetic response or major cytogenetic response was achieved in 85.8% (139/162 patients). Conclusion This PMS study shows consistent results in terms of safety and efficacy compared with previous studies. Nilotinib was well tolerated and efficacious in adult Korean patients with Ph + CML in routine clinical practice settings.

Background: The aim of this study was to evaluate the short-term and long-term results of surgical treatment for native valve endocarditis (NVE) and to investigate the risk factors associated with mortality. Methods: Data including patients’ characteristics, operative findings, postoperative results, and survival indices were retrospectively obtained from Hallym University Sacred Heart Hospital. Results: A total of 29 patients underwent surgery for NVE (affecting the mitral valve in 20 patients and the aortic valve in 9) between 2003 and 2017. During the follow-up period (median, 46.9 months; interquartile range, 19.1–107.0 months), the 5-year survival rate was 77.2%. In logistic regression analysis, body mass index (p=0.031; odds ratio [OR], 0.574; 95% confidence interval [CI], 0.346–0.951), end-stage renal disease (ESRD) (p=0.026; OR, 24.0; 95% CI, 1.459–394.8), and urgent surgery (p=0.010; OR, 34.5; 95% CI, 2.353–505.7) were significantly associated with in-hospital mortality. Based on Cox proportional hazard regression analysis, the statistically significant predictors of long-term outcomes were hypertension, ESRD, and urgent surgery. Conclusion Surgical treatment for NVE is associated with considerable mortality. The in-hospital mortality and 5-year survival rates of this study were 13.8% and 77.2%, respectively. Underlying conditions, including hypertension and ESRD, and urgent surgery were independent risk factors for unfavorable outcomes.

Objective: The purpose of this study was to understand the mechanism of normal hyoid movement during swallowing by calculating the activity of each muscle involved in the hyoid movement and propose a new kinetic modeling of hyoid movement using videofluoroscopy images. Methods: Eight healthy volunteers with an average age of 56.8 swallowed 2-ml of diluted barium under videofluoroscopy. A video image was digitized to analyze the movement of the hyoid bone. The activity of the muscles acting on the hyoid bone was calculated from the movement of the hyoid bone using kinetic modeling. A surface electromyogram was measured simultaneously with videofluoroscopy, and the muscle force calculated by kinetic modeling was compared with the muscle force measured by surface EMG. Results: The muscles acting on the hyoid bone were divided into three groups according to the direction of force and analyzed. The contraction of the retractor muscle group was observed as a median of 433 ms (95% CI 264-602, P=0.012) earlier than the contraction of protractor muscle group in all subjects. Generally, the peak activity of each muscle group was observed in the order of retractor (0 ms), protractor (592 ms, 95% CI 429-755), and depressor (717 ms, 95% CI 535-899) muscle group. The contraction of the protractor muscle measured by surface electromyography showed an earlier onset latency with a median of 82 2 ms (95% CI 615-102 9, P=0.012 ) compared to the contraction of the protractor muscle calculated by kinetic modeling. Conclusion Kinetic modeling reflects the pattern of contraction in the order of retractor, protractor, depressor muscle groups, as previously known. And it was possible to evaluate the activity of the retractor muscle, which is difficult to evaluate by electromyogram.

Wound healing is composed of a complex process that requires harmonies of various cell populations where fibroblasts play the main role. Oligomeric procyanidins (OPC) are main components of grape (Vitis vinifera) seed extracts, and recent studies showed OPC's effects on inflammation, cell migration, and proliferation. We investigated the effect of OPC on fibroblasts to regulate wound healing process. Human dermal fibroblast known as Hs27 cells were treated with various concentrations of OPC (0, 2.5, 5, 10, and 20 µg/µl). Cell cytotoxicity was evaluated by the Cell Counting Kit assay, and the expression levels of secreted procollagen were analyzed. Procollagen levels in OPC treated cells exposed to transforming growth factor beta 1 (TGF-β1) or ascorbic acid were evaluated using Western blot and immunocytochemistry. Relative mRNA expressions of procollagen, molecular chaperone such as HSP47, P4H were determined by real-time PCR in OPC treated cells. OPC showed no cytotoxicity on Hs27 cells at every concentration but inhibited procollagen secretion in a dose-dependent manner. The inhibitory effect also appeared under TGF-β1 induced collagen overproduction. Immunocytochemistry showed that higher levels of intracytoplasmic procollagen were accumulated in TGF-β1 treatment group, whereas ascorbic acid induced a release of accumulated procollagen under OPC treatment. The mRNA expressions of procollagen, molecular chaperone were not affected by OPC, but procollagen level was increased when exposed to TGF-β1. OPC inhibits procollagen secretion from fibroblasts with no effects on cell proliferations even under the environment of TGF-b1-induced collagen overproduction. OPC could regulate the diseases and symptoms of abnormal overabundant collagen production.
Ascorbic Acid ; Blotting, Western ; Cell Count ; Cell Movement ; Collagen ; Collagen Type I* ; Fibroblasts* ; Humans ; Immunohistochemistry ; Inflammation ; Molecular Chaperones ; Proanthocyanidins* ; Procollagen* ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Transforming Growth Factor beta ; Vitis ; Wound Healing

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)
14-alpha Demethylase Inhibitors/adverse effects/therapeutic use ; Adolescent ; Adult ; Aged ; Antifungal Agents/adverse effects/*therapeutic use ; Aspergillosis/complications/*drug therapy ; Candidiasis/complications/*drug therapy ; Coccidioidomycosis/complications/drug therapy ; Febrile Neutropenia/complications/drug therapy ; Female ; Hematologic Neoplasms/complications/drug therapy/*microbiology ; Humans ; Itraconazole/adverse effects/*therapeutic use ; Male ; Mannans/blood ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult

BACKGROUND: It has been known that Asians are more likely to develop atherosclerosis of the intracranial arteries while Caucasians have more extracranial arterial diseases. Angiographic distribution and frequency of the carotid artery stenosis have not been well known in Korean patients with acute ischemic stroke. METHODS: From the Yonsei Stroke Registry, a total of 300 acute ischemic stroke patients, who were evaluated by a conventional cerebral angiography from July 1997 to September 2000, were enrolled for this study. Patients were divided into three groups: isolated intracranial internal carotid artery (ICA) stenosis (IICA group); isolated extracranial ICA stenosis (EICA group); and combined stenosis of intracranial and extracranial ICAs (combined group). The clinical and angiographical characteristics were investigated and compared among them. RESULTS: A total of 107 patients had stenotic lesions in the ICA. They were 45 patients with lesions in the intracranial ICA (IICA group), 42 in the extracranial ICA (EICA group), and 20 patients in the both intracranial and extracranial ICAs (combined group). No significant differences were found among the three groups in terms of the degree of stenosis (50.2%, 49.6%, 56.8% each: p= 0.34), risk factors of ischemic stroke, and frequency of combined stenosis in the other intracranial arteries. CONCLUSIONS: ICA stenosis was common in patients with acute ischemic stroke. Significant differences of the frequency and risk factors between intracranial and extracranial ICA stenosis were not found. ICA stenosis at the extracranial portion as well as at the intracranial portion should be considered as a common cause of ischemic stroke occurring in the carotid artery system.
Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Carotid Arteries ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebral Angiography ; Constriction, Pathologic ; Humans ; Risk Factors ; Stroke*

BACKGROUND: To evaluate the efficacy and toxicity of combination chemotherapy using ifosfamide, cisplatin, and etoposide in patients with advanced non-small cell lung cancer(NSCLC). MATERIALS AND METHODS: Thirty-three patients with inoperable NSCLC(stage III b+IV) who had measurable diseases, and had not been treated with chemotherapeutic drugs, were enrolled in this study(from March 1995 to December 1996). The patients received ifosfamide(1500mg/m2/day, a full drop with Mesna on days 1-5), Cisplatin (80mg/m2/day infusion with a hydration on day 2), and Etoposide (100mg/m2/day infusion for 2 hours on days 1-3). The treatment was repeated every 4 weeks. RESULTS: Ten patients showed a partial responses (30.3%). The overall survival time of the responders was longer than that of the non-responders (median 55 vs 22 weeks, p=0.01). The toxicities of this treatment were tolerable. Grade 3 or 4 leukopenia was observed in 21%. There was 1 death related to febrile neutropenia. The non-hematologic toxicity was mild. The relative dose intensity given to the patients was 0.86 ifosfamide, 0.87 cisplatin, and 0.89 etoposide, showing an average dose intensity of 0.87. CONCLUSIONS: A combination regimen of ifosfamide, cisplatin, and etoposide is effective and tolerable for treating advanced non-small cell lung cancer.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Febrile Neutropenia ; Humans ; Ifosfamide* ; Leukopenia ; Lung ; Mesna

BACKGROUND: Previous data have been reported that subtype B is prevalent in South Korea, but neither the extent nor the proportion of subtypes could be evaluated. This study was designed to analyze the distribution of HIV-1 subtypes, temporal instructions and transmission dynamics between epidemiological groups. METHODS: 1,280 Koreans had been diagnosed as HIV seropositive during the period 1985 to 2000. Among them, 134 individuals were selected for this molecular epidemiological study. 134 DNAs were isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 env gene was amplified by nested polymerase chain reaction and was sequenced. RESULTS: HIV-1 isolates from thirty-seven homosexuals were all subtype B (100%). On the other hand, 66 isolates from 94 heterosexuals were subtype B (70%) and 28 were non B subtypes (30%:13 A, 4 C, 2 D, 8 E, 1 G). Only subtype B strains were isolated from 73 males who were infected with HIV inside Korea while 16 B and 20 non B subtype strains were isolated from 36 males who were HIV infected outside of Korea. However, B and non B strains were isolated half and half from females who were infected inside Korea except one. CONCLUSION: The HIV-1 subtype B strains are prevalent in Korea from the early HIV infection until present in both homo and heterosexuals. Non B strains have been transmitted from men who were infected outside Korea to their spouses and casual partners. So, we need further study to monitor subtype B and non B HIV transmission in epidemiological groups of Korea.
DNA ; Female ; Genes, env ; Hand ; Heterosexuality ; HIV ; HIV Infections ; HIV-1* ; Hominidae ; Homosexuality ; Humans ; Korea* ; Male ; Molecular Epidemiology ; Polymerase Chain Reaction ; Spouses