Background: Because the etiologies of bronchiectasis and related diseases vary significantly among different regions and ethnicities, this study aimed to develop a diagnostic bundle for bronchiectasis in South Korea. Methods: A modified Delphi method was used to develop expert consensus statements on a diagnostic bundle for bronchiectasis in South Korea. Initial statements proposed by a core panel, based on international bronchiectasis guidelines, were discussed in an online meeting and two email surveys by a panel of experts (≥70% agreement). Results: The study involved 21 expert participants, and 30 statements regarding a diagnostic bundle for bronchiectasis were classified as recommended, conditional, or not recommended. The consensus statements of the expert panel were as follows: A standardized diagnostic bundle is useful in clinical practice; diagnostic tests for specific diseases, including immunodeficiency and allergic bronchopulmonary aspergillosis, are necessary when clinically suspected; initial diagnostic tests, including sputum microbiology and spirometry, are essential in all patients with bronchiectasis, and patients suspected with rare causes such as primary ciliary dyskinesia should be referred to specialized centers. Conclusion Based on this Delphi survey, expert consensus statements were generated including specific diagnostic, laboratory, microbiological, and pulmonary function tests required to manage patients with bronchiectasis in South Korea.

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma–COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

Kawasaki disease (KD) is an acute pediatric vasculitis that affects genetically susceptible infants and children. To identify coding variants that influence susceptibility to KD, we conducted whole exome sequencing of 159 patients with KD and 902 controls, and performed a replication study in an independent 586 cases and 732 controls. We identified five rare coding variants in five genes (FCRLA, PTGER4, IL17F, CARD11, and SIGLEC10) associated with KD (odds ratio [OR], 1.18–4.41; p = 0.0027–0.031). We also performed association analysis in 26 KD patients with coronary artery aneurysms (CAAs; diameter > 5 mm) and 124 patients without CAAs (diameter < 3 mm), and identified another five rare coding variants in five genes (FGFR4, IL31RA, FNDC1, MMP8, and FOXN1), which may be associated with CAA (OR, 3.89–37.3; p = 0.0058–0.0261). These results provide insights into new candidate genes and genetic variants potentially involved in the development of KD and CAA.

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

Ginsenosides, one of the active ingredients of Panax ginseng, show various pharmacological and physiological effects, and they are converted into compound K (CK) or protopanaxatriol (M4) by intestinal microorganisms. CK is a metabolite derived from protopanaxadiol (PD) ginsenosides, whereas M4 is a metabolite derived from protopanaxatriol (PT) ginsenosides. The gamma-aminobutyric acid receptorC (GABAC) is primarily expressed in retinal bipolar cells and several regions of the brain. However, little is known of the effects of ginsenoside metabolites on GABAC receptor channel activity. In the present study, we examined the effects of CK and M4 on the activity of human recombinant GABAC receptor (rho1) channels expressed in Xenopus oocytes by using a 2-electrode voltage clamp technique. In oocytes expressing GABAC receptor cRNA, we found that CK or M4 alone had no effect in oocytes. However, co-application of either CK or M4 with GABA inhibited the GABA-induced inward peak current (IGABA). Interestingly, pre-application of M4 inhibited IGABA more potently than CK in a dose-dependent and reversible manner. The half-inhibitory concentration (IC50) values of CK and M4 were 52.1+/-2.3 and 45.7+/-3.9 microM, respectively. Inhibition of IGABA by CK and M4 was voltage-independent and non-competitive. This study implies that ginsenoside metabolites may regulate GABAC receptor channel activity in the brain, including in the eyes.
Brain ; Eye ; gamma-Aminobutyric Acid ; Ginsenosides ; Humans ; Oocytes ; Panax ; Retinal Bipolar Cells ; RNA, Complementary ; Sapogenins ; Xenopus

This study was performed to investigate prevalence of clonorchiasis among the inhabitants living in villages along the 4 major rivers, Nakdong-gang (= river), Seomjin-gang, Youngsan-gang, and Guem-gang in southern Korea. From January to December 2006, a total of 24,075 stool samples (1 sample per an inhabitant) were collected in 23 localities and examined by the formalin-ether sedimentation technique. Of the inhabitants examined, 3,441 (14.3%) were found to harbor various types of intestinal parasite eggs, cysts or larvae. Numbers of infected people were 2,661 (11.1%) for Clonorchis sinensis, 431 (1.8%) for heterophyids, 226 (0.9%) for Entamoeba spp., 57 (0.2%) for Giardia lamblia, 30 (0.1%) for Trichuris trichiura, and 18 (0.07%) for echinostomes. Prevalence rates of clonorchiasis according to the river basin were 17.1% in Nakdong-gang, 11.2% in Seomjin-gang, 5.5% in Youngsan-gang and 4.6% in Guem-gang. Of the 2,661 C. sinensis egg-positive cases, 57.7% was male. The present findings suggest that clonorchiasis is still highly prevalent among inhabitants in the riverside areas of southern Korea, and it is necessary to implement a systematic control program in the endemic areas.
Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Animals ; Clonorchiasis/*epidemiology ; Clonorchis sinensis ; Endemic Diseases ; Feces/parasitology ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Parasite Egg Count ; Prevalence ; Rivers

PURPOSE: We report our early experience of endovascular abdominal aortic aneurysm repair (EAVR) performed by vascular surgeon. METHODS: A retrospective study was performed based on the medical records of 9 cases operated for EVAR due to abdominal aortic aneurysm at the Eulji University Hospital from Jan. 2007 to Apr. 2008. RESULTS: 9 subjects consisted of 7 males and 2 female and their mean age was 70.0 years. The surgical indications of EVAR were 5 cases of abdominal pain, 3 asymptomatic cases, and 1 of pulsating abdominal mass. The mean diameter of aneurysm, mean diameter of the aortic neck, mean length of the neck and mean aortic neck angle was 56.0 mm, 23.4 mm, 32.0 mm and 46.8o respectively. The mean time for stent-grafting was 241.8 minutes and the mean contrast amount was 301.4 ml. Adjunctive procedures were performed in 3 cases. One case had the type II endoleak from the right internal iliac artery. And all cases showed to be technical and clinical success. Deployment-related complications occurred in 2 cases (access site hematoma and lymphorrhea). Mean length of hospitalization and ICU stay were 10.5, 1.2 days. The mean follow up period was 2.4 months (1~12). There was no newly developed complication such as endoleak and so on. CONCLUSION: In this study, it was shown that vascular surgeon could successfully perform EVAR. In this era of minimal invasive surgery, vascular surgeon should play an important role even in intervention such as EVAR. And it suggests that it requires more effort and the experience of a vascular surgeon.
Abdominal Pain ; Aneurysm ; Aortic Aneurysm, Abdominal ; Endoleak ; Female ; Follow-Up Studies ; Hematoma ; Hospitalization ; Humans ; Iliac Artery ; Male ; Medical Records ; Neck ; Retrospective Studies

BACKGROUND: The objective of this study was to evaluate the clinical applicability of the repeatability criteria recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) spirometry guidelines and to determine which factors affect the repeatability of spirometry in Korean adults. METHODS: We reviewed the spirometry data of 4,663 Korean adults from the Korean National Health and Nutritional Examination Survey (KNHANES) Chronic Obstructive Pulmonary Disease Cohort (COPD cohort) and the Community-based Cohort Study VI-Fishing village/Islands (community cohort). We measured the anthropometric factors and differences between the highest and second-highest FVC (dFVC) and FEV1 (dFEV1) from prebronchodilator spirometry. Analyses included the distribution of dFVC and dFEV1, comparison of the values meeting the 1994 ATS repeatability criteria with the values meeting the 2005 ATS/ERS repeatability criteria, and the performance of linear regression for evaluating the influence of subject characteristics and the change of criteria on the spirometric variability. RESULTS: About 95% of subjects were able to reproduce FVC and FEV1 within 150 ml. The KNHANES based on the 1994 ATS guidelines showed poorer repeatability than the COPD cohort and community cohort based on the 2005 ATS/ERS guidelines. Demographic and anthropometric factors had little effect on repeatability, explaining only 0.5 to 3%. CONCLUSION: We conclude that the new spirometry repeatability criteria recommended by the 2005 ATS/ERS guidelines is also applicable to Korean adults. The repeatability of spirometry depends little on individual characteristics when an experienced technician performs testing. Therefore, we suggest that sustained efforts for public awareness of new repeatability criteria, quality control of spirograms, and education of personnel are needed for reliable spirometric results.
Adult* ; Cohort Studies ; Education ; Humans ; Linear Models ; Pulmonary Disease, Chronic Obstructive ; Quality Control ; Spirometry*

OBJECTIVE: To assess the visualization rate and size of the cavum septum pellucidum (CSP) by transabdominal sonography in normal fetuses in the second and third trimesters of pregnancy. METHODS: The CSP was prospectively researched and measured using an axial transventricular plane in 308 consecutive uncomplicated singleton pregnancies between 15 and 41 weeks of gestation. RESULTS: The CSP was seen in 42.5% of cases at 15 weeks, 84.78% at 16-17 weeks, 100% at 18-37 weeks and 81.25% at 38-41 weeks. Compared to biparietal diameter (BPD), the visualization rate was 35.29% between 31 and 32 mm, 47.8% between 33 and 34 mm, 84% between 35 and 43 mm, 100% between 44 and 88 mm and 87.5% between 89 and 101 mm. Mean CSP width was 5.5+/-1.7 mm (range 2-9 mm). The CSP width was increased with gestational age and BPD, but with a slight decrease around term. CONCLUSION: In normal fetuses the CSP should always be visualized between 18 and 37 weeks, or with a BPD of 44-88 mm. Failure to observe the CSP in this interval, or possibly the presence of a large CSP, may indicate abnormal cerebral development and warrant further investigation. Conversely, absence of the CSP prior to 18 weeks, or later than 37 weeks, is a normal finding.
Female ; Fetus* ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Trimester, Third* ; Pregnancy* ; Prospective Studies ; Septum Pellucidum*

In the treatment of chronic adult periodontitis, scaling and root planing have been generally performed prior to periodontal flap surgery. The purpose of this study was to evaluate the clinical significance of non-surgical periodontal therapy prior to periodontal flap surgery in patients with chronic adult periodontitis. Fifty six molars showing bilateral bony defects and 4-6mm periodontal pocket in twelve patients with chronic adult periodontitis were selected. By randomized split-mouth design, in one side, flap operation was performed 4 weeks after scaling and root planing, in the other group, flap operation was only performed without scaling and root planing. Probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index, and tooth mobility were measured at baseline, before flap operation and post-operation 12 weeks. The difference of clinical parameters between groups and between each measuring time was statistically analyzed. The results were as follows; 1. At 12 weeks after flap operation, there was no significant difference in probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index and tooth mobility between groups(p<0.05). 2. In both groups, probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index and tooth mobility were significantly improved at 12 weeks after flap operation compared to baseline(p<0.05). Within the limitation of short period, the results failed to demonstrate that the non-surgical periodontal therapy prior to periodontal flap surgery could have clinical significance in improvement of clinical parameters compared to periodontal surgery without non-surgical periodontal therapy.
Chronic Periodontitis ; Gingival Recession ; Humans ; Molar ; Periodontal Index ; Periodontal Pocket ; Root Planing ; Tooth Mobility