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: To develop a set of reference standards for tibial motor, common peroneal motor, sural sensory, and superficial peroneal sensory nerve conduction studies (NCSs) with expanded uncertainty in a healthy Korean population. Methods: Standardized procedures were conducted for individual lower extremity NCSs of 199 healthy participants in their 20s (n=100) and 50s (n=99). Mean values and expanded uncertainties for parameters were analyzed with thorough consideration of multiple uncertainty factors under the International Guide to the Expression of Uncertainty in Measurement. In addition, side-to-side differences in onset latency, amplitude, and nerve conduction velocity (NCV) were analyzed. Results: Mean (reference range) for distal onset latency, baseline to negative peak amplitude, NCV of tibial motor nerve in males in their 20s were 4.3 ms (3.1–5.4 ms), 7.1 mV (3.4–10.9 mV), and 50.7 m/s (42.2–59.3 m/s), respectively; sural sensory nerve baseline to negative peak amplitude in males in their 20s was 21.7 μV (8.3–35.2 μV). Including the aforementioned data, we present a vast dataset of normative mean values and expanded uncertainties for NCSs of the leg in a healthy Korean population. Furthermore, upper limits for normal side-to-side differences for onset latency, amplitude, and NCV of each nerve are suggested. Conclusion To our knowledge, this is the first study to present the reference standards of leg NCSs with consideration for multifactorial uncertainties in an Asian population. We expect these results to help practitioners make reliable and reproducible clinical decisions.

Purpose: In elderly patients, femoral neck insufficiency fractures that occur without a history of trauma are difficult to diagnose and treat, so it is emphasized that early suspicion of fractures and additional diagnostic tests are conducted. Materials and Methods: Between December 2010 to December 2019, 12 femoral neck insufficiency fractures (group 1) were evaluated by comparing them with 50 traumatic femoral neck fractures of a similar age. Along with demographic data, neck cortical thickness, shaft cortical thickness, head diameter, neck width, trochanter width, shaft width, neck-shaft angle, hip axis length, femoral neck index on the simple radiographic image were compared. Results: Seven of the 12 cases were non-displaced fractures, and it took an average of 19.2 days to diagnose the fracture after the symptoms occurred. The height was smaller than the control group at 149.1 cm in group 1 and 157.2 cm in group 2 (p<0.001). The cortical thickness of the medial femoral neck showed significant differences between the two groups: 3.16 mm in group 1 and 4.11 mm in group 2 (p=0.004). There was no statistical difference in the other measurements. Conclusion Femoral neck insufficiency fracture often has a delayed diagnosis because of the characteristics of the fracture. The cortical thickness of the medial femoral neck in simple radiographic images can help suspect femoral insufficiency fractures in elderly patients when considered with detailed medical history taking and a physical examination.

Objective: As coping strategies can influence the illness course of mood disorder, they could be potential targets for psychological intervention. The current study investigated the similarities and differences in stress coping styles between bipolar disorder (BD) and depressive disorder (DD). Methods: Subjects with BD (n=135) and DD (n=100) who met the DSM-IV diagnostic criteria were included in this analysis. Coping strategies were assessed using the coping inventory for stressful situations and depressive symptoms were assessed by Beck depression inventory. Results: The BD group showed significantly more avoidant and task-oriented coping than the DD group (t=2.714, p=0.007; t=2.193, p=0.039). After excluding the effect of the depressive symptoms themselves (by comparing two groups in non-depressive state), the BD group still showed significantly more avoidant and task-oriented coping than the DD group (t=2.040, p=0.045; t=2.556, p=0.013), but when the symptoms of depression get greater, the difference between BD and DD coping strategies were reduced. Conclusion Subjects with BD tend to use more task and avoidant coping than DD subjects. But when the symptoms of depression get greater, the difference in coping strategies between BD and DD were reduced.

Objective: Though anger was highly associated with eveningness in general population, there is no study on the relationship between chronotype and anger-related characteristics in bipolar or depressive disorders. This study aimed to investigate the difference of anger-related characteristics according to chronotypes in bipolar or depressive disorders. Methods: Patients with bipolar or depressive disorders (n=238) were included in this study. Their chronotypes and anger-related characteristics were assessed with a self-evaluation of the Composite Scale of Morningness (CSM), the State Trait Anger Expression Inventory (STAXI) and the Anger Coping Scale (ACS). Results: The eveningness group in patients with mood disorders showed the highest scores of anger-trait (p<0.001), anger-expression (p=0.002) and anger-in (p<0.001) in STAXI subscales, verbal aggression (p=0.010) in ACS subscales among three groups, but the morningess group showed the lowest scores of these subscales among three groups. However, there were no significant differences in all subscales of the STAXI and ACS according to diagnostic subtypes in the Friedman test. Conclusion The results of this study suggested that eveningness in patients with mood disorders might be related to anger proneness and maladaptive anger coping. To manage anger emotion in the patients with mood disorders, therapeutic interventions to modulate eveningness might be helpful.

PURPOSE: Head and neck squamous cell carcinoma (HNSCC) is a deadly disease in which precision medicine needs to be incorporated. We aimed to implement next-generation sequencing (NGS) in determining actionable targets to guide appropriate molecular targeted therapy in HNSCC patients. MATERIALS AND METHODS: Ninety-three tumors and matched blood samples underwent targeted sequencing of 244 genes using the Illumina HiSeq 2500 platform with an average depth of coverage of greater than 1,000×. Clinicopathological data from patients were obtained from 17 centers in Korea, and were analyzed in correlation with NGS data. RESULTS: Ninety-two of the 93 tumors were amenable to data analysis. TP53 was the most common mutation, occurring in 47 (51%) patients, followed by CDKN2A (n=23, 25%), CCND1 (n=22, 24%), and PIK3CA (n=19, 21%). The total mutational burden was similar between human papillomavirus (HPV)–negative vs. positive tumors, although TP53, CDKN2A and CCND1 gene alterations occurred more frequently in HPV-negative tumors. HPV-positive tumors were significantly associated with immune signature-related genes compared to HPV-negative tumors. Mutations of NOTCH1 (p=0.027), CDKN2A (p < 0.001), and TP53 (p=0.038) were significantly associated with poorer overall survival. FAT1 mutations were highly enriched in cisplatin responders, and potentially targetable alterations such as PIK3CA E545K and CDKN2A R58X were noted in 14 patients (15%). CONCLUSION: We found several targetable genetic alterations, and our findings suggest that implementation of precision medicine in HNSCC is feasible. The predictive value of each targetable alteration should be assessed in a future umbrella trial using matched molecular targeted agents.
Biomarkers ; Carcinoma, Squamous Cell* ; Cisplatin ; Epithelial Cells* ; Head* ; Humans ; Korea ; Molecular Targeted Therapy ; Neck* ; Precision Medicine ; Statistics as Topic

CXCR5⁺ T follicular helper (Tfh) cells are associated with aberrant autoantibody production in patients with antibody-mediated autoimmune diseases including lupus. Follicular regulatory T (Tfr) cells expressing CXCR5 and Bcl6 have been recently identified as a specialized subset of Foxp3+ regulatory T (Treg) cells that control germinal center reactions. In this study, we show that retroviral transduction of CXCR5 gene in Foxp3⁺ Treg cells induced a stable expression of functional CXCR5 on their surface. The Cxcr5-transduced Treg cells maintained the expression of Treg cell signature genes and the suppressive activity. The expression of CXCR5 as well as Foxp3 in the transduced Treg cells appeared to be stable in vivo in an adoptive transfer experiment. Moreover, Cxcr5-transduced Treg cells preferentially migrated toward the CXCL13 gradient, leading to an effective suppression of antibody production from B cells stimulated with Tfh cells. Therefore, our results demonstrate that enforced expression of CXCR5 onto Treg cells efficiently induces Tfr cell-like properties, which might be a promising cellular therapeutic approach for the treatment of antibody-mediated autoimmune diseases.
Adoptive Transfer ; Antibody Formation ; Autoimmune Diseases ; B-Lymphocytes ; Germinal Center ; Humans ; T-Lymphocytes* ; T-Lymphocytes, Regulatory ; Zidovudine

A febrile respiratory infectious disease unit (FRIDU) with a negative pressure ventilation system was constructed outside the emergency department (ED) of the Samsung Medical Center in 2015, to screen for patients with contagious diseases requiring isolation. We evaluated the utility of the FRIDU during 1 year of operation. We analyzed 1,562 patients who were hospitalized after FRIDU screening between August 2015 and July 2016. The level of isolation recommended during their screening at the FRIDU was compared with the level deemed appropriate given their final diagnosis. Of the 1,562 patients screened at the FRIDU, 198 (13%) were isolated, 194 (12%) were reverse isolated, and 1,170 (75%) were not isolated. While hospitalized, 97 patients (6%) were confirmed to have a contagious disease requiring isolation, such as tuberculosis; 207 patients (13%) were confirmed to be immunocompromised and to require reverse isolation, mainly due to neutropenia; and the remaining 1,258 patients (81%) did not require isolation. The correlation coefficient for isolation consistency was 0.565 (P < 0.001). The sensitivity and negative predictive value of FRIDU screening for diagnosing contagious disease requiring isolation are 76% and 98%, respectively. No serious nosocomial outbreaks of contagious diseases occurred. During FRIDU screening, 114 patients were admitted to the resuscitation zone due to clinical instability, and three of these patients died. The initial isolation levels resulting from FRIDU screening were moderately well correlated with the isolation levels required by the final diagnosis, demonstrating the utility of pre-hospitalization screening units. However, the risks of deterioration during the screening process remain challenges.
Communicable Diseases* ; Diagnosis ; Disease Outbreaks ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Mass Screening ; Neutropenia ; Resuscitation ; Tuberculosis ; Ventilation

BACKGROUND AND OBJECTIVES: When monotherapy is inadequate for blood pressure control, the next step is either to continue monotherapy in increased doses or to add another antihypertensive agent. However, direct comparison of double-dose monotherapy versus combination therapy has rarely been done. The objective of this study is to compare 10 mg of amlodipine with an amlodipine/valsartan 5/160 mg combination in patients whose blood pressure control is inadequate with amlodipine 5 mg. SUBJECTS AND METHODS: This study was conducted as a multicenter, open-label, randomized controlled trial. Men and women aged 20-80 who were diagnosed as having hypertension, who had been on amlodipine 5 mg monotherapy for at least 4 weeks, and whose daytime mean systolic blood pressure (SBP) ≥135 mmHg or diastolic blood pressure (DBP) ≥85 mmHg on 24-hour ambulatory blood pressure monitoring (ABPM) were randomized to amlodipine (A) 10 mg or amlodipine/valsartan (AV) 5/160 mg group. Follow-up 24-hour ABPM was done at 8 weeks after randomization. RESULTS: Baseline clinical characteristics did not differ between the 2 groups. Ambulatory blood pressure reduction was significantly greater in the AV group compared with the A group (daytime mean SBP change: -14±11 vs. -9±9 mmHg, p<0.001, 24-hour mean SBP change: -13±10 vs. -8±8 mmHg, p<0.0001). Drug-related adverse events also did not differ significantly (A:AV, 6.5 vs. 4.5%, p=0.56). CONCLUSION: Amlodipine/valsartan 5/160 mg combination was more efficacious than amlodipine 10 mg in hypertensive patients in whom monotherapy of amlodipine 5 mg had failed.
Amlodipine* ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Male ; Random Allocation

PURPOSE: The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. MATERIALS AND METHODS: Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. RESULTS: The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. CONCLUSION: Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.
Arthroplasty, Replacement, Hip* ; Classification ; Dislocations ; Femur ; Follow-Up Studies ; Hip ; Humans ; Postoperative Complications ; Survival Rate ; Walking