Purpose: The aim of this study was to show that bariatric surgery (BS) is more effective than medical therapy (MT) in Asian obese patients. Methods: In this prospective, multicenter, nonrandomized, controlled trial, obese patients with body mass index of ≥35 kg/m2 or 30.0–34.9 kg/m2 with obesity-related comorbidities were assigned to undergo BS, such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, or MT. Patients who underwent BS were evaluated 4, 12, 24, and 48 weeks after surgery, whereas patients who received MT were monitored at a hospital every 6 weeks for 1 year. At each visit, weight, waist and hip circumference, and blood pressure were measured, and patients underwent physical examination and laboratory testing. Health-related quality of life (HQOL) was investigated using Euro QOL-5 Dimension, Impact of Weight on Quality of Life questionnaire-Lite and Obesity-related Problems scale. Results: The study included 264 patients from 13 institutions; of these, 64 underwent BS and 200 received MT. Of the patients who underwent BS, 6.3% experienced early complications. Relative weight changes from baseline to 48 weeks were significantly greater in the BS than in the MT group (26.9% vs. 2.1%, P < 0.001), as were the rates of remission of diabetes (47.8% vs. 16.7%, P = 0.014), hypertension (60.0% vs. 26.1%, P < 0.001), and dyslipidemia (63.2% vs. 22.0%, P < 0.001). HQOL was better in the BS than in the MT group at 48 weeks. Conclusion BS was safe and effective in Korean obese patients, with greater weight reduction, remission of comorbidities, and quality of life improvement than MT.

Objective: We aimed to explore the differential impact of cigarette smoking on fracture risks in SCD and dementia. Methods: A nationwide population-based cohort study design was used. Out of all the people aged 66 (n=1,555,103) who went through the National Screening Program from 2009–2014, 968,240 participants with eligible data were included in the study. Time-to-event was calculated as the duration between the NSPTA and fracture incidence. Cox proportional-hazard regression analyses were conducted to evaluate the risk of fractures. Results: Increased risk of all [adjusted hazard ratio (aHR)=1.184; 95% confidence interval (CI)=1.184, 1.093–1.283], hip (aHR=1.518; 95% CI=1.168–4.972), vertebral (aHR=1.235; 95% CI=1.101–1.386) fractures were increased in current smokers with more than 20 or more pack years (≥20 py) of SCD group, after adjusting for all relevant confounding factors. In dementia group, however, current smokers ≥20 py were at reduced risk of hip fractures (aHR=0.249; 95% CI=0.089–0.97). Conclusion There was a disparate influence of cigarette smoking on the fracture risks in SCD and dementia group. Further studies are warranted to explicate this phenomenon, and personalized preventive measures according to one’s cognitive status are imperative, since risk factors of fractures can exert disparate influence on patients at different stage of cognitive trajectory.

Objective: Previous studies investigating association of alcohol intake and fracture risk in elderly yielded conflicting results. We first examined the association between alcohol intake and total fracture risk in elderly subjects and further analyzed whether the association varied by fracture locations. Methods: This is a nationwide population-based cohort study which included all people aged 66 (n=1,431,539) receiving the National Screening Program during 2009–2014. Time-to-event were defined as duration from study recruitment, the day they received health screening, to the occurrence of fracture. Results: Total fracture was significantly lower in mild drinkers [adjusted hazard ratio (aHR)=0.952; 95% confidence interval (95% CI) =0.931–0.973] and higher in heavy drinkers (aHR=1.246; 95% CI=1.201–1.294) than non-drinkers. Risk pattern of alcohol consumption and fracture differed according to affected bones. Similar J-shaped trends were observed for vertebra fractures, but risk of limb fracture showed a linear relationship with alcohol intake. For hip fracture, risk decrement was more pronounced in mild and moderate drinkers, and significant increment was noted only in very severe drinkers [≥60 g/day; (aHR)=1.446; 1.162–1.801]. Conclusion Light to moderate drinking generally lowered risk of fractures, but association between alcohol and fracture risk varied depending on the affected bone lesions.

Objectives: To investigate the effect of nicotine on the healing of an oral cavity wound, high and low concentrations of nicotine were administered on human gingival fibroblasts. Methods: Nicotine at concentrations of 0.1, 1, 5, and 10 mM were administered to gingival fibroblasts to evaluate the survival capability of the cells. Nicotine at 0.1 mM, a nonapoptotic concentration, was administered to evaluate apoptosis using Annexin V-FITC/Propidium Iodide cell staining.Nicotine at 1, 10, and 100 mM were administered to measure the expression of inflammatory cytokines, which was measured by RT-PCR and ELISA. FGF was treated with an additional 1, 10, or 100 mM of nicotine to evaluate cell proliferation and wound healing. Results: As the concentration of nicotine increased (0.1, 1, 5, and 10 mM), the survival capability of the cells reduced. When cells were exposed to low nicotine concentration (0.1 mM) for 24 h, apoptosis occurred. Moreover, if the cell was exposed for 48 h, cell apoptosis occurred with necrosis. As the concentration of nicotine increased (1, 10, and 100 mM), more inflammatory cytokines were expressed. When EC LPS and TF LPS were combined with a low concentration of nicotine (1 and 10 mM), the expression of inflammatory cytokines was suppressed. The FGF level decreased as the nicotine concentration increased (1, 10, and 100 mM). Conclusions Nicotine interferes with the wound healing process of gingival fibroblasts. To maintain the wound healing process after a surgery or dental procedure, cessation of smoking is recommended.

The recent emergence and re-emergence of porcine epidemic diarrhea virus (PEDV) underscore the urgent need for the development of novel, safe, and effective vaccines against the prevailing strain. In this study, we generated a cold-adapted live attenuated vaccine candidate (Aram-P29-CA) by short-term passage of a virulent PEDV isolate at successively lower temperatures in Vero cells. Whole genome sequencing identified 12 amino acid changes in the cold-adapted strain with no insertions and deletions throughout the genome. Animal inoculation experiments confirmed the attenuated phenotype of Aram-P29-CA virus in the natural host. Pregnant sows were orally administered P29-CA live vaccines two doses at 2-week intervals prior to parturition, and the newborn piglets were challenged with the parental virus. The oral homologous prime-boost vaccination of P29-CA significantly improved the survival rate of the piglets and notably mitigated the severity of diarrhea and PEDV fecal shedding after the challenge. Furthermore, strong antibody responses to PEDV were detected in the sera and colostrum of immunized sows and in the sera of their offspring. These results demonstrated that the cold-adapted attenuated virus can be used as a live vaccine in maternal vaccination strategies to provide durable lactogenic immunity and confer passive protection to litters against PEDV.
Animals ; Antibody Formation ; Colostrum ; Diarrhea ; Genome ; Genotype ; Humans ; Infant, Newborn ; Parents ; Parturition ; Phenotype ; Porcine epidemic diarrhea virus ; Survival Rate ; Vaccination ; Vaccines ; Vero Cells

Amputation of the lower extremities followed by the use of an artificial leg is very common. However, malignancy arising in an amputation stump is an extremely rare event. In this report, we describe a case of squamous cell carcinoma arising in the amputation stump of a 56-year-old Korean man. To the best of our knowledge, similar cases have not been previously reported in Korea.
Amputation Stumps ; Amputation ; Artificial Limbs ; Carcinoma, Squamous Cell ; Epithelial Cells ; Humans ; Korea ; Lower Extremity ; Middle Aged

PURPOSE: The optimal cytotoxic regimens have not been established for patients with non-small cell lung cancer (NSCLC) who develop disease progression on first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). MATERIALS AND METHODS: We conducted a multi-center randomized phase II trial to compare the clinical outcomes between pemetrexed plus cisplatin combination therapy followed by maintenance pemetrexed (PC) and pemetrexed monotherapy (P) after failure of first-line EGFR-TKI. The primary objective was progression-free survival (PFS), and secondary objectives included overall response rate (ORR), overall survival (OS), health-related quality of life (HRQOL), and safety and toxicity profiles. RESULTS: A total of 96 patientswere randomized, and 91 patientswere treated at 14 centers in Korea. The ORR was 34.8% (16/46) for the PC arm and 17.8% (8/45) for the P arm (p=0.066). With 23.4 months of follow-up, the median PFS was 5.4 months in the PC arm and 6.4 months in the P arm (p=0.114). The median OS was 17.9 months and 15.7 months in PC and P arms, respectively (p=0.787). Adverse events ≥ grade 3 were reported in 12 patients (26.1%) in the PC arm and nine patients (20.0%) in the P arm (p=0.491). The overall time trends of HRQOL were not significantly different between the two arms. CONCLUSION: The outcomes of pemetrexed therapy in NSCLC patients with disease progression after firstline EGFR-TKI might not be improved by adding cisplatin.
Arm ; Carcinoma, Non-Small-Cell Lung ; Cisplatin ; Disease Progression ; Disease-Free Survival ; Epidermal Growth Factor ; Follow-Up Studies ; Humans ; Korea ; Lung Neoplasms ; Lung ; Pemetrexed ; Protein-Tyrosine Kinases ; Quality of Life ; Receptor, Epidermal Growth Factor ; Tyrosine

OBJECTIVES: The purpose of this study was to identify and compare the difference and related factors with general characteristic and health behaviors, a experience of diagnosis and treatment of chronic diseases between rural and urban among elderly in Korea. METHODS: We used the data of Community Health Survey 2017 which were collected by the Korean Center for Disease Control and Prevention. The study population comprised 67,835 elderly peopled aged 65 years or older who participated in the survey. The chi-square test, univariate and multivariate logistic regression analysis were used to analyze data. RESULTS: We identified many significant difference of health behaviors, an experience of diagnosis and treatment with chronic diseases between rural and urban. Compared to urban elderly, the odds ratios (ORs) (95% confidence interval) of rural elderly were 1.136 (1.092–1.183) for diagnosis of diabetes, 1.278 (1.278–1.386) for diagnosis of dyslipidemia, 0.940 (0.904–0.977) for diagnosis of arthritis, 0.785(0.736–0.837) for treatment of arthritis, 1.159 (1.116–1.203) for diagnosis of cataracts, and 1.285(1.200–1.375) for treatment of cataracts. In the experience of diagnosis and treatment of chronic diseases, various variables were derived as contributing factors for each disease. Especially, there were statistically significant difference in the experience of diabetes diagnosis, arthritis diagnosis, cataract diagnosis and dyslipidemia except for hypertension diagnosis (p<0.01) between urban and rural elderly. There were statistically significant differences in the experience of treatment for arthritis and cataract (p<0.01), but there was no significant difference in the experience of treatment for hypertension, diabetes, dyslipidemia between urban and rural elderly. CONCLUSION Therefore, it would be necessary to implement a strategic health management project for diseases that showed significant experience of chronic diseases with diagnosis and treatment, reflecting the related factors of the elderly chronic diseases among the urban and rural areas.

PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.
Bariatric Surgery ; Gastrectomy ; Hand ; Hospitals, Private ; Hospitals, University ; Incidence ; Korea ; Methods ; Obesity

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
Acute Kidney Injury* ; Body Mass Index* ; Epidemiologic Studies ; Humans ; Mortality* ; Obesity ; Observational Study ; Renal Replacement Therapy*