OBJECTIVES: We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea. METHODS: In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022. RESULTS: In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%. CONCLUSIONS The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of severe cutaneous adverse reactions (SCARs). The present study aimed to investigate the characteristics of SCARs induced by NSAIDs in the Korean SCAR registry. METHODS: A retrospective survey of NSAID-induced SCARs recorded between 2010 and 2015 at 27 university hospitals in Korea was conducted. Clinical phenotypes of SCARs were classified into Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS-TEN overlap syndrome and drug reaction with eosinophilia and systemic symptoms (DRESS). Causative NSAIDs were classified into 7 groups according to their chemical properties: acetaminophen, and propionic, acetic, salicylic, fenamic and enolic acids. RESULTS: A total of 170 SCARs, consisting of 85 SJS, 32 TEN, 17 SJS-TEN overlap syndrome and 36 DRESS reactions, were induced by NSAIDs: propionic acids (n=68), acetaminophen (n=38), acetic acids (n=23), salicylic acids (n=16), coxibs (n=8), fenamic acids (n=7), enolic acids (n=5) and unclassified (n=5). Acetic acids (22%) and coxibs (14%) accounted for higher portions of DRESS than other SCARs. The phenotypes of SCARs induced by both propionic and salicylic acids were similar (SJS, TEN and DRESS, in order). Acetaminophen was primarily associated with SJS (27%) and was less involved in TEN (10%). DRESS occurred more readily among subjects experiencing coxib-induced SCARs than other NSAID-induced SCARs (62.5% vs. 19.7%, P = 0.013). The mean time to symptom onset was longer in DRESS than in SJS or TEN (19.1 ± 4.1 vs. 6.8 ±1.5 vs. 12.1 ± 3.8 days). SCARs caused by propionic salicylic acids showed longer latency, whereas acetaminophen- and acetic acid-induced SCARs appeared within shorter intervals. CONCLUSIONS: The present study indicates that the phenotypes of SCARs may differ according to the chemical classifications of NSAIDs. To establish the mechanisms and incidences of NSAID-induced SCARs, further prospective studies are needed.
Acetaminophen ; Acetates ; Acetic Acid ; Anti-Inflammatory Agents, Non-Steroidal ; Cicatrix ; Classification ; Cyclooxygenase 2 Inhibitors ; Diethylpropion ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome ; Hospitals, University ; Incidence ; Korea ; Phenotype ; Propionates ; Prospective Studies ; Retrospective Studies ; Salicylates ; Salicylic Acid ; Stevens-Johnson Syndrome

PURPOSE: Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) to antiepileptic drug (AED), are rare, but result in significant morbidity and mortality. We investigated the major culprit drugs, clinical characteristics, and clinical course and outcomes of AED-induced SCARs using a nationwide registry in Korea. METHODS: A total of 161 patients with AED-induced SCARs from 28 referral hospitals were analyzed. The causative AEDs, clinical characteristics, organ involvements, details of treatment, and outcomes were evaluated. We compared the clinical and laboratory parameters between SJS/TEN and DRESS according to the leading causative drugs. We further determined risk factors for prolonged hospitalization in AED-induced SCARs. RESULTS: Carbamazepine and lamotrigine were the most common culprit drugs causing SCARs. Valproic acid and levetiracetam also emerged as the major causative agents. The disease duration and hospital stay in carbamazepine-induced SJS/TEN were shorter than those in other AEDs (P< 0.05, respectively). In younger patients, lamotrigine caused higher incidences of DRESS than other drugs (P= 0.045). Carbamazepine, the most common culprit drug for SCARs, was associated with a favorable outcome related with prolonged hospitalization in SJS (odds ratio, 0.12; 95% confidence interval, 0.02-0.63, P= 0.12), and thrombocytopenia was found to be a risk factor for prolonged hospitalization in DRESS. CONCLUSION: This was the first large-scale epidemiological study of AED-induced SCARs in Korea. Valproic acid and levetiracetam were the significant emerging AEDs causing SCARs in addition to the well-known offending AEDs such as carbamazepine and lamotrigine. Carbamazepine was associated with reduced hospitalization, but thrombocytopenia was a risk factor for prolonged hospitalization. Our results suggest that the clinical characteristics and clinical courses of AED-induced SCARs might vary according to the individual AEDs.
Anticonvulsants ; Carbamazepine ; Cicatrix ; Drug Hypersensitivity Syndrome ; Epidemiologic Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Length of Stay ; Mortality ; Referral and Consultation ; Risk Factors ; Stevens-Johnson Syndrome ; Thrombocytopenia ; Valproic Acid

In patients with tumors and spinal cord lesions, inflammation and tissue infection can result in mass effect detection on imaging. As a result, surgical biopsy procedures are often performed on the lesions. We report a rare case in which the thickening ligamentum flavum (LF) appeared to be a tumor in the epidural space of the cervical spine based on imaging findings. A 52-year-old man visited our outpatient clinic with severe shoulder pain and radicular pain in his right arm that had developed gradually after a traffic accident two months earlier. Magnetic resonance imaging of the cervical spine revealed an extradural mass at the cervicothoracic junction level. Suspecting a tumor, spinal decompression surgery was performed and a biopsy of the mass was obtained. At the time of surgery, the LF was thick and compressed the spinal cord. After successful removal of the LF, the spinal cord appeared normal. Histopathological examination confirmed the mass as the LF. The patient was discharged without pain or weakness two weeks postoperatively. This case demonstrated that when the LF of the cervicothoracic junction is thickened, it may be misdiagnosed as a cervical spine tumor compressing the spinal cord.
Accidents, Traffic ; Ambulatory Care Facilities ; Arm ; Biopsy ; Cervical Vertebrae ; Decompression ; Epidural Space* ; Female ; Humans ; Inflammation ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Middle Aged ; Radiculopathy ; Shoulder Pain ; Spinal Cord ; Spinal Cord Compression ; Spine*

Dental implants are valuable devices for restoring lost teeth. At this moment, nanotechnology has emerged with several techniques to modify implant surfaces. In addition, some evaluation techniques at the nano level are contributing important information regarding tissue and cell interactions with the implanted material. The purpose of this study was to analyze and compare the bone responses to 3 different types of 4.1-mm-diameter, 10mm-long implant surfaces on a dog femur model: 1) Sand blasted with alumina and Acid etched (SA), 2) Resorbable blast media (RBM), functioning as control groups, and 3) Anode oxidation nano-titana (Anodized TiO2) surface implants as experimental group. For this study, implants were placed in 3 beagle dogs (age, 18 months; weight, 11-14 kg). Their purchase, selection, management, and experimental procedure were carried out according to established conditions by the Department of Laboratory Animal Medicine, Medical Research Center, Medical College of Yonsei University. Nineteen turned screw-shaped implants with 3 different surfaces (4.1mm in diameter, 10mm in length) were made from commercially pure titanium (grade IV). Thirteen implants were placed in each beagle dogs no. 1 and 2 and six implants were placed in the remaining beagle dog. Implants placed in beagle dogs no. 1 and 2 underwent histology analysis, X-ray and CT taking, and analysis of relative bone mineral density with Dataviewer program. While removal torque was measured in the implants placed in beagle no. 3 after a healing period of 4 and 8 weeks. A histological evaluation of the specimens in this study showed that osseointegration was achieved for all control and experimental group after a healing period of 4 and 8 weeks. The following means were obtained for bone-implant contact (BIC) percentage for 4 and 8-week groups, respectively: SA: 85.16%, 38.88%; RBM: 41.62%, 58.87%; and Anodized TiO2: 43.85%, 61.3%. The following means were obtained for bone volume (BV) percentage for 4 and 8-week groups, respectively: SA: 34.48%, 51.55%; RBM: 58.56%, 81.56%; and Anodized TiO2: 47.22%, 63.53%. In this study, 8-week consolidated Anodized TO2 surface implants showed increased removal torque value (RTV) compared to that of the 4-week group. The obtained RTV means were 86.0 and 99.7Ncm, respectively, for 4 and 8-week Anodized TiO2 implants. The present study showed that osseointegration occurred in all investigated types of surface-treated implants. However, the control groups showed slight increase in the BIC and BIV values compared to the experimental groups. Therefore the clinical relevance of the observed results remains to be shown.

BACKGROUND AND PURPOSE: Measuring the extent of the collateral blood vessels using computed tomography (CT) angiography source images may promote tissue survival and functional gain in acute ischemic stroke patients who are candidates for endovascular recanalization treatment. METHODS: Of 5,558 acute stroke patients registered in a prospective clinical stroke registry, 104 met the selection criteria of endovascular recanalization treatment for internal cerebral artery or middle cerebral artery main-stem (M1) occlusions and presented for treatment ≤4 hours after the event. Using CT angiography source images, two independent and blinded reviewers measured the extent of collateral circulations at four regions, with good interrater reliability. The functional recovery at 3 months after stroke was used as an outcome variable. RESULTS: Cases with a sufficient collateral circulation at the Sylvian fissure showed significantly increased likelihood of having a modified Rankin Scale score of ≤2 at 3 months after stroke (adjusted odds ratio=3.03, 95% confidence interval=1.19–7.73, p=0.02), but the association became nonsignificant after adding the infarct volume to the model (p=0.65). The association between leptomeningeal convexity collaterals and functional recovery was no longer significant after adjusting for the infarct volume (p=0.28). The natural indirect effect of infarct volume on functional recovery was significant for both the Sylvian fissure (p=0.03) and leptomeningeal convexity (p=0.02) collaterals. CONCLUSIONS: The extent of collateral circulation at the Sylvian fissure was significantly associated with functional recovery, which may be mediated via the volume of the final infarction.
Angiography* ; Blood Vessels ; Cerebral Arteries ; Collateral Circulation ; Humans ; Infarction ; Middle Cerebral Artery ; Mortality ; Patient Selection ; Prospective Studies ; Stroke* ; Tissue Survival

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.
Aneurysm* ; Embolization, Therapeutic ; Emergencies ; Emergency Service, Hospital ; Endovascular Procedures ; Gyeongsangbuk-do ; Hemothorax ; Humans ; Mammary Arteries* ; Middle Aged ; Neurofibromatosis 1 ; Resuscitation ; Rupture ; Thoracic Surgery, Video-Assisted

Although cardiac myxoma is the most commonly encountered benign cardiac tumor in cardiac surgery practice, recurrent cardiac myxoma is very rare, is most commonly related to the Carney complex, and usually requires multiple cardiac operations with specific requirements in terms of perioperative management. In this report, we describe a patient who experienced the fourth recurrence of cardiac myxoma and review the diagnostic criteria of the Carney complex. This is the first report of such a case in Korea.
Carney Complex* ; Heart Neoplasms ; Humans ; Korea ; Myxoma* ; Recurrence* ; Thoracic Surgery

PURPOSE: The mortality of motorcycle accidents in old age is very high in Korea compared with other countries. The aim of this study is to compare the differences in injury patterns and severity between younger and older riders in motorcycle accidents. METHODS: Cross sectional data from Konkuk University Chung-ju Hospital were used to evaluate patients who visited the emergency department as a result of a motorcycle accident from June 2012 to May 2014. We separated the patients into younger rider group from 16 to 64 and older rider group over 65 years of age. Injury sustained, the types of severe injuries and injury severity between two groups were compared using Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). RESULTS: The younger and older rider group included 310 and 111 patients, respectively. Injuries in head, face, chest, and lumbar spine were higher in the older rider group (p<0.05). In the comparison of severe injury sustained over AIS 2, the older rider group had a four-fold odds increased rate of head injury (OR 3.718, 95% CI: 2.317-5.965, p<0.001) and a two-fold odds increased rate of chest injury (OR 2.306, 95% CI: 1.199-4.437, p=0.016) compared with the younger rider group. In addition, the older rider group had a nearly seven fold increased odds of severe injury over ISS 15 (OR 7.108, 95% CI: 3.579-14.119, p<0.001). CONCLUSION: In a motorcycle accident, the frequency of head, facial, chest, and lumbar injuries was higher in the older rider group. In addition, the older rider group had a higher injury severity, particularly a higher risk of head and chest injury.
Abbreviated Injury Scale ; Chungcheongbuk-do ; Craniocerebral Trauma ; Emergency Service, Hospital ; Head ; Humans ; Injury Severity Score ; Korea ; Mortality ; Motorcycles* ; Spine ; Thoracic Injuries ; Thorax

The need for standard endovascular neurosurgical (ENS) training programs and certification in Korea cannot be overlooked due to the increasing number of ENS specialists and the expanding ENS field. The Society of Korean Endovascular Neurosurgeons (SKEN) Certification Committee has prepared training programs and certification since 2010, and the first certificates were issued in 2013. A task force team (TFT) was organized in August 2010 to develop training programs and certification. TFT members researched programs and systems in other countries to develop a program that best suited Korea. After 2 years, a rough draft of the ENS training and certification regulations were prepared, and the standard training program title was decided. The SKEN Certification Committee made an official announcement about the certification program in March 2013. The final certification regulations comprised three major parts: certified endovascular neurosurgeons (EN), certified ENS institutions, and certified ENS training institutions. Applications have been evaluated and the results were announced in June 2013 as follows: 126 members received EN certification and 55 hospitals became ENS-certified institutions. The SKEN has established standard ENS training programs together with a certification system, and it is expected that they will advance the field of ENS to enhance public health and safety in Korea.
Advisory Committees ; Certification* ; Education ; Korea ; Public Health ; Social Control, Formal ; Specialization