Background/Aims: This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract. Methods: The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016. Results: UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs. Conclusions The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.

Background: This retrospective observational matched-cohort study of 2,151,216 individuals from the Korean coronavirus disease 2019 (COVID-19) vaccine effectiveness cohort aimed to evaluate the comparative effectiveness of the COVID-19 bivalent versus monovalent vaccines in providing additional protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, critical infection, and death in Korea. Methods: Among individuals, those vaccinated with COVID-19 bivalent vaccines were matched in a 1:1 ratio with those who were vaccinated with monovalent vaccines (bivalent vaccines non-recipients) during the observation period. We fitted a time-dependent Cox proportional-hazards model to estimate hazard ratios (HRs) of COVID-19 outcomes for infection, critical infection, and death, and we defined vaccine effectiveness (VE) as 1–HR. Results: Compared with the bivalent vaccination group, the incidence proportions in the monovalent vaccination group were approximately three times higher for infection, nine times higher for critical infection, and 11 times higher for death. In the early stage of bivalent vaccination, relative VE of bivalent vaccine against monovalent vaccine was 42.4% against SARS-CoV-2 infection, 81.3% against critical infection, and 85.3% against death. In addition, VE against critical infection and death according to the elapsed period after bivalent vaccination was maintained at > 70%. Conclusion The bivalent booster dose provided additional protection against SARS-CoV-2 infections, critical infections, and deaths during the omicron variant phase of the COVID-19 pandemic.

This study reports the first two clinical cases of spirometrosis caused by Spirometra sp. in cats in Korea. In these two cases, the cats vomited, and long proglottids of tapeworm were recovered. The sick cats presented with anorexia and lethargy. However, they unexpectedly showed no diarrhea, which is the main symptom of spirometrosis. Based on a fecal floatation test as well as morphological and molecular analyses, the parasite was diagnosed as Spirometra sp. The 2 cases were treated with praziquantel. This study suggests regular monitoring of health and deworming in companion animals, even when animals are well cared for, with regular preventive medication. Additionally, spirometrosis should be considered in the differential diagnosis in cases of gastrointestinal symptoms in Spirometra endemic areas.

This study reports the first two clinical cases of spirometrosis caused by Spirometra sp. in cats in Korea. In these two cases, the cats vomited, and long proglottids of tapeworm were recovered. The sick cats presented with anorexia and lethargy. However, they unexpectedly showed no diarrhea, which is the main symptom of spirometrosis. Based on a fecal floatation test as well as morphological and molecular analyses, the parasite was diagnosed as Spirometra sp. The 2 cases were treated with praziquantel. This study suggests regular monitoring of health and deworming in companion animals, even when animals are well cared for, with regular preventive medication. Additionally, spirometrosis should be considered in the differential diagnosis in cases of gastrointestinal symptoms in Spirometra endemic areas.

OBJECTIVE: Syncope is mostly benign, but it can also be caused by a life-threatening situation. In Korea, no studies have investigated application of the Canadian Syncope Risk Score (CSRS) to patients with syncope; therefore, this study was started to evaluate the usefulness of CSRS. METHODS: A total of 222 patients who visited the emergency room with syncope for one year from January 2016 to December 2016 were enrolled in this study. Patients were divided into two groups, a serious adverse events (SAE) group and a non-serious adverse events group. The scores of the nine CSRS variables were added and the CSRS was then calculated after the addition. RESULTS: The CSRS score for patients with SAE ranged from 0 to 8. The CSRS score was 18.6%, 31.7%, 55.6%, and 58.8% for 0, 1, 2, and 3, respectively. In the case of CSRS 0 and 1, 17 patients (81.0%) and 11 patients (84.6%) were non-cardiac. In the case of CSRS 2, 7 were non-cardiac (70.0%). In the case of CSRS 3, 6 cases (60.0%) were cardiogenic and 4 cases (40.0%) were non-cardiogenic. The area under the receiver operating characteristic curve of CSRS to predict SAE was 0.71. Setting the CSRS cutoff value to 0, we found that sensitivity and specificity of predicting SAE was 67.19% and 67.09%, respectively. CONCLUSION: CSRS may be difficult to predict for acute intracranial disease or acute hemorrhagic disease requiring transfusion; therefore, it is necessary to supplement it further.
Emergencies* ; Emergency Service, Hospital ; Humans ; Korea* ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Syncope*

BACKGROUND AND OBJECTIVES: The burden of heart failure has increased in Korea. This registry aims to evaluate demographics, clinical characteristics, management, and long-term outcomes in patients hospitalized for acute heart failure (AHF). SUBJECTS AND METHODS: We prospectively enrolled a total of 5625 consecutive subjects hospitalized for AHF in one of 10 tertiary university hospitals from March 2011 to February 2014. Descriptive statistics were used to determine the baseline characteristics of the study population and to compare them with those from other registries. RESULTS: The mean age was 68.5±14.5 years, 53.2% were male, and 52.2% had de novo heart failure. The mean systolic and diastolic blood pressures were 131.2±30.3 mmHg and 78.6±18.8 mmHg at admission, respectively. The left ventricular ejection fraction was ≤40% in 60.5% of patients. Ischemia was the most frequent etiology (37.6%) and aggravating factor (26.3%). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and aldosterone antagonists were prescribed in 68.8%, 52.2%, and 46.6% of the patients at discharge, respectively. Compared with the previous registry performed in Korea a decade ago, extracorporeal membrane oxygenation (ECMO) and heart transplantation have been performed more frequently (ECMO 0.8% vs. 2.8%, heart transplantation 0.3% vs. 1.2%), and in-hospital mortality decreased from 7.6% to 4.8%. However, the total cost of hospital care increased by 40%, and one-year follow-up mortality remained high. CONCLUSION: While the quality of acute clinical care and AHF-related outcomes have improved over the last decade, the long-term prognosis of heart failure is still poor in Korea. Therefore, additional research is needed to improve long-term outcomes and implement cost-effective care.
Demography ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Guideline Adherence ; Heart Failure* ; Heart Transplantation ; Heart* ; Hospital Mortality ; Hospitals, University ; Humans ; Ischemia ; Korea* ; Male ; Mineralocorticoid Receptor Antagonists ; Mortality ; Peptidyl-Dipeptidase A ; Prognosis ; Prospective Studies ; Quality of Health Care ; Registries ; Stroke Volume ; Treatment Outcome

BACKGROUND: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
Adult ; Asthma* ; Education* ; Humans ; Nebulizers and Vaporizers ; Pamphlets ; Physicians, Primary Care ; Primary Health Care*

BACKGROUND/AIMS: The present study aimed to investigate the associations between a change in body weight from 20 years of age to the present with insulin resistance and several parameters of metabolic syndrome in individuals at an increased risk of diabetes. METHODS: From patients with a diagnosis related to an increased risk of diabetes who were examined at our endocrinology clinic from January 2012 to December 2014, the present study recruited 125 individuals between 30 and 64 years of age with hemoglobin A1c levels from 5.7 to 6.4%. The change in body weight of each patient from 20 years of age to the present was retrospectively determined, and the associations of this change with insulin resistance and several parameters of metabolic syndrome were analyzed. RESULTS: The average gain in body weight after 20 years of age was 11.3 kg and there was no significance difference between the male and female patients. The proportion of overweight and obese patients at 20 years of age was 14%, but was 74% at the time of the visits to our endocrinology clinic. A change in body weight was significantly correlated with body mass index, insulin resistance, and waist circumference. Additionally, as the tertile of change in body weight increased, fasting insulin levels, insulin resistance, and the prevalence of abdominal obesity significantly increased. CONCLUSIONS: In the present study, an increase in body weight from 20 years of age to the present was correlated with insulin resistance and several parameters of metabolic syndrome in individuals at an increased risk of diabetes.
Body Mass Index ; Body Weight* ; Diagnosis ; Endocrinology ; Fasting ; Female ; Humans ; Insulin Resistance* ; Insulin* ; Male ; Obesity ; Obesity, Abdominal ; Overweight ; Prevalence ; Retrospective Studies ; Waist Circumference

OBJECTIVE: Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis (RA), and an important cause of morbidity and mortality in RA. We compared demographic and clinical characteristics of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) patterns in RA patients and determined the prognostic factors that influence the survival of RA-ILD patients. METHODS: 51 enrolled RA patients (male n=21, female n=30) with ILD underwent HRCT. We categorized ILD into two groups, as the UIP pattern and the NSIP pattern, using HRCT. HRCT scans were scored to investigate the extent of the ILD. We divided the extent of the interstitial lung disease into 4 groups 1~14%, 15~19%, 20~24%, >25%. RESULTS: There were no significant differences between the UIP and NSIP pattern in the clinical characteristics, except for age at the time of the study (RA-NSIP pattern vs RA-UIP pattern 62.3+/-11.7 vs 68.2+/-8.4, p=0.042). There were no significant differences in survival time between the RA-UIP and RA-NSIP pattern (Log rank p=0.985). The extent of ILD on chest HRCT was significantly associated with mortality (HR=1.044, 95% CI 1.019~1.069) and patients that were diagnosed with ILD at an older age (HR=1.109, 95% CI 1.024~1.200) were associated with a worse prognosis. Comparing four groups divided by the extent of the lung disease, there were significant differences in survival estimates (Log-rank p-value<0.001) based on an ILD extent of 15%. CONCLUSION: Our study reveals that the extent of ILD on chest HRCT was found to be significantly associated with poor prognosis of RA-ILD patients.
Arthritis, Rheumatoid ; Female ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases ; Lung Diseases, Interstitial ; Prognosis ; Thorax

OBJECTIVE: Interstitial lung disease (ILD) is a common pulmonary manifestation of rheumatoid arthritis (RA), and an important cause of morbidity and mortality in RA. We compared demographic and clinical characteristics of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) patterns in RA patients and determined the prognostic factors that influence the survival of RA-ILD patients. METHODS: 51 enrolled RA patients (male n=21, female n=30) with ILD underwent HRCT. We categorized ILD into two groups, as the UIP pattern and the NSIP pattern, using HRCT. HRCT scans were scored to investigate the extent of the ILD. We divided the extent of the interstitial lung disease into 4 groups 1~14%, 15~19%, 20~24%, >25%. RESULTS: There were no significant differences between the UIP and NSIP pattern in the clinical characteristics, except for age at the time of the study (RA-NSIP pattern vs RA-UIP pattern 62.3+/-11.7 vs 68.2+/-8.4, p=0.042). There were no significant differences in survival time between the RA-UIP and RA-NSIP pattern (Log rank p=0.985). The extent of ILD on chest HRCT was significantly associated with mortality (HR=1.044, 95% CI 1.019~1.069) and patients that were diagnosed with ILD at an older age (HR=1.109, 95% CI 1.024~1.200) were associated with a worse prognosis. Comparing four groups divided by the extent of the lung disease, there were significant differences in survival estimates (Log-rank p-value<0.001) based on an ILD extent of 15%. CONCLUSION: Our study reveals that the extent of ILD on chest HRCT was found to be significantly associated with poor prognosis of RA-ILD patients.
Arthritis, Rheumatoid ; Female ; Humans ; Idiopathic Pulmonary Fibrosis ; Lung Diseases ; Lung Diseases, Interstitial ; Prognosis ; Thorax