Background: To report the clinical manifestations of non-arteritic anterior ischemic optic neuropathy (NAION) cases after coronavirus disease 2019 (COVID-19) vaccination in Korea. Methods: This multicenter retrospective study included patients diagnosed with NAION within 42 days of COVID-19 vaccination. We collected data on vaccinations, demographic features, presence of vascular risk factors, ocular findings, and visual outcomes of patients with NAION. Results: The study included 16 eyes of 14 patients (6 men, 8 women) with a mean age of 63.5 ± 9.1 (range, 43–77) years. The most common underlying disease was hypertension, accounting for 28.6% of patients with NAION. Seven patients (50.0%) had no vascular risk factors for NAION. The mean time from vaccination to onset was 13.8 ± 14.2 (range, 1–41) days. All 16 eyes had disc swelling at initial presentation, and 3 of them (18.8%) had peripapillary intraretinal and/or subretinal fluid with severe disc swelling. Peripapillary hemorrhage was found in 50% of the patients, and one (6.3%) patient had peripapillary cotton-wool spots. In eight fellow eyes for which we were able to review the fundus photographs, the horizontal cup/ disc ratio was less than 0.25 in four eyes (50.0%). The mean visual acuity was logMAR 0.6 ± 0.7 at the initial presentation and logMAR 0.7 ± 0.8 at the final visit. Conclusion Only 64% of patients with NAION after COVID-19 vaccination have known vascular and ocular risk factors relevant to ischemic optic neuropathy. This suggests that COVID-19 vaccination may increase the risk of NAION. However, overall clinical features and visual outcomes of the NAION patients after COVID-19 vaccination were similar to those of typical NAION.

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/AIMS: Treating hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remains controversial. We compared the outcomes of hepatic resection (HR), transarterial chemoembolization (TACE), and sorafenib therapy as treatments for HCC with PVTT. METHODS: Patients diagnosed as HCC with PVTT between January 2000 and December 2011 who received treatment with sorafenib, HR, or TACE were included. Patients with main PVTT, superior mesenteric vein tumor thrombosis, or Child-Turcotte-Pugh (CTP) class C were excluded. The records of 172 patients were analyzed retrospectively. HR, TACE, and sorafenib treatment were performed is 40, 80, and 52 patients respectively. PVTT was classified as either involving the segmental branch (type I) or extending to involve the right or left portal vein (type II). RESULTS: The median survival time was significantly longer in the HR group (19.9 months) than in the TACE and sorafenib groups (6.6 and 6.2 months, respectively; both p<0.001), and did not differ significantly between the latter two groups (p=0.698). Among patients with CTP class A, type I PVTT or unilobar-involved HCC, the median survival time was longer in the HR group than in the TACE and sorafenib groups (p=0.006). In univariate analyses, the initial treatment method, tumor size, PVTT type, involved lobe, CTP class, and presence of cirrhosis or ascites were correlated with overall survival. The significant prognostic factors for overall survival in Cox proportional-hazards regression analysis were initial treatment method (HR vs. TACE: hazard ratio=1.750, p=0.036; HR vs. sorafenib: hazard ratio=2.262, p=0.006), involved lobe (hazard ratio=1.705, p=0.008), PVTT type (hazard ratio=1.617, p=0.013), and CTP class (hazard ratio=1.712, p=0.012). CONCLUSIONS: Compared with TACE or sorafenib, HR may prolong the survival of patients with HCC in cases of CTP class A, type I PVTT or unilobar-involved HCC.
Adult ; Aged ; Antineoplastic Agents/*therapeutic use ; Carcinoma, Hepatocellular/complications/drug therapy/*therapy ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/complications/drug therapy/*therapy ; Male ; Middle Aged ; Niacinamide/*analogs & derivatives/therapeutic use ; Phenylurea Compounds/*therapeutic use ; Portal Vein ; Proportional Hazards Models ; Retrospective Studies ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Venous Thrombosis/*complications

There are many studies on the prevalence, clinical characteristics, and economic burden of diabetes across the past four decades in Korea. Nonetheless, there is a dearth of nationwide study regarding diabetes encompassing all age group. Eight years ago, the Committee on the Epidemiology of Diabetes Mellitus of Korean Diabetes Association collaborated with Health Insurance Review & Assessment Service to evaluate the status of diabetes care and characteristics in diabetic patients in Korea. In 2007, the collaborative task force team published a comprehensive survey titled "Diabetes in Korea 2007." In this review, we reappraise the diabetic epidemics from the joint report and suggest further studies that are needed to be investigated in the future.
Advisory Committees ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Humans ; Insurance, Health ; Joints ; Korea ; Prevalence

PURPOSE: To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. MATERIALS AND METHODS: Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. RESULTS: The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p = 0.10 and p = 0.62, respectively). CONCLUSION: The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.
Chemoradiotherapy ; Disease-Free Survival ; Fluorouracil ; Follow-Up Studies ; Humans ; Rectal Neoplasms ; Retrospective Studies

OBJECTIVES: A growing body of research has documented that job stress has a pivotal role in developing adverse health outcomes. However, little is known about the relationship between farmers' job stress and health outcomes. This study was undertaken to identify the relationship between job stress and self-perceived fatigue in Korean farmers. METHODS: A total of 526 Korean farmers were asked to participate in this study. A self-administered questionnaire was used to assess the participants' general characteristics, job stress and self-perceived fatigue. Job stress was measured using a forty-eight item Farm Stressor Inventory (FSI), and the self-perceived fatigue was estimated by Multidimensional Fatigue Scale (MFS). Binary logistic regression analysis was conducted to examine the relationship between job stress and self-perceived fatigue. RESULTS: The result showed that job stress was associated with self-perceived fatigue. For the farmers with high job stress, the risk of self-perceived fatigue was more likely to increase compared to those with low job stress. For males, labor intensity (OR, 3.88; 95% CI, 1.91~7.89), job environment (OR, 2.45; 95% CI, 1.22~4.93), social support (OR, 2.10; 95% CI, 1.07~4.13), social isolation (OR, 2.45; 95% CI, 1.15~5.60), financial problems (OR, 3.25; 95% CI, 1.53~6.91), uncertainty (OR, 2.48; 95% CI, 1.30~4.75) and health problems (OR, 5.77; 95% CI, 2.46~13.53) were associated with self-perceived fatigue. For females, job environment (OR, 2.23; 95% CI, 1.22~4.08), social isolation (OR, 2.08; 95% CI, 1.05-4.15), physical environment & weather condition (OR, 2.61; 95% CI, 1.33~5.12), financial problems (OR, 2.87; 95% CI, 1.55~5.32), uncertainty (OR, 3.65; 95% CI, 1.95~6.83) and health problems (OR, 3.38; 95% CI, 1.57~7.27) were associated with self-perceived fatigue. CONCLUSIONS: This result suggests that farmers' job stress plays a role in the development of fatigue, and job stressors related to fatigue are slightly different according to gender.
Agriculture ; Fatigue ; Female ; Humans ; Logistic Models ; Male ; Questionnaires ; Social Isolation ; Uncertainty ; Weather

OBJECTIVES: To investigate the occurring characteristics of pulmonary tuberculosis (TB) among nurses working at a university hospital in Korea. METHODS: A retrospective cohort study was conducted using medical records from a university hospital. A total of 351 nurses without any pulmonary disease were enrolled during 2000~2007, and were followed up until October 2010. To compare with the incidence of TB between occupational subgroups, workplaces were divided into high and low TB-exposure risk departments. For statistical analysis, the relative risks for TB incidences between departments were estimated using Cox proportional hazards models and mean incidences were estimated with person-time years. RESULTS: Seven cases of TB were observed during 2001 person-years. Five and two cases were observed in the high and low TB-exposure risk departments, respectively. The relative risk of TB infection in the high TB-exposure risk departments were 6.52 (95% CI, 1.26~33.60) compared to that in the low TB-exposure risk department. The mean incidence of TB in the total nurses was 0.350% per person-year. CONCLUSIONS: According to the concept of occupational and environmental medicine, high TB-exposure risk departments were more likely to be at increased risk of tuberculosis.
Cohort Studies ; Environmental Medicine ; Hospital Departments ; Incidence ; Lung Diseases ; Medical Records ; Proportional Hazards Models ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND AND OBJECTIVES: Although human papillomavirus (HPV) infection has been recognized as having an important role in the pathogenesis of head and neck squamous cell carcinoma (HNSCC), there is no simple and reliable screening test of HPV infection in HNSCC to date. In the present study, we investigated the usability of p16 immunohistochemical staining as a screening test for HPV infection in HNSCC. SUBJECTS AND METHOD: Paraffin blocks were obtained from 45 tonsil SCC patients, who underwent surgery as an initial treatment between 1995 and 2004. Paraffin blocks were also obtained from 20 normal controls. Expression of p16 was investigated immunohistochemically and these results were compared with results of HPV genotyping and the real-time polymerase chain reaction (PCR) assay of viral oncoprotein to validate p16 staining as a reliable diagnostic tool of HPV infection. RESULTS: The expression of p16 was found to be significantly different between tonsil SCC (32/45, 71.1%) and normal control tissues (0/20, 0%)(p<0.05). Among the 45 patients, HPV genotyping and real-time PCR assay were performed in 21 of the 32 p16 (+) patients and in 6 patients of the 13 p16 (-) patients. HPV-16 was detected in 18 (85.7%) out of the 21 p16 (+) patients and in 2 (33.3%) out of the 6 p16 (-) patients. The p16 expression and HPV-16 status was significantly correlated (p<0.05). The two patients who had HPV-16 infection but did not have p16 expression showed an episomal infection or very low viral copy number each. CONCLUSION: The p16 expression may be an useful marker of HPV infection in HNSCC and may be used as a screening test for HPV infection in HNSCC.
Carcinoma, Squamous Cell ; Coat Protein Complex I ; Head ; Human papillomavirus 16 ; Humans ; Immunohistochemistry ; Mass Screening ; Neck ; Palatine Tonsil ; Papillomavirus Infections ; Paraffin ; Real-Time Polymerase Chain Reaction

PURPOSE: We designed a pig to canine liver xenotransplantation model to study the diverse immunologic and hemodynamic consequences that follow xenotransplantation and hyperacute rejection. METHODS: The animals were divided into two groups: the cobra venom factor and Gadolinium chloride treatment group (CVF+Gd group) (3 cases) and the control group (3 cases). The donor pig's whole liver was harvested, and then the harvested pig's whole liver was transplanted into a dog after the dog underwent left hepatectomy. After reperfusion of the graft, blood samples were taken 20, 40 and 60 minutes after reperfusion, and the liver, lung and kidney tissues were taken 1 hour after reperfusion. RESULTS: In the control group, the grafts showed a patchy hypoperfused liver surface and it felt rubbery solid compared to the CVF+Gd group. The serum total protein, albumin, fibrinogen and platelets decreased abruptly and there were no significant differences between the two groups. The serum PT, PTT and FDP were increased in both groups and the CVF+Gd group showed a more obtuse slope than the control group. We could not find any intravascular pathologic changes on the microscopic findings of the graft. Only scant intravascular fibrin deposition was found. Hepatocellular vacuolization and sinusoidal dilatation were also found. There were patches of necrosis without any zonal distribution, intrasinusoidal neutrophil sequestration and interstitial hemorrhage. These findings were milder in the CVF+Gd group. CONCLUSION: The pig to canine partial auxiliary liver xenotransplantation model is feasible and it is a good model before starting to perform pig to primate liver xenotransplantation. In the CVF+Gd group, pathologic findings like patch hepatocyte necrosis etc. were less severe. As there were no corresponding vascular pathologic findings, these findings are not the direct effect of CVF and gadolinium treatment, and so other factors like Ischemia- reperfusion injury should be considered.
Animals ; Blood Platelets ; Cobra Venoms ; Complement System Proteins ; Dilatation ; Dogs ; Fibrin ; Fibrinogen ; Fluconazole ; Formycins ; Gadolinium ; Hemodynamics ; Hemorrhage ; Hepatectomy ; Hepatocytes ; Humans ; Kidney ; Kupffer Cells ; Liver ; Lung ; Necrosis ; Neutrophils ; Primates ; Rejection (Psychology) ; Reperfusion ; Reperfusion Injury ; Ribonucleotides ; Tissue Donors ; Transplantation, Heterologous ; Transplants

PURPOSE: To evaluate the effect of the simulation method on recurrence among the patients who received radiotherapy after breast-conserving surgery (BCS) for early breast carcinoma. METHODS AND MATERIALS: Between 1995 and 2000, 70 patients with stage I-II breast carcinoma underwent breast-conserving surgery and adjuvant radiotherapy. Twenty nine patients (41.4%) were simulated with the 2D contour-based method (September 1995 to August 1997) and 41 patients (58.6%) were simulated with the 3D CT-based method (September 1997 to February 2000). To analyze the effect of the simulation method, the patient and treatment characteristics were compared. RESULTS: The characteristics were similar for the patients between the 2D contour-based simulation group and the 3D CT-based simulation group. During a median follow-up period of 75 months, 4 (13.8%) of 29 patients who were treated with 2D simulation and 1 (2.4%) of 41 patients who were treated with 3D simulation group devel-oped treatment failure. The five-year survival rates were 89.2% and 95.1% between the 2D and 3D simulation groups (p=0.196). The five-year disease free survival (DFS) rates were 86.2% and 97.5% between the 2D and 3D simulation groups (p=0.0636). On univariate analysis, age > 40 (p= 0.0226) and the number of dissected axillary lymph node > or = 10 (p=0.0435) were independent predictors of improved 5-year DFS. CONCLUSIONS: Although our data showed marginal significance for the DFS between the two groups, it is insufficient, due to the small number of patients in our study, to prove whether 3D CT-based simulation might improve the DFS and reduce the risk of recurrence when compared with 2D contour-based simulation. Further study is needed with a larger group of patients.
Breast Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mastectomy, Segmental* ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence* ; Survival Rate ; Treatment Failure