Purpose: The introduction of immune checkpoint inhibitors represents a major advance in the treatment of lung cancer, allowing sustained recovery in a significant proportion of patients. Nivolumab is a monoclonal anti–programmed death cell protein 1 antibody licensed for the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) after prior chemotherapy. In this study, we describe the demographic and clinical outcomes of patients with advanced NSCLC treated with nivolumab in the Korean expanded access program. Materials and Methods: Previously treated patients with advanced non-squamous and squamous NSCLC patients received nivolumab at 3 mg/kg every 2 weeks up to 36 months. Efficacy data including investigator-assessed tumor response, progression data, survival, and safety data were collected. Results: Two hundred ninety-nine patients were treated across 36 Korean centers. The objective response rate and disease control rate were 18% and 49%, respectively; the median progression-free survival was 2.1 months (95% confidence interval [CI], 1.87 to 3.45), and the overall survival (OS) was 13.2 months (95% CI, 10.6 to 18.9). Patients with smoking history and patients who experienced immune-related adverse events showed a prolonged OS. Cox regression analysis identified smoking history, presence of immune-related adverse events as positive factors associated with OS, while liver metastasis was a negative factor associated with OS. The safety profile was generally comparable to previously reported data. Conclusion This real-world analysis supports the use of nivolumab for pretreated NSCLC patients, including those with an older age.

PURPOSE: This randomized phase III study was designed to compare the efficacy and safety of irinotecan plus cisplatin (IP) over etoposide plus cisplatin (EP) in Korean patients with extensive-disease small-cell lung cancer (SCLC). MATERIALS AND METHODS: Patients were randomly assigned to receive IP, composed of irinotecan 65 mg/m2 intravenously on days 1 and 8+cisplatin 70 mg/m2 intravenously on day 1 every 3 weeks, or EP, composed of etoposide 100 mg/m2 intravenously on days 1, 2, 3+cisplatin 70 mg/m2 intravenously on day 1, every 3 weeks for a maximum of six cycles, until disease progression, or until unacceptable toxicity occurred. The primary endpoint was overall survival. RESULTS: A total of 362 patients were randomized to IP (n=173) and EP (n=189) arms. There were no significant differences between IP and EP arms for the median overall survival (10.9 months vs. 10.3 months, p=0.120) and the median progression-free survival (6.5 months vs. 5.8 months, p=0.115). However, there was a significant difference in response rate (62.4% vs. 48.2%, p=0.006). The pre-planned subgroup analyses showed that IP was associated with longer overall survival in male (11.3 months vs. 10.1 months, p=0.036), < 65 years old (12.7 months vs. 11.3 months, p=0.024), and Eastern Cooperative Oncology Group performance status 0/1 (12.4 months vs. 10.9 months, p=0.040) patient groups. The severity of treatment-related adverse events such as grade 3/4 anemia, nausea and diarrhea was more frequent in patients treated with IP. CONCLUSION: The IP chemotherapy did not significantly improve the survival compared with EP chemotherapy in Korean patients with extensive-disease SCLC.
Anemia ; Arm ; Cisplatin* ; Diarrhea ; Disease Progression ; Disease-Free Survival ; Drug Therapy ; Etoposide* ; Humans ; Lung Neoplasms ; Male ; Nausea ; Small Cell Lung Carcinoma*

We collected and identified 5,721 ectomycorrhizal fruiting bodies (EcM) from Naejangsan National Park from June 2004 to 2013, belonging to 1 phylum, 1 class, 6 orders, 19 families, 40 genera, and 196 species. Of these, 2,249 individuals were identified as 89 species belonging to 11 genera in 7 families in the Agaricales; 1,511 were identified as 43 species belonging to 2 genera in 1 family in the Russulales; 1,132 were identified as 50 species belonging to 21 genera in 6 families in the Boletales; 793 were identified as 8 species belonging to 3 genera in 2 families in the Cantharellales; 29 were identified as 3 species belonging to 2 genera in 2 families in the Thelephorales; and 7 were identified as 3 species belonging to 1 genus in 1 family in the Gomphales. Thus, most of the EcMs identified belonged to the following 3 orders: Agaricales, Russulales, and Boletales. Russulaceae were most common (43 species), followed by Boletaceae (39 species), and Amanitaceae (27 species); most individuals were Russulaceae (1,511), followed by Hydnagiaceae (1,071) and Boletaceae (804). The monthly distribution showed that the greatest number of individuals and species of EcM, including the dominant ones, occur around July~September at an elevation of 200~299 m, diminishing markedly above 600 m. The greatest number of individuals and species, including the dominant ones, were collected in the period with average temperatures 25.0~26.9degrees C, lows of 21.0~22.9degrees C, and highs of 30.0~31.9degrees C, relative humidity > 76%, and rainfall > 400 mm.
Agaricales ; Fruit* ; Humans ; Humidity

From April 2009 to October 2011, we surveyed the higher fungi in the Byeonsanbando National Park, Korea. In total, we identified 2 kingdoms, 3 divisions, 7 classes, 22 orders, 63 families, 149 genera, and 313 species (including 6 undocumented taxa: 2 families, 2 genera, and 2 species). Seventeen 17 orders, 49 families, 128 genera, and 286 species belonged to Basidiomycota; 7 orders, 9 families, 15 genera, and 21 species were of Ascomycota; and 4 orders, 5 families, 6 genera, and 6 species of primordial fungi. Among the Basidiomycota, Agaricomycetes were represented by 47 families, 126 genera, and 282 species. The most common fungi were Boletaceae (33 species), followed by Russulaceae (30), Agaricaceae (27), and Amanitaceae (24). Various species of most of the higher fungi occurred during periods with average temperatures of 23~24.9degrees C, maximum temperatures of 28~31.9degrees C, minimum temperatures of 22~23.9degrees C, > 82% relative humidity, and > 200 mm precipitation.
Agaricales ; Ascomycota ; Basidiomycota ; Fungi* ; Humans ; Humidity ; Korea

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

PURPOSE: The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele. METHODS: A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed. RESULTS: The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients. CONCLUSION: A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.
Cystadenoma, Mucinous ; Demography ; Female ; Follow-Up Studies ; Humans ; Imidazoles ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Nodes ; Male ; Mucins ; Mucocele ; Nitro Compounds ; Operative Time ; Pseudomyxoma Peritonei ; Recurrence

BACKGROUND AND OBJECTIVES: Although there have been so many reports of catheter ablation of atrial fibrillation (AF) with magnetic navigation system (MNS), it is not necessarily obvious that MNS is more effective than conventional ablation. We performed AF ablation with MNS and compared the clinical outcomes and radiofrequency ablation parameters with those of conventional ablation. SUBJECTS AND METHODS: One hundred eleven consecutive patients (conventional group, n=70 vs. MNS group, n=41) undergoing catheter ablation of AF were enrolled. We compared and analyzed the procedural parameters, namely fluoroscopic time, procedural time, acute procedural success and 3 months success rate of both groups. RESULTS: The MNS group was associated with slightly larger left atrial size (43.7+/-6.3 mm vs. 41.2+/-6.3 mm, p=0.04), significantly longer total procedure time (352+/-50 minutes vs. 283+/-75 minutes, p<0.0001), and shorter total fluoroscopic time (99+/-28 minutes vs. 238+/-45 minutes, p<0.0001) than the conventional group. The MNS and conventional group did not differ with respect to acute procedural success, AF recurrence, atrial flutter/atrial tachycardia recurrence, or total arrhythmia recurrence. While no complications were observed in the MNS group, eight cases of significant pericardial effusion occurred in the conventional group. CONCLUSION: The MNS system seems to be effective and safe in the catheter ablation of AF, particularly in the population of patients with persistent AF and slightly dilated left atria.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Catheter Ablation ; Catheters ; Humans ; Magnetics ; Magnets ; Pericardial Effusion ; Recurrence ; Tachycardia

Piriformis syndrome consists of pain, tingling sensation, and paresthesia in areas innervated by sciatic nerve and is one of the main causes of low back pain. A 43-year-old male made a visit for continuous left buttock pain and tingling sensation in lower limbs for three years. Medication, epidural block and sacroiliac joint block were performed, but without effect. Sciatic nerve block with local anesthetics and steroid, however, showed some improvement for a short period of time. The patient's symptoms, physical examination, and the fact that sciatic nerve block showed improvement for a while led to the suspicion of piriformis syndrome. Thus, pulsed radiofrequency was performed on sciatic nerve twice. Visual analog scale (VAS) was 8-9 on first visit, which decreased to 1 after treatment and lasted for more than 18 months.
Adult ; Anesthetics, Local ; Buttocks ; Catheter Ablation ; Humans ; Low Back Pain ; Lower Extremity ; Male ; Paresthesia ; Physical Examination ; Piriformis Muscle Syndrome ; Sacroiliac Joint ; Sciatic Nerve ; Sensation