Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal. Materials and Methods: We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation. Results: Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529). Conclusion In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.

Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

Purpose: This study examined the recognition of rehabilitative robots for treatment in physical therapists. Methods: This study surveyed 100 physical therapists in Seoul and Gyeonggi-do using Google Form, an online survey tool. The questionnaire consisted of 21 questions, including eight questions on the general characteristics, 13 questions on the recognition of rehabilitative robots. Results: The general characteristics of the physical therapists showed differences and influences on recognition of rehabilitative robots, and there were statistically significant differences. There were significant differences in the recognition of rehabilitation robots according to general characteristics in gender, age, education degree, type of hospital, average weekly working time, and treatment field. Multiple regression analysis found that gender and the type of hospital influenced the recognition of rehabilitation robots. Conclusion Physical therapists showed differences in recognition of rehabilitative robots according to their general characteristics, and gender and the type of hospital influence the recognition of rehabilitation robots. Sufficient systematic education programs should be provided, and physical therapists require policy adjustments to increase their accessibility to rehabilitation robots through continuing education.

Purpose: This study examined the recognition of rehabilitative robots for treatment in physical therapists. Methods: This study surveyed 100 physical therapists in Seoul and Gyeonggi-do using Google Form, an online survey tool. The questionnaire consisted of 21 questions, including eight questions on the general characteristics, 13 questions on the recognition of rehabilitative robots. Results: The general characteristics of the physical therapists showed differences and influences on recognition of rehabilitative robots, and there were statistically significant differences. There were significant differences in the recognition of rehabilitation robots according to general characteristics in gender, age, education degree, type of hospital, average weekly working time, and treatment field. Multiple regression analysis found that gender and the type of hospital influenced the recognition of rehabilitation robots. Conclusion Physical therapists showed differences in recognition of rehabilitative robots according to their general characteristics, and gender and the type of hospital influence the recognition of rehabilitation robots. Sufficient systematic education programs should be provided, and physical therapists require policy adjustments to increase their accessibility to rehabilitation robots through continuing education.

Hair graying is an obvious sign of human aging. Although graying has been investigated extensively, the mechanism remains unclear. Here, we reviewed previous studies on the mechanism of graying and seek to offer some new insights. The traditional view is that hair graying is caused by exhaustion of the pigmentary potential of the melanocytes of hair bulbs. Melanocyte dysfunction may be attributable to the effects of toxic reactive oxygen species on melanocyte nuclei and mitochondria. A recent study suggests that bulge melanocyte stem cells (MSCs) are the key cells in play. Graying may be caused by defective MSC self-maintenance, not by any deficiency in bulbar melanocytes. Our previous study suggested that graying may be principally attributable to active hair growth. Active hair growth may produce oxidative or genotoxic stress in hair bulge. These internal stress may cause eventually depletion of MSC in the hair follicles. Taken together, hair graying may be caused by MSC depletion by genotoxic stress in the hair bulge. Hair graying may also be sometimes caused by dysfunction of the melanocytes by oxidative stress in the hair bulb. In addition, hair graying may be attributable to MSC depletion by active hair growth.
Aging ; DNA Damage ; Hair Follicle ; Hair* ; Humans ; Melanocytes ; Mitochondria ; Oxidative Stress ; Reactive Oxygen Species ; Rivers* ; Stem Cells

Nineteen highly pathogenic avian influenza (HPAI) H5N8 viruses were isolated from wild birds in the Donglim reservoir in Gochang, Jeonbuk province, Korea, which was first reported to be an outbreak site on January 17, 2014. Most genes from the nineteen viruses shared high nucleotide sequence identities (i.e., 99.7% to 100%). Phylogenetic analysis showed that these viruses were reassortants of the HPAI H5 subtype and the H4N2 strain and that their hemagglutinin clade was 2.3.4.4, which originated from Eastern China. The hemagglutinin protein contained Q222 and G224 at the receptor-binding site. Although the neuraminidase protein contained I314V and the matrix 2 protein contained an S31N substitution, other mutations resulting in oseltamivir and amantadine resistance were not detected. No substitutions associated with increased virulence and enhanced transmission in mammals were detected in the polymerase basic protein 2 (627E and 701D). Non-structural-1 was 237 amino acids long and had an ESEV motif with additional RGNKMAD amino acids in the C terminal region. These viruses caused deaths in the Baikal teal, which was unusual, and outbreaks occurred at the same time in both poultry and wild birds. These data are helpful for epidemiological understanding of HPAI and the design of prevention strategies.
Amantadine ; Amino Acids ; Animals ; Base Sequence ; Birds ; China ; Disease Outbreaks ; Hemagglutinins ; Influenza in Birds* ; Jeollabuk-do ; Korea* ; Mammals ; Neuraminidase ; Oseltamivir ; Poultry ; Virulence

PURPOSE: The purpose of this study was to assess the safety and early outcomes of the Pipeline device for large/giant or fusiform aneurysms. MATERIALS AND METHODS: The Pipeline was implanted in a total of 45 patients (mean age, 58 years; M:F=10:35) with 47 large/giant or fusiform aneurysms. We retrospectively evaluated the characteristics of the treated aneurysms, the periprocedural events, morbidity and mortality, and the early outcomes after Pipeline implantation. RESULTS: The aneurysms were located in the internal carotid artery (ICA) cavernous segment (n=25), ICA intradural segment (n=11), vertebrobasilar trunk (n=8), and middle cerebral artery (n=3). Procedure-related events occurred in 18 cases, consisting of incomplete expansion (n=8), shortening-migration (n=5), transient occlusion of a jailed branch (n=3), and in-stent thrombosis (n=2). Treatment-related morbidity occurred in two patients, but without mortality. Both patients had modified Rankin scale (mRS) scores of 2, but had an improved mRS score of 0 at 1-month follow-up. Of the 19 patients presenting with mass effect, 16 improved but three showed no changes in their presenting symptoms. All patients had excellent outcomes (mRS, 0 or 1) during the follow-up period (median, 6 months; range, 2-30 months). Vascular imaging follow-up (n=31, 65.9%; median, 3 months, range, 1-25 months) showed complete or near occlusion of the aneurysm in 24 patients (77.4%) and decreased sac size in seven patients (22.6%). CONCLUSION: In this initial multicenter study in Korea, the Pipeline seemed to be safe and effective for large/giant or fusiform aneurysms. However, a learning period may be required to alleviate device-related events.
Aneurysm* ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Korea* ; Learning ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Thrombosis

OBJECTIVES: The purpose of this study was to evaluate the effect of regular oral health care using Watanabe's tooth brushing method on aggressive periodontitis. METHODS: A 14-year-old female visited our clinic with the chief complaint of gingival swelling and teeth mobility in 2008. The present illness on the day of visit was gingivitis with swelling and redness on marginal gingiva, root exposure due to the attachment loss and gingival recession and the degree 3 mobility of #26, 36, 46 with no systemic disease and familial tendency. The panoramic radiograph showed the severe vertical and horizontal alveolar bone loss in the first molars. For the treatment, preventive care including tooth brushing instruction and professional tooth brushing using Watanabe's method and periodontal treatment using scaling and root planing, plaque control and antibiotics prescription were performed from the July, 2008 to September, 2012. RESULTS: The patient could maintain all of her teeth without extraction except for one molar during the treatment period and symptoms of gingivitis decreased all over the oral region. But dental plaque level was not decreased. CONCLUSIONS: The regular oral health care with professional toothbrushing by Watanabe's method was effective in relieving the gingival inflammation of patients with aggressive periodontitis.
Aggressive Periodontitis ; Alveolar Bone Loss ; Anti-Bacterial Agents ; Dental Plaque ; Female ; Gingiva ; Gingival Recession ; Gingivitis ; Humans ; Inflammation ; Molar ; Oral Health ; Prescriptions ; Root Planing ; Tooth ; Toothbrushing

OBJECTIVES: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. MATERIALS AND METHODS: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and 40x40 pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. RESULTS: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. CONCLUSION: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.
Bone Density ; Bone Diseases, Metabolic ; Fractals ; Humans ; Mandible ; Molar ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Tooth Movement

OBJECTIVES: This study was conducted to implement Health Plus Happiness Plus projects in Gyeongsangnam-Do and assess the policy implications of initiatives to address regional health inequalities. METHODS: Health Plus Happiness Plus projects were started as strategies to address regional health inequalities in Gyeongsangnam-Do. The principles of these projects are taken from the Health Action Zones initiatives in England: participation, partnership, resource concentration in project areas. The time period for these projects is from 2010 to 2017, and the total budget is 5.6 billion won. In 2010, a 6.8 hundred million won total budget was invested in 17 project areas. Such investments fell into four broad categories: establishment of the means and local framework; survey development to analyze the health determinants; development of an education and training center; and establishment of a technical support center. RESULTS: Education and training programs for practitioners and coordinators were provided, and project teams and project promotion committees were established in project areas. Health survey result briefing meetings were held, and 17 health committees were established in project areas. CONCLUSIONS: Health Plus Happiness Plus projects have some problems in relation to participation and partnerships, however, if these principled projects are performed continuously, they will contribute to a reduction of standardized mortality rate and regional health inequalities in Gyeongsangnam-Do and the improvement of residents' well-being in project areas.
Budgets ; Happiness ; Health Surveys ; Investments ; Socioeconomic Factors