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Introduction: Korean Americans are a growing but understudied population group in the United States. High rates of potentially preventable hospitalizations suggest that primary care is underutilized. We compared preventable hospitalizations for chronic conditions in aggregate and for congestive heart failure (CHF) for Korean Americans and whites in Hawaii., Methods: Discharge data from 2010 to 2012 for all hospitalizations of adults in Hawaii for preventable hospitalizations in aggregate and for CHF included 4,345 among Korean Americans and 81,570 among whites. Preventable hospitalization rates for chronic conditions and CHF were calculated for Korean Americans and whites by sex and age group (18-64 y vs ≥65 y). Unadjusted rate ratios for Korean Americans were calculated relative to whites. Multivariate models, controlling for insurance type and comorbidity, provided adjusted rate ratios (aRRs)., Results: Korean American women and men aged 65 or older were at greater risk of preventable hospitalization overall than white women (aRR, 2.48; P = .003) and white men (aRR, 1.82; P = .049). Korean American men aged 65 or older also were at greater risk of hospitalization for CHF relative to white men (aRR, 1.87; P = .04) and for older Korean American women (aRR, 1.75; P = .07). Younger age groups did not differ significantly., Conclusion: Older Korean American patients may have significant disparities in preventable hospitalizations, which suggests poor access to or poor quality of primary health care. Improving primary care for Korean Americans may prevent unnecessary hospitalizations, improve quality of life for Korean Americans with chronic illness, and reduce health care costs.

Background: Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) exhibits distinct patterns worldwide, but its prevalence has not been extensively evaluated in Korea. The E7 oncogene-mediated carcinogenesis and its meaning are yet to be uncovered for oropharyngeal SCCs., Methods: In a Korean oropharyngeal SCC cohort, epidemiological indicators, HPV, and G1 cell cycle marker expressions were correlated with survival., Results: Among 93 surgically treated patients with oropharyngeal SCCs, 49.5% were HPV+, which were significantly younger, and predominantly nonsmoking. They demonstrated better survival than HPV- (94% vs 60%). Patients who were HPV+ with oropharyngeal SCCs expressed higher p16, cyclin-dependent kinase 4 (cdk4), and lower pRb. The p16 (hazard ratio [HR] 2.39), pRb (HR 2.13), and CCND1 (HR 2.09) correlated with survival. Notably, combined markers like p16/cdk4 ratio (HR 2.47) and cdk4+CCND1 sum (HR 2.65) were more significantly correlated., Conclusion: Incidence of HPV-related oropharyngeal SCC in Korea is similar to U.S.-European data. HPV presence correlates with improved survival. Expression ratios of G1 markers may predict survival of oropharyngeal SCCs better than each marker alone., (Copyright © 2011 Wiley Periodicals, Inc.)

Seroepidemiological changes of Toxoplasma gondii infection among the residents of the islands of Gangwha-gun, Incheon for 2 years were surveyed and evaluated by ELISA using a crude extract antigen. In 2010, sera of 919 adult residents in Gyodong-myeon and 313 adults in Samsan-myeon were collected and checked for IgG antibody titers, which showed 14.5% (133 sera) and 19.8% (62 sera) positive rates, respectively. In 2011, sera of 955 adults in Gyodong-myeon and 341 adults in Samsan-myeon were examined, which showed an increase of positive rates to 23.8% (227 sera) and 31.7% (108 sera), respectively. Totally, the seroprevalence of the first year was 15.8% and it increased rapidly to 25.8% in the second year. The positive rates of both sexes increased simultaneously with the significant ratio of males to females by 1.7-2.2 fold (P<0.05). In both myeons, 661 sera were collected every year and showed changes in optical density (OD) in 177 sera; newly found as positives in 73 persons (11.0%), negative conversion in 10 persons (1.5%), and maintained or increased in 94 persons (14.2%). This rapid increase in the prevalence of toxoplasmosis in Gangwha islands may be due to in part peculiar changes in the toxoplasmic environment of the islands and presumably the consumption of the pork bred domestically within the islands or imported from high endemic nations. It is necessary to find out symptomatic toxoplasmic patients and confirm the risk factors for further infection in the islands of Gangwha-gun.

This study examined the differences in the masticatory function of patients with temporomandibular disorder (TMD) in Korea. The experimental groups were as follows: 23 patients with painful arthralgia classified as pain group according to the research diagnostic criteria for temporomandibular disorder (RDC/TMC) and 28 patients with pain-free disc displacement and reduction classified as clicking group. The subjects were obtained from those who had visited Yonsei University Dental Hospital from 2007 to 2008. Twenty dental students without TMD symptoms were enroled as the normal control group. The Mixing Ability Index (MAI) was used as the objective index, and the Food Intake Ability (FIA) Index, Visual Analogue Scale (VAS) and oral health impact profile (OHIP) were used as the subjective indices. The MAI, FIA and VAS were significantly lower in the pain group than in the normal and clicking groups (P<0·05). The pain group showed a MAI, FIA and VAS of 16%, 81% and 67%, respectively, compared to that of the normal group. However, there were no significant differences in the MAI, FIA and VAS between the clicking and normal groups. The pain and clicking groups showed a 1·7 and 1·4 times higher OHIP value than the normal group (P<0·05). The MAI and subjective indices, such as the FIA (r=0·40) and VAS (r=0·48), showed a moderate correlation (P<0·01). In conclusion, pain is the main factor for the reduced masticatory function in patients with TMD in Korea, and the joint sound, not the masticatory function, affects the declining OHIP., (© 2010 Blackwell Publishing Ltd.)

The Seoul Neuropsychological Screening Battery (SNSB) is one of the standardized neuropsychological test batteries widely used in Korea. However, it may be a bit too lengthy for patients with decreased attention span; and it does not provide the score of global cognitive function (GCF), which is useful for monitoring patients longitudinally. We sought to validate a dementia version of SNSB (SNSB-D) that was shorter than the original SNSB and contained only scorable tests with a GCF score of 300. We administered SNSB-D to patients with mild cognitive impairment (MCI) (n=43) and Alzheimer's disease (AD) (n=93), and normal controls (NC) (n=77). MCI and AD groups had GCF scores significantly different from NC group, and GCF scores were able to distinguish patients with Clinical Dementia Rating of 0.5 and 1. Test-retest reliability was high, with a correlation coefficient of 0.918 for AD, 0.999 for MCI, and 0.960 for NC. The GCF score significantly correlated with the Mini-Mental State Examination (MMSE). Through ROC-curve analysis, GCF scores were found to yield more accurate diagnoses than the MMSE. The SNSB-D is a valid, reliable tool for assessing the overall cognitive function, and can be used to monitor cognitive changes in patients with dementia.

Environmental vineyard conditions can affect the chemical composition or metabolites of grapes and their wines. Grapes grown in three different regions of South Korea were collected and separated into pulp, skin, and seed. The grapes were also vinified after crushing. (1)H NMR spectroscopy with pattern recognition (PR) methods was used to investigate the metabolic differences in pulp, skin, seed, and wines from the different regions. Discriminatory compounds among the grapes were Na, Ca, K, malate, citrate, threonine, alanine, proline, and trigonelline according to PR methods of principal component analysis (PCA) or partial least-squares discriminant analysis (PLS-DA). Grapes grown in regions with high sun exposure and low rainfall showed higher levels of sugar, proline, Na, and Ca together with lower levels of malate, citrate, alanine, threonine, and trigonelline than those grown in regions with relatively low sun exposure and high rainfall. Environmental effects were also observed in the complementary wines. This study demonstrates that (1)H NMR-based metabolomics coupled with multivariate statistical data sets can be useful for determining grape and wine quality.

Objectives: To investigate the presentation of germ cell tumors (GCT) in terms of histology and stage, to better clarify the epidemiology of this disease in eastern Asia., Methods: Six hundred ninety-eight patients diagnosed with GCT between 1995 and 2004 were analyzed. Clinical parameters at the time of initial diagnosis were classified in terms of the American Joint Committee on Cancer (AJCC) tumor, nodes, metastasis staging (TNMS) system, the International Germ Cell Cancer Collaborative Classification (IGCCC), for high-risk stage I nonseminomatous GCT (NSGCT) of testis., Results: The anatomic distributions for the primary sites of the observed tumors were as follows: testis 471 cases (67%); central nervous system (CNS) 137 cases (20%); mediastinum 78 cases (11%), and retroperitoneum 12 cases (2%); 239 (51%) of 471 tumors with testicular primary were seminoma. High risk vs. non-high risk stage I NSGCT cases were 62 vs. 58. Of NSGCT of testis, 129 (58%), 73 (33%), and 21 (9%) of tumors presented with good, intermediate, and poor prognosis, respectively, based on IGCCC, whereas 231 (99%) patients were classified with a good prognosis and 3 (1%) with an intermediate prognosis amongst seminomas of testis; 193 (82%) cases presented as stage I testicular seminoma whereas 120 (54%) cases presented as stage I NSGCT., Conclusions: Extragonadal primary GCTs are very common in Korean. Incidence of high risk NSGCT of testis with stage I disease was lower than in the Western report. NSGCT presents itself as a more aggressive form whereas seminoma is a very indolent tumor when compared with cases in Western countries.

Toxoplasma gondii is an obligate intracellular zoonotic protozoan with a worldwide distribution. It infects humans as well as a broad spectrum of vertebrate hosts. Cats and wild felidae play crucial roles in the epidemiology of toxoplasmosis. This study was performed to survey the prevalence of T. gondii infection among stray cats in the Gyeonggi-do, Republic of Korea. A total of 174 stray cat blood samples were collected from Gwacheon-si (n=20), Bucheon-si (82), and Yangju-si (72). Positive sera for T. gondii were identified in 14 samples (8.1%) exclusively via the latex agglutination test, 28 (16.1%) via ELISA, and 23 (13.2%) via PCR analysis. The overall infection rate of female stray cats (29.2%) presented as higher than that of male cats (24.0%). This study suggests that T. gondii is widespread in the stray cat population of Gyeonggi-do, Korea. It is urgently needed to control urban stray cat population and to reduce the risk of zoonotic transmission of toxoplasmosis to other animal hosts and humans.

Background: The shortage of donor organs is one of the major barriers to transplantation worldwide. After the success of the direct exchange donor (swap) program in Korea since 1991, we have developed a swap-around program. However, reports on the long-term outcomes of exchange donor programs are scarce., Methods: From September 1995 to September 2006, we performed 1193 cases of renal transplantation, including 398 cases from living-unrelated donors. The living-unrelated donors included 129 exchange donors and 269 nonexchange donors. We compared the outcomes of the exchange program with that of the nonexchange program, and examined the merits and limitations of the exchange program., Results: The reasons for the exchange program were ABO incompatibility (n=84, 65.1%), human leukocyte antigen mismatching beyond our criteria (n=39, 30.2%), or positive lymphocyte crossmatch (n=6, 4.7%). The overall 10-year graft survival (86.3%) of exchange transplantation was comparable with that of nonexchange (82.3%) or one- haplotype matched living-related (81.2%) transplantation (P=0.2994). In multivariate analysis, exchange versus nonexchange donors did not affect graft survival. The proportion of blood-type O donors was much lower in the exchange group (29.5%) than in the nonexchange group (42.4%; P=0.026). Blood-type O kidneys were preferentially allocated to blood-type O recipients (78.9%) in the exchange group as compared with the nonexchange group (54.4%; P=0.007)., Conclusion: We achieved excellent outcomes by using a donor exchange program as an option to reduce the donor organ shortage. However, the exchange donor program has no added benefit for blood-type O recipients.

Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after surgery. An identification of risk factors associated with PONV would make it easier to select specific patients for effective antiemetic therapy. We designed a case-controlled study to identify the risk factors for PONV in 5,272 surgical patients. At postoperative 2 and 24 hr, patients were visited and interviewed on the presence and severity of PONV. Thirty nine percent of patients experienced one or more episodes of nausea or vomiting. Five risk factors were highly predictive of PONV: 1) female, 2) history of previous PONV or motion sickness, 3) duration of anesthesia more than 1 hour, 4) non-smoking status, and 5) use of opioid in the form of patient controlled analgesia (PCA), in the order of relevance. The formula to calculate the probability of PONV using the multiple regression analysis was as follows: P (probability of PONV)=1/1+e(-Z), Z=-1.885+0.894 (gender)+0.661 (history)+0.584 (duration of anesthesia)+0.196 (smoking status)+0.186 (use of PCA-based opioid) where gender: female=1, male=0; history of previous PONV or motion sickness: yes=1, no=0; duration of anesthesia:more than 1 hr=1, less than or 1 hr=0; smoking status: no=1, yes=0; use of PCA-based opioid: yes=1, no=0.

Twelve Rsv resistance-breaking (RB) isolates of Soybean mosaic virus (SMV) were obtained from field-grown soybean plants showing mosaic symptoms and subsequently examined biologically and molecularly. All of these RB isolates were identified as SMV based on serological and infectivity assays, and the amplification of P1 gene products by reverse transcription-polymerase chain reaction (RT-PCR). Differential soybean cultivars, lines or accessions Lee 68 (rsv), PI 96983, York, Marshall, Ogden, Kwanggyo, Suweon 97 (Rsv1 alleles), L29 (Rsv3), and V94-5152 (Rsv4), following inoculation with each RB isolate, showed similar systemic symptoms suggesting that these RB isolates can overcome Rsv resistance at three loci. To differentiate the 12 RB isolates molecularly, the P1 coding region for each isolate was amplified, cloned, sequenced and compared to known SMV strains. The P1 region from the RB isolates shared 86-90% and 90-99% similarities in amino acid (aa) and nucleotide sequence, respectively, with known SMV strains. Comparison of aa sequences indicated that these RB isolates are newly emerging isolates capable of breaking Rsv resistance. Phylogenetic analysis further suggested that the RB isolates can be classified as three major types. However, recombination was not observed within the coding region of P1 protein among the types. This is the first report on the emergence of SMV isolates capable of overcoming all of the known resistance alleles at the Rsv1 locus, as well as distinct resistance genes at Rsv3 and Rsv4.

Background/aims: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center., Methods: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA., Results: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients., Conclusions: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.

The prevalence of Behcet's disease is the highest in the East Asian and the Mediterranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.