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Hyperplastic polyposis syndrome (HPS) is a rare condition characterized by the presence of numerous hyperplastic polyps (HPs) in the colon and rectum. Patients with HPS have an increased risk of colorectal cancer. This link is associated with gene mutations, especially B type Raf kinase (BRAF). However, a case of HPS associated with gene mutations has seldom been reported in Korea. Here, we describe a case of HPS in which a BRAF mutation was present in a 34-yearold woman. She had more than 110 HPs in the stomach and colorectum, which we removed. All of the polyps were diagnosed histologically as HPs, and no adenomatous or malignant changes were noted. We performed a BRAF and K-ras mutation analysis as well as a microsatellite analysis on the resected colon polyps. BRAF mutations were found in the resected colon polyps, but there was no evidence of K-RAS mutation or microsatellite instability. [ABSTRACT FROM AUTHOR]

Abstract: The emission characteristics of airborne PM10 in the Sihwa and Banwol Industrial Complex Area of Korea are highly complicated because of diverse man-made activities (about 4000 stacks). The measurements of 16 metals were undertaken using collision cell technology-inductively coupled plasma mass spectrometry (CCT-ICP-MS) from two industrial sites and one reference site in the vicinity of a residential area. Based on our measurements, we attempted to characterize the pollution status of PM10 and metals in the study area. The spatial differences in the PM10 and metal levels were significant except for the crustal and marine derived metals. Temporal variations in the PM10 and most metal data were fairly distinct so that their highest concentrations generally occur in the fall or spring, while the lowest in the summer. The daily concentrations of most metals and PM10 showed strong or moderate correlations among the three sites; however, results of conditional probability function (CPF) obviously accounted for the influences of industrial activities. Thus, concentrations of airborne PM10 and anthropogenic metals in residential area adjacent to Sihwa and Banwol (S/B) industrial areas were tightly affected by industrial activities. [Copyright &y& Elsevier]

Abstract: In this study, PM10-bound concentrations of 28 trace metals and 3 ionic components were measured from samples collected at Daejeon Industrial Complexes I and II, Korea from April 2000 to December 2002. Positive matrix factorization (PMF) and conditional probability function (CPF) were applied to these PM data sets to identify the diverse sources in the industrial area. A total of nine source types were identified to be important which include: secondary aerosol, cement/construction, soil dust, road dust, vehicle exhaust, incineration/Pb-related industry, metal smelting, fossil fuel combustion, and field burning. Results of our study suggest that there are competing relationships between anthropogenic and natural source processes in this industrial area. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Clinical characteristics and treatment outcomes of 3 subtypes of achalasia according to the Chicago classification in a tertiary institute in Korea" published in a previous issue.

Introduction: The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified.Discussion: We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P > 0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P < 0.05, respectively). The most common cause of perforation was sphincterotomy (n = 8) in the conservative group whereas scope itself (n = 6) in operative group, showing a significant difference between the two groups (P < 0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P < 0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered. [ABSTRACT FROM AUTHOR]

The Lagrangian FLEXible PARTicle (FLEXPART) dispersion model and National Centers for Environmental Prediction/Global Forecast System (NCEP/GFS) meteorological data were used to simulate the long range transport pathways of three artificial radionuclides: 131 I, 137 Cs, and 133 Xe, coming into Korean Peninsula during the Fukushima Dai-ichi nuclear accident. Using emission rates of these radionuclides estimated from previous studies, three distinctive transport routes of these radionuclides toward the Korean Peninsula for a period from 10 March to 20 April 2011 were exploited by three spatial scales: 1) intercontinental scale – plume released since mid-March 2011 and transported to the North to arrive Korea on 23 March 2011, 2) global (hemispherical) scale – plume traveling over the whole northern hemisphere passing through the Pacific Ocean/Europe to reach the Korean Peninsula with relatively low concentrations in late March 2011 and, 3) regional scale – plume released on early April 2011 arrived at the Korean Peninsula via southwest sea of Japan influenced directly by veering mesoscale wind circulations. Our identification of these transport routes at three different scales of meteorological circulations suggests the feasibility of a multi-scale approach for more accurate prediction of radionuclide transport in the study area. In light of the fact that the observed arrival/duration time of peaks were explained well by the FLEXPART model coupled with NCEP/GFS input data, our approach can be used meaningfully as a decision support model for radiation emergency situations. [ABSTRACT FROM AUTHOR]

Conclusion: Establishing a straight and firm septum supporting the overlying nasal structures is the most important step in correcting the post-traumatic combined deviated and saddle nose. Objectives: To present a surgical algorithm and key maneuvers that were successfully applied in the correction of post-traumatic combined deviated and saddle nose deformity. Methods: Twenty-five patients who had undergone primary rhinoplasty for a post-traumatic combined deviated and saddle nose were included. The patterns of deformity, surgical maneuvers, surgical results, and complications were analyzed using retrospective chart review, telephone interview, and preoperative and postoperative photographs. Results: Three distinct groups undergoing different techniques to correct the deformity were noted. Eighteen patients (72%) with intact septal support were treated by straightening the nose and septum followed by simple onlay grafts. Five patients (20%) with loss of septal support needed septal reconstruction. In two patients (8%) showing deviation, generalized saddling, and loss of septal support, a dorsal graft integrated to an extended columellar strut was performed, bypassing the major septal reconstruction. The key maneuvers for correction were dorsal onlay graft (100%), septoplasty (92%), and bilateral osteotomies (84%). No major complications were found. Objective evaluation showed complete correction of the deviation and saddling in 76%. [ABSTRACT FROM AUTHOR]

Abstract: Vital area analysis study and its application for nuclear facilities have been performed since the late 1970s. The Korea Atomic Energy Research Institute (KAERI) has performed a development of VAI methodology since the early 2000s, and the Vital area Identification Package Expert (VIPEX) was developed to identify vital areas using the conventional Probabilistic Safety Assessment (PSA) models, including internal and external PSA models. This study is to demonstrate the applicability of KAERI''s VAI methodology to a hypothetical facility containing processes that could have unacceptable onsite and offsite consequences if interrupted due to a security threat, and to identify the importance of location dependencies, such as cable and pipe runs, when identifying the vital areas. The hypothetical facility is assumed to be a nuclear material processing and storage facility in order to identify the vital areas. The target sets and Top Event Prevention Sets (TEPS) are calculated by two conditions: the first condition is to analyze the target sets and TEPS with information of the cable and pipe runs, and the second is to analyze them without it. It is necessary to consider cable and pipe runs in order to determine accurate and realistic TEPS. If the information about cable and pipe runs of a nuclear power plant is not considered when determining TEPS, it is absolutely impossible to acquire complete TEPS, and the results are distorted. When determining TEPS, it is more efficient, and requires lower costs than other methods using location fault trees to use the plant-specific internal and external PSA models including the information of cable and pipe runs. [Copyright &y& Elsevier]

Abstract: The nuclear industry has made so great efforts to attain safe and economically viable Nuclear Power Plants all over the world. Probabilistic Safety Assessment (PSA) applications are required now more than ever in order to operate Nuclear Power Plants. In this paper, the unavailability model of Engineered Safety Feature (ESF) actuated components, which is part of the Korean Standard Nuclear Power Plant (KSNPP) PSA model, is used to analyze the effects of Surveillance Test Interval (STI) extension of Engineered Safety Feature Actuation System (ESFAS) on the unavailability of the ESF actuated components. To develop a more accurate and realistic PSA model, the loop controller modules of Plant Control System (PCS) are also modeled on the KSNPP PSA model. The fault tree developed by each ESF actuated component includes the component failure, ESFAS signal failure, and loop controller module failure of PCS. When the ESFAS STI is extended from one month to three months, the unavailability of ESF actuated components partially increased by 10%. This shows the STI extension of ESFAS has minor effects on the unavailability of the ESF actuated components. The effects of ESFAS STI extension of KSNPP on the unavailability of the ESF actuated components as well as Core Damage Frequency (CDF) and Large Early Release Frequency (LERF) is less than expected. That result indirectly indicates that the ESFAS in KSNPP is designed well enough to extend the ESFAS STI. [Copyright &y& Elsevier]

Objectives: Submucosal leiomyoma commonly causes abnormal uterine bleeding, menstrual abnormalities, and infertility, and is usually treated by hysteroscopy. However, not all submucosal leiomyomas can be treated by hysteroscopy; patients with high-scoring submucosal leiomyoma must undergo transabdominal myomectomy to preserve the uterus. This article reports experience with a group of patients who underwent transvaginal radiofrequency (RF) thermal ablation of uterine submucosal leiomyomas of all grades, with emphasis on the safety and efficacy of this procedure. Study design: This was a prospective observational study. Materials and methods: Premenopausal women with symptomatic uterine submucosal leiomyoma were included in this study. The pre- and postoperative myoma volumes were measured by three-dimensional ultrasonography. The effect of symptoms on health-related quality of life (HRQoL) was assessed using the Uterine Fibroids Symptom and Quality of Life questionnaire. Results: Submucosal leiomyoma volume reduction rate was 75.5 ± 14.1% at 3 months and 80.7 ± 22.1% at 6 months postoperation. No differences were seen in the volume reduction rate according to the preoperative grade of leiomyoma. Symptom scores and HRQoL scores showed improvements 18 months after surgery with no differences between grades. Penetration/burn injuries of the bowel or bladder, sepsis, shock, embolism, and peritonitis were not reported. Conclusions: Transvaginal RF thermal ablation is a good treatment method for symptomatic submucosal leiomyoma, especially for patients with a high leiomyoma grade and when there is no choice for treatment except hysterectomy or hysterotomy. (J GYNECOL SURG 26:227) [ABSTRACT FROM AUTHOR]

Background: We have previously reported that TNF-α levels correlate to total mycobacterial burden in tuberculosis (TB) patients. Objective: To characterize the dynamics of cytokine responses in TB patients during chemotherapy to identify potential surrogate markers for effective treatment. Methods: Following induction by culture filtrate proteins in whole blood, production patterns of TNF-α, IL-10, IFN-γ and IL-12 were measured in 23 non-multidrug-resistant (MDR)-TB and 16 MDR-TB patients and in 31 healthy controls. Rates of mycobacterial clearance from the sputum were then measured and compared. Results: Prior to the initiation of chemotherapy, TNF-α and IL-10 levels were significantly higher in TB patients than in healthy controls while IFN-γ and IL-12 levels were similar. During chemotherapy, the levels of all 4 cytokines increased. We evaluated these responses separately in patients that did and did not clear their sputum culture at 2 and 6 months. At 2 months, decreases in both IFN-γ and IL-12 correlated strongly with a successful early response, while after 6 months of therapy, when half (7/14) of MDR-TB patients were still sputum culture positive, downregulation of TNF-α was uniquely correlated with sputum conversion between the groups. Conclusion: Our findings suggest the possibility that the regulation of TNF-α production in whole blood may be a more specific indicator of sputum conversion at 6 months than IFN-γ, IL-12 or IL-10 in MDR-TB patients. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The NO 2 and O 3 in an urban background site of Seoul, Korea (Yongsan), were analyzed using hourly data collected from 2005 to 2013. The potential role of meteorological parameters in controlling air quality at the receptor site was analyzed using a conditional probability function. In addition, the relative contributions of such variables were examined for special cases (i.e., more than 60 ppb of NO 2 and O 3 ) with the help of trajectory. A potential source contribution function with a grid size resolution of 0.25° × 0.25° was used to determine the potential exogenous sources of NO 2 and O 3 for the study area. The results of both the trajectory and potential source contribution function analyses suggest that both the northern China region and local emission sources are the most influential source pathways contributing to the recent increase in NO 2 concentration at the study site. In the case of O 3 , this role was shared by both oceanic and mountainous regions of China and Japan. [ABSTRACT FROM AUTHOR]

Amyloidosis is characterized by the abnormal deposition of extracellular amyloid fibrils. Cases involving amyloid light-chain amyloidosis in the small intestine have been reported infrequently in Korea. Here, we report a case of localized light chain protein amyloidosis in the small intestine. Esophagogastroduodenoscopy, push enteroscopy, and capsule endoscopy revealed submucosal tumor-like lesions, multiple shallow ulcers, and several erosions in the distal duodenum and jejunum. An endoscopic biopsy established the diagnosis of amyloidosis. In through an immunohistochemical analysis, the presence of lambda light chain protein was detected. The patient had no evidence of an underlying clonal plasma cell disorder or additional organ involvement. Therefore, we concluded that the patient had localized amyloidosis of the small intestine. [ABSTRACT FROM AUTHOR]

Background: The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has been increased not only in the hospital but also in the community worldwide. This study was aimed to characterize ESBL- producing E. coli isolates and to investigate the molecular epidemiology of community isolates in comparison with hospital isolates at a single center in Korea. Methods: A total of 142 ESBL-producing E. coli isolates were collected at Daejeon St Mary’s Hospital in Korea from January 2008 to September 2009. The ESBLs were characterized by PCR sequencing using specific primers. The genetic relatedness was determined by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Results: Of 142 isolates, 139 were positive for CTX-M type ESBLs; CTX-M-14 (n = 69, 49.6 %), CTX-M-15 (n = 53, 38.1 %) and both CTX-M-14 and -15 (n = 17, 12.2 %). CTX-M-14 and CTX-M-15 were detected in both community and hospital isolates whereas isolates producing both CTX-M14 and-15 were mainly identified in the hospital. CTX-M producing E. coli isolates were genetically heterogeneous, revealing 75 distinct PFGE types. By MLST, 21 distinctive STs including 5 major STs (ST131, ST405, ST38, ST10, and ST648) were identified. Major STs were distributed in both community and hospital isolates, and ST131 was the predominant clone regardless of the locations of acquisition. No specific major STs were confined to a single type of ESBLs. However, ST131 clones were significantly associated with CTX-M-15 and the majority of them were multidrug-resistant. Distinctively, we identified a hospital epidemic caused by the dissemination of an epidemic strain, ST131-PFGE type 10, characterized by multidrug resistance and co-producing both CTX-Ms with OXA-1 or TEM-1b. Conclusions: The epidemiology of ESBL-producing E. coli is a complex and evolving phenomenon attributed to the horizontal transfer of genetic elements and clonal spread of major clones, predominantly ST131. The multidrug resistant ST131 clone producing CTX-M-15 has emerged as a major clone in both the community and hospital, suggesting the widespread of this epidemic clone in Korea. [ABSTRACT FROM AUTHOR]

Group B streptococcus (GBS) is the most common cause of invasive neonatal infections in developed countries. The incidence of early-onset GBS disease in Korea is known to be much lower than that in other developed countries; however neonatal GBS disease has been frequently reported in recent years in Korea. This retrospective study sought to determine the current status and clinical presentation of neonatal GBS disease in Korea. From January 1996 through December 2005, GBS cases ( n= 157) diagnosed in blood, cerebrospinal fluid, or other sterile body fluids among infants <3 months of age from 14 university hospitals in Korea were identified. Age of onset, diagnosis, underlying medical conditions, and outcomes were investigated by reviewing the medical records. A total of 157 cases were identified during the study period. Of the cases, 32 were early-onset disease (EOD) and 125 were late-onset disease (LOD). Twenty-six of the EOD cases had symptoms during the first 24 h after birth. One hundred of the 157 GBS cases were diagnosed as meningitis. The mortality rate of EOD was 20.7%. The case fatality rate of LOD was 7.2% and 25.2% of LOD cases had sequelae. GBS is becoming an important cause of invasive neonatal infections in Korea, with LOD being more common. It may not be currently necessary to adopt the prevention guidelines of perinatal GBS disease in Korea. However, studies of maternal GBS carriage rates and neonatal GBS disease will continue. [ABSTRACT FROM AUTHOR]

Background/aim: The natural course of hepatitis B virus (HBV) infection is likely related to host immune factors. Interleukin-18 (IL-18) plays a significant role in immune defense. This study was undertaken to determine the association between the presence of hepatocellular carcinoma (HCC) and single-nucleotide polymorphisms (SNPs) in the IL-18 gene in HBV-infected patients.Methods: Between March 2002 and December 2004, 730 Korean subjects were enrolled in two different groups: (1) chronic carrier without HCC (n=637) and (2) HCC (n=93). We analyzed SNPs at four polymorphic sites in the IL-18 gene at positions -667G>T, -148G>C, +8925C>G, and +13925A>C in the study subjects. To evaluate the functional significance of SNPs in the IL-18 gene promoter region, we performed a reporter gene assay in HepG2 and Hep3B cells transfected with different alleles.Results: The IL-18 -148C allele, +8925G allele, +13925C allele, and haplotype 3 (TCGC) were associated with the presence of HCC in codominant and dominant models. Furthermore, functional analyses using the reporter gene assay revealed that the -148C allele conferred significantly lower promoter activity.Conclusions: This study indicates that the -148C, +8925G, and +13925C alleles of the IL-18 gene are associated with the presence of HCC and the 148G>C SNP is functionally important in determining disease outcome. [ABSTRACT FROM AUTHOR]

For air pollution monitoring, about 1300 airborne particulate matter samples were collected by using a low volume air sampler and a polycarbonate filter at two sampling sites in an urban region, Daejeon, the middle of Korea from 2003 to 2006. Mass concentrations of the black carbon were measured using a smoke stain reflectometer. The concentrations of 24 elements in the collected samples were analyzed by using instrumental neutron activation analysis, and its temporal trends and enrichment factors were investigated under different environmental conditions. Analytical control was carried out by using certified reference materials. [ABSTRACT FROM AUTHOR]

In an effort to elucidate the environmental significance of the long-range transport of atmospheric pollutants (LRTAP), the particle-bound Cd data for an aerodynamic diameter less than 2.5 (PM2.5) and 10μm (PM10) fractions were analyzed in the spring periods of four consecutive years between 2001 and 2004. To describe the factors affecting Cd distributions in relation to LRTAP, the Cd measurement data were evaluated after being grouped into several criteria: Asian dust (AD)/non-Asian dust (NAD), particle size, metal specie, source location, etc. According to our analysis, Cd concentrations in the coarse fraction were higher during AD (2.21±1.88ngm−3) than during NAD (1.58±1.11ngm−3). In contrast, its fine-fraction counterpart showed a contrary pattern with more enhanced values during NAD (2.60±1.64ngm−3) than AD (1.60±0.65ngm−3). Evidence collected from the present study indicates that the occurrence of the AD events generally proceed with the inflow of Cd-deficient particle, as reflected by a persistently low Cd/PM ratio from all particle fractions. Inspection of the Cd data in relation with the back trajectory analysis further suggests that the AD event is not the main route of the Cd transport into Korea, although such mechanism can be efficient depending on such variables as the size of particle as well as the intensity and transport route of AD. [Copyright &y& Elsevier]

As part of an air pollution monitoring study, airborne particulate matter (PM2/PM10-2) samples were collected from 2000 to 2003 at two sampling sites in an urban region, Daejeon, the middle of Korea. Mass concentrations of both fine and coarse fractions and that of the black carbon in the fine particles were measured using the Gent stacked filter unit sampler and the smoke stain reflectometer, respectively. In the collected samples the concentrations of 24 elements were analyzed using instrumental neutron activation analysis. Monitored data were investigated for their temporal trends under different environmental conditions and their seasonal correlation patterns. Crustal enrichment factors were also estimated to establish the contribution between anthropogenic and crustal origin. Patterns for airborne particle matter (APM) and elemental concentrations, seasonal variation of some marker elements were investigated. The results can be applied for the investigation of further air pollution sources and for the evaluation of air quality. [ABSTRACT FROM AUTHOR]

Summary: Background: Voriconazole is a triazole agent with excellent antifungal activity against Aspergillus species. However, despite its potential advantages, the occurrence of unpredictable toxicities might be critical in immunocompromised patients. The aim of this study was to analyze risk factors for voriconazole-related severe adverse events (SAEs). Methods: This prospective observational study was conducted in Korean patients with hematological malignancies and invasive aspergillosis on intravenous voriconazole therapy between June 2008 and April 2009. Results: Of the 25 patients enrolled, eight (32%) showed voriconazole-related SAEs, which included hepatotoxicities (n =5), cardiac tachyarrhythmias (n =2), and neurotoxicity (n =1). Sex, age, underlying hematological malignancies, voriconazole dose, the co-administration of a proton pump inhibitor, and CYP2C19 genotype were not found to be related to the occurrence of SAEs. However, trough plasma concentrations of voriconazole were found to be significantly higher in the patients with an SAE: median 6.32mg/l (interquartile range (IQR) 2.86–9.71mg/l) vs. median 2.15mg/l (IQR 0.92–4.00mg/l); p =0.011. Receiver operating characteristic curve analysis identified a cut-off trough concentration for SAEs of 5.83mg/l (sensitivity 62.5% and specificity 94.1%). Furthermore, multivariate analysis showed that a trough concentration of ≥5.83mg/l was the only significant independent risk factor of an SAE. Conclusions: This study shows that therapeutic drug monitoring is indicated in patients with a voriconazole-related SAE and that dose adjustment is required if the trough concentration of voriconazole exceeds 5.83mg/l. [Copyright &y& Elsevier]