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Background Korea has a nationalized health system. The aim of this study was to evaluate the impact of the Korea diagnosis related group–based prospective payment system (K-DRG/PPS) on the use of medical resources and the rate of adverse events during laparoscopic appendectomy. Methods We included patients who underwent laparoscopic appendectomy at Dongtan Sacred Heart Hospital, Korea, between November 2012 and February 2014. The patients were divided into two groups: before-DRG/PPS or after-DRG/PPS groups. The length of the postoperative hospital stay (LOS) and medical costs were indicators of the medical resources. Medical costs included those of the initial hospital stay, outpatient clinic, readmission, and the sum of these charges. Complication and readmission rates were indicators of the rates of adverse events. Results After the implementation of the DRG/PPS, length of the hospital stay decreased by 10% (4.9 d before versus 4.4 d after DRG/PPS; P < 0.001). The initial hospital stay and total cost were significantly lower in the after-DRG/PPS group (both P < 0.001). The complication rates during the initial hospital stay (3.5% before versus 2.3% after DRG/PPS; P = 0.225) and the readmission rates (4.3% versus 2.5%, respectively; P = 0.227) were statistically similar. Conclusions This study shows that the K-DRG/PPS for laparoscopic appendectomy had no negative effect on the rate of adverse events and reduced the use of medical resources. Further evaluation of other procedures is required to determine the overall effects of the K-DRG/PPS. [ABSTRACT FROM AUTHOR]

Abstract: Background: The epidemiological shift of hepatitis A has contributed to a sustained community-wide outbreak in Korea during 2008. Objectives: To assess the risk factors associated with hepatitis A virus (HAV) propagation, and to analyze the circulating genotype in the sustained community-wide outbreak. Study design: The hospital-based case–control study was conducted in an 850-bed university hospital in Seoul from April to August, 2008. For molecular analysis of HAV isolates, a 488-bp gene fragment of the VP1 region was amplified and sequenced. Results: In the multivariated logistic regression model, the risk factors of HAV infection adjusted by age were contacts with hepatitis A case (OR 3.98, 95% CI: 1.36–11.66), residence with child aged ≤5 years (OR 3.43, 95% CI: 1.32–8.87), consuming uncooked lettuce (OR 3.98, 95% CI: 1.83–8.68) or carrot (OR 2.38, 95% CI: 2.38–5.09), drinking tap water (OR 3.68, 95% CI: 1.62–8.37) or portable spring water (OR 2.71, 95% CI: 1.11–6.62) supplied by water purifiers, and eating out (OR 3.87, 95% CI: 1.53–9.78). All isolates analyzed belonged to genotype IIIA. There were 42 nucleotide differences in the sequenced VP1 region among the isolates. Amino acid sequences were identical with each other. Conclusions: Our study suggests that sporadically contaminated food- or water-borne sources as well as person-to-person transmission might lead a sustained community-wide HAV outbreak and pre-existing dominant genotype IA might be replaced with genotype IIIA as a major epidemic strain in Korea. Our findings urge the health authority to make public guidelines for HAV vaccination and outbreak control. [Copyright &y& Elsevier]

Objectives: The aim of this study was to identify the risk factors for prolonged carriage of vancomycin-resistant Enterococcus faecium (VREF) in intensive care units (ICUs)., Methods: A retrospective case-control study was performed in the ICUs of a university hospital in Korea from September 2006 to July 2009. VREF carriage was identified through weekly active surveillance rectal cultures. Clinical characteristics and the risk factors for VREF acquisition were compared between cases with prolonged VREF carriage (≥ 5 weeks, n = 58) and controls with shorter VREF carriage (<3 weeks, n = 36) in a multivariate logistic regression model. The effect of vancomycin consumption on vancomycin-resistant enterococci (VRE) colonization pressure was investigated using time-series analysis with an autoregressive error model., Results: Out of a total of 6327 rectal swab cultures examined, 1915 (30.3%) specimens from 266 patients were positive for VREF. The weekly VRE colonization pressure ranged from 0.77% to 42.42%. Vancomycin use after VREF acquisition significantly increased VREF carriage (adjusted odds ratio = 4.09; 95% confidence interval = 1.32-12.65). The case group had higher in-hospital mortality than the control group [21 (36.2%) versus 4 (11.1%), P = 0.007]. Increment of VRE colonization pressure was significantly associated with vancomycin consumption of 1week before (i.e. time t - 1) (P = 0.0028) and moderately associated with that of the corresponding week (i.e. time t) (P = 0.0595)., Conclusions: Vancomycin use in patients with VREF colonization might prolong the duration of carriage. Restriction of vancomycin use should be strengthened in these patients through infection control measures.

Objectives: The high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) coupled with an increase in vancomycin use have induced vancomycin tolerance in MRSA, adversely affecting the outcome of MRSA bacteraemia. This study aimed to identify predictors of persistent MRSA bacteraemia (PMRSAB) in patients treated with vancomycin., Methods: A retrospective, case-control study was performed at a university hospital in Korea from January 2006 to February 2009. Subjects included 96 patients who had MRSA bacteraemia and received vancomycin under therapeutic drug monitoring. We compared the clinical characteristics, management and outcomes of cases with PMRSAB (>or=7 days, n = 31) with controls with non-PMRSAB (

Recent advances in sequencing technologies have initiated an era of personal genome sequences. To date, human genome sequences have been reported for individuals with ancestry in three distinct geographical regions: a Yoruba African, two individuals of northwest European origin, and a person from China. Here we provide a highly annotated, whole-genome sequence for a Korean individual, known as AK1. The genome of AK1 was determined by an exacting, combined approach that included whole-genome shotgun sequencing (27.8x coverage), targeted bacterial artificial chromosome sequencing, and high-resolution comparative genomic hybridization using custom microarrays featuring more than 24 million probes. Alignment to the NCBI reference, a composite of several ethnic clades, disclosed nearly 3.45 million single nucleotide polymorphisms (SNPs), including 10,162 non-synonymous SNPs, and 170,202 deletion or insertion polymorphisms (indels). SNP and indel densities were strongly correlated genome-wide. Applying very conservative criteria yielded highly reliable copy number variants for clinical considerations. Potential medical phenotypes were annotated for non-synonymous SNPs, coding domain indels, and structural variants. The integration of several human whole-genome sequences derived from several ethnic groups will assist in understanding genetic ancestry, migration patterns and population bottlenecks.

Objectives: The aim of this study was to evaluate the control of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and antimicrobial resistance through a computerized antibiotic control program., Methods: An ambidirectional intervention study was conducted at a 750-bed university hospital in Korea from February 2004 to April 2006. In November 2004, hospital-wide restriction of third-generation cephalosporin use was integrated into a pre-existing computerized antibiotic prescription program that included an approval system for 15 antimicrobials. The proportions of ESBL-producing K. pneumoniae and other multidrug-resistant clinical isolates were compared during three phases (9 months per phase): Phase I (pre-intervention), Phase II (intensive-intervention) and Phase III (maintenance)., Results: Third-generation cephalosporin use decreased significantly from 103.2 to 84.9 antibiotic use density (AUD, defined daily dose/1000 patient-days) between Phase I and Phase II (P< 0.05), whereas use of carbapenems and beta-lactam/beta-lactamase inhibitors increased from 14.5 to 18.2 AUD and from 53.3 to 62.6 AUD, respectively. The proportion of ESBL-producing K. pneumoniae isolates increased significantly from 8.1% (47/578) in Phase I to 32.0% (188/587) in Phase II, and then decreased significantly to 20.6% (97/470) in Phase III (P < 0.05). In addition, the proportions of imipenem- or piperacillin/tazobactam-resistant Pseudomonas aeruginosa and Acinetobacter baumannii isolates decreased significantly over the same period (P < 0.05)., Conclusions: The computerized antibiotic control program appears to be an effective tool for modifying antibiotic consumption, which may in turn prevent the spread of resistant pathogens.

The performance of the SD Bioline rapid antigen test kit for influenza virus detection was evaluated with 295 respiratory specimens during the influenza season. The overall sensitivity and specificity of the SD Bioline test were 61.9% and 96.8% for the influenza A virus antigen and 54.5% and 100% for the influenza B virus antigen, respectively. The results were consistent with peak influenza activities.

Objective: To examine genetic polymorphisms in the chemokine pathway, and to assess their interactions in relation to susceptibility to systemic sclerosis (SSc)., Methods: To identify the risk of SSc conferred by genetic polymorphisms in the chemokine pathway, 10 single-nucleotide polymorphisms (SNPs) from 8 candidate genes were studied in 99 patients with SSc and 198 age- and sex-matched controls in a Korean population. SNPs were genotyped by polymerase chain reaction-restriction fragment length polymorphism or sequence-specific primer methods. Genetic associations between each SNP and SSc risk, calculated as odds ratios with 95% confidence intervals, were estimated using chi-square tests. Haplotypes for the 2 polymorphisms in the gene CCL5 (RANTES) were constructed, and their associations with SSc were tested. Gene-gene interactions were investigated using a recently described novel method, and the results were confirmed by conditional logistic regression. Adjustment for multiple testing was based on Bonferroni correction., Results: There was significant evidence of gene-gene interaction between polymorphisms in the genes CXCL8 (interleukin-8) and CCL5, and both of these were associated with an increased risk of SSc. This SNP-SNP interaction was confirmed by 2 independent statistical methods. The associations remained significant after Bonferroni adjustment for multiple testing. No significant association between each individual SNP or haplotype and the risk of SSc was found., Conclusion: Crosstalk between the 2 chemokines CXCL8 and CCL5 may contribute to the susceptibility to SSc.

Ecological health in a temperate stream impacted by acid mine drainage (AMD) was evaluated by using a multimetric approach of the Index of Biological Integrity (IBI) based on natural fish assemblage. Recently, this approach has been widely used in many developed countries as a tool for ecological risk assessments of water environments. We used 10 metric systems, instead of 12 metrics suggested by Barbour, M. T., Gerritsen, J., Snyder, B. D., & Stribling, J. B. (1999). Rapid Bioassessment Protocols for Use in Streams and Wadeable Rivers: Periphyton, benthic Macroinvertebrates and Fish, 2nd edn. EPA 841-B-99-002. Washington, DC: U.S. Environmental Protection Agency, Office of Water, for a development of the regional IBI model, and used trophic guilds, habitat guilds, and richness variables for the calculation of IBI values. In the model, the attributes of four of 11 metrics were modified for the regional application. IBI values in the stream averaged 20.6 (n = 5), indicating a "poor condition" in terms of ecological health according to the modified criteria of U.S. EPA (1993). Fish Field and Laboratory Methods for Evaluating the Biological Integrity of Surface Waters. EPA 600-R-92-111. Environmental Monitoring systems Laboratory - Cincinnati office of Modeling, Monitoring systems, and quality assurance Office of Research Development, U.S. EPA, Cincinnati, Ohio, 45268. In particular, mean IBI values in the impacted areas of sites 2 and 3 were 13, and this health condition was categorized as "very poor condition." IBI values in the impacted sites were significantly lower than the values found in the control. Also, we found that fishes in site sites 2 and 3 were not present during the study, and morphological deformity of Rhynchocypris oxycephalus was observed in site 4, influenced directly by sites 2 and 3, indicating a chemical impact in the sites. From the results of experiments in which AMD was treated with marine shells at stagnant condition, pH increased up to 6.0 from 3.1, and Fe and Al were removed up to 99% within 6 h. In the reactor experiment considering field application, pH of effluent maintained around 7.0. In addition, concentrations of Fe, Al, and heavy metals decreased remarkably in the effluents, and bottom-opened screen between neutralizer basins showed high effectiveness in the treatment of AMD.

To investigate whether genetic variations of MICA are associated with susceptibility to rheumatoid arthritis (RA), the (GCT)n microsatellite polymorphism of the transmembrane domain was analyzed in 144 Korean patients with RA and in 297 unrelated healthy controls. The allele frequency of MICA*A9 significantly decreased in RA patients compared with controls (9.0% vs. 15.3%, odds ratio [OR] = 0.55, p = 0.0098, p(c) = 0.049), whereas the frequency of the MICA*A4 and MICA*A5.1 alleles tended to increase in RA patients (21.2% vs. 14.8%, OR = 1.55, p = 0.018, p(c) > 0.05; 20.5% vs. 15.0%, OR = 1.46, p = 0.0403, p(c) > 0.05). By subgroup analysis, the MICA*A4 allele significantly increased in seropositive RA patients versus controls (23.0% vs. 14.8%, OR = 1.69, p = 0.0082, p(c) = 0.041). HLA-DRB1*0405 was strongly associated with RA (p(c) = 0.0000008), and strong linkage disequilibrium was observed between HLA-DRB1*0405 and MICA*A4 alleles in controls (p(c) = 0.000004) as well as in RA patients (p(c) = 0.0012). In Korean patients, HLA-DRB1*0405 was primarily associated with RA and the weak association of RA with MICA*A4 was secondary to that with HLA-DRB1*0405. Additionally, MICA*A9 might have a weak protective effect on the susceptibility to RA in Koreans.

Behcet's disease (BD) is an autoimmune disease characterized by recurrent oral ulcers, genital ulcers, erythema nodosum, and uveitis. Genetic factors are considered important in its pathogenesis. The serum level of tumor necrosis factor (TNF) is elevated in patients with active BD, and its production is elevated in monocytes and in the gamma delta T cells of BD patients. A dramatic response to anti-TNF-alpha antibody treatment further supports the role of TNF in BD. In this study, we investigated genetic polymorphisms of TNF alpha -308 G/A, TNF beta +252 G/A, and TNFR2 196 R/M in 94 Korean BD patients and age- and sex-matched healthy controls to investigate the role of TNF and TNF receptor polymorphisms in BD. The polymerase chain reaction-restriction fragment length polymorphism was used to identify the TNF-alpha promoter (G = TNFA1, A = TNFA2) and TNF-beta intron polymorphisms (G = TNFB1, A = TNFB2), and polymerase chain reaction-singly-strand conformation polymorphism was used to identify TNFR2 196R/M polymorphism (T = TNFR2M, G = TNFR2R). No differences were found in the TNF-alpha, TNF-beta or TNFR2 polymorphisms of the patients and the healthy controls. The allele frequencies of TNFA1/A2 were 0.94/0.06 in patients and 0.96/0.04 in healthy controls (p = 0.36, OR = 0.65, 95% CI = 0.26-1.63), for TNFB1/TNFB2 these were 0.42/0.58 in patients and 0.44/0.56 in controls (p = 0.68, OR = 0.91, 95% CI = 0.61-1.38), and for TNFR2R/TNFR2M 0.23/0.77 in patients and 0.21/0.79 in controls (p = 0.62, OR = 1.13, 95% CI = 0.69-1.84). In conclusion, this study found no differences of TNF alpha -308 G/A, TNF beta +252 G/A or of the TNFR2 196R/M polymorphisms in Korean BD patients versus healthy controls. These findings suggest that the role of TNF in BD is not genetically determined, but can be functionally explained.

Objective: To evaluate the relationship between pelvic organ prolapse in Korean women and joint hypermobility, which suggests a metabolic collagen fiber abnormality., Study Design: Between March 1998 and March 2000, we investigated 55 patients with prolapse. The prevalence of joint hypermobility, by measuring finger extension angle, and the proportion of patients with joint hypermobility were measured in patients with pelvic organ prolapse and benign gynecologic patients (control group)., Results: In middle-aged women (40-59 years), the average finger extension angles were higher in the POP group than in the control group (50.04 +/- 9.70 degrees vs. 39.50 +/- 12.19 degrees, respectively; P < .05), but in older women there was no significant difference between the two groups (42.84 +/- 13.05 degrees vs. 43.00 +/- 13.34 degrees, respectively; P > .05)., Conclusion: The prevalence of joint hypermobility was higher in the POP group and with advanced POP stage (III, IV) than in the control group and early POP stage (I, II). Our results suggest that intrinsic connective tissue abnormality is related to the development of pelvic organ prolapse. Further study involving more patients with pelvic organ prolapse is warranted, and molecular studies to determine the genetic basis of pelvic organ prolapse are also required to further elucidate this abnormality.

The records of adolescent patients (10-21), who were admitted to the severance hospital between 1990 and 1999, were reviewed retrospectively to evaluate the age distribution, diagnosis, clinical stage, and treatment for endometriosis in adolescents. Thirty-nine patients who had undergone a laparotomy or laparoscopy and were diagnosed with endometriosis were identified. Endometriosis was classified according to the revised American Fertility Society classification (AFS). The chief symptoms leading to the diagnosis, clinical stage, age distribution, and treatment modality were reviewed. All patients, whose average age of menarche was 14.2, were diagnosed with endometriosis with an average interval of 5.9 years after menarche. The chief symptoms leading to the diagnosis were chronic pelvic pain (27%), acute pelvic pain (21%), a palpable pelvic mass (21%), and dysmenorrhea (18%). A laparoscopy was performed in 20 (51%). The majority of patients (44%) presented with the revised AFS classification stage II. Four patients (10%) presented with stage I, 11 (28%) with stage III and 7 (18%) with stage IV. Management after surgery included GnRH agonists (64.1%), expectant managements (25.7%), OCPs (5.1%) and danazol (5.1%). In adolescents with chronic pelvic pain, endometriosis is not rare. Therefore, early referral to a gynecologist to diagnose the etiology of the pelvic pain and initiate appropriate therapy is recommended.