Biomimetic Marine-Sponge-Derived Spicule-Microparticle-Mediated Biomineralization and YAP/TAZ Pathway for Bone Regeneration In Vivo.

Marine-sponge-derived spicule microparticles (SPMs) possess unique structural and compositional features suitable for bone tissue engineering. However, significant challenges remain in establishing their osteogenic mechanism and practical application in animal models. This study explores the biomimetic potential of SPM in orchestrating biomineralization behavior and modulating the Yes-associated protein 1/transcriptional coactivator with PDZ-binding motif (YAP/TAZ) pathway both in vitro and in vivo. Characterization of SPM revealed a structure comprising amorphous silica oxide mixed with collagen and trace amounts of calcium and phosphate ions, which have the potential to facilitate biomineralization. Structural analysis indicated dynamic biomineralization from SPM to hydroxyapatite, contributing to both in vitro and in vivo osteoconductions. In vitro assessment demonstrated dose-dependent increases in osteogenic gene expression and bone morphogenetic protein-2 protein in response to SPM. In addition, focal adhesion mediated by silica diatoms induced cell spreading on the surface of SPM, leading to cell alignment in the direction of SPM. Mechanical signals from SPM subsequently increased the expression of YAP/TAZ, thereby inducing osteogenic mechanotransduction. The osteogenic activity of SPM-reinforced injectable hydrogel was evaluated in a mouse calvaria defect model, demonstrating rapid vascularized bone regeneration. These findings suggest that biomimetic SPM holds significant promise for regenerating bone tissue.

Superoxide Dismutase-Mimetic Polyphenol-Based Carbon Dots for Multimodal Bioimaging and Treatment of Atopic Dermatitis.

Polyphenols have been investigated for their potential to mitigate inflammation in the context of atopic dermatitis (AD). In this study, epigallocatechin-3-gallate (EGCG)-based carbon dots (EGCG@CDs) were developed to enhance transdermal penetration, reduce inflammation, recapitulate superoxide dismutase (SOD) activity, and provide antimicrobial effects for AD treatment. The water-soluble EGCG@CDs in a few nanometers size exhibit a negative zeta potential, making them suitable for effective transdermal penetration. The fluorescence properties, including an upconversion effect, make EGCG@CDs suitable imaging probes for both in vitro and in vivo applications. By mimicking the SOD enzyme, EGCG@CDs scavenge reactive oxygen species (ROS) and actively produce hydrogen peroxide through a highly catalytic capability toward the oxygen reduction reaction, resulting in the inhibition of bacterial growth. The enhanced antioxidant properties, high charge mobility, and various functional groups of EGCG@CDs prove effective in reducing intracellular ROS in an in vitro AD model. In the mouse AD model, EGCG@CDs incorporated into a hydrogel actively penetrated the epidermal layer, leading to ROS scavenging, reduced mast cell activation, and histological recovery of skin barriers. This research represents the versatile potential of EGCG@CDs in addressing AD and advancing tissue engineering.

From macro to micro: A close-up look at Hydrangea luteovenosa and Hydrangea serrata.

Understanding the anatomical traits of the foliar epidermis is essential for making precise species identification and categorization. In this study, scanning electron microscopy (SEM) was used to examine the taxonomically significant foliar epidermal traits of Hydrangea luteovenosa and H. serrata. The qualitative and quantitative traits observed included the epidermal cell form, cuticle presence, trichome morphology, stomatal type, and guard cell features. H. serrata had a thin and smooth cuticle, and epidermal cells organized compactly into cubic or hexagonal shapes. The stomata were of the anomocytic type and dispersed, while the trichomes were straightforward, unbranched, and distributed sparsely. The guard cells had distinct cell walls and a kidney-shaped morphology. These crucial traits for taxonomy were in line with an epidermis composed of three to five layers. Similar polygonal epidermal cells with a compact arrangement were observed in H. luteovenosa, together with a thin and smooth cuticle. The stomata were anomocytic and dispersed, while the trichomes were straightforward, unbranched, and sparsely distributed. The guard cells have distinct cell walls and a kidney-shaped morphology. The traits were indicative of an epidermal structure with three to five layers. These traits helped correctly identify and categorize these two species of Hydrangea. In addition to assisting in the taxonomic classification of these species and advancing knowledge of their ecological and evolutionary links, the SEM study provided insightful information into the structural variety of these species. RESEARCH HIGHLIGHTS: Microscopic characteristics of H. luteovenosa and H. serrata Understanding the anatomical traits of the foliar epidermis is essential for precise species identification and categorization.

Pathways to post-traumatic growth in Korean female cancer patients: the mediation effects of coping strategies and resilience.

ABSTRACTBackground: Cancer is a life-threatening disease in Korean women. Female cancer patients in Korea have reported poor physical functioning and psychological distress after diagnosis. However, some patients experience post-traumatic growth (PTG), which includes positive feelings and changes.Objective: The main purpose of this study was to examine the relationships between PTG and its associated factors in Korean female cancer patients to understand how female cancer patients achieve PTG while experiencing cancer diagnosis and treatment. This study aimed to improve the quality of life of many Korean female patients with cancer.Methods: This study investigated the structural model of the paths from the disruption of core beliefs (CBD), coping strategies, and resilience to PTG in a sample of female cancer patients. In total, 164 middle-aged women diagnosed with cancer were included in the final sample.Results: First, it was determined that the proposed structural model was substantial and had high fit indices. Second, problem-solving was positively associated by the CBD routes. Third, it was also favorably expected that problem-solving would lead to resilience and resilience would lead to PTG. These findings are important for developing future interventions for Korean female cancer patients and can be considered as an important variable to improve their PTG.

The proposed structural model observed paths of how female cancer patients achieve post-traumatic growth while experiencing cancer diagnosis and treatment.Disruption of core beliefs as a factor positively associates problem-solving in Korean female cancer patients.Problem-solving and resilience as factors positively associate post-traumatic growth in Korean female cancer patients.

Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea.

The clonal dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia is a serious clinical problem worldwide. However, the factors related to the emergence and replacement of predominant CRAB clones in nosocomial settings are unclear. By multilocus sequence typing (MLST), we evaluated the genetic relatedness of CRAB bloodstream isolates at a tertiary care hospital over a 3.5-year period and investigated the clinical and microbiologic characteristics of the predominant sequence types (STs). One hundred and seventy-nine CRAB bloodstream isolates were collected from June 2016 to December 2019, and their MLSTs according to Oxford scheme and clinical data were obtained. The predominant STs were assessed for in vitro growth, competitive growth, and virulence in a mouse model of intraperitoneal infection. Two dominant clones-ST369 (n = 98) and ST191 (n = 48)-belonging to international clone 2 (IC2) were recovered from patients admitted to intensive care units (ICUs) or wards. ST191 predominated (61%, 27/43) from June 2016 to July 2017, whereas ST369 (72%, 98/136), which was first isolated from a patient admitted to the emergency room, replaced ST191 (15%, 21/136) after August 2017. In a multivariate analysis, leukopenia (OR = 3.62, 95% CI 1.04-12.6, p = 0.04) and ST191 or 369 (OR = 5.32, 95% CI 1.25-22.65, p = 0.02) were independent risk factors for 7-day mortality. Compared with non-ST369, ST369 was associated with a shorter time to bacteremia from ICU admission (7 vs. 11 days, p = 0.01), pneumonia as an origin of bacteremia (67 vs. 52%, p = 0.04), leukopenia (28 vs. 11%, p < 0.01), and a lower 7-day survival rate (41 vs. 70%, p < 0.01). In vitro, ST 369 isolates had significantly higher growth rates and enhanced competitive growth compared to ST191. Finally, ST369 had greater virulence and a higher mortality rate than other STs in a mouse infection model. We report almost-complete replacement of the predominant ST191 clone by ST369 within an 8-month period at our hospital. ST369 had a high incidence density rate of CRAB bacteremia, a short time to bacteremia after ICU admission, and a high early mortality rate, which may be in part explained by its faster competitive growth rate and higher virulence than ST191.

Intra-host diversity of drug-resistant cytomegalovirus: A case report of cytomegalovirus infection after allogeneic hematopoietic cell transplantation.

Cytomegalovirus (CMV) is a major infectious agent causing severe complications in allogeneic hematopoietic cell transplantation (HCT) recipients, thereby warranting the need for aggressive preemptive or targeted antiviral therapy. However, prolonged or repeated use of antiviral agents, such as ganciclovir (GCV), foscarnet (FOS), and cidofovir (CDV), can result in drug-resistant CMV infection, posing challenges to successful outcomes. Here, we report a case of a patient with acute myeloid leukemia and drug-resistant CMV infection who presented with persistent CMV DNAemia, colitis, pneumonia, and encephalitis. An intra-host diversity of UL97 and UL54 mutations were detected through the genotypic resistance testing conducted on two blood samples (D+199 and D+224) and a cerebrospinal fluid (CSF) specimen (D+260) collected from the patient. UL97 L595W/L595F and L595W mutations were detected in the blood and CSF samples, respectively, that conferred GCV resistance. UL54 F412L mutation detected in all three samples conferred GCV/CDV resistance. However, the V787L mutation of UL54, conferring GCV/FOS resistance, was observed only in the D+224 blood sample. Despite combination therapy with FOS and high dose GCV and adjunctive therapy with leflunomide, the patient died from CMV infection and multiple organ failure on D+279. Further data on resistant mutations and intra-host diversity of CMV should be accumulated to elucidate the antiviral resistance and related outcomes.

A latent class analysis of life stress among female East Asian college students: A multi-country study.

BACKGROUND: This study aimed to identify subgroups of East Asian female college students experiencing life stress frequencies, and examine whether a difference in general characteristics existed between the extracted classes. METHODS: This used a cross-sectional design. Female college students from South Korea (n = 220) and Hong Kong (n = 300) participated in the study. Life stress frequencies using the Life Stress Scale were measured. Latent class analysis as well as binary and multinomial logistic regression analyses were performed to identify the factors associated with extracted classes, and ascertain whether a difference in general characteristics existed between the extracted classes. RESULTS: South Korean participants were classified into two latent groups: "life stress - high" (18.6%) or "life stress - low" (81.4%). Within the Korean latent groups, subjective health status was significantly associated with group classification. In Hong Kong, participants were classified into three latent groups: "life stress - high" (13.7%), "life stress - moderate" (43.9%), and "life stress - low" (42.4%), and the classified groups were significantly associated with the financial status of participants' parents, subjective health status, and body mass index. LIMITATIONS: It is difficult to generalize the results to college females in the whole of South Korea and Hong Kong due to the convenience sampling method. Furthermore, further studies using a longitudinal design will be needed to confirm the variables' causal relationship. CONCLUSIONS: For alleviating the experienced stress frequency, it is important for female college students to have interventions at the family, societal, and national levels, in addition to their individual efforts.

Risk factors and clinical impact of COVID-19-associated pulmonary aspergillosis: Multicenter retrospective cohort study.

BACKGROUND/AIMS: The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, and no data have been reported in Korea. This study aimed to investigate the epidemiology and importance of CAPA diagnostic efforts and to identify the predictors of CAPA and the impacts on clinical outcomes. METHODS: Between January 2020 and May 2021, data of severely to critically ill COVID-19 patients were extracted from seven hospitals of the Catholic Medical Center through a clinical data warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day dose, mean daily dose, and duration of use. RESULTS: A total of 2,427 patients were screened, and 218 patients were included. CAPA was diagnosed in 4.6% (10/218) of all hospitalized and 11.2% (10/89) of intensive care unit patients. Total cumulative dose (over 1,000 mg as methylprednisolone) and daily high-dose corticosteroid use (over 60 mg/day) were independent predictors but not early 7-day high-dose corticosteroid use (over 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 to 8.571) nor prolonged use (OR, 2.794; 95% CI, 0.635 to 13.928). In-hospital overall mortality was 11.9% (26 of 218). CAPA itself did not affect the outcome; rather, daily high-dose steroid use significantly increased the 30-day mortality (hazard ratio, 5.645; 95% CI, 1.225 to 26.091). CONCLUSION: CAPA was not uncommon, especially in critically ill patients. Daily high-dose corticosteroid use was the predictor of CAPA and associated with high mortality rates. High-dose corticosteroids use after early inflammatory phase should be avoided, and active surveillance methods for CAPA are essential for those high-risk patients.

The moderating effect of resilience on the relationship between academic stress and school adjustment in Korean students.

Introduction: This study investigated the moderating effects of resilience on the relationship between academic stress and school adjustment among Korean adolescents. We examined the moderating effect for the total scores of school adjustment and the two subscales of school adjustment (academic adjustment and general school adjustment). Methods: Data were obtained in Pusan, Korea, using the convenience sampling method, and a total of 674 participants' responses were used for the final analysis. Hierarchical regression analysis and multiple regression analysis were performed to examine our research questions. Results: The results of the study showed that academic stress was a significant predictor of school adjustment among Korean adolescents. More specifically, academic stress was related to poor school adjustment. The study also found that resilience has a significant mediating effect on the relationship between academic stress and school adjustment. Discussion: Our findings suggest that resilience is likely to alleviate the harmful effect of academic stress on school adjustment. Finally, implications for school-based intervention were discussed for providing practical academic assistance.

Rifamycin resistance, rpoB gene mutation and clinical outcomes of Staphylococcus species isolates from prosthetic joint infections in Republic of Korea.

OBJECTIVES: We conducted an in vitro investigation of the activity of rifamycins against planktonic and biofilm states of Staphylococcus aureus and Staphylococcus epidermidis isolates from patients with prosthetic joint infections (PJIs), characterised their rpoB gene mutations, and analysed the clinical outcomes of rifampicin-resistant isolates. METHODS: A total of 110 staphylococcal isolates were collected from patients with PJI. Antimicrobials tested using the broth microdilution method included rifampicin, rifabutin, rifapentine and rifaximin. We evaluated rpoB gene mutations to identify rifampicin resistance mechanisms. Clinical outcomes were assessed in rifampicin-resistant isolates. RESULTS: The 110 staphylococcal isolates included 85 S. aureus (55% methicillin-resistant) and 25 S. epidermidis (100% methicillin-resistant). Seven S. aureus isolates and two S. epidermidis isolates were resistant to rifampicin [minimum inhibitory concentration (MIC) ≥2 µg/mL] and these isolates exhibited rpoB gene mutations. Among the 78 rifampicin-susceptible S. aureus isolates and 23 S. epidermidis isolates, 76 S. aureus isolates (97.4%) and all S. epidermidis isolates (100%) were highly susceptible (MIC ≤ 0.06 µg/mL) to other rifamycins. The minimum biofilm bactericidal concentrations for ≥50% of isolates (MBBC50) to rifampicin, rifabutin, rifapentine and rifaximin were 4, 1, 2 and 4 µg/mL for S. aureus and 1, 0.125, 0.25 and 0.5 µg/mL for S. epidermidis, respectively, among rifampicin-susceptible isolates. Among nine patients bearing rifampicin-resistant isolates, only three (33%) had successful outcomes. CONCLUSION: Rifamycins other than rifampicin show promising antistaphylococcal activity, including antibiofilm activity. Rifamycin-resistant staphylococci exhibit rpoB gene mutations.

Status of antimicrobial stewardship programmes in Korean hospitals including small to medium-sized hospitals and the awareness and demands of physicians: a nationwide survey in 2020.

OBJECTIVES: This study aimed to identify the status of antimicrobial stewardship programmes (ASPs) in small to medium-sized Korean hospitals as well as the awareness and demands about ASPs of physicians. METHODS: A questionnaire was designed based on a questionnaire from a previous nationwide survey in 2018 targeting large hospitals in Korea and modified to reflect the results of in-depth interviews with non-infectious diseases (IDs) physicians at secondary care hospitals. The survey targeted all hospitals with ≥150 beds in South Korea and was performed in May-June 2020. Only one ASP-associated physician per hospital participated in the survey. RESULTS: The survey response rate was 31.9% (217/680). ID specialists comprised the majority of medical personnel participating in ASPs in tertiary care hospitals. Conversely, in secondary and primary care hospitals there was no predominant medical personnel for ASPs and the median full-time equivalent was 0 for all types of medical personnel. Tertiary care hospitals, more than secondary and primary care hospitals, tended to perform ASP activities more actively. 'Workforce for ASPs', 'Establishment of healthcare fees for ASPs' and 'Development of tools for ASPs' were the most important required support for ASP improvement. CONCLUSION: The level of ASP establishment was more limited in primary care hospitals than in secondary and tertiary care hospitals in Korea. To improve ASPs in Korean hospitals, a supporting workforce and the establishment of a healthcare fee for ASPs appear to be necessary.

Safety and immunogenicity of a seasonal quadrivalent influenza vaccine (GC3110A) in healthy participants aged ≥ 65 years.

BACKGROUND: Seasonal Influenza is still considered associated with seasonal morbidity and hospitalization in the elderly population. The World Health Organization (WHO) recommended seasonal quadrivalent influenza vaccine (QIV) to reduce burden of two currently circulating influenza B lineages. Until 2019 Korean National Immunization Program (NIP) recommended trivalent influenza vaccine (TIV) after ongoing debates on cost effectiveness of QIV for elderly population. Although influenza vaccine only showed modest effect on reducing influenza in elderly, this study aimed to evaluate the immunogenicity and safety of inactivated QIV in healthy participants ≥ 65 years of age. METHODS: A total of 274 healthy participants aged ≥ 65 years received a QIV. Seroconversion-based vaccine efficacy of 4 strains of seasonal influenza was assessed 21 days after vaccination and adverse events were monitored until 180 days after vaccination. RESULTS: The percentages of participants seroconverted after vaccination on HI antibody against each strain were 36.5% (99/271) to A/H1N1, 47.6% (129/271) to A/H3N2, 40.6% (110/271) to B Yamagata, and 49.1% (133/271) to B Victoria. The percentages of participants seroprotected after vaccination on HI antibody against each strain were 81.2% (220/271) to A/H1N1, 98.5% (267/271) to A/H3N2, 95.2% (258/271) to B Yamagata, and 93.7% (254/271) to B Victoria. There was no serious adverse event (SAE) related with the study vaccine. CONCLUSION: The quadrivalent split influenza vaccine is expected to offer seroprotection against influenza A and both influenza B lineages even in the elderly population.

A quasi-experimental study on stethoscopes contamination with multidrug-resistant bacteria: Its role as a vehicle of transmission.

Stethoscopes have been suggested to be a possible vector of contact transmission. However, only a few studies have focused on the prevalence of contamination by multidrug-resistant (MDR) bacteria and effectiveness of disinfection training to reduce. This study is to investigate the burden of stethoscope contamination with nosocomial pathogens and multidrug-resistant (MDR) bacteria and to analyze habit changes in disinfection of stethoscopes among healthcare workers (HCWs) before and after education and training. We performed a prospective pre and post quasi-experimental study. A total of 100 HCWs (55 doctors and 45 nurses) were recruited. HCWs were surveyed on their disinfection behavior and stethoscopes were cultured by pressing the diaphragm directly onto a blood agar plate before and after education on disinfection. Pulsed-field gel electrophoresis was performed to determine the relatedness of carbapenem-resistant Enterobacteriaceae. Most of the stethoscopes were contaminated with microorganisms before and after the intervention (97.9% and 91.5%, respectively). The contamination rate of stethoscopes with nosocomial pathogens before and after education was 20.8% and 19.2%, respectively. Stethoscope disinfection habits improved (55.1% vs 31.0%; p<0.001), and the overall bacterial loads of contamination were reduced (median colony-forming units, 15 vs 10; p = 0.019) after the intervention. However, the contamination rate by nosocomial pathogens and MDR bacteria did not decrease significantly. A carbapenemase-producing Klebsiella pneumoniae isolates from a stethoscope was closely related to isolates from the patients admitted at the same ward where the stethoscope was used. Stethoscopes were contaminated with various nosocomial pathogens including MDR bacteria and might act as a vehicle of MDR bacteria. Continuous, consistent education and training should be provided to HCWs using multifaceted approach to reduce the nosocomial transmission via stethoscopes.

Antimicrobial susceptibility of Staphylococcus species isolated from prosthetic joints with a focus on fluoroquinolone-resistance mechanisms.

We investigated susceptibility to antimicrobials of 89 staphylococcal species from PJIs and analyzed fluoroquinolone (FQ)-resistance mechanisms. Staphylococcal isolates showed high resistance to oral antimicrobials, with the exception of TMP-STX and linezolid. The main mechanism of resistance to FQ was mutations in quinolone-resistance-determining-regions. Fifteen percent of Staphylococcus aureus overexpressed efflux-pump genes.

Paths from core belief disruption to post-traumatic stress symptoms and post-traumatic growth among Korean undergraduates: The mediating role of rumination.

The post-traumatic growth (PTG) model proposes that cognitive processing is a key mechanism that leads to growth in the aftermath of traumatic events. Building upon the PTG model, the present study examined the paths from the disruption of core beliefs to post-traumatic stress symptoms (PTSS) and PTG via intrusive and deliberate rumination. The sample includes 370 Korean undergraduate students who reported at least one highly stressful experience in their lifetime. Structural equation modeling demonstrated that disruption of core beliefs predicted PTG both directly and indirectly through multiple pathways: via deliberate rumination, intrusive rumination, and the path from intrusive to deliberate rumination. The disruption of core beliefs positively predicted PTSS only through intrusive rumination. No bivariate relationship was found between PTSS and PTG. These findings support the different roles of intrusive rumination and deliberate rumination in mediating the paths from disruption of core beliefs to PTSS and PTG. Implications and limitations of this study were discussed.

The changing epidemiology of herpes zoster over a decade in South Korea, 2006-2015.

BACKGROUND: In South Korea, the population is rapidly aging and the prevalence of comorbidities has increased. We investigated longitudinal changes in the herpes zoster (HZ) considering demographic changes and comorbidities in the era of universal single-dose varicella vaccination. METHODS: We used the population-based database of the National Health Insurance Service in South Korea, with approximately 50 million subscribers during 2006-2015. HZ cases were identified using ICD-10 codes and comorbid conditions were also collected. Incidence rates (IRs) and incidence rate ratios (IRRs) per year were calculated adjusting for age, sex, comorbidities and socioeconomic status, and the temporal trends were examined using segmented negative binomial regression analysis. RESULTS: Over a decade, the adjusted HZ IR increased significantly from 4.23 to 9.22 per 1000 person-years (adjusted IRR 1.05, 95% confidence interval [CI] 1.04-1.06). However, during 2012-2015, the increasing trends decelerated (adjusted IRR per year 1.01, 95% CI 0.98-1.04) and slope changes differed by age. There was a declining trend in children under 9 years, sustained increase in adults aged 30-39 years, and near-plateau in those aged 50-69 years. Nonetheless, the age distribution of HZ incidence did not change over a decade, with the peak in adults aged 60-79 years. HZ-associated hospitalization rates also increased, with a deceleration in the increasing trends during 2012-2015. CONCLUSIONS: The HZ burden increased independently of demographic changes and prevalence of comorbidities. However, different trajectories by age group necessitate continuous HZ surveillance for better understanding of these changes, and to provide evidence for development of preventive strategies.

In Vitro Synergy and In Vivo Activity of Tigecycline-Ciprofloxacin Combination Therapy against Vibrio vulnificus Sepsis.

The mortality rate associated with Vibrio vulnificus sepsis remains high. An in vitro time-kill assay revealed synergism between tigecycline and ciprofloxacin. The survival rate was significantly higher in mice treated with tigecycline plus ciprofloxacin than in mice treated with cefotaxime plus minocycline. Thus, combination treatment with tigecycline-ciprofloxacin may be an effective novel antibiotic regimen for V. vulnificus sepsis.

Reply letter: trends in varicella and herpes zoster epidemiology before and after the implementation of universal one-dose varicella vaccination over one decade in South Korea, 2003-2015.

In the letter, Lai SW suggested that the cost-benefit of two-dose varicella vaccines should be considered since universal one-dose vaccination effectively reduced varicella incidence in Taiwan. However, the vaccination impact was different between South Korea and Taiwan. In South Korea, only a moderate reduction in varicella incidence was observed after implementing universal one-dose vaccination. Such difference possibly reflects the relatively high background varicella incidence in South Korea. As substantial variability in varicella epidemiology exists across countries, an optimal vaccination strategy may differ in each country. Despite the effectiveness of one-dose vaccine being moderate, primary vaccine failure and rapidly waning immunity are major concerns. Therefore, two-dose vaccination would be a reasonable choice for effectively preventing virus transmission in South Korea.

Trends in varicella and herpes zoster epidemiology before and after the implementation of universal one-dose varicella vaccination over one decade in South Korea, 2003-2015.

Background: In South Korea, the one-dose varicella vaccine was included in the National Immunization Program for children aged 12-15 months in 2005, and the vaccine coverage reached >95%. The impact of varicella vaccination on varicella and herpes zoster (HZ) was investigated, accounting for demographic changes over time.Methods: We calculated the crude and age-sex standardized incidence rates (IRs) and age-specific IRs of varicella and HZ from 2003 to 2015, using the National Health Information Database including approximately 50 million Koreans. The annual incidence rate ratios (IRRs) were calculated using a negative binomial regression analysis, adjusting for age and sex.Results: The crude varicella IR steadily declined by 67%, from 5.70/1000 to 1.87/1000 person years (IRR per year: 0.91; 95% CI 0.89-0.93), but the adjusted IRs showed a significant decline only during 2010-2015 (adjusted IRR per year: 0.90; 95% CI 0.88-0.93). The greatest decline was found in children ≤4 years of age, whereas the IR increased until 2011 and then declined afterward in children aged 5-9 years, who represented the highest incidence age group in 2013-2015. The crude HZ IR increased from 2.67/1000 to 9.80/1000 person years (IRR per year: 1.12; 95% CI 1.10-1.15), and the adjusted IR also followed the same trend. A similar increasing trend was observed before and after universal vaccination.Conclusions: One-dose varicella vaccination was moderately effective in preventing varicella, but this strategy was insufficient to interrupt varicella transmission in children. Furthermore, the HZ incidence dramatically increased over this decade. The current vaccination strategy against varicella-zoster disease should be reconsidered.

Epidemiology and Antifungal Susceptibility Profile of Aspergillus Species: Comparison between Environmental and Clinical Isolates from Patients with Hematologic Malignancies.

Global data on the epidemiology and susceptibility of Aspergillus are crucial in the management of invasive aspergillosis. Here, we aimed to determine the characteristics of clinical and environmental Aspergillus isolates, focusing mainly on hematologic malignancy patients. We prospectively collected all consecutive cases and clinical isolates of culture-positive proven/probable invasive aspergillosis patients from January 2016 to April 2018 and sampled the air inside and outside the hospital. Cryptic species-level identification of Aspergillus, antifungal susceptibilities, and cyp51 gene sequencing were performed, and clinical data were analyzed. This study was conducted as part of the Catholic Hematology Hospital Fungi Epidemiology (CAFÉ) study. A total of 207 proven/probable invasive aspergillosis and 102 clinical and 129 environmental Aspergillus isolates were included in this analysis. The incidence of proven/probable invasive aspergillosis was 1.3 cases/1,000 patient-days during the study period. Cryptic Aspergillus species accounted for 33.8%, with no differences in proportions between the clinical and environmental isolates. Section Nigri presented a high proportion (70.5%) of cryptic species, mainly from A. tubingensis and A. awamori: the former being dominant in environmental samples, and the latter being more common in clinical isolates (P < 0.001). Of 91 A. fumigatus isolates, azole-resistant A. fumigatus was found in 5.3% of all A. fumigatus isolates. Three isolates presented the TR34/L98H mutation of the cyp51A gene. Patients with invasive aspergillosis caused by azole-resistant A. fumigatus showed 100% all-cause mortality at 100 days. This study demonstrates the significant portion of cryptic Aspergillus species and clinical implications of azole resistance and underscores the comparison between clinical and environmental isolates.