Incidence of Clostridioides difficile Infections in Republic of Korea:A Prospective Study With Active Surveillance vs. National Data From Health Insurance Review & Assessment Service

Background@#Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. @*Methods@#To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. @*Results@#In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patientdays was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25–12.05) and 4.18 per 1,000 admissions (range: 1.92–8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68–13.90) and 6.73 per 1,000 admissions (range: 3.18–15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. @*Conclusion@#The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.

Greater Severity of Steatosis Is Associated with a Higher Risk of Incident Diabetes: A Retrospective Longitudinal Study

Background@#Fatty liver is associated with increased risk of developing type 2 diabetes. We aimed to evaluate whether the severity of hepatic steatosis is associated with incident diabetes. @*Methods@#We conducted a longitudinal analysis using data from 1,798 participants who underwent a comprehensive health checkup and abdominal computed tomography (CT). We assessed the association between baseline liver attenuation value on non-contrast CT images and risk of incident diabetes. All the participants were categorized into three groups based on the baseline liver attenuation value on non-contrast CT images: without hepatic steatosis (>57 Hounsfield unit [HU]), mild hepatic steatosis (41–57 HU), and moderate to severe hepatic steatosis (≤40 HU). @*Results@#During a median follow-up period of 5 years, 6.0% of the study participants progressed to diabetes. The incidence of diabetes was 17.3% in the moderate to severe hepatic steatosis group, 9.0% in the mild steatosis group, and 2.9% in those without hepatic steatosis. In a multivariate adjustment model, as compared with participants without hepatic steatosis, those with moderate to severe steatosis had a hazard ratio (HR) of 3.24 (95% confidence interval [CI], 1.64 to 4.2) for the development of diabetes, and those in the mild steatosis group had a HR of 2.33 (95% CI, 1.42 to 3.80). One standard deviation decrease in mean CT attenuation values of the liver was associated with a 40% increase in the development of diabetes (multivariate adjusted HR, 1.40; 95% CI, 1.2 to 1.63). @*Conclusion@#We found a positive association between severity of hepatic steatosis and risk of incident diabetes. Greater severity of steatosis was associated with a higher risk of incident diabetes.

Healthcare Workforce Response to The Coronavirus Disease Outbreak in Daegu, Korea: A Multi-Center, Cross-Sectional Survey / 감염과화학요법

Background@#Securing an available healthcare workforce is critical to respond to coronavirus disease 2019 (COVID-19); however, research investigating Korea’s COVID-19 staffing response is rare. To present the fundamental data of healthcare staff in response to the surge in COVID-19 cases, we investigated the healthcare workforce response in Daegu, South Korea, which experienced the first largest outbreak of COVID-19 outside of China. @*Materials and Methods@#In response to the COVID-19 outbreak, this retrospective crosssectional study analyzed data on the scale and characteristics of healthcare workers (HCWs). Additionally, it analyzed the clinical and epidemiological characteristics of HCWs infected with COVID-19 in six major teaching hospitals (five tertiary and one secondary) in Daegu from January 19 to April 30, 2020. @*Results@#During this study period, only 1.3% (n = 611) of the total hospitalized patients (n = 48,807) were COVID-19 inpatients, but they occupied 6.0% (n = 303) of the total hospital beds (n = 5,056), and 23.7% (n = 3,471) of all HCWs (n = 14,651) worked in response to COVID-19.HCWs participating in COVID-19-related works comprised 50.6% (n = 1,203) of doctors (n = 2,379), 26.3% (n = 1,571) of nurses (n = 5,982), and 11.4% (n = 697) of other HCWs (n = 6,108).Only 0.3% (n = 51) of HCWs (n = 14,651) developed COVID-19 infections from communityacquired (66.7%) or hospital-acquired (29.4%). Nurses were affected predominantly (33.3%), followed by doctors (9.8%), caregivers (7.8%), radiographers (5.9%), and others (45.1%), including nurse aides and administrative, facility maintenance, telephone appointment centers, and convenience store staff. All HCWs infected with COVID-19 recovered completely. The 32.7% (n = 333) of individuals (n = 1,018) exposed to HCWs who had COVID-19 were quarantined, and only one case of secondary transmission among them occurred. @*Conclusion@#The COVID-19 pandemic has necessitated significant staffing and facility usage, which is disproportionate to the relatively low number of COVID-19 inpatients, imposing a substantial burden on healthcare resources. Therefore, beyond the current reimbursement level of the Korean National Health Insurance, a new type of rewarding system is needed to prepare hospitals for the emerging outbreaks of infectious diseases. Keeping HCWs safe from COVID-19 is crucial for maintaining the healthcare workforce during a sudden massive outbreak. Further studies are needed to determine the standards of required HCWs through detailed research on the working hours and intensity of HCWs responding to COVID-19.

CD11b Deficiency Exacerbates Methicillin-Resistant Staphylococcus aureus-Induced Sepsis by Upregulating Inflammatory Responses of Macrophages

Macrophages are important for the first line of defense against microbial pathogens. Integrin CD11b, which is encoded by Itgam, is expressed on the surface of macrophages and has been implicated in adhesion, migration, and cell-mediated cytotoxicity. However, the functional impact of CD11b on the inflammatory responses of macrophages upon microbial infection remains unclear. Here, we show that CD11b deficiency resulted in increased susceptibility to sepsis induced by methicillin-resistant Staphylococcus aureus (MRSA) infection by enhancing the pro-inflammatory activities of macrophages. Upon infection with MRSA, the mortality of Itgam, knockout mice was significantly higher than that of control mice, which is associated with increased production of TNF-α and IL-6. In response to MRSA, both bone marrowderived macrophages and peritoneal macrophages lacking CD11b produced elevated amounts of pro-inflammatory cytokines and nitric oxide. Moreover, CD11b deficiency upregulated IL-4-induced expression of anti-inflammatory mediators such as IL-10 and arginase-1, and an immunomodulatory function of macrophages to restrain T cell activation. Biochemical and confocal microscopy data revealed that CD11b deficiency augmented the activation of NF-κB signaling and phosphorylation of Akt, which promotes the functional activation of macrophages with pro-inflammatory and immunoregulatory phenotypes, respectively. Overall, our experimental evidence suggests that CD11b is a critical modulator of macrophages in response to microbial infection.

Effects of sarcopenia and sarcopenic obesity on joint pain and degenerative osteoarthritis in postmenopausal women

Purpose@#This study aimed to identify the prevalence of sarcopenia, obesity, and sarcopenic obesity and their association to radiographic knee osteoarthritis (OA) and knee pain in Korean menopausal women. @*Methods@#This study cross-sectional study utilized the data obtained from Korean National Health and Nutrition Examination Surveys (KNHANES) 2009-2011 which included 4,362 menopausal women. The participants were categorized based on their body composition and the prevalence of radiographic knee OA and knee pain were calculated. The effect of hormone therapy (HT) was analyzed as subcohort analysis. @*Results@#The prevalence of radiographic knee OA, knee pain, and both radiographic knee OA and knee pain were all highest in sarcopenic obese group and lowest in non-sarcopenic non-obese group. Among the non-sarcopenic people, the obese people showed higher ratio of only radiographic knee OA (57.64% vs. 41.54%, p ＜ 0.001). When sarcopenic, the coexistence of obesity presented significantly higher ratio of radiographic knee OA, knee pain, and both radiographic knee OA and knee pain compared to sarcopenic without obesity (61.49% vs. 41.82%, 39.11% vs. 27.61%, 32.04 vs. 17.60%, all p ＜ 0.001).Regarding the use of HT for longer than 1 year was not associated with statistically different ratio of neither radiographic knee OA nor knee pain. @*Conclusion@#The obesity in terms of sarcopenia have greater effect on knee OA compared to the obesity without sarcopenia and HT use of longer than 1 year is not associated with the prevalence of knee OA. Therefore, more preventive effort to knee OA should be focused on reducing body fat and increasing muscle in the postmenopausal women.

A Fatal Case of Bacteremia Caused by Vibrio cholerae Non-O1/O139 / 감염과화학요법

Vibrio cholerae is a pathogen known to cause the waterborne epidemic disease cholera. Overall, V. cholerae O1 or O139 strains produce the cholera toxin that cause gastroenteritis, resulting in watery diarrhea. Most of the enterocolitis caused by V. cholerae can be easily treated with fluid therapy and conservative care. However, V. cholerae non-O1/O139 strains can cause extraintestinal infections, such as wound infection or sepsis, in immunocompromised patients. The clinical course of these infections is very similar to that of V. vulnificus infection. We report about a 52-year-old man without previous underlying disease who was diagnosed with V. cholerae non-O1/O139 infection and died within 72 hours after admission to the intensive care unit.

A Fatal Case of Bacteremia Caused by Vibrio cholerae Non-O1/O139 / 감염과화학요법

Vibrio cholerae is a pathogen known to cause the waterborne epidemic disease cholera. Overall, V. cholerae O1 or O139 strains produce the cholera toxin that cause gastroenteritis, resulting in watery diarrhea. Most of the enterocolitis caused by V. cholerae can be easily treated with fluid therapy and conservative care. However, V. cholerae non-O1/O139 strains can cause extraintestinal infections, such as wound infection or sepsis, in immunocompromised patients. The clinical course of these infections is very similar to that of V. vulnificus infection. We report about a 52-year-old man without previous underlying disease who was diagnosed with V. cholerae non-O1/O139 infection and died within 72 hours after admission to the intensive care unit.

Effects of lower parity on sarcopenia in postmenopausal women: An analysis using the 2010-2011 Korean National Health and Nutrition Examination Survey (KNHANES) data

Purpose@#This study aimed to investigate whether the number of parity is associated with the prevalence of sarcopenia in postmenopausal women. @*Methods@#This study was performed using data from the 2010-2011 Korean National Health and Nutrition Examination Survey that included 1,338 postmenopausal women aged 46-70 years. The prevalence of sarcopenia was analyzed according to the number of births. Modifiable risk factors were evaluated to determine the association of parity with sarcopenia in susceptible population. @*Results@#The sarcopenia group (n=343) had lower number of parity, lower body mass index, more frequent previous history of diabetes mellitus, higher Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and higher education level than the non-sarcopenia group (n=995). The sarcopenia risk was significantly lower in postmenopausal women with a higher number of parity (≥3 births) (model 1: odds ratio [OR]=0.308; 95% confidence interval [CI]=0.115–0.827, p=0.0194; model 2: OR=0.269; 95% CI=0.109–0.66, p=0.0042; model 3: OR=0.640; 95% CI=0.428–0.957, p=0.0295; model 4: OR=0.636; 95% CI=0.413–0.980, p=0.0403). In subgroup analysis of the lower parity group, moderate aerobic activity was associated with a lower sarcopenia prevalence (OR: 0.52; 95% CI: 0.317–0.852; p=0.0095). @*Conclusion@#A lower number of parity increases the risk of sarcopenia in postmenopausal Korean women. Moderate aerobic activity may be effective in preventing sarcopenia in postmenopausal women with lower parity who are more susceptible to sarcopenia.

Relationship between the type of hormone replacement

Objective@#After Women's Health Initiative (WHI) trial, hormone replacement therapy (HRT) prescription rate dropped by 16% in Korea. We investigated the relationship between the type of HRT and incidence of breast cancer (BC) in postmenopausal women in Korea.Material & Methods: We compared the prevalence of BC in 356,160 women on HRT, who reached menopause between 2004 and 2007. We divided the type and duration of HRT into three categories, i.e., estrogen-progestogen therapy (EPT), estrogen-only therapy (ET), tibolone, and 1– 3 years, 3–5 years, and ＞5 years, respectively. @*Results@#Regarding the type of HRT among all age groups, BC risk (BCR) was lower in the tibolone group (P＜0.01). Based on age group, BCR was lower in the 50–59 years group using EPT (P=0.03) and tibolone (P＜0.01). HRT administration for ＜3 years showed a significant decrease in the tibolone group (P=0.04) and an increase in the ET group (P=0.03). In groups undergoing HRT for ＞5 years, BCR in all groups decreased (P＜0.05). @*Conclusions@#The results suggest that tibolone reduces the risk of BC in women aged ≥50 years and HRT use for ≥5 years was related to significantly decreased BCR in Korea.

Pelvic malakoplakia presenting as endometrial cancer: a case report

Malakoplakia is a rare granulomatous, inflammatory disease generally manifesting as ulcers of the urogenital tract, especially in the bladder, but it can occur in any part of the body. Because of its varied clinical presentations, malakoplakia is considered for differential diagnosis upon suspicion. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies. We report a case of pelvic malakoplakia accompanied by left lower quadrant pain that was misdiagnosed as endometrial cancer with pelvic mass based on imaging studies. The patient underwent dilatation and curettage, and the pathology report revealed no malignancy. Because of persistent pain and septic shock, she underwent a debulking operation to remove the mass. Histopathologic examination revealed malakoplakia. For postoperative management, she received broad-spectrum antibiotics, but abdominal pelvic computerized tomography performed on postoperative day 9 revealed pelvic mass recurrence. To the best of our knowledge, this is the only rare case report of pelvic malakoplakia mimicking endometrial cancer.

Pelvic malakoplakia presenting as endometrial cancer: a case report

Malakoplakia is a rare granulomatous, inflammatory disease generally manifesting as ulcers of the urogenital tract, especially in the bladder, but it can occur in any part of the body. Because of its varied clinical presentations, malakoplakia is considered for differential diagnosis upon suspicion. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies. We report a case of pelvic malakoplakia accompanied by left lower quadrant pain that was misdiagnosed as endometrial cancer with pelvic mass based on imaging studies. The patient underwent dilatation and curettage, and the pathology report revealed no malignancy. Because of persistent pain and septic shock, she underwent a debulking operation to remove the mass. Histopathologic examination revealed malakoplakia. For postoperative management, she received broad-spectrum antibiotics, but abdominal pelvic computerized tomography performed on postoperative day 9 revealed pelvic mass recurrence. To the best of our knowledge, this is the only rare case report of pelvic malakoplakia mimicking endometrial cancer.

Hand Grip Strength according to the Smoking Status in Korean Adults: The 7th Korea National Health and Nutrition Examination Survey 2016–2017

Background@#Smoking is a well-known risk factor for respiratory diseases, cardiovascular diseases, and many types of cancers, but there is little information about the effects of smoking on muscle strength. Hand grip strength (HGS) is a simple way to measure muscle power. We compared the mean HGS according to smoking status and smoking level in Korean male and female smokers. @*Methods@#We obtained data from the Korea National Health and Nutrition Examination Survey VII and included adults aged 20–79 years. We identified factors that affect HGS and after adjusting for these factors, we compared the mean HGS of smokers, ex-smokers, and nonsmokers. We also compared the mean HGS of smokers according to the smoking level. ANOVA and ANCOVA analyses were performed to compare the mean HGS. In addition, we examined the relationship between smoking, and mean main HGS, which is the mean HGS of the dominant hand. @*Results@#A total of 9,848 people were analyzed after excluding those with uncertain smoking status and those who did not respond to the study variables. After adjusting for all cofactors, the mean HGS and the mean main HGS were higher in smokers and ex-smokers than in both male and female nonsmokers with no previous history of smoking. In smokers, the amount of smoking did not affect the mean HGS or mean main HGS. @*Conclusion@#Smokers and ex-smokers have higher mean HGS and mean main HGS than nonsmokers, and the amount of smoking does not affect the mean HGS and mean main HGS in smokers.

Treatment of Class I crowding using simple tubes bonded with customized resin coverings: A case report / 대한치과교정학회지

As an alternative to the conventional fixed appliance that uses orthodontic brackets, a simple round tube without a bonding base can be bonded to the tooth surface by covering the tube with flowable resin. In this technique, bent wires cannot be inserted into the simple tubes; therefore, repositioning of the simple tubes is often required for adjustments. To reduce repositioning of simple tubes, a dome-shaped resin covering of the simple tube can be designed with a customized in-and-out compensation, using three-dimensional computer-aided design software based on digital simulation of orthodontic tooth movement. In the present case, the use of simple tubes bonded with customized resin coverings in a Class I nonextraction case is described in a 17-year-old male, in whom moderate crowding of the anterior teeth was treated over an 8-month period. This case shows that simple tubes can be used as an alternative to brackets in some Class I nonextraction cases, with the potential benefit of reducing decalcification.

Benefits and risks of induction of labor at 39 or more weeks in uncomplicated nulliparous women: a retrospective, observational study

OBJECTIVE: To critically compare the benefits and risks of labor induction versus spontaneous labor in uncomplicated nulliparous women at 39 or more weeks of gestation. METHODS: We conducted a retrospective, observational study of 237 nulliparous women who were at 39 or more weeks of a singleton pregnancy with vertex presentation and intact membranes. We compared maternal outcomes including the Cesarean section rate and neonatal outcomes in the induced labor and spontaneous labor groups. RESULTS: Among the 237 women, 199 delivered vaginally (84.0%). The spontaneous labor group and induced labor group had a similar incidence of Cesarean delivery (17.7% vs. 12.3%, P=0.300). The length of stay and blood loss during delivery were also similar between the groups (4.3±1.5 vs. 3.9±1.5 days and 1.9±1.3 vs. 1.8±1.0 mg/sL, respectively; all P > 0.05). Regarding neonatal outcomes, the rate of meconium-stained amniotic fluid, Apgar score 0.05). Only the neonatal intensive care unit admission rate was significantly lower in the induction group than in the spontaneous labor group (28.0% vs. 13.2%, P=0.001). CONCLUSION: Maternal adverse outcomes of labor induction at 39 weeks of gestation were similar to those in a spontaneous labor group in uncomplicated nulliparous women. Neonatal adverse events were also similar between the groups. It may be acceptable to schedule labor induction as long as 7 days before the estimated date, even when the indication is only relative.

Differing Associations between Fatty Liver and Dyslipidemia According to the Degree of Hepatic Steatosis in Korea

OBJECTIVE: Fatty liver is associated with insulin resistance-related diseases, such as dyslipidemia, obesity, and type 2 diabetes. The aim of this study was to evaluate the association of dyslipidemia with fatty liver and assess the differences in these associations according to the degree of hepatic steatosis. METHODS: A total of 2,462 subjects (1,679 men and 783 women) who underwent a comprehensive health check-up (including abdominal computed tomography) from January 2010 to December 2013 were enrolled at Samsung Changwon Hospital Healthcare Center. The liver attenuation index (LAI), defined as the difference between mean hepatic and splenic attenuation, was used to assess the degree of hepatic steatosis. An LAI below 5 Hounsfield units was defined as fatty liver. RESULTS: We found that 32.2% of the study subjects had fatty liver. Serum low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG), and fasting blood glucose concentrations and glycated hemoglobin (HbA1c percentage) were significant greater in the fatty liver group compared with the non-fatty liver group, while serum high-density lipoprotein cholesterol (HDL-C) was significantly lower in the fatty liver group. Subjects with fatty liver had 1.7-fold greater risk of dyslipidemia than those without fatty liver after adjusting for age, sex, body mass index (BMI), and HbA1c. When individuals with fatty liver were analyzed by tertiles of LAI values, LDL-C, TG, fasting glucose, BMI, and HbA1c concentrations increased while HDL-C decreased with decreasing LAI tertiles. Compared with LAI tertile 3, the risk for dyslipidemia significantly increased with adjusted odds ratios of 1.42, and 1.81 in tertiles 2 and 1, respectively. CONCLUSION: Fatty liver was significantly associated with dyslipidemia and this association varied according to the degree of hepatic steatosis.

Preliminary Report of Seroprevalence of Anti-Measles Immunoglobulin G among Healthcare Workers of 6 Teaching Hospitals of Daegu, Korea in 2019 / 감염과화학요법

The measles outbreak in Daegu of January 2019 made 6 teaching hospitals' organization test the measles immunity of their healthcare workers (HCWs). We found that 6,935 (75.9%) of 9,132 HCWs tested seropositive for anti-measles immunoglobulin G (IgG), and seropositivity rate was very different between 6 hospitals (range, 59.9–93.1%). The seroprevelence was lowest in the age of twenties, but the rate was different between 6 hospitals (range 47.0–85.5%). Therefore, to prevent measles from spreading to HCWs, each hospital should make their own data periodically about anti-measles IgG seropositivity of their HCWs.

Cesarean section does not increase the prevalence of allergic disease within 3 years of age in the offsprings

OBJECTIVE: In this study, we evaluated the prevalence of allergic disease in offsprings delivered via the delivery modes of vaginal delivery vs. planned Cesarean section vs. Cesarean section with labor. METHODS: This study included 175 mother-neonate pairs from Severance Hospital who were enrolled in the Cohort for Childhood Origin of Asthma and allergic diseases study. Information regarding prenatal environmental factors, delivery, and diagnosis of allergic diseases was obtained from a questionnaire and medical record review. Patients with at least 3 years of follow-up data were included in this study. Results were adjusted for sex, birth weight, gestational age at birth, season of birth, neonatal intensive care unit admission, parity, breastfeeding, and maternal factors. RESULTS: A total of 175 offsprings were eligible for analysis. Among the subjects, 52.0% were delivered by vaginal delivery, 34.3% by planned Cesarean section, and 16.6% by Cesarean section with labor. Fifty-nine offsprings (33.7%) were diagnosed with allergic disease at a median age of 1 year (range 0.5–3 years). The prevalence of allergic disease was not associated with delivery mode after adjusting for confounding variables. Time period from membrane rupture to delivery, duration of the active phase, and the beginning of the pelvic division prior to Cesarean section were not associated with allergic disease development in offsprings. CONCLUSION: Cesarean section, irrespective of the occurrence of labor before surgery, did not increase the prevalence of allergic disease in infants up to 3 years of age.

Clinical Outcomes of Differentiated Thyroid Cancer Patients with Local Recurrence or Distant Metastasis Detected in Old Age

BACKGROUND: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. METHODS: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. RESULTS: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. CONCLUSION: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.

Prognosis of Differentiated Thyroid Carcinoma with Initial Distant Metastasis: A Multicenter Study in Korea

BACKGROUND: Most patients with differentiated thyroid cancer (DTC) have a favorable prognosis. However, patients with DTC and initial distant metastasis have not been commonly found, and their clinical characteristics have seldom been reported. In this study, we analyzed the clinical features and prognosis of patients with DTC and initial distant metastasis in Korea. METHODS: We retrospectively reviewed the clinical data of 242 patients with DTC and initial distant metastasis treated from 1994 to 2013, collected from five tertiary hospitals in Korea. RESULTS: The patients' median age was 51 years, and 65% were women. They were followed for a median of 7 years. Lung was the most common site of distant metastasis: only lung 149 patients (62%), only bone 49 (20%), other single site one (pleura), and combined sites 43 (40 were lung and bone, two were bone and other site, and one was lung and other site). At the time of diagnosis, 50 patients (21%) had non-radioactive iodine (RAI) avidity. Five-year disease-specific survival (DSS) was 85% and 10-year DSS was 68%, which were better than those in previous studies. After multivariate analysis, old age, male sex, metastatic site, and histologic type (follicular type) were significant factors for poor prognosis. However, negative RAI avidity status was not a significant prognostic factor after adjusting for other variables. CONCLUSION: The prognosis of Korean patients with DTC and initial distant metastasis was better than in previous studies. Old age, male sex, metastasis site, and histologic type were significant prognostic factors.

Two Treatment Cases of Severe Fever and Thrombocytopenia Syndrome with Oral Ribavirin and Plasma Exchange / 감염과화학요법

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease. The primary symptoms associated with SFTS are fever, thrombocytopenia, leukopenia, nausea, and vomiting. Disease progression shows high mortality rate accompanied with multiple organ failure, bleeding tendency, and altered mentality. However, only supportive care has been the basis for the treatment of SFTS. We are reporting two patients who showed central nervous system manifestation, but cured them with ribavirin together with plasma exchange in an early state. The first case is a 60-year-old male, who was admitted to the hospital with a 7-day history of fever, chills, and thrombocytopenia. He was treated with empirical antibiotics; however, he experienced persistent high fever and an altered mentality has occurred. On hospital day 6, the SFTS virus (SFTSV) result from a real-time reverse transcription-polymerase chain reaction (RT-PCR) was confirmed positive. Therefore, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid for 4 days and then 7.5 mg/kg qid as maintenance dose) was administered orally for 11 days and plasma exchange was performed for 5 days. The clinical outcome has improved. The second case is a 48-year-old male, who was admitted to the hospital with a 10-day history of fever, chills, myalgia, diarrhea, and thrombocytopenia. He was treated with empirical antibiotics. On hospital day 3, ribavirin (30 mg/kg as initial loading dose, 15 mg/kg qid as maintenance dose) was administered orally for 4 days and plasma exchange was performed for 4 days due to his high fever and altered mentality after a positive SFTSV result from a real-time RT-PCR. The patient had a successful recovery.