Predicting the impact of control strategies on the tuberculosis burden in South and North Korea using a mathematical model

Background: Among high-income countries, South Korea has a considerable tuberculosis (TB) burden; North Korea has one of the highest TB burdens in the world. Predicting the impact of control strategies on the TB burden can help to efficiently implement TB control programmes. Methods: We designed a deterministic compartmental model of TB in Korea. After calibration with notification of incidence data from South Korea, the TB burden for 2040 was predicted according to four different intervention strategies: latent TB infection (LTBI) treatment, rapid diagnosis, active case-finding and improvement of the treatment success rate. North Korea's burden in 2040 was similarly estimated by adjusting the model parameters. Results: In South Korea, the number of patients with drug-susceptible TB (DS-TB) and multidrug-resistant TB (MDR-TB) were predicted to be 27 581 and 625, respectively, in 2025. Active case-finding would lower DS-TB by 6.2% and MDR-TB by 26.7%, respectively, in 2040. The improvement in the success rate of DS-TB treatment would reduce the MDR-TB burden by 34.5%. In North Korea, the number of patients with DS-TB and MDR-TB are, respectively, predicted to be 77 629 and 5409 in 2025. Active case-finding would reduce DS-TB by 22.2% and MDR-TB by 69.7%. LTBI treatment would reduce DS-TB by 20.6% and MDR-TB by 38.6%. Conclusion: The impact of control strategies on the TB burden in South and North Korea was investigated using a mathematical model. The combined intervention strategies would reduce the burden and active case-finding is expected to result in considerable reduction in both South and North Korea.ope

읽기 영역 지도 내용의 체계화 방안에 대한 토론문: 읽기 지도 내용의 채계화와 계열화를 위한 몇 가지 제언

국가 수준의 국어과 교육과정을 개발하는 과정에서 가장 복잡하고도 난감한 과제는 아마도 각 학년별로 국어 교과의 하위 영역별 지도 내용을 선정하는 일일 것이다. 제 5차와 제 6차 국어과 교육과정 시안 개발 과정에 직접 참여한 발표자는 자신의 소중한 경험을 바탕으로 하여 읽기 영역 지도 내용의 체계화를 위해 매우 실효성이 높은 방안을 제시하고 있다. 토론자의 기억에 의하면 발표자는 제 6차 국어과 교육과정 시안을 개발하는 과정에서 각 학년별 읽기 영역 지도 내용의 선정을 위해 다양하고도 체계적인 연구를 수행하였다. 발표 원고에 제시된 바와 같이 제 l 차 국어과 교육과정에서부터 제 5차 국어과 교육과정까지 각 시기의 국어과 교육과정에 제시된 지도 내용을 체계적으로 분석하는 연구， 미국 영국 독일 프랑스 일본 등의 자국어 교육과정에 제시된 지도 내용을 비교 분석하는 연구， 면담과 설문지륜 풍한 학교 현장의 의견 수렴을 위한 연구， 읽기 이론과 읽기 지도 이판에 관한 문헌 연구 등윤 통하여 발표자가 획득한 통찰은 이번 발표 내용의 곳곳에 스며 있는 것으로 생각된다

A specific character and structure of human nature in Confucian

2005년 10월 감성과학회논문집 개제예정논문임.With its history of two thousand years of studying the human mind, Confucianism may be applied to contemporary emotional science for its unique perspectives and methodologies in understanding the origin of thehuman mind. By examining the Confucian understanding of human mind according to general Confucian ideas as well as the scholar. LEE Whangs, an idea similar to contemporary emotion in Confucianism was discovered. Importance of the sentiment was not in the resultlng goodness originating from ones fundamental nature, but rather its goodness was only achieved when human nature manifested itself without any distortion. This good emotion, namely sensibility, presents the essential dlfference Confucian understanding bears in comparison to the contemporary concept. And the system for grasping the human mind was considered to be the viewpoint of examining the contents and subject of function than a formal system of functioning human mind. It assumes the stance of looking into thehuman mind from the general and synthetic view of contemporary cognitive, emotional，biological and philosophical perspectives. Overall, the researchconcludes that there existed a long history of high-level research into the human mind in Confucianism that may satisfactorily provide partial reference and understanding as well as consequent perspectives and knowledge for discovering the common denominatorwith the emotional science. 유학은 인간의 심성(心性)에 대한 탐구를 2,000여년에 거쳐 해온 학문분야이다. 따라서 유학에서의 인간의 심성에 대한 관점과 연구방법은 현대의 감성과학에 적용될 가능성이 매우 높다. 유학에서의 인간심성을 유학의 전반적 개념과 퇴계 이황의 개념으로 고찰하여본 결과 현대의 감성과 유사한 정(情)이라는 개념이 있었으며, 본 마음(性)의 발로의 결과인 정의 좋음과 나쁨의 관점은 정이 발현되는 과정에서 좋은 정과 나쁜 정으로 구분되다고하여 정의 형식이 중요한 것이 아니라 인간의 본성이 왜곡됨 없이 발현된 정이 좋은 정, 즉 감성이라하고 있어 현대의 감성의 호악과는 다른 기준을 가지고 있었음을 알 수 있었다. 또한 심성을 파약하는 구조는 심성 작용이 일어나는 형식구조로 파악하고 있는 것이 아니라 심성의 내용과 작용주체를 파악하기 위한 관점으로 파악하고 있음도 알 수 있었다. 또한 현재의 인지, 감성, 생리, 철학 등의 관점이 총체적·종합적인 관점으로 인간의 심성을 바라보고 있음을 알 수 있었다. 연구의 종합 결론으로서는 유학에서도 인간의 심성을 탐구하기 위한 연구가 매우 오랜 기간 수준 높게 진행되었으며. 현재 감성과학에 부분적인 참고와 도움뿐만이 아니라 감성과학의 지향점을 찾는데 중요한 관점과 지식을 충분히 제공할 수 있을 것이라는 알 수 있었다

Impact of Susceptibility to Injectable Antibiotics on the Treatment Outcomes of Mycobacterium abscessus Pulmonary Disease

Background: Current guidelines recommend a susceptibility-based regimen for Mycobacterium abscessus subspecies abscessus pulmonary disease (MAB-PD), but the evidence is weak. We aimed to investigate the association between treatment outcomes and in vitro drug susceptibility to injectable antibiotics in MAB-PD patients. Methods: We enrolled MAB-PD patients treated with intravenous amikacin and beta-lactams for ≥4 weeks at 4 referral hospitals in Seoul, South Korea. Culture conversion and microbiological cure at 1 year were evaluated based on susceptibility to injectable antibiotics among patients treated with those antibiotics for ≥2 weeks. Results: A total of 82 patients were analyzed. The mean age was 58.7 years, and 65.9% were women. Sputum culture conversion and microbiological cure were achieved in 52.4% and 41.5% of patients, respectively. Amikacin was the most common agent to which the M. abscessus subspecies abscessus isolates were susceptible (81.7%); 9.8% and 24.0% of the isolates were resistant to cefoxitin and imipenem, respectively. The clarithromycin-inducible resistance (IR) group (n = 65) had a lower microbiological cure rate than the clarithromycin-susceptible group (35.4% vs 64.7%). The treatment outcomes appeared to be similar regardless of in vitro susceptibility results with regard to intravenous amikacin, cefoxitin, imipenem, and moxifloxacin. In the subgroup analysis of the clarithromycin-IR group, the treatment outcomes did not differ according to antibiotic susceptibility. Conclusions: We did not find evidence supporting the use of susceptibility-based treatment with intravenous amikacin and beta-lactams in patients with MAB-PD. Further research is required.ope

Clinical characteristics and treatment outcomes of patients with macrolide-resistant Mycobacterium avium complex pulmonary disease: a systematic review and meta-analysis

BACKGROUND: Macrolide is a key drug in the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Macrolide-resistant MAC is gaining importance, but there are little data in clinical characteristics and treatment outcomes of macrolide-resistant MAC-PD (MR-MAC-PD). METHODS: We performed a systematic review and meta-analysis of published studies reporting clinical characteristics and treatment outcomes of patients with MR-MAC-PD. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. RESULTS: Nine studies (seven retrospective and two prospective) comprising 319 patients were identified through a database search. Around 73% were women, and 52% had the fibrocavitary form. Pooled sputum culture conversion rate after combined multiple antibiotics or surgical resection was 21% (95% confidence interval [CI], 14-30%), and the one-year all-cause mortality was 10% (95% CI, 5-20%). There was no significant difference in treatment outcomes between nodular bronchiectatic and fibrocavitary types. CONCLUSIONS: Even combination therapy with fluoroquinolone, aminoglycoside, and surgical resection, the treatment outcomes of MR-MAC-PD were poor. The investigation of new treatment modalities is urgent.ope

Treatment shortening of drug-sensitive pulmonary tuberculosis using high-dose rifampicin for 3 months after culture conversion (Hi-DoRi-3): a study protocol for an open-label randomized clinical trial

Background: The standard treatment regimen for drug-sensitive tuberculosis (TB), comprising four companion drugs, requires a minimum duration of 6 months, and this lengthy treatment leads to poor adherence and increased toxicity. To improve rates of adherence, reduce adverse events, and lower costs, a simplified and shortened treatment regimen is warranted. Methods: This study is a multicenter, open-label randomized clinical trial of non-inferiority design that compares a new regimen with the conventional regimen for drug-sensitive pulmonary TB. The investigational group will use a regimen of high-dose rifampicin (30 mg/kg/day) with isoniazid and pyrazinamide, and the treatment will be maintained for 12 weeks after the achievement of negative conversion of sputum culture. The control group will be treated for 6 months with a World Health Organization-endorsed regimen consisting of isoniazid, rifampicin (10 mg/kg/day), ethambutol, and pyrazinamide. The primary endpoint is the proportion of unfavorable outcomes at 18 months after randomization. Secondary outcomes include time to unfavorable treatment outcome, time to culture conversion on liquid medium, treatment success rate at the end of treatment, proportion of recurrence at 18 months after randomization, time to recurrence after treatment completion, and adverse events of grade 3 or higher during the treatment. We predict a 10% unfavorable outcome for the control group, and 0% difference from the investigational group. Based on 80% verification power and a 2.5% one-sided significance level for a non-inferiority margin of 6%, 393 participants per group are required. Considering the 15% dropout rate, a total of 926 participants (463 in each group) will be recruited. Discussion: This study will inform on the feasibility of the treatment regimen using high-dose rifampicin with a shortened and individualized treatment duration for pulmonary TB. Trial registration: ClinicalTrials.gov NCT04485156 . Registered on July 24, 2020.ope

Diagnosis of Cervical OPLL in Lateral Radiograph and MRI: Is it Reliable?

Objective: Cervical OPLL is a relatively common cause of developing cervical myelopathy or radiculopathy in Asians. Cervical OPLL is sometimes missed in lateral radiography or MRI. In the present study, we analyzed the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to CT scan. Methods: This is a retrospective study of forty-six patients who underwent decompressive surgery anteriorly or posteriorly in our institute. All patients were diagnosed with cervical OPLL by CT scan. The patients were grouped into continuous type, segmental type, mixed type, and localized type. We then evaluated lateral radiographs and MRI compared to CT scans. The diagnostic accuracy and false negative rates in lateral radiograph and MRI were evaluate Results: In a total of 46 patients diagnosed with cervical OPLL in CT scans, diagnostic accuracy using lateral radiograph and MRI were 52.2%(24/46) and 58.7%(27/46), respectively. In the continuous type group, diagnostic accuracy using lateral radiograph and MRI were 85.7%(6/7) and 100.0%(7/7). In the segmental type group, diagnostic accuracy using lateral radiograph and MRI were 27.3%(6/22) and 31.8%(7/22). In the mixed type group, diagnostic accuracy was 91.7%(11/12) in lateral radiograph and 83.3%(10/12) in MRI. In the localized group, diagnostic accuracy was 20.0% (1/5) in lateral radiograph and 60.0%(3/5) in MRI. Conclusion: The diagnostic accuracy of cervical OPLL using lateral radiograph and MRI was less than using CT scan. For the best treatment plan, preoperative CT scan should be performed to detect conditions of ossifications such as cervical OPLL.ope

Prediction of 1-year treatment outcome using early sputum culture conversion status in Mycobacterium abscessus pulmonary disease

ope

Cost-Effectiveness of Age-Expanding Strategy of Latent Tuberculosis Infection Treatment in Household Contacts in South Korea

Purpose: The strategy of latent tuberculosis infection (LTBI) treatment in household tuberculosis (TB) contacts has been expanding in South Korea. However, there is little evidence of the cost-effectiveness of LTBI treatment in patients over 35 years of age. This study aimed to evaluate the cost-effectiveness of LTBI treatment among household TB contacts in different age groups in South Korea. Materials and methods: An age-structured model of TB was developed based on the reports from the Korea Disease Control and Prevention Agency and the National Health Insurance Service. Quality-adjusted life-years (QALY) and the averted number of TB-related deaths were estimated along with discounted costs for a measure of incremental cost-effectiveness ratios. Results: The number of cumulative active TB cases would decrease by 1564 and 7450 under the scenario of LTBI treatment for those aged <35 years and <70 years, respectively, relative to the no-treatment scenario. The treatment strategies for patients aged 0 to <35 years, <55 years, <65 years, and <70 years would add 397, 1482, 3782, and 8491 QALYs at a cost of $660,$5930, $4560, and$2530, respectively, per QALY. For the averted TB-related deaths, LTBI treatment targeting those aged 0 to <35 years, <55 years, <65 years, and <70 years would avert 7, 89, 155, and 186 deaths at a cost of $35900,$99200, $111100, and$115700 per deaths, respectively, in 20 years. Conclusion: The age-specific expansion policy of LTBI treatment not only for those under 35 years of age but also for those under 65 years of age among household contacts was cost-effective in terms of QALYs and averted TB deaths.ope

Idiopathic hypertrophic spinal pachymeningitis : report of two cases and review of the literature

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.ope