• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.11
• /
• pp.4759-4768
• /
• 2015

Background: Several studies have investigated predictive and prognostic biomarkers for patients treated with anti-epidermal growth factor receptor (EGFR) agents in lung cancer. However, the conclusion is controversial. Materials and Methods: A meta-analysis was conducted to evaluate the associations of mutant K-ras, PIK3CA and PTEN deficiency with the efficacy of anti-EGFR agents in lung cancer. The primary endpoint was objective response rate (ORR). The secondary endpoints were overall survival (OS) and progression-free survival (PFS). Results: A total of 61 studies were included in the final meta-analysis. The result showed that K-ras mutation was a good predictor for ORR (RR=0.42, 95%CI, 0.33-0.55, p=0.000) and an effective prognostic marker for OS (HR=1.37, 95%CI, 1.15-1.65, p=0.001) and PFS (HR=1.33, 95%CI, 1.05-1.69, p=0.019). However, PTEN deficiency or PIK3CA mutation did not show any significance predictive value for ORR (PTEN, RR=0.82, 95%CI, 0.56-1.19, p=0.286; PIK3CA, RR=1.08, 95%CI, 0.17-6.66, P=0.938). And PTEN deficiency or expression of PIK3CA did not show significance prognostic value for OS (PTEN, HR=0.88, 95%CI, 0.31-2.46,P=0.805; PIK3CA, HR=0.79, 95%CI: 0.23-2.68, P=0.706). Conclusions: Our meta-analysis showed that K-ras mutation may be an effective predictor in lung cancer patients treated with anti-EGFR agents. Whereas, the predictive and prognostic value of PTEN deficiency and PIK3CA mutation need to be further investigated.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.11
• /
• pp.6727-6731
• /
• 2013

Homologous recombination (HR) repair has a crucial role to play in the prevention of chromosomal instability, and it is clear that defects in some HR repair genes are associated with many cancers. To evaluate the potential effect of some HR repair gene polymorphisms with differentiated thyroid carcinoma (DTC), we assessed Rad51 (135G>C), Rad52 (2259C>T), XRCC2 (R188H) and XRCC3 (T241M) polymorphisms in Iranian DTC patients and cancer-free controls. In addition, haplotype analysis and gene combination assessment were carried out. Genotyping of Rad51 (135G>C), Rad52 (2259C>T) and XRCC3 (T241M) polymorphisms was determined by PCR-RFLP and PCR-HRM analysis was carried out to evaluate XRCC2 (R188H). Separately, Rad51, Rad52 and XRCC2 polymorphisms were not shown to be more significant in patients when compared to controls in crude, sex-adjusted and age-adjusted form. However, results indicated a significant difference in XRCC3 genotypes for patients when compared to controls (p value: 0.035). The GCTG haplotype demonstrated a significant difference (p value: 0.047). When compared to the wild type, the combined variant form of Rad52/XRCC2/XRCC3 revealed an elevated risk of DTC (p value: 0.007). It is recommended that Rad52 2259C>T, XRCC2 R188H and XRCC3 T241M polymorphisms should be simultaneously considered as contributing to a polygenic risk of differentiated thyroid carcinoma.

• Korean Journal of Adult Nursing
• /
• v.14 no.2
• /
• pp.174-183
• /
• 2002

Purpose: The purpose of this study was to determine the effect of nurses' pain experience on the inference of their patients' suffering. Method: Study subjects were sampled from 184 nurses who worked in general wards in one S university hospital located at Seoul. Nurses' pain experience consists of personal pain experience and professional pain experience. The Standard Measure of Inference of Suffering (Davitz & Davitz, 1981) was used for suffering inference measure, and patients' suffering which consists of physical pain and psychological distress. Result: Suffering inference scores of nurses without personal pain experience revealed a higher value than that of nurses with personal pain experience. But these differences were not statistically significant. The higher intense pain was experienced, the higher were suffering inference scores. This physical pain inference score was statistically significant(p=.044). Of the nurses who had personal pain experience, suffering inference scores of nurses with unrelieved pain experience revealed a higher value than that of nurses with relieved pain experience. Physical pain and psychological distress inference scores were statistically significant(p=.010, p=.006). Suffering inference scores of nurses without professional pain experience(internal medicine, general surgery, orthopedic surgery) revealed a higher value than that of nurses with professional pain experience. Professional pain experience of internal medical illness was statistically significant in psychological distress of internal medical illness(p=.044), and professional pain experience of orthopedic surgical illness was statistically significant in physical pain of orthopedic surgical illness(p=.027). Conclusion: Nurses who have experienced low pain intensity or good pain relief are inclined n to underestimate patient' pain. Although nurses who care for the same patient over a long time deal skillfully with that patient, nurses are inclined to underestimate that patients' pain. Nurses need to be aware of possible biases related to pain assessment as a result of pain experience.

• Archives of Plastic Surgery
• /
• v.41 no.4
• /
• pp.330-336
• /
• 2014

Background For patients with full thickness skin defects, autologous Split-thickness skin grafts (STSG) are generally regarded as the mainstay of treatment. However, skin grafts have some limitations, including undesirable outcomes resulting from scars, poor elasticity, and limitations in joint movement due to contractures. In this study, we present outcomes of Matriderm grafts used for various skin tissue defects whether it improves on these drawbacks. Methods From January 2010 to March 2012, a retrospective review of patients who had undergone autologous STSG with Matriderm was performed. We assessed graft survival to evaluate the effectiveness of Matriderm. We also evaluated skin quality using a Cutometer, Corneometer, Tewameter, or Mexameter, approximately 12 months after surgery. Results A total of 31 patients underwent STSG with Matriderm during the study period. The success rate of skin grafting was 96.7%. The elasticity value of the portion on which Matriderm was applied was 0.765 (range, 0.635-0.800), the value of the trans-epidermal water loss (TEWL) was 10.0 (range, 8.15-11.00)$g/hr/m^2$, and the humidification value was 24.0 (range, 15.5-30.0). The levels of erythema and melanin were 352.0 arbitrary unit (AU) (range, 299.25-402.75 AU) and 211.0 AU (range, 158.25-297.00 AU), respectively. When comparing the values of elasticity and TEWL of the skin treated with Matriderm to the values of the surrounding skin, there was no statistically significant difference between the groups. Conclusions The results of this study demonstrate that a dermal substitute (Matriderm) with STSG was adopted stably and with minimal complications. Furthermore, comparing Matriderm grafted skin to normal skin using Cutometer, Matriderm proved valuable in restoring skin elasticity and the skin barrier.

• Health Policy and Management
• /
• v.29 no.4
• /
• pp.445-453
• /
• 2019

Background: This study is to investigate the association between the distribution of multimorbidity and length of stay and medical expenses among inpatients in a municipal hospital to achieve an integrated care setting. Methods: We used the exploratory factor analysis and the generalized estimating equation model to analyze the data from patients living in the northeast region of Seoul, who were hospitalized from January 2017 to December 2017 in a municipal hospital. Results: As a result of the factor analysis, seven types of multiple chronic diseases were classified. Among the elderly patients admitted to municipal hospitals, the burden of medical expenses was mainly influenced by the length of stay (B=310,719, p-value <0.0001), not the type of disease (all not significant). Length of stay were mainly due to psychiatric illness (factor 1: B=4.323, p-value <0.0001) related to the brain and metabolic diseases (factor 2: B=2.364, p-value=0.003). Conclusion: This study showed that the medical expenses of the elderly patients were largely due to prolonged hospitalization, not multimorbidity. Therefore, it is necessary to develop an integrated care paradigm strategy cope with the multimorbidity of the elderly in the community and to alleviate the socio-economic burden.

• Archives of Plastic Surgery
• /
• v.38 no.5
• /
• pp.585-589
• /
• 2011

Purpose: Microcirculation of diabetic patients is commonly comporomised, regardless of the condition of the macrocirculation. Therefore, direct tissue oxygenation measurement is recommended in determining tissue viability and predicting wound healing potential. This study was designed to determine cut-off value of the tissue oxygenation in predicting wound healing in diabetic foot patients. Methods: This study included 41 feet of 41 diabetic foot patients who were treated in the Diabetic Wound Center of author's institution between January and June, 2009. Main inclusion criteria were type 1 or 2 diabetes and a foot ulcer (duration > 3 weeks) and ulcer area (from 1 $cm^2$ to 4 $cm^2$). Measurements of the area of diabetic foot ulcer were carried out before treatment. Transcutaneous oxygen pressure ($TcpO_2$) was measured at adjacent site of ulcer. The healing wound was defined as complete wound closure within 12 weeks. Results: Average diabetic foot ulcer areas with healing and nonhealing wounds were $2.67{\pm}0.76$ and $2.59{\pm}0.75\;cm^2$, respectively. There was no significant difference in the wound area between the groups. Average foot $TcpO_2$ in healing and nonhealing wounds were $68.56{\pm}23.07$ and $30.98{\pm}16.66$ mmHg, respectively ($p$ <0.01). The rate of healing wound increased as $TcpO_2$ increased. In particular, $TcpO_2$ lower than 40 mmHg and higher than 40 mmHg showed the most significant difference (wound healing rates of 25% and 71%, respectively). Conclusion: Based on the results of the study, the minimal $TcpO_2$ value thought to be required for adequate wound healing in diabetic wounds (cut-off value) is 40 mmHg.

• Investigative Magnetic Resonance Imaging
• /
• v.23 no.3
• /
• pp.228-240
• /
• 2019

Purpose: The aim of this study is to evaluate the T2 value of the articular cartilage of the glenohumeral joint in rotator cuff disease displayed on 3.0T MRI and to apply it in clinical practice. Materials and Methods: This study involved sixty-two patients who underwent shoulder MRI containing T2 mapping. The mean T2 value was measured by placing a free hand ROI over the glenoid or humeral cartilage from the bone-cartilage interface to the articular surface on three consecutive, oblique coronal images. The drawn ROI was subsequently divided into superior and inferior segments. The assessed mean T2 values of the articular cartilage of the glenohumeral joint were compared and evaluated based on the degree of rotator cuff tear, the degree of fatty atrophy of the rotator cuff, and the acromiohumeral distance. Results: ICC values between two readers indicated moderate or good reproducibility. The mean T2 value for the articular cartilage of the glenoid and humeral head cartilage failed to show any significant difference based on the degree of rotator cuff tear. However, the mean T2 values of articular cartilage, based on fatty atrophy, tended to be higher in fatty atrophy 3 or fatty atrophy 4 groups while some subregions displayed significantly higher mean T2 values. There was no correlation between the acromiohumeral distance and the mean T2 values of the articular cartilage of the glenoid and humeral head. Conclusion: T2 mapping of the glenohumeral joint failed to show any significant difference in quantitative analysis of the degenerative change of the articular cartilage based on the degree of rotator cuff tear. However, it also offers quantitative information on the degenerative change of cartilage of the glenohumeral joint in patients with rotator cuff tear and severe fatty atrophy of the rotator cuff.

• Journal of Korean society of Dental Hygiene
• /
• v.21 no.4
• /
• pp.427-440
• /
• 2021

Objectives: We classified items required for dental hygienists' ethics training by domains. We administered a survey on experts using the Delphi method to collect opinions for guiding future trainings. Methods: 33 participants were selected and analyzed using the Delphi method thrice. Results: For relationships with patients, the item "1.3.1.1 I can keep the confidentiality of the information obtained from patients, including mature minors, related to their specific disease and treatment during medical care as well as other personal information of the patients." had the highest mean value (mean=4.88). For medical and social relations, "2.3.2.2 I can understand how staff provide dental services as a team and explain a dental hygienist's roles and responsibilities that enable a team to function effectively." had the highest mean value (mean=4.85). For individual specialized fields, "3.1.1.1 I can explain the roles and responsibilities in public health of individuals, the public, the state and professional dental hygienist." showed the highest mean value (mean=4.82). Conclusions: We identified 3 categories, 14 sub-categories, and 53 items on the scope of training and standards for ethical competencies for practical applications in professional ethics training of dental hygienists.

• Health Policy and Management
• /
• v.16 no.2
• /
• pp.96-116
• /
• 2006

To assess the economic value of pharmaceutical therapy with Kremezin, we investigated the maximum amount of willingness-to-pay (WTP) of patients with chronic renal failure (CRF) for a hypothetical effect of Kremezin in delaying the initiation of dialysis treatments. A face-to-face survey was carried out in a sample of 141 CRF patients from 2 dialysis centers, composed of 82 hemodialysis patients, 38 peritoneal dialysis patients, and 21 non-dialysis CRF patients. Using a bidding game method with a starting point of 320,000 Won, which is the average monthly out-of-pocket payment for dialysis treatment, we asked the study subjects how much they would pay per month to receive Kremezin therapy. The mean out-of-pocket monthly WTP for Kremezin was 310,000, 430,000, and 520,000 Won (p<0.05, repeated one-way ANOVA)) when Kremezin delays the initiation of dialysis treatments by 1, 2, and 4 years. Significant correlation between the respondent's WTP and income $(r=0.266{\sim}0.368,\;p<0.05)$ confirmed the construct validity of the WTP instrument. Regression results showed that patients with a higher education, with diabetes as a major causes of CRF, and undergoing hemodialysis treatments tended to express higher WTP for Kremezin. The economic value of WTP from the perspective of patients varied from 310,000 to 520,000 Won depending on the effect size of Kremezin. The mean WTP was higher than 32,000 Won, only when the hypothetical effect of Kremezin in delaying the initiation of dialysis is for 2 years. This implies that Kremezin might be the preferred choice of therapy by CRF patients if it delays the initiation of dialysis treatment for at least 2 years.

• Investigative Magnetic Resonance Imaging
• /
• v.23 no.3
• /
• pp.251-258
• /
• 2019

Purpose: To assess the feasibility of the use of spin-echo echo-planar imaging (SE-EPI) magnetic resonance elastography (MRE) in livers of children and young adults. Materials and Methods: Patients (${\leq}20$ years old) who underwent 3T SE-EPI MRE were included retrospectively. Subjects were divided into three groups according to the purpose of the liver MRI: suspicion of fatty liver or focal fat deposition in the liver (FAT group), liver fibrosis after receiving a Kasai operation from biliary atresia (BA group), and hepatic iron deposition after receiving chemotherapy or transfusions (IRON group). Technical failure of MRE was defined when a stiffness map showed no pixel value with a confidence index higher than 95%, and the patients were divided as success and failure groups accordingly. Clinical findings including age, gender, weight, height, and body mass index and magnetic resonance imaging results including proton density fat fraction (PDFF), $T2^*$, and MRE values were assessed. Factors affecting failure of MRE were evaluated and the image quality in wave propagation image and stiffness map was evaluated using the appropriate scores. Results: Among total 240 patients (median 15 years, 211 patients in the FAT, 21 patients in the BA, and 8 patients in the IRON groups), technical failure was noted in six patients in the IRON group (6/8 patients, 75%), while there were no failures noted in the FAT and BA groups. These six patients had $T2^*$ values ranging from 0.9 to 3.8 ms. The image quality scores were not significantly different between the FAT and BA groups (P > 0.999), while the scores were significantly lower in the IRON group (P < 0.001). Conclusion: The 3T SE-EPI MRE in children and young adults had a high technical success rate. The technical failure was occurred in children with decreased $T2^*$ value (${\leq}3.8ms$) from iron deposition.