• 제목/요약/키워드: Classification of Disease

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선택의료급여기관 제도가 만성질환을 가진 의료급여수급권자의 의료이용에 미치는 영향 (The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases)

  • 김민정;조영하;박남희
    • 지역사회간호학회지
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    • 제26권3호
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    • pp.278-291
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    • 2015
  • Purpose: This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences. Methods: Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program. Results: There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution. Conclusion: These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

Treatment Efficacy and Prognostic Factors for Huge HCC Based on Barcelona Clinic Liver Cancer Staging

  • Zhang, Zhi-Ming;Zhang, Yu-Mei;Gao, Sheng;Yuan, Wei-Ping;Zhao, Yin-Nong;Xiang, Bang-De;Wu, Fei-Xiang;Wu, Guo-Bin;Liu, Jian-Yong
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권20호
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    • pp.8823-8828
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    • 2014
  • Objective: To explore the most appropriate treatment for patients with hepatocellular cancer (HCC) >10 cm by using the Barcelona Clinic Liver Cancer (BCLC) classification. Materials and Methods: A total of 124 HCC patients undergoing surgery were selected. Disease-free survival (DFS), overall survival (OS) and prognostic factors were respectively assessed. Results: This study showed that the cumulative 1-, 3-, 5-year survival rates were 79.7%, 59.8% and 41.6% in BCLC-A patients, 76.2%, 9.5% and 0% in BCLC-B patients and 44.9%, 0% and 0% in BCLC-C patients, respectively. The 1-, 3-, 5-year DFS rates were 49%, 24.5% and 9.1% in BCLC-A patients, 7.5%, 0% and 0% in BCLC-B patients, respectively. No BCLC-C patients survived 1 year after surgery. Multivariate analysis indicated that hepatitis B surface antigen (HBsAg), vascular invasion, intra-hepatic metastasis, curative resection, tumor rupture and pathologic differentiation were independent prognostic factors. Conclusions: Surgery is effective and safe for patients with HCC >10 cm with sufficient hepatic reserve.

Impact of Preoperative Serum Levels of CA 125 on Epithelial Ovarian Cancer Survival

  • Pradjatmo, Heru
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권4호
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    • pp.1881-1886
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    • 2016
  • Background: CA125 is very helpful in treatment monitoring and detection of epithelial ovarian cancer (EOC) recurrence. However there is controversy as to its accuracy and optimal usage. What is the impact of the CA125 levels before primary surgery treatment to the survival of patients? This study aimed to detect any association of preoperative serum levels with prognosis and survival in EOC patients. Materials and Methods: Our cohort comprised EOC patients in Dr. Sardjito Hospital, Yogyakarta, Indonesia, who complied with follow up. To explore the effect of preoperative CA125 levels and other variables on survival Cox's regression models were applied. Results: A total of 90 cases of EOC who had surgery were available for follow up. The level of CA125 proved to be a prognostic factor for overall survival of EOC patients, with an adjusted HR of 4.10 (p = 0.03). Adjuvant chemotherapy was another prognostic factor, 1 - 2 cycles having an adjusted HR of 0.17 (p = 0.04) and 3 - 8 cycles HR 0.39 (p = 0.06). Other factors such as age of patients adjusted HR 1.54 (p = 0.32), moderate differentiation (adjusted HR 1.61, p = 0.51) poor differentiation (adjusted HR 3.41, p = 0.15), and stage of disease (adjusted HR 1.98,p=0.27) were statistically not significant. However, this might have been because the power of the study was low. Conclusions: Preoperative level of CA125 is a prognostic factor for overall survival in EOC patients. The best cut-off for prognostic classification of CA125 serum level is 70 U/ml.

The Role of MicroRNAs in Regulatory T Cells and in the Immune Response

  • Ha, Tai-You
    • IMMUNE NETWORK
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    • 제11권1호
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    • pp.11-41
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    • 2011
  • The discovery of microRNA (miRNA) is one of the major scientific breakthroughs in recent years and has revolutionized current cell biology and medical science. miRNAs are small (19~25nt) noncoding RNA molecules that post-transcriptionally regulate gene expression by targeting the 3' untranslated region (3'UTR) of specific messenger RNAs (mRNAs) for degradation of translation repression. Genetic ablation of the miRNA machinery, as well as loss or degradation of certain individual miRNAs, severely compromises immune development and response, and can lead to immune disorders. Several sophisticated regulatory mechanisms are used to maintain immune homeostasis. Regulatory T (Treg) cells are essential for maintaining peripheral tolerance, preventing autoimmune diseases and limiting chronic inflammatory diseases. Recent publications have provided compelling evidence that miRNAs are highly expressed in Treg cells, that the expression of Foxp3 is controlled by miRNAs and that a range of miRNAs are involved in the regulation of immunity. A large number of studies have reported links between alterations of miRNA homeostasis and pathological conditions such as cancer, cardiovascular disease and diabetes, as well as psychiatric and neurological diseases. Although it is still unclear how miRNA controls Treg cell development and function, recent studies certainly indicate that this topic will be the subject of further research. The specific circulating miRNA species may also be useful for the diagnosis, classification, prognosis of diseases and prediction of the therapeutic response. An explosive literature has focussed on the role of miRNA. In this review, I briefly summarize the current studies about the role of miRNAs in Treg cells and in the regulation of the innate and adaptive immune response. I also review the explosive current studies about clinical application of miRNA.

PCR-Restriction Fragment Length Polymorphism 방법에 의한 Borrelia burgdorferi Sensu Lato의 분류 (Molecular Typing of Borrelia burgdorferi Sensu Lato by PCR Restriction Fragment Length Polymorphism Analysis)

  • 송혜원;박성언;박상욱;김근희;김홍;엄용빈;김종배
    • 대한의생명과학회지
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    • 제5권2호
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    • pp.209-212
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    • 1999
  • 라임병의 원인균인 Borrelia burgdorferi에 대하여 각 균종의 표준균주와 진드기에서 추출한 DNA를 template로 PCR을 실시한 후 그 증폭산물을 Alu I으로 처리한 restriction fragment length polymorphism (RFLP) 방법으로 각 균종의 연관성을 조사하고자 하였다. 표준균주로 RFLP를 실시한 결과 B. burgdorferi sensu stricto와 B. garinii의 RFLP 형태 (50 bp, 70 bp, 150 bp)가 유사하였으며 B. afzelii에서는 다른 RFLP 형태 (50 bp,110 bp,150 bp)를 관찰하였다. 그 중 B. afzelii KK-1과 B. garinii HPI은 새로운 RFLP형태를 보여 B. afzelii자 B. garinii는 각각 2 type의 subgroup으로 분류할 수 있었다. 진드기 DNA에서는B. afzelii를 포함한 각 균종에 대하여 모두 유사한 RFLP형태를 보였는데, 진드기 DNA에서 확인된 B. afzelii는 KK-1과 같은 군에 속하는 것으로 사료되었다.

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구강 내에 발생한 원발성 점막관련 림프양 림프종의 치험례 (PRIMARY EXTRANODAL MARGINAL ZONE B-CELL LYMPHOMA OF MUCOSA-ASSOCIATED LYMPHOID TISSUE IN THE ORAL CAVITY : A CASE REPORT)

  • 손장호;박수원;최병환;조영철;성일용;변기정
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제31권1호
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    • pp.77-80
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    • 2009
  • Mucosa-associated lymphoid tissue(MALT) lymphoma is thought to originate from marginal zone B-cells. In the WHO classification, Extranodal marginal zone lymphoma of MALT is classified B-cell Non-Hodgkin lymphoma. Common sites of MALT lymphoma include stomach, lung and the ocular-adnexa. Although less common in other sites, it is the most common low-grade lymphoma of the breast, thyroid, bowel skin and soft tissue. No strong age or gender predominance exists in MALT lymphoma. Dissemination to other sites can occur. In the oral cavity, MALT lymphoma is rare. Herein, we present a case of intra-oral MALT lymphoma. 66 year-old woman without any background of immunodeficiency or autoimmune disease admitted department of oral & maxillofacial surgery in Ulsan university hospital for evaluation of long-standing mild upper lip swelling. The lesion was completely resected and biopsied. Histological and immunohistochemical stains(CD3, CD5, CD20, CD21, CK) findings were used to confirm the lesion. Bone marrow biopsy was done and no bone marrow involvement was found. She did not receive chemotherapy and radiotherapy after surgery. No recurrence has been noted in the 22 months to date.

자궁 체부에 발생한 중신 유사 선종의 영상 소견: 증례 보고 (Radiologic Findings of Mesonephric-Like Adenocarcinoma of the Uterine Corpus: A Case Report)

  • 김하정;김경아;전이경;김정우;이종미;이창희
    • 대한영상의학회지
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    • 제84권3호
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    • pp.698-704
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    • 2023
  • 중신 유사 선종은 2020년 World Health Organization 분류체계에서 자궁내막암의 한 아형으로 새롭게 분류되었고, 드물기 때문에 잘 알려지지 않은 질환이다. 저자들이 아는 한, 영어 문헌에서 영상의학적 소견은 아직 보고된 바 없다. 자궁의 중신 유사 선종은 일반적인 자궁내막암에 비해 예후가 좋지 않고 더 공격적인 생물학적 양상을 보인다. 저자들은 65세 여성의 자궁 체부에 생긴 중신 유사 선종의 영상의학적 소견에 대하여 보고하고자 한다. 자궁내막 고형 종괴가 심부 자궁근 침범을 보였고, 조영 증강은 잘되지 않았고 중등도의 확산제한을 보였다.

Clinical Factors Associated with the Non-Operative Airway Management of Patients with Robin Sequence

  • Albino, Frank P.;Wood, Benjamin C.;Han, Kevin D.;Yi, Sojung;Seruya, Mitchel;Rogers, Gary F.;Oh, Albert K.
    • Archives of Plastic Surgery
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    • 제43권6호
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    • pp.506-511
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    • 2016
  • Background The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention. Methods The authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) findings were recorded. Results Thirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5-70 days). Oxygen desaturation (<70% by pulse oximetry) occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59%) or endotracheal intubation (31%). Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26) demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI) of $19.2{\pm}5.3events/hour$, and an oxygen saturation level <90% during only 4% of the total sleep time. Conclusions Nonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour.

국내 만성 B형 간염 환자의 경구용 항바이러스제 사용 현황 분석 (Analysis of Drug Utilization in Patients with Chronic Hepatitis B)

  • 이유정;배성진;제남경
    • 한국임상약학회지
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    • 제26권3호
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    • pp.220-229
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    • 2016
  • Background: The treatment goal for patients with chronic hepatitis B infection is to prevent progression of the disease to cirrhosis and hepatocellular carcinoma. Current therapies include standard and pegylated interferon-alfa and nucleoside/nucleotide analogues: lamivudine, adefovir, entecavir, telbivudine, clevudine, and tenofovir. This study aims to analyze changes in the prescribing patterns of chronic hepatitis B (CHB) medications in South Korea between 2013 and 2014. Methods: A cross-sectional study was conducted using National Patients Sample data compiled by the Health Insurance Review and Assessment Service from 2013 and 2014. Patients with CHB were identified with Korean Standard Classification of Diseases code-6 (B18.0 and B18.1) and those who were maintaining active prescriptions with CHB medications covering the index date (December $1^{st}$, each year) were included. The utilization of antiviral therapy was investigated during 2013 and 2014. Results: A total of 4,204 and 4,552 patients in 2013 and 2014 respectively, were included in the analysis. The proportion of male patients was two of third and the patients 41-60 years old accounted for 60% of all analyzed patients. The most utilized drug was entecavir (55.1% in 2013 and 44.8% in 2014) and the second most utilized drug was tenofovir in both years (18.8% in 2013 and 29.0% in 2014). The percentage of combination therapy was 13.6% and 13.1% in 2013 and 2014, respectively. The proportion of tenofovir prescriptions was increased in 2014 compared with 2013. Conclusion: With the development of new drugs and the changes in clinical practice guidelines, the prescription pattern of the antiviral agents for patients with CHB has changed. The rate of utilization of tenofovir has increased.

Serum Pleiotrophin Could Be an Early Indicator for Diagnosis and Prognosis of Non-Small Cell Lung Cancer

  • Du, Zi-Yan;Shi, Min-Hua;Ji, Cheng-Hong;Yu, Yong
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권4호
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    • pp.1421-1425
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    • 2015
  • Aims: Pleiotrophin (PTN), an angiogenic factor, is associated with various types of cancer, including lung cancer. Our aim was to investigate the possibility of using serum PTN as an early indicator regarding disease diagnosis, classification and prognosis, for patients with non-small cell lung cancer (NSCLC). Methods: Significant differences among PTN levels in patients with small cell lung cancer (SCLC, n=40), NSCLC (n=136), and control subjects with benign pulmonary lesions (n=21), as well as patients with different pathological subtypes of NSCLC were observed. Results: A serum level of PTN of 300.1 ng/ml, was determined as the cutoff value differentiating lung cancer patients and controls, with a sensitivity and specificity of 78.4% and 66.7%, respectively. Negative correlations between serum PTN level and pathological differentiation level, stage, and survival time were observed in our cohort of patients with NSCLC. In addition, specific elevation of PTN levels in pulmonary tissue in and around NSCLC lesions in comparison to normal pulmonary tissue obtained from the same subjects was also observed (n=2). Conclusion: This study suggests that the serum PTN level of patients with NSCLC could be an early indicator for diagnosis and prognosis. This conclusion should be further assessed in randomized clinical trials.