• Neonatal Medicine
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• v.28 no.3
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• pp.124-132
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• 2021

Purpose: Neonatal near miss (NNM) allows for the detection of risk factors associated with serious newborn complications and death, the prevention of which could reduce neonatal mortality. This study was conducted with the objective of identifying predictors for NNM in a tertiary hospital in Bangalore city. Methods: This was an unmatched case-control study involving 120 NNM cases and 120 controls. NNM was determined using Pileggi-Castro's pragmatic and management criteria. Data was collected from in-patient hospital records and interviews of postpartum mothers. Multiple logistic regression of exposure variables was performed to calculate adjusted odds ratio (AOR) with 95% confidence interval (CI). Results: Significant predictors were maternal age ≥30 years (AOR, 5.32; 95% CI, 1.12 to 9.29; P=0.041), inadequate antenatal care (ANC) (AOR, 8.35; 95% CI, 1.98 to 51.12; P=0.032), <3 ultrasound scans during pregnancy (AOR, 12.5; 95% CI, 1.60 to 97.27; P=0.016), maternal anaemia (AOR, 18.96; 95% CI, 3.10 to 116.02; P=0.001), and any one obstetric complication (hypertensive disorder in pregnancy, diabetes in pregnancy, preterm premature rupture of membranes, prolonged labour, obstructed labour, malpresentation) (AOR, 4.34; 95% CI, 1.26 to 14.95; P=0.02). Conclusion: The predictors of NNM identified has important implications for public health policy and practice whose modifications can improve NNM. These include expanding essential ANC package to include ultrasound scans, ensuring World Health Organization recommendations of eight ANC visits, capacity building at all levels of health care to strengthen routine ANC and obstetric care for effective screening, referral and management of obstetric complications.

• Genomics & Informatics
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• v.19 no.4
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• pp.38.1-38.7
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• 2021

Kawasaki disease (KD) is an acute pediatric vasculitis that affects genetically susceptible infants and children. To identify coding variants that influence susceptibility to KD, we conducted whole exome sequencing of 159 patients with KD and 902 controls, and performed a replication study in an independent 586 cases and 732 controls. We identified five rare coding variants in five genes (FCRLA, PTGER4, IL17F, CARD11, and SIGLEC10) associated with KD (odds ratio [OR], 1.18 to 4.41; p = 0.0027-0.031). We also performed association analysis in 26 KD patients with coronary artery aneurysms (CAAs; diameter > 5 mm) and 124 patients without CAAs (diameter < 3 mm), and identified another five rare coding variants in five genes (FGFR4, IL31RA, FNDC1, MMP8, and FOXN1), which may be associated with CAA (OR, 3.89 to 37.3; p = 0.0058- 0.0261). These results provide insights into new candidate genes and genetic variants potentially involved in the development of KD and CAA.

• Genomics & Informatics
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• v.21 no.1
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• pp.9.1-9.13
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• 2023

Matrix metalloproteinase-9 (MMP-9) is a zinc and calcium-dependent proteolytic enzyme involved in extracellular matrix degradation. Overexpression of MMP-9 has been confirmed in several disorders, including cancers, Alzheimer's disease, autoimmune diseases, cardiovascular diseases, and dental caries. Therefore, MMP-9 inhibition is recommended as a therapeutic strategy for combating various diseases. Cinnamic acid derivatives have shown therapeutic effects in different cancers, Alzheimer's disease, cardiovascular diseases, and dental caries. A computational drug discovery approach was performed to evaluate the binding affinity of selected cinnamic acid derivatives to the MMP-9 active site. The stability of docked poses for top-ranked compounds was also examined. Twelve herbal cinnamic acid derivatives were tested for possible MMP-9 inhibition using the AutoDock 4.0 tool. The stability of the docked poses for the most potent MMP-9 inhibitors was assessed by molecular dynamics (MD) in 10 nanosecond simulations. Interactions between the best MMP-9 inhibitors in this study and residues incorporated in the MMP-9 active site were studied before and after MD simulations. Cynarin, chlorogenic acid, and rosmarinic acid revealed a considerable binding affinity to the MMP-9 catalytic domain (ΔG_binding < -10 kcal/ mol). The inhibition constant value for cynarin and chlorogenic acid were calculated at the picomolar scale and assigned as the most potent MMP-9 inhibitor from the cinnamic acid derivatives. The root-mean-square deviations for cynarin and chlorogenic acid were below 2 Å in the 10 ns simulation. Cynarin, chlorogenic acid, and rosmarinic acid might be considered drug candidates for MMP-9 inhibition.

• Clinical Endoscopy
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• v.56 no.6
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• pp.802-811
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• 2023

Background/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. Methods: Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated. Results: PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). Conclusions: cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.2
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• pp.172-179
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• 2023

Backgrounds/Aims: Cancer stigma (CS), a self-inflicted sense of hopelessness, has been identified as a major factor affecting cancer patients' outcomes. However, few studies have investigated the CS-related outcomes in hepatobiliary and pancreatic (HBP) cancer. Thus, the aim of this study was to investigate effects of CS on quality of life (QoL) of HBP cancer. Methods: From 2017 to 2018, 73 patients who underwent curative surgery for HBP tumor at a single intuitive were enrolled prospectively. The QoL was measured using the European Organization for Research and Treatment of Cancer QoL score, and CS was evaluated in three categories, "impossibility of recovery," "cancer stereotypes," and "social discrimination." the stigma was defined by higher scores of attitudes compared with the median value. Results: The stigma group showed a lower QoL (-17.67, 95% confidence interval [CI]: -26.75 to 8.60, p < 0.001) than the no stigma group. Similarly, most function and symptoms of the stigma group showed worse results than the no stigma group. The difference in function scores between the two groups according to CS was highest in cognitive function (-21.20, 95% CI: -30.36 to 12.04, p < 0.001). Fatigue showed the largest difference between the two groups at 22.84 (95% CI: 12.88-32.07, p < 0.001) and was the most severe symptom in stigma group. Conclusions: CS was an important negative factor affecting the QoL, function, and symptoms of HBP cancer patients. Therefore, appropriate management of CS is crucial for improved postoperative QoL.

• Journal of Preventive Medicine and Public Health
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• v.31 no.3 s.62
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• pp.471-480
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• 1998

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows : 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I. : 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (41.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and fortieg age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

• Radiation Oncology Journal
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• v.34 no.1
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• pp.34-44
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• 2016

Purpose: A prospective phase II trial was conducted to evaluate the effectiveness and toxicity of regional hyperthermia and whole liver irradiation (WLI) for numerous chemorefractory liver metastases from colorectal cancer. Materials and Methods: Enrolled patients had numerous chemorefractory hepatic metastases from colorectal cancer. Five sessions of hyperthermia and seven fractions of 3-gray WLI were planned. Health-related quality of life (HRQoL) was determined using the Korean version of the European Organization for Research and Treatment of Cancer quality of life questionnaire C-30 and the Functional Assessment of Cancer Therapy-Hepatobiliary version 4.0. Objective and pain response was evaluated. Results: A total of 12 patients consented to the study and the 10 who received WLI and hyperthermia were analyzed. WLI was completed as planned in nine patients and hyperthermia in eight. Pain response was partial in four patients and stable in four. Partial objective response was achieved in three patients (30.0%) and stable disease was seen in four patients at the 1-month follow-up. One patient died 1 month after treatment because of respiratory failure related to pleural metastasis progression. Other grade III or higher toxicities were detected in three patients; however, all severe toxicities were related to disease progression rather than treatment. No significant difference in HRQoL was noted at the time of assessment for patients who were available for questionnaires. Conclusion: Combined WLI and hyperthermia were well tolerated without severe treatment-related toxicity with a promising response from numerous chemorefractory hepatic metastases from colorectal cancer.

• Journal of Pharmacopuncture
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• v.21 no.2
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• pp.76-81
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• 2018

Objective: This study compared the safety and efficacy of $Safacto^{(R)}$ versus $xyntha^{(R)}$ in patients with severe hemophilia A. Methods: Thirty-three male patients with severe hemophilia A were randomly divided into two groups. Seventeen patients received $Safacto^{(R)}$ and 16 patients received $Xyntha^{(R)}$ for four consecutive times. The dosage of FVIII was 40-50 IU/kg for each injection. Plasma level of FVIII activity was evaluated before every injection, 15 minutes after the injection and one month after the start of the trial. The rate of factor VIII activity, pain and joint motion were also assessed before and after the treatment. Results: Plasma level of FVIII clotting activity in $Safacto^{(R)}$ and $Xyntha^{(R)}$ were $1.96{\pm}0.5IU/dl$ and $1.63{\pm}0.5IU/dl$ and increased to $88.84{\pm}25.2IU/dl$ and $100.09{\pm}17.8IU/dl$, respectively (P<0.001). Pain score and range of motion improvement were $9.3{\pm}0.9$ and $8.7{\pm}0.1$ in $Safacto^{(R)}$ (P=0.17); and $9.4{\pm}0.8$ and $8.8{\pm}0.3$ in $Xyntha^{(R)}$ (P=0.35), respectively. No allergic or other unfavorable reactions was observed with either of the preparations. Conclusion: This study showed that $Safacto^{(R)}$ has a favorable efficacy and safety profile.

• The Korean Nurse
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• v.36 no.3
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• pp.49-69
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• 1997

The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.

• IMMUNE NETWORK
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• v.22 no.2
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• pp.17.1-17.14
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• 2022

We aimed to investigate associations of dietary diversity (DD) with gut microbial diversity and the development of hen's egg allergy (HEA) in infants. We enrolled 68 infants in a high-risk group and 32 infants in a control group based on a family history of allergic diseases. All infants were followed from birth until 12 months of age. We collected infant feeding data, and DD was defined using 3 measures: the World Health Organization definition of minimum DD, food group diversity, and food allergen diversity. Gut microbiome profiles and expression of cytokines were evaluated by bacterial 16S rRNA sequencing and real-time reverse transcriptase-polymerase chain reaction. High DD scores at 3 and 4 months were associated with a lower risk of developing HEA in the high-risk group, but not in the control group. In the high-risk group, high DD scores at 3, 4, and 5 months of age were associated with an increase in Chao1 index at 6 months. We found that the gene expression of IL-4, IL-5, IL-6, and IL-8 were higher among infants who had lower DD scores compared to those who had higher DD scores in high-risk infants. Additionally, high-risk infants with a higher FAD score at 5 months of age showed a reduced gene expression of IL-13. Increasing DD within 6 months of life may increase gut microbial diversity, and thus reduce the development of HEA in infants with a family history of allergic diseases.