• Title/Summary/Keyword: Primary Care

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Prognostic Factor Analysis of Overall Survival in Gastric Cancer from Two Phase III Studies of Second-line Ramucirumab (REGARD and RAINBOW) Using Pooled Patient Data

  • Fuchs, Charles S.;Muro, Kei;Tomasek, Jiri;Van Cutsem, Eric;Cho, Jae Yong;Oh, Sang-Cheul;Safran, Howard;Bodoky, Gyorgy;Chau, Ian;Shimada, Yasuhiro;Al-Batran, Salah-Eddin;Passalacqua, Rodolfo;Ohtsu, Atsushi;Emig, Michael;Ferry, David;Chandrawansa, Kumari;Hsu, Yanzhi;Sashegyi, Andreas;Liepa, Astra M.;Wilke, Hansjochen
    • Journal of Gastric Cancer
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    • v.17 no.2
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    • pp.132-144
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    • 2017
  • Purpose: To identify baseline prognostic factors for survival in patients with disease progression, during or after chemotherapy for the treatment of advanced gastric or gastroesophageal junction (GEJ) cancer. Materials and Methods: We pooled data from patients randomized between 2009 and 2012 in 2 phase III, global double-blind studies of ramucirumab for the treatment of advanced gastric or GEJ adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing therapy (REGARD and RAINBOW). Forty-one key baseline clinical and laboratory factors common in both studies were examined. Model building started with covariate screening using univariate Cox models (significance level=0.05). A stepwise multivariable Cox model identified the final prognostic factors (entry+exit significance level=0.01). Cox models were stratified by treatment and geographic region. The process was repeated to identify baseline prognostic quality of life (QoL) parameters. Results: Of 1,020 randomized patients, 953 (93%) patients without any missing covariates were included in the analysis. We identified 12 independent prognostic factors of poor survival: 1) peritoneal metastases; 2) Eastern Cooperative Oncology Group (ECOG) performance score 1; 3) the presence of a primary tumor; 4) time to progression since prior therapy <6 months; 5) poor/unknown tumor differentiation; abnormally low blood levels of 6) albumin, 7) sodium, and/or 8) lymphocytes; and abnormally high blood levels of 9) neutrophils, 10) aspartate aminotransferase (AST), 11) alkaline phosphatase (ALP), and/or 12) lactate dehydrogenase (LDH). Factors were used to devise a 4-tier prognostic index (median overall survival [OS] by risk [months]: high=3.4, moderate=6.4, medium=9.9, and low=14.5; Harrell's C-index=0.66; 95% confidence interval [CI], 0.64-0.68). Addition of QoL to the model identified patient-reported appetite loss as an independent prognostic factor. Conclusions: The identified prognostic factors and the reported prognostic index may help clinical decision-making, patient stratification, and planning of future clinical studies.

Experience with Peritoneal Drainage in Extremely Low-birth-weight Infants (초극소 저출생 체중아에서 복막 배액술의 경험)

  • Nam, So-Hyun;Kim, Dae-Yeon;Kim, Seong-Chul;Kim, Ai-Rhan;Kim, Ki-Soo;Pi, Soo-Yung;Kim, In-Koo
    • Advances in pediatric surgery
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    • v.14 no.1
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    • pp.37-47
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    • 2008
  • Recently, the survival rates of extremely low-birth-weight (ELBW) infants have improved with the development of neonatal intensive care. However, these infants were susceptible to intestinal perforation due to prematurity, fluid restriction, and injection of indomethacin, etc. Because of the risks of transportation, anesthesia and surgery itself, peritoneal drainage has been compared with laparotomy. Through our experience, we investigate the usefulness of peritoneal drainage retrospectively. From 1997 to 2007, six ELBW (M:F=5:1) underwent primary peritoneal drainage for intestinal perforation. Their median birth weight was 685g (405~870) and gestational age was $25^{+1}$ weeks ($24^{+3}{\sim}27^{+0}$). We noticed the intestinal perforation at median 10.5 days (8~18) after birth, and placed Penrose drain or Jackson-Pratt drain through right lower quadrant incision under local anesthesia. The cause of intestinal perforation was necrotizing enterocolitis in one patient, but that of the others was not clear. Three patients who showed normal platelet count and stable vital signs recovered uneventfully. Two patients (birth weight less than 500g) who showed unstable vital signs and low platelet count (12,000 / $mm^3$ to 30,000 / $mm^3$)expired despite aggressive resuscitation. One patient required laparotomy due to persistent intestinal obstruction after drain removal and survived. Our experience shows that peritoneal drainage was an acceptable treatment for ELBW infants and the prognosis was related to vital sign and platelet count at the time of intestinal perforation, and birth weight.

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The Effect of a Multidisciplinary Team Approach on the Rehabilitation of Stroke Survivors (뇌졸중 환자를 위한 팀접근 재활프로그램의 효과)

  • Cho, Bok-Hee
    • The Korean Journal of Rehabilitation Nursing
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    • v.6 no.2
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    • pp.137-151
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    • 2003
  • The purpose of this study was to develop a multidisciplinary team approach program for stroke survivors, and to identify its effects on their rehabilitation. The team was composed of 7 members: a rehabilitation nurse, a physician, a physical therapist, an occupational therapist, a therapeutic recreational therapist, a nutritionist, and a researcher. A quasi-experimental study was performed with 36 subjects: 18 in the experimental group and 18 in the control group, using a noneqivalent control group pretest-posttest design. The experimental group participated 4 times in rehabilitation programsfocused on information and emotional support provided by the rehabilation team-and received telephone counseling from the researcher. The control group did not receive any treatment. The selection criteria for the subjects in this study were: (a) patients who were diagnosed as having had an ischemic stroke within the last year, (b) patients free of any communication disorder, (c) and those having a primary caregiver who could assist in filling out the form assessing the level of ADL. The data were collected from patients who had been discharged from a tertiary hospital, between October 1st, 1999 and September 30th, 2000. The data were analysed by $X^2$ test, Fisher's exact test, ANCOVA, Wilcoxon's rank sum test, and Wilcoxon's signed rank test using an SAS program. The results were as follows: 1. In terms of physical variables (blood pressure, grasp power, and ADL) 1) There was a significant difference in blood pressure between the two groups (systolic pressure P= .012, diastolic pressure P= .050). 2) There was also a significant difference in grasp power between the two groups (affected side : P= .012, unaffected side : P= .010). 3) There was no significant change in the level of ADL between the two groups. 2. In terms of psychosocial variables (depression, self-efficacy, self-esteem, and social activities) 1) There were no significant differences between the two groups. However, all four psychosocial variables showed a tendency to improve in the experimental group, while only two variables (depression and self-efficacy) showed a simalar tendency in the control group. 2) The level of social activities in the control group decreased significantly after a month (P= .050). 3. The level of life satisfaction improved in both groups, but no significant difference was found. Stroke has high recurrence rate and requires considerable follow-up care. The program used in this study was developed and designed for stimulting the rehabilitation process of stroke survivors. Through the program period of one month (meetings were held weekly), a positive effect was detected in physical variables, although the psychosocial variables did not improve significantly. In retrospect, a one month period may not be an adequate length of time to improve the psychosocial variables, as the stroke survivors were complicated cases, and most of them were elderly. Further research is therefore recommended by increasing the length of program, so that its effect can be more noticeable.

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Usefulness of Vibration Response Imaging (VRI) for Pneumonia Patients (폐렴환자에서 진동 공명 영상 검사(VRI)의 유용성)

  • Park, Eu-Gene;Park, Jung-Hee;Hong, Mi-Jin;Kim, Won-Dong;Lee, Kye-Young;Kim, Sun-Jong;Kim, Hee-Joung;Ha, Kyoung-Won;Chon, Gyu-Rak;Kim, Hyun-Ai;Yoo, Kwang-Ha
    • Tuberculosis and Respiratory Diseases
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    • v.71 no.1
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    • pp.30-36
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    • 2011
  • Background: Pneumonia is commonly seen in outpatient clinics. it is widely known as the most common cause of death from infectious disease. Pneumonia has been diagnosed by its typical symptoms, chest X-ray and blood tests. However, both chest X-rays and blood tests have limitations in diagnosis. Thus primary care clinicians usually have been constrained due to a lack of adequate diagnostic tools. Vibration response imaging (VRI) is a newly emerging diagnostic modality, and its procedure is non-invasive, radiation-free, and easy to handle. This study was designed to evaluate the diagnostic usefulness of the VRI test among pneumonia patients and to consider its correlation with other conventional tests such as Chest X-ray, laboratory tests and clinical symptoms. Methods: VRI was performed in 46 patients diagnosed with pneumonia in Konkuk University Medical Center. VRI was assessed in a private and quiet room twice: before and after the treatment. Sensors for VRI were placed on a patient's back at regular intervals; they detected pulmonary vibration energy produced when respiration occurred and presented as specific images. Any modifications either in chest X-ray, C-reactive protein (CRP), white blood cell count (WBC) or body temperature were compared with changes in VRI image during a given time course. Results: VRI, chest X-ray and CRP scores were significantly improved after treatment. Correlation between VRI and other tests was not clearly indicated among all patients. But relatively severe pneumonia patients showed correlations between VRI and chest X-ray, as well as between VRI and CRP. Conclusion: This study demonstrates that VRI can be safely applied to patients with pneumonia.

THE TOPICAL ANESTHESIA WITH EMLA CREAM IN CHILDREN : A CASE REPORT (소아에서 EMLA cream을 이용한 도포마취 : 증례보고)

  • Kim, He-Jin;Ko, Sung-Back;Hong, Seong-Soo;Lee, Chang-Seop;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.29 no.1
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    • pp.69-75
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    • 2002
  • A number of techniques may be employed to reduce the discomfort of syringe or needle for dental care. The use of topical anesthesia is one such method. Topical anesthetics are applied to alleviate pain during many clinical procedures, such as injection of local infiltration anesthetics, primary tooth extraction, X-ray taking of sensitive patients, reducing gag reflex prior to impression taking. In children, placement of a rubber dam clamp, however, may cause significant discomfort for purpose of pit and fissure sealant and preventive resin restoration(PRR). A topical anesthetic would be beneficial to aid in rubber dam placement for this purpose. It has been suggested that all intra-oral topical anesthetics are equally effective on reflected mucosa, however EMLA(an acronym for eutectic mixture of local anesthetics), which was developed in the 1980s and produces surface anesthesia of skin, has been shown to be more effective than conventional topical anesthetics when used on attached gingivae. This report is topical anesthesized 4 case by EMLA cream, who showed better effect in reducing the pain of infiltration anesthesia, extraction of deciduous teeth, rubber dam clamp placement and reducing the pain of preformed crown adaptation.

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Wearable antenna for Body area Network

  • Lim, Eng Gee;Wang, Zhao;Lee, Sanghyuk
    • Journal of Convergence Society for SMB
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    • v.3 no.2
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    • pp.27-32
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    • 2013
  • Wireless Body Area Networks (WBAN) have been made possible by the emergence of small and lightweight wireless systems such as Bluetooth, enabled devices and PDAs. Antennas are an essential part of any WBAN system and due to various technical requirements and physical constraints, careful consideration of their design and deployment is needed. This paper is proposing on the design of wearable antenna as parts of clothing to serve communications functions, such as tracking and navigation in health care applications. The substrates of the wearable antennas will be made from textile materials and since it is wearable, it should have a small size, be light weight, low maintenance, and unobtrusive. This proposed paper will also investigate the influence of different parameters for wearable antenna including types of textile/substrate to ensure that the antenna design satisfies WBAN requirements. The characteristics and behavior of the antenna need to adhere to specifications set by wireless standards and system technology requirements. This means that the transmitting and receiving frequency bands of the various units need to be chosen accordingly. Since there are restrictions on the level of power to which the human body can be exposed to, the antenna as well as other RF system components must be designed to meet these restrictions. Antenna gain, which directly affects power transmitted, is a critical parameter in ensuring power levels fall within the safety guidelines and so will be of primary importance in the design. The electromagnetic interaction between WBAN antennas and devices and the human body will also be explored.

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Changes in Oral Microbiota in Patients Receiving Radical Concurrent Chemoradiotherapy for The Head and Neck Squamous Cell Carcinoma

  • Kim, Jin Ho;Choi, Yoon Hee;An, Soo-Youn;Son, Hee Young;Choi, Chulwon;Kim, Seyeon;Chung, Jin;Na, Hee Sam
    • International Journal of Oral Biology
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    • v.43 no.1
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    • pp.13-21
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    • 2018
  • Radiotherapy (RT) is a mainstay in the treatment of head and neck squamous cell carcinoma (HNSCC). For locally advanced HCSCC, concurrent chemoradiotherapy (CCRT) benefits HCSCC patients in terms of better survival and loco-regional control. In this study, we evaluated changes in oral microbiota in patients, who received CCRT for head and neck cancer. Oral rinsed samples were weekly collected before and during CCRT and at 4 weeks following treatment from HNSCC patients, who had received 70 Gy of radiation delivered to the primary sites for over 7 weeks and concurrent chemotherapy. Oral microbiota changes in three patients were analyzed by next-generation sequencing using 16S rRNA 454 pyrosequencing. On an average, 15,000 partial 16S rRNA gene sequences were obtained from each sample. All sequences fell into 11 different bacterial phyla. During early CCRT, the microbial diversity gradually decreased. In a patient, who did not receive any antibiotics during the CCRT, Firmicutes and Proteobacteria were the most abundant phylum. During the early CCRT, proteobacteria gradually decreased while Firmicutes increased. During the late CCRT, firmicutes gradually decreased while Bacteroides and Fusobacteria increased. In all the patients, yellow complex showed a gradual decrease, while orange and red complex showed a gradual increase during the CCRT. At 4 weeks after CCRT, the recovery of oral microbiota diversity was limited. During CCRT, there was a gradual increase in major periodontopathogens in association with the deterioration of the oral hygiene. Henceforth, it is proposed that understanding oral microbiota shift should provide better information for the development of effective oral care programs for patients receiving CCRT for HNSCC.

A Study on The Fruits Mentioned in the Bible (성서에 언급된 과실에 관한 연구)

  • Kim, Sung-Mee;Lee, Kwang
    • Journal of the East Asian Society of Dietary Life
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    • v.9 no.2
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    • pp.149-160
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    • 1999
  • This paper is intended to find out what kinds of fruits are mentioned in the Bible and how they were used in those days. It has also analyzed in what terms they are expressed in the Korean Version of the Bible and studied agricultural regulations involved in the religion, and allegorical uses of the fruits. Olives were the primary fruit in the economy of the ancient times, followed by figs and vines. In addition, there are mentioned in the Bible almonds, apples, dates. mulberries and pomegranates. Olive trees have been grown for more than six thousand years. The Hebrew word. Zayit is mentioned in the Bible more than fifty times. Olive trees are not so beautiful in themselves but as they give us humans abundant reap and a lot of oil, they have been thought to be beautiful. Olive trees grow well on the seaside in the salty air and fog. Vines began to grown as early as in the Bronze Age(the period of 3000 to 2000 B.C.). In Northern Greece, grape seeds were found to belong to the year 4500 B.C. or so. The vine gardens produced raisins and wine as well as vines. Figs are the fruit which are first mentioned in the Bible(Genesis 3:7) and they were the precious product of the Palestine people, which is described in Deuteronomy 8:8. Figs are sweet and watery and can easily quench thirst on hot summer days. They were used for cookies and wine in the raw or dried state. An apple, which is tappuah in Hebrew, is mentioned as 'Sagwa' six times in the Revised Korean Version, and in the Korean Joint Version it is twice mentioned as 'Sagwa' and as 'Neungum' four times. In ASV and KJV, 'apple' appears eleven times. which is because' the apple of eye' is translated in the 'Nun-dong-ja(the pupil of the eye)'In the Korean Version. 'Sagwa(apple)'of Proverb 25:11, the Song of Songs 2:3, 2:5, 7:8, 8:5 and Joel 1 :12 have been thought to be doubtful. because apple trees cannot be grown in the areas mentioned in the Bible. Some maintain that the apples in the Bible refer to apricots(Prunus armeniaca, Citrus medica L.) or golden oranges (Citrus sinensis L. Obsbeck) which is confusing. In the Revised Korean Version, 'Salgu(apricots)' appears eight times while ASV and KJV translate almond into 'Salgu'. So since translating a genuine apricot into 'Salgu' can be confusing, a great care should be taken in the translation into Korean. Some hold that as some papyri arround the year 1200 B.C. describes pomegranate, apple, olive and fig trees growing on the Nile delta, tappuah rightly refers to 'Sagwa(apple)' In the Korean Joint Version, Sagwa and Neungum are used together to refer to the same fruit, which should be avoided. It is desirable to use the same word for the same thing. Sagwa' showing up six times In the HeL.Ised Korean Version should all be replaced by 'Neungum' Dates symbolized peace and abundance were used for food in the raw or dried state, and were made into honey. Pomegranates can be eaten in the raw state and be used for sherbets and wine. Juice made of promegranates can be mixed with wine and drunk.

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Health Behaviors among Adolescents in the Rural Area in Korea (농촌지역 청소년의 건강행태)

  • Park, Soon-Woo
    • Journal of agricultural medicine and community health
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    • v.34 no.2
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    • pp.202-213
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    • 2009
  • Objectives: The aim of this study was to compare health related behaviors among adolescents in the rural area with those in the urban area in Korea. Methods: The data source was the Korea Youth Risk Behavior Web-based Survey in 2005. With two stage cluster sampling, a total of 58,224 sample was selected from 799 middle and high schools nationwide. The area was classified into county area, small to medium city, and large city, and then the county area was considered as a rural area. Data was analyzed with STATA 9.0 using the method of complex survey data analysis considering sampling weight, strata, and primary sampling unit. Results: The prevalence of health related behaviors among adolescents in the rural area was higher than the city area as following health behaviors: smoking behaviors of smoking experience, smoking experience before entrance to middle school; drinking behaviors of frequent drinking, high risk behaviors with drinking; dietary behaviors of omitting of lunch or dinner, less intake of fruits or milk, more intake of cooky; oral hygiene of less tooth brushing, less preventive oral care, more oral symptoms and less dentist visit; safety behaviors of less wearing of safety belt or protective device; general hygiene of less hand washing before meal or after visiting rest room. Conclusions: The health behaviors among adolescents in the rural area were generally poorer than the city area. The results showed national health program for adolescents should be conducted primarily for those in rural areas. Further study is needed to explore the factors related with the discrepancy of health behaviors between the rural and urban area.

DENTAL TREATMENT UNDER GENERAL ANESTHESIA IN A PATIENT WITH LOWE SYNDROME : A CASE REPORT (로웨 증후군 환아의 치아우식 치료 증례 보고)

  • Ryu, Jiyeon;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Young Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Kim, Chong-Chul;Lee, Sang-Hoon
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.12 no.2
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    • pp.82-86
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    • 2016
  • Lowe syndrome is X-linked gene disorder, characterized by cataracts, renal dysfunction and brain abnormalities. Oral healthcare of young patients with Lowe syndrome could be easily neglected due to the uncooperative behavior or other systemic condition of the child. We are presenting a case of successful treatment under general anesthesia with uncooperative child with Lowe syndrome. A 3-year old boy with Lowe syndrome visited Seoul National University Dental Hospital for multiple caries. He had been suffering from congenital cataract, medullary nephrocalcinosis and hypotonia. Multiple caries were observed from clinical and radiographic examination. Concerning behavior management problem and possibility of aspiration due to hypotonia, dental treatment under general anesthesia was planned. Left upper primary first molar was extracted to prevent further infection. Other teeth were treated with Stainless steel crown or composite resin restoration based upon the extent and the severity of dental caries. Under general anesthesia, dental procedure was carried out successfully and safely. Considering uncooperative behavior and other medical conditions of the patient, general anesthesia could be effective. Home oral care and periodic visit to dental clinic should be emphasized to the caregiver of patient with Lowe syndrome, considering the susceptibility of dental caries and other oral manifestation.