• Journal of Korean Society of Health-System Pharmacists
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• v.35 no.4
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• pp.409-417
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• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.1009-1018
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• 2022

Objective: This study aimed to investigate the feasibility of using artificial intelligence (AI) to identify normal chest radiography (CXR) from the worklist of radiologists in a health-screening environment. Materials and Methods: This retrospective simulation study was conducted using the CXRs of 5887 adults (mean age ± standard deviation, 55.4 ± 11.8 years; male, 4329) from three health screening centers in South Korea using a commercial AI (Lunit INSIGHT CXR3, version 3.5.8.8). Three board-certified thoracic radiologists reviewed CXR images for referable thoracic abnormalities and grouped the images into those with visible referable abnormalities (identified as abnormal by at least one reader) and those with clearly visible referable abnormalities (identified as abnormal by at least two readers). With AI-based simulated exclusion of normal CXR images, the percentages of normal images sorted and abnormal images erroneously removed were analyzed. Additionally, in a random subsample of 480 patients, the ability to identify visible referable abnormalities was compared among AI-unassisted reading (i.e., all images read by human readers without AI), AI-assisted reading (i.e., all images read by human readers with AI assistance as concurrent readers), and reading with AI triage (i.e., human reading of only those rendered abnormal by AI). Results: Of 5887 CXR images, 405 (6.9%) and 227 (3.9%) contained visible and clearly visible abnormalities, respectively. With AI-based triage, 42.9% (2354/5482) of normal CXR images were removed at the cost of erroneous removal of 3.5% (14/405) and 1.8% (4/227) of CXR images with visible and clearly visible abnormalities, respectively. In the diagnostic performance study, AI triage removed 41.6% (188/452) of normal images from the worklist without missing visible abnormalities and increased the specificity for some readers without decreasing sensitivity. Conclusion: This study suggests the feasibility of sorting and removing normal CXRs using AI with a tailored cut-off to increase efficiency and reduce the workload of radiologists.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.11 no.2
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• pp.161-168
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• 2001

The types of exposure data needed in an industry-based study depend on the diseases of interest and the study design to be used. The best situation occurs when we have quantified personal exposure estimates for the agents of interest, the least informative case occurs when we have only knowledge of the fact of employment in a plant, industry, or trade where exposure probability is high. Exposure information for most industry-based studies falls somewhere between these tow extremes. Job exposure matrices(JEM) are designed to link information on occupation with information on exposure to specific workplace hazards. Some forms of systematic error of bias may be less likely to occur in studies that utilize job-exposure matrices to indirectly infer exposures from job titles than in studies that assess exposures by asking subjects about their past exposure. JEM can be used effectively in industry-based studies for historic cohort studies, case-control study to assist with the retrospective assessment of occupational exposures among workers whose individual exposure histories are unavailable. JEM generally consist of a computerized database that links information about job categories and likely exposures. These two major axes may be stratified by calendar time. This article reviews the design of JEM in support of industry-based studies. Specific matrices may find broader applicability along with the increasing availability of detailed hygienic data.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.23
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• pp.10505-10508
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• 2015

Background: Breast cancer is an important cause of death among women. One way of classifying different forms of breast cancer is by molecular features, usually in terms of the four subtypes: luminal A, luminal B, HER2-enriched, and triple negative. Objectives: This study aimed to investigate the association between molecular subtypes and survival among breast cancer patients treated with radiotherapy. Materials and Methods: A retrospective cohort study was conducted. The subjects were 272 breast cancer patients who had received treatment in the radiotherapy unit at Srinagarind Hospital, Thailand, between 1 January, 1999, and 31 May, 2009. The end of the study was 1 June, 2014. Overall survival was defined as the time elapsing between initial registration at the radiotherapy unit and death or the end of the study. Survival curves were estimated by the Kaplan-Meier method, and a multivariate analysis was performed using Cox's proportional hazard regression model. Results: The patient mean age was $47.5{\pm}10.4$ at the time of diagnosis. Of the 272 patients, 146 (53.7%) were classified as luminal A, 12 (4.4%) as luminal B, 30 (11.0%) as HER2-enriched, and 84 (30.9%) as triple negative. The overall survival rates at 1, 3 and 5 years were 87.1%, 68.4% and 59.2%, respectively. According to molecular subtypes, HER2-enriched patients had the lowest 5-year survival rate (30.0 %, 95%CI: 15.02-46.55). The median follow-up time was 8.37 years. In the Cox model analysis a higher risk of death was found for patients with HER2-enriched ($HR_{adj}=3.34$, 95%CI:1.96-5.67), triple negative ($HR_{adj}=2.17$, 95%CI: 1.44-3.27), and stage IIlB ($HR_{adj}=2.20$, 95%CI: 1.16-4.17) cancers. Conclusions: The worst survival rates were among patients classified as HER2-enriched, triple negative and at stage IIIB. Early detection and an advanced treatment modality are needed to help these patients.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.2
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• pp.78-86
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• 2015

Purpose: The purpose of this study is to understand what kinds of chemical substances have been used annually and to investigate incidents that occurred due to chemical hazard release and to analyze statistically clinically chemical injury patients who visited one regional emergency medical center in Gumi city with documented references review. Methods: Annual chemical waste emission quantity (Kg/Year) (Cwep) was reproduced using national web site data governed by the Ministry of Environment and 5 years (from 1 .Jan. 2010 to 31. Dec. 2014) of medical records of chemical injury patients who visited our emergency department were reviewed retrospectively. By applying exclusion criteria, 446 patients of 460 patients were selected. Results: Dichloromethane, Toluene, Trichloroethylene, and Xylene were always included within Top 5 of Cweq. Six cases of chemical incidents were reported and in 3 of 6 cases involving Hydrogen fluoride were included during the study period. Male gender and twenties were the most prevalent group. Injury evoking chemicals were Hydrogen fluoride, unknown, complex chemicals (over 2 substances) in sequence. The most frequent site of wounds and injuries was the respiratory tract. Gas among status, intoxication among diagnosis, and discharge among disposition was most numerous in each group. Conclusion: There have been no uniform clinical protocols for chemical wounds and injuries due to various kinds of chemicophysical properties and ignorance of antidotes. Therefore conduct of a multicenter cohort study and experiments for ruling out chemicals according to chemicophysical priority as well as development of antidotes and clinical protocols for chemical injury patients is needed.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6693-6696
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• 2013

Background: Cold knife conization is a surgical procedure that allows both diagnosis and treatment of cervical lesions at the same time. It is mainly performed for indications of high-grade cervical intraepithelial neoplasia (CIN). In this study, we aimed to investigate the clinical outcome of cases without CIN in cold knife conization specimen, following a high-grade lesion (CIN2/3) in cervical biopsy. Materials and Methods: We performed a retrospective cohort study at a tertiary referral hospital between January $1^{st}$ 2008 and August $1^{st}$ 2012. Cases that underwent cold knife conization for CIN2/3 within the study period were included. Cone-negative (Group 1) and cone-positive (Group 2) cases were analyzed for various clinical parameters, and were compared in the 1-year post-conization period for histological recurrence and human papillomavirus (HPV) DNA status. Results: A total of 173 women underwent cold knife conization for CIN2/3 within the study period. Twenty-two cases (12.7%) were included in Group 1 and 151 cases (87.3%) in Group 2. There were no significant differences between the two groups in terms of age, gravidity, parity, menopausal status and HPV-DNA status (pre-conization and 1 year post-conization) (p>0.05). Recurrence rates were also similar between the groups (9.1% vs 9.9%, p>0.05). Conclusions: Clinical outcomes were similar in terms of histological recurrence and HPV persistence after 1 year of follow-up between cone-negative and cone-positive cases. Clinical follow-up of cone-negative cases should therefore be performed similar to cone-positive cases.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.16 no.2
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• pp.152-160
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• 2006

Genotype of ALAD and VDR yields two alleles, respectively and it has been implicated in susceptibility to lead toxicity. Also genotype known to variety by race. To evaluate the genetic susceptibility of ALAD and VDR gene on health effect of lead exposure, this study was done with new workers who entered lead industries from 1992 to 2001. Among database of lead industries of Soonchunhyang University Institute of Industrial Medicine, only new workers were selected for this study. The total of eligible workers for this category was 3,540 workers including non lead exposed workers of same lead industries. Genotype of ALAD and VDR were measured from stored blood in specimen bank of Soonchunhyang University, blood lead and other relevant information were obtained from database of each workers which were gathered at their first year of employment. Among 3,540 new employed study subjects during period of 1992-2001, 3204 workers(90.5%) had ALAD genotype 1-1; whereas 336 workers(9.5%) had variant type of ALAD (1-2 or 2-2). Lead exposed workers, 9.8%(n=243) male and 8.1%(n=16) female were heterozygous for the ALAD allele. Also non lead exposed workers, 8.9%(n=67) male and 9.3%(n=10) female were heterozygous for the ALAD allele. For VDR genotype, 2,903 workers(89.7%) out of total tested 3,238 workers were belonged to type bb and 335 workers(10.3%) were type bB or BB. Lead exposed workers, 10.4%(n=235) male and 12.2%(n=24) female were heterozygous for the VDR allele. Also non lead exposed workers, 9.2%(n=64) male and 12.5%(n=12) female were heterozygous for the VDR allele. No significant differences were seen in mean blood lead levels by ALAD and VDR genotype, nor was significantly associated with blood lead except age in multiple regression analysis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.4
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• pp.227-235
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• 2017

Purpose: Crohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD. Methods: This was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms. Results: Among the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was $14.1{\pm}2.1$ years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate ($60.7{\pm}27.1$ vs. $43.0{\pm}27.6mm/h$, p=0.037) and C-reactive protein ($16.5{\pm}28.2$ vs. $6.62{\pm}13.4mg/dL$, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms. Conclusion: Upper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.

• Journal of Genetic Medicine
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• v.9 no.1
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• pp.22-24
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• 2012

Purpose: The aim of this study was to asses the fetal loss rate after mid-trimester amniocentesis. Materials and Methods: This was a retrospective cohort study including singleton pregnant women who underwent mid-trimester amniocentesis at Cheil General Hospital from January 2008 through December 2010. The procedure-related fetal loss was defined as miscarriage within 2 weeks after amniocentesis. We evaluated the fetal loss rate within 2 weeks after amniocentesis and fetal loss rate before 24 gestational weeks. Results: During the study period, a total of 4,356 singleton pregnant women underwent mid-trimester amniocentesis. A total of Five hundred ninety six women were excluded owing to follow up loss and termination of pregnancy due to abnormal karyotype or major anomaly. At our institute, the fetal loss rate within 2 weeks was 0.1% and before 24 gestational weeks was 0.3% after amniocentesis. Conclusion: The fetal loss rate after mid-trimester amniocentesis in our study is lower than previously reported rate. We suggest that amniocentesis is a safe procedure.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.36-44
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• 2019

Swallowing impairment is a frequent complication following stroke. The characteristics of swallowing impairment with stork patient can facilitate identification of individuals at risk of dysphagia would be of great helpful. The present study examined oropharyngeal swallowing impairment with subacute stroke patients using the Modified Barium Swallowing Impairment Profile(MBSImP). The 49 consecutive patients with the supratentorial stroke met inclusion criteria for the present study. A retrospective review was performed of patients who underwent the videofluoroscopic swallowing study(VFSS). Of Stroke patients, 95.9% exhibited abnormal function of lip closure. 98% and 57.1 % shown abnormal tongue function and lingual motion, respectively. Oral residue was present in 51% and delayed pharyngeal response was present in 89.9%. In addition, abnormal laryngeal and hyoid excursion was seen in 42.9% and 87.8%, respectively. Abnormal function of soft palate elevation was present in 18.4% and abnormal epiglottic movement was seen in 4.1%. 30.6% of 30.6% of these patients exhibited abnormal laryngeal closure. All of the stroke patients(100%) in this study exhibited abnormal pharyngeal stripping wave and pharyngoesophageal segment opening. Abnormal tongue base retraction and oral reside were present 91.8%, respectively. The results suggest that stroke patient is more likely to exhibit reduced swallowing functions including lip closure, tongue control, initiation of pharyngeal swallow, anterior hyoid motion, tongue base retraction, pharyngeal residue and pharyngoesophageal contraction. Therefore, these data could provide valid and precise information regarding physiological evidence to delineate symptoms of dysphagia in this stroke cohort. Future studies should explore the bolus effect in the swallowing impairment.