• Title/Summary/Keyword: clinical implication

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Prognostic Factors in Children with Henoch-$Sch{\ddot{o}}nlein$ Purpura Nephritis (소아 Henoch-$Sch{\ddot{o}}nlein$ 신염의 예후 인자)

  • Choi Hyun Jin;Cho Hee Yeon;Kim Eo Jin;Lee Byong Sop;Kang Hee Gyung;Ha Il Soo;Cheong Hae Il;Choi Yong
    • Childhood Kidney Diseases
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    • v.9 no.2
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    • pp.183-192
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    • 2005
  • Purpose : The long term disease course and prognostic factors were evaluated in childhood Henoch-$Sch{\ddot{o}}nlein$ puruura nephritis(HSPN). Methods : A total of 75 children(44 boys and 31 girls) with HSPN were included in this study. The onset age was $8.0{\pm}3.1$ years(2.3-l5.3 years), and the follow-up period was $4.3{\pm}3.6$ years(1.0-17.1 years). Kidney biopsy was done in 24 children(32$\%$). Initial clinical and laboratory findings were evaluated. In addition, polymorphisms of the renin angiotensin system(RAS) genes(insertion/deletion in intron 16 of ACE gene, M235T in AGT gene, and A1166C in AGTR gene) were analysed. The initial and last clinical states were classified into 4 groups as follows A, normal; B, minor urinary abnormalities; C, active renal disease (nephrotic-range proteinuria and/or hypertension with serum creatinine $\leq$1.5 mg/dL); D, renal insufficiency. Results : At the onset, the clinical states of the patients were B in 26(35$\%$), C in 46(61$\%$), and D, in 3(4$\%$). The distribution of the RAS gene polymorphism of HSPN were not different from that of 100 healthy control subjects. At the last follow-up, the clinical states of the patients were A in 23(31$\%$), B in 38(50$\%$), C in 9(12$\%$), and D in 5(7$\%$). A multiple logistic regression identified age at the onset and initial urine protein excretion as significant prognostic factors. Analysis of genotypes of the 3 RAS genes as prognostic values revealed no statistical significance. Conclusion : Older age at onset and severe proteinuria were identified as poor prognostic factors of childhood HSPN. Implication of the RAS gene polymorphism In HSPN could not be validated in this small-scale retrospective study. (J Korean Soc Pediatr Nephrol 2005;9:183-192)

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Clinical Features and Prognostic Factors in 41 Patients of Primary Nasal/Nasopharyngeal Non-Hodgkin's Lymphoma: Prognostic Significance of Immunophenotype (비/비인강 비호즈킨 림프종의 임상양상과 예후 인자 : 면역 표현형의 임상적 의의)

  • Park Soon-Seo;Park Jong-Beom;Suh Cheol-Won;Park Ji-Woon;Lim Soo-Duk;Huh Joo-Ryung;Nam Soon-Yuhl;Kim Sang-Yoon;Lee Ho-Gyu;Chang Hye-Sook;Kim Tae-Won;Lee Je-Hwan;Kim Sung-Bae
    • Korean Journal of Head & Neck Oncology
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    • v.15 no.2
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    • pp.149-155
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    • 1999
  • Objectives: To study the clinical features of the primary nasal/nasopharyngeal non-Hodgkin's lymphomas and to evaluate the implication of immunophenotyping as a prognostic factor. Patients and Methods: From January 1990 to December 1997,41 patients(median age, 41 years) of primary nasal/nasopharyngeal non-Hodgkin's lymphoma were studied. The clinical records and paraffin-embedded tissue blocks were reviewed retrospectively. The histologic features, immunophenotypic findings(pan-T, pan-B, CD3, CD56) and Epstein-Barr virus in situ hybridizatios were examined. The prognostic factors for clinical outcome were evaluated in these patients. According to Ann-Arbor system, there were 30 patiets(73%) with stage IE, 4(10%) with stage IIE, 3(7%) with stage IIIE, 4(10%) with stage IVE lymphoma. Among the patients with stage IE/IIE, 4 patients received local radiation alone, 4 received chemotherapy alone, 25 received combination chemotherapy and radiotherapy and 1 refused treatment. The patients with stage IIIE/IVE were given combination chemotherapy and radiotherapy. Results: Immunophenotyping were performed in 40 patients and staining results were as follows: 3(7%) patients with B cell, 17(42%) with T cell, 18(44%) with NK/T cell(CD56 positive), and two patients with unclassifiable result. Epstein-Barr(EB) virus in situ hybridization were performed in 28 patients and 23(82%) patients had positive EBV-encoded RNAs(EBERs). 21(55%) patients achieved a complete remission. There was no difference in complete remission between radiation alone and combination therapy. With median follow-up of 30 months, 5-years disease free survival of complete responders was 60% and 5-years overall survival rate was 36%. Multivariate analysis showed that better overall survival was related with absence of B symptoms, ECOG performance${\leq}1$ and non-NK cells. Conclusion: Most of all cases were positive for EBER. Since NK/T phenotype carried the worst prognosis, analysis for CD56 expression should be done. Further prospective studies were warranted to evaluate the role of chemotherapy in stage IE/IIE.

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Different $^{18}$F-FDG Uptake According to Tumor location and Morphology of Cholangiocarcinoma and Its Clinical Implication (담관암의 위치와 형태에 따른 $^{18}$F-FDG 섭취량의 차이와 임상적 의의)

  • Lee, Won-Seok;Lee, Yoon-Jae;Lim, Seok-Tae;Sohn, Myung-Hee;Lee, Seung-Ok
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.4
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    • pp.317-322
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    • 2009
  • Purpose: $^{18}$F-flurodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan has been found to reflect tumor aggressiveness and prognosis in various types of cancer. However, pattern of FDG uptake in biliary malignancies and its clinical significance have not been studied well. The purpose of this study was to assess the additional value of $^{18}$F-FDG PET in differential diagnosis and prognosis of cholangiocarcinoma (CC) according to the tumor location and tumor morphology. Materials and Methods: From April 2005 to May 2008, eighty two patients (M:F = 55:27, age 66.2$\pm$9.6 yrs) with CC underwent $^{18}$F-FDG PET. For semiquantitative analysis, the maximum standardized uptake value (SUV$_{max}$) was obtained from the primary tumor. The difference of SUV$_{max}$ according to the tumor location and tumor growth pattern, such as scirrhous type, nodular type, polypoid type were compared. Results: Overall sensitivity of PET scan was 81.7% in CC. SUV$_{max}$ on PET scan in intrahepatic CC was significantly higher compared to extrahepatic CC. In extrahepatic CC, polypoid type showed significantly higher SUV$_{max}$ compared to scirrhous type. Conclusion: $^{18}$F-FDG PET may have a significant impact on clinical decision-making and on the management of intrahepatic cholangiocarcinoma. And it is related to the shape of the tumor and the sensitivity of detection is higher in the mass-forming type than in the scirrhous type.

MicroRNA 155 Expression Pattern and its Clinic-pathologic Implication in Human Lung Cancer (폐암에서 microRNA 155의 발현 양상과 임상병리학적 의의)

  • Kim, Mi Kyeong;Moon, Dong Chul;Hyun, Hye Jin;Kim, Jong-Sik;Choi, Tae Jin;Jung, Sang Bong
    • Journal of Life Science
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    • v.26 no.9
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    • pp.1056-1062
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    • 2016
  • Lung cancer is currently the most common malignant disease and the leading cause of mortality in the world and non-small cell lung cancer (NSCLC) accounts for 75-80% of lung cancer cases. miR-155 gene was found to be over expressed in several solid tumors, such as thyroid carcinoma, breast cancer, colon cancer, cervical cancer, pancreatic ductal adenocarcinoma (PDAC) and lung cancer. The aims of this study were to define the expression of miR-155 in lung cancer and its associated clinic-pathologic characteristics. Total RNA was purified from formalin-fixed, paraffin-embedded NSCLC tissues and benign lung tissues. Expression of miR-155 in human lung cancer tissues were evaluated as mean fold changes of miR-155 in cancer tissues compared to benign lung tissues by quantitative real-time reverse transcriptase polymerase chain reaction (real-time qRT-PCR) and associations of miR-155 expression with clinic-pathologic findings of cancer. Compared with the benign control group, miR-155 expression was significantly overexpressed in NSCLCs (p=<0.001). miR-155 was more overexpressed in squamous cell carcinoma than in adenocarcinoma. Poorly differentiated tumors showed significantly overexpression of miR-155 than well-differentiated tumors (p=<0.001). Overexpression of miR-155 was significantly associated with lymph node metastasis (p=<0.05). In survival analysis for all NSCLC patients, high miR-155 expression was significantly correlated with worse overall survival (p=<0.05). These results suggested that miR-155 might play an important role in lung cancer progression and metastasis.

The factors to identify high risk family (고위험가족 선별을 위한 위험요인 분석)

  • 방숙명
    • Journal of Korean Academy of Nursing
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    • v.25 no.2
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    • pp.351-361
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    • 1995
  • The main purpose of the study is to identify critical risk factors for development of a family assessment tool to screen high risk family. This study used a conceptual framework of family diagnosis developed by Eui-sook Kim's (1993) and analyzed risk factors to identify the high risk family. As employing a explorative and methodological study design, this study has four stages. 1. In the first stage, 34 family risk factors were identified by doing intensive literature review on conceptual framework of family diagnoses. 2. In the second stage, above risk factors were tested for content validity by consultation with 29 persons in community health nursing, nursing education, family theory, and social work. 3. In the third stage, existing survey data was used for actual application of the identified risk factors. The survey data used for this purpose was previously collected for the community diagnosis in a region of Seoul. At the final stage, through the comparison between high risk and low risk families, initially identified 34 risk factors decreased to 25 risk factors. Among 34 risk factors, six factors did not agree with content of questionnaries sand two factors were not significant in differentiating the high risk family Also, two risk factors showed high correlation between themselves, so only one of those two factors was chosen. As a result, twenty-five risk factors chosen to identify the high risk family are following ; 1. A single parent family due to divorce or death of a partner, or unweded single mother 2. A family with an unrelated household members 3. A family with a working mother with a young child 4. A family with no regular income 5. A family with no rule in family or too strict rules 6. A family with little or no support from other lam-ily members 7. A family with little or no support from friends or relatives 8. A family with little or no time to share with each other 9. A family with family history of hypertension, diabetus, cancer 10. A family with a sick person 11. A family with a mentally ill person 12. A family with a disabled person 13. A family with an alcoholic person 14. A family with a excessive smoker who smokes more than 1 pack / day 15. A family with too much salt intake in their diet. 16. A family with inappropriate management skills for family health 17. A family with high utilization of drug store than hospital to solve the health problems of the family 18. A family with disharmony between husband and wife 19. A family with conflicts among the family members 20. A family with unequal division of labor among family members 21. An authoritative family structure 22. A socially isolated family 23. The location of house is not residential area 24. A family with high risk of accidents 25. The drinking water and sewage systems are not hygienic. The main implication of the results of this study is clinical use. The high risk factors can be used to identify the high risk family effectively and efficiently. The use of high risk factors woule contribute to develop a conceptual framework of family diagnosis in Korea and the list of risk factors need to be revised continuously. Further researches are needed to develop an index of weight of each risk factor and to validate the risk factors.

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Recognition and Attitudes on Ethical Issues for DNR of 119 Rescue Party (119구급대원의 심폐소생술 비 시행(DNR)과 관련된 윤리문제 인식 및 태도)

  • You, Soon-Kyu;Jung, Ji-Yeon;Shin, Sang-Yol;Choi, Yoo-Im;Choi, Hea-Kyung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.10 no.12
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    • pp.3931-3942
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    • 2009
  • This study as a descriptive survey was to investigate recognition and attitudes on ethical issues for DNR of 119 rescue party who are working on the field, and to develop an objective framework which helps rescue team to manage DNR patients. Data were collected from the structured questionnaire, and subject were 226 rescue party in Jeollabuk-do area in Korea. Study was practiced from May 6 through June 20, 2009, and the data were analyzed by frequency, percentage, $x^2$-test, crosstabs using SPSS Win 12.0. The results indicated that ethical attitudes on subjects' factors(sex, age, religion, marital status, clinical working career, current working area, current position, educational experiences for ethics and values, DNR education places, DNR implication experience, and DNR consulting demands) were statistically significant. Therefore, following researches will be necessary in order to consider measures about DNR based on this study.

The Influences of Perceived Locus of Control to Patients with Pain (지각된 통제소재 (Locus of Control)가 통증환자의 심리상태에 미치는 영향)

  • Cho, Sun-Mi;Chin, Bum-Su;Song, Ho-Jeong;Kim, Chan;Han, Gyung-Lim
    • Korean Journal of Psychosomatic Medicine
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    • v.10 no.2
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    • pp.101-109
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    • 2002
  • Objectives: Cognitive-behavioral scientists have long been interested in how a pain patient's cognition such as locus of control relates to coping and adjustment. The present study examined the relationship of locus of control orientation to pain coping strategies, psychological distress and perceived pain intensity of patients with pain. Methods : Subjects were 96 patients with pain who visited pain clinic. All patients were administered the Multidimensional Health Locus of Control Scales, the Minnesota Multiphasic Personality Inventory, the Coping Strategies Questionnaire, and rating for perceived pain intensity, distress, and duration. Results : Correlational analysis revealed that patients who viewed outcomes as controlled by internality tended to have better ability to control and decrease pain. Also they tended to be less depressed and anxious. Regression analysis indicated that patients having a internal locus of control were more likely to use coping self-statement and reinterpreting pain sensation. Powerful others and chance locus of control orientation were predicted reliance on catastrophizing. Conclusion : The clinical implication of the present study is that cognitive factors of patients with pain such as locus of control influence emotional distress and coping. this study show that these factors should be applied to cognitive behavioral therapeutic intervention.

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The Effects of Low Intensity Resisted and Aerobic Exercise Training on Blood Lipid in Chronic Stroke Patients (저강도의 저항운동과 유산소 운동 훈련이 만성 뇌졸중 환자의 혈중지질에 미치는 효과)

  • Lee, Dong-Yeop;Cho, Nam-Jeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.2
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    • pp.753-758
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    • 2011
  • The purpose of this study was to investigate effect of low intensity resistance exercise and aerobic exercise on serum lipid level in chronic stroke patients. A total of 37 chronic stroke patients were enrolled in this study. The participants were allocated randomly to 2 groups: the low intensity resistance exercise group(n=19) and aerobic exercise group(n=18). Low intensity resistance exercise group took exercise with low intensity resistance for 50minutes, 5 times per week over a 8 week period. Aerobic exercise group received only aerobic exercise. We measured serum lipid level to compare of effectiveness both exercises. Paired t test was executed to determine differences between pre and post exercise. For all analyses, a significant level set at p<.05. The low intensity resistance exercise group showed significant increase in TG, TC HDL-C and LDL-C(p<.05). The aerobic exercise group had significantly higher TC and LDL-C (p<.05). Theses results suggest that low intensity resistance exercise and aerobic exercise are feasible for stroke patients by improving motivation and interest. Further studies is necessary to clinical implication classified by onset time and disability level.

Does Process Quality of Inpatient Care Serve as a Guide to Reduce Potentially Preventable Readmission (PPR)? (의료서비스의 과정적 질과 잠재적으로 예방 가능한 재입원율과의 관계)

  • Choi, Jae-Young
    • Korea Journal of Hospital Management
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    • v.23 no.1
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    • pp.87-106
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    • 2018
  • Objective: The objective of this study is to examine the association between process quality of inpatient care and risk-adjusted, thirty-day potentially preventable hospital readmission (PPR) rates. Data Sources/Study Setting: This was an observational cross-sectional study of nonfederal acute-care hospitals located in two states California and Florida, discharging Medicare patients with a principal discharge diagnosis of heart failure, acute myocardial infarction, or pneumonia January through December 31, 2007. Data were obtained from the Healthcare Cost and Utilization Project State Inpatient Database of the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services Hospital Compare database, and the American Hospital Association Annual Survey of Hospitals. Study Design: The dependent variable of this study is condition-specific, risk-adjusted, thirty-day potentially preventable hospital readmission (PPR). 3M's PPR software was utilized to determine whether a readmission was potentially preventable. The independent variable of this study is hospital performance for process quality of inpatient care, measured by hospital adherence to recommended processes of care. We used multivariate hierarchical logistic models, clustered by hospitals, to examine the relationship between condition-specific, risk-adjusted, thirty-day PPR rates and process quality of inpatient care, after taking clinical and socio-demographic characteristics of patients and structural and operational characteristics of hospitals into account. Findings: Better performance on the process quality metrics was associated with better patient outcome (i.e., low thirty-day PPR rates) in pneumonia, but not generally in two cardiovascular conditions (i.e., heart failure and acute myocardial infarction). Practical Implication: Adherence to the process quality metrics currently in use by CMS is associated with risk-adjusted, thirty-day PPR rates for patients with pneumonia, but not with cardiovascular conditions. More evidence-based process quality metrics closely linked to 30-day PPR rates, particularly for cardiovascular conditions, need to be developed to serve as a guideline to reduce potentially preventable readmissions.

Effects of immediate and delayed light activation on the polymerization shrinkage-strain of dual-cure resin cements (즉시 광중합과 지연 광중합이 이원 중합 레진시멘트의 중합 수축량에 미치는 영향)

  • Lee, So-Yeoun;Kim, Sung-Hun;Ha, Seung-Ryong;Choi, Yu-Sung;Kim, Hee-Kyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.52 no.3
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    • pp.195-201
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    • 2014
  • Purpose: This study was designed to compare the amount of polymerization shrinkage of dual-cure resin cements according to different polymerization modes and to determine the effect of light activation on the degree of polymerization. Materials and methods: Four kinds of dual-cure resin cements were investigated: Smartcem 2, Panavia F 2.0, Clearfil SA Luting and Zirconite. Each material was tested in three different polymerization modes: self-polymerization only, immediate light polymerization and 5 minutes-delayed light polymerization. The time-dependent polymerization shrinkage-strain was evaluated for 30 minutes by Bonded-disk method at $37^{\circ}C$. Five recordings of each material with three different modes were taken. Data were analyzed using one-way ANOVA and multiple comparison Scheffe′test (${\alpha}$=.05). Results: All materials, except Panavia F 2.0, exhibited the highest polymerization shrinkage-strain through delayed light-activated polymerization. No significant difference between light activation modes was found with Panavia F 2.0. All materials exhibited more than 90% of polymerization rate in the immediate or delayed light activated group within 10 minutes. Conclusion: As a clinical implication of this study, the application of delayed light activation mode to dual-cure resin cements is advantageous in terms of degree of polymerization.