Risk assessment of cyclohexasiloxane D6 in cosmetic products.

Dodecamethylcyclohexasiloxane (D6) is a siloxane substance mainly used in cosmetics and personal care products. While octamethylcyclotetrasiloxane (D4) and decamethylcyclopentasiloxane (D5) were once commonly used in personal care products, their usage has been restricted due to the classification as persistent, bioaccumulative, and toxic (PBT)/very persistent and very bio-accumulative (vPvB) substances. While D6 has emerged as a substitute for D4 and D5, the risk assessment for D6 remains limited compared to the evaluations for D4 and D5. To address this gap, we conducted a comprehensive risk assessment of D6. In this study, we reviewed the toxicity information on D6 and calculated the exposure level to D6, considering the content of D6 in cosmetic products. No observed adverse effect level (NOAEL) of 1500 mg/kg bw/day was established in a repeated dose toxicity study after oral administration to rats. Negative results were found in tests on the ocular and skin irritation, skin sensitization, and genotoxicity of D6. According to the product content of up to 48% of D6 reported in 2012, the Systemic Exposure Dose (SED) was 5.4E-06 to 7.04 mg/kg bw/day for a 60 kg adult using the exposure factors from Korean cosmetic usage. The Margin of Safety was estimated to be between 35.5 and 4.63E+07, posing a potential health risk of D6 according to the maximum concentration and the product type. Further consideration of the potential of D6 as PBT or vPvB is also required.

Safety assessment of cocamidopropyl betaine, a cosmetic ingredient.

Cocamidopropyl betaine (CAPB) is a surfactant derived from coconut oil that is widely used in cosmetics and personal products for several purposes, such as a surfactant, foam booster, mildness, and viscosity control. Cocamidopropyl betaine is used at concentrations up to 30% in cosmetics. The acute toxicity, skin irritation, eye irritation, skin sensitization, repeated dose toxicity, genotoxicity, carcinogenicity, and phototoxicity of cocamidopropyl betaine were evaluated. Cocamidopropyl betaine was observed to induce mild skin irritation, eye irritation and skin sensitization. The NOAEL of cocamidopropyl betaine was determined to be 250 mg/kg/day based on the results of a 92-day repeated-dose oral toxicity study in rats. The systemic exposure dose of cocamidopropyl betaine was estimated to range from 0.00120 to 0.93195 mg/kg/day when used in cosmetic products. The margin of safety of cocamidopropyl betaine was calculated to be greater than 100 when used at a maximum concentration of 6% in leave-on products and 30% in rinse-off products, suggesting that its use in cosmetic products is safe under current usage conditions.

Economic Inequality, Social Determinants of Health, and the Right to Social Security.

This paper discusses economic inequality as a key social determinant of health. It highlights the potentially transformative role of social protection systems in addressing economic inequality and health inequalities. How to finance social protection and how to distribute benefits among people are key questions in the pursuit of a transformative social protection system that can adequately tackle economic inequalities. This paper argues that a human rights approach can provide a normative orientation in the political process that decides the distribution of burdens and benefits in relation to social protection, calling for an assessment of its impact on socioeconomic inequalities and on disadvantaged groups of people. While the right to social security is at the center of a human rights approach to social protection, the rights to health, education, housing, and work also provide important normative elements for social protection. A human rights-based social protection system requires comprehensive protection for major social risks and challenges throughout the life cycle; universal access to quality services such as health, education, child care, and services for older people or people with disabilities; and a progressive financing mechanism. In this regard, the International Labour Organization's Social Protection Floors Recommendation No. 202 provides strong guidance on the implementation of the right to social security for all.

Suppressing Unfavorable Interfacial Reactions Using Polyanionic Oxides as Efficient Buffer Layers: Low-Cost Li3PO4 Coatings for Sulfide-Electrolyte-Based All-Solid-State Batteries.

The poor electrochemical performance of all solid-state batteries (ASSBs) that use sulfide electrolytes can be attributed to undesirable side reactions at the cathode/sulfide-electrolyte interface; this issue can be addressed via surface coating. Ternary oxides such as LiNbO3 and Li2ZrO3 are generally used as coating materials because of their high chemical stabilities and ionic conductivities. However, their relative high cost discourages their use in mass production. In this study, Li3PO4 was introduced as a coating material for ASSBs, because phosphates possess good chemical stabilities and ionic conductivities. Phosphates also prevent the exchange of S2- and O2- in the electrolyte and cathode and, thus, inhibit interfacial side reactions caused by ionic exchange, because they contain the same anion (O2-) and cation (P5+) species as those present in the cathode and sulfide electrolyte, respectively. Furthermore, the Li3PO4 coatings can be prepared using low-cost source materials such as polyphosphoric acid and lithium acetate. We investigated the electrochemical performance of the Li3PO4-coated cathodes and found that the Li3PO4 coating significantly improved the discharge capacities, rate capabilities, and cyclic performances of the all-solid-state cell. While the discharge capacity of the pristine cathode was ∼181 mAh·g-1, that of 0.15 wt % Li3PO4-coated cathode was ∼194-195 mAh·g-1. And the capacity retention of the Li3PO4-coated cathode over 50 cycles was much superior (∼84-85%) to that of the pristine sample (∼72%). Simultaneously, the Li3PO4 coating reduced the side reactions and interdiffusion at the cathode/sulfide-electrolyte interfaces. The results of this study demonstrate the potential of low-cost polyanionic oxides, such as Li3PO4, as commercial coating materials for ASSBs.

Erratum: Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea.

This corrects the article on p. 419 in vol. 34, PMID: 36478424.

Economic Burden of Recurrence in Completely Resected Stage IB-IIIA Non-Small Cell Lung Cancer: A Retrospective Study Using Nationwide Claims Data of South Korea.

INTRODUCTION: Although many patients with early stage non-small cell lung cancer (NSCLC) experience recurrence despite complete resection, few studies have reported on the corresponding economic burden. This study aimed to understand the economic impact of recurrence by measuring healthcare costs and resource utilization in patients with recurrent stage IB-IIIA NSCLC. METHODS: Using Health Insurance Review and Assessment claims data from South Korea, we included patients who underwent complete resection for stage IB-IIIA NSCLC during the index period (January 1, 2012, to October 31, 2018). Patients who experienced recurrence were matched with those who did not using 1:1 propensity score (PS) matching. The mean healthcare costs and resource utilization were analyzed from the date of complete resection to the last claims for cancer treatment. A generalized linear model (GLM) was used to estimate the impact of covariates on healthcare costs. A difference-in-difference (DID) analysis was conducted to analyze the healthcare costs between the two groups before and after recurrence. RESULTS: Patients with recurrence incurred higher healthcare costs, particularly in outpatient settings. The cost of targeted therapy and immune checkpoint inhibitors primarily contributed to cost differences, and medication costs increased over time after complete resection. Patients with recurrence were also hospitalized more frequently (9.3 vs. 5.0, p < 0.0001) for a longer period (74 days vs. 42 days, p < 0.0001) than those without recurrence. GLM analysis showed that the total cost was 2.31-fold higher in patients with recurrence (95% confidence interval: 2.19-2.44). The DID analysis showed significantly increased total costs in patients with recurrence (ß = 26,269, p < 0.0001), which was mostly attributed to medication costs (ß = 17,951, p < 0.0001). CONCLUSION: Recurrence of completely resected NSCLC leads to a substantial increase in healthcare costs and resource utilization. The results of this study show the economic burden of recurrence, which may help future economic analyses and resource allocation.

Assessment of Risk Factors Affecting Refractive Outcomes after Phacovitrectomy for Epiretinal Membrane.

PURPOSE: To investigate factors associated with refractive outcomes after phacovitrectomy for epiretinal membrane (ERM). METHODS: Retrospective review of patients undergoing phacovitrectomy for ERM was done. The main outcome measure was predictive refraction error (PE), defined as observed refraction error - target refraction error, calculated by the SRK/T, Haigis, and SRK II formulae. PE was measured at postoperative 1, 3, and 6 months. Simple and multiple linear regression analysis were used to evaluate factors associated with PE. RESULTS: A total of 53 eyes of 53 patients were included. The mean PEs at postoperative 1, 3, and 6 months were all negative, implying myopic shift in all patients regardless of the intraocular lens formula used. Haigis formula showed the least myopic shift among the three formulae (p = 0.001, Friedman test). There was no significant difference in PE depending on preoperative central macular thickness (CMT) in subgroup analysis. On stepwise multiple linear regression analysis, ERM etiology (ß = 0.759, p = 0.004, SRK/T formula; ß = 0.733, p = 0.008, Haigis formula; ß = 0.933, p < 0.001, SRK II formula), preoperative anterior chamber depth (ß = -0.662, p = 0.013, Haigis formula; ß = -0.747, p = 0.003, SRK II formula), and decrease of CMT (ß = -0.003, p = 0.025, SRK/T formula) were significantly associated with PE at postoperative 6 months. CONCLUSIONS: Myopic shift in PE was observed after combined phacovitrectomy for epiretinal membrane. ERM etiology, preoperative anterior chamber depth, and decrease of CMT were significantly associated with PE at postoperative 6 months. There was no difference in PE after surgery between the two groups defined by CMT (≥500 and <500 µm).

Assessment of Disease Severity and Quality of Life in Patients with Atopic Dermatitis from South Korea.

BACKGROUND: Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. OBJECTIVE: To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. METHODS: Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. RESULTS: Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7). The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30). Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. CONCLUSION: A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.

Economic burden of brain metastases in non-small cell lung cancer patients in South Korea: A retrospective cohort study using nationwide claims data.

Brain metastases (BM) are common in patients with non-small cell lung cancer (NSCLC). However, the pure economic burden of BM is unknown. This study aimed to evaluate the impact of BM on healthcare costs and resource utilization in patients with NSCLC by comparing patients with and without BM. This was a retrospective cohort analysis of South Korean health insurance review and assessment claims data. Patients with stage IIIB or IV NSCLC were identified (March 1, 2013 to February 28, 2018). We compared their two-year and per-patient-per-month (PPPM) healthcare costs and resource utilization with 1:3 propensity score-matched patients without the condition. A generalized linear model was used to estimate the impact of BM and other covariates on healthcare costs. After propensity score matching with the 33 402 newly diagnosed cases of stage IIIB or IV NSCLC, 3435 and 10 305 patients were classified as having or not having BM, respectively. Mean healthcare costs were significantly greater in patients with BM for both the two years (US$ 44 692 vs. US$ 32 230, p < .0001) and PPPM (US$ 3510 vs. US$ 2573, p < .0001). The length of hospital stay was longer in patients with BM (79.15 vs. 69.41 days for two years, p < .0001; 7.69 vs. 6.86 days PPPM, p < .0001), and patients with BM had more outpatient visits (50.61 vs. 46.43 times for two years, p < .0001; 3.64 vs. 3.40 times PPPM costs, p < .0001). The costs of drugs, radiology/radiotherapy, and admission comprised the majority of PPPM costs and were higher in patients with BM. The generalized linear model analysis suggested that patients with BM had significantly increased healthcare costs (by 1.29-fold, 95% confidence interval 1.26-1.32). BM is a significant economic burden for patients with NSCLC. Therefore, it is important to prevent BM in patients with NSCLC to reduce their economic burden.

A systematic review of economic evaluations of tyrosine kinase inhibitors for non-small cell lung cancer (NSCLC).

INTRODUCTION: Although tyrosine kinase inhibitors (TKIs) have improved the efficacy of treatment for non-small cell lung cancer (NSCLC), the accessibility of TKIs is limited due to high costs. Despite the critical role of the cost-effectiveness of TKIs on decision-making, no systematic reviews have compared the cost-effectiveness of comparable TKIs. Therefore, we systemically reviewed the economic evaluation studies on various TKIs for NSCLC. AREAS COVERED: We searched PubMed and the Cochran Library to identify the published economic evaluation studies of TKIs in NSCLC patients that were published by January 2022. All of the included studies (n = 38) evaluated the cost-effectiveness of epidermal growth factor receptor (EGFR)-TKIs (n = 29) or anaplastic lymphocyte kinase (ALK)-TKIs (n = 9). The cost-effectiveness results were reported as the incremental cost-effectiveness ratio per quality-adjusted life-year, except for three studies. EXPERT OPINION: We found that the economic evaluation studies of the first and second generation of EGFR-TKIs and ALK-TKIs varied by the country and study settings, such as comparator and input parameters. In 12 studies, osimertinib (EGFR-TKI) was not cost-effective compared to other first/second EGFR-TKIs, regardless of the study settings. More evidence can be provided about cost-effectiveness of the third-generation TKIs in future research.

Oncologic outcomes according to the level of disease burden in patients with metachronous distant metastases from uterine cervical cancer: a Korean Radiation Oncology Group study (KROG 18-10).

OBJECTIVE: This study aimed to evaluate the oncologic outcomes according to disease burden in uterine cervical cancer patients with metachronous distant metastases. METHODS: Between 2005 and 2015, 163 patients with metachronous distant metastases from uterine cervical cancer after receiving a definitive therapy were evaluated at seven institutions in Korea. Low metastatic burden was defined as less than 5 metastatic sites, whereas high metastatic burden was others. Each metastasis site was divided based on the lymph node (LN) and organs affected. The overall survival (OS) and progression-free survival (PFS) were assessed. Cox proportional hazards models, including other clinical variables, were used to evaluate the survival outcomes. RESULTS: The median follow-up duration was 22.2 months (range: 0.3-174.8 months). Para-aortic LNs (56.4%), lungs (26.4%), supraclavicular LNs (18.4%), and peritoneum (13.5%) were found to be the common metastasis sites. Among 37 patients with a single metastasis, 17 (45.9%) had LN metastases and 20 (54.1%) had organ metastases. The 1- and 2-year OS rates were 73.9% and 55.0%, respectively, whereas the PFS rates were 67.2% and 42.9%, respectively. SCC Ag after recurrence and high metastatic burden were significant factors affecting the OS (p=0.004 and p<0.001, respectively). Distant organ recurrence, short disease-free interval (≤2 years), and high metastatic burden were unfavorable factors for PFS (p=0.003, p=0.011, and p=0.002, respectively). CONCLUSION: A favorable oncologic outcome can be expected by performing salvage treatments in selected patients with a long disease-free interval, low metastatic burden, and/or lymphatic-only metastasis.

Asynchronous Control for Discrete-Time Hidden Markov Jump Power Systems.

In this article, the stabilization problem of discrete-time power systems subject to random abrupt changes is studied via asynchronous control. In this regard, the transient faults in the power lines, and subsequent switching of associated circuit breakers are modeled as a Markov chain. Based on this, the power systems are described as discrete-time Markov jump systems. The focus is mainly to design the control for Markov jump-based power systems (MJPSs) when modes of the control asynchronously run with the modes of power systems. To do this, a hidden Markov model technique is used to characterize the nonsynchronization between the control and system. By constructing the mode-dependent stochastic Lyapunov function, the sufficient conditions are acquired in the form of linear matrix inequalities (LMIs), which ensure not only the stochastic stability of the resulting hidden MJPSs but also the existence of the desired control. Finally, the simulation example reveals the efficiency of the designed control law.

A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments.

Background: The disease burden of active tuberculosis (TB) is considerable, but systematic reviews of economic evaluations of active TB treatments are scarce. Methods: PubMed, EMBASE, and the Cochrane Library databases were used to search for articles on cost-effectiveness analysis or cost-utility analysis that economically evaluated active TB treatments, which were then systematically reviewed by two independent reviewers. We extracted vital components of the included studies, such as country, population, intervention/comparator, primary outcome, values of outcomes, thresholds, model type, time horizon, and health states included in the model. Results: Seventeen studies were included in this systematic review. Thirteen dealt with interventions of medications, and the remaining four compared care strategies. The Markov model was the most commonly used tool to compare medications, whereas studies on care plans mainly used decision trees. The most commonly used primary outcome was disability-adjusted life years, followed by quality-adjusted life years. For treatment-naïve TB, the 4-month regimen was more cost-effective than the 6-month regimen mainly in low- and middle-income countries. For multidrug-resistant TB, a bedaquiline-based regimen was cost-effective. For multidrug-resistant TB, decentralized care that employed the use of home or mobile devices was more cost-effective than hospital-based centralized care in low- and middle-income countries. Conclusion: New treatment strategies to improve therapeutic outcomes by enhancing treatment adherence, such as regimens with shorter durations (2 or 4 months) and decentralized care, or new anti-TB agents (e.g., bedaquiline) have been suggested as cost-effective interventions for active TB. This review provides information on the economic evaluation of active TB from good-quality studies, thus aiding the future economic evaluation of active TB.

Long-term reliable physical health monitoring by sweat pore-inspired perforated electronic skins.

Electronic skins (e-skins)-electronic sensors mechanically compliant to human skin-have long been developed as an ideal electronic platform for noninvasive human health monitoring. For reliable physical health monitoring, the interface between the e-skin and human skin must be conformal and intact consistently. However, conventional e-skins cannot perfectly permeate sweat in normal day-to-day activities, resulting in degradation of the intimate interface over time and impeding stable physical sensing. Here, we present a sweat pore-inspired perforated e-skin that can effectively suppress sweat accumulation and allow inorganic sensors to obtain physical health information without malfunctioning. The auxetic dumbbell through-hole patterns in perforated e-skins lead to synergistic effects on physical properties including mechanical reliability, conformability, areal mass density, and adhesion to the skin. The perforated e-skin allows one to laminate onto the skin with consistent homeostasis, enabling multiple inorganic sensors on the skin to reliably monitor the wearer's health over a period of weeks.

Standalone real-time health monitoring patch based on a stretchable organic optoelectronic system.

Skin-like health care patches (SHPs) are next-generation health care gadgets that will enable seamless monitoring of biological signals in daily life. Skin-conformable sensors and a stretchable display are critical for the development of standalone SHPs that provide real-time information while alleviating privacy concerns related to wireless data transmission. However, the production of stretchable wearable displays with sufficient pixels to display this information remains challenging. Here, we report a standalone organic SHP that provides real-time heart rate information. The 15-µm-thick SHP comprises a stretchable organic light-emitting diode display and stretchable organic photoplethysmography (PPG) heart rate sensor on all-elastomer substrate and operates stably under 30% strain using a combination of stress relief layers and deformable micro-cracked interconnects that reduce the mechanical stress on the active optoelectronic components. This approach provides a rational strategy for high-resolution stretchable displays, enabling the production of ideal platforms for next-generation wearable health care electronics.

Effect of individuals' forecast for their children's economic environment and satisfaction with their relationships with children on their mortality.

AIM: The aim of this study is to evaluate if the risk of mortality among the elderly Korean individuals is associated with any of the two intergenerational variables: participants' forecast for their children's economic environment (FCEE) and participants' satisfaction with their relationship with their children (SRC). METHODS: Data from the Korean Longitudinal Study of Aging (KLoSA) conducted between 2006 and 2016 were examined. In total, 9937 individuals were included at baseline. The FCEE and SRC were measured using an 11-point Likert scale, which were stratified into four levels: "negative" (0-2), "Moderately negative" (3-5), "moderately positive" (6-8) and "positive" (9, 10). RESULTS: The Cox proportional hazards model was used to calculate hazard ratios of all-cause mortality across different levels of FCEE and SRC while adjusting for other bio-psycho-social variables. Post-hoc subgroup analyses were conducted to examine how potential confounders contribute to the associations found in our study. Multivariate analyses showed that individuals with more negative FCEE were associated with a greater risk of all-cause mortality. Compared with the "positive" FCEE group, the "negative" group showed a 30.6% increase risk of all-cause mortality (hazard ratio = 1.306, 95% confidence interval = 1.066-1.601, P = 0.010). CONCLUSION: The SRC did not exhibit any significant association with the all-cause mortality per multivariate analyses. More negative FCEE was associated with greater all-cause mortality. The FCEE, an individual's appraisal of the financial climate of their children's generation, may be considered a novel correlate of the all-cause mortality in an elderly population. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; 21: 568-576.

Current opinion on risk assessment of cosmetics.

Risk assessment of cosmetic ingredients is a useful scientific method to characterize potential adverse effects resulting from using cosmetics. The process of risk assessment consists of four steps: hazard identification, dose-response assessment, exposure assessment, and risk characterization. Hazard identification of chemicals refers to the initial stage of risk assessment and generally utilizes animal studies to evaluate toxicity. Since 2013, however, toxicity studies of cosmetic ingredients using animals have not been permitted in the EU and alternative toxicity test methods for animal studies have momentum to be developed for cosmetic ingredients. In this paper, we briefly review the alternative test methods that are available for cosmetic ingredients including read-across, in silico, in chemico, and invitro methods. In addition, new technologies such as omics and artificial intelligence (AI) have been discussed to expand or improve the knowledge and hazard identification of cosmetic ingredients. Aggregate exposure of cosmetic ingredients is another safety issue and methods for its improvement were reviewed. There have been concerns over the safety of nano-cosmetics for a long time, but the risk of nano-cosmetics remains unclear. Therefore, current issues of cosmetic risk assessment are discussed and expert opinion will be provided for the safety of cosmetics.

Effectiveness of Chin Tuck on Laryngeal Penetration: Quantitative Assessment.

The effectiveness of the chin tuck maneuver is still controversial, despite being widely used in clinical practice. The chin tuck maneuver has been shown to be able to reduce or eliminate aspiration in a group of patients with a number of favorable conditions, but its effectiveness in preventing or managing penetration remains unclear. This study was designed to investigate whether the chin tuck maneuver is effective in reducing penetration. Images from a videofluoroscopic swallowing study (VFSS) taken from 76 patients with penetration were collected and reviewed retrospectively. The severity of penetration was assessed by the penetration ratio (ratio of the penetration depth to the length of the epiglottis) measured and calculated from the images in which the deepest penetration was observed. The penetration ratio was significantly decreased in the chin tuck posture compared with the ratio in the neutral position (p = 0.001). Significant reducing effect was observed in 26 (34.2%) out of 76 patients. When comparing other parameters of VFSS, residues in the vallecular and pyriformis sinuses were less severe in the effective group. Chin tuck significantly decreased residues in both effective and ineffective group. The results demonstrate that the chin tuck maneuver can reduce penetration, but its effectiveness is limited.

Clinical assessment of an automated fluorescent plaque index scoring with quantitative light-induced fluorescence.

OBJECTIVE: The aims of this study were to evaluate the clinical applicability of a new fluorescent plaque index scoring (FPI) with the Turesky modified Quigley-Hein plaque index (mQH) and to evaluate its relationship with plaque maturity. METHODS: In total 69 subjects participated in this study. White-light and fluorescent images of anterior teeth were acquired using a Qraycam (AIOBIO, Seoul, Korea). FPI was obtained from fluorescent images using the proprietary software (Q-Ray v.1.39, Inspektor Research System BV, Amsterdam, The Netherlands). Teeth were stained with a two-tone disclosing agent. mQH was used to manually score the combined red and blue disclosed plaque (Combi-mQH) and blue disclosed plaque (Blue-mQH) with the white-light images. Linear relationships between FPI and Combi-mQH (or Blue-mQH) were evaluated by using simple linear regression analysis. Differences of Combi-mQH (or Blue-mQH) with respect to FPI scores were statistically evaluated by using ANOVA with Duncan post hoc correction. RESULTS: FPI showed a moderate positive correlation with Combi-mQH (r = 0.66, P < 0.001) and a high positive correlation with Blue-mQH (r = 0.78, P < 0.001). The model explanatory power (R2) between FPI and Blue-mQH was 60.8 %, which is 16.8 % higher than the explanatory power observed with Combi-mQH (44.0 %). Both Combi-mQH and Blue-mQH increased significantly with increasing FPI score (P < 0.001). CONCLUSION: In this study we found that the FPI scoring system can be used to detect plaque and quantitatively distinguish plaque levels. In addition, FPI was determined to be useful in clinic because of its ability to detect and distinguish old and mature plaque.

Choosing Wisely: The Korean Perspective and Launch of the 'Right Decision in Cancer Care' Initiative.

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide 'Right Decisions in Cancer Care' initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide 'Right Decision in Cancer Care' initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.