Reliability of digital repeated-scan superimposition and single-scan techniques for wear volume loss assessment on flat surfaces.

OBJECTIVES: Evidence on the reliability of digital techniques for wear volume assessment using three-dimensional (3D) scan datasets is scarce. This study evaluated the reliability of a repeated-scan superimposition technique and two single-scan techniques in assessing wear volume loss on flat surfaces of 3D-printed resin specimens. METHODS: Cuboid-shaped (15×10×10 mm) resin specimens were 3D-printed (n = 14) and scanned before and after 200,000 cycles of masticatory simulation. For the repeated-scan superimposition technique, digital 3D models of specimens before and after masticatory simulation were superimposed, and the volume loss was determined. The first single-scan technique utilized a computer-aided design freeware program, while the second one employed a 3D-metrology software program. In the freeware program, the worn area of 3D objects was edited directly to obtain a flat surface. In the 3D-metrology software program, the worn area was deleted first and then filled to the flat surface. The volume differences before and after editing were calculated in each software program. Agreement between the three measurement techniques was determined through intraclass correlation coefficients (ICCs). One-way analysis of variance was performed to compare the wear volume loss assessed by the three techniques (α = 0.05). RESULTS: High inter-technique reliability was observed between the three assessment techniques (ICC = 0.998, p < .001). On pair-wise comparisons of two of the three techniques, all pairs showed high consistency (ICC ≥ 0.999, p < .001). No significant difference was found in the wear volume loss assessed using the three techniques (p = .996). CONCLUSIONS: Digital repeated-scan superimposition and two single-scan techniques demonstrated high reliability in assessing wear volume loss on flat surfaces. CLINICAL SIGNIFICANCE: The repeated-scan superimposition technique can be effectively utilized to assess wear volume loss of anatomically shaped specimens and flat surfaces. This study indicates that the single-scan techniques may serve as a suitable alternative to the repeated-scan superimposition technique when evaluating wear volume loss of flat surfaces.

Influence of government-driven quality assessment program on patients with chronic obstructive pulmonary disease.

BACKGROUND: The Korean Health Insurance Review and Assessment Service (HIRA) has launched the Chronic Obstructive Pulmonary Disease (COPD) Quality Assessment Program (CQAP) since 2014. We aimed to reveal the influence of this national program on clinical outcomes and the burden of COPD in Korea. METHODS: The CQAP is conducted annually. We used healthcare claims data linked with the results of the program provided by HIRA between May 2014 and April 2017. Patients were considered to have COPD if they visited a hospital for COPD management during the assessment term. Those who visited a medical institution for COPD and were prescribed COPD medications at least twice were assessed by the CQAP (assessed subjects, AS; not-assessed subjects, NAS). CQAP evaluated the pulmonary function test conduction rate, regular visitation rate, and prescription rates of COPD medications. RESULTS: Among the 560,000 patients with COPD, about 140,000 were assessed by the CQAP annually. In both groups, the pulmonary function test conduction rate and inhaled bronchodilator prescription rate improved since 2014. Compared to the NAS group, the risk of admission and all-cause mortality rate in the AS group were significantly reduced by 21.2% and 40.7%, respectively. In patients who were assessed for 3 consecutive years, all of the above variables were high at baseline and were not improved much from implementation of CQAP. In matching analysis, we observed this improvement to be limited in the COPD quality assessment year. CONCLUSIONS: The CQAP by the health insurance bureau has improved the management protocol and prognosis of COPD.

Impact of the Asthma Quality Assessment Program on Burden of Asthma.

BACKGROUND: In 2013, the Korean Health Insurance Review and Assessment Service launched the Asthma Quality Assessment Program (AQAP) to assess whether patients with asthma were well managed. OBJECTIVE: To show the impact of the AQAP on the medical utilization behavior for asthma. METHODS: We used claims data linked with the results of the AQAP performed between July 2013 and June 2017. Asthma was determined when subjects visited hospital for asthma. Subjects who used asthma medications on at least 2 different occasions were assessed by the AQAP (assessed subjects [Ass]; not-assessed subjects [NASs]). The AQAP evaluated conduction rate of the pulmonary function test, routine visit rate, and prescription rate of asthma medications. Primary clinics were classified as "good" and "not-good" clinics according to the results of the AQAP. RESULTS: Of the 4.3 million subjects with asthma screened, about 0.8 million were assessed by the AQAP annually. Both the conduction rate of pulmonary function test and the prescription rate of inhaled corticosteroids in the ASs and NASs were improved. In addition, the risk of admission and yearly all-cause mortality were significantly reduced (risk reduction rate, 17.1 and 24.4%, respectively, both P < .001) in the AS group compared with the NAS group. However, effects of the AQAP varied according to the subgroup, and they were restricted to the assessment term. In addition, the admission rate and all-cause mortality were decreased by 94.7% and 45.3%, respectively, in "good" clinics as opposed to the "not-good" clinics. CONCLUSIONS: Performing the AQAP improved both the management protocol and prognosis of asthma in Korea.

Accurate assessment of alpha-gal syndrome using cetuximab and bovine thyroglobulin-specific IgE.

SCOPE: IgE against galactose-α-1,3-galactose (α-Gal) causes alpha-gal syndrome. Bovine thyroglobulin (BTG) and cetuximab share this epitope. We aimed to determine the utility of specific IgE (sIgE) against cetuximab as compared to BTG for diagnosing alpha-gal syndrome. METHODS AND RESULTS: Twelve patients with alpha-gal syndrome, 11 patients with immediate beef or pork allergy, 18 asymptomatic individuals with meat sensitization, and 10 non-atopic subjects were enrolled. We checked the levels of sIgE against BTG and cetuximab using the streptavidin CAP assay. Additionally, IgE reactivity to BTG and cetuximab was assessed by immunoblotting. All alpha-gal syndrome patients had a high concentration of sIgE against BTG, and cetuximab. In contrast to alpha-gal syndrome, patients with immediate allergic reactions to meat consumption and those with asymptomatic sensitization had significantly lower concentration of BTG and cetuximab sIgE, and a high prevalence of sIgE against bovine or porcine serum albumin. Although the concentration of sIgE against alpha-gal was lower in individuals with asymptomatic sensitization, IgE immunoblotting showed the presence of sIgE against α-Gal in this group. CONCLUSION: Differentiation of alpha-gal syndrome from patients with immediate allergy to meat consumption or asymptomatic sensitization requires quantification of cetuximab- or BTG-induced sIgE via detection of IgE for α-gal.

Alveolar macrophages play a key role in cockroach-induced allergic inflammation via TNF-α pathway.

The activity of the serine protease in the German cockroach allergen is important to the development of allergic disease. The protease-activated receptor (PAR)-2, which is expressed in numerous cell types in lung tissue, is known to mediate the cellular events caused by inhaled serine protease. Alveolar macrophages express PAR-2 and produce considerable amounts of tumor necrosis factor (TNF)-α. We determined whether the serine protease in German cockroach extract (GCE) enhances TNF-α production by alveolar macrophages through the PAR-2 pathway and whether the TNF-α production affects GCE-induced pulmonary inflammation. Effects of GCE on alveolar macrophages and TNF-α production were evaluated using in vitro MH-S and RAW264.6 cells and in vivo GCE-induced asthma models of BALB/c mice. GCE contained a large amount of serine protease. In the MH-S and RAW264.7 cells, GCE activated PAR-2 and thereby produced TNF-α. In the GCE-induced asthma model, intranasal administration of GCE increased airway hyperresponsiveness (AHR), inflammatory cell infiltration, productions of serum immunoglobulin E, interleukin (IL)-5, IL-13 and TNF-α production in alveolar macrophages. Blockade of serine proteases prevented the development of GCE induced allergic pathologies. TNF-α blockade also prevented the development of such asthma-like lesions. Depletion of alveolar macrophages reduced AHR and intracellular TNF-α level in pulmonary cell populations in the GCE-induced asthma model. These results suggest that serine protease from GCE affects asthma through an alveolar macrophage and TNF-α dependent manner, reflecting the close relation of innate and adaptive immune response in allergic asthma model.