Budget Impact of the Accreditation Program for Clinical Laboratories on Colorectal Cancer Screening via Fecal Immunochemical Testing: Results from the National Cancer Screening Program in Korea

BACKGROUND: False-positive fecal immunochemical test (FIT) results in the National Cancer Screening Program (NCSP) for colorectal cancer may lead to unnecessary procedures, such as colonoscopies, increasing the medical costs. We estimated reductions in the cost of National Health Insurance according to the accreditation status of screening facilities participating in the NCSP for colorectal cancer. METHODS: We used data collected between 2007 and 2010 from NCSP and the Korea Central Cancer Registry to identify patients with colorectal cancer. We also ascertained the history of the accreditation of each facility by the Korean Laboratory Accreditation Program (KLAP). Budget impact was defined as a reduction in medical costs achieved when the false-positive rate of the non-accredited facilities decreased relative to that of the accredited facilities. RESULTS: A total of 3,285 screening facilities participated in the NCSP. Of these, 196 were accredited by the KLAP. The false-positive rate of the accredited facilities was 2.47%, and that of the non-accredited facilities was 6.83%. Medical costs were estimated to be reduced by approximately 19 million US dollars (USD), and the cost of detecting one case of colorectal cancer was estimated to decrease from 9,212 USD to 7,332 USD if the false-positive rate of non-accredited facilities were decreased to that of the accredited facilities. Clinics were estimated to have the largest associated cost reduction. CONCLUSIONS: Quality assurance in clinical laboratories could lower false-positive rates and prevent the use of unnecessary procedures, ensuring patient safety and increasing the cost-effectiveness of FIT screening in the NCSP for colorectal cancer.

Clinical Characteristics of Chronic Headache Patients With Fibromyalgia: A Hospital-based Study

BACKGROUND: Fibromyalgia (FM) is a chronic diffuse pain syndrome of unknown etiology. FM is commonly associated with various neurological symptoms and signs including headache, non-restorative sleep, fatigue, and cognitive dysfunction. The purpose of this study is to investigate the clinical features of chronic daily headache patients with FM comorbidity. METHODS: Outpatients with chronic daily headache were recruited. FM was diagnosed on the basis of 2010 American College of Rheumatology criteria. We analyzed clinical features of the patients with FM and which general somatic symptoms were common in them. RESULTS: Of the 70 patients with chronic headache, 22 (about 31%) met the new ACR criteria of FM. Most of them were female, and their headache was likely to be tension type. Paresthesia, itching, and heartburn were significantly common in the headache patients with FM. CONCLUSIONS: Our study showed that a significant proportion of female patients with chronic tension type headache had chance to have FM. While taking history from patients with headache, neurologists should concern other somatic symptoms of FM as well as headache itself. Identification of FM in chronic headache patients may help more efficient treatment for the headache.

The Abnormality of Posterior Default Mode Network in Medication-Naive Attention-Deficit Hyperactivity Disorder Children : Resting State fMRI Study

OBJECTIVES: Characteristic symptoms, including hyperactivity and easy distractibility, in children with attention-deficit hyperactivity disorder (ADHD) suggest that their brain status, even at rest, might differ from that of healthy children. This study was conducted in order to determine whether resting state brain activity is compromised in medication-naive children with ADHD. METHODS: Twenty medication-naive children with ADHD (mean age 10.3+/-2.5) and 28 age- and gender-matched healthy volunteers (mean age 10.3+/-2.0) underwent measurements for resting state brain activity using functional magnetic resonance imaging (fMRI). Among resting state related-independent components (RSICs) extracted from fMRI data using independent component analysis, a significant difference in RSICs was observed between groups, using a mixed Gaussian/gamma model. RESULTS: Except for IQ, which was higher in the healthy control group, no demographic difference was observed between the two groups (p<.001). Significantly less activation of one RSIC, which includes the bilateral precuneus/posterior cingulate cortex, occipito-temporal junction, and anterior cingulate cortex, was observed in the ADHD group, compared with the control group (p<.05). CONCLUSION: An abnormal RSIC, posterior default mode network (DMN), was observed in the medication-naive ADHD group. Results of our study suggest that abnormality of posterior DMN is one of the main pathophysiologies of ADHD.

Clinical Usefulness of Alendronate for Osteoporosis in Postmenopausal women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the usefulness of alendronate for prevention and treatment of postmenopausal osteoporosis this study was taken. METHODS: This prospective randomized clinical trial examined the effects of oral alendronate and HRT(conjugated estrogen plus medroxyprogesterone acetate), in combination and seperately, on BMD, biochemical markers of bone turnover in 79 women with low bone mass. Treatment included alendronate(10mg daily) plus HRT(group I, n=38), or HRT(group II, n=41) for 6 months. Bone density measurements were performed at months 0 and 6 at the lumbar spine. Biochemical markers of bone turnover were also measured every three months. RESULTS: Serum Osteocalcin decreased by 19.2% in group I and by 10.0% in group II at 3 months(p<0.05), and by 30.9% in group I and by 19.8% in group II at 6 months(p<0.05). Urinary deoxypyridinoline showed decrease of 19.75%(I) vs. 10.4%(II) at 3 months, 30.1%(I) vs. 20.7%(II) at 6 months, the difference was significant. Percent change of BMD measurements from baseline at 6 months in group I was 6.2% and in group II 0.6% on the lumbar spine(p<0.05). CONCLUSION: The treatment with alendronate is useful to postmenopausal women with osteoporosis by decreasing bone turnover markers, and by increasing the BMD.

Localization and mRNA Expression of Angiogenin in Bovine Ovary / 대한해부학회지

Ovary is one of the organs in which angiogenesis occurs during ovarian cycle. Angiogenesis is associated with angiogenic factor like acidic fibroblast growth factor, basic fibroblast growth factor and transformation growth factor. Therefore, we performed this study to identify the distribution and mRNA expression of angiogenin, new potential angiogenic factor, in ovary of Korean native cattle by immunohistochemistry and in situ hybridization. Angiogenin immunoreactivity and mRNA expression were observed in endothelial cells, fibroblast and vascular smooth muscle cells. However, we could not observed angiogenin immunoreactivity and mRNA expression in primordial ovarian follicle. In follicular epithelial cells of primary ovarian follicle, weak angiogenin immunoreactivity and mRNA expression were observed. Follicular epithelial cells, theca interna and externa in secondary ovarian follicles, showed angiogenin immunoreactivity, while follicular epithelial cells did the weak mRNA expression. Angiogenin immunoreactivity and mRNA expression were observed in follicular epithlial cells, theca interna and oocyte in tertiary ovarian follicle. The corpus luteum showed strong immunoreactivity and mRNA expression but atretic follicle weak. However, these angiogenin immunoreactivity and mRNA expression became to be weaker during regression. These results suggest that angiogenin may play a role as not only an angiogenic factor but a growth factor in ovary.