Asan Medical Information System for Healthcare Quality Improvement / 대한의료정보학회지

OBJECTIVES: This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. METHODS: Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. RESULTS: AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. CONCLUSIONS: AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

The Association of KLOTHO Gene Polymorphism with Serum Osteoprotegerin Levels in Maintenance Hemodialysis Patients / 대한신장학회지

PURPOSE: Klotho mutant mice showed abnormal calcium and vitamin D metabolism, hyperphosphatemia and vascular calcification. We observed the frequencies of klotho gene polymorphism and investigated their relation with some clinical parameters including serum osteoprotegerin (OPG) levels in maintenance hemodialysis (HD) patients. METHODS: Total 88 patients (mean age 58+/-13 years, male:female=47:41) on maintenance HD were enrolled. The genotypings for G-395A in promoter and C1818T in exon 4 of klotho gene were performed with real-time polymerase chain reaction. We measured blood pressure, body mass index (BMI), and serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase, hs-CRP, lipid profiles and OPG. RESULTS: In G-395A in promoter, the distribution of genotypes was GG 66% (n=58), GA 23% (n=20) and AA 11% (n=10), respectively and the allele frequencies were 0.773 for G allele and 0.227 for A allele. In C1818T in exon 4, the distribution of genotypes was CC 63% (n=55), CT 30% (n=26), and TT 7% (n=7), and the frequencies were 0.773 for C allele and 0.227 for T allele. G-395A shows correlations with BMI and HDL-cholesterol (p<0.005). G-395A and C1818T in klotho gene show no statistical correlation with other clinical parameters of vascular calcification including OPG. CONCLUSION: Klotho G-395A and C1818T polymorphisms are not correlated with OPG in maintenance HD patients. Further research needs for the other klotho polymorphisms on chronic kidney disease and end-stage renal disease.

The Reliability and the Validity of Health Related QOL Measurement Method in Hemodialysis Patients / 대한신장학회지

PURPOSE: It is necessary to confirm of the reliability and the validity of health-related quality of life (HRQOL) methods, because there could be some difference according to the underlying diseases, languages and cultures. METHODS: To assess the reliability, we did the test-retest by using the WHO-QOL (Korean version) and the SF-36 (Korean version) in the maintain hemodialysis (HD) patients (N=57). And then, we measured the Cronbach coefficient in the domains of both HRQOL methods. To assess the validity, we compared the result of both HRQOL methods in HD group with control group (N=60). We analyzed the inter-relationship of the domains which keep identical meanings in both methods. RESULT: 1. The test-retest showed high correlation between two tests, except the two domains of SF- 36 which are the role limitation-physical activity (RP) domain and the role limitation-emotion (RE) domain. The Cronbach coefficients are range of 0.749-0.862 in the WHO-QOL, and 0.666-0.944 in the SF-36 (p<0.05). 2. We found that HRQOL of HD group was lower than that of control group except in the RP domain and the RE domain of SF-36. And there was the highest correlation between the domains which keep identical meaning of both HRQOL methods. CONCLUSION: The Korean WHO-QOL and SF-36 are reliable and valid to measure the QOL of ESRD patients except in the RP domain and the RE domain of SF-36. We expect these methods will be used easily in the evaluation of the HRQOL in HD patients.

A case of acute renal failure associated with non-fulminant acute hepatitis A / 대한내과학회지

Acute hepatitis A is generally a mild, self-limiting disease of the liver. Acute renal failure is extremely rare in patients with acute non-fulminant hepatitis A. Acute tubular necrosis is the most common form of renal injury found in such patients. The 27 years old male patient visited our hospital with complaint of fatigue, nausea and vomiting. He was diagnosed with acute renal failure associated with acute non-fulminant hepatitis A. The renal biopsy demonstrates tubulointerstitial nephritis with focal tubular necrosis on light microscopy. We report here on a case of acute renal failure associated with non-fulminant hepatitis A, and we include a review of the literature.

A Case of Tuberous Sclerosis Complicated with Massive Bleeding of Renal Angiomyolipoma / 대한신장학회지

Tuberous sclerosis (TSC) is a systemic, autosomal dominant disorder resulting from mutations in one of two genes, TSC1 (encoding hamartin) or TSC2 (enconding tuberin). TSC causes seizure, mental retardation and hamartomatous tumors in multiple organs, including facial angiofibromas, cortical tubers, pulmonary lymphangiomatosis, renal angiomyolipomas and polycystic kidney disease. Renal angiomyofibromas may cause serious complications such as life threatening retroperitoneal hemorrhage or hematuria. The following is a report concerning a 41-year-old man with TSC who suffered spontaneous hemorrhage within the angiomyofibroma of the left kidney and underwent curative selective renal embolization. Then larger angiomyolipoma was suggested to be more likely to bleed, so secondary prophylactic selective renal embolization was done into five angiomyolipomas of the right kidney. After selective embolization, tumor size decreased and renal function was preserved. This patient did not show neurologic abnormality and family history of tuberous sclerosis. However, the brain magnetic resonance imaging revealed typical signs of tuberous sclerosis, and the computerized tomography of the abdomen showed bilateral renal angiomyolipomas and polycystic renal lesion. Herein we present a rare case of bilateral renal angiomyolipomas with spontaneous hemorrhage and preserved renal function after curative and prophylactic selective embolization.

The Relationship Between Serum Adiponectin Level and Serum Alanine Aminotransferase Elevation in Korean Male with Nonalcoholic Fatty Liver Disease / 대한간학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) comprises a large part of chronic liver diseases. Recently it was reported that adipokines are closely associated with the common risk factors for NAFLD, such as obesity, diabetes, dyslipidemia, and insulin resistance. We aimed to evaluate the changes in serum adiponectin, resistin and leptin concentrations related to alanine aminotransferase (ALT) elevations in Korean men with NAFLD. METHODS: We studies 38 men who were diagnosed with fatty liver by abdominal ultrasonography. None had a history of excessive alcohol consumption, autoimmune hepatitis, inherited or metabolic liver disease or viral hepatitis. The subjects were divided into two groups. One group had normal levels of ALT (n=28) and the other had increased ALT (n=10). We compared anthropometrical parameters, biochemical items and serum adipokine levels between these two groups. RESULTS: Serum adiponectin levels were lower in the increased ALT group than in the normal ALT group (3.89 +/- 1.77 vs 7.01 +/- 2.54 microgram/dL, P=0.001). But there were no significant differences in serum leptin and resistin levels between two groups (4.02 +/- 2.04 vs 3.26 +/- 1.41 ng/mL, p=0.245, 80.14 +/- 14.8 vs 80.5 +/- 11.34 ng/mL, P=0.937, respectively). Multiple linear regression analyses demonstrated that the serum adiponectin level is inversely correlated with serum ALT level and that the serum aspartate aminotransferase (AST) level is positively correlated with the serum ALT level. CONCLUSIONS: Our study shows that hypoadiponectinemia is associated with an ALT elevation in patients with NAFLD. Adiponectin may play an indirect role in the development of NAFLD.

Evaluation of Glomerular Filtration Rate by Prediction Equation in the Elderly / 대한신장학회잡지

BACKGROUND: The glomerular filtration rate (GFR) is considered the best overall index for the level of renal function and is estimated commonly by the creatinine-based, Cockcroft-Gault (CG) equation or the Modification of Diet Disease Study (MDRD) equation indirectly. Recently, cystatin C has been reported as a new endogenous marker of GFR. To predict the decrease of renal function in the elderly, we measured standard GFR (EDTA-GFR) by (51)Cr- EDTA and attempted to compare the result with CG, MDRD, and cystatin C equation for accuracy. METHODS: Sixty-three elderly persons (28 men, 35 women:mean age 70, range 65-78) who underwent health screening, were measured for plasma creatinine, cystatin C and EDTA-GFR. RESULTS: The CG and MDRD equations performed better than the cystatin C equation with an accuracy of within 30% (68 and 67%, respectively, versus 37%) and 50% (98 and 94%, respectively, versus 72%) of EDTA-GFR. The coefficient of determination (R2) of each estimated equation was 0.08 (p=0.03) in CG, 0.06 (p=0.04) in MDRD, and 0.07 (p=0.04) in cystatin C equation. Analysis of ROC curves with EDTA-GFR 60 mL/min/1.73m2 showed that each estimated equation was inadequate for the diagnosis of chronic kidney disease (sensitivity and specificity, 73% and 65% in CG, and 68% and 65% in MDRD, respectively). CONCLUSION: In the elderly, CG or MDRD equation was more accurate than cystatin C equation. Nevertheless, problems remain in the assessment of GFR using these equations and caution is particularly necessary in the diagnosis of chronic kidney disease with calculated estimates of GFR<60 mL/ min/1.73m2 in the elderly.

Evaluation of Glomerular Filtration Rate by Prediction Equation in the Elderly / 대한신장학회잡지

BACKGROUND: The glomerular filtration rate (GFR) is considered the best overall index for the level of renal function and is estimated commonly by the creatinine-based, Cockcroft-Gault (CG) equation or the Modification of Diet Disease Study (MDRD) equation indirectly. Recently, cystatin C has been reported as a new endogenous marker of GFR. To predict the decrease of renal function in the elderly, we measured standard GFR (EDTA-GFR) by (51)Cr- EDTA and attempted to compare the result with CG, MDRD, and cystatin C equation for accuracy. METHODS: Sixty-three elderly persons (28 men, 35 women:mean age 70, range 65-78) who underwent health screening, were measured for plasma creatinine, cystatin C and EDTA-GFR. RESULTS: The CG and MDRD equations performed better than the cystatin C equation with an accuracy of within 30% (68 and 67%, respectively, versus 37%) and 50% (98 and 94%, respectively, versus 72%) of EDTA-GFR. The coefficient of determination (R2) of each estimated equation was 0.08 (p=0.03) in CG, 0.06 (p=0.04) in MDRD, and 0.07 (p=0.04) in cystatin C equation. Analysis of ROC curves with EDTA-GFR 60 mL/min/1.73m2 showed that each estimated equation was inadequate for the diagnosis of chronic kidney disease (sensitivity and specificity, 73% and 65% in CG, and 68% and 65% in MDRD, respectively). CONCLUSION: In the elderly, CG or MDRD equation was more accurate than cystatin C equation. Nevertheless, problems remain in the assessment of GFR using these equations and caution is particularly necessary in the diagnosis of chronic kidney disease with calculated estimates of GFR<60 mL/ min/1.73m2 in the elderly.

Serum C-Reactive Protein Level and its Association with Atrial Fibrillation in Korean Adults

BACKGROUND AND OBJECTIVES: Recent studies have implicated inflammation as playing an important role in the occurrence, persistence and recurrence of atrial fibrillation and that C-reactive protein is a useful marker of the inflammation. The purpose of this study is to evaluate the association between serum CRP levels and the risk of atrial fibrillation. SUBJECTS AND METHODS: This study was performed on 9,487 subjects (5,263 men and 4,224 women; mean age: 58.8+/-6.6 years) who underwent medical check-ups at the Health Promotion Center in Kanbuk Samsung Hospital. 9,438 normal control subjects and 49 atrial fibrillation patients were included in the study. The CRP was measured using a highly sensitive Behring Nephelometer II. RESULTS: When comparing the two groups, there were significant differences in age, gender and the presence of hypertension and cerebrovascular accident, and these are the previously known risk factors for atrial fibrillation. After adjustment was made for the clinical significant variables of atrial fibrillation, multiple regression analysis revealed that the hsCRP levels were not associated with the risk for atrial fibrillation (p=0.52). CONCLUSION: The inflammatory markers (CRP, WBC count) were not predictive of a higher risk for atrial fibrillation in the Korean population.

The Relative Effects of Obesity and Insulin Resistance on Cardiovascular Risk Factors in Nondiabetic and Normotensive Men

BACKGROUND: Several reports have documented that Asians have a strong tendency to develop insulin resistance. The aims of this study were to evaluate the relative effects of insulin resistance and obesity on the risk factors for coronary heart disease (CHD) and to clarify whether insulin resistance accentuates these effects in apparently healthy men. METHODS: We conducted a cross sectional survey on 4, 067 apparently healthy Korean men, aged between 20 and 83 years, with body mass indices (BMI) ranging from 15.19 to 40.29 kg/m2. The presence of insulin resistance was defined as a homeostasis model assessment (HOMA-IR) value > 2.23, which is the cutoff for the highest decile in the normal BMI group (BMI or=25 kg/m2; 1, 370 subjects). The BMI was identified as the major determinant for total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), and waist circumference (WC) as the most important for apolipoprotein B (Apo B), systolic and diastolic blood pressures and C-reactive protein (CRP), and HOMA-IR as the most important for fasting blood sugar, triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (Apo A-I) and TC/HDL ratio. The presence of insulin resistance was found to accentuate the risk factors for CHD, with the exception of LDL-C and Apo A-I in the obese. CONCLUSION: WC and HOMA-IR were found to be closely associated with non-traditional markers for CHD, such as high Apo B, hypertriglyceridaemia and the TC/HDL-C ratio, which are predictors for the presence of small, dense LDL particles. The insulin resistance among obese men was more prevalent than expected, and the presence of insulin resistance accentuates the effect of obesity in terms of the risk of CHD.

Obesity and insulin resistance in apparently healthy Korean men / 대한내과학회지

BACKGROUND: Several reports document Asians have a strong tendency of developing insulin resistance. We aimed to evaluate the relative effects of insulin resistance and obesity on coronary heart disease (CHD) risk factors and to clarify whether insulin resistance accentuates the effect of obesity on CHD risk factors in apparently healthy men. METHODS: We conducted the cross-sectional survey of 4,067 apparently healthy Korean men aged 20-83 years, with a body mass index (BMI) ranging from 15.19 to 40.29 kgm-2. Insulin resistance was defined as the highest decile of homeostasis model assessment (HOMA-IR) in the lean group (BMI<23 kgm-2; 1,438 subjects). RESULTS: The prevalence of insulin resistance was 24.7% in the overweight subgroup (23