Evaluation of diagnostic medical exposure in Republic of Korea.

National statistical data for diagnostic radiation exposure in Republic of Korea were collected from four public institutes and government agencies during the period 2006-2013. The data were pooled, reclassified and analysed. A total of 1574 million exposures occurred during the study period. To evaluate the effective diagnostic radiation exposure dose, the dose conversion factors developed by the Korea Food and Drug Administration were applied. The number of diagnostic radiation exposures was 197 million per year. The collective effective dose averaged 64 043 man Sv y(-1), and the annual per caput effective dose averaged 1.27 mSv. The annual per caput effective dose in 2013 was 1.54 mSv compared with 0.89 mSv in 2006, a marked increase of 73.9 % over the study period. These research data, compiled from reliable sources within the public health system of Republic of Korea, demonstrate a trend of increasing diagnostic radiation exposure and provide valuable information for further research.

Oncogenic potential of CK2α and its regulatory role in EGF-induced HDAC2 expression in human liver cancer.

Histone deacetylase 2 (HDAC2) is aberrantly regulated and plays a pivotal role in the development of hepatocellular carcinoma (HCC) through regulation of cell-cycle components at the transcriptional level, but the underlying mechanism leading to oncogenic HDAC2 remains unknown. In this study, we show that expression of CK2α (casein kinase II α subunit) was up-regulated in a large cohort of human HCC patients, and that high expression of CK2α was significantly associated with poor prognosis of HCC patients in terms of five-year overall survival. It was also found that CK2α over-expression positively correlated with HDAC2 over-expression in a subset of HCCs. We observed that treatment with epidermal growth factor (EGF) elicited an increase in CK2α expression and Akt phosphorylation, causing induction of HDAC2 expression in liver cancer cells. It was also observed that ectopic expression of dominant-negative CK2α blocked EGF-induced HDAC2 expression, and that ectopic CK2α expression attenuated the suppressive effect of Akt knockdown on HDAC2 expression in liver cancer cells. Targeted disruption of CK2α influenced the cell cycle, causing a significant increase in the number of liver cancer cells remaining in G2/M phase, and suppressed growth via repression of Cdc25c and cyclin B in liver cancer cells. Taken together, our findings suggest the oncogenic potential of CK2α in liver tumorigenesis. Furthermore, a regulatory mechanism for HDAC2 expression is proposed whereby EGF induces transcriptional activation of HDAC2 by CK2α/Akt activation in liver cancer cells. Therefore, this makes CK2α a promising target in cancer therapy.

Strengthening information capture in rehabilitation discharge summaries: an application of the Siebens Domain Management Model.

OBJECTIVE: To increase relevant information capture in inpatient rehabilitation discharge summaries. DESIGN: In July 2008, the Siebens Domain Management Model (SDMM) was incorporated into discharge summaries. This model organizes patients' health-related issues into 4 domains: I. Medical/Surgical Issues, II. Mental Status/Emotions/Coping, III. Physical Function, and IV. Living Environment (© Hilary C. Siebens MD 2005). Discharge summary content was measured through retrospective chart review. SETTING: An inpatient rehabilitation unit affiliated with a physical medicine and rehabilitation residency program. PARTICIPANTS: Forty cases with discharge summaries: 20 traditional reports (historic controls) and 20 SDMM reports after model introduction randomly chosen from residents' final inpatient rotation week. METHODS: A documentation review form included 36 items that covered the 4 SDMM domains and assessed item presence in reports. The Global score and 4 Domain scores per each patient report were calculated to reflect the percentage of items present in the entire report and each domain, respectively. Descriptive statistics for these scores were generated and compared between traditional and SDMM reports by using a 2-group t-test. MAIN OUTCOME MEASUREMENTS: Global scores and Domain scores. RESULTS: Global scores increased from 34% to 53% of items present in traditional versus SDMM reports respectively (P < .001); Domain Scores also increased in domains I (81% to 92%, P = .047), II (9% to 47%, P < .001), III (25% to 34%, P = .062), and IV (11% to 33%, P < .001). CONCLUSION: Traditional rehabilitation discharge summaries lacked information relevant to rehabilitation care. Information capture and total relevant report content increased significantly after SDMM integration into reports.

Organochlorine pesticides and polychlorinated biphenyls in Korean human milk: contamination levels and infant risk assessment.

The levels of persistent organic pollutants (POPs) were determined in 50 samples of Korean human milk. POPs include organochlorine pesticides (OCPs) [aldrin, chlordanes, dieldrin, dichlorodiphenyltrichloroethanes (DDTs), endrins, heptachlors, hexachlorobenzene (HCB), hexachlorocyclohexanes (HCHs), mirex, and toxaphenes] and marker PCBs (PCB28, PCB52, PCB101, PCB138, PCB153 and PCB180). In all samples, p,p'-DDE were determined as 75.5-1115.3 ng/g fat. The compounds ß-HCH and p,p'-DDT were detected at 72% and 60% of the samples, respectively. Chlordanes (nd-84.9 ng/g fat) heptachlors (nd-40.1 ng/g fat), HCB (nd-42.9 ng/g fat) and PCBs (nd-38.3 ng/g fat) were detected in several samples. The ratio of dichlorodiphenyltrichloroethylene (DDE)/DDT was 6.8, which explained that exposure of volunteers to DDT did not occur recently. Compared with the previous monitoring data, the level of marker PCBs generally decreased in the milk samples. The levels of OCPs are significantly correlated to the residential periods of the mothers but not with their dietary habits. Considering the daily intake of each OCPs, 18% of infants would ingest the amount of heptachlor exceeding the acceptable daily intake (ADI) proposed by World Health Organization (WHO). There was no sample surpassing the WHO ADI for DDTs, HCB and chlordanes.

In situ intestinal permeability and in vivo absorption characteristics of olmesartan medoxomil in self-microemulsifying drug delivery system.

To characterize the intestinal absorption behavior of olmesartan medoxomil (OLM) and to evaluate the absorption-improving potential of a self-microemulsifying drug delivery system (SMEDDS), we performed in situ single-pass intestinal perfusion (SPIP) and in vivo pharmacokinetic studies in rats. The SPIP study revealed that OLM is absorbed throughout whole intestinal regions, favoring proximal segments, at drug levels of 10-90 µM. The greatest value for effective permeability coefficient (P(eff)) was 11.4 × 10(-6) cm/s in the duodenum (90 µM); the lowest value was 2.9 × 10(-6) cm/s in the ileum (10 µM). A SMEDDS formulation consisting of Capryol 90, Labrasol, and Transcutol, which has a droplet size of 200 nm and self-dispersion time of 21 s, doubled upper intestinal permeability of OLM. The SMEDDS also improved oral bioavailability of OLM in vivo: a 2.7-fold increase in the area under the curve (AUC) with elevated maximum plasma concentration (C(max)) and shortened peak time (T(max)) compared to an OLM suspension. A strong correlation (r(2) = 0.955) was also found between the in situ jejunal P(eff) and the in vivo AUC values. Our study illustrates that the SMEDDS formulation holds great potential as an alternative to increased oral absorption of OLM.

Application of simplified Fuhrman grading system in clear-cell renal cell carcinoma.

OBJECTIVE: To investigate the efficacy of simplified (two- or three-tiered) Fuhrman grading systems as prognostic indicators in clear-cell renal cell carcinoma (RCC). PATIENTS AND METHODS: By reviewing records, various clinicopathological factors were assessed in 431 patients who received surgical management for clear-cell RCC. A conventional four-tiered Fuhrman grading system was compared with a modified two-tiered grading system (Fuhrman grades I and II were combined as one class, and grades III and IV as another) and also with a three-tiered grading system (only grades I and II were combined). Efficacies of grading systems were assessed via univariate analyses and multivariate models for prediction of cancer-specific survival. RESULTS: In univariate analysis, the four-tiered and three-tiered grading systems showed similar accuracies (76.5 vs 76.2%, P =0.614) for predicting cancer-specific survival, which were greater than that of the two-tiered system (72.5%; both P < 0.05). Of the three grading systems, only the three-tiered system was an independent predictor of cancer-specific survival in multivariate analysis (P = 0.046). When receiver operating characteristic-derived areas under the curve (AUCs) of multivariate models for predicting cancer-specific survivals were assessed, AUCs for models including the three-tiered Fuhrman grading system and the conventional four-tiered Fuhrman grading system were the same (95.3%), followed by that of a model incorporating the two-tiered grading system (95.1%). CONCLUSION: A modified, three-tiered Fuhrman grading system can be considered an appropriate option in the application of a nuclear grading system to the prognostication of clear-cell RCC in both univariate analysis and multivariate model setting.

Pharmacokinetic interaction between liquiritigenin (LQ) and DDB: increased glucuronidation of LQ in the liver possibly due to increased hepatic blood flow rate by DDB.

It has been reported that both liquiritigenin (LQ) and dimethyl-4,4'-dimethoxy-5,6,5',6'-dimethylenedioxybiphenyl-2,2'-dicarboxylate (DDB) have a hepatoprotective effect, and administration of both drugs together shows additive protective effect against acute liver injuries. Therefore, the pharmacokinetic interaction between LQ and DDB in rats was studied. LQ (20 and 50mg/kg for the i.v. and p.o. administration, respectively), DDB (10mg/kg for both i.v. and p.o. administration), and both drugs together were once administered intravenously or orally to rats. After the i.v. administration of both drugs together, the Cl(nr) and AUC of LQ were significantly faster (by 30.5%) and smaller (by 22.5%), respectively, than those of without DDB due to the faster hepatic blood flow rate by DDB. After the p.o. administration of both drugs together, the AUC of LQ was comparable to that of without DDB due to negligible effect of DDB on intestinal metabolism of LQ. The pharmacokinetic parameters of DDB after both i.v. and p.o. administration were not altered by LQ, indicating that LQ did not considerably affect the pharmacokinetics of DDB in rats.

Influence of detrusor overactivity on storage symptoms following potassium-titanyl-phosphate photoselective vaporization of the prostate.

OBJECTIVES: To investigate whether the presence of detrusor overactivity (DO) influences storage symptoms after photoselective laser vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH). METHODS: A total of 149 patients who underwent PVP were included in this retrospective study. All patients underwent a preoperative evaluation including multichannel video urodynamics. The efficacy of the PVP was assessed at 1, 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), uroflowmetry, postvoid residual urine volume, and 3-day frequency-volume charts (FVC). The patients were stratified into 2 groups (DO group vs non-DO group). RESULTS: The IPSS and FVC showed that the storage symptoms were reduced significantly after the PVP in both groups (P<.05). Starting from 6 months after the PVP, the DO group (n=39) showed a significantly greater reduction in the subtotal storage symptom score than the non-DO group (n=110). When the improvement of storage symptoms was defined as a reduction of >or=50% in the subtotal storage symptom scores, the percentage of patients with improvement in the storage symptoms at 1, 3, 6, and 12 months after the PVP was 13.9%, 25.9%, 47.8%, and 52.9% in the DO group, and 22.2%, 24.4%, 33.3%, and 33.3% in the non-DO group, respectively. CONCLUSIONS: Our results show that storage and voiding symptoms significantly improved after the PVP. In addition, we found that men with DO might show more improvement of storage symptoms, after the PVP, than men without DO.

Scanning laser-Doppler imaging of leg- and foot-skin perfusion in normal subjects: analysis of age, gender, site, and laser-type effects.

OBJECTIVES: To report normal values of skin perfusion in healthy subjects in three age groups using a laser Doppler imager; to determine differences attributable to gender, age, site, and use of red or near-infrared lasers; and to correlate transcutaneous oxygen with laser flux values. DESIGN: Flux and transcutaneous oxygen were measured at ten sites in the lower extremity in 60 subjects from three age groups. Heated and unheated sites were scanned with red and near-infrared lasers. RESULTS: Heat hyperemia was prominent at all sites. Small, statistically significant mean +/- SD differences were found between heated and nonheated sites for the red and near-infrared lasers (P = 0.02). All flux ratios were independent of gender but were higher in the oldest group. Plantar sites demonstrated higher flux in unheated areas and lower flux ratios compared with leg sites. Transcutaneous oxygen did not correlate significantly with flux for either laser type. CONCLUSIONS: Scanning laser-Doppler imaging flux values provide a reference for identifying patients at risk for tissue ischemia and poor healing potential caused by impaired circulatory reserve in the legs and distal feet. The lack of correlation between flux and transcutaneous oxygen in healthy individuals suggests that they measure different physiologic processes.