Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 119
Filtrar
1.
Ann Lab Med ; 42(1): 89-95, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34374353

RESUMO

Background: Total laboratory automation (TLA) is an innovation in laboratory technology; however, the high up-front costs restrict its widespread adoption. To examine whether the capital investment for TLA is worthwhile, we analyzed its clinical- and cost-effectiveness for the expected payback period. Methods: Clinical chemistry tests and immunoassays performed in the clinical laboratory of a tertiary care hospital were divided into a post-TLA group, including 1,182,419 tests performed during December 2019, and a pre-TLA group, including 1,151,501 tests performed during December 2018. Laboratory information system data were used to measure clinical effectiveness, and depreciation data were used to calculate TLA costs. Results: Laboratory performance improved after TLA adoption in all four key performance indicators: mean turn-around time (TAT), representing the timeliness of result reporting, decreased by 6.1%; the 99th percentile of TAT, representing the outlier rate, decreased by 13.3%; the TAT CV, representing predictability, decreased by 70.0%; and weighted tube touch moment (wTTM), representing staff safety, improved by 77.6%. Based on these effectiveness results, economic evaluation was performed using two approaches. First, the incremental cost-effectiveness ratio and wTTM were used as the most cost-effective performance indicators. Second, the expected payback period was calculated. Considering only staff cost reduction, it was anticipated that 4.75 yrs would be needed to payback the initial investment. Conclusions: TLA can significantly enhance laboratory performance, has a relatively quick payback period, and can reduce total hospital expenses in the long term. Therefore, the capital investment for TLA adoption is considered to be worthwhile.


Assuntos
Automação Laboratorial , Serviços de Laboratório Clínico , Análise Custo-Benefício , Humanos , Laboratórios , Centros de Atenção Terciária
2.
Int J Mol Sci ; 22(19)2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34638528

RESUMO

Dry and eczema-prone skin conditions such as atopic dermatitis and xerotic eczema primarily indicate an impaired skin barrier function, which leads to chronic pruritus. Here, we investigated the effects of a novel emollient containing H.ECMTM liposome, which contains a soluble proteoglycan in combination with hydrolyzed collagen and hyaluronic acid. A prospective, single-arm study was conducted on 25 participants with mild atopic dermatitis or dry skin to assess the hydration and anti-inflammatory effect of the novel emollient applied daily over four weeks. All efficacy parameters, including itching severity, transepidermal water loss, and skin hydration, improved significantly after four weeks. The in vitro and ex vivo studies confirmed the restoration of the skin's barrier function. The study revealed the clinical and laboratory efficacy of H.ECMTM liposome in reducing itching and improving the skin's barrier integrity. Thus, the use of H.ECMTM liposome can be considered a therapeutic option for dry and eczema-prone skin.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34444530

RESUMO

Previous studies have shown that the physical functioning of older adults directly affects their depressive symptoms, and suicide is also closely associated with depression. This study determined the effects of physical functioning on depressive symptoms and suicidal ideation among older Korean adults. This study used data from the 2017 National Survey of Older Persons. Among the 10,299 participants in the entire data set, 10,083 participants were analyzed, excluding 216 participants who did not respond to the dependent variables. Data analyses included frequency, chi-squared tests, and binary logistic regression. The results indicated that physical functioning among older adults was associated with reduced depressive symptoms and suicidal ideation. Compared to the group that had non-limited activities of daily living (ADL) function, the group with limitations was 1.66 times more likely to show depressive symptoms (OR: 1.66, 95% CI: 1.36-2.02). Similar trends were observed in instrumental activities of daily living (IADL) (OR: 1.85, 95% CI: 1.58-2.16). When suicidal ideation was set as a dependent variable, IADL had a statistically significant impact (OR: 1.41, 95% CI: 1.14-1.74); however, ADL did not seem to have an impact. Moreover, both ADL (OR: 1.62, 95% CI: 1.35-1.94) and IADL (OR: 1.72, 95% CI: 1.49-1.97) had statistically significant effects when combined with depressive symptoms and suicidal ideation. Better physical functioning was associated with a reduction in depressive symptoms and suicidal ideation. This study emphasizes the importance of physical functioning when examining older adults' mental health.


Assuntos
Depressão , Ideação Suicida , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Depressão/epidemiologia , Humanos , República da Coreia/epidemiologia , Fatores de Risco
4.
Nat Commun ; 12(1): 4669, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344873

RESUMO

Diseases are a manifestation of how thousands of proteins interact. In several diseases, such as cancer and Alzheimer's disease, proteome-wide disturbances in protein-protein interactions are caused by alterations to chaperome scaffolds termed epichaperomes. Epichaperome-directed chemical probes may be useful for detecting and reversing defective chaperomes. Here we provide structural, biochemical, and functional insights into the discovery of epichaperome probes, with a focus on their use in central nervous system diseases. We demonstrate on-target activity and kinetic selectivity of a radiolabeled epichaperome probe in both cells and mice, together with a proof-of-principle in human patients in an exploratory single group assignment diagnostic study (ClinicalTrials.gov Identifier: NCT03371420). The clinical study is designed to determine the pharmacokinetic parameters and the incidence of adverse events in patients receiving a single microdose of the radiolabeled probe administered by intravenous injection. In sum, we introduce a discovery platform for brain-directed chemical probes that specifically modulate epichaperomes and provide proof-of-principle applications in their use in the detection, quantification, and modulation of the target in complex biological systems.


Assuntos
Sistema Nervoso Central/metabolismo , Chaperonas Moleculares/metabolismo , Mapeamento de Interação de Proteínas/instrumentação , Proteoma/metabolismo , Animais , Biomarcadores Tumorais/metabolismo , Barreira Hematoencefálica/metabolismo , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Sistema Nervoso Central/efeitos dos fármacos , Glioblastoma/diagnóstico , Glioblastoma/metabolismo , Proteínas de Choque Térmico HSP90/antagonistas & inibidores , Proteínas de Choque Térmico HSP90/química , Proteínas de Choque Térmico HSP90/metabolismo , Humanos , Camundongos , Sondas Moleculares/química , Sondas Moleculares/farmacocinética , Sondas Moleculares/farmacologia , Sondas Moleculares/uso terapêutico , Tomografia por Emissão de Pósitrons
5.
Disabil Health J ; 14(4): 101127, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34134944

RESUMO

BACKGROUND: Evidence regarding the risk of coronavirus disease (COVID-19) and the major adverse clinical outcomes of COVID-19 among people with disabilities (PwDs) is scarce. OBJECTIVE: This study investigated the association of disability status with the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test positivity and the risk of major adverse clinical outcomes among participants who tested positive for SARS-CoV-2. METHODS: This study included all patients (n = 8070) who tested positive for SARS-CoV-2 and individuals without COVID-19 (n = 121,050) in South Korea from January 1 to May 30, 2020. The study variables included officially registered disability status from the government, SARS-CoV-2 test positivity, and major adverse clinical outcomes of COVID-19 (admission to the intensive care unit, invasive ventilation, or death). RESULTS: The study participants included 129,120 individuals (including 7261 PwDs), of whom 8070 (6.3%) tested positive for SARS-CoV-2. After adjusting for potential confounding factors, PwDs had an increased risk of SARS-CoV-2 test positivity compared with people without disabilities (odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.24-1.48). Among participants who tested positive for SARS-CoV-2, PwDs were associated with an increased risk of major adverse clinical outcomes from COVID-19 compared to those without disabilities (OR: 1.43, 95% CI: 1.11-1.86). CONCLUSIONS: PwDs had an increased risk of COVID-19 and major adverse clinical outcomes of COVID-19 compared with people without disabilities. Given the higher vulnerability of PwDs to COVID-19, tailored policy and management to protect against the risk of COVID-19 are required.


Assuntos
COVID-19 , Pessoas com Deficiência , Humanos , Razão de Chances , República da Coreia , SARS-CoV-2
6.
Int J Dermatol ; 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34105764

RESUMO

BACKGROUND: As the average life expectancy increases, skin aging and wrinkles due to photoaging have gained attention. Collagen is closely involved in the process of skin aging. Among the potential methods of drug delivery to the skin, oral disintegrating films show promise for their ability to bypass the loss of active components that is typical of drug absorption via oral administration. This study was conducted to investigate the effect of an oral disintegrating collagen film on skin aging. METHODS: We performed a prospective, single-arm study in a cohort of 22 women to assess the anti-aging effect of a novel oral disintegrating film containing collagen applied daily over a 12-week period. We measured the clinical indicators of skin integrity and performed immunofluorescence and high-performance liquid chromatography analyses of an ex vivo oral mucosa model to compare the absorption rates of collagen films and conventional oral tablets via the mucosa. RESULTS: We found that the oral disintegrating collagen film reduced skin wrinkle depth and number and significantly increased skin elasticity and density. CONCLUSIONS: The novel mode of delivery of collagen via oral disintegrating films has a clinically potential anti-aging efficacy and is safe and convenient for daily use.

7.
Environ Pollut ; 285: 117406, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34051564

RESUMO

Outdoor concentrations of particulate matter with an aerodynamic diameter of <2.5 µm (PM2.5) are often used as a surrogate for population exposure to PM2.5 in epidemiological studies. However, people spend most of their daily activities indoors; therefore, the relationship between indoor and outdoor PM2.5 concentrations should be considered in the estimation of population exposure to PM2.5. In this study, a population exposure model was developed to predict seasonal population exposure to PM2.5 in Seoul, Korea. The input data for the population exposure model comprised 3984 time-location patterns, outdoor PM2.5 concentrations, and the microenvironment-to-outdoor PM2.5 concentrations in seven microenvironments. A probabilistic approach was used to develop the Korea simulation exposure model. The determinants for the population exposure group were identified using a multinomial logistic regression analysis. Population exposure to PM2.5 varied significantly among the three seasons (p < 0.01). The mean ± standard deviation of population exposures to PM2.5 was 21.3 ± 4.0 µg/m3 in summer, 9.8 ± 2.7 µg/m3 in autumn, and 29.9 ± 10.6 µg/m3 in winter. Exposure to PM2.5 higher than 35 µg/m3 mainly occurred in winter. Gender, age, working hours, and health condition were identified as significant determinants in the exposure groups. An "unhealthy" health condition was the most significant determinant. The high PM2.5 exposure group was characterized as a higher proportion of males of a lower age with longer working hours. The population exposure model for PM2.5 could be used to implement effective interventions and evaluate the effectiveness of control policies to reduce exposure.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Exposição Ambiental/análise , Monitoramento Ambiental , Humanos , Masculino , Tamanho da Partícula , Material Particulado/análise , Estações do Ano , Seul
8.
Artigo em Inglês | MEDLINE | ID: mdl-33810096

RESUMO

No-show appointments waste resources and decrease the sustainability of care. This study is an attempt to evaluate patient no-shows based on modes of appointment-making and types of appointments. We collected hospital information system data and appointment data including characteristics of patients, service providers, and clinical visits over a three-month period (1 September 2018 to 30 November 2018), at a large tertiary hospital in Seoul, Korea. We used multivariate logistic regression analyses to identify the factors associated with no-shows (Model 1). We further assessed no-shows by including the interaction term ("modes of appointment-making" X "type of appointment") (Model 2). Among 1,252,127 appointments, the no-show rate was 6.12%. Among the modes of appointment-making, follow-up and online/telephone appointment were associated with higher odds of no-show compared to walk-in. Appointments for treatment and surgery had higher odds ratios of no-show compared to consultations. Tests for the interaction between the modes of appointment-making and type of appointment showed that follow-up for examination and online/telephone appointments for treatment and surgery had much higher odds ratios of no-shows. Other significant factors of no-shows include age, type of insurance, time of visit, lead time (time between scheduling and the appointment), type of visits, doctor's position, and major diagnosis. Our results suggest that future approaches for predicting and addressing no-show should also consider and analyze the impact of modes of appointment-making and type of appointment on the model of prediction.


Assuntos
Pacientes não Comparecentes , Agendamento de Consultas , Humanos , República da Coreia , Seul , Centros de Atenção Terciária
9.
Eur J Nucl Med Mol Imaging ; 48(8): 2642-2651, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33495926

RESUMO

PURPOSE: Peptide-based prostate-specific membrane antigen (PSMA) targeted radionuclide therapy (TRT) agent [177Lu]-PSMA-617 has emerged as leading TRT candidate for treatment of castration-resistant prostate cancer (mCRPC). [177Lu]-PSMA-617 and other small molecule-based PSMA ligands have shown efficacy in reducing the tumor burden in mCRPC patients but irradiation to the salivary gland and kidneys is a concern and dose-limiting factor. Therefore, methods to reduce non-target organ toxicity are needed to safely treat patients and preserve their quality of life. Herein, we report that addition of cold PSMA ligand PSMA-11 can aid in reducing the uptake of [177Lu]-PSMA-617 in the salivary glands and kidneys. METHODS: Groups of athymic nude mice (n = 4) bearing PC3-PIP (PSMA+) tumor xenografts were administered with [177Lu]-PSMA-617 along with 0, 5, 100, 500, 1000, and 2000 pmoles of PSMA-11 and biodistribution studies were performed at 1 h. RESULTS: Biodistribution studies at 1 h post-administration revealed that [177Lu]-PSMA-617 uptake in PC3-PIP tumors was 21.71 ± 6.13, 18.7 ± 2.03, 26.44 ± 2.94, 16.21 ± 3.5, 13.52 ± 3.68, and 12.03 ± 1.96 %ID/g when 0, 5, 100, 500, 1000, and 2000 pmoles of PSMA-11 were added, respectively. Corresponding uptake values in kidney were 123.14 ± 52.52, 132.31 ± 47.4, 84.29 ± 78.25, 2.12 ± 1.88, 1.16 ± 0.36, and 0.64 ± 0.23 %ID/g, respectively. Corresponding salivary gland uptake values were 0.48 ± 0.11, 0.45 ± 0.15, 0.38 ± 0.3, 0.08 ± 0.03, 0.09 ± 0.07, and 0.05 ± 0.02 % ID/g, respectively. CONCLUSION: The uptake of [177Lu]-PSMA-617 in the salivary gland and kidney can be substantially reduced without significantly impacting tumor uptake by adding cold PSMA-11.


Assuntos
Rim , Compostos Radiofarmacêuticos , Glândulas Salivares/metabolismo , Animais , Antígenos de Superfície/metabolismo , Glutamato Carboxipeptidase II/metabolismo , Compostos Heterocíclicos com 1 Anel/metabolismo , Humanos , Rim/metabolismo , Camundongos , Camundongos Nus , Qualidade de Vida , Compostos Radiofarmacêuticos/farmacocinética , Distribuição Tecidual
10.
J Nucl Med ; 62(4): 584-590, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32826318

RESUMO

With the successful development and increased use of targeted radionuclide therapy for treating cancer comes the increased risk of radiation injury to bone marrow-both direct suppression and stochastic effects, leading to neoplasia. Herein, we report a novel radioprotector drug, a liposomal formulation of γ-tocotrienol (GT3), or GT3-Nano for short, to mitigate bone marrow radiation damage during targeted radionuclide therapy. Methods: GT3 was loaded into liposomes using passive loading. 64Cu-GT3-Nano and 3H-GT3-Nano were synthesized to study the in vivo biodistribution profile of the liposome and GT3 individually. The radioprotection efficacy of GT3-Nano was assessed after acute 137Cs whole-body irradiation at a sublethal (4 Gy), a lethal (9 Gy), or a single high-dose administration of 153Sm-ethylenediamine-N,N,N',N'-tetrakis(methylene phosphonic acid) (EDTMP). Flow cytometry and fluorescence microscopy were used to analyze hematopoietic cell population dynamics and the cellular site of GT3-Nano localization in the spleen and bone marrow, respectively. Results: Bone marrow uptake and retention (percentage injected dose per gram of tissue) at 24 h was 6.98 ± 2.34 for 64Cu-GT3-Nano and 7.44 ± 2.52 for 3H-GT3-Nano. GT3-Nano administered 24 h before or after 4 Gy of total-body irradiation (TBI) promoted rapid and complete hematopoietic recovery, whereas recovery of controls stalled at 60%. GT3-Nano demonstrated dose-dependent radioprotection, achieving 90% survival at 50 mg/kg against lethal 9-Gy TBI. Flow cytometry of the bone marrow indicated that progenitor bone marrow cells MPP2 and CMP were upregulated in GT3-Nano-treated mice. Immunohistochemistry showed that GT3-Nano accumulates in CD105-positive sinusoid epithelial cells. Conclusion: GT3-Nano is highly effective in mitigating the marrow-suppressive effects of sublethal and lethal TBI in mice. GT3-Nano can facilitate rapid recovery of hematopoietic components in mice treated with the endoradiotherapeutic agent 153Sm-EDTMP.


Assuntos
Cromanos/administração & dosagem , Cromanos/farmacologia , Hematopoese/efeitos dos fármacos , Hematopoese/efeitos da radiação , Protetores contra Radiação/administração & dosagem , Protetores contra Radiação/farmacologia , Radioterapia/efeitos adversos , Vitamina E/análogos & derivados , Animais , Cromanos/farmacocinética , Lipossomos , Camundongos , Protetores contra Radiação/farmacocinética , Distribuição Tecidual , Vitamina E/administração & dosagem , Vitamina E/farmacocinética , Vitamina E/farmacologia
11.
J Korean Med Sci ; 35(39): e341, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33045770

RESUMO

BACKGROUND: The global disease burden of infertility is rising and accessibility to infertility treatments and assisted reproduction is a challenging issue. Therefore, we investigated characteristics of successful delivery after an infertility diagnosis among infertile women. METHODS: We designed a retrospective cohort study with the main outcome measure of a delivery medical record after the initial diagnosis of infertility. A total of 10,108 women patients who were diagnosed with infertility between 2005 to 2013 in the National Health Insurance Cooperation Cohort Database of Korea were enrolled. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent delivery were estimated by applying a Cox proportional-hazard regression model. RESULTS: Approximately 55% of infertile women who reported infertility had a delivery eventually. Infertile women who are aged between 30 to 39 (HR, 0.80; 95% CI, 0.75-0.84), in low income level (HR, 0.77; 95% CI, 0.71-0.84), or diagnosed with diabetes (HR, 0.76; 95% CI, 0.60-0.96) were less likely to report a delivery. CONCLUSION: These findings highlight demographic, socioeconomic, and medical characteristics of reporting a consequent delivery. Although many previous articles reported an association between socioeconomic status and receiving medical evaluation, there were few studies regarding successful delivery after an infertility diagnosis across socioeconomic status. Thus, the maintaining of support for low socioeconomic status infertile women and their family should be considered after the infertility diagnosis in aspects of financial and social approaches.

12.
Int J Qual Health Care ; 32(9): 569-576, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32797161

RESUMO

OBJECTIVES: The objective of this study was to identify the association between continuity of ambulatory psychiatric care after hospital discharge among psychiatric patients and readmission, mortality and suicide. DESIGN: Nationwide nested case-control study. SETTINGS: South Korea. PARTICIPANTS: Psychiatric inpatients. INTERVENTIONS: Continuity of psychiatric outpatient care was measured from the time of hospital discharge until readmission or death occurred, using the continuity of care index. MAIN OUTCOME MEASURES: Readmission, all-cause mortality and suicides within 1-year post-discharge. RESULTS: Of 18 702 psychiatric inpatients in the study, 8022 (42.9%) were readmitted, 355 (1.9%) died, and 108 (0.6%) died by suicide within 1 year after discharge. Compared with the psychiatric inpatients with a high continuity-of-care score, a significant increase in the readmission risk within 1 year after discharge was found in those with medium and low continuity of care scores. An increased risk of all-cause mortality within 1 year after hospital discharge was shown in the patients in the low continuity group, relative to those in the high-continuity group. The risk of suicide within 1 year after hospital discharge was higher in those with medium and low continuity of care than those with high continuity of care. CONCLUSION: The results of this study provide empirical evidence of the importance of continuity of care when designing policies to improve the quality of mental health care, such as increasing patient awareness of the importance of continuity and implementation of policies to promote continuity.

13.
Int J Geriatr Psychiatry ; 35(3): 282-289, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31859411

RESUMO

OBJECTIVES: The present study evaluated suicide risk within 1 year after discharge among older adults with stroke as a function of depression onset. METHOD: We used the Korean National Health Insurance Service-Senior cohort data and included first discharged patients with a stroke as the principal diagnosis. The comparison group was selected by a 1:2 case-control propensity score matching for age, sex, Charlson comorbidity index, and diagnosis year between 2005 and 2012. Suicide deaths were measured by code for causes of death from Statistics Korea, and the main outcome was suicide death within 1 year following discharge. An adjusted hazard ratio (AHR) of suicidal risk was measured using a Cox proportional hazard model. RESULTS: In the total sample of 128 286 older adults (aged 63-114 years), the higher suicidal risk was examined for stroke patients vs the comparison group (AHR = 1.4; 95% confidence interval [CI], 1.1-1.8). Stroke patients with depression had an increased suicide risk (AHR = 2.9; 95% CI, 1.8-4.8) but only for poststroke depression (AHR = 4.1; 95% CI, 1.8-9.5). Pre and poststroke depression suicidality (AHR = 4.8; 95% CI, 2.1-11.1) was also higher when compared to stroke patients without depression. CONCLUSIONS: Poststroke patients are at increased suicidal risk during 1 year following discharge. Furthermore, patients who were diagnosed with depression after a stroke are more likely to commit suicide than stroke patients without depression. This suggests a necessity for early suicide preventive intervention for stroke patients while considering depressive symptomology.


Assuntos
Suicídio , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
Food Chem ; 308: 125657, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-31669950

RESUMO

This study investigated the effects of drought stress on Chinese cabbage (Chcab) by measuring plant growth responses, total antioxidant enzyme activities, the contents of bioactive compounds including glucosinolates (GLS, aliphatic and indolic), and binding with human serum albumin (HSA). Forty-day-old Chinese cabbage (Brassica rapa L. ssp. pekinensis) seedlings were transplanted into pots and maintained for three weeks at 10% (drought-treated, D-T) and 30% (control, C) soil water. The total leaf number, leaf area, and fresh and dry weights were significantly lower in D-T Chcab than in controls. Total GLSs and catalase activities were found to be significantly higher in D-T Chcab than in controls. Indolic GLSs were significantly higher than aliphatic GLSs in D-T Chcab. These results show that D-T Chcab reduced growth parameters and binding properties with HSA and influenced total contents of GLSs, polyphenols, flavonoids, total antioxidant enzyme activities, catalase and peroxidase.


Assuntos
Antioxidantes/metabolismo , Brassica rapa/metabolismo , Secas , Glucosinolatos/análise , Flavonoides/metabolismo , Glucosinolatos/metabolismo , Polifenóis/metabolismo , Plântula/metabolismo , Estresse Fisiológico
15.
Cancer Res ; 80(5): 1219-1227, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31690670

RESUMO

Tissue survival responses to ionizing radiation are nonlinear with dose, rather yielding tissue-specific descending curves that impede straightforward analysis of biologic effects. Apoptotic cell death often occurs at low doses, while at clinically relevant intermediate doses, double-strand break misrepair yields mitotic death that determines outcome. As researchers frequently use a single low dose for experimentation, such strategies may inaccurately depict inherent tissue responses. Cutting edge radiobiology has adopted full dose survival profiling and devised mathematical algorithms to fit curves to observed data to generate highly reproducible numerical data that accurately define clinically relevant inherent radiosensitivities. Here, we established a protocol for irradiating organoids that delivers radiation profiles simulating the organ of origin. This technique yielded highly similar dose-survival curves of small and large intestinal crypts in vivo and their cognate organoids analyzed by the single-hit multi-target (SHMT) algorithm, outcomes reflecting the inherent radiation profile of their respective Lgr5+ stem cell populations. As this technological advance is quantitative, it will be useful for accurate evaluation of intestinal (patho)physiology and drug screening. SIGNIFICANCE: These findings establish standards for irradiating organoids that deliver radiation profiles that phenocopy the organ of origin.See related commentary by Muschel et al., p. 927.


Assuntos
Organoides , Células-Tronco , Intestinos , Tolerância a Radiação , Radiação Ionizante
16.
Healthcare (Basel) ; 8(1)2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31861601

RESUMO

Because the high-cost of medical imaging can cause a tremendous economic burden across the health care system, we investigated factors associated with taking additional computed tomography (CT) scans. Data of gastric cancer patients were eligible for analysis if the patient underwent a gastrectomy during the study period (2002-2013). We defined initial CT scans as those taken within 90 days from the surgery date. If there was an additional CT scan between the date of an initial CT scan and the surgery date, we regarded it as a reexamination. We used multivariate logistic regression analysis for reexamination CT scans. Among 3342 gastrectomy patients, 1165 participants underwent second CT scans. Transfer experience (adjusted odds ratio (OR) = 23.87, 95% confidence interval (CI) = 18.15-31.39) was associated with higher OR for reexamination. Among transferred patients, an increased number per 100 beds at the initial CT hospital was associated with a decreased OR for reexamination (OR = 0.88, 95% CI = 0.83-0.94), but increased beds in surgery hospitals was related to an increased OR for reexamination (OR = 1.29, 95% CI = 1.20-1.36). In our study, transfer experience, initial CT scan in a low-volume hospital, and surgical treatment in a high-volume hospital were associated with reexamination CT scans.

17.
Age Ageing ; 48(5): 636-642, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31268493

RESUMO

OBJECTIVES: despite the extensive literature on the effectiveness of cognitive training, its effectiveness has not been demonstrated within a population-based long-term care system. To provide cognitive training services to older people with mild dementia, Korea introduced a special dementia rating, as a long-term care grades, in the national long-term care insurance in July 2014. These services are only offered to those with the special dementia rating. This study evaluated the national long-term care insurance-funded cognitive function training programme for older people with mild dementia. METHODS: data were derived from the Korean National Health Insurance Elderly Cohort database between 2008 and 2015. We compared changes in function between the intervention (n = 352) and control (n = 1952) groups before (2014) and after (2015) introduction of the cognitive function training programme. Difference-in-differences analysis was performed, to compare changes in each score between the intervention and control groups before and after introduction of the cognitive function training programme. RESULTS: introduction of the cognitive function training programme was associated with significantly less cognitive function decline in the intervention group than in the control groups (ß = -3.39; standard errors [SE] = 1.14; P = 0.003). A subgroup analysis revealed that this effect increased in subjects in the youngest group, low income bracket, who had a primary caregiver, who were supported in multiple activities of daily living by the primary caregiver, or who were not living alone. CONCLUSIONS: introduction of the cognitive function training programme was associated with positive effects on cognitive function.


Assuntos
Atividades Cotidianas , Cognição/fisiologia , Demência/reabilitação , Seguro de Assistência de Longo Prazo/economia , Assistência de Longa Duração/métodos , Educação de Pacientes como Assunto/organização & administração , Avaliação de Programas e Projetos de Saúde , Idoso , Idoso de 80 Anos ou mais , Demência/economia , Demência/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos
18.
Eur J Cancer Care (Engl) ; 28(5): e13084, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31087439

RESUMO

OBJECTIVE: Cancer is a major cause of the burden of disease, and obesity is widely recognised one of the most important modifiable risk factor of cancer. Considering the economic impact of obesity and cancer, it is necessary to measure the economic burden of cancer attributable to excess body mass index (BMI). METHODS: This study used medical check-up sample cohort data of National Health Insurance Service (NHIS) claims and during 2002-2015. To estimate the costs (direct and indirect) according to obesity-related cancer sites, we performed a Cox proportional hazard model and cost of illness (COI) methods. RESULTS: Among male obesity-related cancer sites, the largest total costs caused by overweight or obesity were 5.5 trillion USD for liver cancer, 1.8 trillion USD for colorectal cancer and 1.6 trillion USD for kidney cancer. Among women, post-menopausal breast, liver and colorectal cancers had the largest total costs attributable to excess BMI (breast: 3.7 trillion USD, liver: 2.3 trillion USD, colorectal: 2.1 trillion USD). CONCLUSIONS: Approximately, 4.5% and 15.8% of total costs in obesity-related cancers can be reduced in men and women respectively. This study's findings highlight the importance of improved interventions, which can yield healthier lives and economic benefits beyond simply reducing cancer incidence and mortality.


Assuntos
Custos de Cuidados de Saúde , Neoplasias/economia , Obesidade/complicações , Adulto , Idoso , Neoplasias da Mama/economia , Neoplasias da Mama/etiologia , Estudos de Coortes , Neoplasias Colorretais/economia , Neoplasias Colorretais/etiologia , Custos e Análise de Custo , Feminino , Humanos , Neoplasias Renais/economia , Neoplasias Renais/etiologia , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/etiologia , Modelos de Riscos Proporcionais , República da Coreia
19.
Medicine (Baltimore) ; 98(20): e15353, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096434

RESUMO

Ischemic stroke, hemorrhagic stroke, and acute myocardial infarction (AMI) are diseases with golden hour. This study aimed to identify and compare factors that affect in-hospital mortality in patients with stroke and AMI who admitted via the emergency department.This study used the Korean National Health Insurance claims data from 2002 to 2013. The study sample included 7693 patients who had an ischemic stroke, 2828 patients who had a hemorrhagic stroke, and 4916 patients with AMI who were admitted via the emergency departments of a superior general hospital and general hospital, did not transfer to another hospital or come from another hospital, and were aged ≥20 years. This study was analyzed by using Cox's proportional hazards frailty model.Five hundred (6.5%) of 7693 patients with ischemic stroke, 569 (20.1%) of 2828 patients with hemorrhagic stroke, and 399 (8.1%) of 4916 patients with AMI were dead. The clinical factors were associated with in-hospital mortality such as age, CCI, hypertension, and diabetes of patient characteristics. In treatment characteristics, performing PCI and weekday admission was associated with in-hospital mortality (aHR, 0.43; 95% CI, 0.27-0.67; aHR, 1.42; 95% CI, 1.14-1.77, respectively). In hospital characteristics, the volume, the proportion of transferred patient to other hospital and ratio of beds per one nurse was associated with in-hospital mortality.Clinical factors of patient characteristics, intervention such as performing PCI and reducing ICP of treatment characteristics, and the volume, transferred rate, and the number of nurse of hospital characteristics were associated with in-hospital mortality.


Assuntos
Isquemia Encefálica/mortalidade , Mortalidade Hospitalar/tendências , Hemorragias Intracranianas/mortalidade , Infarto do Miocárdio/mortalidade , Qualidade da Assistência à Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/mortalidade , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Transferência de Pacientes , Intervenção Coronária Percutânea/métodos , Qualidade da Assistência à Saúde/tendências , República da Coreia/epidemiologia , Acidente Vascular Cerebral/epidemiologia
20.
Eur J Public Health ; 29(6): 1031-1036, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30778529

RESUMO

BACKGROUND: Severe maternal morbidity is an indicator for quality of maternal care. Recently, there has been growing interest in identifying which provision factors affect the quality of maternity care. The extent to off-hour delivery on SMM rates contributes to individual or provision factor in Korea has not been studied. This study aimed to determine the relationship between off-hour delivery and SMM during childbirth hospitalization. METHODS: This is a population-based retrospective cohort study. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 90 072 cases of delivery in Korea between 2003 and 2013. The main outcome was SMM which was determined using the Center for Disease Control and Prevention's algorithm. A generalized estimating equation model with log link was performed for the relationship with SMM and day/time of delivery adjusted covariates. RESULTS: Of the 90 072 delivery cases, 2085 (2.31%) had SMM. Women who were on weekdays at night time or on weekend delivery had a higher risk of SMM compared with those who were on weekdays at daytime (RR 1.26, 95% CI 1.10-1.46, and RR 1.58, 95% CI 1.30-1.93, respectively). CONCLUSION: Weekday at night time or weekend delivery was related to the risk of SMM. Policymakers should provide financial support and systematically allocate adequate human resources and labour facilities in vulnerable areas, as well as during weekends and night times to improve the quality of intrapartum and postpartum maternity care.


Assuntos
Plantão Médico , Saúde Materna/tendências , Morbidade/tendências , Adolescente , Adulto , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...