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Understanding the Utilization of Tertiary Hospitals by Mild Disease Patients: Travel Cost Method Analysis
No full textPURPOSE: Tertiary hospital utilization for patients with mild diseases creates inefficiencies in medical utilization for medical consumers and providers, collapses the healthcare delivery system, and has negative consequences for the public health system. This study aims to identify the factors that lead to the selection of tertiary hospitals and the medical needs of patients with mild diseases. We evaluate the value of using medical institutions by comparing and analyzing regional and individual patient characteristics. METHODS: The travel cost method based on the travel cost incurred according to the consumer's temporal choice, was used to evaluate the medical use. We considered data from Ajou University Hospital from 2017 to 2022. The variables used for travel costs are travel costs, time costs, and medical costs. The Quantum Geographic Information System(QGIS) network analysis was used to calculate travel costs and time costs, and independent sample t-tests and analysis of variance (ANOVA) were used to compare the evaluated values between groups. RESULTS: The analysis revealed that travel costs were the highest for patients with diabetes. Regarding personal characteristics, men exhibited higher rates than women, and individuals under 65 years of age and those receiving type 2 medical benefits demonstrated higher travel costs. Travel costs and outpatient visit rates for mild diseases exhibited a direct proportional relationship. We compared the total economic value assessed for each type of mild disease and found the highest value for diabetes patients with the highest number of outpatient visits. CONCLUSION: These findings highlight the importance of incorporating patient segmentation into policy formulation to alleviate the overcrowding of patients with mild diseases in tertiary care hospitals. Furthermore, they advocate adopting a primary care-centered approach to enhance the healthcare delivery system and address imbalances in community healthcare resources
Targeted inhibition of Ninjurin2 promotes chemosensitivity in chemoresistant gastric cancer by suppressing cancer-initiating cells
No full textBACKGROUND: The combination of epirubicin, cisplatin, and 5-fluorouracil (ECF) is widely used for gastric cancer treatment. However, cancer cells can acquire chemoresistance over multiple treatment cycles, leading to recurrence. This study aimed to investigate a novel biomarker for predicting ECF resistance and its biological roles in gastric cancer. METHODS: ECF-resistant (ECF-R) gastric cancer cell lines were established through stepwise ECF treatment. Transcriptome analysis was performed to identify resistance-related genes, which were validated in tumor organoids and in vivo models. Additionally, gastric cancer patient tumor tissues were analyzed for clinical relevance. RESULTS: Transcriptome analysis revealed that NINJURIN2 and CD44 were highly expressed in ECF-R cells but rarely expressed in normal gastric tissues. NINJURIN2 inhibition significantly increased chemosensitivity to ECF in vitro and in vivo. Liquid chromatography-tandem mass spectrometry identified periostin as a binding partner of NINJURIN2, mediating chemoresistance. Furthermore, VAV2 phosphorylation was markedly upregulated in ECF-R cells but was inhibited by NINJURIN2 knockdown. Clinical analysis showed that high NINJURIN2 expression correlated with poor survival outcomes in gastric cancer patients. CONCLUSION: Our findings suggest that NINJURIN2 can be used as a novel biomarker for chemoresistant gastric cancer patients and that inhibiting NINJURIN2 along with standard chemotherapy could prevent chemoresistance-associated relapse in gastric cancer
Real-World Effectiveness and Safety of Mepolizumab in Severe Eosinophilic Asthma: Insights From the Korean Severe Asthma Registry (KoSAR)
No full textMepolizumab, an interleukin-5 antagonist, is globally recognized for its efficacy in randomized controlled trials for the treatment of severe eosinophilic asthma. The present study explored its real-world effectiveness and safety in a Korean cohort, filling a critical gap in current research. This multi-center retrospective study used data from the Korean Severe Asthma Registry, involving 67 patients treated with mepolizumab for uncontrolled severe asthma between September 2017 and July 2022. We assessed the effects of treatment on acute exacerbations, oral corticosteroid (OCS) maintenance dose, lung function, and quality of life. The notable findings included a marked reduction in the proportion of patients experiencing acute exacerbations, with 73.0% of patients reporting no exacerbations during the 6-month treatment period. At baseline, 31.8% of patients had reported no exacerbations over the prior 12 months. The OCS maintenance doses also decreased substantially, with only 3.2% of patients requiring OCS after 6 months. Additionally, there was an improvement in lung function. No severe adverse reactions were reported in this study, highlighting the safety of mepolizumab. This study confirmed that mepolizumab reduced exacerbations and OCS use, with additional improvements seen in asthma control, lung function, and patient-reported quality of life. These real-world findings support broader applications and reinforce the need for further research to optimize treatment strategies. Despite certain limitations, such as the small sample size and retrospective design, this study significantly contributes to the understanding of the real-world efficacy and safety of mepolizumab
Phase 2 trial of avelumab in combination with gemcitabine in advanced leiomyosarcoma as a second-line treatment (EAGLES, Korean Cancer Study Group UN18-09)
No full textBackground: In this single-arm, multicenter, phase 2 trial, the authors evaluated the efficacy and safety of avelumab plus gemcitabine in patients with leiomyosarcoma (LMS) who failed on first-line chemotherapy. Methods: Patients with advanced LMS received avelumab 10 mg/kg on days 1 and 15 (for up to 24 months) plus gemcitabine 1000 mg/m2 on days 1, 8, and 15 of a 28-day cycle until they developed disease progression or intolerable toxicity. The primary end point was the objective response rate (ORR). Results: In total, 38 patients were enrolled. Of these, 35 patients were evaluable, and the ORR was 20% (95% confidence interval; [CI], 8%–37%). The disease control rate was 71%, and the median duration of response was 21.8 months (range, 7.6 to ≥43.3 months). The median progression free-survival was 5.6 months (95% CI, 4.5–6.8 months), and the median overall survival was 27.5 months (95% CI, 20.4–34.6 months). Grade 3–4 adverse events occurred in 70% of patients, of which neutropenia was the most common (54%). Immune-mediated adverse events occurred in five patients (14%; hypothyroidism, n = 3; hepatitis, n = 2). Patients who had a higher density of tumor-infiltrating lymphocytes (greater than the median) exhibited better ORR (35% vs. 8%; p =.104), progression-free survival (median, 7.3 vs. 3.3 months; p =.024), and overall survival (median, not reached vs. 21.5 months; p =.027). Conclusions: The combination of avelumab and gemcitabine demonstrated promising efficacy and manageable safety in patients with advanced LMS who progressed on first-line therapy. Tumor-infiltrating lymphocyte density may be an important factor in predicting the response to combining immunotherapy with chemotherapy
Cost burden of productivity loss due to sickness presenteeism among nurses in South Korea: A cross-sectional study
No full textAim: This study aimed to estimate the annual cost burden of productivity loss due to sickness presenteeism among hospital nurses in South Korea. Background: Despite nurses being potentially more vulnerable to presenteeism, few studies have analyzed nurses’ productivity losses due to sickness presenteeism. Methods: This cross-sectional study employed an online survey in January 2023 with 607 nurses working in general/tertiary hospitals in South Korea. The annual cost burden of productivity loss due to sickness presenteeism was calculated based on nurse health conditions, productivity loss, the number of days worked while sick, and income. This study was reported according to the STROBE checklist. Results: Overall, 93.2% of participants (n = 566) reported at least one health condition, and musculoskeletal diseases were the most prevalent, followed by weariness or fatigue, and sleep-related problems. Approximately 63.9% of participants reported experiencing sickness presenteeism in the preceding four weeks. Those in the severe multimorbidity group exhibited the highest prevalence of sickness presenteeism and productivity loss. The average annual cost of productivity loss due to sickness presenteeism was USD 2,388.26 per nurse and USD 382.11 million at the national level. Discussion: The cost of sickness presenteeism is high among hospital nurses in South Korea. Nurses with severe multimorbidity engaged in more sickness presenteeism and had higher productivity losses than nurses who were relatively healthy or exhibited moderate multimorbidity. Conclusion: These findings support the need for stakeholders to develop strategies/policies to better address nurses’ health conditions, secure better staffing, and reduce sickness presenteeism. Implications for nursing policy: Addressing this issue will not only improve nurse well-being and patient care but also lead to substantial cost savings for healthcare facilities. Additionally, the study findings can inform future cost-effectiveness studies
The antipsychotic chlorpromazine reduces neuroinflammation by inhibiting microglial voltage-gated potassium channels
No full textNeuroinflammation, the result of microglial activation, is associated with the pathogenesis of a wide range of psychiatric and neurological disorders. Recently, chlorpromazine (CPZ), a dopaminergic D2 receptor antagonist and schizophrenia therapy, was proposed to exert antiinflammatory effects in the central nervous system. Here, we report that the expression of Kv1.3 channel, which is abundant in T cells, is upregulated in microglia upon infection, and that CPZ specifically inhibits these channels to reduce neuroinflammation. In the mouse medial prefrontal cortex, we show that CPZ lessens Kv1.3 channel activity and reduces proinflammatory cytokine production. In mice treated with LPS, we found that CPZ was capable of alleviating both neuroinflammation and depression-like behavior. Our findings suggest that CPZ acts as a microglial Kv1.3 channel inhibitor and neuroinflammation modulator, thereby exerting therapeutic effects in neuroinflammatory psychiatric/neurological disorders
Systematic construction of composite radiation therapy dataset using automated data pipeline for prognosis prediction
No full textBackground: Existing research on medical data has primarily focused on single time-points or single-modality data. This study aims to collect all data generated during radiotherapy comprehensively to improve the treatment and prognosis of patients with malignant tumors. Methods: The data collected from each medical institution were transmitted to the lead organization, where they underwent a file integrity check and were processed using a data pipeline. The key metadata of the collected data were compiled into a database, which were examined by data analysts to identify outliers based on theoretical and institution-specific characteristics. Appropriate filters were applied and the filtered data were subsequently reviewed by artificial intelligence (AI)-based models and researchers for radiotherapy organ slides. Finally, they were annotated by specialists. Results: The final dataset included 30,136 three-dimensional cone-beam computed tomography scans and 5,019 tabular data entries collected from 5,019 patients. It comprised 2,043,162 Digital Imaging and Communications in Medicine-format files with a total file size of 832 GB. Quality verification of the data using AI models revealed high classification performance for most organs, with relatively poor performance for the rectum. Overall, the macro AUROC value was 0.947. Conclusions: This study implemented an automated data pipeline and AI-based verification to enhance the quality of collected radiotherapy data. The constructed dataset can be utilized for various types of future research and is expected to contribute to the improvement of radiotherapy efficiency
Establishing cutoff values for visual amyloid positivity in [18F]flutemetamol PET
No full textBACKGROUND: This study aimed to establish the optimal cutoff values for visual amyloid positivity using standardized uptake value ratios (SUVRs) in [(18)F]flutemetamol (FMM) positron emission tomography (PET) imaging. Given the variability in amyloid assessment, our goal was to determine cutoff values that enhance diagnostic accuracy and assist clinicians in reliably identifying amyloid positivity. RESULTS: The identified cutoff values for visual amyloid positivity were > 1.6 for the cerebellar gray matter, > 1.38 for the whole cerebellum, and > 0.63 for the pons, yielding high sensitivity (95.5%, 94.5%, and 95.8%, respectively) and specificity (91.2%, 94.3%, and 95.2%, respectively). CONCLUSIONS: The SUVR cutoff values demonstrated excellent diagnostic performance, supporting their clinical use in assessing visual amyloid positivity in [(18)F]FMM PET imaging
A study on the compressive strength of three-dimensional direct printing aligner material for specific designing of clear aligners
No full textBACKGROUND: The demand for orthodontic treatment using clear aligners has been gradually increasing because of their superior esthetics compared with conventional fixed orthodontic therapy. This study aimed to evaluate and compare the compressive strength of three-dimensional direct printing aligners (3DPA) with that of conventional thermo-forming aligners (TFA) to determine their clinical applicability. In the experimental group, the 3DPA material TC-85 (TC-85 full) was used to create angular protrusions called rectangular pressure areas (RPA). A protrusion akin to the power ridge typically employed in conventional TFAs was created using glycol-modified polyethylene terephthalate (PETG; Control 1). RPA was created using the same TC-85 without filling the protrusions (TC-85 blank; Control 2). Compression cycle tests were conducted on an LTM 3 h electrodynamic testing machine (Zwick Roell, Germany), with 500 cycles and compression depths of 100, 300, 500, and 700 microm. Twenty specimens were tested for PETG, 17 for the TC-85 blank, and 19 for the TC-85 full. RESULTS: Changes in the compressive force were assessed based on the material and thickness. The results indicated significantly higher and broader ranges of compressive strength for specimens fabricated with the 3DPA material TC-85 compared with those fabricated using PETG. Among the TC-85 specimens, TC-85 full demonstrated the highest statistically significant compressive strength . CONCLUSIONS: 3DPA technology enables precise modifications in the shape and inner thickness at specific dental sites, including the creation of ridges in targeted areas, of aligners. These alterations enhance the biomechanical capability of aligners to exert selective forces necessary for desired tooth movement while reducing the number of attachments, thereby demonstrating the clinical potential of 3D-printed aligners in orthodontic treatment