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Kim MS, Kim JK, Lee MW, Moon KC, Kim BJ, Son SW, Ahn HH, Oh SH, Yu HJ, Lee DY, Cho KH, Cho BK, Kim MB, Suh KS, Kim YC, Ro BI, Park JS, Choi JS, Lee JB. Epidemiology of deep cutaneous fungal infections in Korea (2006-2010). J Dermatol 2015; 42:962-6. [DOI: 10.1111/1346-8138.12968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/26/2015] [Indexed: 11/29/2022]
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Yang JY, Kwak HS, Han JY, Choi JS, Ahn HK, Oh YJ, Velázquez-Armenta EY, Nava-Ocampo AA. Linear Versus Non-Linear Dose-Response Relationship Between Prenatal Alcohol Exposure and Meconium Concentration of Nine Different Fatty Acid Ethyl Esters. Dose Response 2015; 13:10.2203_dose-response.14-056_Yang. [PMID: 26691866 PMCID: PMC4679215 DOI: 10.2203/dose-response.14-056_yang] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Presence of individual fatty acid ethyl esters (FAEEs) in meconium is considered to be a reliable biomarker of prenatal alcohol exposure, and their concentration has been found to be linearly associated with poor postnatal development, supporting the widely extended idea that ethanol is a non-threshold teratogen. However, a growing number of epidemiological studies have consistently found a lack of adverse short- and long-term fetal outcomes at low exposure levels. We therefore aimed to investigate the relationship between the concentration of individual FAEEs and prenatal alcohol exposure in meconium samples collected within the first 6 to 12?h after birth from 182 babies born to abstainer mothers and from 54 babies born to women who self-reported either light or moderate alcohol ingestion in the second or third trimester of pregnancy. In most cases, the individual FAEE concentrations were negligible and not significantly different (P >0.05) between exposed and control babies. The concentrations appeared to increase linearly with the dose only in the few babies born to mothers who reported >3 drinks/week. These results provide evidence that the correlation between prenatal alcohol exposure and individual FAEE concentrations in meconium is non-linear shape, with a threshold probably at 3 drinks/week.
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Choi JS, Bae EH, Ma SK, Kweon SS, Kim SW. Prognostic impact of hyponatraemia in patients with colorectal cancer. Colorectal Dis 2015; 17:409-16. [PMID: 25524356 DOI: 10.1111/codi.12878] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 12/03/2014] [Indexed: 12/11/2022]
Abstract
AIM Hyponatraemia is a common in surgical practice, but its clinical impact in patients with colorectal cancer has not been evaluated. METHOD We retrospectively assessed 2944 patients who had been admitted to Chonnam National University Hwasun Hospital, Korea with a diagnosis of colorectal cancer. In order to determine the relationship between the serum sodium level and 3-year mortality, we categorized the patients as having normonatraemia (135-147 mEq/l), or mild (130-134 mEq/l), moderate (125-129 mEq/l) or severe hyponatraemia (< 125 mEq/l). RESULTS Hyponatraemia, defined as a serum sodium level of < 135 mEq/l, was evident in 27.6% of patients during hospitalization. Declining serum sodium levels were associated with increasing age, a higher number of comorbidities, a more advanced TNM stage and worsening biochemical parameters. In a multivariate Cox-proportional regression analysis, the mortality risk was correlated with the severity of hyponatraemia [hazard ratio (HR) 1.65, 95% CI 1.38-1.96; HR 2.24, 95% CI 1.69-2.98; HR 2.20, 95% CI 1.25-3.90, for patients with mild, moderate, and severe hyponatraemia, respectively, compared with patients with normonatraemia]. An independent association between hyponatraemia and long-term mortality was sustained among various subpopulations and patients with persistent hyponatraemia had a worse prognosis than those with hyponatraemia that resolved. CONCLUSION A substantial proportion of patients developed hyponatraemia during hospitalization, and the long-term mortality risk increased even in mild cases of hyponatraemia. Hyponatraemia should be considered as an important prognostic factor in colorectal cancer.
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Lee H, Kim DY, Lee KH, Choi JS, Suh MK. Deformity of the earlobe caused by fixed cutaneous sporotrichosis in a pediatric patient. Int J Dermatol 2015; 54:e187-9. [DOI: 10.1111/ijd.12757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Choi JS, Han JY, Ahn HK, Lee SW, Koong MK, Velazquez-Armenta EY, Nava-Ocampo AA. Assessment of fetal and neonatal outcomes in the offspring of women who had been treated with dried ginger (Zingiberis rhizoma siccus) for a variety of illnesses during pregnancy. J OBSTET GYNAECOL 2015; 35:125-30. [PMID: 25093607 DOI: 10.3109/01443615.2014.941342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present study was designed to investigate if exposure to dried ginger during pregnancy would increase the risk of adverse fetal and neonatal outcomes. Participants consisted of 159 singleton pregnant women who received dried ginger as a herbal medication. We also included a control group of 306 pregnant women who had not been exposed to any herbal medication or any known teratogen. No increased risk of major malformations was detected in exposed women (OR = 4.9; 95% CI 0.9-25.5; p = 0.051). The incidence of stillbirths in the exposed group was marginally higher than in the controls (OR = 7.8; 95% CI 0.9-70.3; p = 0.05). The risk was more evident when the exposed group was compared with the general population in the Republic of Korea (OR = 7.9; 95% CI 2.9-21.4; p < 0.0001). Other fetal and neonatal study outcomes investigated in the exposed group were similar (p > 0.05) to the controls. In conclusion, dried ginger does not appear to be a major teratogen. However, due to the limitations of the study, e.g. the large variability in the dose of dried ginger in the exposed group, as well as the concomitant exposure to other herbal medications, the increased incidence of stillbirths requires confirmation in larger cohort studies.
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Kim BS, Kim YW, Choi JH, Sohng SH, Shin DH, Choi JS. Clear cell acanthoma on areola. Yeungnam Univ J Med 2015. [DOI: 10.12701/yujm.2015.32.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Han HW, Hsu MML, Choi JS, Hsu CK, Hsieh HY, Li HC, Chang HC, Chang TC. Rapid detection of dermatophytes and Candida albicans in onychomycosis specimens by an oligonucleotide array. BMC Infect Dis 2014; 14:581. [PMID: 25377491 PMCID: PMC4234842 DOI: 10.1186/s12879-014-0581-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/22/2014] [Indexed: 11/25/2022] Open
Abstract
Background Onychomycosis is a fungal infection of nails, leading to the gradual destruction of the nail plate. Treatment of onychomycosis may need long-time oral antifungal therapy that can have potential side effects, thus accurate diagnosis of the disease before treatment is important. Culture for diagnosis of onychomycosis is time-consuming and has high false-negative rates. To expedite the diagnosis, an oligonucleotide array, based on hybridization between immobilized oligonucleotide probes and PCR products, for direct detection of dermatophytes and Candida albicans in clinical specimens was evaluated. Methods Species-specific oligonucleotide probes designed from the internal transcribed spacer (ITS) regions of the rRNA gene were immobilized on a nylon membrane. The assay procedures consisted of PCR amplification of the ITS using universal primers, followed by hybridization of the digoxigenin-labeled amplicons to probes on the array. Thirty two nail samples (29 patients) were analyzed by the array, and the results were compared with those obtained by culture. Array-positive but culture-negative samples were confirmed by cloning and re-sequencing of the amplified ITS and by reviewing patient’s clinical data. The total recovery of culture and confirmed array-positive but culture-negative results was considered 100% and was used for performance evaluation of both methods. Results Concordant results were obtained in 21 samples (10 positives and 11 negatives) by both methods. Eleven samples were array-positive but culture-negative; among them, 9 samples were considered true positives after discrepant analysis. Comparing with culture, the array had significantly higher sensitivity [100% (95% CI 82.2% −100%) vs 52.6% (28.9% −75.5%), p <0.001] and negative predictive value [100% (71.3% −100%) vs 59.1% (36.4% −79.3%), p <0.05), while no significant differences were observed in specificity (84.6% vs 100%, p =0.48) and positive predictive value (90.5% vs 100%, p =1.0). The whole procedures of the array were about 24 h, whilst results from culture take 1 to 3 weeks. Conclusions The array offers an accurate and rapid alternative to culture. Rapid diagnosis can expedite appropriate antifungal treatment of onychomycosis. However, the single site nature of this study conducted at a referral hospital invites caution. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0581-5) contains supplementary material, which is available to authorized users.
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Lee HJ, Shin DH, Choi JS, Kim KH. A case of isolated bowenoid papulosis of the nipple. Ann Dermatol 2014; 26:381-4. [PMID: 24966640 PMCID: PMC4069651 DOI: 10.5021/ad.2014.26.3.381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/09/2012] [Accepted: 01/10/2012] [Indexed: 12/02/2022] Open
Abstract
Bowenoid papulosis (BP) is a disease that mainly occurs in sexually active young adults. The patients present with multiple pigmented papular lesions with a verrucous surface on the anogenital area. Although extragenital BP is usually associated with concomitant genital involvement, a few cases of isolated extragenital BP have been reported. However, to our knowledge, BP of the nipple has not yet been reported in the medical literature. We report the case of a 32-year-old woman who presented with isolated extragenital BP of the nipple caused by human papillomavirus-16.
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Kang KW, Lee JH, Choi JS, Lee SR, Park Y, Kim BS, Kim I. Spontaneous resolution of post-transplant localized cytomegalovirus lymphadenitis mimicking tumor recurrence. Transpl Infect Dis 2014; 16:676-80. [PMID: 24965019 DOI: 10.1111/tid.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 11/29/2022]
Abstract
Compromised T-cell immunity persists for up to 1 year after autologous stem cell transplantation (ASCT), and patients treated with ASCT are more likely to develop atypical lymphoid hyperplasia that mimics tumor recurrence. Here, we present a case of cervical lymphadenitis due to cytomegalovirus (CMV) reactivation in a patient who had undergone ASCT for Burkitt lymphoma, which mimicked tumor recurrence on computed tomography and positron emission tomography-computed tomography 6 months after ASCT. This lesion was confined to the regional lymph nodes and was not accompanied by signs of systemic involvement, such as fever, splenomegaly, an elevated C-reactive protein level, or viremia. The localized CMV lymphadenitis resolved spontaneously without treatment after 6 months (12 months after ASCT) and the elevated CMV immunoglobulin-M titer normalized 6 months after resolution. Our experience with this case suggests that cautious follow-up without anti-CMV treatment should be considered in cases of post-ASCT localized CMV lymphadenitis without systemic involvement in patients with complete engraftment.
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Choi JS, Yun SH, Kim D, Park SW. Impact of doctors' resistance on success of drug utilization review system. Healthc Inform Res 2014; 20:99-108. [PMID: 24872908 PMCID: PMC4030065 DOI: 10.4258/hir.2014.20.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/17/2014] [Accepted: 01/18/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system. METHODS This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. RESULTS This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. CONCLUSIONS The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
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Lee SH, Joo DJ, Kim SU, Kim MS, Lee AL, Choi GH, Choi JS, Han KH, Kim SI. Graft function measured by transient elastography in living donor liver transplantation: preliminary. Transplant Proc 2014; 45:3028-31. [PMID: 24157028 DOI: 10.1016/j.transproceed.2013.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Liver stiffness measurements (LSMs) using transient elastography (TE) provide a noninvasive means to assess liver fibrosis that correlate with hepatic cholestasis. However, few studies have examined the correlation of TE to obtain LSMs with perioperative clinical and laboratory parameters in living donor liver transplantation (LDLT). PATIENTS AND METHODS We retrospectively reviewed forty-eight subjects who underwent LDLT between November 2010 and October 2012. All donors and recipients underwent TE, abdominal computed tomography (CT), and biochemical tests within 1 month before and at 1 week after transplantation. Using a cut-off LSM of 7.5 kPa, which we arbitrarily assigned to be indicative of significant fibrosis, we divided our study population into ≤7.5 kPa (group L; n = 15, 31.3%) versus >7.5 kPa; (group H; n = 33, 68.8%). RESULTS Pretransplantation serum total bilirubin, international normalized ratio, and Model for End-stage Liver Disease scores of recipients were significantly higher in group H than group L. Regarding the pretransplantation donor characteristics, the graft-recipient weight ratio was significantly smaller among those in group H (P = .039). In addition, the post-transplantation 1-week serum total bilirubin level was significantly higher in group H (2.3 mg/dL versus 1.2 mg/dL, P = .015), although neither biliary complications norhepatic congestion was identified by abdominal CT. Among the 1-week post-transplantation laboratory findings, only total bilirubin positively correlated with LSM (P = .044). CONCLUSIONS This pilot study suggested that a high LSM after LDLT suggests intrahepatic cholestasis and portal hypercirculation in the graft, irrespective of liver fibrosis, outflow obstruction, or biliary obstruction.
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Lee HS, Choi GH, Joo DJ, Kim MS, Kim SI, Han KH, Ahn SH, Kim DY, Park JY, Choi JS. Prognostic value of model for end-stage liver disease scores in patients with fulminant hepatic failure. Transplant Proc 2014; 45:2992-4. [PMID: 24157020 DOI: 10.1016/j.transproceed.2013.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study was undertaken to investigate risk factors of mortality in patients with fulminant hepatic failure (FHF). METHODS Fifty-three patients with FHF treated from January 2006 to April 2011 were allocated to a spontaneous survival group (group 1), a death without liver transplantation (LT) group (group 2), and an LT group (group 3). To analyze risk factors associated with mortality in FHF, we excluded group 3 patients. Clinical features, Model for End-Stage Liver Disease (MELD) scores, and King's College Hospital criteria at the time of hepatic encephalopathy in group 2 were compared with those of group 1. RESULTS The causes of FHF were acute viral infection (n = 29, hepatitis A:B, 28:1), drugs (n = 18; including 4 acetaminophen and 14 herbal medication), autoimmune (n = 4), and miscellaneous (n = 2). Of the 53 patients, 19 were allocated to group 1, 18 to group 2, and 16 to group 3. According to univariate analysis, risk factors for mortality in group 2 were acute renal failure requiring renal replacement therapy and a MELD score ≥30 at the time of hepatic encephalopathy. However, by multivariate analysis, a MELD score ≥30 was the only independent risk factor for mortality in group 2 (P = .042; hazard ratio, 4.500). CONCLUSIONS A MELD score ≥30 was found to be the only independent risk factor of mortality in FHF patients without LT. Therefore, the findings of this study suggest that these patients may need emergent LT for survival.
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Choi JS, Choi YJ, Kim EK, Yoon JH, Youk JH, Han KH, Moon HJ, Kang WJ, Kwak JY. A risk-adapted approach using US features and FNA results in the management of thyroid incidentalomas identified by 18F-FDG PET. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2014; 35:51-58. [PMID: 24458573 DOI: 10.1055/s-0033-1335328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the risk of malignancy of thyroid incidentalomas found on 18F-FDG PET/CT by US features and cytologic results, and to evaluate the clinical usage of a combination of US features and cytology for post-FNA management of thyroid incidentalomas on 18F-FDG PET/CT. MATERIALS AND METHODS From September 2006 to December 2008, 132 patients with 134 thyroid incidentalomas detected on 18F-FDG PET/CT who had undergone US and US-FNA were included in this study. We evaluated the malignancy rate of thyroid incidentalomas in different subgroups subdivided by US features and US-FNA cytology results. Several variables were compared between the benign and malignant group. RESULTS The risk of malignancy was 58.2 % (78/132) in thyroid incidentalomas on 18F-FDG PET/CT. Age, gender, and tumor size were not significantly different between the malignant and benign group. Malignancy rate of thyroid incidentalomas was significantly higher in the suspicious malignant (88.9 %) than in the probably benign group (11.3 %) on US (p < 0.001). Malignancy rates were high in thyroid nodules with "malignancy", "suspicious for malignancy", or "follicular neoplasm" on cytologic results, regardless of US features. However, malignancy rates of thyroid incidentalomas with "unsatisfactory" or "benign" results on cytology were higher in the suspicious malignant (75 %, 12.5 %, respectively) than in the probably benign (0 %) group on US. CONCLUSIONS This study demonstrated that the risk of malignancy was high in thyroid incidentalomas on 18F-FDG PET/CT even without suspicious US features. However, there was no malignancy in nodules with no suspicious US features and benign cytology. Based on these results, we concluded that US may not replace FNA in the diagnosis of PET incidentalomas, and that a follow-up may be considered of thyroid incidentalomas with benign cytology and no suspicious US features.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Age Factors
- Aged
- Algorithms
- Biomarkers, Tumor/blood
- Biopsy, Fine-Needle
- Diagnosis, Differential
- Early Detection of Cancer
- Female
- Fluorodeoxyglucose F18
- Humans
- Incidental Findings
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/pathology
- Neoplasms, Second Primary/diagnostic imaging
- Neoplasms, Second Primary/pathology
- Positron-Emission Tomography
- Risk Adjustment
- Risk Factors
- Sensitivity and Specificity
- Sex Factors
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/pathology
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/pathology
- Tomography, X-Ray Computed
- Tumor Burden
- Ultrasonography
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Choi JH, Kim BS, Sohng SH, Lee HJ, Shin DH, Choi JS, Bae YK. Fast-growing multiple symmetric lipomatosis. Yeungnam Univ J Med 2014. [DOI: 10.12701/yujm.2014.31.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hyun MK, Jung KH, Yun YH, Kim YA, Lee WJ, Do YR, Lee KS, Heo DS, Choi JS, Kim SY, Kim HT, Hong SW. Factors Associated with Place of Death in Korean Patients with Terminal Cancer. Asian Pac J Cancer Prev 2013. [DOI: 10.7314/apjcp.2013.14.12.7309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Choi JS, Choi JS, Choi DH. Effects of licochalcon A on the pharmacokinetics of losartan and its active metabolite, EXP-3174, in rats. DIE PHARMAZIE 2013; 68:882-888. [PMID: 24380237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Losartan and licochalcon A interact with cytochrome P-450 (CYP) enzymes and P-glycoprotein (P-gp), and the increase in the use of health supplements may result in licochalcon A being taken concomitantly with losartan to treat or prevent cardiovascular diseases as a combination therapy. The effect of licochalcon A, a natural flavonoid, on the pharmacokinetics of losartan and its active metabolite, EXP-3174, was investigated in rats. Pharmacokinetic parameters of losartan and EXP-3174 were determined after oral administration of losartan (9 mg/kg) to rats in the presence or absence of licochalcon A (0.5, 2.5 and 10 mg/kg). The effect of licochalcon A on P-glycoprotein (P-gp) as well as CYP3A4 and 2C9 activities was also evaluated. Licochalcon A inhibited CYP3A4 and CYP2C9 enzyme activities with 50% inhibition concentrations (IC50) of 2.0 and 0.1 microM, respectively. In addition, licochalcon A significantly enhanced the cellular accumulation of rhodamine-123 in a concentration-dependent manner in MCF-7/ADR cells overexpressing P-gp. The pharmacokinetic parameters of losartan were significantly altered by licochalcon A. Licochalcon A (2.5 mg/kg or 10 mg/kg) increased AUC0-infinity of losartan by 33.4-63.2% and Cmax of losartan by 34.0-62.8%. The total body clearance (CL/F) was significantly decreased (2.5 mg/kg, p < 0.05; 10 mg/kg, p < 0.01) by licochalcon A. Consequently, the absolute bioavailability of losartan in the presence of licochalcon A increased significantly (2.5 mg/kg, p < 0.05; 10 mg/kg, p < 0.01) compared to that in the control group. The relative bioavailability (R.B.) of losartan was 1.15- to 1.63-fold greater than that of the control group. However, there was no significant change in Tmax and t1/2 of losartan in the presence of licochalcon A. Licochalcon A (10 mg/kg) increased the AUC0-infinity of EXP-3174 but this was not significant. Furthermore, concurrent use of licochalcon A (10 mg/kg) significantly decreased the metabolite-parent AUC ratio (M.R.) by 20%, suggesting that licochalcon A inhibited the CYP-mediated metabolism of losartan to its active metabolite, EXP-3174. In conclusion, the enhanced oral bioavailability of losartan in the presence of licochalcon A may mainly result from decreased P-gp-mediated efflux transporter in the small intestine and from the inhibition of CYP 3A- and CYP2C9-mediated metabolism in the small intestine and liver and/or from the reduction of total body clearance of losartan by licochalcon A.
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Choi JS, Lee WB, Rhee PL. Cost-benefit analysis of electronic medical record system at a tertiary care hospital. Healthc Inform Res 2013; 19:205-14. [PMID: 24175119 PMCID: PMC3810528 DOI: 10.4258/hir.2013.19.3.205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/19/2013] [Accepted: 08/12/2013] [Indexed: 11/23/2022] Open
Abstract
Objectives Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Methods Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). Results During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Conclusions Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.
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Lee JK, Yun YH, An AR, Heo DS, Park BW, Cho CH, Kim S, Lee DH, Lee SN, Lee ES, Kang JH, Kim SY, Lee JL, Lee CG, Lim YK, Kim S, Choi JS, Jeong HS, Chun M. The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues. Med Decis Making 2013; 34:720-30. [PMID: 23975503 DOI: 10.1177/0272989x13501883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 07/25/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. METHODS A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. RESULTS A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent). CONCLUSIONS The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.
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Park JY, Shin DH, Choi JS, Kim KH. Metallic discoloration on the right shin caused by titanium alloy prostheses in a patient with right total knee replacement. Ann Dermatol 2013; 25:356-9. [PMID: 24003281 PMCID: PMC3756203 DOI: 10.5021/ad.2013.25.3.356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/29/2011] [Accepted: 09/05/2011] [Indexed: 11/16/2022] Open
Abstract
The differential diagnosis of bluish-gray pigmentation of the skin includes dermal melanocytosis, malignant melanoma and metallic discoloration. Of these disorders, metallic discoloration, which develops from deposits of fine metallic particles on the skin, is an uncommon dermatologic disease. We report a case of metallic discoloration of the right shin caused by titanium alloy prostheses in a patient with right total knee replacement. The patient had bluish-gray pigmentation on her right shin as well as pain while walking. Histopathologic findings of the skin lesion showed abundant black particles in the perivascular area of the lower dermis. Polarizing microscopy revealed refractile foreign materials in the dermis. An energy dispersive X-ray spectrophotometer unit attached to a transmission electron microscope detected titanium and aluminium peaks in the specimen.
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Yoon JH, Kim MJ, Kim EK, Moon HJ, Choi JS. Discordant elastography images of breast lesions: how various factors lead to discordant findings. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2013; 34:266-271. [PMID: 22723039 DOI: 10.1055/s-0032-1312948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate the rate of the elastography-pathology discordance, and evaluate which various factors have an effect on discordant elastography images (DEI) of breast lesions. MATERIALS AND METHODS Elastography images of 284 pathologically confirmed breast lesions of 233 patients were evaluated. Elasticity scores were compared to pathology results, and lesions were divided into 4 groups: benign concordant/discordant, and malignant concordant/discordant. The rate of DEI among benign and malignant lesions was calculated and compared. Patient, lesion factors and image adequacy were compared among the concordant and discordant groups for analysis. RESULTS Among the 284 breast lesions, 225 (79.2%) were benign, and 59 (20.8%) were malignant. The rate of DEI among malignant lesions was significantly higher than in benign lesions, i. e., 52.5 vs. 3.1% (p < 0.001). Discordant images were more significantly seen in patients with extremely dense breasts on mammography in benign lesions, 42.9 vs. 11.9% (p = 0.034). Discordant images were more significantly seen in malignant lesions < 10 mm or ≥ 20 mm (p = 0.006), and those with inadequate images (64.5 vs. 35.5%, p < 0.001). CONCLUSION The rate of DEI was higher in malignant lesions than in benign lesions. Dense breast parenchyma, lesion size and image adequacy showed significance in discordant images of elastography which need consideration in image acquisition and interpretation.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Elasticity Imaging Techniques/methods
- Female
- Humans
- Hyperplasia/diagnostic imaging
- Hyperplasia/pathology
- Image Enhancement/methods
- Image Interpretation, Computer-Assisted/methods
- Mammary Glands, Human/pathology
- Middle Aged
- Predictive Value of Tests
- Ultrasonography, Interventional/methods
- Ultrasonography, Mammary/methods
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Kim DM, Lee MH, Suh MK, Ha GY, Kim H, Choi JS. Onychomycosis Caused by Chaetomium globosum. Ann Dermatol 2013; 25:232-6. [PMID: 23717019 PMCID: PMC3662921 DOI: 10.5021/ad.2013.25.2.232] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/09/2011] [Accepted: 10/01/2011] [Indexed: 11/17/2022] Open
Abstract
Onychomycosis is usually caused by dermatophytes, but some nondermatophytic molds and yeasts are also associated with invasion of nails. The genus Chaetomium is a dematiaceous nondermatophytic mold found in soil and plant debris as a saprophytic fungus. We report the first Korean case of onychomycosis caused by Chaetomium globosum in a 35-year-old male. The patient showed brownish-yellow discoloration and subungual hyperkeratosis on the right toenails (1st and 5th) and left toenails (1st and 4th). Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide slants showed the same fast-growing colonies, which were initially velvety white then turned to dark gray to brown. However, there was no growth of colony on SDA with cycloheximide slants. Brown-colored septated hyphae, perithecia and ascospores were shown in the slide culture. The DNA sequence of internal transcribed spacer region of the clinical sample was a 100% match to that of C. globosum strain ATCC 6205 (GenBank accession number EF524036.1). We confirmed C. globosum by KOH mount, colony, and light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical amorolfine 5% nail lacquer for 3 months.
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Najafzadeh MJ, Suh MK, Lee MH, Ha GY, Kim JR, Kim TH, Lee HJ, Choi JS, Meis JF, De Hoog GS. Subcutaneous phaeohyphomycosis caused by Exophiala equina, with susceptibility to eight antifungal drugs. J Med Microbiol 2013; 62:797-800. [DOI: 10.1099/jmm.0.057406-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A case of subcutaneous phaeohyphomycosis caused by Exophiala equina is reported in a 75-year-old female, who showed subcutaneous abscesses on both forearms for 8 months. A lesion was initiated by inoculation with a spine from a tree. Histopathologically, suppurative granulomatous inflammation was present and short hyphal elements were observed. Upon culture greyish–black, velvety colonies of a black yeast were obtained after 3 weeks. The strain grew well at 25 °C, but poorly at 37 °C. After sequencing the internal transcribed spacer domain and the partial β-tubulin gene, the fungus was identified as E. equina. The patient was successfully treated with fluconazole for 3 months.
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Kwon HJ, Sung BK, Kim JW, Lee JH, Kim ND, Yoo MA, Kang HS, Baek HS, Bae SJ, Choi JS, Takahashi R, Goto S, Chung HY. The effect of lipopolysaccharide on enhanced inflammatory process with age: Modulation of NF-κB. J Am Aging Assoc 2013; 24:163-71. [PMID: 23604881 DOI: 10.1007/s11357-001-0017-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Oxidative stress is thought to be a causative factor for age-related damage in a wide variety of cellular constituents that can lead to dysfunction and various pathological conditions, including the inflammatory process. At the molecular level, the redox-sensitive transcription factor, NF-κB plays a key role in the regulation of the inflammatory process, along with cytokines, cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS). We studied the mechanism underlying the modulation of the inflammatory reaction with age by investigating NF-κB activation and the expression of COX-2, iNOS, and cytokines genes in hepatic tissues isolated from young and old rats. We expanded our investigation of these factors in rats injected with the inflammatory activator, lipopolysaccharide (LPS). Data showed that NF-κB activity was up-regulated with age and was further enhanced by LPS injection, indicating an increased susceptibility and sensitivity to the inflammatory stimulus with age. To explore further the molecular events leading to NF-κB activation, we investigated the inhibitory component of NF-κB complex, IκB. Cytosolic IκBα, but not IκBβ, was significantly decreased in both old and LPS-treated rats, signifying the enhanced migration of cytosolic NF-κB complex into the nucleus following dissociation from the inhibitor. The appearance of the polypeptide, p65, as determined in the nucleus, corresponded with the change in IκBα, providing further supporting evidence for the molecular process involved in NF-κB activation. Our additional investigation of two proinflammatory-related enzymes, COX-2 and iNOS, and three cytokines, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α, clearly showed aged-related increases, in corroboration with the NF-κB activation. Our results demonstrated that LPS injection caused the enhanced gene expression of inducible proinflammatory proteins, COX-2 and iNOS through NF-κB activation.
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Yun YH, Lee MK, Park SM, Kim YA, Lee WJ, Lee KS, Choi JS, Jung KH, Do YR, Kim SY, Heo DS, Kim HT, Park SR. Effect of complementary and alternative medicine on the survival and health-related quality of life among terminally ill cancer patients: a prospective cohort study. Ann Oncol 2013; 24:489-494. [PMID: 23110809 DOI: 10.1093/annonc/mds469] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND We evaluated whether complementary and alternative medicine (CAM) use influenced outcomes [survival and health-related quality of life (HRQOL)] of cancer patients whose condition had just been judged terminal. PATIENTS AND METHODS From July 2005 to October 2006, we conducted a prospective cohort study of 481 terminally ill cancer patients at 11 university hospitals and the National Cancer Center in Korea. We assessed how the use of CAM affected HRQOL and survival. RESULTS In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased cases. On multivariate analyses, CAM users did not have better survival compared with nonusers [adjusted hazard ratio (aHR), 0.91; 95% confidence interval (CI) 0.74-1.10]. Among mind-body interventions, prayer showed significantly worse survival (aHR, 1.56; 95% CI, 1.00-2.43). Clinically, CAM users reported significantly worse cognitive functioning (-11.6 versus -1.3; P < 0.05) and fatigue (9.9 versus -1.0; P < 0.05) than nonusers. Compared with nonusers in subgroup analysis, users of alternative medical treatments, prayer, vitamin supplements, mushrooms, or rice and cereal reported clinically significant worse changes in some HRQOL subscales. CONCLUSION While CAM did not provide any definite survival benefit, CAM users reported clinically significant worse HRQOLs.
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Hyun MK, Jung KH, Yun YH, Kim YA, Lee WJ, Do YR, Lee KS, Heo DS, Choi JS, Kim SY, Kim HT, Kim SW. Factors associated with place of death in koprean patients with terminal cancer. Asian Pac J Cancer Prev 2013; 14:7309-7314. [PMID: 24460293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
AIM To investigate factors that affect the place of death (POD) of terminal cancer patients. MATERIALS AND METHODS We recruited 702 consecutive patients (>18 years) from 12 centers during July 2005 to October 2006, and 481 completed the questionnaire. In April 2011, we linked the data for 96.0% (n=462) of the deceased patients to the POD using the 2005-2009 death certificate data of Korea's National Statistical Office. The primary outcome variable was POD, and the predictive value of variables pertaining to patients and caregivers was evaluated using univariate and multivariate analyses. RESULTS Most patients died in a hospital (91.5%, n=441) and age, education, preference for place of terminal care, wish to use hospice/palliative care services, terminal cancer awareness, time between diagnosis and death, and global quality-of-life subscale of the EORTC QLQ-C30 of patients, and education and preference for place of terminal care of caregivers were significant predictors in univariate analyses. On multivariate analysis, patients and caregivers who preferred hospital/palliative care as the terminal care option over home care [adjusted odds ratio (aOR), 2.68; 95% confidential interval (CI), 1.18- 7.04 and aOR: 2.65; 95%CI: 1.15-6.09 for patient and caregiver preferences, respectively] and caregivers who were highly educated (aOR, 3.19; 95%CI, 1.44-7.06) were predictors of POD. CONCLUSIONS Most of the terminal cancer patients died in a hospital. Our findings indicate that major predictors of hospital deaths are preference of both the patient and caregiver for hospital/palliative care as the terminal care option and higher education of the caregiver.
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Jung US, Choi JS, Ko JH, Lee JH, Park SY, Park SH. Decreased prevalence of high-risk human papillomavirus infection is associated with obesity. EUR J GYNAECOL ONCOL 2013; 34:70-74. [PMID: 23590005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE OF INVESTIGATION Obesity is correlated with low education, low economic status, and lower rates of Pap smears, which are known as socio-demographic risk factors for cervical cancer. However, the association between obesity and high-risk human papillomavirus (HR-HPV) infection, the necessary cause of cervical cancer, and its related precursors, is not established. MATERIALS AND METHODS The authors examined the association between obesity and HR-HPV infection in 6,868 patients, who participated in annual health examinations at the Kangbuk Samsung Hospital in Seoul, Korea, from January through December 2007. RESULTS The prevalence of HR-HPV infection was 14.8%. Women infected with HR-HPV had a lower body mass index (BMI), when compared with non-infected women. After adjustment for alcohol intake, cigarette smoking, and marital status, HR-HPV infection was found to be negatively associated with BMI. When the analysis was stratified according to BMI, the risk of HR-HPV infection was significantly lower among those who were overweight (OR = 0.817, 95% CI = 0.680-0.982), or obese (OR = 0.688, 95% CI = 0.556-0.851), when compared with women with normal weight. CONCLUSION HR-HPV infection was associated with obesity defined by BMI, with a lower prevalence of infection observed in obese women.
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Lee HJ, Shin DH, Choi JS, Kim KH. Leukocytoclastic vasculitis associated with influenza A virus infection. J Korean Med Sci 2012; 27:1601-3. [PMID: 23255867 PMCID: PMC3524447 DOI: 10.3346/jkms.2012.27.12.1601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/30/2012] [Indexed: 02/06/2023] Open
Abstract
Leukocytoclastic vasculitis (LCV) usually presents palpable purpura characterized by inflammation of vessel walls and fragmentation of nuclei. Various conditions can cause LCV, and it can be induced by influenza A virus infection. We report a 2-yr-old Korean girl who presented palpable purpuric and hemorrhagic lesions with fever. She was diagnosed as LCV by skin biopsy, and influenza A virus was isolated from nasopharyngeal swab. She was treated with oseltamivir (Tamiflu®) and prednisolone with dramatic effect of vasculitis and fever.
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MESH Headings
- Anti-Inflammatory Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Child, Preschool
- Female
- Fever/etiology
- Humans
- Influenza A virus/genetics
- Influenza A virus/isolation & purification
- Influenza, Human/complications
- Influenza, Human/drug therapy
- Influenza, Human/virology
- Nasopharynx/virology
- Oseltamivir/therapeutic use
- Prednisolone/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Skin/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
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Lee HJ, Shin DH, Choi JS, Kim KH. Metastatic adenocarcinoma from the lung diagnosed by presenting sign of a hemangioma-like cutaneous lesion. ACTA ACUST UNITED AC 2012; 148:1329-31. [PMID: 23165850 DOI: 10.1001/archdermatol.2012.1963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lee HJ, Jung JH, Kang SS, Choi JS. A rubrofusarin gentiobioside isomer from roastedCassia tora. Arch Pharm Res 2012; 20:513-5. [PMID: 18982501 DOI: 10.1007/bf02973951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/1997] [Indexed: 11/25/2022]
Abstract
From the roasted seeds ofCassia tora L., a new naphthopyrone glycoside was isolated and characterized as 10-[(beta-D-glucopyranosyl-(1-->6)-O-beta-D-glucopyranosyl)oxyl-5-hydroxy-8-methoxy-2-methyl-4H-naphtho [1,2-b]pyran-4-one(isorubrofusarin gentiobioside). Along with isorubrofusarin gentiobioside, alaternin and adenosine were isolated and identified.
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Shin SR, Lee MS, Park SH, Choi JS, Lee KM, Kim JB, Kim HS, Kim JW. A case of breast cancer in a male patient with cryptogenic cirrhosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:182-5. [PMID: 23018541 DOI: 10.4166/kjg.2012.60.3.182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Breast cancer is a rare disease in men. We report a case of 53-year-old obese male, with known cryptogenic cirrhosis and hepatocellular carcinoma, presenting a tender mass on left breast. He was diagnosed with invasive intraductal carcinoma, which was consistent with a sporadic lesion. On the basis of previous literatures, obesity can be regarded as a cause for breast cancer even in men. However, there has been inconsistent data about link between liver cirrhosis and male breast cancer, which can be due to heterogenity in the etiology of cirrhosis. Through this case, it can be postulated that the risk for male breast cancer may vary according to the etiology of cirrhosis.
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Joo DJ, Ju MK, Huh KH, Kim MS, Choi GH, Choi JS, Jeon KO, Kim SI. Does lymphocyte cross-matching predict acute rejection and graft survival in liver transplantation? Transplant Proc 2012; 44:418-20. [PMID: 22410032 DOI: 10.1016/j.transproceed.2012.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The role of lymphocyte cross-matches (LCM) remains controversial in the liver transplant field. The aim of this study was to correlate the risk for acute rejection episodes and graft survival in liver transplantation with pretransplant LCM results. PATIENTS AND METHODS We enrolled 184 adult liver transplantation patients, excluding pediatric and second grafts. The 129 living donor and 55 deceased donor liver transplantations were divided into 2 groups: LCM (+); (n=20) and LCM (-); (n=164). RESULTS There were no differences in the demographic features, such as gender and recipient age, original disease, Model for End-Stage Liver Disease score, donor type, number of human leukocyte antigen mismatches, and cold ischemia times. There were no hyperacute rejection episodes in the LCM (+) group. Also, posttransplant complications such as acute rejection episode, biliary complication, or hepatic artery thrombosis were not different. Acute rejection episodes occurred in 5.0% of the LCM (+) group and 15.2% of the LCM (-) group (P=.317). Bile duct complications after transplantation arose in 20.0% of the LCM (+) group and in 32.9% of the LCM (-) group (P=.312). The 2 groups showed no difference in graft survival rate analyzed by the Kaplan-Meier method according to LCM results. CONCLUSION Pretransplant LCM results were not associated with overall graft survival or acute rejection episodes in this study.
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Suh MK, Lee HC, Kim DM, Ha GY, Choi JS. Molecular phylogenetics of exophiala species isolated from Korea. Ann Dermatol 2012; 24:287-94. [PMID: 22879712 PMCID: PMC3412237 DOI: 10.5021/ad.2012.24.3.287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/24/2011] [Accepted: 08/30/2011] [Indexed: 01/04/2023] Open
Abstract
Background Recently, identification of fungi have been supplemented by molecular tools, such as ribosomal internal transcribed spacer (ITS) sequence analysis. According to these tools, morphological Exophiala species was newly introduced or redefined. Objective This study was designed to investigate the phylogenetics based on ribosomal ITS sequence analysis from clinical Exophiala species isolated in Korea. Methods The strains of Exophiala species were 4 clinical isolates of phaeohyphomycosis agents kept in the department of dermatology, Dongguk University Medical Center(DUMC), Gyeongju, Korea. The DNAs of total 5 strains of Exophiala species were extracted by bead-beating method. Polymerase chain reaction of ITS region using the primer pairs ITS1-ITS4, was done and phylogenetic tree contributed from sequences of ITS region from 5 Korean isolates including E. dermatitidis CBS 109154 and comparative related strains deposited in GenBank. Results The strains of Exophiala species were 3 strains of E. dermatitidis, 1 strain of E. jeanselmei and 1 strain of Exophiala new species. Among the 3 subtypes (type A, B, C) of E. jeanselmei, E. jeanselmei DUMC 9901 belonged to type B. Of the 2 main types of E. dermatitidis (type A, B) and 3 subtypes of E. dermatitidis type A (A0, A1 and A2), two strains (E. dermatitidis CBS 709.95, E. dermatitidis CBS 109154) belonged to A0 subtypes, 1 strain (E. dermatitidis DUMC 9902) A1 subtype, respectively. Conclusion Phylogenetic analysis of ITS region sequence provided useful information not only for new species identification but for the subtyping and origin of Exophiala species.
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Lee HJ, Park JY, Kim YS, Shin DH, Choi JS, Kim KH, Bae YK. Cardiac myxoma diagnosed by signs of purpuric macules on both palms and soles. Ann Dermatol 2012; 24:337-40. [PMID: 22879718 PMCID: PMC3412243 DOI: 10.5021/ad.2012.24.3.337] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/09/2011] [Accepted: 06/09/2011] [Indexed: 12/04/2022] Open
Abstract
Cardiac myxoma, the most prevalent primary cardiac tumor, is rare. The clinical features of this tumor are principally intracardiac obstruction, extracardiac embolism, and general symptoms including fever, myalgia, arthralgia. Although cutaneous manifestations in patients with cardiac myxoma are frequent, in rare cases, cutaneous signs have been clues to the correct diagnosis. We report a 42-year-old male who presented with recurrent multiple purpuric patches on both palms and soles for 4 months. Histopathological finding showed a myxomatous embolus in the arteriole in the lower dermis. Echocardiogram demonstrated the presence of a left atrial myxoma with a provisional diagnosis of left atrial myxoma. In our patient, skin examinations and histopathological finding led us to the diagnosis of cardiac myxoma.
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Choi JS, Kim D. Design and implementation of wireless patient monitoring system for postoperative patients on general care floor. Inform Health Soc Care 2012; 37:141-58. [PMID: 22571684 DOI: 10.3109/17538157.2011.647936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postoperative patients on the general care floor (GCF), though no longer in acute danger, remain subject to relapse or other complications. One of the major clues to patient status is to measure the saturation of peripheral oxygen (SpO(2)). OBJECTIVE The objective of this study is to present a framework for Wireless Patient Monitoring System (WPMS) for postoperative patients on the GCF. METHODS We designed and implemented a very adaptable WPMS using the existing network infrastructure, in order to recognize any change of condition of postoperative patients on the GCF. RESULTS Unlike the existing pager system, our system not only can inform healthcare professionals of any deterioration of patient condition more quickly but also can help them make decisions more effectively in emergency situations. CONCLUSIONS This system, as demonstrated in a case study, both helps to save postoperative patients at risk and improves the nursing process and overall quality of care.
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Lee W, Woo ER, Choi JS. Effects of myricetin on the bioavailability of carvedilol in rats. PHARMACEUTICAL BIOLOGY 2012; 50:516-522. [PMID: 22132944 DOI: 10.3109/13880209.2011.611141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT As an inhibitor of CYP2C9, CYP2D6 and P-gp, myricetin might affect the bioavailability of carvedilol when myricetin and carvedilol are used concomitantly for the prevention or therapy of cardiovascular diseases as a combination therapy. However, the effect of myricetin on the pharmacokinetics of carvedilol has not been reported in vivo. OBJECTIVE This study investigated the effects of myricetin on the pharmacokinetics of carvedilol after oral or intravenous administration of carvedilol in rats. MATERIALS AND METHODS Carvedilol was administered orally or intravenously with or without oral administration of myricetin to rats. RESULTS The effects of myricetin on P-gp, CYP2C9 and 2D6 activity were evaluated. Myricetin inhibited CYP2C9 and CYP2D6 enzyme activity with IC50 of 13 and 57 μM, respectively. In addition, myricetin significantly enhanced the cellular accumulation of rhodamine-123 in MCF-7/ADR cells overexpressing P-gp. Compared with the control group, the AUC was significantly increased by 52.0-85.1%, and the C(max) was significantly increased by 93.1-133.4% in the presence of myricetin after oral administration of carvedilol. Consequently, the relative bioavailability of carvedilol was increased by 1.17- to 1.85-fold and the absolute bioavailability of carvedilol in the presence of myricetin was increased by 18.1-86.4%. T(max) was significantly decreased. DISCUSSION AND CONCLUSION The enhanced oral bioavailability of carvedilol may result from both inhibition of CYP2C9 or CYP2D6-mediated metabolism and P-gp-mediated efflux of carvedilol in small intestine and/or in liver by myricetin rather than reducing renal elimination. Concomitant use of myricetin or myricetin-containing dietary supplements with carvedilol will require close monitoring for potential drug interactions.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Administration, Oral
- Animals
- Antihypertensive Agents/administration & dosage
- Antihypertensive Agents/blood
- Antihypertensive Agents/pharmacokinetics
- Aryl Hydrocarbon Hydroxylases/antagonists & inhibitors
- Aryl Hydrocarbon Hydroxylases/metabolism
- Biological Availability
- Carbazoles/administration & dosage
- Carbazoles/blood
- Carbazoles/pharmacokinetics
- Carvedilol
- Cell Line, Tumor
- Cytochrome P-450 CYP2C9
- Cytochrome P-450 CYP2D6/metabolism
- Cytochrome P-450 CYP2D6 Inhibitors
- Drug Interactions
- Enzyme Inhibitors/administration & dosage
- Flavonoids/administration & dosage
- Fluorescent Dyes/metabolism
- Humans
- Injections, Intravenous
- Intestine, Small/drug effects
- Intestine, Small/enzymology
- Liver/drug effects
- Liver/enzymology
- Male
- Propanolamines/administration & dosage
- Propanolamines/blood
- Propanolamines/pharmacokinetics
- Rats
- Rats, Sprague-Dawley
- Rhodamine 123/metabolism
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Shin Y, Kim JB, Choi JS, Lee KM, Shin SR, Park SH, Kim JW, Lee MS. A case of nonpolypoid cancer arising from colonic muco-submucosal elongated polyp. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:257-9. [PMID: 22460576 DOI: 10.4166/kjg.2012.59.3.257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A colonic muco-submucosal elongated polyp (CMSEP) was identified at colonoscopy in a 53-year-old male patient with lower gastrointestinal bleeding. Non-polypoid depressed type of early cancer was noted at the tip of the colonic polyp. The CMSEP is very rare and incidentally found in most cases. Moreover, its association with colonic neoplasia is extremely rare. To our knowledge, this is the second case report of CMSEP associated with a cancerous transformation.
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Choi JS, Gräser Y, Walther G, Peano A, Symoens F, de Hoog S. Microsporum mirabileand its teleomorphArthroderma mirabile, a new dermatophyte species in theM. cookeiclade. Med Mycol 2012; 50:161-9. [DOI: 10.3109/13693786.2011.594456] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Hereditary sclerosing poikiloderma (HSP) is a very rare disease. The clinical features are principally widespread poikiloderma and linear hyperkeratotic and sclerotic bands. We report an 18-yr-old male who presented reticular hyperpigmented lesions on the trunk and extremities since 2-yr-old. Also, linear sclerosing bands appeared on both antecubital and popliteal fossae after yr. Histopathologic finding showed dense sclerotic collagen fibers with telangiectasia in the upper dermis and fragmentations of damaged elastic fibers in the elastic stain, consistent with HSP. We report the first Korean case of HSP.
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Cho YA, Lee W, Choi JS. Effects of curcumin on the pharmacokinetics of tamoxifen and its active metabolite, 4-hydroxytamoxifen, in rats: possible role of CYP3A4 and P-glycoprotein inhibition by curcumin. DIE PHARMAZIE 2012; 67:124-130. [PMID: 22512082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The effects of curcumin, a natural anti-cancer compound, on the bioavailability and pharmacokinetics of tamoxifen and its metabolite, 4-hydroxytamoxifen, were investigated in rats. Tamoxifen and curcumin interact with cytochrom P450 (CYP) enzymes and P-glycoprotein, and the increase in the use of health supplements may result in curcumin being taken concomitantly with tamoxifen as a combination therapy to treat or prevent cancer. A single dose of tamoxifen was administered orally (9 mg x kg(-1)) with or without curcumin (0.5, 2.5 and 10 mg x kg(-1)) and intravenously (2mg x kg(-1)) with or without curcumin (2.5 and 10 mg x kg(-1)) to rats. The effects of curcumin on P-glycoprotein (P-gp) and CYP3A4 activity were also evaluated. Curcumin inhibited CYP3A4 activity with 50% inhibition concentration (IC50) values of 2.7 microM. In addition, curcumin significantly (P < 0.01 at 10 microM) enhanced the cellular accumulation of rhodamine-123 in MCF-7/ADR cells overexpressing P-gp in a concentration-dependent manner. This result suggested that curcumin significantly inhibited P-gp activity. Compared to the oral control group (given tamoxifen alone), the area under the plasma concentration-time curve (AUC(0-infinity)) and the peak plasma concentration (C(max)) of tamoxifen were significantly (P < 0.05 for 2.5 mg x kg(-1); P < 0.01 for 10 mg x kg(-1)) increased by 33.1-64.0% and 38.9-70.6%, respectively, by curcumin. Consequently, the absolute bioavailability of tamoxifen in the presence of curcumin (2.5 and 10 mg x kg(-1)) was 27.2-33.5%, which was significantly enhanced (P < 0.05 for 2.5 mg x kg(-1); P < 0.01 for 10 mg x kg(-1)) compared to that in the oral control group (20.4%). Moreover, the relative bioavailability of tamoxifen was 1.12- to 1.64-fold greater than that in the control group. Furthermore, concurrent use of curcumin significantly decreased (P < 0.05 for 10 mg x kg(-1)) the metabolite-parent AUC ratio (MR), implying that curcumin may inhibit the CYP-mediated metabolism of tamoxifen to its active metabolite, 4-hydroxytamoxifen. The enhanced bioavailability of tamoxifen by curcumin may be mainly due to inhibition of the CYP3A4-mediated metabolism of tamoxifen in the small intestine and/or in the liver and to inhibition of the P-gp efflux transporter in the small intestine rather than to reduction of renal elimination of tamoxifen, suggesting that curcumin may reduce the first-pass metabolism of tamoxifen in the small intestine and/or in the liver by inhibition of P-gp or CYP3A4 subfamily.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Administration, Oral
- Animals
- Antineoplastic Agents, Hormonal/blood
- Antineoplastic Agents, Hormonal/pharmacokinetics
- Area Under Curve
- Biological Availability
- Cell Line, Tumor
- Chromatography, High Pressure Liquid
- Curcumin/pharmacology
- Cytochrome P-450 CYP3A
- Cytochrome P-450 Enzyme Inhibitors
- Cytochrome P-450 Enzyme System/metabolism
- Erythromycin Ethylsuccinate
- Fluorescent Dyes
- Humans
- Indicators and Reagents
- Injections, Intravenous
- Male
- Rats
- Rats, Sprague-Dawley
- Rhodamine 123
- Tamoxifen/analogs & derivatives
- Tamoxifen/blood
- Tamoxifen/pharmacokinetics
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Park KY, Lee JW, Kim IS, Suh MK, Choi JS, Moon NJ, Seo SJ. Longitudinal melanonychia caused by Fusarium oxysporum in immunocompetent patient. Mycoses 2011; 55:e40-1. [DOI: 10.1111/j.1439-0507.2011.02129.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee KJ, Lee YB, Lee JY, Cho BK, Choi JS, Park HJ. Proximal Subungual Onychomycosis in a Patient with Classic Kaposi Sarcoma Caused by Trichophyton rubrum. Ann Dermatol 2011; 23 Suppl 1:S11-5. [PMID: 22028554 PMCID: PMC3199404 DOI: 10.5021/ad.2011.23.s1.s11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 08/03/2010] [Accepted: 08/03/2010] [Indexed: 11/08/2022] Open
Abstract
A 58-year-old man presented with whitish patches on both great toenails for four weeks prior to visiting our hospital; the patches spread rapidly to other finger- and toe-nails. Prior to presentation, the patient had been diagnosed with idiopathic thrombocytopenic purpura two months ago and Kaposi's sarcoma three weeks ago. The patient was treated with human immunoglobulin for five days, and then received prednisolone 40 mg bid. Serology showed that the patient was negative for HIV and results of other laboratory tests were normal. The KOH slide preparation of the nail scraping showed long septated hyphae and numerous arthrospores. The fungus culture revealed whitish downy colonies on the front side and wine-red reverse pigmentation on Sabouraud's dextrose agar. Trichophyton rubrum was isolated on fungus culture and slide culture. The internal transcribed space (ITS) regions of ribosomal DNA of the cultured fungus were identical to Trichophyton rubrum. Proximal subungual onychomycosis (PSO) is the rarest form of onychomycosis. PSO initially presents as whitish patch(es) on the proximal side of the nail plate(s). Because PSO shows whitish to yellowish patches on the nail plate, the result of KOH examination of nail scrapings from the nail plate is almost always negative. Herein, we report on a case of multiple PSO in a patient with classic Kaposi sarcoma and suggest a method for easy KOH scraping on PSO.
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Kim DM, Yun NR, Neupane GP, Shin SH, Ryu SY, Yoon HJ, Wie SH, Kim WJ, Lee CY, Choi JS, Yang TY. Differences in clinical features according to Boryoung and Karp genotypes of Orientia tsutsugamushi. PLoS One 2011; 6:e22731. [PMID: 21857951 PMCID: PMC3156117 DOI: 10.1371/journal.pone.0022731] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 07/05/2011] [Indexed: 11/19/2022] Open
Abstract
Background Scrub typhus is an infectious disease caused by Orientia tsutsugamushi. The differences in virulence of O. tsutsugamushi prototypes in humans are still unknown. We investigated whether there are any differences in the clinical features of the Boryoung and Karp genotypes. Methodology/Principal Findings Patients infected with O. tsutsugamushi, as Boryoung and Karp clusters, who had visited 6 different hospitals in southwestern Korea were prospectively compared for clinical features, complications, laboratory parameters, and treatment responses. Infected patients in the Boryoung cluster had significantly more generalized weakness, eschars, skin rashes, conjunctival injection, high albumin levels, and greater ESR and fibrinogen levels compared to the Karp cluster. The treatment response to current antibiotics was significantly slower in the Karp cluster as compared to the Boryoung cluster. Conclusion The frequency of occurrence of eschars and rashes may depend on the genotype of O. tsutsugamushi.
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Choi JS, Yi B, Park JH, Choi K, Jung J, Park SW, Rhee PL. The uses of the smartphone for doctors: an empirical study from samsung medical center. Healthc Inform Res 2011; 17:131-8. [PMID: 21886874 PMCID: PMC3155170 DOI: 10.4258/hir.2011.17.2.131] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/27/2011] [Indexed: 11/23/2022] Open
Abstract
Objectives In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Methods Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. Results We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Conclusions Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements.
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Yun YH, Han KH, Park S, Park BW, Cho CH, Kim S, Lee DH, Lee SN, Lee ES, Kang JH, Kim SY, Lee JL, Heo DS, Lee CG, Lim YK, Kim SY, Choi JS, Jeong HS, Chun M. Attitudes of cancer patients, family caregivers, oncologists and members of the general public toward critical interventions at the end of life of terminally ill patients. CMAJ 2011; 183:E673-9. [PMID: 21624907 DOI: 10.1503/cmaj.110020] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Whereas most studies have focused on euthanasia and physician-assisted suicide, few have dealt comprehensively with other critical interventions administered at the end of life. We surveyed cancer patients, family caregivers, oncologists and members of the general public to determine their attitudes toward such interventions. METHODS We administered a questionnaire to four groups about their attitudes toward five end-of-life interventions--withdrawal of futile life-sustaining treatment, active pain control, withholding of life-sustaining measures, active euthanasia and physician-assisted suicide. We performed multivariable analyses to compare attitudes and to identify sociodemographic characteristics associated with the attitudes. RESULTS A total of 3840 individuals--1242 cancer patients, 1289 family caregivers and 303 oncologists from 17 hospitals, as well as 1006 members of the general Korean population--participated in the survey. A large majority in each of the groups supported withdrawal of futile life-sustaining treatment (87.1%-94.0%) and use of active pain control (89.0%-98.4%). A smaller majority (60.8%-76.0%) supported withholding of life-sustaining treatment. About 50% of those in the patient and general population groups supported active euthanasia or physician-assisted suicide, as compared with less than 40% of the family caregivers and less than 10% of the oncologists. Higher income was significantly associated with approval of the withdrawal of futile life-sustaining treatment and the practice of active pain control. Older age, male sex and having no religion were significantly associated with approval of withholding of life-sustaining measures. Older age, male sex, having no religion and lower education level were significantly associated with approval of active euthanasia and physician-assisted suicide. INTERPRETATION Although the various participant groups shared the same attitude toward futile and ameliorative end-of-life care (the withdrawal of futile life-sustaining treatment and the use of active pain control), oncologists had a more negative attitude than those in the other groups toward the active ending of life (euthanasia and physician-assisted suicide).
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Yun YH, Lee MK, Kim SY, Lee WJ, Jung KH, Do YR, Kim S, Heo DS, Choi JS, Park SY, Jeong HS, Kang JH, Kim SY, Ro J, Lee JL, Park SR, Park S. Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study. J Clin Oncol 2011; 29:2474-80. [PMID: 21576638 DOI: 10.1200/jco.2010.30.1184] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We conducted this study to evaluate the validity of the perception that awareness of their terminal prognosis and use of palliative care or nonuse of an intensive care unit (ICU) causes patients to die sooner than they would otherwise. PATIENTS AND METHODS In this prospective cohort study at 11 university hospitals and the National Cancer Center in Korea, we administered questionnaires to 619 consecutive patients immediately after they were determined by physicians to be terminally ill. We followed patients during 6 months after enrollment and assessed how their survival was affected by the disclosure of terminal illness and administration of palliative care or nonuse of the ICU. RESULTS In a follow-up of 481 patients and 163.8 person-years, we identified 466 deceased patients. Nineteen percent of the patients died within 1 month, while 41.3% lived for 3 months, and 17.7% lived for 6 months. Once the cancer was judged terminal, the median survival time was 69 days. On multivariate analysis, neither patient awareness of terminal status at baseline (adjusted hazard ratio [aHR], 1.20; 95% CI, 0.96 to 1.51), use of a palliative care facility (aHR, 0.96; 95% CI, 0.76 to 1.21), nor general prostration (aHR, 1.23; 95% CI, 0.96 to 1.57) was associated with reduced survival. Use of the ICU (aHR, 1.47; 95% CI, 1.06 to 2.05) and poor Eastern Cooperative Oncology Group performance status (aHR, 1.37; 95% CI, 1.10 to 1.71) were significantly associated with poor survival. CONCLUSION Patients' being aware that they are dying and entering a palliative care facility or ICU does not seem to influence patients' survival.
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Choi JS, Lee JH, Park JH, Nam HS, Kwon H, Kim D, Park SW. Design and implementation of a seamless and comprehensive integrated medical device interface system for outpatient electronic medical records in a general hospital. Int J Med Inform 2011; 80:274-85. [DOI: 10.1016/j.ijmedinf.2010.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/11/2010] [Accepted: 11/16/2010] [Indexed: 11/24/2022]
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Kim YH, Hwang JY, Lee KM, Choi JH, Lee TY, Choi JS, Park HS. Seroepidemiologic survey of varicella-zoster virus in korean adults using glycoprotein enzyme immuno assay and fluorescent antibody to membrane antigen test. Ann Dermatol 2011; 23:39-43. [PMID: 21738361 DOI: 10.5021/ad.2011.23.1.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 10/05/2010] [Accepted: 10/05/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) occurs mainly in the elderly and Korea is rapidly becoming an aging society. Therefore, it is important to know the immune status against varicella-zoster virus (VZV) in Korean adults to prevent the disease. OBJECTIVE The aim of this study was to survey the immune status of Korean adults over 40 years of age against VZV. METHODS Antibody titer was measured using a VaccZyme™ VZV glycoprotein enzyme immunoassay (gpEIA) (Binding Site, UK). Fluorescent antibody to membrane antigen (FAMA) test was performed to measure the seropositive rate. RESULTS HZ incidence in the 214 adults enrolled in this study was 10.3%. The gpEIA geometric mean titer (GMT) was 490 mIU/ml and 90.2% of the subjects had a protective level of gpEIA antibody titer against varicella. The average gpEIA GMT of adults who previously had HZ was 1,122 mIU/ml, which was higher than the average gpEIA GMT of 457 mIU/ml in adults who had not had HZ. The FAMA positive rate was 98.6%. CONCLUSION Most (90.2%) Korean adults ≥40-years-of-age have a protective level of gpEIA antibody against varicella and 98.6% were FAMA seropositive. The GMT of gpEIA antibody was significantly increased with age, and was higher in adults with a history of HZ.
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Choi JS, Kim MJ. Education and imaging: hepatobiliary and pancreatic: focal steatohepatitis mimicking a metastasis. J Gastroenterol Hepatol 2011; 26:415. [PMID: 21261737 DOI: 10.1111/j.1440-1746.2010.06614.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lee HJ, Han JY, Yook JH, Choi JS, Ahn HK, Kim MY, Song IO, Yang JH, Nava-Ocampo AA. A prospective cohort study of pregnancy outcomes of women inadvertently exposed to methylephedrine in the 1st trimester of pregnancy. J OBSTET GYNAECOL 2011; 30:563-6. [PMID: 20701502 DOI: 10.3109/01443615.2010.487577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
No information is currently available on the safety of methylephedrine, a component of various cold medications available in South Korea. With previous approval by an Institutional Review Board, 349 women inadvertently exposed to methylephedrine during the 1st trimester of pregnancy and an age- and gravidity-matched control group, were enrolled in a prospective cohort study. Study outcomes, for example gestational age at birth, birth weight and major and minor malformations were evaluated in 282 cases and 280 controls. Exposure to methylephedrine was at a gestational age of 4.0 weeks (median), at doses ranging from 52.5 to 1,575 mg/day, for a median duration of 3 (range: 1-30) days. No differences were observed between cases and controls in any of the pregnancy outcomes studied. There were 4/265 (1.5%) babies born with major malformations in the case group and 4/260 (1.5%) in the control group. In conclusion, inadvertent exposure to methylephedrine as a component of over-the counter oral cold remedies in early pregnancy was not associated with an increased rate of adverse pregnancy outcomes. Co-exposure with acetaminophen, cigarette smoking or alcohol did not appear to modify the outcomes.
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Lee YS, Lee JH, Choi JS, Son CE, Jeon SW, Kim JT, Joo KJ, Cho YS, Jung US. Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy. EUR J GYNAECOL ONCOL 2011; 32:87-90. [PMID: 21446334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To increase vigilance among gynecological surgeons for the presence of accessory polar renal artery (APRA) encountered with transperitoneal systemic laparoscopic paraaortic lymphadenectomy (LPAL). METHODS A retrospective review was conducted on 156 women who underwent LPAL for various gynecologic malignancies between November 2003 and December 2009. RESULTS The median age, parity, body mass index, and number of previous abdominal surgeries, respectively, of the women were 52 years (range, 23-82 years), two (range, 0-7), 24.1 kg/m2 (range, 17.4-35.0 kg/m2), and 0 (range, 0-3). During the study period, we found four women with APRA. There were three cases of right lower APRAs arising from the abdominal aorta, caudal to the inferior mesenteric artery (IMA), terminating at the parenchyma of the lower pole of the right kidney. In the other case, the APRA arose from the abdominal aorta superior to the IMA. There were no vascular complications, such as transection or ligation of the APRA. CONCLUSION It is important for the gynecological oncologic surgeon to have knowledge of retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during LPAL.
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