Understanding the long-term impact of incident osteoporotic fractures on healthcare utilization and costs in Korean postmenopausal women

This study provides long-term evidence that healthcare resource utilization and costs of care in women who experienced incident osteoporotic fractures remained higher than those in women without fractures over a span of 5 years. These findings emphasize the importance of early diagnostics and treatment for osteoporosis.

PURPOSE

To evaluate healthcare resource utilization (HCRU) and costs of care over 5 years after the incident osteoporotic fractures (OF) in postmenopausal women.

METHODS

We used data from the National Health Insurance Service databases 2011-2018. Women aged ≥ 50 years with incident OF (OF group) were matched to women without OF (non-OF group). HCRU (inpatient, outpatient, and emergency room [ER] visits) and costs of care (inpatient, outpatient, and ER visits) during the 5-year follow-up period were derived after propensity score matching (PSM). Additionally, we identified women with subsequent fractures within the first 2 years after the incident OF.

RESULTS

After PSM, 47,238 OF and 134,813 non-OF women were identified. HCRU rates and costs of care were highest in the first year after OF and decreased substantially, but remained higher in the OF group during the entire follow-up period. The increase in cumulative HCRU rates over 5 years was highest in inpatient admissions with ER visits (138% higher in OF vs non-OF). The cumulative total costs over 5 years were 73% higher in the OF group than in the non-OF group, which was mostly driven by inpatient costs. Trends were similar for women with subsequent fractures, but they generally showed higher HCRU and costs than those in the total OF group.

CONCLUSION

OF imposes a substantial and sustained economic burden on women, resulting in an approximately twofold increase in the cumulative cost over 5 years compared to women without fracture, which highlights the need for early diagnostics and treatment of osteoporosis.

Estimating the economic burden of osteoporotic fractures in a multinational study: a real-world data perspective

Fracture-related costs vary by country. A standardized methodology and presentations were proposed to fairly assess the economic burden of osteoporotic fracture. Results indicated substantial costs of osteoporotic fractures for pharmacy, hospitalization, emergency care, and outpatient visits in women aged ≥ 50 years in Australia, Germany, South Korea, Spain, and the USA.

PURPOSE

The objective of this multinational, retrospective matched cohort study was to use a standardized methodology across different healthcare systems to estimate the burden of osteoporotic fracture (OF) in women aged ≥ 50 years in Australia, Germany, South Korea, Spain, and the USA.

METHODS

Within each country, healthcare resource utilization and direct costs of care were compared between patients with newly identified OF and a propensity score-matched cohort without OF during follow-up periods of up to 5 years.

RESULTS

Across all five countries, the OF cohort had significantly higher rates and length of inpatient admissions compared with the non-OF cohort. In each country, the adjusted total costs of care ratio between OF and non-OF cohorts were significant. The adjusted cost ratios for pharmacy, inpatient care, emergency care, and outpatient visits were similarly higher in the OF cohort across countries.

CONCLUSION

The current study demonstrates the substantial economic burden of OF across different countries when compared with matched non-OF patients. The findings would assist stakeholders and policymakers in developing appropriate health policies.

Adherence to Long-Acting Inhaler Use for Initial Treatment and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study

We aimed to determine the effect of long-acting inhaler use adherence on acute exacerbations in treatment-naïve patients with chronic obstructive pulmonary disease (COPD) using claims data from the Korean Health Insurance Review and Assessment Service from July 2015−December 2016. Patients with COPD aged ≥ 40 years who used long-acting inhalers were enrolled and observed for 6 months. Medication adherence was determined by the medication possession ratio (MPR); patients were categorized to adherence (MPR ≥ 80%) and non-adherence (MPR < 80%) groups. Ultimately, 3959 patients were enrolled: 60.4% and 39.6% in the adherence and non-adherence groups, respectively. The relative risk of acute exacerbation in the non-adherence group was 1.58 (95% confidence interval [CI] 1.25−1.99) compared with the adherence group. The adjusted logistic regression analysis revealed a relative risk of acute exacerbation in the non-adherence vs. adherence group of 1.68 (95% CI 1.32−2.14) regarding the number of inhalers used. Poor adherence to long-acting inhalers influenced increased acute exacerbation rates among patients with COPD. The acute exacerbation of COPD risk requiring hospitalization or ED visits was high in the non-adherence group, suggesting that efforts to improve medication adherence may help reduce COPD exacerbations even in the initial management of treatment-naïve patients.

Antihistamine use and the risk of injurious falls or fracture in elderly patients: a systematic review and meta-analysis

Despite their anticholinergic side effects, first-generation antihistamines are widely prescribed to elderly patients. A systematic review was conducted to synthesize real-world evidence. First-generation antihistamine use is considerably associated with an increased risk of injurious falls or fracture among the elderly.

INTRODUCTION

First-generation antihistamines are considered potentially inappropriate for elderly patients owing to anticholinergic side effects. We aimed to determine whether elderly patients taking antihistamines are at increased risk of injurious falls or fracture.

METHODS

We identified studies in MEDLINE, EMBASE, and several local databases through November 2016. Observational studies on the association between antihistamine use and the risk of injurious falls or fracture were selected. Quality of the studies and the level of evidence were assessed. The random-effects model was employed for meta-analysis, and heterogeneity was examined based on I-square and Cochrane's Q test. Subgroup analyses were performed when the heterogeneity among studies could not be explained.

RESULTS

From 473 identified studies, five (three case-control studies, one cohort study, and one case-crossover study) were included in our analysis based on eligibility criteria. First-generation antihistamine use showed significantly increased risk of injurious falls or fracture (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.49-2.76, heterogeneity: p = 0.41, I² = 0%). Studies including antihistamines of all generations or containing no generation information were dealing with falls during hospitalization. Among these studies, the association was statistically significant without heterogeneity (OR 2.89, 95% CI 1.71-4.89, heterogeneity: p = 0.42, I² = 0%). Due to the small number of studies included and unadjusted results, meaningful interpretation based on subgroup analysis was limited.

CONCLUSIONS

First-generation antihistamine use is considerably associated with increased risk of injurious falls or fracture among the elderly. Clinicians need to exercise caution when prescribing first-generation antihistamines to elderly patients.

Investigation of Werner protein as an early DNA damage response in actinic keratosis, Bowen disease and squamous cell carcinoma

BACKGROUND

Werner protein (WRN) has DNA helicase activity and participates in recombination, replication and repair of DNA. Loss-of-function mutations in WRN gives rise to genetic instability and diseases such as premature ageing and cancer. Upregulation of WRN promotes proliferation and survival of cancer cells.

AIM

To evaluate the expression pattern of WRN in closely related skin cancers and their correlation with age, sex and UV exposure.

METHODS

Immunohistochemistry was used to investigate expression of WRN in formalin-fixed, paraffin wax-embedded tissue specimens of 9 squamous cell carcinoma (SCC), 15 actinic keratosis (AK), 11 Bowen disease (BD) and 11 normal-appearing peripheral tissue samples, obtained from patients during surgical resections.

RESULTS

WRN expression was significantly increased in BD, AK and SCC compared with normal controls, with the mean WRN staining score being highest in BD, followed by AK and SCC. However, age, sex and sun exposure were not associated with WRN expression.

CONCLUSIONS

To our knowledge, this is the first report to date investigating the expression of WRN in skin cancers. The overtly high expression of WRN in premalignant lesions and in in situ cancer, with relatively low WRN expression in SCC, may indicate that WRN contributes as a checkpoint for early DNA damage response in skin tumorigenesis.

Associations between the GNB3 C825T polymorphism and obesity-related metabolic risk factors in Korean obese women

PURPOSE

It is important to identify a 'metabolically unhealthy obese' subset with higher cardiovascular risk among obese individuals. We investigated the associations between the GNB3 C825T polymorphism and obesity-related metabolic risk factors among Korean obese women.

METHODS

This study was a sub-investigation of a double-blind randomized controlled trial that examined the additive effect of or list at on weight loss with sibutramine. A sample of 111 obese women were divided into T-carriers (CT/TT) or a homozygous CC group, according to the presence of the 825T allele at GNB3. These groups were compared to determine their associations with obesity-related metabolic risk factors, i.e., fasting plasma glucose, serum lipids, serum insulin/insulin resistance, and abdominal fat amounts.

RESULTS

The allele frequencies of the GNB3 polymorphism were C allele = 59.5% and T allele = 40.5%. The T allele was found to be significantly associated with greater visceral fat and higher serum lipids, and these significances remained robust after adjusting for potential covariates.

CONCLUSIONS

The GNB3 825T polymorphism is significantly associated with greater visceral fat and higher serum lipids in Korean obese women and it suggests that the GNB3 C825T is a determinant of obesity-related metabolic traits in this population.

Improving acne keloidalis nuchae with targeted ultraviolet B treatment: a prospective, randomized, split-scalp comparison study

BACKGROUND

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis with fibrotic papules on the occipital scalp. Its treatment is limited and unsatisfactory.

OBJECTIVES

To determine whether targeted ultraviolet B (tUVB) phototherapy will (i) improve the clinical appearance of AKN and (ii) induce extracellular matrix remodelling in affected lesions.

METHODS

Eleven patients with AKN were enrolled in a prospective, randomized, split-scalp comparison study. One randomly selected side of the scalp was treated with tUVB up to three times weekly for 8 weeks. After week 8, both sides were treated for eight additional weeks. Assessment included lesion counts in two 3 × 3-cm regions of interest (ROIs), one on each side of the scalp (ROI-1: tUVB weeks 0-16, ROI-2: tUVB weeks 9-16), patient self-assessment and analysis of MMP1, MMP9, TGFB1 and COL1A1 mRNA expression by quantitative reverse-transcription polymerase chain reaction.

RESULTS

Before treatment, the mean lesion count was similar between tUVB-treated and untreated sides (14·8 vs. 15·0). After 8 weeks of tUVB, the mean lesion count decreased significantly to 9·4 ± 1·2 (P =  0·03), with no change on the untreated side. With continued treatment, the mean lesion count in ROI-1 decreased further to 7 ± 1·5 (P = 0·04) after 16 weeks of tUVB.

CONCLUSIONS

tUVB significantly improved the clinical appearance of AKN, led to patient satisfaction and was well tolerated.

Effect of the G-protein β3 subunit 825T allele on the change of body adiposity in obese female

No clinical studies on the lipolytic effect of guanine nucleotide-binding protein β3 subunit gene (GNB3) 825T polymorphism have been performed. This study was a subinvestigation of a 12-week randomized controlled trial (NCT01184560) for the additive effect of orlistat on sibutramine treatment. The analysis involved 101 obese females aged 18-49 years, genotyped at the GNB3 825 locus. To exclude any influence from potential confounders, we used an analysis of covariance model. After the intervention, fat mass proportion in total weight loss was significantly lower in subjects with a T allele than in those without a T allele (p = 0.034). GNB3 825T allele was associated with blunted fat mass reduction in obese females.

Anterior cingulotomy for refractory obsessive-compulsive disorder

OBJECTIVE

This study was designed to prospectively investigate the efficacy and cognitive adverse effects of stereotactic bilateral anterior cingulotomy as a treatment for refractory obsessive-compulsive (OCD) patients for 12 months.

METHOD

Patients were eligible if they had severe OCD and rigorous treatments had been unsuccessful. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impression (CGI) and neuropsychological tests were used to assess the efficacy and cognitive changes of cingulotomy before and 12 months after operation.

RESULTS

The mean improvement rate of the Y-BOCS scores achieved from baseline was 36.0%. Out of 14 patients six met responder criteria; 35% or higher improvement rate on Y-BOCS and CGI improvement of very much or much better at 12-month follow-up. There was no significant cognitive dysfunction after cingulotomy.

CONCLUSION

Anterior cingulotomy shows few cognitive adverse effects, with about half of the OCD patients demonstrating significant symptomatic improvement.

Cytological observation of two environmental genic male-sterile lines of rice

We report here two environmental genic male-sterilities (EGMS) in rice. These two EGMS rice lines, thermo-sensitive genic male-sterility (TGMS) and photoperiod-sensitive genic male-sterility (PGMS), are controlled by temperature and photoperiod, respectively, in determining their male-sterility. Male-sterility of the TGMS and PGMS was found to be induced when they were grown at 32 degrees C/26 degrees C (day/night) with 14 h daylight, while they were fertile at 26 degrees C/20 degrees C (day/night) with 10 h daylight in a growth chamber. We also examined their anther structures under a light microscope. The light microscopic observation revealed that the EGMS lines showed a complete pollen abortion at the sterile growth condition while they produced normal fertile pollens at the fertile growth condition.

Identification of rice varieties with high tolerance or sensitivity to lead and characterization of the mechanism of tolerance

Pb inhibits plant growth. To study Pb tolerance in rice (Oryza sativa), we screened 229 varieties for Pb tolerance or sensitivity. Three-day-old seedlings were treated for 12 d with 20 microM Pb solution. Based on the dry weight of the root, three Pb-tolerant (var CH-55, var KH-2J, var Kumnung) and three Pb-sensitive (var Aixueru, var C-9491, var Milyang23) rice varieties were selected. The root biomasses of the tolerant varieties were approximately 10-fold higher than those of the sensitive ones. The greatest morphological difference between the two groups was in the growth of the adventitious roots, as tolerant lines were able to develop adventitious roots after 6 d of Pb treatment, whereas sensitive ones did not develop any even after 15 d. The growth of adventitious roots in the tolerant varieties was dependent on a mechanism, whereby Pb was altered to a form that cannot be taken up by the tissue, because (a) the solution in which the tolerant varieties of rice had grown still contained Pb but nevertheless did not affect the root growth of new rice seedlings, and (b) the adventitious roots of tolerant seedlings developed in Pb solution contained little Pb. The oxalate content in the root and root exudate increased upon Pb treatment in the tolerant varieties, whereas the opposite was observed for the sensitive ones. Oxalate added to the growth solution ameliorated the inhibition of root growth by Pb. These results suggest that compounds such as oxalate secreted from the root may reduce the bio-availability of Pb, and that this may constitute an important Pb tolerance mechanism in the tolerant rice varieties studied here.

Clinical implication of altered expression of Mad1 protein in human breast carcinoma

BACKGROUND

Mad1 protein is known to repress Myc target genes and antagonize Myc function. The authors undertook this study to investigate the clinical implication of Mad1 expression in human breast carcinoma.

METHODS

The authors performed immunohistochemical assays for Mad1 and Myc proteins in human breast carcinoma, along with tissues from normal breast and benign diseases. The data from protein assays were analyzed in terms of the clinical and biologic characteristics of the patients.

RESULTS

Of 66 patients with invasive ductal carcinoma, Mad1 expression was detected in 22 (33. 3%). Intensity and area of Mad1 expression significantly decreased in DCIS and invasive cancers, whereas high levels of Mad1 expression were persistent in benign breast lesions. Mad1 expression was significantly reduced in poorly differentiated tumors (P < 0.001). Expression of Mad1 was not associated with tumor size, lymph node status, or stage of disease. The authors did not observe any correlation between S-phase and expression status of Myc or Mad1. Mad1 expression was closely linked to differentiation of the cancer cells and inversely correlated with Myc expression (P = 0.042). In survival analysis, Mad1 was a significant factor in predicting recurrence of the disease, but not overall survival after CMF chemotherapy.

CONCLUSIONS

In human breast carcinoma cells, expression of Mad1 seems to be down-regulated, whereas expression of Myc is amplified. Altered expression of Mad1 may play a role in the malignant transformation of human mammary epithelial cells and represent an aggressive phenotype in human breast carcinoma.

A case of hidroacanthoma simplex

There are many conditions characterized by nests of cells within the epidermis. One of them, hidroacanthoma simplex, has been regarded as an epidermal tumor differentiating to intraepidermal eccrine duct cell. We report a case of hidroacanthoma simplex with the results of immunohistochemical study. Staining for 35 beta H11 (reacting with keratin No. 8), 35 beta E12 (reacting with keratin No. 1, 5, 10, 11), S-100 protein, and CEA was negative in the tumor cell nests; these monoclonal antibodies stained the nests of eccrine poroma.

Apoptosis is induced by anti-Fas antibody alone in cultured human keratinocytes

Fas is a well-known cell surface receptor whose main function is the induction of apoptosis in many cell types including human keratinocytes. Several reports indicate that anti-Fas antibody can induce apoptosis in cultured keratinocytes after interferon gamma (IFN gamma) pretreatment. Because IFN gamma is synthesized by activated T cells, but not by keratinocytes, these results suggest that Fas may only be effective in apoptosis occurring in T-cell mediated inflammatory skin diseases. We hypothesized that Fas alone might mediate apoptosis in normal human keratinocytes without any other help and thus play a role in normal epidermal homeostasis. By using Cell Death Detection ELISA, we observed keratinocyte apoptosis 24 hours after anti-Fas antibody stimulation not only in IFN gamma-pretreated conditions but also in non-pretreated conditions. Even though the percentage of cultured keratinocytes stained by anti-Fas antibody increased from 7.8 to 25.8% 24 hours after IFN gamma stimulation, the apoptotic rate of the anti-Fas only group was the same as that of the anti-Fas plus IFN gamma treated group. In both conditions, we have verified apoptotic phenomena in cultured keratinocytes in situ by TUNEL staining. Some apoptotic bodies were phagocytosed by neighboring keratinocytes. Fas-mediated apoptosis was not inhibited by the protein synthesis inhibitor cycloheximide and was enhanced by inhibitors of several protein kinases, including PKC and staurosporine. These results suggest that Fas-mediated apoptosis may play a role in both T cell-mediated skin diseases and normal epidermal homeostasis.

Radiation treatment in patients with recurrent Kimura's disease

PURPOSE

To assess the benefits of radiotherapy for patients with recurrent Kimura's disease and to document the role of radiation treatment as a successful mode of therapy.

METHODS AND MATERIALS

From 1985 to 1991, a total of 26 patients with Kimura's disease were treated by local excision and/or systemic steroids at Yonsei University, Yonsei Cancer Center Hospital. Seventeen patients among them eventually had local recurrence after surgical excision. The 17 patients with recurrent Kimura's disease were divided into two groups on the basis of those who received radiation treatment and those who did not. Eight patients in the nonradiation group were treated by systemic steroids alone with individualized doses and schedules. The remaining nine patients in the radiation group were treated by external beam irradiation. The prescribed radiation doses varied from 21.6 to 45 Gy. A comparative analysis on treatment results between both groups was undertaken retrospectively.

RESULTS

The majority of the recurrent cases in the nonradiation group treated by steroids alone experienced rapid rerecurrence of the disease. In contrast, all of the patients except one case in the radiation group achieved excellent local control with moderate doses of radiation. There was a significant difference in the rerecurrence rate between the patients of the radiation group (11%) and the nonradiation group (75%). No clear dose-response relationship could be derived from the patients of the radiation group. No secondary malignancies in the irradiated areas have been observed.

CONCLUSION

Our results suggest that radiation treatment is preferable as an alternative option for patients with recurrent Kimura's disease who have failed to achieve local control by other modalities.

Dissecting aneurysm of the superior mesenteric artery

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