Evaluation of the resection efficiency and safety of an enhanced power plasma generator using cadaveric intervertebral discs

Plasma energy has been used to provide minimally invasive interventional treatment for spinal problems. However, this procedure has been used for limited indications mainly because of its small resection range. To overcome this problem, we designed the enhanced power plasma device. This device seeks to maximize the resection area by modifying the electrode arrangement and enhancing the maximum electric power. The purpose of this study is to assess the efficiency and safety of this newly designed plasma generator, a device for percutaneous disc decompression. We performed an intradiscal procedure on 7 fresh human cadaver lumbar spine specimens using the enhanced power plasma under C-arm fluoroscopic guidance at various voltages. As a result, the volume of the removed area was proportional to the applied magnitude of the electric power level. In particular, under the high-power level condition after 500 s treatment, nearly the entire nucleus pulposus was eliminated. The generated plasma density also tends to grow along with the given electric power. The highest level of temperature rise did not exceed the level that would lead to degeneration in the collagen tissue of the intervertebral disc. Histopathologic examination also demonstrated that there was no thermal damage to the surrounding neural tissues. In conclusion, we speculate that the concepts of this newly designed enhanced plasma generator could be applied to remove huge disc materials without thermal or structural damage to the adjacent target tissues in future spine clinics.

Waning Effectiveness of One-dose Universal Varicella Vaccination in Korea, 2011-2018: a Propensity Score Matched National Population Cohort

BACKGROUND

Despite high coverage (~98%) of universal varicella vaccination (UVV) in the Republic of Korea since 2005, reduction in the incidence rate of varicella is not obvious. The study aimed to evaluate the vaccine effectiveness (VE) of one-dose UVV by timeline and severity of the disease.

METHODS

All children born in Korea in 2011 were included for this retrospective cohort study that analyzed insurance claims data from 2011-2018 and the varicella vaccination records in the immunization registry. Adjusted hazard ratios by Cox proportional hazard models were used to estimate the VE through propensity score matching by the month of birth, sex, healthcare utilization rate, and region.

RESULTS

Of the total 421,070 newborns in the 2011 birth cohort, 13,360 were matched for age, sex, healthcare utilization rate, and region by the propensity score matching method. A total of 55,940 (13.29%) children were diagnosed with varicella, with the incidence rate 24.2 per 1000 person-year; 13.4% of vaccinated children and 10.4% of unvaccinated children. The VE of one-dose UVV against any varicella was 86.1% (95% confidence interval [CI], 81.4-89.5) during the first year after vaccination and 49.9% (95% CI, 43.3-55.7) during the 6-year follow-up period since vaccination, resulting in a 7.2% annual decrease of VE. The overall VE for severe varicella was 66.3%. The VE of two-dose compared to one-dose was 73.4% (95% CI, 72.2-74.6).

CONCLUSION

We found lower long-term VE in one-dose vaccination and waning of effectiveness over time. Longer follow ups of the vaccinated children as well as appropriately designed studies are needed to establish the optimal strategy in preventing varicella in Korea.

Trends in Viral Respiratory Infections During COVID-19 Pandemic, South Korea

We compared weekly positivity rates of 8 respiratory viruses in South Korea during 2010-2019 and 2020. The overall mean positivity rate for these viruses decreased from 54.7% in 2010-2019 to 39.1% in 2020. Pandemic control measures might have reduced the incidence of many, but not all, viral respiratory infections.

Changes in the working conditions and learning environment of medical residents after the enactment of the Medical Resident Act in Korea in 2015: a national 4-year longitudinal study

PURPOSE

In 2015, the South Korean government legislated the Act for the Improvement of Training Conditions and Status of Medical Residents (Medical Resident Act). This study investigated changes in the working and learning environment pre- and post-implementation of the Medical Resident Act in 2017, as well as changes in training conditions by year post-implementation..

METHODS

An annual cross-sectional voluntary survey was conducted by the Korean Intern Resident Association (KIRA) between 2016 and 2019. The learning and working environment, including extended shift length, rest time, learning goals, and job satisfaction, were compared by institution type, training year, and specialty

RESULTS

Of the 55,727 enrollees in the KIRA, 15,029 trainees took the survey, and the number of survey participants increased year by year (from 2,984 in 2016 to 4,700 in 2019). Overall working hours tended to decrease; however, interns worked the most (114 hours in 2016, 88 hours in 2019; P<0.001). Having 10 hours or more of break time has gradually become more common (P<0.001). Lunch breaks per week decreased from 5 in 2017 to 4 in 2019 (P<0.001). Trainees’ sense of educational deprivation due to physician assistants increased from 17.5% in 2016 to 25.6% in 2018 (P<0.001). Awareness of tasks and program/work achievement goals increased from 29.2% in 2016 to 58.3% in 2018 (P<0.001). Satisfaction with the learning environment increased over time, whereas satisfaction with working conditions varied.

CONCLUSION

The Medical Resident Act has brought promising changes to the training of medical residents in Korea, as well as their satisfaction with the training environment.

Paradoxical health care utilization patterns among children in Korea who did not receive mandatory pneumococcal vaccination

BACKGROUND

Unvaccinated children in the National Immunization Program (NIP) are a public health concern. We used Korean national population data to analyze health care utilization patterns of NIP-eligible children and identify the unvaccinated group.

METHODS

Pneumococcal vaccination (PCV) records were reviewed to determine the vaccination status of children born between 2013 and 2015. Children who received three doses or more from a 3 + 1 schedule were defined as vaccinated, while those who had not received any pneumococcal vaccinations were defined as unvaccinated. Corresponding health care utilization records were retrieved from the National Health Insurance Review and Assessment Service. The incidence of combined pneumococcal infections and health care utilization rates were estimated and the proportion of complementary and alternative medicine (CAM) utilization among the total health care utilization records was measured.

RESULTS

In total, 26,893 (2.1%) of 1,272,685 children remained unvaccinated. The incidence of pneumococcal infection was lower in unvaccinated children, at 10.1 cases (9.8-10.3) per 1000 person-months. However, their health care utilization was significantly lower than that noted for vaccinated children (hospital visit rate: 26.6 (95% confidence interval [CI] 26.5-26.7) vs. 3.2 (3.2-3.3) visits annually), indicating underdetection. CAM treatment was sought at least three times often more in unvaccinated children than in vaccinated children (3.5% vs. 1.1%).

CONCLUSION

Unvaccinated children showed significantly lower utilization of overall health care than the vaccinated children; however, a higher preference for CAM was noted among unvaccinated children than among vaccinated children. These differences in care-seeking patterns should be considered when identifying unvaccinated children and providing protection through vaccination programs.

Effects of psychological behaviour management programme on dental fear and anxiety in children: A randomised controlled clinical trial

AIM

A psychological behaviour management programme with information and communications technology was developed that includes symbolic modelling, tell-show-do, positive reinforcement and distraction, and provides real-time treatment information. We hypothesised that the programme would help patients feel less stressed and show less uncooperative behaviours and subjective pain.

MATERIALS AND METHODS

Forty-eight paediatric patients were recruited from May 2016 to January 2017, and randomly divided into a control group and an experimental group. In the control, patients watched cartoon animations during the first and second treatments. The experimental group watched cartoon animations during the first treatment, and they used the programme during the second treatment. To measure stress, uncooperative behaviour and subjective pain, we recorded the heart rate, Procedure Behaviour Checklist (PBCL) and Wong and Baker's Faces Pain Rating Scale (FPRS).

RESULTS

The experimental group resulted in a significantly lower mean heart rate, uncooperative behaviour and subjective pain in the second treatment than did the control group (p<0.001). The differences in heart rate and uncooperative behaviour between the treatments were also significantly greater in the experimental group than in the control group (p<0.001).

CONCLUSION

The programme was effective in relieving fear and anxiety as well as learning cooperative behaviour.

2700. Evaluation of 10- and 13-Valent Protein Conjugate Pneumococcal Vaccine Effectiveness for Children in Korea

Background

Pneumococcal vaccination for infants was introduced to the mandatory National Immunization Program (NIP) of Korea in May 2014. Both 10- and 13-valent protein conjugated vaccines (PCV) have been in use with 3 + 1 dose schedule. We assessed the vaccine effectiveness in protecting children from all-cause pneumonia (ACP), pneumococcal pneumonia (PP), invasive pneumococcal diseases (IPD), and acute otitis media (AOM).

Methods

The birth cohort of children born between 2013 and 2015 was identified from the national population registry for retrospective observation. Vaccination status was confirmed through NIP registry by Korean Centers for Disease Control and Prevention, and disease occurrence was detected through the National Health Insurance System. Children who finished at least 3-doses of PCV were classified vaccinated while who did not receive any type of pneumococcal vaccine until study end were classified unvaccinated. The outcome of interest was hospital admission from any of pneumococcal infections among ACP, PP, IPD or AOM. After adjusting for high risk and underlying conditions, the vaccine effectiveness (VE) was calculated with Cox regression. VE of different valent PCV was also compared within fully vaccinated (4-doses) children.

Results

A total of 1,243,432 children were included. Fifty-one percent of children were boys and median age was 30-months. Ninety-eight percent were vaccinated and 89% of them were fully vaccinated. The incidence (per 100,000 person-years) of ACP was 10,982 in vaccinated and 9,276 in unvaccinated, and that of IPD and AOM were 1.0 vs 1.5 and 45.7 vs 31.3, respectively. The vaccine had protective effect for ACP (VE 20.2% [95% CI 19.5–20.9]), PP (VE 25.5% [95% CI 21.1–29.6]), IPD meningitis (VE 93.6% [95% CI 27.1–99.4]) and AOM (VE 4.6% [95% CI 4.1–5.1]). When fully vaccinated with PCV10, compared with PCV13, it was statistically more protective against ACP (VE 22.7% vs. 19.6%, P = 0.033) and PP (VE 50.8% vs. 21.3%, P < 0.001) but not different against AOM (VE 4.2% vs. 6.0%, P = 0.53).

Conclusion

Four-doses of PCV strategy for children in current mandatory NIP is effective for protecting the vaccinated from ACP, PP, IPD, and AOM.

Disclosures

All authors: No reported disclosures.

2713. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine in Korean National Population Cohort over 65 Years Old

Background

Twenty-three valent pneumococcal polysaccharide vaccine (PPSV) has been introduced to the National Immunization Program (NIP) for adults aged 65 years and older in Korea since 2013. We describe the effectiveness evaluation of PPSV among adults against pneumococcal infections including all-cause pneumonia (ACP), pneumococcal pneumonia (PP), and invasive pneumococcal diseases (IPD) using national population cohort.

Methods

Vaccination records of the national population, aged 65 years and older, from NIP registry by Korea Centers for Disease Control and Prevention (KCDC) were matched to their corresponding medical records by National Health Insurance Service (NHIS) for retrospective cohort analysis. Adults vaccinated with 1-dose PPSV between 2013 and 2016 were compared with those non-vaccinated. Primary outcomes were hospitalization due to ACP, PP, and IPD. Vaccine effectiveness (VE) adjusted for high risk and underlying conditions was calculated as one minus hazard rate ratio (HR) using Cox regression.

Results

Records of 6,743,002 cohort members were included. Forty-three percent were male, and median age was 75-years. Among the cohort, 3,425,949 (51%) were vaccinated during the study period. Incidence (per 100,000 person-years) of each disease in vaccinated and unvaccinated, respectively, was 2,184 and 1,584 for ACP, 8.9 and 5.4 for PP, and 1.6 and 1.9 for IPD. VE against IPD was 41.7% (95% CI 28.8–52.3) and against IPD sepsis was 53.5% (95% CI 39.8–64.0). PPSV was also protective against ACP with VE 7.2% (95% CI 6.6–7.8). When stratified by age-group, adults aged 65–74 years were better protected from ACP (VE 16.5% [95% CI 15.6–17.3]) compared with older adults aged 75 years or older (VE –0.4% [95% CI –1.2 to 0.4]), while VE was higher in older adults against IPD (VE 47.6% [95% CI 32.4–59.4]) and IPD sepsis (VE 54.9 [95% CI 38.4–66.9]) than in 65–74 years group (IPD VE 30.4% [95% CI 3.4–49.9]; sepsis VE 49.0% [95% CI 19.7–67.6]).

Conclusion

Single-dose PPSV strategy for adults in general population is protective against PCV, IPD, and IPD sepsis.

Disclosures

All authors: No reported disclosures.

1632. Different Healthcare Utilization Pattern in Vaccine Hesitant Children

Background

National Immunization Program (NIP) in Korea provides 17 types of mandatory vaccines for all children free of charge. However, vaccine-hesitant group refusing the NIP are being a major threat to public health. We analyzed the healthcare utilization pattern observed in NIP eligible children and sought to identify those who remain unvaccinated using national population data.

Methods

History of receiving protein conjugate pneumococcal vaccine (PCV) was reviewed to determine the vaccination status of children born between 2013 and 2015. Children who had 3-doses or more out of 3 + 1 schedule were defined vaccinated, while those with no record of vaccination were defined unvaccinated. Their healthcare utilization records, including a number of visits, total duration, type of institution (hospitals, complementary and alternative medicine [CAM]), and purpose of visits (outpatient care, hospitalization), were retrieved from the National Health Insurance (NHI) Review and Assessment Service. Annual healthcare utilization rate and incidence of pneumococcal infections were estimated with Poisson regression and compared between study arm. The proportion of CAM out of total healthcare utilization was also compared.

Results

Among 1,272,685 children, 51% were boys and median age was 29.4-months. Two-percent of the cohort remained unvaccinated until study end. Annual hospital visiting rates were 26.9 times (95% confidence interval [CI] 26.9–27.0) for vaccinated and 3.4 (95% CI 3.4–3.5) for unvaccinated. Average NHI benefit period per year was 28.8 days (95% CI 28.8–29.0) for vaccinated and 3.9 (95% CI 3.8–3.9) for unvaccinated. The discrepancy resulted in under-detection of pneumococcal incidence in unvaccinated with 10.1 cases (95% CI 9.9–10.4) per 1,000 child-months whereas that of vaccinated was 42.5 (95% CI 42.4–42.6). Vaccine hesitant children preferred CAM at least 3-times more than vaccinated children (CAM proportion 3.5% in hesitant group vs. 1.07% in vaccinated group, P < 0.001).

Conclusion

Vaccine hesitant group not only refuses vaccination but also tends to opt-out from the entire medical attention and prefer CAM. Active detection considering this different pattern should be implemented in order to ensure the public benefits from the vaccination program.

Disclosures

All authors: No reported disclosures.

Estimating Influenza-associated Mortality in Korea: The 2009-2016 Seasons

OBJECTIVES

Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes.

METHODS

Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype.

RESULTS

Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus-associated influenza or pneumonia deaths were more common in those under 65 years old.

CONCLUSIONS

Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.

The flipped classroom model for an undergraduate epidemiology course

PURPOSE

The flipped classroom has been suggested as a method for efficient teaching in medical education. However, its feasibility and effectiveness in the educational environment are often overlooked. The authors redesigned an epidemiology course applying the flipped classroom method under a traditional curriculum consisting of heavily scheduled classroom hours and explored its feasibility and effectiveness.

METHODS

In the fall semester of 2017, we flipped the 'practice of epidemiology' course for third-year medical students at Korea University College of Medicine. We provided online lectures and assigned readings as pre-class materials, and substituted group discussions and communicative activities for traditional lectures. We conducted pre- and post-course surveys to review students' perceptions. We also analyzed the pre-test results and final exam scores for quantitative comparison.

RESULTS

Ninety-seven students out of 120 completed the course. Most students made use of the online lectures, but not the reading materials. Lack of time was the most frequently cited reason for under-preparedness. We observed improvements in preparedness, participation, and effectiveness at the end of the course, while changes in satisfaction were unclear. Students' perceptions of course relevance and difficulty were predictive of pre-test outcomes, but the effects of preparedness and length of materials were insignificant. The authors found no evidence of differing test scores before and after the course.

CONCLUSION

This study supports the feasibility of the flipped classroom model even under a traditional, heavily scheduled medical curriculum. To encourage self-directed learning and achieve better learning outcomes, restructuring pre-existing curricular components should also be considered in parallel with new instructional methods.

'Pneumonia Weather': Short-term Effects of Meteorological Factors on Emergency Room Visits Due to Pneumonia in Seoul, Korea

Objectives

Many studies have explored the relationship between short-term weather and its health effects (including pneumonia) based on mortality, although both morbidity and mortality pose a substantial burden. In this study, the authors aimed to describe the influence of meteorological factors on the number of emergency room (ER) visits due to pneumonia in Seoul, Korea.

Methods

Daily records of ER visits for pneumonia over a 6-year period (2009-2014) were collected from the National Emergency Department Information System. Corresponding meteorological data were obtained from the National Climate Data Service System. A generalized additive model was used to analyze the effects. The percent change in the relative risk of certain meteorological variables, including pneumonia temperature (defined as the change in average temperature from one day to the next), were estimated for specific age groups.

Results

A total of 217 776 ER visits for pneumonia were identified. The additional risk associated with a 1°C increase in pneumonia temperature above the threshold of 6°C was 1.89 (95% confidence interval [CI], 1.37 to 2.61). Average temperature and diurnal temperature range, representing within-day temperature variance, showed protective effects of 0.07 (95% CI, 0.92 to 0.93) and 0.04 (95% CI, 0.94 to 0.98), respectively. However, in the elderly (65+ years), the effect of pneumonia temperature was inconclusive, and the directionality of the effects of average temperature and diurnal temperature range differed.

Conclusions

The term ‘pneumonia temperature’ is valid. Pneumonia temperature was associated with an increased risk of ER visits for pneumonia, while warm average temperatures and large diurnal temperature ranges showed protective effects.

Usefulness of asthma predictive index in ascertaining asthma status of children using medical records: An explorative study

BACKGROUND

Frequent wheezing in original asthma predictive index (API) was defined by parental report of recurrent wheezing within 1 year during the first 3 years of life. The nature of frequent wheezing in children, particularly aged over 3 years, has not been studied. We aimed to assess the frequency and interval of wheezing to define frequent wheezing in ascertaining asthma for children using medical records.

METHODS

Among children who participated in a previous study (n = 427), all wheezing episodes documented in medical records were collected for children who had ≥2 wheezing episodes PLUS met one major criterion or two minor criteria of API. We compared the distribution of known risk factors for asthma between subjects having two consecutive wheezing episodes with shorter interval (≤1 year) compared to those with longer interval (1 to 3 years).

RESULTS

A total of 62 children met API at median age of 2.3 years. During follow-up period (median age: 11.3 years), a total of 198 wheezing episodes were observed. 81% of wheezing intervals were within 3 years from the earlier wheezing episode, including 60% within 1 year. Children who met API based on 1-year interval (n = 40) vs 1- to 3-year interval (n = 13) appeared to be similar in regard to the known risk factors for asthma.

CONCLUSIONS

Our exploratory study finding suggests that children who had frequent wheezing episodes with longer interval (<3 years) need to be considered to be determined as asthma cases when API is applied to retrospective medical records. Prospective studies with a larger sample size need to replicate this finding.

Feasibility of Navigable Percutaneous Disk Decompressor (L'DISQ-C) for Cervical Disk Herniation

OBJECTIVE

 To assess the procedural efficacy and safety of a Navigable Percutaneous Disk Decompressor (L'DISQ-C) for cervical disk herniation.

METHODS

 We performed intradiskal decompression on cervical spine specimens from five human cadavers using the L'DISQ-C under C-arm fluoroscopic guidance. We evaluated our success for positioning the navigable wand tip into the target region and recorded temperature variation at various distances from the wand tip in the cervical nucleus pulposus. The histologic effect of plasma decompression was examined microscopically using harvested tissues adjacent to the procedure site.

RESULTS

 We successfully navigated the tip of the L'DISQ-C into the target region of the posterior cervical disks on the first insertion attempt in all C3-C4 to C6-C7 disks and in 50% of the C2-C3 and C7-T1 disks. The average temperature elevations within the nucleus pulposus ranged from 4.14 ± 0.08°C to 12.17 ± 0.76°C at various distances from the wand tip with or without saline infusion. A histologic examination showed only minor denaturation at the marginal border of the procedure tract.

CONCLUSION

 We effectively navigated the L'DISQ-C wand tip into the posterior target region of six cadaveric cervical disks and performed percutaneous resection of the target disk tissues without significant thermal or structural damage to adjacent tissues.

The Role of ORAI1 in the Odontogenic Differentiation of Human Dental Pulp Stem Cells

Pulp capping, or placing dental materials directly onto the vital pulp tissues of affected teeth, is a dental procedure that aims to regenerate reparative dentin. Several pulp capping materials are clinically being used, and calcium ion (Ca(2+)) released from these materials is known to mediate reparative dentin formation. ORAI1 is an essential pore subunit of store-operated Ca(2+) entry (SOCE), which is a major Ca(2+) influx pathway in most nonexcitable cells. Here, we evaluated the role of ORAI1 in mediating the odontogenic differentiation and mineralization of dental pulp stem cells (DPSCs). During the odontogenic differentiation of DPSCs, the expression of ORAI1 increased in a time-dependent manner. DPSCs knocked down with ORAI1 shRNA (DPSC/ORAI1sh) or overexpressed with dominant negative mutant ORAI1(E106Q) (DPSC/E106Q) exhibited the inhibition of Ca(2+) influx and suppression of odontogenic differentiation and mineralization as demonstrated by alkaline phosphatase (ALP) activity/staining as well as alizarin red S staining when compared with DPSCs of their respective control groups (DPSC/CTLsh and DPSC/CTL). The gene expression for odontogenic differentiation markers such as osteocalcin, bone sialoprotein, and dentin matrix protein 1 (DMP1) was also suppressed. When DPSC/CTL or DPSC/E106Q cells were subcutaneously transplanted into nude mice, DPSC/CTL cells induced mineralized tissue formation with significant increases in ALP and DMP1 staining in vivo, whereas DPSC/E106Q cells did not. Collectively, our data showed that ORAI1 plays critical roles in the odontogenic differentiation and mineralization of DPSCs by regulating Ca(2+) influx and that ORAI1 may be a therapeutic target to enhance reparative dentin formation.

Caries-preventive Activity of Fluoride-containing Resin-based Desensitizers

Objective

The purpose of this study was to evaluate the effects of different desensitizing agents on the prevention of root caries when applied to root surfaces.

Materials and Methods

Thirty human roots were sectioned into quarters with a 3 × 4 mm window. A desensitizer (VX, Clinpro™ XT Varnish; SP, Seal & Protect®; or PB, Clearfil™ Protect Bond) was applied to three of the quarters in each window. Teeth were stored separately in water for one day, 30 days, or 60 days. The remaining quarter, without the application of desensitizer, served as a control. After storage in water, all specimens were subjected to pH cycling. Scanning electron microscopy was used to observe the demineralization bands created on the subsurface layer. The weight percentages of fluorine (F), silica, and calcium (Ca) were determined using electron probe microanalysis to quantify the elemental distributions in the root dentin. The concentrations of F released during a pH cycling were measured.

Results

For the control group, the average lesion depth was 18.92 ± 5.42 μm, and the average Ca loss was 15.66% ± 6.80% in the superficial layer and 30.44% ± 9.61% in the subsurface layer. No Ca loss occurred in the desensitizer-treated groups. All desensitizing agents remained intact for at least 60 days. F levels were increased in the hybrid layer but not in the subhybrid area. Outward release of F diminished with time.

Conclusion

The F-containing resin-based desensitizers protected exposed root surfaces from demineralization. F liberated from the desensitizers was detected only at minimal levels.

Learning from HSV-infected mice as a model of Behçet's disease

Several animal models of Behçet's disease (BD) have been proposed according to putative etiology. Among these models, the herpes simplex virus (HSV)-induced model produced the most similar disease attributes observe in patients. Inoculation of HSV type 1 to the scratched earlobe of mice produced the appropriate symptoms, including oral, genital, and skin ulcers, eye lesions, arthritis, and intestinal involvement. This HSV-induced BD model is the only continuously used model, to which various therapeutic modalities have been applied.

[Public reporting in health care: the impact of publicly reported quality data on patient steerage]

BACKGROUND

Public reporting (PR) has been gaining more weight as a mechanism for patient steerage. According to the theory of PR, patients use information about the quality of health care providers before making decisions and selecting health-care providers. This paper contributes further knowledge on the effectiveness of PR and identifies critical success factors. These should be taken into account when implementing PR in the German health care system.

METHODOLOGY

The peer-reviewed English, Spanish, and German language literature was searched in the following five databases: The Cochrane Library, Medline (via PubMed), ISI Web of Knowledge, EconLit, and PsycINFO (since 2005). In addition, reference lists of the included studies and reviews were screened in order to identify previously published studies.

RESULTS

In total, 21 studies were identified regarding the impact of 12 different PR instruments on patient steerage. An impact could be demonstrated in 9 studies, 7 studies showed mixed results, while 5 studies could not show any effect on patient steerage. 20 studies were carried out in the US environment, 1 study in Germany. The most researched instrument is the New York State Cardiac Surgery Reporting System (N=8).

CONCLUSION

PR can be effective in steering patients when seeking a health-care provider, especially for elective procedures. To be successful, information provided must be reliable, easily understandable, should further represent real news, and be disseminated widely. Besides this, it has to be applicable and modifiable according to individual preferences.

Role of Amino Acids and Vitamins in Nutrition of Mesophilic Methanococcus spp

In this study we found that autotrophic methanococci similar to Methanococcus maripaludis obtained up to 57% of their cellular carbon from exogenous amino acids. About 85% of the incorporation was into protein. Primarily nonpolar and basic amino acids and glycine were incorporated; only small amounts of acidic and some polar amino acids were taken up. An additional 10% of the incorporation was into the nucleic acid fraction. Because little CO(2) was formed from the C-amino acids, little metabolism of the amino acids occurred. Therefore the growth stimulation by amino acids was probably due to the sparing of anabolic energy requirements. Of the amino acids incorporated, only alanine was also a sole nitrogen source for these methanococci. In contrast, Methanococcus vannielii and "Methanococcus aeolicus" are autotrophic methanococci which did not incorporate amino acids and did not utilize alanine as a sole nitrogen source. Although glutamine served as a sole nitrogen source for the autotrophic methanococci and Methanococcus voltae, a heterotrophic methanococcus, growth was due to chemical deamination in the medium. M. voltae requires leucine and isoleucine for growth. However, these amino acids were not significant nitrogen sources, and alanine was not a sole nitrogen source for the growth of M. voltae. The branched-chain amino acids were not extensively metabolized by M. voltae. Pantoyl lactone and pantoic acid were readily incorporated by M. voltae. The intact vitamin pantothenate was neither stimulatory to growth nor incorporated. In conclusion, although amino acids and vitamins are nutritionally important to both autotrophic and heterotrophic methanococci, generally they are not subject to extensive catabolism.

Association between P53 expression or TP53 codon 72 polymorphism and prognosis in patients with operated invasive breast cancer

e22175

Background: The present study analyzed the impact of p53 expression and TP53 codon 72 polymorphism on the prognosis in patients with operated invasive breast cancer. Methods: Two hundred thirty-four patients with ductal breast cancer who underwent surgery with curative intent were enrolled in the present study. The tumor expressions of p53, ER, PR, and HER2 were graded immunohistochemically and TP53 codon 72 polymorphism was determined by a PCR-RFLP assay using genomic DNA extracted from paraffin-embedded tissue. Results: The median age was 49 (range, 24–82) years, and 134 (57.3%) patients were premenopause at the time of diagnosis. Pathologic stages after surgery were as follows: stage I (n=77, 32.9%), stage II (n=110, 47.0%), and stage III (n=47, 20.1%). Tumor overexpression of p53 protein was observed in 59 (25.2%) patients and was associated with an unfavorable relapse-free survival (RFS) in an univariate analysis adjusted to age, stage, and menstrual status. In a multivariate analysis, p53 overexpression was an independent prognostic factor for RFS (HR=2.36; 95% CI=1.09–5.13; p=0.030). However, no associations were observed between the genotype of TP53 codon 72 polymorphism and survival or clinicopathologic characteristics. Conclusions: Overexpression of p53 protein can be considered as a prognostic factor for RFS in the breast cancer patients after surgery.

No significant financial relationships to disclose.

-93G>A polymorphism of hMLH1 associated with prognosis for patients with colorectal cancer

4039

Background: Polymorphisms in the DNA repair genes may contribute to variation in DNA repair capacity, thereby affecting the risk of carcinogenesis and prognosis of colorectal cancer. Accordingly, the present study analyzed polymorphisms of DNA repair genes and their impact on the prognosis for patients with colorectal cancer. Methods: Three hundred and ninety- seven consecutive patients with curatively resected colorectal adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from fresh colorectal tissue and 14 polymorphisms of DNA repair genes (XRCC1, hMLH1, ERCC2, ERCC4, VARS2[rs2074511, rs2249459], XPA, XPC, POLR2A, POLR2B, RFC1, RFC4, XAB2, DNMT3B) determined using a PCR-RFLP assay. Results: The median age of the patients was 63 years (range, 21–85), and 218 (54.9%) patients had colon cancer and 179 (45.1%) patients rectal cancer. Pathologic stages after surgery were as follows: stage 0/I (n=86, 21.7%), stage II (n=146, 36.8%), stage III (n=145, 36.5%), and stage IV (n=20, 5.0%). Multivariate survival analysis including stage, differentiation, age, and CEA level showed that the survival for the patients with the -93AA genotype of hMLH1 was worse than for the patients with the combined -93GG and GA genotype (overall survival: hazard ratio [HR]=2.953, 95% Confidential Interval [CI], 1.273–6.850, P=0.012; disease-free survival: HR=2.299, 95% CI, 1.417–3.730, P=0.001), whereas the other polymorphisms were not associated with survival. Conclusions: The -93G>A polymorphism of hMLH1 was found to be an independent prognostic marker for patients with colorectal cancer. Accordingly, in addition to the pathologic stage, the analysis of -93G>A polymorphism of hMLH1 can help identify patient subgroups at high risk of a poor disease outcome.

No significant financial relationships to disclose.

Prognostic impact of polymorphisms of caspase genes on survival in patients with operated invasive ductal breast cancer

e22020

Background: Since the apoptosis induced by caspases may play a role in the prognosis of breast cancer, the present study analyzed the polymorphisms of caspase genes and their impact on the survival in patients with operated invasive ductal breast cancer. Methods: Two hundred eighty patients with breast cancer who underwent surgery with curative intent were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tissue, and 7 single nucleotide polymorphisms (SNPs) of 6 caspase genes were determined using a PCR-RFLP assay. Results: The median age was 49 (range, 24–82) years, and 157 (56.1%) patients were premenopause at the time of diagnosis. Thirty-six (12.9%) patients underwent breast-conserving surgery. Pathologic stages after surgery were as follows: stage I (n=86, 30.7%), stage II (n=129, 46.1%), and stage III (n=63, 22.5%). Among the target SNPs, CASP6 (rs2301717, +5095G>T) and CASP7 (rs11593766, +11G>T) were found to correlate with relapse-free survival (RFS) after curative surgery in an univariate analysis adjusted to age, stage, histological grade, and the immunohistochemical expression of estrogen receptor and HER2. Meanwhile, multivariate analysis showed that the combined GT and TT genotype of CASP6 (rs2301717) was associated with a better RFS than the GG genotype (HR=0.39; 95% CI=0.19–0.79; p=0.009). However, there was no significant association with overall survival. Conclusions: The CASP6 (rs2301717) polymorphism may be considered as a possible prognostic factor for survival in patients with operated invasive breast cancer.

No significant financial relationships to disclose.

RIPK1 gene polymorphism as a prognostic marker for survival in patients with colorectal cancer

e15078

Background: Since apoptosis plays a key role in cancer progression, we hypothesized that single nucleotide polymorphisms (SNPs) of apoptosis-related gene can affect survival after curative resection in patients with colorectal cancer. Patients and Methods: Three hundred and ninety seven patients with colorectal cancer who underwent surgery with curative intent were enrolled in the present study. The genomic DNA was extracted from fresh colorectal mucosal tissue, and the 19 SNPs of 15 apoptosis-related genes (CASP3, CASP6–10, FAS, FAS ligand [FASLG], TNSFR1A, TNSFR10B, RIPK1, BCL2, BCL2 ligand [BCL2L], TP53, and PTGS2) were determined using a PCR-RFLP assay. Results: The median age of the patients was 63 years (range, 21–85), and 218 (54.9%) patients had colon cancer and 179 (45.1%) patients rectal cancer. Pathologic stages after surgery were as follows: stage 0/I (n=86, 21.7%), stage II (n=146, 36.8%), stage III (n=145, 36.5%), and stage IV (n=20, 5.0%). Multivariate survival analysis including pathologic stage, differentiation, age, and CEA level showed that relapse-free survival for the patients with the GA+AA genotype of RIPK1 (Receptor interacting serine/threonine kinase 1) +83G>A (rs2272990) was worse than for the patients with the GG genotype (hazard ratio [HR]=1.66, 95% confidence interval [CI]=1.03–2.68, p=0.038). However, no associations were observed between the polymorphisms and overall survival (OS) in a multivariate analysis. Conclusions: RIPK1 gene polymorphism can be considered as a possible prognostic marker for survival after curative resection in patient with colorectal cancer.

No significant financial relationships to disclose.

The clinical significance of oophorectomy in gastric patients

e15646

Background: The oophorectomy in isolated metastasis of ovary can lead to long term survival in patients with gastric cancer, but the clinical significance of oophorectomy in stage IV gastric cancer patients is not known well in this time. Methods: We reviewed the medical record of the 55 gastric cancer patients who were metastasis or recurrent in ovary at Dongsan Medical Center, Kimyung University School of Medicine, Daegu, Korea from 1985 to 2008. Results: Twenty-one patients were metastasis to ovary at the time of diagnosis of gastric cancer, and 34 patients were recurrent in ovary after the gastric resection. The mean age was 45.3 ± 11.6 years in metastatic cancer and 46.8 ±12.6 years in recurrent cancer patients. The stage at the time of gastric resection in 34 recurrent patients were I in 3, II in 1, III in 18, and IV in 10. Adjuvant chemotherapy were performed in 26 (76.5%) patients. Oophorectomy were performed in 33 (97.1%) of recurrent cancer, and 17 (81.0%) of metastatic cancer. The 1-year and 2-year survival rate of metastatic cancer were 14.7%, and 0%, and 1-year, 2-year, and 3-year survival rate of recurrent cancer were 47.2%, 18.1%, and 0%, respectively. The median survival duration of metastatic cancer were 8.9 ±1.0 months, and recurrent cancer were 11.4 ±2.3 months. Recurrent cancer were better survival than metastatic cancer patients (p=0.014). The long-term survival (over 2 years) was noted in 5 patients of recurrent cancer patients. The stage of gastric cancer was correlated to overall survival time in total patients (p=0.028). But, the relapse-free survival time after gastrectomy is the only factor to predict survival duration after oophorectomy in recurrent cancer patients (p=0.029). Age, stage of gastric cancer, extent of involvement of ovary, and systemic chemotherapy were not related to survival time of recurrent cancer patients. Conclusions: The survival time in patients with oophorectomy in recurrent gastric cancer was correlated to relapse-free survival time after gastric resection.

No significant financial relationships to disclose.

Prognostic impact of the NFKB1 insertion/deletion promoter polymorphism on survival in patients with surgically resected gastric cancer

e15638

Background: The present study analyzed the functional insertion/deletion polymorphism in the promoter region of NKFB1 gene and their impact on the prognosis for patients with gastric adenocarcinoma. Methods: Five hundred and three consecutive patients with surgically resected gastric adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tissue and the -94 insertion/deletion ATTG polymorphism of NFKB1 determined using a PCR- RFLP assay. Results: The NFKB1 promoter gene polymorphism was successfully amplified in 97.8% of the cases. There were no sexual differences in relation to the genotype and allele. No correlation was observed between the frequency of the genotype or allele and the T, N, or M stage. The multivariate survival analysis showed no association between the NFKB1 -94 insertion/deletion promoter polymorphism and the disease-free survival or overall survival of the patients with gastric cancer. Conclusions: The functional NFKB1 promoter polymorphism was not found to be a prognostic marker for Korean patients with surgically resected gastric adenocarcinoma.

No significant financial relationships to disclose.

Effects of irradiation on cytokine production in a mouse model of Behçet's disease

OBJECTIVE

Low-dose whole-body irradiation is known to have anti-inflammatory effects. The objectives of this study were to verify that cytokine augmentation is induced by irradiation in vivo, and to assess the effectiveness of radiation in treating Behçet's disease (BD).

METHODS

Whole-body and half-body irradiation with single doses of 10cGy, 2Gy and 10Gy were delivered to normal mice, and cytokine and chemokine levels were analyzed in PBMC and sera. BD-like mice were treated with low-dose, half-body 10cGy irradiation.

RESULTS

In normal mice, PBMC cytokine mRNA levels peaked four days after irradiation. Of the cytokines and chemokines examined, the levels of IL-4, IL-6, IL-12p40, TNF-alpha, TGF-b, MIP-1alpha and IL-18 were all influenced by radiation treatment. Of these, IL-4, an ameliorating factor for BD, was the most elevated following low-dose irradiation (10cGy group). FACS analysis showed intracellular IL-4-staining of 7.24+/-0.92% of PBMC from irradiated mice compared to 1.3+/-0.1% from non-irradiated, normal mice (p<0.005). Serum IL-4 levels were also significantly increased (6.08+/-1.7 pg/ml) relative to control (1.83+/-0.8; p<0.005).

CONCLUSION

Augmentation of cytokine production may contribute to the anti-inflammatory effects of low dose irradiation and amelioration of BD symptoms in this mouse model.

[Overall burden to society caused by hyperkinetic syndrome (HKS) and attention deficit hyperactivity disorder (ADHD)]

OBJECTIVE

The purpose of this work was to provide an analysis of medical costs for HKS/ADHD on the basis of a cost-of-illness study.

METHODS

A systematic literature review concerning the direct and indirect costs of HKS/ADHD and its related implications was complemented by a special analysis of the German Federal Office of Statistics on ICD-10 F 90.

RESULTS

An analysis of overall medical costs by the Federal Office of Statistics results in expenses of 142 million euro in 2002 corresponding to ca. 630 euro per patient per year. These values are considerably below the values calculated for the USA. Increased indirect costs related to different implications of the indication were stated in international studies.

CONCLUSION

A first estimate of the direct costs for HKS/ADHS in Germany has been conducted. A reduction of the difference between the German and the US direct cost values may be expected. An increased level of the indirect costs related to HKS/ADHD may be assumed for Germany and requires further research.