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Background@#Papillary thyroid carcinoma (PTC) can be classified into two distinct molecular subtypes, BRAF-like (BL) and RASlike (RL). However, the molecular characteristics of each subtype according to clinicopathological factors have not yet been determined. We aimed to investigate the gene signatures and tumor microenvironment according to clinicopathological factors, and to identify the mechanism of progression in BL-PTCs and RL-PTCs. @*Methods@#We analyzed RNA sequencing data and corresponding clinicopathological information of 503 patients with PTC from The Cancer Genome Atlas database. We performed differentially expressed gene (DEG), Gene Ontology, and molecular pathway enrichment analyses according to clinicopathological factors in each molecular subtype. EcoTyper and CIBERSORTx were used to deconvolve the tumor cell types and their surrounding microenvironment. @*Results@#Even for the same clinicopathological factors, overlapping DEGs between the two molecular subtypes were uncommon, indicating that BL-PTCs and RL-PTCs have different progression mechanisms. Genes related to the extracellular matrix were commonly upregulated in BL-PTCs with aggressive clinicopathological factors, such as old age (≥55 years), presence of extrathyroidal extension, lymph node metastasis, advanced tumor-node-metastasis (TNM) stage, and high metastasis-age-completeness of resection- invasion-size (MACIS) scores (≥6). Furthermore, in the deconvolution analysis of tumor microenvironment, cancer-associated fibroblasts were significantly enriched. In contrast, in RL-PTCs, downregulation of immune response and immunoglobulin-related genes was significantly associated with aggressive characteristics, even after adjusting for thyroiditis status. @*Conclusion@#The molecular phenotypes of cancer progression differed between BL-PTC and RL-PTC. In particular, extracellular matrix and cancer-associated fibroblasts, which constitute the tumor microenvironment, would play an important role in the progression of BL-PTC that accounts for the majority of advanced PTCs.
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Background@#We explored the risk of death from pneumonia according to cumulative duration in low household income state (LHIS) among adults with type 2 diabetes mellitus (T2DM). @*Methods@#Using Korean National Health Insurance Service data (2002 to 2018), the hazards of mortality from pneumonia were analyzed according to duration in LHIS (being registered to Medical Aid) during the 5 years before baseline (0, 1–4, and 5 years) among adults with T2DM who underwent health examinations between 2009 and 2012 (n=2,503,581). Hazards of outcomes were also compared in six groups categorized by insulin use and duration in LHIS. @*Results@#During a median 7.18 years, 12,245 deaths from pneumonia occurred. Individuals who had been exposed to LHIS had higher hazards of death from pneumonia in a dose-response manner (hazard ratio [HR], 1.726; 95% confidence interval [CI], 1.568 to 1.899 and HR, 4.686; 95% CI, 3.948 to 5.562 in those exposed for 1–4 and 5 years, respectively) compared to the non-exposed reference. Insulin users exposed for 5 years to LHIS exhibited the highest outcome hazard among six groups categorized by insulin use and duration in LHIS. @*Conclusion@#Among adults with T2DM, cumulative duration in LHIS may predict increased risks of mortality from pneumonia in a graded dose-response manner. Insulin users with the longest duration in LHIS might be the group most vulnerable to death from pneumonia among adults with T2DM.
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Background@#This study investigated the trends of insulin use among Korean patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Changes in prescription of antidiabetic medications in T2DM patients taking insulin therapy were evaluated. @*Methods@#We analyzed data from the National Health Insurance Service database in Korea to evaluate the prevalence of insulin users and trends of insulin use in T1DM and T2DM patients from January 2002 to December 2019. We also investigated numbers and types of antidiabetic medications in insulin users with T2DM. @*Results@#The overall total number of insulin users increased from 2002 to 2019, reaching 348,254 for T2DM and 20,287 for T1DM in 2019 compared with 109,974 for T2DM and 34,972 for T1DM in 2002. The proportion of patients using basal analogs and short acting analogs have increased and those using human insulin, premixed insulin, or biphasic human insulin have decreased (rapid acting analogs: 71.85% and 24.12% in T1DM and T2DM, respectively, in 2019; basal analogs: 76.75% and 75.09% in T1DM and T2DM, respectively, in 2019). The use of other antidiabetic medication in addition to insulin increased for T2DM, especially in dual therapy, reaching up to 52.35% in 2019 compared with 16.72% in 2002. @*Conclusion@#The proportion of the patients using basal or rapid acting analogs increased among all insulin users in both T1DM and T2DM patients. Among patients with T2DM, the proportion of patients using antidiabetic medications in addition to insulin was significantly increased compared to those who used insulin alone.
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A seated saline loading test (SLT) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) is one of the most accepted confirmatory tests of primary aldosteronism. However, LC-MS/MS is time-consuming and is not widely available in diagnostic laboratories compared to immunoassay. With immunoassay, it is unknown whether SLT in the seated position is more accurate than that of the supine position, and a cutoff value of post-seated SLT plasma aldosterone concentration (PAC) must be established in the Korean population. Ninety-eight patients underwent SLT in both positions, and post-SLT PAC was measured by LC-MS/MS and radioimmunoassay. We confirmed primary aldosteronism if post-seated SLT PAC by LC-MS/MS exceeded 5.8 ng/dL. The area under the receiver operating characteristic curve was greater for seated than supine SLT (0.928 vs. 0.834, P=0.003). The optimal cutoff value of post-seated SLT by radioimmunoassay was 6.6 ng/dL (sensitivity 83.3%, specificity 92.2%).
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Purpose@#This study investigated the physical and emotional health of South Korean mothers of preterm infants in the early postpartum period. @*Methods@#In this descriptive correlational study, the participants included 91 mothers of preterm infants who were admitted to the neonatal intensive care unit of a tertiary hospital in South Korea. Physical health status was measured using a self-reported questionnaire, postpartum depression using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, and guilt using a 4-item scale. @*Results@#Fatigue had the highest score among mothers' physical health problems, followed by shoulder pain, nipple pain, neck pain. The average postpartum depression score was 11.02 points, and 44% of women had postpartum depression with a score of 12 or above. Postpartum depression significantly was correlated with physical health (r=.35, p=.001), anxiety (r=.84, p<.001), and guilt (r=.75, p<.001) and was significantly higher for women with multiple births, and preterm infants who required ventilator and antibiotic treatment. Anxiety also showed a significant difference according to preterm infants’ condition. @*Conclusion@#The significant correlations between postpartum depression and physical health, anxiety, and guilt indicate a need for nursing interventions that provide integrated management of mothers’ physical and emotional health.
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Background@#Subclinical left ventricular diastolic dysfunction (LVDD) is an emerging consequence of increased insulin resistance, and dyslipidemia is one of the few correctable risk factors of LVDD. This study evaluated the role of mean and visit-to-visit variability of lipid measurements in risk of LVDD in a healthy population. @*Methods@#This was a 3.7-year (interquartile range, 2.1 to 4.9) longitudinal cohort study including 2,817 adults (median age 55 years) with left ventricular ejection fraction >50% who underwent an annual or biannual health screening between January 2008 and July 2016. The mean, standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (apoB), non-HDL-C, and triglycerides were obtained from three to six measurements during the 5 years preceding the first echocardiogram. @*Results@#Among the 2,817 patients, 560 (19.9%) developed LVDD. The mean of no component of lipid measurements was associated with risk of LVDD. CV (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.10 to 1.67), SD (HR, 1.27; 95% CI, 1.03 to 1.57), and VIM (HR, 1.26; 95% CI, 1.03 to 1.55) of LDL-C and all the variability parameters of apoB were significantly associated with development of LVDD. The association between CV-LDL and risk of LVDD did not have significant interaction with sex, increasing/decreasing trend at baseline, or use of stain and/or lipid-modifying agents. @*Conclusion@#The variability of LDL-C and apoB, rather than their mean, was associated with risk for LVDD.
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PURPOSE: Glycosylated hemoglobin (HbA1c) is often used as an indicator of glucose control. It usually reflects the average glucose levels over two to three months, and is correlated with the development of long-term diabetic complications. However, it can vary in cases of hemoglobinopathy or an altered red blood cell lifespan. The serum fructosamine levels reflect the mean glucose levels over two to three weeks. This study was designed to determine the clinical usefulness of the combined measurement of serum fructosamine and HbA1c in the management of childhood diabetes mellitus and the correlation between them. METHODS: Clinical data on 74 Korean children and adolescents with diabetes mellitus who were under management at the Department of Pediatrics of Dankook University Hospital were evaluated. Their fructosamine and HbA1c levels were reviewed based on clinical information, and analyzed using IBM SPSS Statistics ver. 21. RESULTS: Their HbA1c levels showed a strong correlation with their fructosamine levels (r=0.868, P<0.001). The fructosamine level was useful for the prompt evaluation of the recent therapeutic efficacy after the change in therapeutic modality. It was also profitable in determining the initial therapeutics and for the estimation of the onset of the disease, such as fulminant diabetes. CONCLUSION: The measurement of both fructosamine and HbA1c was useful in managing childhood diabetes mellitus, especially when there was discrepancy between the clinical information and the HbA1c level.
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Adolescente , Niño , Humanos , Complicaciones de la Diabetes , Diabetes Mellitus , Eritrocitos , Fructosamina , Glucosa , Hemoglobina Glucada , Hemoglobinopatías , PediatríaRESUMEN
OBJECTIVES: Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model. METHODS: The evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible. RESULTS: Information quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance. CONCLUSIONS: This study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems.
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Atención a la Salud , Sector de Atención de Salud , Gestión de la Información en Salud , Promoción de la Salud , Sistemas de Información , Informática MédicaRESUMEN
PURPOSE: Neonatal seizures are one of the most common neurologic manifestations in neonates and could be the important clinical sign of underlying brain disorders. The aim of this study is to review the clinical characteristics and to find the prognostic factors related to the outcomes of neonatal seizures. METHODS: We reviewed medical records retrospectively in 23 patients with neonatal seizures who admitted to Dankook University Hospital from July 2007 to June 2009. RESULTS: During the study period, neonatal seizures were diagnosed in 23/1,474 (1.56%) neonates. Nineteen of them (82.6%) were term and 4 were preterm. The main cause of neonatal seizures was hypoxic ischemic encephalopathy (n=8, 35%). Other various causes included metabolic disorders (n=4, 17%, carnitine palmitoyl transferase 1 deficiency, severe hypernatremic dehydration, prolonged severe hypoglycemia, and pyridoxine dependent seizure), intracranial hemorrhages (n=2, 9%), congenital brain anomaly (callosal dysgenesis, hemimegalencephaly) (n=2, 9%), and infection (congenital syphilis, early neonatal sepsis, n=2, 9%). Among nineteen neonates (82.6%) who were treated with anticonvulsants, we could not stop the anticonvulsants in six of them (32%). They had severe HIE, prolonged severe hypoglycemia with residual encephalomalatic changes, sinovenous thrombotic hemorrhages due to antithrombin III deficiency, congenital brain anomaly, and septic shock, respectively. CONCLUSION: Approximately one third of neonatal seizures were caused by HIE, and moderate to severe HIE had more serious outcomes. Neonatal seizure could be a significant clinical sign indicating specific underlying etiologies such as stroke, metabolic disturbances or congenital brain anomalies. Therefore, intensive workup and prompt management for neonatal seizures should be considered for better outcomes.
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Humanos , Recién Nacido , Anticonvulsivantes , Deficiencia de Antitrombina III , Encéfalo , Encefalopatías , Carnitina , Deshidratación , Hemorragia , Hipoglucemia , Hipoxia-Isquemia Encefálica , Hemorragias Intracraneales , Registros Médicos , Manifestaciones Neurológicas , Pronóstico , Piridoxina , Estudios Retrospectivos , Convulsiones , Sepsis , Choque Séptico , Accidente Cerebrovascular , Sífilis , TransferasasRESUMEN
Customer relationship management (CRM) is a valuable method for establishing long-term customer relationships across different business areas. CRM system stores and analyzes a vast amount of customer information and provides alternatives to meet customer expectations using data warehouse and on-line analysis processing technology. Intensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of CRM systems to meet diverse customer satisfaction. Leading the adoption of information technology in the healthcare businesses has enabled the use of CRM technology to develop close patient-provider relationship. Especially, healthcare centers are using CRM system to provide better healthcare services as well as customer management services. This study aims to explore the current status and influential factors that will stimulate and drive the successful use of CRM system in healthcare centers. For this purpose, a survey has been conducted for CRM system users in 13 healthcare centers to investigate the current status of CRM system and the influential factors for successful use. The evaluation criteria include four categories; system quality, information quality, service quality and perceived usefulness. These criteria have been developed based on previous researches, especially DeLone & McLean information system success model. In addition, the system output is evaluated by user satisfaction, personal performance and organizational performance. The study showed that users evaluated information quality and service quality positively and to be higher than other factors in terms of influence. And the user evaluation proved that CRM system provides increased user satisfaction, organizational performance, and especially, individual performance. This is clear evidence that CRM system will improve organizational efficiency and effectiveness, which in turn, can provide competitive advantage for the healthcare centers.
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Adopción , Comercio , Atención a la Salud , Eficiencia Organizacional , Sector de Atención de Salud , Imidazoles , Sistemas de Información , Nitrocompuestos , Satisfacción PersonalRESUMEN
Hypercalcemia is not common, and occurs more frequently in children than in adults. Left untreated, hypercalcemia could result in a profound impact on growth and development. We report a case of recurrent idiopathic infantile hypercalcemia with poor weight gain, constipation, and a renal stone. We successfully treated the infantile hypercalcemia with a low-calcium diet and intravenous pamidronate.
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Adulto , Niño , Humanos , Lactante , Estreñimiento , Dieta , Difosfonatos , Crecimiento y Desarrollo , Hipercalcemia , Cálculos Renales , Aumento de PesoRESUMEN
Hypercalcemia is not common, and occurs more frequently in children than in adults. Left untreated, hypercalcemia could result in a profound impact on growth and development. We report a case of recurrent idiopathic infantile hypercalcemia with poor weight gain, constipation, and a renal stone. We successfully treated the infantile hypercalcemia with a low-calcium diet and intravenous pamidronate.
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Adulto , Niño , Humanos , Lactante , Estreñimiento , Dieta , Difosfonatos , Crecimiento y Desarrollo , Hipercalcemia , Cálculos Renales , Aumento de PesoRESUMEN
PURPOSE: Most childhood diabetes mellitus (DM) is usually thought of as type 1 DM (T1DM), but the incidence of type 2 DM (T2DM) in childhood is increasing. Sometimes, it might not be easy to determine which type of DM a patient has and to choose the best treatment. The purpose of this study is to evaluate the usefulness of autoantibody test and clinical characteristics for the specific diagnosis of DM in childhood. METHODS: In this study, we retrospectively reviewed the medical records of 42 patients who were diagnosed with DM and followed at the department of pediatrics, Dankook University Hospital from January 2002 to October 2010. RESULTS: The patients were grouped as T1DM, T2DM, or T1.5DM (unclassified) according to the clinical and laboratory findings. T1DM had an earlier onset age compared to T2DM. Diabetic ketoacidosis (DKA) was the presenting symptom in 57% of T1DM, but there was no DKA in T2DM. Initial serum insulin and C-peptide levels were lower in T1DM than T2DM. Thirty nine percent and 70% of the patients had a family history of DM, respectively. The average body mass index (BMI) in T2DM was higher than that in T1DM. At least one of autoantibodies was positive in 80% of T1DM. But no antoantibody was detected in T2DM. During follow up, higher levels of HbA1c and more frequent microalbuminuria were detected in the female adolescents. CONCLUSION: We can confirm that the autoantibody test is very valuable in diagnosing specific types of DM. And adolescent period was thought as a very vulnerable period to manage the diabetes requiring more intensive emotional support including family cooperation.