Cost-Benefit Analysis of Tafenoquine for Radical Cure of Plasmodium vivax Malaria in Korea

Background@#Plasmodium vivax malaria has a persistent liver stage that causes relapse, and introducing tafenoquine to suppress relapse could aid in disease eradication. Therefore, we assessed the impact of tafenoquine introduction on P. vivax malaria incidence and performed a cost-benefit analysis from the payer’s perspective. @*Methods@#We expanded the previously developed P. vivax malaria dynamic transmission model and calibrated it to weekly civilian malaria incidences in 2014–2018. Primaquine and tafenoquine scenarios were considered by assuming different relapse probabilities, and relapse and total P. vivax malaria cases were predicted over the next decade for each scenario. We then estimated the number of cases prevented by replacing primaquine with tafenoquine. The cost and benefit of introducing tafenoquine were obtained using medical expenditure from a nationwide database, and a cost-benefit analysis was conducted. A probabilistic sensitivity analysis was performed to assess the economic feasibility robustness of tafenoquine introduction under uncertainties of model parameters, costs, and benefits. @*Results@#Under 0.04 primaquine relapse probability, the introduction of tafenoquine with relapse probability of 0.01 prevented 129 (12.27%) and 35 (77.78%) total and relapse cases, respectively, over the next decade. However, under the same relapse probability as primaquine, introducing tafenoquine had no additional preventative effect. The 14-day primaquine treatment cost was $3.71. The tafenoquine and the glucose-6-phosphate dehydrogenase rapid diagnostic testing cost $57.37 and $7.76, totaling $65.13. The average medical expenditure per malaria patient was estimated at $1444.79. The cost-benefit analysis results provided an incremental benefit-cost ratio (IBCR) from 0 to 3.21 as the tafenoquine relapse probability decreased from 0.04 to 0.01. The probabilistic sensitivity analysis showed an IBCR > 1, indicating that tafenoquine is beneficial, with a probability of 69.1%. @*Conclusion@#Tafenoquine could reduce P. vivax malaria incidence and medical costs and bring greater benefits than primaquine.

The Correlation Between Defense Mechanism and Posttraumatic Stress Disorder in Burn Patients / 정신신체의학

Objectives@#：This study was designed to investigate the correlation between defense mechanism and posttraumatic stress disorder in burn patients. @*Methods@#：We recruit 40 burn patients and we evaluate sociodemographic characteristics, characteristics related to burn, korean version of Impact of Event Scale-Revised (IES-R), Korean Version of Center for epidemiologic studies depression scale (CES-D) and Ewha Defense Mechanisms Test (EDMT). Multiple regression analysis was performed to evaluate the correlation between EDMT score and IES-R score. @*Results@#：Factor 2 of EDMT which consists of Ego-expansion subjects was significantly correlate with IER-S score. In factor 2, Controlling (β=-0.299, p<0.05), Sublimation (β=-0.276, p<0.05) is significantly correlate with IER-S score. @*Conclusions@#：Some subjects of defense mechanism was significantly correlate with IES-R score. it might behelpful to understand defense mechanism for the posttraumatic stress disorder in burn patients.

A Case of Idiopathic Renal Hypouricemia with SLC22A12 Gene Mutation Showing General Weakness and Incidental Renal Stone

Idiopathic renal hypouricemia (iRHUC) is a rare hereditary disease caused by a defect in urate handling of renal tubules. Type 1 renal hypouricemia (RHUC1) is diagnosed with confirmation of a mutation in SLC22A12 gene which encodes a renal urate-anion exchanger (URAT1). The majority of iRHUC patients are asymptomatic, especially during childhood, and thus many cases go undiagnosed or they are diagnosed late in older age with complications of hematuria, renal stones, or acute kidney injury (AKI). We report a case of a 7-year-old boy with subtle symptoms such as general weakness and dizziness and revealed hypouricemia and incidental nephrolithiasis. Homozygous mutations were detected in the SLC22A12(c.774G>A) by molecular analysis. The present case suggests that fractional excretion of uric acid (FEUA) screening could be better followed by the coincidental discovery of hypouricemia, to prevent conflicting complications of iRHUC, even with normal urine uric acid to creatinine ratio (UUA/UCr), and sequential genetic analysis if needed.

A Case of Idiopathic Renal Hypouricemia with SLC22A12 Gene Mutation Showing General Weakness and Incidental Renal Stone

Idiopathic renal hypouricemia (iRHUC) is a rare hereditary disease caused by a defect in urate handling of renal tubules. Type 1 renal hypouricemia (RHUC1) is diagnosed with confirmation of a mutation in SLC22A12 gene which encodes a renal urate-anion exchanger (URAT1). The majority of iRHUC patients are asymptomatic, especially during childhood, and thus many cases go undiagnosed or they are diagnosed late in older age with complications of hematuria, renal stones, or acute kidney injury (AKI). We report a case of a 7-year-old boy with subtle symptoms such as general weakness and dizziness and revealed hypouricemia and incidental nephrolithiasis. Homozygous mutations were detected in the SLC22A12(c.774G>A) by molecular analysis. The present case suggests that fractional excretion of uric acid (FEUA) screening could be better followed by the coincidental discovery of hypouricemia, to prevent conflicting complications of iRHUC, even with normal urine uric acid to creatinine ratio (UUA/UCr), and sequential genetic analysis if needed.

Degradation of Interface Pressure under Tubular Compressive Bandage (Tubifast™) for 6 Days

PURPOSE: Pressure garment is the most effective tool in treatment of burn scar hypertrophy. But most patients feel discomfort to pressure garment. So tubular compressive bandage (TCB; Tubifast™) is widely used as a substitute. We checked daily pressure of tubular pressure bandage for 6 days and tried to find out the proper use. METHODS: Three doctors and two nurses were included in this study. They wore the TCB on both arms. One arm worn with one layer and the other arm with two layers. For six days, we checked the average pressure on arm and forearm with Picopress®. We used the SPSS (PASW statistics 18) as a statistics. RESULTS: During the first three days the pressure was markedly declined on both arm and forearm when with two layers. After then the pressure showed plateau. But one layer showed slow and continuous declining. The plateau pressure was above 10 mmHg with two layers and below 7 mmHg with one layer. CONCLUSION: Wearing the tubular compressive bandage (TCB; Tubifast™) is better with two layers than one layer and must be changed it in every 4 days.

The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults

BACKGROUND: We investigated the association of coronary artery calcium score (CACS) with body composition and insulin resistance in apparently healthy Korean adults. METHODS: Nine hundred forty-five participants (mean age, 48.9 years; 628 men) in a medical check-up program were selected for analysis. Body composition was assessed by bioelectrical impedance analysis (BIA). Insulin resistance was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The CACS was assessed by multidetector computed tomography. RESULTS: One hundred forty-six subjects (15.4%) showed coronary artery calcification and 148 subjects (15.7%) had metabolic syndrome. CACS showed a significant positive correlation with age, fasting glucose level, waist circumference (WC), blood pressure, hemoglobin A1c, HOMA-IR, and waist-hip ratio (WHR) assessed by BIA. CACS had a negative correlation with high density lipoprotein cholesterol (HDL-C). Subjects with high CACS showed significantly higher mean WHRs and lower mean values for lean body mass compared with subjects without coronary artery calcification. In logistic regression analyses with coronary artery calcification as the dependent variable, the highest quartile of WHR showed a 3.125-fold increased odds ratio for coronary artery calcification compared with the lowest quartile after adjustment for confounding variables. When receiver operating characteristics analyses were performed with coronary artery calcification as the result variable, WHR showed the largest area under the curve (AUC) value among other variables except for age and WC in women (AUC=0.696 for WHR, 0.790 for age, and 0.719 for WC in women). CONCLUSION: In our study population of apparently healthy Korean adults, WHR was the most significant predictor for coronary artery calcification among other confounding factors, suggesting that it may have implication as a marker for early atherosclerosis.

Acute human immunodeficiency virus infection managed with highly active antiretroviral therapy / 대한내과학회지

Acute human immunodeficiency virus (HIV) infection is a transient symptomatic illness associated with high-titer HIV replication and an expansive immunologic response to the invading pathogen. The diagnosis of acute HIV infection is difficult because the symptoms are those of common illnesses and HIV antibodies are usually not detected during the early phase of infection. An accurate early diagnosis is important because of the potential clinical benefit of early antiretroviral therapy, and to prevent the spread of infection. We report a case of acute HIV infection presenting as an acute febrile illness. We started treatment with highly active antiretroviral therapy (HAART) and the patient is now well with no other complications

A Study of the Radiotherapy Techniques for the Breast Including Internal Mammary Lymph Nodes / 대한방사선종양학회지

PURPOSE: This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery. MATERIALS AND METHODS: We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field. RESULTS: The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF. CONCLUSION: Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.

Clinicopathologic Features and Difference in Prognosis in Synchronous and Metachronous Hepatic Metastases of Gastric Cancer

PURPOSE: The aim of this study was to compare synchronous and metachronous hepatic metastases in patients with gastric cancer to determine clinicopathologic features and differences in prognosis as a function of the timing of the metastasis and the treatment modality rendered. MATERIALS AND METHODS: Sixty-seven patients who were diagnosed with gastric cancer metastatic to the liver and treated at the Hanyang University Hospital between June 1992 and December 2006 were retrospectively analyzed to study the pertinent clinicopathologic features and effect of treatment methods. RESULTS: There was a significant difference with respect to lymphatic (P=0.041) and vascular invasion (P=0.036) in comparing the clinicopathologic features between the patients with synchronous and metachronous hepatic metastases. The 1-year survival rate and median survival time of patients with gastric cancer and liver metastases were 38.9% and 9.2 months in the entire patient cohort, 30.9% and 9.2 months in the synchronous group, and 44.5% and 9.7 months in the metachronus group, respectively (P=0.436). The group of patients undergoing local treatment (such as surgery and radiologic intervention) followed by systemic chemotherapy, the group of patients receiving systemic chemotherapy only, and the untreated group of patients were compared, and there was no difference between the synchronous and metachronous groups. The synchronous and metachronous groups had high survival rates with local treatment. CONCLUSION: In patients with gastric cancer and liver metastases, there was no difference in prognosis based on the timing of the hepatic metastases. Independent of the timing of hepatic metastasis, aggressive treatment, such as surgery and radiologic intervention, may help improve the prognosis.

Sex of Ancient Mongolian Human Bones Using Biallelic Marker RPS4Y for Y haplogroup / 대한해부학회지

Many data from ancient human remains became useful by molecular approach for ancient human DNA. In anthropology, genetic sex is essential to understand marriage and burial patterns, differential mortality rates between sexes, and differential patterns by sex of disease, diet, status, and material possessions. This study was designed to determine genotype sex of 52 ancient human bones with well preserved skulls, and to compare with the orphological sex. Parts of femur and other bones were used as ancient bones excavated in Mongolia aged between bronze and Mongol period. Morphological sex was determined by Mongolian scientist, and genotype sex was determined by using biallelic marker RPS4Y for Y haplogroup. Of 52 genetic males, 10 samples were morphologically female. In conclusion, biallelic marker RPS4Y. PCR amplication method will be useful in sex determination of ancient bones.

A Case of Eosinophilic Esophagogastroenteritis with Transmural Involvement / 대한소화기내시경학회지

Eosinophilic gastroenteritis is an uncommon disorder characterized by eosinophilic inflammation of the gastrointestinal tract that can present with various gastrointestinal manifestations, depending on the specific site of the affected gastrointestinal tract and the specific layer of the affected gastrointestinal wall. The depth of infiltration is the basis for a proposed classification as mucosal, muscular and serosal subtypes. Diagnostic criteria include the demonstration of eosinophilic infiltration of the bowel wall and lack of evidence of extra-intestinal disease. We experienced a 56-year-old woman that presented with postprandial epigastric pain and, 3 weeks later, with low abdominal pain. An abdominal examination showed tenderness and rebound tenderness in the whole abdomen and a hypoactive bowel sound. Endoscopy demonstrated the presence of mild edematous mucosa in the esophagus and stomach. There was eosinophilic infiltration in the esophagus, stomach and duodenum on as determined by a histological examination and muscular layer hypertrophy as determined on an endoscopic ultrasound examination. A CT scan showed wall thickening of the lower esophagus and gastric antrum to the mid-jejunum with mesenteric fat haziness, and a small amount of ascites was seen in the pelvic cavity. Eosinophilia was seen in the serum and from a fluid examination of aspirated fluid determined by culdocentesis. There was no evidence of parasitic infection based on a serum immunoassay and stool examination. The symptoms disappeared with oral prednisolone management and the patient was discharged from the hospital. This case showed continuous involvement from the lower esophagus to the mid-jejunum with transmural eosinophilic infiltration.

Internal Mammary Lymph Node Irradiation after Breast Conservation Surgery: Radiation Pneumonitis versus Dose?Volume Histogram Parameters / 대한방사선종양학회지

PURPOSE: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast cancer including internal mammary lymph nodes. MATERIALS AND METHODS: Twenty patients with early breast cancer who underwent a partial mastectomy were involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram parameters were compared between patients with grade or =2 RPC. The parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20, V30, V40, and normal tissue complication probability (NTCP). RESULTS: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p<0.05). Fisher's exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level. CONCLUSION: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP is greater than 45%.

Endothelial Dysfunction is Associated with Future Stroke in Patients Who Undergo Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Endothelial dysfunction plays a key role in atherogenesis and it can predict future cardiovascular events in subjects with and without coronary artery disease. This study was designed to evaluate the association between endothelial dysfunction and major adverse cardiovascular events (MACEs), and especially future stroke in patients who have undergone percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study subjects consisted of 182 patients (mean age; 59 years, 120 males) who underwent PCI and flow-mediated brachial arterial dilation (FMD) using high-resolution ultrasound. They were followed up for a mean of 28 months (maximum; 34 months). MACEs included cardiac death, non-cardiac death, acute myocardial infarction (AMI), stroke, coronary artery bypass graft (CABG), target lesion revascularization (TLR) and PCI due to de novo lesion during follow-up. RESULTS: The study subjects were divided into two groups according to the median value of the FMD; one was a patient with a high FMD (3.61% and the other was a patients with a low FMD0.05). Univariate analysis showed that the patients with a lower FMD had a higher incidence of stroke (7 vs. 0, respectively, p=0.005) than those patients with a higher FMD, while there was no significant difference between the two groups in terms of AMI (1 vs. 2, respectively), TLR (28 vs. 21, respectively), de novo PCI (6 vs. 7, respectively), CABG (0 vs. 2, respectively) and cardiac death (0 vs. 0, respectively). On the multivariate Cox regression analysis, FMD was the strongest predictor of stroke (OR; 0.418, 95% CI; 0.185 to 0.940, p=0.035). CONCLUSION: Endothelial dysfunction is also associated with future stroke in patients who have undergone PCI.

Comparison between Morphological Sex and Genotype Sex of Uzbekistan Ancient Bones Using Improved Amelogenin PCR Amplication Method / 체질인류학회지

Determination of male and female is important in anthropology, archeology and forensic science. This study was designed to compare genotype sex of improved amelogenin PCR amplication method with morphological sex of ancient human bones. Sixty human skulls which lived from the Bronze Age to twenties centuries and excavated in Uzbekistan were used in this study. Morphological sex was determined by Uzbekistan scientist, and genotype sex was determined by improved amelogenin PCR amplication developed in this study. Among 20 morphological males, 13 samples (65%) were genotypical male. Among 40 morphological females, 20 samples (50%) were genotypical male. In conclusion, morphological method might be inadequate for sex determination of ancient bones. The improved amelogenin PCR method will be useful in sex determination of ancient bones.

Development of Ancient DNA Isolation Method for Improved PCR Amplification / 체질인류학회지

Ancient DNA analyses are widely used for evolutionary and phylogenetic study of mankind in anthropology and archeology. However, the DNA extraction from particularly poorly preserved ancient human samples is often unsuccessful in these analyses. In the present study, to improve the success rate of ancient DNA analysis, we introduced a high grade ancient DNA purification method using ion-exchange columns. We compared the success rate of ancient DNA analysis of this new method with that of the two methods that have been used for ancient DNA extraction, GENECLEAN(R) kit (Qbiogene) and Qiaquick column (Qiagen). Twelve ancient bone samples from Korea and Mongolia that are about 500 to 5,000 years old by an archeological estimation were used. As the DNA analysis methods, polymerase chain reaction (PCR) methods for the amplification of a mitochondrial DNA HV1 segment, a male sex determination marker DNA and M175 marker DNA that is used for the determination of O haplogroup of Y chromosome that is reportedly a common one in modern Korean people. The method developed in this study remarkably increased the success rate of DNA analysis compared with the other two methods. Using the GENECLEAN(R) kit, only two samples were amplifiable for the mitochondrial DNA, no samples for the male sex determination marker and M175 marker DNAs. Using the Qiaquick columns, nine samples were amplifiable for mitochondirial DNA, nine samples for male sex determination marker and six samples for M175 marker. The developed method allowed for the amplification of mitochondrial DNA from all samples, male sex determination marker from eight samples and M175 marker from eight samples. The results demonstrate that ion-exchange columns can be useful for the improved ancient DNA extraction in anthropology and archeology.

A study of trabecular bone strength and morphometric analysis of bone microstructure from digital radiographic image / 대한구강악안면방사선학회지

PURPOSE: To evaluate the relationship between morphometric analysis of bone microstructure from digital radiographic image and trabecular bone strength. MATERIALS AND METHODS: One hundred eleven bone specimens with 5 mm thickness were obtained from the mandibles of 5 pigs. Digital images of specimens were taken using a direct digital intraoral radiographic system. After selection of ROI (100x100 pixel) within the trabecular bone, mean gray level and standard deviation were obtained. Fractal dimension and the variants of morphometric analysis (trabecular area, periphery, length of skeletonized trabeculae, number of terminal point, number of branch point) were obtained from ROI. Punch sheer strength analysis was performed using Instron (model 4465, Instron Corp., USA). The loading force (loading speed 1 mm/min) was applied to ROI of bone specimen by a 2 mm diameter punch. Stress-deformation curve was obtained from the punch sheer strength analysis and maximum stress, yield stress, Young's modulus were measured. RESULTS: Maximum stress had a negative linear correlation with mean gray level and fractal dimension significantly (p< 0.05). Yield stress had a negative linear correlation with mean gray level, periphery, fractal dimension and the length of skeletonized trabeculae significantly (p< 0.05). Young's modulus had a negative linear correlation with mean gray level and fractal dimension significantly (p< 0.05). CONCLUSIONS: The strength of cancellous bone exhibited a significantly linear relationship between mean gray level, fractal dimension and morphometric analysis. The methods described above can be easily used to evaluate bone quality clinically.

A Case of Xanthogranulomatous Oophoritis / 대한산부인과학회잡지

Xanthogranulomatous oophoritis is uncommon forms of chronic granulomatous inflammation in the female genital tract. It is characterized by the presence of foamy histiocytes with admixed lymphocytes, plasma cells, and neutrophils. We describe a case of xanthogranulomatous oophoritis in a 75-year-old woman, which was misdiagnosed as uterine sarcoma preoperatively.

A Case of Xanthogranulomatous Oophoritis / 대한산부인과학회잡지

Xanthogranulomatous oophoritis is uncommon forms of chronic granulomatous inflammation in the female genital tract. It is characterized by the presence of foamy histiocytes with admixed lymphocytes, plasma cells, and neutrophils. We describe a case of xanthogranulomatous oophoritis in a 75-year-old woman, which was misdiagnosed as uterine sarcoma preoperatively.

Effect of exposure time and image resolution on fractal dimension / 대한구강악안면방사선학회지

PURPOSE: To evaluate the effect of exposure time and image resolution on fractal dimension calculations for determining the optimal range of these two variances. MATERIALS AND METHODS: Thirty-one radiographs of the mandibular angle area of sixteen human dry mandibles were taken at different exposure times (0.01, 0.08, 0.16, 0.25, 0.40, 0.64, and 0.80 s). Each radiograph was digitized at 1200 dpi, 8 bit, 256 gray level using a film scanner. We selected an Region of Interest (ROI) that corresponded to the same region as in each radiograph, but the resolution of ROI was degraded to 1000, 800, 600, 500, 400, 300, 200, and 100 dpi. The fractal dimension was calculated by using the tile-counting method for each image, and the calculated values were then compared statistically. RESULTS: As the exposure time and the image resolution increased, the mean value of the fractal dimension decreased, except the case where exposure time was set at 0.01 seconds (alpha = 0.05). The exposure time and image resolution affected the fractal dimension by interaction (p<0.001). When the exposure time was set to either 0.64 seconds or 0.80 seconds, the resulting fractal dimensions were lower, irrespective of image resolution, than at shorter exposure times (alpha = 0.05). The optimal range for exposure time and resolution was determined to be 0.08-0.40 seconds and from 400-1000 dpi, respectively. CONCLUSION: Adequate exposure time and image resolution is essential for acquiring the fractal dimension using tile-counting method for evaluation of the mandible.

A comparative study on the accuracy of digital subtraction radiography according to the aquisition methods of reconstructed images / 대한구강악안면방사선학회지

PURPOSE: To compare the accuracy of digital subtraction images acquired by two different methods different in positioning four reference points for geometrical standardization. MATERIALS AND METHODS: A total of 36 digital radiographic images of 6 volunteers were taken at the areas of the incisor, premolar, and molar of both the maxilla and mandible using the Digora system. Each image was moved 4 mm vertically and horizontally. Four oral and maxillofacial radiologists performed digital subtraction radiography between the paired images before and after movement using Emago (Oral Diagnostic Systems, Amsterdam, The Netherlands) and Sunny (Biomedisys Co., Seoul, Korea). The standard deviation of the internal gray value in Region of Interest (ROI) was statistically analyzed between the two programs using the paired t-test. RESULTS: The standard deviation of pixel gray values from the digital subtraction images using the Sunny program were lower than that of the Emago program (p<0.05). All observers showed significant differences between each other when the Sunny program was used (p<0.05), but one observer showed a significantly higher score than other observers when they used Emago (p<0.05). The standard deviations of premolar area from both Sunny and Emago programs were significantly higher than those of anterior and molar regions (p<0.05). CONCLUSION: The subtracted images using the Sunny program were more accurate and sensitive than those taken using the Emago program.