Changes in Indicators after Assessment of Diabetes Mellitus Adequacy Evaluation: Korean Health Insurance Review and Assessment Service Data 2010-2015

Background@#The Korean Health Insurance Review and Assessment Service has conducted diabetes medical adequacy evaluation projects since 2010. This study aimed to evaluate the medical adequacy of type 2 diabetes mellitus patients after the assessment project and help establish the direction of future projects. @*Methods@#Using data from the Health Insurance Review & Assessment Service (2010-2015), chi-square tests and t-tests were used to analyze the enforcement rate according to a combination of items for appropriate management methods. Logistic regression and linearity test were performed to assess the relationships among the evaluation group, appropriate test items, and prescription rate. @*Results@#We found that 33.6-39.8% of patients did not undergo any diabetes-related tests. Only about 7% of hemoglobin A1c (HbA1c) tests were performed, and 36% of cases were tested simultaneously with serum lipid profile tests. As age increased, the number of days taken to prescribe diabetes medications also increased.The prescription rate of diabetes drugs for 292 days or more was 61% in patients who had not been tested for adequacy, and the average prescription rate increased as the number of tests increased. @*Conclusions@#In older adults with a high prevalence of diabetes, it is necessary to establish a test rate for proper management of diabetes, including HbA1c, and related test items to increase the average prescription rate.

Changes in Indicators after Assessment of Diabetes Mellitus Adequacy Evaluation: Korean Health Insurance Review and Assessment Service Data 2010-2015

Background@#The Korean Health Insurance Review and Assessment Service has conducted diabetes medical adequacy evaluation projects since 2010. This study aimed to evaluate the medical adequacy of type 2 diabetes mellitus patients after the assessment project and help establish the direction of future projects. @*Methods@#Using data from the Health Insurance Review & Assessment Service (2010-2015), chi-square tests and t-tests were used to analyze the enforcement rate according to a combination of items for appropriate management methods. Logistic regression and linearity test were performed to assess the relationships among the evaluation group, appropriate test items, and prescription rate. @*Results@#We found that 33.6-39.8% of patients did not undergo any diabetes-related tests. Only about 7% of hemoglobin A1c (HbA1c) tests were performed, and 36% of cases were tested simultaneously with serum lipid profile tests. As age increased, the number of days taken to prescribe diabetes medications also increased.The prescription rate of diabetes drugs for 292 days or more was 61% in patients who had not been tested for adequacy, and the average prescription rate increased as the number of tests increased. @*Conclusions@#In older adults with a high prevalence of diabetes, it is necessary to establish a test rate for proper management of diabetes, including HbA1c, and related test items to increase the average prescription rate.

MiR-9 Controls Chemotactic Activity of Cord Blood CD34⁺ Cells by Repressing CXCR4 Expression

Improved approaches for promoting umbilical cord blood (CB) hematopoietic stem cell (HSC) homing are clinically important to enhance engraftment of CB-HSCs. Clinical transplantation of CB-HSCs is used to treat a wide range of disorders. However, an improved understanding of HSC chemotaxis is needed for facilitation of the engraftment process. We found that ectopic overexpression of miR-9 and antisense-miR-9 respectively down- and up-regulated C-X-C chemokine receptor type 4 (CXCR4) expression in CB-CD34⁺ cells as well as in 293T and TF-1 cell lines. Since CXCR4 is a specific receptor for the stromal cell derived factor-1 (SDF-1) chemotactic factor, we investigated whether sense miR-9 and antisense miR-9 influenced CXCR4-mediated chemotactic mobility of primary CB CD34⁺ cells and TF-1 cells. Ectopic overexpression of sense miR-9 and antisense miR-9 respectively down- and up-regulated SDF-1-mediated chemotactic cell mobility. To our knowledge, this study is the first to report that miR-9 may play a role in regulating CXCR4 expression and SDF-1-mediated chemotactic activity of CB CD34⁺ cells.

The Clinical Characteristics and Outcome of Neonates born to Systemic Lupus Erythematosus Mothers

PURPOSE: Neonatal lupus erythematosus (NLE) is a rare disorder caused by the transplacentally transmitted maternal autoantibodies. It is characterized by congenital complete atrioventricular block (CCAVB), skin lesion and less commonly hepatic and hematologic abnormalities. This study was designed to investigate the clinical characteristics and outcome of systemic lupus erythematosus (SLE) mothers and their neonates. METHODS: 29 neonates born to 25 SLE mothers were admitted to the Neonatal Intensive Care Unit of Chonnam University Hospital between January 1994 and June 2005. We investigate the medical records retrospectively. RESULTS: Among 25 SLE mothers, 32.4% had history of spontaneous abortion or stillbirth in previous pregnancy, and 7 (28.0%) of preeclampsia and 3 (12.0%) of premature rupture of membranes in present pregnancy. Among 29 newborns, 14 (48.2%) were premature, 4 (13.7%) were intrauterine growth retardation, and 11 (37.9%) were confirmed as NLE. Anti-SSA/Ro was positive in 13 (52.0%) of 25 examined neonates including 6 (85.7%) of 7 neonates with electrocardiographic abnormalities. Two cases of CCAVB were diagnosed during the pregnancy. One patient didn't show heart failure, he is on the followed up without medical treatment until 4 years of age. The other one showed heart failure, cardiac pacemaker was inserted at 7 days of age, dilated cardiomyopathy developed at 4 years of age. Five neonates with sinus bradycardia resolved spontaneously. One (3.4%) had typical lupus skin lesion with thrombocytopenia and elevated liver enzyme, one (3.4%) had leukopenia, and two (6.9%) had elevated liver enzymes only. CONCLUSIONS: With careful antenatal monitoring of SLE mothers and their fetuses, neonates should be monitored by autoantibody, EKG, and laboratory test.

Frequency and clinical characteristics of prenatally diagnosed congenital hydronephrosis and outcomes of ureteropelvic junction stenosis / 소아과

PURPOSE: Popular use of fetal ultrasonography has increased to detect congenital hydronephrosis(CH) which is the most common anomaly prenatally detected. We'd like to determine the frequency and clinical characteristics of prenatally diagnosed CH and outcome of ureteropelvic junction stenosis(UPJS). METHODS: The records of births between January 1994 and June 2003 in Chonnam National University Hospital(CNUH), and the records of children who were diagnosed with CH in the Department of Pediatrics of CNUH during the above period, were retrospectively analyzed. In the patients with UPJS, the initial anterior posterior diameters of renal pelvis(APD) were compared between the spontaneous regression (SR) and operation group(OP). In the SR group, sequential regression rates of APD were estimated. RESULTS: Among a total 9,076 births, 231(2.54 percent) patients with 293 renal units were diagnosed as CH and 19(6.78 percent) renal units spontaneously regressed 3 days after birth. In 228 children(56 bilateral; 172 unilateral; total 284 renal units) diagnosed with CH in the department of pediatrics of CNUH, male(71.9 percent) and left kidney(69.2 percent) predilection were found and 78.1 percent of CH were caused by UPJS. The initial APD of the SR group(121 units) in UPJS was 7.8+/-6.28 mm, which was significantly smaller than the APD(26.8+/-12.14 mm) of the OP group(25 unit)(P<0.05). In the SR group, 81 percent spontaneously regressed within one year. CONCLUSIONS: In CH, male and left kidney predilection were found. UPJS was the most common cause of CH and initial APD in UPJS at 3 days of age was a good prognostic indicator. Close monitoring should be done for at least one year because most SR in UPJS regressed spontaneously within one year.

Marshall-Marchetti Operation and Modified Pereyra Procedure for Stress Urinary Incontinence / 대한비뇨기과학회지

The most common cause of stress urinary incontinence in the women is the characteristic abnormality of the anatomic supports of the vesical neck and proximal urethra. For the successful surgical management of stress urinary incontinence, these abnormal anatomic defects should be corrected adequately. Herine, we report 5 cases of Marshall-Marchetti operation and 2 cases of modified Pereyra procedure for stress urinary incontinence. The follow-up periods of 7 cases range from 6 months to 4 years. The mean length of catheter drainage postoperatively was 9.4 days, with a range of 5 to 15 days. All cases had excellent results without postoperative urinary retention or urinary tract infection. But, only one case undergoing Marshall-Marchetti operation recurred urinary incontinence 3 months later.

A Case of Renal Cell Carcinoma Invading the Inferior Vena Cava / 대한비뇨기과학회지

Involvement of the vena cava by direct vascular extension of renal cell carcinoma occurs in approximately 5% of patients undergoing nephrectomy for this neoplasm. While successful, removal of caval neoplastic thrombi has been reported occasionally, it has been general impression that renal cell carcinoma extending into the vena cava carried an extremely poor prognosis. A 45 years-old male patient was admitted with painless gross hematuria and palpable mass on fight upper quadrant. Surgical exploration was done through 10th thoracoabdominal incision. A right nephrectomy and retroperitoneal lymph node dissection were done for renal cell carcinoma. It was evident on palpation that the tumor was in the It was evident on palpation that the tumor was in the inferior vena cava Partial resection of the inferior vena cava and removal of intra vena cava thrombus were performed. This patient has led a normal life for 18 months following surgery without clinical evidence of tumor. And so, we were presented with review of the literature.

Extended Pyelolithotomy in Staghorn Calculi / 대한비뇨기과학회지

A retrospective study was conducted on 10 patients who had undergone extended pyelolithotomy for staghorn calculi. There were some complications which were such as retained stones in 3 cases, urine leak 1 case, pneumothorax 1 case, but this surgical technique was relatively simple and easy for patients with staghorn calculi disease.

Statistical Observation on In-patient in the Past 2 Years / 대한비뇨기과학회지

A statistical observation was made on 525 in-patients in the Department of Urology Catholic Medical College, during the period from the January 1. 1978 to December 31, 1979.