Periodontitis-induced systemic inflammation exacerbates atherosclerosis partly via endothelial-mesenchymal transition in mice / 国际口腔科学杂志·英文版

Growing evidence suggests close associations between periodontitis and atherosclerosis. To further understand the pathological relationships of these associations, we developed periodontitis with ligature placement around maxillary molars or ligature placement in conjunction with Porphyromonas gingivalis lipopolysaccharide injection at the ligature sites (ligature/P.g. LPS) in Apolipoprotein E knock out mice and studied the atherogenesis process in these animals. The mice were fed with high fat diet for 11 weeks and sacrificed for analyzing periodontitis, systemic inflammation, and atherosclerosis. Controls did not develop periodontitis or systemic inflammation and had minimal lipid deposition in the aortas, but mice receiving ligature or ligature/P.g. LPS showed severe periodontitis, systemic inflammation, and aortic plaque formation. The aortic plaque contained abundant macrophages and cells expressing both endothelial and mesenchymal cell markers. The severity of periodontitis was slightly higher in mice receiving ligature/P.g. LPS than ligature alone, and the magnitude of systemic inflammation and aortic plaque formation were also notably greater in the mice with ligature/P.g. LPS. These observations indicate that the development of atherosclerosis is due to systemic inflammation caused by severe periodontitis. In vitro, P.g. LPS enhanced the secretion of pro-inflammatory cytokines from macrophages and increased the adhesion of monocytes to endothelial cells by upregulating the expression of adhesion molecules from endothelial cells. Moreover, secretory proteins, such as TNF-α, from macrophages induced endothelial-mesenchymal transitions of the endothelial cells. Taken together, systemic inflammation induced by severe periodontitis might exacerbate atherosclerosis via, in part, causing aberrant functions of vascular endothelial cells and the activation of macrophages in mice.

Clinical Characteristics and Treatment Outcomes of Patients with Pulmonary Tuberculosis at a Private General Hospital / 결핵

BACKGROUND: Until the early 1990's in Korea, treatment outcomes of patients with pulmonary tuberculosis in the private sector were reported to be inferior to those of the public health center under the National Tuberculosis Programme. The purpose of this study was to analyze the clinical characteristics and the treatment efficacy of the patients with pulmonary tuberculosis recently diagnosed at a private general hospital. MATERIALS and METHODS: The study included all pulmonary tuberculosis patients diagnosed at Samsung Medical Center and notified to the public health center from August 2000 to January 2001. RESULTS: Of the 232 patients included in the study during a 6-month period, 188 were (81.0%) initial treatment cases and 44 (19.0%) were re-treatment cases. Eighty-three (35.8%) patients had smear-positive sputa, and 27 (11.6%) had smear-negative, culture-positive sputa. Initial sputum examinations were not performed in 47 (20.3%) patients. A six-month, short-course treatment using isoniazid, rifampin, ethambutol and pyrazinamide was prescribed for 31.4% of the patients under the initial treatment. The success rate (cured plus treatment completed) of the initial treatment for the smear-positive patients was 69.1%. Eleven (13.3%) of the 83 patients with smear-positive pulmonary tuberculosis discontinued their treatment without notice. CONCLUSIONS: To improve the treatment efficacy and decrease the default rates of the patients with pulmonary tuberculosis in the private sector, further efforts are required in line with the Korean Academy of Tuberculosis and Respiratory Disease Treatment Guidelines and in the implementation of an appropriate model of public-private mix for tuberculosis control in Korea.

Study on Establishment of Disease Database and Query System Through Internet Using Uniform Hospital Discharge Data Sets / 대한의료정보학회지

It is necessary to have accurate statistical data of disease for planning and evaluating public health policy as well as assessing population health index. The national health insurance data is the only data to assess incidence of diseases nation-wide. However, inaccuracy of the data pose serious limitations of use of the data. The Medical Record Departments of individual health facilities have used discharge summary information for hospital management and clinical research, but a nation-wide integrated database of diseases has not been setup and utilized. We applied previously developed Korean Uniform Hospital Discharge Data Sets to collect discha rge summary data from health care facilities and establish integrated database. We also made the question and answer column about disease of the database in the internet. We collected patient discharge data from a tertiary-care hospital for one year using the electronic discharge summary data collection system, except for health care costs. The internet querying system provided optional selection of columns or rows, individual and/or disease groups and surgical procedures. To make query easy, the system provided various functions like querying codes of diseases and/or surgical operations, reviewing questions, downloading results via excel files, help functions of query. The establishment of disease database and the interactive system through internet is in its inception, further studies may be necessary to make it a user friendly and accurate system. There is a need of an accurate assessment of current population-based health status and future trends in Korea. It is hoped that this study may trigger to establish national accurate database for enhancing studies of health policy making, clinical research and vital health statistics by expanding data collections to the se condary- care and primary- care institutions.

The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims / 예방의학회지

OBJECTIVES: We attempted to assess the accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. METHODS: A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met one of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. RESULTS: The accuracy rate of the ICMIC was 83.0% (425 cases). Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. CONCLUSION: The accuracy rate of the ICMIC was 83.0%.

Feasibility Study of Application of UHDDS Items for Hospital Discharge Abstract and Analysis in Tertiary Care Hospitals / 대한의료정보학회지

The purpose of this study is to identify standardized items from Hospital Discharge Abstract and Analysis data by using UHDDS(Uniform Hospital Discharge Data Sets in USA) and to ascertain the computerization in tertiary hospitals. The data were collected by questionnaire survey, responded 38 hospitals(86.4%) out of 44 tertiary hospitals, and the conclusions are as follows. 1. As for the general characteristics of patient; hospital registration number, patient name, sex and social identification number were reported to 0.92%. 2. As for admission and discharge aspects; admission date was showed 0.92, type of admission and insurance were 0.87%, discharge date 0.92%, the code of primary condition, other diagnoses and primary procedure were 0.89%, disposition of discharge was 0.61%. 3. As for the other characteristics; attending physician license number and name of operating physician were showed 0.87%, birth weight of newborn 0.74%, nationality 0.44%. 4. As for the order communicating system, computerization for the medical record management was showed 57.9%, administration of outpatient 53.6%, administration of inpatient 44.7%, administration of emergency care 28.9%. Judging from the study, the development of Korean Uniform Hospital Discharge Data Sets using Discharge Abstract and Analysis System is applicable to the national wide collection of statistics on the diseases for the discharged patients.

A Survey Study of Organizational Situation of Medical Record Department for Producation of Disease Statistics on National Basis / 대한의료정보학회지

The purpose of this study was to survey the organizational situation of medical record department(MRD) in hospitals to identify the factors influencing the production ol disease statistics in Korea. 134 hospitals answered for the structured questionnaires mailed to the 218 hospitals. This studs results are as follows. 1 ) There were three types in organizational situation of MRD: independent department (70.1%) a unit in other department (26.1 %) .and in the rest 3.7%. there were no MRD or unit. 2) The differences of work performed in MR ~) or on it in the second referral level hospitals and the third referral level hospitals were statistically significant in incomplete medical record management(p<0.05) DRG coding supplying research data, quality improvement activity. cancer registration(p<0.01) and transeription of medical record( p<0.0l). 3) 66.4% of the target hospitals were performing the recheeking of disease classification data after reponsible physicians completed the incomplete record 4) statistically significant variables which affect works performed in MRD are organizational situation of MRD(<0.001) and the number of medical record professionals. 41.3% of variation of works performed in MRD was explained by variation of organizational situation and the number of medical record professionals.

A Survey on the Status of Health Statistics Generation by the Medical Record Offices of Hospitals and its Automation Rate / 대한의료정보학회지

We surveyed the generation rate of health statistics by medical records offices of the 78 hospitals and its automation rate using computerized hospital information system. Structured questionnaire was given to one medical record officer of each hospital. Items in the questionnaire was selected from statistics required for hospital service evaluation or OECD health statistics. More than 50% of the medical record office generated questioned health statistics, and most of them was automated. Because many of the medical record offices of the hospitals are producing essential health statistics and automated, there is a possibility that we can collect and use these datas to build up national health database if adequate standardization procedure can be implemented.