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Purpose – This study analyzes the current status, background, and factors that affect the maintenance and success of the South Korea–U.S. medical foreign direct investment (FDI), which has been rapidly increasing since the COVID-19 pandemic. Design/Methodology/Approach – This study was conducted from the perspective of the United States (U.S.), the host country of investment. A panel analysis was conducted with the 10-year data of economic and logistics factors of 30 major U.S. states. The independent variables were Gross domestic product (GDP), payroll, and employment rate, and logistics factors were the number of logistics bases and amount of investment. The dependent variable was the amount of South Korea–U.S. medical FDI. Findings – The empirical analysis revealed that GDP, payroll, and number of airports had significant positive effects on FDI. The medical industry is a typical high value-added process industry, and the economic power of the host region and payroll to employ excellent workers were key variables. Air transport infrastructure was also a prominent factor due to the nature of pharmaceutical drugs. Research Implications – The analysis results show the typical characteristics of the medical industry. Theresults and implications can guide future medical FDI in a more effective direction. © 2023 International Academy of Global Business and Trade. All rights reserved.
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INTRODUCTION: Allogeneic hematopoietic cell transplant (allo-HCT) exists as a potential cure to a number of different benign and malignant hematologic conditions. About 50% of patient develop cGVHD, the most important long-term complication of allo-HCT with profound effects on immune recovery. This immunocompromised patient population requires careful consideration regarding approach to vaccination. As the SARS-CoV-2 vaccines were developed and made available at an unprecedented rate, we are learning in real-time how specific vulnerable patient populations are affected, particularly as patients with cGVHD were largely excluded from clinical trials for the SARS-CoV-2 mRNA vaccines. Though the immunomodulatory mechanisms of the Pfizer and Moderna vaccines are poorly understood, societies such as ASH and ASTCT recommend that patients with cGVHD receive it. Here, we report our experience in patients with cGVHD who received the mRNA SARS-CoV-2 vaccine. METHODS: We performed this retrospective analysis of all Huntsman Comprehensive Cancer Center patients who underwent allo-HCT between 2013 and 2020. Patients who had a diagnosis of cGVHD requiring systemic therapy and were alive in December 2020, (when the SARS-CoV-2 vaccine became available), were included in the analysis. The clinical data was queried from the bone marrow transplant (BMT) database, and medical records were individually reviewed for documentation of SARS-CoV-2 mRNA vaccination. Patients meeting criteria were screened in clinic for symptoms post-vaccination. We define worsening or flare of disease as an organ upstage of at least 1 by NIH Consensus Criteria scale, in addition to requirement of intervention with a systemic or topical therapy. All patients were consented under a University of Utah IRB-approved protocol for participation in this study. RESULTS: A total of 52 patients at our institution met the inclusion criteria of being alive with cGVHD at the time Covid mRNA vaccinations became available. Of these 52 patients, 65.4% (n=34) had had two doses of SARS-CoV-2 vaccine. Of these 34 patients, 26.5% (n=9) experienced worsening of their cGVHD manifestations after vaccination. All 9 of these patients (100%) received the Pfizer vaccine. Mean time between transplant day 0 and flare date was 1,222 days (95% CI 511-1,933). At the time of flare, 3/9 patients were on systemic treatment for cGVHD, 6/9 patients had been tapered off systemic therapy, and half of them were on topical therapies. Three patients (33.3%) experienced GVHD flare after SARS-CoV-2 vaccine dose #1. The remaining 6 (66.7%) experienced flare after dose #2, with a median time to flare of 1.5 days. Five of the 9 patients (55.6%) required systemic steroid therapy, with 2 patients (22.2%) requiring >30 days of treatment. The most common organs involved were skin and eyes. Six patients (66.7%) had resolution of flare symptoms. One patient (11.1%) subsequently developed Covid pneumonia and had relapse of AML. CONCLUSION: Though reports have emerged highlighting hematologic and other autoimmune disease recrudescence in response to SARS-CoV-2 vaccination, to our knowledge this is the first large case series demonstrating chronic GVHD flare in response to the vaccine. Almost a third of our cGVHD patients experienced disease flare shortly after vaccination, which raises questions of the degree and mechanism of such heightened immunogenicity in an mRNA vaccine. Consistent with prior studies, most of our patients (66.7%) experienced disease flare after receiving the 2 nd mRNA vaccine dose, Although correlation with vaccine administration does not necessary prove causation of GVHD flare, in counseling patients, the possibility of a severe flare should be weighed against risk of Covid infection. [Formula presented] Disclosures: Lee: Jazz,: Consultancy;Fresensius Kabi: Consultancy;Kite: Membership on an entity's Board of Directors or advisory committees;Kadmon: Membership on an entity's Board of Directors or advisory committees;CareDx: Membership on an entity's Board of Directors or advisory committ es;Incyte: Research Funding.
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We would like to correct author’s affiliations, add an author and an edit one sentence as shown below. 1) The corrected affiliations (switch affiliation 1 and 2) and added author are marked by bold and underlines. Joungha Won1,2, Solji Lee2, Myungsun Park2, Tai Young Kim2, Mingu Gordon Park2,3, Byung Yoon Choi4, Dongwan Kim5,6, Hyeshik Chang5,6, Won Do Heo1, V. Narry Kim5,6 and C. Justin Lee2* 1Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, 2Center for Cognition and Sociality, Cognitive Glioscience Group, Institute for Basic Science, Daejeon 34126, 3KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul 02841, 4Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam 13620, 5Center for RNA Research, Institute for Basic Science, Seoul 08826, 6School of Biological Sciences, Seoul National University, Seoul 08826, Korea 2) In Quantitative rtPCR section (Page 110, in material and methods) we would like to correct the following sentence from;“In brief, each reaction buffer consisted of a total volume of 20 µl containing 8 µl of 100 µM forward and reverse primers (4 µl for each primer), 2 µl of cDNA, and 10 µl power SYBR Green PCR Master Mix.” to;“In brief, each reaction buffer consisted of a total volume of 20 µl containing 2 µl of 10 µM forward and reverse primers (1 µl for each primer), 2 µl of cDNA, and 10 µl power SYBR Green PCR Master Mix”. © 2020 Korean Society for Neurodegenerative Disease. All rights reserved.