A Study on National Health Insurance Literacy among International Students in Korea and Their Medical Service Use

Background@#This study aimed to examine international students’ perceptions, characteristics, use of public medical services, and satisfaction with the National Health Insurance System, and compared the results with the Health Insurance System Perception Survey conducted on Korean population to understand the differences between the two groups’ perceptions of the health insurance system and their use of medical services. @*Methods@#A survey was conducted from May 23, 2022 to June 21, 2022 to measure various data of international students related to the National Health Insurance System and analyzed the results. @*Results@#Most international students were in their 20s (the average age was 23±2.06 years), which showed that they were less likely to use medical services compared to Korean population in their 20s. Both Korean population and international students viewed their subjective health as generally good. Regarding the perceptions of the National Health Insurance System, 75.6% of the Korean population responded positively, while only 16% of international students responded positively. The biggest reason for the negative responses was the higher contributions compared to private health insurance, showing that financial hardship played a large role in the negative perceptions. The insurance contribution calculation methods by the Government showed differences.International students receive the same insurance contributions regardless of their nationality, age, income, or assets. @*Conclusions@#Through this study, it has been confirmed that further research and examination are needed regarding the application of Korean health insurance to foreign residents and the appropriate calculation of insurance contributions.

Phase II Randomized Trial of Rituximab Plus Cyclophosphamide Followed by Belimumab for the Treatment of Lupus Nephritis.

OBJECTIVE: To assess the safety, mechanism of action, and preliminary efficacy of rituximab followed by belimumab in the treatment of refractory lupus nephritis (LN). METHODS: In a multicenter, randomized, open-label clinical trial, 43 patients with recurrent or refractory LN were treated with rituximab, cyclophosphamide (CYC), and glucocorticoids followed by weekly belimumab infusions until week 48 (RCB group), or treated with rituximab and CYC but no belimumab infusions (RC group). Patients were followed up until week 96. Percentages of total and autoreactive B cell subsets in the patients' peripheral blood were analyzed by flow cytometry. RESULTS: Treatment with belimumab did not increase the incidence of adverse events in patients with refractory LN. At week 48, a complete or partial renal response occurred in 11 (52%) of 21 patients receiving belimumab, compared to 9 (41%) of 22 patients in the RC group who did not receive belimumab (P = 0.452). Lack of improvement in or worsening of LN was the major reason for treatment failure. B cell depletion occurred in both groups, but the percentage of B cells remained lower in those receiving belimumab (geometric mean number of B cells at week 60, 53 cells/µl in the RCB group versus 11 cells/µl in the RC group; P = 0.0012). Percentages of total and autoreactive transitional B cells increased from baseline to week 48 in both groups. However, percentages of total and autoreactive naive B cells decreased from baseline to week 48 in the belimumab group compared to the no belimumab RC group (P = 0.0349), a finding that is consistent with the observed impaired maturation of naive B cells and enhanced censoring of autoreactive B cells. CONCLUSION: The addition of belimumab to a treatment regimen with rituximab and CYC was safe in patients with refractory LN. This regimen diminished maturation of transitional to naive B cells during B cell reconstitution, and enhanced the negative selection of autoreactive B cells. Clinical efficacy was not improved with rituximab and CYC in combination with belimumab when compared to a therapeutic strategy of B cell depletion alone in patients with LN.

Glucocorticoid use and factors associated with variability in this use in the Systemic Lupus International Collaborating Clinics Inception Cohort.

Objectives: To describe glucocorticoid (GC) use in the SLICC inception cohort and to explore factors associated with GC use. In particular we aimed to assess temporal trends in GC use and to what extent physician-related factors may influence use. Methods: Patients were recruited within 15 months of diagnosis of SLE from 33 centres between 1999 and 2011 and continue to be reviewed annually. Descriptive statistics were used to detail oral and parenteral GC use. Cross sectional and longitudinal analyses were performed to explore factors associated with GC use at enrolment and over time. Results: We studied 1700 patients with a mean (s.d.) follow-up duration of 7.26 (3.82) years. Over the entire study period, 1365 (81.3%) patients received oral GCs and 447 (26.3%) received parenteral GCs at some point. GC use was strongly associated with treatment centre, age, race/ethnicity, sex, disease duration and disease activity. There was no change in the proportion of patients on GCs or the average doses of GC used over time according to year of diagnosis. Conclusion: GCs remain a cornerstone in SLE management and there have been no significant changes in their use over the past 10-15 years. While patient and disease factors contribute to the variation in GC use, between-centre differences suggest that physician-related factors also contribute. Evidence-based treatment algorithms are needed to inform a more standardized approach to GC use in SLE.

Geriatric Assessment of Physical and Cognitive Functioning in a Diverse Cohort of Systemic Lupus Erythematosus Patients: A Pilot Study.

OBJECTIVE: To use multidomain functional assessment, which is commonly performed in geriatric patients but is novel in patients with systemic lupus erythematosus (SLE), to better understand functional impairment in patients with SLE. METHODS: We recruited 60 adult participants (aged 20-39 years [26.7%], 40-59 years [50.0%], and ≥60 years [23.3%]; 80.0% African American and 90.0% female) from an existing cohort of SLE patients. During in-person visits (from October 2016 to April 2017), we evaluated physical performance (range 0-4, with higher scores indicating better performance), cognitive performance (5 fluid cognition domains; adjusted T scores), and self-reported measures including physical functioning (T scores), activities of daily living (ADLs), falls, and life-space mobility. RESULTS: In the SLE patients, the mean balance score (3.7) and gait speed score (3.4) were high, while the mean lower body strength score was low (1.8). Cognitive performance was average (score of 5.0) for episodic (47.7) and working (48.6) memory and low average for cognitive flexibility (43.7), processing speed (42.6), and attention/inhibitory control (38.8 [>1 SD below average]) when compared with healthy individuals of the same age, sex, race, ethnicity, and education level. Most participants reported the ability to independently perform basic ADLs, but many reported the inability to independently perform instrumental ADLs. Nearly half (45.0%) of participants reported falling in the prior year. Only 40.0% reported unlimited ability to travel without the help of another person. Scores generally did not differ substantially according to age. CONCLUSION: Our results suggest a high prevalence of impairment across multiple domains of function in SLE patients of all ages, similar to or exceeding the prevalence observed in much older geriatric populations. Further research into the added value of geriatric assessment in routine care for SLE is warranted.

The effect of mineral trioxide aggregate on the production of growth factors and cytokine by human periodontal ligament fibroblasts / 대한치과보존학회지

Mineral trioxide aggregate (MTA) would influence healing of periapical tissues by modulating the production of growth factors and cytokines from PDL fibroblasts, however, the studies are insufficient. Therefore, the purpose of this study was to monitor the expression of transforming growth factor-beta1 (TGF- beta1), fibroblast growth factor-2 (FGF-2), and interleukin-6 (IL-6) from PDL fibroblasts in the presence of MTA. The human PDL fibroblasts were seeded onto the set MTA or IRM at a level of 1 x 10(5) cells per unit well, and further incubated for 6, 12, 24, and 48 hours. The levels of TGF-beta1, FGF-2, and IL-6 from the supernatant were measured by enzyme-linked immunosorbent assay (ELISA). The data were analyzed using one-way ANOVA. The level of TGF-beta1 was down-regulated when the cells were grown in the presence of MTA except at 6 hours. The levels of FGF-2 release were significantly suppressed when PDL fibroblasts were grown in the presence of MTA or IRM at all time intervals (p < 0.05). The expressions of IL-6 from MTA treated cells were comparable to those of untreated control cells throughout the observation periods. We presume that this material inhibits the stimulatory function of growth factors on granulation tissue formation and in turn, it promotes the healing process modulated by other bone-remodeling cells.

The effect of mineral trioxide aggregate on the production of growth factors and cytokine by human periodontal ligament fibroblasts / 대한치과보존학회지

Mineral trioxide aggregate (MTA) would influence healing of periapical tissues by modulating the production of growth factors and cytokines from PDL fibroblasts, however, the studies are insufficient. Therefore, the purpose of this study was to monitor the expression of transforming growth factor-beta1 (TGF- beta1), fibroblast growth factor-2 (FGF-2), and interleukin-6 (IL-6) from PDL fibroblasts in the presence of MTA. The human PDL fibroblasts were seeded onto the set MTA or IRM at a level of 1 x 10(5) cells per unit well, and further incubated for 6, 12, 24, and 48 hours. The levels of TGF-beta1, FGF-2, and IL-6 from the supernatant were measured by enzyme-linked immunosorbent assay (ELISA). The data were analyzed using one-way ANOVA. The level of TGF-beta1 was down-regulated when the cells were grown in the presence of MTA except at 6 hours. The levels of FGF-2 release were significantly suppressed when PDL fibroblasts were grown in the presence of MTA or IRM at all time intervals (p < 0.05). The expressions of IL-6 from MTA treated cells were comparable to those of untreated control cells throughout the observation periods. We presume that this material inhibits the stimulatory function of growth factors on granulation tissue formation and in turn, it promotes the healing process modulated by other bone-remodeling cells.

Effect of sonicated extracts of Enterococcus faecalis on the production of matrix metalloproteinase-8 by human polymorphonuclear neutrophils / 대한치과보존학회지

This in vitro study monitored MMP-8 production on PMN by stimulated with the following three groups; Sonicated extracts of E. faecalis (SEF), SEF treated with Ca(OH)2 (12.5mg/ml) for 7 days, and lipopolysaccharides (LPS) of E. coli. The level of MMP-8 in each group was immediately measured by ELISA. The data were analyzed with Kruskal-Wallis test and Mann-Whitney U test. In the SEF group, the level of production of MMP-8 was higher than the negative control group in low concentration (0.05microg/ml) of SEF (p 0.05). All of the levels in E. coli LPS were increased with increasing concentrations (p 0.05).

Effects of Enterococcus faecalis sonicated extracts on IL-2, IL-4 and TGF-beta1 production from human lymphocytes / 대한치과보존학회지

In order to examine the immunoresponse of host cells to Enterococcus faecalis, this in vitro study monitored the production of Interleukin-2 (IL-2), Interleukin-4 (IL-4) and Transforming growth factor-beta1 (TGF-beta1) in human lymphocytes. Lymphocytes were activated with PHA in the presence or abscence of sonicated extracts of E. Faecalis (SEF) and further incubated for 72 hours. The level of each cytokine was measured by ELISA. Data were analyzed with Kruskal-Wallis test and Mann-Whitney U test (P < 0.05). PHA-activated group did exhibit higher level of IL-2 and IL-4 than untreated control group. The levels of expression of both cytokines were significantly decreased following the treatment of high (25 microg/ml) and medium concentration (12.5 microg/ml) of SEF (P <0 .05) than those of PHA activated group. But low concentration (5 microg/ml) of SEF showed the similar level of IL-2 and IL-4 production as those of PHA activated group. TGF-beta1 was unaffected by SEF treatment. These results suggested that E. faecalis may suppress IL-2 and IL-4 production by lymphocytes and this could be one of possible factors why E. faecalis are found frequently in the teeth with failed endodontic treatment.

Cytotoxicity and antibacterial property of new resin-based sealer / 대한치과보존학회지

No abstract available.

The levels of interleukin-2, interferon-gamma, interleukin-4 and T lymphocyte subpopulations in rat pulpal inflammation induced experimentally by specific bacteria / 대한치과보존학회지

Immune responses associated with bacterial infection involve various inflammatory cells. Clinical symptoms and pathologic features are particularly influenced by the predominant cells. Among inflammatory cells, T cells have the heterogenity. T cells may develop into the mature cells expressing the cell surface markers with different functions and T helper cells are categorized into Th1 and Th2 cells based on their different patterns of cytokine production. The objective of this study was to investigate the change of expression of surface markers on T cells and the Th1/Th2 immune response in pulpal inflammation associated with specific bacteria. We experimentally induced pulpal inflammation in rat incisors by drilling without coolant and innoculated with Streptococcus mutans (S.M. group), Porphyromonas endodontalis (P.E. group), or only sterile cotton (control group). After 1, 2, and 5 days, mandibular incisors were extracted and the pulp tissues were extirpated. The expressions of IL-2 recepters (CD25) and ICAM-1 (CD54) on CD4+ and CD8+ cells in the pulps were determined using a flow cytometer, and the concentration of IL-2, IFN-gamma and IL-4 was measured by enzyme-linked immunosorbent assay. The results were as follows; 1. In the S.M. group, CD4+ cells were more increased at 2nd day than 1st day and in the P.E. group, CD8+ cells were more increased at 2nd day than 1st day. 2. The percentages of CD4+, CD4+25+ and CD4+54+ cells were decreased in the pulp tissues at 5th day after irritation in all groups. 3. The ratios of CD4+/CD8+, CD4+/CD4+25+ and CD4+/CD4+54+ in the pulps at 2nd day after irritation by P. endodontalis were significantly lower than the other groups. 4. The higher concentrations of IFN-gamma than IL-4 in the pulps at 2nd day after irritation by P. endodontalis showed that T helper 1 reaction were predominant in the early stage of the pulpal inflammation induced by P. endodontalis. 5. The higher concentrations of IL-4 than IFN-gamma in the pulps at 1st day and 5th day after irritation by S. mutans were measured but the differences were not significant.

Interleukin-6 and interleukin-10 in experimentally induced rat pulpal inflammation / 대한치과보존학회지

No abstract available.

IL-1 and TNF-alpha release in human polymorphonuclear leukocytes after exposure to calcium hydroxide treated Porphyromonas endodontalis lipopolysaccharide / 대한치과보존학회지

Bacterial lipopolysaccharide (LPS) plays a major role in stimulating the synthesis and release of the principal osteoclast-activating cytokines, namely, interleukin 1 and tumor necrosis factor-alpha from immune cells. Although monocytes/macrophages are the main producers of these cytokines, recent evidence has indicated that polymorphonuclear leukocytes (PMN) have the ability to release IL-1 and TNF-alpha. Calcium hydroxide has been shown to be an effective medicament in root canal infections, reducing the microbial titre within the canal. It has been proposed that the therapeutic effect of Ca(OH)2 may also be the result of direct inactivation of LPS. The purpose of this study was to investigate whether treatment of Porphyromonas endodontalis LPS with calcium hydroxide alters its biological action as measured by human PMN secretion of IL-1 and TNF-alpha, and it was compared with Escherichia coli LPS. P. endodontalis ATCC 35406 was cultured in anaerobic condition, and LPS was extracted using the hot-phenol water extraction method and purified. Purchased E. coli LPS was also purified. 100 microg/ml of each LPS in pyrogen free water were incubated with 25mg/ml Ca(OH)2 at 37degrees C for 7 days. The supernatants were subjected to ultrafiltration, and the isolates were lyophilized and weighed. PMNs were obtained from peripheral blood by centrifugation layered over Lymphoprep. The cells were resuspended (4x106 cells/ml) in RPMI 1640 followed by treatment with various concentrations of LPS (0, 0.1, 1, 10microg/ml) for 24 hours at 37degrees C in 5% CO2 incubator. The supernatants of cells were collected and the levels of IL-1alpha, IL-1beta and TNF-alpha were measured by enzyme-linked immunosorbent assay. The results were as follows; 1. The levels of IL-1alpha, IL-1beta, TNF-alpha from PMN treated with each LPS were significantly higher than those released from unstimulated PMN of the control group (p0.05). 3. The levels of secretion for all three cytokines were affected in a dose-dependent manner in PMN stimulated with each LPS (p0.05). 4. The levels of all three cytokines released from PMN stimulated with P. endodontalis LPS were significantly lower than those released from PMN stimulated with E. coli LPS (p<0.05).

The Clinicopathological Study On The Relation Of Microvessel Density And Aggressiveness In Oral Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC), the most common head and neck cancer, shows poor prognosis as a result of frequent local invasion and lymph node metastasis that is mediated by multiple proteolytic enzymes and angiogenesis. In recent reports, angiogenesis is known to play an important role in tumor invasion and metastasis. The purpose of this study was to determine the role of angiogenesis in OSCCs, particularly with respect to the invasive and the metastatic potential. The microvessel density (CD31) in 34 human OSCC cases were investigated by immunohistochemistry, and reviewed with respect to the invasiveness and the presence of lymph node metastasis and following results were obtained. The blood vessel density (28.8+/-7.9) in the strong invasive cases were significantly higher than those (23.3+/-6.9) in the weak invasive cases. (p 0.05) These results suggest that angiogenesis may be related to the local invasion of OSCC and further research will be needed to investigate the possibility that antiangiogenic agent can be used as an anticancer agent for OSCC.

The Tibial Condylar Fractures with Dissociation of Metaphysis and Diaphysis Treated by Surgical Methods / 대한정형외과학회잡지

The tibial plateau fracture involving the articular surface clinically is a very important injury which often can cause disabilities of the knee joint. Open reduction and internal fixation have been proposed as the optimal treatment of patient with Schatzker's type VI tibial plateau fracture because of the decrease in the functional impairment of the knee joint by allowing early motion. But the injury to the soft tissue is usually severe, which may lead to wound complications after internal fixation. Also delayed union, nonunion, and infection after such operation is not a few. Recently some authors have studied about the external fixation or minimal internal fixation as the treatment for tibial plateau fracture. The purpose of the current study was to compare the results of two different operative methods. The authors analyzed 9 cases of Schatzker's type VI tibial plateau fracture surgically treated at the Pusan National University Hospital from March 1991 to August 1994. The follow-up period ranged from 1 year to 4 year 7 months. The results were obtained as follows. 1. Of the 9 cases, 7 were male and 2 were female, the major population were the 6th and 7th decades. 2. The most common cause of this injury was traffic accident in 7 cases(78%). 3. About the fracture pattern, the most commom type was intercondylar fracture type in 5 cases(56%), the next one lateral condyle fracture type in 4 cases (44%). 4. Common associated injuries were ipsilateral fibula fracture in 8 cases(89%) and ipsilateral femur fracture in 4 cases(44%). 5. Six cases were treated by open reduction and internal fixation, and 3 cases were treated by external fixator. 6. According to Poster's criteria, the results were “Acceptable” in 7 cases(89%), “Unacceptable” in 2 cases(11%).

Radiological Assessment of Porous-coated Acetabular Component with Screw Fixation in Primary Total Hip Arthroplasty / 대한정형외과학회잡지

This is a follow up study on 124 cases of primary total hip arthroplasty with Harris-Galante porous-coated acetabular component with the line-to-line technique, performed at the Department of Orthopaedic Surgery, Pusan National University Hospital from January 1986 to February 1992. The follow-up ranged from 24 months to 92 months, the average being 53 months. The results were as follows; 1. At the last follow-up, a radiolucent line was found in 20 cases(16.1%), but the width was less than one millimeter. Among the 20 cases, the continuous radiolucent line was found in two cases(1.6%), the progressive radiolucent line in five cases(4.0%). 2. Areas of non-contact(initial gap) between the porous mesh of the acetabular component and the bone were seen on the immediate postoperative radiographs of 35 cases(28.2%) among 124 cases. A radiolucent line developed around 13 cases(34.2%) of the 35 cases that were associated with an initial gap, but a radiolucent line developed around only seven cases(7.8%) of the 89 cases(71.8%) not associated with such a gap. 3. At the last follow-up, a vertical migration was found in five cases(4.0%), an angulation change of the acetabular cup in two cases(1.6%), but a horizontal migration of the acetabular cup was not found. 4. There was no evidence of the disruption of the titanium porous mesh of the acetabular component, and loosening, bending or breakage of the screw for fixation of the acetabular cup. And there was no revision for acetabular loosening. In conclusion, because overall loosening rate was less than 5%, the results were very satisfactory. Considering an initial gap is a important factor of acetabular loosening, we think that it is important to make less initial gap during operation.

The Treatment of Acromioclavicular Separation / 대한정형외과학회잡지

There are many procedures described for the treatment of acromioclavicular separation. Eleven cases were operated on by technique of Weaver and Dunn method and ten cases by modified Phemister method and four cases by Dewar and Barrington method, and one cases by Mumford method, Dept. of Orthopaedic Surgery, Capital Armed Forces General Hospital from March 1986 to March 1989. The following results were obtained. l. All patients were male and the peak incidence was in 3rd decade(77%). 2. The most common causes of the injuries were athletic accidents and followed by traffic accidents. 3. Twenty three patients were grade III by Allman's classification and grade II in three cases. 4. Clinical results were good in 19 cases(73.1%), fair in 5 cases(19.2%) and poor in 2 cases(7.7%). 5. The operative procedures in grade III may be good treatment of acromioclavicular separation.