Patterns of medical care utilization according to environmental factors in asthma and chronic obstructive pulmonary disease patients

Background/Aims@#Weather and air pollution are associated with the exacerbation of respiratory diseases. We investigated patterns of medical care use according to meteorological factors and air pollution in patients with asthma or chronic obstructive pulmonary disease (COPD). @*Methods@#We analyzed the medical care utilization patterns of patients with asthma or COPD registered in the Korea Health Insurance Review and Assessment database for the period 2007 to 2013. The patterns were divided into hospitalization and emergency department (ED) use. @*Results@#The medical care use of patients with asthma or COPD increased when the mean temperature and relative humidity were lower, and the temperature difference and atmospheric pressure were greater. Medical care use increased with the concentrations of particulate matter and ozone. Among age groups, sensitivity to pollutants was greatest in patients aged ≥ 65 years. The effect of being elderly was greater for asthma than for COPD, with a higher hospitalization rate. ED utilization affected by environmental factors was significantly greater for females and hospitalization was significantly more common for males. @*Conclusions@#Meteorological factors and air pollutants were shown to contribute to increased medical care utilization by patients with asthma and COPD, particularly elderly patients. The overall effect was greater for COPD, but the effect in elderly patients was greater for asthma. In addition, the patterns of change in medical care use due to environmental factors differed according to sex.

A Comparative Study on the Nursing Dependency of Suspected COVID-19 Patients and General Patients in the Emergency Department / 임상간호연구

Purpose@#This study was conducted to investigate the nursing needs and workload of nurses according to nursing dependency for effective placement of nursing staff in the emergency department (ED). @*Methods@#In June 2020, 256 adult patients who visited the ED were classified as two groups, suspected COVID-19 patients and general patients. The participants’electronic medical records were analyzed using descriptive statistics, t-test, x 2 -test, and Fisher's exact test using the SPSS. @*Results@#The patient dependence score showed a significant difference between the two groups, with an average of 13.99±1.85 for the suspected COVID-19 patient group and 10.58±2.10 for the general patient group (t=12.42, p<.001). There were statistically significant differences in communication (t=3.28, p=.001), mobility (t=3.29, p=.001), nutrition, elimination, and personal care (t=7.34, p<.001) among the six domains of nursing dependency. In the domains of environment, safety, health, and social needs, the dependency score was 3 for all suspected COVID-19 patients and 1 for all general patients. @*Conclusion@#The results of this study confirmed that infection control activities of emergency patients who need isolation affect the patients’ nursing dependency on nursing care.

Patterns of medical care utilization according to environmental factors in asthma and chronic obstructive pulmonary disease patients

Background/Aims@#Weather and air pollution are associated with the exacerbation of respiratory diseases. We investigated patterns of medical care use according to meteorological factors and air pollution in patients with asthma or chronic obstructive pulmonary disease (COPD). @*Methods@#We analyzed the medical care utilization patterns of patients with asthma or COPD registered in the Korea Health Insurance Review and Assessment database for the period 2007 to 2013. The patterns were divided into hospitalization and emergency department (ED) use. @*Results@#The medical care use of patients with asthma or COPD increased when the mean temperature and relative humidity were lower, and the temperature difference and atmospheric pressure were greater. Medical care use increased with the concentrations of particulate matter and ozone. Among age groups, sensitivity to pollutants was greatest in patients aged ≥ 65 years. The effect of being elderly was greater for asthma than for COPD, with a higher hospitalization rate. ED utilization affected by environmental factors was significantly greater for females and hospitalization was significantly more common for males. @*Conclusions@#Meteorological factors and air pollutants were shown to contribute to increased medical care utilization by patients with asthma and COPD, particularly elderly patients. The overall effect was greater for COPD, but the effect in elderly patients was greater for asthma. In addition, the patterns of change in medical care use due to environmental factors differed according to sex.

A Comparative Study on the Nursing Dependency of Suspected COVID-19 Patients and General Patients in the Emergency Department / 임상간호연구

Purpose@#This study was conducted to investigate the nursing needs and workload of nurses according to nursing dependency for effective placement of nursing staff in the emergency department (ED). @*Methods@#In June 2020, 256 adult patients who visited the ED were classified as two groups, suspected COVID-19 patients and general patients. The participants’electronic medical records were analyzed using descriptive statistics, t-test, x 2 -test, and Fisher's exact test using the SPSS. @*Results@#The patient dependence score showed a significant difference between the two groups, with an average of 13.99±1.85 for the suspected COVID-19 patient group and 10.58±2.10 for the general patient group (t=12.42, p<.001). There were statistically significant differences in communication (t=3.28, p=.001), mobility (t=3.29, p=.001), nutrition, elimination, and personal care (t=7.34, p<.001) among the six domains of nursing dependency. In the domains of environment, safety, health, and social needs, the dependency score was 3 for all suspected COVID-19 patients and 1 for all general patients. @*Conclusion@#The results of this study confirmed that infection control activities of emergency patients who need isolation affect the patients’ nursing dependency on nursing care.

Trends of presentation and clinical outcome of treated renal angiomyolipoma.

PURPOSE: The purpose of this study is to set guidelines for the management of renal angiomyolipoma (AML), clinical prognosis according to tumor size, in association with tuberous sclerosis complex (TSC), multiplicity, radiographic finding, and treatment modality. MATERIALS AND METHODS: Between March 1998 and October 2008, 129 out of 254 patients with AML who underwent surgical intervention or angioembolization were enrolled. Diagnosis of AML was determined by the presence of a low attenuated component on CT imaging or by pathological confirmation. Indications of treatment were intractable pain, hematuria, suspicion of malignancy, large tumor size, spontaneous rupture, and radiographically equivocal tumors in which a differential diagnosis was needed to rule out malignancy. Parameters including age, sex, tumor size, multiplicity, radiographic characteristics, association with TSC, and treatment modality were reviewed. RESULTS: Age at presentation was 50.6 years and mean tumor size was 3.5 cm. Presentation symptoms were flank pain, hematuria, spontaneous rupture, and fatigue. 97 (75.2%) patients were incidentally discovered. 100 (77.5%) were females. 68 (52.7%) underwent nephron-sparing surgery (NSS), 35 (27.1%) radical nephrectomy, and 26 (20.2%) angioembolization. TSC was accompanied in 12 (9.3%) patients. No patient developed renal function impairment during the mean follow-up period of 64.8 months. Patients with TSC presented at a younger age, along with larger, bilateral, and multiple lesions. CONCLUSION: Significant differences in clinical manifestations and treatment outcomes were noted in respect to tumor characteristics, association with TSC, and treatment modality. Considering the benign nature of AML, these parameters ought to be considered when deciding upon active surveillance or prophylactic intervention.

Clinical characteristics of renal cell carcinoma in Korean patients with von Hippel-Lindau disease compared to sporadic bilateral or multifocal renal cell carcinoma.

This study was done to analyze the clinical characteristics of renal cell carcinoma (RCC) in Korean patients with von Hippel-Lindau (VHL) disease. Between January 1996 and July 2008, 1,514 patients were diagnosed with RCC and 24 patients were diagnosed with VHL disease at our institute. We analyzed the clinical characteristics of the 24 patients diagnosed with VHL. The mean age of patients with VHL was 39.2+/-12.6 yr; the mean age of patients with both VHL and RCC was 42.5+/-10.3 yr. Among the 24 patients with VHL, 7 patients had retinal angiomas, 11 had RCC, 16 had renal lesions, 18 had pancreatic lesions and 21 had cerebellar hemangioblastomas. There was no significant difference between survival rates of patients with VHL alone and those with VHL and RCC. However, cancer-specific survival rates were significantly different between patients with both VHL and RCC and patients with sporadic bilateral or multifocal RCC. In our Korean study, the incidence of RCC in patients with VHL disease is 45.8% and the incidence of VHL disease in patients with RCC is 0.73%. Due to the low overall incidence of VHL in Korea, extended multi-institutional studies are needed to establish the true characteristics of VHL disease.

Pathological effects of prostate cancer correlate with neuroendocrine differentiation and PTEN expression after bicalutamide monotherapy.

PURPOSE: Androgen deprivation therapy is the primary treatment for advanced prostate cancer but many patients eventually experience progression to hormone refractory status. Understanding the molecular changes after androgen deprivation therapy would help evaluate the efficacy or failure of second line therapies. Therefore, we analyzed the expression of the tumor suppressor phosphatase and tensin homologue deleted on chromosome 10 (PTEN), the human epidermal receptor-2 and neuroendocrine differentiation after bicalutamide monotherapy, which is emerging as an alternative treatment for locally advanced prostate cancer. MATERIALS AND METHODS: Molecular arrangements were evaluated in 107 radical prostatectomy specimens from patients given 150 mg bicalutamide before surgery. Pathological regressive changes, and the correlation of postoperative biochemical failure with the extent of molecular arrangements and pathological effects were analyzed. RESULTS: Patients with minimal regression effects after bicalutamide therapy had advanced pathological stage disease, and tended to have positive chromogranin A expression and PTEN inactivation. Only 4 (3.7%) prostatectomy specimens showed human epidermal receptor-2 immunostaining. The probability of positive chromogranin A expression in the PTEN inactivation group was 2.5-fold (OR 2.5, 95% CI 1.1-5.6, p = 0.023) higher than in the nonPTEN inactivation group. Cox regression analysis revealed that seminal vesicle invasion, PTEN/chromogranin A expression and lymph node invasion were significant variables for time to biochemical recurrence. CONCLUSIONS: PTEN inactivation and neuroendocrine differentiation were related to refractoriness to bicalutamide therapy. These results support the hypothesis that neuroendocrine differentiation is caused by activation of the serine threonine kinase Akt pathway, which results from PTEN inactivation.

Isolation and characterization of the Aspergillus nidulans eglC gene encoding a putative beta-1,3-endoglucanase.

The Aspergillus nidulans eglC gene, which encodes a putative beta-1,3-endoglucanase, was isolated from a chromosome-specific library by using an expressed sequence tag, esd0113. The EglC open reading frame encodes a 465 amino acid polypeptide, of which the amino acid sequence showed 46% similarity to that of Saccharomyces cerevisiae beta-1,3-endoglucanase. The eglC transcript level at the early stages of asexual and sexual developments was dependent on the presence of the nsdD gene that encodes a GATA-type transcription factor, confirming that the nsdD gene is necessary for full accumulation of the eglC transcript. Deletion of the eglC gene did not affect the radial growth rate, the germination rate of conidia, and both of asexual and sexual development. However, deletion of the gene led to hyphae more resistant to a cell wall-lyzing enzyme, implying that the cell wall structure of the eglC-null mutant is altered from a wild type one. Furthermore, deletion of the fadA and sfaD genes, that encode a Galpha and a Gbeta subunits of a heterotrimeric G protein, respectively, did not affect the eglC transcript level at the early developmental stages. In contrast, deletion of the flbA gene, that codes for a regulatory protein having an RGS (regulator of G protein signaling) motif, led to decrease in the eglC transcript level. The eglC transcript level was not higher in a creA mutant than in a wild type, indicating that the eglC gene is not sensitive to carbon-catabolite repression.

Search for Differentially Expressed Genes in Preterm Human Placentae and Their Membranes by Annealing Control Primer System / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to investigate the gene expression profiles using GeneFishingTM kit in human placentae and their membranes delivered at preterm caused by preterm labor. METHODS: Specimens were obtained from placenta, chorion, and amnion delivered at preterm and term, respectively. Total RNAs were isolated from each specimen. Thereafter, the profiles of expression genes between preterm and term specimens were compared using a new and accurate reverse transcription-polymerase chain reaction (RT-PCR) that involves annealing control primers (ACPs) to identify the genes expressed differentially and screened by basic local alignment search tool (BLAST) search. RESULTS: Using 20 ACPs, 13 differentially expressed genes (DEGs) were identified and sequenced. 7 of them were expressed up-regulation, while 6 were expressed down-regulation in preterm deliveries. A BLAST searches revealed that 11 were known genes and 2 were unknown genes. Among known genes, up-regulated genes were insulin-like growth factor II associated protein, vigilin, acyl-Coenzyme A dehydrogenase, tissue inhibitor of metalloproteinase 1 (TIMP1), ribosomal protein S26 (RPS26), follistatin-like 1 (FSTL1) and down-regulated genes were two mitochondrial DNAs, ribosomal protein S28 (RPS28), transglutaminase 2 (TGM2), heparin sulfate proteoglycan (HSPG, perlecan). CONCLUSION: This study shows that the ACP system is a good method for the identification of preterm-related genes. Furthermore, this study suggests that further analysis of the differentially expressed genes in preterm we have identified should provide insights into the molecular basis of preterm delivery caused by preterm labor.