BACKGROUND: There are significant concerns about emerging antibiotic resistance that are largely due to the inappropriate use of antibacterial agents for viral respiratory infections. We explored clinicians' attitude on antibiotic prescription for patients with respiratory tract infections (RTIs) using survey. METHODS: A random, stratified sample of physicians in Seoul, Gyeonggi, and Incheon was surveyed with a mailed questionnaire, and 353 clinicians completed information. A total of 344 were included in the final dataset after excluding incomplete data with missing information (response rate 34.4%). RESULTS: Among 344 physicians, those who would prescribe antibiotics in scenario patient were 39.2%, wait and prescribe 30.5% and not prescribe antibiotics 30.2%. Those who believed antibiotics would help treatment of acute sinusitis were 83.7%, acute pharyngitis 36%, acute tonsillitis 86.3%, acute bronchitis 64% and acute lower respiratory diseases 66.9%. In logistic regression analysis, those who were located in Gyeonggi region and those who believed antibiotics help treatment of tonsillitis and suppurative otitis media would prescribe antibiotics in scenario patient significantly more, whereas those who believe antibiotics help treatment of acute pharyngitis and lower respiratory disease prescribe antibiotics less. CONCLUSIONS: Physicians' attitude to antibiotics in respiratory disease has a significant effect on antibiotic prescription for RTIs. Interventions such as practice guidelines and patient education to optimize antibiotic prescription should take this effect into account.
Anti-Bacterial Agents ; Bronchitis ; Drug Resistance, Microbial ; Humans ; Logistic Models ; Otitis Media, Suppurative ; Palatine Tonsil ; Patient Education as Topic ; Pharyngitis ; Postal Service ; Prescriptions* ; Respiratory Tract Diseases ; Respiratory Tract Infections* ; Sinusitis ; Tonsillitis ; Surveys and Questionnaires

BACKGROUND: In South Korea, 22.3% of women ≥50 years of age and 37% of women ≥70 years of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor. METHODS: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. RESULTS: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental costeffectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate. CONCLUSION: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.
Alendronate ; Cohort Studies ; Cost-Benefit Analysis ; Denosumab* ; Economics, Pharmaceutical ; Female ; Hip ; Humans ; Incidence ; Korea* ; National Health Programs ; Osteoporosis ; Osteoporosis, Postmenopausal* ; Osteoporotic Fractures ; Wrist

BACKGROUND: Korea is expected to become an ultra-aged society, in which the elderly population will account for more than 20% of the total population, after 2025. Thus, the social costs due to osteoporotic fractures are expected to increase. Therefore, this study aimed to measure disability weights (DWs) of osteoporosis and osteoporotic fractures in Korea. METHODS: The scenarios were developed to standardize the severity of 6 health statuses: osteoporosis and osteoporotic fractures including wrist, hip, post-hip, vertebral, and post-vertebral fracture. The values for these 6 health statuses were sought via a person trade-off (PTO) approach. We measured the value by PTO and we calculated it to DW of 6 health statuses. Three clinical expertise panels of 33 experts were established, and face-to-face interviews were conducted from July to December 2017. RESULTS: The distribution of DW varied by panel. DWs ranged from 0.5 (Osteoporosis) to 0.857 (Hip fracture) for Panel 1, 0.091 (Osteoporosis) to 0.5 (Hip fracture) for Panel 2, and 0.091 (Osteoporosis) to 0.726 (Hip fracture) for Panel 3. The final values for the 6 health statuses obtained by pooling all data from 3 panels ranged from 0.286 (Osteoporosis) to 0.750 (Hip fracture). There was no significant difference in rankings for the 6 health statuses among the 3 panels. CONCLUSIONS: Comparing the DW of osteoporotic fracture in this study with other diseases in previous studies, it is predicted that osteoporotic fractures, especially hip fractures, will have a considerable burden of disease.
Aged ; Hip ; Hip Fractures ; Humans ; Korea ; Osteoporosis ; Osteoporotic Fractures ; Weights and Measures ; Wrist

PURPOSE: Hypertrophic scars after burn wound management remain a difficult problem for many burn surgeons despite of new treatment option is developed. After burn wound healed with scarring or pigmentation, the patient suffer in daily life with the cosmetic results and scar symptoms. Dermastamp(R) is new treatment modality on burn scar management in our burn center. Dermastamp(R) is stamp shaped and it contains 0.8 mm or 2.1 mm long multiple stainless steel needles. Dermastamp(R) was simply pressed down on the scar 3~4 times and makes 200~300 holes on 1 cm2 scar area. Dermastamping breaks the dense collagen fiber and fibroblast in the scar tissue and rearranges collagen fiber and fibroblast in the scar tissue. METHODS: The 51 patients were selected. The group consisted of 26 male and 25 female patients. 21 patients were adult and 30 patients were children. Stamping area of the 18 patients was below 25 cm2, 6 patients were in 25 to 100 cm2, and 27 patients were above 100 cm2, stamping area. They received Dermastamp(R) treatment 3 to 23 times in every 1 or 2 weeks interval at least 2 months. The 33 patients received Dermastamp(R) under local anesthesia and other 18 patients received under volatile induction anesthesia. Hypertrophic scar is evaluated with Vancouber Scar Scale (VSS) score by two surgeons and scar height using Sonography (17 patients). And pathologic study (17 patients) was done on volunteer cases. RESULTS: Clinically improvements with VSS score (1 to 6 points down) were noted in all patients group. Scar height was lowered (0.8 to 3.6 mm) on sonography and pathologic report revealed collagen fiber rearrangement and scar height thinning in examined group. CONCLUSION: Microneedling procedure is a effective modality of management on hypertrophic scarring and pigmentation. Microneedling induces collagen fiber rearrangement on scar tissue and thinner the scar height in pathology and improves clinical evaluating with VSS score and patients symptoms.
Adult ; Anesthesia ; Anesthesia, Local ; Burn Units ; Burns ; Child ; Cicatrix ; Cicatrix, Hypertrophic ; Collagen ; Cosmetics ; Female ; Fibroblasts ; Humans ; Male ; Needles ; Pigmentation ; Stainless Steel

BACKGROUND/AIMS: In multicenter clinical trials, laboratory tests are performed in the laboratory of each center, mostly using different measuring methodologies. The purpose of this study was to evaluate coefficients of variation (CVs) of laboratory results produced by various measuring methods and to determine whether mathematical data adjustment could achieve harmonization between the methods. METHODS: We chose 10 clinical laboratories, including Green Cross Laboratories (GC Labs), the central laboratory, for the measurement of total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum triglycerides, creatinine, and glucose. The serum panels made with patient samples referred to GC Labs were sent to the other laboratories. Twenty serum samples for each analyte were prepared, sent frozen, and analyzed by each participating laboratory. RESULTS: All methods used by participating laboratories for the six analytes had traceability by reference materials and methods. When the results from the nine laboratories were compared with those from GC Labs, the mean CVs for total cholesterol, HDL-C, LDL-C, and glucose analyzed using the same method were 1.7%, 3.7%, 4.3%, and 1.7%, respectively; and those for triglycerides and creatinine analyzed using two different methods were 4.5% and 4.48%, respectively. After adjusting data using Deming regression, the mean CV were 0.7%, 1.4%, 1.8%, 1.4%, 1.6%, and 0.8% for total cholesterol, HDL-C, LDL-C, triglyceride, creatinine, and glucose, respectively. CONCLUSIONS: We found that more comparable results can be produced by laboratory data harmonization using commutable samples. Therefore, harmonization efforts should be undertaken in multicenter trials for accurate data analysis (CRIS number; KCT0001235).
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Creatinine ; Glucose ; Humans ; Methods ; Multicenter Studies as Topic ; Research Design* ; Statistics as Topic ; Triglycerides

Background: The coronavirus disease 2019 pandemic has been challenging the healthcare service, i.e., the vitalization of the point of care accompanying self-testing in vitro diagnostic medical devices (IVDs). This study aims to suggest priority criteria to classify self-testing IVDs using the analytic hierarchy process technique. Methods: Two dimensions of the characteristics embedded in the IVDs and the diseases to be diagnosed with self-testing IVDs were parallelly considered and independently investigated. In addition, three expert panels consisting of laboratory medical doctors (n=11), clinicians (n=10), and citizens (n=11) who have an interest in the selection of self-testing IVDs were asked to answer to questionnaires. Priorities were derived and compared among each expert panel. Results: First of all, ease of specimen collection (0.241), urgency of the situation (0.224), and simplicity of device operation (0.214) were found to be the most important criteria in light of the functional characteristics of self-testing IVDs. Medical doctors valued the ease of specimen collection, but the citizen’s panel valued self-management of the disease more. Second, considering the characteristics of the diseases, the priority criteria were shown in the order of prevalence of diseases (0.421), fatality of disease (0.378), and disease with stigma (0.201). Third, medical doctors responded that self-testing IVDs were more than twice as suitable for non-communicable diseases as compared to communicable diseases (0.688 vs. 0.312), but the citizen’s group responded that self-testing IVDs were slightly more suitable for infectious diseases (0.511 vs. 0.489). Conclusion Our findings suggested that self-testing IVDs could be primarily classified as the items for diagnosis of non-communicable diseases for the purpose of self-management with easy specimen collection and simple operation of devices, taking into account the urgency of the situation as well as prevalence and fatality of the disease.

The world is facing the new challenges of an aging population, and understanding the process of aging has therefore become one of the most important global concerns. Sarcopenia is a condition which is defined by the gradual loss of skeletal muscle mass and function with age. In research and clinical practice, sarcopenia is recognized as a component of geriatric disease and is a current target for drug development. In this review we define this condition and provide an overview of current therapeutic approaches. We further highlight recent findings that describe key pathophysiological phenotypes of this condition, including alterations in muscle fiber types, mitochondrial function, nicotinamide adenine dinucleotide (NAD+) metabolism, myokines, and gut microbiota, in aged muscle compared to young muscle or healthy aged muscle. The last part of this review examines new therapeutic avenues for promising treatment targets. There is still no accepted therapy for sarcopenia in humans. Here we provide a brief review of the current state of research derived from various mouse models or human samples that provide novel routes for the development of effective therapeutics to maintain muscle health during aging.

Microorganisms play important roles in obesity; however, the role of the gut microbiomes in obesity is controversial because of the inconsistent findings. This study investigated the gut microbiome communities in obese and lean groups of captive healthy cynomolgus monkeys reared under strict identical environmental conditions, including their diet. No significant differences in the relative abundance of Firmicutes, Bacteroidetes and Prevotella were observed between the obese and lean groups, but a significant difference in Spirochetes (p < 0.05) was noted. Microbial diversity and richness were similar, but highly variable results in microbial composition, diversity, and richness were observed in individuals, irrespective of their state of obesity. Distinct clustering between the groups was not observed by principal coordinate analysis using an unweighted pair group method. Higher sharedness values (95.81% ± 2.28% at the genus level, and 79.54% ± 5.88% at the species level) were identified among individual monkeys. This paper reports the association between the gut microbiome and obesity in captive non-human primate models reared under controlled environments. The relative proportion of Firmicutes and Bacteroidetes as well as the microbial diversity known to affect obesity were similar in the obese and lean groups of monkeys reared under identical conditions. Therefore, obesity-associated microbial changes reported previously appear to be associated directly with environmental factors, particularly diet, rather than obesity.
Bacteroidetes ; Diet ; Environment, Controlled ; Firmicutes ; Gastrointestinal Microbiome ; Haplorhini ; Macaca fascicularis ; Methods ; Microbiota ; Obesity ; Prevotella ; Primates ; Spirochaetales

The function of microglia/macrophages after ischemic stroke is poorly understood. This study examines the role of microglia/macrophages in the focal infarct area after transient middle cerebral artery occlusion (MCAO) in rhesus monkeys. We measured infarct volume and neurological function by magnetic resonance imaging (MRI) and non-human primate stroke scale (NHPSS), respectively, to assess temporal changes following MCAO. Activated phagocytic microglia/macrophages were examined by immunohistochemistry in post-mortem brains (n=6 MCAO, n=2 controls) at 3 and 24 hours (acute stage), 2 and 4 weeks (subacute stage), and 4, and 20 months (chronic stage) following MCAO. We found that the infarct volume progressively decreased between 1 and 4 weeks following MCAO, in parallel with the neurological recovery. Greater presence of cluster of differentiation 68 (CD68)-expressing microglia/macrophages was detected in the infarct lesion in the subacute and chronic stage, compared to the acute stage. Surprisingly, 98~99% of transforming growth factor beta (TGFβ) was found colocalized with CD68-expressing cells. CD68-expressing microglia/macrophages, rather than CD206⁺ cells, may exert anti-inflammatory effects by secreting TGFβ after the subacute stage of ischemic stroke. CD68⁺ microglia/macrophages can therefore be used as a potential therapeutic target.
Brain ; Haplorhini ; Immunohistochemistry ; Infarction, Middle Cerebral Artery ; Inflammation ; Macaca mulatta ; Magnetic Resonance Imaging ; Microglia ; Middle Cerebral Artery ; Primates ; Stroke ; Transforming Growth Factor beta