BACKGROUND: The long-term impact of symptom classification on quality of life (QOL) and economic outcomes among individuals with long coronavirus disease (COVID) remains poorly understood. This study aimed to clarify the situation of long COVID in Japan by analyzing patients using cluster classification. METHODS: This multicenter, retrospective cohort study enrolled 515 patients with COVID-19 and followed up for 36 months via standardized questionnaires. Patients were classified based on: 1) symptom trajectory over time and 2) symptom cluster profiles at 3 months. RESULTS: While the number of symptoms decreased, fatigue and dyspnea frequently persisted, whereas anosmia and dysgeusia declined. Cough and sputum decreased gradually. The proportion of patients with 5-9 symptoms increased. The mean (interquartile range) presenteeism scores were lower in the continuous (60 [50-80]) and relapse groups (65 [48-80]) than in the recovered group (70 [50-80]). The multiple symptoms cluster had the worst SF-36, presenteeism, and absenteeism scores (47.2 [44.7-49.8], 48.8 [27.5-72.5], and 10.9 [0.0-11.0], respectively). CONCLUSIONS Patients with continuous and multiple symptoms experienced persistently lower QOL and greater economic burden up to 36 months after COVID-19 diagnosis. The long-term effects of long COVID are not only physical but also mental and economical. Thus, further research is needed to clarify the economical and physiological impact of long COVID.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; COVID-19/complications* ; Japan/epidemiology* ; Post-Acute COVID-19 Syndrome/psychology* ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; East Asian People

An exciting debate has emerged whether bacille Calmette-Guérin (BCG) vaccination is effective for the coronavirus disease 2019 (COVID-19) pandemic. Some advocated that BCGvaccinated people are less suffered from the virus because BCG vaccination is recommendedin COVID-19 high burden countries. However, the others objected because this seemingly attractive relationship is explainable with confounding factors. In a multiple regression with 171 countries adjusting socioeconomical and climatic covariates, countries with current universal pediatric BCG policy were associated with 30-fold (95% confidence interval, 17–52) decrease of COVID-19 mortality per population compared to countries without the policy.

An exciting debate has emerged whether bacille Calmette-Guérin (BCG) vaccination is effective for the coronavirus disease 2019 (COVID-19) pandemic. Some advocated that BCGvaccinated people are less suffered from the virus because BCG vaccination is recommendedin COVID-19 high burden countries. However, the others objected because this seemingly attractive relationship is explainable with confounding factors. In a multiple regression with 171 countries adjusting socioeconomical and climatic covariates, countries with current universal pediatric BCG policy were associated with 30-fold (95% confidence interval, 17–52) decrease of COVID-19 mortality per population compared to countries without the policy.

OBJECTIVE: This study determined whether cognitive behavioral therapy for insomnia (CBT-i) decreased the need for sleep medications and produced better treatment outcomes than pharmacotherapy alone. METHODS: We reviewed data from patients with insomnia in the outpatient clinic of a general hospital between 2009 and 2015. We compared 41 patients who received five sessions of CBT-i with 100 age- and sex-matched patients who received pharmacotherapy only. We evaluated the change in prescription for sleep (i.e., antidepressants, hypnotics, and others) between the first and last visits using repeated measures analysis of variance (ANOVA). Clinical global impressions and completion status at the last visit were assessed using the chisquare test. RESULTS: We found a significant decrease in the prescription rate and the dosage of hypnotics among patients who received CBT-i when compared with control patients. There was no significant change in the dosage of antidepressants between the two groups. Achievement of case closure was better in the CBT-i group at the trend level. Clinical global impression at the last visit was not significantly different. CONCLUSION: These results show that CBT-i reduces the need for hypnotics among insomnia patients. Our results indicate that CBT-i offers additional benefits beyond improving sleep characteristics and thus provides another reason for recommending CBT-i as a first-line treatment for insomnia.
Ambulatory Care Facilities ; Antidepressive Agents ; Cognitive Therapy* ; Drug Therapy ; Hospitals, General ; Humans ; Hypnotics and Sedatives ; Prescriptions* ; Sleep Initiation and Maintenance Disorders*

OBJECTIVE: To evaluate the compliance and satisfaction of rehabilitation recommendations for advanced cancer patients hospitalized in the palliative care unit. METHODS: Advanced cancer patients admitted to a hospice palliative care unit were recruited. Patients with advanced cancer and a life expectancy of less than 6 months, as assumed by the oncologist were included. Patients who were expected to die within 3 days were excluded. ECOG and Karnofsky performance scales, function ambulatory category, level of ambulation, and survival days were evaluated under the perspective of comprehensive rehabilitation. Problem-based rehabilitations were provided categorized as physical therapy at the gym, bedside physical therapy, physical modalities, medications and pain intervention. Investigation of compliance for each category was completed. Patient satisfaction was surveyed using a questionnaire. RESULTS: Forty-five patients were recruited and received evaluations for rehabilitation perspective. The subjects were reported to have gait-related difficulties (71.1%), pain (68.9%), poor medical conditions (68.9%), bladder or bowel problems (44.4%), dysphagias (11.1%), mental status issues (11.1%), edemas (11.1%), spasticity (2.2%), and pressure sores (2.2%). In the t-test, patients with good compliance for GymPT showed higher survival days (p < 0.05). In the satisfaction survey, patients with performance scales showed a greater satisfaction in Spearman's correlation analysis (p < 0.05). CONCLUSION: Advanced cancer patients admitted to the hospice palliative care unit have many rehabilitation needs. Patients with a longer survival time showed better compliance for GymPT. Patients with a better performance scale showed a higher satisfaction. Comprehensive rehabilitation may be needed to advanced cancer patients in the hospice palliative care unit.
Compliance ; Deglutition Disorders ; Edema ; Hospice Care ; Hospices ; Humans ; Life Expectancy ; Muscle Spasticity ; Palliative Care ; Patient Satisfaction ; Pressure Ulcer ; Rehabilitation ; Urinary Bladder ; Walking ; Weights and Measures

Primary Hyperparathyroidism is the metabolism abnormality of calcium, phosphate, and bone due to the high synthesis of parathyroid hormone, a rare endocrine disease in children. It scarcely occurs in children so that till now it was reported only 4 cases in Korea, especially with abdominal symptoms. We report this case of primary hyperparathyroidism with brief review of literatures.
Abdominal Pain ; Calcium ; Child ; Endocrine System Diseases ; Humans ; Hyperparathyroidism, Primary ; Korea ; Parathyroid Hormone ; Parathyroid Neoplasms

OBJECTIVE: The aim of this study is to verify the clinical outcome of staging surgery with and (or) without bilateral salpingo-oophorectomy (BSO) in clinical stage I-II endometrial cancer patients. METHODS: We reviewed the medical records of 178 surgically treated patients in clinical stage I-II endometrial cancer between January 1994 and December 2004. Overall survival (OS) and disease free survival (DFS) were analyzed by using data gathered from the National Statistics Office. The clinical outcome was compared between patients who underwent hysterectomy with and without BSO. RESULTS: One hundred sixty patients were in clinical stage I, and 18 patients were in clinical stage II. Most of the cases showed endometrioid (93.8%) in histology and G1 (56.1%) in differentiation. BSO was performed in 142 patients. Surgico-pathological features of two group are not different but the group without BSO were younger (40.7 vs. 55.8 years old) and less myometrial invasion than the group with BSO. After mean 39.27 months follow up, we found no difference in OS and DFS between the two groups with BSO and without BSO. No factors except stage were significantly related with OS and DFS by multivariate Cox regression analysis. The rate of pelvic and paraaortic lymph node metastasis was not different between two groups. CONCLUSION: The retrospective data in the study reveals that staging surgery with and without BSO does not affect OS and DFS in clinical stage I-II endometrial cancer patients. In limited cases, such as young women, omitting BSO can be considered carefully.
Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Retrospective Studies

OBJECTIVE: Previous reports have shown that transcutaneous immunization (TCI) with proteins or peptides in combination with adjuvants efficiently induces specific cellular and humoral immune responses. We compared the immune response after TCI with new construct which was derived from HPV-16 E7opt+K and pK6hf promoter instead of pCMV promoter and various adjuvant. METHODS: First, we made new construct ligated with HPV-16 E7 opt+K to Hair-follicle Specific pK6hf Promoter. Second, we applied pk6hf-E7 opt+K DNA with or without Lipofectamine 2000 and a combination of cholera toxin (CT) and CpG oligodeoxynucleotide (CpG) onto cold wax-depilated and hydrated bare skin of C57 BL/6 mice. To assess the ability of CTL(cytotoxic T-lymphocyte) activity, we performed intracellular cytokine staining with flow cytometric analysis to determine the number of E7-specific IFN-gamma- secreting CD8+ T cells generated in vaccinated mice with the DNA vaccine. RESULTS: Female C57BL/6 mice immunized by TCI methods with 30 microgram of pk6hf-E7 opt+K DNA with Lipofectamine2000 and CT efficiently generated E7-specific CD8(+) T cells compared with the group of pk6hf-E7 opt+K DNA only or DNA with Lipofectamine2000. CONCLUSION: Our results demonstrate that TCI of the linkaged-E7 DNA , E7 opt+K DNA to pk6hf, and Lipofectamine2000 and CT induced an antigen-specific CTL response. This result is of potential relevance for the development of therapeutic HPV-specific DNA vaccines with TCI and pK6hf promoter can be used safely.
Animals ; Cholera Toxin ; DNA* ; Female ; Human papillomavirus 16* ; Humans ; Immunity, Humoral ; Immunization* ; Mice* ; Peptides ; Skin ; T-Lymphocytes ; Vaccines, DNA

No abstract available.
Uterine Cervical Neoplasms*

OBJECTIVE: The "sentinel node" is defined as the first lymph node encountered by lymphatic vessels draining a tumor. We tried to examine whether pathologic status of sentinel nodes of cervical cancer patients represent metastatic status of pelvic and paraaortic lymph nodes and to investigate the correlation between sentinel node HPV status and lymph node metastasis and recurrence of cervical cancer patients. METHODS: From August 2001 to December 2003, 57 patients affected by stage IB-IIA cervical cancer had sentinel node biopsies performed during radical hysterectomy and pelvic and paraaortic lymphadenectomy. We performed sentinel lymph node pathologic examination by frozen section and HPV typing by oligonucleotide microarray. After two years of follow up, we analyzed the prognosis of patients. RESULTS: Sentinel nodes were identified in all of our patients. A total of 79 nodes were detected as sentinel nodes. Metastasis in the sentinel nodes were found in 10 patients by frozen section and 11 patients by permanent pathologic examination. The results of sentinel lymph node frozen biopsy were statistically significant for predicting the metastatic status of the pelvic lymph nodes (p<0.05), but showed one false negative case. HPV DNA was detected in the cervices of 55 patients (96.5%), 44 (80.0%) of whom were found to have HPV DNA in the sentinel nodes. HPV DNA was detected in sentinel nodes of 10 patients among 11 patients with lymph node metastases. After mean follow up of 31.7 months (range; 1-48), disease recurred in five patients and all of these patients showed HPV in sentinel nodes. Combination of sentinel node frozen biopsy and HPV typing showed negative predictive value of 100% in predicting lymph node metastasis and recurrence. CONCLUSION: Our result suggests the possibility that sentinel node HPV typing would play a supportive role to reduce false negative rate of sentinel node biopsy. Additional study will be needed to confirm the clinical application of sentinel lymph procedure and to reveal correlation between HPV status of sentinel nodes and lymph node metastasis and recurrence of cervical cancer patients.
Biopsy ; DNA ; Follow-Up Studies ; Frozen Sections ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Vessels ; Neoplasm Metastasis* ; Oligonucleotide Array Sequence Analysis ; Prognosis ; Recurrence* ; Uterine Cervical Neoplasms*