Background: Limited access to medical services causes problems in patients’ health and life. Also, hospital closures cause concentration towards general hospitals, which leads to worsening National Health Insurance finance. Therefore, hospital closure is an important topic to be analyzed. Methods: This paper analyzed the factors that affect hospital closures using survival analysis with the data of 970 hospitals opened between 2010 and 2019 in Korea. The number of medical personnel, hospital rooms, sickbeds, and medical departments were used as explanatory variables. Results: The number of medical personnel and hospital rooms increased the survival probability while the number of sickbeds and medical departments decrease the survival probability. Conclusion The results suggest that hospitals have economies of scale and diseconomies of scope in management.

BACKGROUND: Sex steroid hormones are believed to play an important role in the genesis and growth of uterine myoma. Several studies suggest a possible role of insulin-like growth factor(IGF) as a mediator of estradiol in uterine myama. We have recently demonstrated that some IGF binding proteins(IGFRPs) messenger ribonucleic acid(mRNA) expressions in myoma are dependent on the in vivo esttogen status. The purposes of this study are to evaluate the in vitro effects of sex steroid hormones including estrogen on the IGFBPs gene expression in tissues from uterine myoma and adjacent normal myometrium. METHODS: Tissues from myoma and adjacent normal myometrium of patients with uterine myoma during early proliferative phase of menstrual cycle were cultured in the absence(control) and presence of 17b-estradiol(10M/L) or/and progesterone(10M/L) for 3 days. The IGFBPs mRNA expressions in these explants were analyzed by Nothern blot using specific human complementary deoxyribonucleic acid(cDNA) probes. RESULTS: The addition of 17b-estradiol, progesterone alone and in combination to conditioned media of explants from myoma and adjacent normal myornetrium did not result in any changes in the expression of IGFBP-2, IGFBP-4, IGFBP-5, and IGFBP-6 mRNA. With progesterone addtion, lGFBP-3 rnRNA expression was significantly reduced in myoma explant but not in adjacent ncemal myometrium explant. There was no significant change in the IGFBP-3 mRNA expression with 17b-estradiol and with the combination of both 17b-estradiol and progesterone. CONCLUSION: 17b-estradiol does not affect IGFBPs gene expression in the myoma and adjacent normal myometrium explant regardless of the presence of progesterone in vitro. However progesterone alone induces a decrease in IGFBP-3 synthesis in myoma explant.
Animals ; Culture Media, Conditioned ; Estradiol ; Estrogens ; Female ; Gene Expression ; Gonadal Steroid Hormones ; Humans* ; Insulin-Like Growth Factor Binding Protein 2 ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor Binding Protein 4 ; Insulin-Like Growth Factor Binding Protein 5 ; Insulin-Like Growth Factor Binding Protein 6 ; Insulin-Like Growth Factor Binding Proteins ; Leiomyoma* ; Menstrual Cycle ; Mice ; Myoma ; Myometrium* ; Progesterone ; RNA, Messenger*

The purposes of this study were to evaluate the effects of insulin-like growth factor (IGF)s in peritoneal fluid (PF) from patients with and without endometriosis on the proliferation of endometrial stromal cells and to investigate the effects of type I IGF receptor antibody on the response of endometrial stromal cells to PF from patients with endometriosis. IGFs in PF from patients with endometriosis (n=14) and without endometriosis (n=10) were measured by immunoradiometric assay and PF samples were divided into low IGF-I PF group (less than 85 ng/ml) and high IGF-I PF group (more than 85 ng/ml). Endometrial stromal cells from patients without endometriosis were cultured in serum free media in the presence or absence of 1% PF and thymidine incorporation test were used to evaluate the proliferation of endometrial stromal cells. Also cultures were incubated with type I IGF receptor monoclonal antibody (alpha IR3) before adding PF. PF from patients with endometriosis and without endometriosis increased thymidine incorporation in endometrial stromal cells. In patients with endometriosis, high IGF-I PF group had high IGF-II levels and resulted in higher thymidine incorporation than low IGF-I PE and low IGF-I PF group was noted in patients without endometriosis. There was not a significant correlation between increase in thymidine incorporation and IGF-I levels in PF from patients without endometriosis but in PF from patients with endometriosis. Preincubation with alphaIR3 significantly inhibited the mitogenic response of endometrial stromal cells to PF. Our data indicate that IGF-I in PF may be involved in the growth of ectopic endometrium in patients with endometriosis.
Ascitic Fluid* ; Culture Media, Serum-Free ; Endometriosis* ; Endometrium ; Female ; Humans ; Immunoradiometric Assay ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Stromal Cells* ; Thymidine

STUDY DESIGN: Retrospective case series. OBJECTIVES: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. MATERIALS AND METHODS: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. RESULTS: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases. CONCLUSIONS: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.
Back Pain ; Consensus ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Nerve Block ; Quality of Life ; Retrospective Studies ; Treatment Outcome

OBJECTIVES: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs).SUMMARY OF LITERATURE REVIEW: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. MATERIALS AND METHODS: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. RESULTS: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the follow-up period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p < 0.05). Complications were not reported in any cases. CONCLUSIONS Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.

BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

No abstract available.
Fallopian Tubes* ; Female ; Mucous Membrane* ; Sterilization*

No abstract available.
Pressure Ulcer*

PURPOSE: The aim for this study was to investigate clinical manifestation of seasonal influenza A and B during the 2012 winter season in Wonju, South Korea. Their clinical and laboratorial characteristics and effect of oseltamivir were compared and analyzed. METHODS: Children under the age of 18 years who visited the Wonju Severance Christian Hospital with fever or acute respiratory symptoms and who were diagnosed with influenza A or B by rapid antigen test from nasopharyngeal swab were selected for the study. The medical records of patients were retrospectively reviewed. RESULTS: Influenza A was detected in 374 patients (83.7%), and influenza B in 72 (16.6%). The incidence of influenza A was highest in February (n=186), while that of influenza B was highest in March (n=36). The most common symptoms were fever (n=434, 97.1%) and cough (n=362, 81.0%). No significant differences were observed between influenza A and B in symptoms and laboratory data. Patients who had used oseltamivir within 2 days showed statistically lower admission rate, shorter admission duration, and lower incidence of pneumonia. CONCLUSION: This study found no statistical difference between influenza A and B, in symptoms, progression, and laboratory test, but those who were treated with oseltamivir given within 2 days of the onset of fever experienced more positive outcomes.
Child ; Cough ; Fever ; Gangwon-do ; Humans ; Incidence ; Influenza, Human* ; Korea ; Medical Records ; Oseltamivir ; Pneumonia ; Retrospective Studies ; Seasons*

PURPOSES: To evaluate the effect of hormone replacement therapy(HRT) on serum insulin-like growth factors(IGFs) levels and to investigate if changes in serum IGFs reflect changes in BMD after HRT in postmenopausal women. MATERIAL & METHODS: IGF-I and IGF-II were measured by radioimmunoassay after Bio-spin P-10 seperation in sera obtained every 3 months from postmenopausal women who was taking premarin alone (premarin group; n=17) or premarin-medroxyprogesterone acetate(MPA group; n=42) for 1 year. Also, bone mineral density(BMD) were determined before and 1 year after HRT by dual energy X-ray absorptiometry(DEXA). All statistics were performed by Paired t-test, student's t-test, repeated measures ANOVA test, Pearson's coefficient. RESULTS: HRT increased BMD of the lumbar spine and proximal femur in both premarin group and MPA group, but any difference in degreee of increase in BMD was not noted between premarin group and MPA group. Compared with pretreatment levels, serum IGF-I levels decreased at 3, 6 and 12 months after therapy only in latter group whereas serum IGF-II levels increased at 6 and 12 months after HRT in both groups. Changes in serum IGF-I and IGF-II levels during therapy did not show any difference by the bone response to HRT. Changes in serum IGF-II levels after HRT did not correlated with the 1 year changes in BMD at any skeletal sites studied, but changes in serum IGF-I levels from pretreatment to 6 months after HRT was negatively correlated with change in BMD of Ward's triangle. CONCLUSION: HRT influences serum IGF levels in postmenopausal women and changes in serum IGF-I levels may predict the changes in BMD of Ward's triangle after HRT.
Bone Density* ; Estrogens, Conjugated (USP) ; Female ; Femur ; Hormone Replacement Therapy* ; Humans ; Insulin-Like Growth Factor I ; Insulin-Like Growth Factor II ; Postmenopause ; Radioimmunoassay ; Spine