The Korean government operates a fee-for-service system, as well as a diagnosis-related group (DRG) payment system that only applies to 7 different specific disease groups. To control rapidly increasing health expenditures, the Korean government adopted a compulsory DRG payment system for 7 disease groups in 2013. However, the current Korean DRG (K-DRG) system does not address the cost of new medical technologies and accompanying services, whereas the United States and European countries have implemented incentive systems within the DRG payment system to promote technological innovations. The Korean government is expanding the accessibility of new medical technologies to strengthen the coverage of 4 major conditions with a selective reimbursement system, but the K-DRG system is inconsistent with the selective reimbursement system in terms of adopting new medical technology. Such inconsistency is clearly shown in the case of advanced energy devices that are essential for surgical procedures. Despite their clinical usefulness and the high demand for such instruments, there is little space for compensation for advanced energy devices in DRG groups. Neither healthcare providers nor patients can choose selectively reimbursed medical devices under the current DRG system, leading to unequal healthcare benefits among patient groups. This paper proposes additional payments for new medical technology that is costly but clinically effective to ensure patient access to new medical technology under the K-DRG system, and suggests that a fair and consistent policy would be to apply the selective reimbursement of medical services in K-DRG.
Compensation and Redress ; Delivery of Health Care ; Diagnosis-Related Groups* ; Health Expenditures ; Health Personnel ; Humans ; Inventions ; Korea* ; Motivation ; United States

The Korean government operates a fee-for-service system, as well as a diagnosis-related group (DRG) payment system that only applies to 7 different specific disease groups. To control rapidly increasing health expenditures, the Korean government adopted a compulsory DRG payment system for 7 disease groups in 2013. However, the current Korean DRG (K-DRG) system does not address the cost of new medical technologies and accompanying services, whereas the United States and European countries have implemented incentive systems within the DRG payment system to promote technological innovations. The Korean government is expanding the accessibility of new medical technologies to strengthen the coverage of 4 major conditions with a selective reimbursement system, but the K-DRG system is inconsistent with the selective reimbursement system in terms of adopting new medical technology. Such inconsistency is clearly shown in the case of advanced energy devices that are essential for surgical procedures. Despite their clinical usefulness and the high demand for such instruments, there is little space for compensation for advanced energy devices in DRG groups. Neither healthcare providers nor patients can choose selectively reimbursed medical devices under the current DRG system, leading to unequal healthcare benefits among patient groups. This paper proposes additional payments for new medical technology that is costly but clinically effective to ensure patient access to new medical technology under the K-DRG system, and suggests that a fair and consistent policy would be to apply the selective reimbursement of medical services in K-DRG.
Compensation and Redress ; Delivery of Health Care ; Diagnosis-Related Groups* ; Health Expenditures ; Health Personnel ; Humans ; Inventions ; Korea* ; Motivation ; United States

BACKGROUND: Bentonite clay, which is a major component of mud pack, has been used for various purposes in cosmetics. Glycolic acid is known to be effective in the treatment of acne. Al-though those products are used widely, information on the mode of action and effects on the skin are little and controversial till now. OBJECTIVE: To investigate whether bentonite alone, or bentonite with glycolic acid in mixed formulation affect the stratum corneum leading to alteration on cutaneous barrier function and whether those products alter the lipid lamellae and desmosomes of corneocytes. MATERIALS AND METHODS: Mud pack-type ointment of bentonite, bentonite and 5% glycolic acid formulation, bentonite and 10% glycolic acid formulation were applied on the volar fore-arm of the five healthy men and flank skin of five 6-8 week old hairless mice. Transepidermal water loss and capacitance were measured. Electron microscopic examination after ruthenium tetroxide postfixation was performed on the flank skin of the mice. RESULTS: Transepidermal water loss(TEWL) increased immediately and normalized 4 to 6 hours later after removal of vapor permeable membrane in both mouse and human. Capacitance did not show any evidence of change in the water content of the stratum corneum. Electron microscopic examination revealed that lipid lamellae and desmosome of corneocytes were not de-graded, but lamellar body secretion and partially electron-lucent material was-increased in 10% glycolic acid and bentonite mixture-treated area. CONCLUSION: Barrier function of stratum corneum is not disturbed by bentonite and glycolic acid formulations at the concentration used. Barrier structures are not disrupted, but lamellar body secretion and partially electron-lucent material was increased by bentonite and glycolic acid formulations at higher concentration.
Acne Vulgaris ; Animals ; Bentonite* ; Desmosomes ; Humans ; Male ; Membranes ; Mice ; Mice, Hairless ; Mud Therapy ; Ruthenium ; Skin ; Water

No abstract available.
Immunoglobulins* ; Lactoglobulins* ; Milk*

BACKGROUND AND PURPOSE: The present study was carried out to investigate transient arteriolar vasospasm following reperfusion in the gerbil as an ischemic model and relationship between vasospasm and the changes of morphologic, physiologic and regional blood flow. METHODS: The transient arteriolar vasospasm was observed under the microscope. All gerbils were perfusion fixed and ischemic neuronal damage was checked in the CA1 subfield of the dorsal hippocampus. Metabolic parameters were serially measured during the occlusion and after recirculation, and cerebral blood flow was measured with a laser Doppler flowmetry. RESULTS: 1. Among the 18 gerbils with BCAO(bilateral carotid artery occlusion) for 2 minutes, 8 gerbils showed vasospasm after reopening, namely post-ischemic vasospasm, and 10 gerbils did not show vasospasm. 2. In all animals, metabolic parameters showed decreased PaCO2 and high pH just after the occlusion but increased PaCO2 and lowered pH following the recirculation. BCAO caused marked increase in systemic blood pressure but it returned to preischemic levels following the recirculation. 3. In all animals, BCAO caused marked decrease of cerebral blood flow compared to preischemic levels immediately following the occlusion but it returned to preischemic levels following the recirculation. And it took some longer the onset and duration of the transient increase in blood volume after reopening in the animals with vasospasm than those without vasospasm. 4. There was no morphological neuronal damage in the hippocampal CA1 subfield, at 1, 3, 7 days following 2-minute ischemic insult. CONCLUSION: The present study confirmed that BCAO in gerbils resulted in forebrain ischemia caused transient cortical vasospasm in the gerbil. But there was no close relationship between vasospasm and the changes of morphologic, physiologic and regional blood flow.
Animals ; Blood Pressure ; Blood Volume ; Brain Ischemia* ; Brain* ; Carotid Arteries* ; Cerebral Cortex* ; Gerbillinae* ; Hippocampus ; Hydrogen-Ion Concentration ; Ischemia ; Laser-Doppler Flowmetry ; Microcirculation* ; Neurons ; Perfusion ; Prosencephalon ; Regional Blood Flow ; Reperfusion

Background: Brain MRI may unexpectedly display abnormalities in splenium of the corpus callosum (SCC). However, the clinical implications of this lesion are unclear and are not always consistent with ischemic infarctions. We performed this study to clarify the clinical and radiological implications in patients with SCC lesions. Methods: We retrospectively reviewed consecutive patients with MRIreported SCC changes between 2009 and 2012. We analyzed clinical and radiological findings, etiologies, cognitive impairment, and clinical outcomes. Results: We found 30 patients (16 females; mean 50.5 years) who had SCC lesions on MRI. Confusion was the most common clinical finding in 50% of cases. Cerebral infarction was the most common etiology (50%). The most consistent SCC changes on MRI were low signal in T1WI, high signal on T2WI and FLAIR, and high signal on DWI. We classified SCC lesions into in situ SCC lesions (SCC only) and multiple (SCC plus) lesions for patients with multiple lesions. The clinical symptoms of SCC only lesions were relatively mild. Cognitive functions were evaluated by Mini Mental State Examination (MMSE) and clinical dementia rating (CDR) scale at the time of discharge and patients with SCC only lesions showed less impaired cognition compared with those with SCC plus lesions. Clinical outcomes were evaluated by the modified Rankin scale at 1 month and patients with SCC only lesions revealed good clinical outcomes compared with those with SCC plus lesions. Conclusions: MRI-reported SCC lesions may have heterogeneous etiologies and present with various symptoms. The clinical course and outcome are relatively good, particularly in small isolated and oval shaped SCC lesions.

Background & Objective: Hiccups is a disabling condition of lateral medullary infarction (LMI). Unlike other symptoms of LMI, the anatomical lesions of hiccups are not well known. Few studies have evaluated the relationship between the lesional location of LMI and hiccups. We performed this study to correlate hiccups and magnetic resonance imaging (MRI)-based lesional location in pure LMI. Methods: Between January 1997 and February 2013, we identified 24 patients with pure LMI who presented with hiccups in addition to typical lateral medullary syndrome. Sixty six pure LMI patients without hiccups were included as a control group. Clinical and radiologic findings were compared between the two groups. MRI-identified lesions were classified rostrocaudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. Results: The pure LMI patients with hiccups had significantly more frequent aspiration pneumonia (P = 0.001) and longer hospital stay (P = 0.03). The patients with hiccups significantly more often had dorsal rather than ventral lesion at horizontal levels (P = 0.012). But, there were no rostro-caudal differences at vertical levels (P = 0.162). Conclusions: We suggest that pure LMI associated with hiccups often locates in the dorsal medulla at horizontal correlation. This MRI-based comparative study has advanced the understanding of the neural substrate for hiccups in LMI, and indicates that hiccups become predictable when specific lesional locations in the lateral medulla are considered.

Aims: An actinomycete strain, designated KBS50, was isolated from a beach sediment sample collected from the Santubong area in Sarawak, Malaysia. This study reports on the identification, characterization and evaluation of the antimicrobial potential of this rare actinomycete. Methodology and results: KBS50 was identified as a potentially new species of Plantactinospora genus using the 16S rRNA gene sequence analysis. The rare actinomycete showed distinct morphological and physiological characteristics from other species of Plantactinospora. KBS50 exhibited strong antagonistic activities against Gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis) and fungi (Aspergillus niger, Ganoderma boninense, and Rhizoctonia solani). The actinomycete also tested positive for proteolytic activity. Meanwhile, secondary screening of the cell-free culture broths and the ethyl acetate crude extracts detected antimicrobial activity against the Gram-positive bacteria only. The minimum inhibitory concentration of the crude extract against B. subtilis and S. aureus was 5.21±1.30 μg/mL and 15.63±0.00 μg/mL, respectively. Conclusion, significance and impact of study The results presented in this paper provided an insight into the capability of Plantactinospora sp. KBS50 as a potential source of bioactive secondary metabolites compounds. This study also showed that the marine-associated environment such as the coastal area in Sarawak can be a valuable source of unique actinomycetes that can be exploited for natural product discovery.

No abstract available.
Child* ; Humans ; Immunoglobulins ; Infant, Newborn* ; Lactoglobulins ; Milk Proteins* ; Milk* ; Mothers* ; Postpartum Period*

BACKGROUND: Small subcortical infarctions of basal ganglia can be divided into either lacunes or striatocapsular infarctions by size of lesion. However, there are some controversies concerning the size criteria of lacune and striatocapsular infarction. To better understand differences among these patients, we elucidated clinical and other properties of deep small basal ganglia infarctions (DSBIs), which could not be clearly classified as either lacunes or striatocapsular infarction by their sizes only. METHODS: We analyzed 27 patients with acute ischemic lesion of basal ganglia with which the size varying from 1.5 cm to 3 cm in their maximal diameters. We assessed clinical features, laboratory data, stroke risk factors, and radiologic findings such as MRI and MR angiography. RESULTS: These patients could be largely divided into two distinct groups, either with or without associated cortical symptoms and signs. The most common clinical feature was motor weakness that was found in all but one patient. Sensory disturbances, altered deep tendon reflexes, and positive Babinski signs were also commonly found. Ten of the 27 patients showed cortical manifestations such as eyeball deviation, visual field defect, aphasia and neglect. Eight of the 10 patients with cortical manifestations showed MCA or ICA stenotic lesions. CONCLUSIONS: We found that many patients with 1.5 cm to 3 cm sized DSBIs could have the features of either lacune or striatocapsular infarction. Careful evaluation of clinical and radiologic findings should be performed in patients with clinically appearing lacunar syndrome in order to differentiate lacunar infarction of small vessel disease from striatocapsular infarction of other various pathophysiologies. Echocardiogram, cerebral angiogram and perfusion and diffusion MRI could be recommended for further evaluation and to better understand the pathogenesis in these patients.
Angiography ; Aphasia ; Basal Ganglia* ; Cerebral Infarction ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Perfusion ; Reflex, Babinski ; Reflex, Stretch ; Risk Factors ; Stroke ; Stroke, Lacunar ; Visual Fields