BACKGROUND: Burn is one of the most common illness in primary care. Most burns are partial skin thickness burns. The purpose of this study was to evaluate the use ofSilvadene (silver sulfadiazine) ointment (antibacterial agent) and DuoDERMR (artificial syntheticmaterial). METHODS: The subjects of this study were 46 patients with partial skin thickness burns who had visited a general hospital burn clinic from May 1, 2002 to June 30, 2002. They were randomly assigned to the silvadine ointment or DuoDERMR group. The patients were evaluated for pain, the number of dressing change, the ease of dressing application and removal, limitation of activity, comfortableness, satisfaction with the appearance, sleep disturbance, treatment cost, and the number of days for complete epithelialization. RESULTS: DuoDERMR treated burns had a fewer dressing change (3.19 times vs 5.36 times), less time for dressing change (4.13 min vs 6.26 min) and less cost (P<0.01). But there was no statistical difference in the number of days for complete epithelialization (P=0.197) and it depended on the size of the wounds (P=0.005). The cost of treatment was related with the number of dressing change (P=0.000). CONCLUSION: Treatment methods had no effect on duration of treatment but artificial synthetic material was shown to reduce the time for dressing and the cost.
Bandages ; Burns* ; Health Care Costs ; Hospitals, General ; Humans ; Primary Health Care ; Skin* ; Wounds and Injuries

BACKGROUNDS: Inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD) increased prevalence and economic burden. OBJECTIVES: This study aimed to investigate drug use pattern in IBD patients in a real world. METHODS: National Health Insurance claim data from 2010 to 2014 were used in this population-based study. All IBD patients diagnosed during study period were enrolled. IBD medications included 5-aminosalicylic acid (ASA), glucocorticoid, immunomodulator and anti-tumor necrosis factor-α agent(anti TNF-α). Growth rate of IBD prevalence, prescribed drug classes, duration of drug therapy and medication cost were analyzed. Number and percentage of patients for categorical variables, and mean and median for continuous variables were presented. RESULTS: Total numbers of patients were 131,158 and 57,286 during 5 years, and their annual growth rate were 3.2 and 5.7% for UC and CD. UC and CD were prevalent in the 40–50 (41.2%) and 20–30 age groups (36.0%). About 60% of IBD patients was prescribed any of medications. 5-ASA was the most frequently prescribed, followed by corticosteroid and immunomodulator. Anti TNF-α use was the lowest, but 5 times higher than UC in CD. Combination therapies with different class of drugs were in 29% for UC and 62% for CD. Mean prescription days per patient per year were 306 and 378, and the median medication cost per patient per year was KRW 420,000 (USD 383) and KRW 830,000 (USD755), for UC and CD, respectively. CONCLUSIONS: Increasing prevalence of IBD requires further studies to contribute to achieve better clinical outcomes of drug therapy.
Colitis, Ulcerative ; Crohn Disease ; Drug Therapy ; Health Expenditures ; Humans ; Inflammatory Bowel Diseases ; Mesalamine ; National Health Programs ; Necrosis ; Prescriptions ; Prevalence

BACKGROUND/OBJECTIVES: Although globally the numbers of children diagnosed with failure to thrive (FTT) have decreased, FTT is still a serious pediatric problem. We aimed to investigate the effects of zinc supplementation for 6 months on growth parameters of infants and children with FTT. SUBJECTS/METHODS: In this retrospective study, of the 114 participants aged between 4 months and 6 years, 89 were included in the zinc supplementation group and were provided with nutrition counseling plus an oral zinc supplement for 6 months. The caregivers of the 25 participants in the control group received nutrition counseling alone. Medical data of these children, including sex, age, height, weight, serum zinc level, and serum insulin-like growth factor 1 (IGF1) level were analyzed. RESULTS: Zinc supplementation for 6 months increased weight-for-age Z-score and serum zinc levels (5.5%) in the zinc supplementation group of underweight category children. As for stunting category, height-for-age Z-score of the participants in the zinc supplementation group increased when compared with the baseline, and serum zinc levels increased in the normal or mild stunting group. Serum IGF1 levels did not change significantly in any group. Thus, zinc supplementation was more effective in children in the underweight category than those in the stunted category; this effect differed according to the degree of the FTT. CONCLUSION: These findings suggest that zinc supplementation may have beneficial effects for growth of infants and children with FTT, and zinc supplementation would be required according to degree of FTT.
Caregivers ; Child* ; Counseling ; Failure to Thrive* ; Growth Disorders ; Humans ; Infant ; Retrospective Studies ; Thinness ; Zinc*

BACKGROUND/AIMS: To evaluate the treatment patterns of knee osteoarthritis (OA) patients in South Korea. METHODS: Using the Korean nationwide claims database, all knee OA patients in Korea during 2014 were identified by the knee OA diagnostic code (M17) or any OA diagnostic code (M15 to M19) in combination with a procedure for a knee X-ray. Patterns of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CSs), analgesics, and symptomatic slow acting drugs for OA (SYSADOA) were analyzed. Prevalence and characteristics of knee OA patients who received a CS intra-articular injection (IAI) were also evaluated. RESULTS: We identified 2,016,516 knee OA patients whose age (mean ± standard deviation) was 63.2 ± 10.8 years. The number of patients with at least one use of NSAIDs, analgesics, CS, and SYSADOA were 82.5%, 32.2%, 8.6%, and 43.4%, respectively. The use of herbal SYSADOAs was 29.7%. For regular users (medication possession ratios ≥ 50%), the use of NSAIDs was substantially decreased (48.8%), while the use of SYSADOA (37.3%) and CS (6.7%) were not significantly changed. The number of CS IAI users among knee OA patients was 0.18%; they were slightly older (64.4 ± 10.9 vs. 63.2 ± 10.8, p < 0.01) and more skewed towards females (75.7% vs. 71.5%, p < 0.01) than patients who had not received CS IAI. CONCLUSIONS In Korea, the use of SYSADOA or CS in knee OA patients was relatively high. Further studies on the effectiveness and the safety of these treatment options for knee OA are needed.

Osteoclasts originated from hematopoietic stem cells are multi-nucleated cells that can resorb the bone matrix. Receptor activator of nuclear factor kappa-B (RANK)/RANK ligand (RANKL) signaling pathway is crucial for the differentiation and activation of osteoclasts. In this study, we investigated for the first time whether or not RANKL induced mitogen- and stress-activated kinase 1 (MSK1) phosphorylation at Ser 376. Activation of MSK1 was detected as soon as 5 min after RANKL stimulation and sparsely detected at 30 min after stimulation. RANKL-induced MSK1 phosphorylation occurred in a dose-dependent manner. MSK1 is known as a downstream signaling molecule of cAMP-dependent protein kinase (PKA). Treatment with the PKA inhibitor H89 significantly suppressed c-Fos and nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1) induction upon RANKL stimulation. In addition, cAMP response element-binding protein (CREB) phosphorylation was extremely inhibited by H89 treatment. Mitogen-activated protein kinases (MAPKs) have been investigated for induction of MSK1 phosphorylation. Specific signaling pathway inhibitors for p38 and extracellular signal-regulated kinases (ERKs) significantly blocked RANKL-induced MSK1 activation. Finally, as a downstream effector of the p38-MSK1 pathway, c-Fos transcriptional activity was determined. RANKL-mediated elevation of c-Fos transcriptional activity was significantly suppressed by p38 inhibitor. Moreover, a dominant negative form of CREB suppressed activation of NFATc1. In conclusion, RANKL-stimulated MSK1 phosphorylation could play a role in induction of NFATc1 through CREB and c-Fos activation as a downstream molecule of p38, ERK MAPKs, and PKA. Our results support basic information for the development of osteoclast specific inhibitors.
Bone Matrix ; Cyclic AMP Response Element-Binding Protein ; Cyclic AMP-Dependent Protein Kinases ; Extracellular Signal-Regulated MAP Kinases ; Hematopoietic Stem Cells ; Mitogen-Activated Protein Kinases ; NFATC Transcription Factors ; Osteoclasts ; Phosphorylation ; Phosphotransferases

BACKGROUND: Tsutsugamushi disease is an acute febrile disease in Korea. Some patients with tsutsugamushi disease have severe illness, which needs care in intensive care unit, and may die due to the disease. We analyzed the cases with tsutsugamushi disease who lived in Chuncheon and neighboring communities to find out clinical manifestations, laboratory findings especially in severe cases. METHODS: We reviewed the clinical records of the 81 cases who were diagnosed as tsutsugamushi in Chuncheon Sacred Heart Hospital from April, 1997 to December, 2002. We analyzed the clinical and laboratory findings of the 81 cases, and the treatment results of 79 cases who recieved the treatment in this hospital. We also compared the characteristics of the patients between admission to general ward and intensive care unit (ICU). RESULTS: Seventy three cases developed the disease in autumn. Seventy cases had fever. 58 cases had eschar in their bodies. With the doxycycline treatment, forty five cases subsided the fever within 48 hours, but in 13 cases, fever continued after 5 days of treatment. Twenty five cases were admitted to ICU, 8 cases among them were treated with ventilator, 3 cases died due to the multi-organ failure. When we compared the clinical characteristics of the patients admitted to ICU with those to general wards, leukocyte count, the level of BUN and creatinine were higher, the albumin level was lower in ICU patients than those of general ward patients. CONCLUSION: Tsutsugamushi disease can progress to severe disease, and be fatal to the patients. So it is necessary to diagnose early and treat carefully. We suggest that leukocyte count, BUN, creatinine, or albumin can be used to predict the prognosis.
Creatinine ; Doxycycline ; Fever ; Gangwon-do* ; Heart ; Humans ; Intensive Care Units ; Korea ; Leukocyte Count ; Orientia tsutsugamushi ; Patients' Rooms ; Prognosis ; Scrub Typhus* ; Ventilators, Mechanical

OBJECTIVE: To evaluate the differences in subjective calcification detection rates and objective calcium volumes in lung nodules according to different reconstruction methods using hybrid kernel (FC13-H) and iterative reconstruction (IR). MATERIALS AND METHODS: Overall, 35 patients with small (< 4 mm) calcified pulmonary nodules on chest CT were included. Raw data were reconstructed using filtered back projection (FBP) or IR algorithm (AIDR-3D; Canon Medical Systems Corporation), with three types of reconstruction kernel: conventional lung kernel (FC55), FC13-H and conventional soft tissue kernel (FC13). The calcium volumes of pulmonary nodules were quantified using the modified Agatston scoring method. Two radiologists independently interpreted the role of each nodule calcification on the six types of reconstructed images (FC55/FBP, FC55/AIDR-3D, FC13-H/FBP, FC13-H/AIDR-3D, FC13/FBP, and FC13/AIDR-3D). RESULTS: Seventy-eight calcified nodules detected on FC55/FBP images were regarded as reference standards. The calcium detection rates of FC55/AIDR-3D, FC13-H/FBP, FC13-H/AIDR-3D, FC13/FBP, and FC13/AIDR-3D protocols were 80.7%, 15.4%, 6.4%, 52.6%, and 28.2%, respectively, and FC13-H/AIDR-3D showed the smallest calcium detection rate. The calcium volume varied significantly with reconstruction protocols and FC13/AIDR-3D showed the smallest calcium volume (0.04 ± 0.22 mm³), followed by FC13-H/AIDR-3D. CONCLUSION: Hybrid kernel and IR influence subjective detection and objective measurement of calcium in lung nodules, particularly when both techniques (FC13-H/AIDR-3D) are combined.
Calcium ; Humans ; Lung* ; Research Design ; Thorax* ; Tomography, X-Ray Computed*

Background and Objectives: This study aimed to analyze the outcomes of Fontan surgery in the Republic of Korea, as there were only a few studies from Asian countries. Methods: The medical records of 1,732 patients who underwent Fontan surgery in 10 cardiac centers were reviewed. Results: Among them, 1,040 (58.8%) were men. The mean age at Fontan surgery was 4.3±4.2 years, and 395 (22.8%) patients presented with heterotaxy syndrome. According to the types of Fontan surgery, 157 patients underwent atriopulmonary (AP) type; 303, lateral tunnel (LT) type; and 1,266, extracardiac conduit (ECC) type. The overall survival rates were 91.7%, 87.1%, and 74.4% at 10, 20, and 30 years, respectively. The risk factors of early mortality were male, heterotaxy syndrome, AP-type Fontan surgery, high mean pulmonary artery pressure (mPAP) in pre-Fontan cardiac catheterization, and early Fontan surgery year. The risk factors of late mortality were heterotaxy syndrome, genetic disorder, significant atrioventricular valve regurgitation (AVVR) before Fontan surgery, high mPAP in pre-Fontan cardiac catheterization, and no fenestration. Conclusions In Asian population with a high incidence of heterotaxy syndrome, the heterotaxy syndrome was identified as the poor prognostic factors for Fontan surgery. The preoperative low mPAP and less AVVR are associated with better early and long-term outcomes of Fontan surgery.

Background and Objectives: This study aimed to analyze the outcomes of Fontan surgery in the Republic of Korea, as there were only a few studies from Asian countries. Methods: The medical records of 1,732 patients who underwent Fontan surgery in 10 cardiac centers were reviewed. Results: Among them, 1,040 (58.8%) were men. The mean age at Fontan surgery was 4.3±4.2 years, and 395 (22.8%) patients presented with heterotaxy syndrome. According to the types of Fontan surgery, 157 patients underwent atriopulmonary (AP) type; 303, lateral tunnel (LT) type; and 1,266, extracardiac conduit (ECC) type. The overall survival rates were 91.7%, 87.1%, and 74.4% at 10, 20, and 30 years, respectively. The risk factors of early mortality were male, heterotaxy syndrome, AP-type Fontan surgery, high mean pulmonary artery pressure (mPAP) in pre-Fontan cardiac catheterization, and early Fontan surgery year. The risk factors of late mortality were heterotaxy syndrome, genetic disorder, significant atrioventricular valve regurgitation (AVVR) before Fontan surgery, high mPAP in pre-Fontan cardiac catheterization, and no fenestration. Conclusions In Asian population with a high incidence of heterotaxy syndrome, the heterotaxy syndrome was identified as the poor prognostic factors for Fontan surgery. The preoperative low mPAP and less AVVR are associated with better early and long-term outcomes of Fontan surgery.