Plasmid vectors with either RSV or CMV promoter are frequently used for DNA- mediated immunization due to the availability in commercial. Consequently, influence of the vector constituents, such as promoter, enhancer and transcription termination signal etc. on vaccination efficiency is not studied extensively. As an initial attempt to develop an efficient vector system for DNA-rnediated immunization, influence of promoter for antigen gene expression on vaccination efficiency has been analyzed. Initially, plasmids with either B-actin or muscle creatine kinase (MCK) promoter were constructed from the plasmid with prototype CMV promoter. In addition, ovalbumin (OVA) antigen gene has been cloned into each vectors to generate the plasmid vectors with different promoters for induction of the anti-OVA immune responses. Antigen protein expression in antigen gene transfected mouse muscle myoblast cells showed that the level from MCK promoter containing plasmid was slightly higher than those from either CMV or B-actin promoter containing plasmids. Also, the same plasmid turned out to be slightly more efficient than other plasmids in antibody imrnune response induction in vivo, when they were applied both through intramuscularly and intradermally. These results suggest that the commonly used CMV promoter containing plasmid vector could be further modified to develop an efficient vector for DNA-mediated immunization.
Animals ; Clone Cells ; Creatine Kinase, MM Form ; Gene Expression ; Immunization ; Mice ; Myoblasts ; Ovalbumin ; Plasmids* ; Vaccination*

BACKGROUND: As life span is increasing, so is interest about adult disease. Especially the number of postmenopausal women has increased, and postmenopausal symptoms have become a important problem causing low quality of life. Hormone replacement therapy was introduced to overcome these problems. Authors investigated to evaluate the effect of hormone replacement therapy on the quality of life of postmenopausal women. METHODS: From April to June 1997, we surveyed 188 postmenopausal women (91 women were on hormone replacement therapy, and 97 women were in the controlled group in Sungnam Central Hospital) with COOP/WONCA chart Korean version. RESULTS: COOP/WONCA chart (Korean version) is composed of seven dimensions, among these four dimensions (change in health, overall health, daily activity and pain) were shown statistically significant difference between two groups. But three dimensions (social activity, physical fitness and feelings) were not shown to be statistically different. Total mean score of COOP/WONCA chart showed statistically significant difference. CONCLUSIONS: To improve the quality of life of postmenopausal women, primary care physician should consider hormone replacement therapy along with proper patient selection and periodic follow up.
Adult ; Female ; Follow-Up Studies ; Gyeonggi-do ; Hormone Replacement Therapy ; Humans ; Menopause* ; Motor Activity ; Patient Selection ; Physicians, Primary Care ; Quality of Life*

No abstract available.
Carcinoma, Transitional Cell*

To investigate the risk factors and clinical characteristics of postrenal transplant diabetes mellitus (PTDM), we reviewed the records of 177 renal allograft recipients in Maryknoll Hospiatal whose allografts had functioned longer than 6 months. Nineteen patients (10.7%) developed PTDM at 5.0+/-7.8 (1-52) months; 9 (47%) of these within 1 month. PTDM patients were older than nondiabetic renal transplants (42+/-2 vs 37+/-1 years, P<0.05). Body mass index tended to be higher in PTDM (23.5+/-1.0 vs 21.8+/-0.3kg/m2, P=0.09). Number of acute rejections (0.6+/-0.2 vs 0.5+/-0.1) and serum creatinine at 1 year after transplantation (1.2+/-0.8 vs 1.3+/-0.3mg/dL) were not different. Fasting (103.6+/-10.4 vs 84.4+/-1.6mg/dL, P<0.05) and postprandial (189.2+/-24.8 vs 118.6+/-2.3 mg/dL, P<0.01) blood sugars, measured before transplantation, were higher in PTDM. CsA blood level at 1 month posttransplantation was higher in PTDM (350+/-34 vs 279+/-8ng/mL, P<0.05). Fasting serum insulin was significantly higher (28.2+/-12.2 vs 7.3+/-2.0 microunit/dL, P<0.05) and serum C-peptide tended to be higher in PTDM patients compared with euglycemic renal recipients (6.3+/-1.6 vs 3.8+/-0.9ng/dL, P=0.08). All the PTDM patients were treated by either insulin or oral agent; 15 of 19 required no treatment after 4.7+/-6.9 months. In conclusion, prevalence of PTDM was 10.7%. PTDM patients were older. Body mass index was tended to be higher. Fasting and postprandial blood sugars, measured before transplantation, were higher in PTDM. Faslting serum insulin was higher and C-peptide tended to be higher in diabetics. These results suggested that increased insulin resistance plays a major role in the pathogenesis of PTDM.
Allografts ; Blood Glucose ; Body Mass Index ; C-Peptide ; Creatinine ; Cyclosporine ; Diabetes Mellitus* ; Fasting ; Humans ; Insulin ; Insulin Resistance ; Prevalence ; Risk Factors*

OBJECTIVE: Here we describe a microsurgical method for decompression and the radiological findings of the extraforaminal entrapment of the L5 spinal nerve. METHODS: The authors reviewed the clinical and neurodiagnostic findings, surgical management, and outcomes in 53 patients with extraforaminal entrapment of L5 who had been successfully decompressed via a microsurgical paramedian tangential approach. A total of 28 women and 25men ranging in age from 54 to 73(mean age 65 years). All patients had uni- or bilateral leg pain due to extraforaminal entrapment of L5 in the lumbosacral spine. The mean follow-up period was 9 months (range 3-15 months). RESULTS: Pain was measured by the Numerical Rating Scale. The function of back was assessed by the Oswestry Disability Index score, and the patient satisfaction was evaluated by the North American Spine Society Outcome Questionnaire. Relief of back pain was obtained for all patients immediately after surgery. The mean Numerical Rating Scale improved from 8.2 before the surgery to 1.7 after the surgery (P<0.0001). The mean ODI score improved from 74.6 before the surgery to 15.3 after the surgery (P<0.0001). Overall, excellent and good result were achieved in 27(51%) and 23(43%) at the last follow-up examination. There was no complications related to the surgery, nor was any spinal instability was detected. The parasagittal T-1 weighted magnetic resonance images showed foraminal stenosis with the circumferential loss of the perineural fat signal at L5-1 level in 23 of 53(43%) patients. Radiological and operating finding showed narrowing of the extraforaminal tunnel that resulted from the annulus bulging in 36 patients(68%), disc protrusion or rupture in 17 patients(30%) and osteophytes of the vertebral body in 39 patients(74%). CONCLUSION: The paramedian tangential approach is a safe, effective procedure that avoids the risk of secondary spinal instability. This study showed that the major causes of the extraforaminal nerve root entrapment in the lumbosacral spine are the bulged annulus, the disc protrusion and osteophytes. The major pathognomonic cause of the extraforaminal L5 nerve entrapment was the bulged annulus fibrosus with the osteophytes.
Back Pain ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Leg ; Nerve Compression Syndromes ; Osteophyte ; Patient Satisfaction ; Surveys and Questionnaires ; Radiculopathy ; Rupture ; Spinal Nerves ; Spine*

No abstract available.
Electrocardiography* ; Family Practice* ; Humans

Tools for assessing methodological quality or risk of bias in randomized controlled trials (RCTs) and non-randomized studies (NRS) were reviewed. The van Tulder scale and Cochrane's assessment of risk of bias are the two most useful methodological quality evaluation tools for RCTs. Cochrane's tool includes sequence generation, allocation of sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other potential sources of bias. The Cochrane Collaboration Group recommends the Downs and Black instrument and the Newcastle-Ottawa Scale for evaluating the quality of NRS. In conclusion, this study offers useful information to physicians about tools for assessing the quality of evidence in clinical guidelines. Further research is needed to provide an essential core for evidence-based decision making regarding levels and/or grades of recommendations.
Bias (Epidemiology) ; Cooperative Behavior ; Decision Making

Targetoid hemosiderotic nevus (THN) is a rare variant of melanocytic nevus, characterized by a sudden development of a targetoid ecchymotic halo around a pre-existing nevus. THN clinically raises concern for malignant transformation due to its abrupt change in color and size. THN should be distinguished from other diseases showing a peripheral halo, including targetoid hemosiderotic hemangioma, halo nevus, and Meyerson nevus. Dermoscopy can help clinicians to differentiate THN from these diseases. The typical dermoscopic features of THN are known to be divided into two distinctive areas: the central melanocytic area and the peripheral ecchymotic area. In our case, dermoscopy revealed a novel bull’s eye pattern composed of a central area with characteristic features of benign melanocytic nevus, an intermediated white circular ring, and a peripheral milky red area. When a sudden change occurs in a pre-existing nodule showing targetoid features, dermoscopy should be considered before conducting a biopsy or surgical intervention.

OBJECTIVES: To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.
Adult ; Aged ; Aged, 80 and over ; Female ; *Health Care Costs ; *Health Expenditures ; Humans ; Insurance Claim Review ; Korea ; Male ; Middle Aged ; Prevalence ; Socioeconomic Factors ; Stroke/*economics ; Young Adult

BACKGROUND/AIMS: The introduction of direct-acting antivirals (DAA) in 2013 revolutionized hepatitis C virus (HCV) treatment, offering a cure rate >90%. However, this therapy is expensive, and estimations of the number of chronic HCV-infected (CHC) patients and their treatment costs pre-2013 are therefore essential for creating policies and expanding drug access. Herein, we aimed to investigate the number of HCV-related liver disease patients, their healthcare utilization, their annual direct medical costs, and the interferon-based antiviral treatment rates and costs from 2009 to 2013 in South Korea. METHODS: The National Health Insurance database was reviewed, and patients diagnosed with CHC from 2009 to 2013 were extracted. Data regarding detailed healthcare utilization, prescribed drugs, and direct medical costs were obtained. For annual direct healthcare cost calculations, a prevalence-based approach was used. RESULTS: Overall, 181,768 CHC patients were identified. In 2013, the annual per-patient costs for chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and the first year post-liver transplant were 895, 1,873, 6,945, and 67,359 United States dollars, respectively. Interferon-based antiviral therapeutics were prescribed to 25,223 patients (13.9%). CONCLUSIONS: Healthcare costs have increased remarkably with increasing liver disease severity. Thus, efforts to stop disease progression are needed. Moreover, the low rate of interferon-based therapy indicates an unmet need for DAA.
Antiviral Agents ; Carcinoma, Hepatocellular ; Costs and Cost Analysis ; Delivery of Health Care* ; Disease Progression ; Health Care Costs* ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Korea* ; Liver Cirrhosis ; Liver Diseases ; National Health Programs* ; Ribavirin ; United States