Background: The purpose of this study is to analyze the current status and factors of elderly patients’ hospitalization for hip replacement, knee replacement, and general spine surgery. Methods: National health insurance data in 2018 was provided by the National Health Insurance Service. We used multiple regression to analyze factors associated with the medical utilization of hip replacement, knee replacement, and general spine surgery in elderly patients over 65 years old. The dependent variables are the length of stay and total health expenditure. The independent variables are the demographic-social factors (sex, age, region, insurance type, income level) and surgery-related factors (institution type, location of the hospital, surgery classification). Results: The most common factor affecting surgery was the location of medical institutions. Compared with the medical institutions located in metropolitan, the length of stay in rural medical institutions was higher and total health expenditure was lower. The lower quartile of income, the higher the length of stay and total health expenditure. In addition, the variables of age, type of health insurance, and type of medical institution were statistically significant. Conclusion In this study, we confirmed the effect of sociodemographic factors and medical institution factors on the Healthcare Utilization of spinal and joint surgery.

OBJECTIVE: Recently, a fixed combination of grazoprevir and elbasvir (GE) has been introduced to the arsenal of chemotherapeutics to fight against this virus. The study aimed to provide information on the efficacy and safety of GE for the treatment of HCV infection by performing a meta-analysis of literature data. METHODS: PubMed and EMBASE database searches were conducted. Among the literature retrieved, pivotal Phase III clinical studies were analyzed. Statistical analysis of the data was performed by RevMan. RESULTS: Four pivotal Phase III clinical studies compared the efficacy and safety of GE. When HCV patients were treated with GE for 12 weeks, the sustained virologic response, defined as the viral RNA level below the lower limit of quantification at 12 weeks after the cessation of therapy (SVR12), was 94.7%. The clinical advantage of GE involves its use by patients with cirrhosis and/or renal failure without dose adjustment. If the genotype (GT) of the causative virus was GT1a with NS5A polymorphism or GT4 with resistance to peginterferon/ribavirin, treatment with GE plus ribavirin for 16 weeks resulted in a better outcome compared to treatment with GE alone for 12 weeks. Adverse events reported during the four clinical studies were 71.09% in the GE arms and it was 76.61% in the non-GE arms, with the most frequent events being mild central nervous system symptoms. CONCLUSION: GE was generally safe and effective for the treatment of HCV infection. However, since HCV mutates very rapidly and becomes resistant to antiviral agents, long-term monitoring should be mandatory.
Antiviral Agents ; Arm ; Central Nervous System ; Fibrosis ; Genotype ; Hepacivirus ; Hepatitis C ; Hepatitis ; Humans ; Renal Insufficiency ; Ribavirin ; RNA, Viral

Vertical gaze palsy is usually associated with lesions of the rostral midbrain and thalamo-mesencephalic junction. The rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), the interstitial nucleus of Cajal, and the posterior commissure located in the midbrain are the critical area in supranuclear control of vertical eye movements. We describe a case of vertical one-and-a-half syndrome accompanying contralateral abduction and incomplete depression palsy due to thalamo-mesencephalic infarction. These vertical eye movement abnormalities are presumed to be caused by damage to the ipsilateral riMLF, interstitial nucleus of Cajal, and oculomotor fascicles.
Cerebral Infarction ; Depression ; Eye Movements ; Infarction ; Mesencephalon ; Paralysis ; Tegmentum Mesencephali

No abstract available.
Cellulitis ; Humans ; Lymphedema

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.
Acne Vulgaris ; Adenocarcinoma* ; Appetite ; Clinical Study ; Diarrhea ; Drug Resistance ; Erlotinib Hydrochloride ; Exanthema ; Humans ; Lung* ; Nausea ; Pneumonia* ; Protein-Tyrosine Kinases ; Pruritus ; Receptor, Epidermal Growth Factor ; Receptors, Vascular Endothelial Growth Factor ; Stomatitis ; Treatment Outcome

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.
Acne Vulgaris ; Adenocarcinoma* ; Appetite ; Clinical Study ; Diarrhea ; Drug Resistance ; Erlotinib Hydrochloride ; Exanthema ; Humans ; Lung* ; Nausea ; Pneumonia* ; Protein-Tyrosine Kinases ; Pruritus ; Receptor, Epidermal Growth Factor ; Receptors, Vascular Endothelial Growth Factor ; Stomatitis ; Treatment Outcome

OBJECTIVE: To evaluate the efficacy of temozolomide (TMZ) chemotherapy for recurrent anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA). METHODS: A multi-center retrospective trial enrolled seventy-two patients with histologically proven AO/AOA who underwent TMZ chemotherapy for their recurrent tumors from 2006 to 2010. TMZ was administered orally (150 to 200 mg/m2/day) for 5 days per 28 days until unacceptable toxicity occurred or tumor progression was observed. RESULTS: TMZ chemotherapy cycles administered was median 5.3 (range, 1-41). The objective response rate was 24% including 8 cases (11%) of complete response and another 23 patients (32%) were remained as stable disease. Severe side effects (> or =grade 3) occurred only in 9 patients (13%). Progression-free survival (PFS) of all patients was a median 8.0 months (95% confidence interval, 6.0-10.0). The time to recurrence of a year or after was a favorable prognostic factor for PFS (p<0.05). Overall survival (OS) was apparently differed by the patient's histology, as AOA patients survived a median OS of 18.0 months while AO patients did not reach median OS at median follow-up of 11.5 months (range 2.7-65 months). Good performance status of Eastern Cooperative Oncology Group 0 and 1 showed prolonged OS (p<0.01). CONCLUSION: For recurrent AO/AOA after surgery followed by radiation therapy, TMZ could be recommended as a salvage therapy at the estimated efficacy equal to procarbazine, lomustine, and vincristine (PCV) chemotherapy at first relapse. For patients previously treated with PCV, TMZ is a favorable therapeutic option as 2nd line salvage chemotherapy with an acceptable toxicity rate.
Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Lomustine ; Oligodendroglioma* ; Procarbazine ; Recurrence ; Retrospective Studies ; Salvage Therapy ; Vincristine

No abstract available.
Cerebral Infarction ; Fingers ; Infarction ; Muscle Weakness

PURPOSE: To study tissue adhesive effectiveness in with laceration at various body sites. METHODS: From January 2007 to December 2009, we collected the data of laceration patients treated using tissue adhesive in the emergency department of a university hospital. Data concerning treatment satisfaction were collected twice and analyzed. RESULTS: Of the 8665 patients with laceration, 196 (mean age 23 years, 106 males) were treated using tissue adhesive. Many of the 196 patients were <15-years-of-age. Involved body sites mainly comprised head/neck, followed by the upper extremities. The procedure was the most rapid of all treatments. CONCLUSION: Emergency physicians can reliably use tissue adhesive treatment for various lacerations in the emergency setting.
Emergencies ; Humans ; Lacerations ; Tissue Adhesives ; Upper Extremity

Background: Verbal learning test is useful and significant test to evaluating memory function. There were many memory tests but few for elderly and dementia patients. Although there have been a variety of Korean memory tests developed, these tests were difficult to administer to dementia patients and elderly individuals with low educational levels. Therefore, we developed the Korean Memory Test (KMT). Methods: The KMT task consists of three trials of free recall of 10 simplified line drawing figures of familiar materials. Three immediate recall trials and one 20 minutes delayed recall and one recognition trial were administered. Sixty-five of probable Alzheimer's patients received the Korean version of Mini-Mental State Examination (K-MMSE), Korean version of expanded Clinical Dementia Rating Scale (CDR) and KMT. Also sixty-seven of normal controls were enrolled. We tested reliability and validity of the KMT and also evaluated scores of the KMT with progression of dementia. Results: The parameters of the KMT correlated with CDR -0.74~-0.77 (p<0.01), K-MMSE 0.66~0.68 (p<0.01). The internal consis- tency was 0.78 (Cronbach's alpha). Most of the KMT's parameters decreased with CDR significantly (p<0.01). Conclusions: The KMT is a good test for evaluating memory function of elderly with low educational level. Also it is a sensitive and specific test to detection of dementia in early stage and has excellent reliability and validity.
Aged* ; Alzheimer Disease ; Dementia ; Humans ; Memory* ; Memory, Short-Term ; Neuropsychology ; Reproducibility of Results* ; Verbal Learning