Purpose: This study aimed to confirm the decision-making patterns for life-sustaining treatment (LST) and analyze medical service utilization changes after enforcement of the Life-Sustaining Treatment Decision-Making Act. Materials and Methods: Of 1,237 patients who completed legal forms for life-sustaining treatment (hereafter called the LST form) at three academic hospitals and died at the same institutions, 1,018 cancer patients were included. Medical service utilization and costs were analyzed using claims data. Results: The median time to death from completion of the LST form was three days (range, 0 to 248 days). Of these, 517 people died within two days of completing the document, and 36.1% of all patients prepared the LST form themselves. The frequency of use of the intensive care unit, continuous renal replacement therapy, and mechanical ventilation was significantly higher when the families filled out the form without knowing the patient’s intention. In the top 10% of the medical expense groups, the decision-makers for LST were family members rather than patients (28% patients vs. 32% family members who knew and 40% family members who did not know the patient’s intention). Conclusion The cancer patient’s own decision-making rather than the family’s decision was associated with earlier decision-making, less use of some critical treatments (except chemotherapy) and expensive evaluations, and a trend toward lower medical costs.

BACKGROUND/AIMS: The aim of this study was to analyze the trend of the prevalences of atrophic gastritis (AG) and intestinal metaplasia (IM) from 2011 to 2016~2017 in Korea. And, the risk factors of AG and IM were compared between 2011 and 2016~2017. MATERIALS AND METHODS: A total of 4,023 subjects in 2011 and 2,506 subjects in 2016~2017 were enrolled. AG and IM were diagnosed on the basis of endoscopic findings. Multivariate analysis was performed for risk factors of AG and IM. Seventeen factors were analyzed. RESULTS: The seroprevalence of Helicobacter pylori decreased from 2011 (59.8%; 2,407/4,023) to 2016~2017 (51.6%; 1,293/2,506; P < 0.001). The prevalence of AG decreased from 2011 to 2016~2017 (P=0.018), but that of IM increased (P < 0.001). The risk factors of AG in 2011 were male sex, old age, H. pylori immuoglobulin G (IgG) positivity, family history of gastric cancer (GC), and high-salt diet. For IM in 2011, the risk factors were male sex, old age, H. pylori IgG positivity, and family history of GC. Risk factors of AG in 2016~2017 were old age, H. pylori IgG positivity, and country of residence. For IM in 2016~2017, the risk factors were male sex, old age, family history of GC, high fasting glucose level (≥126 mg/dL), H. pylori IgG positivity, and low income level. CONCLUSIONS: The difference in prevalence trends of AG and IM between 2016~2017 and 2011 could be the result of the different risk factors of AG and IM, such as decreased prevalence of H. pylori infection.
Diet ; Fasting ; Gastritis, Atrophic ; Glucose ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Korea ; Male ; Metaplasia ; Multivariate Analysis ; Prevalence ; Risk Factors ; Seroepidemiologic Studies ; Stomach Neoplasms

PURPOSE: The purpose of this study was to assess current levels of awareness of clinical trials (CTs), perceptions regarding their benefits and willingness to participate to CTs among Korean cancer patients. MATERIALS AND METHODS: From December 2012 to August 2015, we distributed questionnaires to cancer patients receiving systemic anti-cancer therapy at Seoul National University Hospital, Seoul, Korea. RESULTS: A total of 397 out of 520 requested patients (76.3%) responded to the survey. Among the 397 patients, 62.5% were female and the median age was 52 years. Overall, 97.4% (387/397) answered that they have at least heard of CTs. When asked about their level of awareness, 23.8% (92/387) answered that they could more than roughly explain about CTs. The average visual analogue scale score of CT benefit in all patients was 6.43 (standard deviation, 2.20). Patients who were only familiar with the term without detailed knowledge of the contents had the least expectation of benefit from CTs (p=0.015). When asked about their willingness to participate in CTs, 56.7% (225/397) answered positively. Patients with higher levels of awareness of CTs showed higher willingness to participate (p < 0.001). Heavily treated patients and patients with previous experience regarding CTs also showed a higher willingness to participate (p < 0.001). The perceived benefit of CTs was higher in the group willing to participate (p=0.026). CONCLUSION: The patient’s level of awareness regarding CTs was positively related to the positive perception and willingness to participate. Although the general awareness of CTs was high, a relatively large proportion of patients did not have accurate knowledge; therefore, proper and accurate patient education is necessary.
Female ; Humans ; Korea ; Patient Education as Topic ; Seoul ; Volition

A 0.035-inch guide wire fracture and entrapment in a peripheral artery is a very rare complication, but when it does occur it may lead to life-threatening complications, such as perforation, thrombus formation, embolization, and subsequent limb ischemia. We describe our experience of successfully retrieving a fractured 0.035-inch Terumo guide wire in the external iliac artery using a biopsy forcep.
Angioplasty, Balloon, Coronary ; Arteries ; Biopsy ; Extremities ; Femoral Artery ; Iliac Artery ; Ischemia ; Surgical Instruments ; Thrombosis

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care.
Advance Directives ; Consensus ; Humans ; Societies, Medical

PURPOSE: This study aims to establish a new strategy that provides for the rapid establishment of human clonal adipose derived stem cell (hADSC) lines with aspirated adipose tissue and to characterize newly generated hMSC lines for their cell phenotype, differentiation potential, lineage-specific gene expression. METHODS: Human adipose tissue-derived stem cells (hADSCs) were isolated from subcutaneous adipose tissue based on standard protocols. After incubation for 2 h, only the cell culture supernatant was transferred to a new dish. This process was repeated several times with 30 h incubations. RESULTS: We confirmed the difference in growth rate, however, differences were not seen in the differentiation capabilities and stemness of the each cell lines. CONCLUSION: It is necessary to establish cell lines via single cell level for application to disease specific tissue engineering.
Adipose Tissue ; Cell Culture Techniques ; Cell Line ; Humans ; Phenotype ; Stem Cells ; Subcutaneous Fat ; Tissue Engineering

BACKGROUND: We report here the results of surveys for external quality assessment of blood bank tests performed in 2009. METHODS: Survey specimens were sent three times to 488, 491 and 490 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.7%, 98.0%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. RESULTS: The average accuracy rates of ABO grouping and Rh typing were 99.6-100% and 98.5-100%, respectively. In crossmatching test, the accuracy rates were 99.3-99.8% for the compatible samples, 92.7-100% for the incompatible samples, and 92.6-93.1% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.5-100% for negative samples and 98.1-98.8% for positive samples. The correctresults were reported by 98.0-100% of the surveyed institutions for antibody screening test and 82.9-100% for antibody identification test. Nineteen institutions gave repeatedly incorrect answers for crossmatching test. Eight institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year. CONCLUSIONS: The overall results of this survey were good, however, it is required that the institutions where the incorrect results were reported should perform corrective actions for quality improvement.
Academies and Institutes ; Blood Banks ; Coombs Test ; Korea ; Mass Screening ; Quality Improvement

We report here the results of surveys for external quality assessment of blood bank tests performed in 2008. Survey specimens were sent three times to 460, 470 and 473 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.6%, 97.7%, and 97.7%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. The average accuracy rates of ABO grouping and Rh typing were 100% and 98.3-100%, respectively. In crossmatching test, the accuracy rates were 97.5-99.7% for the compatible samples, 92.4-99.2% for the incompatible samples, and 88.2-98.9% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.4-99.7% for negative samples and 93.4-99.7% for positive samples. The correct results were reported by 99.6-100% of the surveyed institutions for antibody screening test and 98.2-100% for antibody identification test. Twenty-three institutions gave repeatedly incorrect answers for crossmatching test. Ten institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.
Academies and Institutes ; Blood Banks ; Coombs Test ; Korea ; Mass Screening

This study was designed to determine whether early gabapentin treatment has a protective analgesic effect on neuropathic pain and compared its effect to the late treatment in a rat neuropathic model, and as the potential mechanism of protective action, the alpha2delta1-subunit of the voltage-dependent calcium channel (alpha2delta1-subunit) was evaluated in both sides of the L5 dorsal root ganglia (DRG). Neuropathic pain was induced in male Sprague-Dawley rats by a surgical ligation of left L5 nerve. For the early treatment group, rats were injected with gabapentin (100 mg/kg) intraperitoneally 15 min prior to surgery and then every 24 hr during postoperative day (POD) 1-4. For the late treatment group, the same dose of gabapentin was injected every 24 hr during POD 8-12. For the control group, L5 nerve was ligated but no gabapentin was administered. In the early treatment group, the development of allodynia was delayed up to POD 10, whereas allodynia was developed on POD 2 in the control and the late treatment group (p<0.05). The alpha2delta1-subunit was up-regulated in all groups, however, there was no difference in the level of the alpha2delta1-subunit among the three groups. These results suggest that early treatment with gabapentin offers some protection against neuropathic pain but it is unlikely that this action is mediated through modulation of the alpha2delta1-subunit in DRG.
Amines/administration & dosage/*therapeutic use ; Analgesics/administration & dosage/*therapeutic use ; Animals ; Calcium Channels/genetics/*metabolism ; Cyclohexanecarboxylic Acids/administration & dosage/*therapeutic use ; Disease Models, Animal ; Injections, Intraperitoneal ; Ligation ; Male ; Neuralgia/*drug therapy/metabolism ; Pain Measurement ; Protein Subunits/genetics/metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Nerves/surgery ; Up-Regulation ; gamma-Aminobutyric Acid/administration & dosage/*therapeutic use

We report here the results of external quality assessment of blood bank tests performed in 2007. Survey specimens were sent three times to 448, 450, and 455 participant institutes, and the response rates were 99.3%, 97.3%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh(D) typing, crossmatching, direct antiglobulin test, antibody screening and identification test. The average accuracy rates of ABO grouping and Rh typing were in the range of 99.5-100% and 98.9-100%, respectively. In crossmatching test, the accuracy rates were 96.0-97.1% for the compatible samples, 89.6-92.4% for the incompatible samples, and 89.6-92.4% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.0-99.7% for negative samples and 96.3-99.0% for positive samples. The correct results were reported by 95.7-100% of the surveyed institutions for antibody screening test and 98.2-100% for identification test. Fifteen institutions gave repeatedly incorrect answers for crossmatching. Five institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.
Academies and Institutes ; Blood Banks ; Coombs Test ; Korea ; Mass Screening