Background: Dipeptidyl peptidase-4 (DPP4) inhibitors are frequently prescribed for patients with type 2 diabetes; however, their cost can pose a significant barrier for those with impaired kidney function. This study aimed to estimate the economic benefits of substituting non-renal dose-adjusted (NRDA) DPP4 inhibitors with renal dose-adjusted (RDA) DPP4 inhibitors in patients with both impaired kidney function and type 2 diabetes. Methods: This retrospective cohort study was conducted from January 1, 2012 to December 31, 2018, using data obtained from common data models of five medical centers in Korea. Model 1 applied the prescription pattern of participants with preserved kidney function to those with impaired kidney function. In contrast, model 2 replaced all NRDA DPP4 inhibitors with RDA DPP4 inhibitors, adjusting the doses of RDA DPP4 inhibitors based on individual kidney function. The primary outcome was the cost difference between the two models. Results: In total, 67,964,996 prescription records were analyzed. NRDA DPP4 inhibitors were more frequently prescribed to patients with impaired kidney function than in those with preserved kidney function (25.7%, 51.3%, 64.3%, and 71.6% in patients with estimated glomerular filtration rates [eGFRs] of ≥60, <60, <45, and <30 mL/min/1.73 m2, respectively). When model 1 was applied, the cost savings per year were 7.6% for eGFR <60 mL/min/1.73 m2 and 30.4% for eGFR <30 mL/min/1.73 m2. According to model 2, 15.4% to 51.2% per year could be saved depending on kidney impairment severity. Conclusion Adjusting the doses of RDA DPP4 inhibitors based on individual kidney function could alleviate the economic burden associated with medical expenses.

Background: This study aimed to generate a Z score calculation model for coronary artery diameter of normal children and adolescents to be adopted as the standard calculation method with consensus in clinical practice. Methods: This study was a retrospective, multicenter study that collected data from multiple institutions across South Korea. Data were analyzed to determine the model that best fit the relationship between the diameter of coronary arteries and independent demographic parameters. Linear, power, logarithmic, exponential, and square root polynomial models were tested for best fit. Results: Data of 2,030 subjects were collected from 16 institutions. Separate calculation models for each sex were developed because the impact of demographic variables on the diameter of coronary arteries differs according to sex. The final model was the polynomial formula with an exponential relationship between the diameter of coronary arteries and body surface area using the DuBois formula. Conclusion A new coronary artery diameter Z score model was developed and is anticipated to be applicable in clinical practice. The new model will help establish a consensus-based Z score model.

The most common heart valve disorder is calcific aortic valve stenosis (CAVS), which is characterized by a narrowing of the aortic valve. Treatment with the drug molecule, in addition to surgical and transcatheter valve replacement, is the primary focus of researchers in this field. The purpose of this study is to determine whether niclosamide can reduce calcification in aortic valve interstitial cells (VICs). To induce calcification, cells were treated with a pro-calcifying medium (PCM). Different concentrations of niclosamide were added to the PCM-treated cells, and the level of calcification, mRNA, and protein expression of calcification markers was measured. Niclosamide inhibited aortic valve calcification as observed from reduced alizarin red s staining in niclosamide treated VICs and also decreased the mRNA and protein expressions of calcification-specific markers: runt-related transcription factor 2 and osteopontin. Niclosamide also reduced the formation of reactive oxygen species, NADPH oxidase activity and the expression of Nox2 and p22 phox . Furthermore, in calcified VICs, niclosamide inhibited the expression of β-catenin and phosphorylated glycogen synthase kinase (GSK-3β), as well as the phosphorylation of AKT and ERK. Taken together, our findings suggest that niclosamide may alleviate PCM-induced calcification, at least in part, by targeting oxidative stress mediated GSK-3β/β-catenin signaling pathway via inhibiting activation of AKT and ERK, and may be a potential treatment for CAVS.

BACKGROUND: The aim of this multicenter, randomized, double-blind study was to examine the effect of lobeglitazone, a novel thiazolidinedione, on the changes in bone mineral density (BMD) in patients with type 2 diabetes mellitus. METHODS: A 24-week, double-blinded phase was followed by a 28-week, open-label phase, in which the placebo group also started to receive lobeglitazone. A total of 170 patients aged 34 to 76 years were randomly assigned in a 2:1 ratio to receive lobeglitazone 0.5 mg or a matching placebo orally, once daily. BMD was assessed using dual-energy X-ray absorptiometry at week 24 and at the end of the study (week 52). RESULTS: During the double-blinded phase, the femur neck BMD showed decreasing patterns in both groups, without statistical significance (−0.85%±0.36% and −0.78%±0.46% in the lobeglitazone and placebo groups, respectively). The treatment difference between the groups was 0.07%, which was also not statistically significant. Further, minimal, nonsignificant decreases were observed in both groups in the total hip BMD compared to values at baseline, and these differences also did not significantly differ between the groups. During the open-label phase, the BMD was further decreased, but not significantly, by −0.32% at the femur neck and by −0.60% at the total hip in the lobeglitazone group, and these changes did not significantly differ compared with the original placebo group switched to lobeglitazone. CONCLUSION: Our results indicate that treatment with lobeglitazone 0.5 mg over 52 weeks showed no detrimental effect on the BMD compared to the placebo.
Absorptiometry, Photon ; Bone Density* ; Diabetes Mellitus, Type 2* ; Double-Blind Method ; Femur Neck ; Hip ; Humans ; Thiazolidinediones

BACKGROUND/AIMS: The standard guideline for the management Helicobacter pylori infection in Korean children is not present until now. In present study, we conducted the questionnaire survey to investigate the real situation of H. pylori eradication in children. MATERIALS AND METHODS: Questionnaire concerning the indications of H. pylori eradication, the first choice of treatment modality, the decision method of eradication result, experience of eradication failure, the second choice of treatment modality was sent to doctors who are members of the Korean Society for Pediatric Gastorenterology, Hepatology, and Nutrition. RESULTS: A total of 28 doctors (90.3%) answered the questionnaires among 31 doctors. The most common indication for eradication of H. pylori was peptic ulcer (n=24) followed by chronic abdominal pain (n=17) and positive family history of gastric cancer (n=12). The most common choice of first-line eradication therapy was omeprazole, amoxicillin, clarithromycin triple therapy (n=21) and followed by bismuth subsalicylate, amoxicillin, metronidazole, clarithromycin quadruple therapy (n=7). The results of treatment were judged by C13-urea breath test after 2 months later in 19 doctors (67.8%). Twenty four (85.7%) out of 28 doctors had experienced treatment failure. The most common second-line therapy was the sequential therapy (58.3%, 14 doctors among 24). CONCLUSIONS: This was the first study for the survey of the treatment of H. pylori infection to Korean pediatricians. The results of this study showed that most pediatric gastroenterologists used to treat H. pylori infection according to the textbook and the common use of bismuth-based quadruple therapy for the first-line treatment was notable.
Abdominal Pain ; Amoxicillin ; Bismuth ; Breath Tests ; Child* ; Clarithromycin ; Gastroenterology ; Helicobacter pylori* ; Helicobacter* ; Humans ; Methods ; Metronidazole ; Omeprazole ; Peptic Ulcer ; Pilot Projects* ; Stomach Neoplasms ; Treatment Failure

PURPOSE: Oropharyngeal squamous cell carcinoma (OSCC) has been recognized as an immunosuppressive disease. Various mechanisms have been proposed for immune escape, including dysregulation of immune checkpoints such as the PD-1:PD-L1 pathway. We investigated the expression of programmed cell death-ligand 1 (PD-L1) in HPV-negative and HPV-positive OSCC to determine its prevalence and prognostic relevance. MATERIALS AND METHODS: Using immunohistochemistry, 133 cases of OSCC were evaluated for expression of PD-L1. Formalin-fixed paraffin-embedded tumor samples were stained with monoclonal antibody (clone 5H1) to PD-L1. PD-L1 positivity was defined as membrane staining in ≥20% of tumor cells. Correlations between PD-L1 expression and HPV status and survival parameters were analyzed. RESULTS: Of the 133 patients, 68% showed PD-L1 expression, and 67% of patients were positive for p16 expression by immunohistochemistry. No significant difference in PD-L1 expression was observed between HPV(-) and HPV(+) tumors (61% vs. 71%, p=0.274). No significant difference in age, gender, smoking history, location of tumor origin, or stage was observed according to PD-L1 status. With a median follow-up period of 44 months, older age (≥65) (p=0.017) and T3-4 stage (p<0.001) were associated with poor overall survival (OS), whereas PD-L1 expression did not affect OS in univariate and multivariate analysis. CONCLUSION: PD-L1 expression was observed in the majority of OSCC patients regardless of HPV status. Further large prospective studies are required to determine the role of PD-L1 expression as a prognostic or predictive biomarker, and clinical studies of immune checkpoint inhibitors in OCSS are warranted regardless of HPV status.
Carcinoma, Squamous Cell* ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Membranes ; Multivariate Analysis ; Oropharyngeal Neoplasms ; Prevalence ; Prospective Studies ; Smoke ; Smoking ; United Nations

PURPOSE: Sleep deprivation may exert many negative effects on hippocampus-dependent cognitive function, such as learning and memory. The present study was conducted in order to investigate the effects of repetitive sleep deprivation on cognition, apoptotic neuronal cell death, and cell proliferation in the hippocampus, using mice. METHODS: To induce sleep deprivation, mice were placed in a water cage containing six platforms (3 cm in diameter), surrounded by water up to 1 cm beneath the surface of the platform for 24 h. Mice were randomly divided into four groups (n=20 in each group): control group, 24 h rest after 24 h sleep deprivation group, 48 h rest after 24 h sleep deprivation group, and 72 h rest after 24 h sleep deprivation group. This cycle was continued for 36 days. Novel objective recognition test and immunohistochemistry for 5-bromo-2'-deoxyuridine (BrdU), western blot for expression of Bax, Bcl-2, brain-derived neurotrophic factor (BDNF), and caspase-3 were performed. RESULTS: Results of the novel objective recognition test showed decreased cognition in the 24 h rest after 24 h sleep deprivation group, while a similar effect was observed in other groups, compared to the control group. Increased cell proliferation and enhanced expression of BDNF and Bax protein were observed in the 24 h rest after 24 h sleep deprivation group and the 48 h rest after 24 h sleep deprivation group, compared to the control group. Expression of Bcl-2 showed a decrease in the 24 h and 48 h rest groups, compared to the control group. Expression of caspase-3 in the dentate gyrus of the hippocampus showed a significant increase in the 24 h rest after 24 h sleep deprivation group and in the 48 h rest after 24 h sleep deprivation group, compared to the control group. CONCLUSION: Results of the present study indicate that insufficient rest after sleep deprivation may induce impairment of cognitive function. After sleep deprivation, at least 72 hr of rest time is needed for recovery.
Animals ; Apoptosis ; bcl-2-Associated X Protein ; Blotting, Western ; Brain-Derived Neurotrophic Factor ; Bromodeoxyuridine ; Caspase 3 ; Cell Death ; Cell Proliferation ; Cognition ; Dentate Gyrus ; Hippocampus ; Immunohistochemistry ; Learning ; Memory ; Memory, Short-Term ; Mice ; Neurons ; Sleep Deprivation ; Water

PURPOSE: The purpose of this study was to investigate the relationship between suicide risk factors and psychiatric disorders, and between suicide risk factors and suicide attempts after discharge, and to analyze the necessity of a psychiatrist referral in patients who intentionally ingested drug but did not make a suicide attempt. METHODS: Between January 1, 2004 and December 31, 2008, we investigated cases of intentional drug ingestion in patients greater than 15 years of age who visited Kyung Hee University emergency medical center. We divided the patients into two groups - a suicide attempt group and a non-suicide attempt group. The difference between suicide risk factors of the two groups was investigated prospectively. Among the risk factors for suicide, we determined whether psychiatric diagnosis was highly associated with suicide and whether it was an influential factor in suicide attempts after discharge. SPSS version 13.0 was used for statistical analysis. Chi-square, paired sample t-test, and Fisher's exact test were performed, and a p<0.05 was considered to be statistically significant. RESULTS: There were no significant differences in suicide risk factors between the two groups (p>0.05). Patients who did not attempt suicide who had a psychiatric history associated with suicide attempts, who had previous suicide attempts, who had a family history of suicide, and who lived alone, may have psychiatric disorders associated with suicide or suicide attempt after discharge (p<0.05). CONCLUSION: All patients who intentionally ingested drugs should be given a psychiatrist referral, even if the patients did not attempt suicide. In particular, the psychiatric referral should be made when the patient has risk factors such as a psychiatric history associated with suicide attempts, previous suicide attempts, a family history of suicide, and living alone.
Eating ; Emergencies ; Humans ; Intention ; Mental Disorders ; Prospective Studies ; Psychiatry ; Referral and Consultation ; Risk Factors ; Suicide

PURPOSE: To investigate which factors are associated with the causes and results of medical malpractice claims on emergency medical facilities. The study analyzed the alteration of judicial precedents between before and after 1995 when the court ruled that the burden of proof was to be placed upon the accused as well as the plaintiff. METHODS: We collect 213 medical malpractice claims covering from 1953 to 2008, using a database of closed claims maintained by the Supreme Court of Korea. Of the 213 claims, 31 involved emergency medical facilities. The cases were divided into 4 groups according to the physician's specialty and the causes and results of the claims were compared among each group. The causes and results were also compared between before and after 1995. RESULTS: In the medical department, the physicians were mainly accused in connection with mis- or delayed diagnosis. In the surgical and emergency departments, the plaintiff denounced the physician generally for neglect of duty in the emergency medical service system. The tendency of the court's ruling related to the distribution of the burden of proof has been changed after 1995 and the rate of physician legal victory in the judicial precedents has declined since then. CONCLUSION: Medical malpractice claims on emergency medical facilities were mostly related to misdiagnosis or emergency medical service system. Due to the change in the court's ruling regarding the distribution of the burden of proof, emergency physicians with medical malpractice claims need to change their attitude with regards to the activeness in the claims.
Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Emergency Medical Services ; Korea ; Malpractice

PURPOSE: Dizziness is a common chief complaint in patients presenting at emergency deparments. As central dizziness can be life-threatening, it is important to differentiate central from peripheral dizziness. VBI (vertebrobasilar insufficiency) or PICA (posterior inferior cerebellar artery) infarction can present as only isolated dizziness without other neurologic symptoms, thus mimicking peripheral dizziness. It is difficult to differentiate from isolated dizziness in emergency departments because of limitations attendant to time, space, laboratory tests and diagnostic procedures. This study was performed with the goal of devising a protocol to positively identify isolated dizziness at the bedside in emergency departments. METHODS: We retrospectively reviewed the medical records of 384 patients with isolated dizziness who visited the emergency department of Kyunghee Medical Center from January 1, 2006 to December 31, 2006. We analyzed age, gender, the risk factors of cerebral vascular accident, neurologic examinations, and features of dizziness and performed a logistic regression analysis. RESULTS: In logistic regression analysis, age of at least 65 years, cerebral vascular accident history, disequilibrium character, cranial nerve system, and tandem gait abnormality were significantly associated with central dizziness. Negative predictive value and sensitivity of the protocol were 99.6% and 98.7%, respectively. CONCLUSION: In patients presenting with isolated dizziness in the emergency department, patients less than 65 years old, and without history of cerebral vascular accident, disequilibrium character, cranial nerve system, or tandem gait abnormality can be safely discharged after conservative management without further evaluation.
Brain Infarction ; Cranial Nerves ; Dizziness ; Emergencies ; Gait ; Humans ; Infarction ; Ischemic Attack, Transient ; Logistic Models ; Medical Records ; Neurologic Examination ; Neurologic Manifestations ; Pica ; Retrospective Studies ; Risk Factors ; Vertigo