Real-World Treatment Intensity and Patterns in Patients With Myopic Choroidal Neovascularization: Common Data Model in Ophthalmology

Bui Manh-Hung,Lee Da Yun,Park Sang Jun,Park Kyu Hyung 대한의학회 2023 Journal of Korean medical science Vol.38 No.23

Background: A paucity of data addressing real-world treatment of myopic choroidal neovascularization (mCNV) in the era of anti-vascular endothelial growth factor (VEGF) drugs led us to investigate real-world treatment intensity and treatment patterns in patients with mCNV. Methods: This is a retrospective, observational study using the Observational Medical Outcomes Partnership-Common Data Model database of treatment-naïve patients with mCNV over the 18-year study period (2003–2020). Outcomes were treatment intensity (time trends of total/average number of prescriptions, mean number of prescriptions in the first year and the second year after initiating treatment, proportion of patients with no treatment in the second year) and treatment patterns (subsequent patterns of treatment according to the initial treatment). Results: Our final cohort included 94 patients with at-least 1-year observation period. Overall, 96.8% of patients received anti-VEGF drugs as first-line treatment, with most of injections from bevacizumab. The number of anti-VEGF injections in each calendar year showed an increasing trend over time; however, there was a drop in the mean number of injections in the second year compared to the first year from 2.09 to 0.47. About 77% of patients did not receive any treatment in their second year of treatment regardless of drugs. Most of patients (86.2%) followed non-switching monotherapy only and bevacizumab was the most popular choice either in the first-line (68.1%) or in the second-line (53.8%) of treatment. Aflibercept was increasingly used as the first-line treatment for patients with mCNV. Conclusion: Anti-VEGF drugs have become the treatment of choice and second-line treatment for mCNV over the past decade. Anti-VEGF drugs are effective for the treatment of mCNV as the non-switching monotherapy is the main treatment regimen in most cases and the number of treatments decreases significantly in the second year of treatment.

공통 데이터 모델을 이용한 성인 조현병 환자의 항정신병 약물 처방 패턴 분석

윤현아,한솔아,최경선,서혜선 한국보건사회약료경영학회 2021 한국보건사회약료경영학회지 Vol.9 No.2

BACKGROUND Many antipsychotic drugs have been used to treat schizophrenia, and many treatment patterns have been observed. Most schizophrenia treatment pattern studies were done by analyzing survey data or several hospitals’ electronic health records. This study aimed to analyze early treatment pathways of newly diagnosed schizophrenia patients. METHOD Using 2012-2017 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS) which was standardized to the Common Data Model (CDM), we selected newly diagnosed schizophrenia patients. The inclusion criteria were 18-64 aged patients who have continuous observation at least 30 days before and 180 days after index date, and patients who have at least one diagnosis of schizophrenia between pre-index date and 180 days after index date. The exclusion criterion was patients who have diagnosis of bipolar disorder or depressive disorder. We used Observational Health Data Sciences and Informatic (OHDSI)’s ATLAS platform to analyze baseline characteristics and treatment patterns of selected patients. RESULTS For the schizophrenia first line treatment, risperidone was the most commonly used treatment in all years (2012-2017), followed by aripiprazole and olanzapine. Among typical antipsychotics, haloperidol was the most commonly used treatment. The patients with younger age were more likely to use second or later line drugs. CONCLUSIONS We comprehensively evaluated the treatment pathway of antipsychotics in adult patients with schizophrenia by using representative claims data that was standardized to the CDM. This study found the most commonly used antipsychotics by different age groups and the proportion of patients who switched to later line treatments.

Preliminary Correlation Between Warm Needling Treatment for Knee Osteoarthritis of Deficiency-Cold Syndrome and Metabolic Functional Genes and Pathways

Conge Tan,Weijun Ding,Wenzhe Feng,Jianguo Wang,Miqu Wang 사단법인약침학회 2010 Journal of Acupuncture & Meridian Studies Vol.3 No.3

The warm needling technique used in traditional Chinese medicine has been shown to be effective in the treatment and prevention of knee osteoarthritis (OA), but the biological mechanisms behind this action have not been well explored. This study investigated the molecular mechanisms behind warm needling using cDNA microarray technology, thus providing further scientific evidence for its efficacy. Ten patients with knee OA of deficiency-cold syndrome were selected for 2 weeks of warm needling treatment. This treatment involved stimulating the selected acupoints using needles with a burning moxa stick on their handle for 40 minutes per session. Pain intensity and accumulated clinical scores of deficiency-cold syndrome were assessed pretreatment and posttreatment using a 40-factor questionnaire of OA with deficiency-cold syndrome. Four patients with the best therapeutic efficacy were selected for cDNA microarray testing. Among the four patients, 41, 246,57 and 70 differentially expressed genes were obtained, with more than 50% of these differentially expressed genes functionally linked to primary, cellular and energy metabolism pathways. This work demonstrates that the molecular mechanism behind warm needling treatment may be associated with the regulation of metabolism-related genes and pathways.

일개 응급센터에 내원한 외상성 혈관손상 환자의 임상적 특성

박용면 ( Yong Myeon Park ),염석란 ( Seok Ran Yeom ),정진우 ( Jin Woo Jeong ),한상균 ( Sang Kyun Han ),조석주 ( Suck Ju Cho ),류지호 ( Ji Ho Ryu ),김용인 ( Yong In Kim ),정성운 ( Sung Woon Chung ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: The mortality and the amputation rates due to vascular trauma remain high despite advanced vascular surgical techniques and supportive management. The clinical features of patients with vascular trauma have not been well studied in the Korean population. The aim of this study was to analyze the clinical characteristics of patients with vascular trauma and to develop a database and guidelines for improving the outcomes of treatment. Methods: The medical records of 37 patients with traumatic vascular injuries who had visited in an emergency center between January 2002 and December 2006 were retrospectively reviewed and statistically analyzed. Results: The mean age was 37.8 years, and the male-to-female ratio was 5.2:1. The mechanism of vascular trauma was penetrating in 18 patients and blunt in 19 patients. Upper extremities were most frequently injured (39.4%). The treatment methods were primary repair in 21 patients, exploratory laparotomies in 7, radiological interventions in 3, resections and graft interpositions of the pseudoaneurysm in 3, observations in 3 and a bypass graft in 1. Four out of the 37 patients died, and three of these who died had injuried abdominal vessels. Twenty-five of the patients recovered completely, four expired, seven had neuropathy in the course of treate-ment, one had his limb amputated, and one experienced wound necrosis. Conclusion: Peripheral vessel injuries are commonly accompanied by nerve, muscle, or tendon injuries. Patients without associated fractures or compartment syndrome had good prognosis. Although the time intervals from hospital arrival to definite treatment were the shortest among patients with blunt abdominal vascular injuries, three expired. Therefore, we offer a `critical pathway` to improve the outcomes of patients with blunt abdominal vascular injury. (J Korean Soc Traumatol 2009;22:5-11)

Electric Stimulation Hyperthermia Relieves Inflammation via the Suppressor of Cytokine Signaling 3-Toll Like Receptor 4 Pathway in a Prostatitis Rat Model

Guan Qun Zhu,전승환,이규원,Wen Jie Tian,조혁진,하유신,홍성후,이지열,문명건,문성희,김세웅,배웅진 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.3

Purpose: Chronic prostatitis (CP), including chronic pelvic pain syndrome (CPPS), is the most commonly encountered manifestation of prostatitis. The aim of this study was to evaluate the effect of electric stimulation hyperthermia treatment (ESHT) on CP/CPPS and to explore the underlying mechanism. Materials and Methods: RWPE-2 cells with lipopolysaccharide-induced inflammation and a prostatitis rat model induced by 17β-estradiol and dihydrotestosterone underwent sham, electric stimulation, or ESHT treatment. Four weeks later, cells, supernatants, and rat prostates were collected for analysis using immunohistochemistry, Western blots, and enzyme-linked immunosorbent assays. Results: We found that ESHT improved prostatitis in vivo and attenuated inflammation in vitro. ESHT significantly induced suppressor of cytokine signaling 3 (SOCS3) expression and subsequently promoted HSP70. It attenuated inflammation through decreased expression of toll-like receptor 4 (TLR4), nuclear factor kappa B, and subsequent inflammatory cytokines. ESHT also inhibited apoptosis and released growth factor in tissue affected by prostatitis. Conclusions: ESHT improved CP/CPPS and reversed pathologic changes of prostatitis by inhibiting the SOCS3-TLR4 pathway.

How do readers choose to undergo treatments based on medical articles?

Lee, Ye-Seul,Kim, Jeongjoo,Joo, Seongsu,Go, Byeongho,Lee, Hyangsook,Chae, Younbyoung Williams & Wilkins Co 2016 Medicine Vol.95 No.49

<P><B>Abstract</B></P><P>The purpose of this study is to study the reader's cognitive process in reading medical articles and its influence on the decision-making process. Twenty-four participants completed a survey pertaining to 36 medical articles on new treatments with similar text structures and similar titles. Participants rated each article on its level of interest, informativeness, and reliability, and were asked whether they would choose the treatments in the news article. A cognitive decision-making model can be applied to health contexts, in which the reader's subjective ratings on interest, informativeness, and reliability were positively associated with choosing new treatments. The decision-making process path from the perception of informativeness was mediated by the reliability of the news article. Interest was positively linked to informativeness, although it was not directly associated with reliability. This study shows that readers’ subjective ratings on health information can indicate their decision-making. Artifacts in the information that might incite emotions or interest, such as framing, can affect the reader's decision-making process.</P>

위암 환자의 한의 표준 임상경로(Clinical Pathway)개발 임상적용 관찰연구

이건준,김동현,김종희,주한음,조영민,조정효,박지혜,박소정 대한한의학회 2024 대한한의학회지 Vol.45 No.2

Objectives: The objective of this study was to explore the integration of Traditional Korean Medicine (TKM) into existing clinical pathways for the treatment of gastric cancer. focusing on enhancing treatment outcomes and improving patient quality of life. Methods: Employing a prospective observational design, the study targeted adults aged 20-75 diagnosed with gastric cancer. It assessed the TKM pathway's impact on quality of life, tumor markers, complete blood count test values, and patient satisfaction, and monitored adverse reactions to evaluate effectiveness and safety. Results: The study demonstrated improved quality of life(QOL), as indicated by increased Karnofsky Performance Scale(KPS) scores Mean Difference(MD)=20.37, and better quality of life (MD=19.79) assessments. Blood test results showed notable enhancements in immune function markers such as Neutrophil (MD=-7.34%) and Lymphocyte (6.80%), and Erythrocyte Sedimentation Rate (ESR)(MD=-11.05mm/hr). Both patient and medical staff satisfaction (MD=0.33) improved, although changes in tumor markers were not statistically significant. Conclusions: The integration of TKM into the treatment of gastric cancer can significantly improve patient quality of life and satisfaction. To further substantiate these results, developing and implementing more critical pathways across varied clinical settings, along with larger-scaled studies, are essential.

A Prototype Safety Assessment Tool for a Radioactive Waste Treatment Complex Based on IAEA SADRWMS Methodology Using Microsoft Excel and Visual Basic Add-in

In Gyu Chang,Jae Hak Cheong 한국방사성폐기물학회 2023 한국방사성폐기물학회 학술논문요약집 Vol.21 No.1

Kori Unit 1 was permanently shut down in 2017 and is preparing to be dismantled. Decommissioning nuclear power plants is expected to generate a lot of decommissioning waste. Therefore, a radioactive waste treatment complex will be built on the site to safely and effectively the process of decommissioning waste generated from the Kori Unit 1, and the details are specified in the decommissioning plan. Therefore, a safety assessment should be conducted according to the facility’s normal and abnormal operations to construct a radioactive waste treatment complex. Currently, a safety assessment for a radioactive waste treatment complex can be conducted by the Safety Assessment Framework (SAFRAN) Tool based on the Safety Assessment Driving Radioactive Waste Management Solutions (SADRWMS) methodology developed by the International Atomic Energy Agency (IAEA). The SAFRAN Tool can be calculated radiation dose and hazard quotient (HQ) for workers and the public under normal and abnormal conditions of the radioactive waste treatment complex. When evaluating the radiation dose for the public due to releasing radioactive materials into the air or discharging radioactive materials into liquids, the radiation dose is calculated using the amount discharged or released from the treatment complex, and the Pathway Dose Factors (PDFs) derived from the generic environmental model given in the IAEA Safety Reports Series No.19. PDFs, which reflect the specific site data rather than the generic environmental model data, should be calculated and evaluated when performing the safety evaluation of the radioactive waste treatment complex to be built on the Kori site. In addition, in the SAFRAN tool, there is an inconvenience in that it must be calculated separately by radionuclides to calculate the contribution of dose or HQ for each radionuclide. Therefore, in this study, a safety assessment tool for a radioactive waste treatment complex was developed using Visual Basic by supplementing the limitations of the SAFRAN tool. This tool was developed to allow users to choose whether to apply PDFs based on the IAEA SRS-19 based on the generic environmental model or PDFs calculated to reflect the specific site data. Furthermore, the tool considered all types of decommissioning wastes that may occur during the decommissioning of the Kori Unit 1 and the treatment process scheduled to be introduced. Therefore, this study is expected to be used as basic data when conducting the safety assessment of radioactive waste treatment complex scheduled to be introduced in Korea.

Characterizing treatment pathways at scale using the OHDSI network

Hripcsak, George,Ryan, Patrick B.,Duke, Jon D.,Shah, Nigam H.,Park, Rae Woong,Huser, Vojtech,Suchard, Marc A.,Schuemie, Martijn J.,DeFalco, Frank J.,Perotte, Adler,Banda, Juan M.,Reich, Christian G.,S National Academy of Sciences 2016 PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF Vol.113 No.27

<P>Observational research promises to complement experimental research by providing large, diverse populations that would be infeasible for an experiment. Observational research can test its own clinical hypotheses, and observational studies also can contribute to the design of experiments and inform the generalizability of experimental research. Understanding the diversity of populations and the variance in care is one component. In this study, the Observational Health Data Sciences and Informatics (OHDSI) collaboration created an international data network with 11 data sources from four countries, including electronic health records and administrative claims data on 250 million patients. All data were mapped to common data standards, patient privacy was maintained by using a distributed model, and results were aggregated centrally. Treatment pathways were elucidated for type 2 diabetes mellitus, hypertension, and depression. The pathways revealed that the world is moving toward more consistent therapy over time across diseases and across locations, but significant heterogeneity remains among sources, pointing to challenges in generalizing clinical trial results. Diabetes favored a single first-line medication, metformin, to a much greater extent than hypertension or depression. About 10% of diabetes and depression patients and almost 25% of hypertension patients followed a treatment pathway that was unique within the cohort. Aside from factors such as sample size and underlying population (academic medical center versus general population), electronic health records data and administrative claims data revealed similar results. Large-scale international observational research is feasible.</P>

Combined Treatment with Coptidis Rhizoma Extract and Arsenic Trioxide Enhanced Apoptosis through Diverse Pathways in H157 Cells

Youn, Myung-Ja,Kim, Yun-Ha,Kim, Hyung-Jin,Song, Je-Ho,Jeon, Ho-Sung,Yu, Dong-Hee,Sul, Jeong-Dug,So, Hong-Seob,Park, Rae-Kil The Physiological Society of Korean Medicine and T 2009 동의생리병리학회지 Vol.23 No.6

Coptidis rhizoma (huanglian) is an herb that is widely used in traditional Chinese medicine that has recently been shown to possess anticancer activity. However, the molecular mechanism underlying the anticancer effects of this herb is poorly understood. In this study, we investigated the anticancer activity of a combination of CR extract and arsenic trioxide, as well as the apoptotic pathway associated with its mechanism of action in human lung cancer H157 cells. Combined treatment of H157 cells with CR extract and arsenic trioxide resulted in significant apoptotic death. In addition, combined treatment with CR extract and arsenic trioxide acted in concert to induce a loss of mitochondrial membrane potential (${\Delta}{\Psi}$), the release of cytochrome c from mitochondria, and an increase in the expression of pro-apoptotic p53 and Bax protein, which resulted in activation of caspases and apoptosis. CR extract combined with arsenic trioxide also increased the lipid peroxidation, mRNA expression of DR4 and DR5 and caspase-8 activity. These data indicate that combined treatment with CR extract and arsenic trioxide enhanced apoptotic cell death in H157 cells through diverse pathways, including mitochondrial dysfunction and death receptors, particularly DR4 and DR5. Thus, this treatment may be an effective from of chemotherapy.