Patient factors affecting frequent potential unnecessary injection use in outpatient care setting

This study aimed to investigate the prevalence of potential unnecessary injection (PUNI) and to identify factors associated with frequent PUNI uses. Population-based National Health Insurance claims data for outpatient health care settings during the six month period from July to December 2011 were retrospectively reviewed. Patients aged 18–80 without severe diseases and visited healthcare centers more than 25 times during study period were included. PUNI was defined as injection used where substitutable oral agents were available and where injection uses are not warranted. A total of 801,532 patients were included for this analysis. Among them, 29.0 % were frequent PUNI user defined as ≥10 PUNI used during the study period. In multivariate logistic regression results revealed significant associations between frequent PUNI use and several patient and healthcare utilization factors. Women than men, elderly than younger people, residents in rural areas than in big cities, and more frequent visitors to healthcare centers than less frequent visitors were more likely to be frequent PUNI users. Larger number of healthcare center utilized and higher out-of-pocket expense level showed significant lower risks of frequent PUNI uses. Identified factors associated with frequent PUNI use in this study could be the targets to develop programs for reducing injection overuse.     

Dietary intake of vitamin K in relation to bone mineral density in Korea adults: The Korea National Health and Nutrition Examination Survey (2010–2011)

Low vitamin K nutritional status has been associated with increased risk of fracture, however inconsistent results exist to support the role of vitamin K on bone mineral density depending on ethnic difference and gender. Our objective was to determine vitamin K intake in Korean adults, examine correlation between vitamin K intake and bone mineral density. This study analyzed raw data from the fifth Korea National Health and Nutrition Examination Survey for adults (2,785 men, 4,307 women) aged over 19 years. Cross-sectional analyses showed only positive association between vitamin K intake and femur bone mineral density in men after adjusting bone-related factors. However, women in high tertiles of vitamin K intake had a significantly higher bone mineral density both in femur and lumber as compared to women in lowest tertiles (p<0.05). The risk for osteoporosis was decreased as vitamin K intake increased in women, but this effect was not persisted after adjusting factors. The findings of this study indicate that low dietary vitamin K intake was associated with low bone mineral density in subjects. From these results we may suggest an increase in dietary vitamin K intakes for maintaining bone mineral density. (2010-02CON-21-C, 2011-02CON-06-C)     

Do Recent Advances in Diagnostic and Therapeutic Procedures Negate the Benefit of Postmastectomy Radiotherapy in N1 Patients With a Low Risk of Locoregional Recurrence?

Recent advances in breast cancer management might make the use of postmastectomy radiotherapy (PMRT) redundant in the treatment of pT1/T2N1 patients. We investigated the impact of PMRT on disease-free survival (DFS) in these patients who have a low risk of locoregional recurrence (LRR) after contemporary multidisciplinary management.Between 1998 and 2011, 1123 patients underwent upfront surgery for pathologically diagnosed pT1/T2N1 breast cancer, at a single institution. A retrospective review was performed on 692 patients who had a mastectomy with axillary lymph node (LN) clearance. Most patients received adjuvant systemic chemotherapy and/or endocrine therapy. PMRT was administered to 17.8% of the patients. The median follow-up time was 98 months.The entire cohort was divided into 2 groups, the early-era (1998–2003) and late-era (2004–2011) cohorts. Grouping was based on the use of modern therapies since 2004 including sentinel LN (SLN) biopsy, anthracycline/taxane-based chemotherapy, and aromatase inhibitors. Late-era patients had a significantly lower 5-year LRR compared with early-era patients (3.2% vs 10.3%, respectively; P < 0.001). In late-era patients, although PMRT did not significantly reduce the 5-year LRR rate (1% vs 3.8%, respectively), it did improve the 5-year DFS rate (96.1% vs 87.5%, respectively). After controlling for all clinicopathological variables, PMRT was independently associated with improved DFS. In subgroup analysis, depending on the presence of micro- or macrometastasis in the axillary nodes, the benefit of PMRT was most apparent in patients with macrometastasis (hazard ratio, 0.19). In the late-era cohort with no PMRT, the 3-year distant metastasis risk increased according to LN tumor burden (0%, 5.2%, and 9.8% in micrometastasis, SLN macrometastasis, and non-SLN macrometastasis, respectively).Advanced surgical and systemic therapies might not negate the benefit of PMRT in recently diagnosed pN1 patients who have a very low risk for LRR. Our data indicate that the overall recurrence risk combined with the LRR should be considered for an indication of PMRT, and raises the question of whether the receipt of PMRT would improve outcome in patients with micrometastasis.     

Recent progress of M13 virus-based chemical and biological sensing

Discriminating the minute content of chemicals both in precise and concise way is to use core technique for detecting water pollution. Recently a novel virus-based sensor system functionalized by M13 bacte-riophage-based structure got great attention. This system can detect various chemicals in superior sensitivity and selectivity. The filamentous and consistent shape of M13 bacteriophage can be ordered by self-assembly technique in high established form. This allows M13 bacteriophage as a template to build homogeneous distribution and permeable network structures of inorganic nanostructures under mild conditions. Phage display, genetic engineering technique of M13 bacteriophage, is another strong feature of M13 bacteriophage as a functional building block. The numerous possibility of genetic modification of M13 bacteriophage is definitely a key feature, and we have seen only the tip of an iceberg of it so far. Here, we review the very recent progress in the application of M13 bacteriophage self-assembly structures to a sensor system and discuss about M13 bacteriophage technology of our future.     

Clinical characteristics and outcomes of patients with grayanotoxin poisoning after the ingestion of mad honey from Nepal

The aims of this study were to evaluate the clinical characteristics and outcomes of patients with grayanotoxin poisoning due to mad honey brought from Nepal. Medical records of patients with mad honey poisoning admitted to the emergency department between 1 January 2004 and 31 May 2012 were retrospectively reviewed. A total of 15 patients were included in this study. In all patients, mad honey was brought from the Himalayan region of Nepal. The mean age was 52.2 years, and 66.7 % were men. The mean amount of mad honey ingested was 47 cc, and the mean time from ingestion to onset of symptoms was 36 min. In all patients, initial vital signs showed hypotension and bradycardia. The initial electrocardiogram showed sinus bradycardia in eight patients, junctional bradycardia in four patients, complete atrioventricular block in two patients, and atrial fibrillation with slow ventricular response in one patient. Four patients were treated with intravenous normal saline solution only. Eleven patients were treated with intravenous normal saline solution and intravenous atropine sulfate in a dose ranging from 0.5 to 2.0 mg. In all patients, the blood pressure and pulse rate returned to normal limits within 24 h. There were no deaths. The clinical characteristics and outcome of grayanotoxin poisonings caused by the ingestion of mad honey from Nepal are similar with those of mad honey from the Black Sea region of Turkey.     

Protective Effect of ECQ on Rat Reflux Esophagitis Model

This study was designed to determine the protective effect of Rumex Aquaticus Herba extracts containing quercetin-3-β-D-glucuronopyranoside (ECQ) on experimental reflux esophagitis. Reflux esophagitis was induced by surgical procedure. The rats were divided into seven groups, namely normal group, control group, ECQ (1, 3, 10, 30 mg/kg) group and omeprazole (30 mg/kg) group. ECQ and omeprazole groups received intraduodenal administration. The Rats were starved for 24 hours before the experiments, but were freely allowed to drink water. ECQ group attenuated the gross esophagitis significantly compared to that treated with omeprazole in a dose-dependent manner. ECQ decreased the volume of gastric juice and increased the gastric pH, which are similar to those of omeprazole group. In addition, ECQ inhibited the acid output effectively in reflux esophagitis. Significantly increased amounts of malondialdehyde (MDA), myeloperoxidase (MPO) activity and the mucosal depletion of reduced glutathione (GSH) were observed in the reflux esophagitis. ECQ administration attenuated the decrement of the GSH levels and affected the MDA levels and MPO activity. These results suggest that the ECQ has a protective effect which may be attributed to its multiple effects including anti-secretory, anti-oxidative and anti-inflammatory actions on reflux esophagitis in rats.