Publications by authors named "Eun Ju Park"

60 Publications

Prognosis palliative care study, palliative prognostic index, palliative prognostic score and objective prognostic score in advanced cancer: a prospective comparison.

BMJ Support Palliat Care 2021 Jul 2. Epub 2021 Jul 2.

Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of).

Background: Predicting how long a patient with far advanced cancer has to live is a significant part of hospice and palliative care. Various prognostic models have been developed, but have not been fully compared in South Korea.

Objectives: We aimed to compare the accuracy of the Prognosis in Palliative Care Study (PiPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) and Objective Prognostic Score (OPS) for patients with far advanced cancer in a palliative care unit in South Korea.

Methods: This prospective study included patients with far advanced cancer who were admitted to a single palliative care unit at the National University Hospital. Variables for calculating the prognostic models were recorded by a palliative care physician. The survival rate was estimated using the Kaplan-Meier method. The sensitivity, specificity, positive predictive value and negative predictive value of each model were calculated.

Results: A total of 160 patients participated. There was a significant difference in survival rates across all groups, each categorised through the five prognostic models. The overall accuracy (OA) of the prognostic models ranged between 54.5% and 77.6%. The OA of clinicians' predictions of survival ranged between 61.9% and 81.3%.

Conclusion: The PiPS, PPI, PaP and OPS were successfully validated in a palliative care unit of South Korea. There was no difference in accuracy between the prognostic models, and OA tended to be lower than in previous studies.
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http://dx.doi.org/10.1136/bmjspcare-2021-003077DOI Listing
July 2021

Diet-Regulating Microbiota and Host Immune System in Liver Disease.

Int J Mol Sci 2021 Jun 13;22(12). Epub 2021 Jun 13.

Institute for Liver and Digestive Diseases, Hallym University College of Medicine, Chuncheon 24253, Korea.

The gut microbiota has been known to modulate the immune responses in chronic liver diseases. Recent evidence suggests that effects of dietary foods on health care and human diseases are related to both the immune reaction and the microbiome. The gut-microbiome and intestinal immune system play a central role in the control of bacterial translocation-induced liver disease. Dysbiosis, small intestinal bacterial overgrowth, translocation, endotoxemia, and the direct effects of metabolites are the main events in the gut-liver axis, and immune responses act on every pathways of chronic liver disease. Microbiome-derived metabolites or bacteria themselves regulate immune cell functions such as recognition or activation of receptors, the control of gene expression by epigenetic change, activation of immune cells, and the integration of cellular metabolism. Here, we reviewed recent reports about the immunologic role of gut microbiotas in liver disease, highlighting the role of diet in chronic liver disease.
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http://dx.doi.org/10.3390/ijms22126326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231888PMC
June 2021

Electricity auto-generating skin patch promotes wound healing process by activation of mechanosensitive ion channels.

Biomaterials 2021 Jun 9;275:120948. Epub 2021 Jun 9.

Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea; Department of Nanobiomedical Science and BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea; Department of Biomaterials Science, College of Dentistry, Dankook University, Cheonan, 31116, Republic of Korea; Department of Regenerative Dental Medicine, College of Dentistry, Dankook University, Cheonan, 31116, Republic of Korea; Cell & Matter Institute, Dankook University, Cheonan, 31116, Republic of Korea; Mechanobiology Dental Medicine Research Center, Cheonan, 31116, Republic of Korea; UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, 31116, Republic of Korea. Electronic address:

Electricity constitutes a natural biophysical component that preserves tissue homeostasis and modulates many biological processes, including the repair of damaged tissues. Wound healing involves intricate cellular events, such as inflammation, angiogenesis, matrix synthesis, and epithelialization whereby multiple cell types sense the environmental cues to rebuild the structure and functions. Here, we report that electricity auto-generating glucose-responsive enzymatic-biofuel-cell (EBC) skin patch stimulates the wound healing process. Rat wounded-skin model and in vitro cell cultures showed that EBC accelerated wound healing by modulating inflammation while stimulating angiogenesis, fibroblast fuctionality and matrix synthesis. Of note, EBC-activated cellular bahaviors were linked to the signalings involved with calcium influx, which predominantly dependent on the mechanosensitive ion channels, primarily Piezo1. Inhibition of Piezo1-receptor impaired the EBC-induced key functions of both fibroblasts and endothelial cells in the wound healing. This study highlights the significant roles of electricity played in wound healing through activated mechanosensitive ion channels and the calcium influx, and suggests the possibility of the electricity auto-generating EBC-based skin patch for use as a wound healing device.
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http://dx.doi.org/10.1016/j.biomaterials.2021.120948DOI Listing
June 2021

The Risk of Osteoporosis and Osteoporotic Fracture Following the Use of Irritable Bowel Syndrome Medical Treatment: An Analysis Using the OMOP CDM Database.

J Clin Med 2021 May 10;10(9). Epub 2021 May 10.

Pusan National University School of Medicine, Yangsan 50612, Korea.

Patients with irritable bowel syndrome (IBS) are at increased risk of osteoporosis and osteoporotic fracture. This study investigated whether IBS medication attenuated the rate of osteoporosis and osteoporotic fracture risk. We conducted a retrospective large-scale multicenter study across eight hospital databases encoded in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The primary outcome was the incidence of osteoporosis, whereas secondary outcomes were osteoporotic fractures. After 1:4 matching, 24,723 IBS patients, 78,318 non-IBS patients, 427,640 non-IBS patients with IBS medication, and 827,954 non-IBS patients without IBS medication were selected. The risk of osteoporosis was significantly increased in the IBS group compared to the non-IBS group (hazard ratio (HR) 1.33; confidence interval (CI) 1.17~1.51). Even in patients who were not diagnosed with IBS, the risk of osteoporosis was significantly increased in those with IBS medication compared to those without (HR 1.77, CI 1.62~1.93). The risk of osteoporotic fracture was significantly increased in the IBS medication group (HR 1.69, CI 1.55~1.84). Patients exposed to IBS treatment even without IBS diagnosis were at increased risk of osteoporosis and osteoporotic fracture. Early diagnosis and treatment of osteoporosis should be considered in patients who have received medication for IBS symptoms.
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http://dx.doi.org/10.3390/jcm10092044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126251PMC
May 2021

The Relationship of Sitting Time and Physical Activity on the Quality of Life in Elderly People.

Int J Environ Res Public Health 2021 02 4;18(4). Epub 2021 Feb 4.

Department of Internal Medicine, Division of Infections Disease, Medical Research Institute, Pusan National University School of Medicine, Yangsan 50612, Korea.

Few studies have shown the combined impact of sitting time and physical activity on quality of life in older people. This cross-sectional study, using data from the 2016-2018 Korean National Health and Nutrition Examination Survey, examines the association between sitting time and physical activity and health-related quality of life (HRQoL) in Korean adults aged ≥ 65 years. HRQoL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). We divided subjects into groups based on sitting time and physical activity and analyzed the combined association of sitting time and physical activity with HRQoL. The association between longer sitting time (≥8 h) and HRQoL was analyzed using multiple logistic regression. In total, 4276 participants were included. Prolonged sitting time was associated with all of the EQ-5D dimensions: mobility (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.22-1.68), self-care (OR: 1.65 [95% CI 1.25-2.17]), usual activities (OR: 2.07 [95% CI 1.69-2.52]), pain/discomfort (OR: 1.57 [95% CI 1.34-1.84]), and anxiety/depression (OR: 1.49 [95% CI 1.17-1.91]). The prolonged sitting time/inactive group had higher ORs for all the EQ-5D dimensions than the low sitting time/active group. Prolonged sitting time was associated with low HRQoL in elderly Korean adults; physical activity could weaken the negative influence of prolonged sitting time on HRQoL.
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http://dx.doi.org/10.3390/ijerph18041459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916059PMC
February 2021

Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study.

Cancer Res Treat 2021 Jul 22;53(3):881-888. Epub 2020 Dec 22.

Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

Purpose: The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access.

Materials And Methods: Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death).

Results: A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, 'a little comfort' or 'much comfort') compared with the usual IV arm (21%) (p <0.001).

Conclusion: Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.
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http://dx.doi.org/10.4143/crt.2020.1008DOI Listing
July 2021

Effect of education on preference of parenteral nutrition for patients in palliative care unit: quantitative and qualitative study with an anthropological approach.

Ann Palliat Med 2020 Sep 26;9(5):2793-2799. Epub 2020 Aug 26.

Hospice and Palliative Care Team, Pusan National University Yangsan Hospital, Yangsan, Korea.

Background: Patients and their family have resistance in withholding parenteral nutrition (PN) when patient become unable to intake food in the end-of-life. We aimed to investigate whether the preference for PN is changed after receiving an individual education about the risk and benefit of PN. Additionally, we focused on the preferences of patients and their family and why they prefer it about the nutritional support in the end of life.

Methods: This is prospective study. Patients are eligible if they cannot tolerate oral intake and enteral feeding and have Palliative Performance Scale (PPS) ≤50% due to progressive cancer. After informed consent, investigators educated patients and family for an hour using the handouts. Then, patients decided if they will receive PN. Quality of life (QOL) was checked by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL) weekly during 3 weeks. Symptoms related to fluid overloading or dehydration was surveyed weekly also. A social anthropologist participated as an observer or interviewer during whole process of this study.

Results: After education, 12 patients (80%) chose to keep receiving PN and 3 patients (20%) changed their decision from PN to minimal hydration among the 15 patients. More calories were administered to patients who chosen PN (median 1,042.2 vs. 324.3 Kcal/day, P<0.001) for initial 7 days. Overall survival, scores of QLQ-C15-PAL, and symptoms were not different with or without PN. According to the anthropologist, medical staffs regard PN as complex medical treatments, while patients and family recognize it as meal rather than medicine.

Conclusions: Most patients and family prefer to receive PN despite its potential harm and marginal benefit. An in-depth discussion about prognosis and aim of care must be preceded before a decision whether to receive PN can be made.
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http://dx.doi.org/10.21037/apm-20-269DOI Listing
September 2020

Association between Time to First Cigarette and Health-Related Quality of Life of Middle-Aged Male Current Smokers: A Nationwide Representative Study in Korea.

Korean J Fam Med 2021 May 4;42(3):225-231. Epub 2020 Aug 4.

Family Medicine Clinic, Obesity, Metabolism and Nutrition Center, Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Background: Although many studies have demonstrated that the first cigarette in the morning increases the prevalence of smoking-related morbidity, limited studies have examined the impact of time to first cigarette (TTFC) on the health-related quality of life (HRQoL). Thus, we assessed this relationship using nationally-representative data from the Korea National Health and Nutrition Examination Survey VII-1 (2016).

Methods: We conducted a cross-sectional study using data from 577 current male smokers aged 30-59 years, after excluding those with a certain disease. Participants were divided into four categories according to TTFC (≤5 min, 6-30 min, 31-60 min, >60 min). HRQoL was measured using self-reported EuroQol-5 (EQ-5D). The relationship between TTFC and EQ-5D index was analyzed using a multivariate-adjusted generalized linear model to assess how HRQoL varies according to TTFC. After adjusting for confounders, a multivariate-adjusted logistic regression analysis was performed to identify which of the five dimensions of the EQ-5D affected the HRQoL according to TTFC.

Results: The generalized linear analysis indicated that as TTFC decreased (6-30 min, 31-60 min vs. >60 min), the EQ-5D index score decreased significantly (P=0.037). Shorter TTFC (≤5 min vs. >60 min) was associated with higher pain/discomfort (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.39-10.48) and anxiety/depression (OR, 7.58; 95% CI, 1.75-32.88).

Conclusion: Higher nicotine dependence was associated with impaired HRQoL. These results may be used to improve smoking cessation treatment outcomes.
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http://dx.doi.org/10.4082/kjfm.19.0103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164927PMC
May 2021

Association of Work Patterns and Periodontitis Prevalence in Korean Adults Aged 50 Years or Older: A Nationwide Representative Study.

Int J Environ Res Public Health 2020 06 4;17(11). Epub 2020 Jun 4.

Family Medicine Clinic, Obesity, Metabolism and Nutrition Center and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea.

This study analyzed the relationship between the work pattern and the prevalence of periodontitis. We analyzed the data of 3320 adults (1779 men, 1543 women) aged 51-80 years from the Korean National Health and Nutrition Examination Survey (2013-2015). The work pattern was divided into two groups (regular and irregular). The periodontal status was assessed using the community periodontal index. We observed a statistically significant difference in the association between work patterns and prevalence of periodontitis in Korean women aged over 50 years. For female workers with irregular work patterns, the prevalence of periodontitis was lower than that in workers with regular work patterns by 10.3% (40.3% vs. 30.0%, = 0.011). The annual health examination rate was significantly higher in the irregular group than in the regular group (for men 77.9% vs. 73.5%; < 0.001, for women 76.4% vs. 75.9%; < 0.001). In female workers with irregular work patterns, the annual dental examination rate was significantly higher than that in workers with a regular work pattern by 7.7% (34.3% vs. 26.6%, = 0.043). In conclusion we found a statistically significant difference between the work patterns and prevalence of periodontitis in Korean women aged over 50 years.
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http://dx.doi.org/10.3390/ijerph17114006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312641PMC
June 2020

Association Between Weekend Catch-Up Sleep and Metabolic Syndrome with Sleep Restriction in Korean Adults: A Cross-Sectional Study Using KNHANES.

Diabetes Metab Syndr Obes 2020 1;13:1465-1471. Epub 2020 May 1.

Department of Statistics Pusan National University, Busan 609-735, South Korea.

Background: Many researchers have identified that adequate sleep duration is linked to the quality of life and metabolic diseases. Nowadays, it is hard to take enough sleep, so weekend catch-up sleep (CUS) may be an alternative option in modern society. To our knowledge, no previous studies reported the association between weekend CUS and metabolic syndrome, especially in the Korean population.

Objective: We investigated the association between weekend CUS and the prevalence of metabolic syndrome in Korean adults (≥20 years old) with less than 6 hours of average weekday sleep.

Patients And Methods: A total of 1,453 individuals were selected from the Korean National Health and Nutrition Examination Survey. Weekend CUS was divided into four categories: ≤0 hour, 0-1 hour, 1-2 hours, and ≥2 hours. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived by univariate and multivariate logistic regression analyses.

Results: Participants with weekend CUS ≥1 hour had decreased risk of metabolic syndrome in univariate analysis (CUS 1-2 hours: OR: 0.413, 95% CI: 0.301-0.568; CUS ≥2 hours: OR: 0.382, 95% CI 0.296-0.493). Weekend CUS 1-2 hours reduced the risk of metabolic syndrome in multivariate logistic regression analysis (OR: 0.552, 95% CI: 0.369-0.823). Based on the age group analysis, weekend CUS ≥1 hour reduced the metabolic syndrome among those aged 20-39 and 40-65 (20-39: CUS 1-2 hours OR: 0.248, 95% CI: 0.078-0.783, CUS ≥2 hours OR: 0.374, 95% CI: 0.141-0.991; 40-65: CUS 1-2 hours OR: 0.507, 95% CI 0.309-0.832 CUS ≥2 hours OR: 0.638, 95% CI: 0.415-0.981).

Conclusion: Weekend CUS was associated with a low risk of metabolic syndrome among Korean adults with sleep restriction.
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http://dx.doi.org/10.2147/DMSO.S247898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200717PMC
May 2020

Effects of taichi on grade 1 hypertension: A study protocol for a randomized controlled trial.

Trials 2020 Feb 13;21(1):177. Epub 2020 Feb 13.

Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongnam, 50612, Republic of Korea.

Background: Medication is generally recommended to reduce the morbidity and mortality caused by cardiovascular disease in hypertensive patients. However, considering the difficulties and economic factors associated with long-term medication, interest in taichi as an exercise treatment method has increased recently in Korean medical practice. Numerous studies have suggested that taichi can be used to treat various diseases and that is can affect psychosomatic factors such as anxiety. This study aims to evaluate the effect of taichi in reducing blood pressure among grade 1 hypertensive patients.

Methods/design: In this randomized, active-controlled, assessor-blinded, two parallel-armed trial, 80 grade 1 hypertension patients will be recruited and randomly assigned to the usual care group or to the taichi group (n = 40 in each group). Subjects who voluntarily sign a study agreement will be educated in managing their own blood pressure by restricting salt intake, losing weight, moderating alcohol consumption, performing exercise, and regulating dietary intake at their first visit. In addition to self-management, the taichi group will perform two 60-min taichi sessions per week for a total of 8 weeks. Blood pressure will be measured as the primary outcome. In addition, body composition, heart rate, and the perceived intensity and difficulty of the exercise will be measured as secondary outcomes.

Discussion: This study is a randomized controlled trial of taichi, which is not widely practiced in Korea. It may provide valuable data on the effects of taichi on hypertension, which will inform non-pharmaceutical treatment options for this disorder.

Trial Registration: Clinical Research Information Service, KCT0003632. Registered on 18 March 2019.
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http://dx.doi.org/10.1186/s13063-019-4028-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020504PMC
February 2020

Association between Relative Handgrip Strength and Dyslipidemia in Korean Adults: Findings of the 2014-2015 Korea National Health and Nutrition Examination Survey.

Korean J Fam Med 2020 Nov 12;41(6):404-411. Epub 2020 Feb 12.

Busan Tobacco Control Center, Pusan National University Hospital, Busan, Korea.

Background: Grip strength is a convenient method to measure muscle strength. Recently, relative handgrip strength (HGS) was recommended as a clinical predictor of metabolic health and disease, such as dyslipidemia, which is considered a risk factor for cardiovascular disease. The purpose of this study was to characterize the association between relative HGS and dyslipidemia.

Methods: We included 6,027 adults (2,934 men, 3,093 women) aged 30-69 years who participated in the Korea National Health and Nutrition Examination Survey in 2014 and 2015. Relative HGS was obtained by dividing the HGS by body mass index. Complex sampling analysis was conducted to compare the general characteristics of participants according to the quartiles of relative HGS. Logistic regression analysis was used to examine the association between quartiles of relative HGS and dyslipidemia.

Results: After adjustment for age, prevalence of diabetes mellitus, prevalence of hypertension, alcohol consumption, smoking status, exercise, income, and education level, relative HGS was inversely associated with dyslipidemia in both men and women. In multivariable logistic regression analysis, the odds ratios (95% confidence intervals) for dyslipidemia in quartiles 1, 2, and 3 relative to quartile 4 were 1.36 (1.00-1.83), 1.29 (0.98-1.70), 1.23 (0.95- 1.60) in men and 1.81 (1.30-2.50), 1.81 (1.32-2.47), 1.39 (1.07-1.81) in women, respectively.

Conclusion: Relative HGS was inversely associated with dyslipidemia risk in Korean adults. Muscle-strengthening exercise is recommended to enhance health outcomes.
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http://dx.doi.org/10.4082/kjfm.19.0073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700830PMC
November 2020

Elevated C-reactive protein level, obesity, and quality of life.

J Pak Med Assoc 2019 Dec;69(12):1771-1776

Family Medicine Clinic and Research Institute of Convergence of Biomedical Science and Technology.

Objective: To investigate the association between serum C-reactive protein level and health-related quality of life, and to assess the relationship between the two in terms of controlling for obesity and other covariates.

Methods: The cross-sectional study was conducted retrospectively at university hospital in Yangsan from January to December 2017 using the nationally representative 2015 Korea National Health and Nutrition Examination Survey (KNHANES). High C-reactive protein was defined as level ≥1.0mg/L. Health-related quality of life was assessed using the Euro-Quality of Life-5 dimensions tool. The association between high C-reactive protein and health-related quality of life was analysed using logistic regression analysis and was adjusted for variables. The subjects were categorised into four groups according to the level of C-reactive protein, and the presence of obesity was analysed.

Results: Of the 3376 subjects, 1,413(42%) were men and 1,963(58%) were women. C-reactive protein level was <1.0 in 2490(73.7%) subjects and ≥1.0 in 886(26.2%). High CRP level was associated with low health-related quality of life for mobility and usual activities (p<0.05). However, in multivariable logistic model, the associations ceased to be statistically significant (p>0.05) after adjusting for the presence of obesity.

Conclusions: Obesity was found to play an important role in the association between C-reactive protein and healthrelated quality of life in Korean population.
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http://dx.doi.org/10.5455/JPMA.298182DOI Listing
December 2019

Cancer Survivorship in Primary Care.

Korean J Fam Med 2019 Nov 20;40(6):353-361. Epub 2019 Nov 20.

Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

With the early detection of cancer and improvement in cancer therapy, the number of cancer survivors is rapidly increasing. This number is expected to reach 2 million by the end of 2019. Cancer survivors struggle with not only cancer-related health problems but also diverse acute and chronic diseases. These health issues make cancer survivorship more complex, and proper care coordination is necessary. This study aimed to summarize the definition of cancer experience and management of cancer survivors, specifically focused on gastric, colorectal, lung, breast, thyroid, prostate, and cervical cancers. Furthermore, it aimed to discuss the role of primary care in cancer survivorship and survivorship care models and the National Policy for Cancer Survivors and Future Challenges.
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http://dx.doi.org/10.4082/kjfm.19.0108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887764PMC
November 2019

Association between new anthropometric parameters and arterial stiffness based on brachial-ankle pulse wave velocity.

Diabetes Metab Syndr Obes 2019 3;12:1727-1733. Epub 2019 Sep 3.

Department of Family Medicine, Pusan National University School of Medicine, Yangsan 626-780, South Korea.

Background: Obesity is an important risk factor of cardiovascular disease (CVD). Atherosclerosis can be considered an important signal of CVD. Primary physicians can reduce the risk of CVD by preventing and treating obesity. Therefore, finding a tool to diagnose the association of obesity with arteriosclerosis is important. The association between obesity parameters and arterial stiffness remains controversial. To our knowledge, no previous studies reported the relationships between multiple new anthropometric parameters (a body shape index [ABSI], body round index [BRI], and visceral adiposity index [VAI]) and brachial-ankle wave velocity (ba-PWV) as an indicator of CVD risk, especially in the Korean population.

Objective: To investigate the relationships between arterial stiffness (assessed using ba-PWV) and anthropometric parameters estimated on the basis of body mass index (BMI), waist circumference (WC), ABSI, BRI, and VAI, and to identify the indicators of obesity that best represents CVD risk.

Methods: A total of 2,647 adults (1,474 men and 1,173 women) were recruited for this cross-sectional study. The correlations between the anthropometric indexes (BMI, WC, ABSI, BRI, and VAI) and mean ba-PWV were analyzed. A multivariate linear regression analysis was performed to evaluate the association between each anthropometric and the presence of arterial stiffness.

Results: We investigated the relationships between the obesity parameters and ba-PWV by adjusting the covariates (age, diabetes mellitus [DM], hypertension [HTN], and smoking status) related to the mean ba-PWV. In the multivariate regression analysis, ABSI (men: =0.066, <0.01; women: =0.087, <0.001) and VAI (men: =0.067, <0.01; women: =0.136, <0.001) were found to be significantly correlated with the mean ba-PWV in both men and women in Korea.

Conclusion: Among the new obesity indices, ABSI and VAI were found to be significantly associated with arterial stiffness, represented by the mean ba-PWV, in both men and women in Korea. These results suggest that ABSI and VAI may be convenient, highly cost-effective, and simple assessment tools for obesity and CVD risk in clinical practice.
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http://dx.doi.org/10.2147/DMSO.S211542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731955PMC
September 2019

The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes.

Korean J Fam Med 2019 May 10;40(3):176-181. Epub 2019 May 10.

Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.

Background: The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes.

Methods: We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation.

Results: Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009- 3.236) and 1.834 (95% confidence interval, 1.162-2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline.

Conclusion: In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.
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http://dx.doi.org/10.4082/kjfm.18.0139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536908PMC
May 2019

Feasibility of Early Application of an Advance Directive at the Time of First-Line Palliative Chemotherapy in Patients With Incurable Cancer: A Prospective Study.

Am J Hosp Palliat Care 2019 Oct 26;36(10):893-899. Epub 2019 Mar 26.

2 Department of Medical Oncology and Hematology, Hanil General Hospital, Seoul, Korea.

Context: This study aimed to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments between before and after AD.

Methods: Patients with advanced cancer who had just started palliative chemotherapy were prospectively enrolled. We assessed attitudes toward chemotherapy, Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) before conducting the AD and subsequently performed the AD after the first cycle of chemotherapy. Follow-up evaluations using same parameters were performed in the next cycle visit.

Results: During the study period, 104 patients started palliative chemotherapy. Among them, 41 patients (11 with cognitive impairment at baseline, 14 with clinical deteriorations after the first cycle of chemotherapy, 6 with follow-up loss, 7 without proxy, 3 with protocol violations) were excluded, and the AD were recommended in the remaining 64 patients (proportion of AD recommendation: 62%). Among the 64 patients, 44 agreed to conduct the AD (proportion of AD consent: 69%). There were no significant changes before and after AD in terms of HADS and EORTC-QLQ. Attitudes regarding chemotherapy were also unchanged ( = .773). A total of 36 (82%) patients followed physician's recommendations, with the exception of 8 patients who terminated chemotherapy due to refusal or loss to follow-up.

Conclusions: Considering our results showing no significant changes in depression and anxiety scores, QoL, and attitudes toward anticancer treatments after the AD, early integration of the AD at initiation of first-line palliative chemotherapy might be feasible.
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http://dx.doi.org/10.1177/1049909119839355DOI Listing
October 2019

Secondhand smoke knowledge, sources of information, and associated factors among hospital staff.

PLoS One 2019 22;14(1):e0210981. Epub 2019 Jan 22.

Department of Family Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.

Purpose: To evaluate knowledge of secondhand smoke (SHS) risks, sources of information, and associated factors and behaviors among hospital staff.

Methods: We conducted a cross-sectional survey using a 40-item self-administered questionnaire among 328 employees at a university hospital. The questions on representative diseases related to SHS were used to measure the degree of knowledge of SHS. Multiple regression analysis was used to determine the correlation between SHS knowledge scores and variables.

Results: Females had better SHS knowledge scores than males, regardless of smoking status (p<0.05). SHS knowledge was positively correlated with cessation education in males, non-smokers, and the total sample (β = 3.950, 2.356, and 2.684, respectively, p<0.05). It was correlated with the experience of any SHS exposure-related symptoms in males, non-smokers, and the total sample (β = 3.950, 2.356, and 2.684, respectively, p<0.05) and discomfort when exposed to SHS in non-smokers and the total sample (β = 0.670 and 0.821, respectively, p<0.05).

Conclusion: SHS knowledge is high among females, when hospital staff are educated about SHS risks, and when they have experienced any SHS exposure-related symptoms or felt uncomfortable when exposed to SHS. SHS risk education is an effective tool to increase SHS knowledge in hospital staff.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210981PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342318PMC
November 2019

Metabolic syndrome as a risk factor for high intraocular pressure: the Korea National Health and Nutrition Examination Survey 2008-2010.

Diabetes Metab Syndr Obes 2019 14;12:131-137. Epub 2019 Jan 14.

Department of Family Medicine, Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-780, Korea,

Background: High intraocular pressure (IOP) is well established as the most significant risk factor for both the development and progression of primary open-angle glaucoma. Elevated IOP is more frequently seen in the presence of metabolic disturbances that are associated with the components of metabolic syndrome (MetS). The aim of this study was to investigate the association between ocular hypertension and MetS.

Patients And Methods: We examined the relationship between ocular hypertension and MetS in 17,160 Korean adults without glaucoma aged >19 years (7,368 men and 9,792 women) who participated in the 2008-2010 Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analysis was used to assess the relationship between MetS and ocular hypertension, after adjusting for age, body mass index, smoking, alcohol consumption, and regular exercise.

Results: The prevalence of MetS was 35.1% among males and 30.1% among females. The prevalence of ocular hypertension was 1.3% among males with MetS and 0.7% among females with MetS. Participants with MetS had a significantly higher IOP than those without MetS (≤0.001), and each component of MetS had a different effect on the IOP. Hypertension was the strongest predictor of an elevated IOP. In multivariate regression analysis, ocular hypertension was significantly associated with MetS (=0.027 for men; =0.015 for women).

Conclusion: There is a statistically significant relationship between MetS and ocular hypertension.
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http://dx.doi.org/10.2147/DMSO.S185604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336017PMC
January 2019

HMGCLL1 is a predictive biomarker for deep molecular response to imatinib therapy in chronic myeloid leukemia.

Leukemia 2019 06 16;33(6):1439-1450. Epub 2018 Dec 16.

Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.

Achieving a deep molecular response (DMR) to tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML) remains challenging and at present, there is no biomarker to predict DMR in this setting. Herein, we report that an HMGCLL1 genetic variant located in 6p12.1 can be used as a predictive genetic biomarker for intrinsic sensitivity to imatinib (IM) therapy. We measured DMR rate according to HMGCLL1 variant in a discovery set of CML patients (n = 201) and successfully replicated it in a validation set (n = 270). We also investigated the functional relevance of HMGCLL1 blockade with respect to response to TKI therapy and showed that small interfering RNA mediated blockade of HMGCLL1 isoform 3 results in significant decrease in viability of BCR-ABL1-positive cells including K562, CML-T1 or BaF3 cell lines with or without ABL1 kinase domain mutations such as T315I mutation. Decreased cell viability was also demonstrated in murine CML stem cells and human hematopoietic progenitor cells. RNA sequencing showed that blockade of HMGCLL1 was associated with G0/G1 arrest and the cell cycle. In summary, the HMGCLL1 gene polymorphism is a novel genetic biomarker for intrinsic sensitivity to IM therapy in CML patients that predicts DMR in this setting.
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http://dx.doi.org/10.1038/s41375-018-0321-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756062PMC
June 2019

Correlation between dermal thickness and scar formation in female patients after thyroidectomy.

Arch Craniofac Surg 2018 Jun 30;19(2):120-126. Epub 2018 Jun 30.

Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.

Background: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment.

Methods: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery.

Results: There was a positive correlation between dermal thickness and scar score (p<0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p<0.05).

Conclusion: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.
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http://dx.doi.org/10.7181/acfs.2018.01907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057126PMC
June 2018

Graves Disease Is Associated With Endometriosis: A 3-Year Population-Based Cross-Sectional Study.

Medicine (Baltimore) 2016 Mar;95(10):e2975

From the Department of Obstetrics and Gynecology (J-SY, E-JP, Y-SS, HJK, WIP), School of Medicine, Eulji University, Daejeon; Department of Obstetrics and Gynecology (J-SY), MizMedi Hospital, Seoul; and Department of Family Medicine (S-YK), Yonsei Spring Clinic, Gyeonggi, Korea.

The aim of this cross-sectional study was to compare the prevalence of thyroid diseases between women with and without endometriosis.We established the endometriosis group according to diagnosis codes, surgery codes, and gonadotropin-releasing hormone agonist codes using the Korean Health Insurance Review and Assessment Service-National Inpatients Sample (HIRA-NIS) from 2009 to 2011. Four controls were randomly matched to each endometriosis case. Thyroid disease cases were selected using the thyroid disease diagnosis code (E0X).Among the 1,843,451 women sampled, 5615 had endometriosis; 22,460 controls were matched to the endometriosis cases. After adjustment for age and sampling year, Graves disease was associated with endometriosis (odds ratio [OR]: 2.52; 95% CI: 1.30-4.88; P < 0.01), while hypothyroidism was not (OR: 1.17; 95% CI: 0.90-1.52; P = 0.25). Autoimmune hypothyroidism was also not associated with endometriosis (OR: 1.61; 95% CI: 0.88-2.94; P = 0.12).This study revealed an association between Graves disease and endometriosis.
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http://dx.doi.org/10.1097/MD.0000000000002975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998884PMC
March 2016

Urinary Malondialdehyde Is Associated with Visceral Abdominal Obesity in Middle-Aged Men.

Mediators Inflamm 2015 11;2015:524291. Epub 2015 Oct 11.

Research And Statistical Support, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, Republic of Korea.

The purpose of the present study was to investigate multiple anthropometric parameters used to evaluate obesity, particularly visceral abdominal fat area, and various metabolic parameters including malondialdehyde (MDA) as an oxidative stress marker. We evaluated various measures of obesity, including body mass index (BMI), waist circumference (WC), sagittal abdominal diameter, fat percentages using dual-energy X-ray absorptiometry, visceral fat area (VFA), subcutaneous fat area, multiple biomarkers related to metabolic disease, and urinary MDA, in 73 asymptomatic middle-aged men who were not severely obese. We examined relationships between multiple measures of obesity, metabolic markers, and urinary MDA levels and evaluated associations between VFA and urinary MDA. In the visceral obesity group, γ-glutamyl transferase (GGT), uric acid, and urinary MDA levels were significantly higher than in the nonvisceral obesity group (P = 0.008, P = 0.002, and P = 0.018). Urinary MDA (r = 0.357, P = 0.002) and uric acid (r = 0.263, P = 0.027) levels were only significantly positively correlated with VFA among measures of obesity. Urinary MDA, serum GGT, and serum CRP were significantly positively associated with VFA (P = 0.001, P = 0.046, and P = 0.023, resp.), even after adjusting for BMI and WC.
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http://dx.doi.org/10.1155/2015/524291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619966PMC
August 2016

A case of spitzoid melanoma.

Ann Dermatol 2015 Apr 24;27(2):206-9. Epub 2015 Mar 24.

Department of Dermatology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Spitzoid melanoma is a subtype of melanoma that, clinically and histologically, resembles a Spitz nevus. Clinically, spitzoid melanomas usually evolve from amelanotic nodular lesions, growing to 1 cm or more in diameter. They often remain clinically undiagnosed because of their wide variety of clinical appearances and a lack of pigmentation. Distinguishing a Spitz nevus from a spitzoid melanoma can be extremely difficult. Features that favor the diagnosis of a spitzoid melanoma are asymmetrical shape, diameter greater than 1 cm, a lesion with a deep invasive component, and a high degree of cytologic atypia. There have been only rare reports in the literature of the presence of giant cells in malignant melanoma, and the presence of these cells may result in its misdiagnosis as a histiocytic tumor. We present a case of spitzoid melanoma on the right ankle of a 22-year-old-woman.
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http://dx.doi.org/10.5021/ad.2015.27.2.206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377413PMC
April 2015

Changes in physical activity and cognitive decline in older adults living in the community.

Age (Dordr) 2015 24;37(2):20. Epub 2015 Feb 24.

Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164 World cup-ro, Youngtong-gu, Suwon, 443-380, Republic of Korea,

Accumulating evidence suggests that physical activity may be beneficial in preserving cognition in late life. This study examined the association between baseline and changes in physical activity and cognitive decline in community-dwelling older people. Data were from the Korean Longitudinal Study of Aging, with 2605 aged 65 years and older subjects interviewed in 2006 and followed up for 2 years. Cognitive decline was defined by calculating the Reliable Change Index using the Mini-Mental State Examination. Physical activity levels were categorized as sedentary, low, or high. Changes in physical activity were classified as inactive, decreaser, increaser, or active. Logistic regression analysis of baseline and changes in physical activity with cognitive decline was performed. Compared with the sedentary group at baseline, both the low and high activity groups were less likely to experience cognitive decline. The active (odds ratio [OR] = 0.40, 95 % confidence interval [CI] 0.23-0.68) and increaser (OR = 0.45, 95 % CI 0.27-0.74) group, compared with the inactive counterpart, demonstrated a significantly lower likelihood of cognitive decline. Older adults who remained active or increased activity over time had a reduced risk of cognitive decline. Engagement in physical activity in late life may have cognitive health benefits.
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http://dx.doi.org/10.1007/s11357-015-9759-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338105PMC
February 2016

Case of keratosis punctata palmaris et plantaris with unusual skin manifestation.

J Dermatol 2015 Jan 10;42(1):110-1. Epub 2014 Dec 10.

Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

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http://dx.doi.org/10.1111/1346-8138.12733DOI Listing
January 2015

Indispensable platforms for bioimmobilization: maleimide-based thiol reactive hydrogels.

Bioconjug Chem 2014 Nov 9;25(11):2004-11. Epub 2014 Oct 9.

Department of Chemistry and ‡Center for Life Sciences and Technologies, Bogazici University , Istanbul 34342, Turkey.

Poly(ethylene glycol)-based hydrogels containing thiol-reactive maleimide functional groups is prepared via a Diels-Alder/retro Diels-Alder reaction sequence using a masked maleimide monomer. Bulk and micropatterned hydrogels containing varying amounts of the thiol-reactive maleimide functional group are fabricated at ambient temperature. During the fabrication, the reactive maleimide functional group in the monomer is masked with a furan moiety and then unmasked to its reactive form via the retro-Diels-Alder reaction. The reactive maleimide groups embedded within the hydrogel are amenable to facile and efficient functionalization with thiol-containing molecules such as fluorescent dyes. Furthermore, these hydrogels are readily biotinylated using the nucleophilic thiol-ene conjugation to enable immobilization of streptavidin onto the hydrogel patterns to achieve facile bioimmobilization. Notably, the extent of functionalization of these hydrogels can be easily tailored by varying the amount of reactive handles incorporated during their fabrication.
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http://dx.doi.org/10.1021/bc500375rDOI Listing
November 2014

Discovery of novel pyrimidine and malonamide derivatives as TGR5 agonists.

Bioorg Med Chem Lett 2014 Sep 18;24(17):4271-5. Epub 2014 Jul 18.

College of Pharmacy, Chung-Ang University, Seoul 156-756, Republic of Korea. Electronic address:

Takeda G-protein-coupled receptor 5 (TGR5) is a promising molecular target for metabolic diseases. A series of 4-(2,5-dichlorophenoxy)pyrimidine and cyclopropylmalonamide derivatives were synthesized as potent agonists of TGR5 based on a bioisosteric replacement strategy. Several compounds exhibited improved potency, compared to a reference compound with a pyridine scaffold. The pharmacokinetic profile of the representative compound 18 was considered moderate.
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http://dx.doi.org/10.1016/j.bmcl.2014.07.026DOI Listing
September 2014

Automatic delirium prediction system in a Korean surgical intensive care unit.

Nurs Crit Care 2014 Nov 24;19(6):281-91. Epub 2013 Oct 24.

Surgical Intensive Care Unit, Seoul St. Mary's Hospital, Seoul, Korea.

Background: In Korea, regular screening for delirium is not considered essential. In addition, delirium is often associated with vague concepts, making it harder to identify high-risk patients and impeding decision-making.

Aims: To assess the impact of the Automatic PREdiction of DELirium in Intensive Care Units (APREDEL-ICU) system on nursing-sensitive and patient outcomes for surgical ICU patients and to evaluate nurse satisfaction with the system and its usability.

Methods: A pre-post research design was adopted. Our study included 724 patients admitted before the implementation of the APREDEL-ICU (January to December 2010) and 1111 patients admitted after the system was installed (May 2011 to April 2012). The APREDEL-ICU uses a pop-up window message to inform the nursing staff of patients at risk for delirium, allowing evidence-based nursing interventions to be applied to the identified patients. A total of 42 nurses were surveyed to determine the system's usability and their level of satisfaction with it.

Results: After the implementation of APREDEL-ICU, high-risk patients, determined using a prediction algorithm, showed a slight decrease in the incidence of delirium, but the changes were not significant. However, significant decreases in the number and duration of analgesic/narcotic therapies were observed after the implementation of the system. Nurse self-evaluation results showed an improvement in all categories of knowledge regarding delirium care.

Conclusion: The use of a prediction and alerting system for ICU patients at high risk of delirium showed a potential increase in the quality of delirium care, including early detection and proper intervention.
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http://dx.doi.org/10.1111/nicc.12048DOI Listing
November 2014
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