PREDICTORS OF HEALTHCARE OUTCOMES AT THE LOCAL COMMUNITY LEVEL: VARIATIONS IN THE VALUE OF HEALTHCARE SERVICES UNDER KOREA’S UNIVERSAL HEALTH INSURANCE SYSTEM

Abstract Objectives: To determine the possible relationship between the premature death and national health insurance (NHI) healthcare services expenditures (HE) at the local community level, and possible local determinants of health that might affect the variation in premature deaths among 231 local communities (n=231). Methods: Based on the simplified Local Determinants of Health (LDH) framework, a value of HE model for local healthcare services (HS) was designed, and the following health outcome variables were defined: Years of Potential Life Lost before age 75 (YPLL-75) of all premature deaths and YPLL-75s of premature deaths due to Cancers and Suicide in 231 local communities. The incremental Value of HS models and Multiple Linear Regression (MLR) models (n = 231 local communities) for all NHI HS as well as healthcare services for cancers and mental health problems were constructed to determine the relationships between the averted YPLLs (the dependent variables) and the changes of NHI HE (the main independent variable) between 2007 and 2012 at the local community level. In the MLR models, 16 independent variables were included in order to represent determinants of health outcomes. Results: Overall, the recently increased NHI HE at the local community level was associated with a decrease of premature deaths under the Korean NHI system. But the regional variations in the values of HS were somewhat large. Specifically, when the various determinants of health were considered and controlled in the MLR model, the influences of the NHI HE increases on the health outcomes (the averted YPLLs) were very limited. More specifically it was found that in the important healthcare service areas like cancer care and mental health care, the values of HS showed negative ratios and diminishing trends as the NHI HE increased among communities. Regardless of NHI HE’s increases, certain determinants of health including some biological and behavioral factors, affected the health outcomes directly and modified the values of NHI HE as well. Conclusions: Improving the biological and behavioral health status and targeted health policies for low health performance areas are important to improve the health outcomes in terms of YPLLs and the value of NHI HE in Korea

Design, Field Evaluation, and Traffic Analysis of a Competitive Autonomous Driving Model in a Congested Environment

Recently, numerous studies have investigated cooperative traffic systems using the communication among vehicle-to-everything (V2X). Unfortunately, when multiple autonomous vehicles are deployed while exposed to communication failure, there might be a conflict of ideal conditions between various autonomous vehicles leading to adversarial situation on the roads. In South Korea, virtual and real-world urban autonomous multi-vehicle races were held in March and November of 2021, respectively. During the competition, multiple vehicles were involved simultaneously, which required maneuvers such as overtaking low-speed vehicles, negotiating intersections, and obeying traffic laws. In this study, we introduce a fully autonomous driving software stack to deploy a competitive driving model, which enabled us to win the urban autonomous multi-vehicle races. We evaluate module-based systems such as navigation, perception, and planning in real and virtual environments. Additionally, an analysis of traffic is performed after collecting multiple vehicle position data over communication to gain additional insight into a multi-agent autonomous driving scenario. Finally, we propose a method for analyzing traffic in order to compare the spatial distribution of multiple autonomous vehicles. We study the similarity distribution between each team's driving log data to determine the impact of competitive autonomous driving on the traffic environment

Favorable prognosis in colorectal cancer patients with co-expression of c-MYC and ß-catenin

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Abstract Background The purpose of our research was to determine the prognostic impact and clinicopathological feature of c-MYC and β-catenin overexpression in colorectal cancer (CRC) patients. Methods Using immunohistochemistry (IHC), we measured the c-MYC and β-catenin expression in 367 consecutive CRC patients retrospectively (cohort 1). Also, c-MYC expression was measured by mRNA in situ hybridization. Moreover, to analyze regional heterogeneity, three sites of CRC including the primary, distant and lymph node metastasis were evaluated in 176 advanced CRC patients (cohort 2). Results In cohort 1, c-MYC protein and mRNA overexpression and ß-catenin nuclear expression were found in 201 (54.8 %), 241 (65.7 %) and 221 (60.2 %) of 367 patients, respectively, each of which was associated with improved prognosis (P = 0.011, P = 0.012 and P = 0.033, respectively). Moreover, co-expression of c-MYC and ß-catenin was significantly correlated with longer survival by univariate (P = 0.012) and multivariate (P = 0.048) studies. Overexpression of c-MYC protein was associated with mRNA overexpression (ρ, 0.479; P  0.05). Conclusions Co-expression of c-MYC and ß-catenin was independently correlated with favorable prognosis in CRC patient. We concluded that the expression of c-MYC and ß-catenin might be useful predicting indicator of CRC patients prognosis

ARGem: a new metagenomics pipeline for antibiotic resistance genes: metadata, analysis, and visualization

Antibiotic resistance is of crucial interest to both human and animal medicine. It has been recognized that increased environmental monitoring of antibiotic resistance is needed. Metagenomic DNA sequencing is becoming an attractive method to profile antibiotic resistance genes (ARGs), including a special focus on pathogens. A number of computational pipelines are available and under development to support environmental ARG monitoring; the pipeline we present here is promising for general adoption for the purpose of harmonized global monitoring. Specifically, ARGem is a user-friendly pipeline that provides full-service analysis, from the initial DNA short reads to the final visualization of results. The capture of extensive metadata is also facilitated to support comparability across projects and broader monitoring goals. The ARGem pipeline offers efficient analysis of a modest number of samples along with affordable computational components, though the throughput could be increased through cloud resources, based on the user’s configuration. The pipeline components were carefully assessed and selected to satisfy tradeoffs, balancing efficiency and flexibility. It was essential to provide a step to perform short read assembly in a reasonable time frame to ensure accurate annotation of identified ARGs. Comprehensive ARG and mobile genetic element databases are included in ARGem for annotation support. ARGem further includes an expandable set of analysis tools that include statistical and network analysis and supports various useful visualization techniques, including Cytoscape visualization of co-occurrence and correlation networks. The performance and flexibility of the ARGem pipeline is demonstrated with analysis of aquatic metagenomes. The pipeline is freely available at https://github.com/xlxlxlx/ARGem

A standardized pathology report for gastric cancer: 2nd edition

The first edition of ‘A Standardized Pathology Report for Gastric Cancer’ was initiated by the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists and published 17 years ago. Since then, significant advances have been made in the pathologic diagnosis, molecular genetics, and management of gastric cancer (GC). To reflect those changes, a committee for publishing a second edition of the report was formed within the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. This second edition consists of two parts: standard data elements and conditional data elements. The standard data elements contain the basic pathologic findings and items necessary to predict the prognosis of GC patients, and they are adequate for routine surgical pathology service. Other diagnostic and prognostic factors relevant to adjuvant therapy, including molecular biomarkers, are classified as conditional data elements to allow each pathologist to selectively choose items appropriate to the environment in their institution. We trust that the standardized pathology report will be helpful for GC diagnosis and facilitate large-scale multidisciplinary collaborative studies

Thoracoscopic Patch Insulation for Phrenic Nerve Stimulation after Permanent Pacemaker Implantation

One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation

Optimal timing of heart transplantation in patients with an implantable left ventricular assist device

Heart transplantation (HTPL) has been established as the gold-standard surgical treatment for end-stage heart failure. However, the use of a left ventricular assist device (LVAD) as a bridge to HTPL has been increasing due to the limited availability of HTPL donors. Currently, more than half of HTPL patients have a durable LVAD. Advances in LVAD technology have provided many benefits for patients on the waiting list for HTPL. Despite their advantages, LVADs also have limitations such as loss of pulsatility, thromboembolism, bleeding, and infection. In this narrative review, the benefits and shortcomings of LVADs as a bridge to HTPL are summarized, and the available literature evaluating the optimal timing of HTPL after LVAD implantation is reviewed. Because only a few studies have been published on this issue in the current era of third-generation LVADs, future studies are needed to draw a definite conclusion

Occurrence rate and fate of competitive flow of the left internal thoracic artery used in Y-composite grafts

© 2022 The Author(s)Objectives: We evaluated the occurrence rate of competitive flow and the fate of grafts of left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis after coronary artery bypass grafting with Y-composite grafts using early and 1-year angiography. Methods: From 2008 to 2017, 923 patients underwent off-pump coronary artery bypass grafting using Y-composite grafting based on the in situ LITA. Early postoperative angiography was performed for all patients. One-year angiography (mean, 13.2 ± 3.1 months) was performed for 86.7% (800 of 923) of patients. Results: The early occlusion rate of LITA with Y-composite graft (CompLITA) to LAD was 0.7%. Among 917 patent CompLITA-LAD grafts, competitive flow was observed in 39 patients (4.3%). Multivariable analysis showed that the degree of LAD stenosis (odds ratio, 0.897; 95% CI, 0.875-0.920; P < .001) and 3-vessel disease (odds ratio, 5.632; 95% CI, 1.168-27.155; P = .031) were factors associated with the occurrence of competitive flow of CompLITA-LAD grafts. The receiver operating characteristics curve determined that the cutoff degree of LAD stenosis was 82.5% (sensitivity 82.1% and specificity 85.2%). The failure rate of CompLITA-LAD grafts seen on 1-year angiography was 58.3% in patients with competitive flow. Among patients with competitive flow, left main coronary artery disease was a protective factor (odds ratio, 0.055; 95% CI, 0.009-0.337; P = .002) against graft failure of the CompLITA-LAD seen on 1-year angiography. Conclusions: In CompLITA-LAD, the degree of LAD stenosis and combined 3-vessel disease were associated with the occurrence of competitive flow. CompLITA-LAD grafts with early competitive flow showed a high 1-year graft failure rate of 58%.N

Patterns and Prognostic Significance of Cervical Lymph Node Metastasis and the Efficacy of Cervical Node Dissection in Esophageal Cancer

Background: The clinical value of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to identify the patterns and prognostic significance of cervical lymph node metastasis (CLNM) in ESCC. Methods: A r etrospective r eview of 7 7 patients with E SCC who underwent esophagectomy and 3FLND between 2002 and 2016 was conducted. For each cervical node level, the efficacy index (EI), overall survival, recurrence rate, and complication rate were compared. Results: CLNM was identified in 34 patients (44.2%) who underwent 3FLND. Patients with CLNM had a significantly lower overall survival rate (22.7% vs. 58.2%) and a higher recurrence rate (45.9% vs. 16.3%) than patients without CLNM. CLNM was an independent predictor of recurrence in ESCC patients. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% confidence interval, 2.0 to 57.5; p= 0.005). Level IV dissection had the highest EI, and level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Conclusion: CLNM was a significant prognostic factor for ESCC patients and was more common among patients with advanced nodal stages. Level IV exhibited the highest risk of metastasis, and dissection at level IV may be crucial when performing 3FLND, especially in advanced nodal stage disease