BackgroundHeart failure (HF) is one of the leading causes of morbidity and mortality in South Korea. With the rapidly aging population in the country, the prevalence of HF and its associated costs are expected to rise continuously. This study was carried out to estimate the prevalence and economic burden of HF in order to understand its impact on our society.MethodsA prevalence-based, cost-of-illness study was conducted using the 2014 Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) data. Adult HF patients were defined as those aged ≥19 years who had at least one insurance claim record with a primary or secondary diagnosis of HF (ICD-10 codes of I11.0, I13.0, I13.2, and I50.x). The costs consist of direct costs (i.e., medical and non-medical costs) and indirect costs (i.e., productivity loss cost due to morbidity and premature death). Subgroup analyses were conducted by age group, history of HF hospitalization, and type of universal health security program enrolled in.ResultsA total of 475,019 adults were identified to have HF in 2014. The estimated prevalence rate of HF was 12.4 persons per 1,000 adults. According to the base cases and the extended definition of the cases, the annual economic burden of HF from a societal perspective ranges from USD 1,414.0 to 1,560.5 for individual patients, and from USD 752.8 million to 1,085.6 million for the country. A high percentage (68.5 %) of this socioeconomic burden consist of medical costs, followed by caregiver’s cost (13.2 %), productivity loss costs due to premature death (10.8 %) and morbidity (4.2 %), and transportation costs (3.4 %). The HF patients with prior hospitalization due to HF annually spent 9.7 times more for National-Health-Insurance-covered medical costs compared to HF patients who were not previously hospitalized.ConclusionsIn the present study, HF patients who were older and had a history of prior hospitalization for HF as well as an indigent status were shown at high risk of spending more for healthcare to treat their HF. An effective disease management protocol should be employed to target this patient group.

Mucosal inflammation is characterized by neutrophil and mononuclear cell infiltration. This study aimed to determine the gastric and duodenal microbiota associated with histological, endoscopic, and symptomatic gastritis. Dyspeptic adults who presented for evaluation were included. Subjects with either comorbidities or recent drug intake were excluded. Three endoscopic biopsies were obtained from the antrum, body, and duodenum. Next-generation sequencing for 16S ribosomal RNA V1–V2 hypervariable regions was performed. The correlation between the composition of microbiota and the degree of inflammatory cell infiltration, endoscopic findings, and Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM) score was analyzed. In 98 included subjects, microbial communities in the antrum and body showed Bray–Curtis similarity; however, those in the duodenum showed dissimilarity. Histological and endoscopic gastritis was associated with the abundance of Helicobacter pylori and that of commensal bacteria in the stomach. The abundances of Variovorax paradoxus and Porphyromonas gingivalis were correlated with histological gastritis, but not with endoscopic or symptomatic gastritis. The total PAGI-SYM score showed a stronger correlation with the duodenal microbiota (Prevotella nanceiensis and Alloprevotella rava) than with the gastric microbiota (H. pylori, Neisseria elongate, and Corynebacterium segmentosum). Different correlations of the gastric and duodenal microbiota with histological, endoscopic, and symptomatic gastritis were observed for the first time at the species level. H. pylori-negative gastritis is not associated with endoscopic or symptomatic gastritis. Only H. pylori-induced endoscopic gastritis requires gastric cancer surveillance. Owing to the weak correlation with H. pylori, symptomatic gastritis should be assessed separately from histological and endoscopic gastritis.

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Aims Haemophilia A patients with factor VIII inhibitors (HAPI) experience frequent spontaneous bleeding, approximately once a week, and require expensive bypassing agent (BPA) treatments to control bleeding over their lifetime. According to the HAVEN 1 trial, weekly emicizumab (Hemlibra®) prophylaxis injection reduces annualized bleeding rates (ABR) by 87% compared with BPA on‐demand treatment (BPA‐OD) administered at the time of bleeding. Our study aimed to assess the cost‐effectiveness of emicizumab prophylaxis in HAPI in Korea. Methods Using a lifetime Markov model with health states of ‘alive with bleeds’ and ‘dead’, we simulated the experience of HAPI receiving emicizumab prophylaxis (treatment arm) or BPA‐OD (control arm) and estimated expected clinical and economic outcomes under each treatment arm. Model parameters included comparative effectiveness, clinical and epidemiologic characteristics of Korean HAPI, costs of drug treatment and medical events and utility for ‘alive with bleeds’ state under each treatment. We utilized local data, including National Health Insurance claims data, national statistics, literature and expert surveys with haematologists. Results Base‐case analysis results showed that compared with BPA‐OD, lifetime emicizumab prophylaxis prevented 807 bleedings, extended 3.04 quality‐adjusted life‐years and reduced costs by 2.6 million US dollars. Thus, emicizumab prophylaxis is a dominant treatment option with better effectiveness and lower costs than BPA‐OD. A series of one‐way sensitivity analyses consistently showed dominant results, confirming that lifetime emicizumab prophylaxis is a cost‐saving intervention for HAPI. Conclusion Emicizumab prophylaxis is an excellent treatment choice reducing ABR, improving quality of life and reducing costs.

Presently, it is important to address the harmful effects of environmental chemicals on living organisms. The toxic effects of bisphenol A (BPA), one of the endocrine disruption chemicals (EDCs), have been documented in many studies since the 1930s. However, BPA has continued to be used to make polycarbonate plastic, etc. Therefore, it is necessary to conduct toxicogenomic studies to assess the harmful effects of BPA. In this study, microarray technology was used to study the harmful effects format the genomic level. We used two types of microarray chips to study of the relationship between gene and miRNA expression profiles, the Agilent mouse genome 4 44 K array for gene expression profiling and the Agilent mouse miRNA v13 for miRNA expression profiling. As a result, we identified 37 miRNAs that were 2-fold up-or down-regulated within 24 hrs than 3 hrs of BPA treat times. The gene expression patterns related to miRNAs were classified into a total of 4 groups. The first and third groups and the second and fourth groups had similar functions to each other as determined by related gene expression. In the first and third groups included overexpressed genes that were related to metabolism. The second and fourth groups included overexpressed genes that were related to reproduction. miRNA expression levels were exchanged for BPA degradation. So, genes of related metabolism were overexpressed. This result was occurred the side effect that was down-expression of reproduction. Thus, miRNAs were regulated by BPA, and gene expression was subsequently regulated by miRNAs.