PURPOSE: To compare 2 surgical techniques, endoscopic transnasal reconstruction and transcaruncular reconstruction in isolated medial orbital wall fractures. METHODS: This study included 79 isolated medial orbital wall fracture patients from January 2011 to December 2012 of Department of Ophthalmology, Inha University Hospital. The authors compared computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-surgery. Thirty-five patients received endoscopic transnasal reconstruction and 44 received transcaruncular reconstruction. RESULTS: The 2 surgical methods showed no significant differences in primary gaze diplopia (p = 0.50), restriction of EOM movements (p = 0.48), remaining enophthalmos of more than 2 mm (p = 0.99), and improvement in enophthalmos (p = 0.07) when compared 6 months after surgery. Statistically significant differences were observed in peripheral diplopia (p = 0.04) 6 months after surgery. CONCLUSIONS: The 2 surgical methods present similar effectiveness in postoperative primary gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic transnasal reconstruction method showed advantages. The surgical method should be selected by comparing advantages and disadvantages.
Diplopia ; Enophthalmos ; Humans ; Ophthalmology ; Orbit*

PURPOSE: To evaluate the validity and usefulness of the waist circumference-to-height ratio (WHtR) in screening for metabolic syndrome in Korean adolescents aged 17~19 years. METHODS: Data (body mass index, waist circumference, and height) and blood samples were obtained from adolescents in A University Hospital in 2011. This study included 554 adolescents (176 boys and 378 girls) aged 17~19 years. Dependent variables were systolic and diastolic blood pressure, fasting blood glucose (FBS), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). Using the Pearson's correlation analysis and logistic regression analysis, we measured the WHtR against Body mass index (BMI). RESULTS: An assessment was carried out of the ability of the 2 indexes to 1) account for the variability in each metabolic risk factor and 2) correctly identify adolescents with metabolic risk factors. The results revealed that the predictive abilities of the waist-to-height ratio index were better values. The waist-to-height ratio showed superior values in predicting concentrations of DBP, FBS, TC, TG and LDL-C. However, BMI showed better values in identifying adolescents with high systolic blood pressure and HDL-C. 3) Normal weight adolescents (BMI: 5th< or =BMI<85th percentiles) were divided by WHtR (obesity cutoff value: > or =0.51 in male, > or =0.49 in female). WHtR was better than the BMI index for signaling metabolic risk in the normal-weight adolescents. CONCLUSION: The WHtR is a better predictor for finding metabolic risk factors in adolescents aged 17~19 years with normal BMI. The WHtR is proposed as an alternative, convenient measure of screening metabolic syndrome for adolescents aged 17~19 years independent of age and sex.
Adolescent ; Aged ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol ; Fasting ; Humans ; Logistic Models ; Male ; Mass Screening ; Risk Factors ; Waist Circumference

Purpose: The study aimed to design and develop an automated personalized self-care (APSC) program for patients with type 2 diabetes mellitus. The secondary aim was to present a clinical protocol as a mixed-method research to test the program effects. Methods: The APSC program was developed in the order of analysis, design, implementation, and evaluation according to the software development life cycle, and was guided by the self-regulatory theory. The content validity, heuristics, and usability of the program were verified by experts and patients with type 2 diabetes mellitus. Results: The APSC program was developed based on goal setting, education, monitoring, and feedback components corresponding to the phases of forethought, performance/volitional control, and self-reflection of self-regulatory theory. Using the mobile application, the participants are able to learn from educational materials, monitor their health behaviors, receive weekly-automated personalized goals and feedback messages, and use an automated conversation system to solve the problems related to self-care. The ongoing two-year study utilizes a mixed method design, with 180 patients having type 2 diabetes mellitus randomized to receive either the intervention or usual care. The participants will be reviewed for self-care self-efficacy, health behaviors, and health outcomes at 6, 12, 18, and 24 months. Participants in the intervention group will be interviewed about their experiences. Conclusion The APSC program can serve as an effective tool for facilitating diabetes health behaviors by improving patients’ self-care self-efficacy and self-regulation for self-care. However, the clinical effectiveness of this program requires further investigation.

Enhanced recovery after surgery (ERAS) is a multidisciplinary and multimodal evidence-based approach aimed at improving the recovery of surgical patients. Successful implementation of ERAS protocols requires proper perioperative communication and collaboration among surgeons, anesthesiologists, nurses, and other medical personnel.Current Concepts: The anesthesiologist is the clinical leader responsible for the ERAS program. Preoperative patient evaluation, optimization, and patient education are essential components of the ERAS program. The program also involves preoperative fasting and carbohydrate loading to minimize catabolic effects. Selection of an appropriate anesthetic regimen, fluid and temperature management, avoidance of intra/postoperative nausea and vomiting, and multimodal pain management are the key components of ERAS for which the anesthesiologist is responsible.Discussion and Conclusion: Factors that enable the successful implementation of ERAS include the willingness to change to ERAS, formation of multidisciplinary teams to improve cooperation, and support from the hospital management, as well as standardization of order sets and care processes and the appropriate use of audits. As the leader of the ERAS team, the anesthesiologist should be actively involved in comprehensive management of the patient during the perioperative period.

Purpose: Preventing diabetic complications involves regular outpatient follow-up and maintaining low variability in hemoglobin A1c (HbA1c) levels. This study investigated the factors associated with diabetic complications, with a specific focus on the impact of regular outpatient follow-up and HbA1c variability, among patients with type 2 diabetes. Methods: The study design was secondary data analysis of electronic medical records from a university hospital in Korea. It included patients aged 40–79 with type 2 diabetes who were prescribed diabetes medication within three months of their first HbA1c test by an endocrinologist and were followed up for at least five years. Follow-up regularity, adjusted standard deviation of HbA1c levels, and diabetic complication indices were collected. Data were analyzed using the Chi-square test, independent t-test, repeated measures analysis of variance, and multiple regression analysis. Results: The study included 1566 patients. Lower follow-up regularity was observed in patients of older age, with comorbidities, diabetic complications, insulin treatment, a history of hospitalization, lower baseline estimated glomerular filtration rate (eGFR) and total cholesterol (TC), and higher HbA1c variability. Higher HbA1c variability was observed in younger patients without comorbidity but with insulin treatment, a history of hospitalization, higher baseline blood glucose (BG), HbA1c, TC, and triglyceride levels. HbA1c variability had the strongest influence on BG and HbA1c levels at the five-year follow-up. Baseline eGFR and TC were the most influential factors for their respective levels at the five-year follow-up. Follow-up regularity significantly affected BG, HbA1c, eGFR, and TC at five-year follow-up. Conclusions It has been shown that several variables besides regular follow-up and HbA1c variability have an influence. However, these are the two that can be corrected through nursing intervention and are important, so intervention on these is important.

This study presents the development and validation of a risk assessment program of highly pathogenic avian influenza (HPAI). This program was developed by the Korean government (Animal and Plant Quarantine Agency) and a private corporation (Korea Telecom, KT), using a national database (Korean animal health integrated system, KAHIS).

γδ T cells are a rare and unique prototype of T cells that share properties with natural killer cells in secondary lymphoid organs. Although many studies have revealed the function and importance of adult-derived γδ T cells in cancer biology and regenerative medicine, the low numbers of these cells hamper their application as therapeutic cell sources in the clinic. To solve this problem, pluripotent stem cell-derived γδ T cells are considered alternative cell sources; however, few studies have reported the generation of human pluripotent stem cell-derived γδ T cells. In the present study, we investigated whether lymphoid lineage γδ T cells were successfully generated from human pluripotent stem cells via hemogenic endothelium under defined culture conditions. Our results revealed that pluripotent stem cells successfully generated γδ T cells with an overall increase in transcriptional activity of lymphoid lineage genes and cytolytic factors, indicating the importance of the optimization of culture conditions in generating lymphoid lineage γδ T cells. We uncovered an initial step in differentiating γδ T cells that could be applied to basic and translational investigations in the field of cancer biology. Based on our result, we will develop an appropriate method to purify γδ T cells with functionality and it helpful for the study of basic mechanism of γδ T cells in pathophysiologic condition as well as clinic application.

Firefighters are facing occupational hazards such as exposures to a variety of carcinogens and toxic agents, heat, physical stress and psychological stress. This occupation involves an increased risk of particular health concerns including cardiovascular diseases, cancers, and reproductive hazards. Cardiovascular diseases are the leading cause of lifetime mortality among the firefighters as well as the principal cause of on-duty deaths. In spite of "healthy worker effect", a number of studies have found an increased risk of cardiovascular disease morbidity and mortality in firefighters. There are various carcinogens in the fire smoke. Many studies address that some types of cancers are related to firefighting. These cancers include brain tumors, cancers of hematopoietic and lymphatic systems, cancers of genitourinary tract, and skin cancers. To date, the relationship between firefighting and reproductive hazards has not been widely studied. However, since firefighters are exposed to various chemical and physical hazards which might influence the reproductive systems, the concerns are raising. It is important to recognize that firefighters are at a risk of several significant health problems. To reduce the risk, it should be encouraged to use protective equipments efficiently and manage physically exerted firefighters appropriately at the fire scene. Furthermore, we should activate not only screening programs to detect health risk factors, but also medical programs to help firefighters maintain a good physical fitness.
Brain Neoplasms ; Carcinogens ; Cardiovascular Diseases ; Firefighters ; Fires ; Hot Temperature ; Humans ; Lymphatic System ; Mass Screening ; Occupations ; Risk Factors ; Skin Neoplasms ; Smoke ; Stress, Psychological

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.
Behavior Therapy ; Case Management ; Chronic Disease ; Diabetes Mellitus ; Diagnosis ; Fees and Charges* ; Fees, Medical ; Follow-Up Studies ; Humans ; Hypertension* ; Patient Care Planning ; Primary Health Care* ; Referral and Consultation

The enhanced primary care demonstration (EPD) was launched in November 2014 to provide high-quality care for people with chronic illnesses. In the EPD, comprehensive assessment and care planning (CAP) is a critical component, along with behavior modification and case management services. In this study, we measured CAP duration and calculated the fee for CAP sessions performed with patients with hypertension and/or diabetes mellitus. In 5 primary care clinics participating in the EPD, the duration of CAP sessions and usual consultations was measured. The duration of CAP sessions was measured on 2 separate occasions because CAP involves 2 separate consultations, including an initial consultation for comprehensive patient assessment and laboratory testing and a follow-up consultation for creating a care plan based on the assessment and test results. The CAP fee was calculated as the ratio of CAP time to the usual consultation time. The median (interquartile range) and the mean ± standard deviation of CAP duration were 15.4 (7.1) minutes and 15.6 ± 4.2 minutes, respectively. The first and second CAP sessions lasted for 5.3 and 4.6 times longer than usual consultations, respectively. The calculated CAP fees were 76,299 won (median) and 65,766 won (mean). The length of CAP sessions for patients with hypertension and/or diabetes mellitus was approximately 5 times longer than that of usual consultations. If consultation lengths were measured in a representative patient sample, it would be possible to improve the external validity of the measurements.
Behavior Therapy ; Case Management ; Chronic Disease ; Diabetes Mellitus ; Diagnosis ; Fees and Charges* ; Fees, Medical ; Follow-Up Studies ; Humans ; Hypertension* ; Patient Care Planning ; Primary Health Care* ; Referral and Consultation