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

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

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

Adefovir dipivoxil is used antiviral agent in the treatment of chronic hepatitis B virus infection. This drug is recommended for patients infected with lamivudine-refractory hepatitis B. Many studies of low-dose adefovir have shown little evidence of renal tubular dysfunction. However, hypophosphatemic osteomalacia has recently been reported in patients treated with adefovir. We report three cases of low dose adefovir-induced hypophosphatemic osteomalacia with fractures. All three patients had been receiving adefovir due to lamivudine-refractory hepatitis B, presented multiple bone pain. The laboratory tests revealed hypophosphatemia and phosphaturia. Bone scintigraphy showed increased uptake in multiple lesions. They were diagnosed as adefovir induced hypophophatemic osteomalacia. Changing the antiviral agent and administration of calcitriol and phosphates improved hypophosphatemia and clinical symptoms. Patients with hepatitis B virus treated with adefovir should be monitored with the serum phosphate levels and presenting symptoms of diffuse bone pain, clinicians need to suspect this infrequent complication.
Calcitriol ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Hypophosphatemia ; Hypophosphatemia, Familial ; Osteomalacia ; Phosphates ; Radionuclide Imaging

Objective: The aim of this study was to evaluate the correlation between the vertical position of maxillary first molar and vertical skeletal measurements in lateral cephalograms by using new linear measurements on the vertical axis of coordinates with calibration. Methods: The vertical position of maxillary first molar (U6-SN), and the conventionally used variables (ConV) and the newly derived linear variables (NwLin) for vertical skeletal patterns were measured in the lateral cephalograms of 103 Korean adults with normal occlusions. Pearson correlation analyses and multiple linear regression analyses were performed with and without calibration using the anterior and posterior cranial base (ACB and PCB, respectively) lengths to identify variables related to U6-SN. Results: The PCB-calibrated statistics showed the best power of explanation. ConV indicating skeletal hyperdivergency was significantly correlated with U6-SN.Six NwLin regarding the position of palatal plane were positively correlated with U6-SN. Each multiple linear regression analysis generated a two-variable model: sella and nasion to palatal plane. Among the three models, the PCBcalibrated model yielded highest adjusted R2 value, 0.880. Conclusions U6-SN could be determined by the vertical position of the maxilla, which could then be used to plan the amount of molar intrusion and estimate its clinical stability. Cephalometric calibration on the vertical axis of coordinates by using PCB for vertical linear measurements could strengthen the analysis itself.

Objective: The aim of this study was to evaluate the correlation between the vertical position of maxillary first molar and vertical skeletal measurements in lateral cephalograms by using new linear measurements on the vertical axis of coordinates with calibration. Methods: The vertical position of maxillary first molar (U6-SN), and the conventionally used variables (ConV) and the newly derived linear variables (NwLin) for vertical skeletal patterns were measured in the lateral cephalograms of 103 Korean adults with normal occlusions. Pearson correlation analyses and multiple linear regression analyses were performed with and without calibration using the anterior and posterior cranial base (ACB and PCB, respectively) lengths to identify variables related to U6-SN. Results: The PCB-calibrated statistics showed the best power of explanation. ConV indicating skeletal hyperdivergency was significantly correlated with U6-SN.Six NwLin regarding the position of palatal plane were positively correlated with U6-SN. Each multiple linear regression analysis generated a two-variable model: sella and nasion to palatal plane. Among the three models, the PCBcalibrated model yielded highest adjusted R2 value, 0.880. Conclusions U6-SN could be determined by the vertical position of the maxilla, which could then be used to plan the amount of molar intrusion and estimate its clinical stability. Cephalometric calibration on the vertical axis of coordinates by using PCB for vertical linear measurements could strengthen the analysis itself.

BACKGROUND: Both the Trendelenburg position and pneumoperitoneum with carbon dioxide have been reported to increase intracranial pressure (ICP) and to alter cerebral blood flow or cerebral blood volume. Also anesthetic agents have variable effects on cerebral hemodynamics and ICP. The present study was conducted to determine whether regional cerebral oxygen saturation (rSO2) values differ between propofol and sevoflurane anesthesia during laparoscopic surgery in the Trendelenburg position. METHODS: Thirty-two adult women undergoing gynecological laparoscopic surgery were divided into sevoflurane and propofol groups. rSO2 values were recorded at 10 min after induction in the neutral position (Tpre), 10 min after the pneumoperitoneum in the Trendelenburg position (Tpt) and 10 min after desufflation in the neutral position (Tpost). For analysis of rSO2, we did ANOVA and univariate two-way ANCOVA with covariates being mean arterial pressure and end tidal carbon dioxide tension. RESULTS: Between sevoflurane and propofol groups, the change in rSO2 was significantly different even after ANCOVA. rSO2 at Tpt (76.3 +/- 5.9% in sevoflurane vs 69.4 +/- 5.8% in propofol) and Tpost (69.5 +/- 7.1% in sevoflurane vs 63.8 +/- 6.6% in propofol) were significantly higher in the sevoflurane group compared with the propofol group. In the propofol group, rSO2 at Tpost was significantly lower than at Tpre (71.1 +/- 4.8%) and cerebral oxygen desaturation occurred in two patients (14.3%). CONCLUSIONS: Significantly lower rSO2 values were observed in the propofol group during gynecological laparoscopic surgery. The possibility of cerebral oxygen desaturation should not be overlooked during propofol anesthesia even after desufflation of the abdomen in the neutral position.
Abdomen ; Adult ; Anesthesia ; Anesthetics ; Antigens, Ly ; Arterial Pressure ; Blood Volume ; Carbon Dioxide ; Female ; Head-Down Tilt ; Hemodynamics ; Humans ; Hypoxia, Brain ; Intracranial Pressure ; Isoantigens ; Laparoscopy ; Methyl Ethers ; Oxygen ; Pneumoperitoneum ; Propofol ; Prostaglandins, Synthetic ; Spectroscopy, Near-Infrared

This study was done to characterize the natural course of C-peptide levels in patients with type 1 diabetes and identify distinguishing characters among patients with lower rates of C-peptide decline. A sample of 95 children with type 1 diabetes was analyzed to retrospectively track serum levels of C-peptide, HbA1c, weight, BMI, and diabetic complications for the 15 yr after diagnosis. The clinical characteristics were compared between the patients with low and high C-peptide levels, respectively. The average C-peptide level among all patients was significantly reduced five years after diagnosis (P < 0.001). The incidence of diabetic ketoacidosis was significantly lower among the patients with high levels of C-peptide (P = 0.038). The body weight and BMI standard deviation scores (SDS) 15 yr after diagnosis were significantly higher among the patients with low C-peptide levels (weight SDS, P = 0.012; BMI SDS, P = 0.044). In conclusion, C-peptide level was significantly decreased after 5 yr from diagnosis. Type 1 diabetes patients whose beta-cell functions were preserved might have low incidence of diabetic ketoacidosis. The declines of C-peptide level after diagnosis in type 1 diabetes may be associated with changes of body weight and BMI.
Adolescent ; Body Mass Index ; Body Weight ; C-Peptide/*blood ; Child ; Child, Preschool ; Diabetes Complications ; Diabetes Mellitus, Type 1/blood/*diagnosis ; Diabetic Ketoacidosis/epidemiology ; Diabetic Retinopathy/epidemiology ; Female ; Follow-Up Studies ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Infant ; Male ; Peripheral Nervous System Diseases/epidemiology ; Retrospective Studies