BACKGROUND/AIMS: The risk of cardiovascular morbidity and mortality is high in patients with diabetes. Since studies suggest that aspirin is less effective in diabetic patients, this study evaluated the prevalence of aspirin resistance and related factors in Korean type-2 diabetics. METHODS: All patients taking aspirin 100 mg/day for at least 4 weeks and no other anti-platelet agents were enrolled. The compliance of aspirin intake was determined from patient interviews and using the pill-count method. All other medications were continued during the study, including oral hypoglycemics, antihypertensives, and lipid-lowering agents. The effect of aspirin was assessed using the Ultegra Rapid Platelet Function Assay-ASA (VerifyNow-Aspirin, Accumetrics, San Diego, CA) and aspirin resistance was defined as >550 aspirin reaction units (ARU). RESULTS: The prevalence of aspirin resistance in Korean type-2 diabetics was 14.8%, and was more prevalent in males than in females (28.1% vs. 7.1%). Aspirin resistance was correlated with male sex, smoking, high hemoglobin levels, a high estimated glomerular filtration rate (GFR), and low fibrinogen levels. After controlling for sex, aspirin resistance was related to the estimated GFR (r=0.247, p=0.029), hemoglobin (r=0.23, p=0.043), and fibrinogen (r=0.304, p=0.007) levels. CONCLUSION: The prevalence of aspirin resistance in Korean type-2 diabetics was 14.8%. Therefore, a laboratory test for aspirin resistance should be considered in diabetic patients taking aspirin to prevent cardiovascular complications.
Antihypertensive Agents ; Aspirin ; Blood Platelets ; Compliance ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Female ; Fibrinogen ; Glomerular Filtration Rate ; Hemoglobins ; Humans ; Hypoglycemic Agents ; Male ; Prevalence ; Smoke ; Smoking

BACKGROUND: Plate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient's condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs. METHODS: Fifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: In groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent. CONCLUSIONS: The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Nails/*statistics & numerical data ; Bone Plates/*statistics & numerical data ; Female ; Forearm/surgery ; Fracture Fixation, Intramedullary/adverse effects/*methods/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Radius Fractures/epidemiology/*surgery ; Range of Motion, Articular/*physiology ; Retrospective Studies ; Treatment Outcome ; Ulna Fractures/epidemiology/*surgery ; Young Adult

PURPOSE: To investigate levels of serum homocysteine in patients with pseudoexfoliation syndrome and the association between serum homocysteine levels and risk of coronary heart disease. METHODS: From March 2013 to September 2013, 37 patients with pseudoexfoliation syndrome and 59 age-matched patients (control group) were enrolled in this prospective study. Serum homocysteine levels were compared between the 2 groups. We compared the estimated 10-year risk of coronary heart disease based on Framingham risk score between the 2 groups. Additionally, we analyzed correlations between risk of coronary heart disease and serum homocysteine levels. RESULTS: The mean homocysteine level of patients with pseudoexfoliation syndrome was significantly higher than the control group (13.3 ± 6.8 µmol/L vs. 10.0 ± 5.2 µmol/L, p = 0.009). The rate of high risk defined as a 10-year coronary heart disease risk >20% in the patients with pseudoexfoliation syndrome was significantly higher than in the control group (21.4% vs. 4.4%, p = 0.048). Correlation between serum homocysteine levels and estimated 10-year risk of coronary heart disease was statistically significant (r = 0.578, p < 0.001). CONCLUSIONS: Hyperhomocysteinemia and high risk of coronary heart disease were observed in patients with pseudoexfoliation syndrome. Therefore, we suggest efforts to prevent coronary heart disease in pseudoexfoliation syndrome patients with hyperhomocysteinemia are necessary.
Coronary Disease* ; Exfoliation Syndrome* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Prospective Studies

Background: Although neuromyelitis optica spectrum disorder (NMOSD) is known to be a rare disease, its prevalence and incidence have not yet been studied in Korea. We performed a population-based study to examine the prevalence and incidence of NMOSD in Korea using data from the Korean National Health Insurance (NHI) claims database. Methods: Data from 2013 to 2017 were obtained, with a washout period set as 2013 and 2014. The prevalence and incidence of NMOSD in 2016 and 2017 were calculated using population census data. Subjects were divided into 5 groups at 15-year intervals, depending on the age at which the diagnostic code was entered. The relative risk (RR) for each age group was compared with the oldest (≥ 60 years) age group. Results: The overall prevalence was estimated to be 3.36 and 3.56 per 100,000 individuals, with an incidence of 0.41 and 0.65 per 100,000 individuals-year in 2016 and 2017, respectively. The mean age was 43.08 (standard deviation, 14.56) years, and the ratio of male to females was 1:4.7. The incidence was higher in female individuals aged between 30 and 59 years (RR, 2.8–3.05; P < 0.05). Conclusion Nationwide prevalence of NMOSD in Korea was 3.36 and 3.56/100,000 and its incidence was 0.41 and 0.65/100,000-year in 2016 and 2017 respectively.

Head trauma has been mentioned as an uncommon cause of secondary Parkinsonism. We report a 68-year-old woman who developed a rapidly evolving post-traumatic encephalopathy with predominant akinetic-rigid syndrome. The clinical manifestations were mainly bradykinesia, rigidity, cognitive dysfunction and emotional lability. Brain SPECT showed perfusion defect in the left basal ganglia and thalamus. The parkinsonian symptoms improved moderately with levodopa.
Aged ; Basal Ganglia ; Brain Injuries* ; Brain* ; Craniocerebral Trauma ; Female ; Humans ; Hypokinesia ; Levodopa ; Parkinson Disease, Secondary ; Parkinsonian Disorders ; Perfusion ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Recently, the colour change plaster (NeuroCheck(R)) has been introduced, which measures sweat production on the basis of a colour change from blue to pink. This new test was useful to detect of diabetic peripheral neuropathy. The aim of this study was to evaluate the usefulness of the colour change plaster (NeuroCheck(R)) for the diagnosis of cardiac autonomic neuropathy in type 2 diabetic patients. METHODS: This study include 35 type 2 diabetic patients (10 male, 25 female) with a mean age of 55+/-14.9 years and a mean diabetes duration of 11.8+/-8.8 years. Cardiac autonomic neuropathy was diagnosed by means of Ewing's method. Peripheral autonomic neuropathy (Sudomotor function abnormality) was assessed by means of time (more than 600 seconds) until complete colour change in the indicator test. RESULTS: Peripheral autonomic neuropathy was diagnosed in 23 patients (65.7%). Time until starting colour change of plaster in normal and abnormal sudomotor patients were 38.3+/-33.7 sec and 367.1+/-470.3 sec (p<0.05). Time until completing colour change of plaster in normal and abnormal sudomotor patients were 372.5+/-198.8 sec and 1677.4+/-711.9 sec (p<0.05). The autonomic score of two groups were 2.4+/-2.3, 4.6+/-2.2 (p<0.05). Sudomotor abnormal group was older than normal (59.2+/-11.7 yrs, vs 47+/-17.4 yrs). Presence of retinopathy was related with sudomotor abnormality. Peripheral autonomic neuropathy was related with parasympathetic cardiac autonomic neuropathy. Sudomotor function abnormality was related with definite cardiac autonomic neuropathy, but it was not related with early cardiac autonomic neuropathy. The sensitivity, specificity, positive predictive value and negative predictive value of colour change plaster in the diagnosis of definitive cardiovascular autonomic neuropathy was 86.7%, 62.5%, 68.4% and 83.3%, respectively. CONCLUSIONS: The colour change plaster (NeuroCheck(R)) is not useful for the early diagnosis of cardiac autonomic neuropathy in type 2 diabetic neuropathy, but it may be possible for the screening test of definite cardiac autonomic neuropathy.
Diabetic Neuropathies ; Diagnosis* ; Early Diagnosis ; Humans ; Male ; Mass Screening ; Peripheral Nervous System Diseases ; Sensitivity and Specificity ; Sweat

The purpose of this study was to evaluate the effect of the reaction between investment material and zirconia on the strength of zirconia in the application of heat-pressing method. Sixty specimens were cut (24 mm×4 mm×0.5 mm) into plates from Zirtooth ™ Multi O-9814 block (∅98×14T, HASS, Gangwondo, Korea) and sintered at 1450℃. Specimens were divided into 6 subgroups according to the depending on the investement material; (a) UN group (Control), (b) PH group (Prime vest HS), (c) CP group (Calibra-press), (d) BV group (BC-Vest), (e) MH group (Microstar-HS), (f) F1 group (Formula 1). Five investment materials were buried according to the procedure recommended by the manufacturer and left at room temperature for 30 minutes. The investment mold was dried and maintained at an elevated temperature of 850℃ for 50 minutes. Then, Amber Lisi-POZ LT (HASS) was placed in a thermoformed electric furnace (Programat EP3000/G2, Ivoclar Vivadent, Schaan, Liechtenstein) together with the mold, heated to 915℃ at an elevation temperature of 45℃/min, and moored for 15 minutes. The specimens were loaded to fracture in a universal testing machine and the fracture surface was examined by a field-emission scanning electron microscopy (FE-SEM). The surface of the zirconia specimen with the investment material was analyzed by energy dispersive X-ray spectroscopy (EDS). The 3-point flexural strength test showed the highest value (1265.5 MPa) in the UN group and the lowest value (756.1 MPa) in the F1 group. As a result of EDS analysis, the largest amount of Si was detected in the F1 group, and the most interfacial changes occurred as a result of FE-SEM analysis. It was concluded that when the zirconia is buried with the investment material and the heat press molding is performed, the state of the interface is changed due to the investment material at the bonding interface while the strength is lowered.

The purpose of this study was to evaluate the structural characteristics of the thread length of orthodontic mini-screws and the effects of insertion and removal torques according to the formation of the cutting flute. Two types of mini-screws were made, with a thread length of 6.0 mm and a thread length of 3.3 mm. In order to examine the effect of flute formation, the experiment group was divided into a miniscrew test group with flute formation and an experiment group without flute formation. To evaluate the effect of flute formation, two flutes were formed at 180°on the circumference, and at the tip of the mini screw, up to 4 mm for thread length of 6.0 mm and 2.4 mm for thread length of 3.3 mm. A biomechanical test block formed of 2 mm cortical bone and 10 mm cancellous bone was used to eliminate the influence of the difference in cortical bone thickness and bone density according to the insertion site. 1 mm diameter guide hole was drilled on the test block and the mini-screw was placed vertically. Using a 0.1 N·cm precision digital torque gauge, the maximum torque value was recorded at this time by embedding it to the top of the screw under a static load of 1.2 kg and the value when it was removed in the opposite direction. The insertion torque values for the 6.0 mm and 3.3 mm length mini screws were (29.53±1.84) N·cm and (26.84±2.15) N·cm, and the removal torque values are (14.50±1.37) N·cm and (13.15±2.89) N·cm, respectively.There were no statistically significant differences (P>0.05). The flute of 6.0 mm mini-screws had no statistically significant difference in both insertion and removal torque values and increased to (30.13±1.97) N·cm and (18.65±1.10) N·cm (P>0.05). In experiments with 3.3 mm mini-screws, the insertion and removal torque values decreased to (20.99±3.94) N·cm and (11.32±2.03) N·cm, respectively, showing a statistically significant decrease only in the insertion torque values (P<0.05). The insertion and removal torque values of the mini-screw were not significantly increased even when the screw length was doubled, and the flute formation effect was different with the screw length.

The purpose of this study was to evaluate the effect of the reaction between investment material and zirconia on the strength of zirconia in the application of heat-pressing method. Sixty specimens were cut (24 mm×4 mm×0.5 mm) into plates from Zirtooth ™ Multi O-9814 block (∅98×14T, HASS, Gangwondo, Korea) and sintered at 1450℃. Specimens were divided into 6 subgroups according to the depending on the investement material; (a) UN group (Control), (b) PH group (Prime vest HS), (c) CP group (Calibra-press), (d) BV group (BC-Vest), (e) MH group (Microstar-HS), (f) F1 group (Formula 1). Five investment materials were buried according to the procedure recommended by the manufacturer and left at room temperature for 30 minutes. The investment mold was dried and maintained at an elevated temperature of 850℃ for 50 minutes. Then, Amber Lisi-POZ LT (HASS) was placed in a thermoformed electric furnace (Programat EP3000/G2, Ivoclar Vivadent, Schaan, Liechtenstein) together with the mold, heated to 915℃ at an elevation temperature of 45℃/min, and moored for 15 minutes. The specimens were loaded to fracture in a universal testing machine and the fracture surface was examined by a field-emission scanning electron microscopy (FE-SEM). The surface of the zirconia specimen with the investment material was analyzed by energy dispersive X-ray spectroscopy (EDS). The 3-point flexural strength test showed the highest value (1265.5 MPa) in the UN group and the lowest value (756.1 MPa) in the F1 group. As a result of EDS analysis, the largest amount of Si was detected in the F1 group, and the most interfacial changes occurred as a result of FE-SEM analysis. It was concluded that when the zirconia is buried with the investment material and the heat press molding is performed, the state of the interface is changed due to the investment material at the bonding interface while the strength is lowered.

The purpose of this study was to evaluate the structural characteristics of the thread length of orthodontic mini-screws and the effects of insertion and removal torques according to the formation of the cutting flute. Two types of mini-screws were made, with a thread length of 6.0 mm and a thread length of 3.3 mm. In order to examine the effect of flute formation, the experiment group was divided into a miniscrew test group with flute formation and an experiment group without flute formation. To evaluate the effect of flute formation, two flutes were formed at 180°on the circumference, and at the tip of the mini screw, up to 4 mm for thread length of 6.0 mm and 2.4 mm for thread length of 3.3 mm. A biomechanical test block formed of 2 mm cortical bone and 10 mm cancellous bone was used to eliminate the influence of the difference in cortical bone thickness and bone density according to the insertion site. 1 mm diameter guide hole was drilled on the test block and the mini-screw was placed vertically. Using a 0.1 N·cm precision digital torque gauge, the maximum torque value was recorded at this time by embedding it to the top of the screw under a static load of 1.2 kg and the value when it was removed in the opposite direction. The insertion torque values for the 6.0 mm and 3.3 mm length mini screws were (29.53±1.84) N·cm and (26.84±2.15) N·cm, and the removal torque values are (14.50±1.37) N·cm and (13.15±2.89) N·cm, respectively.There were no statistically significant differences (P>0.05). The flute of 6.0 mm mini-screws had no statistically significant difference in both insertion and removal torque values and increased to (30.13±1.97) N·cm and (18.65±1.10) N·cm (P>0.05). In experiments with 3.3 mm mini-screws, the insertion and removal torque values decreased to (20.99±3.94) N·cm and (11.32±2.03) N·cm, respectively, showing a statistically significant decrease only in the insertion torque values (P<0.05). The insertion and removal torque values of the mini-screw were not significantly increased even when the screw length was doubled, and the flute formation effect was different with the screw length.