Background/Aims: The aim of this study is to compare Friedewald-estimated and directly measured low density lipoprotein cholesterol (LDL-C) values and assess the concordance in guideline risk classification between the two methods. Methods: The data were derived from the 2009 to 2011 Korea National Health and Nutrition Examination Survey. We included subjects with triglyceride (TG) levels < 400 mg/dL. Analysis was done for 6,454 subjects who had all lipid panels— total cholesterol, directly measured LDL-C, high density lipoprotein cholesterol (HDL-C), and TG. Results: The subjects ranged in age from 10 to 87 years old. The mean age was 41.5 ± 17.3 years. For subjects with TG < 400 mg/dL, overall concordance in guideline risk classification was 79.1%. The Friedewald formula tended to underestimate LDL-C more at higher TG or lower HDL-C levels. Especially, the percent of subjects who were misclassified into a lower risk category was 31% when TG were 200 to 299 mg/dL; and 45.6% when TG were 300 to 399 mg/dL. A greater underestimation of LDL-C occurred at higher TG and lower Friedewald-estimated LDL-C levels. Of subjects with a Friedewald-estimated LDL-C < 70 mg/dL, 55.4% had a directly measured LDL-C ≥ 70 mg/dL when TG were 200 to 399 mg/dL. Conclusions The Friedewald equation tends to underestimate LDL-C in highrisk subjects such as hypertriglyceridemia and hypo-HDL-cholesterolemia. For these individuals accurate assessment of LDL-C is crucial, and therefore additional evaluation is warranted.

BACKGROUND: Pneumocystis is difficult to culture or detect in laboratory environments. Its ecology including the timing and method of transmission as well as environmental sources and communicability remain unclear. METHODS: We retrospectively evaluated the pattern and treatment outcome of Pneumocystis jirovecii pneumonia (PCP) in children with acute lymphoblastic leukemia (ALL) who received chemotherapy. RESULTS: A total of 56 patients with ALL were evaluated. While on chemotherapy, all patients received PCP prophylaxis. PCP were found in a total of 6 patients, including definite PCP in 2, probable PCP in 2, and possible PCP in 2 patients. There were no significant differences in sex, age group, National Cancer Institute risk group, or pneumocystis prophylaxis type between PCP and non-PCP groups. However, there was a significant statistical difference in the times of ALL diagnosis. Regarding recent chemotherapy at the time of PCP diagnosis, there were one induction, one consolidation, and four maintenance cases. All PCP patients were treated with high-dose sulfamethoxazole (100 mg/kg/day) and trimethoprim (20 mg/kg/day) intravenously. Five patients survived, while one patient with endotracheal mechanical ventilation therapy died due to respiratory failure in spite of aggressive treatment. CONCLUSION: Pediatric PCP became extremely rare due to routine prophylaxis in clinical practice of pediatric malignancy. Nevertheless, we analyzed patients with acute lymphoblastic leukemia who had received PCP prophylaxis for 14 years, and analyzed the clustered outbreaks of PCP. It is still important to emphasize the need for prophylaxis and to increase the level of attention and isolation under environmental and personal risk factors.
Child ; Compliance ; Diagnosis ; Disease Outbreaks ; Drug Therapy ; Ecology ; Humans ; Methods ; National Cancer Institute (U.S.) ; Pneumocystis jirovecii ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Sulfamethoxazole ; Treatment Outcome ; Trimethoprim

Esthetic restoration of maxillary anterior implant heavily depends on the direction of installation of implant fixture. In patients with malpositioned implant, it is crucial to communicate the limitations of prosthetic outcome with the patient before starting on a restoration. To facilitate the communication, three-dimensional virtual representation by superimposing facial and intraoral digital scans with Computed Tomography (CT, dicom file) was used for visualization of the limitations of prosthesis. Through digital diagnostic wax-up, the profile of right maxillary anterior incisor implant was expected to be protrusive, which the patient was not satisfied with. Since the patient already had done root canal treatment on left maxillary anterior incisor due to previous trauma, a new prosthetic design including both right and left maxillary anterior incisors was presented to the patient. The second design was chosen and his comments were delivered to dental lab. The patient was satisfied with the new prosthesis, aesthetically and functionally.

The implant prosthesis of anterior maxilla requires careful consideration in planning. In order to satisfy both esthetic and functional needs of a patient, fusion of intra-oral scan in Cone-beam computed tomography (CBCT) and facial scan can be considered. Bony structures and soft tissues captured in CBCT and occlusal surfaces of intra oral scan were incorporated into personal characteristics from facial scan. The patient had insufficient buccal bone on maxillary anterior area. The maxillary implants could not be placed on the most ideal position. However, the “top down” approach completed by computer-generated arranging of teeth in implant planning and surgery with surgical guide resulted in esthetically and functionally satisfying result regardless of the limitation. Careful diagnosis with digital technique and the usage of surgical guide resulted in successful surgery and esthetic restoration. The temporary fixed prostheses were designed, restored and evaluated. The patient was not satisfied with the first design of temporary prosthesis, which showed uneven space distribution between teeth due to the position of maxillary implant. The design was modified by changing proximal emergence contours and line angle to alter the perceived since of incisors. The patient was satisfied with the new design of provisional restoration. A digital occlusion analyzer (Arcus Digma II, KaVo, Leutkirch, Germany) was used to measure inherent condylar guidance and anterior guidance of a patient to provide a definitive prosthesis.

Fabrication of dentures using CAD/CAM system has the advantage of reducing the number of patient visits and reducing errors during laboratory work. After the extraction of maxillary residual teeth, this patient changed to a completely edentulous state and the stability and retention of the existing mandibular complete denture were insufficient due to the absorption of the mandibular residual ridge, so the restoration of the mandibular implant retained overdenture and maxillary complete denture were planned.By digitizing the concept of BPS (Biofunctional prosthetic system) that uses the patient’s functional movement in closed mouth technique, the vertical dimension was taken by Gnathometer CAD and digital facebow transfer was performed using UTS CAD. In this case, fabrication of maxillary complete denture and mandibular implant-retained overdenture using monolithic disc and CAD/ CAM system demonstrated favorable denture retention, stability, and support and the patient is satisfied with improved functions and esthetic of dentures.