PURPOSE: The increasing survival rate of colorectal cancer demands various nursing interventions and continuous care for patients to adapt to their psychosocial daily lives. The purpose of this study was to identify factors associated with psychosocial adjustment in colorectal cancer survivors. METHODS: A cross-sectional descriptive study with face-to-face interviews was conducted of 156 colorectal cancer survivors after surgery visiting an outpatient cancer clinic at a tertiary hospital in S city, Korea. Posttraumatic growth, health-promoting behavior, length of treatment, difficulty in activities of daily living, and having a stoma were entered into the linear regression model. RESULTS: The strongest factor influencing the level of psychosocial adjustment was health-promoting behavior (β=.33, p < .001), followed by difficulty in activities of daily living (β=-.24, p=.001), posttraumatic growth (β=.20, p=.004), and having a stoma (β=-.19, p=.004). CONCLUSION: Nursing interventions for psychosocial adjustment in colorectal cancer survivors need to include the contents for posttraumatic growth, as well as health-promoting behavior, and activities of daily living.
Activities of Daily Living ; Colorectal Neoplasms* ; Health Promotion ; Humans ; Korea ; Linear Models ; Nursing ; Outpatients ; Social Adjustment ; Survival Rate ; Survivors* ; Tertiary Care Centers

Arterioureteral fistula is a rare but life-threatening condition. An endovascular treatment approach is commonly used; however, there is a potential risk of infection. We present a case in which a patient presented with abdominal pain and was diagnosed with a ruptured internal iliac artery aneurysm and a subsequent arterioureteral fistula. An aortic stent graft was inserted to treat the arterioureteral fistula, but it subsequently became infected, resulting in the patient's death. This case underscores the importance of early diagnosis and treatment of arterioureteral fistula and the possibility of graft infection.

BACKGROUND/OBJECTIVES: The prevalence of vitamin D deficiency in Koreans is quite high; however, until recently, Korean National Health and Nutrition Survey (KNHANES) had not analyzed the vitamin D intake among Koreans. Additionally, the Korean Dietary Reference Intake for vitamin D was established based on insufficient evidence. Therefore, we investigated vitamin D intake and its relationship with bone mineral density (BMD) in Korean adults using the combined data from the 2009–2011 KNHANES. MATERIALS AND METHODS: This study was conducted in 11,949 healthy adults. Vitamin D intake was assessed using a 24-h recall method, and the BMD was measured using dualenergy X-ray absorptiometry. RESULTS: The prevalence of vitamin D deficiency (< 20 ng/mL) was 64% in men and 77% in women. In women aged ≥ 50 yrs and men aged < 50 yrs, there was a significant positive correlation between vitamin D intake and serum 25-hydroxyvitamin D level after sun exposure adjustment. The BMD of postmenopausal women aged ≥ 50 yrs with a vitamin D intake of 5 µg/day or more was significantly higher than that of women with intake less than 5 µg/day. After adjusting for age, energy, and calcium intake, the vitamin D intake of the osteoporotic group was significantly lower than that of the osteopenia group in women. CONCLUSIONS Since the relationship between vitamin D intake and BMD was observed in women aged ≥ 50 yrs, further research is needed to clarify these findings using cohort or randomized controlled trials.

BACKGROUND: Epicardial adipose tissue (EAT) is suggested to play an important role in the progression of metabolic syndrome. We aimed to establish a simple method to measure EAT and examine the differences in EAT thickness according to the presence of type 2 diabetes mellitus or obesity. METHODS: A total of 94 patients (42.6% type 2 diabetes mellitus, 53.2% obese, mean age 61+/-13) who underwent multidetector computed tomography were enrolled. Thickness of EAT was measured on the parasternal short and horizontal long axis view. Epicardial fat area (EFA) was measured at the level of left main coronary artery (LMCA). RESULTS: All EAT thicknesses were correlated with EFA at the LMCA level (r=0.235 to 0.613, all Ps<0.05), and EAT thickness in the left atrioventricular groove (LAVG) had the highest correlation coefficient (r=0.613). EFA, and EAT thicknesses in the LAVG and the left ventricular apex were higher in the group with type 2 diabetes mellitus than in the group without type 2 diabetes mellitus when adjusted only for body mass index. When adjusted only for type 2 diabetes mellitus, EFA, and EAT thicknesses in the LAVG and the right atrioventricular groove were higher in obese group than in nonobese group. CONCLUSION: In conclusion, EAT thickness can be easily measured and represent EFA. EAT thickness, especially in LAVG, was higher in groups with type 2 diabetes mellitus and obesity independently. These findings implicate that EAT thickness may be a useful indicator for type 2 diabetes mellitus and obesity.
Adipose Tissue* ; Axis, Cervical Vertebra ; Body Mass Index ; Coronary Vessels ; Diabetes Mellitus, Type 2* ; Humans ; Multidetector Computed Tomography ; Obesity*

BACKGROUND: The fat mass and obesity-associated (FTO) gene is associated with obesity and type 2 diabetes mellitus. Obesity and insulin resistance are also common features of polycystic ovary syndrome (PCOS). Therefore, the FTO gene might be a candidate gene for PCOS susceptibility. The aim of the present study was to evaluate the effects of FTO gene variants on PCOS susceptibility and metabolic and reproductive hormonal parameters. METHODS: We recruited 432 women with PCOS (24+/-5 years) and 927 healthy women with regular menstrual cycles (27+/-5 years) and performed a case-control association study. We genotyped the single nucleotide polymorphisms rs1421085, rs17817449, and rs8050136 in the FTO gene and collected metabolic and hormonal measurements. RESULTS: Logistic regression revealed that the G/G genotype (rs1421085, 1.6%), the C/C genotype (rs17817449, 1.6%), and the A/A genotype (rs8050136, 1.6%) were strongly associated with an increased risk of PCOS (odds ratio, 2.551 to 2.559; all P<0.05). The strengths of these associations were attenuated after adjusting for age and BMI. The women with these genotypes were more obese and exhibited higher free androgen indices (P<0.05) and higher free testosterone levels (P=0.053 to 0.063) compared to the other genotypes. However the significant differences disappeared after adjusting for body mass index (BMI). When we analyzed the women with PCOS and the control groups separately, there were no significant differences in the metabolic and reproductive hormonal parameters according to the FTO gene variants. CONCLUSION: The rs1421085, rs17817449, and rs8050136 variants of the FTO gene were associated with PCOS susceptibility and hyperandrogenemia in young Korean women. These associations may be mediated through an effect of BMI.
Body Mass Index ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; Female ; Genotype ; Humans ; Hyperandrogenism ; Insulin Resistance ; Logistic Models ; Menstrual Cycle ; Obesity ; Polycystic Ovary Syndrome ; Polymorphism, Single Nucleotide ; Testosterone

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic. Methods: This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients’ in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type. Results: The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4). Conclusions This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.

Objective: The objectives of this study were to compare the time-dependent changes in occlusal contact area (OCA) and bite force (BF) of the deviated and non-deviated sides in mandibular prognathic patients with mandibular asymmetry before and after orthognathic surgery and investigate the factors associated with the changes in OCA and BF on each side. Methods: The sample consisted of 67 patients (33 men and 34 women; age range 15-36 years) with facial asymmetry who underwent 2-jaw orthognathic surgery. OCA and BF were taken before presurgical orthodontic treatment, within 1 month before surgery, and 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. OCA and BF were measured using the Dental Prescale System. Results: The OCA and BF decreased gradually before surgery and increased after surgery on both sides. The OCA and BF were significantly greater on the deviated side than on the non-deviated side before surgery, and there was no difference after surgery. According to the linear mixed-effect model, only the changes in the mandibular plane angle had a significant effect on BF (p < 0.05). Conclusions There was a difference in the amount of the OCA and BF between the deviated and non-deviated sides before surgery. The change in mandibular plane angle affects the change, especially on the non-deviated side, during the observation period.

Purpose: Acute myocardial infarction (AMI) and stroke are leading global causes of death and can be used to assess acute care quality. We examined the 30-day mortality trends after emergency department admission for AMI and stroke in Korea from 2008 to 2019, focusing on regional and income disparities. Materials and Methods: The AMI and stroke patients admitted to hospitals in Korea were collected from the claims data. We analyzed age and sex-standardized 30-day mortality for AMI, as well as hemorrhagic and ischemic strokes. Disparities in mortality were analyzed using absolute differences and relative ratios between the Organization for Economic Cooperation Development (OECD) and Korea, and among income levels and regions in Korea. A 12-year joinpoint regression was used to determine the annual percent change and the average annual percent change. Results: The trends in the 30-day AMI mortality of Korea were not significantly changed from 2008 to 2019; the gap remained at 1.2 between the OECD and Korea. Korea maintained lower mortality rates for hemorrhagic and ischemic stroke than the mean of OECD. In Korea, the 30-day hemorrhagic stroke mortality showed a constant decreasing trend for the higher-income group living in urban areas; it led to a widened gap based on income levels in urban areas. The 30-day mortality for ischemic stroke tended to decrease in the higher-income group and urban areas. Conclusion National-level intervention is needed to manage regional and income-based disparities in AMI and stroke 30-day mortality. It is important to understand the variance in mortality rate by different geographical regions and income levels to establish an appropriate public health strategy.

BACKGROUND: The cause of dementia in Parkinson's disease (PD) remains incompletely understood. Cerebrovascular lesions (CVLs) are frequently found in the aging brain and may coexist with PD pathology. We hypothesized that lacunar infarction, which is one type of CVL, impacts on cognitive decline in patients with PD. METHODS: The Mini Mental Status Examination (MMSE) and Clinical Dementia Rating (CDR) tools were applied to PD patients with lacunar infarction (<1.5 cm on brain MRI; PD-S) and PD patients with normal brain MRI (PD-NS). RESULTS: Totals of 19 PD-S patients (9 males and 10 females) and 59 PD-NS patients (16 males and 43 females) took part in this study. Univariate analysis revealed that the gender distribution did not differ between the PD-S and PD-NS groups (p=0.1731), whereas age did differ significantly [79.1+/-5.0 years vs 73.0+/-7.8 years (mean+/-SD), respectively; p=0.0002]. There was no difference between the PD-S and PD-NS patients in either PD disease duration (6.9+/-3.2 vs 5.6+/-3.8 years, respectively; p=0.1790) or education duration (5.3+/-5.4 vs 6.4+/-5.3 years, respectively; p=0.4168). After adjustment for age in ANCOVA analysis, the MMSE score was significantly lower (p=0.0128) and the CDR score was significantly higher (p=0.0426) in the PD-S group than in the PD-NS group. Ten of the PD-S patients had a single lesion. The lacunar infarctions appeared in various locations in these patients, but they were most common in the basal ganglia, thalamus, and periventricular white matter. CONCLUSIONS: Lacunar infarction appears to be associated with cognitive decline in patients with PD even after adjustment for age. Analysis of larger age-matched cases for PD-S and PD-NS is required in order to validate these results.
Aging ; Basal Ganglia ; Brain ; Cognition ; Dementia ; Deoxycytidine ; Humans ; Male ; Parkinson Disease ; Stroke, Lacunar ; Thalamus

BACKGROUND: Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation and hyperandrogenism and this malady arises in 5~10% of reproductive women. There may be significant ethnic and racial variations in the clinical presentation of PCOS. The current study is aimed to define the clinical characteristics, including the metabolic features, of Korean women with PCOS. METHODS: We recruited 156 patients with PCOS and 252 healthy regular cycling women as controls between March 2003 and May 2006. The diagnosis of PCOS was made according to the criteria of the European Society of Human Reproduction and Embryology in 2003. The anthropometric measurements including weight, height, waist circumference, and physical examination for the modified Ferriman-Gallwey hirsutism scoring scale were performed. Reproductive hormones, blood lipids and standard 75g oral glucose tolerance tests were done to assess glucose tolerance and insulin sensitivity. RESULTS: Twenty six percent of the women with PCOS were obese and 6.4% of them had hirsutism. One of the 156 women (0.6%) with PCOS was newly diagnosed with diabetes mellitus and 25 of them (16.0%) had impaired glucose tolerance. The triglyceride levels and plasma glucose levels at 0, 30, 60, 90 and 120 minute and the plasma insulin levels at 30, 60, 90 and 120 minutes after initiating the oral glucose tolerance test in women with PCOS were significantly higher compared to those values for the controls. The HOMA-IR was significantly higher in the women with PCOS compared to the controls, even after adjusting for age and the body mass index. CONCLUSIONS: Obesity and clinical hyperandrogenism were not frequent in Korean women with PCOS, but this population did display distinct insulin resistance.
Anovulation ; Blood Glucose ; Body Mass Index ; Diabetes Mellitus ; Diagnosis ; Embryology ; Female ; Glucose ; Glucose Tolerance Test ; Hirsutism ; Humans ; Hyperandrogenism ; Insulin ; Insulin Resistance ; Obesity ; Physical Examination ; Plasma ; Polycystic Ovary Syndrome* ; Reproduction ; Triglycerides ; Waist Circumference