OBJECTIVES: This study was performed to estimate the prevalence and possible risk factors of the metabolic syndrome in steel-mill workers, and to evaluate the relation between gamma-glutamyltransferase (gamma-GTP) and the metabolic syndrome. METHODS: The study subjects comprised 1,604 male steel-mill workers. The indices of metabolic syndrome, such as BMI, triglyceride, HDL-cholesterol, blood pressure, fasting glucose, and gamma-GTP were analyzed in each subject. We collected information about demographic characteristics, behavioral patterns, such as alcohol drinking, smoking, and exercise, and family medical history through a self-administered questionnaire. Statistical analysis was done by using the chi-square test, Mantel-Haenszel trend test and logistic regression model. RESULTS: The crude and age-adjusted prevalences of the metabolic syndrome were 21.3% and 15.5%, respectively, in the steel-mill workers. Age (OR: 1.063, 95% CI: 1.033-1.094), alcohol drinking (OR: 1.657, 95% CI: 1.175-2.337) and smoking (OR: 1.359, 95% CI: 1.017-1.816) were risk factors for the metabolic syndrome. Meanwhile, shift work showed a significant relation with hypertension (OR: 1.329, 95% CI: 1.038-1.700), but not with other metabolic syndrome components. However, tenure, exercise and family medical history were not significant factors for the metabolic syndrome in this study. The risk ratio of the metabolic syndrome (OR: 3.345, 95 % CI: 2.534-4.416) and its components, such as obesity, hypertriglyceridemia, hypertension and hyperglycemia, were higher in the high gamma-GTP group (> or =63 IU/ liter) than in the controls (<63 IU/liter). CONCLUSIONS: These results confirm the need for health education to control the metabolic syndrome by improving behavioral patterns, such as alcohol drinking and smoking, in factory workers. In addition, it is suggested that gamma-GTP might be a useful candidate in screening for the metabolic syndrome.
Alcohol Drinking ; Blood Pressure ; Fasting ; gamma-Glutamyltransferase ; Glucose ; Health Education ; Humans ; Hyperglycemia ; Hypertension ; Hypertriglyceridemia ; Logistic Models ; Male ; Mass Screening ; Obesity ; Odds Ratio ; Prevalence ; Questionnaires ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

BACKGROUND: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. METHODS: All received 17.9+/-2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T12-L1 interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. RESULTS: The blood pressure of the patients started to decrease in 5 minutes and most decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3+/-2.0 and 9.2+/-1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). CONCLUSION: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Blood Pressure ; Bupivacaine ; Catheters ; Cesarean Section* ; Ephedrine ; Female ; Heart Rate ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypotension ; Infant, Newborn ; Intracranial Hemorrhages ; Intubation ; Needles ; Neurologic Manifestations ; Pregnancy ; Pulmonary Edema ; Recovery Room

Proper positioning of maxillary incisors is key to success of surgery combined treatment. Establishing surgery plan would be a difficult job if maxillary incisors are lost. Patient who lost all of her maxillary incisors due to accident came for orthodontic treatment. Through careful modification of maxillary archform, pre-surgical orthodontic treatment was conducted with four prosthetic space consolidation. Position of incisors was decided by help of 3D prosthetic set-up, and 1-jaw surgery was planned. After relative short treatment period of 28 months, final prosthesis was done. When alveolar bone loss happens, harmonious prosthesis of upper incisors is difficult. Utilizing mandibular set-back surgery and incisor positioning using 3D set-up could make a better environment for treatment outcome. Strategic pre-surgical orthodontic treatment can allow shorter time and less number of prosthetics.

BACKGROUND/AIMS: The aim of this study was to elucidate the antiviral efficacy and the predictors of entecavir treatment in nucleoside-naive chronic hepatitis B patients. METHODS: A total of 160 patients treated with entecavir (0.5 mg daily) for at least 24 weeks were consecutively enrolled. The virologic response (HBV DNA<2,000 copies/mL), biochemical response (ALT< or = upper limit of normal), and virologic breakthrough (>1 log10 copies/mL increase in HBV DNA level above nadir on two consecutive occasions) were retrospectively analyzed. RESULTS: The mean follow-up duration was 58.8 weeks, and 85 patients (53.1%) showed HBeAg positivity. The median pretreatment levels of serum ALT and HBV DNA were 99 IU/L and 7.6 log10 copies/mL, respectively. The cumulative rates at 12, 24, 48, and 72 weeks were 37.5%, 68.1%, 87.4%, and 95.8%, respectively, for the virologic response; 40.0%, 66.2%, 84.5%, and 92.7% for the biochemical response; 10.6%, 18.8%, 27.0%, and 34.5% for HBeAg loss; and 3.5%, 7.1%, 9.0%, and 13.2% for HBeAg seroconversion. There was no case of virologic breakthrough. An absence of HBeAg and a low serum HBV DNA level (<8 log10 copies/mL) at baseline were significant predictors of the virologic response in a multivariate analysis (P<0.01). CONCLUSIONS: Entecavir therapy showed excellent efficacy in nucleoside-naive chronic hepatitis B patients. The predictors of a virologic response were an absence of HBeAg and a low baseline HBV DNA level.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Female ; Genotype ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/analysis ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Time Factors

PURPOSE: The Korean Intern Resident Association and Korean Society of Emergency Medicine announced the 'Hospital violence response system' to secure patient safety and provide a health care provider countermeasures against hospital violence. The aim of this study is to investigate the response to hospital violence in the ER and which measures could improve the current status. METHODS: Emergency medicine residents in the Seoul, Incheon, Kyung-gi area participated in the survey. The questionnaire included 4 categories (1. Awareness of protocol, 2. Experience and countermeasure for hospital violence, 3. Understanding of protocol, 4. Suggestions to improve against hospital violence) RESULTS: Among 362 candidates, 236 (65.2%) participated in the survey. Only 7.6% of residents have not experienced hospital violence. In the group of people who were aware of the protocol, participants tended to be more familiar with processes of the hospital violence response protocol, and willing to deal with violence using a better systematic support. People did not counteract to hospital violence because the process was thought to be too complicated. Only 63 participants were actively involved in an official course for countermeasure. Participants suggested that police should deal more appropriately with hospital violence. CONCLUSION: The hospital violence response protocol is thought to have a positive effect on appropriate management of hospital violence. However, a multi-disciplinary approach to hospital violence from the hospital, police, and judicial authority should be developed.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Gyeonggi-do ; Health Personnel ; Humans ; Incheon ; Internship and Residency ; Patient Safety ; Police ; Seoul ; Violence*

This study was performed to evaluate the effect of cyclic precalcification treatment on the improvement of bioactivity of Ti-6Al-4V mini-screws. The cutted plate-shaped specimens of 10 mm × 10 mm dimensions, and a mini-screw with a diameter of 1.6 mm × 6.0 mm in length were used. Anodic oxidation treatment was carried out in a glycerol electrolyte solution containing 20 wt% H2O and 1.5 wt% NH 4F. Voltage of 20 V with current density of 20 mA/cm2 was applied for 1 hour to form a nanotube TiO2 layer. Afterwards, to improve the bioactivity, specimens were immersed in 0.5 vol% silica aqueous solution at 37 ℃ for 5 minutes, and then cyclic precalcification treatment with 0.05 M NH 4H2PO4and 0.01 M Ca(OH)2 solution at 90 ℃ was repeated with 20 times. Based on surface treatment the experimental groups were divided into three groups, namely untreated group (UT), anodized and heat-treated group (AH), and anodized, silica-treated, cyclic precalcified and heat-treated group (ASPH). There were TiO2 nanotubes completely self-aligned and formed in a dense structure on the surface after anodic oxidation treatment. A fine granular cluster layer of hydroxyapatite and octacalcium phosphate were formed on the surface after the cyclic precalcification treatment. As a result of immersion test in the simulated body fluid (SBF), bioactivity was confirmed to be improved by the precipitation of protrusions appearing at the initial stage of formation of hydroxyapatite.

The prolonged neglect of the posterior teeth missing area may cause mesial drift, extrusion, unexpected movement of the adjacent teeth and alveolar bone loss with occlusion collapse. Therefore it is recommended to treat that area by the prosthesis as soon as possible after tooth missing. However, if orthodontic treatment is applied to move the remained teeth, it can create improved biomechanical dentoalveolar environment. The use of the third molars in teeth missing area provides advantages as optimizing of prosthesis size. However, crown shape, location, soundness of the third molar and possible of eruption failure should be considered. In this case report, two patients closed a second teeth missing site and reduced the size of the first and second teeth missing area for an implant by protraction of impacted third molars. This case reports the considerations for closing or reducing the posterior teeth space with protracting the third molars by comparing two patients.

The prevalence of colorectal cancer is increasing now in Korea and the principal strategy of its management is early detection and surgical resection. Current discussion of the topic of colorectal polyps and cancer is largely based on the concept of the adenoma-carcinoma sequence, which is thought to be the most probable pathogenesis for colorectal cancer. But the case reports about colonic adenocarcinoma arising from adenoma in clinical practice between short interval are rare in Korea. We experienced two cases of colon cancer, which were transformed from small adenoma can not be removed because of patients' refusal, 3 years ago. So we present these cases with a review of relevant literatures.
Adenocarcinoma* ; Adenoma* ; Colon* ; Colonic Neoplasms ; Colorectal Neoplasms ; Disulfiram ; Korea ; Polyps ; Prevalence

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
Abdomen ; Budgets ; Chest Pain ; Critical Care ; Dyspnea ; Emergencies ; Heart ; Heart Arrest ; Insurance Coverage ; Insurance ; Insurance, Health ; Korea ; Medical Records ; National Health Programs ; Patient Care ; Point-of-Care Systems ; Prescriptions ; Shock ; Thorax ; Ultrasonography

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.