Cyclic strabismus is a rare entity, which is characterized by alternating periods of strabismus and orthophoria.The mechanism is not clear but seems to be related to the biological clock. Cyclic esotropia is the most common type. On "strabismic"days,a large-angle esotropia will appear, and the binocular vision is impaired. On "straight"days, orthophoria or microstrabismus will appear and no abnor-mal binocular vision is observed. As a treatment, surgery based on the full amount of heterotropia on the strabismic day,has been successful, but treatment by chemodenervation ith botulinum toxin has not been reported yet. Authors experienced the cyclic esotropia following head trauma by a traffic accident in a 3-year-old boy and tried the injection of botulinum toxin on both medial rectus muscles as a treatment. In one-year follow-up observation, the cyclic pattern and esodeviation has disappeared.
Accidents, Traffic ; Biological Clocks ; Botulinum Toxins* ; Child, Preschool ; Craniocerebral Trauma ; Esotropia* ; Follow-Up Studies ; Humans ; Male ; Muscles ; Nerve Block ; Strabismus ; Vision, Binocular

BACKGROUND AND OBJECTIVES: The renin-angiotensin system (RAS) is a major regulator of blood pressure. The angiotensin II receptor type 1 (AGTR 1) A1166C has been extensively studied in searching for their involvement in the development of hypertension. The aim of this study was to determine the association of the AGTR 1 A1166C marker with essential hypertension in Korean adolescents. SUBJECTS AND METHODS: Forty hypertensive adolescents were included in this study. The obesity index (OI) and body mass index (BMI) of the subjects were calculated. Blood pressure was measured at the resting state by oscillometric methods. The serum aldosterone, renin, insulin, angiotensin converting enzyme (ACE), homocysteine, vitamin B12 and folate levels were measured. The carotid intima-media thickness (IMT) and diameter and the brachial-ankle pulse wave velocity (baPWV) were evaluated by ultrasound. Polymerase chain reaction (PCR) was conducted to amplify the DNA of each of the study subjects to analyze the polymorphism of AGTR 1 A1166C. RESULTS: The genotypic frequency of AA was 87.5%, that for adenylate cyclase (AC) was 12.5% and no CC type was detected. The serum homocysteine level was higher in the subjects with the AC genotype than that in the subjects with the AA genotype (11.9+/-2.9 umol/L vs 17.1+/-4.2 umol/L, respectively). The carotid IMT of the subjects with the AA genotype was greater than that of the subjects with the AC genotype (5.0+/-0.1 mm vs 8.0+/-0.2 mm, respectively). CONCLUSION: In conclusion, the A1166C mutation group had a significantly greater carotid IMT and higher homocysteine levels than the group with the normal genotype of AGTR 1. The AC genotype of A1166C may be useful to predict the presence of early coronary artery disease in hypertensive adolescents. More investigation is necessary to clarify the relation between the A1166C gene and its involvement with coronary artery disease in hypertensive Korean adolescents.
Adenylyl Cyclases ; Adolescent ; Aldosterone ; Angiotensin II ; Angiotensins ; Blood Pressure ; Body Mass Index ; Carotid Intima-Media Thickness ; Coronary Artery Disease ; DNA ; Folic Acid ; Genotype ; Homocysteine ; Humans ; Hypertension ; Insulin ; Obesity ; Peptidyl-Dipeptidase A ; Polymerase Chain Reaction ; Pulse Wave Analysis ; Receptor, Angiotensin, Type 1 ; Receptors, Angiotensin ; Renin ; Renin-Angiotensin System ; Vitamin B 12

The present study was conducted to provide the basis for improvement of clinical nutrition services through development of job standards of clinical dietitian for the clinical nutrition therapy to cancer patients in hospitals. Developing A Curriculum (DACUM) method was used for job analysis and development of job standards for clinical dietitians for cancer care. Based on DACUM analysis, information about duties, tasks, and task elements of clinical dietitians for cancer care was collected. Developed job standards were applied to clinical nutrition care for cancer patients in hospitals for evaluation. Based on DACUM analysis, consultations from professionals, and field application tests, the final job standards were composed of four duties, 18 tasks, and 56 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring.evaluation. For cancer nutrition care, 109 work activities were developed. They were composed of 75 basic and 34 recommended work activities. The application of developed job standards for clinical dietitians for cancer care at 10 hospitals showed a performance rate of 72.3%. In conclusion, job standards for clinical dietitians for cancer care developed in this study might be effectively used as guidelines for providing clinical nutrition services for cancer patients in hospitals.
Curriculum ; Diagnosis ; Humans ; Nutrition Assessment ; Nutrition Therapy* ; Nutritionists* ; Referral and Consultation

Dyslipidemia has significantly contributed to the increase of death and morbidity rates related to cardiovascular diseases. Clinical nutrition service provided by dietitians has been reported to have a positive effect on relief of medical symptoms or reducing the further medical costs. However, there is a lack of researches to identify key competencies and job standard for clinical dietitians to care patients with dyslipidemia. Therefore, the purpose of this study was to analyze the job components of clinical dietitian and develop the standard for professional practice to provide effective nutrition management for dyslipidemia patients. The current status of clinical nutrition therapy for dyslipidemia patients in hospitals with 300 or more beds was studied. After duty tasks and task elements of nutrition care process for dyslipidemia clinical dietitians were developed by developing a curriculum (DACUM) analysis method. The developed job standards were pretested in order to evaluate job performance, difficulty, and job standards. As a result, the job standard included four jobs, 18 tasks, and 53 task elements, and specific job description includes 73 basic services and 26 recommended services. When clinical dietitians managing dyslipidemia patients performed their practice according to this job standard for 30 patients the job performance rate was 68.3%. Therefore, the job standards of clinical dietitians for clinical nutrition service for dyslipidemia patients proposed in this study can be effectively used by hospitals.
Cardiovascular Diseases ; Curriculum ; Dyslipidemias* ; Humans ; Job Description ; Nutrition Therapy* ; Nutritionists ; Professional Practice

This study was conducted to develop job standards for clinical dietitian administering clinical nutrition therapy to diabetic patients in hospitals. Based on DACUM (Developing A Curriculum) analysis of 17 members including clinical dietitians, professors majoring in clinical nutrition and researchers, information on duties, tasks and task elements of clinical dietitians for diabetes care were derived and applied to diabetes mellitus-specific clinical nutrition care in hospitals for evaluation. The final developed job standards for clinical dietitians for diabetes care included four duties, 19 tasks and 56 task elements. The duties consisted of nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring . evaluation. For application of diabetes mellitus-specific job standards in clinical nutrition care, 108 work activities were developed and classified into 90 basic and 18 recommended types. Performance rates of standardized jobs were 80.2% at nutrition assessment, 99.6% at nutrition diagnosis, 78.5% at nutrition intervention, and 32.9% at nutrition monitoring . evaluation. These results can be applied as guidelines to implement jobs for diabetes mellitus-specific clinical nutrition services in clinical settings. In addition, they would be useful for education standards in educational institutions for education and training of clinical dietitian.
Diabetes Mellitus ; Diagnosis ; Education ; Humans ; Job Description ; Nutrition Assessment ; Nutrition Therapy* ; Nutritionists*

PURPOSE: To evaluate the amount and pattern of change in deviation angle with time course after surgical correction of intermittent exotropia and to evaluate the effect of pre-operative deviation and operation age on post-operative deviation change. METHODS: 54 patients who followed more than 60 months (60~120 months, mean 71.7 months) after surgical correction of intermittent exotropia were selected. We defined 'satisfactory results' that alignment of orthotropia, under 10delta esotropia and under 10delta exotropia. RESULTS: Of 54 patients, satisfactory results obtained in 96.2%(52 patients), immediate post-operation day and decreas with time course to 35.1% (19 patients) at post-operative 5 years. To quantification of change of deviation, author defined exotropic drift as +, esotropic drift as -, and no change as 0. The change of deviation between immediate post-operation and 2 years after operation is +14.55delta, between 2 years after and 5 years is +2.70delta. The change of deviation developed between immediate post-operation and 2 years after operation has statistical significance in comparison with change of deviation developed between after 2 years and 5 years after operation (P=0.0001). Pre-operative deviation has no effect on post-operative deviation change (P=0.4472) and operation age was same (P=0.3461). CONCLUSIONS: The results of surgical correction of intermittent exotropia is significantly deteriorated with time course. Exotropic drift was more pronounced between immediate post-operation and 2 years after operation and then decreased. Therefore we recommend that after surgery of intermittent exotropia patients should be followed by schedule more than 2 years and thereafter the tendency for exotropic drift will more stable. After 2 years, however, small amount exotropic drift can be possible.
Appointments and Schedules ; Esotropia ; Exotropia* ; Humans

OBJECTIVE: To evaluate the effectiveness of hysteroscopy and the incidence of endometrial polyps in women with endometriosis. METHODS: A total of 99 patients determined to be with infertility by laparoscopic procedure from March 1999 to February 2000 were prospectively analyzed at Ajou University Hospital, Suwon, Korea. The study group was 63 patients with endometriosis and the control group consisted of 36 patients without endometriosis. The presence of endometriosis was documented laparoscopically and scored according to The American Fertility Society Classification. We confirmed the presence of endometrial polyps by pathologic examination after polypectomy. We compared the results of the operation to that of the hysterosalpingogram(HSG) and transvaginal sonogram(TVS) before the procedure. RESULTS: Among the 99 patients with infertility, endometrial polyps were found in 40 of 63 women(63.5%) with endometriosis but in only 10 of 36 women(38.5%) without endometriosis. The greater the degree of endometriosis was accompanied by increased incidence of endometrial polyps, and in particular, women with stage three endomeriosis or higher all showed the presence of endometrial polyps. The sensitivity and specificity of the HSG detecting the presence of an endometrial polyp is 55.3%, 87.2%, and that of the TVS is 78.9%, 95.7%. DISCUSSION: The presence of endometrial polyps is significantly associated with the presence of endometriosis, and therefore hysteroscopy should be performed in patients with endometriosis who have not been confirmed with endometrial pathology by HSG or TVS.
Classification ; Endometriosis* ; Female ; Fertility ; Gyeonggi-do ; Humans ; Hysteroscopy* ; Incidence ; Infertility ; Korea ; Laparoscopy ; Pathology ; Polyps* ; Prospective Studies ; Sensitivity and Specificity

Background: Interprofessional education (IPE) is important for collaboration between professionals in the team-based practices of the healthcare field. Objectives: This study aimed to examine pharmacy students across in Korea on the experience of IPE and the perceptions of the importance of interprofessional collaboration (IPC) and the need of IPE. Methods: A cross-sectional survey using a 20 questionnaire to pharmacy students nationwide was conducted from March to May 2019. Results: A total of 555 students from 32 pharmacy schools participated. They recognized that the importance of close pharmacist-medical doctor collaboration was an average of 5.38 points (out of 6 points), but the current level of pharmacist-to-medical doctor collaboration was an average of 2.51 points (out of 6 points), and the reasons for the insufficient IPC were the lack of an environment encouraging mutual cooperation (79.5%) and the psychological distance to the other professional (35.3%). They perceived the necessity of IPE between pharmacistmedical doctor was 4.95 points (out of 6 points), with the curriculum including how to cooperate with medical doctors (78.2%), communication skills (51.0%), and understanding of medical doctors’ functions (44.5%), etc. Only 52 respondents (9.4%) had experience in IPE. Respondents who recognized the importance of IPC (≥5 points) showed 4.44-fold higher agreement on the need for IPE than those who did not (≤4 points) (OR 4.44, 95% CI 2.56, 7.68). Conclusions Further attention and discussion to add IPE program in the pharmacy school curriculum is necessary in order to cultivate pharmacists with sufficient professional collaboration capabilities.

BACKGROUND: Although photodynamic therapy (PDT) is widely performed for acne, little is known about its exact therapeutic mechanism. OBJECTIVE: We aimed to estimate the efficacy and safety of PDT on acne and to discover its mode of action. METHODS: We performed PDT on 12 patients with mild to moderate acne. The clinical efficacy was assessed by counting the acne lesions and measuring the sebum secretion before and after PDT. In addition, we took biopsy samples from the peri-lesional areas before and after 3-session of PDT. To examine the degree of apoptosis of the sebaceous follicles, TUNEL assay was performed. To investigate the changes of toll-like receptor (TLR)-2 and TLR-4 expression after PDT, immunohistochemical stainings were also carried out. Finally, we performed TUNEL assay using the cultured sebocytes to confirm the apoptosis of sebocytes in vitro after PDT. RESULTS: There was a significant reduction in the number of inflammatory acne lesions after PDT, compared to baseline (p<0.05). Sebum excretion significantly decreased 2 weeks after the first PDT session except for one patient (p<0.05). The TUNEL positive cells in the peri-lesional sebaceous glands after PDT markedly increased, compared with those of before PDT. A decrease in TLR-2 and TLR-4 expression by sebaceous glands and epidermis after PDT was 50% and 30%, respectively. CONCLUSION: Our results demonstrate that apoptosis of the sebaceous glands is associated with improvement of acne by PDT. PDT has shown to down-regulate TLR-2 and TLR-4 expression in the sebaceous glands and epidermis of acne patients.
Acne Vulgaris ; Apoptosis ; Biopsy ; Epidermis ; Humans ; In Situ Nick-End Labeling ; Photochemotherapy ; Sebaceous Glands ; Sebum ; Toll-Like Receptors ; Triazenes

PURPOSE: Although a diet that is rich in fiber is widely recommended to prevent and treat constipation, the efficacy of fiber supplements with yogurt has not been studied sufficiently. The aim of this study was to evaluate the effect of a yogurt enriched water-soluble fiber on the various symptoms of constipation in female adults with functional constipation. RESULTS: We did a double-blind and case-controlled study between two groups (placebo vs. fiber group), which were randomly allocated out of 42 subjects with functional constipation by using Rome II criteria. Bowel habits, daily nutritional intakes and physical activities were determined by using a questionnaire, and the segmental colonic transit time was evaluated three times: before treatment, after 4 weeks of treatment, and at the end of the study (2 weeks after treatment). RESULTS: After 4 weeks of treatment, all defecation symptoms tested, except manual evacuation, showed significant improvements in the fiber group; fiber-enriched yogurt increased the number of bowel movements (P=0.002), reduced the presence of hard stools (P=0.001), improved the frequency of straining (P=0.048), the sense of incomplete evacuation (P= 0.013), and the sense of anorectal obstruction (P= 0.032). The total colonic transit time was shortened after intake of fiber-enriched yogurt (P=0.023). Satisfactory relief was significantly higher in the fiber group (P= 0.011). CONCLUSIONS: Functional constipation may be improved with water-soluble fiber supplements in yogurt without serious side effects.
Adult ; Case-Control Studies ; Colon ; Constipation* ; Defecation ; Diet ; Female ; Humans ; Motor Activity ; Surveys and Questionnaires ; Yogurt*