Objective To evaluate the effect of dexmedetomidine and tramadol on perioperative insulin resistance in patients undergoing radical resection of rectal carcinoma.Methods Sixty ASA I or II patients undergo-ing radical resection of rectal carcinoma were randomly divided into 3 groups(n =20 each):dexmedetomidine group (group D),tramadol group(group T),control group(group C).Group D was given dexmedetomidine intravenously at 1μg/kg 15min before induction of anesthesia followed by a continuous infusion of 0.5μg·kg -1 ·h -1 until the abdo-men was closed,and group T was given tramadol intravenously at 1.5mg/kg 15min before induction of anesthesia fol-lowed by a continuous infusion of 0.5mg·kg -1 ·h -1 until the abdomen was closed,whereas group C received the same volume of normal saline.Venous blood samples were taken at 30min before anesthesia induction(T1 ),1 h after the beginning of the operation(T2 ),1h after operation(T3 ),24h after operation(T4 )for determination of blood con-centrations of glucose(BG),insulin(INS),interleukin -6 (IL -6),tumor necrosis factor -α(TNF -α).Insulin resistance(HOMA -IR)and insulin sensitivity index(QUICKI)were calculated.The numbers of patients with PONV were studied respectively.Results The serum IL -6,TNF -α,BG,INS concentrations and HOMA -IR were signifi-cantly lower while ISI was significantly higher in both group D[t =7.71,3.37,8.78,8.73,11.45,2.82(T2 ),3.04, 2.95,12.75,10.73,16.09,2.92(T3 ),11.26,2.45,11.40,5.10,14.5,2.51(T4 ),all P <0.05]and group T[t =3.02,2.59,2.93,7.76,6.32,2.03(T2 ),8.78,2.27,4.14,8.83,7.68,2.12(T3 ),6.10,2.05,3.71,2.35,7.12, 2.09(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group C.The serum TNF -αconcentration and HOMA -IR were significantly lower while ISI was significantly higher in group D[t =6.68,4.58,2.05 (T2 ),9.01,6.66,2.23 (T3 ),7.54,5.5,2.02(T4 ),all P <0.05]at T2 ,T3 and T4 than those in group T.The numbers of patients with PONV were significantly higher in group T than those in group D and group C (χ2 =26.13,18.75,all P <0.05 ). Conclusion Both dexmedetomidine and tramadol can attenuate perioperative insulin resistance in patients undergo-ing Radical Resection of Rectal Carcinoma,and the decrease the consentrations of IL -6 and TNF -αmay be involved in the mechanism.The roles of prevention of perioperative insulin resistance in dexmedetomidine group are superior to tramadol group.The incidence of PONV is less in a dexmedetomidine group than that in a tramadol group.

Purpose: This study aimed to estimate the risk of cancer incidence and mortality according to adherence to lifestyle-related cancer prevention guidelines. Materials and Methods: Men and women who participated in the general health screening program in 2002 and 2003 provided by the National Health Insurance Service were included (n=8,325,492). Self-reported smoking, alcohol consumption, and physical activity habits and directly measured body mass index were collected. The participants were followed up until the date of cancer onset or death or 31 December 2018. The Cox proportional hazard model was used to evaluate the hazard ratio (HR) for cancer incidence and mortality according to different combinations of lifestyle behaviors. Results: Only 6% of men and 15% of women engaged in healthy behavior at baseline, such as not smoking, not drinking alcohol, being moderately or highly physically active, and within a normal body mass index range. Compared to the best combination of healthy lifestyle behaviors, the weak and moderate associations with increased all cancer incidence (HR < 1.7) and mortality (HR < 2.5) were observed in those with heavy alcohol consumption and in former or current smokers. HRs of cancer mortality were significantly increased among current smokers in most combinations. Conclusion Compared to full adherence to cancer prevention recommendations, unhealthy behaviors increase cancer risk. As few people meet these recommendations, there is a great opportunity for cancer prevention.

Objective: The disabled are in a blind spot for obtaining information on drugs, and the pharmacies’ counseling on drug use is centered on non-disabled people. Few studies have investigated the current statuses of drug use by type of disability. The purpose of this study is to understand the drug use by type of disability and by life cycle of visually impaired and hearing impaired in Korea. Methods: The study participants consisted of 16 people with visually impairments, 12 people with hearing impairments. One indepth interview was conducted per participant, and each interview was recorded and documented. Results: Common barriers against safe medication and medical service uses across disability types are ‘lack of consideration and service for the disabled, limited access to medical facilities due to disability, limited access to information regarding medication use, psychological anxiety about drug use and side effects, and inconvenience regarding COVID-19 epidemic. The specific factors were ‘difficulties in identifying proper medicines and following prescribed dosages’ in the case of visually impaired, and ‘problems with sign language interpretation system’ for the hearing impaired. Conclusion Disabled people are hindered from using medicines properly due to various factors. Based on the content derived from this study, it is necessary to eliminate the inhibition factors and devise specific measures for the safety of each type of disorder such as developing a method for medication counseling considering disabilities and establishing communication support systems.

This research proposes a safety strategy for coronavirus disease 2019 (COVID-19) walkthrough booths to optimize pandemic preparedness. These booths, designed for respiratory sample collection during the COVID-19 pandemic, effectively reduce infection risk and personal protective equipment-related fatigue among healthcare workers. However, inadequate disinfection and glove management could escalate infection transmission. Using computational fluid dynamics simulations, we analyzed droplet dispersion on booth surfaces and gloves under various wind conditions. Our findings suggest that when setting up COVID-19 walk-through booths, their location should be strategically chosen to minimize the effects of wind. All surfaces of booth gloves must be thoroughly disinfected with a certified disinfectant after nasopharyngeal swab collection. It is also recommended to wear disposable gloves over booth gloves when changing between patient examinations. In wind-affected areas, individuals nearby should not solely rely on the 2-meter distancing rule due to potential droplet spread from walk-through booths. We strongly recommend consistent and proper mask use for effective droplet blocking. Adherence to these guidelines can significantly enhance the safety and efficiency of walk-through booths, particularly in potential future pandemics.

OBJECTIVES: In 1995, an outbreak survey in Gozan-dong concluded that an association between fiberglass exposure in drinking water and cancer outbreak cannot be established. This study follows the subjects from a study in 1995 using a data linkage method to examine whether an association existed. The authors will address the potential benefits and methodological issues following outbreak surveys using data linkage, particularly when informed consent is absent. METHODS: This is a follow-up study of 697 (30 exposed) individuals out of the original 888 (31 exposed) participants (78.5%) from 1995 to 2007 assessing the cancer outcomes and deaths of these individuals. The National Cancer Registry (KNCR) and death certificate data were linked using the ID numbers of the participants. The standardized incidence ratio (SIR) and standardized mortality ratio (SMR) from cancers were calculated by the KNCR. RESULTS: The SIR values for all cancer or gastrointestinal cancer (GI) occurrences were the lowest in the exposed group (SIR, 0.73; 95% CI, 0.10 to 5.21; 0.00 for GI), while the two control groups (control 1: external, control 2: internal) showed slight increases in their SIR values (SIR, 1.18 and 1.27 for all cancers; 1.62 and 1.46 for GI). All lacked statistical significance. All-cause mortality levels for the three groups showed the same pattern (SMR 0.37, 1.29, and 1.11). CONCLUSIONS: This study did not refute a finding of non-association with a 13-year follow-up. Considering that many outbreak surveys are associated with a small sample size and a cross-sectional design, follow-up studies that utilize data linkage should become standard procedure.
Drinking Water/chemistry ; Environmental Exposure/*adverse effects ; Female ; Follow-Up Studies ; *Glass ; Humans ; Incidence ; Male ; Neoplasms/epidemiology/etiology/*mortality ; Registries ; Republic of Korea ; Risk Factors ; Time Factors

OBJECTIVES: The purpose of this study is to describe beverage patterns among healthy Korean adults and investigate their association with prevalence and components of metabolic syndrome. METHODS: Subjects consisted of 6,927 Korean adults, aged 19-64 years in the 6th Korea National Health and Nutrition Examination Survey (KNHANES, 2013-2015). Beverages were regrouped into twelve groups based on food codes and beverage intake (g/day) was assessed by 24-hour recall. Factor analysis was used to obtain beverage patterns. Waist circumference and body mass index (BMI) were used as anthropometric data; fasting blood glucose, triglyceride, high density lipoprotein (HDL), and blood pressure were used as biochemical indicators. The odds ratio (OR) for prevalence of metabolic syndrome and components of metabolic syndrome was assessed using logistic regression analysis. RESULTS: Three beverage patterns were identified using factor analysis: 1) carbonated soft drinks 2) coffee (without added sugar or powdered creamer), and 3) alcoholic beverages. Subjects with high scores for the carbonated soft drink and coffee without added sugar or powdered creamer patterns were younger and subjects with high scores for the alcoholic beverage pattern were older. There were significant differences in gender distribution in all three beverage patterns, with men more likely to have high scores for carbonated soft drink and alcoholic beverage patterns. On the other hand, women were more likely to have higher scores for coffee without added sugar or powdered creamer pattern. Within each pattern, there were significant differences in sociodemographic and lifestyle characteristics such as education, household income, frequency of eating out, and smoking status according to the quartile of pattern scores. Alcoholic beverages and carbonated soft drinks patterns were associated with an increased levels of metabolic syndrome components, but coffee without added sugar or powdered creamer was not associated with any of metabolic syndrome components in healthy Korean adults after adjusting for age, sex, education, BMI, weight management, household income, smoking status, frequency of eating out, and energy intake. CONCLUSIONS: Alcoholic beverages and carbonated soft drinks patterns are associated with increased levels of metabolic syndrome components while coffee without added sugar or powdered creamer pattern is not associated with any of metabolic syndrome components in healthy Korean adults.
Adult* ; Alcoholic Beverages ; Beverages* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Carbon ; Carbonated Beverages ; Coffee ; Eating ; Education ; Energy Intake ; Family Characteristics ; Fasting ; Female ; Hand ; Humans ; Korea ; Life Style ; Lipoproteins ; Logistic Models ; Male ; Nutrition Surveys ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Triglycerides ; Waist Circumference

PURPOSE: The prevalence rates of metabolic syndrome (MetS) and percentile distribution of insulin resistance (IR) among Korean children and adolescents were investigated. The cutoff values of IR were calculated to identify high-risk MetS groups. METHODS: Data from 3,313 Korean subjects (1,756 boys and 1,557 girls, aged 10–18 years) were included from the Korean National Health and Nutrition Examination Survey conducted during 2007–2010. Three different sets of criteria for MetS were used. Indirect measures of IR were homeostasis model assessment (HOMA-IR) and triglyceride and glucose (TyG) index. The cutoff values of the HOMA-IR and TyG index were obtained from the receiver operation characteristic curves. RESULTS: According to the MetS criteria of de Ferranti el al., Cook et al., and the International Diabetes Federation, the prevalence rates in males and females were 13.9% and 12.3%, 4.6% and 3.6%, and 1.4% and 1.8%, respectively. Uses these 3 criteria, the cutoff values of the HOMA-IR and TyG index were 2.94 and 8.41, 3.29 and 8.38, and 3.54 and 8.66, respectively. The cutoff values using each of the 3 criteria approximately corresponds to the 50th–75th, 75th, and 75th–90th percentiles of normal HOMA-IR and TyG index levels. CONCLUSION: This study describes the prevalence rates of MetS in Korean children and adolescents, an index of IR, and the cutoff values for MetS with the aim of detecting high-risk groups. The usefulness of these criteria needs to be verified by further evaluation.
Adolescent* ; Child* ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Korea ; Male ; Nutrition Surveys ; Prevalence ; Triglycerides

PURPOSE: The prevalence rates of metabolic syndrome (MetS) and percentile distribution of insulin resistance (IR) among Korean children and adolescents were investigated. The cutoff values of IR were calculated to identify high-risk MetS groups. METHODS: Data from 3,313 Korean subjects (1,756 boys and 1,557 girls, aged 10–18 years) were included from the Korean National Health and Nutrition Examination Survey conducted during 2007–2010. Three different sets of criteria for MetS were used. Indirect measures of IR were homeostasis model assessment (HOMA-IR) and triglyceride and glucose (TyG) index. The cutoff values of the HOMA-IR and TyG index were obtained from the receiver operation characteristic curves. RESULTS: According to the MetS criteria of de Ferranti el al., Cook et al., and the International Diabetes Federation, the prevalence rates in males and females were 13.9% and 12.3%, 4.6% and 3.6%, and 1.4% and 1.8%, respectively. Uses these 3 criteria, the cutoff values of the HOMA-IR and TyG index were 2.94 and 8.41, 3.29 and 8.38, and 3.54 and 8.66, respectively. The cutoff values using each of the 3 criteria approximately corresponds to the 50th–75th, 75th, and 75th–90th percentiles of normal HOMA-IR and TyG index levels. CONCLUSION: This study describes the prevalence rates of MetS in Korean children and adolescents, an index of IR, and the cutoff values for MetS with the aim of detecting high-risk groups. The usefulness of these criteria needs to be verified by further evaluation.
Adolescent* ; Child* ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Korea ; Male ; Nutrition Surveys ; Prevalence ; Triglycerides

PURPOSE: There are inconsistencies in the results reported in a small number of previous studies into growth hormone (GH) treatment in Korean children with idiopathic short stature (ISS) and idiopathic growth hormone deficiency (IGHD). Thus, the authors retrospectively compared the effects of GH in ISS and IGHD. METHODS: From the medical records of 26 ISS and 30 IGHD children, auxological and biochemical changes including chronologic age (CA), bone age (BA), height standard deviation score (HT-SDS), predicted adult height (PAH), midparental height (MPH), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-3 (IGFBP-3) were compared. RESULTS: Before treatment, IGHD group had younger BA, lower BA/CA ratio, and lower IGF-1 level than those in the ISS group. During GH treatment, the levels of IGF-1 and IGFBP-3 were not different. Although annual BA increment was higher in IGHD group, and annual PAH-SDS increment was higher in ISS group, annual HT-SDS increments were not different. Both HT-SDS and PAH-SDS in the ISS group increased significantly until the end of the second year, and then those were not significantly different from MPH-SDS. In the IGHD group, the HT-SDS showed a significant increase till the end of the second year, and the PAH-SDS was not significantly changed at each year, but both HT-SDS and PAH-SDS were not significantly different from MPH-SDS at the end of the third year. CONCLUSION: During GH treatment, both HT-SDS and PAH-SDS approached the genetic target range of MPH-SDS after 2 years in ISS children and 3 years in IGHD children.
Adult ; Child* ; Growth Hormone* ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Medical Records ; Retrospective Studies

BACKGROUND: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. METHODS: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. RESULTS: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. CONCLUSION: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.
Clinical Decision-Making ; Consensus ; Kidney Transplantation ; Kidney ; Korea ; Transplant Recipients