The aim of this study was to evaluate the association between various predicting tools and Apnea-Hypopnea Index (AHI) to identify children with sleep disordered breathing (SDB). From 5 to 10 years old who came for orthodontic counseling, 61 children, whom had lateral cephalograms, pediatric sleep questionnaire (PSQ) records, and portable sleep monitoring results, were included in this study. A total of 17 measurements (11 distances and 6 angles) were made on lateral cephalograms. The measurements of lateral cephalograms, PSQ scales and portable sleep monitoring results were statistically analyzed. 49 of 61 (80%) patients showed AHI > 1, which suspected to have SDB and their mean AHI was 2.75. In this study, adenoid size (A/N ratio), position of the hyoid bone from mandibular plane, gonial angle, and PSQ scale were related to a higher risk of pediatric SDB. Also, oxygen desaturation index (ODI) and snoring time from sleep monitoring results were statistically significant in children with SDB using Mann-Whitney test (p ＜ 0.05).
In conclusion, evaluation of hyoid bone position, adenoidal hypertrophy, gonial angle in lateral cephalogram, and PSQ scale was important to screen out potential SDB, especially in children with frequent snoring.

The purpose of this study was to investigate current status of sedation training for the residents in pediatric dentistry training institutions and opinions about continuing education after the residency program.
Surveys were sent to 18 pediatric dentistry training institutions by e-mail, and the responses were collected and analyzed. Most of the sedation education period for the residents were the 1st-year education (61.1%) and 1 - 3 years of integrated education (55.6%). In terms of an externship, 5 institutions (27.8%) sent their residents to the department of anesthesiology. Second half of the 1st year (50%) was the highest for a resident to use sedation for the first time. The period of supervisor participation varied from not participating at all to whole time throughout the residency program. The sedation training is conducted at all training institutions, but there were variations in the experience that a resident can gain.
All training institutions agreed on the necessity of continuing education of the sedation, but there were various opinions regarding time, method, and the period of review course. Overall, this study suggested that continuing education should be consisted of 1 - 2 hours of didactic education every year and clinical skills and simulation training in every 2 - 3 years.

Objectives: The purpose of this study was to compare the demographic, clinical, and criminal characteristics and legal judgments of criminal cases, in which psychiatric evaluation was requested, and to identify factors affecting criminal responsibility judgments. Methods: The medical records of 100 subjects that committed crimes and the judgment records of 51 subjects admitted to Yongin Mental Hospital from February 2005 to February 2021 were analyzed retrospectively. Psychiatric disorder groups were compared with respect to demographic, clinical, criminal characteristics, and legal judgments. Factors affecting criminal responsibility judgments were identified by comparing legal judgment groups. Results: Psychiatric history, criminal motivation, and criminal history differed significantly between psychiatric disorder groups. Differences between the opinions of the appraiser and courts regarding criminal responsibility were significantly dependent on psychiatric disorder type, and there was a consistent tendency according to the psychiatric disorders, but there was a difference of opinion between the two groups. Conclusion The findings of the current study suggest psychiatric diagnoses and symptoms such as psychotic symptoms and cognitive impairments that provoke crime can influence criminal responsibility judgments.

Background: This study aimed to identify factors that affect fasting hyperglycemia (FHG) and postprandial hyperglycemia (PPG) and their contributions to overall hyperglycemia in Korean patients with type 2 diabetes mellitus (T2DM). Methods: This was a retrospective study conducted on 194 Korean T2DM patients with 7-point self-monitoring blood glucose (SMBG) profiles plotted in 4 days in 3 consecutive months. We calculated the areas corresponding to FHG and PPG (area under the curve [AUC]FHG and AUCPPG) and contributions (%) in the graph of the 7-point SMBG data. The levels of glycated hemoglobin (HbA1c) were categorized by tertiles, and the contributions of FHG and PPG were compared. Results: The relative contribution of FHG increased (44.7%±5.6%, 58.0%±4.4%, 66.5%±2.8%; PANOVA=0.002, PTREND <0.001), while that of PPG decreased (55.3%±5.5%, 42.0%±4.4%, 33.5%±2.8%; PANOVA=0.002, PTREND <0.001) with the elevated HbA1c. Multivariate analysis showed that HbA1c (β=0.615, P<0.001), waist circumference (β=0.216, P=0.042), and triglyceride (β=0.121, P=0.048) had a significant association with AUCFHG. Only HbA1c (β=0.231, P=0.002) and age (β=0.196, P=0.009) was significantly associated with AUCPPG. Conclusion The data suggested that in Korean T2DM patients, FHG predominantly contributed to overall hyperglycemia at higher HbA1c levels, whereas it contributed to PPG at lower HbA1c levels. It is recommended that certain factors, namely age, degree of glycemic control, obesity, or triglyceride levels, should be considered when prescribing medications for T2DM patients.

Since sarcomatoid carcinoma in the common bile duct (CBD) is rarely reported, the clinical course and prognosis after surgery are unclear. We report a case of a patient who died within 1 month after surgery due to rapid tumor progression. A 65-year-old woman had abdominal pain with jaundice. She was diagnosed with CBD cancer and underwent pancreatoduodenectomy. Pathologic examination revealed sarcomatoid carcinoma. There was no postoperative complication, but multiple liver metastasis was diagnosed on computed tomography at 7 days after surgery. Also, the patient complained of abdominal pain and had jaundice with elevated liver enzyme on the 14th postoperative day. Her general condition was getting worse and she died of hepatic failure 23 days after surgery. We report a case of sarcomatoid carcinoma of the CBD that progressed very rapidly. Further research and case reports are needed to establish proper diagnostic and treatment tools.
Abdominal Pain ; Aged ; Carcinosarcoma ; Common Bile Duct ; Female ; Humans ; Jaundice ; Liver ; Liver Failure ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Postoperative Complications ; Prognosis

Objectives: . Bone-anchored hearing device (BAHD) is contraindicated in patients younger than 5 years because their calvarial bones are not thick enough to be implanted site. However, it has not been studied in the Korean population. This study was not only to establish a safe guideline for depth of implant device in all age groups who undergo BAHD implant surgery, but also to investigate whether implantation of currently used BAHDs could be done safely in Korean children, especially those younger than 5. Methods: . Two hundred eighty patients, who underwent high-resolution temporal bone computed tomography (TBCT) images between August 2010 and October 2018 were randomly enrolled in all ages. We retrospectively reviewed TBCT imaging to measure skull bone thickness at the recommended BAHD implant site. Results: . The average skull bone thickness was 2.87 mm in patients younger than 5 years and 6.72 mm in patients older than 5 years, respectively, which conforms to the current guideline. The results indicate nearly 50% of calvarial bone thicknesses were less than 3 mm in patients under 5 years old, while 92.78% of the patients older than 5 years of age showed bone thickness greater than 4 mm. Of note, calvarial bone thickness was thicker than 3 mm in all patients who are older than 6 years. Conclusion . This study confirms that the currently approved BAHD implantation guideline is suitable in the Korean population. For safety, we suggest taking TBCTs prior to surgery, especially in pediatric patients. Besides, noninvasive applications are recommended for patients younger than 5.

OBJECTIVE: Postmenopausal women show a more atherogenic lipid profile and elevated cardiovascular risk compared to premenopausal women. The aim of this study was to investigate the efficacy and safety of high-dose atorvastatin on the improvement of the blood lipid profile of postmenopausal women in Korea. METHODS: This study is a prospective, open-label, single-arm clinical trial that was conducted in 3 teaching hospitals. Postmenopausal women with a moderate-to-high cardiovascular risk, according to guidelines from the Korean Society of Lipid & Atherosclerosis, were enrolled. Participants were administered 20 mg of atorvastatin daily for the first 8 weeks, and if the targeted low-density lipoprotein cholesterol (LDL-C) level was not achieved, the dose was increased to 40 mg for the second 8 weeks. The primary endpoint was percentage change of LDL-C from baseline after 16 weeks of drug administration. RESULTS: Forty-four women were enrolled, 28 of whom (75.6%) had diabetes mellitus. By the end of treatment period (16 weeks) all patients had achieved LDL-C target levels, with 33 (94.2%) of the participants achieving it after only 8 weeks of administration. After 16 weeks, LDL-C decreased by 45.8±16.7% (p<0.001) from the baseline, and total cholesterol (33.2±10.9%; p<0.001), triglyceride (24.2±37.5%; p=0.001), and apolipoprotein B (34.9±15.6%; p<0.001) also significantly decreased. Blood glucose and liver enzyme levels slightly increased, but none of the participants developed serious adverse events that would cause them to prematurely withdraw from the clinical trial. CONCLUSION 20 and 40 mg atorvastatin was effective and safe for treating dyslipidemia in postmenopausal Korean women with moderate-to-high cardiovascular risk.

BACKGROUND: Increased low density lipoprotein cholesterol (LDL-C) level and the presence of metabolic syndrome (MetS) are important risk factors for cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Recent studies demonstrated apolipoprotein B (apoB), a protein mainly located in LDL-C, was an independent predictor of the development of CVD especially in patients with T2DM. The aim of this study was to investigate the relationship between apoB and MetS in T2DM patients. METHODS: We analyzed 912 patients with T2DM. Fasting blood samples were taken for glycated hemoglobin, high-sensitivity C-reactive protein, total cholesterol, triglyceride (TG), high density lipoprotein cholesterol, LDL-C, and apoB. MetS was defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria. We performed a hierarchical regression analysis with apoB as the dependent variable. Age, sex, the number of components of MetS and LDL-C were entered at model 1, the use of lipid-lowering medications at model 2, and the individual components of MetS were added at model 3. RESULTS: Seventy percent of total subjects had MetS. ApoB level was higher in subjects with than those without MetS (104.5+/-53.3 mg/dL vs. 87.7+/-33.7 mg/dL, P<0.01) even after adjusting for LDL-C. ApoB and LDL-C were positively correlated to the number of MetS components. The hierarchical regression analysis showed that the increasing number of MetS components was associated with higher level of apoB at step 1 and step 2 (beta=0.120, P<0.001 and beta=0.110, P<0.001, respectively). At step 3, TG (beta=0.116, P<0.001) and systolic blood pressure (beta=0.099, P<0.05) were found to significantly contribute to apoB. CONCLUSION: In patients with T2DM, apoB is significantly related to MetS independently of LDL-C level. Of the components of MetS, TG, and systolic blood pressure appeared to be determinants of apoB.
Adult ; Apolipoproteins B ; Apolipoproteins* ; Blood Pressure ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL* ; Diabetes Mellitus, Type 2 ; Education ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Risk Factors ; Triglycerides

BACKGROUND: Intra-class correlation coefficients (ICCs) provide a statistical means of testing the reliability. However, their interpretation is not well documented in the orthopedic field. The purpose of this study was to investigate the use of ICCs in the orthopedic literature and to demonstrate pitfalls regarding their use. METHODS: First, orthopedic articles that used ICCs were retrieved from the Pubmed database, and journal demography, ICC models and concurrent statistics used were evaluated. Second, reliability test was performed on three common physical examinations in cerebral palsy, namely, the Thomas test, the Staheli test, and popliteal angle measurement. Thirty patients were assessed by three orthopedic surgeons to explore the statistical methods testing reliability. Third, the factors affecting the ICC values were examined by simulating the data sets based on the physical examination data where the ranges, slopes, and interobserver variability were modified. RESULTS: Of the 92 orthopedic articles identified, 58 articles (63%) did not clarify the ICC model used, and only 5 articles (5%) described all models, types, and measures. In reliability testing, although the popliteal angle showed a larger mean absolute difference than the Thomas test and the Staheli test, the ICC of popliteal angle was higher, which was believed to be contrary to the context of measurement. In addition, the ICC values were affected by the model, type, and measures used. In simulated data sets, the ICC showed higher values when the range of data sets were larger, the slopes of the data sets were parallel, and the interobserver variability was smaller. CONCLUSIONS: Care should be taken when interpreting the absolute ICC values, i.e., a higher ICC does not necessarily mean less variability because the ICC values can also be affected by various factors. The authors recommend that researchers clarify ICC models used and ICC values are interpreted in the context of measurement.
Adolescent ; Biomedical Research/*methods/*standards ; Cerebral Palsy ; Child ; Child, Preschool ; Computer Simulation ; Databases, Factual ; Female ; Humans ; Male ; Models, Theoretical ; Orthopedics/*methods/*standards ; Physical Examination ; Range of Motion, Articular ; Reproducibility of Results ; Research Design ; Statistics as Topic ; Young Adult

Background: Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated. Methods: This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models. Results: During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30−34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35−39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse. Conclusion Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.