Zenker’s diverticulum (ZD) is an abnormally protruding space in the Killian triangle due to weakness between the inferior pharyngeal constrictor muscle and cricopharyngeal muscle. A rare disease that is found more often in the West than in the East, it occurs in the elderly, inducing dysphagia, globus symptom, reflux and etc. For the treatment, various transoral endoscopic techniques have been developed over the past 20 years: these include flexible and rigid endoscopy are used and several devices like scissors, staplers, CO2 laser and energy device. We report here the first case using the endoscopic energy device assisted diverticulostomy of ZD in Korea. Transoral endoscopic treatment is less invasive than classical transcervical approach treatment, showing better clinical course and results. Both rigid endoscope and energy device are also very familiar to head and neck surgeons, so this approach can be one of the best treatments for ZD.

BACKGROUND/OBJECTIVES: To encourage schools to transform school meal programs to be more educational, it is necessary to evaluate the related environment using a whole school approach. We developed a school food culture evaluation tool to quantitatively evaluate school food culture in Gyeonggi Province, Korea. SUBJECTS/METHODS: Based on a literature review, a school food culture evaluation system consisting of areas, subareas, indicators, and questions (scored on a 5-point scale) was constructed. The validity of the tool was reviewed using focus group interviews, the Delphi technique, and a preliminary survey. Subsequently, evaluation tool was applied to elementary, middle, and high schools in Gyeonggi Province. Data from 115 schools were used for the final analysis. This included 64 elementary schools, 29 middle schools, and 22 high schools. At least one respondent from each group—school administrators, teachers, and nutrition teachers (or dietitians)—participated. The results were compared at the school level. RESULTS: The evaluation tool consisted of 66 questions in 5 areas (institutional environment, physical environment, educational environment, educational governance, and school meal quality). The total average score for school food culture was 3.83 points (elementary school 3.89 points, middle school 3.76 points, and high school 3.76 points) and did not differ significantly among school levels. Among the 5 evaluation areas, scores were highest for institutional environment (4.43 points) and lowest for physical environment (3.07 points).Scores for educational environment, educational governance, and school meal quality were 3.86, 3.85, and 3.97 points, respectively. CONCLUSION It is necessary to improve the physical environment to create a desirable school food culture in Gyeonggi Province. To effectively promote healthy eating, ongoing investment and interventions by local authorities at improving school food culture are needed, with an emphasis on particular factors, such as the eating environment and staff training.

BACKGROUND/OBJECTIVES: To encourage schools to transform school meal programs to be more educational, it is necessary to evaluate the related environment using a whole school approach. We developed a school food culture evaluation tool to quantitatively evaluate school food culture in Gyeonggi Province, Korea. SUBJECTS/METHODS: Based on a literature review, a school food culture evaluation system consisting of areas, subareas, indicators, and questions (scored on a 5-point scale) was constructed. The validity of the tool was reviewed using focus group interviews, the Delphi technique, and a preliminary survey. Subsequently, evaluation tool was applied to elementary, middle, and high schools in Gyeonggi Province. Data from 115 schools were used for the final analysis. This included 64 elementary schools, 29 middle schools, and 22 high schools. At least one respondent from each group—school administrators, teachers, and nutrition teachers (or dietitians)—participated. The results were compared at the school level. RESULTS: The evaluation tool consisted of 66 questions in 5 areas (institutional environment, physical environment, educational environment, educational governance, and school meal quality). The total average score for school food culture was 3.83 points (elementary school 3.89 points, middle school 3.76 points, and high school 3.76 points) and did not differ significantly among school levels. Among the 5 evaluation areas, scores were highest for institutional environment (4.43 points) and lowest for physical environment (3.07 points).Scores for educational environment, educational governance, and school meal quality were 3.86, 3.85, and 3.97 points, respectively. CONCLUSION It is necessary to improve the physical environment to create a desirable school food culture in Gyeonggi Province. To effectively promote healthy eating, ongoing investment and interventions by local authorities at improving school food culture are needed, with an emphasis on particular factors, such as the eating environment and staff training.

BACKGROUND/OBJECTIVES: To encourage schools to transform school meal programs to be more educational, it is necessary to evaluate the related environment using a whole school approach. We developed a school food culture evaluation tool to quantitatively evaluate school food culture in Gyeonggi Province, Korea. SUBJECTS/METHODS: Based on a literature review, a school food culture evaluation system consisting of areas, subareas, indicators, and questions (scored on a 5-point scale) was constructed. The validity of the tool was reviewed using focus group interviews, the Delphi technique, and a preliminary survey. Subsequently, evaluation tool was applied to elementary, middle, and high schools in Gyeonggi Province. Data from 115 schools were used for the final analysis. This included 64 elementary schools, 29 middle schools, and 22 high schools. At least one respondent from each group—school administrators, teachers, and nutrition teachers (or dietitians)—participated. The results were compared at the school level. RESULTS: The evaluation tool consisted of 66 questions in 5 areas (institutional environment, physical environment, educational environment, educational governance, and school meal quality). The total average score for school food culture was 3.83 points (elementary school 3.89 points, middle school 3.76 points, and high school 3.76 points) and did not differ significantly among school levels. Among the 5 evaluation areas, scores were highest for institutional environment (4.43 points) and lowest for physical environment (3.07 points).Scores for educational environment, educational governance, and school meal quality were 3.86, 3.85, and 3.97 points, respectively. CONCLUSION It is necessary to improve the physical environment to create a desirable school food culture in Gyeonggi Province. To effectively promote healthy eating, ongoing investment and interventions by local authorities at improving school food culture are needed, with an emphasis on particular factors, such as the eating environment and staff training.

BACKGROUND/OBJECTIVES: To encourage schools to transform school meal programs to be more educational, it is necessary to evaluate the related environment using a whole school approach. We developed a school food culture evaluation tool to quantitatively evaluate school food culture in Gyeonggi Province, Korea. SUBJECTS/METHODS: Based on a literature review, a school food culture evaluation system consisting of areas, subareas, indicators, and questions (scored on a 5-point scale) was constructed. The validity of the tool was reviewed using focus group interviews, the Delphi technique, and a preliminary survey. Subsequently, evaluation tool was applied to elementary, middle, and high schools in Gyeonggi Province. Data from 115 schools were used for the final analysis. This included 64 elementary schools, 29 middle schools, and 22 high schools. At least one respondent from each group—school administrators, teachers, and nutrition teachers (or dietitians)—participated. The results were compared at the school level. RESULTS: The evaluation tool consisted of 66 questions in 5 areas (institutional environment, physical environment, educational environment, educational governance, and school meal quality). The total average score for school food culture was 3.83 points (elementary school 3.89 points, middle school 3.76 points, and high school 3.76 points) and did not differ significantly among school levels. Among the 5 evaluation areas, scores were highest for institutional environment (4.43 points) and lowest for physical environment (3.07 points).Scores for educational environment, educational governance, and school meal quality were 3.86, 3.85, and 3.97 points, respectively. CONCLUSION It is necessary to improve the physical environment to create a desirable school food culture in Gyeonggi Province. To effectively promote healthy eating, ongoing investment and interventions by local authorities at improving school food culture are needed, with an emphasis on particular factors, such as the eating environment and staff training.

OBJECTIVE: To evaluate the usefulness of power spectral analysis on fetal heart rate variability as a new diagnostic method of fetal distress. STUDY DESIGN: Among 76 pregnant women who underwent computerized electronic fetal monitoring and cord blood gas analysis, we divided them into 3 groups, i.e.; normal fetus group (36), presumed distress group (26) and acidemic distress group (14). In order to perform linear analysis on the raw data of the fetal heart rate, after resampling, we performed Fourier transformation and investigated power distributions among very low frequency (VLF), low frequency (LF), high frequency (HF) bands, and autonomic balance (LF/HF). RESULTS: The results of the spectral analysis showed that in normal fetus group, the difference in the distribution of power spectrums of VLF, LF and HF was significantly higher than in presumed distress group and acidemic distress group. In fetal distress, the LF and VLF value (0.0023, 0.0437) were good predictors (sensitivity 97.5%, 75.0% and specificity 86.1%, 94.4%). The LF value (0.0013) was a good predictor in fetal acidemia (sensitivity 97.5% and specificity 86.1%). CONCLUSIONS: A computerized spectral analysis of fetal heart rate variation is a good predictor of fetal distress, which is made automatically and objectively.
Female ; Fetal Blood ; Fetal Distress* ; Fetal Heart* ; Fetal Monitoring ; Fetus ; Fourier Analysis ; Heart Rate, Fetal* ; Humans ; Pregnancy ; Pregnant Women ; Sensitivity and Specificity

BACKGROUND: Heart rate (HR) is an essential vital sign based on the finding that HR beyond its normal range is associated with several conditions or diseases, including high mortality in several clinical settings. Nevertheless, the clinical implications of HR remain unresolved in patients undergoing continuous renal replacement therapy (CRRT). METHODS: This retrospective cohort study included 828 patients who underwent CRRT due to acute kidney injury between 2010 and 2014. HR and other baseline parameters at the time of CRRT initiation were retrieved. The odds ratio (OR) of 30-day mortality was calculated using a multivariate logistic model. RESULTS: CRRT significantly lowered the HR of patients such that the pre- and post-CRRT HRs (average 6 hours) were 107 beats/min and 103 beats/min, respectively (P < 0.001). When we explored the relationship with 30-day mortality, only HR at the time of CRRT initiation, but not pre- or post-CRRT HR, had a significant relationship with mortality outcome. Based on this result, we divided patients into quartiles of HR at the time of CRRT initiation. Mortality OR in the 4th quartile HR group was 2.6 (1.78–3.92) compared with the 1st quartile HR group. This relationship remained consistent despite adjusting for 28 baseline covariates: OR, 1.7 (1.09–2.76); P = 0.020. However, HR was not associated with the weaning rate from CRRT. CONCLUSION: High HR at the time of CRRT initiation is subsequently related with high mortality. These results can be a basis for a future predictive model of CRRT-related mortality.
Acute Kidney Injury ; Cohort Studies ; Heart Rate* ; Heart* ; Humans ; Logistic Models ; Mortality* ; Odds Ratio ; Reference Values ; Renal Replacement Therapy* ; Retrospective Studies ; Vital Signs ; Weaning

BACKGROUND: Polyomavirus BK (BKV) infection is an important cause of graft loss in kidney transplant patients.PURPOSE: The purpose of this study was to evaluate clinical findings and risk factors for BKV in pediatric patients after kidney transplantation.METHODS: This retrospective single-center study included 31 pediatric kidney transplant recipients from January 2002 to December 2017. Two patients received 2 transplantations during the study period, and each transplant was analyzed independently. Total number of cases is 33 cases with 31 patients. BKV infection was confirmed from blood samples via periodic quantitative polymerase chain reaction.RESULTS: The mean age at kidney transplantation was 11.0±4.7 years, and the male-to-female ratio was 2.7:1. Three patients had a past medical history of high-dose chemotherapy and autologous stem-cell transplantation for solid tumors. Nine patients (27.3%) developed BKV infection. The median period from kidney transplantation to BKV detection in blood was 5.6 months. There was no statistically significant difference in estimated glomerular filtration rate between patients with and those without BKV infection. Among 9 patients with BKV viremia, 7 were treated by reducing their immunosuppressant dose, and BKV was cleared in 6 of these 7 patients. In the other 2 BKV-positive patients, viremia improved without immunosuppressant reduction.CONCLUSION: BKV infection is common in children with kidney transplantation and might not have affected short-term renal function in our patient sample due to early immunosuppressant reduction at the time of BKV detection.
BK Virus ; Child ; Drug Therapy ; Glomerular Filtration Rate ; Humans ; Kidney Transplantation ; Kidney ; Polymerase Chain Reaction ; Polyomavirus ; Retrospective Studies ; Risk Factors ; Transplant Recipients ; Transplants ; Viremia

BACKGROUND: Obesity is related to several comorbidities and mortality, but its relationship with acute kidney injury (AKI) and long-term mortality remain undetermined in patients undergoing coronary artery bypass grafting. METHODS: Data from 3,018 patients (age ≥ 18 years) who underwent coronary artery bypass graft surgery from two tertiary referral centers were retrospectively reviewed between 2004 and 2015. Obesity was defined using the body mass index, according to the World Health Organization's recommendation. The odds and hazard ratios in post-surgical, AKI, and all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed for 90 ± 40.9 months (maximum: 13 years). RESULTS: Among the cohort, 37.4%, 2.4%, 21.1%, 35.1%, and 4.0% of patients were classified as normal weight, underweight, overweight-at-risk, obese I, and obese II, respectively. Post-surgical AKI developed in 799 patients (26.5%). Patients in the obese groups (overweight-at-risk to obese II) had a higher risk of AKI than did those in the normal-weight group. During the follow-up period, 787 patients (26.1%) died. Underweight patients had a higher risk of mortality than did normal-weight patients, whereas overweight-at-risk, obese I, and obese II patients showed better survival rates. CONCLUSION: After coronary artery bypass graft surgery, obese patients encountered a high risk of AKI, and underweight patients exhibited a low chance of survival. Awareness of both obese and underweight statuses should be raised in these patients.
Acute Kidney Injury* ; Body Mass Index ; Cohort Studies ; Comorbidity ; Coronary Artery Bypass* ; Coronary Vessels* ; Follow-Up Studies ; Global Health ; Humans ; Mortality* ; Obesity* ; Retrospective Studies ; Survival Rate ; Tertiary Care Centers ; Thinness ; Transplants

The incidence of lung cancer has rapidly increased and cancer patients at a later cancer stage frequently suffer from unbearable cancer-associated pain. However, the pathophysiology of lung cancer pain has not been fully described due to a lack of appropriate animal models. This study was designed to determine the effect of Lewis lung carcinoma (LLC) cell inoculation on formalin-induced pain behavior and spinal Fos expression in C57BL/6 mice. LLC cells (1.5 × 10⁵, 2.5 × 10⁵, 3.0 × 10⁵ or 5.0 × 10⁵) were inoculated into back or peri-sciatic nerve areas. Back area inoculation was adopted to determine the effect of cancer cell circulating factors and the peri-sciatic nerve area was used to evaluate the possible effects of cancer cell contacting and circulating factors on formalin-induced pain. At postinoculation day 7, LLC cell (5.0 × 10⁵) inoculations in both back and peri-sciatic nerve area significantly increased formalin-induced paw-licking time and spinal Fos expression over those in cell-media-inoculated (control) mice. Enhanced pain behavior and spinal Fos expression were significantly suppressed by ibuprofen pretreatment (250 mg/kg). The results of this study suggest that LLC cell circulating factors and inflammatory responses may be critical in enhancing pain sensation in the early stage of lung cancer cell inoculation.
Animals ; Carcinoma, Lewis Lung* ; Formaldehyde ; Humans ; Ibuprofen ; Incidence ; Lung Neoplasms ; Mice* ; Models, Animal ; Sensation