Background: This study investigates the long-term efficacy and safety of evogliptin add-on therapy in patients with inadequately controlled type 2 diabetes mellitus (T2DM) previously received dapagliflozin and metformin (DAPA/MET) combination. Methods: In this multicenter randomized placebo-controlled phase 3 trial, patients with glycosylated hemoglobin (HbA1c) levels 7.0% to 10.5% (n=283) previously used DAPA 10 mg plus MET (≥1,000 mg) were randomly assigned to the evogliptin 5 mg once daily or placebo group (1:1). The primary endpoint was the difference in the HbA1c level from baseline at week 24, and exploratory endpoints included the efficacy and safety of evogliptin over 52 weeks (trial registration: ClinicalTrials.gov NCT04170998). Results: Evogliptin add-on to DAPA/MET therapy was superior in HbA1c reduction compared to placebo at weeks 24 and 52 (least square [LS] mean difference, –0.65% and –0.55%; 95% confidence interval [CI], –0.79 to –0.51 and –0.71 to –0.39; P<0.0001). The proportion of patients achieving HbA1c <7% was higher in the triple combination group at week 52 (32.14% vs. 8.51% in placebo; odds ratio, 5.62; P<0.0001). Evogliptin significantly reduced the fasting glucose levels and mean daily glucose levels with improvement in homeostatic model assessment of β-cell function (LS mean difference, 9.04; 95% CI, 1.86 to 16.21; P=0.0138). Adverse events were similar between the groups, and no serious adverse drug reactions were reported in the evogliptin group. Conclusion Long-term triple combination with evogliptin added to DAPA/MET showed superior HbA1c reduction and glycemic control compared to placebo at 52 weeks and was well tolerated.

STUDY DESIGN: This is a retrospective study OBJECTIVES: This study compared the clinical outcomes of posterior lumbar interbody fusion (PLIF) using hydroxyapatite blocks with PLIF using a metal or poly-ether-ether-ketone (PEEK) cage. SUMMARY OF THE LITERATURE REVIEW: There are few reports on the clinical outcomes of PLIF using a hydroxyapatite block for treating lumbar degenerative disease. MATERIALS AND METHODS: The 27 PLIF cases (62 units, HA block) that were followed up for 1-year were compared with 13 cases using a metal cage and 13 cases using a PEEK cage. Pedicle screw fixation was performed for all the cases. If the local bone is deficient, then an additional bone graft with autogeous iliac bone or bone substitute was used. The visual analog scale(VAS) for low back pain and radiating pain, the Oswestry disability index (ODI), the intervertebral height and the halo sign around the cages and pedicle screws were comparatively analyzed. RESULTS: The mean VAS score for low back pain before PLIF and using the HA block, the metal cage and the PEEK cage was 7.5, 8.3 and 6.2, respectively, and this was 3.3, 2.9 and 4.8 after PLIF (P<0.05 with using the HA block and the metal cage (Wilcoxon test). The mean VAS score for radiating pain before PLIF was 7.9, 8.3 and 8.5, respectively, and the VAS score was 3.5, 3.1 and 3.9, respectively, after PLIF (P<0.05 for all cases, Wilcoxon test). For the ODI, the means before PLIF were 60.3, 51.2 and 53.8, respectively, and they changed to 30.5, 24.9 and 29.7, respectively, after PLIF (P<0 .05 for all cases, Wilcoxon test). On the X-ray images, there was no halo sign greater than 2 mm near the pedicle screws or greater than 1 mm near the cages and no breakage of the HA block. No additional bone graft was needed for the PLIF using the HA block and local bone. There was no statistically significant differences among the groups (P>0.05, One-way ANOVA). CONCLUSION: PLIF using a HA block showed improvements, including the back pain, and the ODI was satisfactory and this didn't fall below those ODIs of using metal or PEEK cages. Although a HA block may have higher tendency to break, there was no breakage at the 1-year follow up.
Back Pain ; Bone Substitutes ; Durapatite ; Follow-Up Studies ; Ketones ; Low Back Pain ; Polyethylene Glycols ; Retrospective Studies ; Transplants

STUDY DESIGN: This is a retrospective study. PURPOSE: We wanted to investigate the clinical relevance of the lumbar high intensity zone (HIZ) on magnetic resonance imaging (MRI) and the relationship of trauma history to internal disc disruption (IDD). OVERVIEW OF LITERATURE: HIZs on lumbar spine (L-spine) MRI have been suggested as a reliable marker of IDD by some authors. The prevalence and type of spinal trauma in IDD have not yet been carefully analyzed. METHODS: L-spine MRIs of 737 patients with low back pain with or without associated leg pain were reviewed for the presence of HIZs. HIZs on T2-weighted MR images were determined according to the Aprill and Bogduk criteria. A review of medical records and a telephone interview were performed for further analyses of pain. RESULTS: HIZs were found in 117 patients and 153 discs among a total of 737 patients who met the inclusion criteria. Both a medical record review and a telephone interview were possible with 99 patients. Among these, 42 patients had had an episode of trauma. Seventeen of these had a relatively high-energy injury such as a traffic accident or a fall. Regarding back pain, 27 patients complained of typical discogenic back pain. Only 11 patients had both a trauma history and typical discogenic pain and 41 patients (42%) had neither a trauma history nor typical natural pain. CONCLUSIONS: Given the low incidence of discogenic pain, a HIZ on an L-spine MRI appears less meaningful than often assumed as a specific marker of IDD. Trauma, such as a traffic accident, seems unlikely to be the main cause of IDD.
Accidents, Traffic ; Back Pain ; Humans ; Incidence ; Interviews as Topic ; Leg ; Low Back Pain ; Magnetic Resonance Imaging* ; Medical Records ; Prevalence ; Retrospective Studies ; Spine

Even though atelectasis develops rare during anesthesia and/or surgical operation, it may be very important complication because it can be fatal. Atelectasis may be due to airway or bronchus obstruction, compression of the lung by position, primary surfactant deficiency, increased pleural pressure due to fluid or air in the pleural space, chest wall restriction due to skeletal deformity and/or muscular weakness. We report a case of acute intraoperative unilateral lobar atelectasis in 87-years-old woman patient undergoing regional anesthetic for total hip replacement surgery.
Anesthesia ; Anesthesia, Conduction* ; Arthroplasty, Replacement, Hip* ; Bronchi ; Congenital Abnormalities ; Female ; Humans ; Lung ; Muscle Weakness ; Pulmonary Atelectasis* ; Thoracic Wall

BACKGROUND: During general anesthesia, the most commonly used way of keeping airway patency is endotracheal intubation. However, for relatively short and simple surgery, less invasive method using laryngeal tube (LT) or laryngeal mask airway (LMA) is generally accepted and the comparative study between the two apparatus is now being actively done. In this study, we evaluated the usefulness of two apparatus from pediatric patients. METHODS: We select 58 children from one to ten years old who are to be given short operation and then anesthetize 30 children by using LT and 28 children by LMA. The size of LT and LMA is chosen by body weight according to the manufacturer's recommendation. We evaluated the seal pressure of LT and LMA, ventilatory efficiency, attempt number, facility of insertion, proper positioning confirmed by fiberoptic bronchoscopy, and complications. RESULTS: There was no statistically significant difference in the attempt number and facility of insertion between the two groups. LT and LMA were both properly positioned and the ventilation efficiency was not different from the two groups. The LT group shows higher seal pressure than the LMA group and there is no correlation between sealing pressure and ventilation efficiency. There is close correlation between bronchoscopic grade and ventilatory efficiency. complications are not different between two groups. CONCLUSIONS: Both LT and LMA are useful for simple surgery of children and LT has higher sealing pressure.
Anesthesia, General ; Body Weight ; Bronchoscopy ; Child ; Humans ; Intubation, Intratracheal ; Laryngeal Masks* ; Respiration* ; Ventilation

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.
Anesthesia, Spinal ; Aneurysm, False* ; Aorta, Thoracic ; Chest Pain* ; Diagnostic Tests, Routine ; Prostate* ; Thorax*

BACKGROUND/AIM: Colonoscopy has been known as the best diagnostic and therapeutic modality for colorectal polyps. However, it has been difficult to assess its accuracy. METHODS: We studied the data from patients who had colonoscopic polypectomy within 30 days after the initial examination. RESULTS: From 218 patients, a total of 362 polyps were found, 51 (14.1%) of which were missed. There were 17 patients with missed polyps among 59 patients who had two or more polyps on the initial examination. According to the location, the missing rates were variable: the splenic and hepatic flexure had the highest missing rates, and the sigmoid colon had the lowest missing rate. In our study, there was no difference of missing rate according to the size and shape. CONCLUSIONS: There is a significant colonoscopic missing rate for colorectal polyps in routine clinical practice, especially in patients with multiple colonic polyps and at the site of the colonic flexure.
Colon ; Colon, Sigmoid ; Colonic Polyps ; Colonoscopy ; Humans ; Polyps*

BACKGROUND: Laryngoscopy and tracheal intubation often provoke an undesirable increase in blood pressure and heart rate. This study was done to determine median effective dose (ED50) of nicardipine for prevention of hemodynamic response to tracheal intubation during induction of anesthesia with thiopental, propofol, or etomidate. METHODS: Fourty-five ASA physical status 1 adult patients were allocated into three group; thiopental group (n = 15), propofol group (n = 15), and etomidate group (n = 15). The first patient of each groups received 10microgram/kg of nicardipine 1 minute before induction. Subsequent dose was determined by the hemodynamic response of the previous patient to tracheal intubation based on Dixon's up and down sequential allocation. The test dosing interval was set at 3microgram/kg. If mean arterial pressure increased more than 20% after tracheal intubation, dose of the subsequent patient was increased by 3microgram/kg. If not, it was decreased by 3microgram/kg. Blood pressure was measured after arrival at the operating room, before tracheal intubation, and 1, 2, 3, 4, and 5 minutes following intubation by non invasive method. RESULTS: ED50 of nicardipine for attenuation of hypertensive response after tracheal intubation were 18.0microgram/kg (95% Confidence Limit [CL], 14.8-22.0microgram/kg), 6.2microgram/kg (CL, 2.6-9.5microgram/kg), and 16.7microgram/kg (CL, 13.6-20.7microgram/kg) in thiopental group, propofol group andetomidate group, respectively. CONCLUSIONS: We concluded that less nicardipine dose in propofol group was needed to prevent hypertensive response after tracheal intubation (P < 0.05).
Adult ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Etomidate* ; Heart Rate ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Nicardipine* ; Operating Rooms ; Propofol* ; Thiopental*

The aims of this paper are to identify where the quality research activity has been and is carried out in Korea, and to examine weather the Korean plastic surgeons have sufficient capacity to place their official journal "The Journal of Korean Society of Plastic and Reconstructive Surgeons(KPRS)" to international databases. We investigated the publication productivity of all departments of plastic surgery in Korean medical colleges, hospitals, and clinics as measured by the number of papers in journals indexed in SCI(Science citation index). The 27 year period from 1974 to 2000 is covered. A total of 195 papers is published in SCI journals by the plastic surgeons in Korea. The first SCI paper was published in 1985; the number of publication has gradually increased. Since 1998, over 30 papers are annually published in SCI journals by Korean plastic surgeons. The production of SCI papers are concentrated in a few universities. About seventy percent of SCI journal papers is published by top seven medical schools; 25.6% by Yonsei university. In 1985, only one medical school was involved in the production of SCI journal papers. After 1997, however, more than 10 medical school and some surgeons in local clinics published SCI journal papers. The percent of SCI journal papers among all papers written by the Korean plastic surgeons increased recently: About 15% are published in SCI journals in 1999 and 2000 respectively. These data suggest that Korean plastic surgeons have enough capacity to place their official journal KPRS into international data bases.
Efficiency* ; Korea ; Publications* ; Schools, Medical ; Surgery, Plastic ; Weather