Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.
Critical Care ; Critical Illness ; Diagnosis ; Humans ; Incidence ; Critical Care ; Intermittent Pneumatic Compression Devices ; Male ; Pilot Projects* ; Stockings, Compression* ; Venous Thrombosis*

The time domain entombment of bacteria by intratubular mineralization following orthograde canal obturation with mineral trioxide aggregate (MTA) was studied by scanning electron microscopy (SEM). Single-rooted human premolars (n=60) were instrumented to an apical size #50/0.06 using ProFile and treated as follows: Group 1 (n=10) was filled with phosphate buffered saline (PBS); Group 2 (n=10) was incubated with Enterococcus faecalis for 3 weeks, and then filled with PBS; Group 3 (n=20) was obturated orthograde with a paste of OrthoMTA (BioMTA, Seoul, Korea) and PBS; and Group 4 (n=20) was incubated with E. faecalis for 3 weeks and then obturated with OrthoMTA-PBS paste. Following their treatments, the coronal openings were sealed with PBS-soaked cotton and intermediate restorative material (IRM), and the roots were then stored in PBS for 1, 2, 4, 8 or 16 weeks. After each incubation period, the roots were split and their dentin/MTA interfaces examined in both longitudinal and horizontal directions by SEM. There appeared to be an increase in intratubular mineralization over time in the OrthoMTA-filled roots (Groups 3 and 4). Furthermore, there was a gradual entombment of bacteria within the dentinal tubules in the E. faecalis inoculated MTA-filled roots (Group 4). Therefore, the orthograde obturation of root canals with OrthoMTA mixed with PBS may create a favorable environment for bacterial entombment by intratubular mineralization.
Aluminum Compounds ; therapeutic use ; Calcification, Physiologic ; physiology ; Calcium Compounds ; therapeutic use ; Crystallization ; Dental Pulp Cavity ; microbiology ; Dentin ; microbiology ; Drug Combinations ; Enterococcus faecalis ; ultrastructure ; Humans ; Methylmethacrylates ; therapeutic use ; Microscopy, Electron, Scanning ; Oxides ; therapeutic use ; Root Canal Filling Materials ; therapeutic use ; Root Canal Obturation ; methods ; Root Canal Preparation ; instrumentation ; Silicates ; therapeutic use ; Time Factors ; Zinc Oxide-Eugenol Cement ; therapeutic use

BACKGROUND: Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome caused by the NF2 tumor suppressor gene. However, the NF2 mutation characteristics in Korean patients are not sufficiently understood. In this study, we conducted a comprehensive mutational analysis in 7 Korean NF2 patients by performing direct sequencing and gene-dosage assessment. METHODS: We analyzed all exons and flanking regions of NF2 by direct sequencing and screened the deletions or duplications involving NF2 by multiplex ligation-dependent probe amplification. RESULTS: Four novel NF2 mutations, including 2 splice-site mutations (c.364-1G>A and c.886-3C>G), 1 frameshift mutation (c.524delA), and 1 missense mutation (c.397T>C; p.Cys133Arg), were identified in our patients. No large deletion or duplication was identified in our series. Subsequently, we identified an abnormal splicing product by using reverse transcription-PCR and direct sequencing in 2 patients with a novel splice-site mutation. The missense mutation c.397T>C was predicted to have harmful effects on protein function. CONCLUSIONS: The detection rate of NF2 mutations in Korean patients (57%) is similar to those in other populations. Our results provided a greater insight into the mutational spectrum of the NF2 gene in Korean subjects.
3' Flanking Region/genetics ; 5' Flanking Region/genetics ; Adult ; Aged ; Amino Acid Sequence ; Asian Continental Ancestry Group/*genetics ; Child, Preschool ; Exons ; Female ; Frameshift Mutation ; *Genes, Neurofibromatosis 2 ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; *Mutation ; Mutation, Missense ; Neurofibromatosis 2/diagnosis/*genetics ; RNA Splice Sites ; Republic of Korea ; Sequence Analysis, DNA ; Young Adult

BACKGROUND: Medical skin care is essential for the treatment of skin diseases all over the world. Medical skin care is also part of medical practice and this must be differentiated from the simple skin care that is given for normal healthy skin. OBJECTIVE: We wanted to discuss medical skin care and the related medical devices and legal issues. METHODS: We reviewed the related laws and regulations, we consulted experts and associations and we analyzed the result of the survey. RESULTS: Legally, medical skin care and simple skin care are well classified. However, many illegal procedures are still performed by non-medical personnel and many adverse effects have been reported as a result. Furthermore, there are no legal restrictions for the performer based on the grade of each medical skin care procedure. CONCLUSION: For the best results and safe procedures, medical skin care must be performed by approved medical equipment under the supervision of a physician or medical personnel. Continuous control and guidance by the government is strongly needed.
Jurisprudence ; Organization and Administration ; Skin ; Skin Care ; Skin Diseases ; Social Control, Formal

PURPOSE: Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. MATERIALS AND METHODS: We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. RESULTS: The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. CONCLUSION: These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Facial Paralysis/*etiology/*rehabilitation/therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies ; Treatment Outcome

BACKGROUND: Chronic rhino-sinusitis and persistent allergic rhinitis is often cited as risk factor for developing adenoid hypertrophy or adenoiditis, but this relationship has not been studied extensively. In this study, we evaluated the mucosal barrier, squamous changes of ciliated epithelium, IgA secretion and BCL-6 expression in adenoids, and adenoid size. METHODS: Six children with allergic rhinitis and sinusitis, nine children with only allergic rhinitis, nine children with only sinusitis and six children without any history of allergic rhinitis and sinusitis were enrolled. H-E stain of adenoid for squamous metaplasia, immunohistochemical study of adenoid for IgA and BCL-6, cytokeratin stain for evaluation of mucosal barrier and lateral view X-ray for adenoid size were performed. ANOVA test was used in the analysis and data showing p value of less than 0.05 were considered significant. RESULTS: The number of ciliated cells had tendency to be decreased and squamous metaplasia had tendency to be increased in three experimental groups (p>0.05). Deterioration of mucosal barrier had tendency to be detected in three experimental groups than control group (p>0.05). BCL-6 had tendency to be increased and IgA secretion had tendency to be decreased in three experimental groups (p>0.05). There is no difference in adenoid size between three experimental groups and control group. CONCLUSION: Despite the expectation that adenoid would be affectecd by allergic rhinitis and rhino-sinusitis, we found no evidence for influence of adenoid immunity.
Adenoids* ; Child ; Epithelium ; Humans ; Hypertrophy ; Immunoglobulin A ; Keratins ; Metaplasia ; Rhinitis* ; Risk Factors ; Sinusitis*

PURPOSE: To assess clinical difference between total knee replacement (TKR) performed with tourniquet and diluted adrenine infiltration without tourniquet. MATERIALS AND METHODS: We analyzed the postoperative transfusion amount, intraoperative blood loss, operation time, range of motion and postoperative thigh pain in 60 cases. 30 cases (group I) were performed TKR with tourniquet and the others (group II) were performed TKR using diluted adrenaline (2.5mg of 1:1000 epinephrine diluted in 500 ml of normal saline) infiltration without tourniquet. Closed suction drainage was not used in all patients. RESULTS: In gruop I, the intraoperative blood loss was average 407.6 ml, pre- and postoperative hemoglobin average 12.6 and 9.4 g/dl, postoperative transfusion average 1.83 unit, operative time average 116.5 minutes and range of motion (at preoperative, at 7days and 6 weeks after the operation) average 116.3 degrees, 90.7degrees and 103.4degrees. In group II, the intraoperative blood loss was average 398.2 ml, pre- and postoperative hemoglobin average 13.1 and 9.7 g/dl, postoperative transfusion amount average 1.76 unit, operative time average 118.3 minutes and range of motion average 113.6 degrees, 89.2 degrees, and 105.7degrees. But average postoperative thigh pain score was significantly higher in group I (average 3.7) than group II (average 0.9). CONCLUSION: There was no significant difference in intraoperative blood loss, pre- and postoperative hemoglobin, postoperative transfusion amount, operative time and range of motion between the two groups. But we could decrease the thigh pain after TKR, not using the tourniquet.
Arthroplasty, Replacement, Knee ; Epinephrine* ; Humans ; Operative Time ; Range of Motion, Articular ; Suction ; Thigh ; Tourniquets

Retroperitoneal fibrosis is proliferation of fibrous tissue with inflammatory process in retroperitoneal cavity. It is relatively rare disease that has been reported less than 20 cases in Korea until now. Idiopathic type is more frequent but secondary type is increasing nowadays. Secondary causes include drugs, infections, and leakage of blood or urine, malignancies, connective tissue diseases, etc. Recent studies suggest the relationship between retroperitoneal fibrosis and autoimmunity to own vascular or lipoid tissue. It can cause compression and obstruction of ureter, abdominal aorta, hypertension and finally collapse of renal function. Surgical procedure and immunosuppressive therapy consist of mainstay of management. Corticosteroid therapy may reduce inflammation and reverse fibrosis. Retroperitoneal fibrosis is thought to have some reVersible components in early stage. Corticosteroid may be used as initial therapy but more studies should be performed. We report a case of idiopathic retroperitoneal fibrosis with acute renal failure improved with ureter stent insertion and steroid therapy.
Acute Kidney Injury* ; Aorta, Abdominal ; Autoimmunity ; Connective Tissue Diseases ; Fibrosis ; Hypertension ; Inflammation ; Korea ; Rare Diseases ; Retroperitoneal Fibrosis* ; Stents ; Ureter