The impact of baseline estimated glomerular filtration rate (eGFR) on the risk of adverse outcomes according to metabolic parameter variabilities in chronic kidney disease has rarely been investigated. Methods: We conducted a retrospective nationwide cohort study using the National Health Insurance System data in Korea from 2007 to 2013 to identify individuals with three or more health screenings. The metabolic components variability was defined as intraindividual variability between measurements using the variability independent of the mean. The metabolic variability score was defined as the total number of high-variability metabolic components. Multivariable-adjusted Cox regression analysis was conducted to evaluate the risks of all-cause mortality, myocardial infarction, and ischemic stroke. Results: During a mean follow-up of 6.0 ± 0.7 years, 223,531 deaths, 107,140 myocardial infarctions, and 116,182 ischemic strokes were identified in 9,971,562 patients. Low eGFR categories and higher metabolic variability scores were associated with a higher risk of adverse outcomes. The degree of association between metabolic variability and adverse outcomes was significantly larger in those with low eGFR categories than in those with preserved eGFR (p for interaction < 0.001). Representatively, those with high metabolic variability in the eGFR of <15 mL/min/1.73 m2 group showed a prominently higher risk for all-cause mortality (adjusted hazard ratio [aHR], 5.28; 95% confidence interval [CI], 4.02–6.94) when the degree was compared to the findings in those with preserved (eGFR of ≥60 mL/min/1.73 m2) kidney function (aHR, 2.55; 95% CI, 2.41–2.69). Conclusion: The degree of adverse association between metabolic variability and poor prognosis is accentuated in patients with impaired kidney function.

Early-onset diabetes mellitus has a significant lifetime burden and is associated with higher morbidity and mortality. Since insulin resistance is one of the mechanisms of podocyte injury, we aimed to evaluate the effect of albuminuria on newly developed early-onset type 2 diabetes mellitus (T2DM). Methods: We screened 6,891,399 subjects aged ≥20 and <40 years without a history of prediabetes or diabetes from the Korean National Health Insurance Service database between 2009 and 2012. A multivariate Cox proportional hazard model was used to identify the impact of albuminuria on early-onset T2DM. Results: Among a total of 5,383,779 subjects, 62,148 subjects (1.2%) developed early-onset diabetes over 7.3 ± 1.2 years. Albuminuria was significantly associated with early-onset T2DM (adjusted hazard ratio [aHR], 1.62; 95% confidence interval [CI], 1.55–1.70) after adjustment for age, sex, anthropometric data, physical exercise status, serum glucose, and total cholesterol. The risk of early-onset T2DM increased more in subjects with more components of metabolic syndrome (MetS). Among each component of MetS, hypertriglyceridemia was prominently associated with early-onset T2DM (aHR, 2.02; 95% CI, 1.81–2.25) in subjects with albuminuria. Conclusion: Dipstick albuminuria was significantly associated with early-onset T2DM in young adult populations. Close monitoring of albuminuria is warranted for disease risk modification, especially in subjects with MetS.

Loss of tooth structures caused by dental erosion can compromise both function and esthetics, and extensive involvement often necessitates comprehensive restorative treatment. When utilizing a digital facebow transfer for prosthesis fabrication, the characteristics of each method must be carefully considered to choose the most appropriate technique an appropriate approach.This case report describes the prosthetic rehabilitation of a female patient with a history of bulimia nervosa. The patient presented with severely eroded dentition due to self-induced vomiting, resulting in impaired masticatory function and esthetics. For the restoration, three types of digital facebow transfer methods—standardized photography, facial scanning, and jaw motion tracking— were employed during the provisional phase to assess posterior function. Various provisional restorations with different lengths of incisal edge lengths and anterior guidance angles were tested to evaluate anterior function and esthetics. Definitive restorations were fabricated using monolithic zirconia crowns. This case report presents the successful recovery of esthetics and function through a digitally guided, full-mouth rehabilitation approach.

Partially edentulous patients with a crossed occlusion have poor denture support, retention, and stability. Moreover, residual abutments showed a poor prognosis due to denture rotation. The use of a conical double crown removable partial denture to establish proper horizontal and vertical interocclusal relationships, it can establish a stable occlusal plane and occlusal contacts providing a sufficient restorative space and a favorable functional and aesthetic outcome. In this case, a patient with an anteriorposterior crossed occlusion with mandibular prognathism and no occluding teeth in habitual centric position was treated with a conical double crown removable partial denture. After diagnostic cast analysis and digital diagnosis, provisional prosthesis templates were fabricated. It was possible to intuitive and appropriate vertical dimension determination and esthetic evaluation were performed. Definitive prosthesis with proper function and aesthetics can be fabricated by the digital and conventional treatment process.

Partially edentulous patients with a crossed occlusion have poor denture support, retention, and stability. Moreover, residual abutments showed a poor prognosis due to denture rotation. The use of a conical double crown removable partial denture to establish proper horizontal and vertical interocclusal relationships, it can establish a stable occlusal plane and occlusal contacts providing a sufficient restorative space and a favorable functional and aesthetic outcome. In this case, a patient with an anteriorposterior crossed occlusion with mandibular prognathism and no occluding teeth in habitual centric position was treated with a conical double crown removable partial denture. After diagnostic cast analysis and digital diagnosis, provisional prosthesis templates were fabricated. It was possible to intuitive and appropriate vertical dimension determination and esthetic evaluation were performed. Definitive prosthesis with proper function and aesthetics can be fabricated by the digital and conventional treatment process.

Partially edentulous patients with a crossed occlusion have poor denture support, retention, and stability. Moreover, residual abutments showed a poor prognosis due to denture rotation. The use of a conical double crown removable partial denture to establish proper horizontal and vertical interocclusal relationships, it can establish a stable occlusal plane and occlusal contacts providing a sufficient restorative space and a favorable functional and aesthetic outcome. In this case, a patient with an anteriorposterior crossed occlusion with mandibular prognathism and no occluding teeth in habitual centric position was treated with a conical double crown removable partial denture. After diagnostic cast analysis and digital diagnosis, provisional prosthesis templates were fabricated. It was possible to intuitive and appropriate vertical dimension determination and esthetic evaluation were performed. Definitive prosthesis with proper function and aesthetics can be fabricated by the digital and conventional treatment process.

The long-term use of an implant overdenture shows problems, such as wear of attachment, concentrated occlusal forces on the anterior teeth, fracture of artificial teeth and rotation of denture. By transitioning to an Implant-assisted removable partial denture (IARPD) using additional implant placement, the problems can be solved. In this case report, a transition was made from implant overdenture to IARPD utilizing surveyed crowns to distribute occlusal forces concentrated on anterior teeth and to prevent denture rotation in a skeletal Class III patient. Design of definitive prosthesis with appropriate function and aesthetics was determined through several stages of provisional restorations. In this case, appropriate posterior occlusion and maintenance of peri-implant bone level of definitive prosthesis were observed.

PURPOSE: This study assessed the feasibility of near-infrared (NIR) imaging with indocyanine green (ICG) in investigating the completeness of laparoscopic lymph node (LN) dissection for gastric cancer. MATERIALS AND METHODS: Patients scheduled for laparoscopic gastrectomy for treating gastric cancer were enrolled in the study. After intraoperative submucosal ICG injection (0.05 mg/mL), LN dissection was performed under conventional laparoscopic light. After dissection, the LN stations of interest were examined under the NIR mode to locate any extra ICG-stained (E) tissues, which were excised and sent for pathologic confirmation. This technique was tested in 2 steps: infra-pyloric LN dissection (step 1) and review of all stations after proper radical node dissection (step 2). RESULTS: In step 1, 15 patients who underwent laparoscopic pylorus-preserving gastrectomy (LPPG) and 15 patients who underwent laparoscopic distal gastrectomy (LDG) were examined. Seven and 2 E-tissues were obtained during LPPG and LDG, respectively. From the retrieved E-tissues, 1 and 0 tissue obtained during LPPG and LDG, respectively, was confirmed as LN. In step 2, 20 patients were enrolled (13 D1+ dissection and 7 D2 dissection). Six E-tissues were retrieved from 5 patients, and 1 tissue was confirmed as LN in the pathologic review. Overall, 15 E-tissues were detected and removed, and 2 tissues were confirmed as LNs in the pathologic review. Both nodes were from LN station #6, with 1 case each in the LDG and LPPG groups. CONCLUSIONS: NIR imaging may provide additional node detection during laparoscopic LN dissection for gastric cancer, especially in the infra-pyloric area.
Diagnostic Imaging ; Gastrectomy* ; Humans ; Indocyanine Green* ; Lymph Node Excision* ; Lymph Nodes* ; Stomach Neoplasms*

The authors found out that this article was omitted “Funding section” for grant support.

PURPOSE: The aim of this study was to establish an anthropometric reference of the stomach for gastric cancer surgery and a modeling formula to predict stomach length. MATERIALS AND METHODS: Data were retrieved for 851 patients who underwent total gastrectomy at the Seoul National University Hospital between 2008 and 2013. Clinicopathological data and measurements from a formalin-fixed specimen were reviewed. The lengths (cm) of the greater curvature (GC) and lesser curvature (LC) were measured. Anthropometric data of the stomach were compared according to age, body weight, height (cm), and body mass index. To predict stomach length, two multiple regression analyses were performed. RESULTS: The mean lengths of the GC and LC were 22.2±3.1 cm and 16.3±2.6 cm, respectively. The men’s GC length was significantly greater than the women’s (22.4±3.1 cm vs. 21.2±2.9 cm, P=0.003). Patients aged >70 years showed significantly longer LC than those aged <50 years (16.9±2.9 cm vs. 15.9±2.4 cm, P=0.002). Patients with body weights >70 kg showed significantly longer GC than those with body weights <55 kg (23.0±2.9 cm vs. 21.4±3.2cm, P<0.001). In the predicted models, 4.11% of the GC was accounted for by age and weight; and 4.94% of the LC, by age, sex, height, and weight. CONCLUSIONS: Sex, age, height, and body weight were associated with the length of the LC, while sex and body weight were the only factors that were associated with the length of the GC. However, the prediction model was not sufficiently strong.
Body Mass Index ; Body Weight ; Gastrectomy ; Humans ; Organ Size ; Seoul ; Stomach Neoplasms ; Stomach*