Background/Aims: A relationship between fatty liver and lung function impairment has been identified, and both are independently associated with metabolic dysfunction. However, the temporal relationship between changes in fatty liver status and lung function and their genome-wide association remain unclear. Methods: This longitudinal cohort consisted of subjects who received serial health check-ups, including liver ultrasonography and spirometry, for ≥3 years between 2003 and 2015. Lung func-tion decline rates were classified as “slow” and “accelerated” and compared among four different sonographic changes in steatosis status: “normal,” “improved,” “worsened,” and “persistent.” A genome-wide association study was conducted between the two groups: normal/improved steatosis with a slow decline in lung function versus worsened/persistent steatosis with an accelerated decline in lung function. Results: Among 6,149 individuals, the annual rates of decline in forced vital capacity (FVC) and forced expiratory volume measured in the first second of exhalation (FEV 1 ) were higher in the worsened/persistent steatosis group than in the normal/improved steatosis group. In multivariable analysis, persistent or worsened status of fatty liver was significantly associated with accelerated declines in FVC (persistent status, odds ratio [OR]=1.22, 95% confidence interval [CI]=1.04–1.44; worsened status, OR=1.30, 95% CI=1.12–1.50), while improved status of fatty liver was significantly associated with slow declines in FEV 1 (OR=0.77, 95% CI=0.64–0.92). The PNPLA3 risk gene was most strongly associated with steatosis status change and accelerated declines in FVC (rs12483959, p=2.61×10 -7 ) and FEV 1(rs2294433, p=3.69×10 -8 ). Conclusions Regression of fatty liver is related to lung function decline. Continuing efforts to improve fatty liver may preserve lung function, especially for subjects with a high genetic risk.

Extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD) is approximately 36%. Of genitourinary complications as an EIM of Crohn’s disease (CD), nephrolithiasis is the most common urinary complication in patients with CD. CD patients have been shown to have decreased urinary volume, pH, magnesium, and excretion of citrate, all of which are significant risk factors for nephrolithiasis. Genitourinary complications often occur in case of a severe longstanding disease and are associated with, the activity of bowel disease, especially in those who have undergone bowel surgery. As uncontrolled nephrolithiasis could impair renal function as well as adversely affect quality of life, proper monitoring, early detection, and prevention of the occurrence of urologic complications in CD is crucial. Few data are available about urolithiasis in patients with CD. Herein we report a case of a successful removal of a 2.7 cm calcium oxalate stone using percutaneous nephrolithotomy from a patient with long-standing CD with a previous surgery for small intestinal and colonic stricture.

Purpose: The purpose of this study was to figure out the association of nursing activity participation and clinical practice stress with career maturity during clinical practice among nursing college students. Methods: Participants of the study were 201 nursing college students located in nationwide regions. Data collection was performed between July 18 and August 8, 2019. Data analyses were performed through an independent t-test, ANOVA, Pearson’s correlation coefficient, and multiple linear regression analysis using SPSS WIN 25.0. Results: The results of this study were as follows. We ran multiple regression analyses to see which critical factors influenced career maturity. The general characteristics significantly associated with career maturity were preference for clinical nursing, admission to nursing college due to belief, time off, and being satisfied with clinical practice. Regarding clinical practice stress, clinic environment, interpersonal relationship conflict, inappropriate role model and conflict with patients were significantly associated with career maturity. Conclusion This study suggested that, to improve nursing students’ career maturity, nursing colleges and training fields should collaboratively make an efforts to reduce students’ stress by building educational clinic environments including managing conflicts in interpersonal relationships among patients, caregivers, and medical and non-medical personnel, and improving inappropriate role models in nursing.

PURPOSE: To assess the effectiveness and safety of intravitreal ranibizumab compared with bevacizumab for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: This was a retrospective study of 80 eyes with macular edema associated with BRVO. Patients received either 0.5 mg of ranibizumab (n = 24) or 1.25 mg of bevacizumab (n = 56) intravitreally. Both groups received three initial monthly injections followed by as-needed injections. The best-corrected visual acuity, central subfield thickness, mean number of injections, and retreatment rate were evaluated monthly for 6 months after the initial injection. RESULTS: The best-corrected visual acuity significantly improved from logarithm of the minimal angle of resolution (logMAR) 0.55 ± 0.26 at baseline to 0.24 ± 0.26 at 6 months in the ranibizumab group (p < 0.001) and from logMAR 0.58 ± 0.21 at baseline to 0.29 ± 0.25 at 6 months in the bevacizumab group (p < 0.001), which is not a statistically significant difference (p = 0.770). The mean reduction in central subfield thickness at 6 months was 236 ± 164 µm in the ranibizumab group (p < 0.001) and 219 ± 161 µm in the bevacizumab group (p < 0.001), which is not also a statistically significant difference (p = 0.698). The mean numbers of ranibizumab and bevacizumab injections were 3.25 ± 0.53 and 3.30 ± 0.53, respectively (p = 0.602). In addition, after the three initial monthly injections, the retreatment rates for ranibizumab and bevacizumab injections were 20.8% and 26.7%, respectively (p = 0.573). CONCLUSIONS: Both ranibizumab and bevacizumab were effective for the treatment of BRVO and produced similar visual and anatomic outcomes. In addition, the mean number of injections and the retreatment rates were not significantly different between the groups.
Bevacizumab* ; Humans ; Macular Edema* ; Ranibizumab* ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retreatment ; Retrospective Studies ; Visual Acuity

OBJECTIVES: Shiftwork is known to be one of the common causes of sleep and health problems and finally causes the decreased quality of life. The purpose of this study was to investigate the sleep patterns of shiftworking and daytime psychiatric nurses using actigraphy and compare it with subjective assessment for sleep. METHODS: Twenty-three shift-working and 25 daytime nurses were enrolled. They rated their sleep quality using Pittsburgh Sleep Quality Index(PSQI) and other self-rating scales were measured for psychosocial aspects. Actigraphy was applied to the subjects for a total of 7 days to measure the sleep parameters. They also wrote sleep diaries during the period of wearing actigraphy. Sleep-related parameters of actigraphy, global score and components of PSQI, and the results of other self-rating scales were compared between shift-working and daytime nurses. RESULTS: Although the global score of PSQI did not show significant difference, the PSQI components showed significant differences between two groups: the shift-working nurses showed lower sleep quality, more sleep disturbance and hypnotic medication use, and worsened daytime dysfunction than daytime nurses. The shift-working nurses showed significantly shorter total time in bed and total sleep time, lower sleep efficiency, and longer average awakening time than those of daytime nurses in actigraphy. CONCLUSIONS: The results showed that shift-working nurses experienced more sleep disturbances in both subjective and objective aspects of sleep than daytime nurses. This study also suggests that actigraphy may be useful to measure the objective aspects of sleep that are difficult to assess with subjective questionnaires alone.
Actigraphy ; Quality of Life ; Weights and Measures

BACKGROUND: The prevalence of novel type 1 diabetes mellitus (T1DM) antibodies targeting eukaryote translation elongation factor 1 alpha 1 autoantibody (EEF1A1-AAb) and ubiquitin-conjugating enzyme 2L3 autoantibody (UBE2L3-AAb) has been shown to be negatively correlated with age in T1DM subjects. Therefore, we aimed to investigate whether age affects the levels of these two antibodies in nondiabetic subjects. METHODS: EEF1A1-AAb and UBE2L3-AAb levels in nondiabetic control subjects (n=150) and T1DM subjects (n=101) in various ranges of age (18 to 69 years) were measured using an enzyme-linked immunosorbent assay. The cutoff point for the presence of each autoantibody was determined based on control subjects using the formula: [mean absorbance+3×standard deviation]. RESULTS: In nondiabetic subjects, there were no significant correlations between age and EEF1A1-AAb and UBE2L3-AAb levels. However, there was wide variation in EEF1A1-AAb and UBE2L3-AAb levels among control subjects <40 years old; the prevalence of both EEF1A1-AAb and UBE2L3-AAb in these subjects was 4.4%. When using cutoff points determined from the control subjects <40 years old, the prevalence of both autoantibodies in T1DM subjects was decreased (EEFA1-AAb, 15.8% to 8.9%; UBE2L3-AAb, 10.9% to 7.9%) when compared to the prevalence using the cutoff derived from the totals for control subjects. CONCLUSION: There was no association between age and EEF1A1-AAb or UBE2L3-AAb levels in nondiabetic subjects. However, the wide variation in EEF1A1-AAb and UBE2L3-AAb levels apparent among the control subjects <40 years old should be taken into consideration when determining the cutoff reference range for the diagnosis of T1DM.
Antibodies ; Autoantibodies* ; Diabetes Mellitus, Type 1 ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Eukaryota* ; Humans ; Peptide Elongation Factor 1* ; Peptide Elongation Factors* ; Prevalence ; Reference Values ; Young Adult*

PURPOSE: This study investigated the prevalence and risk factors associated with vitamin D deficiency in children. METHODS: We analyzed the medical records of 330 patients from the age of 6 to 12, who visited the endocrinology clinic of the Department of Pediatrics at Pusan National University Hospital, from September, 2013 to May, 2014. According to their serum 25-hydroxyvitamin D (25(OH)D) levels, the patients were grouped into either the deficiency group (25(OH)D<20 ng/mL), or the sufficiency group (25(OH)D≥20 ng/mL). The differences between the 2 groups were compared. RESULTS: There were 195 patients (59.1%) who had vitamin D deficiency. Their mean serum 25(OH)D level was 14.86±3.20 ng/mL. The differences in sex, age, and pubertal status between the 2 groups were not statistically significant. Weight standard deviation score (SDS), and body mass index SDS, were significantly higher in the vitamin D deficiency group (P=0.002 for each), compared to the sufficiency group. Compared with Autumn, both Spring (odds ratio [OR], 9.7; 95% confidence interval [CI], 4.3–22.0), and Winter (OR, 5.9; 95% CI, 3.5–10.0), were risk factors for vitamin D deficiency. In multiple logistic regression analysis, only seasonal differences have been confirmed to have an effect on vitamin D deficiency. CONCLUSION: Vitamin D deficiency in children aged 6 to 12 years is very common. Spring and Winter are the most important risk factors for vitamin D deficiency. We suggest that it is necessary to supplement the guideline for the vitamin D intake according to our situation.
Body Mass Index ; Busan* ; Child* ; Endocrinology ; Humans ; Logistic Models ; Medical Records ; Pediatrics ; Prevalence ; Risk Factors ; Seasons ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

PURPOSE: This study investigated the prevalence and risk factors associated with vitamin D deficiency in children. METHODS: We analyzed the medical records of 330 patients from the age of 6 to 12, who visited the endocrinology clinic of the Department of Pediatrics at Pusan National University Hospital, from September, 2013 to May, 2014. According to their serum 25-hydroxyvitamin D (25(OH)D) levels, the patients were grouped into either the deficiency group (25(OH)D<20 ng/mL), or the sufficiency group (25(OH)D≥20 ng/mL). The differences between the 2 groups were compared. RESULTS: There were 195 patients (59.1%) who had vitamin D deficiency. Their mean serum 25(OH)D level was 14.86±3.20 ng/mL. The differences in sex, age, and pubertal status between the 2 groups were not statistically significant. Weight standard deviation score (SDS), and body mass index SDS, were significantly higher in the vitamin D deficiency group (P=0.002 for each), compared to the sufficiency group. Compared with Autumn, both Spring (odds ratio [OR], 9.7; 95% confidence interval [CI], 4.3–22.0), and Winter (OR, 5.9; 95% CI, 3.5–10.0), were risk factors for vitamin D deficiency. In multiple logistic regression analysis, only seasonal differences have been confirmed to have an effect on vitamin D deficiency. CONCLUSION: Vitamin D deficiency in children aged 6 to 12 years is very common. Spring and Winter are the most important risk factors for vitamin D deficiency. We suggest that it is necessary to supplement the guideline for the vitamin D intake according to our situation.
Body Mass Index ; Busan* ; Child* ; Endocrinology ; Humans ; Logistic Models ; Medical Records ; Pediatrics ; Prevalence ; Risk Factors ; Seasons ; Vitamin D Deficiency* ; Vitamin D* ; Vitamins*

Although the prognosis of papillary thyroid cancer (PTC) is extremely good, locoregional recurrences after initial treatment occur. Thyroglobulin (Tg) is a reliable tumor marker to detect recurrence or persistence of PTC. However, occasionally serum Tg may miss the detection of a recurrence. We report a 54-year-old female presented with hoarseness due to cervical recurrence without concomitant elevation of serum Tg and anti-Tg antibody, in contrast to extremely increased needle-washout Tg, who had undergone a total thyroidectomy and radioiodine ablation as initial therapies for PTC. Several factors causing such discrepancy between needle-washout Tg and serum Tg can be suggested including site of recurrence, volume of tumor, interference by some kind of plasma antibodies other than anti-Tg antibody, and any conformational defect of Tg protein. Among them, the most convincing explanation is that any conformational defect of Tg may lead to impaired secretion of Tg to blood. We suggest that more studies are needed to find the cause for potential mechanisms involved in PTC recurrences without increased serum Tg.
Antibodies ; Female ; Hoarseness ; Humans ; Middle Aged ; Plasma ; Prognosis ; Recurrence ; Thyroglobulin* ; Thyroid Neoplasms* ; Thyroidectomy

BACKGROUND: The current perception threshold (CPT) could be quantified by stimulating Abeta and C fibers at 2,000 and 5 Hz, respectively. C fibers play a role in the autonomic nervous system and are involved in temperature and pain sensation. We evaluated the usefulness of CPT for diagnosing distal polyneuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in diabetic patients. METHODS: The CPT was measured in the index finger (C7 level) and in the third toe (L5 level) in diabetic patients aged 30 to 69 years. We assessed DPN according to the neuropathy total symptom score-6 (NTSS-6) and 10-g monofilament pressure sensation. Subjects with a NTSS-6 >6 or with abnormal 10-g monofilament sensation were defined to have DPN. CAN was evaluated by spectral analysis of heart rate variability and by Ewing's traditional tests. RESULTS: The subjects with DPN had significantly higher CPT at all of the frequencies than the subjects without DPN (P<0.05). Abnormal 10-g monofilament sensation and NTSS-6 >6 could be most precisely predicted by CPT at 2,000 and 5 Hz, respectively. However, only 6.5% and 19.6% of subjects with DPN had an abnormal CPT at 2,000 Hz at the C7 and L5 levels. Although CPT at 5 Hz showed a negative correlation with the power of low and high frequency in the spectral analysis (P<0.05), only 16.7% of subjects with CAN exhibited an abnormal CPT at the same frequency. CONCLUSION: Although the CPT is significantly associated with neuropathic symptoms or signs corresponding to the nerve fiber stimulated, it provides little additional information compared with conventional evaluations.
Autonomic Nervous System ; Diabetes Mellitus* ; Diabetic Neuropathies* ; Fingers ; Heart Rate ; Humans ; Nerve Fibers ; Nerve Fibers, Unmyelinated ; Polyneuropathies ; Sensation ; Toes