Background: Human breast milk is essential and provides irreplaceable nutrients for early humans. However, breastfeeding is not easy for various reasons in medical institution environments. Therefore, in order to improve the breastfeeding environment, we investigated the difficult reality of breastfeeding through questionnaire responses from medical institution workers. Methods: A survey was conducted among 179 medical institution workers with experience in childbirth within the last five years. The survey results of 175 people were analyzed, with incoherent answers excluded. Results: Of the 175 people surveyed, a total of 108 people (61.7%) worked during the day, and 33 people (18.9%) worked in three shifts. Among 133 mothers who stayed with their babies in the same nursing room, 111 (93.3%) kept breastfeeding for more than a month, but among those who stayed apart, only 10 (71.4%) continued breastfeeding for more than a month (P = 0.024). Ninety-five (88.0%) of daytime workers, 32 (94.1%) two-shift workers, and 33 (100%) three-shift workers continued breastfeeding for more than a month (P = 0.026). Workers in general hospitals tended to breastfeed for significantly longer than those that worked in tertiary hospitals (P = 0.003). A difference was also noted between occupation categories (P = 0.019), but a more significant difference was found in the comparison between nurses and doctors (P = 0.012). Longer breastfeeding periods were noted when mothers worked three shifts (P = 0.037). Depending on the period planned for breastfeeding prior to childbirth, the actual breastfeeding maintenance period after birth showed a significant difference (P = 0.002). Of 112 mothers who responded to the question regarding difficulties in breastfeeding after returning to work, 87 (77.7%) mentioned a lack of time caused by being busy at work, 82 (73.2%) mentioned the need for places and appropriate circumstances. Conclusion In medical institutions, it is recommended that environmental improvements in medical institutions, the implementation of supporting policies, and the provision of specialized education on breastfeeding are necessary to promote breastfeeding.

BACKGROUND: This study assessed the association between shift work and high-sensitivity C-reactive protein (hs-CRP) level, a risk factor for cardiovascular disease (CVD), in female workers in electronics manufacturing services (EMS). METHODS: Female EMS workers who received special medical examinations for workers in Gyeongnam, Korea between January 2017 and December 2017 were enrolled in this study. Their age, marital status, education level, alcohol consumption, smoking habit, regular exercise, quality of sleep, work stress, and depression were investigated, and blood tests were conducted. The t- and χ2 tests were conducted to compare the general and biochemical characteristics between daytime and shift worker groups. Age-adjusted partial correlation analysis was performed to examine the linear relationship between hs-CRP level and other risk factors for CVDs. In addition, the difference in hs-CRP levels according to work schedule was analyzed by ANCOVA after adjusting for variables that could affect the hs-CRP level. RESULTS: Although the average hs-CRP levels did not differ significantly between daytime and shift workers (0.92 ± 1.87 and 1.07 ± 2.20 mg/dL, respectively), shift workers tended to show a higher hs-CRP level (p = 0.067). After adjusting for variables that can affect the hs-CRP level, the estimated average hs-CRP level was significantly higher in shift workers (1.325 ± 0.156 mg/dL) than that in daytime workers (0.652 ± 0.350 mg/dL) (p = 0.003). CONCLUSIONS: The results of this study identified a relationship between shift work and hs-CRP level increase in women. Because multiple studies have reported associations between increased hs-CRP and CVD, follow-up of hs-CRP may help early detection of CVD in shift workers.
Alcohol Drinking ; Appointments and Schedules ; C-Reactive Protein ; Cardiovascular Diseases ; Depression ; Education ; Female ; Follow-Up Studies ; Hematologic Tests ; Humans ; Inflammation ; Korea ; Marital Status ; Risk Factors ; Smoke ; Smoking

PURPOSE: To describe the technical skills and to estimate the clinical outcomes of port-hole decompression preserving the posterior ligaments during lumbar spinal stenosis surgery. MATERIALS AND METHODS: Between March 2014 and March 2016, a total of 101 patients who underwent port-hole decompression were retrospectively analyzed. The mean age was 71.3 years (58–84 years) and there were 46 males and 55 females. The mean follow-up period was 18 months. Degenerative spondylolisthesis was observed in 24.8% of patients (25/101). Port-hole decompression was performed by removing the central portion of the distal part of the upper lamina with a burr. Then, the contralateral side of ligamentum flavum and hypertrophied facet joints were removed. We estimated the lumbar lordotic angle using radiographs, and measured the depth from skin to upper lamina central area using magnetic resonance imaging axial images. We estimated the mean slip angle and mean degree of slip in preoperative and postoperative radiography in standing flexion and extension. We also measured the operational time, length of skin incision, and blood loss. The clinical results were estimated by a walking distance caused by neurologic intermittent claudication, visual analogue scale, and Oswestry disability index. RESULTS: Most patients were generally older, and the mean lordotic angle was 25.3°, which is considered to be lower when compared with younger people. The mean depth from skin to lamina was mean 5.4 cm. With respect to the radiological results, there were no significant differences between the preoperative and postoperative groups. The operation time, length of skin incision, and bleeding were not increased proportionally to the operation level. The walking distance caused by neurologic intermittent claudication, visual analogue scale, and Oswestry disability index of the post-operative group were all improved compared with the pre-operative group. CONCLUSION: The port-hole decompression, which decompresses the contralateral side while preserving the posterior ligaments and facet joints may be a useful technique for elderly patients with multiple level stenosis, minimizing spinal segmental instability.
Aged ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Intermittent Claudication ; Ligaments ; Ligamentum Flavum ; Magnetic Resonance Imaging ; Male ; Radiography ; Retrospective Studies ; Skin ; Spinal Stenosis ; Spondylolisthesis ; Walking ; Zygapophyseal Joint

PURPOSE: To assess the prevalence and the risk factors of dry eye disease after refractive surgery. METHODS: A retrospective study was performed on 180 eyes of 98 patients based on medical records. Those who had tear break-up time less of than 5 seconds or had an Oxford stain scale equal to or greater than 2 were defined to have dry eye disease. We analyzed the prevalence of dry eye, compared demographic and clinical features of the dry eye group and normal group, and found risk factors of dry eye after refractive surgery. RESULTS: The prevalence of postoperative dry eye was 62.2%. Compared to the normal eye group, the dry eye group had a significantly higher proportion of women (p = 0.016), older age (p = 0.001), and thin cornea (p = 0.002). The most significant risk factor of dry eye after refractive surgery was presence of dry eye before refractive surgery (odds ratio [OR] = 9.02, confidence interval [CI] = 3.8-21.4). Old age was also found to be an independent risk factor of dry eye after refractive surgery (OR = 1.06, CI = 1.01-1.11). CONCLUSIONS: The risk of dry eye after refractive surgery was increased in older age and preoperative dry eye disease. In order to prevent post-refractive surgery dry eye, caution should be exercised in middle aged patients with preoperative dry eye disease.
Cornea ; Eye Diseases* ; Female ; Humans ; Medical Records ; Middle Aged ; Prevalence* ; Refractive Surgical Procedures* ; Retrospective Studies ; Risk Factors* ; Tears

PURPOSE: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. MATERIALS AND METHODS: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. RESULTS: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were “excellent” or “good” in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. CONCLUSION: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.
Classification ; Diabetes Mellitus ; Diskectomy* ; Follow-Up Studies ; Humans ; Reoperation ; Smoke ; Smoking

BACKGROUND: The development of pedicle screw-based posterior spinal instrumentation is recognized as one of the major surgical treatment methods for thoracolumbar burst fractures. However, the appropriate level in posterior segment instrumentation is still a point of debate. To assesses the long-term results of two-level and three-level posterior fixations of thoracolumbar burst fractures that have load-sharing scores of 7 and 8 points. METHODS: From January 1998 to May 2009, we retrospectively analyzed clinical and radiologic outcomes of 45 patients with thoracolumbar burst fractures of 7 and 8 points in load-sharing classification who were operated on using two-level posterior fixation (one segment above and one segment below: 28 patients, group I) or three-level posterior fixation (two segments above and one segment below: 17 patients, group II). Clinical results included the grade of the fracture using the Frankel classification, and the visual analog score was used to evaluate pain before surgery, immediately after surgery, and during follow-up period. We also evaluated pain and work status at the final follow-up using the Denis pain scale. RESULTS: In all cases, non-union or loosening of implants was not observed. There were two screw breakages in two-level posterior fixation group, but bony union was obtained at the final follow-up. There were no significant differences in loss of anterior vertebral body height, correction loss, or change in adjacent discs. Also, in clinical evaluation, there was no significant difference in the neurological deficit of any patient during the follow-up period. CONCLUSIONS: In our study, two-level posterior fixation could be used successfully in selected cases of thoracolumbar burst fractures of 7 and 8 points in the load-sharing classification.
Adult ; Back Pain ; Female ; Follow-Up Studies ; Fracture Fixation, Internal/adverse effects/instrumentation/methods/*statistics & numerical data ; Humans ; Lumbar Vertebrae/*injuries/physiopathology/*surgery ; Male ; Middle Aged ; Pedicle Screws ; Postoperative Complications ; Retrospective Studies ; Spinal Fractures/physiopathology/*surgery ; Thoracic Vertebrae/*injuries/physiopathology/*surgery ; Treatment Outcome

Transglutaminase 2 (TG2) is a ubiquitously expressed enzyme that catalyzes crosslinking, polyamination or deamidation of glutamine residues in proteins. It has been reported that TG2 is involved in the pathogenesis of various inflammatory diseases including celiac disease, pulmonary fibrosis, cystic fibrosis, multiple sclerosis and sepsis. Recently, using a mouse model of bleomycin-induced lung fibrosis, we showed that TG2 is required to trigger inflammation via the induction of T helper type 17 (Th17) cell differentiation in response to tissue damage. However, the role of TG2 in inflammatory bowel disease (IBD), which is thought to be a Th17 cell-associated disease, has remained elusive. In this study, we investigated the role of TG2 in dextran sulfate sodium (DSS)-induced colitis, the most widely used mouse model for IBD. Age- and sex-matched wild-type and TG2(−/−) mice were fed 2% DSS for 7 days or 3.5% DSS for 5 days in drinking water. An in situ TG activity assay revealed that DSS treatment activates TG2 in various colon cell types, including columnar absorptive cells and goblet cells. DSS-treated TG2(−/−) mice showed lower interleukin (IL)-6, but higher IL-17A and RORγt (retinoic acid receptor-related orphan receptor-γt) expression levels in the colon tissues than that in the wild-type mice. Moreover, TG2(−/−) mice showed higher mortality than the wild-type mice because of DSS treatment. Nevertheless, we found no significant differences in changes of body weight, colon length, morphology, immune cell infiltration and in vivo intestinal permeability between DSS-treated wild-type and TG2(−/−) mice. These results indicate that TG2-mediated Th17 cell differentiation is not required for the pathogenesis of DSS-induced acute colitis.
Animals ; Body Weight ; Celiac Disease ; Cell Differentiation ; Child ; Child, Orphaned ; Colitis* ; Colon ; Cystic Fibrosis ; Dextran Sulfate* ; Dextrans* ; Drinking Water ; Fibrosis ; Glutamine ; Goblet Cells ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Interleukin-17 ; Interleukins ; Lung ; Mice* ; Mortality ; Multiple Sclerosis ; Permeability ; Pulmonary Fibrosis ; Sepsis ; Th17 Cells

OBJECTIVE: Post-contrast T1 values are closely related to the degree of myocardial extracellular space expansion. We determined the relationship between post-contrast T1 values and left ventricular (LV) diastolic function, LV remodeling, and neurohormonal activation in patients with dilated cardiomyopathy (DCM). MATERIALS AND METHODS: Fifty-nine patients with DCM (mean age, 55 +/- 15 years; 41 males and 18 females) who underwent both 1.5T magnetic resonance imaging and echocardiography were enrolled. The post-contrast 10-minute T1 value was generated from inversion time scout images obtained using the Look-Locker inversion recovery sequence and a curve-fitting algorithm. The T1 sample volume was obtained from three interventricular septal points, and the mean T1 value was used for analysis. The N-Terminal pro-B-type natriuretic peptide (NT-proBNP) level was measured in 40 patients. RESULTS: The mean LV ejection fraction was 24 +/- 9% and the post-T1 value was 254.5 +/- 46.4 ms. The post-contrast T1 value was significantly correlated with systolic longitudinal septal velocity (s'), peak late diastolic velocity of the mitral annulus (a'), the diastolic elastance index (Ed, [E/e']/stroke volume), LV mass/volume ratio, LV end-diastolic wall stress, and LV end-systolic wall stress. In a multivariate analysis without NT-proBNP, T1 values were independently correlated with Ed (beta = -0.351, p = 0.016) and the LV mass/volume ratio (beta = 0.495, p = 0.001). When NT-proBNP was used in the analysis, NT-proBNP was independently correlated with the T1 values (beta = -0.339, p = 0.017). CONCLUSION: Post-contrast T1 is closely related to LV remodeling, diastolic function, and neurohormonal activation in patients with DCM.
Adult ; Aged ; Algorithms ; Blood Pressure ; Cardiomyopathy, Dilated/*diagnosis/radiography ; Echocardiography ; Extracellular Space/physiology/*radiography ; Female ; Heart Ventricles/physiopathology/radiography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate Analysis ; Natriuretic Peptide, Brain/analysis ; Peptide Fragments/analysis ; *Ventricular Remodeling

The publisher and authors would like to draw the reader's attention to an error.

Although digital gangrene is an uncommon clinical feature, it may lead to serious complications, such as amputation. Therefore, it requires prompt evaluation and treatment. Digital gangrene is often seen in systemic sclerosis, but is rare in systemic lupus erythematosus (SLE). In SLE, digital gangrene results from vasculitis, vasospasm, and thromboembolism. Here, we report a 15-year-old male SLE patient who initially presented with digital gangrene, and present a review of the relevant literature.
Amputation ; Gangrene ; Humans ; Lupus Erythematosus, Systemic ; Male ; Scleroderma, Systemic ; Thromboembolism ; Vasculitis