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.

BACKGROUND: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. METHODS: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. RESULTS: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. CONCLUSIONS: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.
Acromioclavicular Joint ; Dislocations ; Follow-Up Studies ; Humans ; Joints ; Ligaments ; Range of Motion, Articular ; Shoulder ; Suture Anchors ; Sutures

BACKGROUND: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. METHODS: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. RESULTS: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was 164.6°, external rotation at the side was 61.2°, and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. CONCLUSIONS The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

BACKGROUND: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. METHODS: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. RESULTS: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of −24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. CONCLUSION: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.
Aged ; Aging ; Cardiovascular Diseases ; Delivery of Health Care ; Economics, Medical ; Foster Home Care ; Health Policy ; Health Services Needs and Demand ; Humans ; Insurance, Health ; Korea ; National Health Programs ; Surgeons* ; Thoracic Surgery

BACKGROUND: The Korean National Diabetes Program (KNDP) cohort study is performing an ongoing large-scale prospective multicenter investigation to discover the pathogenesis of type 2 diabetes in Korean patients. This study was performed to examine the prevalence of chronic complications in patients with type 2 diabetes among those registered in the KNDP cohort within the past 4 years. METHODS: This study was performed between June 2006 and September 2009 at 13 university hospitals and included 4,265 KNDP cohort participants. Among the participants, the crude prevalence of microvascular and macrovascular diseases of those checked for diabetes-related complications was determined, and the adjusted standard prevalence and standardization of the general population prevalence ratio (SPR) was estimated based on the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) population demographics. RESULTS: Among the KNDP registrants, 43.2% had hypertension, 34.8% had dyslipidemia, 10.8% had macrovascular disease, and 16.7% had microvascular disease. The SPR of the KNDP registrants was significantly higher than that of the KNHANES subjects after adjusting for demographics in the KNHANES 2005 population. However, with the exception of cardiovascular disease in females, the standardized prevalence for the most complicated items in the survey was significantly higher than that in the KNHANES subjects. CONCLUSION: The prevalence of macrovascular disease and peripheral vascular disease were significantly higher in Korean patients with type 2 diabetes than in the normal population. However, no significant difference was noted in the prevalence of cardiovascular disease in females.
Cardiovascular Diseases ; Cerebrovascular Disorders ; Cohort Studies ; Coronary Disease ; Demography ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Diabetic Retinopathy ; Dyslipidemias ; Female ; Hospitals, University ; Humans ; Hypertension ; Korea ; Nutrition Surveys ; Peripheral Vascular Diseases ; Prevalence ; Prospective Studies

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.
Anesthesia ; Cooperative Behavior ; Curriculum ; Floors and Floorcoverings ; Humans ; Massage ; Surveys and Questionnaires ; Respiration ; Retrospective Studies ; Students, Nursing ; Women's Health

This research was performed to investigate the effects of NEP (Nutritional Education Practice) program developed by KHyDDI (Korea Hypertension Diabetes Daegu Initiative) for hypertension and diabetes patients. The subjects were 116 patients (hypertension 70, diabetes 46) who had completed basic education program at the education information center and four-session program was implemented for them. Nutrient intake was analyzed and compared before and after the program by 24-hr recall method and evaluate weight, waist circumference, body fat, blood pressure and eating habits in terms of nutrition knowledge, eating behavior, salty taste assessment. The improved results after the program were observed in weight, waist circumference, body fat ratio, blood pressure, slightly salty taste in salty taste assessment, nutrition knowledge, eating behavior, sodium, energy, carbohydrate and protein intake ratio to total energy (p < 0.001). Therefore, this program is effective in the improvement of weight, waist circumference and eating behavior, and the continued management would lead to the prevention of cardio-cerebrovascular diseases in the community.
Adipose Tissue ; Blood Pressure ; Eating ; Feeding Behavior ; Humans ; Hypertension ; Information Centers ; Nutrition Assessment ; Sodium ; Waist Circumference

Leptospirosis is a spirochetal infectious disease caused by Leptospira interrogans, and may vary in degree from an asymptomatic infection to a severe and fatal illness. The kidney is one of the principal target organs of Leptospira. Renal disorders caused by Leptospira infection vary from an abnormality in urinalysis to acute kidney injury (AKI). Incidence of AKI in severe leptospirosis varies from 40% to 60%. AKI reflects the severity of leptospirosis and is generally accompanied by cholestatic jaundice. The pathophysiology of AKI in leptospirosis consists of hypovolemia, direct tubular toxicity, and rhabdomyolysis. Most patients with acute leptospirosis experience severe myalgias, and show laboratory evidence of mild rhabdomyolysis. However, occurrence of severe rhabdomyolysis is rare. We report here on a patient with leoptospirosis, who had severe rhabdomyolysis and acute kidney injury without jaundice.
Acute Kidney Injury ; Asymptomatic Infections ; Communicable Diseases ; Humans ; Hypovolemia ; Incidence ; Jaundice ; Jaundice, Obstructive ; Kidney ; Leptospira ; Leptospira interrogans ; Leptospirosis ; Rhabdomyolysis ; Urinalysis

No abstract available.

Primary nonampullary duodenal adenocarcinoma is an extremely rare disease. In the past, almost all duodenal adenocarcinomas were detected at an advanced stage. Yet recently, an increased number of case reports of early duodenal adenocarcinoma has coincided with the advances in the field of endoscopy, and there has also been an increased number of case reports of duodenal adenocarcinoma treated by endoscopic mucosal resection. We report here on a case of primary nonampullary duodenal adenocarcinoma that was treated by endoscopic mucosal resection, and there has been no recurrence for over 3 years, as assessed by endoscopic examination.
Adenocarcinoma ; Endoscopy ; Rare Diseases ; Recurrence