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: During the coronavirus disease 2019 (COVID-19) pandemic, there was a shortage of medical resources and the need for proper treatment guidelines for brain tumor patients became more pressing. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. As part II of the guideline, this consensus survey is to suggest management options in specific clinical scenarios during the crisis period. Methods: The KSNO Guideline Working Group consisted of 22 multidisciplinary experts on neuro-oncology in Korea. In order to confirm a consensus reached by the experts, opinions on 5 specific clinical scenarios about the management of brain tumor patients during the crisis period were devised and asked. To build-up the consensus process, Delphi method was employed. Results: The summary of the final consensus from each scenario are as follows. For patients with newly diagnosed astrocytoma with isocitrate dehydrogenase (IDH)-mutant and oligodendroglioma with IDH-mutant/1p19q codeleted, observation was preferred for patients with low-risk, World Health Organization (WHO) grade 2, and Karnofsky Performance Scale (KPS) ≥60, while adjuvant radiotherapy alone was preferred for patients with high-risk, WHO grade 2, and KPS ≥60. For newly diagnosed patients with glioblastoma, the most preferred adjuvant treatment strategy after surgery was radiotherapy plus temozolomide except for patients aged ≥70 years with KPS of 60 and unmethylated MGMT promoters. In patients with symptomatic brain metastasis, the preferred treatment differed according to the number of brain metastasis and performance status. For patients with newly diagnosed atypical meningioma, adjuvant radiation was deferred in patients with older age, poor performance status, complete resection, or low mitotic count. Conclusion It is imperative that proper medical care for brain tumor patients be sustained and provided, even during the crisis period. The findings of this consensus survey will be a useful reference in determining appropriate treatment options for brain tumor patients in the specific clinical scenarios covered by the survey during the future crisis.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the need for appropriate treatment guidelines for patients with brain tumors was indispensable due to the lack and limitations of medical resources. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. Methods: The KSNO Guideline Working Group was composed of 22 multidisciplinary experts on neuro-oncology in Korea. In order to reach consensus among the experts, the Delphi method was used to build up the final recommendations. Results: All participating experts completed the series of surveys, and the results of final survey were used to draft the current consensus recommendations. Priority levels of surgery and radiotherapy during crises were proposed using appropriate time window-based criteria for management outcome. The highest priority for surgery is assigned to patients who are life-threatening or have a risk of significant impact on a patient’s prognosis unless immediate intervention is given within 24–48 hours. As for the radiotherapy, patients who are at risk of compromising their overall survival or neurological status within 4–6 weeks are assigned to the highest priority. Curative-intent chemotherapy has the highest priority, followed by neoadjuvant/adjuvant and palliative chemotherapy during a crisis period. Telemedicine should be actively considered as a management tool for brain tumor patients during the mass infection crises such as the COVID-19 pandemic. Conclusion It is crucial that adequate medical care for patients with brain tumors is maintained and provided, even during times of crisis. This guideline will serve as a valuable resource, assisting in the delivery of treatment to brain tumor patients in the event of any future crisis.

PURPOSE: To report a case of moyamoya disease initially presenting transient visual loss in a healthy young subject. CASE SUMMARY: A 20-year-old male with no history of systemic disease or trauma visited our clinic due to sudden onset visual loss in the right eye. There were no accompanying symptoms, including headache, seizure, paresis, or paresthesia. Best corrected visual acuity at the first visit was hand movement in the right eye and 20/20 in the left eye. No abnormal finding was revealed in the anterior segment. On fundus examination, whitening at post pole was found in the right eye. In fluorescein angiography, a choroidal and retinal artery filling delay in the posterior pole was noted. The patient's visual acuity began to improve gradually and was recovered to 20/20 by the next day. Moyamoya disease was diagnosed based on magnetic resonance angiography of the brain and transfemoral cerebral angiography as well as stenosis of the internal carotid artery and middle cerebral artery with collateral vessel networks. CONCLUSIONS: Moyamoya disease should be considered as a possible cause of transient visual loss in healthy young subjects.
Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Choroid ; Constriction, Pathologic ; Eye ; Fluorescein Angiography ; Glycosaminoglycans ; Hand ; Headache ; Humans ; Magnetic Resonance Angiography ; Male ; Middle Cerebral Artery ; Moyamoya Disease ; Paresis ; Paresthesia ; Retinal Artery ; Seizures ; Visual Acuity ; Young Adult

PURPOSE: To compare contrast sensitivity and color vision after implantation of a clear intraocular lens (IOL) and a yellow-tinted IOL in diabetic retinopathy patients. METHODS: In the 50 eyes of 25 diabetic patients with non-proliferative diabetic retinopathy, clear IOLs were implanted in 25 eyes, and yellow-tinted IOLs were implanted in 25 fellow eyes. Three months after the surgery, contrast sensitivity function was measured with a vision contrast test system, and color discrimination was tested using the Farnsworth Munsell 100-hue test. RESULTS: Eyes implanted with yellow-tinted IOLs had significant differences in contrast sensitivity values compared to those of fellow eyes implanted with clear IOLs in both the moderate diabetic retinopathy group (6.0 cycles per degree) and the severe diabetic retinopathy group (throughout all spatial frequencies except 12.0 cycles per degree). The yellow-tinted IOL did not modify chromatic discrimination compared with that of the clear IOL. In the blue-yellow axis error score, however, there were significant differences between the clear IOL and the yellow-tinted IOL. CONCLUSIONS: With progressing diabetic retinopathy, the yellow-tinted IOL provided better contrast sensitivity than the clear IOL. The yellow-tinted IOL improved color vision in the blue-yellow chromatic axis without causing chromatic discrimination defects.
Axis, Cervical Vertebra ; Color Vision ; Contrast Sensitivity ; Diabetic Retinopathy ; Discrimination (Psychology) ; Eye ; Humans ; Lenses, Intraocular ; Vision, Ocular

We report a case of toxic epidermal necrolysis with ocular involvement following vaccination for hemorrhagic fever with renal syndrome. A healthy 20-year-old male soldier presented with confluent purpuric and erythematous dusky red macules evolving to flaccid blister and epidermal detachment on the whole body with conjunctival injection. The patient had no antecedent medical or surgical conditions except for two doses of hemorrhagic fever with renal syndrome vaccination. With supportive care, skin lesions were improved. Ophthalmic examinations revealed conjunctival injection with epithelial defects in both eyes. Ocular complications were resolved after amniotic membrane transplantation. Toxic epidermal necrolysis may be considered as a possible complication of hemorrhagic fever with renal syndrome vaccination.
Conjunctival Diseases/*etiology ; Epidermal Necrolysis, Toxic/*etiology ; Hemorrhagic Fever with Renal Syndrome/*prevention & control ; Humans ; Male ; Severity of Illness Index ; Viral Vaccines/*adverse effects ; Young Adult

Blood Platelets ; Centrifugation ; Intercellular Signaling Peptides and Proteins ; Mandible ; Osteoblasts ; Osteogenesis ; Platelet Count ; Platelet-Rich Plasma ; Transplants

BACKGROUND: Extubation failure was associated with poor prognosis and high hospital mortality. Cuff leak test (CLT) has been proposed as a relatively simple method for detecting laryngeal obstruction that predispose toward postextubation stridor (PES) and reintubation. We examined the risk factors of extubation failure and evaluated the usefulness and limitation of CLT for predicting PES and reintubation. METHODS: Thirty-four consecutive patients intubated more than 24 hours were examined. The subjects were evaluated daily for extubation readiness, and CLT was performed prior to extubation. Several parameters in the extubation success and failure group were compared. The accuracy and limitation of CLT were evaluated after choosing the thresholds values of the cuff leak volume (CLV) and percentage (CLP). RESULTS: Of the 34 patients studied, 6 (17.6%) developed extubation failure and 3 (8.8%) were accompanied by PES. The patients who had extubation failure were more likely to have a longer duration of intubation and more severe illness. The patients who developed PES had a smaller cuff leak than the others: according to the CLV (22.5+/-23.8 vs 233.3+/-147.1ml, p=0.020) or CLP (6.2+/-7.3 vs 44.3+/-24.7%, p=0.013). The best cut off values for the CLV and CLP were 50ml and 14.7%, respectively. The sensitivity, negative predictive value, and specificity of CLT were relatively high, but the positive predictive value was low. CONCLUSION: The likelihood of developing extubation failure increases with increasing severity of illness and duration of intubation. A low CLV or CLP (<50ml or 14.7%) is useful in identifying patients at risk of PES, but the CLT is not an absolute predictor and should not be used an indicator for delaying extubation.
Hospital Mortality ; Humans ; Intubation ; Prognosis ; Respiratory Sounds* ; Risk Factors*

PURPOSE: To investigate the improvement in balance after TKA and the difference of balance between posterior cruciate ligament retaining & posterior cruciate ligament substituting prostheses. MATERIALS AND METHODS: Twenty-six patients scheduled to undergo TKA were randomly assigned to receive either PCL-retaining or PCL-substituting prosthesis. The balance of the subjects were checked prior to and at least six months after the operation by computerized dynamic posturography. We investigated whether the balance improve and the difference of change between the implants. RESULTS: Patients showed significantly the improvement of balance by the knee proprioception after TKA (p<0.05) during intercepting visual compensation and the more HSS Knee score improve, the more its balance improve (p<0.05, r=0.667). But the difference of balance between the implants was not detected significantly (p>0.05). CONCLUSION: The balance by the proprioception improves as the HSS Knee Score increases after TKA, and does not show the difference between the implants.
Compensation and Redress ; Humans ; Knee ; Posterior Cruciate Ligament ; Proprioception ; Prostheses and Implants

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide