This study explores the development, roles, and key initiatives of the Regional Environmental Health Centers in Korea, detailing their evolution through four distinct phases and their impact on environmental health policy and local governance. It chronicles the establishment and transformation of these centers from their inception in May 2007, through four developmental stages. Originally named Environmental Disease Research Centers, they were subsequently renamed Environmental Health Centers following legislative changes. The analysis includes the expansion in the number of centers, the transfer of responsibilities to local governments, and the launch of significant projects such as the Korean Children’s Environmental Health Study (Ko-CHENS ). During the initial phase (May 2007–February 2009), the 10 centers concentrated on research-driven activities, shifting from a media-centered to a receptor-centered approach. In the second phase, prompted by the enactment of the Environmental Health Act, six additional centers were established, broadening their scope to address national environmental health issues. The third phase introduced Ko-CHENS, a 20-year national cohort project designed to influence environmental health policy by integrating research findings into policy frameworks. The fourth phase marked a decentralization of authority, empowering local governments and redefining the centers' roles to focus on regional environmental health challenges. The Regional Environmental Health Centers have significantly evolved and now play a crucial role in addressing local environmental health issues and supporting local government policies. Their capacity to adapt and respond to region-specific challenges is essential for the effective implementation of environmental health policies, reflecting geographical, socioeconomic, and demographic differences.

PURPOSE: The aim of this study was to evaluate the clinical performance and survival rate of implant-supported zirconia-lithium disilicate (Zr-LiSi) bilayered ceramic prostheses over 3 years. MATERIALS AND METHODS: This study included 71 patients, including 34 with implant-supported metal-ceramic prostheses (control group) and 37 with implant-supported Zr-LiSi bilayered ceramic prostheses (test group). The implant survival rate and incidence of prosthetic and biological complications (veneer fractures, dislodgement of screw-access hole filling material, screw loosening, peri-implant mucositis and peri-implantitis, and marginal bone loss) were investigated. The survival rate was analyzed using Kaplan-Meier survival curves, and the identity between two groups was confirmed by the log-rank test. RESULTS: Both groups showed a 100% survival rate, whereas the prosthetic survival rates were 77% and 73% for the metal-ceramic and Zr-LiSi groups, respectively. Biological complications did not appear in the metal-ceramic group, and 16.2% of peri-implant mucositis occurred in the Zr-LiSi group, which was significant (P < .05). Prosthetic complications occurred in 5.8% of the metal-ceramic group with veneer fractures and did not occur in the Zr-LiSi bilayered ceramic group. CONCLUSION This study revealed that posterior Zr-LiSi bilayered ceramic implant prostheses showed high survival rates and similar survival rates to metal-ceramic implant prostheses; however, additional consideration should be given to avoid overcontouring. Zr-LiSi bilayered ceramic implant prostheses may be an option for posterior implant-supported prosthetic treatment.

PURPOSE: The purpose of this clinical study was to evaluate the extent of intraoral occlusal adjustment required for zirconia crowns designed with a dynamic jaw motion tracking method compared to a conventional approach. MATERIALS AND METHODS: Fifteen patients needing zirconia crown restorations in the anterior or posterior regions participated in this study. Following tooth preparation, dynamic jaw motion tracking records were gathered using a tracking device. These records were imported into computer-aided design software and aligned with scanned upper and lower jaw data to design each crown's occlusal surface. Two crowns were fabricated for each patient: one using motion tracking data and another without it. Crowns were scanned pre- and post-adjustment following standard protocols. The scanned data were analyzed with 3D inspection software to calculate occlusal adjustments in the segmented occlusal area as root mean square values, with a paired t-test used for statistical analysis (α = 0.05). RESULTS: Crowns designed with motion tracking data required significantly less intraoral occlusal adjustment than those designed conventionally (P = .028). CONCLUSION Dynamic jaw motion tracking in crown design reduces the extent of intraoral occlusal adjustment, potentially enhancing clinical efficiency.

PURPOSE: This study aimed to evaluate the accuracy of static computer-assisted implant surgery (s-CAIS) by comparing the planned and actual positions of implants placed in a partially edentulous model using surgical templates with different sleeve designs. MATERIALS AND METHODS: Forty-nine mandibular partially edentulous models were scanned using a model scanner to create standard tessellation language (STL) files. The models were divided into seven groups based on sleeve design: Group 1–4 (Open non-metal sleeves with varying heights (3 mm, 6 mm) and buccal widths (5 mm, 6 mm)), Group 5–6 (Closed non-metal sleeves with heights of 3 mm and 6 mm), and Group 7 (Closed metal sleeve). After implant placement at #45 and #47, STL files were generated and analyzed using 3D measurement software. Deviations were measured in terms of horizontal deviation (coronal and apical), vertical deviation, and angular deviation. Statistical significance was evaluated using the Wilcoxon rank sum test, Kruskal-Wallis test, and multiple generalized linear models. RESULTS: While height differences showed no significant deviations (P > .05), there was a tendency for larger apical deviation with increased sleeve height (P < .1). Closed metal and closed non-metal sleeves showed smaller deviations compared to open non-metal sleeves, except in vertical deviation. CONCLUSION Closed sleeves demonstrated greater accuracy in s-CAIS compared to open sleeves. Higher sleeves may improve implant placement accuracy, but buccal insertion width did not significantly affect accuracy.

Patients with ectodermal dysplasia often have atrophied alveolar bone and an inadequate maxillomandibular relationship owing to congenital edentulism.Accurate implant placement that can overcomes anatomical limitations and orthognathic surgery to improve the maxillomandibular relationship is necessary for creating implant-supported prosthesis for these patients. Implant placement and provisional prosthesis fabrication before orthognathic surgery can provide critical fixed reference points and ensure accuracy during orthognathic surgery.In our patient, a digital system was used to design a surgical guide that considered the predictable position of the definitive prosthesis, allowing the placement of implants to overcome anatomical limitations and the creation of fixed reference points via the delivery of a provisional prosthesis for effective orthognathic surgery. The lack of compensation during orthognathic surgery was considered in the definitive prosthesis. As a result, a prosthesis with a minimal anterior cantilever was fabricated. This study aimed to determine the appropriate sequence of multidisciplinary collaborations that would, result in the best functional and aesthetic outcomes.

Background/Aims: Studies on the clinical outcomes after detecting low-grade dysplasia (LGD) in patients with inflammatory bowel disease (IBD) are insufficient. This study evaluated the clinical features, frequency, and risk factors for advanced neoplasia in patients with IBD after an LGD diagnosis. Methods: The medical records of 166 patients with IBD from six university hospitals in Korea from 2010 to 2019 were reviewed retrospectively. LGD was diagnosed in all patients during surveillance. The frequency and risk factors for advanced neoplasia were evaluated, and the clinical features of patients with and without advanced neoplasia were compared. Results: Advanced neoplasia developed in 12 patients (six with large LGD, three with tubulovillous adenoma, and three with high-grade dysplasia), and all cases developed from UC. Patients with advanced neoplasia had significantly higher Mayo scores, and colitis-associated dysplasia was more common than sporadic lesions (83.3% vs. 29.9%; p<0.001). Multivariate analysis showed that colitis-associated LGD significantly increased the risk of developing advanced neoplasia (odds ratio [OR], 10.516; 95% confidence interval [CI], 2.064–53.577). Among patients with colitis-associated lesions, a significant risk factor for advanced neoplasia was a prior history of LGD (OR, 9.429; 95% CI, 1.330–66.863). Conclusions Advanced neoplasia developed in 7.2% of patients with IBD and LGD. Most advanced neoplasms developed from colitis-associated lesions, and the risk was higher in patients with a history of LGD before index colonoscopy.

Background/Aims: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification. Methods: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification. Results: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61–0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06–8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001). Conclusions We refined troponin’s predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.

Background/Aims: To determine the effectiveness of tyrosine kinase inhibitor (TKI) plus reduced-intensity therapy in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL), this retrospective study compared treatment outcomes and induction mortality according to backbone regimen intensity. Methods: The data of 132 patients diagnosed with Ph-positive ALL were retrospectively collected from five centers. Patients received imatinib plus intensive chemotherapy (modified VPD, KALLA1407, or hyper-CVAD) or reduced-intensity chemotherapy (EWALL) for curative purposes. This study analyzed 117 patients, of which 35,22,46, and 14 received modified VPD, KALLA1407, hyper-CVAD, and EWALL, respectively. All patients used imatinib as a TKI. Results: The median age of the patients who received reduced-intensity chemotherapy was 64.4 years, while that of the patients with intensive regimens was 47.5 years. There was no induction death in the reduced-intensity group, while nine patients died in the intensive therapy group. Major molecular response achievement tended to be higher in the intensive chemotherapy group than in the reduced-intensity group. More patients in the intensive chemotherapy group received allogeneic stem cell transplantation (allo-SCT). There was no statistically significant difference in long-term survival between the two groups in terms of relapse-free survival and overall survival rates. Conclusions When imatinib plus reduced-intensity therapy was used as a frontline treatment, there was no inferiority in obtaining complete remission compared to imatinib plus intensive chemotherapy or significant difference in long-term survival. Since imatinib plus reduced-intensity therapy has limitations in obtaining a deep molecular response, proceeding to allo-SCT should be considered.

Background/Aims: Adiponectin, a hormone primarily produced by adipocytes, typically shows an inverse relationship with body mass index (BMI). However, some studies have reported a positive correlation between the two. Thus, this study aimed to examine the relationship between adiponectin level and BMI in diabetic patients, focusing on the impact of past obesity on current adiponectin levels. Methods: We conducted an observational study analyzing data from 323 diabetic patients at Kyungpook National University Hospital. Based on past and current BMIs, participants were categorized into never-obese (nn, n = 106), previously obese (on, n = 43), and persistently obese (oo, n = 73) groups based on a BMI threshold of 25 kg/m2. Adiponectin level and BMI were key variables. Kaplan–Meier analysis assessed their impact on all-cause mortality up to August 2023, with survival differences based on adiponectin quartiles and follow-up starting from patient enrollment (2010–2015). Results: The analysis revealed a significant inverse correlation between adiponectin level and past maximum BMI. The on group exhibited approximately 10% lower adiponectin levels compared to the nn group. This association remained significant after adjusting for current BMI, age, and sex, highlighting the lasting influence of previous obesity on adiponectin levels. Furthermore, survival analysis indicated that patients in the lowest adiponectin quartile had reduced survival, with a statistically significant trend (p = 0.062). Conclusions Findings of this study suggest that lower adiponectin levels, potentially reflecting past obesity, are associated with decreased survival in diabetic patients, underscoring a critical role of adiponectin in long-term health outcomes.

Background/Aims: The clinical outcomes and optimal treatment of esophageal squamous cell carcinoma (ESCC) in elderly patients are unclear. This study aimed to assess the clinical outcomes of ESCC in patients aged ≥ 80 years. Methods: Medical records of patients diagnosed with ESCC between December 2008 and February 2024 were retrospectively reviewed. In total, 479 patients with ESCC were included and divided into the elderly (n = 52) and younger (n = 427) groups based on age. The clinical outcomes and survival rates, according to treatment, were compared between the two groups. Results: The median ages of the two groups were 82 years (range, 80–95 yr) and 66 years (41–79 yr). The overall survival was slightly lower in the elderly group; however, no statistical significance (hazard ratio [HR] 1.27, 95% confidence interval [CI] 0.85−1.91; p = 0.238) was observed. No differences were observed in the outcomes or survival between the two groups according to the treatment method (surgery, chemoradiotherapy or radiotherapy alone, and endoscopic resection). The elderly group was more likely to receive no treatment for cancer (30.8% vs. 13.6%, p = 0.002) than the younger group. However, when there was no treatment for cancer in the elderly group, survival was significantly lower than when treatment was administered (HR 0.08, 95% CI 0.03−020; p < 0.001). Conclusions In patients with ESCC aged ≥ 80 years, active cancer treatment was beneficial, and the results did not differ from those of younger patients.