Background/Aims: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. Methods: An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. Results: Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 minutes vs 34.3±8.3 minutes, p<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 mm 2 /min vs 18.1±4.7 mm 2 /min, p<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8%±3.4% vs 35.1%±3.9%, p<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. Conclusions The dissection speed and safety profile improved significantly with the retractable RESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.

The age- and sex-related differences on the impacts of body composition on diabetes mellitus (DM) remain uncertain.

The age- and sex-related differences on the impacts of body composition on diabetes mellitus (DM) remain uncertain.

Background: The age- and sex-related differences on the impacts of body composition on diabetes mellitus (DM) remain uncertain. Methods: The fourth and fifth Korea National Health and Nutrition Examination Survey included 15,586 subjects over 30 years of age who completed dual-energy X-ray absorptiometry. We conducted a cross-sectional study to investigate whether muscle mass index (MMI), defined as appendicular skeletal muscle divided by body mass index (BMI), and fat mass index (FMI), defined as trunk fat mass divided by BMI, were differently associated with DM according to age and sex. Results: In multivariate logistic regression, the risk for DM significantly increased across quartiles of FMI in men aged ≥70.Meanwhile, MMI showed a protective association with DM in men of the same age. The odds ratios (ORs) for the highest quartile versus the lowest quartile of FMI and MMI were 3.116 (95% confidence interval [CI], 1.405 to 6.914) and 0.295 (95% CI, 0.157 to 0.554), respectively. In women, the ORs of DM was significantly different across FMI quartiles in those over age 50. The highest quartile of FMI exhibited increased ORs of DM in subjects aged 50 to 69 (OR, 1.891; 95% CI, 1.229 to 2.908) and ≥70 (OR, 2.275;95% CI, 1.103 to 4.69) compared to lowest quartile. However, MMI was not significantly associated with DM in women of all age groups. Conclusion Both FMI and MMI were independent risk factors for DM in men aged 70 years or more. In women over 50 years, FMI was independently associated with DM. There was no significant association between MMI and DM in women.

Many previous studies have shown reduced glucose uptake in the ischemic brain. In contrast, in a permanent unilateral common carotid artery occlusion (UCCAO) mouse model, our pilot experiments using 18F-fluorodeoxyglucose positron emission tomography (FDG PET) revealed that a subset of mice exhibited conspicuously high uptake of glucose in the ipsilateral hemisphere at 1 week post-occlusion (asymmetric group), whereas other mice showed symmetric uptake in both hemispheres (symmetric group). Thus, we aimed to understand the discrepancy between the two groups. Cerebral blood flow and histological/metabolic changes were analyzed using laser Doppler flowmetry and immunohistochemistry/Western blotting, respectively. Contrary to the increased glucose uptake observed in the ischemic cerebral hemisphere on FDG PET (p<0.001), cerebral blood flow tended to be lower in the asymmetric group than in the symmetric group (right to left ratio [%], 36.4±21.8 vs. 58.0±24.8, p=0.059). Neuronal death was observed only in the ischemic hemisphere of the asymmetric group. In contrast, astrocytes were more activated in the asymmetric group than in the symmetric group (p<0.05). Glucose transporter-1, and monocarboxylate transporter-1 were also upregulated in the asymmetric group, compared with the symmetric group (p<0.05, respectively). These results suggest that the increased FDG uptake was associated with relatively severe ischemia, and glucose transporter-1 upregulation and astrocyte activation. Glucose metabolism may thus be a compensatory mechanism in the moderately severe ischemic brain.

BACKGROUND: Sarcopenic obesity (SO) is a serious public health concern, few studies have examined the clinical implications of SO in newly-diagnosed type 2 diabetes mellitus (T2DM) patients. We evaluated the prevalence of the newly diagnosed, drug-naïve T2DM patients with low muscle mass with abdominal obesity and its association with insulin resistance and other diabetic complications. METHODS: We classified 233 drug-naïve T2DM subjects into four groups according to abdominal obesity (waist circumference ≥90 cm in men and ≥85 cm in women) and low muscle mass status (appendicular skeletal muscle <7.0 kg/m² for men and <5.4 kg/m² for women). RESULTS: The proportion of the subjects with low muscle mass and abdominal obesity among the newly diagnosed, drug-naïve T2DM patients was 8.2%. Homeostasis model assessment of insulin resistance (HOMA-IR) increased linearly according to body composition group from normal to abdominal obesity to both low muscle mass and abdominal obesity. The multiple logistic regression analysis indicated that subjects with low muscle mass and abdominal obesity (odds ratio [OR], 9.39; 95% confidence interval [CI], 2.41 to 36.56) showed a higher risk for insulin resistance, defined as HOMA-IR ≥3, than those with abdominal obesity (OR, 5.36; 95% CI, 2.46 to 11.69), even after adjusting for other covariates. However, there were no differences in lipid profiles, microalbuminuria, or various surrogate markers for atherosclerosis among the four groups. CONCLUSION: Subjects with both low muscle mass and abdominal obesity had a higher risk of insulin resistance than those with low muscle mass or abdominal obesity only.
Atherosclerosis ; Biomarkers ; Body Composition ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Homeostasis ; Humans ; Insulin Resistance ; Logistic Models ; Male ; Muscle, Skeletal ; Obesity ; Obesity, Abdominal ; Prevalence ; Public Health

PURPOSE: This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning. METHODS: We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels. RESULTS: Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001). CONCLUSION: Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Carboxyhemoglobin* ; Consciousness Disorders ; Creatine Kinase ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Hyperlactatemia ; Lactates ; Lactic Acid* ; Leukocytes ; Nervous System Diseases ; Poisoning ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Troponin I

OBJECTIVES: The aims of this study were to examine validity and reliability of the Korean version of the Social Function Questionnaire (SFQ) and evaluated social function with SFQ in patients with personality disorder. METHODS: The SFQ was administered to 186 psychiatric patients (155 patients with personality disorder and 31 patients without personality disorder), and 22 healthy men were recruited to examine the test-retest reliability of SFQ. The severity of personality disorders was determined using the proposed the International Classification of Diseases (ICD)-11th revision (ICD-11) personality disorders. All participants completed the NEO-Five Factor Inventory, Beck Depression Inventory, and Spielberger State and Trait Anxiety Inventory to examine the convergent validity of SFQ. RESULTS: The Korean version of the SFQ showed good internal consistency (Cronbach's alpha=0.811) and test-retest reliability (r=0.746). Patients with personality disorder had more social dysfunction than those without personality disorder. A graded increase in social dysfunction was observed with increasing severity of personality disorder. Social dysfunction showed a strong linear relationship with the 5 factor model. CONCLUSION: The Korean version of the SFQ has good psychometric properties. The results of our study support the severity classification of personality disorder integrated to upcoming ICD-11.
Anxiety ; Classification ; Depression ; Humans ; International Classification of Diseases ; Male ; Personality Disorders* ; Psychometrics ; Reproducibility of Results

BACKGROUND: Selenoprotein P (SeP) has recently been reported as a novel hepatokine that regulates insulin resistance and systemic energy metabolism in rodents and humans. We explored the associations among SeP, visceral obesity, and nonalcoholic fatty liver disease (NAFLD). METHODS: We examined serum SeP concentrations in subjects with increased visceral fat area (VFA) or liver fat accumulation measured with computed tomography. Our study subjects included 120 nondiabetic individuals selected from participants of the Korean Sarcopenic Obesity Study. In addition, we evaluated the relationship between SeP and cardiometabolic risk factors, including homeostasis model of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hsCRP), adiponectin values, and brachial-ankle pulse wave velocity (baPWV). RESULTS: Subjects with NAFLD showed increased levels of HOMA-IR, hsCRP, VFA, and several components of metabolic syndrome and decreased levels of adiponectin and high density lipoprotein cholesterol than those of controls. Serum SeP levels were positively correlated with VFA, hsCRP, and baPWV and negatively correlated with the liver attenuation index. Not only subjects with visceral obesity but also those with NAFLD exhibited significantly increased SeP levels (P<0.001). In multiple logistic regression analysis, the subjects in the highest SeP tertile showed a higher risk for NAFLD than those in the lowest SeP tertile, even after adjusting for potential confounding factors (odds ratio, 7.48; 95% confidence interval, 1.72 to 32.60; P=0.007). CONCLUSION: Circulating SeP levels were increased in subjects with NAFLD as well as in those with visceral obesity and may be a novel biomarker for NAFLD.
Adiponectin ; C-Reactive Protein ; Cholesterol ; Cholesterol, HDL ; Energy Metabolism ; Fatty Liver ; Homeostasis ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Lipoproteins ; Liver ; Logistic Models ; Obesity ; Obesity, Abdominal ; Pulse Wave Analysis ; Risk Factors ; Rodentia ; Selenoprotein P ; Selenoproteins

PURPOSE: In patients with unilateral cleft lip and nose deformity, alar retraction is commonly seen on the non-cleft side after cleft side is corrected. Spacer graft was used to drag down the inferior border of the alar cartilage of the non-cleft side so as to match the cleft side. By performing spacer graft and septal extension graft together, symmetry and cosmetic improvements were achieved. METHODS: Seven unilateral cleft lip and nose deformity patients underwent surgery for alar retraction correction. The median age was 24 years (ranged from 15 to 34 years), and the median follow-up period was 7.4 months (ranged from 6 to 12 months). The perpendicular length from the longitudinal axis of the nostril to the alar rim, the nasolabial angle and the ala-labial angle were measured in the lateral view photo. The longest perpendicular length from the cephalic border of the alar rim to the parallel line of the alar base was measured in the frontal view photo. RESULTS: Improvement in alar retraction was seen after the surgery. There were no specific complications during the follow-up and the symmetry of both nostrils was satisfactory. No increase in the nasolabial angle or exposure of the nostrils was seen after the tip projection via tip plasty. CONCLUSION: The fundamental factor in correcting alar retraction with secondary cleft lip and nose deformity is repositioning the alar rim with spacer graft, which seems to be more physiologic than other methods. The method combining spacer graft with septal extension graft will bring symmetry as well as more cosmetic improvement in correction of alar retraction with secondary cleft lip and nose deformity.
Axis, Cervical Vertebra ; Cartilage ; Cleft Lip ; Congenital Abnormalities ; Cosmetics ; Follow-Up Studies ; Humans ; Nose ; Succinates ; Transplants