A Case of Torsades de Pointes Induced by Cisapride

Torsades de pointes, a polymorphic ventricular tachycardia associated with prolonged QT interval, is a well-known life-threatening arrhythmia, which has been found to be induced by various causes such as drugs, electrolyte imbalances, and severe bradycardia. Cisapride is a gastrointestinal prokinetic drug, which is widely used to treat gastroesophageal reflux disease or other functional gastrointestinal disorders. Cisapride can cause torsades de pointes and cases of torsedes de pointes induced by cisapride have been reported in other countries. Cases of torsades de pointes associated with antihistamine drugs have been reported in Korea, however, cisapride-induced torsades de pointes case has not been reported. We report a case of 31 year-old female patient who experienced repeated loss of consciousness due to cisapride-induced torsades de pointes.ope

Self-perceptions of body weight status according to age-groups among Korean women: A nationwide population-based survey

While numerous studies have investigated body image, including body weight perception, most of which have focused on adolescents or young women, few studies have attempted to evaluate body weight perceptions in adult women according to age groups. This study was conducted to investigate the accuracy of self-perceived weight and actual body mass index (BMI) values among adult Korean women according to age. We used data from the 2016 Korean Study of Women's Health Related Issues, a population-based, nationwide, cross-sectional survey. BMI was calculated from self-reported weight and height. Participants were asked to describe their body image by choosing one of the following descriptions: very underweight, underweight, about right, overweight, or obese. The proportions of women aged 20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years who underestimated their body weight relative to their actual BMI category were 12.6%, 15.1%, 22.2%, 34.0%, 45.6%, and 50.7%, respectively; those who overestimated their body weight comprised 18.7%, 17.8%, 14.3%, 10.8%, and 7.4%. In all BMI categories, the proportion of those who overestimated their weight status increased as age decreased, while those who underestimated their weight status increased as age increased. After adjusting for possible covariates, age was strongly associated with both underestimation and overestimation. The odds ratio for underestimating one's weight status among women aged 70-79 yeas was 2.96 (95% CI: 2.10-4.18), and that for overestimation was 0.52 (95% CI: 0.35-0.79), compared to women aged 20-29 years. Age is the most important factor associated with weight perceptions among Korean women, affecting both underestimation and overestimation of weight status.ope

Coronary Artery Calcification Quantified by Electron Beam Tomography as a Screening for Coronary Artery Disease in Asymptomatic Non-Insulin-Dependent Diabetes Mellitus

ope

Metabolic Subtyping of Adrenal Tumors: Prospective Multi-Center Cohort Study in Korea

Background: Conventional diagnostic approaches for adrenal tumors require multi-step processes, including imaging studies and dynamic hormone tests. Therefore, this study aimed to discriminate adrenal tumors from a single blood sample based on the combination of liquid chromatography-mass spectrometry (LC-MS) and machine learning algorithms in serum profiling of adrenal steroids. Methods: The LC-MS-based steroid profiling was applied to serum samples obtained from patients with nonfunctioning adenoma (NFA, n=73), Cushing's syndrome (CS, n=30), and primary aldosteronism (PA, n=40) in a prospective multicenter study of adrenal disease. The decision tree (DT), random forest (RF), and extreme gradient boost (XGBoost) were performed to categorize the subtypes of adrenal tumors. Results: The CS group showed higher serum levels of 11-deoxycortisol than the NFA group, and increased levels of tetrahydrocortisone (THE), 20α-dihydrocortisol, and 6β-hydroxycortisol were found in the PA group. However, the CS group showed lower levels of dehydroepiandrosterone (DHEA) and its sulfate derivative (DHEA-S) than both the NFA and PA groups. Patients with PA expressed higher serum 18-hydroxycortisol and DHEA but lower THE than NFA patients. The balanced accuracies of DT, RF, and XGBoost for classifying each type were 78%, 96%, and 97%, respectively. In receiver operating characteristics (ROC) analysis for CS, XGBoost, and RF showed a significantly greater diagnostic power than the DT. However, in ROC analysis for PA, only RF exhibited better diagnostic performance than DT. Conclusion: The combination of LC-MS-based steroid profiling with machine learning algorithms could be a promising one-step diagnostic approach for the classification of adrenal tumor subtypes.ope

Effects of digital dentistry as an international development cooperation plan for the improvement of dental education in University of Dental Medicine, Mandalay, Myanmar

학위논문 (박사) -- 서울대학교 대학원 : 치의학대학원 치의과학과, 2020. 8. 이승표.연구목적: 국제개발협력에서는 교육과 보건 및 의료를 포함하는 사회 분야에 대한 원조가 개발도상국들의 역량강화를 위해 가장 효과적인 성과가 기대되는 사업으로 여겨진다. 2011년 신정부 수립 후 초기 산업화단계에 있는 미얀마는 교육 및 보건·의료와 직업훈련을 사회 발전의 핵심 요소로 삼고 있는데 치과의료를 포함한 치의학 및 치의학교육 분야에서는 상대적으로 그 발달이 미약한 실정이다. 따라서 미얀마 만달레이치과대학교(University of Dental Medicine–Mandalay; UDMM, Myanmar)의 여러 구성원을 대상으로 디지털 치과의료 장비를 이용한 치의학교육과 치과기공물 제작 방식을 다양하게 적용하여 실습교육을 시행하고 교육 전·후의 변화를 조사하여 국제개발협력 방안으로서 디지털 치의학의 유익성 여부를 알아보고자 한다. 연구방법: UDMM을 2019년 8월과 2020년 2월에 총 2회 방문하여 5주의 기간 동안 3차원프린터, 구강스캐너, 모형스캐너의 사용방법 교육과 치과보철물 디자인 프로그램을 이용한 치과보철물 설계 실습교육을 진행하였다. 실습교육 전·후의 설문조사와 집단면담을 통한 활동 효과 분석은 총 151명을 대상으로 진행하였다. 대상자는 50명의 치과대학교 강사와 3명의 치과기공사, 98명의 치과대학교 학생으로 구성되었다. 특히, 대상자 중 치과대학교 강사, 치과기공사의 교육 종료 후에는 피교육자들간의 교육실습을 진행하고 UDMM의 교과과정에 디지털 치과의료 장비를 적용하는 것에 대해 설문조사한 후 집단면담을 실시하였다. 연구결과: 실습교육은 교육자의 시연 후 피교육자의 직접적인 실습으로 이루어졌으며 교육 후 진행한 설문조사 결과, 디지털 장비를 이용한 치과 진료와 치과보철물 제작과정에 대한 교육 전·후의 결과의 비교에서 높은 점수 향상을 보였다. 교육에 참여한 대상자들은 디지털 장비를 사용한 치과치료 능력이 전반적으로 향상되었다고 자가 평가하였다. 결론: 본 연구를 통하여 UDMM에서 디지털 치과의료 장비를 사용한 치의학교육이 국제개발협력 방안으로서 나타내는 효과가 매우 높음을 확인하였고, 이러한 활동이 UDMM의 치의학교육 역량을 강화할 수 있으며, 나아가 미얀마의 국민 구강보건 수준도 향상시킬 것으로 기대된다. 따라서 구강스캐너, 모형스캐너, CAD/CAM뿐만 아니라 콘빔CT와 같은 다양한 디지털 치과의료 장비들을 활용한 치의학교육 분야의 개발협력이 더욱 필요하며, 디지털 치의학 관련 교과목의 신설과 교수, 강사진의 교육 등으로 UDMM의 지속적인 치의학교육 발전을 이룰 수 있을 것이다.Objectives: Republic of Korea was elected in 2019 as vice-chair country in Development Assistance Committee (DAC) in Organization for Economic Cooperation and Development (OECD) and has been commonly acknowledged as the exemplary model of recipient of the international aid that turned into a major donor. Education, especially, has so largely contributed to the rapid growth of the country, which lead to the hosting of World Education Forum (WEF) in 2015 organized by United Nations Educational, Scientific and Cultural Organization (UNESCO) and to the sharing of the development and growth experience through education with the global community. International development cooperation is the global efforts to close the gap between the developed and the developing countries, between the developing countries, or within the developing country. It also tries to tackle the poverty in developing countries, thereby, to protect the human right. In international development cooperation, aid to the social sector including education and health care, is considered to be the most anticipated project to strengthen the capacity of developing countries. Myanmar, which is in the early industrialization stage after the establishment of the new government in 2011, has made education, health care, and vocational training a key element of social development, but its development is relatively weak in the field of dentistry and dental education, including dental care, compared to the medical field. Meanwhile, in the field of dentistry, traditional dental treatment methods are changing due to the development of digital dental equipments. Oral scanners and cone beam computed tomography (CBCT) in dental clinics, or model scanners, 3-dimensional printers, and computer-aided design/computer-aided manufacturing (CAD/CAM) in dental laboratories has dramatically shortened the treatment time and the dental lab production time and reduced the number of visits of patients. So the application of these digital equipments in dental clinics and labs is gradually expanding. Therefore, the purpose of this study is to apply various types of digital dental equipments in education and hands-on practice to various members of the Mandalay Dental University in Myanmar and to evaluate changes before and after training to find out whether digital dentistry is beneficial as an international development cooperation plan. Methods: During 5 weeks in August 2019 and February 2020 in University of Dental Medicine, Mandalay (UDMM), Myanmar, students and staffs (instructors and dental technicians) of the dental department had been taught how to use 3D printers (Raydent Studio 600, Ray Co., Ltd., Korea), oral scanners (Medit i500, Medit Korea, Korea), and model scanners (Medit T500, Medit Korea, Korea), and to design dental prosthesis using EXO CAD (EXO CAD & Collab, Medit Korea, Korea) with hands-on practices. Total of 151 subjects consisted of 50 dental university instructors, 3 dental technicians, and 98 dental university students. Among the subjects, 98 dental university students underwent questionnaire surveys before and after the training. And 50 dental university instructors and 3 dental technicians were interviewed after the practical training with questionnaires on the use of digital dental equipments to the UDMM training course, and in particular, practised to teach each other how to use the equipments and programs. Results : As a result of the students' questionnaires conducted after the training following the educator's demonstration, the scores were improved in comparing the results before the education of dental treatment and the making process of dental prosthesis using digital equipments. The subjects who participated in the education self-evaluated that the overall dental treatment and prosthesis producing ability using digital equipments were improved after the training. The university instructors and dental technicians, especially, acknowledged the effectiveness of digital dentistry equipments in the education of dental university. Conclusions : In this study, the use of digital dentistry equipments in UDMM was highly effective that it is expected to contribute to strengthening the capacity of dental education in UDMM and furthermore to improve the national oral health care condition in Myanmar. Therefore, it is necessary to increase the international development cooperation in dental education using various digital dentistry equipments such as oral scanners, model scanners and cone beam computed tomography. In addition, followed by the establishment of digital dentistry subjects with consecutive education and training of staffs, UDMM will achieve the continuous improvement in dental education in Myanmar.서론 5 연구 대상 13 연구 방법 21 연구 결과 27 고찰 36 결론 50 참고문헌 51 영문 초록 58Docto

Real-world Safety and Effectiveness of Denosumab in Patients With Osteoporosis: A Prospective, Observational Study in South Korea

Backgruound: The efficacy and safety of denosumab have been established in a phase 3, randomized, placebo-controlled trial in Korean postmenopausal women with osteoporosis. This postmarketing surveillance study was aimed to investigate the safety and effectiveness of denosumab in Korean real-world clinical practice. Methods: Patients with osteoporosis who had received denosumab per the Korean approved indications in the postmarketing setting between September 2014 and September 2019 were enrolled. The primary endpoint was the incidence of adverse events (AEs) and adverse drug reactions (ADRs). The secondary endpoint was the percent change from baseline in bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck. Results: Of the 3,221 patients enrolled, 3,185 were included in the safety analysis set; 2,973 (93.3%) were female, and the mean± standard deviation (SD) age was 68.9±9.9 years. The mean±SD study period was 350.0±71.4 days. AEs, fatal AEs, and ADRs occurred in 19.3%, 0.8%, and 1.6%, respectively. The most frequent AEs, occurring in >0.5% of patients, were dizziness (0.7%), arthralgia (0.7%), back pain (0.6%), and myalgia (0.6%). Hypocalcemia occurred in 0.3% of patients. There were no cases of osteonecrosis of the jaw and atypical femoral fracture. Mean±SD percent change from baseline in BMD of the lumbar spine, total hip, and femoral neck was 7.3%±23.6%, 3.6%±31.4%, and 3.2%±10.7%, respectively. Conclusion: The safety and effectiveness of denosumab in Korean patients with osteoporosis in this study were comparable with those in the Korean randomized controlled trial, with no new safety findings.ope

Asia-Pacific Consensus Recommendations on X-Linked Hypophosphatemia: Diagnosis, Multidisciplinary Management, and Transition From Pediatric to Adult Care

X-linked hypophosphatemia (XLH) is a rare, inherited, multisystem disorder characterized by hypophosphatemia that occurs secondary to renal phosphate wasting. Mutations in PHEX gene (located at Xp22.1) in XLH alter bone mineral metabolism, resulting in diverse skeletal, dental, and other extraskeletal abnormalities that become evident in early childhood and persist into adolescence and adult life. XLH impacts physical function, mobility, and quality of life, and is associated with substantial socioeconomic burden and health care resource utilization. As the burden of illness varies with age, an appropriate transition of care from childhood and adolescence to adulthood is necessary to meet growth-related changes and minimize long-term sequelae of the condition. Previous XLH guidelines that encompassed transition of care have focused on Western experience. Regional differences in resource availability warrant tailoring of recommendations to the Asia-Pacific (APAC) context. Hence, a core expert panel of 15 pediatric and adult endocrinologists from nine countries/regions across APAC convened to formulate evidence-based recommendations for optimizing XLH care. A comprehensive literature search on PubMed using MeSH and free-text terms relevant to predetermined clinical questions on diagnosis, multidisciplinary management, and transition of care of XLH revealed 2171 abstracts. The abstracts were reviewed independently by two authors to shortlist a final of 164 articles. A total of 92 full-text articles were finally selected for data extraction and drafting the consensus statements. Sixteen guiding statements were developed based on review of evidence and real-world clinical experience. The GRADE criteria were used to appraise the quality of evidence supporting the statements. Subsequently, a Delphi technique was utilized to rate the agreement on statements; 38 XLH experts (15 core, 20 additional, 3 international) from 15 countries/regions (12 APAC, 3 EU) participated in the Delphi voting to further refine the statements. Statements 1-3 cover the screening and diagnosis of pediatric and adult XLH; we have defined the clinical, imaging, biochemical, and genetic criteria and raised red flags for the presumptive and confirmatory diagnosis of XLH. Statements 4-12 tackle elements of multidisciplinary management in XLH such as therapeutic goals and options, composition of the multidisciplinary team, follow-up assessments, required monitoring schedules, and the role of telemedicine. Treatment with active vitamin D, oral phosphate, and burosumab is discussed in terms of applicability to APAC settings. We also expound on multidisciplinary care for different age groups (children, adolescents, adults) and pregnant or lactating women. Statements 13-15 address facets of the transition from pediatric to adult care: targets and timelines, roles and responsibilities of stakeholders, and process flow. We explain the use of validated questionnaires, desirable characteristics of a transition care clinic, and important components of a transfer letter. Lastly, strategies to improve XLH education to the medical community are also elaborated in statement 16. Overall, optimized care for XLH patients requires prompt diagnosis, timely multidisciplinary care, and a seamless transfer of care through the coordinated effort of pediatric and adult health care providers, nurse practitioners, parents or caregivers, and patients. To achieve this end, we provide specific guidance for clinical practice in APAC settings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.ope

Low Serum Vitamin E Level Associated with Low Hand Grip Strength in Community-Dwelling Adults: Korean National Health and Nutrition Examination Survey (KNHANES VII) 2016-2018

This study assessed the association between serum vitamin E levels and hand grip strength (HGS) in community-dwelling adults data of 1011 men aged 50 years and older and 1144 postmenopausal women were analyzed. Low HGS was defined as HGS below the sex-stratified median value. Proportion of low HGS was the greatest in the lowest quintile of serum vitamin E level (17.81 mg/L, 43.6%; p 0.05). Individuals with the lowest quintile vitamin E level had elevated odds of low HGS independent of covariates, findings which merit further validation.ope

Medication Related Osteonecrosis of the Jaw: 2015 Position Statement of the Korean Society for Bone and Mineral Research and the Korean Association of Oral and Maxillofacial Surgeons

Bisphosphonates are the most widely prescribed drugs for the treatment of osteoporosis, and are also used in malignant bone metastases, multiple myeloma, and Paget's disease, and provide therapeutic efficacy on those diseases. However, it was reported that occurrence of osteonecrosis of the jaw (ONJ) could be related with bisphosphonate exposures, and there have been many cases regarding this issue. Therefore, a clearer definition and treatment guidelines were needed for this disease. The American Society for Bone and Mineral Research (ASBMR) and American Association of Oral and Maxillofacial Surgeons (AAOMS) reported statements on bisphosphonate-related ONJ (BRONJ), and a revised version was recently presented. In the revised edition, the diagnosis BRONJ was changed to medication-related ONJ (MRONJ), which reflects a consideration of the fact that ONJ also occurs for denosumab, a bone resorption inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) antibody family, and bevacizumab, an anti-angiogenesis inhibitor. In 2009, a statement on ONJ was also reported locally by a relevant organization, which has served as basis for clinical treatment in Korea. In addition to the new official stance of the AAOMS and ASBMR, with an increasing pool of ONJ clinical experience, a revised version of the 2009 local statement is needed. As such, the Korean Society for Bone and Mineral Research (KSBMR) and the Korean Association of Oral and Maxillofacial Surgeons (KAOMS) have collectively formed a committee for the preparation of an official statement on MRONJ, and have reviewed recent local and international data to propose guidelines customized for the local Korean situation.ope

Sleep Quality and Associated Factors in Premenopausal, Perimenopausal, and Postmenopausal Women in Korea: Findings from the K-Stori 2016

Purpose: Poor sleep quality is a common problem among middle-aged women. Few studies, however, have assessed differences in sleep quality among premenopausal, perimenopausal, and postmenopausal women and related risk factors in Korea women. The aim of this study was to assess sleep quality and factors associated therewith according to menopausal status in Korean women. Patients and methods: This study was based on the 2016 Korean Study of Women's Health Related Issues (K-Stori), a cross-sectional survey employing nationally representative random sampling. In total, 3000 Korean women aged 45 to 64 years completed the Pittsburgh Sleep Quality Index (PSQI). Comparison of demographic characteristics and sleep quality among pre-, peri-, and postmenopausal women was conducted. Results: Among the participants, 26% suffered from poor sleep quality based on the PSQI. The prevalence of poor sleep quality increased with later menopausal stage (from 18.8% in the premenopausal stage to 29.5% in the postmenopausal stage P <0.001). Multivariate logistic regression analysis showed that peri- and postmenopausal women were 1.50 and 1.73 times more likely to have poor sleep quality in comparison to premenopausal women, respectively. Chronic disease, depression, at-risk drinking, taking dietary supplements, and single women were associated with a higher likelihood of having poor sleep quality. Health status, at-risk drinking, chronic illness, dietary supplementation, and depression were significantly associated with poor sleep quality. Conclusion: Poor sleep quality appears to be prevalent in peri- and postmenopausal women in Korea. The management of sleep quality during menopause transition is important, and further research on how sleep disturbances influence the health status of women in menopausal transition is required.ope