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1.  Transverse myelitis following combined spinal-epidural anesthesia 
Korean Journal of Anesthesiology  2012;63(5):473-474.
PMCID: PMC3506862  PMID: 23198046
2.  Spatial analysis of PM10 and cardiovascular mortality in the Seoul metropolitan area 
Numerous studies have revealed the adverse health effects of acute and chronic exposure to particulate matter less than 10 μm in aerodynamic diameter (PM10). The aim of the present study was to examine the spatial distribution of PM10 concentrations and cardiovascular mortality and to investigate the spatial correlation between PM10 and cardiovascular mortality using spatial scan statistic (SaTScan) and a regression model.
From 2008 to 2010, the spatial distribution of PM10 in the Seoul metropolitan area was examined via kriging. In addition, a group of cardiovascular mortality cases was analyzed using SaTScan-based cluster exploration. Geographically weighted regression (GWR) was applied to investigate the correlation between PM10 concentrations and cardiovascular mortality.
An examination of the regional distribution of the cardiovascular mortality was higher in provincial districts (gu) belonging to Incheon and the northern part of Gyeonggido than in other regions. In a comparison of PM10 concentrations and mortality cluster (MC) regions, all those belonging to MC 1 and MC 2 were found to belong to particulate matter (PM) 1 and PM 2 with high concentrations of air pollutants. In addition, the GWR showed that PM10 has a statistically significant relation to cardiovascular mortality.
To investigate the relation between air pollution and health impact, spatial analyses can be utilized based on kriging, cluster exploration, and GWR for a more systematic and quantitative analysis. It has been proven that cardiovascular mortality is spatially related to the concentration of PM10.
PMCID: PMC4152940  PMID: 25116367
Cardiovascular mortality; Geographically weighted regression; PM10; SaTScan; Spatial epidemiology
3.  Diethylhexyl Phthalates Is Associated with Insulin Resistance via Oxidative Stress in the Elderly: A Panel Study 
PLoS ONE  2013;8(8):e71392.
Insulin resistance (IR) is believed to be the underlying mechanism of metabolic syndrome and type 2 diabetes mellitus (DM). Recently, a few studies have demonstrated that phthalates could cause oxidative stress which would contribute to the development of IR. Therefore, we evaluated whether exposure to phthalates affects IR, and oxidative stress is involved in the phthalates-IR pathway.
We recruited 560 elderly participants, and obtained blood and urine samples during repeated medical examinations. For the determination of phthalate exposure, we measured urinary levels of mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) as metabolites of diethylhexyl phthalates (DEHP), and mono-n-butyl phthalate (MnBP) as a metabolite of di-butyl phthalate (DBP). Malondialdehyde (MDA), an oxidative stress biomarker, was also measured in urine samples. We measured serum levels of fasting glucose and insulin, and derived the homeostatic model assessment (HOMA) index to assess IR. A mixed-effect model and penalized regression spline were used to estimate the associations among phthalate metabolites, MDA, and IR.
The molar sum of MEHHP and MEOHP (∑DEHP) were significantly associated with HOMA (β = 0.26, P = 0.040), and the association was apparent among participants with a history of DM (β = 0.88, P = 0.037) and among females (β = 0.30, P = 0.022). However, the relation between MnBP and HOMA was not found. When we evaluated whether oxidative stress is involved in increases of HOMA by ∑DEHP, MDA levels were significantly associated with increases of ∑DEHP (β = 0.11, P<0.001) and HOMA (β = 0.49, P = 0.049).
Our study results suggest that exposure to DEHP in the elderly population increases IR, which is related with oxidative stress, and that participants with a history of DM and females are more susceptible to DEHP exposure.
PMCID: PMC3747269  PMID: 23977034
4.  Air Pollution and Symptoms of Depression in Elderly Adults 
Environmental Health Perspectives  2012;120(7):1023-1028.
Background: Although the effect of air pollution on various diseases has been extensively investigated, few studies have examined its effect on depression.
Objectives: We investigated the effect of air pollution on symptoms of depression in an elderly population.
Methods: We enrolled 537 participants in the study who regularly visited a community center for the elderly located in Seoul, Korea. The Korean version of the Geriatric Depression Scale-Short Form (SGDS-K) was used to evaluate depressive symptomatology during a 3-year follow-up study. We associated ambient air pollutants with SGDS-K results using generalized estimating equations (GEE). We also conducted a factor analysis with items on the SGDS-K to determine which symptoms were associated with air pollution.
Results: SGDS-K scores were positively associated with interquartile range (IQR) increases in the 3-day moving average concentration of particulate matter with an aerodynamic diameter ≤ 10 μm (PM10) [17.0% increase in SGDS-K score, 95% confidence interval (CI): 4.9%, 30.5%], the 0–7 day moving average of nitrogen dioxide [NO2; 32.8% (95% CI: 12.6%, 56.6%)], and the 3-day moving average of ozone [O3; 43.7% (95% CI: 11.5%, 85.2%)]. For these three pollutants, factor analysis showed that air pollution was more strongly associated with emotional symptoms such as feeling happy and satisfied than with somatic or affective symptoms.
Conclusions: Our study suggests that increases in PM10, NO2, and O3 may increase depressive symptoms among the elderly. Of the symptoms evaluated, ambient air pollution was most strongly associated with emotional symptoms.
PMCID: PMC3404652  PMID: 22514209
air pollution; depressive symptoms; elderly; factor analysis; panel study
5.  Association of Serum 25-Hydroxyvitamin D Levels with Markers for Metabolic Syndrome in the Elderly: A Repeated Measure Analysis 
Journal of Korean Medical Science  2012;27(6):653-660.
The purpose of current study was to investigate associations of serum 25-hydroxyvitamin D (OHVD) levels with markers for metabolic syndrome in elderly Koreans. We conducted a panel study on 301 individuals over 60 yr old in Seoul, Korea, and repeatedly measured serum OHVD, glucose, insulin, and lipid levels. Mixed effect model and generalized estimating equations were used to investigate relationships between serum OHVD levels with marker levels for metabolic syndrome and each of its categories. Of all subjects, 76.6% were vitamin D deficient (< 50 nM) and 16.9% were insufficient (< 75 nM). Inverse association was demonstrated between serum OHVD levels and insulin (P = 0.004), triglyceride (P = 0.023) and blood pressure (systolic blood pressure: P = 0.002; diastolic blood pressure: P < 0.001). Vitamin D deficiency was found to increase risk of 'hypertriglyceridemia' category of metabolic syndrome (odds ratio: 1.73, 95% confidence interval: 1.13-2.66). In conclusion, we found from our repeated measure analysis that decreasing serum OHVD levels are associated with increasing insulin resistance, increasing serum triglyceride levels and increasing blood pressure in elderly Koreans, and confirmed on the risk of 'hypertriglyceridemia' in vitamin D deficient subjects.
PMCID: PMC3369452  PMID: 22690097
Vitamin D; Insulin Resistance; Metabolic Syndrome; Elderly; Mixed Effect Model
7.  Ethnic Coefficients for Glomerular Filtration Rate Estimation by the Modification of Diet in Renal Disease Study Equations in the Korean Population 
Journal of Korean Medical Science  2010;25(11):1616-1625.
Race and ethnicity are influential in estimating glomerular filtration rate (GFR). We aimed to find the Korean coefficients for the Modification of Diet in Renal Disease (MDRD) study equations and to obtain novel proper estimation equations. Reference GFR was measured by systemic inulin clearance. Serum creatinine (SCr) values were measured by the alkaline picrate Jaffé kinetic method, then, recalibrated to CX3 analyzer and to isotope dilution mass spectrometry (IDMS). The Korean coefficients for the 4 and 6 variable MDRD and IDMS MDRD study equations based on the SCr recalibrated to CX3 and to IDMS were 0.73989/0.74254 and 0.99096/0.9554, respectively. Coefficients for the 4 and 6 variable MDRD equations based on the SCr measured by Jaffé method were 1.09825 and 1.04334, respectively. The modified equations showed better performances than the original equations. The novel 4 variable equations for Korean based on the SCr measured and recalibrated to IDMS were 107.904×SCr-1.009×age-0.02 (×0.667, if woman) and 87.832×SCr-0.882×age0.01 (×0.653, if woman), respectively. Modified estimations of the MDRD and IDMS MDRD study equations with ethnic coefficients and the novel equations improve the performance of GFR estimation for the overall renal function.
PMCID: PMC2966999  PMID: 21060751
Coefficient; Glomerular Filtration Rate; Inulin Clearance; Modification of Diet in Renal Disease Study
8.  Factors in patient dissatisfaction and refusal regarding spinal anesthesia 
Korean Journal of Anesthesiology  2010;59(4):260-264.
Spinal anesthesia is the most common regional anesthesia conducted for many surgical procedures. Multiple factors can affect the success, the side effects, and patient satisfaction with the procedure. This study was undertaken prospectively to discover factors affecting dissatisfaction and refusal of spinal anesthesia.
Starting in December 2007, patients who underwent spinal anesthesia in the operating rooms of our hospital were surveyed over a period of a year. Before attempting the procedure, patient characteristics and previous history of anesthesia were recorded. Spinal anesthesia was administered with 0.5% heavy bupivacaine combined with fentanyl 0-20 µg. Intraoperative data and postoperative data on the day after surgery were collected. The patients were also asked about their general satisfaction with spinal anesthesia, causes of dissatisfaction with the procedure, and causes of their refusal to have spinal anesthesia again.
Six patients among 1,197 cases were excluded from the study because of spinal anesthesia failure. The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%, and its risk factors were postoperative backache and dissatisfaction.
Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.
PMCID: PMC2966707  PMID: 21057616
Dissatisfaction; Refusal; Spinal anesthesia

Results 1-8 (8)