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1.  Intrauterine therapy for macrocystic congenital cystic adenomatoid malformation of the lung 
Obstetrics & Gynecology Science  2014;57(2):102-108.
Objective
To report on our experiences with thoracoamniotic shunting and/or the injection of a sclerosing agent (OK-432) to treat fetuses diagnosed with macrocystic congenital cystic adenomatoid malformation (CCAM) of the lung.
Methods
A retrospective study was undertaken in six fetuses with macrocystic CCAM at our institute that had been confirmed by postnatal surgery between August 1999 and January 2012.
Results
Six fetuses that had been diagnosed with macrocystic CCAM were analyzed. The median gestational age at diagnosis was 23.5 weeks (range, 19.5-31.0 weeks), and at the time of primary treatment was 24.0 weeks (range, 20.5-31.0 weeks). The mean size of the largest cyst at the initial assessment was 42.5±15 mm. Four fetuses were associated with mediastinal shifting, and one also showed fetal hydrops. All fetuses underwent a shunting procedure within the cysts, one case among them was also treated with OK-432. After the completion of all procedures, the mean size of the largest cyst was all decreased (14.2±12 mm). The median gestational age at delivery was 38.0 weeks (range, 32.4-40.3 weeks). All of the newborns underwent the surgical resection at a median age of 6 days (range, 1-136 days) and are currently doing well without any complications.
Conclusion
We suggest that intrauterine decompression therapy to manage fetal macrocystic CCAM is recommendable treatment for good perinatal outcome.
doi:10.5468/ogs.2014.57.2.102
PMCID: PMC3965692  PMID: 24678482
Congenital cystic adenomatoid malformation of lung; Fetal therapies; Prenatal diagnosis; Sclerosing solutions
2.  Impact of body mass index on the prognosis of Korean women with endometrioid adenocarcinoma of the uterus: A cohort study 
Obstetrics & Gynecology Science  2014;57(2):115-120.
Objective
To analyze how pretreatment body mass index relates to known endometrial cancer prognostic factors and how it impacts the disease-free survival and cause-specific survival of Korean women with endometrial cancer.
Methods
The patients were divided into the non-obese (<25 kg/m2) and obese groups (≥25 kg/m2) according to their pretreatment body mass index. The 25 kg/m2 body mass index cut-off was based on the World Health Organization criteria for Asian people. The two groups were compared in terms of their clinicopathological characteristics and survival outcomes.
Results
A total of 213 consecutive patients with endometrioid adenocarcinoma of the uterus met the eligibility criteria of this study and were included in the analysis. Of these patients, 105 patients had a body mass index less than 25 kg/m2 (non-obese group) and 108 patients had a body mass index equal to or more than 25 kg/m2 (obese group). The two groups did not differ in terms of age, menopause, parity, height, FIGO (International Federation of Obstetrics and Gynecology) stage, tumor grade, tumor size, myometrial invasion, lymphovascular space invasion, cytology, and lymph node metastasis. Body mass index was not a significant factor for disease-free and cause-specific survival in univariate analysis, and after adjusting for all prognostic factors that were significant in univariate analysis, it did not associate significantly with disease-free and cause-specific survival.
Conclusion
In Korean women with endometrioid adenocarcinoma of the uterus, a high pretreatment body mass index did not associate with other prognostic factors and had little impact on the disease-free survival and cause-specific survival of these women.
doi:10.5468/ogs.2014.57.2.115
PMCID: PMC3965694  PMID: 24678484
Body mass index; Endometrial neoplasms; Obesity; Prognosis
3.  Serum C-peptide levels and risk of death among adults without diabetes mellitus 
Background:
Connecting peptide (C-peptide) plays a role in early atherogenesis in patients with diabetes mellitus and may be a marker for cardiovascular morbidity and mortality in patients without diabetes. We investigated whether serum C-peptide levels are associated with all-cause, cardiovascular-related and coronary artery disease–related mortality in adults without diabetes.
Methods:
We used data from the Third Nutrition and Health Examination Survey (NHANES III) and the NHANES III Linked Mortality File in the United States. We analyzed mortality data for 5902 participants aged 40 years and older with no history of diabetes and who had available serum C-peptide levels from the baseline examination. We grouped the participants by C-peptide quartile, and we performed Cox proportional hazards regression analysis. The primary outcome was all-cause, cardiovascular-related and coronary artery disease–related mortality.
Results:
The mean serum C-peptide level in the study sample was 0.78 (± standard deviation 0.47) nmol/L. The adjusted hazards ratio comparing the highest quartile with the lowest quartile was 1.80 (95% confidence interval [CI] 1.33–2.43) for all-cause mortality, 3.20 (95% CI 2.07–4.93) for cardiovascular-related mortality, and 2.73 (95% CI 1.55–4.82) for coronary artery disease–related mortality. Higher C-peptide levels were associated with increased mortality among strata of glycated hemoglobin and fasting serum glucose.
Interpretation:
We found an association between serum C-peptide levels and all-cause and cause-specific mortality among adults without diabetes at baseline. Our finding suggests that elevated C-peptide levels may be a predictor of death.
doi:10.1503/cmaj.121950
PMCID: PMC3680586  PMID: 23589428
4.  Social Engagement, Health, and Changes in Occupational Status: Analysis of the Korean Longitudinal Study of Ageing (KLoSA) 
PLoS ONE  2012;7(10):e46500.
Background
We focused on whether changes in the occupational status of older male adults can be influenced by social engagement and health status measured at the baseline.
Methods
This study used a sample of the Korean Longitudinal Study of Aging (KLoSA), and the study population was restricted to 1.531 men who were aged 55 to 80 years at the 2006 baseline survey and participated in the second survey in 2008. Social engagement and health status, measured by the number of chronic diseases, grip strength, and depressive symptoms as well as covariates (age, marital status, educational level, and household income) were based on data from the 2006 baseline survey. Occupational engagement over the first and second survey was divided into four categories: ‘consistently employed’ (n = 892), ‘employed-unemployed’ (n = 152), ‘unemployed-employed’ (n = 138), and ‘consistently unemployed’ (n = 349).
Results
In the multinomial model, the ‘consistently employed’ and ‘unemployed-employed’ groups had significantly higher social engagement (1.19 and 1.32 times, respectively) than the referent. The number of chronic diseases was significantly associated with four occupational changes, and the ‘unemployed-employed’ had the fewest chronic conditions.
Conclusion
Our finding suggests that social engagement and health status are likely to affect opportunities to continue working or to start working for older male adults.
doi:10.1371/journal.pone.0046500
PMCID: PMC3462751  PMID: 23056323
5.  Perfluorooctanoic acid exposure is associated with elevated homocysteine and hypertension in US adults 
Objective
To investigate the association between serum perfluorooctanoic acid (PFOA) concentration and cardiovascular disease, as measured by homocysteine level and blood pressure in a representative sample of US adults.
Methods
A cross-sectional study of 2934 adults (≥20 years) who participated in the 2003–2004 and 2005–2006 National Health and Nutrition Examination Survey and had detectable levels of PFOA in their serum. The health effects analysed as potentially associated with PFOA exposure included homocysteine level and blood pressure.
Results
The geometric mean value (95% CI) of the study participants' serum PFOA concentration was 4.00 μg/l (95% CI 3.86 to 4.13). The homocysteine and systolic blood pressure were shown to increase significantly with an increase in the log-transformed serum PFOA concentration, after adjusting for potential confounding variables. Adjusted ORs comparing participants at the 80th versus the 20th percentiles were 2.62 for hypertension (95% CI 2.09 to 3.14), and a positive association was also evident in models based on quartiles or based on restricted cubic splines.
Conclusion
These findings suggest that background exposure to PFOA may continue a risk factor for the development of cardiovascular diseases.
doi:10.1136/oemed-2011-100288
PMCID: PMC3426376  PMID: 22652006
Perfluorooctanoic acid; homocysteine; blood pressure; perfluorooctane sulfonate; ageing; cardiovascular; lung function; neurobehavioural effects; smoking
6.  Macrolide Therapy in Respiratory Viral Infections 
Mediators of Inflammation  2012;2012:649570.
Background. Macrolides have received considerable attention for their anti-inflammatory and immunomodulatory actions beyond the antibacterial effect. These two properties may ensure some efficacy in a wide spectrum of respiratory viral infections. We aimed to summarize the properties of macrolides and their efficacy in a range of respiratory viral infection. Methods. A search of electronic journal articles through PubMed was performed using combinations of the following keywords including macrolides and respiratory viral infection. Results. Both in vitro and in vivo studies have provided evidence of their efficacy in respiratory viral infections including rhinovirus (RV), respiratory syncytial virus (RSV), and influenza virus. Much data showed that macrolides reduced viral titers of RV ICAM-1, which is the receptor for RV, and RV infection-induced cytokines including IL-1β, IL-6, IL-8, and TNF-α. Macrolides also reduced the release of proinflammatory cytokines which were induced by RSV infection, viral titers, RNA of RSV replication, and the susceptibility to RSV infection partly through the reduced expression of activated RhoA which is an RSV receptor. Similar effects of macrolides on the influenza virus infection and augmentation of the IL-12 by macrolides which is essential in reducing virus yield were revealed. Conclusion. This paper provides an overview on the properties of macrolides and their efficacy in various respiratory diseases.
doi:10.1155/2012/649570
PMCID: PMC3375106  PMID: 22719178
7.  Lead and Cadmium Levels and Balance and Vestibular Dysfunction among Adult Participants in the National Health and Nutrition Examination Survey (NHANES) 1999–2004 
Environmental Health Perspectives  2012;120(3):413-417.
Background: Few studies have been conducted to identify risk factors for balance and vestibular dysfunction in general populations, but previous studies have reported evidence of adverse effects of lead and cadmium on balance control in high-risk groups.
Objective: We evaluated the relationship between blood lead and cadmium levels and balance and vestibular dysfunction in a general population study.
Methods: We analyzed data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) of 5,574 adults ≥ 40 years of age. Balance dysfunction was evaluated by the Romberg Test of Standing Balance on Firm and Compliant Support Surfaces, which examines the ability to stand unassisted using four test conditions to evaluate vestibular system, vision, and proprioception inputs that contribute to balance. Blood levels of lead and cadmium were measured by atomic absorption spectrometry. Associations were estimated using logistic regression models adjusted for potential confounders. Associations with time to loss of balance were estimated using adjusted Cox proportional hazard models.
Results: The adjusted odds ratio (OR) for balance dysfunction in association with the highest quintile (3.3–48 µg/dL) versus the lowest quintile (< 1.2 µg/dL) of lead was 1.42 [95% confidence interval (CI): 1.07, 1.89]. The corresponding OR for cadmium (0.9–7.4 µg/L vs. < 0.2 µg/L) was 1.27 (95% CI: 1.01, 1.60). The adjusted hazard ratio for time to failure for the most physiologically challenging balance test among subjects with the highest vs. lowest quintiles of blood lead was 1.24 (95% CI: 1.04, 1.48). Cadmium levels were not associated with time to failure.
Conclusions: Our findings suggest that blood lead and cadmium levels may be associated with balance and vestibular dysfunction in a general sample of U.S. adults.
doi:10.1289/ehp.1103643
PMCID: PMC3295341  PMID: 22214670
cadmium; lead; ototoxicity; neurotoxicity; vestibular disturbance
8.  Role of Intranasal Topical Steroid in Pediatric Sleep Disordered Breathing and Influence of Allergy, Sinusitis, and Obesity on Treatment Outcome 
Objectives
To evaluate efficacy of short term intranasal corticosteroid (mometasone furoate) treatment in pediatric sleep-disordered breathing (SDB) patients.
Methods
A prospective, observational study was done. A total of 41 children (2-11 years old) were enrolled into this study. All patients received 4-weeks course of mometasone furoate 100 µg/day treatment. They were evaluated at pretreatment and immediately after treatment with obstructive sleep apnea (OSA)-18 quality of life survey and lateral neck X-ray. Also, the assessment of each patients included history, skin prick test or CAP test, and sinus radiography. We compared the OSA-18 survey score and adenoidal-nasopharyngeal (AN) ratio between before and after treatment.
Results
Total OSA-18 score and AN ratio decreased significantly after treatment regardless of allergy, sinusitis, and obesity (P=0.003, P=0.006). There was no complication after treatment of mometasone furoate.
Conclusion
Pediatric SDB patients with adenoid hypertrophy could be effectively treated with 4-weeks course of mometasone furoate. Allergy, obesity, and sinusitis did not affect on the result of treatment.
doi:10.3342/ceo.2011.4.1.27
PMCID: PMC3062224  PMID: 21461060
Steroid; Topical administration; Sleep disorder; Adenoid; Pediatrics; Allergy
9.  Endodontic Treatment: A Significant Risk Factor for the Development of Maxillary Fungal Ball 
Objectives
The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.
Methods
One hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.
Results
There were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).
Conclusion
Endodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.
doi:10.3342/ceo.2010.3.3.136
PMCID: PMC2950265  PMID: 20941331
Fungal sinusitis; Fungal ball; Endodontics; Endodontic treatment; Maxillary sinus
10.  A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate 
Objectives
The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS).
Methods
This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients.
Results
The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P<0.001). A significant correlation was found between the percentage of time spent at a SpO2 below 90% and the ESR level in the obese group (BMI ≥25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO2 below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables.
Conclusion
The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.
doi:10.3342/ceo.2009.2.3.126
PMCID: PMC2751876  PMID: 19784404
Blood sedimentation; Obstructive sleep apnea; Oximetry; Polysomnography
11.  Sentinel Lymph Node Radiolocalization with 99mTc Filtered Tin Colloid in Clinically Node-Negative Squamous Cell Carcinomas of the Oral Cavity 
Journal of Korean Medical Science  2006;21(5):865-870.
The objective of this study was to evaluate the feasibility of sentinel lymph node biopsy by using a radiotracer lymphatic mapping technique in patients with squamous cell carcinoma of the oral cavity, and the diagnostic value of this technique. We studied twenty patients with previously untreated squamous cell carcinomas of the oral cavity and N0 necks. After the peritumoral injection of 99mTc filtered tin colloid preop-eratively, lymphoscintigraphy and intraoperative mapping using a gamma detector were performed to localize sentinel nodes. An open biopsy of the sentinel node was followed by complete neck dissection. We identified the sentinel nodes in 19 of 20 patients (95.0%) by lymphoscintigraphy and in all (100%) by intraoperative gamma detector. In all cases, the status of the sentinel node accurately predicted the pathologic status of the neck with the false negative rate being 0%. The negative predictive value for the absence of cervical metastases was 100%. In conclusion, our radio-localization technique of sentinel nodes using 99mTc filtered tin colloid in N0 squamous cell carcinomas of the oral cavity is technically feasible and appears to accurately predict the presence of the occult metastatic disease.
doi:10.3346/jkms.2006.21.5.865
PMCID: PMC2721997  PMID: 17043421
Sentinel Lymph Node Biopsy; Lymphatic Metastasis; Mouth Neoplasms; Radionuclide Imaging

Results 1-11 (11)