Three-dimensional evaluation of the correlation between lip canting and craniofacial planes / 대한치과교정학회지

Objective@#This study aimed to analyze the correlation of horizontal and sagittal planes used in two-dimensional diagnosis with lip canting by using threedimensional (3D) analysis. @*Methods@#Fifty-two patients (25 men, 27 women; average age: 24 years) undergoing treatment for dentofacial deformity were enrolled. Computed tomography images were acquired, and digital imaging and communication in medicine files were reconstructed into a 3D virtual model wherein horizontal and sagittal craniofacial planes were measured. Subsequently, the correlations of lip canting with these horizontal and sagittal planes were investigated. @*Results@#The mandibular symmetry plane, the occlusal plane, Camper’s plane, the mandibular plane, Broadbent’s plane, and the nasal axis plane were correlated with the amount of lip canting (Pearson’s correlation coefficients: 0.761, 0.648, 0.556, 0.526, 0.438, and 0.406, respectively). Planes associated with the lower part of the face showed the strongest correlations; the strength of the correlations decreased in the midfacial and cranial regions. None of the planes showed statistically significant differences between patients with clinical lip canting (> 3°) and those without prominent lip canting. @*Conclusions@#The findings of this study suggest that lip canting is strongly correlated with the mandibular symmetry plane, which includes menton deviation. This finding may have clinical implications with regard to the treatment of patients requiring correction of lip canting. Further studies are necessary for evaluating changes in lip canting after orthognathic surgery.

Lung Function Trajectory Types in Never-Smoking Adults With Asthma: Clinical Features and Inflammatory Patterns

PURPOSE: Asthma is a heterogeneous disease that responds to medications to varying degrees. Cluster analyses have identified several phenotypes and variables related to fixed airway obstruction; however, few longitudinal studies of lung function have been performed on adult asthmatics. We investigated clinical, demographic, and inflammatory factors related to persistent airflow limitation based on lung function trajectories over 1 year. METHODS: Serial post-bronchodilator forced expiratory volume (FEV) 1% values were obtained from 1,679 asthmatics who were followed up every 3 months for 1 year. First, a hierarchical cluster analysis was performed using Ward's method to generate a dendrogram for the optimum number of clusters using the complete post-FEV1 sets from 448 subjects. Then, a trajectory cluster analysis of serial post-FEV1 sets was performed using the k-means clustering for the longitudinal data trajectory method. Next, trajectory clustering for the serial post-FEV1 sets of a total of 1,679 asthmatics was performed after imputation of missing post-FEV1 values using regression methods. RESULTS: Trajectories 1 and 2 were associated with normal lung function during the study period, and trajectory 3 was associated with a reversal to normal of the moderately decreased baseline FEV1 within 3 months. Trajectories 4 and 5 were associated with severe asthma with a marked reduction in baseline FEV1. However, the FEV1 associated with trajectory 4 was increased at 3 months, whereas the FEV1 associated with trajectory 5 was persistently disturbed over 1 year. Compared with trajectory 4, trajectory 5 was associated with older asthmatics with less atopy, a lower immunoglobulin E (IgE) level, sputum neutrophilia and higher dosages of oral steroids. In contrast, trajectory 4 was associated with higher sputum and blood eosinophil counts and more frequent exacerbations. CONCLUSIONS: Trajectory clustering analysis of FEV1 identified 5 distinct types, representing well-preserved to severely decreased FEV1. Persistent airflow obstruction may be related to non-atopy, a low IgE level, and older age accompanied by neutrophilic inflammation and low baseline FEV1 levels.

Clinical Characteristics of Exacerbation-Prone Adult Asthmatics Identified by Cluster Analysis

PURPOSE: Asthma is a heterogeneous disease characterized by various types of airway inflammation and obstruction. Therefore, it is classified into several subphenotypes, such as early-onset atopic, obese non-eosinophilic, benign, and eosinophilic asthma, using cluster analysis. A number of asthmatics frequently experience exacerbation over a long-term follow-up period, but the exacerbation-prone subphenotype has rarely been evaluated by cluster analysis. This prompted us to identify clusters reflecting asthma exacerbation. METHODS: A uniform cluster analysis method was applied to 259 adult asthmatics who were regularly followed-up for over 1 year using 12 variables, selected on the basis of their contribution to asthma phenotypes. After clustering, clinical profiles and exacerbation rates during follow-up were compared among the clusters. RESULTS: Four subphenotypes were identified: cluster 1 was comprised of patients with early-onset atopic asthma with preserved lung function, cluster 2 late-onset non-atopic asthma with impaired lung function, cluster 3 early-onset atopic asthma with severely impaired lung function, and cluster 4 late-onset non-atopic asthma with well-preserved lung function. The patients in clusters 2 and 3 were identified as exacerbation-prone asthmatics, showing a higher risk of asthma exacerbation. CONCLUSIONS: Two different phenotypes of exacerbation-prone asthma were identified among Korean asthmatics using cluster analysis; both were characterized by impaired lung function, but the age at asthma onset and atopic status were different between the two.

Risk Factors for Vancomycin-Associated Nephrotoxicity in Elderly Patients

OBJECTIVE: Infection is very common in the elderly, so there is a high prevalence of antibiotics use among this population. Especially, due to the emergence of resistant bacteria, the use of vancomycin is growing. The purpose of this study was to evaluate risk factors associated with vancomycin-induced nephrotoxicity in elderly patients. METHODS: The subjects of this study were patients over 18 years old who received intravenous vancomycin in a general hospital located in Gangneung-si, Korea between August 1, 2013 and July 31, 2015. Data collection regarding vancomycin use and baseline characteristics was conducted using computerized hospital database. Logistic regression analysis was used to identify risk factors associated with vancomycin-induced nephrotoxicity. RESULTS: A total of 290 patients were finally included, and 191(66%) out of these patients were age 65 or older. The incidence of vancomycin-induced nephrotoxicity was 11.0%, 12.6%, and 7.0% in the all adult patients, the elderly patients, and the non-elderly patients, respectively. There were significant differences in comorbidities between patients with nephrotoxicity and patients without nephrotoxicity in the all adult patients, and there were significant differences in vancomycin duration, comorbidities, and number of nephrotoxic agents between patients with nephrotoxicity and patients without nephrotoxicity in the elderly patients. However, according to the logistic regression analysis, there was no significant risk factor that increases the incidence of vancomycin-induced nephrotoxicity in all three age groups. CONCLUSION: There were no differences in risk factors that increase the incidence of vancomycin-induced nephrotoxicity between all adult patients, elderly patients, and non-elderly patients. Further studies with larger sample sizes to identify risk factors associated with vancomycin-induced nephrotoxicity in the elderly to improve the outcome of pharmacotherapy are required.

Management of Chronic Kidney Disease-Mineral Bone Disorder with Sevelamer Hcl Phosphate Binder in Korean Patients with Dialysis

BACKGROUND: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. METHODS: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). RESULTS: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). CONCLUSION: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.

Asthma-Predictive Genetic Markers in Gene Expression Profiling of Peripheral Blood Mononuclear Cells

PURPOSE: We sought to identify asthma-related genes and to examine the potential of these genes to predict asthma, based on expression levels. METHODS: The subjects were 42 asthmatics and 10 normal healthy controls. PBMC RNA was subjected to microarray analysis using a 35K array; t-tests were used to identify genes that were expressed differentially between the two groups. A multiple logistic regression analysis was applied to the differentially expressed genes, and area under the curve (AUC) values from receiver operating characteristic (ROC) curves were obtained. RESULTS: In total, 170 genes were selected using the following criteria: P or =2-fold change. Among these genes, 57 were up-regulated and 113 were down-regulated in asthmatics versus normal controls. A multiple logistic regression analysis was done using more stringent criteria (P or =5-fold change), and eight genes were selected as candidate asthma biomarkers. Using these genes, 255 models (2(8)-1) were generated. Among them, only 85 showed P< or =0.05 by multiple logistic regression analysis. Based on the AUCs from ROC curves for the 85 models, we found that the best model consisted of the genes MEPE, MLSTD1, and TRIM37. The model showed 0.9928 of the AUC with 98% sensitivity and 80% specificity. CONCLUSIONS: MEPE, MLSTD1, and TRIM37 may be useful biomarkers for asthma.

Template therapy for mouth opening limitation by temporomandibular joint disorders

INTRODUCTION: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. MATERIALS AND METHODS: A total of 14 patients (female 12, male 2, average age: 29.1+/-14.4), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range < 35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. RESULTS: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was 30.2+/-3.5 mm and the average MMO after treatment and follow up was 47.1+/-4.7 mm. The mean amount of mouth opening increment was 16.9+/-5.4 mm (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) CONCLUSION: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.

Risk and Protective Factors in the School Adjustment of Socially Bullied Secondary Students / 신경정신의학

OBJECTIVES: Although verbal and social bullying is more common than physical school violence among secondary students, it's harmful influences have been underestimated. It is essential to investigate the risk factors of clinically referred bullied children with school maladjustment and psychiatric symptoms and the protective factors of the non-referred resilient children despite of being bullied for developing the anti-bullying program. METHODS: The questionnaire asking frequency and severity of being bullied socially, Kovacs Children's Depression Scale, and Piers-Harris Children's Self-Concept Scale were administered to 128 secondary students in Wonju and 65 secondary students referred for their school maladjustment to psychiatric outpatient clinic. Fifty-five students (boys: 19, girls: 36) of bullied non-clinical group and 42 students(boys: 21, girls: 21) of bullied clinical group were compared with their scores of being bullied, depression and self-concept, and the gender difference in those comparisons was studied. RESULTS: More negative self-concept and poorer relationship with family were noticed in the clinical group, despite of no difference in being-bullied score and depression score between the two. Five subscales of the self-concept, behavior, academic status, appearance, popularity and happiness were more negative in clinical group, but not with anxiety subscale. With coping strategy, there was no difference. Multiple regression analysis showed that depression score was accountable by negative self-concept only in the clinical group, and by appearance and anxiety in non-clinical group. And gender differences were not found in those all variables. CONCLUSION: It is suggested that the risk factor for school maladjustment occurred after being bullied socially is the negative self-concept, and the protective factor for resilient children is the supportive relationship within family.