Risk of Ischemic Heart Disease in Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study

Background@#Subjects with chronic obstructive pulmonary disease (COPD) have a higher risk of ischemic heart disease (IHD) than individuals without COPD; however, longitudinal evidence is lacking. Therefore, we aimed to estimate the risk of IHD between COPD and control cohorts using a longitudinal nationwide database. @*Methods@#We used 2009–2017 data from the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC). Adult participants at least 20 years of age who underwent health examinations and without a history of COPD or IHD were included (n = 540,976). Participants were followed from January 1, 2009, until death, development of IHD, or December 31, 2019, whichever came first. @*Results@#At baseline, there were 3,421 participants with incident COPD and 537,555 participants without COPD. During a median of 8.0 years (5.3–9.1 years) of follow-up, 2.51% of the participants with COPD (n = 86) and 0.77% of the participants without COPD (n = 4,128) developed IHD, with an incidence of 52.24 and 10.91 per 10,000 person-years, respectively. Participants with COPD had a higher risk of IHD (adjusted hazard ratio, 1.55;95% confidence interval, 1.25–1.93) than subjects without COPD. Demographics such as age, sex, body mass index, and personal health behaviors including smoking status and physical activity did not show significant interaction with the relationship between COPD and IHD (P for interaction > 0.05 for all). @*Conclusion@#The results indicate that COPD is associated with the development of IHD independent of demographic characteristics and health-related behaviors. Based on these results, clinicians should closely monitor the onset of IHD in subjects with COPD.

Effectiveness of Intratympanic Dexamethasone Injection for Tinnitus Treatment: A Systematic Review and Meta-Analysis

Objectives@#. Intratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and metaanalysis, we evaluated the effectiveness of ITDI for tinnitus treatment. @*Methods@#. We searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis. @*Results@#. In the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment. @*Conclusion@#. ITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

Physical Activity Patterns and Their Associated Factors Measured by Global Physical Activity Questionnaire Survey among Korean / 대한스포츠의학회지

Research on physical activity and health is actively being conducted. In the Korea National Health and Nutrition Examination Survey (KNHANES), the Global Physical Activity Questionnaire (GPAQ) was newly introduced in 2014. The purpose of this study was to investigate the levels of physical activity and related factors in Koreans who were assessed through the GPAQ by dividing the physical activity by occupation, leisure, and transport domain. This study used data from the KNHANES (2014–2016), the study population of which included 17,357 participants aged 12 to 80 years. We compared the differences in physical activity by sociodemographic factors, health-related factors, and psychological health-related factors. Moreover, we also compared the mean metabolic equivalent of task and daily sitting time according to physical activity domain by sex and age group. Finally, we investigated the sociodemographic factors, health-related factors, and psychological health-related factors that significantly affect the average physical activity per week. The various factors were found to differ in the frequency of physical activity levels. In addition, there was a difference in the amount of physical activity per occupation, leisure, and transport domain in each age group. Finally, age, sex, high-density lipoprotein cholesterol levels, arthritis, allergic rhinitis and sinusitis, sleeping time, and perceived health status significantly affected physical activity. The levels of physical activity significantly differed by sociodemographic factors, health-related factors, and psychological health-related factors. There was also a difference in the physical activity levels according to the age and sex per each domain of physical activity.

Perceptual and Acoustic Outcomes of Early-Stage Glottic Cancer After Laser Surgery or Radiotherapy: A Meta-Analysis

Laser surgery (LS) or radiotherapy (RT) is normally recommended in early glottic cancer. The objective of this study was to perform a comprehensive meta-analysis of acoustic and perceptual outcomes to compare voice quality of LS or RT in early-stage glottic cancer. Data sources were obtained after searching PubMed, Google Scholar, EBSCO, and RISS using the following search terms: glottic cancer, glottic carcinoma, endoscopic surgery, laser surgery, radiotherapy, radiation, voice, voice quality, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Articles that compared voice outcomes between LS and RT were identified. This meta-analysis included 15 articles with 744 patients, including 400 in the LS group and 344 in the RT group. Random effects models were selected. Forest plots included standardized mean differences, standard errors, variance, 95% confidence intervals (lower limit to upper limit), z-values, and P-values. In perceptual analysis, grade (G) and asthenia (A) of RT were significantly better than LS. There was no statistically significant difference in roughness (R), breath (B), or strain (S) between LS and RT groups. Jitter, shimmer, and noise to harmonic ratio measurements showed significant differences, resulting in enhanced posttreatment effect of RT compared to LS. Results of our meta-analysis suggested that RT might lead to superior voice quality than LS in early glottic cancer.

Long-term Breastfeeding in the Prevention of Allergic Rhinitis: Allergic Rhinitis Cohort Study for Kids (ARCO-Kids Study)

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.

Erratum: Instant noodle consumption is associated with cardiometabolic risk factors among college students in Seoul

The paper by Huh et al. [1] was printed with an error the name and affiliation of author.

Substance P and Calcitonin Gene-Related Peptide in the Glands of External Auditory Canal Skin

OBJECTIVES: The earwax (cerumen) that covers external auditory canal (EAC) skin contains a mixture of ceruminous and sebaceous gland substances, such as lipids, peptides, and proteins. The components secreted from the ceruminous gland that is a modified sweat gland form cerumen and contain several antimicrobial factors. Since substance P (SP) and calcitonin gene-related peptide (CGRP), known as a secretagogue, have been found in sweat glands, our purpose was to determine the expression of SP and CGRP in the glands of EAC skin. METHODS: Sections of normal human EAC skins were immunostained for the presence of SP and CGRP using polyclonal antibodies. Immunoreactivity was detected using an avidin-biotin peroxidase complex method. RESULTS: SP staining was found in ceruminous gland acini and myoepithelial cells. But the SP staining was not found in the sebaceous glands and epidermal region. CGRP was strongly stained in the ceruminous gland and weakly in the sebaceous gland cells. Interestingly, most prominent staining of SP and CGRP was noted in the myoepithelial cells of the ceruminous gland. CONCLUSION: The findings in this study suggest that SP and CGRP are expressed in the glands of the EAC skin and secreted in the process of ceruminous gland secretion.

Instant noodle consumption is associated with cardiometabolic risk factors among college students in Seoul

BACKGROUND/OBJECTIVES: Increased consumption of instant noodles has recently been reported to be positively associated with obesity and cardiometabolic syndrome in South Korea, which has the highest per capita instant noodle consumption worldwide. This study aimed to investigate the association between instant noodle consumption and cardiometabolic risk factors among college students in Seoul. SUBJECTS/METHODS: The study subjects consisted of 3,397 college students (1,782 male; 1,615 female) aged 18-29 years who participated in a health checkup. Information on instant noodle consumption was obtained from the participants' answers to a question about their average frequency of instant noodle intake over the 1 year period prior to the survey. RESULTS: Statistical analysis using a general linear model that adjusted for age, body mass index, gender, family income, health-related behaviors, and other dietary factors important for cardiometabolic risk, showed a positive association between the frequency of instant noodle consumption and plasma triglyceride levels, diastolic blood pressure, and fasting blood glucose levels in all subjects. Compared to the group with the lowest frequency of instant noodle intake (≤ 1/month), the odds ratio for hypertriglyceridemia in the group with an intake of ≥ 3/week was 2.639 [95% confidence interval (CI), 1.393–5.000] for all subjects, while it was 2.149 (95% CI, 1.045–4.419) and 5.992 (95% CI, 1.859–21.824) for male and female students, respectively. In female students, diastolic blood pressure was also higher among more frequent consumers of instant noodles. CONCLUSIONS: Our results suggest that frequent consumption of instant noodles may be associated with increased cardiometabolic risk factors among apparently healthy college students aged 18–29 years.

A Twenty-Minute Nap Boosts the Planning Domain of Executive Function in Sleep Deprived Late Adolescents

OBJECTIVES: The positive effects of nap on cognitive function and memory have been researched intensively among children and adults. However, the relationship between afternoon nap and executive function among sleep deprived late adolescents has not been studied as much. METHODS: Ten sleep deprived, otherwise healthy Korean high school students were recruited, and asked to fill out Pittsburgh Sleep Quality Index questionnaire. They were put to nap for 5 min on three days during the first week, then for 10, 20, and 30 min in the same protocol during the consecutive weeks. After a 1-h class, both the students themselves and their corresponding teachers evaluated the participation level of the participants. They were then divided into two groups, and were instructed to play iPad game ‘Free Flow’. One group took a nap while the other group was prohibited from taking a nap. Both groups were instructed to play the game again. This was repeated once every afternoon for three days. RESULTS: The experiment showed that 20-min nap was superior in subjective evaluations to the other nap duration, and the mean game score differences before and after were significantly higher in the nap taking group after the 20-min nap when analyzed using non-parametric statistical method (p-value 0.04). CONCLUSIONS: Therefore, 20-min nap is likely to boost planning domain of executive function on sleep deprived late adolescents.

Six-week Diet Correction for Body Weight Reduction and Its Subsequent Changes of Gut Microbiota: A Case Report

Impact of intestinal microbes on obesity and health is a new topic recently started to get attention. Comparing to the global concern and research trends, there are few research on the association between intestinal bacteria and life style disease in Korean. One voluntary case (female) was reported to show the change in gut microbiota and weight by diet intervention. She was overweight (BMI 23.2 kg/m2) and has abnormal liver function, and the causes of overweight were frequent drinking and meat consumption at the late evening hours. For 47 days, she was administered an improved diet on breakfast and dinner with reduction of meat consumption frequency by 50%. Alcohol consumption was reduced to once a week. As a result, she lost 3 kilograms of body weight. Her fecal sample was collected before and after the intervention, and gut microbiota change was compared using a high-throughput sequencing technique. After diet correction, the shift of gut microbiota was clearly observed with decreased proportion of Firmicutes (from 75.7% to 47.3% in total microbiota) but increased proportion of Bacteroidetes upto 47.7%. After incorporating the diet intervention, it is meaningful to confirm the changes in dominant gut microbiota and weight loss.

Effects of Three-Week Stair Climbing Exercise for Weight Control: A Case Series Study / 대한스포츠의학회지

This study is designed to check whether everyday-life stair climbing, which is a low-cost and readily accessible form of exercise, is effective for reducing overweight of sedentary people in various health indicators. We selected four overweight people and measured body weight, body fat percentage, muscle quantity, pulmonary function, lower-extremity strength and volume of thigh muscle and fat. After 3-week exercise of climbing stairs in more than 5 minutes twice a day, same procedures were taken. Body weight was reduced by 3.35 kg on average (standard deviation [SD], 0.79), and body fat mass by 2.53 kg (SD, 1.36). Lower extremity strength improved about 5%, and slight loss of thigh fat (right 3.2%; left 13.4%) was observed. However, pulmonary function and muscle quantity did not grow significantly. Although only four people may not be representative as targets, but it is suggested that stair climbing has sufficient utility as an easily accessible exercise.

Relationship between Low Muscle Mass and Metabolic Syndrome in Elderly People with Normal Body Mass Index

BACKGROUND: Metabolically obese normal weight (Wt) occurs in people who have high prevalence of cardiovascular disease even with normal body mass index (BMI). In this study, we determined the relationship between low muscle mass and metabolic syndrome which is known to be associated with cardiovascular disease in aged people with normal BMI. METHODS: This study used the data of Korea National Health and Nutrition Examination Survey. Aged people (> or = 65 years) with normal BMI (18.5 to 22.9 kg/m2) were enrolled. Low muscle mass class I was defined as appendicular skeletal muscle divided by Wt 1 to 2 standard deviation below the mean of gender specific young healthy adult and class II was defined as below 2 standard deviations. RESULTS: The prevalence of low muscle mass class I and II were 18.8% and 5.2% in men and 11.2% and 2.2% in women, respectively. In men and women, low muscle mass and metabolic syndrome was associated with each other after adjusting for age. After further adjusting for BMI, smoking status, alcohol consumption, and exercise frequency, the relationship was maintained in aged men. Moreover in aged men, the risk of metabolic syndrome was increased according to the grade increase in low muscle mass class. CONCLUSIONS: In the aged with normal BMI, low muscle mass was a risk factor of metabolic syndrome. Furthermore, in normal BMI men, when the degree of low muscle mass was enhanced, the risk of metabolic syndrome was increased.

The Cutoff Value in Body Fat Percentage for Increased Risk of Metabolic Syndrome in Elderly People With Normal Body Weight

BACKGROUND: In this study, we identified the cutoff value for the percentage in body fat related to metabolic syndrome in elderly people with normal body mass index (BMI). We also found the correlation between body fat percentage and metabolic syndrome. METHODS: We used data from the Korean National Health and Nutrition Examination Survey conducted from 2008 to 2011. Our subjects were elderly people aged 65 or above, with BMI less than 23.0 kg/m2. We determined the cutoff value for body fat percentage through receiver operating characteristic analysis. RESULTS: The cutoff value for percentage body fat related to metabolic syndrome was 19.5% for men (sensitivity 68.0%, specificity 62.9%) and 30.0% for women (sensitivity 55.1%, specificity 62.0%). Based on the cutoff value, 43.3% in men and 43.1% in women were classified into the high body fat percentage group. After adjusting for age, smoking status, alcohol consumption, and exercise status, the men with higher than normal body fat percentage had an odds ratio of 3.61 (95% confidence interval [CI], 2.10-6.22; p<0.001) for developing metabolic syndrome, whereas women had an odds ratio of 1.95 (95% CI, 1.30-2.92; p<0.001). CONCLUSION: The cutoff value for body fat percentage related to metabolic syndrome was lower in elderly. In the elderly with normal body mass index, high percentage of body fat percentage was associated with a high risk of metabolic syndrome.

A "Boxer Glove" Contoured Laryngeal Amyloidosis

Laryngeal amyloidosis is uncommon and poorly understood, with limited long-term studies. Although primary localized laryngeal amyloidosis is extremely rare, it frequently involves the ventricles and the false and true vocal cords. We present a 58-year-old woman with localized laryngeal amyloidosis who presented no symptoms. On indirect laryngoscopic examination, the mass involved both arytenoids only, and had a likeness to a "boxer glove." She was treated surgically by microlaryngoscopy under general anesthesia and the mass was excised using a carbon dioxide laser. We present this case and a review of literature.

Primary Malignant Melanoma of the Parotid Gland Metastasing to the Appendix / 대한이비인후과학회지

Malignant melanoma originates from melanocytes which are derived from the neural crest. These melanocytes are found in the basal layer of the epidermis. Malignant melanoma of the parotid gland is very rare, and when they are found, most of them are a metastasized form of a cutaneous primary lesion in the head region. We experienced one case of primary parotid melanoma which was metastasizing to the appendix two years later. We report it with a review of literature.

Association between Self-Perceived Health Status and Health Related Behavior in Routine Health Examinees / 가정의학회지

BACKGROUND: Self-perceived health is a good indicator of health status. It is generally accepted that self-perceived health status has important role on one's health behavior and public health education. Smoking, drinking, and obesity are well known risk factors for one's health. But its effects on self-perceived health status are not known so well in Korea. This study was planned to evaluate the effect of health behavior such as smoking, drinking, and obesity on self-perceived health status. METHODS: We enrolled a total of 6,040 Koreans, visited to one general hospital health promotion center from June, 2004 through June, 2007. Data was collected by questionnaire, including basic demographic variables, family history of cancers or cerobrovascular accidents, psycho-emotional factors such as stress, depression, anxiety, insomnia, and health behaviors including smoking, drinking, and exercise. Risk factors for metabolic syndrome were also obtained including waist circumference, blood pressure, triglyceride, high-density lipoprotein (HDL), fasting blood sugar, and body mass index (BMI). RESULTS: Older age, higher alcohol consumption, higher BMI, and regular exercise were associated with higher selfperceived health status. Higher education status, higher score of stress, symptoms such as depression, anxiety, and insomnia, drug medication, operation history, and abnormal HDL status were associated with lower self-perceived health status. Smoking and metabolic syndrome had no relation with self-perceived health status. CONCLUSION: Drinking and higher BMI were associated with higher self-perceived health status, indicating discrepancies between self-perceived health status and medical advice. More strict education might be required for those risk factors.

Differences in Circulating Dendritic Cell Subtypes in Pregnant Women, Cord Blood and Healthy Adult Women

Different subtypes of dendritic cells (DC) influence the differentiation of naive T lymphocytes into T helper type 1 (Th1) and Th2 effector cells. We evaluated the percentages of DC subtypes in peripheral blood from pregnant women (maternal blood) and their cord blood compared to the peripheral blood of healthy non pregnant women (control). Circulating DC were identified by flow cytometry as lineage (CD3, CD14, CD16, CD19, CD20, and CD56)-negative and HLA-DR-positive cells. Subtypes of DC were further characterized as myeloid DC (CD11c+/CD123+/-), lymphoid DC (CD11c-/CD123+++) and less differentiated DC (CD11c-/CD123+/-). The frequency of DC out of all nucleated cells was significantly lower in maternal blood than in control (P<0.001). The ratio of myeloid DC/lymphoid DC was significantly higher in maternal blood than in control (P<0.01). HLA-DR expressions of myeloid DC as mean fluorescence intensity (MFI) were significantly less in maternal blood and in cord blood than in control (P<0.001, respectively). The DC differentiation factors, TNF-alpha and GM-CSF, released from mononuclear cells after lipopolysaccharide stimulation were significantly lower in maternal blood than in control (P<0.01). The distribution of DC subtypes was different in maternal and cord blood from those of non-pregnant women. Their role during pregnancy remains to be determined.

Localization of the Focal Gastric Lesion on Abdominal MDCT: The Importance of the Right and Left Gastric Arteries and Gastroepiploic Arteries

PURPOSE: To identify the importance of the right and left gastric arteries, as well as the gastroepiploic arteries, for the localization of focal gastric lesions from axial images of abdominal MDCTs. MATERIALS AND METHODS: Axial image interpretations from abdominal MDCTs were performed to diagnose the location of focal gastric lesions. The interpretations were performed on 72 patients retrospectively by two radiologists who were blinded from the endoscopic and surgical results by consensus at two different time intervals. No information was provided to the observers, who were asked to determine the precise location of the focal gastric lesion, for the first interpretation. Next, the observers were informed that the right and left gastric arteries, as well as the gastroepiploic arteries, are on the lesser and greater curvature, respectively. Moreover, the gastric angle is on the course of the right and left gastric arteries. One week later, the second interpretation was performed using the same subjects and methods as the first interpretation. The diagnostic accuracy of each interpretation was comparatively evaluated. RESULTS: The diagnostic accuracy of the first and second interpretations was 52.8% (38/72) and 98.6% (71/72), respectively (p < 0.05). CONCLUSION: The results of this study suggest that the right and left gastric arteries, as well as the gastroepiploic arteries, are reliable markers for the localization of the focal gastric lesions on axial images of abdominal MDCTs.

Patients' Attitudes toward Proactive Screening for Sexual Dysfunction

BACKGROUND: Although proactive screening for sexual dysfunction in primary care has been emphasized as an important part of comprehensive care, doctors seldom ask their patients about their sexual function. Worry about patients' responses was reckoned as a major barrier, but few studies have dealt with how patients feel and what they want. This study was aimed to describe and analyze the attitudes of patients toward proactive screening for sexual dysfunction. METHODS: A set of self-administered questionnaire was given to every patients who visited a family medicine clinic in a university hospital for 2 weeks from March 16, 2005. RESULTS: A total of 185 patients were analyzed. Among them, 72.4% were willing to consult their physician when they were in trouble with their sexual function, and 84.3% said proactive screening for sexual dysfunction was necessary. Many patients did not care about 'when to be asked' and wanted to be asked in face-to-face interview rather than by a questionnaire. Sentence emphasizing that every patient is given the same question was most preferred. CONCLUSION: Patients' attitude toward proactive screening for sexual dysfunction in primary care was generally positive. Patients preferred to be asked "I ask every patient about his sexual problem. If you're OK, I ask you about your sexual problem." regardless of timing, during the interview.

Iron Deficiency and Hemoglobin Content of RBC in Infants / 대한진단검사의학회지

BACKGROUND: Iron deficiency is one of the commonest nutritional diseases in young children, which influences cognitive performance and motor development. For the diagnosis of iron deficiency in infants, we evaluated several parameters obtained during the test of routine complete blood count. METHODS: A total of 192 full-term infants were studied. They were aged from 6 to 12 months, who visited Boramae Hospital from Aug 2002 to Oct 2004 according to their routine check up schedules. Venous blood was drawn to determine hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, hemoglobin content (CH), hemoglobin content of reticulocyte and red cell distribution width (RDW) using ADVIA 120 (Bayer Diagnostics, NY, USA). For iron status, iron, total iron binding capacity and ferritin were determined. The normal, iron deficiency, and iron deficiency anemia groups were defined on the basis of Hb level of 11 g/dL, transferrin saturation of 20%, and/or ferritin level of 12 microgram/L. RESULTS: The significant predictors of iron deficiency state were CH (P<0.001) and RDW (P=0.035). Infants with CH < or = 26 pg could be diagnosed as having an iron deficiency state with 80% sensitivity and 86% specificity. CONCLUSIONS: CH can be used as a new parameter to diagnose an iron deficiency state in infants with the advantage of cost saving and avoiding additional blood sampling. However the reference range should be established before clinical testings and the parameter should be generalized to other automatic analyzers.