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Background@#The purpose of this study was to evaluate the effect of vanishing twin (VT) on maternal serum marker concentrations and nuchal translucency (NT). @*Methods@#This is a secondary analysis of a multicenter prospective cohort study in 12 institutions. Serum concentrations of pregnancy-associated plasma protein-A in the first trimester and alpha-fetoprotein (AFP), total human chorionic gonadotrophin, unconjugated estriol, and inhibin A in the second trimester were measured, and NT was measured between 10 and 14 weeks of gestation. @*Results@#Among 6,793 pregnant women, 5,381 women were measured for serum markers in the first or second trimester, including 65 cases in the VT group and 5,316 cases in the normal singleton group. The cases in the VT group had a higher median multiple of the median value of AFP and inhibin A than the normal singleton group. The values of other serum markers and NT were not different between the two groups. After the permutation test with adjustment,AFP and inhibin A remained significant differences. The frequency of abnormally increased AFP was also higher in the VT group than in the normal singleton group. @*Conclusion@#VT can be considered as an adjustment factor for risk assessment in the secondtrimester serum screening test.
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Background@#This study aimed to investigate the changes of incidence and treatment of choice for hyperthyroidism from 2003 to 2018 and explore the treatment-related complications and concomitant comorbidities in South Korea using data from the National Health Insurance Service. @*Methods@#This is a retrospective observational study. Hyperthyroidism was defined as a case having two or more diagnostic codes of thyrotoxicosis, with antithyroid drug intake for more than 6 months. @*Results@#The average age-standardized incidence of hyperthyroidism from 2003 to 2018 was 42.23 and 105.13 per 100,000 men and women, respectively. In 2003 to 2004, hyperthyroidism was most often diagnosed in patients in their 50s, but in 2017 to 2018, people were most often diagnosed in their 60s. During the entire period, about 93.7% of hyperthyroidism patients were prescribed with antithyroid drugs, and meanwhile, the annual rates of ablation therapy decrease from 7.68% in 2008 to 4.56% in 2018. Antithyroid drug-related adverse events, mainly agranulocytosis and acute hepatitis, as well as complications of hyperthyroidism such as atrial fibrillation or flutter, osteoporosis, and fractures, occurred more often in younger patients. @*Conclusion@#In Korea, hyperthyroidism occurred about 2.5 times more in women than in men, and antithyroid drugs were most preferred as the first-line treatment. Compared to the general population, hyperthyroid patients may have a higher risk of atrial fibrillation or flutter, osteoporosis, and fractures at a younger age.
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Purpose@#Although previous research showed the importance of safety culture on health care workers' speaking up behaviors, it is not clear how particular safety culture domains are associated with the speaking up behaviors of hospital staff. Also, researchers have suggested that health care workers’ speaking up behaviors vary by profession, but there has been limited research into such differences. Thus, this study examined differences in perceptions of patient safety culture and the promotive and prohibitive speaking up behaviors of health care workers by profession and investigated the relationships between patient safety culture and the two types of speaking up behaviors. @*Methods@#A descriptive correlational study was conducted using secondary data collected through an online survey of health care workers at a private, nonprofit, tertiary-level teaching hospital in South Korea. The sample (N = 831) consisted of nurses (54.0%), physicians (13.0%), and other licensed and unlicensed hospital personnel (33.0%). Analyses of variance were conducted to examine differences in study variables by profession. Hierarchical regression analyses were conducted to evaluate the effects of the seven patient safety culture factors on promotive and prohibitive voice after controlling for tenure and profession. @*Results@#Perceptions of safety culture and promotive voice behaviors were higher for physicians compared with nurses. Communication openness, reporting patient adverse events, and unit supervisors' and hospital managements’ support for patient safety were significant predictors of both types of voice behaviors. @*Conclusion@#Hospital administrators and unit managers should create a supportive environment where staff feel free to voice their concerns and suggestions. They should also pay attention to the varying perspectives held by different groups of hospital workers and their different voice behaviors. Knowing which dimensions of patient safety culture are most strongly related to health care workers’ voice behaviors can guide patient safety improvement activities in health care organizations.
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Background@#Targeted therapy and immunotherapy such as programmed death-1 (PD-1) targeting have been introduced for treating many types of cancers, including primary cutaneous angiosarcoma (CA). However, studies that examined other targeted molecules in CA are scarce. @*Objective@#We aim to declare the expression of endoglin and survivin in addition to PD-1 and assess the clinical correlation between the expression of these molecules and clinical variables, overall survival (OS), and progressionfree survival (PFS) in CA. @*Methods@#We identified 51 patients diagnosed with CA at Asan Medical Center over the last 14 years, based on the staining results of paraffin sections of tissue samples for endoglin, survivin, and PD-1 that were reviewed by two dermatologists. @*Results@#Statistical analysis for the correlation between results and clinical data of CA revealed that whereas 35 (63.6%) and 30 samples (54.5%) were positive for endoglin and survivin respectively, only nine samples were positive for PD-1 (16.4%). Co-expression of endoglin and survivin was detected in 24 lesions (p=0.013) and was significantly correlated to head, neck, face, and scalp (HNFS) lesions in CA (p=0.005, p=0.038, respectively). However, the expression of these target molecules did not correlate with the OS or PFS of CA. @*Conclusion@#Considering that HNFS type CA is associated with unfavorable clinical outcomes in similar populations, our findings can be helpful in matching patients with CA with effective targeted therapy.
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Background@#Adiponectin is an adipose-derived hormone that plays a role in various metabolic diseases. We previously demonstrated that adiponectin inhibits melanin synthesis through adenosine monophosphate-activated protein kinase (AMPK) activation in melanocytes. However, melanocytes can be affected by neighboring keratinocytes, and the effect of adiponectin on these functional units has not been investigated. @*Objective@#We investigated the effect of adiponectin on melanogenesis in co-cultured models of normal human melanocytes (NHMs), normal human keratinocytes (NHKs), and human dermal fibroblasts (HDFs), and the effect of adiponectin on melanin content in human skin tissues. @*Methods@#Quantitative real-time polymerase chain reaction (qPCR) was performed for tyrosinase and microphthalmia-associated transcription factor (MITF). The degree of phosphorylation of AMPK, cAMP response element binding protein (CREB), and AKT was evaluated by western blot assay, and Fontana-Masson staining was performed on cultured human skin tissues. @*Results@#Adiponectin decreased the melanin content in the co-culture models of NHMs with NHKs, NHMs with HDFs, and NHMs with both NHKs and HDFs. qPCR revealed that both tyrosinase and MITF were decreased after adiponectin treatment in the co-culture system. Following adiponectin treatment, AMPK was activated in all cell groups; however, the phosphorylation of CREB was decreased in HDFs and NHKs. The phosphorylation of AKT was decreased in only NHMs. In the experiment with human skin tissues cultured ex vivo, the densitometric analysis of Fontana-Masson staining revealed that adiponectin treatment reduced the melanin level of ultraviolet-irradiated human skin tissues. @*Conclusion@#Adiponectin inhibited melanogenesis in both co-culture models and human skin tissues ex vivo.
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The effect of dupilumab on allergic contact dermatitis or patch testing is unknown. Here, we present a case of excited skin syndrome that appeared after patch testing during dupilumab treatment. A 21-year-old woman presented with atopic dermatitis that showed only a partial response to cyclosporine and dupilumab. A patch test was performed to check for underlying allergic contact dermatitis. The result was consistent with excited skin syndrome.Some studies argue that dupilumab suppresses allergic reactions triggered by allergens that activate the Th2 pathway. Others suggest that it does not affect the result of patch testing, regardless of the type of allergen tested. Even if dupilumab suppresses a certain allergic or immunologic pathway, this case shows that it cannot mask excited skin syndrome on patch testing.
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Purpose@#We assessed prenatal detection rates of congenital heart disease (CHD) and associations between maternal serum biomarkers and non-chromosomal CHD in singleton pregnancies. @*Materials and Methods@#This study was conducted as a secondary analysis of data obtained during a multicenter prospective cohort study that investigated the cost-effectiveness of prenatal testing for fetal aneuploidy. We analyzed the prenatal detection rate and accuracy for CHD screening via ultrasound during the second trimester, as well as associations between serum biomarkers and CHDs, in singleton newborns without chromosomal abnormalities. @*Results@#Among 6715 women, 142 (2.1%) newborns were born with CHDs, of which 67 (1.0%) newborns had major CHDs. The prenatal detection rate for all CHDs and major CHDs were 34.5% and 58.2%, respectively. After excluding isolated ventricular septal defects, the detection rate for critical CHDs was 85.9%. Women with low pregnancy-associated plasma protein A (PAPP-A) (<0.4 multiples of the median, MOM) face increased risks of non-chromosomal CHDs [adjusted odds ratio (aOR) 2.76; 95% confidence interval (CI) 1.36–5.13] and major CHDs (aOR 7.30; 95% CI 3.18–15.59), compared to those without CHDs. A higher inhibin A level (≥2.5 MOM; aOR 4.84; 95% CI 1.42–12.46) was associated with non-chromosomal major CHDs. @*Conclusion@#Ultrasonography performed during the second trimester by obstetricians detected over 85% of critical CHDs. Low maternal serum PAPP-A or high inhibin-A was associated with non-chromosomal CHDs. These results may contribute to an improvement in prenatal diagnosis of CHDs.
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Purpose@#This study was conducted to effectively apply the nutrition and hygiene education program for improving the nutritional status of the elderly aged 65 years and above. @*Methods@#The first study was conducted by enrolling 121 willing elderly subjects from welfare centers in four regions of Chungbuk. The second study included 347 people from 10 regions of Chungbuk. Data were analyzed using the SPSS (version 12.0) and SAS (version 9.2) programs. @*Results@#Most participants in both studies were women, ranging from 70-79 years of age. In the first study, the performance rates of subjects, after imparting the education on hygiene, eating habits, and nutritional knowledge, were significantly increased for all factors. Goesan and Boeun areas were highly effective in hygiene practice and eating habits after education.In the second study, Chungju had the most educational effect on hygiene education, with a score of 6.41 points before education and 7.68 points after education. The greatest impact of education on eating habits was obtained at Goesan, with 9.23 points and 11.26 points before and after education, respectively. Large regional differences were determined for the effect of the education program. For nutritional knowledge, the combined average score of Boeun and Goesan showed a maximum increase after education. When considering satisfaction, the scores of Cheongju and Jeungpyeong increased the most after education, whereas Goesan showed that the average scores before and after education were close to perfect. Surprisingly, the Okcheon area, where there was no significant difference in the educational effect after the education program in the first study, showed significant improvement for all factors after the second education program. The current study indicates that continuous education programs are essential for improving the nutritional status of the elderly. @*Conclusion@#Therefore, continuous nutrition and hygiene education programs are recommended to improve the nutritional status of the elderly.
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Background@#People are generally considered overweight and obese if their body mass index (BMI) is above 25 kg/m 2 and 30.0 kg/m 2 , respectively. The World Health Organization proposed stricter criteria for Asians (≥ 23 kg/m2 : overweight, ≥ 25 kg/m2 : obese). We aimed to verify whether this criteria could predict adverse pregnancy outcomes in Korean women. @*Methods@#We included 7,547 Korean women from 12 institutions enrolled between June 2016 and October 2018. Women with no pre-pregnancy BMI data, not Korean, or lost to followup were excluded, leaving 6,331. The subjects were categorized into underweight, normal, overweight, class I obesity, and class II/III obesity based on a pre-pregnancy BMI of < 18.5, 18.5–22.9, 23.0–24.9, 25.0–29.9, and ≥ 30.0 kg/m2 , respectively. @*Results@#Overall, 13.4%, 63.0%, 11.8%, 9.1%, and 2.6% of women were underweight, normal, and overweight and had class I obesity and class II/III obesity, respectively. In the multivariable analysis adjusted for maternal age, a higher BMI significantly increased the risk of preeclampsia, gestational diabetes, preterm delivery caused by maternal-fetal indications, cesarean section, large for gestational age, and neonatal intensive care unit admission. @*Conclusion@#Adverse pregnancy outcomes started to increase in those with a pre-pregnancy BMI ≥ 23.0 kg/m2 after adjusting for maternal age. The modified obesity criteria could help predict adverse pregnancy outcomes in Koreans.
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Purpose@#This study examined the effects of the type of video contents used for action observations on the ability to control posture. @*Methods@#The participants were 48 healthy adults. The two hands of the participants were crossed on both shoulders, and the other foot was placed in a straight line in front of the target to allow them to watch a video of the monitor. The videos were presented in random order with three video contents (natural, stable balance posture, and unstable balance posture) consisting of 30 seconds each. A 15-second resting time was given between each video. During action observation using various video content forms, the posture control ability was measured using a TekScan MetScan® system. @*Results@#The results revealed statistically significant differences in the area of movement and the distance by COP and distance by the type of action-observation videos, and the distance by the anteroposterior and mediolateral sides (p<0.05). The stable balance posture and unstable balance posture video showed significant differences in the distance by the COP, anteroposterior, and mediolateral distance. (p<0.05) @*Conclusion@#This study suggests that choosing the contents of the videos is important during action-observation training, and action-observation training can help improve postural control.
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Purpose@#This study examined the effects of heel raise exercises combined with neuromuscular electrical stimulation (NMES) on the muscle strength and postural control ability of subjects with functional ankle instability (FAI). @*Methods@#Twenty-two subjects with FAI participated in this study. They were assigned randomly to two groups: 11 each in the NMES and the sham-NMES groups. Heel raise exercise was applied, and NMES electrodes were attached to the peroneus longus muscles. The NMES group applied NMES during the heel raise exercise. NMES was applied for 20 minutes during the heel raise exercise. The heel raise exercise was performed four times a week for five weeks. The muscle strength and balance error scoring system (BESS) were measured before and after the intervention. @*Results@#A comparison of before and after the intervention within the groups revealed improved muscle strength in the NMES and Sham-NMES groups, but the BESS was improved under all conditions only in the NMES group. The Sham-NMES group showed no improvement in the unstable support surface. Furthermore, when comparing the amount of change before and after the intervention between the groups, there were significant differences in the total score and unstable support in the BESS and muscle strength. @*Conclusion@#NMES had a positive effect on the functional activities of the functional ankle instability subjects, such as balancing on an unstable support surface during postural control and increasing muscle strength.
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Purpose@#: The purpose of this study was to understand the relationship between workplace bullying, empathic ability, resilience, and job satisfaction to provide basic data for the development of programs and education aimed at improving nurses’ job satisfaction. @*Methods@#: Data were collected through a structured questionnaire disseminated to nurses working in general hospitals. A total of 226 questionnaires were used for the analysis. We analyzed the data using descriptive statistics, an independent t-test, a one-way ANOVA, Pearson’s correlation coefficient, and a stepwise multiple regression analysis. @*Results@#: Nurses’ job satisfaction showed a significant positive correlation with empathic ability and resilience and a significant negative correlation with workplace bullying. Additionally, resilience, workplace bullying, empathic ability, religion, and the hope of moving to another department were significant factors affecting job satisfaction. The explanatory power of these variables for job satisfaction was 41.0%. @*Conclusion@#: To improve job satisfaction, a strategy to lower workplace bullying and increase empathic ability and resilience is necessary. The results of this study suggest the need for further research to develop educational programs for nurses to strengthen their empathic ability and resilience.
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Purpose@#This study examined the effects of the type of video contents used for action observations on the ability to control posture. @*Methods@#The participants were 48 healthy adults. The two hands of the participants were crossed on both shoulders, and the other foot was placed in a straight line in front of the target to allow them to watch a video of the monitor. The videos were presented in random order with three video contents (natural, stable balance posture, and unstable balance posture) consisting of 30 seconds each. A 15-second resting time was given between each video. During action observation using various video content forms, the posture control ability was measured using a TekScan MetScan® system. @*Results@#The results revealed statistically significant differences in the area of movement and the distance by COP and distance by the type of action-observation videos, and the distance by the anteroposterior and mediolateral sides (p<0.05). The stable balance posture and unstable balance posture video showed significant differences in the distance by the COP, anteroposterior, and mediolateral distance. (p<0.05) @*Conclusion@#This study suggests that choosing the contents of the videos is important during action-observation training, and action-observation training can help improve postural control.
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Purpose@#This study examined the effects of heel raise exercises combined with neuromuscular electrical stimulation (NMES) on the muscle strength and postural control ability of subjects with functional ankle instability (FAI). @*Methods@#Twenty-two subjects with FAI participated in this study. They were assigned randomly to two groups: 11 each in the NMES and the sham-NMES groups. Heel raise exercise was applied, and NMES electrodes were attached to the peroneus longus muscles. The NMES group applied NMES during the heel raise exercise. NMES was applied for 20 minutes during the heel raise exercise. The heel raise exercise was performed four times a week for five weeks. The muscle strength and balance error scoring system (BESS) were measured before and after the intervention. @*Results@#A comparison of before and after the intervention within the groups revealed improved muscle strength in the NMES and Sham-NMES groups, but the BESS was improved under all conditions only in the NMES group. The Sham-NMES group showed no improvement in the unstable support surface. Furthermore, when comparing the amount of change before and after the intervention between the groups, there were significant differences in the total score and unstable support in the BESS and muscle strength. @*Conclusion@#NMES had a positive effect on the functional activities of the functional ankle instability subjects, such as balancing on an unstable support surface during postural control and increasing muscle strength.
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Purpose@#: The purpose of this study was to understand the relationship between workplace bullying, empathic ability, resilience, and job satisfaction to provide basic data for the development of programs and education aimed at improving nurses’ job satisfaction. @*Methods@#: Data were collected through a structured questionnaire disseminated to nurses working in general hospitals. A total of 226 questionnaires were used for the analysis. We analyzed the data using descriptive statistics, an independent t-test, a one-way ANOVA, Pearson’s correlation coefficient, and a stepwise multiple regression analysis. @*Results@#: Nurses’ job satisfaction showed a significant positive correlation with empathic ability and resilience and a significant negative correlation with workplace bullying. Additionally, resilience, workplace bullying, empathic ability, religion, and the hope of moving to another department were significant factors affecting job satisfaction. The explanatory power of these variables for job satisfaction was 41.0%. @*Conclusion@#: To improve job satisfaction, a strategy to lower workplace bullying and increase empathic ability and resilience is necessary. The results of this study suggest the need for further research to develop educational programs for nurses to strengthen their empathic ability and resilience.
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Objective@#To report our experience with management of fetuses with congenital high airway obstruction syndrome (CHAOS). @*Methods@#We retrospectively reviewed the cases of fetuses who were prenatally diagnosed and postnatally confirmed with CHAOS between 2010 and 2019 at Asan Medical Center, Seoul, Korea. @*Results@#Of 13 fetuses prenatally diagnosed with CHAOS, 7 were lost to follow-up and 6 were postnatally confirmed as having CHAOS. All fetuses, except one were delivered via cesarean section with an ex utero intrapartum treatment (EXIT) procedure. Two patients had coexisting congenital heart diseases requiring several cardiac surgeries following birth. Both of these patients demonstrated developmental delay; however, the remaining 4 had a normal development except for expressive language. Two infants died of respiratory complications, and the remaining 4 were alive at the end of the follow-up period. All 4 live patients underwent tracheostomy with planned reconstruction surgery. Three children are now able to phonate, and 1 can maintain a conservation. @*Conclusion@#The proper management of CHAOS using the EXIT procedure results in high survival and low hypoxemia-induced complication rates. Therefore, an accurate prenatal diagnosis is necessary for an appropriate perinatal management.
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Purpose@#Hospital-acquired infections, common in developing countries, are a leading cause of morbidity and mortality. This study was done to examine the effects of organizational culture and awareness of infection control on nursing practice of infection control by nurses working in emergency departments. @*Methods@#This descriptive correlational study was conducted with 135 nurses from the emergency department of a hospital. Data were collected from December 23, 2019, to January 14, 2020, using a structured questionnaire. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN 18.0. @*Results@#The mean score of organizational culture, awareness, nursing practice of infection control were 5.56±0.78 out of 7, 4.66±0.36 out of 5 and 4.51±0.38 out of 5, respectively. The multiple regression analysis demonstrated that awareness and organizational culture of infection control accounted for 43% of the nursing practice of infection control. @*Conclusion@#Study findings showed that there is a significant correlation between organizational culture, awareness, and nursing practice of infection control in the emergency department. Therefore, to improve nursing practices infection control in the emergency department, efforts should be made to promote infection control by developing education programs that can improve infection control awareness as well as strategies for a positive organizational culture.
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Purpose@#The purpose of this study was to identify the relationship between nursing error experience, coping behavior and job stress in operating room. @*Methods@#A descriptive research design was used in this study. The participants were 228 operating room nurses in G city who surveyed between October 25 and November 25, 2017 using self-report questionnaires. The data were analyzed using IBM SPSS/WIN 24.0/AMOS WIN 24.0 Program, which determined frequency, percentage, mean, standard deviation, Pearson correlation coefficient, and structural equation model. @*Results@#There were significant positive correlations between six sub-categories of nursing errors and job stress. We found negative correlations between coping behavior and job stress. There was a mediating effect of active coping between knowledge of nursing error and job stress. We found passive coping between inspection & monitoring related error and job stress. @*Conclusion@#Study findings suggest that adequate education and the improvement in hospital environment and system should be required to reduce the nurses’ job stress related to the patients’ safety in operating room.
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This study aimed to evaluate the relationship of sweet taste perception with overweight and obesity among workers in some industrial areas. Participants were 63 workers (mean age: 57.8±7.8 years), who were divided into three subgroups based on sweet taste evaluation using a sweet taste assessment tool provided by Ministry of Food and Drug Safety: unsweet group (n=25), medium sweet group (n=27), and sweet group (n=11). There was no significant difference in body mass index (BMI), and any work-related variables among the three groups; however, the difference between subjective perception and objective perception for sweet tastes is statistically different. We also found slight or fair agreement between subjective and objective sweet taste perception of the subjects (weighted kappa value 0.34~0.43). The present study provided measuring objective sweet taste perception may be useful for assessing the risk of high sugar consumption and for improving undesirable dietary behaviors, and management of non-communicable disease among workers.
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Objective@#The aim of this retrospective study was to evaluate the pre- and postsurgical bone densities at alveolar and extra-alveolar sites following twojaw orthognathic surgery. @*Methods@#The sample consisted of 10 patients (mean age, 23.2 years; range, 18.0–27.8 years; 8 males, 2 females) who underwent two-jaw orthognathic surgery. A three-dimensional imaging program (Invivo 5) was used with multidetector computed tomography images taken preand postoperatively (obtained 32.3 ± 6.0 days before surgery and 5.8 ± 2.6 days after surgery, respectively) for the measurement of bone densities at the following sites: (1) alveolar bone in the maxilla and mandible, (2) extra-alveolar sites, such as the top of the head, menton (Me), condyle, and the fourth cervical vertebrae (C4). @*Results@#When pre- and postsurgical bone densities were compared, an overall tendency of decrease in bone density was noted. Statistically significant reductions were observed in the densities of cancellous bone at several areas of the maxillary alveolar bone; cortical and cancellous bone in most areas of the mandibular alveolar bone; cortical bone in Me; and cancellous bone in C4. There was no statistically significant difference in bone density in relation to the depth of the alveolar bone. In a comparison of the bone densities between groups with and without genioplasty, there was almost no statistically significant difference. @*Conclusions@#Accelerated tooth movement following orthognathic surgery may be confirmed with reduced bone density. In addition, this study could offer insights into bone metabolism changes following orthognathic surgery, providing direction for further investigations in this field.