Nutrition teacher’s perception and current status of nutrition education for free learning semester program: a preliminary study / 대한지역사회영양학회지

Objectives@# This study aimed to investigate the current status of nutrition education via a free learning semester program (NE). The understanding of the program, the potential difficulties, and future initiatives for NE improvement were also investigated. @*Methods@# A total number of 161 nutrition teachers from Gwangju and Jeonnam filled in a questionnaire and participated in this survey, which was performed from July to August 2019. @*Results@# Our results showed that 8.1% of the nutrition teachers had taught nutrition education in free learning semester programs. The most frequently implemented model was subject selection, followed by club activities. Most of the nutrition teachers comprehended the purpose of NE. The attitude of nutrition teachers to NE differed by the understanding of its purpose. Positive attitude was evident due to a better understanding of the purpose by nutrition teachers. Nutrition teachers reported the most common difficulties of NE were the lack of preparation due to the heavy workload and the lack of a standard running program.The most effective method of NE was the activity classes. The experience of practicing NE influenced the choice of contents for each operating model. Nutrition teachers that were experienced in NE conducted via free learning semester programs preferred the selected topics model, but those without experience chose the career search model. @*Conclusions@# Although some obstacles exist, nutrition teachers had a positive attitude and perceived well the importance of NE. Therefore, the awareness for the significance of NE of nutrition teachers needs to be improved. For better NE practice, it is necessary to reduce/ manage the workload of general food service. Furthermore, the development of standard running and promotion programs, and teacher training programs should be ensured.

Study on Needs for Functional Candy (lozenges) Development for Oral Dryness

As the morbidity of chronic diseases such as diabetes and high blood pressure has increased, the frequency of oral dryness upon taking drugs for a long time or several drugs at the same time has greatly increased. This study was conducted to investigate the status of oral dryness and utilize the data to develop treatment products. Surveys were assembled from October to December 2018, and a statistical analysis of the 144 responses was conducted. The surveyed consisted of 60 males and 84 females, with 31.3% of those in their 70s and older. Among them, 100 people took drugs for chronic diseases, while 27 people took drugs for more than 10 years and less than 20 years. Exactly 23 respondents who took drugs suffered from more than two types of chronic diseases, of which high blood pressure was the most cited, followed by hyperlipidemia and diabetes. Regarding complications, oral dryness (33.8%) was the most frequent, and there were significant differences in the degree of discomfort when taking medicine, especially for oral dryness depending on the age (P＜0.05). Groups that took medicine showed severe symptoms of dry mouth, especially when waking up at night or in the morning (P＜0.001) and eating food (P＜0.01), and had difficulty in swallowing food (P＜0.01) and speaking (P＜0.01). Exactly 89.6% of the respondents didn’t take lozenges (candy) for improvement of oral dryness, and the type of the product that they wanted to purchase the most was candy (45.1%). Respondents worried about rising blood sugar, dental caries, and calories when eating candy for relieving dryness (P＜0.01).

Digital Therapeutics: Emerging New Therapy for Neurologic Deficits after Stroke / 대한뇌졸중학회지

Digital therapeutics is an evidence-based intervention using high-quality software, with the sole purpose of treatment. As many healthcare systems are encountering high demands of quality outcomes, the need for digital therapeutics is gradually increasing in the clinical field. We conducted review of the implications of digital therapeutics in the treatment of neurological deficits for stroke patients. The implications of digital therapeutics have been discussed in four domains: cognition, speech and aphasia, motor, and vision. It was evident that different forms of digital therapeutics such as online platforms, virtual reality trainings, and iPad applications have been investigated in many trials to test its feasibility in clinical use. Although digital therapeutics may deliver high-quality solutions to healthcare services, the medicalization of digital therapeutics is accompanied with many limitations. Clinically validated digital therapeutics should be developed to prove its efficacy in stroke rehabilitation.

Characteristics of Nystagmus during Attack of Vestibular Migraine / 대한평형의학회지

OBJECTIVES: The purpose of this study is to investigate characteristics of nystagmus during attacks of vestibular migraine (VM), and to find a distinct clinical feature compared to other migraine and peripheral vestibular disorders. METHODS: This study is a retrospective chart review of 82 patients satisfied with VM criteria, which is formulated by the new Bárány Society. Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography in all patients. Bithermal caloric test and cervical vestibular evoked myogenic potential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, unilateral caloric weakness and interaural difference of cVEMP were analyzed. Control groups were lesion side in acute VN for nystagmus results and healthy side in the patients with benign paroxysmal positional vertigo of posterior semicircular canal for caloric and cVEMP results. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: During the acute attack, nystagmus was seen in 71.9% (59 of 82) of patients. Horizontal nystagmus was the predominant type. Peak SPV in VM patients was much slower than in the control group (2.37±1.73 °/sec vs. 17.05±12.69 °/sec, p<0.0001). There was no significant difference on the result of both caloric and cVEMP test, compared to those of control groups. CONCLUSION: Nystagmus with horizontal directions and low SPV was dominant form in the attack of VM. Close observation of nystagmus can be helpful to make a correct diagnosis and to understand the pathomechanism of vertigo in VM.

Posttraumatic Peripheral Vertigo / 대한평형의학회지

Posttraumatic vertigo can be defined as the vertiginous disorder occurred after head and neck trauma without other pre-existing vestibular disorder. Central, peripheral, and combined deficits might cause this condition. Especially, various peripheral vestibulopathies are possible causes of posttraumatic vertigo; benign paroxysmal positional vertigo, temporal bone fracture, perilymphatic fistula, labyrinthine concussion, posttraumatic hydrops, and cervical vertigo. Since the differential diagnosis of the posttraumatic vertigo is often difficult, it is essential to acquire knowledge of their pathophysiology and clinical features. In this review, peripheral vestibulopathy as the possible causes of posttraumatic vertigo were described according to the current literature.

Identification of Vestibular Organ Originated Information on Spatial Memory in Mice / 대한평형의학회지

OBJECTIVES: We aimed to study the role of vestibular input on spatial memory performance in mice that had undergone bilateral surgical labyrinthectomy, semicircular canal (SCC) occlusion and 4G hypergravity exposure. METHODS: Twelve to 16 weeks old ICR mice (n=30) were used for the experiment. The experimental group divided into 3 groups. One group had undergone bilateral chemical labyrinthectomy, and the other group had performed SCC occlusion surgery, and the last group was exposed to 4G hypergravity for 2 weeks. The movement of mice was recorded using camera in Y maze which had 3 radial arms (35 cm long, 7 cm high, 10 cm wide). We counted the number of visiting arms and analyzed the information of arm selection using program we developed before and after procedure. RESULTS: The bilateral labyrinthectomy group which semicircular canal and otolithic function was impaired showed low behavioral performance and spacial memory. The semicircular canal occlusion with CO₂ laser group which only semicircular canal function was impaired showed no difference in performance activity and spatial memory. However the hypergravity exposure group in which only otolithic function impaired showed spatial memory function was affected but the behavioral performance was spared. The impairment of spatial memory recovered after a few days after exposure in hypergravity group. CONCLUSIONS: This spatial memory function was affected by bilateral vestibular loss. Space-related information processing seems to be determined by otolithic organ information rather than semicircular canals. Due to otolithic function impairment, spatial learning was impaired after exposure to gravity changes in animals and this impaired performance was compensated after normal gravity exposure.

Laboratory Management Status of Vestibular Function Test in Korea / 대한평형의학회지

OBJECTIVES: This study was conducted to assess the current management status of the vestibular function test laboratories in Korea. METHODS: Questionnaire about the management status of the vestibular function test laboratories was sent by email to the entire members of the Korean Balance Society. The contents of questionnaire included situation of employees who perform the tests, the types of vestibular function tests and equipment, frequency of the test and types of dizziness related questionnaires. RESULTS: Forty-nine hospitals and clinics responded. All the 49 respondents answered that they have videonystagmography. Spontaneous nystagmus analysis by videonystagmogrphy was the most frequently tests for patients with dizziness. Questionnaires for dizziness were used by 27 respondents (55.1%) for initial evaluation of the dizziness patients. The Korean version of dizziness handicap inventory was the most frequently used dizziness related questionnaire. CONCLUSIONS: We analyzed the current management status of vestibular function test laboratories to comprehend the present condition of the vestibular function test. We think that these results will help to provide a standard for laboratory operations and prepare for the education, focusing on high-demand tests.

Hyper-response of Cervical Vestibular Evoked Myogenic Potential in Patients with Meniere Disease: A Preliminary Study / 대한평형의학회지

OBJECTIVES: The purpose of this study is to investigate the hyper-responsiveness of cervical vestibular-evoked myogenic potential (cVEMP) in patients with Meniere disease (MD), and to compare the result of cVEMP between probable and definite MD group. METHODS: A total of 110 patients satisfied with probable MD and definite MD criteria, which is recently formulated by the Classification Committee of the Bárány Society, were included. An interpeak amplitude and interaural amplitude difference (IAD) ratio of both ears was measured. The abnormal response of ipsi-lesional cVEMP was categorized into 2 groups; hyper-response and hypo-response. Chi-square test and Mann-Whitney U-test were used for statistical analysis. RESULTS: In the probable MD and definite MD group, the mean IAD was 25.24%±17.79% and 53.82%±34.98%, respectively (p < 0.01). The abnormal response of cVEMP at the affected ear was more frequent in the definite MD group, compared to the probable MD group (32/40 vs. 13/36, p < 0.01). However, hyper-response was more frequently observed in the patients with probable MD, compared to the patients with definite MD (13/36 vs. 3/40, p < 0.01). CONCLUSION: Hyper-response of cVEMP was more frequently observed in the early probable MD patients. It might be an early sign of MD, related with the saccular hydrops, which can help the early detection and treatment.

The Relationship of Caffeine Intake with Depression, Anxiety, Stress, and Sleep in Korean Adolescents / 가정의학회지

BACKGROUND: In various studies in adults, caffeine may increase wakefulness and relieve pain, but caffeine overdose can cause many adverse serious effects on health. Caffeine intake has recently been increasing in adolescents. In spite of importance of caffeine effects on Korean adolescents, there are lack of scientific and systematic studies. The purpose of our study was to identify the relationship between caffeine consumption and effects on adolescents. METHODS: We performed study on 234 middle school students at one middle school in Daegu using a self-report questionnaire. We divided students to quartiles according to amount of caffeine intake. We used Beck Depression Inventory (BDI) to evaluate the degree of depression and Beck Anxiety Inventory (BAI) to evaluate the degree of anxiety. We also used Insomnia Severity Scale (ISI) to evaluate the degree of insomnia and Global Assessment of Recent Stress (GARS) to evaluate the stress in students. We used logistic regression analysis to identify the relationship between caffeine consumption and effects. RESULTS: Higher caffeine intake was associated with higher weight, height, lower academic achievement, and higher score in BDI, BAI, ISI, and GARS (P for trend <0.005). Higher caffeine intake quartile was associated with greater odds of having significant depression (BDI ≥10, P for trend=0.011), and insomnia (ISI ≥8, P for trend=0.015) after adjustment for factors that can affect the psychological status. CONCLUSION: We found that caffeine intake is associated weight, height, academic achievement, and higher score in BDI, BAI, ISI, and GARS. Caffeine intake was positively associated with the severity of depression and the severity of insomnia among adolescents in Korean.

Experiemental Model for Ménière's Disease Using Surgical Ablation of Endolymphatic Sac / 대한평형의학회지

Endolymphatic hydrops is a representing pathologic finding of Ménière's disease. For the induction of endolymphatic hydrops in an animal model, surgical ablation of endolymphatic sac has been used. Although traditional model with the blockage of endolymphatic sac induced severe hydrops, it has several limitations for the study of pathophysiology of Ménière's disease. Recently, modified experimental models have been introduced, in which additional procedure was performed to induce the acute aggravation of hydrops after the surgical ablation. These new models could be helpful to elucidate the mechanism and develop a new treatment of Ménière's disease. In this review, we introduce the characteristics of animal models using surgical ablation of endolymphatic sac from the classical model to novel modified models.

Acute Vestibular Neuritis and Ramsay-Hunt Syndrome / 대한평형의학회지

Acute vestibular neuritis is the disorder characterized by acute, spontaneous vertigo with the unilateral vestibular loss. Reactivation of herpes simplex virus is considered as its cause. Its management consists of symptomatic therapy in the acute phase and following rehabilitation exercise to improve central compensation. The differential diagnosis should include central vestibular disorders mimicking peripheral vertigo. Ramsay-Hunt syndrome, which defined as a herpes zoster oticus with facial paresis, is also a disorder frequently accompanied with vestibular deficit. Combination therapy of acyclovir and corticosteroid is recommended for the treatment. In this review, diagnosis and management of the two disorders are described.

Vestibulo-Ocular Reflex Recordings of Small Rodents using a Novel Marker Array / 대한평형의학회지

OBJECTIVE: Recording the nystagmus of small experimental rodents is an integral technique in vestibular research. Theoretically, the size and the shape of markers strongly affect the analysis of 3 dimensional nystagmus. METHODS: The nystagmus of 6 healthy ICR mice were recorded and their gain values were compared using 200 µm, 300 µm, 400 µm, and 600 µm isosceles triangle markers at the peak velocity of 60°/sec and 100°/sec with the rotational stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz. RESULTS: The gain values of 3 different sizes of the markers showed no significant differences in horizontal- vertical-torsional component. However, it was unable to record the nystagmus with 200 µm markers since the markers were too small to be placed and stayed on the center of the pupils. CONCLUSION: Technicians can decide the size of the markers from 200 to 600 µm to record the nystagmus of mice, depending on the technicians' skills.

Predictors of Distant Metastasis after Radical Surgery Followed by Postoperative Radiotherapy with or without Chemotherapy for Oropharyngeal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We investigated the prognostic factors for distant metastasis (DM) in patients with locally advanced oropharyngeal cancer (OPC) treated with surgery and adjuvant radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS: Eighty-five patients treated between January 1995 and August 2014 were evaluated retrospectively. Data regarding the pathological tumour and nodal status, human papillomavirus (HPV) status, treatment characteristics, and pretreatment maximum standardized uptake value (SUVmax) of 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography scan (¹⁸F-FDG PET-CT) were evaluated, and their influence on DM and survival outcomes were analyzed. RESULTS: Median follow-up period was 48.0 months. Recurrence was observed in 20 patients, including locoregional recurrence and DM. DM was observed in 13 patients. A multivariate analysis confirmed that the presence of lymphovascular invasion (p=0.031), lower neck lymph node (LN) involvement (p=0.006), SUVmax ≥ 9.7 (p=0.014), and tumour size ≥ 3 cm (p=0.037) significantly affected DM. HPV status was not associated with DM. Perineural invasion (p=0.048), lower neck LNinvolvement (p=0.008), SUVmax ≥ 9.7 (p=0.019), and tumour size ≥ 3 cm (p=0.033) were also significant factors for the DM-free survival rate. CONCLUSION: Lower neck LN involvement, high SUVmax in pretreatment ¹⁸F-FDG PET-CT, and large tumour size were predictive factors for DM in patients of OPC.

Intracardiac Echocardiography to Guide Biopsy for Two Cases of Intracardiac Masses

Pathologic diagnosis of a cardiac mass is vital in determining the proper treatment modality. Open heart surgery or transesophageal echocardiography guided biopsy can be feasible methods to confirm the pathology. However, the former is highly invasive and both methods require general anesthesia. The introduction of intracardiac echocardiography (ICE) can provide good anatomic information of heart and does not require general anesthesia. In this report, we present two cases of cardiac tumors which were confirmed by percutaneous biopsy under the guidance of an ICE. The patients underwent cardiac biopsy without any complications.

A Dosimetric Comparative Analysis of TomoDirect and Three-Dimensional Conformal Radiotherapy in Early Breast Cancer / 한국유방암학회지

PURPOSE: The purpose of this study is to compare dosimetric parameters of intensity-modulated mode of TomoDirect and three-dimensional conformal radiotherapy (3D-CRT) in patients with early breast cancer. METHODS: TomoDirect and 3D-CRT planning were carried out for 26 patients with early breast cancer who had received breast-conserving surgery. A total of 50.4 Gy in 28 fractions were prescribed to the planning target volume. The organs at risk (OAR) such as lung and heart were contoured. Planning target volume (PTV) dose coverage, radiation conformity index (RCI), radical dose homogeneity index (rDHI), and irradiation dose of organs at risk were compared between TomoDirect and 3D-CRT planning. RESULTS: The mean PTV dose (51.65+/-0.37 Gy) and V47.8 (100%) in TomoDirect were significantly higher than the mean PTV dose (50.88+/-0.65 Gy) and V47.8 (89.23%+/-0.06%) in 3D-CRT (all, p<0.001). The RCI value in TomoDirect was significantly better than that in 3D-CRT (1.00 vs. 1.13, p<0.001). However, the rDHI value in TomoDirect was not significantly better than that in 3D-CRT (0.72 vs. 0.67, p=0.056). The mean lung dose and V10, V20, V30, and V40 values of ipsilateral lung in TomoDirect were significantly lower than those in 3D-CRT (all, p<0.05). There is no significant difference in the V10, V20, V30, and V40 values of heart between TomoDirect and 3D-CRT. And the mean dose for heart in TomoDirect was marginally lower than that in 3D-CRT (1.05 Gy vs. 1.62 Gy, p=0.085). The mean dose for left anterior descending coronary artery in left breast cancer was significantly lower in TomoDirect than in 3D-CRT (7.2 Gy vs. 12.1 Gy, p<0.001). CONCLUSION: Compared to 3D-CRT, TomoDirect could result in favorable target coverage while reducing the irradiation dose of the ipsilateral lung for patients with early breast cancer.

Validation of Waist-to-Height Ratio for Predicting Metabolic Syndrome in Patients with Prediabetes

BACKGROUND: Metabolic syndrome is associated with type 2 diabetes and cardiovascular disease in patients with prediabetes. The aim of this study was to investigate and compare WHtR (Waist-to-Height Ratio) as a predictor of metabolic syndrome with other anthropometric indices as in Body Mass Index (BMI), Waist Circumference (WC) and Waist to Hip Ratio (WHR) in prediabetes. METHODS: A total of 816 subjects with prediabetes were recruited from a community based Cohort Study. Receiver operating characteristic (ROC) curve was performed to find the optimal cutoff value of WHtR. Area under the curve (AUC) was calculated for each anthropometric index and correlation coefficient between WHtR and various dermographic and clinical factors was calculated. RESULTS: WHtR had a significant correlation with metabolic parameters except for fasting glucose and increased with increasing number of risk factors for metabolic syndrome. AUC of WHtR was significantly higher than that of other anthropometric indices. The optimal cutoff value of WHtR was 0.53 for metabolic syndrome in prediabetes. CONCLUSION: WHtR may be the simple and effective anthropometric index for predicting metabolic syndrome in prediabetic patients.

Pharmacists' Perceptions of Barriers to Providing Appropriate Pharmaceutical Services in Community Pharmacies

BACKGROUND: In order to achieve the goals of community pharmacy practice, its legal, labour-related, and economic barriers need to be identified. This study examined pharmacists' perceptions of constraints on providing optimal pharmacy services in order to identify underlying factors and analyse the associations between barriers and pharmaceutical services in community pharmacies. METHODS: A survey targeting pharmacy owners was conducted from May to June 2012 using a structured questionnaire including nine pharmaceutical service items. According to the service provision level, we classified pharmacists as inactive (fewer than 5 items among the listed 9 service items) and active providers (5 or more items). Principal component analysis was used to group significant factors for barriers into four thematic components. Associations between the participants' demographics and pharmacy characteristics and the services provided were explored by logistic regression analyses. RESULTS: Participants were 402 pharmacists. Over 60% provided disease management services for hypertension, diabetes, and hyperlipidaemia. Variables that affected pharmaceutical services included the lack of separate areas for patient counselling (OR: 2.12, 95% CI: 1.18-3.80), and clinical knowledge and information-related barriers (OR: 0.59, 95% CI: 0.36-0.97). CONCLUSION: Strategies for improving clinical knowledge and providing expeditious information are necessary in order to improve community pharmacy services.

Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. MATERIALS AND METHODS: We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared. RESULTS: The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010). CONCLUSION: Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

Pulmonary Artery Angiosarcoma Confused with Acute Pulmonary Thromboembolism: Focusing on Clinical and Echocardiographic Features in the Differentiation of Two Categories

Although pulmonary artery angiosarcoma is rare, it can be misdiagnosed as pulmonary embolism because of its similar clinical and diagnostic features. The diagnosis is often delayed and the misdiagnosis brings unnecessary treatment. Because we made a wrong diagnosis of pulmonary artery angiosarcoma as an acute pulmonary embolism, we did thrombolytic therapy which could be dangerous to the patient. In this case report, we focused on the clinical and echocardiographic features of pulmonary artery angiosarcoma which can be used in differentiating the diagnosis from pulmonary embolism.

Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study investigated setup error and effectiveness of weekly image-guided radiotherapy (IGRT) of TomoDirect for early breast cancer. MATERIALS AND METHODS: One hundred and fifty-one breasts of 147 consecutive patients who underwent breast conserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013 were evaluated. All patients received weekly IGRT. The weekly setup errors from simulation to each treatment in reference to chest wall and surgical clips were measured. Random, systemic, and 3-dimensional setup errors were assessed. Extensive setup error was defined as 5 mm above the margin in any directions. RESULTS: All mean errors were within 3 mm of all directions. The mean angle of gantry shifts was 0.6degrees. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariate analysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significant factor for extensive error. The largest significant deviation of setup error was observed in the first week of radiotherapy (p < 0.001) and the deviations gradually decreased with time. The deviation of setup error was 5.68 mm in the first week and within 5 mm after the second week. CONCLUSION: In this study, there was a significant association between breast size and significant setup error in breast cancer patients who received TomoDirect. The largest deviation occurred in the first week of treatment. Therefore, patients with large breasts should be closely observed on every fraction and fastidious attention is required in the first fraction of IGRT.