• Journal of Nutrition and Health
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• v.48 no.2
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• pp.167-179
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• 2015

Purpose: This study was conducted to evaluate the association between intakes of potassium, magnesium, and calcium and diet quality in ischemic stroke patients. Methods: This study analyzed data from 285 subjects recruited from February 2011 to August 2014 in Seoul, Korea. Nutrition intakes were obtained from a semi-quantitative food frequency questionnaire composed of 111 food items. The subjects were divided into 4 groups by quartiles according to intakes of potassium, magnesium, and calcium. Index of Nutritional Quality (INQ), Mean Adequacy Ratio (MAR), and DQI-International (DQI-I) were analyzed for assessment of diet quality. Results: We found a positive association of intakes of these three minerals with MAR and DQI-I after adjustment for age, sex, education level, smoking, atrial fibrillation, and total energy intake. However, total moderation of DQI-I score in the Q4 group was significantly lower than that of the Q1 group. The age, sex, education level, and smoking, atrial fibrillation, and total energy intake-adjusted odds ratios of extensive cerebral atherosclerosis were inversely associated with intake of magnesium (Ptrend = 0.0204). However, this association did not exist with intakes of potassium and calcium. Conclusion: Potassium, magnesium, and calcium rich and high quality diet could be associated with decreased risk of ischemic stroke, in part, via effect on extensive cerebral atherosclerosis.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.11
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• pp.4603-4608
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• 2015

Background: To determine the potential value of serum tumor markers in predicting pCR (pathological complete response) during neoadjuvant chemotherapy. Materials and Methods: We retrospectively monitored the pro-, mid-, and post-neoadjuvant treatment serum tumor marker concentrations in patients with locally advanced breast cancer (stage II-III) who accepted pre-surgical chemotherapy or chemotherapy in combination with targeted therapy at Fudan University Shanghai Cancer Center between September 2011 and January 2014 and investigated the association of serum tumor marker levels with therapeutic effect. Core needle biopsy samples were assessed using immunohistochemistry (IHC) prior to neoadjuvant treatment to determine hormone receptor, human epidermal growth factor receptor 2(HER2), and proliferation index Ki67 values. In our study, therapeutic response was evaluated by pCR, defined as the disappearance of all invasive cancer cells from excised tissue (including primary lesion and axillary lymph nodes) after completion of chemotherapy. Analysis of variance of repeated measures and receiver operating characteristic (ROC) curves were employed for statistical analysis of the data. Results: A total of 348 patients were recruited in our study after excluding patients with incomplete clinical information. Of these, 106 patients were observed to have acquired pCR status after treatment completion, accounting for approximately 30.5% of study individuals. In addition, 147patients were determined to be Her-2 positive, among whom the pCR rate was 45.6% (69 patients). General linear model analysis (repeated measures analysis of variance) showed that the concentration of cancer antigen (CA) 15-3 increased after neoadjuvant chemotherapy in both pCR and non-pCR groups, and that there were significant differences between the two groups (P=0.008). The areas under the ROC curves (AUCs) of pre-, mid-, and post-treatment CA15-3 concentrations demonstrated low-level predictive value (AUC=0.594, 0.644, 0.621, respectively). No significant differences in carcinoembryonic antigen (CEA) or CA12-5 serum levels were observed between the pCR and non-pCR groups (P=0.196 and 0.693, respectively). No efficient AUC of CEA or CA12-5 concentrations were observed to predict patient response toward neoadjuvant treatment (both less than 0.7), nor were differences between the two groups observed at different time points. We then analyzed the Her-2 positive subset of our cohort. Significant differences in CEA concentrations were identified between the pCR and non-pCR groups (P=0.039), but not in CA15-3 or CA12-5 levels (p=0.092 and 0.89, respectively). None of the ROC curves showed underlying prognostic value, as the AUCs of these three markers were less than 0.7. The ROC-AUCs for the CA12-5 concentrations of inter-and post-neoadjuvant chemotherapy in the estrogen receptor negative HER2 positive subgroup were 0.735 and 0.767, respectively. However, the specificity and sensitivity values were at odds with each other which meant that improving either the sensitivity or specificity would impair the efficiency of the other. Conclusions: Serum tumor markers CA15-3, CA12-5, and CEA might have little clinical significance in predicting neoadjuvant treatment response in locally advanced breast cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.3785-3791
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• 2016

Background: Previous studies have assessed the association between the Cytotoxic T-lymphocyte Antigen-4(CTLA-4) polymorphism with the risk of malignant bone tumor, but the conclusions were inconsistent. We aimed to clarify association of cytotoxic T-lymphocyte antigen-4 polymorphisms with malignant bone tumors risk by performing a meta-analysis. Materials and Methods: The databases including PubMed, EMBase databases and the Cochrane Library were searched to identify the eligible studies prior to January 30 2016. Odds ratio (OR) with 95% confidence interval (95%CI) were used to estimate the strengths of the association between the CTLA-4 polymorphism and the malignant bone tumor risks. The meta-analysis was performed by STATA 12.0. Results: Four individual studies with a total of 1003 cases with malignant bone tumor and 1162 controls were included in our meta-analysis. The results of meta-analysis on those data demonstrated that CTLA-4 +49G>A polymorphism was associated with the risk of Ewing's sarcoma and osteosarcoma strongly (A vs. G: OR=1.36, 95%CI:1.20-1.54, p=0.000; AA+AG vs. GG: OR=1.35, 95%CI:1.14-1.61, p=0.001; AA vs. GG: OR=2.24, 95%CI:1.67-2.99, p=0.000; AA vs. AG+GG: OR=2.00, 95%CI:1.53-2.62, p=0.000), but CTLA-4 -318C/T polymorphism was not associated with the risk of malignant bone tumor (C vs. T: OR=0.76, 95%CI:0.76-1.08, p= 0.262; CC+CT vs. TT: OR=0.70, 95%CI:0.41-1.20, p= 0.198; CC vs. TT: OR=0.69, 95%CI:0.40-1.19, p= 0.183; CC vs. CT+TT: OR=0.92, 95%CI:0.75-1.13, p= 0.419). Subgroup analysis showed that there are significantly positive correlations between CTLA-4 +49G>A polymorphism and increased risks of malignant bone tumors in large size of sample (A vs. G: OR=1.347, 95%CI: 1.172,1.548, p=0.000; AA vs. GG: OR=2.228, 95%CI: 1.608,3.085, p=0.000), Ewing's Sarcoma or Osteosarcoma (A vs. G: OR=1.361, 95%CI: 1.201,1.540, p=0.000; AA vs. GG: OR=2.236, 95%CI: 1.674,2.986, p=0.000), and PCR-RFLP or Sequencing(A vs. G: OR=1.361, 95%CI: 1.201,1.540, p=0.000; AA vs. GG: OR=2.236, 95%CI: 1.674,2.986, p=0.000), but CTLA-4 -318C/T polymorphism was not associated with the risk of malignant bone tumors in diagnosis, genotype method, and sample size (all p>0.05). Conclusions: CTLA-4 +49A/G variant was associated with an increased risk of developing the malignant bone tumors, such as Ewing's sarcoma and osteosarcoma. However, it failed to show the association between CTLA-4 -318C/T polymorphism and the risk of malignant bone tumors. Future large-scale studies remain to be done to confirm our conclusions.

• Journal of agricultural medicine and community health
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• v.40 no.1
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• pp.21-31
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• 2015

Objective: This study was to evaluate the health-related quality of life (HRQoL) among patients with diabetes in Korea and to compare them with the HRQoL of individuals without diabetes history. Methods: The study subjects were 17,655 adults aged over 19 who participated in the 5th Korea National Health and Nutrition Examination Survey (2010-2012). The EuroQoL-5Dimension was used to evaluate HRQoL. Chi-square test, t-test, ANOVA and multiple regression analysis were performed to test the difference of HRQoL in diabetic subjects and controls. Results: The mobility dimension was the highest reported problem: 36.4% for diabetic subjects. The proportion of any reported problem was significantly high among diabetic subjects compared with two controls in terms of mobility [reference group: diabetic subjects, chronic controls: adjusted odds ratio (aOR)=0.77, 95% confidence interval (95% CI)=0.66-0.91, healthy controls: aOR=0.61, 95% CI=0.50-0.75], self-care [reference group: diabetic subjects, chronic controls: aOR=0.68, 95% CI=0.55-0.83, healthy controls: OR=0.69, 95% CI=0.51-0.94]. and usual activities [reference group: diabetic subjects, chronic controls: aOR=0.85, 95% CI=0.72-0.99, healthy controls: OR=0.79, 95% CI=0.62-0.98]. Also, EQ-5D index were significantly low in subjects with diabetes compared to two controls. Conclusions: Subjects with diabetes had a significantly lower HRQoL compared with two controls. To improve the quality of life of diabetics, it is necessary to study various variables related to the quality of life, and develop and manage various health programs or welfare policies reflecting socio-demographic characteristics and health related features that affect the quality of life.

• Journal of dental hygiene science
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• v.16 no.3
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• pp.217-224
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• 2016

The aim of this study was to evaluate whether the number of existing permanent teeth is associated with chronic obstructive pulmonary disease (COPD) in a representative sample of Korean adults. Data from 3,107 subjects who participated in the 2009 Korea National Health and Nutrition Examination Survey were examined. The dependent variable was COPD and the independent variable was the number of existing permanent teeth. Spirometry results were classified into three groups (normal pattern, restrictive pattern, and obstructive pattern) by trained technicians. We used dichotomized COPD variables (no vs. yes). The number of existing permanent teeth was evaluated by oral examination and divided into 3 groups (0~19, 20~27, and 28). Demographic factors (age group and sex group), socioeconomic status (education and income), health behaviors (smoking and drinking), oral health and behavior (frequency of toothbrushing; periodontitis; decayed, missing, filled, permanent teeth index; and denture status), and general health status (body mass index, diabetes mellitus, and hypertension) were included as confounders in the analysis. Bivariate analysis and multivariate logistic regression analyses including confounders were applied, and all analyses considered a complex sampling design. Stratified analysis was performed by smoking status. After controlling for various confounders, there was a significant association between the number of existing permanent teeth and COPD (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.20~3.00 for the 20~27 group; OR, 3.93; 95% CI, 1.75~8.84 for the 0~19 group). The association was more significant in current smokers (OR, 8.90; 95% CI, 2.53~31.33). Our data indicate that the number of existing permanent teeth was independently associated with COPD, especially in current smokers. Further longitudinal research is needed to determine whether oral health promotion plays a role in the improvement of lung function and prevention of COPD.

• Journal of dental hygiene science
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• v.16 no.3
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• pp.193-199
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• 2016

The objective of this study was to investigate the relationship between health-risk factors and oral health in Korean adolescents. This cross-sectional study was based on the 9th Korea Youth Risk Behavior Web-Based Survey (2013). The final participation rate in the survey was 96.4%. of a Total of 72,435 adolescents (age, 12~18 years) who had participated in the survey, 66,951 adolescents (33,777 boys and 33,174 girls) were selected for analysis, after excluding those with missing data. The key variables were oral health factors (one or more of the six oral symptoms), general characteristics (five factors), and health-risk factors (five factors). After adjusting for the general characteristics, frequency analysis, ${\chi}^2-test$ using PASW Statistics ver. 18.0, and logistic regression analysis were performed to understand the effects of health risk-factors on the oral symptoms experienced by the study subjects. Subjects who answered 'Yes' for alcohol consumption had a 1.33 times higher risk of experiencing oral symptoms. Further, subjects who smoked were at a 1.2 times higher risk of experiencing oral symptoms. With regard to internet use, the risk of experiencing oral symptoms was 1.25 times higher for subjects who used the internet for 7 hours or more than for those who used it for less than 1 hour. Compared to those subjects who had not experienced violence in school, the odds ratio of subjects who had experienced it 3~4 times was 1.54-fold higher. The study found that health-risk factors were associated with oral symptom experience. Therefore, programs to understand health-risk factors and interventions should be developed for Korean adolescents and provided on a regular basis along with oral health education.

• Journal of dental hygiene science
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• v.14 no.4
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• pp.468-476
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• 2014

The aim of this study was to examine whether there is an association between vitamin intakes and established periodontitis in Korean adult population. The 6,245 subjects aged over 19 years old, who participated in health survey, oral examination and nutrition survey were selected for this study from the database of the Fourth Korean National Health and Nutrition Examination Survey. Established periodontitis was defined as ${\geq}$ code 3 in community periodontal index. Vitamin intake was assessed with the food-frequency questionnaire. In analysis, participants were classified by quintile of vitamin intakes. We also considered covariates as socio-demographic characteristics, health-related behaviors including physical activities, systemic diseases and oral health-related behaviors. Multiple logistic regression was performed to assess the crude and adjusted associations. All analyses considered a complex sampling design using SAS 9.2. In crude analysis, less intake of vitamin A, retinol and vitamin B2 significantly increased the risk of periodontitis (vitamin A, odds ratio [OR] Q1=1.00, Q2=0.73, Q3=0.80, Q4=0.77, Q5=0.78; retinol, OR: Q1=1.00, Q2=0.86, Q3=0.73, Q4=0.62, Q5=0.55; vitamin B2, OR: Q1=1.00, Q2=0.70, Q3=0.63, Q4=0.67, Q5=0.68). However, after adjusting for socio-demographics, general and oral health status and behaviors, only vitamin B2 was significantly associated with established periodontitis (OR: Q1=1.00, Q2=0.72, Q3=0.73, Q4=0.76, Q5=0.84). An adequate vitamin B2 intake was significantly associated with a decreased risk of periodontitis. This finding shows that nutrient intake is slightly correlated with periodontitis in Korean adult population. Further studies are needed to understand this association between nutrients intake and periodontitis in more details.

• Journal of the Korean Society of Food Science and Nutrition
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• v.33 no.1
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• pp.83-90
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• 2004

This study was conducted to examine the effects of $\beta$3-adrenergic receptor polymorphism on the blood glucose level and obesity in 530 volunteers, who attended a weight loss program in a local obesity clinic. The age differences in total subjects and the distribution of male and female were 26.55$\pm$0.31 yr, 9.1% (n=48), 90.9% (n=492). The genotype distribution of $\beta$3-AR gene polymorphism were WW type 75%, WR type 22% and RR type 3%. Among many parameters, fasting blood glucose was significantly higher in WR＋RR type (p=0.001) compared with WW type. When the subjects were divided into two groups by 6.105 mmol/L of the fasting blood glucose level, the frequency of hyperglycemia was 23.3% in WW type subjects, while there was a increase to 35.6% in WR＋RR type subjects (p=0.011, $\chi$$^2$-analysis). When hyperglycemia group was compared with normoglycemia group, obesity index (p=0.044), %body fat (p=0.046) and TG (p=0.000) were significantly higher, and HDL (p=0.006) was significantly lower in the hyperglycemia. When all of the above factors were included in stepwise logistic regression analysis to find risk factors of hyperglycemia, the results were that the odds ratio for hyperglycemia were 2.015 (p=0.011) for WR+RR type of $\beta$3-AR gene, 2.165 (p=0.000) for TG and 0.419 (p=0.059) for HDL cholesterol. There was a significantly positive correlation between the blood glucose vs BMI, WHR, body fat in the WW type (r=0.099, 0.119, 0.082) However, in the WR and RR type there were no significance between the blood glucose vs BMI, WHR, body fat. These data suggest that the WR＋RR genotype of $\beta$3-AR has a very strong association with increased blood glucose level and might be a significant risk factor for hyperglycemia among Korean subjects.

• Journal of agricultural medicine and community health
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• v.38 no.4
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• pp.229-242
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• 2013

Objectives: The objective of this study was to identify the influence of shift work on sleep quality, daytime sleepiness, and perceived errors during nursing work among hospital nurses. Methods: The study subjects were 209 hospital nurses working in two general hospitals in South Korea. The data were collected through self-administered questionnaires in May 2013. Sleep quality was measured using Korea Pittsburgh Sleep Quality Index (PSQI-K), daytime sleepiness was measured using Epworth Sleepiness Scale (ESS), and perceived errors in past 6 months during nursing duty hours with the tool developed in this study. Results: The sleep quality was significantly worse among rotating shift nurses when compared to fixed day duty nurses. However, the odds ratio (OR) of 1.92 [95% confidence interval(CI): 0.58-6.37] adjusted for sociodemographic variables, health behaviors, and working environment in logistic regression was not significant. There was no significant difference in the daytime sleepiness between rotating shift nurses and fixed day duty nurses in both simple and multivariable analyses. There were significantly more perceived errors in rotating shift nurses than fixed day duty nurses. However, the OR of 1.26 (95% CI: 0.38-4.21) adjusted for sociodemographic variables, health behaviors, working environment, sleep quality, and daytime sleepiness in logistic regression was not significant. Depression (OR=3.31, 95% CI: 1.11-9.84) and daytime sleepiness(OR=1.18, 95% CI: 1.07-1.30) were significantly associated with perceived errors in logistic regression. Conclusion: This study suggested shift work among hospital nurses had no independent influence of sleep quality, daytime sleepiness, and perceived errors. However, daytime sleepiness had independent influence of perceived errors. More studies are warranted to achieve more reliable conclusion.