Temporomandibular disorders and autonomic dysfunction: Exploring the possible link between the two using a questionnaire survey.

OBJECTIVE: To assess autonomic function and investigate factors related to its dysfunction in patients with temporomandibular disorders (TMD) from a biopsychosocial perspective. METHODS: Seventy-six patients with TMD were investigated by clinical examination and questionnaires concerning biopsychosocial aspects (The Brief Pain Inventory, the Pain Catastrophizing Scale, and the Symptom Checklist-90-Revised) and autonomic dysfunction (The COMPASS 31). RESULTS: Seventy-one patients were included in the study. The result of multiple regression analysis showed that four variables (sex, depression, age, and pain interference) were significantly associated with autonomic dysfunction. Increased orthostatic intolerance and bladder dysfunction were observed in females and males, respectively. Younger age was associated with higher orthostatic intolerance, while higher pain interference was associated with higher secretomotor dysfunction and bladder dysfunction. Further, higher depression scores were linked to higher scores in the gastrointestinal subdomain. CONCLUSION: Autonomic dysfunction may affect TMD-related pain in the context of a biopsychosocial perspective.

Principal component analysis of the biopsychosocial features relevant to temporomandibular disorders.

OBJECTIVES: This study aimed to explore the dimensionality of three biopsychosocial constructs with multiple subdimensions, including the Symptom Checklist-90-Revised (SCL-90R), pain catastrophizing scale (PCS) and Pittsburgh Sleep Quality Index (PSQI), and to identify the latent dimensions of five biopsychosocial constructs (SCL-90R, PCS, PSQI, pain severity, and pain interference) using the principal component analysis (PCA) in patients with temporomandibular disorder (TMD). SUBJECTS AND METHODS: A secondary analysis of a previous cross-sectional study comprising 1488 patients with painful TMD was conducted using multiple questionnaires. RESULTS: PCA of the SCL-90R and PCS identified one factor, which explained 60.8% and 80.2% of the total variance, respectively. For the PSQI, three factors explained 61.3% of the variance. PCA resulted in two main orthogonal components: factor 1, which comprised a combination of scores for pain severity, pain interference and global scores of PCS, and PSQI; and factor 2, which comprised one measure of the SCL-90R. Factors 1 (46.5%) and 2 (20.0%) explained 66.5% of the total variance. CONCLUSION: The findings of this study revealed that five measures can be primarily categorised into two latent constructs of the psychological (affective) and pain-related (sensory-cognitive) dimensions. These core components could be applied in clinical settings and for research purposes.

Relevance of sleep, pain cognition, and psychological distress with regard to pain in patients with burning mouth syndrome.

Objective: To clarify the influence of sleep, psychological distress, and pain catastrophizing on the pain experience in patients with burning mouth syndrome (BMS).Methods: Ninety-three patients with BMS were investigated by reviewing medical records and questionnaires using the Brief Pain Inventory (BPI), Pittsburgh Sleep Quality Index (PSQI), Symptom Checklist-90 revised (SCL-90R), and pain catastrophizing scale (PCS).Results: Of the 65 patients included in the study, 81.5% and 66% showed high PSQI and PCS scores, respectively. The PSQI, PCS, and SCL-90R scores correlated positively with pain interference. The result of multiple regression analysis demonstrated that helplessness and rumination of PCS significantly add to the prediction of pain interference.Discussion: Pain catastrophizing rather than psychological distress and sleep quality seems to be associated with pain experience in patients with BMS. Therefore, targeting pain catastrophizing, specifically rumination and helplessness, might lead to reduction of pain-related disability in BMS patients.

Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders.

BACKGROUND: Pain related to temporomandibular disorder (TMD) usually affects jaw function. In patients with TMD, little is known about the biopsychosocial relevance to jaw functional limitations. OBJECTIVE: This study explored the impact of biopsychosocial risk factors on jaw functional limitation in patients with painful TMD. METHODS: A comprehensive set of patient-reported outcomes (PROs), consisting of pain severity (Brief Pain Inventory), psychological stress (Symptom Checklist-90-Revised), catastrophising thought (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-TMD), sleep quality (Pittsburgh Sleep Quality Index) and jaw functional limitation (Jaw Functional Limitation Scale-20), were administered, and clinical examinations were performed in patients with TMD. RESULTS: This study included the data obtained from 131 patients with painful TMD. In the logistic regression analysis, biomedical factors (age, sex, pain duration and TMD phenotype) were not associated with jaw functional limitation. Correlations were higher in the order of sleep quality (ρ = 0.946), pain severity (ρ = 0.582), pain catastrophising (ρ = 0.535), kinesiophobia (ρ = 0.486) and emotional distress (ρ = 0.268). Multiple regression analysis demonstrated three predictors, including pain severity (p = .001), kinesiophobia (p = .023) and sleep quality (p < .001) for jaw functional limitation. In the mediation analysis, the indirect effect of pain severity on the association between sleep and limitation was significant (p < .0001). CONCLUSION: Jaw functional limitation is associated with biopsychosocial factors. In particular, sleep may be a core risk factor for functional limitation in patients with painful TMD.

Influence of government-driven quality assessment program on patients with chronic obstructive pulmonary disease.

BACKGROUND: The Korean Health Insurance Review and Assessment Service (HIRA) has launched the Chronic Obstructive Pulmonary Disease (COPD) Quality Assessment Program (CQAP) since 2014. We aimed to reveal the influence of this national program on clinical outcomes and the burden of COPD in Korea. METHODS: The CQAP is conducted annually. We used healthcare claims data linked with the results of the program provided by HIRA between May 2014 and April 2017. Patients were considered to have COPD if they visited a hospital for COPD management during the assessment term. Those who visited a medical institution for COPD and were prescribed COPD medications at least twice were assessed by the CQAP (assessed subjects, AS; not-assessed subjects, NAS). CQAP evaluated the pulmonary function test conduction rate, regular visitation rate, and prescription rates of COPD medications. RESULTS: Among the 560,000 patients with COPD, about 140,000 were assessed by the CQAP annually. In both groups, the pulmonary function test conduction rate and inhaled bronchodilator prescription rate improved since 2014. Compared to the NAS group, the risk of admission and all-cause mortality rate in the AS group were significantly reduced by 21.2% and 40.7%, respectively. In patients who were assessed for 3 consecutive years, all of the above variables were high at baseline and were not improved much from implementation of CQAP. In matching analysis, we observed this improvement to be limited in the COPD quality assessment year. CONCLUSIONS: The CQAP by the health insurance bureau has improved the management protocol and prognosis of COPD.

Phenotyping 1488 patients with painful temporomandibular disorders and its relevance to subjective sleep quality: A key step for stratified medicine.

Objective: To investigate biopsychosocial characteristics and sleep quality among three TMD phenotypes and to identify the influential factors on sleep quality among those patients.Methods: Retrospective data from chart review and self-reported questionnaires included demographics, the Brief Pain Inventory, the Pain CatastropPain Prospective Evaluation and Risk Assessmenthizing Scale, the Symptom Check List-90 Revised, and the Pittsburgh Sleep Quality Index.Results: A total of 1488 patients with painful TMD (female, 63.8%) were included and stratified into three groups: joint pain (n = 570), muscle pain (n = 542), and joint-muscle combined pain (n = 376). There were significant differences among demographic characteristics, pain experience, pain catastrophizing, and psychological distress of the three groups. Poor sleep quality presented in 78.4% of all patients. Sleep quality was significantly associated with TMD phenotypes, sex, and a helplessness component of pain catastrophizing.Discussion: This patient-centered and stratified approach will allow clinicians to come one step closer to personalized medicine.

Profiling thermal pain using quantitative sensory testing in patients with trigeminal nerve injury.

OBJECTIVES: To investigate the thermal pain phenotypes using QST in patients with unilateral trigeminal nerve injury and to explore whether these different thermal pain phenotypes are associated with clinical and psychophysical characteristics. METHODS: This retrospective study included 84 patients diagnosed with posttraumatic trigeminal neuropathy involving inferior alveolar nerve (IAN) and lingual nerve (LN). Data on clinical characteristics, subjective symptoms including hypoesthesia, dysesthesia, and allodynia, and objective signs using thermal QST were collected and explored. RESULTS: Three heat (heat hypoalgesia, heat hyperalgesia, and within normal range) and cold pain phenotypes (cold hypoalgesia, cold hyperalgesia, and within normal ranges) were identified, respectively. Thermal hypoalgesia was more frequently observed than thermal hyperalgesia. Heat hypoalgesia regardless of cold pain abnormalities appears to be associated with subjective negative symptoms, while thermal hyperalgesia seems to have little relationship with negative and positive symptoms. Thermal pain phenotypes were associated with loss of innocuous thermal sensation. Unlike heat pain phenotypes, cold pain phenotypes differed between IAN injury and LN injury. CONCLUSION: The thermal pain phenotypes identified in this study seem to be related to clinical and psychophysical findings differently. These results would be a good starting point for assessing posttraumatic trigeminal neuropathy and interpreting the thermal QST results.

Impact of the Asthma Quality Assessment Program on Burden of Asthma.

BACKGROUND: In 2013, the Korean Health Insurance Review and Assessment Service launched the Asthma Quality Assessment Program (AQAP) to assess whether patients with asthma were well managed. OBJECTIVE: To show the impact of the AQAP on the medical utilization behavior for asthma. METHODS: We used claims data linked with the results of the AQAP performed between July 2013 and June 2017. Asthma was determined when subjects visited hospital for asthma. Subjects who used asthma medications on at least 2 different occasions were assessed by the AQAP (assessed subjects [Ass]; not-assessed subjects [NASs]). The AQAP evaluated conduction rate of the pulmonary function test, routine visit rate, and prescription rate of asthma medications. Primary clinics were classified as "good" and "not-good" clinics according to the results of the AQAP. RESULTS: Of the 4.3 million subjects with asthma screened, about 0.8 million were assessed by the AQAP annually. Both the conduction rate of pulmonary function test and the prescription rate of inhaled corticosteroids in the ASs and NASs were improved. In addition, the risk of admission and yearly all-cause mortality were significantly reduced (risk reduction rate, 17.1 and 24.4%, respectively, both P < .001) in the AS group compared with the NAS group. However, effects of the AQAP varied according to the subgroup, and they were restricted to the assessment term. In addition, the admission rate and all-cause mortality were decreased by 94.7% and 45.3%, respectively, in "good" clinics as opposed to the "not-good" clinics. CONCLUSIONS: Performing the AQAP improved both the management protocol and prognosis of asthma in Korea.

Quantitative and qualitative sensory testing results are associated with numbness rather than neuropathic pain in patients with post-implant trigeminal neuropathy: a cross-sectional pilot study.

Purpose: This study aimed to characterize the sensory profile of patients with post-implant trigeminal neuropathy and identify the association between subjective symptoms and objective signs including psychophysical testing and radiographic imaging. This study further evaluated to the association between quantitative sensory testing (QST)/qualitative sensory testing (QualST) and the severity of nerve injury graded by radiographic imaging. Materials and methods: This retrospective study included 34 patients diagnosed with post-implant trigeminal neuropathy. Data on the neuropathic pain symptom inventory (NPSI), thermal and electric QST, bedside QualST, and cone beam computed tomography (CBCT) was collected and the association between these variables were analysed. Results: Numbness was the most common subjective symptom and evoked pain was the most frequent neuropathic pain. There was no significant correlation between negative and positive symptoms. Spearman's rank correlation analyses indicated that objective findings including QST/QualST correlated with a sensory loss profile rather than a gain of function profile. Moderate positive correlations between some positive symptoms and the score of QualST were observed. The Mann-Whitney U test showed that subjective symptoms did not differ according to the severity of nerve damage according to CBCT, but the electric QST and QualST was discriminative. Conclusions: This study suggests that QST/QualST associated with the severity of nerve damage according to CBCT might be useful in assessing numbness in patients with negative and positive symptoms after implant surgery, but may be of marginal utility in the evaluation of neuropathic pain within the limitation of this cross-sectional study with small sample size.

Job stress and its related factors among Korean dentists: An online survey study.

OBJECTIVES: The aims of this study were to investigate the dentists' job-related stress using the newly developed Dentist Job Stress (DJS) questionnaire, and to explore the relationships among sociodemographic factors, job stress and mental health indicators, including psychosocial stress, depression, anxiety and sleep among Korean dentists. MATERIALS AND METHODS: An online survey including 1,520 dentists was conducted using the Brief Encounter Psychological Instrument-Korean version (BEPSI-K), the Center for Epidemiologic Studies Depression Scale (CES-D), the State-Trait Anxiety Index (STAI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The response rate was 15.2% (n = 231). The DJS questionnaire consisted of environmental and vocational factors, and Cronbach's α coefficient was 0.69. Dentists' job stress was significantly associated with income (P = 0.0230), work time (P = 0.0009) and job satisfaction (P < 0.0001). A bivariate correlation study revealed that the BEPSI-K, CES-D, STAI-S and PSQI exhibited a significant correlation with the DJS scale. Multiple regression analysis found that depression, job satisfaction and sleep quality were associated with dentists' job stress, and this model accounted for 37.9% of the variation in the DJS scale (P < 0.0001). CONCLUSIONS: The findings of this study revealed that the DJS questionnaire showed acceptable validity and reliability, and dentists' job stress was associated with depression, job satisfaction and sleep quality. The major implication of this study is that a stress-management programme focusing on practical ways to improve the mental health status and job satisfaction of dentists is critical to the reduction of occupational stress among Korean dentists.

Therapeutic vitamin delivery: Chemical and physical methods with future directions.

Vitamins are a diverse group of "life nourishing" molecules that are essential for proper childhood development, and for maintaining health throughout adulthood into old age. Vitamin supplementation is an important strategy for reducing the severe and chronic effects of malnutrition in subsets of the population of the developing world. Additionally, the precise role of many vitamins in certain conditions, including cancer and cardiovascular disease, remains an area of active research, although guidelines for vitamin supplementation in otherwise adequately nourished populations remain controversial. This review describes vitamin delivery methods and techniques, focusing on the most recent advances and novel approaches. Specific attention has been given to physical methods and novel formulations for delivery with an emphasis on reporting pros and cons of each technique and highlighting future directions. Of particular interest is the potential for transdermal delivery of certain vitamins, which is an approach that may provide advantages in some populations (e.g. for vitamin D), but that still requires considerable additional research and clinical validation.

Pain Catastrophizing Mediates the Effects of Psychological Distress on Pain Interference in Patients with Orofacial Pain: A Cross-Sectional Study.

AIMS: To investigate whether pain catastrophizing has not only direct effects as a predictor of pain-related interference but also indirect effects as a mediator in the relationship between psychological distress and pain interference and to examine the mediating roles of subtypes of catastrophizing (magnification, rumination, and helplessness) between psychological distress and interference. METHODS: This retrospective study included 815 patients with orofacial pain aged 18 to 81 years. All participants completed a set of self-administered questionnaires concerning pain interference (Brief Pain Inventory), psychological distress (Symptom Checklist-90-Revised), and pain catastrophizing (Pain Catastrophizing Scale) at the first consultation. The associations between these three variables were calculated using mediation path analysis. RESULTS: Pain catastrophizing predicted pain interference. In addition, 34% of the variance in pain interference attributable to psychological distress was mediated by catastrophizing when controlling for pain duration and severity. The greatest portion of the mediating effect of catastrophizing was attributable to the helplessness component. CONCLUSION: Within the limitations of cross-sectional studies, this study demonstrated that pain catastrophizing mediates the effects of psychological distress on pain interference in patients with orofacial pain. Most of the mediating effects were attributable to the helplessness component of pain catastrophizing. Cognitive behavioral therapy targeting pain catastrophizing, specifically helplessness, could potentially reduce pain-related disability in orofacial pain patients.

Comparison of unpleasant and pain thresholds of thermal stimuli in the orofacial regions: a psychophysical study using quantitative sensory testing in healthy young men.

Purpose/Aim: To gain a better understanding of the psychophysics of thermal pain perception in a clinical setting, this study investigated whether thermal thresholds of unpleasantness are different from pain thresholds of cold and heat stimuli. Of particular interest was the relationship between unpleasantness and pain thresholds for cold vs heat stimuli. MATERIAL AND METHODS: Thirty healthy male volunteers (mean age 26.1 years, range 23 to 32 years) participated. Thermal detection, cold pain (CPT) and heat pain (HPT) thresholds were measured at 5 trigeminal sites by the method of limits using quantitative sensory testing (QST), followed by cold unpleasant (CUT) and heat unpleasant (HUT) thresholds. RESULTS: The temperatures at which individuals first reported thermal sensations as unpleasant or painful substantially differed among subjects. CUT exhibited a higher mean value with less variability than CPT, and HUT presented a lower mean than HPT (p < .001). As with CPT, CUT did not show any significant difference between the test sites. On the other hand, HUT, like HPT, exhibited site differences (p < .001). There was moderate correlation between CUT and CPT, whereas HUT and HPT were strongly correlated. The relationship between unpleasant and pain thresholds of cold vs heat stimuli was significantly different even when controlling for test site variability (p < .001). CONCLUSION: These findings indicate that unpleasant and pain thresholds to thermal stimuli differ in healthy young men. Of particular note is the distinct relationship of unpleasant and pain thresholds of cold vs heat stimuli, revealing the thermal difference in temperature transition from unpleasantness to pain.

Risk factors for the efficacy of oral appliance for treating obstructive sleep apnea: A preliminary study.

OBJECTIVE: To identify potential risk factors of response to oral appliance in patients with obstructive sleep apnea (OSA). METHODS: Fifteen OSA patients were enrolled. Clinical characteristics, cephalometric measurements, and the results of home sleep testing were retrospectively obtained at baseline, and a sleep test was done again at the end of treatment. RESULTS: Twelve subjects were responders and three were non-responders. The diastolic blood pressure, minimum pulse rate, SNA (Angle between sella-nasion and nasion-A point), ANB (Anteroposterior maxilla/mandible discrepancy), and facial convexity of non-responders was higher than those of responders. Unlike AHI, non-responders showed a lower lowest oxygen saturation (%) than responders. DISCUSSION: Elevated diastolic pressure and minimal pulse rate, higher skeletal convexity and lowered lowest oxygen saturation might be risk factors to oral appliance efficacy in the OSA patients. More research in a large sample is needed to verify the results of the current study.

Two-point discrimination values vary depending on test site, sex and test modality in the orofacial region: a preliminary study.

OBJECTIVE: The aims of the present study were to determine the normal values of TPD in the six trigeminal sites (the forehead, cheek, mentum, upper lip, lower lip, and the tongue tip) and to investigate the effect of the site, sex, and test modality on the TPD perception. MATERIAL AND METHODS: Forty healthy volunteers consisting of age-matched men (20) and women (20) with a mean age of 27.1 years were recruited. One examiner performed the TPD test using a simple hand-operated device, i.e., by drawing compass with a blunt or sharp-pointed tip. The static TPD with a blunt-pointed tip (STPDB), moving TPD with a blunt-pointed tip (MTPDB), and static TPD with a sharp-pointed tip (STPDS) were measured. The predictors were the site, sex, and test modality, and the outcome variable was the TPD value. Three-way ANOVA was used for statistics. RESULTS: The analysis showed a significant effect of the site, sex and test modality on the TPD values. Significant differences between the test sites were observed with the descending order from the forehead and cheek>mentum>upper lip and lower lip>tongue tip and index finger. Women showed lower TPD values than those of men. The STPDS measurements were consistently lower than those of the STPDB and MTPDB. CONCLUSIONS: The normal values of TPD in this study suggest that the cheek and forehead were less sensitive than other regions evaluated and women were more sensitive than men. The STPDS was the most sensitive test modality.

Two-point discrimination values vary depending on test site, sex and test modality in the orofacial region: a preliminary study

Abstract The two-point discrimination (TPD) test is one of the most commonly used neurosensory tests to assess mechanoperception in the clinical settings. While there have been numerous studies of functional sensibility of the hand using TPD test, there have been relatively not enough reports on TPD in the orofacial region. Objective The aims of the present study were to determine the normal values of TPD in the six trigeminal sites (the forehead, cheek, mentum, upper lip, lower lip, and the tongue tip) and to investigate the effect of the site, sex, and test modality on the TPD perception. Material and Methods Forty healthy volunteers consisting of age-matched men (20) and women (20) with a mean age of 27.1 years were recruited. One examiner performed the TPD test using a simple hand-operated device, i.e., by drawing compass with a blunt or sharp-pointed tip. The static TPD with a blunt-pointed tip (STPDB), moving TPD with a blunt-pointed tip (MTPDB), and static TPD with a sharp-pointed tip (STPDS) were measured. The predictors were the site, sex, and test modality, and the outcome variable was the TPD value. Three-way ANOVA was used for statistics. Results The analysis showed a significant effect of the site, sex and test modality on the TPD values. Significant differences between the test sites were observed with the descending order from the forehead and cheek>mentum>upper lip and lower lip>tongue tip and index finger. Women showed lower TPD values than those of men. The STPDS measurements were consistently lower than those of the STPDB and MTPDB. Conclusions The normal values of TPD in this study suggest that the cheek and forehead were less sensitive than other regions evaluated and women were more sensitive than men. The STPDS was the most sensitive test modality.

Thermal Perception as a Key Factor for Assessing Effects of Trigeminal Nerve Injury.

AIMS: To conduct a functional examination using multimodal exploration of a sample of patients with iatrogenic trigeminal nerve injury to understand the underlying mechanisms of neuropathic pain following trigeminal nerve injury. METHODS: Subjective and objective symptoms and responses to thermal and electrical quantitative sensory testing (QST) were evaluated in 85 patients with unilateral trigeminal nerve injury. Objective symptoms were measured by seven clinical sensory tests. Thermal QST included cold detection threshold (CDT), warm detection threshold (WDT), and heat pain threshold (HPT). Electrical current perception threshold was performed with electrical stimuli of 2,000, 250, and 5 Hz. The time since injury was included as a possible independent variable. The data were analyzed using chi-square test, independent t test, Mann Whitney U test, one-way analysis of variance (ANOVA), and Kruskal-Wallis test. Further analyses with Pearson correlation analysis, Spearman rank correlation analysis, and cluster analysis were applied. RESULTS: Unlike objective symptoms, thermal and electrical QST values and subjective symptoms did not improve in patients with an old injury. Thermal QST, particularly WDT, showed the highest positive correlation with subjective symptoms in all tests. Cluster analysis of the thermal QST values identified three subgroups: cluster 1, which was characterized by prominent cold and warm hypoesthesia; cluster 2, which presented elevated WDT; and cluster 3, which showed the smallest thermal differences for all thermal variables but had the highest proportion of neuropathic pain. CONCLUSION: These findings have demonstrated that thermal QST is a suitable tool for evaluating and characterizing the sensory effects of trigeminal nerve injury. Three subgroups with different thermosensory profiles showed that the less the damage, the more neuropathic pain occurs. The loss of warm perception in particular might play a pivotal role in the chronicity and severity of subjective sensory symptoms.

Targeted population screening of late onset Pompe disease in unspecified myopathy patients for Korean population.

We performed targeted population screening of late onset Pompe disease (LOPD) in unspecified myopathy patients, because early diagnosis is difficult due to its heterogeneous clinical features. We prospectively enrolled 90 unrelated myopathic patients who had one or more signs out of five LOPD-like clinical findings (proximal weakness, axial weakness, lingual weakness, respiratory difficulty, idiopathic hyperCKemia). Acid alpha glucosidase activity was evaluated with dried blood spot and mixed leukocyte simultaneously. For a final diagnosis of LOPD, 16 patients with decreased enzyme activity were genotyped by GAA molecular analysis. We found two patients with LOPD (2.2%), and the remaining 14 patients had at least one G576S or E689K mutation, known as the pseudodeficiency allele. Acid alpha glucosidase activity of LOPD patients was significantly lower than that of patients with at least one pseudodeficiency allele (p = 0.017). This study is the first LOPD screening study for targeted Korean population, and more generally, an Asian population. Our findings suggest that for diagnosis of LOPD in Asian population, modified cutoff value of acid alpha glucosidase activity with dry blood spot considering that of patients having heterozygote pathogenic variants or pseudodeficiency alleles may reduce time and cost requirements and increase the comfort of patients.

Normal-weight obesity is associated with increased risk of subclinical atherosclerosis.

BACKGROUND: Subjects with normal body mass index (BMI) but elevated amounts of body fat (normal-weight obesity; NWO) show cardiometabolic dysregulation compared to subjects with normal BMI and normal amounts of body fat (normal-weight lean; NWL). In this study, we aimed to evaluate whether NWO individuals have higher rates of subclinical atherosclerosis compared to NWL subjects. METHODS: From a large-scale health checkup system, we identified 2078 normal weight (18.5 ≤ BMI < 25 kg/m(2)) subjects with no previous history of coronary artery disease who underwent analysis of atherosclerosis using coronary computed tomography angiography (CCTA) and pulse wave velocity (PWV). NWO was defined as normal BMI and highest tertile of body fat percentage by sex (men ≥ 25. 4 % and women ≥ 31.4 %). CCTA was performed using a 64-detector row CT. A plaque was defined as a structure >1 mm(2) within and/or adjacent to the vessel lumen and classified according to the presence/proportion of intraplaque calcification. RESULTS: NWO subjects (n = 283) demonstrated metabolic dysregulation compared to NWL individuals (n = 1795). After adjusting for age, sex, and smoking, NWO individuals showed higher PWV values than NWL individuals (1474.0 ± 275.4 vs. 1380.7 ± 234.3 cm/s, p = 0.006 by ANCOVA). Compared with NWL subjects, NWO subjects had a higher prevalence of soft plaques even after age, sex, and smoking adjustment (21.6% vs. 14.5%, p = 0.039 by ANCOVA). The PWV value and the log{(number of segments with plaque) + 1} showed a positive correlation with numerous parameters such as age, systolic blood pressure, visceral fat, fasting glucose level, serum triglyceride level, and C-reactive protein (CRP) in contrast to the negative correlation with high-density lipoprotein-cholesterol level. The visceral fat was an independent determinant of log{(number of segments with plaque) + 1} (ß = 0.027, SE = 0.011, p = 0.016) even after adjustment for other significant factors. Most importantly, NWO was an independent risk factor for the presence of soft plaques (odds ratio 1.460, 95 % confidence interval 1.027-2.074, p = 0.035) even after further adjustment for multiple factors associated with atherosclerosis (blood pressure, blood glucose, lipid level, CRP, medication, smoking status, physical activity). CONCLUSIONS: NWO individuals carry a higher incidence of subclinical atherosclerosis compared with NWL individuals, regardless of other clinical risk factors for atherosclerosis.

Prevalence of and risk factors for gastrointestinal diseases in korean americans and native koreans undergoing screening endoscopy.

BACKGROUND/AIMS: In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. METHODS: In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. RESULTS: The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. CONCLUSIONS: Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.