Effects of education methods on self-efficacy of smoking cessation counseling among medical students.

BACKGROUND: Medical students need to receive training in providing smoking cessation counseling to provide effective smoking cessation interventions to smokers when they become doctors. This study examined the smoking cessation education curricula and factors affecting counseling self-efficacy (CSE) in smoking cessation treatment among medical students. METHODS: In a multicenter cross-sectional study, we obtained demographic information, personal history of tobacco use and intention to quit smoking, exposure to secondhand smoke in the school premises during the past week, the experience of learning about tobacco in each medical school, tobacco-related medical knowledge, and self-efficacy in smoking cessation counseling on medical students of four Korean medical schools. RESULTS: Among 1,416 medical students eligible, 313 (22.1%) students completed a self-administered questionnaire. Only 20.3% of the students reported positive CSE on smoking cessation. The factors affecting positive CSE were scores of ≥ 60 on tobacco-related medical knowledge, smoking experience, and blended learning (p = 0.014, 0.005, and 0.015, respectively). CONCLUSION: This study shows that high scores in tobacco-related medical knowledge and blended learning are correlated with positive CSE for smoking cessation counseling.

Triolein emulsion infusion into the hepatic artery increases vascular permeability to doxorubicin in rabbit liver.

BACKGROUND: The infusion of triolein emulsion (TE) induced increased vascular permeability and a negligible and temporary decrease in liver function without specific histopathological damage. AIM: To assess changes in doxorubicin concentration according to the percentage of TE infused via a hepatic artery to study the vascular permeability in the rabbit liver. METHODS: Thirty-nine healthy rabbits were divided into five groups according to the concentration of emulsified triolein infused into the hepatic arteries: Group 0, saline infusion (control group, n = 5); group 1, 0.3% TE (n = 13); group 2, 0.6% TE (n = 6); group 3, 0.9% TE (n = 8); and group 4, 1.5% TE (n = 6). Doxorubicin (2.4 mg/kg) was infused immediately after TE injection via the hepatic arteries. After 2 h, the livers were harvested, and doxorubicin concentrations were calculated fluorometrically. The doxorubicin concentrations were compared between TE groups and the control group, and the optimal concentrations within the TE groups were calculated. Statistical analysis was performed using the nonparametric Mann-Whitney U test and Kruskal-Wallis test. P < 0.05 were considered statistically significant. RESULTS: In the liver, doxorubicin concentrations were 2.06, 2.07, 2.16 and 1.66 times higher in groups 1 through 4, respectively, and significantly higher in the TE groups than in the control group (all P < 0.05). However, there were no significant differences in the mean doxorubicin concentrations between the four TE groups (P = 0.642). In the lungs, the mean doxorubicin concentrations were not significantly different between the control and TE groups (P > 0.05). CONCLUSION: TE infusion into the hepatic arteries significantly increased the doxorubicin concentration approximately twofold but was not different between the TE groups. These findings suggest that TE infusion might be a useful adjuvant treatment of liver cancers.

Metabolic syndrome as a risk factor for high intraocular pressure: the Korea National Health and Nutrition Examination Survey 2008-2010.

BACKGROUND: High intraocular pressure (IOP) is well established as the most significant risk factor for both the development and progression of primary open-angle glaucoma. Elevated IOP is more frequently seen in the presence of metabolic disturbances that are associated with the components of metabolic syndrome (MetS). The aim of this study was to investigate the association between ocular hypertension and MetS. PATIENTS AND METHODS: We examined the relationship between ocular hypertension and MetS in 17,160 Korean adults without glaucoma aged >19 years (7,368 men and 9,792 women) who participated in the 2008-2010 Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analysis was used to assess the relationship between MetS and ocular hypertension, after adjusting for age, body mass index, smoking, alcohol consumption, and regular exercise. RESULTS: The prevalence of MetS was 35.1% among males and 30.1% among females. The prevalence of ocular hypertension was 1.3% among males with MetS and 0.7% among females with MetS. Participants with MetS had a significantly higher IOP than those without MetS (P≤0.001), and each component of MetS had a different effect on the IOP. Hypertension was the strongest predictor of an elevated IOP. In multivariate regression analysis, ocular hypertension was significantly associated with MetS (P=0.027 for men; P=0.015 for women). CONCLUSION: There is a statistically significant relationship between MetS and ocular hypertension.

Health behaviors of Korean adults with hepatitis B: Findings of the 2016 Korean National Health and Nutrition Examination Survey.

AIM: To assess the frequencies of five health-related behaviors (smoking, alcohol consumption, body weight, sleep duration, and physical activity) in Korean adults with chronic hepatitis B. METHODS: Data were obtained from the 2016 Korean National Health and Nutrition Examination Survey. In total, 5887 subjects (2568 males, 3319 females) over 19 years old were enrolled in this study. Interviews were performed to obtain information on demographic characteristics and medical conditions. A selfadministered questionnaire and medical examination were used to assess the smoking history, alcohol use, physical activity, sleep duration, and body weight of the subjects. Chronic hepatitis B was diagnosed based on detection of hepatitis B surface antigen (HBsAg). The subjects were categorized into HBsAg positive and negative groups, and a complex sampling analysis was conducted to compare the health behaviors between these groups. RESULTS: Among males, the current smoking rate in the HBsAg positive group was higher than that in the negative group (45.5% vs 38.5%). In the positive group, the rates of monthly and high-risk alcohol use were 70.4% and 17.6% in males and 45.9% and 3.8% in females, respectively. The rate of alcohol use was similar between the two groups [P = 0.455 (males) and P = 0.476 (females)]. In the HBsAg positive group, 32.3% and 49.9% of males and 26.5% and 49.6% of females were overweight and physically inactive, respectively. High-risk alcohol consumption and physical inactivity were significantly associated with self-perceived health status. CONCLUSION: Our data demonstrate that a large proportion of Korean adults with chronic hepatitis B have poor health behaviors. Further studies are needed to confirm our results.

Morphologic mechanisms of increased vascular permeability of triolein emulsion to the blood-brain barrier.

Triolein emulsion has been known to increase vascular permeability in the brain when it is infused into the carotid artery. The purpose of this study was to identify the morphologic mechanism of increased vascular permeability in brain induced by infusion of emulsified triolein into the carotid artery by transmission electron microscopy (TEM). Triolein emulsion was infused into the carotid artery of rats. TEM using lanthanum tracer was used to evaluate morphologic changes in endothelium with a focus on transcytotic vesicles and tight junction opening. The treat group showed multiple transcytotic vesicles containing lanthanum tracer within endothelium on TEM. TEM also revealed that lanthanum tracer entered neural interstitium through tight junctions between capillary endothelial cells infrequently in the treat group. No evidence of transcytotic vesicles containing lanthanum tracer or lanthanum leakage through tight junctions was observed in the control group. Transcytosis and the opening of tight junctions appears the pathway for vascular permeability enhancement by triolein. This result could be utilized in studies on the blood-brain barrier and by those searching for chemotherapeutic methods that deliver anti-tumor agents to normally drug inaccessible organs.

Triolein Emulsion Infusion Into the Carotid Artery Increases Brain Permeability to Anticancer Agents.

BACKGROUND: Triolein emulsion infusion into the carotid artery has been reported to induce temporary and reversible opening of the blood-brain barrier by increasing vascular permeability. OBJECTIVE: To evaluate the effect of triolein emulsion infusion on brain permeance by anticancer agents. METHODS: In the doxorubicin study. 2.4 mg/kg doxorubicin was injected immediately after triolein emulsion (1%, 1.5%, and 2%) infusion into rabbit carotid arteries. Two hours later, bilateral hemispheres and eyeballs were harvested, and doxorubicin concentrations were measured fluorometrically. Doxorubicin ratios of ipsilateral/contralateral hemispheres were compared with those of doxorubicin controls by use of the Kruskal-Wallis test followed by the Dunn test. In the cisplatin study, 10 mg/kg cisplatin was injected immediately after 2% triolein emulsion infusion into rat carotid arteries. Ipsilateral hemispheres were harvested 2, 6, 12, 24, and 36 hours after treatment. Time-dependent cisplatin concentrations were determined by liquid chromatography/electrospray ionization-tandem mass spectrometry/mass spectrometry. RESULTS: Doxorubicin concentrations were significantly higher in ipsilateral hemispheres and eyeballs in all 3 triolein treatment groups than in doxorubicin controls. In the cisplatin study, cisplatin concentrations in the ipsilateral hemispheres peaked at 6 hours after infusion of cisplatin. CONCLUSION: Brain permeance to anticancer agents was increased by triolein emulsion infusion, which suggests that triolein infusion might be a useful adjuvant treatment for brain tumors.

Concentration and correlations of perfluoroalkyl substances in whole blood among subjects from three different geographical areas in Korea.

Toxicity and persistence of perfluorinated alkyl substances (PFASs) in human have raised considerable concern and several biomonitoring studies throughout the world reported the widespread occurrence of these compounds in human tissues. However, information regarding influence of geographic, lifestyle and demographic factor on PFAS levels in human blood tissues is limited. In this study, whole blood samples collected in 2006-2007 from 319 donors from suburban Seoul (Suwon and Yongin), Busan and Yeosu in Korea were analyzed for perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), perfluorohexane sulfonate (PFHxS) and perfluorooctane sulfonamide (PFOSA). Blood donors classified into seven age groups with ages ranging from 8 to 82 years, and different lifestyles and socio-economic status. PFOS (median=4.15 ng/mL) was found at the highest concentration with a maximum concentration of 59.1 ng/mL. The concentrations of other PFASs were in the decreasing order of; PFOA (median=1.30 ng/mL)>PFNA (median=0.85 ng/mL)>PFHxS (median=0.47 ng/mL)>PFOSA (median=0.12 ng/mL). Geographical differences in the concentrations of five target PFASs were found. Significant positive relationships between PFAS concentrations and the age of the donors were found. Gender-related differences were found in the concentrations of PFOA, PFNA, PFHxS and PFOSA. No association was found between PFAS levels and several lifestyle factors and socio-economic status which included drinking habit, furniture/carpet in an indoor environment and monthly income. Occupation was an important determinant for PFNA and PFHxS concentrations in the whole blood. Except for PFOSA, significant associations were noted between PFASs concentrations and smoking habit. The results of this study provide information for further public health monitoring and safety management for PFASs in Korea.

Serum 25-hydroxyvitamin D levels and testosterone deficiency in middle-aged Korean men: a cross-sectional study.

Previous studies have demonstrated that male hypogonadism is associated with a low level of vitamin D. However, no reports have investigated the effects of vitamin D on testosterone levels in Korean men. Our aim was to investigate whether testosterone levels are associated with serum vitamin D levels and whether seasonal variation exists. This cross-sectional study analyzed serum 25-hydroxyvitamin D [25(OH)D], total testosterone (TT), and free testosterone (FT) in 652 Korean men over 40 years of age who had undergone a comprehensive medical examination. The average age of the subjects was 56.7 ± 7.9 years, and the mean serum 25(OH)D, TT and FT levels were 21.23 ± 7.9 ng ml-1 , 4.70 ± 1.6 ng ml-1 , and 8.12 ± 3.3 pg ml-1 , respectively. In the multiple linear regression model, 25(OH)D showed positive association with TT (ß =0.137, P< 0.001) and FT (ß =0.103, P= 0.008). 25(OH)D and FT showed similar seasonal or monthly variation after adjustment for age. A vitamin D deficiency [25(OH)D < 20 ng ml-1 ] was associated with an increased risk of deficiencies of TT (<2.30 ng ml-1 ) (odds ratio [OR]: 2.65; 95% confidence interval [CI]: 1.21-5.78, P= 0.014) and FT (<6.50 pg ml-1 ) (OR: 1.44; 95% CI: 1.01-2.06 P= 0.048) after adjusting for age, season, body mass index, body composition, chronic disease, smoking, and alcohol use. In conclusion, we demonstrated a positive correlation between 25(OH)D and testosterone, which showed similar seasonal variation in Korean men.

The association between a low urine pH and the components of metabolic syndrome in the Korean population: Findings based on the 2010 Korea National health and nutrition examination survey.

BACKGROUND: Low urine pH is related to obesity and insulin resistance, which are components of metabolic syndrome (MS). The aim of this study was to identify the relation between a low urine pH and MS after controlled for other covariates including demographic and lifestyle factors in adult Korean population. MATERIALS AND METHODS: We analyzed data from the 2010 Korea National Health and Nutrition Examination Survey, a cross-sectional and nationally representative survey and 1960 men and 2702 women were included in this study. Study subjects were divided into the group with urine pH <5.5 and the group with urine pH ≥5.5 refer to literature. We then evaluated the association between low urine pH and MS. RESULTS: After adjusting for age, sex, smoking status, drinking status, regular exercise, and blood urea nitrogen level, the odds ratio (OR) for the presence of MS in the group with urine pH <5.5 was 1.350 (95% confidence interval [95% CI]: 1.158-1.573) using the American Heart Association/National Heart, Lung, and Blood Institute criteria or 1.304 (95% CI: 1.082-1.572) using the International Diabetes Federation criteria. Among MS components, elevated fasting glucose (OR: 1.231, 95% CI: 1.058-1.433, P = 0.007) and elevated triglyceride (TG) (OR: 1.389, 95% CI: 1.189-1.623, P < 0.001) showed a significantly high OR. CONCLUSION: The findings confirmed that low urine pH is associated with MS in the Korean population. Among MS components, elevated fasting glucose and elevated TG showed a significantly high OR.

The association between 25-hydroxyvitamin D and mammographic density in healthy pre- and postmenopausal women regardless of the menstrual cycle phase: a cross-sectional study.

Vitamin D deficiency is a known risk factor of breast cancer. An association between vitamin D and breast density has been suggested; however, it remains controversial. The aim of this study was to determine the association between serum 25-hydroxyvitamin D [25(OH)D] level and mammographic density. Subjects in our study included 517 patients who visited the health promotion center of the University Hospital. Mammographic density was classified using the American College of Radiology, Breast Imaging Reporting and Data System. Analysis of variance was performed to clarify the association of serum 25(OH)D level and mammographic density, and odds ratio was calculated by ordinal logistic regression analysis. The mean serum 25(OH)D level was 14.3 ± 7.0 ng/mL in all subjects. In correlation analysis, weak negative correlation was observed between serum 25(OH)D level and mammographic density groups (r = -0.09, P = 0.049). However, ordinal logistic regression analysis showed no statistically significant association between serum 25(OH)D level and mammographic density (odds ratio: 0.75, 95% confidence interval: 0.50-1.13). Results of our study showed that there is no significant association between serum 25(OH)D level and mammographic density. It is thought to be an another mechanism of serum 25(OH)D level on breast cancer risk in addition to breast density.

Association of chronic viral hepatitis B with insulin resistance.

AIM: To investigate the relationship between chronic viral hepatitis B (CVHB) and insulin resistance (IR) in Korean adults. METHODS: A total of 7880 adults (3851 men, 4029 women) who underwent a comprehensive medical examination were enrolled in this study. Subjects diagnosed with either diabetes mellitus, or any other disorder that could influence their insulin sensitivity, were rejected. Anthropometry, metabolic risk factors, hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, fasting plasma glucose and insulin were measured for all subjects. Homeostasis model assessment (HOMA), quantitative insulin check index (QUICKI), and Mf(fm) index were used for determining insulin sensitivity. Each participant was categorized into a negative, recovery, or CVHB group. To compare variables between groups, a t-test and/or one-way analysis of variance were used. Partial correlation coefficients were computed to present the association between insulin resistance and other variables. Multiple logistic regression analysis was used to assess the independent association between CVHB and IR. RESULTS: The mean age of men and women were 48.9 and 48.6 years, respectively. Subjects in the CVHB group had significantly higher waist circumference [(86.0 ± 7.7 cm vs 87.3 ± 7.8 cm, P = 0.004 in men), (78.3 ± 8.6 cm vs 80.5 ± 8.5 cm, P < 0.001 in women)], cystatin C [(0.96 ± 0.15 mg/dL vs 1.02 ± 0.22 mg/dL, P < 0.001 in men), (0.84 ± 0.15 mg/dL vs 0.90 ± 0.16 mg/dL, P < 0.001 in women)], fasting insulin [(5.47 ± 3.38 µU/mL vs 6.12 ± 4.62 µU/mL, P < 0.001 in men), (4.57 ± 2.82 µU/mL vs 5.06 ± 3.10 µU/mL, P < 0.001 in women)] and HOMA index [(1.24 ± 0.86 vs 1.43 ± 1.24, P < 0.001 in men), (1.02 ± 0.76 vs 1.13 ± 0.87, P = 0.033 in women)] compared to control group. The HOMA index revealed a positive correlation with body mass index (BMI) (r = 0.378, P < 0.001), waist circumference (r =0.356, P < 0.001), percent body fat (r = 0.296, P < 0.001), systolic blood pressure (r = 0.202, P < 0.001), total cholesterol (r = 0.134, P < 0.001), triglycerides (r = 0.292, P < 0.001), cystatin C (r = 0.069, P < 0.001) and uric acid (r = 0.142, P < 0.001). The QUICKI index revealed a negative correlation with BMI (r = -0.254, P < 0.001), waist circumference (r = 0-0.243, P < 0.001), percent body fat (r = -0.217, P < 0.001), systolic blood pressure (r = -0.132, P < 0.001), total cholesterol (r = -0.106, P < 0.001), triglycerides (r = -0.205, P < 0.001), cystatin C (r = -0.044, P < 0.001) and uric acid (r = -0.096, P < 0.001). For subjects identified with IR, the odds ratio of an accompanying diagnosis of chronic hepatitis B was 1.534 (95% CI: 1.158-2.031, HOMA index criteria) or 1.566 (95% CI: 1.124-2.182, QUICKI criteria) after adjustment for age, gender, BMI, and amount of alcohol consumption. CONCLUSION: Our study demonstrates that CVHB is associated with IR. CVHB may need to be monitored for occurrence of IR and diabetes mellitus.

Parental perception of optimal surgical age for correction of cryptorchidism: a multicenter surveillance study.

OBJECTIVE: To perform a multicenter survey to determine how many parents understood the optimal time for surgical correction of cryptorchidism in children. METHODS: We enrolled 377 parents of patients who had recently undergone surgical correction of cryptorchidism. These parents were divided into 3 groups according to their indicated preference of the optimal patient age for surgical correction: group 1 (<1 year old, 39 parents, 10.3%), group 2 (1-2 years old, 169 parents, 44.8%), and group 3 (>3 years, 169 parents, 44.8%). RESULTS: The mean age of the children who underwent orchiopexy was 4.9 ± 5.2 years. The interval from diagnosis to surgical correction of cryptorchidism was 17.1 ± 29.8, 15.4 ± 14.4, and 29.0 ± 24.4 months in groups 1, 2, and 3, respectively (P < .001). The mean age of the parents was significantly associated with the perception of the optimal time for surgical correction of cryptorchidism (P = .021 and P = .002). The number of highly educated parents was lowest in group 3 (P < .001). The number of parents with >2 children was 69.2% in group 1, 71.0% in group 2, and 84.0% in group 3 (P = .009). In group 3, the parents often delayed surgery because of the patient being too young (49.1%) and the parents' expectations of spontaneous descent (48.5%). CONCLUSION: Parents younger in age, with higher education levels and with fewer children, preferred early orchiopexy. Active intervention by a physician and public education for parents might be necessary to encourage earlier treatment of cryptorchidism.

Metabolic syndrome and arterial pulse wave velocity.

OBJECTIVE: The metabolic syndrome is associated with increased risk of cardiovascular disease. It is important to examine the relation of the metabolic syndrome with the early stages of atherosclerosis. We sought to determine the impact of the metabolic syndrome, defined with International Diabetes Federation criteria, on arterial pulse wave velocity. METHODS AND RESULTS: Four hundred fifty-eight Korean adults (aged 26-77 years) were recruited into this cross-sectional study. Subjects were not taking any drugs other than antihypertensive or antidiabetic medication. All subjects were examined for body mass index, blood pressure, lipid profile, hs-CRP, uric acid, cystatin C, fasting glucose, and brachial-ankle pulse wave velocity. The prevalence of the metabolic syndrome by International Diabetes Federation definition was 20.7%. A positive correlation was observed between blood pressure, total cholesterol, triglycerides, uric acid, cystatin C, waist circumference, fasting glucose, and the brachial-ankle pulse wave velocity (P < 0.05). Subjects with metabolic syndrome had significantly higher arterial pulse wave velocity than subjects without metabolic syndrome. Multivariate logistic regression analysis adjusted for sex, age, and current smoking status showed that metabolic syndrome was associated with increased risk of high arterial pulse wave velocity (odds ratio: 3.31) (P < 0.05). CONCLUSIONS: Metabolic syndrome is associated with arterial stiffness by arterial pulse wave velocity. Monitoring of arterial pulse wave velocity in patients with metabolic syndrome may be helpful in identifying persons at high risk for subclinical atherosclerosis.

Multiple biomarkers and their relative contributions to identifying metabolic syndrome.

BACKGROUND: Several biological markers have been identified as risk factors for cardiovascular disease and are associated with increased risk of metabolic syndrome. We thus compared biomarkers and their association with metabolic syndrome. METHODS: We measured the white blood cell count, high-sensitivity C-reactive protein, homeostasis model assessment of insulin resistance (HOMA-IR), homocysteine, cystatin C, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT) and uric acid levels in 4624 adults without a medical history of cardiovascular disease. Metabolic syndrome was defined using criteria from the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF). RESULTS: The HOMA-IR and GGT were most strongly correlated with metabolic syndrome. The area under the receiver operating characteristic curve was highest for the HOMA-IR (0.773, 95% CI: 0.755-0.791 [men]; 0.792, 95% CI: 0.775-0.808 [women]) and the GGT (0.687, 95% CI: 0.667-0.706 [men]; 0.721, 95% CI: 0.703-0.739 [women]) in AHA/NHLBI criteria. The best cut-off value of HOMA-IR and GGT for identifying metabolic syndrome was (1.22, 30 IU/l [men], 1.28, 15 IU/l [women]). CONCLUSION: HOMA-IR and GGT are most strongly associated with metabolic syndrome, suggesting that theses biomarkers may contribute to identifying metabolic syndrome more than other factors.

Induction chemotherapy of docetaxel and Cisplatin for the elderly patients with squamous cell carcinoma of the head and neck.

PURPOSE: Although concurrent chemoradiotherapy (CCRT) has been considered as a standard treatment for locally advanced squamous cell carcinoma of the head and neck (SCCHN), this treatment is associated with increased toxicities such as mucositis and dermatitis. As a result, the dose intensity can be reduced and interruptions of radiotherapy are more common for CCRT than for sequential treatment, especially for the elderly patients. This prospective study was performed to assess the efficacy and safety profiles of the induction chemotherapy of docetaxel and cisplatin for elderly patients with locally advanced SCCHN. MATERIALS AND METHODS: Patients over 65 years of age with locally advanced SCCHN were treated with docetaxel (70 mg/m(2)) and cisplatin (75 mg/m(2)) every 21 days. The chemotherapy consisted of two cycles with a third cycle that was administered to the responding patients. Patients who did not respond to initial chemotherapy underwent radiotherapy as a definitive local treatment. RESULTS: Fifty patients were enrolled in this study and 44 patients were assessable for response and toxicity. The overall response rate was 88%, 16 patients (36%) achieved a complete response and 23 patients (52%) achieved a partial response. After a median follow-up of 24 months (range: 9 approximately 38 months) the median disease free period and overall survival period had not yet been reached. The one year and two year survival rates were 89% and 70%, respectively. The most common grade 3/4 adverse event was neutropenia, which occurred in 33 patients (75%) and 4 patients had febrile neutropenia. CONCLUSION: Combination chemotherapy of docetaxel and cisplatin is an effective regimen with an acceptable safety profile as the induction treatment for elderly patients suffering with SCCHN.

Corneal endothelial cell change after phacoemulsification relative to the severity of diabetic retinopathy.

PURPOSE: To investigate the differences in corneal endothelial cell morphology between diabetic patients who were divided by the degree of the severity of diabetic retinopathy and normal patients after phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea. METHODS: Before and 6 months after phacoemulsification, specular microscopy was used to evaluate the number and morphology of endothelial cells in patients with diabetic retinopathy. The patients were divided into 3 groups: group I (n=30 eyes), without diabetes; group II (n=30 eyes), diabetes with severe nonproliferative diabetic retinopathy; group III (n=30 eyes), diabetes with high-risk proliferative diabetic retinopathy (PDR). RESULTS: Postoperative corneal endothelial cell density and hexagonality were significantly decreased and the coefficient of variation in cell size increased in all groups, in contrast to the preoperative state (P<.05). During the postoperative 6 months, the percentage of hexagonal cells showed a tendency to decrease progressively, and this was a significant difference between the 3 groups (P<.05). However, the patterns of change in endothelial cell density and the coefficient of variation in cell size were not different between the groups (P>.05). At the postoperative 6 months, the corneal endothelial cell density and the coefficient of variation in cell size of high-risk PDR patients were statistically changed compared with normal persons (P<.05). However, the percentage of hexagonal cell was not significantly difference between diabetic retinopathy patients and normal patients (P>.05). CONCLUSIONS: Corneal endothelial cell density significantly decreased and the coefficient of variation in cell size significantly increased for high-risk PDR patients undergoing phacoemulsification, in contrast to normal persons at the postoperative 6 months.