Clinical Research from a Health Insurance Database: Practice and Perspective / 대한내과학회지

Health insurance big data not only provide real-world evidence of unmet needs in actual clinical practice but also of breakthroughs in the medical industry which will shape the future of health care. Big data are also expected to transform the existing medical paradigm and provide a truly personalized medical age. However, questions about research through the collection and utilization of various big data in various fields have also been raised because quality limitations cannot be overlooked. Therefore, many challenges remain to be overcome in the use of big data research as a basis for changing medical practice. Intervention and interpretation by clinical medical experts are required in judging the scientific trustworthiness of the big data analysis process and the validity of the results. Therefore, healthcare big data research cannot achieve its goal by the efforts of researchers alone. Teams of data analysis scientists, epidemiologists, statistics experts, and clinical researchers are required to collaborate closely with team members, from the design phase to expert consultation, through regular meetings. In addition, it is necessary, in the creation of a healthier community, to cooperate with government agencies that provide data based on the whole nation or the world's population, as well as interest groups representing the people, and policy-making organizations. In this paper, we describe the knowledge, practical clinical applications, and future research directions and prospects for the next phase of health care, from the design of clinical research using health insurance big data to report writing.

Transrectal or transvaginal ultrasoundguided biopsy for pelvic masses: external validation and usefulness in oncologic patients

PURPOSE: The purpose of this study was to externally validate the diagnostic usefulness of transrectal ultrasound (TRUS) or transvaginal ultrasound (TVUS)-guided biopsy for pelvic masses, and to analyze the diagnostic performance of these methods in oncologic patients. METHODS: A consecutive series of 30 patients who underwent TRUS- or TVUS-guided biopsy for pelvic masses was included. Tissue samples were obtained using an 18-gauge core biopsy needle under local anesthesia for lesions detected on computed tomography or magnetic resonance imaging. We analyzed the rates of diagnostic biopsies upon pathologic examination and biopsy-related major complications requiring treatment. In diagnostic biopsy cases, the performance was also investigated for all patients and patients with underlying malignancy. RESULTS: The diagnostic biopsy rate was 93.3% (28 of 30) for all patients and 95.0% (19 of 20) for oncologic patients. No patients had major complications. In diagnostic biopsies, the sensitivity, specificity, positive and negative predictive value, and accuracy for identifying malignancy were 100% (17 of 17), 72.7% (8 of 11), 85.0% (17 of 20), 100% (8 of 8), and 89.3% (25 of 28) for all patients and 100% (14 of 14), 60.0% (3 of 5), 87.5% (14 of 16), 100% (3 of 3), and 89.5% (17 of 19) for oncologic patients, respectively. CONCLUSION: This study externally validated the feasibility and safety of TRUS- or TVUS-guided biopsy. In addition, these techniques appear to enable accurate pathologic diagnoses of pelvic masses in oncologic patients to be made safely and relatively noninvasively.

Clinical Research from a Health Insurance Database: Practice and Perspective / 대한내과학회지

Health insurance big data not only provide real-world evidence of unmet needs in actual clinical practice but also of breakthroughs in the medical industry which will shape the future of health care. Big data are also expected to transform the existing medical paradigm and provide a truly personalized medical age. However, questions about research through the collection and utilization of various big data in various fields have also been raised because quality limitations cannot be overlooked. Therefore, many challenges remain to be overcome in the use of big data research as a basis for changing medical practice. Intervention and interpretation by clinical medical experts are required in judging the scientific trustworthiness of the big data analysis process and the validity of the results. Therefore, healthcare big data research cannot achieve its goal by the efforts of researchers alone. Teams of data analysis scientists, epidemiologists, statistics experts, and clinical researchers are required to collaborate closely with team members, from the design phase to expert consultation, through regular meetings. In addition, it is necessary, in the creation of a healthier community, to cooperate with government agencies that provide data based on the whole nation or the world's population, as well as interest groups representing the people, and policy-making organizations. In this paper, we describe the knowledge, practical clinical applications, and future research directions and prospects for the next phase of health care, from the design of clinical research using health insurance big data to report writing.

Comparative Effects of Curcumin and Tetrahydrocurcumin on Dextran Sulfate Sodium-induced Colitis and Inflammatory Signaling in Mice

BACKGROUND: Curcumin, a yellow ingredient of turmeric (Curcuma longa Linn, Zingiberaceae), has long been used in traditional folk medicine in the management of inflammatory disorders. Although curcumin has been reported to inhibit experimentally-induced colitis and carcinogenesis, the underlying molecular mechanisms remain largely unresolved. METHODS: Murine colitis was induced by dextran sulfate sodium (DSS) which mimics inflammatory bowel disease. Curcumin or tetrahydrocurcumin was given orally (0.1 or 0.25 mmol/kg body weight daily) for 7 days before and together with DSS administration (3% in tap water). Collected colon tissue was used for histologic and biochemical analyses. RESULTS: Administration of curcumin significantly attenuated the severity of DSS-induced colitis and the activation of NF-κB and STAT3 as well as expression of COX-2 and inducible nitric oxide synthase. In contrast to curcumin, its non-electrophilic analogue, tetrahydrocurcumin has much weaker inhibitory effects. CONCLUSIONS: Intragastric administration of curcumin inhibited the experimentally induced murine colitis, which was associated with inhibition of pro-inflammatory signaling mediated by NF-κB and STAT3.

The Effect of Mindfulness-Based Cognitive Therapy on Psychiatric Staff / 정신신체의학

OBJECTIVES: Psychiatric staffs may experience excessive work stress, burnout, and reduced job satisfaction in clinical settings. This can increase chances of diminishing their overall working efficiency or having difficulty managing their own mental health. The purpose of this study was to investigate the effect of group mindfulness- based cognitive therapy(MBCT) on job stress, burnout, self-efficacy, resilience, and job satisfaction. METHODS: Twenty eight psychiatric staffs who agreed to participate in the study were included. Self-report questionnaires were used to measure job stress, burnout, resilience, self-efficacy, and job satisfaction. To examine the effects of group MBCT, the scores were compared before and after MBCT. RESULTS: Work stress and burnout scale scores were significantly decreased after group MBCT. Resilience, job satisfaction, and self-efficacy scale scores were significantly increased after group MBCT. CONCLUSIONS: In the current study, group MBCT for psychiatric staffs helped to reduce their work stress and burnout, and, as well, helped to improve resilience, self-efficacy, and job satisfaction. This suggests that, in mental health treatment settings, psychiatric staffs can improve their mental health through group MBCT. Improving mental health of psychiatric staff may also have a positive impact on their patients.

Evaluation of the Efficacy and Safety of DA-9601 versus Its New Formulation, DA-5204, in Patients with Gastritis: Phase III, Randomized, Double-Blind, Non-Inferiority Study

This study compared the efficacy of DA-9601 (Dong-A ST Co., Seoul, Korea) and its new formulation, DA-5204 (Dong-A ST Co.), for treating erosive gastritis. This phase III, randomized, multicenter, double-blind, non-inferiority trial randomly assigned 434 patients with endoscopically proven gastric mucosal erosions into two groups: DA-9601 3 times daily or DA-5,204 twice daily for 2 weeks. The final analysis included 421 patients (DA-5204, 209; DA-9601, 212). The primary endpoint (rate of effective gastric erosion healing) and secondary endpoints (cure rate of endoscopic erosion and gastrointestinal [GI] symptom relief) were assessed using endoscopy after the treatment. Drug-related adverse events (AEs), including GI symptoms, were also compared. At week 2, gastric healing rates with DA-5204 and DA-9601 were 42.1% (88/209) and 42.5% (90/212), respectively. The difference between the groups was −0.4% (95% confidence interval, −9.8% to 9.1%), which was above the non-inferiority margin of −14%. The cure rate of gastric erosion in both groups was 37.3%. The improvement rates of GI symptoms with DA-5204 and DA-9601 were 40.4% and 40.8%, respectively. There were no statistically significant differences between the two groups in both secondary endpoints. AEs were reported in 18 (8.4%) patients in the DA-5204 group and 19 (8.8%) in the DA-9601 group. Rates of AE were not different between the two groups. No serious AE or adverse drug reaction (ADR) occurred. These results demonstrate the non-inferiority of DA-5204 compared to DA-9601. DA-5204 is as effective as DA-9601 in the treatment of erosive gastritis. Registered randomized clinical trial at ClinicalTrials.gov (NCT02282670)

Diagnosis and treatment of Crohn's disease

Crohn's disease is a chronic and relapsing disease that is not easily controlled with medications. It is characterized by progressive transmural inflammation, and ultimately leads to stricture and penetrating complications requiring surgery. Over the past decades, the prevalence of Crohn's disease has gradually increased in Korea. Conventional treatments with aminosalicylates, steroids, and immunosuppressants are inadequate to control its symptoms and complications. Biologic therapy shows promise for controlling disease activity and promoting mucosal healing. Despite the development of several medical therapies, the treatment of Crohn's disease remains challenging. Individually tailored treatment according to an endoscopic or symptomatic assessment is required.

The Korean guideline for colorectal cancer screening

Colorectal cancer is the third most common cancer in Korea; it is the second most common cancer in men and the third most common in women. The incidence rate in Korea has continuously increased since 1999 when the National Cancer Registry statistics began. Currently; there are several screening modalities; that have been recommended by expert societies, including fecal occult blood test, colonoscopy, computed tomographic colonography The annual fecal immunochemical test (FIT) has been used in adults aged 50 and older as part of the National Cancer Screening Program in Korea since 2004. Although several study results from regional or national colorectal cancer screening programs in other countries have been reported, the National Cancer Screening Program in Korea has not yet been evaluated with evidence-based methods. Herein report the consensus statements on the National Screening Guideline for colorectal cancer developed by a multi-society expert committee in Korea, as follows: 1) We recommend annual or biennial FIT for screening for colorectal cancer in asymptomatic adults, beginning at 45 years of age and continuing until 80 years (recommendation B). 2) There is no evidence for the risks or benefits of FIT in adults older than 80 years (recommendation I). 3) Selective use of colonoscopy for colorectal cancer screening is recommended, taking into consideration individual preference and the risk of colorectal cancer (recommendation C). 4) There is no evidence for the risks or benefits of double-contrast barium enema for colorectal cancer screening in asymptomatic adults (recommendation I). 5) There is no evidence for the risks or benefits of computed tomographic colonography for colorectal cancer screening in asymptomatic adults (recommendation I).

Surgical Correction Is Ineffective for Improvement of Dyssynergic Defecation in Patients With Rectal Prolapse

BACKGROUND/AIMS: The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse. METHODS: This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study. RESULTS: Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 +/- 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery. CONCLUSIONS: In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary.

Epigallocatechin-3-gallate Inhibits the Expression of Adhesion Molecules by Blocking Nuclear Factor Kappa B Signaling in Intestinal Epithelial Cells

BACKGROUND/AIMS: Epigallocatechin-3-gallate (EGCG) is the main polyphenol in green tea and has anti-inflammatory and anti-oxidative effects. The aim of this study was to determine the impact of EGCG on the expression of adhesion molecules and lipopolysaccharide (LPS)-induced nuclear factor-kappa B (NF-kappaB) signaling in rat intestinal epithelial (RIE) cells. METHODS: The effect of EGCG on LPS-induced NF-kappaB signaling and expression of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 was examined by reverse transcription polymerase chain reaction, western blotting, immunofluorescence and electrophoretic mobility shift assay. RESULTS: LPS-induced expression of ICAM-1 and VCAM-1 mRNA was inhibited by EGCG treatment in RIE cells. LPS-induced inhibitor of kappa B alpha degradation and NF-kappaB nuclear translocation were blocked by EGCG in RIE cells. EGCG blocked LPS-induced NF-kappaB DNA-binding activity in RIE cells. The pharmacological NF-kappaB inhibitor Bay11-7082 suppressed the LPS-induced expression of ICAM-1 and VCAM-1 mRNA in RIE cells. CONCLUSIONS: These results indicate that EGCG inhibits LPS-induced ICAM-1 and VCAM-1 expression by blocking NF-kappaB signaling in intestinal epithelial cells.

Epigallocatechin-3-gallate Inhibits LPS-Induced NF-kappaB and MAPK Signaling Pathways in Bone Marrow-Derived Macrophages

BACKGROUND/AIMS: Epigallocatechin-3-gallate (EGCG), the primary catechin in green tea, has anti-inflammatory and anti-oxidative properties. The aim of the current study was to characterize the impact of EGCG on lipopolysaccharide (LPS)-induced innate signaling in bone marrow-derived macrophages (BMMs) isolated from ICR mice. METHODS: The effect of EGCG on LPS-induced pro-inflammatory gene expression and nuclear factor-kappaB (NF-kappaB) and mitogen-activated protein kinase (MAPK) signaling was examined using reverse transcription-polymerase chain reaction, Western blotting, immunofluorescence, and the electrophoretic mobility shift assay. RESULTS: EGCG inhibited accumulation of LPS-induced IL-12p40, IL-6, MCP-1, ICAM-1, and VCAM-1 mRNA in BMMs. EGCG blocked LPS-induced IkappaBalpha degradation and RelA nuclear translocation. EGCG blocked the DNA-binding activity of NF-kappaB. LPS-induced phosphorylation of ERK1/2, JNK, and p38 was inhibited by EGCG. U0126 (an inhibitor of MEK-1/2) suppressed the LPS-induced IL-12p40, IL-6, MCP-1, ICAM-1, and VCAM-1 mRNA accumulation in BMMs. CONCLUSIONS: These results indicate that EGCG may prevent LPS-induced pro-inflammatory gene expression through blocking NF-kappaB and MAPK signaling pathways in BMMs.

Efficacy of Rifaximin Compared with Ciprofloxacin for the Treatment of Acute Infectious Diarrhea: A Randomized Controlled Multicenter Study

BACKGROUND/AIMS: Ciprofloxacin has been widely prescribed for acute infectious diarrhea. However, the resistance to this drug is increasing. Rifaximin is a novel but poorly absorbed rifamycin derivative. This study evaluated and compared the efficacies of rifaximin and ciprofloxacin for the treatment of acute infectious diarrhea. METHODS: We performed a randomized controlled multicenter study in Korea. Patients with acute diarrhea were enrolled and randomized to receive rifaximin or ciprofloxacin for 3 days. The primary efficacy endpoint was the time to last unformed stool (TLUS). Secondary endpoints were enteric wellness (reduction of at least 50% in the number of unformed stools during 24-hour postenrollment intervals), general wellness (subjective feeling of improvement), and proportion of patients with treatment failure. RESULTS: Intent-to-treat analysis (n=143) showed no significant difference between the rifaximin and ciprofloxacin groups in the mean TLUS (36.1 hours vs 43.6 hours, p=0.163), enteric wellness (49% vs 57%, p=0.428), general wellness (67% vs 78%, p=0.189), or treatment failure rate (9% vs 12%, p=0.841). The adverse events did not differ significantly between the two groups. CONCLUSIONS: These results suggest that rifaximin is as safe and effective as ciprofloxacin in the treatment of acute infectious diarrhea.

Appendiceal Mucocele-Induced Intussusception That Presented as a Huge Mass on the Hepatic Flexure Area / 대한소화기내시경학회지

Appendiceal intussusception is a rare disease entity and appendiceal mucocele is one of the causes of this disease. Although computed tomography, ultrasonography, barium enema and colonoscopy can be performed to make a preoperative diagnosis, only a few cases of appendiceal mucocele-induced intussusception have been precisely diagnosed by these diaggnostic tools. Most of all, few such cases have been confirmed by colonoscopic examination. Colonoscopic examination has a supplementary role for the differential diagnosis of acute or chronic appendicitis, tumor or abscess in the ascending colon and cecum that is caused by appendiceal intussusception. We report here on a case of intussusception that was caused by an appendiceal mucocele, and this showed a target appearing structure in the hepatic flexure and a cystic mass inside the intussusceptive lumen on abdominal CT, and a huge mass was discovered on the colonoscopic examination.

A Case of Pneumatosis Cystoides Intestinalis in a Cirrhosis Patient / 대한소화기학회지

Pneumatosis cystoides intestinalis (PCI) is a relatively rare condition in which gas is found as a linear or cystic form in the submucosa or subserosa of bowel wall. PCI is usually found incidentally on an imaging study. Treatment is usually conservative including oxygen and antibiotics therapy. So far, etiology and pathogenesis of PCI remain uncertain. PCI is associated with various medical conditions including various pulmonary diseases, connective tissue diseases, and endoscopic procedures. However, there are only few reports on lactulose causing PCI in patients with cirrhosis. Oral lactulose or enema is one of the main treatment modalities in hepatic encephalopathy. Here, we report a case of PCI which was found during the treatment with lactulose therapy in a patient with liver cirrhosis and hepatic encephalopathy.

Neostigmine for the Treatment of Acute Hepatic Encephalopathy with Acute Intestinal Pseudo-obstruction in a Cirrhotic Patient

We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple airfluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gutderived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.

Analysis of Simultaneous Positivity to Multiple Allergens on MAST CLA Test / 대한진단검사의학회지

BACKGROUND: Allergic patients showing a simultaneously positive reaction to multiple allergens are frequently found. The purpose of this study was to analyze the pattern of simultaneously positive results to the allergens of MAST CLA Korean inhalant and food panels. METHODS: From March 2004 to March 2005, we analyzed the results of the MAST CLA allergy test performed at Bundang Jesaeng General Hospital. During this period, 1, 421 inhalant panels and 331 food panels were tested. RESULTS: Mite-farinae (40.3%) and mite-pterony (34.8%) specific IgE were the most frequently detected in the inhalant panel and also in the food panel. Simultaneously positive rates to two or more allergens were 41.9% (595/1421) in the inhalant panel and 32.3% (107/331) in the food panel. Allergens with a highly positive rate (Mite-f, Mite-p, house dust) were frequently detected simultaneously with other allergens, and allergens known to have cross-reactivity showed simultaneously positive results among themselves (i.e. among various pollen allergens; among allergens associated with the pollen-food syndrome; among grain allergens; among milk and cheese; among fungi allergens; among house dust mites and house dust; among cockroach, crab and shrimp; and among cat and dog). CONCLUSIONS: Simultaneous positivity on the MAST CLA allergy test can be found frequently among various allergens, especially allergens with cross-reactivity. More advanced techniques using recombinant allergens may be needed for further analysis of this finding.

Clinical Impacts of Tumor Cell Contamination of Hematopoietic Stem Cell Products in Metastatic Breast Cancer Patients undergoing Autologous Peripheral Blood Stem Cell Transplantation: Multicenter Trial

To determine whether the tumor cell contamination of peripheral blood stem cells influences clinical impacts on high-dose chemotherapy in patients with metastatic breast cancer, we analyzed carcinoembryonic antigen (CEA) mRNA in the apheresis products by nested RT-PCR (reverse transcriptase-polymerase chain reaction). A total of 38 metastatic breast cancer patients and ten normal healthy subjects as a negative control were included. Twenty out of 38 (51.3%) apheresis products from patients with metastatic breast cancer were positive for CEA mRNA. CEA mRNA was noted in 54.8% (17/31) of patients mobilized with chemotherapy plus G-CSF and 42.8% (3/7) of patients with G-CSF alone. There was no significant difference in age, estrogen receptor, menopausal status, mobilization method, disease free interval, or number of metastasis sites (1 vs >/=2) between positive and negative groups. The presence of CEA mRNA in apheresis products did not influence the time to progression and overall survival in both groups. However, both the univariate and the multivariate analysis disclosed that the number of metastasis was associated with survival significantly. We suggest that the tumor cell contamination does not predict poor treatment outcome in patients with metastatic breast cancer.

Hemodynamic changes after single large volume paracentesis(SLVP) in cirrhosis with tense ascites: Focusing on the effect of albumin as a plasma expander / 대한내과학회지

BACKGROUND: In patients with cirrhosis, single large volume paracentesis(SLVP) is an effective and safe treatment for the tense ascites. But the need for routine administration of albumin remains controversial. We investigated the necessity of albumin administration in cirrhosis with tense ascites after SLVP. METHODS: 23 patients with cirrhosis with tense ascites were recruited, and examined before and 48 hour after a SLVP. Patients were randomly assigned to be administrated with albumin(6 g/L of ascites removed, n=11) or not(n=12). Systemic and renal hemodynamic parameters(mean arterial blood pressure, cardiac index, systemic vascular resistance index, resistive index of kidney, and serum creatinine), indices associated with sodium homeostasis(urine sodium and osmolarity) and neurohumoral factors such as plasma renin activity and plasma concentration of aldosterone were measured before and 48 hour after a SLVP. RESULTS: There was no significant difference in clinical and laboratory parameters between two groups at entry into the study. Plasma renin activity was significantly increased 48 hour after a SLVP in patients without albumin administration, but the change of plasma renin activity before and after paracentesis((delta)plasma renin activity) was not significantly different between two groups. There was no difference in the mean arterial blood pressure, cardiac index, systemic vascular resistance index, resistive index of kidney, serum creatinine, urine sodium and osmolarity and plasma concentration of aldosterone between two groups after SLVP. CONCLUSION: Single large volume paracentesis without albumin administration is a safe and effective treatment in cirrhosis with tense ascites.

Comparison of clinical usefulness of low-calorie-diet combined with exercise and low-calorie-diet alone

BACKGROUND: To assess the efficacy and safety of low-calorie-diet(LCD) using formular diet and to compare clinical usefulness of LCD combined with exercise with LCD alone, sixty obese females were prescribed LCD with exercise or LCD alone, randomly. METHODS: Thirty obese females were treated with LCD of 1,000kcal/d for 8 weeks(group A). Another thirty obese females were treated with LCD of 1,000kcal/d combined with supervised aerobic exercise for 8 weeks(group B). RESULTS: 22 out of 30 obese females in group A[37.3+/-5.0yr ; body fat 40.3+/-3.9%] and 26 out of 30 obese females in group B[37.9+/-7.6yr ; body fat 41.5+/-3.7%] completed the study. At the eighth week, mean weight loss was 5.8+/-2.1kg(8.1%) for group A, and 6.8+/-1.6kg(9.7%) for group B. Differences in weight loss between two groups were statistically significant(p<0.05). In group 4 blood pressure, serum glucose, uric acid, total cholesterol, HDL-cholesterol, sodium, chloride, body fat were significantly reduced, and serum zinc, calcium, phosphorus were significantly increased(p<0.05). In group B, blood pressure, serum glucose, uric acid, total cholesterol, HDL-cholesterol, triglyceride, insulin, iron, sodium, body fat were significantly reduced, and serum zinc, calcium, phosphorus, magnesium were significantly increased(p<0.05). However, the differences of the changes in the above laboratory data between two groups were not statistically significant. Side effects were few and occurred mainly during the first week of the trial. CONCLUSIONS: Low calorie diet for 8 weeks decreased body fat, BP, glucose, uric acid, total cholesterol, MDL-cholesterol levels significantly, and when combined with exercise weight loss was much more than LCD only.

Clinical Study for Monitored Anesthesia Undergoing Ophthalmic Surgery / 대한구급학회지

Intoduction: The phrase "Monitored Anesthesia Care" refers to instances in which an anesthesiologist has been called upon to provide specific anesthesia services to a particular patient understanding a planned procedure, in connection with which a patient receives local anesthesia. Monitored anesthesia care is being increasingly used in the 1990s for a wide variety of diagnostic and therapeutic procedure. The primary objective in providing monitored anesthesia care is to ensure patient comfort and safety. METHOD: We classified patients in three groups by premedication and oxygen administration, no premedication and no oxygen administration (group A), premedication and oxygen administration (group B), premedication and no oxygen administration (group C), measured vital signs and SpO2 (peripheral oxygen saturation) from just before operation, and checked the satisfaction score of surgeon and patients. RESULT: SpO2 and satisfaction score of surgeon and patients are the best at premedication and oxygen administration group. CONCLUSION: Monitored anesthesia is assumed to give more comfort and safety to patients than local anesthesia alone.