Accuracy of virtual 3-dimensional cephalometric images constructed with 2-dimensional cephalograms using the biplanar radiography principle

Lee, Jae-Seo,Kim, Sang-Rok,Hwang, Hyeon-Shik,Lee, Kyungmin Clara Korean Academy of Oral and Maxillofacial Radiology 2021 Imaging Science in Dentistry Vol.51 No.-

Purpose: The purpose of this study was to evaluate the accuracy of virtual 3-dimensional (3D) cephalograms constructed using the principle of biplanar radiography by comparing them with cone-beam computed tomography (CBCT) images. Materials and Methods: Thirty orthodontic patients were enrolled in this study. Frontal and lateral cephalograms were obtained with the use of a head posture aligner and reconstructed into 3D cephalograms using biplanar radiography software. Thirty-four measurements representing the height, width, depth, and oblique distance were computed in 3 dimensions, and compared with the measurements from the 3D images obtained by CBCT, using the paired t-test and Bland-Altman analysis. Results: Comparison of height, width, depth, and oblique measurements showed no statistically significant differences between the measurements obtained from 3D cephalograms and those from CBCT images (P>0.05). Bland-Altman plots also showed high agreement between the 3D cephalograms and CBCT images. Conclusion: Accurate 3D cephalograms can be constructed using the principle of biplanar radiography if frontal and lateral cephalograms can be obtained with a head posture aligner. Three-dimensional cephalograms generated using biplanar radiography can replace CBCT images taken for diagnostic purposes.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea

Lee, Clara,Kim, Stella Jung-Hyun,Lee, Changwoo,Shin, Euichul The Korean Society for Preventive Medicine 2019 Journal of Preventive Medicine and Public Health Vol.52 No.5

Objectives: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. Methods: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. Results: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. Conclusions: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea

Clara Lee,Stella Jung-Hyun Kim,Changwoo Lee,신의철 대한예방의학회 2019 Journal of Preventive Medicine and Public Health Vol.52 No.5

Objectives: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. Methods: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. Results: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. Conclusions: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Association between dietary sodium intake and disease burden and mortality in Koreans between 1998 and 2016: The Korea National Health and Nutrition Examination Survey

Clara Yongjoo Park,Garam Jo,Juhee Lee,Gitanjali M. Singh,Jong-Tae Lee,Min-Jeong Shin 한국영양학회 2020 Nutrition Research and Practice Vol.14 No.5

BACKGROUND/OBJECTIVES: Sodium intake is positively associated with blood pressure, which may increase the risk for cardiovascular disease (CVD). Therefore, we assessed the disease burden of CVD attributable to sodium intakes above 2,000 mg/day and prospectively investigated the association between dietary/urinary sodium levels and the risk of all-cause and CVD-mortality using the Korea National Health and Nutrition Examination Survey (KNHNES). SUBJECTS/METHODS: A total of 68,578 and 33,113 participants were included for comparative risk assessment (CRA) analysis and mortality analysis, respectively, and mean follow-up time for mortality was 5.4 years. CRA analysis was used to quantify attributable incidences of stroke, ischemic heart disease (IHD), and deaths attributable to sodium intake between 1998 and 2016. Cox proportional hazard regression model was used to determine the association between sodium intake and all-cause and CVD-mortality. RESULTS: Mean dietary sodium intake decreased over time, reaching 3,647 mg/day in 2016. Similarly, the population attributable fractions of stroke and IHD, and the number of CVD-associated deaths attributable to high sodium intake/excretion also decreased. In terms of association with mortality, when participants were grouped into quartiles (Q) by energyadjusted sodium intake, those in Q2 had a lower risk of all-cause mortality than those in Q1 with lower intakes. The risk of CVD-associated mortality was higher only in females with high sodium intake in Q4 than those in Q1. CONCLUSIONS: This nationwide data indicates that, in line with previous studies of multiple cohorts, both low and high sodium intakes may be associated with an increased risk of mortality; therefore, the optimal sodium intake for Koreans needs to be revised.

Accuracy of virtual 3-dimensional cephalometric images constructed with 2-dimensional cephalograms using the biplanar radiography principle

Lee Jae-Seo,Kim Sang-Rok,Hwang Hyeon-Shik,Lee Kyungmin Clara 대한영상치의학회 2021 Imaging Science in Dentistry Vol.51 No.4

Purpose: The purpose of this study was to evaluate the accuracy of virtual 3-dimensional (3D) cephalograms constructed using the principle of biplanar radiography by comparing them with cone-beam computed tomography (CBCT) images. Materials and Methods: Thirty orthodontic patients were enrolled in this study. Frontal and lateral cephalograms were obtained with the use of a head posture aligner and reconstructed into 3D cephalograms using biplanar radiography software. Thirty-four measurements representing the height, width, depth, and oblique distance were computed in 3 dimensions, and compared with the measurements from the 3D images obtained by CBCT, using the paired t-test and Bland-Altman analysis. Results: Comparison of height, width, depth, and oblique measurements showed no statistically significant differences between the measurements obtained from 3D cephalograms and those from CBCT images (P>0.05). Bland-Altman plots also showed high agreement between the 3D cephalograms and CBCT images. Conclusion: Accurate 3D cephalograms can be constructed using the principle of biplanar radiography if frontal and lateral cephalograms can be obtained with a head posture aligner. Three-dimensional cephalograms generated using biplanar radiography can replace CBCT images taken for diagnostic purposes.

Emergency Department Visits Can Be Reduced by Having a Regular Doctor for Adults with Diabetes Mellitus: Secondary Analysis of 2013 Korea Health Panel Data

Clara Lee,성낙진,임형석,이재호 대한의학회 2017 Journal of Korean medical science Vol.32 No.12

Chronic diseases pose a major challenge to population health worldwide. Diabetes is a major chronic disease that is managed overwhelmingly in primary care. There is an increasing recognition of the role that primary care physicians play to achieve high-quality care for patients with diabetes. By analyzing 2013 Korean Health Panel data, the authors aimed to determine the current status of having a regular doctor (RD) for adults (aged 18 years or older) with diabetes. In addition, the association of having a RD with the experience of emergency department (ED) visits was determined in this study. Among adults with diabetes, those with RD accounted for 41.0%. The older the age group and the higher the Charlson comorbidity index score, the higher the percentage of adults with diabetes had RD. Even for those with RD, coordination of care was very poor (positive answer: 27.1%). After adjustment for confounding variables, those having (vs. not having) a RD (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35–0.94), especially those whose RDs delivered good comprehensiveness of care (OR, 0.47; 95% CI, 0.26–0.84) or worked at a primary care clinic (OR, 0.43; 95% CI, 0.22–0.81), and those whose longitudinal relationship with a RD was 5 years or less (OR, 0.45; 95% CI, 0.22–0.91) were less likely to have ED visits within the last year. In conclusion, health care policies that promote having a RD who delivers high-quality primary care could decrease unnecessary ED visits by diabetic adults. This can partly reduce ED overcrowding in Korea.

Short Term Intake of Undaria pinnatifida Does Not Affect Bone Biomarkers in Young Korean Women with Low Calcium Intake

( Clara Yongjoo Park ),( Bora Lee ),( Sung Jae Lee ) 한국임상영양학회 2020 Clinical Nutrition Research Vol.9 No.2

Calcium intake is essential for bone health, but young Korean women have low calcium intakes. Seaweeds have high calcium content, which may affect calcium metabolism. Twenty nine females aged 18-39 years with low calcium intake (< 400 mg/day) participated in a 19-day open-label randomized controlled trial. During the first five days, participants adhered to a controlled-feeding protocol followed by a two-week supplementation period in free-living conditions. The treatment group (n = 14) received an additional 200 mg Ca/day through Undaria pinnatifida and Porphyra in meals during the controlled-feeding period, and as U. pinnatifida noodles during days 6-19. Mineral intake (Ca, P, Mg, Na, and K) was assessed from diet composites and three 24-hour recalls during the controlled-feeding and free-living periods, respectively. Fasting serum levels of calcium, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D (1,25[OH]D), phosphorus, parathyroid hormone (PTH), and alkaline phosphatase (ALP) were assessed at baseline, day 6, and day 19. Statistical analyses were performed by Student's t-test and mixed ANOVA. Mean intakes of all minerals during days 1-5 and mean Ca and Mg intakes during days 6-19 were greater in the treatment group compared to the control group. No group effect or group and time interaction was observed in serum biomarkers. Serum 1,25(OH)D increased while PTH and ALP tended to decrease on day 6 but returned to baseline values on day 20. Short-term intake of U. pinnatifida and Porphyra does not affect calcium metabolism in young Korean women with low calcium intakes.

모성(母性) 정체성(正體性)의 변화 : 해외입양인 생모의 자녀재회경험 사례연구

이현정(LEE, Clara Hyun-Jung) 한국가족학회 2021 가족과 문화 Vol.33 No.3

친생모(親生母)가 해외입양자녀와 이루는 관계의 특이성은 개인의 정체성을 이해하고 규명하는 데에 있어 중요한 주제이다. 자녀의 해외입양과 동시에 친권을 잃는 생모(生母)는 자녀유기담론 아래 부정적인 모성 이미지를 남기고 한국 사회에서 사라졌다가 성인이 되어 돌아온 해외입양자녀의 원가족 재회 요청으로 한국 사회에 다시 나타난다. 본 연구는 해외입양자녀와의 재회 전과 후를 기점으로 생모가 경험하는 모성과 모성 역할, 모성 정체성의 변화에 주목한다. 이를 위해 자녀 재회를 경험한 해외입양인 생모들을 면접참여자로 선정하여 심층면접한 결과, 해외입양인 생모는 존재의 현재성에 기반한 다양한 관계를 타인과 맺는 개인으로 존재하고 이는 ‘해외입양인 생모’ 정체성에 선행한다. 해외입양자녀와의 재회는 면접참여자들이 해외입양인 생모로서 갖는 사회 인식적 자아 정체성에서 스스로 벗어나는 계기를 마련하고 모성과 모성 역할의 경계선에서 모성 정체성의 새로운 의미와 변화를 확인하는 경험을 제공한다. 끝으로, 본 연구는 해외입양인 생모가 자녀 재회 권리를 갖는 것의 중요성을 설명하고 이에 대한 사회적 관심과 법 제도적 보완의 필요성을 논의한다. The specificity of the relationship between a birth mother and a transnational adopted child is an important topic in understanding and defining an individual s identity. A birth mother, who loses parental authority with her child s adoption abroad, disappears from Korean society, leaving a negative image of motherhood under the discourse of child abandonment. She then reappears in Korean society at the request of the adopted child returning as an adult to reunite with his/her family of origin. This study focuses on motherhood, maternal roles, and changes in maternal identity experienced by birth mothers in South Korea before and after reunion with transnational adopted child(ren). For this purpose, the birth mothers of transnational adoptees who have experienced child reunion were selected as interview participants. The in-depth interviews found that the birth mothers of transnational adoptees exist as individuals who form various relationships with others based on the presentity of their existence, which precedes the identity of “transnational adoptee’s birth mothers”. Reunion with transnational adopted children provides an opportunity for interviewees to free themselves from the socially-cognitive self-identity that they had as birth mothers (related to the abandonment), and also provides an experience of confirming the new meaning of maternal identity at the boundary between motherhood and maternal roles. Finally, this study explains the importance of providing the family of origin(the birth mother) the right to reunite with their transnational adopted child(ren), and discusses the need for social attention and legal system supplementation.

Evaluation of different bioimpedance methods for assessing body composition in Asian non-dialysis chronic kidney disease patients

( Sean Wy Lee ),( Clara Lee Ying Ngoh ),( Horng Ruey Chua ),( Sabrina Haroon ),( Weng Kin Wong ),( Evan Jc Lee ),( Titus Wl Lau ),( Sunil Sethi ),( Boon Wee Teo ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.1

Background: Chronic kidney disease (CKD) is associated with fluid retention, which increases total body water (TBW) and leads to changes in intracellular water (ICW) and extracellular water (ECW). This complicates accurate assessments of body composition. Analysis of bioelectrical impedance may improve the accuracy of evaluation in CKD patients and multiple machines and technologies are available. We compared body composition by bioimpedance spectroscopy (BIS) against multi-frequency bioimpedance analysis (BIA) in a multi-ethnic Asian population of stable, non-dialysis CKD patients. Methods: We recruited 98 stable CKD patients comprising 54.1% men and 70.4% Chinese, 9.2% Malay, 13.3% Indian, and 8.2% other ethnicities. Stability was defined as no variation in serum creatinine > 20% over three months. Patients underwent BIS analyses using a Fresenius body composition monitor, while BIA analyses employed a Bodystat Quadscan 4000. Results: Mean TBW values by BIS and BIA were 33.6 ± 7.2 L and 38.3 ± 7.4 L; mean ECW values were 15.8 ± 3.2 L and 16.9 ± 2.7 L; and mean ICW values were 17.9 ± 4.3 L and 21.0 ± 4.9 L, respectively. Mean differences for TBW were 4.6 ± 1.9 L (P < 0.001), for ECW they were 1.2 ± 0.5 L (P < 0.001), and for ICW they were 3.2 ±1.8 L (P < 0.001). BIA and BIS measurements were highly correlated: TBW r = 0.970, ECW r = 0.994, and ICW r = 0.926. Compared with BIA, BIS assessments of fluid overload appeared to be more associated with biochemical and clinical indicators. Conclusion: Although both BIA and BIS can be used for body water assessment, clinicians should be aware of biases that exist between bioimpedance techniques. The values of body water assessments in our study were higher in BIA than in BIS. Ethnicity, sex, body mass index, and estimated glomerular filtration rate were associated with these biases.

임상 ; 조기분만과 만삭분만 산모의 모발에서 측정한 중금속 농도의 비교

김석영 ( Suk Young Kim ),이글라라 ( Clara Lee ),이호형 ( Ho Hyoung Lee ),황병철 ( Byung Chul Hwang ),이순표 ( Soon Pyo Lee ),박종민 ( Jong Min Park ) 대한주산의학회 2010 Perinatology Vol.21 No.4

목적: 산모의 영양상태는 태아에게 직접적인 영향을 미치며 산모의 영양상태뿐만이 아니라 산모 체내의 유해한 중금속도 태아의 발육에 영향을 미친다. 이전의 연구에서 산모의 중금속이 높을수록 태아의 발육지연이나 조기분만의 비 율이 높아진다는 보고가 있었다. 그러나 최근 여러 연구에서 산모의 중금속의 농도와 태아의 발육지연이나 조기분만 과의 관계에 대해 일치할 만한 결과를 내놓고 있지 못하다. 따라서 이번 연구를 통해 조기분만과 정상분만 산모간에 중금속 농도의 유의한 차이가 있는지 알아보고자 하였다. 방법: 2008년 3월부터 2008년 8월까지 본원을 방문한 52명의 산모를 대상으로 연구를 진행하였으며 임신주수 37주를 기준으로 조기분만군과 정상분만으로 나누어 두군을 비교 평가하였다. 조기분만군은 23명, 정상분만군은 29명 이었다. 중금속의 농도를 측정하기 위해서 모발 미네랄 검사를 사용하였으며 머리카락을 이용한 모발미네랄 검사의 항목으로는 칼슘, 마그네슘, 나트륨, 칼륨, 구리, 아연 등 15가지 영양 미네랄을 검사하였으며 중금속으로는 안티몬, 우라늄, 비소, 베릴륨, 수은 카드뮴, 납, 알루미늄의 7가지 중금속이 검사항목에 포함되어 있으며 그 외에 백금, 니켈등 14가지 기타 미네랄을 검사하였다. 결과: 모발 미네랄 검사를 통해 산모의 모발에서 얻은 검체의 중금속 농도를 비교했을 때, 수은, 알루미늄, 납 성분이 조기분만군과 정상분만군 모두에서 검출되었으나 두 군간의 유의한 차이를 나타내는 중금속은 없었다. 결론: 모발 미네랄 검사를 통해 산모의 몸속에 중금속이 축적되어 있음을 확인하였고 비록 조기분만군과 정상분만 군 간의 농도를 비교해 본 결과 유의한 차이는 없었다. 그러나 중금속의 노출이 태아의 발달 이상이나 분만 시 여러 합병증을 야기시킨다는 여러 논문들의 연구결과를 볼때 중금속의 악영향을 간과할 수는 없었다. Objectives: Previous studies on the effects of heavy metal exposure on adverse birth outcomes are still inconsistent. Heavy metal exposure would be related to decreased birth weight and a shortened gestational age. The aim of this work was to investigate maternal hair heavy metal concentrations in relation to gestational age at delivery. Methods: A total of 52 maternal hair samples were collected at the department of Obstetrics and Gynecology, Gil hospital, Korea. Delivery before 37 weeks of gestation was defined as preterm and delivery after 37 weeks of gestation was defined as full-term delivery. We gathered the specimens from maternal hair approaching delivery. 23 samples were taken from preterm delivered mothers and 29 samples from full term delivered mothers. We evaluated maternal specimen by hair tissue mineral analysis to measure heavy metal concentrations accumulated for more than several months. All statistical analyses were performed with Chisquare test, Mann-Whitney U test and Wilcoxon W test. Results: Heavy metal was revealed in pregnant women`s hair but there was not a significant correlation between levels of heavy metal and gestational age at delivery. Compared numbers of preterm delivery and fullterm delivery by stratified by heavy metal concentrations did not have significant correlation. Conclusions: This study does not show any strong relationship between delivery outcome and heavy metal measured by hair tissue mineral analysis. Further prospective studies with serial measures of cord blood heavy metal level and hair its levels may be required.