The purpose of this study was to evaluate the association between alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and metabolic syndrome (MS) in the Korean population. A total of 11,587 adults ≥30 years of age and with complete data were selected from Korea National Health and Nutrition Examination Survey VI conducted from 2013 to 2015. Normal ALT and AST levels were divided into quartiles, and their associations with MS were assessed by logistic regression analysis. Elevated levels of ALT [adjusted odds ratio (aOR) = 7.90, 95% confidence interval (CI) = 6.50–9.60] and AST (aOR = 3.81, 95% CI = 3.10–4.74) were both significantly associated with a higher prevalence of MS. The quartile group containing the highest levels of ALT and AST within the normal range also showed an increased risk of MS and its components. Elevated levels of ALT and AST, even within the normal range, were associated with prevalence of MS.

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ImportanceAdrenalectomy is the definitive treatment for multiple adrenal abnormalities. Advances in technology and genomics and an improved understanding of adrenal pathophysiology have altered operative techniques and indications.ObjectiveTo develop evidence-based recommendations to enhance the appropriate, safe, and effective approaches to adrenalectomy.Evidence ReviewA multidisciplinary panel identified and investigated 7 categories of relevant clinical concern to practicing surgeons. Questions were structured in the framework Population, Intervention/Exposure, Comparison, and Outcome, and a guided review of medical literature from PubMed and/or Embase from 1980 to 2021 was performed. Recommendations were developed using Grading of Recommendations, Assessment, Development and Evaluation methodology and were discussed until consensus, and patient advocacy representation was included.FindingsPatients with an adrenal incidentaloma 1 cm or larger should undergo biochemical testing and further imaging characterization. Adrenal protocol computed tomography (CT) should be used to stratify malignancy risk and concern for pheochromocytoma. Routine scheduled follow-up of a nonfunctional adrenal nodule with benign imaging characteristics and unenhanced CT with Hounsfield units less than 10 is not suggested. When unilateral disease is present, laparoscopic adrenalectomy is recommended for patients with primary aldosteronism or autonomous cortisol secretion. Patients with clinical and radiographic findings consistent with adrenocortical carcinoma should be treated at high-volume multidisciplinary centers to optimize outcomes, including, when possible, a complete R0 resection without tumor disruption, which may require en bloc radical resection. Selective or nonselective α blockade can be used to safely prepare patients for surgical resection of paraganglioma/pheochromocytoma. Empirical perioperative glucocorticoid replacement therapy is indicated for patients with overt Cushing syndrome, but for patients with mild autonomous cortisol secretion, postoperative day 1 morning cortisol or cosyntropin stimulation testing can be used to determine the need for glucocorticoid replacement therapy. When patient and tumor variables are appropriate, we recommend minimally invasive adrenalectomy over open adrenalectomy because of improved perioperative morbidity. Minimally invasive adrenalectomy can be achieved either via a retroperitoneal or transperitoneal approach depending on surgeon expertise, as well as tumor and patient characteristics.Conclusions and RelevanceTwenty-six clinically relevant and evidence-based recommendations are provided to assist surgeons with perioperative adrenal care.

Cancer survivors remain at life-long risk of developing oral complications. This study investigated the oral health status and behavior among cancer survivors in comparison to subjects without a history of cancer using a nationwide survey. Cancer survivors and control subjects were selected from the sixth Korean National Health and Nutrition Examination Survey (2013–2015). Survivors reported chewing (34.8%) and speaking difficulties (15.3%) resulting from oral health problems. More than 36% of survivors had periodontal disease and 15.9% needed dentures. In multiple logistic regression analysis, age, household income, education level, smoking status, cancer site, and current cancer status were associated with oral health status. Approximately 43.3% of cancer survivors brushed their teeth more than three times a day. In addition, 44.9% of survivors used secondary oral products, and 30.8% had been screened for oral health problems over the past year. Age, household income and education level were associated with oral health behavior. The oral health status and behavior excepting periodontal disease and the use of secondary oral products were not significantly different between cancer survivors and controls. Although oral health status of cancer survivors was not worse than that of controls, more than half of the survivors maintained unhealthy oral practices.

The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are known to be markers of the systemic inflammatory response. However, the few studies that have been done on the relationship between the NLR and PLR and osteoporosis have yielded inconsistent results. Therefore, we assessed the relationship between the NLR and PLR and bone mineral density (BMD). This study was conducted with postmenopausal patients admitted to an orthopaedic hospital. Data including BMD, NLR, PLR and covariates were obtained from the subjects' medical records. In total, 407 postmenopausal patients were enrolled in this study. Analysis of covariance was performed to identify significant differences in BMD according to NLR and PLR. After adjusting for other covariates, a quartile of NLR was negatively associated with the mean value of lumbar BMD (p=0.040, p for trend=0.005) but not with the mean value of femur neck BMD. However, there were no significant associations among the PLR, the BMD of the lumbar and the femur neck. In conclusion, the quartile of NLR was negatively associated with the mean value of lumbar BMD in Korean postmenopausal patients.

The incidence of thyroid cancer has recently increased in most industrialized countries, including Korea. To date, few studies have examined the association between thyroid cancer and socioeconomic status (SES). The current study was based on data collected from a total of 12,276 subjects (5,277 men and 6,999 women) by the Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2011. Univariate and multivariate logistic regression analysis revealed that older age (odds ration [OR], 1.03; 95% confidence interval [CI], 1.00-1.05), being female (OR, 8.16; 95%CI, 2.99-22.24), being overweight (OR, 1.04; 95%CI, 1.01-1.06), monthly household income (OR, 3.27; 95%CI, 1.16-9.20 for medium-highest household income vs lowest household income; OR, 3.30; 95%CI, 1.16-9.34 for highest household income vs lowest household income), educational level (OR, 2.74; 95%CI, 1.16-6.46 for 10-12 yr vs < 7 yr) and alcohol consumption (OR, 1.89; 95%CI 1.08-3.32) were significant risk factors for thyroid cancer. Our results indicate that the recent increase in thyroid cancer is attributable to better early detection rather than to any increase in actual prevalence.

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The purpose of this study was to identify the association between health-related behaviors including smoking, alcohol intake, and the practice of a low-salt diet using data from a Community Health Survey conducted in 2008. The study subjects were 129,151 persons (19 years and older) without cardiovascular diseases or diabetes mellitus diagnosis history. An index for evaluating low salinity was created by summing three low salinity-related questions (range: 0∼3), and a low-salt diet was defined if the index of low salinity was 3. We examined the levels of smoking and alcohol intake according to the index of low salinity, and conducted multiple logistic regression analysis to examine the odds ratios of low-salt diet practice in relation to smoking and drinking behavior, adjusting for general characteristics. The smoking and drinking status significantly improved as the level of low salinity index increase. Adjusting for general characteristics, those with smoking, alcohol intake, or a combined habit of the two behaviors had significantly lower odds ratios for practice of a low-salt diet. In conclusion, smoking and drinking behavior were negatively associated with the practice of a low-salt diet. Based on these findings, it may be necessary to have comprehensive nutritional education programs that consider the multiple effects of smoking, drinking, and a low-salt diet.