Asan Foundation

Evogliptin, a dipeptidyl peptidase-4 inhibitor with a glucose-dependent mechanism of action, is widely used as a monotherapy or in combination with other agents. However, observational studies in routine clinical settings remain limited. This study aimed to evaluate the effectiveness and safety of evogliptin in combination with other antidiabetic agents frequently used in clinical practice. This study was conducted in 51 hospitals in South Korea. We evaluated evogliptin in three groups: the evogliptin add-on, evogliptin-switching, and initial combination groups. The primary endpoint was the change in haemoglobin A1c (HbA1c) levels (%) from baseline to 12 weeks. The change in HbA1c (%) levels from baseline to 24 weeks was a secondary endpoint in the extended study. Proportions of patients achieving the HbA1c target, changes in fasting and postprandial glucose levels, and safety endpoints were also evaluated. Between-group comparisons were performed between the add-on and initial combination groups. In the 1596 patients of the effectiveness set, the mean changes in HbA1c levels at 12 weeks were -0.8% ± 1.2%, -0.3% ± 0.8% and -1.9% ± 1.4% for the evogliptin add-on, evogliptin-switching and initial combination groups, respectively. Among the 1920 patients in the safety set, 23 experienced adverse drug reactions, and there was no significant difference among the three groups. Evogliptin reduces blood glucose levels and is well-tolerated when used as an add-on, as a switch from other dipeptidyl peptidase 4 inhibitors, or as part of an initial combination therapy in patients with type 2 diabetes mellitus.

ObjectiveThis study aimed to elucidate the normative upper lumbar lordosis (ULL) and lower LL (LLL) based on individual pelvic and spinal morphology within an asymptomatic elderly population.MethodsWhole spine standing radiographs were obtained from asymptomatic elderly populations who had not undergone previous spinal surgery. The LL, LLL and ULL were measured. Pelvic incidence (PI), upper lumbar distribution index (ULDI), and lower LDI were calculated. Pearson correlation and linear regression analyses were performed, and the mean value for each parameter was obtained according to PI subgroup (PI <40°, 40°≤ PI <50°, 50°≤ PI <60°, and 60°≤ PI) and “theoretical” Roussouly type.ResultsOverall, data from 150 male were retrospectively collected in the study, with an average age of 64.1±6.4 years. The mean height was 167.0±5.5 cm, weight was 67.3±9.8 kg, and body mass index was 24.1±3.1 kg/m2. The average LL was -57.5°±9.0°, LLL was -39.7°±6.8°, and PI was 48.6°±8.6°. Pelvic tilt (PT) tended to increase with ULL, PI-LL, PI-ULL, PI-LLL, and ULDI and decrease with LLL and LDI. However, PT was not significantly related to LL. The mean ULDI and LDI were 30.4%±11.7% and 69.7%±11.7%, respectively. The differences between PI and LL (PI-LL) and between PI and LLL (PI-LLL) were -8.9°±8.0° and 9.0°±9.3°, respectively. As PI increased from low (<40°) to high (≥60°), ULDI increased significantly from 25.9% to 38.9%, while LDI decreased from 74.1% to 61.1%. Additionally, LDI varied by Roussouly type, ranging from 62.6% to 81.0%. The LDIs of Roussouly types 1 and 4 were significantly higher and lower, respectively, than those of types 2 and 3 (p<0.001).ConclusionAs PI and Roussouly type increase, the contribution of ULL to overall LL rises, reaching up to 38.9%. Conversely, LLL substantially impacts LL in patients with a low PI and those classified as Roussouly type 1. PT is significantly related to LLL instead of LL according to PI.

Smoking can be changed by health behavior education on the fact that unhealthy behaviors can cause chronic diseases and cancer and that it is important to identify health behaviors in smoking. We try to compare the health behaviors of combustible cigarette (CC), heated tobacco (HT) users, and quitters. Smoking behaviors were divided into three groups (CC, HT users, and quitters). The HT user group (n = 100) was selected among those who underwent a health examination in 2021-2022. CC smokers cohort group (n = 100) and quitters cohort (n = 100) were randomly selected from the same groups (age ± 2) who underwent a health examination in the same period. Sleep-related problems (snoring and sleep apnea), alcohol consumption, and exercise were compared in the CC group, HT group, and quitters group, respectively. Snoring was more common in the quitters group (27%) than in the CC users group (19%) and HT users group (18%). It can be related to weight gain during quitting tobacco use. Nondrinkers were more common in the CC users group (21%) than the HT users group (8%) and quitters group (10%). CC users seem to be more concerned about the health effects of drinking compared to HT users and quitters. Anaerobic exercise was different among groups, and aerobic exercise was not. HT users group did more aerobic exercise than CC users and quitters group. Differences in healthy behaviors among CC and HC users and quitters can be useful information for health education to smokers. Understanding smokers’ health behavior is important to smoking cessation counseling in clinical practice.

Abstract Background Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.Methods Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).Results No significant differences in clinical outcomes (ASES score, constant score, and range of motion)were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p=0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.Conclusions When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.Level of evidence: Level III-2, Retrospective study

ObjectiveCervical pedicle screw (CPS) placement is very challenging due to high risk of neurovascular complications. We devised a new technique (medial funnel technique) to improve the accuracy and feasibility of CPS placement.MethodsWe reviewed 28 consecutive patients undergoing CPS instrumentation using the medial funnel technique. Their mean age was 51.4 years (range, 30–81 years). Preoperative diagnosis included degenerative disease (n=5), trauma (n=22), and infection (n=1). Screw perforations were graded with the following criteria: grade 0 having no perforation, grade 1 having <25%, grade 2 having 25%–50% and grade 3 having >50% of screw diameter. Grades 0 and 1 were considered as correct position. The degree of perforation was determined by 2 junior neurosurgeons and 1 senior neurosurgeon.ResultsA total of 88 CPSs were inserted. The rate of correct placement was 94.3%; grade 0, 54 screws; grade 1, 29 screws; grade 2, 4 screws; and grade 3, 1 screw. No neurovascular complications or failure of instrumentation occurred. In perforated screws (34 screws), lateral perforations were 4 and medial perforations were 30.ConclusionWe performed CPS insertion using medial funnel technique and achieved 94.3% (83 of 88) of correct placement. And it can decrease lateral perforation.

This study aimed to compare the effects of lumbar stabilization exercise with those of the neurodynamic technique on low back pain in patients with lumbar instability.

The 2015 Paris Climate summit consolidated the transition of the climate regime from a “regulatory” to a “catalytic and facilitative” model. A key component of this shift was the intergovernmental regime’s embrace of climate action by sub- and nonstate actors. Although a groundswell of transnational climate action has been growing over time, the Paris Agreement seeks to bring this phenomenon into the heart of the new climate regime. This forum article describes that transition and considers its implications.