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OBJECTIVE There is limited evidence on the association of sustained low-income status, income changes, and all-cause mortality risk in individuals with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Using the Korean Health Insurance Service database, we studied 1,923,854 adults with T2D (aged ≥30 years) without cardiovascular disease and cancer, who were enrolled from 2009 through 2012 and followed to the end of 2020 (median 10.8 years of follow-up). We defined income levels based on the amount of health insurance premiums and categorized them into quartiles, the first being the low-income group, and assessed the income status annually in the preceding 5 years. Cox proportional hazards models were used to quantify the association of low-income status and income changes with mortality, with adjustment for sociodemographic factors, comorbidities, and diabetes duration and treatment. RESULTS Participants who consecutively had low income showed a higher risk of mortality (hazard ratio [HR] 1.19; 95% CI 1.16–1.22), compared with those who had never been in the low-income group. This association was much stronger for consecutive recipients of Medical Aid, reflecting very-low-income status (HR 2.26; 95% CI 2.16–2.36), compared with those who had never been Medical Aid beneficiaries. Sustained low- and very-low-income status was associated with increased risk of mortality, specifically for younger adults (aged CONCLUSIONS Among Korean adults with T2D, sustained low-income status and declines in income were associated with increased risk of mortality.

Background: Statin-associated muscle symptoms are one of the side effects that physicians should consider when prescribing statins. In this study, creatine kinase (CK) levels were measured following statin prescription, and various factors affecting the CK levels were determined using machine learning.Methods: Changes in the CK were observed every 3 months for a 12-month period in patients who received statins for the first time at Seoul St. Mary's Hospital. For each visit, we developed four basic models based on changes in the CK levels. Extreme gradient boosting, a scalable end-to-end tree boosting algorithm, which employs a decision-tree-based ensemble machine learning algorithm, was used for the prediction of changes in the CK.Results: A total of 23,860 patients were included. Among them, 19 patients (0.08%) had increased CK levels of 2,000 IU·L−1 or more 3 months after statin prescription, and 65 patients (0.27%) exhibited CK levels of over 2,000 IU·L−1 at least once during the 12-month study period. The area under the receiver operator characteristic of each model for each visit was 0.709–0.769, and the accuracy was 0.700–0.803. In each of the models, the variables that had the strongest influence on changes in the CK were sex and previous CK value.Conclusions: Through machine learning, factors influencing changes in the CK were identified. These results will provide the basis for future research, through which the optimal parameters of the CK prediction model can be found and the model can be used in clinical applications.

DA-9801, a plant-based drug used for the treatment of diabetic neuropathy, is known to improve angiotensin II (Ang II)-induced vascular endothelial cell dysfunction. However, the underlying mechanism is not fully understood. We aimed to determine whether the protective effect of DA-9801 against Ang II-induced endothelial cell dysfunction was mediated via inhibition of endothelial cell inflammation and apoptosis. Ang II-induced oxidative stress was attenuated by pretreatment of human dermal microvascular endothelial cells (HDMECs) with DA-9801. This prevented the Ang II-induced upregulation of NAD(P)H oxidase (the NOX4 and p22phox subunits) and reactive oxygen species. Further, pretreatment of HDMECs with DA-9801 ameliorated Ang II-mediated nuclear factor kappa B activity via prevention of the upregulation of extracellular signal-regulated kinase and p38 mitogen-activated protein kinase. It also decreased the Ang II-stimulated increase in inducible nitric oxide synthase (NOS) and decreased endothelial NOS protein expression. DA-9801 decreased Ang II-induced upregulation of intercellular adhesion molecule 1, vascular adhesion molecule, and E-selectin in HDMECs. Moreover, TUNEL and annexin V-FITC fluorescence staining for apoptosis and the activities of caspases 9, 7, and 3 decreased in HDMECs pretreated with DA-9801, indicating that the drug enhanced anti-apoptotic pathways. Thus, DA-9801 modulated Ang II-induced endothelial cell dysfunction via inflammatory and apoptotic pathways.

Aims Heart failure (HF) is associated with obesity, but the relationship between weight change and HF is inconsistent. We examined the relationship between weight change and the incidence of HF in the Korean population. Design Retrospective cohort study design. Methods and results A total of 11 210 394 subjects (6 198 542 men and 5 011 852 women) >20 years of age were enrolled in this study. Weight change over 4 years divided into seven categories from weight loss ≥15% to weight gain ≥15%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of HF were analysed. The HR of HF showed a slightly reverse J-shaped curve by increasing weight change in total and >15% weight loss shows the highest HR (HR 1.647) followed by −15 to −10% weight loss (HR = 1.444). When using normal body mass index with stable weight group as a reference, HR of HF decreased as weight increased in underweight subjects and weight gain ≥15% in obesity Stage II showed the highest HR (HR = 2.97). Sustained weight for 4 years in the underweight and obesity Stages I and II increased the incidence of HF (HR = 1.402, 1.092, and 1.566, respectively). Conclusion Both weight loss and weight gain increased HR for HF. Sustained weight in the obesity or underweight categories increased the incidence of HF.

Background: Surgeries in patients with coronavirus disease 2019 (COVID-19) put medical staff at a high risk of infection. We report the anesthetic management and infection control of a mechanically ventilated COVID-19 patient who underwent exploratory laparotomy for suspected duodenal ulcer perforation.Case: A 73-year-old man, mechanically ventilated for confirmed COVID-19, showed clinical and radiographic signs of a perforated duodenal ulcer, and he was transferred under sedation and intubation to a negative-pressure operating room. The operating and assistant staff wore personal protective equipment. High-efficiency particulate absorbing (HEPA) filters were inserted into the expiratory circuits of the anesthesia machine and portable ventilator. No participating staff contracted COVID-19, although the patient later died due to pneumonia.Conclusions: This report can contribute to establishing clinical guidelines for the surgical management and operation room setting of COVID-19 patients.

Background: The analgesic effect of perineural opioid in clinical practice are still controversial. This randomized controlled trial compared analgesic effect of ropivacaine with fentanyl or ropivacaine alone for continuous femoral nerve block following unilateral total knee arthroplasty. Methods: Fourty patients of ASA PS Ⅰ or Ⅱ receiving total knee arthroplasty with spinal anesthesia were enlisted and randomly allocated into two groups. Group R; bolus injection of 0.375% ropivacaine, 30 ml and an infusion of 0.2% ropivacaine at 8 ml/h (n = 20). Group RF; 0.375% ropivacaine, 29 ml added with 50 μg of fentanyl as a bolus and an infusion of 0.2% ropivacaine mixed with 1 μg/ml of fentanyl at 8 ml/h (n = 20). Local anesthetic infusion via a femoral nerve catheter was started at the end of operation and continued for 48 h. Intravenous patient-controlled analgesia with hydromorphone (0.15 mg/ml, 0-1-10) were used for adjuvant analgesics. Position of catheter tip and contrast distribution, visual analog scale of pain, hydromorphone consumption, side effects were recorded for 48 h after operation. Patient satisfaction for the pain control received were noted. Results: The pain visual analogue scale, incidences of side effects and satisfaction were not different between the two groups (P > 0.05), but the hydromorphone usage at 48 h after operation were lower in the Group RF than in the Group R (P = 0.047). Conclusions: The analgesic effect of ropivacaine with fentanyl for continuous femoral nerve block after knee replacement arthroplasty was not superior to that of the ropivacaine alone.

Inflammatory potential of diet may contribute to poor health outcomes in individuals with metabolic disorders. In a representative sample of the U.S. population, we investigated the association between consuming a pro-inflammatory diet and mortality risk in adults with normal range of body mass index (BMI) but with central obesity.This prospective cohort study included 3521 adults 20-90 years of age with normal BMI who participated in the National Health and Nutrition Examination Survey III, 1988-1994 and did not have a history of cardiovascular disease (CVD) or cancer and did not change their dietary intake in the year preceding baseline measurements. Mortality from all causes, CVD, and cancer was ascertained from the National Death Index. Normal-weight central obesity (NWCO, n = 1777) was defined as those with BMI 18.5 to25 kg/mIn individuals with NWCO, DII score (i.e., more pro-inflammatory diet) was associated with increased risk of CVD mortality (HRAmong individuals in the normal-weight range of BMI, a pro-inflammatory diet assessed by high DII scores was associated with increased risk of CVD mortality in those with central obesity.

Background : The global prevalence of obesity has increased steadily in recent years. Waist circumference (WC) reflects body composition better than body mass index. The Korean Society for the Study of Obesity released the 2018 Obesity Fact Sheet to address the incidence of obesity-related comorbidities according to WC levels. Methods : Data from the Korean National Health Insurance Service health examination database from 2009 to 2016 were analyzed. Abdominal obesity was defined as a WC ≥90 cm in men and ≥85 cm in women. Incidence rates of comorbidities and all-cause mortality rates were calculated after standardizing by age and sex based on the 2010 census. Results : From 2009 to 2015, the incidence rates of type 2 diabetes mellitus, hypertension, myocardial infarction, and ischemic stroke increased both in men and women. Individuals with the lowest WC levels had the highest all-cause mortality rates followed by those with the highest WC levels in men, women, and the total population. The incidence rates of total cancer increased as WC levels escalated between 2009 and 2016. In men, the incidence rates of colorectal, prostate, and liver cancers increased as WC levels increased. The incidence rates of thyroid, colorectal, and stomach cancers increased as WC levels rose in women. In addition, medical expenses continuously increased as WC increased in both men and women. Conclusion : Based on the 2018 Obesity Fact Sheet, strategies for reducing the abdominal obesity and related comorbidities and medical expenses are a public health priority.

BACKGROUND AND AIMS: This study was designed to investigate the association between the dietary inflammatory index (DII(®)) scores, metabolic phenotypes, and risk of mortality risk in overweight/obese individuals from a representative sample of the U.S. population. METHODS: Data from 3733 overweight/obese adults (BMI≥25kg/m(2)) aged 20–90 years from the National Health and Nutrition Examination Survey III, 1988–1994 were analyzed; these participants were followed for mortality through December 31, 2011. DII scores were computed based on baseline dietary intake using 24-hour dietary recalls. Metabolically unhealthy status was defined as having 2 or more of these metabolic abnormalities: high glucose, insulin resistance, elevated blood pressure, triglycerides, C-reactive protein levels, or low high-density lipoprotein-cholesterol values. RESULTS: In metabolically unhealthy overweight/obese (MUO) individuals, DII score was associated with increased risk of all-cause mortality (HR(Tertile 3 vs Tertile 1) 1.44; 95% CI 1.11–1.86 P(trend)=0.008; HR(1SD increase) 1.08; 95% CI 0.99–1.18). Additionally, a stronger association with cardiovascular mortality was observed (HR(T3 vs T1) 3.29; 95% CI 2.01–5.37 P(trend)

We sought to analyze the visual outcome and systemic prognostic factors for diabetic vitrectomy and predicted outcomes using these factors.This was a multicenter electronic medical records (EMRs) review study of 1504 eyes with type 2 diabetes that underwent vitrectomy for proliferative diabetic retinopathy at 6 university hospitals. Demographics, laboratory results, intra-operative findings, and visual acuity (VA) values were analyzed and correlated with visual outcomes at 1 year after the vitrectomy. Prediction models for visual outcomes were obtained using machine learning.At 1 year, VA was 1.0 logarithm of minimal angle resolution (logMAR) or greater (poor visual outcome group) in 456 eyes (30%). Baseline visual acuity, duration of diabetes treatment, tractional membrane, silicone oil tamponade, smoking, and vitreous hemorrhage correlated with logMAR VA at 1 year (r = 0.450, -0.159, 0.221, 0.280, 0.067, and -0.105; all P ≤ 0.036). An ensemble decision tree model trained using all variables generated accuracy, specificity, F1 score (the harmonic means of which precision and sensitivity), and receiver-operating characteristic curve area under curve values of 0.77, 0.66, 0.85, and 0.84 for the prediction of poor visual outcomes at 1 year after vitrectomy.Visual outcome after diabetic vitrectomy is associated with pre- and intra-operative findings and systemic factors. Poor visual outcome after diabetic vitrectomy was predictable using clinical factors. Intensive care in patients who are predicted to result in poor vision may limit vision loss resulting from type 2 diabetes.This study demonstrates that a real world EMR big data could predict outcome after diabetic vitrectomy using clinical factors.

Background This study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged ≥30 years by analyzing nationally representative data. Methods This study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people ≥30 years of age with diabetes and impaired fasting glucose (IFG) were estimated. Results In 2018, 13.8% of Korean adults aged ≥30 years had diabetes, and adults aged ≥65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged ≥30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of

Background : The prevalence of obesity has rapidly increased in countries across the world in recent decades. The 2019 Obesity Fact Sheet released by the Korean Society for the Study of Obesity addressed the prevalence of obesity and abdominal obesity during the period of 2009 to 2018 and obesity-related social factors. Methods : Data from the Korean National Health Insurance Service health checkup database between 2009 and 2018 and the Korea National Health and Nutrition Examination Survey between 2010 and 2017 were analyzed. The prevalence of obesity and abdominal obesity was calculated after standardizing for age and sex based on the 2010 population and housing census. Results : From 2009 to 2018, the prevalence of obesity and abdominal obesity increased to 35.7% and 23.8%, respectively, in 2018. Upward trends in the prevalence of obesity and abdominal obesity was observed among both sexes and nearly all age groups. The prevalence of obesity and abdominal obesity was higher among individuals with lower education and household income levels. Among occupations, managers exhibited the highest prevalence of obesity and abdominal obesity. Further, the prevalence of obesity and abdominal obesity became higher among individuals working longer hours and split and night shift workers. Conclusion : The 2019 Obesity Fact Sheet provides information on changes in obesity dynamics during the past decade and obesity-related social factors in the Korean adult population. This report might constitute a cornerstone by which to establish targets for future interventions for reversing the rise in the prevalence of obesity and reducing the burden of obesity in Korea.

Background Increased oxidative stress and impaired antioxidant defense are important mechanisms in the pathogenesis of diabetic myopathy. Alpha-lipoic acid (ALA) has been indicated as a weight-loss treatment in rodents and humans, but studies are limited. In the present study, we aimed to determine the influence of ALA, a potent biological antioxidant, on metabolic and growth processes in diabetic rat skeletal muscle. Methods Male 25-week-old type 2 diabetic rats (OLETF) were randomly divided into two groups, a control group (OLETF-C) and an ALA-treated group (OLETF-ALA) supplemented with 100 mg/kg ALA for 8 weeks. Age-matched, healthy, nondiabetic LETO (LETO-C) rats were used as controls. Results At 32 weeks of age, body weight was decreased by 6.8%, and the areas under the curve of IP-GTT, fasting glucose, and insulin were less in OLETF-ALA rats compared with OLETF-C rats. ALA significantly preserved muscle mass and enhanced muscle fiber cross-sectional area and fiber frequency percentage in the skeletal muscle of OLETF rats. Although the activation of myoD, myogenin, and myostatin in gastrocnemius muscle was significantly inhibited in OLETF-ALA rats relative to OLETF-C rats, there were no differences in the expression levels of muscle atrogin-1 and MuRF1 between the two groups. ALA treatment significantly increased the levels of phosphorylated 5′-AMPK, SIRT1, and PGC-1α, as well as the levels of phosphorylated AKT, mTOR, and p70S6 kinase in OLETF-ALA rats compared with OLETF-C rats. In contrast, the levels of phosphorylated p38 MAPK, IRS-1, and FOXO1 were decreased in OLETF-ALA rats compared with OLETF-C rats. Conclusions ALA treatment preserved mass in the gastrocnemius muscles of OLETF rats. ALA significantly upregulated the AMPK/SIRT1/PGC-1α and AKT/mTOR/p70S6K signaling pathways in OLETF rat skeletal muscle. Therefore, ALA may be a potential therapeutic intervention for skeletal muscle loss in animal models of insulin resistance.

Background This report presents the recent prevalence and comorbidities related to diabetes in Korea by analyzing the nationally representative data. Methods Using data from the Korea National Health and Nutrition Examination Survey for 2013 to 2014, the percentages and the total number of subjects over the age of 30 years with diabetes and prediabetes were estimated and applied to the National Population Census in 2014. Diagnosis of diabetes was based on fasting plasma glucose (≥126 mg/dL), current taking of antidiabetic medication, history of previous diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. Impaired fasting glucose (IFG) was defined by fasting plasma glucose in the range of 100 to 125 mg/dL among those without diabetes. Results About 4.8 million (13.7%) Korean adults (≥30 years old) had diabetes, and about 8.3 million (24.8%) Korean adults had IFG. However, 29.3% of the subjects with diabetes are not aware of their condition. Of the subjects with diabetes, 48.6% and 54.7% were obese and hypertensive, respectively, and 31.6% had hypercholesterolemia. Although most subjects with diabetes (89.1%) were under medical treatment, and mostly being treated with oral hypoglycemic agents (80.2%), 10.8% have remained untreated. With respect to overall glycemic control, 43.5% reached the target of HbA1c

Background : The prevalence of obesity and related comorbidities is increasing worldwide, including in Korea. The Korean Society for the Study of Obesity released the Obesity Fact Sheet 2017 to address this problem in the Korean population. Methods : Data from the National Health Insurance Service Health Checkup database from 2006 to 2015 were standardized by age and sex using the 2010 Census. The definition of obesity was a body mass index (BMI) ≥25 kg/m², and that of abdominal obesity was a waist circumference ≥90 cm in men and ≥85 cm in women. Multivariate adjusted Cox regression analysis was conducted, and hazard ratios (HRs) with 95% confidence intervals were calculated for comorbidities. Results : From 2009 to 2015, the prevalence of obesity increased from 29.7% to 32.4%, and that of abdominal obesity increased from 18.4% to 20.8%. Obesity with abdominal obesity also increased from 15.1% to 17.7%. Between 2014 and 2015, the prevalence of obesity increased until 30–40 years of age, but decreased from 40–50 years of age in men. In women, it increased until the mid-70s, and decreased thereafter. Abdominal obesity increased from 20–30 years of age to 70–80 years of age, but decreased thereafter. The HRs for type 2 diabetes mellitus, hypertension, dyslipidemia, myocardial infarction, and ischemic stroke were elevated in subjects with abdominal obesity, and their incidence increased as the BMI increased, but slowed down at BMI ≥35 kg/m². Conclusion : Based on the Obesity Fact Sheet 2017, strategies for reducing the prevalence of obesity and abdominal obesity are essential.

The clinical utility of the combined use of BMI and waist circumference (WC) to indicate the cardiovascular disease (CVD) risk factors in Asians remains unclear. Using a large-scale population-based cohort from the KNHIS health checkup data from 2009 to 2015, we investigated the relationship between BMI, WC and subsequent CVD risk factors (at least one from type 2 diabetes, hypertension or dyslipidemia). BMI was categorized into 5 subgroups at 18.5, 23.0, 25.0 and 30.0kg/m2. The cut-off points of WC for central obesity were 90cm in men and 85cm in women. The participants were subdivided into a total of 10 subgroups according to the presence of central obesity in each of the 5 BMI ranges. The incidence risk of CVD risk factors in each subgroup was comparatively analyzed using a multivariable Cox's proportional hazard model. Participants were 14,170,134 adults above 20 years of age who did not have type 2 diabetes, hypertension or dyslipidemia at the baseline examinations. During a mean follow-up of 5.3 years, CVD risk factors developed in 1,857,307 participants. The HRs for CVD risk factors were increased by 8.2% per 1kg/m2 increment of BMI. The HRs (95% CI) for CVD risk factors across BMI categories were 0.573, 1.0, 1.479, 1.962 and 3.03, respectively, after adjusting for age, sex, smoking, alcohol drinking, physical activity, and monthly income. Compared to the group with BMI of 18.5 to 23 kg/m2 without central obesity, which served as the reference group, the multivariable-adjusted HRs in those with central obesity was significantly increased from 1.00 to 1.27 with a BMI of 18.5 to 23.0 kg/m2, from 1.45 to 1.64 with a BMI of 23.0 to 25.0 kg/m2, from 1.83 to 2.10 with a BMI of 25.0 to 30.0 kg/m2, and from 2.56 to 3.08 with a BMI of 30.0 kg/m2 or over. These findings show that assessment of central obesity provided additional clinical utility beyond BMI for reclassifying the risk of CVD risk factors in Korean populations, even those with a low BMI. Disclosure J. Son: None. S. Lee: None. H. Kwon: None. S. Yoo: None.

Background: Waist circumference (WC) is an index of abdominal obesity and associated with co-morbidities and mortality. Higher WC is positively associated with increased mortality; therefore, we examined the relationship between WC and mortality in Korean populations with the interaction of body mass index (BMI) and WC for mortality. Methods: A total of 23,263,878 subjects (men = 11,813,850 and women = 11,450,028) who were older than 20 years and underwent the National Health Insurance Service health checkup were included. WC was divided into six categories by 5 cm increments and level 3 (85-90 cm in men and 80-85 cm in women) was referenced. Multivariable Cox proportional hazard models were used to obtain the hazard ratios (HRs) and 95% confidence intervals for all-cause mortality according to the six levels of WC. Results: WC in 5 cm increments showed a positively increased all-cause mortality after adjusting for all covariates including BMI. Men showed higher HRs for mortality than women as WC increased, and the HRs were higher in the lower WC levels, but lower in the higher WC levels among the subjects aged 65-85 years than subjects aged 40-65 years. Even in subjects with normal weight and overweight, increased WC (levels 4, 5, and 6) showed increased HRs for mortality (HRs = 1.156, 1.412, and 1.614 in normal BMI and 1.145, 1.401, and 1.909 in overweight, respectively). Conclusion: There was a linear association between WC and all-cause mortality across all BMI categories even in the subjects with normal or overweight BMI. Physicians should check WC routinely even in the subjects with normal weight or overweight. Disclosure Y. Kim: None. S. Yoo: None. S. Lee: None.

Background : In Korea, the prevalence of obesity has steadily increased, and the socioeconomic burden of obesity has increased along with it. In 2015, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society for the Study of Obesity (KSSO), providing limited open access to its databases so that the status of obesity and obesity management could be investigated. Methods : Using NHIS databases, we analyzed nationwide population-based studies for obesity using the definition of obesity (body mass index ≥25 kg/m²) in subjects over the age of 20. Age and sex standardization were used for all data. Results : The KSSO released the ‘Obesity Fact Sheet 2016’ using the 2006-2015 NHIS Health Checkup database. The prevalence of obesity steadily increased from 28.7% in 2006 to 32.4% in 2015, and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015. The prevalence of class II obesity steadily increased from 2006 to 2015, such that the total prevalence was 4.8% in 2015 (5.6% in men and 4.0% in women). The highest prevalence of obesity was found in Jeju Island, while the lowest prevalence was found in Daegu City. The highest prevalence of abdominal obesity was also found in Jeju Island, while the lowest prevalence was found in Gwangju City. Conclusion : Based on the Obesity Fact Sheet 2016, a strategy for reducing the prevalence of obesity is needed, especially in Korean men.

The aim of this study was to determine an appropriate index for age-related sarcopenia and sarcopenic obesity (SO) and investigate relationships among sarcopenia, insulin resistance and risk of type 2 diabetes. Our analyses included 1285 men and 1724 women who had complete data available for body composition analysis and the 75 g oral glucose tolerance test. A whole-body DXA scan was performed for each patient to measure the total and regional lean mass (kg), the total body fat (kg), and the total body fat percentage (%). The appendicular skeletal muscle mass ASM (kg) was defined as the sum of the lean mass of the arms and legs. Sarcopenia was assessed by the ASM/height2, or the ASM/weight (%). Obesity was identified based on the total body fat percentage or the BMI. The mean ages of men and women were 62.8 ± 8.4 years and 63.3 ± 8.6 years, respectively. As measured using the ASM/Ht2, the cut-off values for sarcopenia were 6.61 kg/m2 in men and 4.25 kg/m2 in women. For the ASM/Wt %, the cut-offs were 30.1% in men and 23.4% in women. ASM/weight, but not ASM/height2, was inversely associated with the homeostasis model assessment of insulin resistance (HOMA-IR). The prevalence of sarcopenia and SO, defined as ASM/weight less than the one standard deviation below the sex-specific normal mean of a younger reference group and a BMI of over 25 kg/m2, tended to be higher with increased HOMA-IR tertile. Compared to either sarcopenia or obesity alone, SO was associated with a higher risk of developing type 2 diabetes (P < 0.001, OR = 4.23, 95% CI = 2.08-8.99) in those 60 years or older after adjusting for confounding factors. Subjects with sarcopenia were at especially high risk of newly diagnosed diabetes in older age groups (P < 0.001, OR = 2.92, 95% CI = 1.21-7.02). Sarcopenia and SO, assessed by the ASM/weight and BMI, were strongly associated with the degree of insulin resistance and the risk of developing type 2 diabetes in older adults.

Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index

Many studies have reported the frequency and distribution of haplogroups among various cattle breeds for verification of their origins and genetic diversity. In this study, 318 complete sequences of the mtDNA control region from four Korean cattle breeds were used for haplogroup classification. 71 polymorphic sites and 66 haplotypes were found in these sequences. Consistent with the genetic patterns in previous reports, four haplogroups (T1, T2, T3, and T4) were identified in Korean cattle breeds. In addition, T1 a, T3a, and T3b sub-haplogroups were classified. In the phylogenetic tree, each haplogroup formed an independent cluster. The frequencies of T3, T4, T1 (containing T1a), and T2 were 66%, 16%, 10%, and 8%, respectively. Especially, the T1 haplogroup contained only one haplotype and a sample. All four haplogroups were found in Chikso, Jeju black and Hanwoo. However, only the T3 and T4 haplogroups appeared in Heugu, and most Chikso populations showed a partial of four haplogroups. These results will be useful for stable conservation and efficient management of Korean cattle breeds.

Background Element™ Auto-coding Blood Glucose Monitoring System (BGMS; Infopia Co., Ltd., Anyang-si, Korea) was developed for self-monitoring of blood glucose (SMBG). Methods Precision, linearity, and interference were tested. Eighty-four capillary blood samples measured by Element™ BGMS were compared with central laboratory method (CLM) results in venous serum. Accuracy was evaluated using ISO 15197:2013 criteria. Results Coefficients of variation (CVs; mean) were 2.4% (44.2 mg/dl), 3.7% (100.6 mg/dl), and 2.1% (259.8 mg/dl). Linearity was shown at concentrations 39.25–456.25 mg/l (y = 0.989 + 0.984x, SE = 17.63). Up to 15 mg/dl of galactose, ascorbic acid, and acetaminophen, interference > 10.4% was not observed. Element™ BGMS glucose was higher than CLM levels by 3.2 mg/dl (at 200 mg/dl) to 8.2 mg/dl (at 100 mg/dl). The minimum specification for bias (3.3%) was met at 140 and 200 mg/l glucose. In the Clarke and consensus error grids, 100% of specimens were within zone A and B. For Element™ BGMS values, 92.9% (78/84) to 94.0% (79/84) were within a 15 mg/dl ( 100 mg/dl) of the average CLM value. Conclusion Element™ BGMS was considered an appropriate SMBG for home use; however, the positive bias at low-to-mid glucose levels requires further improvement.

Background: Waist circumference (WC) is an index of abdominal obesity and associated with co-morbidities and mortality. Higher WC is positively associated with increased mortality, therefore, we examined the relationship between WC and mortality in Korean populations with the interaction of body mass index (BMI) and WC for mortality. Methods: A total of 23,263,878 subjects (men = 11,813,850 and women = 11,450,028) who were older than 20 years and underwent the National Health Insurance Service health checkup were included. WC was divided into six categories by 5 cm increments and level 3 (85&ndash, 90 cm in men and 80&ndash, 85 cm in women) was referenced. Multivariable Cox proportional hazard models were used to obtain the hazard ratios (HRs) and 95% confidence intervals for all-cause mortality according to the six levels of WC. Results: WC in 5 cm increments showed a positively increased all-cause mortality after adjusting for all covariates including BMI. Men showed higher HRs for mortality than women as WC increased, and the HRs were higher in the lower WC levels, but lower in the higher WC levels among the subjects aged 65&ndash, 85 years than subjects aged 40&ndash, 65 years. Even in subjects with normal weight and overweight, increased WC (levels 4, 5, and 6) showed increased HRs for mortality (HRs = 1.156, 1.412, and 1.614 in normal BMI and 1.145, 1.401, and 1.909 in overweight, respectively). Conclusion: There was a linear association between WC and all-cause mortality across all BMI categories even in the subjects with normal or overweight BMI. Physicians should check WC routinely even in the subjects with normal weight or overweight.

We aimed to investigate the association of various obesity parameters and phenotypes with hypertension in nationally representative Korean adults. Among adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey in 2008-2010, a total of 16,363 subjects (8,184 men and 8,179 women) were analyzed. Hypertension was defined as blood pressure of 140/90 mm Hg or higher or taking antihypertensive medication. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Higher obesity parameters [body mass index (BMI) representing general obesity, waist circumference (WC) representing central obesity, and percentage body fat (PBF) representing elevated body fat] were consistently associated with increased odds of prevalent hypertension (OR, 7.54; 95% CI, 5.89-9.65 for BMI ≥30 vs. 18.5-23; OR, 3.97; 95% CI, 3.41-4.63 for WC ≥95 cm in males and ≥90 cm in females vs.

In this paper, we propose a method of measuring mechanical activity of the heart using flat coil via wireless power charging receiver coil in a mobile communication devices such as mobile phone. The basic principle of the proposed method is based on the variation of magnetic inductance of coil antenna near biological tissues caused by the eddy current according to the Faraday’s law of magnetic induction. In order to recover the movement of ventricular muscle of the heart, FM demodulation scheme was applied. The correlation between the cardiac cycle and the measured heart activities was compared with standard ECG lead II signals. As a result, the period of the measured signals almost close to the intrinsic period of R-R intervals of the heart. The proposed method shows the possibility of using wireless power charging receiver coil embedded in the personal communication devices such as mobile phone and tablet device as a new heart-rate sensor.

Purpose: The objective of this study was to investigate molecular and physiological changes in response to long-term insulin glargine treatment in the skeletal muscle of Otsuka Long-Evans Tokushima Fatty (OLETF) rats. Methods: Protein changes in the skeletal muscle of type 2 diabetic rats was detected by Western blot analysis, and muscle fiber type composition was assessed by real-time PCR. Results: Insulin glargine (1 U/kg) treatment in OLETF rats (OLETF-G) for 24 weeks were changed in blood glucose levels in intraperitoneal glucose tolerance tests compared with age-matched, untreated OLETF rats (OLETF-C), and the area under the curve was significantly decreased for OLETF-G rats compared with OLETF-C rats (P < 0.05). The protein levels of myosin heavy chain (MHC) isoforms were altered in gastrocnemius muscle of OLETF rats, and the proportions of MHC type I and II fibers were lower and higher, respectively, in OLETF-G compared with OLETF-C rats. Activation of myokines (interleukin [IL]-6, IL-15, fibronectin type III domain containing 5 [FNDC5]/irisin, and myostatin) in gastrocnemius muscle was significantly inhibited in OLETF-G compared with OLETF-C rats (P < 0.05). Moreover, myogenin determination gene D and myogenin levels were decreased, while insulin-like growth factor-I levels were increased, in the skeletal muscle of OLETF-G rats (P < 0.05). Insulin glargine treatment significantly increased the phosphorylation levels of 5’-AMP-activated protein kinase, sirtuin 1, and peroxisome proliferator-activated receptor γ coactivator 1α. Conclusions: Our results suggest that long-term insulin glargine treatment can effectively alter protein expression in the gastrocnemius muscle of OLETF rats. Disclosure H. Kwon: None. O. Hong: None. H. Kwon: None. Y. Kang: None. S. Lee: None. S. Kim: None. S. Yoo: None.

BACKGROUND: The laser is able to irradiate the exact amount of stimulation to an area by a non contact method, and has the advantage of being able to stimulate the local target area. OBJECTIVE: This study examined an efficient method of laser tactile stimulation using laser parameter combinations. METHODS: The laser parameters that could cause an increase in the cognitive response rate of human subjects were examined without increasing the amount of total laser energy. RESULTS: As a result, the appropriate matching parameters such as duty ratio, pulse frequency, and exposure time of laser pulses showed a dominant influence in effectively increasing the tactile response rate of subjects with limited amount of total laser energy. CONCLUSIONS: This study can be applied to neurophysiology, cognitive research, and clinical laser application.

The goals of this study were to identify sequence variations in the mitochondrial cytochrome b (mtDNA cyt b) gene in White Hanwoo (Wh) and the genetic relationship between the Wh and other breeds. When whole sequences of the mtDNA cyt b gene in 14 Wh cattle were determined, a silent mutation and two haplotypes were detected in the Wh cattle. The major haplotype, H1, was found in 13 of 14 individuals in the Wh cattle. Haplotype diversity and nucleotide diversity were 0.143 and 0.00013, respectively. Compared to previous reports, these levels of genetic diversity are lower than other Korean and Chinese breeds. To identify the genetic relati onship among Korean, Chinese, Japanese, and European cattle breeds, the neighbor-joining (NJ) tree was constructed based on Dxy genetic distances. Two distinct groups were identified and classified as A and B. Wh was found in the A group, which consisted of Bos taurus breeds. From calculating the Dxy genetic distances, Wh was found to be genetically more closely related to two breeds, Heugu (0.00018) and Yanbian (0.00021), than to other breeds. In conclusion, Wh is genetically related to Chikso, Heugu, and Yanbian breeds based on maternal inheritance. The results of this study will be useful for efficient management and sustainable utilization of Wh.

Allergic reaction to insulin is uncommon since the introduction of human recombinant insulin preparations and is more rare in pregnant than non-pregnant females due to altered immune reaction during pregnancy. Herein, we report two cases of allergic reaction to insulin in gestational diabetes that were successfully managed. One case was a 33-year-old female using isophane-neutral protamine Hagedorn human insulin and insulin lispro. She experienced dyspnea, cough, urticaria and itching sensation at the sites of insulin injection immediately after insulin administration. We discontinued insulin therapy and started oral hypoglycemic agents with metformin and glibenclamide. The other case was a 32-year-old female using insulin lispro and insulin detemer. She experienced pruritus and burning sensation and multiple nodules at the sites of insulin injection. We changed the insulin from insulin lispro to insulin aspart. Assessments including immunoglobulin E (IgE), IgG, eosinophil, insulin antibody level and skin biopsy were performed. In the two cases, the symptoms were resolved after changing the insulin to oral agents or other insulin preparations. We report two cases of allergic reaction to human insulin in gestational diabetes due to its rarity.

Background: This study aimed to investigate the relationship between obesity and chronic laryngitis in South Korea using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) collected during 2008-2010. Methods: KNHANES was a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 13,819). Obesity status was measured by using BMI and waist circumference. Results: Among the population over 19 years of age, the prevalence of chronic laryngitis was 4.0 ± 0.4%. Chronic laryngitis was significantly associated with age, BMI, waist circumference, fat proportion, both systolic and diastolic blood pressure, fasting blood sugar, triglycerides, and high-density lipoprotein cholesterol in women. Old age and current smoking were significantly associated with chronic laryngitis in men. Obese women were at a higher risk for chronic laryngitis than women without obesity (odds ratio (OR) 2.022, 95% confidence interval (95% CI) 1.412-2.895) after further adjustment for confounders. Women with abdominal obesity were also at higher risk for chronic laryngitis (OR 1.475, 95% CI 1.024-2.126). Conclusion: Obese women in Korea have an elevated risk for developing chronic laryngitis. Further epidemiological and experimental studies are necessary to clarify the impact of obesity on this condition.

Objective To investigate the relationship between bone mineral density (BMD) and hearing impairment using a nationally demonstrative sample of Korean female adults. Study design Cross-sectional study of a national health survey. Methods Data from the 2009–2010 Korean National Health and Nutrition Examination Surveys (KNHANES) with 19 491 participants were analysed, and 8773 of these participants were enrolled in this study. BMD was measured using dual-energy X-ray absorptiometry. Auditory functioning was evaluated by pure-tone audiometric testing according to established KNHANES protocols. We deliberated auditory impairment as pure-tone averages at frequencies of 0.5, 1.0, 2.0 and 3.0 kHz at a threshold of ≥40 decibels hearing level in the auricle with better hearing status. Results Among women aged 19 years and older, prevalences of bilateral hearing impairment in premenopausal and postmenopausal women were 0.1%±0.1% and 11.5%±1.1% (mean±SE), respectively. Hearing impairment was meaningfully associated with low BMD in postmenopausal women. Logistic regression models indicated that lower BMDs of the total femur (OR=0.779; 95% CI 0.641 to 0.946, P=0.0118) and femur neck (OR=0.746; 95% CI 0.576 to 0.966, P=0.0265) were significantly associated with hearing impairment among postmenopausal women. Conclusions Postmenopausal Korean women with low BMD of the total femur and femoral neck showed an increased risk for developing hearing impairment. Further epidemiological and investigational studies are needed to elucidate this association.

Background: Higher waist circumference (WC) is positively associated with increased mortality; therefore, we examined the relationship between WC and mortality in Korean populations with the interaction of body mass index (BMI) and WC for mortality. Methods: A total of 23,263,878 subjects who were older than 20 years and underwent the National Health Insurance Service health checkup were included. WC was divided into six categories by 5 cm increments and level 3 (85-90 cm in men and 80-85 cm in women) was referenced. Multivariable Cox proportional hazard models were used to obtain the hazard ratios (HRs) and 95% confidence intervals for all-cause mortality according to the six levels of WC. Findings: WC in 5 cm increments showed a positively increased all-cause mortality after adjusting for all covariates including BMI. Men showed higher HRs for mortality than women as WC increased, and the HRs were higher in the lower WC levels, but lower in the higher WC levels among the subjects aged 65–85 years than subjects aged 40–65 years. Even in subjects with normal weight and overweight, increased WC (levels 4, 5, and 6) showed increased HRs for mortality (HRs = 1·156, 1·412, and 1·614 in normal BMI and 1·145, 1·401, and 1·909 in overweight, respectively). Interpretation: This study provides evidence of the need to lose WC in the subjects with normal or overweight BMI categories. The importance of assessing WC routinely should be raised and the guidelines to keep proper WC are stressed. Funding Statement: We would like to thank the Korean National Health Insurance Corporation and all the participants of the study and health check-up. This study was supported by grant HC16C2285 from the Korean Health Technology and Research and Development project, Ministry of Health and Welfare, Republic of Korea. This research was also supported by a grant of the Development of an Interactive Medical History Taking Software (2017-0-00588), funded by the Ministry of Science and ICT, Republic of Korea Declaration of Interests: The authors have nothing to disclose. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of the Korea University Anam Hospital (ED17115) and permission for the use of health checkup data was granted by the NHIS (NHIS-2018-1-035).

Background: Chronic ethanol consumption induces pancreatic β-cell dysfunction and metabolic syndrome. Results: Ethanol-induced Atf3 inhibits glucokinase transcriptional activity through direct binding or Atf3/Pdx-1/Hdac1 axis on glucokinase promoter. Conclusion: ATf3 fosters β-cell dysfunction via Gck down-regulation and triggers T2D, which is ameliorated by in vivo Atf3 silencing. Significance: The presented data uncover a new role for Atf3 as a potential therapeutic target in treating type 2 diabetes., Chronic ethanol consumption induces pancreatic β-cell dysfunction through glucokinase (Gck) nitration and down-regulation, leading to impaired glucose tolerance and insulin resistance, but the underlying mechanism remains largely unknown. Here, we demonstrate that Gck gene expression and promoter activity in pancreatic β-cells were suppressed by chronic ethanol exposure in vivo and in vitro, whereas expression of activating transcription factor 3 (Atf3) and its binding to the putative Atf/Creb site (from −287 to −158 bp) on the Gck promoter were up-regulated. Furthermore, in vitro ethanol-induced Atf3 inhibited the positive effect of Pdx-1 on Gck transcriptional regulation, enhanced recruitment of Hdac1/2 and histone H3 deacetylation, and subsequently augmented the interaction of Hdac1/Pdx-1 on the Gck promoter, which were diminished by Atf3 siRNA. In vivo Atf3-silencing reversed ethanol-mediated Gck down-regulation and β-cell dysfunction, followed by the amelioration of impaired glucose tolerance and insulin resistance. Together, we identified that ethanol-induced Atf3 fosters β-cell dysfunction via Gck down-regulation and that its loss ameliorates metabolic syndrome and could be a potential therapeutic target in treating type 2 diabetes. The Atf3 gene is associated with the induction of type 2 diabetes and alcohol consumption-induced metabolic impairment and thus may be the major negative regulator for glucose homeostasis.

In obese Zucker diabetic fatty (ZDF) rats, ER stress is associated with insulin resistance and pancreatic β-cell dysfunction; however the exact mechanisms by which ER stress drives type-2 diabetes remain uncertain. Here, we investigated the role of ATF3 on the preventive regulation of AMPK against ER stress-mediated β-cell dysfunction during the end-stage progression of hyperglycemia in ZDF rats. The impaired glucose metabolism and β-cell dysfunction were significantly increased in late-diabetic phase 19-week-old ZDF rats. Although AMPK phosphorylation reduced in 6- and 12-week-old ZDF rats was remarkably increased at 19weeks, the increases of lipogenice genes, ATF3, and ER stress or ROS-mediated β-cell dysfunction were still remained, which were attenuated by in vivo-injection of chemical chaperon tauroursodeoxycholate (TUDCA), chronic AICAR, or antioxidants. ATF3 did not directly affect AMPK phosphorylation, but counteracts the preventive effects of AMPK for high glucose-induced β-cell dysfunction. Moreover, knockdown of ATF3 by delivery of in vivo-jetPEI ATF3 siRNA attenuated ER stress-mediated β-cell dysfunction and enhanced the beneficial effect of AICAR. Our data suggest that ATF3 may play as a counteracting regulator of AMPK and thus promote β-cell dysfunction and the development of type-2 diabetes and could be a potential therapeutic target in treating type-2 diabetes.

In general, the solar photovoltaic power increases with higher solar insolation. However, the solar cell generation efficiency reduces because the solar cell surface is heated by solar insolation. According to advanced research, with a increase in the solar cell surface temperature, the generation efficiency decreases by ~0.5%. To solve this problem, we conducted experiments in which we attempted to reduce the solar cell surface temperature using a water jet spray. In this study, we found the long-term experimental results of increases in solar power generation. The experimental results show a comparison of the site with and without cooling and cleaning equipment being installed. The results of the long-term experiments show that solar photovoltaic power generation is increased by at least 13% up to 19% with cooling and cleaning.

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

It has been reported that people with asthma have an increased risk of hypertension. However, little is known about the specific relationship between asthma and hypertension in young adults. Among subjects who participated in the Korea National Health and Nutrition Examination Survey conducted in 2008–2013, a total of 10,138 young adults (4,226 men and 5,912 women) aged 19–39 years were analyzed. Multiple logistic regression analysis was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The prevalence of ever asthma was 11.1% in men and 8.4% in women. The mean diastolic blood pressure (DBP) was lower in men with asthma than in men without asthma (p = 0.03), whereas the mean DBP was higher in women with asthma than in women without asthma (p = 0.04). Having asthma was inversely associated with hypertension in men (OR: 0.62, 95% CI: 0.41–0.91). In contrast, having asthma was positively associated with hypertension in women (OR: 2.19, 95% CI: 1.19–4.02). Our results suggest that asthma pathophysiology might be differentially associated with hypertension in young adults depending on sex.

The aim of this study was to evaluate the effects of early intensive insulin therapy on body fat distribution, lean body mass and β-cell function in patients with newly diagnosed type 2 diabetes.Thirty-eight subjects with newly diagnosed type 2 diabetes participated in a 12-week course of intensive insulin therapy. Patients were administered a 75 g oral glucose tolerance test (OGTT), underwent measurement of visceral and subcutaneous adipose tissues (VAT and SAT) using computed tomography and appendicular skeletal muscle (ASM) mass was assessed using dual-energy X-ray absorptiometry.After intensive insulin therapy, fasting plasma glucose and HbA1c levels decreased. Homeostasis model assessment (HOMA)-B, the insulinogenic index, and the C-peptide-to-glucose area under the curve (AUC) ratio increased. The insulin sensitivity index and the glucose AUC decreased after 12 weeks. The body composition analysis revealed that the VAT and the ratio of VAT to SAT decreased, whereas body weight and total fat mass increased nonsignificantly. The ASM/weight and skeletal muscle mass index increased. The restoration of β-cell function, as identified by HOMA-B, the insulinogenic index, and the C-peptide-to-glucose AUC ratio, was correlated with the changes in VAT when controlled for age and gender. In multiple regression analyses, the decrease in VAT was shown to independently contribute to improved HbA1c over the study period, after adjusting for confounding factors.These results suggest that a shift in fat distribution from visceral to subcutaneous fat after early intensive insulin therapy is associated with improvements in glycemic control and β-cell function in patients with newly diagnosed type 2 diabetes.

Asians have a propensity to develop type 2 diabetes with a lower BMI than Western populations. This discrepancy may be due to differences in body fat and muscle mass for a given BMI. However, unlike adiposity, it is unclear whether muscle mass affects the risk of type 2 diabetes in Asian populations.We conducted a 2-yearly prospective assessment of 6895 participants who were free of diabetes at the baseline examination as part of the Korean Genome Epidemiology Study. The muscle mass index (MMI) was defined as the weight-adjusted appendicular skeletal muscle mass. Using Cox regression models, we evaluated the association between MMI and the risk of developing type 2 diabetes across sex-specific tertiles of MMI. Low muscle mass was defined as the sex-specific lowest tertile of MMI. Main covariates included age, sex, urban or rural residence, family history of diabetes, hypertension, smoking status, education level, monthly income, physical activity, alcohol consumption and diet. In addition, body fat mass, waist circumference and BMI were controlled as categorical variables. Obesity was defined as a BMI of ≥25 kg/mDuring a median follow-up of 9.06 years, 1336 participants developed type 2 diabetes. At baseline, the mean age was 52.1 years and the mean BMI was 24.4 kg/mLow muscle mass as defined by MMI was associated with an increased risk of type 2 diabetes, independent of general obesity, in middle-aged and older Korean adults.

We evaluated the prevalence, awareness, treatment and control of hypertension in Korean adults with diagnosed diabetes using nationally representative data. Among subjects aged ≥30 years who participated in the Fourth Korea National Health and Nutrition Examination Survey in 2007 and 2008, a total of 745 subjects (336 men and 409 women) with a previous diagnosis of diabetes mellitus were analyzed. The prevalence of hypertension in adults with diagnosed diabetes was 55.5%. The rates of awareness, treatment and control were 88.0, 94.2, and 30.8%, respectively. Compared with the general population, the prevalence of hypertension in adults with diagnosed diabetes was higher in all age groups in both genders. Factors independently associated with a high prevalence of hypertension included being male, increasing age, single,9 years of education, the presence of chronic kidney disease risk, hypercholesterolemia (≥240 mg dl(-1)) and high body mass index (≥25 kg m(-2)). Regular medical screening was positively associated with hypertension control, whereas a high triglyceride level (≥150 mg dl(-1)) was inversely associated. A high prevalence and a low control rate of hypertension in adults with diagnosed diabetes suggest that stringent efforts are needed to control blood pressure in diabetic patients.

This research is to apply the control of neuron networks for the real-time walking control of Multi-articulated robot. Multi-articulated robot is expressed with a complicated mathematical model on account of the mechanic, electric non-linearity which each articulation of mechanism has, and includes an unstable factor in time of walking control. If such a complex expression is included in control operation, it leads to the disadvantage that operation time is lengthened. Thus, if the rapid change of the load or the disturbance is given, it is difficult to fulfill the control of desired performance. This paper proposes a new mode to implement a neural network controller by installing a real object for controlling and an algorithm for this, which can replace the existing method of implementing a neural network controller by utilizing activation function at the output node. The proposed control algorithm generated control signs corresponding to the non-linearity of Multi-articulated robot, which could generate desired motion in real time.

Background Alcohol use affecting the risk of type 2 diabetes mellitus (T2DM) is poorly identified as well as the role of brain-derived neurotrophic factor (BDNF), ghrelin, and leptin in alcohol dependence with T2DM. We tested the hypothesis that alcohol abstinence affects diabetes-related factors and BDNF, ghrelin, and leptin secretions in alcohol-dependent patients with glucose intolerance. Methods A total of 64 male alcohol-dependent patients were classified into normal glucose tolerance (NGT), pre-diabetes mellitus (pre-DM), and diabetes mellitus (DM) groups according to a 75-g oral glucose tolerance test (OGTT). All participants got alcohol dependence rehabilitation treatment for 30 days, and then we compared changes in BDNF, ghrelin, and leptin between pre- and post-alcohol abstinence. Results After alcohol abstinence, both pre-DM and DM groups had significantly decreased levels of fasting glucose. All 3 groups exhibited elevated ghrelin levels and reduced leptin levels, but BDNF levels were significantly increased only in the pre-DM group. The pre-DM group had large increases in BDNF and ghrelin levels compared with those of the NGT group. Moreover, decreases in homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose, and leptin levels in the DM group were larger than those in the NGT group. Conclusions Alcohol abstinence might influence diabetes-related factors of alcohol-dependent patients with glucose intolerance. Further, BDNF, ghrelin, and leptin differently affect this improvement, depending on the stage of DM. In the pre-DM group, elevated BDNF and ghrelin levels are likely to influence insulin sensitivity, insulin resistance, and fasting glucose levels. Further, reduced leptin levels after abstinence might be related to improved glucose kinetics in patients with diabetes.

This research is to apply the adaptive control of neuron networks for the real-time attitude control of Multi-articulated robot. Multi-articulated robot is expressed with a complicated mathematical model on account of the mechanic, electric non-linearity which each articulation of mechanism has, and includes an unstable factor in time of attitude control. If such a complex expression is included in control operation, it leads to the disadvantage that operation time is lengthened. Thus, if the rapid change of the load or the disturbance is given, it is difficult to fulfill the control of desired performance. In this research we used the response property curve of the robot instead of the activation function of neural network algorithms, so the adaptive control system of neural networks constructed without the information of modeling can perform a real-time control. The proposed adaptive control algorithm generated control signs corresponding to the non-linearity of Multi-articulated robot, which could generate desired motion in real time.

Background: There have been lots of studies about the relationship between chronic use of alcohol and the development of type 2 diabetes mellitus (T2DM). Chronic use of alcohol can be affected by the altered level of ghrelin and leptin which regulate food-seeking behavior having similar mechanism of controlling alcohol-craving behavior. Those peptides are known to be correlated with T2DM. Ghrelin and leptin also have been regarded as possible regulators of glucose metabolism and insulin function. Hence, there is the possibility that ghrelin and leptin can be related with deteriorated pathophysiology of T2DM in alcoholic patients. Methods: Patients with alcohol dependence diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) underwent an 75 g oral glucose-tolerance test (OGTT), to classify them to normal glucose tolerance (NGT, n = 52), pre-diabetes including impaired glucose tolerance (IGT), impaired fasting glucose level (IFG) and combination of IGT and IFG (Pre-DM, n = 26) and T2DM (n = 24) groups. Fasting plasma ghrelin and leptin levels were compared among groups. Results: There was no difference of ghrelin concentration among the groups but the leptin concentration was significantly different between NGT and T2DM group (p

Purpose: Most gastric cancer patients undergo operations at large tertiary hospitals in Korea. However, some patients are treated at low volume hospitals. We investigated patient outcomes after gastric surgery at a secondary hospital and compared with outcomes of large volume centers. Materials and Methods: We included 184 patients who underwent gastric surgery for gastric cancer at our hospital from January 2003 to December 2008. We conducted a retrospective study and evaluated the clinicopathological characteristics, clinical outcomes and survival rate of patients. Results: Mean age was 61.7 years old. Male to female ratio was 2.2 : 1. Proportion of early gastric cancer was 38.6% and that of advanced gastric cancer was 61.4%. The 5 year overall survival rate of 184 patients was 66.3%. The overall survival rate was significantly lower for people over 62 years old. The morbidity rate and mortality at our hospital were 10.3% and 0.5%, respectively. Conclusions: The overall survival rate, morbidity and mortality were similar to those of the previous reports from Korea. Treatment of gastric cancer at a secondary hospital is feasible and safe. Standardization of operations and management of gastric cancer patients of the Korean Gastric Cancer Association is the most important factor to achieve these outcomes.

Recently, photovoltaic generator system is widely extended by energy policy of the government. Add to this, high efficiency of photocell power generation is steady needed to sun tracking method. However sun tracking method is not widely extended by insufficiency of tracking technology. As method of solving this problem, this paper applied sunlight sensor and neural network control algorithm for maximum power tracking of sun photocell. Sun tracking sensor consists of one upright square pole and form light sensor of east, west, south, north on flat board. Sun tracking dual axes control is operated respectively by two motor. Motor control input is calculated by neural network control algorithm. The function of proposed control method is verified by sun tracking experiment of photocell generation. The sun tracking method of this paper is increased 32[%] efficiency more than fixed method.