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Background: Diabetic foot ulcers are an issue of clinical interest as diabetes has become the leading cause of occlusive vasculopathy. The purpose of this study is to evaluate the clinical outcomes and the effect of revascularization in diabetic foot ulcers with peripheral arterial occlusive disease (PAOD).Methods: A total of 46 patients who had surgical treatment for diabetic foot ulcers were evaluated. We conducted an intergroup comparison of their baseline demographic and clinical characteristics, and also compared surgical outcomes between cases with and without PAOD, and also between cases on which revascularization had and had not been performed.Results: Major amputation was performed on 10 patients (21.7%). Minor amputation and reconstructive surgery were performed on 24 patients (52.2%) and 12 patients (26.1%), respectively. In the 19 patients (41.3%) with severe obstruction, eight patients (42.1%) underwent major amputation. In the patients without severe obstruction, two patients (7.4%) underwent major amputation. The high proportion of major amputation in patients with severe obstruction was statistically significant (P

Striae gravidarum are a common problem in postpartum women, who may experience serious emotional distress due to multiple streaks of scars on the abdomen. There is still no consensus on the treatment method for this problem. For a postpartum woman in her late 30s, who requested striae removal from the lower mid-abdomen, we developed and performed the keyhole-shaped vertical mini-abdominoplasty. This 37-year-old woman, who had given birth to two children, presented with multiple striae on the lower mid-abdomen and periumbilical area, as well as mild bulging in this area. The keyhole-shaped vertical mini-abdominoplasty, including multiple striae on the lower mid-abdomen and periumbilical skin, was designed. An area of striated lower abdominal and periumbilical skin, measuring approximately 10×15 cm2 and weighing about 450 g, was excised. Midline reinforcement of the loosened anterior rectus sheath with 3-0 Prolene sutures was done. Both lateral abdominal skin flaps were medially advanced to close the skin defects. Postoperatively, the patient had a favorable lower abdominal appearance with markedly fewer striae on the lower mid-abdomen and periumbilical area. The keyhole vertical mini-abdominoplasty can effectively correct moderate striae on the lower mid-abdomen and periumbilical area in postpartum women in their late 30s to middle age.

Purpose: Tendon injuries in hand were one of the most frequent injuries caused by trauma. Although consequent tenorrhaphy is frequently conducted, in complete tendon rupture the location of retracted tendon stumps cannot be identified clearly, which causes difficulties in surgical management. Ultrasonography is known to be a fast, accurate, and cost-effective diagnostic method for tendon injury; therefore, the authors studied the usefulness of preoperative ultrasonography in diagnosis and management of tendon injuries in hand.Methods: Among the 34 patients who had hand tendon injuries and visited between January 2017 and March 2018, retrospective studies were conducted on six patients with unidentified tendon stumps. By identifying the location of the tendon injuries and ruptured tendon stumps through preoperative ultrasonography, the operation was conducted under a predetermined surgical plan. The authors compared the ultrasonography results and the surgical findings.Results: For diagnosis of the unidentified tendon injuries and location of ruptured tendon stumps, the ultrasonography results and the surgical findings were matched for all six patients. By prior planning of the operation incision line using the preoperative ultrasonography results, the length of the incision site was minimized without additional incision, and the operation time was shortened.Conclusion: For hand tendon injuries with unidentified tendon stumps, identifying the location of tendon stumps through preoperative ultrasonography is helpful for determining the incision range for the operation. Therefore, preoperative ultrasonography may be useful in the diagnosis and management of tendon injuries in hand.

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

BACKGROUND/OBJECTIVES Few epidemiological studies examined the association between fried food intake and hypertension. This study examined whether fried food intake was associated with higher prevalence of prehypertension and hypertension combined in a cross-sectional study of the Filipino Women's Diet and Health Study (FiLWHEL). SUBJECTS/METHODS This study included a total of 428 women aged 20-57 years who have ever been married to Korean men. Prehypertension was defined as 120 - < 140 mmHg of SBP or 80 - < 90 mmHg of DBP and hypertension as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. Fried food intake was assessed using one-day 24-hour recall. Fried foods were categorized into total, deep/shallow and pan/stir fried foods. The odds ratio (OR)s and 95% confidence interval (CI)s were calculated using multivariate logistic regression. RESULTS The prevalence of prehypertension and hypertension combined was 41.36% in this population. High fried food intake was associated with high prevalence of prehypertension and hypertension combined. The odds of having prehypertension and hypertension was higher in the 3rd tertile of fried food intake among fried food consumers compared to non-fried food consumers (OR = 2.46, 95% CI = 1.24, 4.87; P for trend = 0.004). Separate analysis for types of frying showed that deep and shallow fried food intake was associated with prevalence of prehypertension and hypertension combined for comparing the 3rd tertile vs. non-fried food consumers (OR = 2.93; 95% CI = 1.57-5.47; P for trend = < 0.001). CONCLUSIONS This study showed the evidence that high fried food intake was significantly associated with high prevalence of prehypertension and hypertension combined among Filipino women married to Korean men.

Background Blood pressure (BP) targets in elderly patients with diabetes remain unclear. We evaluated the association between BP and cardiovascular disease in elderly patients with diabetes without cardiovascular disease or heart failure. Methods and Results We performed a retrospective cohort study of 225 563 elderly (aged ≥65 years) patients with diabetes without cardiovascular disease or heart failure from 2009 to 2017 using the National Health Information Database. We divided the participants by systolic BP (SBP) and diastolic BP. Primary composite outcomes were stroke, myocardial infarction, heart failure, and all‐cause death analyzed by Cox proportional hazards regression analysis adjusted for baseline covariates. During a median follow‐up of 7.76 years, the incidence rate of primary composite outcomes was 26.62 per 1000 person‐years. In multivariable Cox proportional hazard modeling, the risk of the primary outcome had a U‐curved association with SBP/diastolic blood pressure with a nadir between 120 and 129 mm Hg/65 and 69 mm Hg, respectively. Hypertension medication was associated with lower risk of primary composite outcomes in SBP ≥140 mm Hg ( P for interaction for SBP P for interaction for diastolic blood pressure=0.018). In participants aged ≥80 years, SBP ≥160 mm Hg was only a marginally higher risk for primary composite outcomes (hazard ratio=1.11; 95% CI, 0.98–1.24). Conclusions In this large sample of older Korean patients with diabetes, cardiovascular events were more common in people with resting SBP or diastolic BP ≥140 or 95 mm Hg, respectively, and also more common in people with resting SBP or diastolic BP

Objectives: Diet quality may be a key modifiable factor for the prevention of non-communicable disease. We aimed to investigate the association between diet quality and prevalence of obesity, dyslipidemia, and insulin resistance among Filipino immigrant women in Korea.Methods: A total of 413 participants from the 2014–2016 baseline population of the Filipino Women's Diet and Health Study (FiLWHEL) were examined. Individual dietary intakes were evaluated through 24-h recalls and then converted into two dietary quality assessments: Minimum Dietary Diversity for Women (MDD-W) developed by the Food and Agriculture Organization (FAO) and the Data Derived Inflammation Index (DDII) originally developed by our group. Fasting blood levels of triglycerides, high-density lipoprotein cholesterols, glucose, and insulin were measured. We used logistic regression models for odds ratios (ORs) with 95% confidence intervals (CIs).Results: We found a statistically significant association between MDD-W scores and decreased prevalence of abdominal obesity; ORs (95% CIs) of the 3rd vs. 1st tertiles were 0.58 (0.36–0.94; p for trend = 0.029). Increased DDII was associated with elevated prevalence of dyslipidemia and insulin resistance; ORs (95% CIs) of the 5th vs. 1–3rd quintiles were 6.44 (2.56–16.20) for triglycerides (TG), 3.90 (1.92–7.90) for low-density lipoprotein (LDL) cholesterol, 3.36 (1.81–6.24) for total cholesterol (TC), 6.25 (2.53–15.41) for abnormal TG/HDL ratios, 3.59 (1.96–6.59) for HbA1c, 2.61 (1.11–6.17) for fasting blood glucose levels, 9.67 (4.16–22.48) for insulin levels, and 9.73 (4.46–21.25) for homeostasis model assessment of insulin resistance (HOMA-IR) (p for trend Conclusions: Greater dietary diversity was inversely associated with the prevalence of abdominal obesity in Filipino immigrant women. Proinflammatory scores based on diet and lifestyle factors were associated with an increased prevalence of dyslipidemia and insulin resistance. Further, epidemiological studies on the relationship between dietary acculturation and chronic disease are warranted.

Context Some studies have suggested that patients with type 2 diabetes mellitus (T2DM) concomitant with obesity have better clinical outcomes than normal-weight patients with T2DM. Objective We evaluated associations among obesity, cardiovascular disease (CVD) events, and mortality in elderly patients with T2DM without CVD. Methods This retrospective observational study from 2009 to 2017, with a mean follow-up of 7.26 years, included 249 903 elderly (≥ 65 years) patients with T2DM and no preexisting CVD from the Korean National Health Information Database. We categorized subjects according to body mass index (BMI) and waist circumference (WC) and analyzed a composite of stroke, myocardial infarction, and all-cause death using Cox proportional hazards regression analysis, adjusting for baseline covariates. Results The incidence rate of composite primary outcomes was 30.95/1000 person-years. The primary outcome risk had an L-shaped and a U-shaped association with BMI and WC, respectively. In the multivariable Cox proportional hazard models, the risk of primary composite outcomes in the highest BMI group (≥ 30 kg/m2; hazard ratio [HR] = 0.824; 95% CI, 0.794-0.855) was lower than in the normal BMI group (≥ 18.5 and Conclusion Our study with elderly patients with diabetes results suggest that while BMI is an inadequate risk indicator for outcomes related to obesity, WC is a suitable alternative.

Background Obesity is a chronic disease associated with metabolic diseases such as diabetes and cardiovascular disease. Since the U.S. Food and Drug Administration approved liraglutide as an anti-obesity drug for nondiabetic patients in 2014, it has been widely used for weight control in overweight and obese people. This study aimed to systematically analyze the effects of liraglutide on body weight and other cardiometabolic parameters. Methods We investigated articles from PubMed, EMBASE, and the Cochrane Library to search randomized clinical trials that examined body weight changes with liraglutide treatment. Results We included 31 studies with 8,060 participants for this meta-analysis. The mean difference (MD) between the liraglutide group and the placebo group was -4.19 kg (95% confidence interval [CI], -4.84 to -3.55), with a -4.16% change from the baseline (95% CI, -4.90 to -3.43). Liraglutide treatment correlated with a significantly reduced body mass index (MD: -1.55; 95% CI, -1.76 to -1.34) and waist circumference (MD: -3.11 cm; 95% CI, -3.59 to -2.62) and significantly decreased blood pressure (systolic blood pressure, MD: -2.85 mm Hg; 95% CI, -3.36 to -2.35; diastolic blood pressure, MD: -0.66 mm Hg; 95% CI, -1.02 to -0.30), glycated hemoglobin (MD: -0.40%; 95% CI, -0.49 to -0.31), and low-density lipoprotein cholesterol (MD: -2.91 mg/dL; 95% CI, -5.28 to -0.53; MD: -0.87% change from baseline; 95% CI, -1.17 to -0.56). Conclusion Liraglutide is effective for weight control and can be a promising drug for cardiovascular protection in overweight and obese people.

Aims To investigate the association of nocturia with the prevalence of cardiovascular disease (CVD) using the National Health and Nutrition Examination Survey (NHANES) data. Methods Among the 40 790 individuals who participated in NHANES from 2005 to 2012, 14 114 adults were analyzed in this study. A participant was considered to have nocturia if they have two or more voiding episodes nightly. In addition, participants with nocturia more than four times in a day were considered to have severe nocturia. A multivariate logistic regression analysis with adjustment for confounding variables, including age, sex, race, body mass index (BMI), smoking status, alcohol consumption, sleeping time, dyslipidemia, hypertension, and diabetes mellitus was performed with 1:1 propensity score matching (PSM). Results Nocturia occurred in 4610 individuals (32.7%). The prevalence of CVD was significantly higher in men, older individuals, those with higher BMI, smokers, and those with diabetes, hypertension, and hyperlipidemia. There was also a significantly higher prevalence of nocturia in the participants with CVD. Multivariate analysis showed that odds ratios (ORs) of mild and severe nocturia for CVD were 1.23 (95% confidence interval [CI]: 1.08-1.39) and 1.74 (95% CI: 1.39-2.17), respectively. After 1:1 PSM, the ORs of mild and severe nocturia were 1.27 (95% CI: 1.10-1.48) and 1.73 (95% CI: 1.33-2.26), respectively, showing statistical significance. Conclusion Data from the NHANES indicate that CVD was significantly associated with the prevalence of nocturia, after taking major confounding factors into account. Furthermore, the risk for CVD increases with increasing nocturia severity.

Background Cardiovascular safety of evogliptin, a novel dipeptidyl peptidase-4 inhibitor (DPP-4i), remains unclear with limited real-world evidence available on its use. We aimed to assess whether the use of evogliptin was associated with an increased risk of cardiovascular events when compared to glimepiride in patients with type 2 diabetes mellitus (T2DM). Methods We conducted a population-based cohort study using South Korea's nationwide healthcare database from 1 January 2014 to 31 December 2018. We identified a base cohort of patients with T2DM who newly initiated metformin monotherapy and from this cohort, identified a study cohort of patients who either added or switched to glimepiride or DPP-4is (including evogliptin). Patients were followed-up from initiation of DPP-4is or glimepiride until the earliest of outcome occurrence or 31 December 2018. Our primary outcome was hospitalization or emergency visit for cardiovascular events, a composite endpoint comprised of cerebrovascular events, heart failure, myocardial infarction, transient ischaemic attack, angina pectoris, and revascularization procedures; secondary outcomes were the individual components of the primary outcome. A multivariable Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the risk of study outcomes associated with evogliptin when compared to glimepiride. Results Our base and study cohorts had 317,307 and 128,788 patients, respectively, of which 100,038 were DPP-4i users (2,946 were evogliptin users) and 28,750 were glimepiride users within the study cohort. The median follow-up was 195 days for evogliptin and 113 days for glimepiride users. Compared with glimepiride, evogliptin was associated with a reduced risk of the primary outcome (aHR 0.67, 95% CI 0.48-0.95) and cerebrovascular events (aHR 0.41, 95% CI 0.22-0.78) but showed non-significant associations for myocardial infarction (aHR 0.63, 95% CI 0.27-1.46), heart failure (aHR 0.35, 95% CI 0.09-1.47), transient ischaemic attack (aHR 0.23, 95% CI 0.03-1.72), and angina pectoris (aHR 1.35, 95% CI 0.82-2.21). Conclusions Findings from this population-based cohort study provide novel real-world evidence in that use of evogliptin, as compared with glimepiride, did not increase the risk of cardiovascular events, including cerebrovascular events, myocardial infarction, heart failure, transient ischemic attack, and angina pectoris. This article is protected by copyright. All rights reserved.

Background : The acute glucose fluctuations in diabetes can be a risk factor of cardiovascular events. Nonetheless, the mechanism of action of intermittent hyperglycemia on the proliferation of vascular smooth muscle cells (VSMCs) is poorly understood. We compared the effects of exposure to constant and intermittent hyperglycemia on in vitro proliferation of aortic VSMCs from obese diabetic rats. Methods : VSMCs from Otsuka Long-Evans Tokushima Fatty (OLETF) rats were incubated for 72 hours with different glucose concentrations: a constant normal-glucose medium (4.8 mM), constant high-glucose medium (24.5 mM), normal- and high-glucose media alternating every 12 hours, and mannose (12.0 mM; an osmotic control for high glucose levels). The proliferation of VSMCs was analyzed by a 3-[4,5-dimethylthiazol-2-yl]-diphenyltetrazolium bromide (MTT) assay. The molecular mechanism (including phospho-p44/42 mitogen-activated protein kinase [MAPK], mitogen-activated protein kinase kinase-1/2 (MEK1/2), Protein kinase B (Akt), and the apoptosis pathway) was then studied. Results : We detected enhanced proliferation of VSMCs incubated with the constant or intermittent high-glucose medium using the MTT assay (p

Background : The aim of this study was to investigate the role of homocysteine on the proliferation of rat aortic vascular smooth muscle cells (VSMCs) by measuring mitogen-activated protein (MAP) kinase under hyperglycemic conditions. Methods : Rat aortic VSMCs were isolated from Otsuka Long-Evans Tokushima Fatty and Long-Evans Tokushima Otsuka rats. VSMCs were incubated in the presence of homocysteine (1 mM) with/without PD98059 (30 μM) and wortmannin (300 nM) for 48 hours in different concentrations of glucose (5.5, 25 mM). Proliferation was evaluated by methylthiazoletetrazolium (MTT), fluorescence-activated cell sorting (FACS), and western blot analyses. Results : In MTT and FACS analyses, the proliferation of VSMCs was increased by homocysteine. After PD98059 (30 μM) and wortmannin (300 nM) treatment with homocysteine (1 mM), the increased proliferation of VSMC caused by homocysteine, decreased to control levels. In Western blot analysis, immunoexpression of phospho-p44/42 MAP kinase was significantly increased by homocysteine (1 mM). After PD98059 and wortmannin treatment, the increased immunoexpression of phospho-p44/42 MAP kinase was suppressed. Conclusion : These results suggest that the MAP kinase and PI3 kinase pathways are the main mechanisms involved in rat VSMC proliferation caused by homocysteine under hyperglycemic conditions.

OBJECTIVES: Cardiovascular disease (CVD) is accountable for major cause of deaths among women worldwide. We aimed to assess the prevalence of CVD risk factors among Filipino women in Korea, Filipino women in the Philippines, Korean women in Korea and US women in the US. METHODS: We randomly selected a sample of 504 women from each study using a 1:1 age-matching analysis. Age range from 20–57 years old. We analyzed anthropometry, blood pressure and biomarkers data from the Filipino Women's Health and Diet Study (FiLWHEL), the Philippine National Nutrition Survey (NNS), Korean National Health and Nutrition Examination Survey (KNHANES) and the US National Health and Nutrition Examination Survey (NHANES). We used the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria to categorize blood lipids. We assessed the prevalence of CVD risk factors using proportions, means and standard deviations. RESULTS: We found that high BMI (≥25 kg/m²) and high waist circumference (WC: ≥85 cm) were prevalent in NHANES (65.6%, mean BMI = 29.48 ± 8.18 and 70.8%, mean WC = 96.16 ± 18.19, respectively) than in FiLWHEL (30.9%, 26.4% respectively), NNS (29.0%, 23.9% respectively) and KNHANES (19.8%, 12.0% respectively), p-value =

As the most widely consumed endocrine-disrupting chemical, bisphenol A (BPA) has been linked to reproductive dysfunction, diabetes mellitus, and obesity. However, the evidence for an association between BPA and cardiovascular disease (CVD) remains insufficient. In the present study, we aimed to identify the association between BPA and CVD, using data from the 2003-2016 National Health and Nutrition Examination Surveys (NHANES). We estimated urine BPA concentration after adjustments for creatinine (ng/mg) and normalized the asymmetrical distribution using natural logarithmic transformation (ln-BPA/Cr). A multivariate logistic regression was performed to evaluate the odds ratio (OR) and 95% confidence interval (CI) for CVD, with ln-BPA/Cr concentration as predictor. We then performed a Mantel-Haenszel meta-analysis with five eligible studies and NHANES 2003-2016 data. Our subjects were 11,857 adults from the NHANES data. After adjusting for age, sex, race/ethnicity, body mass index (BMI), cigarette smoking, diabetes status, hypertension, and dyslipidemia, OR between ln-BPA/Cr and CVD was 1.13 (95% CI: 1.02-1.24). After propensity-score-matching with age, sex, race/ethnicity, BMI, cigarette smoking, diabetes, hypertension, and dyslipidemia, OR continued to be significant for the association between ln-BPA/Cr and CVD (OR: 1.18, 95% CI: 1.04-1.33). A restricted cubic spline plot of this relationship revealed a dose-dependent increase in OR. However, untransformed BPA had a linear relationship with CVD only at low concentrations, whereas the OR of BPA plateaued at high concentrations. In a meta-analysis with 22,878 subjects, after adjusting for age, sex, and various cardiometabolic risk factors, OR was 1.13 (95% CI, 1.03-1.23). In conclusion, our study provides additional epidemiological evidence supporting an association between BPA and CVD.

Background Migration has an influence on health behavior and food intake. Dietary variety is a key component to high-quality diets because a single food item does not contain a variety of nutrients and may not reflect nutritional adequacy. We aimed to compare the dietary diversity scores (DDS), food variety scores (FVS), and nutrient adequacy levels of married Filipino immigrant women in Korea to those of Korean women. Methods We matched the data of 474 participants aged 20-57 years from the Filipino Women’s Diet and Health Study (FiLWHEL) by age category with those of married Korean women randomly selected from the Korea National Health and Nutrition Examination Survey (KNHANES). Dietary information in FiLWHEL and KNHANES were assessed through the 24-hour recall method. We calculated the DDS by summing the number of eleven food groups consumed (DDS 10 g if they consumed at least 10 g/day; DDS all if they consumed any amount) and the FVS by counting the number of food items consumed. For nutrient adequacy, we calculated the probability of adequacy (PA) and intake below the estimated average requirement (EAR). Results Filipino women had a lower DDS and FVS in comparison to Korean women. The means (±SDs) of DDS 10 g, DDS all, and FVS for Filipino women versus Korean women were 6.0 (±1.6) versus 6.8 (±1.5) (p

Background Dietary diversity—eating a more varied diet, may be one of the important components of a healthy diet. We aimed to examine whether dietary diversity score was associated with lower prevalence of obesity. Methods This is a cross-sectional study of 402 married immigrant participants enrolled in the Filipino Women’s diet and health study (FiLWHEL). Dietary information was obtained using the 24-hour recall method. Anthropometric measurements including height, weight, and waist circumference were directly measured. Dietary diversity score was calculated by summing up the reported number of food groups and additional scores for diversity within food groups were derived. We defined general obesity as body mass index (BMI) of ≥25 kg/m2 and abdominal obesity as waist circumference of ≥80 cm. We calculated odds ratios and 95% confidence intervals using the multivariable logistic regression accounting for several potential confounders. Results Dietary diversity score was inversely associated with abdominal and general obesity; odds ratios (95% confidence intervals) were 0.49 (0.30–0.82) (p for trend = 0.009) for abdominal obesity and 0.47 (0.28–0.81) (p for trend = 0.008) for general obesity when we compared the third tertile of diversity scores with the first tertile. In the analyses of diversity within food groups, greater diversity in other vegetables was associated with 49% or 50% lower prevalence of abdominal or general obesity, respectively. Furthermore, poultry diversity score was associated with 56% lower prevalence of general obesity. Conclusion Our study suggests the evidence that high dietary diversity appears to be related to low prevalence of obesity.

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Internal Medicine, Korea University College of Medicine, Seoul, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Department of Internal Medicine, Hallym University Kangnam Sacred Hospital, Seoul, Department of Internal Medicine, Inje University College of Medicine, Busan, Health and Exercise Science Laboratory, Institute of Sports Science, Department of Physical Education, Seoul National University, Seoul, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Korea

Coffee has been proposed to have benefits for chronic diseases; however, the relevant mechanism remains to be elucidated. We conducted a cross-sectional study and evaluated the levels of adiponectin and leptin in relation to coffee consumption. We included a total of 4406 individuals (men = 2587 and women = 1819) for adiponectin analysis and 2922 individuals (men = 1731 and women = 1191) for leptin analysis. Participants answered number of cups of coffee per week and types of coffee they consumed and their serum levels of adiponectin and leptin were measured using an enzyme-linked immunosorbent assay. We found that increasing coffee consumption was associated with increased levels of adiponectin among women; geometric means of adiponectin were 8.0 (95% CI: 7.2-8.9 μg/mL) among women who regularly consumed 15 or greater cups/week, but 7.5 (95% CI: 6.8-8.4 μg/mL) among women who did not consume coffee (P for trend = .009). Leptin levels were inversely associated with coffee consumption among both men and women (P for trend = .04 for men and 0.04 for women); geometric means of 15 or greater cups of coffee per week were 2.6 (95% CI: 2.4-2.8 ng/mL) among men and 5.1 (95% CI: 4.5-5.8 ng/mL) among women, but for noncoffee drinkers, geometric means were 3.0 (95% CI: 2.7-3.3 ng/mL) for men and 5.8 (95% CI: 5.1-6.6 ng/mL) for women. Coffee consumption was associated with higher circulating levels of adiponectin and lower circulating levels of leptin. Our study may suggest that improvement in adipocyte function contributes to the beneficial metabolic effects of coffee consumption.

This paper introduces a robust high-gain observer based state of charge (SOC) estimator for lithium-ion batteries of automated guided vehicles (AGV) . The proposed observer scheme enhances the transient response speed and diminishes the effect of uncertainties. Furthermore, it overcomes the perturbation problem, which is caused by high gains since the proposed observer scheme adopts sliding mode control technique. In order to verify the effectiveness of the propose method, the linear RC battery model in ADVISOR is used.

This paper proposes a fuzzy adaptive control approach based on a modular design for uncertain chaotic Duffing oscillators. Using fuzzy logic, the unknown nonlinear function in the Duffing oscillator is approximated. Subsequently, a modular adaptive controller is derived consisting of an inputtostate stabilizing (ISS) control module and a passive identifier module. Since the modular design allows for independent design of the controller and identifier, the proposed method provides substantial flexibility in the choice of a parameter identifier. Additionally, the modularity of the controller-identifier pair provides simplicity in the control system derivation. Simulation results are included to illustrate the effectiveness of the proposed approach.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 6th Clinical Practice Guidelines in 2019. Targets of glycemic, blood pressure, and lipid control in type 2 diabetes mellitus (T2DM) were updated. The obese and overweight population is increasing steadily in Korea, and half of the Koreans with diabetes are obese. Evidence-based recommendations for weight-loss therapy for obesity management as treatment for hyperglycemia in T2DM were provided. In addition, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations.

We investigated the prevalence and risk factors of vertebral fractures in Korea. In a community-based prospective epidemiology study, 1,155 men and 1,529 women (mean age 59 years, range 43-74) were recruited from Ansung, a rural Korean community. Prevalent vertebral fractures were identified on the lateral spinal radiographs at T11 to L4 using vertebral morphometry. Bone mineral density (BMD) was measured at the lumbar spine, femur neck and total hip. Of the 2,684 subjects, 137 (11.9%) men and 227 (14.8%) women had vertebral fractures and the standardized prevalence for vertebral fractures using the age distribution of Korean population was 8.8% in men and 12.6% in women. In univariate analysis, older age, low hip circumference, low BMD, low income and education levels in both sexes, previous history of fracture in men, high waist-to-hip circumference ratio, postmenopausal status, longer duration since menopause, and higher number of pregnancies and deliveries in women were associated with an increased risk of vertebral fractures. However, after adjusting for age, only low BMD in both sexes and a previous history of fracture in men were significantly associated with an increased risk of vertebral fractures. Vertebral fractures are prevalent in Korea as in other countries. Older age, low BMD and a previous history of fracture are significant risk factors for vertebral fractures.

Pericardial fat surrounding the heart and coronary arteries might aggravate vessel wall inflammation and stimulate the progression of coronary atherosclerosis. However, there has been little comprehensive evaluation of the effects of pericardial fat on coronary artery disease (CAD). We investigated the relationship between pericardial fat volume and the severity of coronary artery stenosis assessed by computed tomography and angiography among patients with suspected CAD. Participants from the cohort of the Korean Atherosclerosis Study 2 (n = 402, mean age of 54 years, 57.0% men) underwent 64-slice multidetector-row computed tomography (MDCT) to assess pericardial fat amount, coronary artery calcium score (CACS), severity of coronary artery stenosis, and plaque characteristics. Patients with atherosclerotic lesion had significantly larger volume of pericardial fat than patients without atherosclerosis (308 ± 96 cm(3) vs. 251 ± 93 cm(3); P0.01). In a multivariate regression analysis adjusting for age, gender and BMI, subjects with more pericardial fat had a higher risk for significant (50%) stenosed coronary vessels (odds ratio (OR) = 1.012; 95% confidence interval (CI) 1.001-1.030; P = 0.017). This association remained after adjusting for hypertension, diabetes, smoking status, and lipid profiles (OR = 1.007; 95% CI 1.001-1.014; P = 0.042). In conclusion, an increased pericardial fat volume was an independent risk factor for stenotic CAD and could be helpful in assessing subclinical CADs.

OBJECTIVE To improve quality and efficiency of care for elderly patients with type 2 diabetes, we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare (u-healthcare) service, which is an individualized health management system using advanced medical information technology. RESEARCH DESIGN AND METHODS We conducted a 6-month randomized, controlled clinical trial involving 144 patients aged >60 years. Participants were randomly assigned to receive routine care (control, n = 48), to the self-monitored blood glucose (SMBG, n = 47) group, or to the u-healthcare group (n = 49). The primary end point was the proportion of patients achieving A1C RESULTS After 6 months of follow-up, the mean A1C level was significantly decreased from 7.8 ± 1.3% to 7.4 ± 1.0% (P < 0.001) in the u-healthcare group and from 7.9 ± 1.0% to 7.7 ± 1.0% (P = 0.020) in the SMBG group, compared with 7.9 ± 0.8% to 7.8 ± 1.0% (P = 0.274) in the control group. The proportion of patients with A1C CONCLUSIONS The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients.

BACKGROUND Little is known about the relative contribution of long-term glycemic variability to the risk of macrovascular complications in type 2 diabetes. This study was conducted to evaluate the effect of A1C variability on the progression of carotid artery intima-media thickness (IMT) in type 2 diabetic patients. METHODS Among type 2 diabetic patients who visited Hallym University Sacred Heart Hospital from March 2007 to September 2009, 120 patients who had carotid artery IMT measured annually and A1C checked every three months for at least one year were analyzed. Individual A1C variability was defined as the standard deviation (SD) of five A1C levels taken every three months for approximately one year. Change in IMT was defined as an increase in IMT on follow-up measurement. The association between the SD of A1C and changes in IMT was evaluated. RESULTS With greater A1C variability, there was a greater increase in the mean IMT (r = 0.350, P < 0.001) of the carotid artery. After adjusting for confounding factors that may influence IMT, A1C variability was significantly associated with the progression of IMT (r = 0.222, P = 0.034). However, the SD of A1C was not a significant independent risk factor for the progression of IMT in multiple regression analysis (beta = 0.158, P = 0.093). CONCLUSION Higher A1C variability is associated with IMT progression in type 2 diabetic patients; however, it is not an independent predictor of IMT progression. Overall glycemic control is the most important factor in the progression of IMT.

Background Lithospermic acid B (LAB), an active component isolated from Salvia miltiorrhiza radix, has been reported to have antioxidant effects. We examined the effects of LAB on the prevention of diabetic retinopathy in Otsuka Long-Evans Tokushima Fatty (OLETF) rats, an animal model of type 2 diabetes. Methods and Findings LAB (10 or 20 mg/kg) or normal saline were given orally once daily to 24-week-old male OLETF rats for 52 weeks. At the end of treatment, fundoscopic findings, vascular endothelial growth factor (VEGF) expression in the eyeball, VEGF levels in the ocular fluid, and any structural abnormalities in the retina were assessed. Glucose metabolism, serum levels of high-sensitivity C-reactive protein (hsCRP), monocyte chemotactic protein-1 (MCP1), and tumor necrosis factor-alpha (TNFα) and urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) levels were also measured. Treatment with LAB prevented vascular leakage and basement membrane thickening in retinal capillaries in a dose-dependent manner. Insulin resistance and glucose intolerance were significantly improved by LAB treatment. The levels of serum hsCRP, MCP1, TNFα, and urinary 8-OHdG were lower in the LAB-treated OLETF rats than in the controls. Conclusions Treatment with LAB had a preventive effect on the development of diabetic retinopathy in this animal model, probably because of its antioxidative effects and anti-inflammatory effects.

Aims While there is thought to be an association between glucose and lipid metabolism, it is largely unknown whether apolipoprotein B and non-high density lipoprotein (HDL) cholesterol are associated with the development of Type 2 diabetes. It is also unknown whether these atherogenic dyslipidaemic profiles have a stronger association with diabetes risk compared with conventional lipid measurements. Methods A total of 118 429 subjects without diabetes (70 980 men and 47 449 women), aged 17–90 years (mean age 39.6 years), were enrolled in this study and followed for a mean duration of 3.1 years. Results Apolipoprotein B and non-HDL cholesterol levels showed a strong association with the development of Type 2 diabetes compared with conventional lipid measurements and their ratios [hazard ratio per 1 sd; 1.39 (95% CI 1.37–1.42) and 1.38 (95% CI 1.35–1.40), respectively; both P

This paper is proposed by 3D facial avatar modeling using stereo camera. We use the adaboost algorithm for facial detection to get 3D facial data. We make the 3D facial modeling to match extractive 3D data with justified 3D facial avatar. We use ICP algorithm for matching 3D data and control the number of vertex and feature point for efficiency and accuracy. Feature point is selected within outline points using canny edge method. We propose to make personal 3D facial avatar for reducing expense and time.

Purpose To investigate bone mineral density (BMD) profiles, osteoporosis prevalence and risk factors in a community-based cohort in Korea. Methods The present study is a cross-sectional study. The study population consisted of 1,547 men and 1991 women aged 40 years and older with BMD measurements using central dual energy X-ray absorptiometry from a prospective community-based cohort. The data were compared with other ethnic groups. Risk factors related to osteoporosis were analyzed. Results Crude prevalence of osteoporosis in the whole subjects (40–79 years old) was 13.1% for men and 24.3% for women by WHO criteria, at any site among lumbar spine, femoral neck or total hip. Standardized prevalence of osteoporosis between age of 50 and 79 at lumbar spine, femoral neck and total hip was 12.9%, 1.3% and 0.7% in men and 24.0%, 5.7% and 5.6% in women, respectively. The mean BMD of studied female subjects after age of 50 was not significantly different from that of Chinese but significantly lower than that of Japanese, non-Hispanic whites, non-Hispanic blacks and Mexican Americans. Risk of osteoporosis was significantly associated with the presence of past fracture history (OR, 1.45; 95% CI, 1.08–1.94), smoking ≥ 1 pack/day (OR, 1.63; 95% CI, 1.01–2.62), menarche after age of 16 (OR, 1.46; 95% CI, 1.14–1.87), last delivery after age of 30 (OR, 1.58; 95% CI, 1.20–2.09), more than three offspring (OR, 1.42; 95% CI, 1.07–1.89), post-menopause status (OR, 7.32; 95% CI, 3.05–17.6), more than 17 years since menopause (OR, 1.53; 95% CI, 1.10–2.14), regular exercise of two to three times per week (OR, 0.40; 95% CI, 0.18–0.89), monthly income above 500,000 won per household (OR, 0.64; 95% CI, 0.45–0.92), college graduate (OR, 0.29; 95% CI, 0.13–0.63) and calcium intake ≥ 627.5 mg/day (OR, 0.65; 95% CI, 0.43–0.98) after adjusting for age and BMI. Conclusion The BMD and osteoporosis prevalence of Koreans are presented. Risk of osteoporosis was significantly associated with fracture history, smoking, reproductive history, regular exercise, income level, education background and calcium intake.

Background We conducted this research in order to evaluate the prevalence of glutamic acid decarboxylase antibodies (GADA) in Korean women with gestational diabetes mellitus (GDM), to identify the clinical characteristics of these women, and to gauge the prevalence of diabetes among them after childbirth. Methods We studied 887 Korean women with GDM who were screened for GADA, and assessed their antepartum clinical characteristics and the outcomes of their pregnancies. At 6 weeks' postpartum, 75 g oral glucose tolerance tests were performed to determine the diabetic status of GDM women with GADA. Results The prevalence of GADA in Korean women with GDM was 1.7%. Plasma glucose levels at 0- and 3-h during oral glucose tolerance tests were significantly different between GADA-positive and GADA-negative women with GDM. There were no significant differences between them in terms of age, body mass index, family history of diabetes, fasting insulin, and lipid profiles. However, GADA-positive women with GDM required insulin treatment during pregnancy more frequently than GADA-negative patients. The development of diabetes at early postpartum was significantly higher in GADA-positive women with GDM than those who were GADA negative. Conclusions The prevalence of GADA in Korean women with GDM was low. However, GADA-positive women with GDM are more susceptible to subsequently developing type 1 diabetes, even in the early postpartum period. Long-term follow up studies and intervention to prevent type 1 diabetes among GADA-positive GDM women are needed. Copyright © 2009 John Wiley & Sons, Ltd.

Objectives: Type 2 diabetes, a leading cause of cardiovascular disease, is well known for its association with accelerated atherosclerosis. Adiponectin and tumor necrosis factor alpha (TNF-α), which are produced and secreted in adipose tissue, have been suggested as predictors for cardiovascular disease. However, little is known about the influence of adiponectin and TNF-α ratio on the progression of carotid atherosclerosis in newly diagnosed type 2 diabetic patients. This study was conducted to evaluate the influence of serum adiponectin/TNF-α levels on the progression of carotid atherosclerosis. Methods: One hundred eleven newly diagnosed type 2 diabetes patients were enrolled. Anthropometric and biochemical data including serum adiponectin, TNF-α were measured for each participant. Also we measured carotid intima-media thickness (CIMT) at baseline and at 1 year follow-up (n=81). We finally examined the relationship among serum adiponectin over TNF-α levels (ADPN/TNF-α), baseline CIMT, and progression of CIMT at 1 year. Results: ADPN/TNF-α negatively correlated with baseline CIMT (r=-0.231, p=0.025). Moreover, progression of CIMT was significant at 1 year (0.011±0.138 mm). There was a negative correlation between ADPN/TNF-α and progression of CIMT at 1 year (r=-0.172, p=0.038). In multiple regression analysis, age and HbA1c were found to be independent risk factors for baseline CIMT. However, only HbA1c was an independent risk factor for the progression of CIMT. Conclusion: ADPN/TNF-α was negatively associated with baseline CIMT and the progression of CIMT at 1 year. Overall glycemic control is the most important factor in the progression of CIMT in patients with type 2 diabetes.

Craniopharyngiomas are rare primary intracranial tumors. Despite their benign histological appearance, they are often associated with an unfavorable prognosis. The typical manifestations upon diagnosis are headache, visual impairment, polyuria/polydypsia, growth retardation, disturbance of pubertal development, and significant weight gain. The treatment options include radical surgery or radiotherapy, or a combination of these modalities. Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder. SCFE occurs when the capital femoral epiphysis displaces posteriorly on the femoral neck at the level of the physis. The etiology of SCFE is thought to be multifactorial and may include obesity, growth surges, and less common endocrine disorders. The related endocrine disorders include hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Reported herein is a case of panhypopituitarism caused by craniopharyngioma combined with SCFE.

Background: Increased cardiovascular events, which is the leading cause of death in type 2 diabetic patients, are mainly caused by accelerated atherosclerosis. Adiponectin has been suggested as a risk factor for cardiovascular diseases in cross-sectional studies. However, little is known about the impact of adiponectin on the progression of carotid atherosclerosis in type 2 diabetic patients. This study was conducted to evaluate the impact of early adiponectin levels on the progression of carotid atherosclerosis. Methods: From March 2009, 150 patients with type 2 diabetes were consecutively enrolled in our affiliated outpatient clinic. An thropometric and biochemical data, including adiponectin levels, were measured in each participant. We measured the carotid intima-media thickness (CIMT) at baseline and at 1-year follow-up (n = 111). Then, we prospectively studied the relationship be tween the serum adiponectin levels and the progression of CIMT for 1 year. Results: Adiponectin levels negatively correlated with CIMT (r = -0.219, P = 0.015). Moreover, mean progression of CIMT was 0.016 ± 0.040 mm. However, there was no correlation between adiponectin levels and the progression of CIMT within 1-year follow-up period (r = -0.156, P = 0.080). Age (β = 0.556, P = 0.004), LDL cholesterol (β = 0.276, P = 0.042), and A1C (β = 0.309, P = 0.038) were found to be independent risk factors for CIMT. However, A1C (β = 0.311, P = 0.042) was found to be the only independent risk factor for the progression of CIMT. Conclusion: In our study, adiponectin levels were negatively associated with CIMT. However, it did not affect the progression of CIMT at 1-year follow-up. Overall glycemic control is the most important factor in the progression of CIMT in patients with type 2 diabetes. (Endocrinol Metab 27:31-38, 2012)

Abdominal fat accumulation is known to be strongly implicated in development of metabolic syndrome (MetS). We examined diagnostic values of obesity-related parameters in 95 men and 185 women, and we determined optimal cutoff values of visceral fat area (VFA) and waist circumference (WC) for predicting the presence of multiple non-adipose components of MetS. Receiver operating characteristic (ROC) curve analysis revealed that VFA was the best indicator of MetS. WC and VFA exhibited similar diagnostic values for men and postmenopausal women, whereas WC was inferior to VFA for premenopausal women (area under ROC curve of VFA and WC was 0.76 and 0.52, respectively; P < 0.001). Optimal cutoff points of VFA and WC for predicting MetS were 136 cm(2) and 89 cm in men and 95 cm(2) and 82 cm in women, respectively. Subjects with VFA and WC above these cutoff values exhibited increased insulin resistance and increased carotid intima-media thickness. In conclusion, WC has a diagnostic value similar to VFA for predicting MetS in men and postmenopausal women, but not in premenopausal women. Further studies are necessary to develop a simple clinical parameter that reflects visceral fat in premenopausal women.

Background: We examined the change in the levels of incretin hormone and effects of glucose-dependent insulinotropic poly peptide (GIP) and glucagon-like peptide 1 (GLP-1) on insulin secretion in women with previous gestational diabetes (pGDM). Methods: A 75-g oral glucose tolerance test (OGTT) was conducted on 34 women with pGDM. In addition, 11 women with normal glucose tolerance, matched for age, height and weight, were also tested. The insulin, GIP, GLP-1, and glucagon concen trations were measured, and their anthropometric and biochemical markers were also measured. Results: Among 34 women with pGDM, 18 had normal glucose tolerance, 13 had impaired glucose tolerance (IGT) and 1 had diabetes. No significant differences were found in GLP-1 concentration between the pGDM and control group. However, a sig nificantly high level of glucagon was present in the pGDM group at 30 minutes into the OGTT. The GIP concentration was ele vated at 30 minutes and 60 minutes in the pGDM group. With the exception of the 30-minute timepoint, women with IGT had significantly high blood glucose from 0 to 120 minutes. However, there was no significant difference in insulin or GLP-1 concen tration. The GIP level was significantly high from 0 to 90 minutes in patients diagnosed with IGT. Conclusion: GLP-1 secretion does not differ between pGDM patients and normal women. GIP was elevated, but that does not seem to induce in increase in insulin secretion. Therefore, we conclude that other factors such as heredity and environment play important roles in the development of type 2 diabetes.