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Background : This study aimed to evaluate cardiovascular risk in subjects with pre-diabetes and diabetes in Korea. Methods : In this pan-Korean, non-interventional, cross-sectional study, data were collected from medical records of 10 hospitals between November 2013 and June 2014. Subjects (aged ≥40 years) with medical records of dysglycemia and documentation of total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, and smoking status in the past 6 months were included. The primary endpoint was to determine the Framingham risk score (FRS). The relationships between FRS and cardiovascular risk factors, glycated hemoglobin, and insulin usage were determined by multiple linear regression analyses. Results : Data from 1,537 subjects with pre-diabetes (n=1,025) and diabetes (n=512) were analyzed. The mean FRS (mean±standard deviation) in subjects with pre-diabetes/diabetes was 13.72±8.77. FRS was higher in subjects with diabetes than pre-diabetes (P

Introduction The aim of this study was to assess the efficacy and safety of switching to teneligliptin from other dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM) inadequately controlled despite treatment with a stable dose of other DPP-4 inhibitors. Methods Patients with glycosylated hemoglobin (HbA1c) ≥ 7% despite taking DPP-4 inhibitors other than teneligliptin, with or without other antidiabetic agents, for at least 3 months were enrolled in this study. Patients on DPP-4 inhibitors administered prior to participation in this study were switched to 20 mg teneligliptin once daily and the dose was maintained for the 52-week study period. The primary endpoint was the change in HbA1c at week 12. Fasting plasma glucose (FPG) and the blood lipid profile were also evaluated. Adverse events were monitored for safety assessment. Results At weeks 12, 24, and 52, the HbA1c values significantly decreased by − 0.39, − 0.44, and − 0.52%, respectively, compared to the baseline value (p

Purpose This study compared the efficacy and safety of controlled-release pregabalin (GLA5PR GLARS-NF1 tablets) with those of an immediate-release pregabalin capsule after 12 weeks' administration to patients with peripheral neuropathic pain. Methods In this multicenter, randomized, double-blind, active-controlled, parallel-group, Phase III study, the primary outcome was to confirm that a single treatment with the study drug (after the evening meal) is clinically noninferior to the control drug (BID regimen) at improving the mean Daily Pain Rating Scale score for treating peripheral neuropathic pain. Secondary outcomes were the Daily Sleep Interference Scale, Medical Outcomes Study Sleep Scale, Hospital Anxiety and Depression scale, and frequency of rescue medication use. The safety and tolerability of GLA5PR GLARS-NF1 tablets were also evaluated. The total daily dose of pregabalin is 150–600 mg. Findings Of the 352 randomized subjects, 261 (n = 130, study group; n = 131, control group) were analyzed. The difference in adjusted mean Daily Pain Rating Scale scores between the groups was −0.11 (95% confidence interval, −0.05 to 0.30), indicating that the study group is noninferior to the control group. There was no statistically significant difference in Daily Sleep Interference Scale, Medical Outcomes Study Sleep Scale, and Hospital Anxiety and Depression scale scores between the groups at treatment termination. Logistic regression analysis revealed no significant difference in the use of rescue medication between the groups (P = 0.217). The overall adverse event profile of the groups was similar, and no serious adverse drug reactions were observed. Implications GLA5PR GLARS-NF1 tablets can be effectively and safely administered to patients with peripheral neuropathic pain. Furthermore, we found that sleep, anxiety, and depression were improved with pain control. Owing to the once-daily administration, treatment effects can be maximized by improved treatment compliance. ClinicalTrials.gov identifier: NCT03221907.

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.

Background: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and

Introduction Teneligliptin, an antidiabetic agent classified as a class III dipeptidyl peptidase-4 (DPP-4) inhibitor, has a unique structural feature that provides strong binding to DPP-4 enzymes. We investigated the efficacy and safety of switching patients with type 2 diabetes mellitus (T2DM) who had inadequate glycemic control on a stable dose of other DPP-4 inhibitors to teneligliptin. Methods Patients with T2DM whose glycosylated hemoglobin (HbA1c) levels were ≥ 7% despite taking DPP-4 inhibitors other than teneligliptin, with or without other hypoglycemic agents, for at least 3 months were enrolled. The DPP-4 inhibitors taken before participating in the study were switched to 20 mg qd teneligliptin, and this was to be maintained for 52 weeks. The primary end point was the change in HbA1c levels after 12 weeks. Metabolic parameters including fasting plasma glucose (FPG) and blood lipids were assessed also. To assess safety, adverse and hypoglycemic events were monitored. The data from baseline to week 12 were used for analysis in this interim report. Results The mean change in HbA1c levels from baseline to week 12 was − 0.44%. At week 12, the percentage of patients achieving HbA1c

Background Epidemiological studies have suggested an association between selenium (Se) and diabetes mellitus (DM). However, different studies have reported conflicting results. Therefore, we performed a comprehensive meta-analysis to clarify the impact of Se on DM. Methods We searched the PubMed database for studies on the association between Se and DM from inception to June 2018. Results Twenty articles evaluating 47,930 participants were included in the analysis. The meta-analysis found that high levels of Se were significantly associated with the presence of DM (pooled odds ratios [ORs], 1.88; 95% confidence interval [CI], 1.44 to 2.45). However, significant heterogeneity was found (I²=82%). Subgroup analyses were performed based on the Se measurement methods used in each study. A significant association was found between high Se levels and the presence of DM in the studies that used blood (OR, 2.17; 95% CI, 1.60 to 2.93; I²=77%), diet (OR, 1.61; 95% CI, 1.10 to 2.36; I²=0%), and urine (OR, 1.49; 95% CI, 1.02 to 2.17; I²=0%) as samples to estimate Se levels, but not in studies on nails (OR, 1.24; 95% CI, 0.52 to 2.98; I²=91%). Because of significant heterogeneity in the studies with blood, we conducted a sensitivity analysis and tested the publication bias. The results were consistent after adjustment based on the sensitivity analysis as well as the trim and fill analysis for publication bias. Conclusion This meta-analysis demonstrates that high levels of Se are associated with the presence of DM. Further prospective and randomized controlled trials are warranted to elucidate the link better.

Background: Combination of metformin to reduce the fasting plasma glucose level and an α-glucosidase inhibitor to decrease the postprandial glucose level is expected to generate a complementary effect. We compared the efficacy and safety of a fixed-dose combination of voglibose plus metformin (vogmet) with metformin monotherapy in drug-naive newly-diagnosed type 2 diabetes mellitus. Methods: A total of 187 eligible patients aged 20 to 70 years, with a glycosylated hemoglobin (HbA1c) level of 7.0% to 11.0%, were randomized into either vogmet or metformin treatments for 24 weeks. A change in the HbA1c level from baseline was mea sured at week 24. Results: The reduction in the levels of HbA1c was -1.62%±0.07% in the vogmet group and -1.31%±0.07% in the metformin group (P=0.003), and significantly more vogmet-treated patients achieved the target HbA1c levels of

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 and objectiveSarcopenic obesity is associated with a higher risk of cardiometabolic disease and mortality than either sarcopenia or obesity alone. However, no study has investigated body shape indices for the assessment of sarcopenia in obese populations. Thus, this study aimed to evaluate the accuracy of body shape indices to assess sarcopenia in nationally representative populations with abdominal obesity.MethodsData from the U.S. National Health and Nutrition Examination Survey (U.S. NHANES) 1999–2006 and Korea NHANES (KNHANES) 2008–2011 were assessed. The association between Body Shape Index and sarcopenia was analyzed using a receiver operating characteristic curve. The Z-score of the log-transformed A Body Shape Index (LBSIZ) cut-off value was defined as that with the highest score of the Youden’s index. Changes in odds ratios (OR) for sarcopenia were investigated using restricted cubic spline (RCS) plots.ResultsThis study included 8,013 American and 4,859 Korean adults with abdominal obesity. The overall area under the curve (AUC) of LBSIZ for sarcopenia was 0.816 (95% CI: 0.794–0.838) in U.S. NHANES and 0.822 (95% CI: 0.799–0.844) in KNHANES, which was higher than that of the body roundness index, conicity index, and waist to height ratio (p with DeLong’s test ConclusionThe increased LBSIZ could function as a reliable and cost-effective screening tool for assessing low muscle mass in populations with abdominal obesity.

Supplemental Digital Content is available in the text, Studies about the effects of metabolically healthy obesity on cardiovascular disease (CVD) have yielded conflicting results. These heterogeneous results could be due to the limited usefulness of BMI in measuring general adiposity, as body mass index (BMI) does not accurately reflect body composition. This study aimed to evaluate the effect of body shape on CVD outcomes across different obesity phenotypes, and to provide an explanation for the heterogeneous effects of metabolically healthy obese (MHO) phenotype on CVD. We analyzed data from the Korean Genome and Epidemiology Study, a population-based cohort study conducted between 2001 and 2012. We divided the participants into 4 groups: metabolically healthy non-obese (MHNO), MHO, metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). To assess body shape, we calculated the z-score of the log-transformed a body shape index (LBSIZ). We computed Pearson correlation coefficients to examine the association of LBSIZ with muscle mass index, percentage of total fat mass (%Total FM), and percentage of abdominal fat mass (%Abdominal FM). We also used Cox proportional hazards regression to evaluate the effect of LBSIZ on CVD events according to the obesity phenotypes. A total of 9460 participants were assessed in this study. The incidence of CVD was 8.53 cases per 1000 person-year. LBSIZ showed strong positive correlation with %Total FM and %Abdominal FM, but negative correlation with muscle mass index. In Cox regression, MHO individuals did not show increased risk of CVD compared with MHNO individuals (hazard ratio [HR], 1.29; 95% confidence interval [CI], 0.96–1.73). However, MHO individuals in the 3rd (HR, 2.40; 95% CI, 1.28–4.51) and 4th (HR, 3.67; 95% CI, 1.99–6.74) quarters of LBSIZ showed significantly higher risk of CVD compared with MHNO individuals in the 1st quarter of LBSIZ. Moreover, LBSIZ showed a linear relationship with CVD among MHO individuals. While the MHO individuals showed similar CVD risk to the MHNO individuals, CVD risk increases with LBSIZ among the MHO individuals. LBSIZ appears to be a useful measure for CVD risk assessment in clinical practice and epidemiologic studies, especially for MHO patients.

Background: We aimed at evaluating the effect of the z-score of the log-transformed A Body Shape Index (LBSIZ) on cardiovascular disease (CVD) outcomes according to obesity phenotype. Methods: Data were collected from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2010. Obesity was defined as a body mass index above 25 kg/m² and metabolic abnormality was defined as the presence of two or more metabolic risk factors of the Adult Treatment Panel III definition. The participants were classified by obesity and metabolic healthy status: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO). Each group was further classified into three groups based on the tertile of LBSIZ. A multivariate logistic regression analysis with adjustment for age, sex, smoking status, income, education level, physical activities, alcohol, and energy intake was conducted to evaluate the odds ratio (OR) for CVD events. Results: In the multivariate logistic regression model, MHO participants who are within the third tertile of LBSIZ had a significantly higher OR for CVD events, whereas those who are within the first and second tertile of LBSIZ were not at high risk of developing CVDs compared to MHNO participants who are within the first tertile of LBSIZ. In addition, a similar increase in the OR was observed in MUNO or MUO participants. Conclusion: LBSIZ had the lowest risk for CVDs in the first tertile of LBSIZ and a linear relationship with all its tertiles in MHO, MUNO, and MUO participants.

To determine the impact of subclinical hypothyroidism (SCH) on the risk of cardiovascular disease (CVD) and all-cause mortality, a comprehensive meta-analysis was performed according to the age or coexisting CVD risk status of the participants.Studies regarding the association of SCH with all-cause mortality from PubMed and Embase databases were included. The pooled relative risk (RR) of CVD and all-cause mortality was calculated using the Mantel-Haenszel method. A subgroup analysis of participants with high CVD risk was conducted, including history of coronary, cerebral, or peripheral artery disease; dilated cardiomyopathy; heart failure; atrial fibrillation; venous thromboembolism; diabetes mellitus; or chronic kidney disease.In total, 35 eligible articles incorporating 555,530 participants were included. SCH was modestly associated with CVD and all-cause mortality (RR for CVD = 1.33 [confidence interval (CI) 1.14-1.54]; RR for all-cause mortality = 1.20 [CI 1.07-1.34]). However, the association was not observed in participants aged ≥65 years. Subgroup analysis showed that participants with SCH and high CVD risk showed a significantly higher risk of all-cause mortality (RR for CVD = 2.20 [CI 1.28-3.77]; RR for all-cause mortality = 1.66 [CI 1.41-1.94]), whereas those with SCH and low CVD risk did not. Additional subgroup analysis of six studies with a mean participant age of ≥65 years and high CVD risk showed a significant high risk of all-cause mortality in the SCH group (RR = 1.41 [CI 1.08-1.85]; ISCH is associated with an increased CVD risk and all-cause mortality, particularly in participants with high CVD risk.

Aims The aim of this study was to evaluate ethnic- and sex-specific associations between DM and hearing impairment. Methods For this cross-sectional study using National Health and Nutrition Examination Survey in the U.S. and Korea, the total number of eligible participants included was 7081 in the U.S. and 15,704 in Korea. Hearing impairment was defined as a pure tone threshold level ≥ 25 dB. Multivariate logistic regression analysis was conducted, adjusting for age, sex, race/ethnicity, socioeconomic status, body mass index, noise exposure, smoking, hypertension, and dyslipidemia. Results The association between DM and hearing impairment was found to be sex-specific. The multivariate adjusted ORs of high-frequency impairment were 0.843 (95% CI, 0.524–1.356) in American men, and 1.073 (95% CI, 0.835–1.379) in Korean men, while the ORs in women from U.S. and Korea were 1.911 (95% CI, 1.244–2.935) and 1.421 (95% CI, 1.103–1.830), respectively. A subgroup analysis of each race/ethnicity among the U.S. adults showed similar results. In contrast to high-frequency impairment, there was no significant association between low-frequency impairment and DM in both men and women. Conclusion Our results suggest that DM is associated with hearing impairment in only women, irrespective of race/ethnicity groups.

Objective Previous studies on the association between urinary incontinence (UI) and falls have reported conflicting results. We, therefore, aimed to evaluate and clarify this association through a systematic review and meta-analysis of relevant studies. Methods We performed a literature search for relevant studies in databases including PubMed and EMBASE from inception up to December 13, 2020, using several search terms related to UI and falls. Based on the data reported in these studies, we calculated the pooled odds ratios (ORs) for falls and the corresponding 95% confidence intervals (CIs) using the Mantel–Haenszel method. Results This meta-analysis included 38 articles and a total of 230,129 participants. UI was significantly associated with falls (OR, 1.62; 95% CI, 1.45–1.83). Subgroup analyses based on the age and sex of the participants revealed a significant association between UI and falls in older (≥65 years) participants (OR, 1.59; 95% CI, 1.31–1.93), and in both men (OR, 1.88; 95% CI, 1.57–2.25) and women (OR, 1.41; 95% CI, 1.29–1.54). Subgroup analysis based on the definition of falls revealed a significant association between UI and falls (≥1 fall event) (OR, 1.61; 95% CI, 1.42–1.82) and recurrent falls (≥2 fall events) (OR, 1.63; 95% CI, 1.49–1.78). According to the UI type, a significant association between UI and falls was observed in patients with urgency UI (OR, 1.76; 95% CI, 1.15–1.70) and those with stress UI (OR, 1.73; 95% CI, 1.39–2.15). Conclusions This meta-analysis, which was based on evidence from a review of the published literature, clearly demonstrated that UI is an important risk factor for falls in both general and older populations.

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: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate ≥25 mL/min/1.73 m2 and albuminuria (urinary albumin-to-creatinine ratio ≥30 to ≤5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level α = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049.

Background The risk factors of nocturia in older adults remain unclear. We aimed to investigate factors associated with nocturia using the National Health and Nutrition Examination Survey (NHANES) data. Methods Among 40,790 participants, 4,698 participants aged ≥65 years were included from the NHANES dataset between 2005 and 2012. A multivariate logistic regression analysis was performed to determine the odds ratio (OR) for nocturia. A subgroup analysis was conducted based on sex and underlying diseases. Results In the multivariate logistic regression model, obesity (OR, 1.46; 95% confidence interval [CI], 1.28-1.68), hypertension (OR, 1.28; 95% CI, 1.07-1.52), and diabetes mellitus (DM) (OR, 1.27; 95% CI, 1.11-1.45) were significantly associated with nocturia. These factors were associated with nocturia regardless of sex. In a subgroup of participants with hypertension, obesity (OR, 1.44; 95% CI, 1.25-1.67) and DM (OR, 1.26; 95% CI, 1.09-1.45) were associated with nocturia. In the additional analysis on patients with DM, nocturia was associated with obesity (OR, 1.33; 95% CI, 1.06-1.67) and duration of DM (OR, 1.02; 95% CI, 1.01-1.03). Conclusion This study demonstrated that hypertension, DM, and obesity were significantly associated with the prevalence of nocturia in older adult patients regardless of sex. In particular, obesity was associated with nocturia in every subgroup analysis.

Objective— To determine the effect of probucol on urine albumin excretion in type 2 diabetes mellitus patients with albuminuria using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Approach and Results— This was a 16-week, phase II, randomized, placebo-controlled, parallel-group study in type 2 diabetes mellitus patients with a urinary albumin/creatinine ratio of ≥300 mg/g using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, conducted in 17 tertiary referral hospitals. Eligible patients were randomized to probucol 250 mg/d (n=44), probucol 500 mg/d (n=41), and placebo (n=41) groups in a ratio of 1:1:1 after block randomization procedures, keeping the treatment assignment blinded to the investigators, patients, and study assistants. The primary end point was change in the geometric mean of urinary albumin/creatinine ratio from baseline to week 16 ( ClinicalTrials.gov identifier NCT01726816). The study was started on November 8, 2012, and completed on March 24, 2014. The least squares mean change±SE from baseline in urinary albumin/creatinine ratio at week 16 was −7.2±639.5 mg/g in the probucol 250 mg/d group (n=43; P =0.2077 versus placebo group), 9.3±587.4 mg/g in the probucol 500 mg/d group (n=40; P =0.1975 versus placebo group), and 259.0±969.1 mg/g in the placebo group (n=41). Although the majority of subjects were on statins, probucol treatment significantly lowered total cholesterol and low-density lipoprotein cholesterol levels. QT prolongation occurred in one and two subjects in control and probucol 250 mg/d groups, respectively. Conclusions— Four months of probucol up to 500 mg/d failed to reduce urinary albumin excretion.

Objectives To investigate the association and influence of urinary incontinence (UI) on falls in older adults using the 2017 National Survey of Older Koreans data. Methods We retrospectively analyzed the 2017 National Survey of Older Koreans, which was conducted on 10,299 adults aged 65 and older in 2017 by the Korea Institute for Health and Social Affairs. Results This study included a total of 6,134 women aged 65–106, with a mean age of 74.8. In total, 1,152 women experienced at least 1 fall in the past 1 year and 382 experienced 2 or more recurrent falls; 281 women were diagnosed with UI. UI and falls (odds ratio, 1.329; 95 % confidence interval, 1.003−1.762) and recurrent falls (odds ratio=,1.703; 95% confidence interval=,1.145−2.534) were significantly associated. Older individuals with UI were more likely to fall at least once per year (odds ratio=,1.52; 95 % confidence interval=,1.15–2.20, odds ratio=,1.49; 95 % confidence interval=,1.09–2.04) than those without and were also linked to higher odds of recurrent falls (odds ratio=,2.16; 95 % confidence interval=,1.47–3.16, odds ratio=,2.13; 95 % confidence interval=,1.41–3.22) in those with at least 1 cognitive impairment, body functional impairment, or activity limitation. Conclusion Our findings showed a possible increased risk of falls and recurrent falls in older individuals with UI compared to those without, especially in people with cognitive and functional impairment.

Various behavioral and physiological pathways follow a pre-determined, 24 hour cycle known as the circadian rhythm. Metabolic homeostasis is regulated by the circadian rhythm. Time-restricted eating (TRE) is a type of intermittent fasting based on the circadian rhythm. In this study, we aim to analyze systemically the effects of TRE on body weight, body composition, and other metabolic parameters. We reviewed articles from PubMed, EMBASE, and the Cochrane Library to identify clinical trials that compared TRE to a regular diet. We included 19 studies for meta-analysis. Participants following TRE showed significantly reduced body weight (mean difference (MD), −0.90; 95% confidence interval (CI): −1.71 to −0.10) and fat mass (MD: −1.58, 95% CI: −2.64 to −0.51), while preserving fat-free mass (MD, −0.24; 95% CI: −1.15 to 0.67). TRE also showed beneficial effects on cardiometabolic parameters such as blood pressure (systolic BP, MD, −3.07; 95% CI: −5.76 to −0.37), fasting glucose concentration (MD, −2.96; 95% CI, −5.60 to −0.33), and cholesterol profiles (triglycerides, MD: −11.60, 95% CI: −23.30 to −0.27). In conclusion, TRE is a promising therapeutic strategy for controlling weight and improving metabolic dysfunctions in those who are overweight or obese. Further large-scale clinical trials are needed to confirm these findings and the usefulness of TRE.

Body mass index (BMI) has limited accuracy for predicting cardiovascular diseases (CVD) and is not capable of identifying sarcopenic obesity, the combination of sarcopenia (an age-associated decline in muscle mass and physical function) and obesity. To overcome this, the z-score of the log-transformed A Body Shape Index (LBSIZ) was recently introduced as a measure of obesity using waist circumference, height, and weight. We aimed to investigate the association of LBSIZ with sarcopenic obesity and CVD, and propose appropriate cut-off values using the National Health and Nutrition Examination Survey 1999–2016 data. Of 92,062 participants, 40,468 adults (≥20 years) were included. Overall area under curve (AUC) of LBSIZ was 0.735 (95% confidence interval [CI]: 0.716–0.754) for sarcopenic obesity, and 0.695 (95% CI: 0.687–0.703) for CVD. The subgroup analysis of ethnicity/race showed similar results. Waist circumference (WC), BMI, conicity index, body roundness index (BRI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), new BMI, and waist to height ratio (WHtR) showed a negative association with sarcopenic obesity, while LBSIZ and conicity index showed a positive association. The AUC of LBSIZ was significantly higher for sarcopenic obesity than that of conicity index (p

BACKGROUND In order to overcome the limitations of body mass index (BMI) and waist circumference (WC), the z-score of the log-transformed A Body Shape Index (LBSIZ) has recently been introduced. In this study, we analyzed the relationship between the LBSIZ and cardiovascular disease (CVD) in a Korean representative sample. METHODS Data were collected from the Korea National Health and Nutrition Examination VI to V. The association between CVD and obesity indices was analyzed using a receiver operating characteristic curve. The cut-off value for the LBSIZ was estimated using the Youden index, and the odds ratio (OR) for CVD was determined via multivariate logistic regression analysis. ORs according to the LBSIZ value were analyzed using restricted cubic spline regression plots. RESULTS A total of 31,227 Korean healthy adults were analyzed. Area under the curve (AUC) of LBSIZ against CVD was 0.686 (95% confidence interval [CI], 0.671 to 0.702), which was significantly higher than the AUC of BMI (0.583; 95% CI, 0.567 to 0.599) or WC (0.646; 95% CI, 0.631 to 0.661) (P

Selenium seems to be a risk factor for diabetes mellitus (DM) in recent studies, opposite to the previous expectation that it may contribute to prevent DM. The authors aimed to ascertain the relationship between selenium and DM.Data were collected from the National Health and Nutrition Examination Survey conducted from 2011 to 2014. A multivariate logistic regression analysis with adjustment for age, sex, race/ethnicity, hypertension, dyslipidemia and body mass index was conducted to evaluate the odds ratio for DM.The total number of subjects was 19,931. Large proportion of subjects were excluded due to young age (20 years) and missing data. The data of 3406 participants were analyzed, and a total of 604 had DM. In a multivariate logistic regression model, the increase of 10 μg/L in selenium increased the prevalence of DM by 12% (OR: 1.12; 95% CI: 1.06-1.18). Further analysis with 1:1 propensity score matching data with age and sex showed a similar results (OR: 1.08; 95% CI: 1.01-1.15). In addition, the restricted cubic spline regression showed a dose-dependent relationship between selenium level and DM. Subgroup analysis showed a dose-dependent relationship between selenium level and DM regardless of sex or race/ethnicity CONCLUSIONS: This large population study clearly demonstrates a positive association between selenium level and DM. This finding could have implications for nutritional supplementation in clinical settings.

AimsTo investigate associations of glomerular hyperfiltration with other metabolic factors in a nationally representative dataset.MethodsWe analyzed cross-sectional data from 15,918 subjects with estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2 and urine albumin creation ratio (ACR) ResultsPrevalence of hyperfiltration was 5.2% and that among normal, prediabetic, and diabetic subjects was 4.9%, 5.6%, and 7.3%, respectively, after adjusting for age, sex, and body weight (p for trend = 0.008). In a multiple logistic regression analysis, hyperfiltration was associated with a body mass index ≥30 kg/m2 [odds ratio (OR) = 3.461, pConclusionsIn a general Korean population, both hyperfiltration and ACR were associated with similar metabolic parameters, and hyperfiltration correlated independently with a high ACR. Longitudinal studies are needed to further explore risks of hyperfiltration and microalbuminuria.

Background This study aimed to identify the gender-specific characteristics of the surrogate measures of insulin resistance and to establish valid cut-off values for metabolic abnormalities in a representative sample in Korea. Methods Data were collected from the datasets of the Korean National Health and Nutrition Examination Survey between 2007 and 2010. The total number of eligible participants was 10,997. We used three measures of insulin resistance: the homeostasis model assessment-insulin resistance (HOMA-IR), McAuley index, and triglyceride and glucose (TyG) index. The estimated cut-off values were determined using the highest score of the Youden index. Results The area under the curve (AUC) of the HOMA-IR, McAuley index, and TyG index were 0.737 (95% confidence interval [CI], 0.725-0.750), 0.861 (95% CI, 0.853-0.870), and 0.877 (95% CI, 0.868-0.885), respectively. The cut-off values of the HOMA-IR were 2.20 in men, 2.55 in premenopausal women, and 2.03 in postmenopausal women, and those of the McAuley index were 6.4 in men and 6.6 in premenopausal and postmenopausal women. For the TyG index, the cut-off values were 4.76 in men and 4.71 in premenopausal and postmenopausal women. Conclusion In conclusion, the present study provides the valid cut-off values of the indirect surrogate measures of insulin sensitivity. These values may be used as reference for insulin sensitivity in a clinical setting and may provide a simple and supplementary method for identifying populations at risk of insulin resistance.

Objective: This study aimed to evaluate the factors associated with increased arterial stiffness (IAS) measured by pulse wave velocity (PWV) and its clinical implications in patients with type 2 diabetes mellitus (DM). Methods: This was an observational, cross-sectional study. The ankle–brachial PWV was used to measure arterial stiffness, and 310 patients (mean age, 49±9 years; 180 men) with type 2 DM were divided into two groups according to the results of PWV: Group 1 (IAS; n=214) and Group 2 (normal arterial stiffness; n=96). Results: Patients in Group 1 were predominantly females (48% vs. 28%, p=0.001) and showed higher blood pressure and faster heart rate (HR). The glomerular filtration rate was lower and the urine microalbumin level was higher in patients with IAS. In multiple regression analysis, female sex and faster HR were independently associated with IAS. In subgroup analysis among female patients, prior stroke was more common in patients with IAS, and faster HR and increased postprandial 2-h C-peptide level were independently associated with IAS. Conclusion: Female sex and faster HR were independently associated with IAS in patients with type 2 DM. In a subgroup analysis among female patients, prior stroke was more common in patients with IAS, and faster HR and elevated postprandial 2-h C-peptide level were found to be independently associated with IAS.

The metabolic outcomes of metabolically healthy obesity (MHO) remain controversial. The aim of the present study was to determine the effect of physical activity on the cardiovascular disease (CVD) outcomes of MHO. The study included participants who were followed for 10 years and recruited from the Korean Genome and Epidemiology Study (KoGES), a population-based cohort study. Participants with previously recorded CVDs or cancer, or who had received steroids or anticoagulants at baseline were excluded. A total of 8144 participants (3,942 men and 4,202 women) fulfilled inclusion criteria. In a multivariate Cox regression model adjusted for age and sex, MHO participants were not at elevated risk of CVD compared with their metabolically healthy non-obese (MHNO) counterparts (HR, 1.28; 95% CI, 0.96–1.71), although both the non-obese (HR, 1.50; 95% CI, 1.19–1.90) and obese (HR, 1.85; 95% CI, 1.48–2.30) participants with metabolic abnormalities were at elevated risk. However, in the subgroup analysis by physical activity, physically inactive MHO participants had a significantly higher HR for CVD events compared to active MHNO participants (HR, 1.54; 95% CI, 1.03–2.30), while active MHO participants were not at elevated risk (HR, 1.15; 95% CI, 0.70–1.89). Physically inactive MHO participants had significantly increased risk of CVD compared to physically active MHNO participants whereas physically active MHO participants did not.

Objective The current methods available for determining insulin resistance are complicated; hence, they are only applicable to small-scale studies. Therefore, this study aimed to classify the characteristics of surrogate measures for insulin resistance and establish valid cut-off values for predicting the development of type 2 diabetes mellitus (DM) in Korean populations. Methods This prospective study included 7,643 participants aged 40–69 years from the Ansung-Ansan cohort database (2001–2012). Four surrogate measures, namely homeostasis model assessment-insulin resistance (HOMA-IR), visceral adiposity index (VAI), lipid accumulation product (LAP), and triglycerides and glucose (TyG) index, were analyzed. We analyzed each measure using receiver operating characteristic (ROC) curve for the development of type 2 DM. The cut-off value was determined as the value with the highest Youden index score in the specificity dominant area. Results The area under the curve (AUC) was 0.566 (95% confidence interval [CI], 0.548–0.583) for HOMA-IR, 0.622 (95% CI, 0.605–0.639) for VAI, 0.642 (95% CI, 0.625–0.658) for LAP, and 0.672 (95% CI, 0.656–0.687) for TyG index. The AUC of TyG index was significantly higher than that of HOMA-IR, VAI, and LAP (p < 0.001). The cut-off value was 2.54 (sensitivity 36.8%; specificity 73.1%; hazard ratio [HR], 1.41, 95% CI, 1.25–1.59) for HOMA-IR, 2.54 (sensitivity 50.4%; specificity 68.8%; HR, 1.75, 95% CI, 1.55–1.96) for VAI, 36.6 (sensitivity 59.2%; specificity 63.9%; HR, 1.87, 95% CI, 1.64–2.14) for LAP, and 4.69 (sensitivity 62.1%; specificity 63.1%; HR, 2.17, 95% CI, 1.92–2.45) for TyG index. Conclusions The TyG index was a better predictor for DM than HOMA-IR. VAI and LAP showed the modest predictability for DM. The TyG index could be a useful supplementary method for identifying individuals at risk for insulin resistance and DM development.

Background: Risk scoring system for thoracic surgery patients have not been widely used, as of recently. We tried to forge a risk scoring system that predicts the risk of postoperative complications in patients undergoing major thoracic surgery. We used a prolonged ICU stay as a representative of postoperative complications and tested various possible risk factors for its relation. Methods: Data from all patients who underwent major lung and esophageal cancer surgeries, between 2005 and 2007 in our hospital, were collected retrospectively (n = 858). Multiple logistic regression analysis was performed with various possible risk factors to build the risk scoring system for prolonged ICU stay (> 3 days). Results: A total of 9% of patients exhibited more than 3 days of ICU stay. Age, operation name, preoperative lung injury, no epidural analgesia, and predicted post operative forced expiratory volume in 1 second (ppoFEV1) were the risk factors for prolonged ICU stay, by multivariable analysis (P < 0.05). Risk score, p was derived from the formula: logit(p/[1-p]) = -5.39 + 0.06 × age + 1.12 × operation name(2) + 1.52 × operation name(3) + 1.32 × operation name(4) + 1.56 × operation name(5) + 1.30 × preoperative lung injury + 0.72 × no epidural analgesia - 0.02 × ppoFEV1 [Age in years, operation name(2): pneumonectomy, operation name(3): esophageal cancer operation, operation name(4): completion pneumonectomy, operation name(5): extended operation, preoperative lung injury(+), epidural analgesia(-), ppoFEV1 in %]. Conclusions: Age, operation name, preoperative lung injury, epidural analgesia, and ppoFEV1 can predict postoperative morbidity in thoracic surgery patients. (Korean J Anesthesiol 2012; 63: 527-532)

Aims To assess the efficacy and safety of gemigliptin, a dipeptidyl peptidase-4 inhibitor, added to metformin and sulphonylurea in patients with type 2 diabetes (T2DM). Materials and methods We conducted a randomized, double-blind, placebo-controlled trial in 219 Korean patients inadequately controlled with metformin and glimepiride. Participants were randomized to gemigliptin 50 mg once daily or placebo added to metformin and glimepiride. The primary endpoint was change in glycated haemoglobin (HbA1c) level from baseline to week 24. Results The baseline HbA1c was 8.2% in both groups. The addition of gemigliptin to metformin and glimepiride significantly reduced HbA1c levels at week 24 compared with placebo (between-group difference in adjusted mean change −0.87%, 95% confidence interval [CI] −1.09% to −0.64%). Fasting plasma glucose level was also significantly reduced with gemigliptin (−0.93 mmol/L, 95% CI −1.50 to −0.35 mmol/L), and a higher proportion of participants achieved an HbA1c level of

Background: Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. This study analyzed the changes in central aortic waveforms and pulse wave velocity as well as related parameters after treatment with valsartan, an angiotensin II type 1 receptor blocker, in patients with type 2 diabetes and hypertension. Methods: We used pulse wave analysis to measure central aortic waveform in a total of 98 subjects. In 47 of these patients, pulse wave velocity measurements were obtained before and after 12 weeks of treatment with valsartan. Results: In the central aortic waveform analysis, the aortic pulse pressure and augmentation index were significantly decreased after valsartan treatment, as was the aortic pulse wave velocity. Factors contributing to the improvement in pulse wave velocity were the fasting blood glucose and haemoglobin A1c levels. Conclusion: Short-term treatment with valsartan improves arterial stiffness in patients with type 2 diabetes and hypertension, and the glucose status at baseline was associated with this effect.

Objective The use of a real time continuous glucose monitoring system (RT-CGM) was studied as a behavior modification tool and the effectiveness of a RT-CGM in glucose control for patients with type 2 diabetes was determined. Methods We conducted a prospective, open-label, randomized, controlled clinical trial in 65 patients with poorly controlled type 2 diabetes (8.0 ≤ HbA1c ≤ 10%) over a 3-month period. The intervention group was monitored monthly with a RT-CGM (three days at a time for 3 months) and the control group continued self-monitoring blood glucose (SMBG) at least four times a week for 3 months. Results The HbA1c of the RT-CGM group was significantly reduced after 12 weeks compared with the SMBG group (9.1 ± 1.0% to 8.0 ± 1.2% vs. 8.7 ± 0.7% to 8.3 ± 1.1%, respectively; P = 0.004). In the RT-CGM group, there was a significant reduction in total daily calorie intake, weight, body mass index (BMI), and postprandial glucose level, and a significant increase in total exercise time per week after 3 months. Conclusions We demonstrated that the RT-CGM was useful in modifying a patient's diet and exercise habits and could induce better glycemic control than SMBG for patients with type 2 diabetes.

Congenital arteriovenous malformation, although its pathogenesis remains elusive, is speculated to result from abnormal vasculogenesis and angiogenesis during early embryogenesis. It usually remains dormant until puberty and become evident at puberty or pregnancy due to hormonal changes, or as a result of trauma or surgical stress. After becoming symptomatic, the engorgement of congenital arteriovenous malformation increases throughout the lifetime without involution. It is now apparent that complete destruction of the nidus by transcatheter embolotherapy, combined with surgery or not, is one of the best approaches for successful treatment [1]. Among the embolic agents, absolute ethanol is considered the more effective agent because of the better possibility of a complete cure [2]. However, intravascular injection of absolute ethanol can cause detrimental cardiopulmonary complications including dysrhythmia, pulmonary hypertension, and even acute cardiopulmonary collapse [3]. Therefore, it is essential for an experienced anesthesiologist to monitor the fluctuating hemodynamic changes at every injection of absolute ethanol, for the safety of patients and better treatment outcomes. We retrospectively evaluated whether initiation of a continuous infusion of nitroglycerin before the first administration of absolute ethanol is more effective in controlling the pulmonary arterial pressure (PAP) than its initiation after a bolus injection of absolute ethanol during the session. We also investigated which time point of nitroglycerine infusion would better moderate the severe hemodynamic changes at the end of the session, another critical period of greatly changing PAP. After obtaining the approval of the Institutional Review Board of our hospital with a waiver of informed consent, this retrospective study was conducted in 24 patients who underwent ethanol embolotherapy from July 2003 to December 2010 at our hospital. Exclusion criteria were patients with cardiomyopathies, and moderate or severe pulmonary hypertension. The following patients who had received a continuous infusion of nitroglycerin before and after a bolus injection of ethanol were retrospectively included in the present study: patients who received a continuous infusion of nitroglycerin (0.5-1.0 mg/kg/min) immediately after the induction of general anesthesia and before a large bolus injection of ethanol (more than 5 ml of bolus injections of absolute ethanol or more than 20 ml of total amount of absolute ethanol) (group P, n = 12); and patients who received a continuous infusion of nitroglycerin at the elevation of mean pulmonary artery pressure (PAP, 10 mmHg greater than the baseline values or higher than 25 mmHg) after the injections of absolute ethanol (group A, n = 12). After the start of the bolus injection of absolute ethanol, the amount of the continuous infusion of nitroglycerin was adjusted within the range of 0.5-3.0 µg/kg/min, according to the elevation of the pulmonary arterial pressure in both groups. We compared the PAPs of the baseline, at the time the pulmonary arterial pressure reached the highest during the session, 10 minutes after the final bolus injection of absolute ethanol, and after restoration of the patient's spontaneous respirations between group A and P. We also compared the difference between the PAPs obtained 10 minutes after the final injection and the baseline, the difference between the hemodynamic values obtained after restoration of the patient's spontaneous respirations and the baseline, and 10 minutes after the final injection of absolute ethanol between the two groups, respectively. The mean volume of absolute ethanol (5.7 ± 2.5 ml in the group P vs 3.5 ± 1.3 ml in the group A, P < 0.05) and mean total amount of absolute ethanol (32.4 ± 12.8 ml in the group P vs 14.8 ± 6.9 ml in group A, P < 0.05) injected into the patients of group P were significantly larger than those of group A. Six patients developed pulmonary hypertension (elevation of mean pulmonary arterial pressure of more than 25 mmHg) in both groups during the session. Baseline measurements of PAPs showed no statistically significant differences between the groups. Compared with the baseline measurement, the systolic, mean and diastolic PAPs were significantly elevated at the time of the mean pulmonary arterial pressure reaching the highest level at the final injection and the restoration of patient's spontaneous respirations in both groups. However, the systolic and mean PAPs of group P at the period of restoration of the patient's spontaneous respirations were statistically significantly higher than those of group A (Table 1). Table 1 Hemodynamic Parameters during Absolute Ethanol Embolotherapy Ethanol embolotherapy requires general anesthesia because of the pain caused by the injection of absolute ethanol into the nidus. After Yakes et al. [4] reported the successful use of absolute ethanol in the treatment of inoperable congenital vascular malformation, there were strong debates over its use. One of the main objections was that direct bolus injection of absolute ethanol into the nidus can cause severe pulmonary arterial hypertension, even catastrophic cardiovascular collapse. The changes of PAP during the session of embolotherapy can be very critical. Moreover, PAP can be elevated by changes of venous return, hypercapnia and tracheal irritation by the endotracheal tube during the recovery period [5]. Although the total amount and the amount of single bolus injection of absolute ethanol administered in group P were significantly larger than those of group A, this study shows that early initiation of a continuous infusion of nitroglycerin before the start of a bolus injection of absolute ethanol is more effective in attenuating the elevation of the PAPs during ethanol embolotherapy of arteriovenous malformation than starting the infusion after the hemodynamic changes have already occurred. During the session, the changes of PAPs were comparable between the groups. However, there were more significant elevations of the mean PAP in group P at the period of recovery than in group A. Perhaps the accumulating effect of a larger amount of total absolute ethanol requires more aggressive management in alleviating elevations of mean pulmonary arterial pressures in group P. In conclusion, this study shows that early initiation of a continuous infusion of nitroglycerin before the start of a bolus injection of absolute ethanol is beneficial in attenuating the pulmonary arterial pressure during ethanol embolotherapy. Furthermore, despite the better moderation of hemodynamic changes with early nitroglycerine infusion, caution is needed during recovery from anesthesia if the patient has received larger doses of absolute ethanol during the session.

CC Hypothermia is frequently encountered during major operations despite many efforts to prevent this complication. Numer ous reports have identified the adverse effects of hypo thermia including coagulopathy, acidosis, alterations in response to pharmacological agents, detrimental cardiac arrhythmias, and a mortality rate of near 100% for cases with a core body temperatures of 32 o C [1,2]. Therefore, a variety of devices have been developed to achieve rapid fluid warming and infusion because prevention of hypothermia via intravenous infusion of warm fluid is probably the most cost effective intervention, particularly for circumstances in which large volumes of fluid are required. However, after the utilization of the rapid infusion system (RIS) in liver transplantation (LT) recipients, we noticed a considerably lower intraoperative body temperature (BT) compared to the recipients before RIS. Therefore, in this study, we aimed to compare the BTs of LT recipients before and after receiving RIS. Medical records of adult patients who underwent first LT were reviewed. Twenty-three recipients were divided into nonRIS (n = 12) and RIS (n = 11) groups. The exclusion criteria in cluded patients with model for end-stage liver disease score less than 9 or greater than 25, total input greater than 20 L, and RIS infusion less than 4 L. After induction, either RIS (Haemonetics Corp., Braintree, MA, USA) or Level 1 (Level 1 Technologies, Rockland, MA, USA) was connected to the Advanced Venous Access catheter (Edwards Lifesciences LLC, Irvine, CA, USA) placed in the right internal jugular vein. For external methods of warming and body temperature preservation, a water circulating heating mattress was used and the extremities were insulated with cotton rolls and vinyl covers. The operating room tempera

We appreciate the interest and comments on our study, "The effect of an angiotensin receptor blocker on arterial stiffness in type 2 diabetes mellitus patients with hypertension," which was published in Diabetes & Metabolism Journal 2011;35:236-242. Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. In type 2 diabetes, hypertension often initiates and accelerates the progression of macrovascular events by increasing arterial stiffness [1,2]. Increased arterial stiffness was recently reported to be a powerful and independent risk factor for early mortality and had more clinical prognostic value than previously identified cardiovascular disease risk factors such as age, gender, smoking and dyslipidemia [3]. Previous studies have reported that angiotensin II type 1 receptor blockers reduce arterial stiffness [4-6]. In our study we assessed changes in central aortic waveforms and pulse wave velocity (PWV) as well as related parameters after treatment with valsartan in patients with type 2 diabetes and hypertension. We excluded patients concomitantly using insulin, thiazolidinedion or metformin as insulin resistance is associated with arterial stiffness and premature vascular sclerosis [7,8]. Our group of study subjects was homogeneous in terms of diabetes treatment, which had a minimal effect on insulin resistance. As Dr. Kim noted, our study has some limitations. There was no control group treated with other anti-hypertensive agents and confounding factors, such as lipid-lowering drugs, antiplatelet agents, and smoking, were not considered in the analysis. We were unable to measure PWV in all participants and the potential selection bias and diminished statistical power due to the small number of subjects was another limitation of this study. Although data was not shown in the article, there was no difference in baseline PWV values between the 'PWV decrease' and 'no PWV decrease' groups (11.0±1.8 vs. 10.5±2.0, P=0.297), and baseline PWV values were not associated with fasting blood glucose or HbA1c (P=0.462, P=0.641). We thought that if the number of subjects were larger, there might be association between them. Because there have been reported that fasting glucose and HbA1c were associated with PWV in type 2 diabetes patients with hypertension [9]. In our results, the baseline glucose level was significantly higher in 'no PWV decrease group.' Therefore, we concluded that the change in PWV was associated with baseline glycemic control status. Also, there were no differences between the two groups in terms of systolic or diastolic blood pressure at 12 weeks (P=0.183, P=0.396) or drug compliance, which was verified at every patient visit. Thus a difference in blood pressure control was excluded as a factor influencing the difference in PWV between the two groups. The results of our study suggested that the angiotensin receptor blocker, valsartan, had a modest beneficial effect in reducing arterial stiffness measured as PWV and the augmentation index in patients with type 2 diabetes and hypertension. Fasting glucose and HbA1c levels are likely to be independently associated with PWV improvement as a result of valsartan treatment. In future, further trials are needed to validate the effect observed in our study, to examine its stability over longer periods of follow-up, and to compare it with that obtained with other antihypertensive agents commonly used in clinical practice, and evaluate the pathogenic mechanism.

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: The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study ex amines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. Methods: Clinical characteristics in type 2 diabetics with (n = 121) and without macrovascular complications (n = 115) were analyzed. In addition, early onset (≤ 5 years, n = 54) and late onset groups (> 5 years, n = 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. Results: The average duration of diabetes was 8.7 ± 7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lowe r in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). Conclusion: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Mor eover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications. (Korean Diabetes J 33:134-142, 2009)

Hyperthyroidism combined with rhabdomyolysis is extremely rare. There are only 6 reported cases of hyperthyroidism accompanied with rhabdomyolysis in the medical literature. Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and intracellular protein to leak into the circulation. The causes of rhabdomyolysis include trauma, electrolyte abnormality, infection, drug, toxin and hypothyroidism. We report here on a patient who presented with thyrotoxic periodic paralysis and rhabdomyolysis with hypokalemia. He complained of lower leg paralysis along with muscle tenderness, and the laboratory findings showed elevated creatine kinase (CK) levels. After treatment by hydration, potassium replacement and drug medication, including propylthiouracil and beta-blocker, his CK levels were normalized and his symptoms were much improved. For patient with thyrotoxic periodic paralysis and muscle tenderness, the possibility of rhabdomyolysis should be clarified by examining the CK levels. (J Korean Endocr Soc

Abstract - - Abstract - - Abstract - - Abstract - Background: Walking is a popular, convenient and relatively safe form of exercise. However, there is few objective data for walking exercise. The aim of this study was to evaluate pedometer-determined physical activity defined as steps/day in type 2 diabetes mellitus. Therefore, it could be the basic data for programming walking exercise in diabetes mellitus. Methods: Participants with type 2 diabetes who visited in 6 university hospitals on February, 2006 in Seoul and Kyung-gi area were recruited. The participants were asked their ambulatory activity with the given pedometer and calorimeter for 1 week. Total 240 (Male 122, Female 118) subjects who walked above 1000 steps/day were analyzed. We also collected their biochemical data from the medical records. Results: Participants took 8532 ± 4130 steps for day (step/day) and energy expenditure were 320 ± 161 Cal/day. Steps/day was not significantly different between male and female, but energy expenditure was higher in male than female ( P < 0.05). Steps/day was significantly lower in obese patients than non-obese patients ( P < 0.001). BMI (r = -0.325, P < 0.001), waist circumference (r = -0.287, P < 0.001), triglyceride (r = 0.164, P < 0.018) showed significant inverse correlation with steps/day, but BUN (r = 0.165, P = 0.019) and HDL-cholesterol (r = 0.164, P = 0.018) were positive correlated with steps/day significantly. BMI (r = -0.14, P < 0.032) and cholesterol (r = -0.139, P < 0.041) showed significantly inverse correlation with energy expenditure and BUN (r = 0.187, P = 0.008) and HDL cholesterol (r = 0.145, P < 0.037) positively correlated with energy expenditure. Pedometer-determined steps/day was positively associated with energy expenditure (r 2 = 0.824, P < 0.001).

Background: It is known that patients with hypopituitarism have a high mortality rate due to the presence of atherosclerosis, cardiovascul ar diseases and stroke. The aim of this study was the effect of growth hormone (GH) on the atherosclerotic markers and the adipocytokine levels. Method: The study was conducted on 13 adult patients with hypopituitarism and growth hormone deficiency (GHD), and they had been stabilized after receiving hormone replacement therapy for other insufficient pituitary hormones, other than GH, for more than o ne year. Before treatment with GH, we compared the lipid metabolism, glucose metabolism, cardiovascular risk factors and adipocytokine levels, including adiponectin, leptin, TNF-α and IL-6, between the GHD patients and 13 healthy adults who were of a similar age and gender distribution. Patients with GHD were treated with 1 U/day of GH for 6 months. We measured insulin-like growth factor- Ⅰ (IGF-Ⅰ), blood pressure, body composition, lipid metabolism, glucose metabolism and hs-CRP, cardiac function, adiponectin, leptin, TNF-α and IL-6 levels, flow mediated vasodilation (FMD) and nitroglycerin mediated vasodilation (NMD) before and after GH treatment. Results: The patients with hypopituitarism and GHD showed significantly higher levels of total cholesterol (P = 0.002), low-density lipoprotein cholesterol (LDL-C) (P = 0.036), hs-CRP (P = 0.0087) and leptin (P < 0.001) than did the normal healthy adults. However, there was no difference between the normal adults and the patients with GHD for the systolic and diastolic BP, the levels of apoA, apoB, fasting blood glucose(FBG) and HOMA-IR. In the subjects with GHD after treatment with GH, the level of fat mass (P = 0.0017), total cholesterol (P = 0.004), LDL-C (P = 0.001), leptin (P = 0.013), TNF-α (P < 0.001) and hs-CRP (P = 0.0001)

Background: Radioiodine treatment is effective for the removal of remnant thyroid tissues after thyroi- dectomy in patients with differentiated thyroid carcinoma. To induce the elevation of serum TSH level which facilitates the uptake of radioiodine into remnants, a 4 to 6 week interval between thyroidectomy and radioio- dine administration has been established. During the period of preparation, most patients have experienced overt symptoms of hypothyroidism which have led to the development of alternative strategies. Some reports have suggested that the interval could be reduced to about 3 weeks with less symptoms. We reevaluated the adequate time needed for the elevation of serum TSH level above 30μU/mL after thyroidectomy. Methods: Forty five patients who had undergone total thyroidectomy for differentiated thyroid carcinoma were investigated. Serum TSH and free T4 levels were measured one or more times within 3 weeks after operation (total 97 blood samples). Eighty nine blood samples were obtained within 15 days. Results: In 41 patients (91.1%) serum TSH levels increased to 30 μU/mL until 15 days after operation. Until postoperative 21 days, serum TSH levels in all the other patients reached 30 μU/mL. In linear equation, the daily increment of serum TSH levels was 2.62 μU/mL for the first 8 days after operation and 5.34 μU/mL for the next 7 days. The half-life of serum free T 4 levels showed marked individual variations. Conclusion: Measurement of serum TSH level at about 15 days after total thyroidectomy for differentiated thyroid carcinoma may be useful in determining the time of radioiodine administration (J Kor Soc Endocrinol 20:460~466, 2005).