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Background Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator-activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Abstract The quantum internet is a cutting‐edge paradigm that uses the unique characteristics of quantum technology to radically alter communication networks. This new network type is expected to collaborate with 6G networks, creating a synergy that will fundamentally alter how we communicate, engage, and trade information. The improved security, increased speed, and increased network capacity of the quantum internet will lead to the emergence of a broad variety of new applications and services. The current state of quantum technology and its integration with 6G networks are summarised in this study, with an emphasis on the key challenges and untapped possibilities. The main goal is to get knowledge about how the quantum internet might impact communication in the future and alter several economic and societal sectors.

Background This study aimed to investigate the prevalence and status of dyslipidemia management among South Korean adults, as performed by the Korean Society of Lipid and Atherosclerosis under the name Dyslipidemia Fact Sheet 2022. Methods We analyzed the lipid profiles, age-standardized and crude prevalence, management status of hypercholesterolemia and dyslipidemia, and health behaviors among Korean adults aged ≥20 years, using the Korea National Health and Nutrition Examination Survey data between 2007 and 2020. Results In South Korea, the crude prevalence of hypercholesterolemia (total cholesterol ≥240 mg/dL or use of a lipid-lowering drug) in 2020 was 24%, and the age-standardized prevalence of hypercholesterolemia more than doubled from 2007 to 2020. The crude treatment rate was 55.2%, and the control rate was 47.7%. The crude prevalence of dyslipidemia—more than one out of three conditions (low-density lipoprotein cholesterol ≥160 or the use of a lipid-lowering drug, triglycerides ≥200, or high-density lipoprotein cholesterol [HDL-C] [men and women]

Abstract The use of target agents and immune checkpoint inhibitors have changed the treatment landscape for AGC in the first-line setting. However, the crosswise comparison between each regimen is rare. Therefore, we estimated the efficacy and safety of targeted therapy or immunotherapy with chemotherapy in AGC patients as the first-line treatment. Included studies were divided into “average” or “specific positivity” group according to whether the patients were selected by a certain pathological expression. We conducted a Bayesian network meta-analysis for all regimens in both groups. In average group, no regimen showed significant improvements in overall survival (OS) and progression free survival (PFS), while pembrolizumab and nivolumab combined with chemotherapy were ranked first and second respectively without an obvious safety difference. In specific positivity group, zolbetuximab plus chemotherapy significantly prolonged OS (HR 0.53, 95% CI 0.36–0.79) and PFS (HR 0.45, 95% CI 0.25–0.81). The top three regimens were zolbetuximab-chemotherapy, trastuzumab plus pertuzuma-chemotherapy and nivolumab-chemotherapy respectively, with no significant safety risk. For average patients, immune checkpoint inhibitor PD-1 plus chemotherapy will be the promising regimen. For patients with overexpression of CLDN18.2, zolbetuximab combined with chemotherapy comes with greater survival benefits, while for patients who have PD-L1 expression with no HER-2 or CLDN18.2 positivity, additional immune checkpoint inhibitor of PD-1 will be a good considered option.

Abstract Background Schema, a concept from cognitive psychology used to explain how new information is integrated with previous experience, is a framework of acquired knowledge within associative network structures as biological correlate, which allows new relevant information to be quickly assimilated by parallel cortical encoding in the hippocampus (HPC) and cortex. Previous work demonstrated that myelin generation in the anterior cingulate cortex (ACC) plays a critical role for dynamic paired association (PA) learning and consolidation, while astrocytes in ACC play a vital role in cognitive decision-making. However, circuit components and mechanism involving HPC-anterior cingulate cortex (ACC) during schema formation remain uncertain. Moreover, the correlation between HPC-ACC circuit and HPC astrocytic activity is unclear. Results Utilizing a paired association (PA) behavioral paradigm, we dynamically recorded calcium signals of CA1-ACC projection neurons and ACC neurons during schema formation. Depending on the characteristics of the calcium signals, three distinct stages of schema establishment process were identified. The recruitment of CA1-ACC network was investigated in each stage under CA1 astrocytes Gi pathway chemogenetic activation. Results showed that CA1-ACC projecting neurons excitation gradually decreased along with schema development, while ACC neurons revealed an excitation peak in the middle stage. CA1 astrocytic Gi pathway activation will disrupt memory schema development by reducing CA1-ACC projection neuron recruitment in the initial stage and prevent both CA1-ACC projection neurons and ACC neuron excitation in the middle stage. CA1 astrocytes Gi markedly suppress new PA assimilation into the established memory schema. Conclusions These results not only reveal the dynamic feature of CA1-ACC network during schema establishment, but also suggest CA1 astrocyte contribution in different stages of schema establishment.

Background It is unclear whether glycemic variability (GV) is a risk factor for diabetic peripheral neuropathy (DPN), and whether control of GV is beneficial for DPN. The purpose of this study was to investigate the effect of GV on peripheral nerve damage by inducing glucose fluctuation in streptozotocin-induced diabetic rats. Methods Rats were divided into four groups: normal (normal glucose group [NOR]), diabetes without treatment (sustained severe hyperglycemia group; diabetes mellitus [DM]), diabetes+once daily insulin glargine (stable hyperglycemia group; DM+LAN), and diabetes+once daily insulin glargine with twice daily insulin glulisine (unstable glucose fluctuation group; DM+Lantus [LAN]+Apidra [API]). We measured anti-oxidant enzyme levels and behavioral responses against tactile, thermal, and pressure stimuli in the plasma of rats. We also performed a quantitative comparison of cutaneous and sciatic nerves according to glucose fluctuation. Results At week 24, intraepidermal nerve fiber density was less reduced in the insulin-administered groups compared to the DM group (P0.05; 16.2±1.6, 12.4±2.0, 14.3±0.9, and 13.9±0.6 for NOR, DM, DM+LAN, and DM+LAN+API, respectively). The DM group exhibited significantly decreased glutathione levels compared to the insulin-administered groups (2.64±0.10 μmol/mL, DM+LAN; 1.93±0.0 μmol/mL, DM+LAN+API vs. 1.25±0.04 μmol/mL, DM; P

Background Only few studies have shown the efficacy and safety of glucose-control strategies using the quadruple drug combination. Therefore, the aim of the present study was to investigate the usefulness of the quadruple combination therapy with oral hypoglycemic agents (OHAs) in patients with uncontrolled type 2 diabetes mellitus (T2DM). Methods From March 2014 to December 2018, data of patients with T2DM, who were treated with quadruple hypoglycemic medications for over 12 months in 11 hospitals in South Korea, were reviewed retrospectively. We compared glycosylated hemoglobin (HbA1c) levels before and 12 months after quadruple treatment with OHAs. The safety, maintenance rate, and therapeutic patterns after failure of the quadruple therapy were also evaluated. Results In total, 357 patients were enrolled for quadruple OHA therapy, and the baseline HbA1c level was 9.0%±1.3% (74.9±14.1 mmol/mol). After 12 months, 270 patients (75.6%) adhered to the quadruple therapy and HbA1c was significantly reduced from 8.9%±1.2% to 7.8%±1.3% (mean change, −1.1%±1.2%; P

Abstract In the plant–insect–insectivorous bird food chain, directional changes in climate can result in mismatched phenology, potentially affecting selection pressures. Phenotypic plasticity in the timing of breeding, characterized by reaction norm slopes, can help maximize fitness when faced with earlier prey emergence. In temperate passerines, the timing of tree budburst influences food availability for chicks through caterpillar phenology and the resulting food abundance patterns. Thus, the timing of tree budburst might serve as a more direct proxy for the cue to time egg‐laying. The evolutionary potential of breeding plasticity relies on heritable variation, which is based upon individual variation, yet studies on individual variation in plasticity are few. Here, we tested for the laying date—budburst date and the clutch size—laying date reaction norms, and examined 1) the among‐individual variance in reaction norm intercepts and slopes; and 2) the selection differentials and gradients on these intercepts and slopes. Using long‐term data of oak (genus Quercus) budburst and blue tit (Cyanistes caeruleus) reproduction, we applied within‐subject centering to detect reaction norms, followed by bivariate random regression to quantify among‐individual variance in reaction norm properties and their covariance with fitness. Individuals significantly differed in intercepts and slopes of both laying date—budburst date and clutch size—laying date reaction norms, and directional selection was present for an earlier laying date and a larger clutch size (intercepts), but not on plasticity (slopes). We found that individuals have their own regimes for adjusting egg‐laying and clutch size. This study provides further support of individual variation of phenotypic plasticity in birds.

Fitness is at the core of evolutionary theory, but it is difficult to measure accurately. One way to measure long-term fitness is by calculating the individual's reproductive value, which represents the expected number of allele copies an individual passes on to distant future generations. However, this metric of fitness is scarcely used because the estimation of individual's reproductive value requires long-term pedigree data, which is rarely available in wild populations where following individuals from birth to death is often impossible. Wild study systems therefore use short-term fitness metrics as proxies, such as the number of offspring produced. This study compared two frequently used short-term metrics for fitness obtained at different offspring life stages (eggs, hatchlings, fledglings and recruits), and compared their ability to predict reproductive values derived from the genetic pedigree of a wild passerine bird population. We used twenty years of precise field observations and a near-complete genetic pedigree to calculate reproductive success, individual growth rate and de-lifed fitness as lifetime fitness measures, and as annual de-lifed fitness. We compared the power of these metrics to predict reproductive values and lineage survival to the end of the study period. The three short-term fitness proxies predict the reproductive values and lineage survival only when measured at the recruit stage. There were no significant differences between the different fitness proxies at the same offspring stages in predicting the reproductive values and lineage survival. Annual fitness at one year old predicted reproductive values equally well as lifetime de-lifed fitness. However, none of the short-term fitness proxies were strongly associated with the reproductive values. The commonly used short-term fitness proxies best predict long-term fitness when measured at recruitment stage. Thus, because lifetime fitness measured at recruit stage and annual fitness in the first year of life were the best proxies of long-term fitness in short-lived birds, we encourage their future use.

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.

Hot flush (hot flush or facial flush) is the most frequent symptom experienced by women of peri-menopausal age. It may appear on women or even men after surgery or chemotherapy. Hot flush is one of the biggest reason for women to undergo hormone replacement therapy (HRT). It also crucially affects various aspects of life quality such as occupation, social life, daily routine and health awareness. The most effective and fundamental remedy for hot flush is HRT. However, a few women is not responsive to HRT and investigation to elucidate other causes of hot flush is warranted, especially in elderly. The contraindications such as breast cancer mandates other modality of treatment. Variety of treatment for hot flush other than HRT will be discussed herein.

Endometriosis is an estrogen-dependent chronic inflammatory condition that affects women in their reproductive period and is associated with pelvic pain and infertility. Oxidative stress (OS) occurs when reactive oxygen stress (ROS) and anti-oxidants are in imbalance. OS is a potential factor involved in the pathophysiology of endometriosis. Iron-induced ROS may trigger a chain of events resulting in the development and progression of endometriosis. Endogenous ROS are correlated with increased cellular proliferation and ERK1/2 activation in human endometriotic cells. An oxidative environment leads to stimulation of the ERK and PI3K/AKT/mTOR signaling pathways that facilitate endometriotic lesion progression through adhesion, angiogenesis, and proliferation. OS is also known to be involved in epigenetic mechanisms in endometriosis. We summarize the recent knowledge in our understanding of the role of oxidative stress in the pathogenesis of endometriosis.

The effect of sodium-glucose cotransporter 2 inhibitors on peripheral nerves and kidneys in diabetes mellitus (DM) remains unexplored. Therefore, this study aimed to explore the effect of empagliflozin in diabetic rats. DM in rats was induced by streptozotocin injection, and diabetic rats were treated with empagliflozin 3 or 10 mg/kg. Following 24-week treatment, response thresholds to four different stimuli were tested and found to be lower in diabetic rats than in normal rats. Empagliflozin significantly prevented hypersensitivity (P

Present study investigated the morphologic changes of autonomic nerves in the adipose tissue in diabetic animal model. Male obese type 2 diabetic db/db mice and age matched non-diabetic db/m control mice were used. Epididymal adipose tissue from diabetic db/db mice with that from control heterozygous db/m mice was compared using confocal microscopy-based method to visualize intact whole adipose tissue. Immunohistochemistry with tyrosine hydroxylase for sympathetic (SP), choline acetyltransferase for parasympathetic (PSP), and protein gene product 9.5 (PGP 9.5) for whole autonomic nerves was performed. The quantity of immunostained portion of SP, PSP, and PGP 9.5 stained nerve fibers showed decreased trend in diabetic group; however, the ratio of SP/PSP of adipose tissue was higher in diabetic group compared with control group as follows (0.70±0.30 vs. 0.95±0.25, P

Trigeminal neuropathic pain (TNP) led to vital cognitive functional deficits such as impaired decision-making abilities in a rat gambling task. Chronic TNP caused hypomyelination in the anterior cingulate cortex (ACC) associated with decreased synchronization between ACC spikes and basal lateral amygdala (BLA) theta oscillations. The aim of this study was to investigate the effect of pain suppression on cognitive impairment in the early or late phases of TNP. Blocking afferent signals with a tetrodotoxin (TTX)-ELVAX implanted immediately following nerve lesion suppressed the allodynia and rescued decision-making deficits. In contrast, the TTX used at a later phase could not suppress the allodynia nor rescue decision-making deficits. Intra-ACC administration of riluzole reduced the ACC neural sensitization but failed to restore ACC-BLA spike-field phase synchrony during the late stages of chronic neuropathic pain. Riluzole suppressed allodynia but failed to rescue the decision-making deficits during the late phase of TNP, suggesting that early pain relief is important for recovering from pain-related cognitive impairments. The functional disturbances in ACC neural circuitry may be relevant causes for the deficits in decision making in the chronic TNP state.

Abstract Menopause is the time at which menstruation stops in women. After menopause, women are more susceptible to some diseases, especially osteoporosis and cardiovascular disease. Vitamin D has a protective effect against osteoporosis by facilitating the absorption of calcium and affecting parathyroid hormone. Vitamin D also affects cardiovascular function by lowering the blood pressure, which affects the renin–angiotensin system and alters the low-density lipoprotein receptor activity. This paper discusses supplemental vitamin D in postmenopausal women with osteoporosis and cardiovascular disease.

Objective. This study used a continuous glucose monitoring system (CGMS) to investigate the glucose profiles and assess the degree of hyperglycemic excursion after kidney or liver transplantation during the early period after operation. Methods. Patients to whom a CGMS was attached during a postoperative period of approximately one month after transplantation were included. The CGM data of 31 patients including 24 with kidney transplantation (KT) and seven with liver transplantation (LT) were analyzed. Results. Hyperglycemia over 126 mg/dL (fasting) or 200 g/dL (postprandial) occurred in 42.1% (8/19) and 16.7% (1/6) of KT and LT patients, respectively, during this early period after transplantation, except for patients with preexisting diabetes (5 KT, 1 LT). The average mean amplitude of glycemic excursion (MAGE) and mean absolute glucose (MAG) levels were 91.18±26.51 vs. 65.66±22.55 (P

The purpose of this study was to estimate sex differences in age-related grip strength decline and describe the course of decline in grip strength from age 40 to 89 years by a longitudinal epidemiological study. Participants were randomly selected community-living men (n = 648) and women (n = 598) aged 40 to 79 years at baseline. Grip strength was measured with standard techniques every other year over a 10-year period. The preservation rate of grip strength was calculated as the 10-year follow-up value divided by the baseline value. The relationship between the preservation rates of grip strength and age group (by decade) at baseline by sex was analyzed using Two-Way Analysis of Variance and the Tukey-Kramer method. The trajectories of grip strength over 10 years were plotted for both men and women. The mean grip strength preservation rates of participants in their 40s, 50s, 60s and 70s over 10 years was 0.90, 0.88, 0.84 and 0.79 in men, and 0.89, 0.89, 0.89 and 0.88 in women, respectively. There were significant differences in sex and age group at baseline in the preservation rate of grip strength. Among men, the preservation rate of grip strength for the 70s group was significantly lower than that of younger groups (p < 0.05); however, no significant difference was observed among age groups in women. The trajectories of grip strength decline year by year were steep in men, but even in women. Age-related decline in grip strength markedly increased in older men, but remained constant throughout middle and late adulthood in women.

Abstract Today, many materials as drug are developed having various prominent function in order to treatment of disease or cancer. Among these materials, especially docosahexaenoic acid (DHA), main constituents of omega-3 fatty acid, has a lot of beneficial and natural effects, so it has been known as anticancer material especially breast cancer. Breast cancer is disease taking high occurrence level among feminine diseases. DHA has anticancer effects on breast cancer cell, representatively inducing apoptosis, inhibiting proliferation or metastasis. Main effect of DHA on breast cancer cell is apoptosis inducing, which has mechanism that treated DHA causes lipid peroxidation increasing reactive oxygen species (ROS) level and it activates caspase 8 and caspase 9 so activated caspase occurs apoptosis. Cell lines of breast cancer are MDA-MB-231, MCF-7, SK-BR-3, T47D and ZR75. Especially this article uses the MCF-7 cell line at experiment of anti-proliferation by DHA, the MDA-MB-231 cell line at experiment of anti-metastasis by DHA, because that cell line has specialized metastasis activity. Therefore, this paper discusses the effects of natural material DHA as drug of breast cancer.

Diabetic neuropathy is one of the major complications of diabetes, and it increases morbidity and mortality in patients with both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Because the autonomic nervous system, for example, parasympathetic axons, has a diffuse and wide distribution, we do not know the morphological changes that occur in autonomic neural control and their exact mechanisms in diabetic patients with diabetic autonomic neuropathy (DAN). Although the prevalence of sympathetic and parasympathetic neuropathy is similar in T1DM versus T2DM patients, sympathetic nerve function correlates with parasympathetic neuropathy only in T1DM patients. The explanation for these discrepancies might be that parasympathetic nerve function was more severely affected among T2DM patients. As parasympathetic nerve damage seems to be more advanced than sympathetic nerve damage, it might be that parasympathetic neuropathy precedes sympathetic neuropathy in T2DM, which was Ewing's concept. This could be explained by the intrinsic morphologic difference. Therefore, the morphological changes in the sympathetic and parasympathetic nerves of involved organs in T1DM and T2DM patients who have DAN should be evaluated. In this review, evaluation methods for morphological changes in the epidermal nerves of skin, and the intrinsic nerves of the stomach will be discussed.

Objective: To determine the accuracy and usefulness of three-dimensional transvaginal ultrasound (3D-TVUS) in diagnosing intrauterine adhesion (IUA) and to evaluate treatment outcomes associated with fertility. Materials and Methods: IUA patients (110) underwent hysteroscopy to definitively diagnose and treat adhesiolysis. Morphologic characteristics of endometrium suggesting IUA, such as marginal irregularity, thinning, defects, obliteration, fibrosis, and calcification, were identified and recorded by 3D-TVUS. The sensitivity of 3D-TVUS findings and the attainment of postoperative fertility were evaluated prospectively. The clinical records were followed up for 2 years for obstetrical outcomes and analyzed. Results: On comparing the findings of 3D-TVUS with those of hysteroscopy in 110 patients, 45 (88.23%) patients were confirmed as IUA by hysteroscopy among 51 (46.36%) patients, with one finding in 3D-TVUS; 42 (97.67%) patients were confirmed among 43 (39.09%) patients with two findings; and 16 (100%) patients were confirmed among 16 (14.55%) patients with over three findings. A pregnancy rate of eight out of 47 (17.02%) was achieved in patients who desired fertility. Conclusion: 3D-TVUS assessment of the uterus provides an accurate depiction of adhesion and extent of cavity damage in patients with suspected IUA.

Objectives: We evaluated the role of three-dimensional power Doppler ultrasound (3D PD-US) to detect endometrial lesions in women with postmenopausal endometrial bleeding. Materials and methods: In this prospective observational study, from January 2009 to November 2012, we recruited 225 postmenopausal women with postmenopausal uterine bleeding who met the study criteria. Women who had hematologic disease, chronic medical diseases, or nonuterine pelvic diseases were excluded. Prior to endometrial biopsy, the patients underwent a baseline transvaginal ultrasound screening. The vascular indices and endometrial volumes were calculated with 3D PD-US and compared with the endometrial histopathology. Results: Among the endometrial histopathologic findings of 174 women, atrophic endometrium was the most common finding (30.5%). Endometrial malignancy was confirmed in 28 cases (16.1%), and endometrial hyperplasia was diagnosed in 17 cases (9.8%). The prevalence of endometrial cancer was high in patients who had endometrial thickness >9.5 mm (p

BackgroundAnemia is associated with various poor clinical outcomes in chronic kidney disease patients. The aim of this study was to investigate the relationship between anemia and the initiation degree and time of dialysis in type 2 diabetic nephropathy patients.MethodsThis observational retrospective study included 130 type 2 diabetic nephropathy patients in Korea. The existence of anemia, the degree and time of dialysis initiation were reviewed. Clinical characteristics and variables were also compared.ResultsThe levels of hemoglobin and serum creatinine were significantly correlated with the dialysis initiation (P

Background This study was aimed to assess the effect of endometrial movements on pregnancy achievement in intrauterine insemination (IUI) cycles. Materials and Methods The population of this observational study was composed of unexplained infertility couples undergoing first-time IUI with clomiphene citrate between September 2010 and October 2011. Not only endometrial movements, but also thickness, volume, pattern, and echogenic change of endometrium were analyzed prospectively in prediction of pregnancy. Results The total number of 241 cycles of IUI with 49 intrauterine pregnancies (20.3%) was analyzed. Pregnancy was not related to endometrial thickness and endometrial volume, but significantly related to endometrial movements associated with the number of contraction, strong movement, cervicofundal direction, and hyperechoic change (p < 0.05). Pregnant group showed higher cervicofundal movement rate (89.8 vs. 75.5%). Conclusion For IUI cycles stimulated by clomiphene citrate in unexplained infertility women, endometrial movements on the day of IUI could be a predictor of pregnancy.

BackgroundThe Survey of Autonomic Symptom (SAS) scale was reported as an easy instrument to assess the autonomic symptoms in patients with early diabetic neuropathy. In this study, we investigated the relationship between the SAS scale and the parameters of cardiac autonomic neuropathy (CAN) in Korean patients with diabetic peripheral neuropathy (DPN).MethodsThe SAS scale was tested in 30 healthy controls and 73 patients with DPN at Chonbuk National University Hospital, in Korea. The SAS score was compared to the parameters of the CAN test and the total symptom score (TSS) for DPN in patients with DPN.ResultsThe SAS symptom score and total impact score were increased in patients with DPN compared to the control group (P=0.01), particularly in sudomotor dysfunction (P=0.01), and vasomotor dysfunction (P=0.01). The SAS score was increased in patients with CAN compared to patients without CAN (P

Objectives: Successful implantation depends on interaction between a blastocyst and a receptive endometrium. Endometrial vasculature is important in the early endometrial response to blastocyst implantation, and vascular changes can affect uterine receptivity. This study aims to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) could predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF–ET) using a gonadotropin releasing hormone (GnRH) agonist long protocol. Materials and methods: This prospective observational study enrolled 236 nulliparous women who underwent a first IVF–ET using a GnRH long protocol with stimulation by recombinant FSH (rFSH) from May 2009 to April 2012. After excluding two cases of tubal pregnancy, 234 women were in either a pregnant group (n = 113) or a nonpregnant group (n = 121). Color Doppler ultrasound and 3D PD-US examinations were performed on the day of embryo transfer. Main outcomes were pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) of the uterine artery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of the endometrium and subendometrial region. Measurements were analyzed relative to IVF–ET outcome (pregnant vs. nonpregnant). Results: No significant differences were observed in patient age, infertility duration, body mass index (BMI), basal FSH levels, number of retrieved oocytes or good quality embryos, or endometrial thickness or volume between the two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, p = 0.000, p = 0.021, respectively). By contrast, neither subendometrial region VI, FI, and VFI scores (p = 0.770, p = 0.252, p = 0.451), nor uterine artery PI, RI, or S/D scores (p = 0.256, p = 0.527, p = 0.365) differed between groups. Cut-off values of endometrial VI, FI, and VFI scores were 0.95, 12.94, and 0.15 for pregnancy achievement. Conclusion: Three dimensional PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of embryo transfer might be associated with high pregnancy success with a GnRH long protocol, because this is indicative of endometrial receptivity in fresh IVF cycles.

ResultsThe efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly. ConclusionsAppropriate to each patient’s symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed. ObjectivesChemotherapy induced nausea and vomiting is most distressing adversed effects in gynecologic cancer patients receiving chemotherapy. we compared effectiveness of ondansetron and ramosetron and aprepitant for optimal antiemetic treatment in gynecologic cancer patient receiving chemotherapy. MethodsThe study was performed retrospective on 189 patients who was diagnosed initially the gynecological cancer during chemotherapy at Kosin university hospital between January 2008 and December 2010. The efficacy of controlling acute/delayed nausea and vomiting were analyzed by counting numbers of nausea and vomiting reported in medical records of 189 patient receiving cisplatin-based chemotherapy. Statistical analysis was performed using the ANOVA and Fisher’s exact chi-square test. ResultsThe efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly. ConclusionsAppropriate to each patient’s symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed.

Due to the increased prevalence of papillary thyroid carcinoma (PTC), difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.

There are controversial reports about the effect of granulocyte colony-stimulating factor (G-CSF) in peripheral nerve protection. Therefore, the present study aimed to investigate the effect of G-CSF on peripheral nerves in streptozotocin (STZ) induced diabetic rats. After STZ or vehicle injection, rats were divided into five groups (n=6) as follows: normal+vehicle, normal+G-CSF (50 µg/kg for 5 days), diabetes mellitus (DM)+vehicle, DM+G-CSF (50 µg/kg for 5 days), and DM+G-CSF extension (50 µg/kg for 5 days and followed by two injections per week up to 24 weeks). Our results showed that the current perception threshold was not significantly different among experimental groups. G-CSF treatment inhibited the loss of cutaneous nerves and gastric mucosal small nerve fibers in morphometric comparison, but statistical significance was not observed. The present results demonstrated that G-CSF has no harmful but minimal beneficial effects with respect to peripheral nerve preservation in diabetic rats.

ObjectivesThe aim of this study was to identify the relationship between serum gamma-glutamyltransferase (GGT) and bone mineral density (BMD) in postmenopausal women. MethodsWe evaluated 200 postmenopausal women who were visiting a health promotion center at a university hospital from January 2009 to December 2011. Their current medical diseases and medication history were collected through medical records. Basic physical examinations and laboratory tests were performed on all subjects. ResultsThe levels of serum GGT within their normal range were positively correlated with waist circumference (P = 0.01), triglycerides (P

Objectives Medical doctors require outstanding communication skills when meeting with their patients. Thus medical student need to education and training about medical communication skill. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. Methods In the year 2010 and 2011, first-year medical students at The Kosin University College of Medicine took 'Communication skills' course in total, 154 first-year medical students survey results was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet'. The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. Results All categories of communication skills showed an improvement. For year 2010, a statistically significant difference was shown into the 22 questions, whereas in 2011, improvements were shown in all questions. Conclusions From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.

The study performed a systematic review of screening for preeclampsia with the combination of vascular parameters and maternal serum markers in the first and early second trimester. We identified eligible studies through a search of Medline, and, for each included study, we focused on the relationship between the maternal serum markers and preeclampsia. In the selected literature, a combination of maternal serum markers was analyzed, also. Several tests suggested moderate or convincing prediction of early preeclampsia, but screening for late preeclampsia was poor. Literatures for serum markers were selected. Each serum marker was identified independently, and where relevant, a combination of these markers was analyzed. Encouraging results for the first trimester screening were observed when it was combined with other markers. Even in the first trimester of pregnancy, we can present the reliable results for the prediction of early preeclampsia. Detection rate for combination markers may yield higher detection rate and be promising to identify patients at high risk of developing preeclampsia.

A physically active lifestyle is important across the entire life span. However, little is known about life-long participation in regular exercise among older people. The purpose of the present study was to describe regular exercise throughout a person's lifetime and evaluate the impact of exercise earlier in life on participation in exercise at age 60 and over. The participants were 984 community-dwelling older people aged 60 to 86 years. Each participant's life was divided into five age categories: 12-19, 20-29, 30-39, 40-59, and 60 years and over. The association between exercise at an earlier age and that at 60 years and over was assessed using logistic regression analysis adjusted for potential confounders. Men had exercised throughout their lives more than women. Among women, participation in exercise during their 20s and 30s showed a sharp decline. The preference for exercise differed according to age and gender. Among men, the most common patterns of exercise throughout life were exercise during all the age categories, and starting exercise at age 60 and over; whereas in women the most common pattern was no exercise at all. The adjusted odds ratio of exercise at 40-59 years for exercise at age 60 and over was 5.85 (95% confidence interval: 3.82-8.96) among men and 6.89 (4.23-11.23) among women. Regular exercise in the younger age categories affected exercise at age 60 and over among men, but not among women. Regular exercise at 40-59 years was a strong predictor of exercise at 60 years and over in both men and women.

Chronic pelvic pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis. The initial history and physical examination can narrow the diagnostic possibilities, guide any subsequent evaluation, and rule out malignancy or significant systemic disease. If the initial evaluation does not reveal a specific diagnosis, a limited laboratory and ultrasound evaluation can clarify the diagnosis, as well as rule out serious disease and reassure the patient. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic pain mapping has been proposed as a way to improve information derived from laparoscopic evaluations.

Vulvitis circumscripta plasmacellularis (VCP) is a rare, benign vulvar disorder that presents with erythematous patches and erosions. Patients with VCP usually experience vulvodynia, pruritus, or dyspareunia, which may cause severe discomfort. A 72-year-old woman presented with 10 years of vulvar pruritus and whitish patches on the labia minora and majora. A biopsy was performed on the labia minora and lichen sclerosus was diagnosed. Her condition improved after treatment with a topical steroid. After 5 months, however, her symptoms reappeared with aggravated skin lesions. A rebiopsy was performed and VCP was diagnosed. There have only been two reported cases of concurrence of VCP with lichen sclerosus. We herein report an unusual case of VCP in pre-existing lichen sclerosus.

DA-9801, a mixture of extracts from Dioscorea japonica Thunb. and Dioscorea nipponica Makino, was reported to have neurotrophic activity. Therefore, we investigated the therapeutic potential of DA-9801, in comparison with alpha lipoic acid (ALA), for peripheral nerves preservation in experimental diabetes. Experimental animals were divided into 4 groups, and each group was designated according to the type of treatment administered as follows: normal, DM, DM+DA-9801, and DM+ALA. After 16 weeks, response thresholds to tactile and thermal stimuli were higher in DM+DA-9801 group than in nontreated DM group. This degree of increase in DM+DA-9801 group indicates more therapeutic potency of DA-9801 than ALA. Western blot analysis showed more significant increase in NGF and decrease in TNF-α and IL-6 in DM+DA-9801 group than in DM or DM+ALA groups (P

Purpose: Clinicians are often uncertain about their prognostic estimates, which may impede prognostic communication and clinical decision-making. We assessed the impact of a web-based prognostic calculator on physicians' prognostic confidence., Methods: In this prospective study, palliative care physicians estimated the prognosis of patients with advanced cancer in an outpatient clinic using the temporal, surprise, and probabilistic approaches for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w, and 3 d. They then reviewed information from www.predictsurvival.com , which calculated survival estimates from seven validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status, and again provided their prognostic estimates after calculator use. The primary outcome was prognostic confidence in temporal CPS (0-10 numeric rating scale, 0 = not confident, 10 = most confident)., Results: Twenty palliative care physicians estimated prognoses for 217 patients. The mean (standard deviation) prognostic confidence significantly increased from 5.59 (1.68) before to 6.94 (1.39) after calculator use (p < 0.001). A significantly greater proportion of physicians reported feeling confident enough in their prognosis to share it with patients (44% vs. 74%, p < 0.001) and formulate care recommendations (80% vs. 94%, p < 0.001) after calculator use. Prognostic accuracy did not differ significantly before or after calculator use, ranging from 55-100%, 29-98%, and 48-100% for the temporal, surprise, and probabilistic approaches, respectively., Conclusion: This web-based prognostic calculator was associated with increased prognostic confidence and willingness to discuss prognosis. Further research is needed to examine how prognostic tools may augment prognostic discussions and clinical decision-making., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)