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This comprehensive review critically examines the detrimental impacts of endocrine-disrupting chemicals (EDCs) on bone health, with a specific focus on substances such as bisphenol A (BPA), per- and polyfluoroalkyl substances (PFASs), phthalates, and dioxins. These EDCs, by interfering with the endocrine system’s normal functioning, pose a significant risk to bone metabolism, potentially leading to a heightened susceptibility to bone-related disorders and diseases. Notably, BPA has been shown to inhibit the differentiation of osteoblasts and promote the apoptosis of osteoblasts, which results in altered bone turnover status. PFASs, known for their environmental persistence and ability to bioaccumulate in the human body, have been linked to an increased osteoporosis risk. Similarly, phthalates, which are widely used in the production of plastics, have been associated with adverse bone health outcomes, showing an inverse relationship between phthalate exposure and bone mineral density. Dioxins present a more complex picture, with research findings suggesting both potential benefits and adverse effects on bone structure and density, depending on factors such as the timing and level of exposure. This review underscores the urgent need for further research to better understand the specific pathways through which EDCs affect bone health and to develop targeted strategies for mitigating their potentially harmful impacts.

Treatment patterns and preferences for patients with Graves’ disease (GD) vary across countries. In this study, we assessed the initial therapies and subsequent treatment modalities employed for GD in real-world clinical practice in Korea. We analyzed 452,001 patients with GD from 2004 to 2020, obtained from the Korean National Health Insurance Service database. Initial treatments included antithyroid drug (ATD) therapy (98% of cases), thyroidectomy (1.3%), and radioactive iodine (RAI) therapy (0.7%). The rates of initial treatment failure were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Even among cases of ATD treatment failure or recurrence, the rates of RAI therapy remained low. Regarding initial treatment, the 5-year remission rate was 46.8% among patients administered ATDs versus 91.0% among recipients of RAI therapy; at 10 years, these rates were 59.2% and 94.0%, respectively. Our findings highlight a marked disparity in the use of RAI therapy in Korea compared to Western countries. Further research is required to understand the reasons for these differences in treatment patterns.

This review article investigates solid organ transplantation-induced osteoporosis, a critical yet often overlooked issue, emphasizing its significance in post-transplant care. The initial sections provide a comprehensive understanding of the prevalence and multifactorial pathogenesis of transplantation osteoporosis, including factors such as deteriorating post-transplantation health, hormonal changes, and the impact of immunosuppressive medications. Furthermore, the review is dedicated to organ-specific considerations in transplantation osteoporosis, with separate analyses for kidney, liver, heart, and lung transplantations. Each section elucidates the unique challenges and management strategies pertinent to transplantation osteoporosis in relation to each organ type, highlighting the necessity of an organ-specific approach to fully understand the diverse manifestations and implications of transplantation osteoporosis. This review underscores the importance of this topic in transplant medicine, aiming to enhance awareness and knowledge among clinicians and researchers. By comprehensively examining transplantation osteoporosis, this study contributes to the development of improved management and care strategies, ultimately leading to improved patient outcomes in this vulnerable group. This detailed review serves as an essential resource for those involved in the complex multidisciplinary care of transplant recipients.

Abstract Background Unhealthy body composition, including high fat mass, low muscle mass and low bone mass, is a critical health issue in adults. The weight‐adjusted waist index (WWI) estimates fat and muscle mass and may have implications for bone health. We examined its association with body composition outcomes in a large Korean adult cohort. Methods This study used data from the Korean National Health and Nutrition Examination Survey (2008–2011). WWI was calculated as waist circumference (cm) divided by the square root of body weight (kg). Dual‐energy X‐ray absorptiometry was used to measure bone mineral density (BMD), appendicular lean mass (ALM) and total body fat percentage. Unhealthy body composition was defined as combined presence of high fat mass, low bone mass and low muscle mass. Results A total of 5983 individuals (3034 men [50.7%] and 2949 women [49.3%]; mean age: 63.5 ± 8.7 years) were included. WWI was positively correlated with total body fat percentage (r = 0.478, P

Abstract Background Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH). Methods From the National Health Insurance Claim database in Korea (2003–2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer’s disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches. Results During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p

BackgroundChronic idiopathic hypophosphatemia (CIH) induced by X-linked hypophosphatemic rickets or tumor-induced osteomalacia is a rare inherited or acquired disorder. However, due to its rarity, little is known about the epidemiology and natural course of CIH. Therefore, we aimed to identify the prevalence and long-term health outcomes of CIH patients.MethodsUsing the Korean Health Insurance Review and Assessment claims database, we evaluated the incidence of hypophosphatemia initially diagnosed from 2003 to 2018. After excluding secondary conditions that could change serum phosphorus levels, we identified 154 patients (76 men and 78 women) with non-secondary and non-renal hypophosphatemia. These hypophosphatemic patients were compared at a ratio of 1:10 with age-, sex-, and index-year-matched controls (n = 1,540).ResultsIn the distribution of age at diagnosis, a large peak was observed in patients aged 1–4 years and small peaks were observed in ages from 40–70 years. The age-standardized incidence rate showed non-statistically significant trend from 0.24 per 1,000,000 persons in 2003 to 0.30 in 2018. Hypophosphatemic patients had a higher risk of any complication (adjusted hazard ratio [aHR], 2.17; 95% confidence interval [CI], 1.67–2.69) including cardiovascular outcomes, chronic kidney disease, hyperparathyroidism, osteoporotic fractures, periodontitis, and depression. Hypophosphatemic patients also had higher risks of mortality and hospitalization than the controls (aHR, 3.26; 95% CI, 1.83–5.81; and aHR, 2.49; 95% CI, 1.97–3.16, respectively).ConclusionThis first nationwide study of CIH in South Korea found a bimodal age distribution and no sex differences among patients. Hypophosphatemic patients had higher risks of complications, mortality, and hospitalization compared to age- and sex-matched controls.

BackgroundEffective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. ObjectiveThis study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). MethodsWe conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. ResultsThe trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and –521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (

The 3He gas is commonly used for the detection of thermal neutrons. However, with the depletion of 3He gas, there is a need to develop new solid scintillators for thermal neutron detection. Solid scintillators containing 6Li, which have large neutron capture cross-sections and a large amount of energy released by transmutation reactions, are commonly used as alternative candidates. However, only single-crystal scintillators are currently used, and their 6Li concentration is limited by their chemical composition. In this study, we designed, grew, and evaluated a new eutectic scintillator, Rb2CeCl5/LiCl, which can improve the 6Li concentration compared with single-crystal scintillators. Rb2CeCl5, which was selected as the scintillator phase, has excellent scintillator properties (light yield: 36,000 photons/MeV, decay time: mostly 24 ns, slightly 153 ns), and is less deliquescent than other halide scintillators. The crystal grown using the vertical Bridgman method exhibited a eutectic phase composed of Rb2CeCl5 and LiCl. The eutectic crystals exhibited Ce3+ 5d-4f emissions, with a peak between 360 and 370 nm. The Rb2CeCl5 phase was identified as the luminescent phase via cathodoluminescence mapping, and 16,000 photons/neutron of the light yield and 56.1 ns of the decay time were observed. This study indicates that the Rb2CeCl5/LiCl eutectic scintillator is a promising candidate for use in thermal neutron detectors.

Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.

Abstract The aim of this study was to evaluate the association between gamma-glutamyl transferase (GGT) levels and the risk of hip fracture among middle-aged women by using the Korean National Health Insurance Service claims database from 2002 to 2015. After exclusion of those with any chronic liver disease, heavy alcohol consumption, any missing values required for our analysis, or GGT levels less than 1 or greater than 99 percentile, we classified subjects into three groups according to baseline GGT levels. A total of 127,141 women aged 50 years or older were included for analysis (GGT range: 8–106 U/L). During an average 12.1 years of follow-up, 2758 patients sustained hip fractures (2.17%). Compared with the group in the lowest tertile, the group in the highest tertile had the highest cumulative incidence of hip fracture. One log-unit increase in GGT was associated with a 17% increased risk of hip fracture. Subgroup analysis by BMI (≥ 25 vs.

Lifestyle is a critical aspect of diabetes management. We aimed to define a healthy lifestyle using objectively measured parameters obtained from a wearable activity tracker (Fitbit) in patients with type 2 diabetes. This prospective observational study included 24 patients (mean age, 46.8 years) with type 2 diabetes. Expectation–maximization clustering analysis produced two groups: A (n=9) and B (n=15). Group A had a higher daily step count, lower resting heart rate, longer sleep duration, and lower mean time differences in going to sleep and waking up than group B. A Shapley additive explanation summary analysis indicated that sleep-related factors were key elements for clustering. The mean hemoglobin A1c level was 0.3 percentage points lower at the end of follow-up in group A than in group B. Factors related to regular sleep patterns could be possible determinants of lifestyle clustering in patients with type 2 diabetes.

Summary: Background: Moderate-intensity statin role with ezetimibe combination therapy following percutaneous coronary intervention (PCI) has not been thoroughly investigated, particularly compared to high-intensity statin monotherapy. We aimed to investigate the effect of ezetimibe combination with moderate-intensity statin in patients with atherosclerotic cardiovascular disease following PCI. Methods: This was a post-hoc analysis of a subset of patients who underwent PCI in the RACING trial. At 26 centres in South Korea, patients with atherosclerotic cardiovascular disease (ASCVD) were randomly assigned to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The prespecified endpoints of the RACING trial were used. The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, and nonfatal stroke. Event rates between the two groups were compared using log-rank tests, and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox regression analysis. Consistent with the RACING trial, the primary and secondary efficacy endpoints were evaluated using an intention-to-treatment approach, and the safety endpoints were assessed in the safety population. The RACING trial was registered at ClinicalTrials.gov (NCT03044665). Findings: Between Feb 14, 2017, and Dec 18, 2018, 3780 participants were enrolled in the RACING trial. Prior history of PCI was found in 2497 patients (67%, median 64 years, 79% male), and was associated with higher rates of the primary endpoint (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.06–1.69; p = 0.014). Among patients with prior PCI, moderate-intensity statin therapy with ezetimibe combination versus high-intensity statin therapy did not increase the risk of the primary endpoint (HR, 0.95; 95% CI, 0.74–1.24; p = 0.781). The proportion of patients with low-density lipoprotein cholesterol (LDL-C)

In this study, Eu:6LiBr/BaBr2 with a high Li concentration was developed as a novel neutron scintillator. Here, an Eu-doped BaBr2 phase acted as a scintillator and 6Li-containing LiBr phase acted as a neutron capturer. Eu:6LiBr/BaBr2 eutectics were fabricated via the vertical Bridgman technique in quartz ampoules. The scintillation performance of Ce:6LiBr/LaBr3 was measured using electron and neutron irradiation to evaluate its potential as a neutron scintillator. The grown Eu:6LiBr/BaBr2 eutectic exhibited a lamellar eutectic structure and optical transparency as well as a 410 nm emission due to the Eu2+ 5d–4f transition. The light yield under thermal neutron excitation was estimated to be 5600 photons/neutrons. The scintillation decay time was 550 ns.

In this study, Tl:CsI/CsCl/KCl ternary eutectic scintillators were grown using the vertical Bridgman–Stockbarger method by unidirectional solidification. The CsI and KCl phases were elongated along the growth direction, based on backscattered electron imaging (BEI) observations. The Tl:CsI scintillator phase grew as a matrix, which can be used to create optical waveguides for scintillation light. The expected Tl+ emission peak was observed at 550 nm under X-ray excitation. This emission was attributed to the self-trapped excitons perturbed by TI+ in Tl:CsI. The decay time of the Tl:CsI/CsCl/KCl eutectic was 285 ns, and its light output was estimated to be 10,800 photons/MeV.

Background To evaluate the association of time to reach the target glycosylated hemoglobin (HbA1c) level with long-term durable glycemic control and risk of diabetic complications in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods In a longitudinal observational cohort, 194 patients with T2DM newly diagnosed between January 2011 and March 2013 were followed up over 6 years. Patients were classified according to the time needed to reach the target HbA1c (

Pheochromocytoma and paraganglioma (PPGLs) are rare catecholamine-secreting neuroendocrine tumors but can be life-threatening. Although most PPGLs are benign, approximately 10% have metastatic potential. Approximately 40% cases are reported as harboring germline mutations. Therefore, timely and accurate diagnosis of PPGLs is crucial. For more than 130 years, clinical, molecular, biochemical, radiological, and pathological investigations have been rapidly advanced in the field of PPGLs. However, performing diagnostic studies to localize lesions and detect metastatic potential can be still challenging and complicated. Furthermore, great progress on genetics has shifted the paradigm of genetic testing of PPGLs. The Korean PPGL task force team consisting of the Korean Endocrine Society, the Korean Surgical Society, the Korean Society of Nuclear Medicine, the Korean Society of Pathologists, and the Korean Society of Laboratory Medicine has developed this position statement focusing on the comprehensive and updated diagnosis for PPGLs.

Background Pheochromocytoma and paragangliomas (PPGL) are hereditary in approximately 30% to 40% cases. With the advancement of genetic analysis techniques, including next-generation sequencing (NGS), there were attempts to classify PPGL into molecular clusters. With NGS being applied to clinical settings recently, we aimed to review the results of genetic analysis, including NGS, and investigate the association with clinical characteristics in Korean PPGL patients. Methods We reviewed the medical records of PPGL patients who visited Severance hospital from 2006 to 2019. We documented the clinical phenotype of those who underwent targeted NGS or had known germline mutations of related genes. Results Among 57 PPGL patients, we found 28 pathogenic germline mutations of susceptibility genes. Before the targeted NGS was implemented, only obvious syndromic feature lead to the Sanger sequencing for the specific genes. Therefore, for the exact prevalence, only patients after the year 2017, when targeted NGS was added, were included (n=43). The positive germline mutations were found in 14 patients; thus, the incidence rate is 32.6%. Patients with germline mutations had a higher likelihood of family history. There were significant differences in the type of PPGLs, percentage of family history, metastasis rate, presence of other tumors, and biochemical profile among three molecular clusters: pseudohypoxic tricarboxylic acid cycle-related, pseudohypoxic von Hippel-Lindau (VHL)/endothelial PAS domain-containing protein 1-related, and kinase-signaling group. Germline mutations were identified in seven PPGL-related genes (SDHB, RET, VHL, NF1, MAX, SDHA, and SDHD). Conclusion We report the expected prevalence of germline mutations in Korean PPGL patients. NGS is a useful and accessible tool for genetic analysis in patients with PPGLs, and further research on molecular classification is needed for precise management.

In this study, it was demonstrated that Zn3Ta2O8 crystals containing zinc oxide with high vapor pressure can grow in melt by the shielded arc melting method. The radiation response characteristics of the crystals were evaluated. The grown crystals showed an emission peak at 410 nm, ascribed to self-trapped excitation, Ta4+–O2−. The full width at half maximum of the X-ray rocking curve was 655 arcsec. The light output under 662 keV gamma-ray irradiation of Zn3Ta2O8 was approximately 4,700 photons/MeV. The decay time was 17.3 μs? Thus, the shielded arc melting method was shown to be a quick and economic growth technique for the survey of new scintillator materials containing high-vapor-pressure starting components.

Abstract Background In the age of aging, Korea’s current medical delivery system threatens to increase the number of medical and caring refugees. This study attempts to develop an integrated senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and inducing well-being, wellness, and well-dying. Methods To develop the integrated healthcare system, data collection and analyses were conducted through a systematic review, literature review, benchmarking, focus group interviews, and expert consultation. Results The senior-specific, citizen-oriented healthcare service system developed in this study is designed to screen patients aged 65 or older within 24 h of being admitted, using the Geriatric Screening for Care-10. If there is reason for concern as a result of the screening, further evaluation is performed through assessment. Doctors and nurses create a care plan and a discharge plan based on the results from the screening and assessment. The nurse further uses the screening to monitor the patient’s condition before discharge. Based on the screening results at the time of discharge, a transitional care plan is prepared and provided to elderly patients and/or their families. This process enables a systematic link between medical institutions and community resources, aiming for the continuous management of health issues. It also establishes a multidisciplinary treatment plan that considers patients and their families so that diseases common to the elderly are diagnosed and treated promptly. Conclusions The most important issue for the elderly is to be able to live healthily and independently for the rest of their lives through well-being, wellness, and well-dying. The senior-specific, citizen-oriented healthcare service proposed in this study is an integrated medical treatment system for elderly users the implementation of which requires the daily care, professional care, and rehabilitation of elderly members of society to be organically organized according to the role of the patients, their families, and the caregiver.

In recent years, thermal neutron detection using scintillators has been used in a wide range of fields. Thus, the development of scintillators with a higher light yield, faster decay, and higher sensitivity for thermal neutrons is required. In this study, K2CeCl5/6LiCl and CeCl3/SrCl2/6LiCl were developed as novel eutectic scintillators for thermal neutron detection. LiCl was selected as the neutron capture phase and K2CeCl5 and CeCl3 were used as the scintillator phases. The eutectics of K2CeCl5/6LiCl and CeCl3/SrCl2/6LiCl were prepared using the Vertical Bridgman method and the phases were identified by scanning electron microscopy and powder X-ray diffraction measurements. The results of radioluminescence measurements under Ag source X-ray tube irradiation confirmed that the 5d-4f emission derived from Ce3+. The cathodoluminescence spectra and thermal neutron responses of the prepared eutectics were measured to evaluate their optical properties.

To date, 3He gas has been commonly used to detect thermal neutrons because of their high chemical stability and low sensitivity to γ-rays, owing to their low density and large neutron capture cross-section. However, the depletion of 3He gas prompts the development of a new solid scintillator for thermal neutron detection to replace 3He gas detectors. Solid scintillators containing 6Li are commonly used to detect thermal neutrons. However, they are currently used in single crystals only, and their 6Li concentration is defined by their chemical composition. In this study, 6Li-containing eutectic scintillators were developed. CeCl3 was selected as the scintillator phase because of its low density (3.9 g/cm3); high light yield (30,000 photons/MeV); and fast decay time with four components of 4.4 ns (6.6%), 23.2 ns (69.6%), 70 ns (7.5%) and >10 μs (16.3%), owing to the Ce3+ 5d-4f emission peak at approximately 360 nm. Crystals of the CeCl3, LiCl and CaCl2 ternary eutectic were fabricated by the vertical Bridgman technique. The grown eutectic crystals exhibited Ce3+ 5d-4f emission with a peak at 360 nm. The light yield was 18,000 photons/neutron, and the decay time was 10.5 ns (27.7%) and 40.1 ns (72.3%). Therefore, this work demonstrates optimization by combining a scintillator phase and Li-rich matrix phase for high Li content, fast timing, high light yield and low density.

Abstract Background Hypothyroidism, one of the prevalent endocrine disorders worldwide, has a broad spectrum of clinical manifestations, from an asymptomatic condition to myxedema coma. Although the majority of patients with hypothyroidism have minor clinical symptoms, which are recovered with levothyroxine treatment, some patients occasionally do experience fatal complications. Here we report, for the first time, the case of a patient who had hypothyroidism with simultaneous occurrence of rhabdomyolysis with acute kidney injury, moderate pericardial effusion, and sudden sensorineural hearing loss. Case presentation A 57-year-old man with a previous history of dyslipidemia and untreated hypothyroidism was admitted to the hospital due to shortness of breath, lethargy, lower extremity discomfort, and unilateral hearing loss. Laboratory results revealed rhabdomyolysis with acute kidney injury and severe hypothyroidism. We detected cardiomegaly without lung parenchymal infiltration on chest radiography and moderate pericardial effusion on transthoracic echocardiography. We performed pure tone audiometry and identified profound unilateral sensorineural hearing loss. Aggressive fluid resuscitation, levothyroxine treatment, and systemic and intratympanic steroid therapy alleviated the patient’s severe hypothyroidism, rhabdomyolysis, and pericardial effusion; however, sensorineural hearing loss was not fully recovered. Conclusions Early recognition of life-threatening complications is important in patients with severe hypothyroidism to prevent adverse outcomes. This case suggests that hypothyroidism should be considered in patients who have rhabdomyolysis with acute kidney disease and pericardial effusion. Moreover, sudden sensorineural hearing loss should be kept in mind as a rare complication of hypothyroidism.

Abstract Background To determine the impact of dipeptidyl peptidase-4 inhibitor (DPP4i) on the risk of major cardiocerebrovascular and renal outcomes compared with sulfonylurea (SU) combined with metformin in patients with type 2 diabetes from a population-based cohort. Methods From a nationwide cohort in Korea (2008–2013), 23,674 patients with type 2 diabetes treated with DPP4i plus metformin or SU plus metformin were selected and matched by propensity score. Composite cardiocerebrovascular events including incident ischemic heart disease (IHD), ischemic stroke (IS), hospitalization for heart failure (HHF), and cardiocerebrovascular death, as well as renal events including incident end-stage renal disease or initiation of renal-replacement therapy were assessed by Cox proportional-hazards models. Results During a median follow-up of 19.6 months (interquartile range 7.2–36.4), 762 composite cardiocerebrovascular events and 17 end-stage renal events occurred. There was no significant difference in the risk of IHD (hazard ratio [HR], 1.00; 95% CI 0.81–1.23), IS (HR, 0.95; 95% CI 0.74–1.23), or cardiocerebrovascular death (HR, 0.74; 95% CI 0.46–1.18) in the DPP4i group compared to that in the SU group. Likewise, DPP4i therapy was not associated with the risk of end-stage renal outcomes (HR, 1.23; 95% CI 0.41–3.62). However, the risk of HHF was significantly higher in the DPP4i group than in the SU group (HR, 1.47; 95% CI 1.07–2.04). Conclusions This real-world database analysis showed that DPP4i therapy did not increase the overall risk of major cardiovascular and renal outcomes compared to SU therapy. However, the DPP4i-associated risk of HHF remained significant.

The bacteriophage P2 capsids have been characterized by transmission electron microscopy and atomic force microscopy (AFM). Studies have been carried out on fully filled and 2/3 filled capsids containing dsDNA genomes. In order to get the quantitative information of the capsid, a nanoindentation technique depending on the tip-shape and an effective spring constant technique with a homogeneous capsid shell model were adopted. The contact region of the AFM contact force curve in an approach mode has been used for the calculation of Young’s moduli as well as the internal pressures of the capsids. By using the continuum theory of elasticity of thin homogeneous capsid shells, Young’s moduli of fully filled and 2/3 filled phage capsids are measured to be 1.17 ± 0.10 GPa and 0.87 ± 0.10 GPa, respectively. These values are close to other reported results. Analysis of the force curves also presented that a fully filled capsid reveals a higher internal pressure than that of a 2/3 filled capsid.

Objective To investigate the prevalence of osteoporosis among North Korean women refugees when compared with South Korean women, who have identical genetic backgrounds but experience different environments.Design Comparative cross-sectional study.Setting North Korean Refugee Health in South Korea (NORNS) study in South Korea.Participants We evaluated 122 North Korean women who participated in NORNS study and 366 age-matched/menopausal status-matched South Korean women from the Korea University Medical Center (KUMC) health examination cohort. The median age of the NORNS participants was 46 years (IQR, 40–60 years) with 52 women (42.6%) being postmenopausal.Results Among the postmenopausal women, NORNS participants had a higher body mass index and number of pregnancies and lower physical activity than the KUMC participants. The overall prevalence of osteoporosis was 48% (25/52) and 17% (27/156) in NORNS and KUMC participants, respectively. The bone mineral density (BMD) values at the lumbar spine, femur neck and total hip were significantly lower in postmenopausal NORNS women than in the postmenopausal KUMC women. Old age, low body weight and late age of menarche were associated with low BMD among the postmenopausal North Korean refugees. In premenopausal participants, the NORNS women had lower body weight and physical activity than the KUMC women at baseline. All the NORNS women had normal Z-scores, although the BMD at the lumbar spine was significantly lower in NORNS women than in the KUMC women (0.952 vs 1.002 g/cm2, p

Background: The identification of frailty is considered an effective means of enhancing healthy aging. The definition of frailty affects its prevalence and associated institutionalization and mortality. This study aimed to identify the prevalence of frailty among community-dwelling older Korean adults according to different frailty scales. Methods: This cross-sectional study based on the Korean Frailty and Aging Cohort Study represents a population of 1,318 people aged 70 years and older. Discrepancies in the prevalence of frailty were evaluated among six validated assessment tools. Multivariate logistic regression analysis was used to evaluate the prevalence of frailty according to its predictors (age, sex, and socioeconomic status). Results: The mean age of the participants was 76.1 (standard deviation, 3.9) years, and females comprised 51.0%. The prevalence of frailty varied from 2.5% to 12.4% using the Study of Osteoporotic Fracture frailty index and the Korean version of the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale, respectively. The prevalence of frailty was higher among women and frailty rates increased with age on all scales. The risks of prefrailty and frailty were increased among participants with a low education level after adjusting for age, sex, residence, and income level. Conclusion: In this study, the prevalence of frailty was found to vary depending on the scale used. Efforts aimed at screening and providing intervention for frailty and frail adults at risk, respectively, are needed to improve health outcomes considering the characteristics of each frailty scale and the determined prevalence.

Abstract Background Elderly people often have more complicated healthcare needs than younger adults due to additional functional decline, physical illness, and psychosocial needs. Unmet healthcare needs increase illness severity, complications, and mortality. Despite this, research on the unmet healthcare needs of elderly people is limited in Korea. This study analysed the effect of functional deterioration related to aging on unmet healthcare needs based on the Korea Health Panel Study. Methods This cross-sectional study used data from the 2011–2013 survey of 8666 baseline participants aged 65 years and older. Unmet healthcare needs were calculated using a complex weighted sample design. Group differences in categorical variables were analysed using the Rao-Scott Chi-square test. Using logistic regression analysis, the association between unmet healthcare needs and aging factors was analysed. Results The prevalence of unmet healthcare needs in Korean elderly was 17.4%. Among them, the leading reason was economic hardship (9.2%). Adjusting for sex, age, socioeconomic characteristics, and health-related characteristics, the group with depression syndrome was 1.45 times more likely to have unmet healthcare needs than that without depression syndrome (95% CI = 1.13–1.88). The group with visual impairment was 1.48 times more likely to have unmet healthcare needs than that without it (95% CI = 1.22–1.79). The group with hearing impairment was 1.40 times more likely to have unmet healthcare needs than that without it (95% CI = 1.15–1.72). The group with memory impairment was 1.74 times more likely to have unmet healthcare needs than that without it (95% CI = 1.28–2.36). Conclusions The unmet medical needs of the elderly are more diverse than those of younger adults. This is because not only socioeconomic and health-related factors but also aging factors that are important to the health of the elderly are included. All factors were linked organically; therefore, integrated care is needed to improve healthcare among the elderly. To resolve these unmet healthcare needs, it is necessary to reorganize the healthcare system in Korea to include preventive and rehabilitative services that address chronic diseases in an aged society and promote life-long health promotion.

BackgroundLong-term durable glycemic control is a difficult goal in the management of type 2 diabetes mellitus (T2DM). We evaluated the factors associated with durable glycemic control in a real clinical setting.MethodsWe retrospectively reviewed the medical records of 194 new-onset, drug-naïve patients with T2DM who were diagnosed between January 2011 and March 2013, and were followed up for >2 years. Glycemic durability was defined as the maintenance of optimal glycemic control (glycosylated hemoglobin [HbA1c]

A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.

Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.

A novel single-crystal growth method was developed, using arc plasma and metal melt, for a quick survey of high melting point materials. Single crystals of Yb-doped Lu2O3, Lu0.388Hf0.612O1.806, and Lu0.18Hf0.82O1.91, with melting points of 2460, 2900, and 2840 °C, respectively, were grown by an indirect heating method using arc plasma. We refer to this indirect heating growth method as the core heating (CH) method. The CH-grown Yb1%-doped Lu2O3 sample showed a full width at half maximum of 286 arcsec in the X-ray rocking curve. This value is better than the 393 arcsec obtained for the crystal grown by the micro-pulling-down (μ-PD) method. The Yb charge transfer state (CTS) emission was observed at 350 nm in the Yb1%-doped Lu2O3 and Lu0.18Hf0.82O1.91. In the case of the μ-PD method, using a rhenium (Re) crucible, absorption due to Re contamination and a resulting reduction in the Yb CTS emission were confirmed. However, contamination did not influence the properties observed in the crystals grown by the CH method.

Ce-doped LaBr3/AEBr2 (AE = Mg, Ca, Sr, Ba) eutectics were grown using the Bridgman–Stockbarger (BS) method in quartz ampoules. The eutectics (AE = Mg and Ca) showed optical transparency like optical fiber bundles. A grown Ce-doped LaBr3/MgBr2 eutectic shows a 355 nm emission ascribed to Ce3+ 4f-5d transition under X-ray excitation. The smaller the ionic size of AE, the higher the light yield of the sample was. The light yield of Ce:LaBr3/MgBr2 was 34,300 photon/MeV, which is higher than Ce:LYSO standard. Scintillation decay time under 662 keV gamma-ray excitation was 18.8 ns.

Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH. The petrosal to peripheral ACTH gradient resulted in no evidence of pituitary adenoma. As the only lesion suspicious for ectopic ACTH secretion was a right lower round cystic lesion that did not appear to be a carcinoid tumor on computed tomography scan of the chest, the patient underwent video-assisted thoracic surgical resection to provide a definitive diagnosis. The final diagnosis was a small ectopic ACTH-secreting carcinoid tumor with unusual superimposed aspergilloma in the periphery of the lung. Postoperatively, the abnormal endocrine levels were normalized, and all of the clinical symptoms and signs were ameliorated. This is an informative case of ectopic ACTH syndrome (EAS) that was the cause of hypokalemia, hypertension, metabolic alkalosis, and hypercortisolism despite its poorly specific cushingoid morphology and uncommon imaging findings. Therefore, we recommend that clinicians investigate any possible lesion as a potential source of EAS.

Context: Although physical activity (PA) is recognized to reduce fracture risk, whether its benefits differ according to glycemic status remains unknown. Objective: We investigated the effect of PA on incident hip fracture (HF) according to glycemic status. Methods: We studied 3 723 097 patients older than 50 without type 1 diabetes mellitus (DM) or past fractures. HF risks were calculated using Cox proportional hazard regression. Participants were categorized by glycemic status into 5 groups: normal glucose tolerance, impaired fasting glucose, new-onset type 2 DM, type 2 DM less than 5 years, and type 2 DM of 5 years or greater. PA was evaluated using the Korean adaptation of the International Physical Activity Questionnaire Short Form. Results: The highest HF risk were associated with the lowest PA level (<500 metabolic equivalent task [MET]-min/wk). While similar risks emerged across MET 500 to 1000, 1000 to 1500, and greater than 1500 categories, the relationship showed variations in different glycemic status groups. Exceptions were particularly noted in women with normoglycemia. However, a consistent inverse pattern, with few exceptions, was observed both in men and women with type 2 DM of 5 years or greater. Furthermore, the benefit of PA in the prevention of HFs was most evident in participants with type 2 DM of 5 years or greater. Compared to the reference group (lowest physical activity level <500 MET-min/wk within type 2 DM ≥5 years), the adjusted hazard ratios were 0.74 (0.62-0.88) in men and 0.74 (0.62-0.89) in women, suggesting a significant reduction in risk. Conclusion: Higher PA levels are associated with a lower risk of HF. This protective effect of PA on fracture risk is greatest in patients with DM, particularly in those with DM of 5 years or greater. [ABSTRACT FROM AUTHOR]

The South Korea Plateau (SKP), a typical submarine plateau, preserves an important tectono-sedimentary evolutionary record and represents a major frontier area for petroleum exploration in the East Sea (Sea of Japan). However, its tectonic mechanisms and their controls on sedimentary fill are underexplored. Here, we present the first integrated tectonostratigraphic framework of the SKP using reprocessed, two-dimensional, seismic-reflection profiles and borehole data. Four regional megasequence boundaries are interpreted, delineating four tectonostratigraphic packages: the syn-rift (MS1), post-rift phase 1 (MS2), post-rift phase 2 (MS3) and syn-compression (MS4) megasequences. We propose a four-stage structural and sedimentary evolution model for the SKP based on the megasequences and structural development. Stage-1 (latest Late Oligocene-Early Miocene): the SKP was rifted and extended through block faulting, resulting in the formation of rift basins dominated by fan-delta and shallow-lacustrine depositional systems. Stage-2 (late Early Miocene-Middle Miocene): hemipelagic sedimentation prevailed with gravity-controlled slope failures under a tectonically stable environment associated with slow thermal subsidence. Stage-3 (late Middle Miocene-Late Miocene): continued thermal subsidence allowed the predominance of hemipelagic biogenic deposits accompanied by intermittent mass-wasting-induced turbidites and resulted in the development of a polygonal fault system. Stage-4 (Early Pliocene-present): the SKP was influenced by E-W compression caused by an eastward movement of the Eurasian plate. Turbiditic and hemipelagic sedimentation was predominant with turbidity-flow-leveed channels derived from direct riverine input or through slope failures. Based on this tectonostratigraphic analysis, we reveal the variation in depositional systems and sand-dispersal patterns for the SKP, highlighting potential targets for sandstone reservoirs: MS1, fan-deltas and lacustrine-fan turbidites; MS3, deepwater fan turbidites; and MS4, deepwater fan turbidites, channel-levee complexes and turbidite frontal-splay deposits. This study proposes a structural and sedimentary evolution model for the SKP that could enhance our understanding of reservoir potential for petroleum-exploration in the future. [ABSTRACT FROM AUTHOR]