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Determine whether the twice daily (BID) regimen is superior to the once daily (QD) regimen for managing glycemic variability by comparing the effects of anagliptin 100 mg BID versus sitagliptin 100 mg QD.A double-blinded, randomized, multicenter study was performed in 89 patients with type 2 diabetes treated with metformin alone (6.5%HbA1c 8.5%). Subjects were randomly assigned to anagliptin 100 mg BID or sitagliptin 100 mg QD in a 1:1 ratio for 12 weeks. Continuous glucose monitoring (CGM) was used to measure the mean amplitude of glycemic excursion (MAGE) and postprandial time in range (TIR) before and after DPP-4 inhibitor treatment to compare glycemic variability.The decrease from baseline in MAGE at 12 weeks after DPP-4 inhibitor treatment was significantly greater in the anagliptin BID group than in the sitagliptin QD group (p0.05); -30.4 ± 25.6 mg/dL (p0.001) in the anagliptin group versus -9.5 ± 38.0 mg/dL (p=0.215) in the sitagliptin group. The TIR after dinner increased by 33.0 ± 22.0% (p0.001) in the anagliptin group and by 14.6 ± 28.2% (p=0.014) in the sitagliptin group, with a statistically significant difference (p=0.009). No statistically significant differences were observed between the groups in the changes in HbA1c and fasting plasma glucose (FPG).The anagliptin BID regimen for the treatment of type 2 diabetes was superior in blood glucose control after dinner to improve glycemic variability, as indicated by MAGE and TIR but equivalent to the QD regimen in terms of HbA1c and FPG. This article is protected by copyright. All rights reserved.

To compare the efficacy and safety of adding low-dose lobeglitazone (0.25 mg/day) or standard-dose lobeglitazone (0.5 mg/day) to patients with type 2 diabetes mellitus (T2DM) with inadequate glucose control on metformin and dipeptidyl peptidase (DPP4) inhibitor therapy.In this phase 4, multicentre, double-blind, randomized controlled, non-inferiority trial, patients with T2DM insufficiently controlled by metformin and DPP4 inhibitor combination therapy were randomized to receive either low-dose or standard-dose lobeglitazone. The primary endpoint was non-inferiority of low-dose lobeglitazone in terms of glycaemic control, expressed as the difference in mean glycated haemoglobin levels at week 24 relative to baseline values and compared with standard-dose lobeglitazone, using 0.5% non-inferiority margin.At week 24, the mean glycated haemoglobin levels were 6.87 ± 0.54% and 6.68 ± 0.46% in low-dose and standard-dose lobeglitazone groups, respectively (p = .031). The between-group difference was 0.18% (95% confidence interval 0.017-0.345), showing non-inferiority of the low-dose lobeglitazone. Mean body weight changes were significantly greater in the standard-dose group (1.36 ± 2.23 kg) than in the low-dose group (0.50 ± 1.85 kg) at week 24. The changes in HOMA-IR, lipid profile and liver enzyme levels showed no significant difference between the groups. Overall treatment-emergent adverse events (including weight gain, oedema and hypoglycaemia) occurred more frequently in the standard-dose group.Adding low-dose lobeglitazone to metformin and DPP4 inhibitor combination resulted in a non-inferior glucose-lowering outcome and fewer adverse events compared with standard-dose lobeglitazone. Therefore, low-dose lobeglitazone might be one option for individualized strategy in patients with T2DM.

Aim To investigate the efficacy and safety of evogliptin compared with linagliptin in patients with type 2 diabetes. Materials and Methods In this 12‐week, multicentre, randomized, double‐blind, active‐controlled, and 12‐week open‐label extension study, a total of 207 patients with type 2 diabetes who had HbA1c levels of 7.0%‐10.0% were randomized 1:1 to receive evogliptin 5 mg (n = 102) or linagliptin 5 mg (n = 105) daily for 12 weeks. The primary efficacy endpoint was the change from baseline HbA1c at week 12. The secondary endpoint was the change in the mean amplitude of glycaemic excursion (MAGE) assessed by continuous glucose monitoring. In the extension study conducted during the following 12 weeks, evogliptin 5 mg daily was administered to both groups: evogliptin/evogliptin group (n = 95) and linagliptin/evogliptin group (n = 92). Results After 12 weeks of treatment, the mean change in HbA1c in the evogliptin group and in the linagliptin group was −0.85% and −0.75%, respectively. The between‐group difference was −0.10% (95% CI: −0.32 to 0.11), showing non‐inferiority based on a non‐inferiority margin of 0.4%. The change in MAGE was −24.6 mg/dL in the evogliptin group and −16.7 mg/dL in the linagliptin group. These values were significantly lower than the baseline values in both groups. However, they did not differ significantly between the two groups. In the evogliptin/evogliptin group at week 24, HbA1c decreased by −0.94%, with HbA1c values of

Background and Aims: Evogliptin is a new dipeptidyl peptidase-4 (DPP-4) inhibitor. We investigated the efficacy and safety of Evogliptin compared with linagliptin in patients with type 2 diabetes (T2D). Materials and Methods: A total of 207 untreated patients with T2D (mean age, 56.1±10.4 years; body mass index, 26.1±3.4 kg/m2) who had HbA1c 7.0-10.0%, prior to the screening were randomized 1:1 for 5 mg Evogliptin (n=102) or 5 mg linagliptin (n=105) once daily for 12 weeks. The primary efficacy endpoint was the change from baseline HbA1c at week 12. The secondary endpoint included the change in mean amplitude of glycemic excursion (MAGE) assessed by 72-hour continuous glucose monitoring. In the extended study for another 12 weeks, open-label treatment with Evogliptin 5 mg qd was conducted in both groups; Evogliptin/Evogliptin group (n=95) and Linagliptin/Evogliptin group (n=92). Results: After 12 weeks of treatment, the mean changes in HbA1c of Evogliptin group and linagliptin group were −0.85% and −0.75%, respectively; the between-group difference was -0.10% (95% confidence interval, −0.32-0.11%), demonstrating non-inferiority, meeting the pre-specified margin of 0.40%. The changes in MAGE were −24.6 mg/dL in the Evogliptin group and −16.7 mg/dL in the linagliptin group, which were significantly lower compared with baseline values in both groups. In the Evogliptin/Evogliptin group at week 24, the mean changes from baseline in HbA1c was −0.94%, achieving HbA1c Conclusion: In this study, once-daily evoglipitin 5 mg treatment significantly decreased HbA1c levels by 0.94% at week 24 and improved glycemic variability without any serious adverse events in Korean patients with T2D (ClinicalTrials.gov Identifier: NCT02974504). Disclosure S. Lim: None. G. Kim: None. H. Kwon: None. I. Park: None. K. Ahn: None. C. Park: None. S. Kwon: None. H. Kim: None. S. Park: None. S. Kim: None. M. Moon: None. E. Kim: None. C.H. Chung: None. K. Won: None. K. Park: None. M. Kim: None. D. Chung: None. C. Lee: None. T. Kim: None. M. Lee: None.

The aim of this study was to evaluate the differences in mortality among colon cancer patients with or without diabetes and to determine optimal glycemic target level for colon cancer patients with diabetes.A total of 741 patients with colon cancer between April 1999 and December 2010 were reviewed. The non-diabetes group had a fasting plasma glucose126mg/dL, and the diabetes group had a fasting plasma glucose ⩾126mg/dL. Patients with diabetes were further divided based on glycemic control into either the uncontrolled subgroup (HbA1c ⩾8%) or the well-controlled subgroup (HbA1c8%).Patients with diabetes had significantly shorter overall survival and median survival than non-diabetes patients. Uncontrolled diabetes patients had significantly shorter overall survival and median survival than well-controlled diabetes patients. The relative risk of mortality for diabetes patients was higher than non-diabetes patients (relative risk 1.17). The relative risk of mortality in uncontrolled diabetes patients was significantly higher than in well-controlled diabetes patients (relative risk 4.58). The area under the curve for mortality and HbA1c level was 0.73. The cut off HbA1c level was 7.75%.A optimal glycemic control level for colon cancer patients with diabetes should be recommended as an HbA1c of 7.8% or below.

Ultrasonographic microcalcification is highly related to papillary thyroid cancer (PTC) and pathologic psammoma body is a poor prognostic factor. However, it is little known about whether the microcalcifications seen on ultrasonography are consistent with the pathologic psammoma bodies. We evaluated the relationship between ultrasonographic (US) calcification types and pathologic calcification features, and the consistency between observed pathologic and US calcifications. US calcifications were classified into microcalcification (MC) and nonmicrocalcification (non-MC) types, and pathologic calcifications were classified into 3 types: psammoma bodies, stromal calcifications, and ossifications. Among the 411 nodules that were reviewed by a pathologist, 38.9% (n = 160) had any type of US calcification. The larger the size of pathologic calcification, the more calcification was present in US (psammoma 46.1%

Summary Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF). A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED). She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT) with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment. Learning points: The presenting manifestations of thyroid storm vary and can include cardiac arrest with multiorgan failure in rare cases. In some patients with thyroid storm, especially those with severe complications, conventional medical treatment may be ineffective or inappropriate. During thyroid storm, the initiation of CRRT can immediately lower body temperature and subsequently stabilize vital signs. Early initiation of CRRT can be life-saving in patients with thyroid storm complicated by MOF, even when used in combination with suboptimal medical treatment.

Background Incretin-based therapies are rapidly becoming one of the main glycemic control strategies in diabetes. Considering the large numbers of papillary thyroid carcinomas (PTCs) and possible effects of glucagon-like peptide-1 (GLP-1) on cell proliferation, the expression of GLP-1 receptor (GLP-1R) in PTC is likely to have clinical significance. We performed this study to evaluate the expression of GLP-1R in PTC and the clinical meaning of GLP-1R expression in PTC. Methods Fifty-six cases of PTC, four cases of medullary thyroid cancer (MTC), seven cases of nodular hyperplasia and 56 normal thyroid tissue samples were selected for immunostaining for GLP-1R. Clinical parameters were obtained by retrospective review of medical records. Results Immunohistochemical staining for GLP-1R showed immunoreactivity in 18 of 56 cases of PTC (32.1%). All four cases of MTC exhibited cytoplasmic GLP-1R expression. Nodular hyperplasia exhibited immunoreactivity in two of seven cases (28.6%). All normal thyroid follicular cells showed negative immunoreactivity. In univariable and multivariable analyses, tumor multifocality was negatively correlated with GLP-1R expression. Extrathyroidal extension showed positive association with GLP-1R expression that was almost significant. Sex, age, tumor size, and lymph node metastasis were not significantly associated with GLP-1R expression. Conclusion Some parts of PTC tissues express GLP-1R, and GLP-1R expression in PTC was negatively correlated with tumor multifocality. The long-term influence of pharmacologically increased GLP-1 on thyroid follicular cells and development and progression of tumors originating from thyroid follicular cells should be investigated.

Objective To identify the most important factor in predicting ovarian reserve after laparoscopic ovarian cystectomy and to evaluate whether there is any difference in the postoperative decline of ovarian reserve between women with endometrioma and those with other benign ovarian cysts. Design Prospective cohort study. Setting University hospital. Patient(s) A total of 100 women who had undergone laparoscopic ovarian cystectomy for endometrioma (n = 68) or other benign ovarian cysts (n = 32). Intervention(s) Serum antimullerian hormone (AMH) levels measured by enzyme immunoassay preoperatively and at 3 months after surgery. Main Outcome Measure(s) Rate of AMH decline after surgery and follicle numbers retained in cystectomy specimens. Result(s) Serum AMH levels were obviously decreased at 3 months after the surgery (4.97 ± 2.83 vs. 3.33 ± 2.08 ng/mL, mean ± standard deviation). Adjusting for several parameters, we could see that bilaterality of the ovarian cyst was the only significant factor in predicting the rate of postoperative decline of AMH levels. The rate of AMH decline did not differ between the endometrioma group and the other benign ovarian cyst group. Conclusion(s) Bilaterality of the ovarian cyst is the only significant factor in predicting the rate of decline of AMH level after laparoscopic ovarian cystectomy. The rate of decline of AMH levels after surgery was similar between the endometrioma group and the other benign ovarian cyst group.

The diagnostic criteria (KCDC Criteria) to define obesity and overweight of Korean children and adolescents were newly presented in the 2007 Korean National Growth Charts. The KCDC Criteria were criticized for several problems caused by upward shift of body mass index (BMI) percentile curves of the growth charts. This study was conducted to establish new diagnostic criteria (New Criteria) for obesity and overweight in Korean children and adolescents that would be less affected by a change of BMI distribution in the reference population of the Growth Charts. The BMI values for ages 2-18 years corresponding to Asia-Pacific adult BMI cutoffs of obesity (25.0 kg/m(2)) and overweight (23.0 kg/m(2)) were calculated with L, M and S values presented in the 2007 Korean National Growth Charts. Additionally, we examined the frequencies of obesity and overweight among children and adolescents who participated in the 2005 National Growth Survey based on both New Criteria and KCDC Criteria. The Z-scores corresponding to BMIs of 25 and 23 kg/m(2) at 18-years-of-age were 0.99 and 0.41 in boys, and 1.34 and 0.71 in girls, respectively. The BMI values corresponding to these Z-scores from age 2 to 18 years were determined as new BMI cutoffs for obesity and overweight. The frequencies of obesity and overweight estimated by New Criteria were greater by 2 times in boys and 1.5 times in girls than those by KCDC Criteria. We suggest that New Criteria could be a good alternative that can resolve problems caused by upward shift of BMI percentile curves of the 2007 Korean National Growth Charts.

This study was performed to investigate the adverse effects of bisphenol A diglycidyl ether (BADGE) on rat epididymis. BADGE was administered orally to pregnant 8-week-old specific-pathogen-free (SPF) Sprague-Dawley female rats from gestational day 6 to lactation once daily at doses of 0 (control), 50, 200, or 400 mg kg−1 day−1. Five male pups in control and three treatment groups were culled and sacrificed by ether on postnatal days (PND) 21, 42, or 56. Body and epididymis changes in weight and developmental characteristics of each male pup were recorded. The pattern of expression of clusterin mRNA in the cauda epididymis was observed using real-time PCR. The level of expression of clusterin proteins was confirmed using Western blot analysis. Body weight of the treated group did not differ markedly from the control. The adjusted anogenital distance (AGD) (in mm kg−(1/3)) on PND 7 in the 50 mg kg−1 day−1 group was significantly shorter than control; however, on PND 14 in the 200 mg kg−1 day−1 group and on...

Thank you for your interest and comments on our article entitled "Expression of glucagon-like peptide-1 receptor in papillary thyroid carcinoma and its clinicopathologic significance," which was published in Endocrinology and Metabolism [1]. We reported the expression of the glucagon-like peptide-1 receptor (GLP-1R) in papillary thyroid carcinoma (PTC) tissues based on immunohistochemical (IHC) staining. However, we could not find a meaningful relationship between clinical prognostic markers and GLP-1R expression in PTC, but the less multifocality of GLP-1R expression in PTC tissues. These findings were unexpected and interesting because previous studies reported that GLP-1R is not expressed in thyroid follicular cells and GLP-1 plays a possible role in cell proliferation and apoptosis in pancreatic β-cells. IHC staining is well-established and used widely for identifying specific pathological processes, including protein expression nevertheless, the pathologist's interpretation is subjective. To convert the subjective perception of IHC marker expression into quantitative data, various semiquantitative scoring systems have been suggested. For example, in breast cancer, representative tumors were subjected to several IHC stains, including estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67. Pathologists use the quickscore, modified H-score, immunoreactive score and Allred score [2,3] as generally accepted standard interpretation guidelines for IHC staining of ER and PR. In Allred score, pathologists score the proportions of ER-positive immunoreactive cells into six categories (0, no cells are ER-positive; 1, ≤1%; 2, 1% to 10%; 3, 11% to 33%; 4, 34% to 66%; and 5, 67% to 100% are ER-positive) and intensity into four categories (0, negative; 1, weak; 2, intermediate; and 3, strong). The final score is the sum of these two scores, where the minimal standard hormone receptor-positive score is 3 and the mandatory minimum of tumor cells is 1% regardless of intensity. A similar approach was demonstrated in "quickscore," modified H-score system, with the differences in values in proportion category A from 1 to 6 (1, 0% to 4%; 2, 5% to 9%; 3, 20% to 39%; 4, 40% to 59%; 5, 60% to 79%; and 6, 80% to 100%) and using multiplication for final scoring [2]. However, the generally accepted interpretation guideline for IHC staining of HER2 is different. Pathologists evaluate the immunoreactive pattern (complete vs. incomplete circumferential membrane staining), intensity (none, weak, moderate, and intense), and proportion of immunoreactive cells (≤10%, >10%). The final interpretation is based on the combination of these three results [4]. In the general guideline for interpreting the IHC staining for Ki67, pathologists evaluate only the proportion of immunoreactive cells (low, Ki67 index

BACKGROUND Many epidemiologic studies have shown that women with type 2 diabetes have an increased risk of developing cardiovascular disease compared with men with diabetes. The aim of this study is to elucidate whether disparities of adiposity, age and insulin resistance (IR) at the time of diabetes diagnosis exist between women and men in the adult Korean population. METHODS Data from The Korea National Health and Nutrition Examination Survey, performed in Korea from 2007 to 2010, were used. In the survey, anthropometric data and blood samples were obtained during a fasting state. IR and β-cell function were calculated using the homeostasis model assessment (HOMA-IR and HOMA-β, respectvely). RESULTS The mean age of diabetes diagnosis was 58.5 years in women and was 55.1 years in men (P=0.015). The mean body mass index (BMI) of newly diagnosed diabetes subjects was 26.1 kg/m(2) in women and 25.0 kg/m(2) in men (P=0.001). The BMI was inversely related to age in both genders, and the higher BMI in women than men was consistent throughout all age groups divided by decade. The HOMA-IR in women with diabetes is higher than in men with diabetes (7.25±0.77 vs. 5.20±0.32; P=0.012). CONCLUSION Korean adult women are diagnosed with type 2 diabetes at higher BMI and older age than men and are more insulin-resistant at the time of diabetes diagnosis. This may help explain why women with diabetes have an increased risk of developing cardiovascular disease after the diagnosis of diabetes, compared to men.

Ho Yeon Chung,1 Jawon Koo,1 Su Kyoung Kwon,2 Moo-IL Kang,3 Seong-Hwan Moon,4 Jin-Young Park,5 Chan Soo Shin,6 Byung-Koo Yoon,7 Hyun-Koo Yoon,8 Jae-Suk Chang,9 Yoon-Sok Chung,10 Hyoung-Moo Park111Department of Internal Medicine, Kyung Hee University, 2Department of Statistics, 3Department of Internal Medicine, Catholic University of Korea, 4Department of Orthopedics, Yonsei University, 5Department of Orthopedics, Konkuk University, 6Department of Internal Medicine, Seoul National University, 7Department of Obstetrics and Gynecology, Sungkyunkwan University, 8Department of Internal Medicine, Kwandong University, 9Department of Orthopedics, University of Ulsan, Seoul, South Korea; 10Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea; 11Department of Obstetrics and Gynecology, Chung-Ang University, Seoul, South KoreaPurpose: This study investigated the efficacy and safety of monthly risedronate, with and without cholecalciferol, on 25-hydroxyvitamin D (25[OH]D) levels and bone markers in Korean patients with osteoporosis.Methods: A randomized, double-blinded, prospective, 16-week clinical trial was conducted in ten hospitals. A total of 150 subjects with osteoporosis were randomized to one of the two treatment groups: RSDM+ (monthly risedronate 150 mg and cholecalciferol 30,000 IU combined in a single pill, n = 74) or RSDM (monthly risedronate 150 mg alone, n = 76). We measured serum levels of 25-hydroxyvitamin D (25[OH]D), parathyroid hormone (PTH), and bone markers, as well as performing muscle-function tests at baseline and after 16 weeks of treatment.Results: After 16 weeks, serum 25(OH)D levels significantly increased from 17.8 to 26.8 ng/mL in the RSDM+ group, but did not change in the RSDM group. The RSDM+ group exhibited significantly decreased serum PTH from 46 to 36.7 pg/mL, while the RSDM group showed a tendency for PTH to increase from 38 to 40.6 pg/mL. In both groups, serum bone-specific alkaline phosphatase and C-terminal telopeptide rapidly declined, with significance at 16 weeks; there were no significant differences between the groups.Conclusion: A once-monthly pill of risedronate and cholecalciferol provided equivalent antiresorptive efficacy to risedronate alone in terms of bone turnover and improved 25(OH)D levels over the 16-week treatment period without significant adverse events in Korean patients with osteoporosis. Keywords: bisphosphonate, cholecalciferol, bone markers, 25(OH)D

Introduction Subacute lymphocytic thyroiditis is anautoimmune thyroid disease presenting with transient thyrotoxicosis as well as transient hypothyroidism. Several factors have been thought to be the initiating event in subacute lymphocytic thyroiditis. However, subacute lymphocytic thyroiditis that develops after thyroid lobectomy has not yet been reported in the literature. We report a case of subacute lymphocytic thyroiditis after lobectomy in a patient with papillary thyroid carcinoma. Case presentation A 30-year-old Korean woman was referred to our center for thyroid tumor operation. She was diagnosed with suspicious papillary thyroid carcinoma by fine needle aspiration at a local medical clinic. The thyroid ultrasonography demonstrated a diffusely enlarged thyroid gland with a 0.4×0.3cm sized hypoechoic nodule in the left lobe. Left thyroid lobectomy by endoscopic thyroidectomy was performed via a transaxillary approach, and the nodule was confirmed to be a papillary thyroid carcinoma. On postoperative day 1, a thyroid function test revealed hyperthyroidism, and on postoperative day 8, a thyroid function test again revealed hyperthyroidism with decreased radioactive iodine uptake. Thyroid function tests showed euthyroid on postoperative day 48 and hypothyroidism on postoperative day 86. She was treated with levothyroxine. Conclusion Subacute lymphocytic thyroiditis can develop after thyroid lobectomy. Thyroid autoantigen released during thyroid lobectomy may cause the onset or exacerbation of the destructive process.

Background Recently, lymph node metastasis (LNM) has been regarded as an important factor influencing loco-regional recurrence and survival rate in papillary thyroid cancer (PTC) patients. The aims of this study were to investigate the detection rate and metastasis rate of the Delphian lymph node (DLN) and clinical patterns related to regional LNM, and to examine how DLN metastasis affects PTC treatment. Methods We reviewed the medical records of 413 patients with pathologically confirmed PTC from among 452 patients who underwent thyroid surgery between January 2010 and October 2010 in the Department of Endocrine Surgery at Kosin University Gospel Hospital in Busan, South Korea. Results Multivariate analyses revealed a significantly higher proportion of cases with lymphovascular invasion (56.6% vs. 12.5%, P P P Conclusion When DLN metastasis is not detected in papillary thyroid microcarcinomas (PTMC), thyroid lobectomy on the affected side and ipsilateral central neck lymph node dissection should be sufficient. In addition, even in cases where lateral neck LNM is not detected on preoperative examination, if DLN metastasis is detected postoperatively, more careful attention should be paid to the lateral neck nodes during follow-up.

This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The incidence was calculated as the number of newly diagnosed patients (males) during the first 4 years after a live birth in a population, nationally and regionally (a non-industrialized area (Chuncheon) and petrochemical estates (Yeocheon and Ulsan)), between 2000 and 2005. The data (numerator) for new patients were acquired from the National Health Insurance Review Agency, and the data (denominator) for the resident registration population were from the National Statistical Office. Between 2000 and 2005, the national incidence of cryptorchidism and hypospadias had an increased tendency from 5.01 to 17.43 per 10 000 persons and from 1.40 to 3.28 per 10 000 persons, respectively. The incidence of cryptorchidism was significantly higher in Yeocheon (throughout the study period) and in Ulsan (2001, 2002, 2004 and 2005) than the national incidence, whereas the incidence in Chuncheon was significantly lower in 2001 and 2002. It was difficult to compare the rates of hypospadias yearly and regionally because of the small number of cases. In conclusion, the incidence of cryptorchidism has recently increased in Korea. The petrochemical estates, Yeocheon and Ulsan, had a significantly higher incidence of cyptorchidism than the national incidence, which suggests that further study is needed to obtain a more precise estimation of the trends in the incidence of the anomalies and to confirm the association between petrochemicals and the anomalies.

Background Glucagon-like peptide 1 (GLP-1), an incretin hormone well known for its glucose-lowering effect, was recently reported to exert an anabolic effect on bone. Although the exact mechanism is not known, it likely involves the GLP-1 receptor (GLP-1R), which is expressed in some osteoblastic cell lines. Adipose-derived stem cells (ADSCs) have mesenchymal stem cell-specific characteristics, including osteoblastic differentiation potential. We evaluated the expression of GLP-1R during osteogenic differentiation of ADSCs. Methods ADSCs were isolated from subcutaneous adipose tissue obtained from three male donors during plastic surgery and were subjected to osteogenic induction. Mineralization was assessed by Alizarin Red staining on day 21. Expression of alkaline phosphatase (ALP), osteocalcin (OC), and GLP-1R was measured by real-time polymerase chain reaction in triplicate for each patient on days 0, 7, 14, and 21. Target mRNA expression levels were normalized to that of β-actin. Results ADSCs were fibroblast-like in morphology, adhered to plastic, and had multipotent differentiation potential, as assessed using specific antigen markers. The osteogenic markers ALP and OC were notably upregulated at 21 days. Osteogenic differentiation resulted in a time-dependent increase in the expression of GLP-1R (P=0.013). Conclusion We demonstrated upregulation of GLP-1R gene expression during osteogenic differentiation of ADSCs. This finding suggests that GLP-1 may induce osteogenic differentiation in bone tissue.

Objective To investigate the causes of amenorrhea in Korean women. Methods Medical records from 1,212 women with amenorrhea who visited the Department of Obstetrics and Gynecology, Asan Medical Center, between January 1989 and December 2011 were retrospectively reviewed. Amenorrhea was categorized as either primary or secondary. Results Primary amenorrhea was identified in 132 of the patients (10.9%) and secondary amenorrhea in 1,080 (89.1%). The most frequent causes of primary amenorrhea were gonadal dysgenesis (28.0%, 37/132); Mayer-Rokitansky-Küster-Hauser syndrome (20.0%, 27/132); and constitutional delay and androgen insensitivity syndrome (8.3%, 11/132; 8.3%, 11/132, respectively). Secondary amenorrhea was due to polycystic ovary syndrome (48.4%, 523/1,080); premature ovarian insufficiency (14.0%, 151/1,080); and nutrition-related hypogonadotropic hypogonadism (8.3%, 90/1,080). Conclusion In this retrospective study, gonadal dysgenesis was the most common cause of primary amenorrhea and polycystic ovary syndrome was the most common cause of secondary amenorrhea in Korean women.

Therapeutic high-dose radiation can induce atherosclerotic changes of affected arteries. Radiation-associated atherosclerotic diseases of coronary, carotid and subclavian arteries have been demonstrated for years in cancer survivors, but peripheral arterial disease (PAD) associated with radiation is rarely reported. PAD is one of the major macrovascular complications of diabetes and is associated with morbidity and increased mortality. We experienced a case of PAD associated with radiation therapy in a 65-year-old diabetic female patient who had undergone cervical cancer treatment 19 years prior. Computed tomographic angiogram showed occlusion and stenosis from common iliac arteries to superficial femoral arteries. However, both infrapopliteal arteries that are commonly involved in diabetes associated PAD were preserved. She was successfully treated with percutaneous angioplasty combined with femoro-femoral bypass operation. Based on the extent and severity of arterial stenosis in this nonsmoking diabetic woman who had a history of high-dose radiation to her pelvis, we concluded that atherosclerotic lesions in this patient were caused by high-dose pelvic irradiation and then exacerbated by diabetes. Therefore, special attention should be given to diabetic patients with history of pelvic irradiation with regard to development of atherosclerosis of peripheral arteries, especially in the pelvic area. (J Korean Diabetes 2014;15:124-128)

Many cases of RET proto-oncogene mutations of hereditary medullary thyroid carcinoma (MTC) have been reported in Korea. However, MTC with V804M RET proto-oncogene germline mutations have not been reported in Korea. A 33-yr-old man was diagnosed with a 0.7-cm sized thyroid nodule. Laboratory testing revealed serum calcitonin was elevated. The patient underwent total thyroidectomy with central compartment neck dissection for the thyroid tumor. RET gene analysis was performed in both the index patient and his family. There were no V804M RET mutation and abnormal laboratory findings within his family except the index patient. Therefore, this patient was a de novo V804M RET germline mutation.

목적 지방평활근종은 매우 드문 자궁의 양성 신생물로 이에 대한 연구보고는 소규모로 제한적이었다. 본 논문의 임상적 분석은 자궁평활근종의 임상적 경과를 명확하게 하고 또한 수술 전 진단 시 영상학적 검사의 유용성과 한계를 이해하여 치료계획을 수립하는 데 도움을 주고자 시행하였다. 연구방법 본 연구는 1995년부터 2009년까지 서울아산병원에서 수술 후 지방평활근종으로 진단된 51예를 후향적으로 검토하였다. 임상적 소견, 영상학적 소견, 그리고 병리적 소견을 환자 의무기록을 토대로 조사하였다. 결과 환자의 평균나이는 52.1±10.8세였고 종양의 크기의 평균값은 5.6 ± 3.5 cm였다. 수술 소견에서 46명(90%)은 자궁체부, 3명(6%)은 자궁넓은인대에 지방평활근종이 있었다. 1명(2%)은 자궁경부에서 다른 1명(2%)은 뒤쪽 더글라스와의 배막뒤공간에서 진단되었다. 모든 환자는 수술 전에 영상학적 검사를 시행하였는데 수술 전에 지방평활근종을 진단받은 환자는 7명(14%)이었다. 난소 종양으로 진단받은 환자가 8명(16%)이었다. 병리학적 소견상 세포학적 이형성, 괴사 또는 다른 변성은 없었다. 추적 관찰기간 동안에 지방평활근종과 관련된 사망은 없었고 재발도 발견되지 않았다. 결론 지방평활근종은 양성 종양이며 지방성분으로 인한 영상학적 특성은 컴퓨터단층촬영과 자기공명영상으로 지방평활근종을 진단하는 데 유용하다. 지방평활근종이 자궁넓은인대나 배막뒤공간에 위치하는 경우에는 수술이 필요한 난소종양과 감별하기 어렵다. 결국 이러한 경우에는 증상이 없어도 병리학적 진단을 위해 수술적 치료를 시행해야 한다.

자궁경부암은 발생 빈도가 높은 여성암 중 하나이다. 초기 자궁경부암 환자에서 생식력보존이 필요한 경우 근치적 자궁경부절제술은 흔히 사용되는 치료법이 되었다. 하지만 근치적 자궁경부절제술 시행 후 임신을 시도할 경우 협부협착으로 인한 불임 그리고 자궁경부 절제로 인한 조기 진통 및 조기 양막파수 등의 합병증이 문제 되고 있다. 본원에서 자궁경부암 Ib1을 진단받고 복강경식 근치적 자궁경부절제술 및 양측 골반내 임파선절제술 시행 후 자궁 협부협착이 발생한 환자에서 협부확장술 시행 후 자궁강내 인공수정으로 임신하고 제왕절개술 분만에 성공한 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다.

Results The number of patients with primary amenorrhea was 89 (12.0%) and secondary amenorrhea was 652 (88.0%). The number of patients with primary amenorrhea was 62 (22.6%) and secondary amenorrhea was 212 (77.4%) in age 10-20 group. In age 2130 group, the number of primary amenorrhea was 27 (6.5%) and secondary amenorrhea was 389 (93.5%). In age 31-40 group, the number of secondary amenorrhea was 51 (100%). The causes of primary amenorrhea in group I were as follows; MayerRokitansky-Kuster-Hauser (MRKH) syndrome (17.7%, 11/62), Turner syndrome (11.3%, 7/62), constitutional delay (9.7%, 6/62). In group II; MRKH syndrome (18.5%, 5/27), Turner syndrome (18.5%, 5/27), and Idopathic hypogonadotropic hypogonadism (14.8%, 4/27). The causes of secondary amenorrhea in group I were as follows; Polycystic ovarian syndrome (PCOS; 60.8%, 129/212), weight related hypogonadotropic hypogonadism (12.3%, 26/212), premature ovarian failure (POF; 9.9%, 21/212). In group II; PCOS (62.5%, 243/389), weight related hypogonadotropic hypogonadism (9.8%, 38/389), POF (9.3%, 36/389). In group III; POF (43.1%, 22/51), PCOS (17.6%, 9/51).

Objectives : Bisphenol A diglycidyl ether (BADGE) is the major component in commercial liquid epoxy resins, which are manufactured by co-reacting bisphenol A with epichlorohydrin. This study was performed to show the developmental effects of prenatal and postnatal exposures to BADGE in male rat offspring. Methods : Mated female rats were divided into four groups, each containing 12 rats. The dosing solutions were prepared by thoroughly mixing BADGE in corn oil at the 0, 375, 1500 and 3000 mg/kg/day concentrations. Mated females were dosed once daily by oral gavage on gestation day (GD) 6 - 20 and postnatal day (PND) 0 - 21. Pregnant female dams were observed general symptoms and body weight. Also, male pups were observed the general symptoms, body weight, developmental parameters (e.g. anogenital distance, pina detachment, incisor eruption, nipple retention, eye opening, testis descent), organ pathologic changes and hormone levels of plasma. Results : Pregnant rats treated with BADGE died at a rate of about 70% in the 1500 mg/kg/day group and all rats treated with 3000 mg/kg/day died. Body weight, for male pups treated with doses of 375 mg/kg/day, was significantly lower than in the control group at PND 42, 56, and 63 (p

Primary squamous cell carcinoma of the thyroid gland is an extremely rare case to observe and represents less than 1% in all the primary thyroid malignancies. Normally, squamous epithelium is absent in the thyroid gland and presently; its origin is believed to arise from metaplasia of follicular epithelium. Cancer has very aggressive clinical behavior and a very poor prognosis with survival rates of less than 1 year. The best chances of survival have been achieved with complete resection followed by postoperative radiotherapy. Recently, we came across a case of 80-year-old woman with primary squamous cell cacinoma of the thyroid gland present in the background of Hashimoto's thyroiditis. The patient had swelling in the anterior neck portion from the past 20 days. On physical examinaton, 3× 3c m 2 hard and fixed ill defined mass was detected in the right lobe of thyroid. Repeated fine needle aspiration biopsy of the thyroid revealed the presence of carcinoma. Apparently, Palliative thyroidectomy was performed after 3 months of diagnosis. During operation, the tumor was revealed as a mass of 100 mm in diameter and infiltrated the surrounding muscles, trachea and other soft tissue in the neck. After the operation, the patient's condition deteriorated and ultimately after 5 months of her initial visit, she died due to respiratory failure (J Kor Soc Endocrinol 20:84～89, 2005).

Background: Angiogenesis is essential for tumor growth and metastasis. Vascular endothelial growth factor (VEGF), also known as vascular permeability factor (VPF), is an angiogenic factor that plays important roles in tumor growth. Angiogenesis studies on VEGF deal with various types of malignant tumors, but little is known about the role or significance of VEGF in human thyroid neoplasms. Therefore, this study was performed to determine whether the VEGF expression in different histological types of thyroid tumors is altered and to see if there was a relationship between the expr ession of VEGF and either metastasis or the invasiveness of thyroid carcinomas. Methods: Forty-two cases that underwent thyroidectomy at Kosin Medical Center, between March, 1999 and February, 2000, were included in this study. Of the 42 cases, 27 were malignant (26 papillary carcinoma, 1 Hurthle cell carcinoma) and 15 were benign lesions. The expression of VEGF was determined by immunohistochemistry using paraffin embedded thyroid tissue blocks, and was quantified as negative (absent), + (1~24%), ++ (25~49%), +++ (50~74%) and ++++ (≥75%), according to the extent of positive cells. Results : VEGF was stained with red-brown colored granules in the cytoplasm of the thyroid tumor epithelium and was expressed in 27 of the 42 cases (+ 1, ++ 8, +++ 5, ++++ 13). Most malignant tumors (24 of 27 cases) were stained with VEGF, but only 3 of the 15 benign tumors cases were stained (P