Retrospective Observational Dose-Titration Study of Subjects with Type 2 Diabetes Mellitus with Inadequate Glycemic Control on 15 mg of Pioglitazone / 임상당뇨병

BACKGROUND: The 30 mg pioglitazone tablet was recently introduced in Korea; no study has yet compared its glucose-lowering or weight gain effects to the 15 mg tablet in Korean patients with type 2 diabetes mellitus (T2DM). METHODS: The electronic medical records of 45 patients with T2DM with glycated hemoglobin (HbA1c) levels > 7.0%, despite taking 15 mg/day pioglitazone and a stable dose of other diabetes drugs for 3 months, were retrospectively reviewed. RESULTS: After dose up-titration, HbA1c levels decreased at 3- and 6-month follow-ups compared with baseline (8.5% at baseline vs. 8.2% at 3 months vs. 7.9% at 6 months; baseline vs. 3 months, P = 0.106; baseline vs. 6 months, P = 0.005; 3 months vs. 6 months, P = 0.096). In the subgroup analysis of 36 patients taking pioglitazone, sulfonylurea, and metformin, HbA1c levels also decreased at 3- and 6-month follow-ups compared with baseline (8.5 % vs. 8.2 % vs. 7.9%; baseline vs. 3 months, P = 0.289; baseline vs. 6 months, P = 0.014; 3 months vs. 6 months, P = 0.232). There was no significant body weight change (70.8 kg vs. 70.7 kg vs. 71.0 kg). CONCLUSION: Up-titrating from 15 mg to 30 mg of pioglitazone in patients with inadequate glycemic control (HbA1c > 9%) who were also taking sulfonylurea and metformin showed additive glucose-lowering effects without significant weight gain in Korean patients with T2DM.

Tenofovir disoproxil fumarate monotherapy for nucleos(t)ide analogue-naive and nucleos(t)ide analogue-experienced chronic hepatitis B patients

BACKGROUND/AIMS: This study investigated the antiviral effects of tenofovir disoproxil fumarate (TDF) monotherapy in nucleos(t)ide analogue (NA)-naive and NA-experienced chronic hepatitis B (CHB) patients. METHODS: CHB patients treated with TDF monotherapy (300 mg/day) for > or =12 weeks between December 2012 and July 2014 at a single center were retrospectively enrolled. Clinical, biochemical, and virological parameters were assessed every 12 weeks. RESULTS: In total, 136 patients (median age 49 years, 96 males, 94 HBeAg positive, and 51 with liver cirrhosis) were included. Sixty-two patients were nucleos(t)ide (NA)-naive, and 74 patients had prior NA therapy (NA-exp group), and 31 patients in the NA-exp group had lamivudine (LAM)-resistance (LAM-R group). The baseline serum hepatitis B virus (HBV) DNA level was 4.9+/-2.3 log IU/mL (mean+/-SD), and was higher in the NA-naive group than in the NA-exp and LAM-R groups (5.9+/-2.0 log IU/mL vs 3.9+/-2.0 log IU/mL vs 4.2+/-1.7 log IU/mL, P<0.01). The complete virological response (CVR) rate at week 48 in the NA-naive group (71.4%) did not differ significantly from those in the NA-exp (71.3%) and LAM-R (66.1%) groups. In multivariate analysis, baseline serum HBV DNA was the only predictive factor for a CVR at week 48 (hazard ratio, 0.809; 95% confidence interval, 0.729-0.898), while the CVR rate did not differ with the NA experience. CONCLUSIONS: TDF monotherapy was effective for CHB treatment irrespective of prior NA treatment or LAM resistance. Baseline serum HBV DNA was the independent predictive factor for a CVR.

Ruptured Cystic Artery Pseudoaneurysm as a Rare Cause of Massive Hemobilia / 대한췌담도학회지

Gastrointestinal bleeding from the biliary tree, called hemobilia, is an uncommon event. It may clinically present as hematemesis or melena. Ruptured cystic artery pseudoaneurysm is a rare cause of hemobilia, with 2 cases reported in Korea. We present this unusual condition in a 65-year-old man whose chief complaint was abdominal pain. His final diagnosis was ruptured cystic artery pseudoaneurysm, and he was successfully treated by transcatheter arterial embolization and laparoscopic cholecystectomy.

A Survey of Female College Students' Knowledge and Attitudes Toward Breastfeeding / 대한지역사회영양학회지

Breastfeeding is an ideal approach for physical and emotional development of babies, as well as recovery of mothers. A breastfeeding education for female students seems to be an effective intervention to increase the Korean women breastfeeding rate. The purpose of this study was to evaluate their knowledge, attitudes, and other related breastfeeding variables for developing a design for a pre-parental breastfeeding educational information for Korean female students of childbearing age. The sample consisted of 205 Korean female college students, ranging in age from 20 to 25 years old. In this study, a self-administered questionnaire included 6 pages with close-ended multiple-choice questions, and included a cover page with 15 questions on demographic characteristics and personal experiences related to breastfeeding. Data analysis was done utilizing inferential statistics using SPSS 12.0 computer program. The findings indicated that breastfeeding education programs should focus on the practical aspect of attitudes toward breastfeeding, and that educational information design should focus on the practical aspects of breastfeeding for all levels of students' education by nurses. Therefore, education for female college students seems to be an effective intervention to increase breastfeeding rate. This study is useful for descriptions of educational activities to help female students develop positive attitudes to breastfeed, to help these students have confidence toward breast-feeding in future by providing correct information and practical techniques on breastfeeding.

Metabolism of C(14)-glucose by Ascaridia galli

The fowl nematode Ascaridia galli employed in this experiment was obtained from the intestine of domestic fowls at the local market. The worms selected and washed several times in normal sterilized saline solution. Each about thirty of intact worms were incubated in 50 cc volume of special incubation flasks with incubation mixture consisting of 10 cc of Krebs-Ringer phosphate buffer (pH 7.4) to which were added universally labeled C14-glucose and non-radioactive carrier glucose so as to contain concentration of 200 mg per cent. The worms were allowed to incubation for 3 hours in Dubnoff metabolic shaking incubator at 38 C. After incubation period, respiratory CO(2) samples from central well of incubation flask were analysed for total CO(2) production rate and their specific activity of respiratory CO(2). Glycogen samples isolated from worms were analysed for uptake rate was determined by analyzing the difference of the glucose concentration in a medium before and after incubation period . Radioactivities of these series of experiments were counted by an endwindow Geiger-Muller counter as an infinitely thin samples. The quantitative analysis of C(14)-glucose utilized by Ascaridia galli was summarized as the following . The glucose uptake rate by A. galli was a mean value of 1.73+/-0.32 micro-mole per hour per gram of wet wt. and total CO(2) production rate by the worms averaged 8.44+/-1.11 micro-mole per hour per gram of wet wt. The relative specific activity of respiratory CO(2) (R.S.A CO(2)) averaged 2.68+/-0.38 per cent . Thus , a man of 2.68 per cent of total CO(2) production rate was originated from the glucose in the medium, therefore the rate of CO(2) production derived from medium glucose was a mean of 0.23+/-0.03 micro-mole per hour per gram of wet wt. Thus, the average value of 2.58+/-0.55 percent (R.G.D CO(2))of glucose utilized by the worms from the medium glucose was oxidized to respiratory CO2. The tissue concentration of glycogen in A. galli was a mean of 22.59+/-1.18 miligram per gram of wet wt or 2.26+/-0.123 percent per gram, and the turnover rate of glycogen pool yielded with a mean of 0.17+/-0.04 percent per hour or 0.037+/-0.006 miligram per hour per gram of wet wt. Therefore, a mean value of 16.37+/-4.04 per cent (R.G.D gly) of glucose was incorporated to the glycogen. These data account for that at least 18.95 per cent of the utilized glucose by the worms participated in furnishing the oxidation into respiratory CO(2) and the synthetic process into glycogen. According to the above data of the experiment, it is suggested in the metabolic process of glucose by Ascaridia galli that the synthetic process into the glycogen is more active than the oxidative process into the respiratory CO(2).

Metabolism of C(14)-glucose by Moniezia expansa and Diphyllobothrium mansoni

The adult worms of cestodes, Moniezia expansa and Diphyllobothrium mansoni employed in this experiment. The worms were divided into three portions, i.e. immature , mature and gravid proglottids, and each proglottids were incubated in a certain incubation period, and the glucose uptake rate, total CO2 production rate, tissue concentration and their radioactivities were employed as previous reports(Rim et al., 1965). The glucose uptake rate by M. expansa was a mean value of 6.46+/-1.23 micromole per hour per gram of wet wt. and the rate by D. mansoni was a mean value of 18.8+/-0.8 micro-mole per hour per gram of wet wt. The higher rates were observed in the mature proglottid of M. expansa and in the immature proglottid of D. mansoni . The total CO(2) production rates by the worms averaged 14.0+/-2.37 micro-mole per hour per gram in M. expansa and 17.51+/-1.54 micro-mole per hour per gram of wet wt. The relative specific activities of respiratory CO(2)(R.S.A CO(2)) averaged 22.2+/-5.15 percent in M. expansa and 54.2+/-2.2 per cent in D. mansoni. In the both worms, the higher values were obtained in the mature proglottids. Therefore, the average value of 8.84+/-2.66 per cent of glucose utilized by M. expansa and 8.23+/-0.50 percent of glucose utilized by D. mansoni from the medium glucose was oxidized into respiratory CO(2). The tissue concentrations of glycogen were a mean of 2.21+/-0.46 percent per gram of wet wt. in M. expansa and 7.56+/-1.24 percent per gram of wet wt. in D. mansoni. The higher concentration of glycogen was observed in the gravid proglottids of M. expansa, however the gravid proglottids of D. mansoni showed lower concentration of glycogen than the other proglottids. The turnover rate of glycogen pool yielded with a mean of 0.04+/-0.01 miligram per hour per gram of wet wt. of M. expansa, whereas a mean of 1.66+/- 0.46 miligram per hour per gram wet wt. of D. mansoni. Therefore, a mean value of 2.58+/-0.93 per cent(R.G.D gly) of glucose utilized by M. expansa and 53.6+/-1.4 percent by D. mansoni was incorproated into the glycogen . These data account for that at least 11.42 per cent of the utilized glucose by M. expansa and 61.83 per cent of the utilized glucose by D. mansoni participated in furnishing the oxidation into respiratory CO2 and the synthetic process into glycogen.

Metabolism of C(14)-acetate by cestodes

The adult worm and plerocercoid larva(sparganum) of Diphyllobothrium mansoni and Moniezia expansa employed in this experiment. The adult worms were divided into three portions, i.e. immature, mature and gravid proglottids, and each proglottids were incubated in 50 cc or 250 cc volume of special incubation flasks with incubation medium consisting of 10 cc of 25 cc of Krebs-Ringer phosphate buffer (pH 7.4). The incubation medium was added C(14)-acetate and non-radioactive carrier Na-acetate so as to contain acetate concentration of 50 mg per cent. The worms were allowed to incubate for 5 hours in the Dubnoff metabolic shaking incubator at 38 C. After incubation period, the lactate and pyruvate appearance rate, total CO(2) production tate, the turnover rates were employed as pervious report(Seo et al., 1965). The quantitative analysis of C(14)-acetate utilized by the adult worm and plerocercoid larva of D. mansoni and M. expansa were compared and discussed in this report. According to these data of the experiment, it is impressed that the fatty acid such as acetate may play a role of major part of their metabolism in the adult worm and plerocercoid larva of D. mansoni , whereas minor part of acetate participated in the metabolism by M. expansa.