Association between Serum Folic Acid Levels and Asthma in the Korean Population: A Study Based on the 2016–2018 Korea National Health and Nutrition Examination Survey / 가정의학회지

Background@#Folic acid is involved in inflammatory reactions; however, the association between folic acid and allergic diseases, particularly asthma, remains unclear. Thus, this study aimed to evaluate the association between serum folic acid levels and asthma in Koreans. @*Methods@#This study analyzed the serum folic acid levels of 6,615 individuals included in the 2016–2018 Korea National Health and Nutrition Examination Survey. The prevalence of asthma was determined using a questionnaire that identified cases of physician-diagnosed asthma. The relationship between serum folic acid levels and asthma was analyzed using logistic regression analysis. @*Results@#Multiple logistic regression analysis showed that a 1 ng/mL increase in serum folic acid level significantly reduced the risk of asthma after adjusting for confounding factors including sex, age, household income, current smoking, current alcohol use, and body mass index (odds ratio [OR], 0.930; 95% confidence interval [CI], 0.876– 0.987; P=0.017). The relationship between the adjusted odds of asthma and serum folic acid levels were consistently inverse (OR, 2.266; 95% CI, 1.126–4.420; P for trend=0.038). @*Conclusion@#Serum folic acid levels are inversely associated with physician-diagnosed asthma in the Korean population.

Analysis of Neck Trauma Patients Using the Korean National Emergency Department Information System

PURPOSE: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. METHODS: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients' demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. RESULTS: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. CONCLUSION: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers.

Corn silk extract improves benign prostatic hyperplasia in experimental rat model

BACKGROUND/OBJECTIVES: This study was conducted to investigate the effect of a corn silk extract on improving benign prostatic hyperplasia (BPH). MATERIALS/METHODS: The experimental animals, 6-week-old male Wistar rats, were divided into sham-operated control (Sham) and experimental groups. The experimental group, which underwent orchiectomy and received subcutaneous injection of 10 mg/kg of testosterone propionate to induce BPH, was divided into a Testo Only group that received only testosterone, a Testo+Fina group that received testosterone and 5 mg/kg finasteride, a Testo+CSE10 group that received testosterone and 10 mg/kg of corn silk extract, and a Testo+CSE100 group that received testosterone and 100 mg/kg of corn silk extract. Prostate weight and concentrations of dihydrotestosterone (DHT), 5α-reductase 2 (5α-R2), and prostate specific antigen (PSA) in serum or prostate tissue were determined. The mRNA expressions of 5α-R2 and proliferating cell nuclear antigen (PCNA) in prostate tissue were also measured. RESULTS: Compared to the Sham group, prostate weight was significantly higher in the Testo Only group and decreased significantly in the Testo+Fina, Testo+CSE10, and Testo+CSE100 groups (P < 0.05), results that were consistent with those for serum DHT concentrations. The concentrations of 5α-R2 in serum and prostate as well as the mRNA expression of 5α-R2 in prostate were significantly lower in the Testo+Fina, Testo+CSE10, and Testo+CSE100 groups than that in the Testo Only group (P < 0.05). Similarly, the concentrations of PSA in serum and prostate were significantly lower in the Testo+Fina, Testo+CSE10, and Testo+CSE100 groups (P < 0.05) than in the Testo Only group. The mRNA expression of PCNA in prostate dose-independently decreased in the Testo+CSE-treated groups (P < 0.05). CONCLUSIONS: BPH was induced through injection of testosterone, and corn silk extract treatment improved BPH symptoms by inhibiting the mRNA expression of 5α-R2 and decreasing the amount of 5α-R2, DHT, and PSA in serum and prostate tissue.

Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes

BACKGROUND: With the advent of sodium glucose co-transporter 2 inhibitors to control glucose and treat diabetes, laboratory data aided by either timed or spot glucose levels in the urine could be used as an alternative marker of drug response. The aim of this study was to assess the agreement between overnight urinary glucose excretion (UGE) and morning spot urinary glucose-to-creatinine ratio (UGCR). METHODS: In this prospective cross-sectional study, we enrolled a total of 215 participants with either normal glucose tolerance (NGT), pre-diabetes, or type 2 diabetes mellitus (T2DM). To exclude external factors such as food intake and physical activity, urine samples collected overnight at an 8-hr interval and the first-voided morning spot urine were collected and compared. RESULTS: The median values of overnight 8-hr UGE in participants with NGT (N=14), pre-diabetes (N=41), and T2DM (N=160) were 35.0 mg, 35.6 mg, and 653.4 mg, respectively. In participants with T2DM, the median values of overnight 8-hr UGCR and first-voided morning spot UGCR (M-UGCR) were 1.37 mg/mg and 0.16 mg/mg, respectively. Quantitative analyses using an intraclass correlation coefficient (ICC) demonstrated a good reliability of measurement of the overnight 8-hr UGCR and M-UGCR (ICC=0.943, P<0.001). The M-UGCR was also significantly related to the overnight 8-hr UGE (r=0.828, P<0.001). CONCLUSIONS: M-UGCR and overnight 8-hr UGCR showed good agreement, suggesting that M-UGCR be used as a simple index for estimating overnight amounts of UGE in patients with T2DM.

Lobeglitazone, a Novel Thiazolidinedione, Improves Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes: Its Efficacy and Predictive Factors Related to Responsiveness

Despite the rapidly increasing prevalence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D), few treatment modalities are currently available. We investigated the hepatic effects of the novel thiazolidinedione (TZDs), lobeglitazone (Duvie) in T2D patients with NAFLD. We recruited drug-naïve or metformin-treated T2D patients with NAFLD to conduct a multicenter, prospective, open-label, exploratory clinical trial. Transient liver elastography (Fibroscan®; Echosens, Paris, France) with controlled attenuation parameter (CAP) was used to non-invasively quantify hepatic fat contents. Fifty patients with CAP values above 250 dB/m were treated once daily with 0.5 mg lobeglitazone for 24 weeks. The primary endpoint was a decline in CAP values, and secondary endpoints included changes in components of glycemic, lipid, and liver profiles. Lobeglitazone-treated patients showed significantly decreased CAP values (313.4 dB/m at baseline vs. 297.8 dB/m at 24 weeks; P = 0.016), regardless of glycemic control. Lobeglitazone improved HbA1C values (7.41% [57.5 mM] vs. 6.56% [48.2 mM]; P < 0.001), as well as the lipid and liver profiles of the treated patients. Moreover, multivariable linear regression analysis showed that hepatic fat reduction by lobeglitazone was independently associated with baseline values of CAP, liver stiffness, and liver enzymes, and metformin use. Lobeglitazone treatment reduced intrahepatic fat content, as assessed by transient liver elastography, and improved glycemic, liver, and lipid profiles in T2D patients with NAFLD. Further randomized controlled trials using liver histology as an end point are necessary to evaluate the efficacy of lobeglitazone for NAFLD treatment (Clinical trial No. NCT02285205).

A Case of Gastrointestinal Sarcoidosis without Pulmonary Involvement / 대한내과학회지

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that is based on the presence of non-caseating granulomas. Sarcoidosis commonly involves the lungs, skin, and eyes. Gastrointestinal tract involvement in sarcoidosis is uncommon. Gastrointestinal tract sarcoidosis commonly occurs subclinically, with clinical manifestations present in only 0.1-0.9% of patients with the disease. There are rare case reports of an individual with symptomatic gastrointestinal sarcoidosis. In Korea, gastrointestinal sarcoidosis without pulmonary involvement has not been reported previously. Here, we describe a case of gastrointestinal sarcoidosis in a 37-year-old male with symptoms of weight loss, fever, and abdominal pain. He was diagnosed based on the presence of non-caseating epithelioid granulomas in the stomach, duodenum, and colon by multiple biopsies.

Primary Methicillin-Resistant Staphylococcus aureus Pericarditis in a Patient Undergoing Hemodialysis

We report a case of a 41-year-old man undergoing hemodialysis who presented with a sudden fever and dyspnea. He developed a severe pericardial effusion due to methicillin-resistant Staphylococcus aureus, which was identified in both blood and pericardial fluid cultures. He was successfully treated with intravenous vancomycin for 6 weeks. Although such cases are very rare in Korea, the current case describes a primary purulent pericarditis without any other potential infectious foci.

Rare Case of Metastasis to Maxillary Sinus Accidently Diagnosed after Operation of Metastatic Renal Cell Carcinoma

The classic presentation of renal cell carcinoma (pain, hematuria, and flank mass) occurs in a minority of patients and often is indicative of advanced disease. Common sites of metastatic renal cell carcinoma are lung, soft tissues, bone, and liver. Paranasal sinus is an unusual site for metastasis of renal cell carcinoma. One 73-year-old male presented to Soonchunhyang University Seoul Hospital with melena. Renal cell carcinoma with metastasis to duodenum was diagnosed by computed tomography (CT). He underwent right radical nephrectomy and Whipple's operation. Positron emission tomography/CT was performed postoperatively, and then metastasis to maxillary sinus was found by accident. He was treated with molecular targeted therapy (pazopanib hydrochloride 800 mg).

Consideration of Discrepancy between Needle-Washout Thyroglobulin and Serum Thyroglobulin of Recurrent Papillary Thyroid Cancer

Although the prognosis of papillary thyroid cancer (PTC) is extremely good, locoregional recurrences after initial treatment occur. Thyroglobulin (Tg) is a reliable tumor marker to detect recurrence or persistence of PTC. However, occasionally serum Tg may miss the detection of a recurrence. We report a 54-year-old female presented with hoarseness due to cervical recurrence without concomitant elevation of serum Tg and anti-Tg antibody, in contrast to extremely increased needle-washout Tg, who had undergone a total thyroidectomy and radioiodine ablation as initial therapies for PTC. Several factors causing such discrepancy between needle-washout Tg and serum Tg can be suggested including site of recurrence, volume of tumor, interference by some kind of plasma antibodies other than anti-Tg antibody, and any conformational defect of Tg protein. Among them, the most convincing explanation is that any conformational defect of Tg may lead to impaired secretion of Tg to blood. We suggest that more studies are needed to find the cause for potential mechanisms involved in PTC recurrences without increased serum Tg.

Methimazole-Induced Acute Cholestatic Hepatitis in a Patient with History of Simvastatin-Induced Liver Injury

Methimazole and prophylthiouracil are commonly prescribed for patients with hyperthyroidism. The serious side effect of toxic hepatitis caused by these two drugs is well known. According to recent Korean and American management guidelines for hyperthyroidism, mehimazole is recommended as the first-choice antithyroid drug for the treatment of hyperthyroidism. Toxic hepatitis rarely occurs in methimazole users. We report a rare case of a 52-year-old female with toxic hepatitis after methimazole use that had past medical history of simvastatin induced liver injury.

Cyclooxygenase-2 inhibitors modulate skin aging in a catalytic activity-independent manner

It has been proposed that the pro-inflammatory catalytic activity of cyclooxygenase-2 (COX-2) plays a key role in the aging process. However, it remains unclear whether the COX-2 activity is a causal factor for aging and whether COX-2 inhibitors could prevent aging. We here examined the effect of COX-2 inhibitors on aging in the intrinsic skin aging model of hairless mice. We observed that among two selective COX-2 inhibitors and one non-selective COX inhibitor studied, only NS-398 inhibited skin aging, while celecoxib and aspirin accelerated skin aging. In addition, NS-398 reduced the expression of p53 and p16, whereas celecoxib and aspirin enhanced their expression. We also found that the aging-modulating effect of the inhibitors is closely associated with the expression of type I procollagen and caveolin-1. These results suggest that pro-inflammatory catalytic activity of COX-2 is not a causal factor for aging at least in skin and that COX-2 inhibitors might modulate skin aging by regulating the expression of type I procollagen and caveolin-1.

Three cases of endometriosis of the urinary tract / 대한산부인과학회지

Endometriosis is a long term, disabling condition and a relatively common disease, affecting 5~15% of the adult female population. Endometriosis of the urinary tract, which occurs mostly bladder or ureter, is rare and accounts for 1 or 2% of cases. However, they may cause hydronephrosis and other serious complications on the involved site. We experienced one case of vesical endometriosis and two cases of ureteral endometriosis, and report these cases with a brief review of the concerned literatures.

The Association between Serum Estradiol Level and Coronary Artery Calcification in Postmenopausal Women: A Preliminary Report / 대한폐경학회지

OBJECTIVES: To estimate whether coronary artery calcification in postmenopausal women is associated with serum estradiol level. METHODS: The present study retrospectively examined the clinical records of 162 postmenopausal women who visited the Health Promotion Center for a routine checkup and underwent a multidetector CT scan of the heart. Serum estradiol level, coronary heart disease (CHD) risk factors, current hormone therapy status, and BMD of the lumbar vertebrae and femoral neck were analyzed in women with coronary artery calcium score (CACS) > or = 100 and or = 100), women with lower CACS (< 100) had a significantly higher level of serum estradiol (27.34 +/- 2.96 vs. 13.31 +/- 1.10 pg/ml, P = 0.030) and lower mean age (57.63 +/- 0.44 vs. 61.88 +/- 1.90, P = 0.037). Women with CACS < 100 were significantly more likely to have a serum estradiol level greater than 20 pg/ml (42.25 vs. 0 %, P = 0.022) and lower prevalence of hypertension (28.17 vs. 62.50%, P = 0.053, borderline significant). However, multiple logistic regression analysis showed that any factors did not have a significant association with CACS except hypertension (OR 5.831 [95% CI 1.035 to 32.85], P = 0.046). CONCLUSION: Serum estradiol level might be associated with the degree of calcification of coronary artery in postmenopausal women.

Low-dose Hormone Therapy in Postmenopausal Women / 대한폐경학회지

The importance of the results of some large, randomized controlled trials on hormone therapy (HT) has changed the perceived risk or benefit of HT. It is now recommended that the dose and regimen of HT should be individualized based on the principle of choosing the lowest appropriate dose in relation to the severity of symptoms and age of menopause. The effectiveness of low and ultra-low dose HT has been demonstrated for the treatment of vasomotor symptoms, genital atrophy and the prevention of bone loss with fewer side-effects than the standard dose HT. Although accumulating evidence demonstrates the efficacy and tolerability of low-dose HT, data about the use are limited by a lack of long-term, randomized studies. Further research is needed to determine the effect on fractures, as well as cardiovascular and breast disease.

Low-dose Hormone Therapy in Postmenopausal Women / 대한폐경학회지

The importance of the results of some large, randomized controlled trials on hormone therapy (HT) has changed the perceived risk or benefit of HT. It is now recommended that the dose and regimen of HT should be individualized based on the principle of choosing the lowest appropriate dose in relation to the severity of symptoms and age of menopause. The effectiveness of low and ultra-low dose HT has been demonstrated for the treatment of vasomotor symptoms, genital atrophy and the prevention of bone loss with fewer side-effects than the standard dose HT. Although accumulating evidence demonstrates the efficacy and tolerability of low-dose HT, data about the use are limited by a lack of long-term, randomized studies. Further research is needed to determine the effect on fractures, as well as cardiovascular and breast disease.

Socioeconomic Factors Associated with Initiating and Quitting Cigarette Smoking Among Korean Men / 가정의학회지

BACKGROUND: The prevalence of current cigarette smoking is the net result of different processes over the entire life course, namely initiation, continuation and cessation of smoking. This study examined the association of socioeconomic indicators with initiating and quitting smoking among South Korean men. METHODS: We analyzed a total of 2,798 men aged 25-64 who participated in the Korean National Health and Nutrition Examination Survey in 2005. Odds ratios (ORs) with 95% confidence intervals (CIs) for smoking initiation and cessation according to socioeconomic position indicators were calculated with logistic regression. Socioeconomic position was measured by education, occupation, income and marital status. RESULTS: Greater rates of ever initiation of smoking were observed among lower educated men (OR = 1.51; 95% CI = 1.09-2.09) after controlling for other socioeconomic factors. Independent associations were found among men who performed manual labor (OR = 1.55; 95% CI = 1.12-2.14). After simultaneous adjustment for socioeconomic factors, lower likelihood of quitting smoking was detected among men who were in the middle third and the lower third income group (OR = 0.72; 95% CI = 0.55-0.92, OR = 0.60; 95% CI = 0.46-0.79, respectively), who performed manual labor (OR = 0.66; 95% CI = 0.50-0.86) or who were not married (OR for never-married = 0.65; 95% CI = 0.42-0.99 and OR for divorced or widowed = 0.56; 95% CI = 0.36-0.87, respectively). CONCLUSION: For Korean men, educational attainment was a strong predictor of ever initiating smoking, however, smoking cessation was independently related to income and marital status. To be effective, tobacco control interventions should consider these different social determinants in initiating and quitting smoking.

The effect of body mass index of on the outcome of in vitro fertilization and embryo transfer in patients with polycystic ovary syndrome / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the effect of body mass index (BMI) on the outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with polycystic ovary syndrome (PCOS). METHODS: Ninety-six patients with PCOS who completed their first cycle of IVF-ET were included in this retrospective study. All patients were stimulated by GnRH antagonist multi-dose protocol. The patients were divided into one of two groups on the basis of BMI > or =23 kg/m2 vs. BMI or =23kg/m2 were divided into patient group with 23 or =25 kg/m2, and these three groups were also compared in regard to the outcome of IVF-ET. RESULTS: The total amount and duration of rhFSH administration were significantly higher in PCOS women with BMI > or =23 kg/m2 than in those with BMI or =23 kg/m2 (17.4% vs 7.8%, P=0.024). When compared three group divided on the basis of BMI or =25 kg/m2, similar results were showed in women with BMI > or =25 kg/m2, although implantation rate in women with BMI > or =25 kg/m2 was lower with borderline significance (P=0.069). CONCLUSION: Obesity (BMI > or =23 kg/m2) has a detrimental effect on implantation rate and is associated with the increased total amount and duration of rhFSH administration for ovarian stimulation in IVF-ET cycle. Consequently BMI may be a predictor for IVF outcomes in patients with PCOS.

Cyclooxygenase-2 promotes cell proliferation, migration and invasion in U2OS human osteosarcoma cells

Osteosarcoma is the most common primary bone tumor, but the pathogenesis is not well understood. While cyclooxygeanse-2 (COX-2) is known to be closely associated with tumor growth and metastasis in several kinds of human tumors, the function of COX-2 in osteosarcoma is unclear. Therefore, to investigate the function of COX-2 in osteosarcoma, we established stable cell lines overexpressing COX-2 in U2OS human osteosarcoma cells. COX-2 overexpression as well as prostaglandin E(2) treatment promoted proliferation of U2OS cells. In addition, COX-2 overexpression enhanced mobility and invasiveness of U2OS cells, which was accompanied by increases of matrix metalloproteinase-2 and -9 (MMP-2 and -9) activities. Selective COX-2 inhibitors, NS-398 and celecoxib, inhibited cell proliferation and abrogated the enhanced mobility, invasiveness and MMP activities induced by COX-2 overexpression. These results suggest that COX-2 is directly associated with cell proliferation, migration and invasion in human osteosarcoma cells, and the therapeutic value of COX-2 inhibitors should be evaluated continuously.

A case of successful treatment of stroke with intracardiac thrombi in a patient with severe ovarian hyperstimulation syndrome / 대한산부인과학회지

Thromboembolism is a rare complication of ovarian hyperstimulation syndrom (OHSS). According to the numerous reports, it most commonly occurs in upper extremities, head, and neck vein. It is also well known that acute cerebral infarction, once occurred, is mainly caused by the occlusion of large arteries, especially middle cerebral artery (MCA) in most cases. Administration of heparin has been considered as the best treatment option, but many studies have been reporting successful treatment results from administrating thrombolytics in patients with cerebral infarction. Although administration of thrombolytics is invasive and has some potential side effects including bleeding or hematoma, it still has been used for treating patients with cerebral infarction. We report a case of patient with intracardiac thrombi and manifested symptoms of acute cerebral infarction originally caused by OHSS followed by the occlusion of MCA. We administered thrombolytics within one and half hours of showing left hemiparesis caused by the occlusion of right MCA, and identified reperfusion of MCA. There was no evidence of complications associated with the administration of thrombolytics on CT scan, which was taken 24 hours later. Thrombi in IVC, right atrium, and right ventricle were found on chest CT with pleural effusion, but soon were disappeared after administrating heparin anticoagulation. We report this case to show that thrombolytics and anticoagulation can be safely used to treat a patient with cerebral infarction and thrombi caused by OHSS without any side effects or complications.

Management of cervical cancer in pregnancy / 대한산부인과학회지

Cervical cancer is the most common gynecologic malignancy diagnosed in pregnancy. Pregnancy represents an opportunity for early diagnosis of cervical cancer, because cervical cytology is considered to be a part of routine antenatal care. An abnormal cervical cytology should generally be managed as in the non-pregnant state. Therefore, colposcopy and directed biopsies, when indicated, should be considered for pregnant patients with abnormal cytology and/or suspicious clinical findings. The only absolute indication for conization in pregnancy is to rule out microinvasive disease or make the diagnosis of invasive carcinoma when such a diagnosis will alter the timing or mode of delivery. Overall, earlier stages of cervical cancer are encountered during pregnancy compared with the general population. In early stage disease, delay in definitive treatment for fetal maturity would be feasible and safe if there is no evidence of disease progression. Treatment of invasive cervical cancer is similar to the non-pregnant state, and should be individualized and undertaken by stage, gestational age and patient's desire to continue the pregnancy. In counseling patients, a multidisciplinary approach coordinated by experts in gynecologic oncology and perinatology is mandatory. After stratifying for stage, the outcome is similar to the non-pregnant state.