The Relation of High-Sensitivity C-Reactive Protein with Hyperuricemia: Using Health Examination Data at One Medical Institution’s Health Examination Center (2016–2017)

Background@#Several studies have shown that elevated serum uric acid levels are associated with cardiovascular disease. High sensitivity C-reactive protein (hs-CRP) has been shown to be a measure of the severity and prognosis of cardiovascular disease. The aim of this study was to investigate the association of hs-CRP with hyperuricemia. @*Methods@#From March 2016 to November 2017, a total of 26,987 patients who received a health check-up at a Soonchunhyang University Cheonan Hospital, Korea, were enrolled. Foreigners, patients who had hs-CRP score greater than 10 or white blood cell score greater than 10,000, those who did not respond sincerely, those who had previously been diagnosed with gout and cerebrovascular disease, and females were excluded. Data were collected from 2,808 patients. @*Results@#The subjects were divided into four sections by 25th percentile, 50th percentile, 75th percentile, and 100th percentile based on the distribution of hs-CRP. Serum hs-CRP levels were 1.85 (1.34–2.56), 2.59 (1.90–3.54), and 3.64 (2.70–4.93) respectively in the second, third, and fourth quartiles based on the first quartile. The odds ratios were 1.46 (1.05–2.03), 1.76 (1.27–2.45), and 2.27 (1.64–3.14) after adjusting the disturbance variables of age, body mass index, smoking status, and regular exercise. @*Conclusion@#In this study, we evaluated the relationship between serum hs-CRP and hyperuricemia, which are the risk factors for cardiovascular disease, and found statistically significant correlations. These results were still significant after adjusting for age, smoking, exercise, and body mass index.

The Change of Metabolic Syndrome Prevalence and Its Risk Factors in Korean Adults for Decade: Korea National Health and Nutrition Examination Survey for 2008–2017

Background@#Metabolic syndrome is a nationwide health problem, which is associated with the development of cardiovascular diseases, diabetes, and chronic renal failure. The prevalence of metabolic syndrome in Korea significantly increased from 1998 to 2007. After that, the prevalence was stable in female but still increasing in male. The objective of this study was to evaluate how the prevalence and risk factors for metabolic syndrome changed in Korean adults through the last decade. @*Methods@#Data from the Korea National Health and Nutrition Examination Survey 2008 to 2017 was used. National Cholesterol Education Program Adult Treatment Panel III were used to define metabolic syndrome. We compared how each metabolic syndrome component and the risk factors changed through the years. @*Results@#A total of 51,177 (30,092 female and 21,085 male) people were included in this study. The prevalence of metabolic syndrome in male increased from 24.5% in 2008 to 28.1% in 2017, whereas that in female was stable at 20.5% in 2008 from 18.7% in 2017. Waist circumference measurements and fasting glucose levels increased through the decade in male, whereas only fasting glucose levels increased in female. @*Conclusion@#Since the last decade, the prevalence of metabolic syndrome in Korean adults has increased in male but remained stable in female. Lifestyle intervention in male, namely ceasing smoking and drinking could prevent increasing metabolic syndrome prevalence in Korean adults.

Association between Glycated Hemoglobin A1c and Intraocular Pressure in Nondiabetic Subjects

BACKGROUND: Diabetic patients are known to have unusually high mean intraocular pressure (IOP); attributable to autonomic dysfunction and genetic factors. A recent study reported that diabetic complications occur in not only diabetes but also prediabetes. We performed this study to analyze the relationship between glycated hemoglobin A1c (HbA1c) levels and IOP in non-diabetics using electronic medical records at the health screening center of Soon Chun Hyang University Seoul Hospital.METHODS: We considered 16,643 individuals who visited the health screening center of Soon Chun Hyang University Seoul Hospital between November 2015 and September 2017. In total, 3,029 subjects were included in the study. Exclusion criteria included a history of hypertension, diabetes, stroke, cardiovascular disease, hepatitis (A-C), cancer, other disease, fasting blood glucose of 126 mg/dL or higher, HbA1c of 6.5% or higher, and individuals whose binocular IOP could not be measured. We categorized subjects into two groups; those with HbA1c less than or equal to 5.6%, and those with HbA1c greater than 5.6% and less than 6.5%. The mean IOP of each group was compared by gender.RESULTS: After adjusting for factors affecting IOP, analysis of variance was performed to analyze the relationship between HbA1c and IOP. There was no statistically significant difference between the HbA1c groups in males. However, there was a significant difference in IOP between females in the the higher and lower HbA1c groups.CONCLUSION: There was a statistically significant relationship between mean IOP and HbA1c in females without diabetes. Further research is needed with prospective and extensive data collection.

The factors associated with Vitamin D deficiency in community dwelling elderly in Korea

BACKGROUND/OBJECTIVES: Recent studies showed vitamin D deficiency is linked to chronic diseases in addition to skeletal metabolism which could threaten the elderly. We analyzed health conditions and socio-demographic factors associated with vitamin D deficiency in community dwelling people aged 65 years and older. SUBJECTS/METHOD: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 to 2012 were obtained. A total of 2,687 subjects aged 65 years and older were participated. The cutoff value of the Vitamin D deficiency was considered as serum 25-hydroxyvitamin D [25(OH)D] ≤ 20 ng/mL (50 nmol/L). RESULTS: The overall prevalence rate of vitamin D deficiency in the elderly was 62.1%. The factors such as female, obesity, metabolic syndrome, current smoker, and skipping breakfast were positively associated with vitamin D deficiency, but high intensity of physical activity and more than 9 hours of sleep duration were negatively associated with vitamin D deficiency (all P < 0.05). CONCLUSIONS: It is important that health professions know that the factors proved in this study are connected to vitamin D deficiency thus provide information and intervention strategies of vitamin D deficiency to old aged people.

Accuracy of Capillary Blood Glucose Test When Fasting in Diabetes Patients or General Population: Performance Evaluation of G300 Based on ISO 15197:2013 Standards

BACKGROUND: Self-monitoring of blood glucose plays an important role in management of diabetes mellitus. Blood glucose measurement is based on using plasma glucose separated from whole blood, but many people with diabetes and health care providers use a portable glucose meter for convenience. The aim of this study was to evaluate the accuracy and agreement of G300 portable glucose monitoring system against standard venous glucose testing methods, based on ISO 15197:2013 standards. METHODS: This study was the evaluation of G300 system accuracy following ISO 15197:2013 standards. We estimated precision, system accuracy, hematocrit interference, interfering substances, and user performance. RESULTS: In repeatability precision evaluation of those glucometers, standard deviation was 2.9–3.7 mg/dL at glucose levels under 100 mg/dL and coefficient of variation was 1.7–3.2% at glucose levels over 100 mg/dL, respectively. In accuracy evaluation, 99.5% of difference values between results of G300 portable glucose monitoring system and clinical laboratory were within 95%. Consensus Error grid analysis showed that all values (100%) are within zone A. Hematocrit range between 20% and 60% did not cause interference. These results were acceptable for the ISO15197:2013 criteria in all glucose concentrations. CONCLUSIONS: This study showed that G300 can provide reliable blood glucose results for patients and health care providers to manage diabetes mellitus, satisfying the ISO 15197:2013 criteria.

Vitamin D status and its association with cardiometabolic risk factors in Korean adults based on a 2008-2010 Korean National Health and Nutrition Examination Survey

Recent studies suggest that vitamin D deficiency and cardiometabolic disorders are becoming increasingly more prevalent across multiple populations. However, there is a lack of comprehensive data for Korean adults. We investigated the vitamin D status, the prevalence of vitamin D deficiency and its association with metabolic syndrome (MS) risk in Korean adults aged 20 years or older. The study subjects (n = 18,305) were individuals who participated in the Korean National Health Examination and Nutrition Survey (KNHANES) in 2008-2010. Vitamin D status (25-hydroxyvitamin D [25(OH)D]) was categorized as or = 30 ng/mL, which are the cut-off points for deficiency, insufficiency and normal limits. A wide variety of cardiometabolic risk factors were compared according to the vitamin D status. Vitamin D deficiency was found in 53.9% of men and 70.5% of women. Mean BMI, systolic BP, HbA1c and low density lipoprotein cholesterol (LDL-C) were highest in the vitamin D deficiency group in both genders. Further, the MS was most prevalent in the vitamin D deficiency group in both genders (12.3%, P = 0.002 in men and 9.2%, P < 0.001 in women). Compared to the vitamin D normal group, the adjusted odds ratio (ORs) (95% confidence interval [95% CI]) for MS in the vitamin D deficiency group were 1.46 (1.05-2.02) in men and 1.60 (1.21-2.11) in women, after adjusting for confounding variables. In conclusion, Vitamin D deficiency is a very common health problem in Korean adults and is independently associated with the increasing risk of MS.

The Analysis of Risk Factors of Gall Stone Associated with Metabolic Syndrome

OBJECTIVE: Recently, the prevalence of gall stone related with metabolic syndrome is increasing in Korea. The aim of this study was to reveal a relationship between components of metabolic syndrome and the development of gall bladder stones. METHODS: Among the subjects who visited a health promotion center of Soonchunhyang University Hospital from March 2009 to March 2010, a total of 5,201 adults were examined. Among them, the final 5,052 (male 3,403, female 1,649) adults were included. Sex, age, body mass index, waist circumference, blood pressure, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol levels, and the presence of gall stones were measured. Metabolic syndrome was defined by criteria of 2004 American Heart Association/Updated National Cholesterol Education Program Adult Treatment Panel III. Analyses were adjusted by age and sex. RESULTS: This study showed that the prevalence of gall stone was 1.6% and metabolic syndrome was 19.3%. The results didn't show an association between gall stone risk and components of metabolic syndrome. But gall stone risk was increased according to aging, high total cholesterol in the abnormal body mass index group. In normal body mass index group, waist circumference was related with the development of gall stone. Total cholesterol level was related with the development of gall stone in overweight group. CONCLUSION: This study showed total cholesterol levels and waist circumference related with prevalence of gall stone in specific body mass index group.

A case of severe metabolic acidosis after orthotopic neobladder replacement / 대한내과학회지

Following a radical cystectomy to treat bladder cancer, the ureters can be implanted in a short loop of ileum, which serves as an orthotopic bladder replacement. However, several investigators have reported the frequent development of a normal anion gap metabolic acidosis and electrolyte disturbance in these patients. The colon segments secrete sodium and bicarbonate ions and reabsorb ammonium, hydrogen, and chloride ions when exposed to urine, causing metabolic acidosis. In most cases, the acid-base disorder is not very troublesome. The metabolic acidosis can usually be corrected by administering sodium bicarbonate. We experienced a case of severe metabolic acidosis associated with urinary diversion that improved with continuous renal replacement therapy (CRRT).

A Case of Partial Spontaneous Regression of Non-Small Cell Lung Cancer / 결핵및호흡기질환

Spontaneous regression is extremely rare in lung cancer and this in spite of its global high incidence. So far, less than 30 such cases have been reported in the literature. We report here on the case of a 68-year-old man who had the diagnosis of adenocarcinoma and in absence of any medical therapy, he had a partial spontaneous regression of tumor.

A Proteomic Approach for Quantitative Analysis of Calcitonin Gene-related Peptides in the Cerebrospinal Fluid Obtained from a Rat Model of Chronic Neuropathic Pain / 대한통증학회지

BACKGROUND: This study was conducted to quantitatively analyze proteins associated with the calcitonin gene-related peptide (CGRP) in cerebrospinal fluid (CSF) that was obtained from a rat model of chronic neuropathic pain following administration of intrathecal CGRP(8-37). METHODS: Male Sprague-Dawley rats (100-150 g, 5-6 wks) were divided into two groups, sham controls and neuropathic pain models. At the time of operation for neuropathic pain model, an intrathecal catheter was threaded through the intrathecal space. At 1 or 2 wks after the operation (maximum pain state), a test dose of 1, 5, 10, or 50 nM of CGRP(8-37) was injected into the intrathecal catheter and the CSF was then aspirated. Conventional proteomics to evaluate the CSF were then performed using high resolution 2-D, gel electrophoresis followed by computational image analysis and protein identification by mass spectrometry. RESULTS: Treatment with CGRP(8-37) effectively alleviated mechanical allodynia in a dose dependent manner. The most effective response was obtained when a dose of 50 nM was administered, but significant differences were obtained following administration of only 5 nM CGRP(8-37). Furthermore, the results of the proteomic analysis were consistent with the experimental results. Specially we detected 30 differentially expressed spots in 7 images when 2-D gel electrophoresis was conducted. The intensity of 6 of these spots (spot number: 20 and 26-30) was found decrease the CGRP(8-37) dose increased; therefore, these spots were evaluated by mass spectrometry. This analysis identified 2 different proteins, CGRP (spot numbers: 26-30) and neurotensin-related peptide (spot number: 20). CONCLUSIONS: The results of this study suggest that CGRP plays a role in chronic central neuropathic pain and is a major target of chronic neuropathic pain management.

A Case Report of Fitz-Hugh-Curtis Syndrome due to Chlamydia in 19-year-old Woman

Fitz-Hugh-Curtis syndrome (FHCS)-inflammation of the liver capsule (Perihepatitis) associated with genital tract infection-occurs in 4~14% of patients with pelvic inflammatory disease (PID). Generally presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis. It needs differential diagnosis such as cholecystitis, pyelonephritis. The pathogenesis of FHCS is incompletely understood. But Neisseria gonorrhoeae and Chlamydia trachomatis are thought to be the primary causative germs of FHCS. We make a report about FHCS in 19-year-old woman who had been sexual history recently.

Upper body cancer pain management by cervical intrathecal catheterization: A case report / 대한마취과학회지

It has been known that more than 5% of cancer patients experience severe pain refractory to medical treatments. So it is necessary to use epidural or intrathecal analgesia with opioids and local anesthetics when systemic trial has failed. Although intrathecal catheter placement and drug infusion has some risks, it shows better pain control with least amount of analgesics. The authors managed a patient who had suffered from intractable cancer pain due to metastatic pancreatic cancer. His pain was spreading to his upper body area including chest wall and interscapular region as well as original abdomen and back pain. Pain severity became extreme reaching VAS (visual analogue scale) score to above 9. Cervical epidural catheterization and continuous drug infusion was not effective in this case. So the authors chose to give analgesics intrathecally, and placed the intrathecal catheter on 5th cervical vertebral level and connected it to subcutaneous port so that drugs could be infused continuously. The effect was dramatic by 5 mg/day morphine and 20 mg/day lidocaine, VAS score decreased to below 3 without any possible complications.

A Case of Pulmonary Thromboembolism in a Patient with Hyperhomocysteinemia / 결핵및호흡기질환

Hyperhomocysteinemia is an independent risk factor for cardiovascular, cerebrovascular and peripheral vascular diseases that are complicated by atherosclerosis and a thromboembolism. An increased level of plasma homocysteine develops from a genetic defect in the of enzyme for the homocysteine metabolism or a vitamin deficiency. Hyperhomocysteinemia has direct toxic effect on the vascular endothelium and causes damages to the antithrombotic action of vascular endothelial cells. Most cases of hyperhomocysteinemia are asymptomatic, but cardiopulmonary or cerebrovascular incidents developin rare cases. In the case of a thromboembolism with an unknown cause, hyperhomocysteinemia should be considered in a differential diagnosis. The authors report a case of pulmonary thromboembolism in a patient with hyperhomocysteinemia with a review of the relevant literature.

Skin Burn Associated with Pulse Oximeter : A case report / 대한마취과학회지

A pulse oximeter is used widely on account of its convenience and very few complications. We experienced a case of accidental burning by a pulse oximeter sensor. An 83-year-old woman underwent total hip replacement surgery. A pulse oximeter (Oxisensor II N-25, Nellcor Puritan Bennett Inc., USA) was placed on the left index finger. The patient complained of pain on her index finger 5 minutes after the operation began. A localized skin burn was found underneath the sensor of the pulse oximeter. The skin burn healed without any sequelae.

Comparing Various Short-Form Geriatric Depression Scales in Elderly Patients

BACKGROUND: A 15-item GDS form is now widely used to screen for depressive symptoms in elderly patients, but even the 15-item version seems fairly long for routine use in busy outpatient settings. This study was conducted to determine which of the three short-form GDS tools with four or five questions extracted from the 15-item GDS tool could be a valid alternative to the 15-item GDS. METHODS: This study was performed using a questionnaire survey of 102 elderly patients over sixty-five, who had either visited or had been admitted in either one of the two universities hospitals in Seoul or ChungCheong district from October 1999 to June 2004. Questionnaire contained demographic and statistical characteristics, items related to health behavior, 15-item GDS, Mini-Mental State Examination Korean (MMSE-K) and activities of daily living. Three scales, namely, D'Ath GDS-4, Van Marwijk GDS-4, and Hoyl GDS-5 were compared to the 15-item GDS. Sensitivity, specificity, positive predictive value and the area under the ROC curves were calculated for each short-form GDS scales. RESULTS: The mean 15-item GDS score was 7.4+/-3.3 and 69.6% of the subjects were to have suggested depression. Hoyl GDS-5 instrument had the highest sensitivity of 87.3%, specificity of 80.6%, and positive predictive value of 91.1% among the three short-form alternatives. The 5-item Hoyl GDS version had the highest area under the curve (0.84), compared to 0.76 for the 4-item Van Marwijk and 0.66 for the 4-item D'Ath GDS version. CONCLUSION: The 5-item Hoyl GDS had superior validity over the D'Ath GDS-4 and Van Marwijk GDS-4. The GDS5/15 may be an effective alternative screening tool.

COX-2 and iNOS Expression and Microvessel Density by Microsatellite Instability in Colorectal Cancer

PURPOSE: We tried to identify the overall incidence of microsatellite instability (MSI) and the utility of mismatch repair (MMR) protein expression in sporadic colorectal cancers in Korean. We also investigate the role of angiogenesis in colorectal cancers by MSI status. METHODS: A total 85 resected colorectal cancers were submitted for MSI study using PCR methods with 5 markers and immunohistochemistry (IHS) for hMLH1 and hMSH2. Expression of COX-2 and iNOS and microvessel density by IHS were correlated with various clinicopathologic prognostic factors. RESULTS: Among 85 cases of sporadic colorectal cancers, MSI was observed in 11 cases (12.9%) including 10 MSI-H and 1 MSI-L cases. Patients with MSI (+) showed female prevalence (1.75 : 1), low Dukes stage, mucinous histologic type, and Crohn-like lymphoid reaction than those with MSS. Overall sensitivity of hMLH1 and/or hMSH2 expression was 98.6% and specificity was 72.7%. iNOS expression was significantly correlated with COX-2 expression in tumor cells (P=0.006), however, they were not correlated with MSI status. High microvessel density was correlated with hMLH1 expression (P=0.025), COX-2 expression (P= 0.05), and Crohn-like lymphoid reaction (P=0.041). CONCLUSIONS: IHS for MMR proteins is a valuable substitute of MSI status and COX-2 related neoangiogenesis is thought to be related to inhibition of microsatellite unstable colorectal cancer progression via decreased microvessel density.

A Case of Multiple Glomus Tumors Showing Histopathologic Feature of Glomangiomyoma / 대한피부과학회지

We report a case of multiple glomus tumors showing histopathologic feature of glomangiomyoma with a review of the literature. The patient presented with multiple, tender, subcutaneous nodules on the back, thigh, and arm. Skin biopsy from the back revealed glomangioma. Three years later, new lesions appeared on the waist and soles and pain was noted on the thigh and back lesions. Additional skin biopsy at the same site was performed to reveal glomangiomyoma.

Factors Related to Cognitive Impairment of Elderly Patients in Kyongin District

BACKGROUND: With the rapid increase in elderly population arousing from development of medical technology and in standards of living, mental disorders as well as organic disorders according to aging constitute a serious social problem. This study aimed to find a factor related closely to cognitive impairment by analyzing the risk factors influencing cognitive impairment, which is one of the typical geriatric neuropsychiatric conditions. METHODS: This study was conducted using a questionnaire survey and history taking and physical examination was done in 200 elderly patients over sixty-five, who had visited either of the four universities hospitals in the Kyongin district from July 1997 to June 2002. A variety of factors being widely known to be related to cognitive impairment by was investigated using the existing comprehensive geriatric assessment. By using MMSE-K (Korea version of Mini- Mental State Examination), the relation between cognitive impairment and each variable was analyzed by using chi-square test and logistic regression analysis with SPSS 10.0k/PC statistical program. RESULTS: The number of males and females was 73 (36.5%) and 127 (63.5%), respectively, among the total number of 200 examinees. Males and females having symptoms of cognitive impairment was 25 (34.2%) and 49 (38.6%) among the total number of 74 (37%), respectively. Total mean point of MMSE-K was 24 5.4, 24 5.3 in males and 23.9 5.5 in females. According to the results of multi-variable quantities analysis, it was shown that the cognitive impairment had positive relation to age (P= 0.004), but negative relation to regular exercising (P= 0.016), instrumental activities of daily living (P=0.039) and social support (P=0.003). CONCLUSIONS: The factors having a close relation to cognitive impairment of elderly people were social support, age, regular exercising and instrumental activities of daily living.

The clinical outcomes of Occlusion for Monocular Amblyopia in Children More than 8 years

PURPOSE: We schemed to help the therapeutic plan in amblyopic children of old age group by analyzing the clinical outcomes of occlusion therapy in amblyopic children more than 8 years old. METHODS: In 104 unilateral amblyopic children whose occlusion therapy had been finished, the retrospective study was performed. The average age at the beginning of treatment was 5.9 years (1.2~15.2 years). We divide the patients into three groups on the basis of age at the beginning of treatment: below 4 years (group 1, N=41), 5~7 years (group 2, N=44), more than 8 years (group 3, N=19). The success rate of occlusion therapy in group 3 was compared with the success rate of other groups, and the clinical features of group 3 were analyzed. RESULTS: The success rate of occlusion therapy in group 3 (68.4%) was significantly low compared with other groups (p<0.05). In group 3, the success rate of anisometropic amblyopia (90.0%) was significnatly higher compared with the success rate of strabismic amblyopia (44.4%)(P<0.05), and it was similar to the success rate of anisometropic amblyopia of other groups. CONCLUSIONS: The success rate of occlusion therapy in amblyopic children more than 8 years old was significantly lower compared with other groups. But the clinical outcomes were fair, especially in anisometropic amblyopia. We suggest to enforce occlusion therapy in amblyopic children more than 8 years old.

Case of Perforating Osteoma Cutis

A 24-year-old man presented with a 1.5 × 0.5 cm-sized erythematous nodule with central crust on the forehead since 5 years ago. There was no history of trauma or previous skin disorders. Histopathologic examination showed a typical picture of osteoma cutis. In addition, transepidermal elimination of bony material was observed: red linear plate-like calcified lamella structures had extruded to the skin surface through the perforated epidermis. The perforating type of osteoma cutis was discussed.