The Usefulness of Indices for Central Obesity Estimated by Bioelectrical Impedance Analysis in the Diagnosis of Metabolic Syndrome

BACKGROUND: Recently-developed equipment based on bioelectrical impedance analysis (BIA) not only measures total body fat but also displays several estimated indicators that reflect intra-abdominal fat, such as waist circumference (WC) and waist-to-hip ratio (WHR). This study examined the usefulness of these indicators in the diagnosis of metabolic syndrome (MS). METHODS: A total of 632 people over 20 years of age (355 men and 277 women, mean age 48.61+/-11.08 years, mean BMI 23.62+/-3.00 kg/m2, 117 MS patients) were enrolled in the study. Measurements of WC and hip circumference were measured by one individual, and WHR was calculated. BIA was performed to estimate waist circumference (BIAWC) and waist-to-hip ratio (BIAWHR). Receiver operating characteristic (ROC) curve analysis was used to examine the usefulness of BIAWC and BIAWHR in diagnosing MS. RESULTS: The areas under the curve (AUCs) were 0.836 (95% CI 0.805-0.864) for WC, 0.814 (95% CI 0.782-0.844) for BIAWC, 0.815 (95% CI 0.782-0.844) for WHR, and 0.805 (95% CI 0.772-0.835) for BIAWHR. The difference between the AUCs of WC and BIAWC (0.022, 95% CI -0.004 to 0.048) and the difference between the AUCs of WHR and BIAWHR (0.010, 95% CI -0.015 to 0.034) were not significant. CONCLUSIONS: The indices for central obesity estimated by BIA had high agreement with the direct method, and they were not inferior to direct measured indices for predicting metabolic syndrome.

Applying Inhaled Furosemide for Refractory Breathlessness in Terminally-ill Cancer Patients: Based on Seminar of Palliative Medicine Research Group, The Korean Academy of Family Medicine / 한국호스피스완화의료학회지

Breathlessness is a frequent and distressing symptom in terminal cancer patients. Refractory breathlessness is defined as a state that does not respond to conventional disease-specific therapy with an exclusion of reversible underlying causes, and the main classes of symptomatic drug treatments include opioids and benzodiazepines. Korean Family Medicine Palliative Medicine Research Group discussed two terminal cancer patients in whom severe breathlessness with different causes were treated with inhalation of nebulized furosemide, which is an emerging option of palliative treatment. It still remains unclear how it becomes effective or how much it is effective, therefore, its routine use seems to be somewhat early. Nevertherless, if a patient with intractable breathlessness does not have a marked obstructive airway lesion, its use should be considered. Based on the discussion in the seminar, we want to share our experience of the application of inhaled furosemide with other palliative care practitioners and strongly recommend further research on this topic in the future.

One Case of Malignant Mixed Mullerian Tumor Developed in a Postmenopausal Woman under Hormone Therapy / 가정의학회지

Hormone therapy for peri- and postmenopausal women is widely used for relieving vasomotor symptoms or preventing osteoporosis. Even though exogenous hormone is the most common cause of vaginal bleeding in postmenopausal women under hormone therapy, in clinical practice, physicians must never exclude the possibility of endometrial disorders, such as endometrial hyperplasia or cancer. Taking thorough medical history and performing physical and pelvic examinations are essential for the evaluation of abnormal uterine bleeding in menopausal hormone therapy. Transvaginal ultrasonography, endometrial aspiration biopsy, dilatation and curettage, and hysteroscopy are the options which physicians may use. This case is about a woman with continuous combined hormone therapy for 5 years who had experienced rather sudden onset of vaginal spotting lasting for several months and was finally diagnosed as having malignant mixed Mullerian tumor. Our purpose is to inquire into the proper approaching steps for vaginal bleeding in menopausal hormone therapy.

Membrane activator of the 72 kDa type IV collagenase in malignant breast carcinoma patients: Expression of membrane-type 1-matrix metalloproteinase (MT1-MMP)

In this study, we determined proMMP-2 activating capacity of membrane extract prepared from the tissue of invasive ductal carcinoma of breast by zymogram gel analysis. We compared the effect of membrane extract on the activation of the latent type IV collagenases with that of the organic mercurial compound leg, APMA)-induced self cleavage of the latent type IV collagenases. We also compared the expression levels of MT1-MMP between invasive carcinoma and normal tissue by Western blot, Northern blot and semi-quantitative RT-PCR analysis. Our result demonstrated that the specificity of processing by breast carcinoma membrane activator corresponds to the specificity of MT1-MMP, which clearly showed the conversion of 72-kDa proMMP-2 to the activated form while APMA processed both 72- and 92-kDa proMMPs to their activated forms. MT1-MMP protein and mRNA were expressed both in invasive carcinoma and normal tissues, and the expression levels in both tissues were comparable. Quantitative analysis of the mRNA level by RT-PCR revealed that the difference of MT1-MMP mRNA between carcinomas and normal tissues was not statistically significant on Wilcoxon signed-ranks test (P>0.05). The results from the study on the expression of MT1-MMP gene suggest that the cellular activation of MMP-2 in breast tissue, requires additional effects in addition to up-regulation of MT1-MMP.