Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study

BACKGROUND: Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ≤ 50 years old. METHODS: We retrospectively analyzed a consecutive cohort of 150 patients (≤ 50 years old) with chronic hip pain (≥ 6 weeks), which was not diagnosed or misdiagnosed based on the information provided on the referral form. RESULTS: Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. CONCLUSION: Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

Effect of 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol on Immune Functions in Healthy Adults in a Randomized Controlled Trial

We previously reported that 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) accelerates hematopoiesis and has an improving effect on animal disease models such as sepsis and asthma. The effects of PLAG supplementation on immune modulation were assessed in healthy men and women. The objective was to evaluate the effects of PLAG supplementation on immune regulatory functions such as activities of immune cells and cytokine production. A randomized double blind placebo-controlled trial was conducted. Seventy-five participants were assigned to one of two groups; all participants had an appropriate number of white blood cells on the testing day. The PLAG group (n=27) received oral PLAG supplements and the control group (n=22) received oral soybean oil supplements. IL-4 and IL-6 production by peripheral blood mononuclear cells (PBMC) were lower (p<0.001 and p<0.001, respectively) with PLAG than with soybean oil. However, the production of IL-2 and IFN-gamma by PBMC was unaltered with PLAG supplementation. The B cell proliferation decreased significantly in the PLAG group compared to the soybean oil control (p<0.05). The intake of PLAG in healthy adults for 4 weeks was deemed safe. These data suggest that PLAG has an immunomodulatory function that inhibits the excessive immune activity of immunological disorders such as atopic and autoimmune diseases. PLAG could improve the condition of these diseases safely as a health food supplement.

National Utilization of Calcium Supplements in Patients with Osteoporotic Hip Fracture in Korea

BACKGROUND: Calcium is prescribed worldwide for patients diagnosed with osteoporosis. However, the national utilization of calcium and compliance with calcium is unclear in Korea. Our purpose is to evaluate Korea's national utilization of calcium and compliance with calcium in patients with osteoporotic hip fracture from 2007 to 2010 using data from the Health Insurance Review and Assessment (HIRA) Service. METHODS: From 2007 to 2011, osteoporotic hip fractures were identified using the International Classification of Diseases, 10th revision (ICD-10) and procedure code form from the nationwide database of the Health Insurance Review and Assessment Service. Compliant users of calcium were defined as the patients' medication possession ratio of 80 or more. We analyzed the compliance of calcium according to age and gender. RESULTS: Among 85,228 patients with hip fracture, 20,800 patients (24.4%) received a prescription of a calcium supplement. Among them, only 1,692 patients (8.1%) were identified as compliant users of calcium. The proportion of compliant users was higher in women than men in all age groups. The proportion of compliant users decreased with age in women. CONCLUSIONS: In Korea, the national utilization of calcium was low and compliance with calcium was unsatisfactory even in patients with osteoporotic hip fracture.

Low Levels of Physical Activity Are Associated with Increased Metabolic Syndrome Risk Factors in Korean Adults

BACKGROUND: Low levels of physical activity (PA) are strongly associated with the development of metabolic syndrome (MetS) and chronic diseases. However, few studies have examined this association in Koreans. The primary purpose of this study was to examine the associations between PA and MetS risks in Korean adults. METHODS: A total of 1,016 Korean adults (494 males and 522 females) participated in this study. PA levels were assessed using the International PA Questionnaire. MetS risk factors were determined using clinically established diagnostic criteria. RESULTS: Compared with the highest PA group, the group with the lowest level of PA was at greater risk of high triglyceride (TG) in males (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.07 to 3.24) and of hemoglobin A1c > or =5.5% in females (OR, 1.75; 95% CI, 1.00 to 3.04) after adjusting for age and body mass index. Compared with subjects who met the PA guidelines, those who did not meet the guidelines were more likely to have low high density lipoprotein cholesterol in both males (OR, 1.69; 95% CI, 1.11 to 2.58), and females (OR, 1.82; 95% CI, 1.20 to 2.77). Furthermore, those who did not meet the PA guidelines were at increased risk of high TG levels in males (OR, 1.69; 95% CI, 1.23 to 2.86) and abnormal fasting glucose (OR, 1.93; 95% CI, 1.17 to 3.20) and MetS (OR, 2.10; 95% CI, 1.15 to 3.84) in females. CONCLUSION: Increased levels of PA are significantly associated with a decreased risk of abnormal MetS components.

Association between Obesity and Physical Fitness, and Hemoglobin A1c Level and Metabolic Syndrome in Korean Adults / 당뇨병

BACKGROUND: The purpose of the current study was to investigate the association of obesity level, physical fitness level, hemoglobin A1c (HbA1c) level and metabolic syndrome (MetS) risk factors among Korean adults. METHODS: A total of 557 adults (272 males and 285 females) who underwent medical check-up at local hospital were recruited. In addition to regular health check-up, cardiopulmonary fitness, muscular endurance were measured and their association were analyzed. RESULTS: The prevalence of MetS was 31.7% for males and 23.7% for females. Females with the higher muscular endurance had lower waist circumference, triglyceride level, and HbA1c level than those with the lower muscular endurance. Males with the higher level of cardiopulmonary fitness had lower diastolic blood pressure, lower high-sensitivity C-reactive protein level and higher high density lipoprotein cholesterol level than males with the lower level of cardiopulmonary fitness. Females with the higher level of cardiopulmonary fitness had lower body weight, body mass index, systolic blood pressure, and fasting blood glucose level than females with the lower level of cardiopulmonary fitness. Participants with the higher level of adiposity and the lower level of physical fitness were 5.26 times (95% confidence interval [CI], 2.19 to 12.62), 5.71 times (95% CI, 2.23 to 14.60) more likely to have MetS, respectively, in male and female compared to participants who were neither obese nor have the lower level of fitness. CONCLUSION: This study suggests that maintaining a healthy body weight as well as a certain level of fitness is important for the prevention of MetS.

Physical and Emotional Status of Nursing Home Residents: Long-term Care of Older People via Incheon Nursing Home Network (LOVE) Study

BACKGROUND: The aim of the Long-term Care of Older People via Incheon Nursing Home Network (LOVE) study was to evaluate disease status and its association with physical activity and emotional status among the elderly in nursing homes. METHODS: This retrospective study included 1,379 nursing home residents aged 65 years and older, of which 260 were excluded due to lack of baseline information. Data regarding major diseases from 1,119 people were analyzed to compare prevalence according to age. Data about physical function and emotional status on admission from 497 residents were analyzed looking for contributing factors to limited function and unstable emotion. RESULTS: Hypertension was the most common ailment at 58.6% of the total followed by dementia (50.6%), stroke (28.7%), and diabetes (24.2%). Prevalence of diabetes (p<0.001) and stroke (p<0.001) were relatively low in the older age groups but that of osteoarthritis (p<0.001) and dementia (p=0.001) were relatively high. After adjusting for age and sex, limited physical activity was more frequent in those with strokes (odds ratio [OR], 3.7 [2.1-6.2], p<0.001) and fractures (OR, 2.1 [1.1-4.1], p=0.023). Unstable emotion was more frequent in residents with dementia (OR, 1.9 [1.3-2.8], p=0.001). CONCLUSION: The most common diseases among nursing home residents, in decreasing order, were hypertension, dementia, stroke, and diabetes. Diseases related to the need for physical aids were strokes and fractures. Effective strategies for the management of unstable emotional status in the elderly with dementia are needed.

Erratum: Author's Name Correction / 당뇨병

No abstract available.

The Significance of Bone Scan and Classificationin Young Adult Osgood-Schlatter Disease

PURPOSE: We retrospectively classified the young adult Osgood-Schlatter disease by plain radiography and accessed the relationship between bone scan results and symptom duration. MATERIALS AND METHODS: From 2004 to 2007, young adults with symptoms of Osgood-Schlatter disease were included in the study. The patients were classified into 3 groups, protrusion, cleft and ossicle, according to their radiographic results. All patients had bone scan exams, we analyzed the correlation between the bone scan results and the duration of symptoms. RESULTS: All patients were male with average age of 19.8 (18.5~22.0) years old. Out of 59 patients, 27 were bilateral. Of 86 knee joints, 36 came out positive with bone scan. Positive bone scan rate was 11.1% in protrusion type, 40.0% in cleft type and 61.4% in ossicle type. The pain persisted longer in ossicle type than the others. The symptom duration correlated with the bone scan results. CONCLUSION: We classified young adult Osgood Schlatter disease as three types. The ossicle type of Osgood-Schlatter disease has longer symptom duration, which correlates with the bone scan results. The bone scan result can be one of reliable reference factors for the treatment of young adult Osgood-Schlatter disease.

Association between Metabolic Syndrome and Plasma Homocysteine among Korean Adults

BACKGROUND: Elevated plasma homocysteine is an independent risk factor for cardiovascular diseases caused by atherosclerosis. Previous studies have shown that plasma homocysteine is associated with components of the metabolic syndrome such as hypertension, insulin resistance, and dyslipidemia. In this study, we investigated the association between the plasma homocysteine levels and the metabolic syndrome on Korean adults. METHODS: The study group with the metabolic syndrome and the control group without the metabolic syndrome were selected from the examinees of equivalent age and gender in the Health Promotion Center. Among the subjects, 107 adults with the metabolic syndrome and 123 adults without the metabolic syndrome were categorized into the study and the control groups, respectively. Medical history, medication, and life style were recorded through a questionnaire and physical examination was performed on all subjects. We measured fasting glucose, total cholesterol, triglycerides, high-density lipoprotein, hs-CRP, homocysteine levels and others by blood sampling. The metabolic syndrome was defined by the criteria for clinical diagnosis of the metabolic syndrome by AHA/NHLBI. RESULTS: The mean ages in the study group and the control group were 54.6+/-9.3 and 54.6+/-8.7 years, respectively, and the numbers of males 29 (27.1%) and 39 (31.7%), respectively. The plasma homocysteine was observed to be positively correlated with age, waist circumference, diastolic blood pressure, apolipoprotein A-1, fasting glucose, fasting insulin, HOMA-IR, and hs-CRP. Among the components of the metabolic syndrome, hypertension showed a strong correlation with the levels of the plasma homocysteine (10.62+/-3.92 micronmol/L vs. 9.09+/- 2.63 micronmol/L, P=0.001), whereas hyperglycemia, abdominal obesity, and dyslipidemia did not correlate with the levels of plasma homocysteine. Adjusted homocysteine levels to age, gender, alcohol drinking history, and smoking history was still higher in the study group compared to those in the control group (10.320+/-0.290 micronmol/L vs. 10.320+/-0.290 micronmol/L, P=0.017). CONCLUSION: The results indicate that the metabolic syndrome leads to a higher level of homocysteine in adults after adjustment to age, gender, alcohol drinking history, and smoking history.

Relationship between Fatty Liver and Osteoporosis in Postmenopausal Women

BACKGROUND: The objective of the current study was to evaluate the association between fatty liver and osteoporosis in Korean postmenopausal women. METHODS: We examined postmenopausal women who participated in a health screening test from April 2004 to November 2007. Data about lifestyle and current medical diseases and medications were collected from medical records and medical interviews. Body weight, height, waist circumference and blood pressure were measured. Bone mineral density (BMD) was measured by dual- energy X-ray absorptiometry and body composition analyzer and abdominal ultrasonography were conducted for each participant. RESULTS: One thousand two hundred forty-five postmenopausal women were selected for this study. In postmenopausal women, the spine BMD levels (g/cm(2)) were significantly different in each subjects with normal (0.819+/-0.004), mild (0.846+/-0.007), moderate (0.844+/-0.009) and severe (0.779+/-0.031) fatty liver adjusted for age (P<0.01). The proportion of osteoporosis were significantly different in each subjects with normal (39.1%), mild (30.3%), moderate (31.6%) and severe (56.3%) fatty liver. A multiple logistic regression analysis was performed to determine the association between fatty liver and osteoporosis after age, body mass index, smoking, alcohol drinking and regular exercise. In severe fatty liver compared to the normal subjects of fatty liver, adjusted odds ratio was 3.6 (95% CI 1.2~10.9). CONCLUSION: In severe fatty liver disease, the proportion of osteoporosis was increased and the bone mineral density was lower than the normal subjects of fatty liver.

Relationship between Insulin Resistance and Circulating Levels of Monocyte Chemoattractant Protein?1 in Healthy Adults

BACKGROUND: Insulin resistance is one of the underlying causes for atherosclerosis. The monocyte chemoattractant protein-1 (MCP-1) plays a crucial role in initiating atherogenesis by recruiting monocytes/macrophages to vessel wall. In this study, we investigated the relationship between homeostasis model assessment-estimated insulin resistance (HOMA-IR) and circulating level of MCP-1 in healthy adults. METHODS: By reviewing the medical records of 171 healthy adults, we determined the circulating level of MCP-1, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL- cholesterol, HDL-cholesterol, fasting glucose, fasting insulin level and HOMA-IR. We studied the relationship between the variables by Pearson correlation coefficients and multiple linear regression analysis. RESULTS: MCP-1 correlated positively with HOMA-IR (r=0.28; P<0.01). Age, systolic blood pressure, diastolic blood pressure, triglycerides, LDL-cholesterol, fasting glucose and insulin level also showed stastically significant correlation. Age, gender, HOMA-IR were the variables which affected MCP-1 by multiple regression analysis adjusting for body mass index, systolic blood pressure, triglycerides, and LDL-cholesterol. CONCLUSION: In our study, circulating levels of MCP-1 were associated with insulin resistance. These findings support the potential role of MCP-1 as a biomarker for subclinical atherosclerosis.

Surgical Treatment of Posterosuperior Hip Dislocation in A Patient with Hereditary Sensory Autonomic Neuropathy Type IV: A Case Report

A 4-year old female patient with a diagnosis of hereditary sensory autonomic neuropathy type IV (congenital insensitivity to pain with anhidrosis) since the age of 1 year, sustained a posterior hip dislocation. During her initial stay at the hospital, an attempt at manual reduction failed. Open reduction, capsulorrhaphy, and Salter operation were done at 36 days after the index dislocation. After the operation there was a 23-degree acetabular index, and there were several abnormal round whitish gray fibrous nodules. There was also severe wound discharge, skin abrasion, and erythema on the patient's back and buttocks due to loss of protective sensation. After conservatively treating the wound and skin problems with prone positioning, we achieved a final acetabular index of 26 degrees. The patient did not have protective sensation in her hip joint. We were able to check for increasing instability after the index operation.

Serum gamma-GT and Hypertension

BACKGROUND: We analyzed the data obtained from regular health checkups performed in a university hospital and investigated the effect of serum gamma-GT on hypertension for both Korean males and females. METHODS: A total of 3,288 adult males and females over 20 years of age were selected for this study who visited a health promotion center from April, 2004 to April, 2005. Patients with HBs Ag (+) or anti-HCV Ab (+) and those currently on medication that could affect hepatic function were excluded. The subjects' history of illness and their present health and medication status were examined through questionnaires and history taking. Also, basic physical examinations and laboratory tests were performed on these subjects. RESULTS: Classifying the serum gamma-GT into quartiles, as the gamma-GT classification stage increased, there was an increase in the amount of smoking, alcohol, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, triglyceride and low density lipoprotein for males or female (respectively, P for trend <0.01). When odd ratio (95% CI) for hypertension in the highest quartile of gamma-GT was compared to that of the lowest quartile, there was an increased risk of hypertension with an odd ratio of 1.6 (95% CI, 1.0~2.3) and 1.6 (95% CI, 1.0~2.4) for males and females, respectively. CONCLUSION: This study showed that the risk of hypertension was increased according to serum gamma-GT, even though the variable index affecting cardiovascular diseases was adjusted.

Thyroid Status and Dementia in Old Age

Background: The relationship between clinical as well as subclinical thyroid disease and cardiovascular disease has been reported. Epidemiological evidence is accumulating that vascular risk factors increase the risk of AD. We sought to investigate the relationship between thyroid function and dementia. Methods: We examined patients who were admitted to geriatric ward of one psychiatric hospital in Kyong-Gi. The control group was individuals who underwent check up at a health promotion center of one university hospital in Daejeon. Results: The number of patients with dementia was 110. In the dementia group, there were 12 people with subclinical hyperthyroidism, 6 with subclinical hypothyroidism, and 2 with apparent hypothyroidism. After controlling for education, hypertension, diabetes and total cholesterol, multiple logistic regression yielded the odds ratio for dementia to be significantly higher in the group with low levels of thyroid stimulating hormone compared to the normal group (OR 4.00, 95% confidence interval 1.04~15.39). Conclusion: We found a significant relationship between dementia and subclinical hyperthyroidism.

The Effect of Pulse Rate on the Risk Factors of Cardiovascular Disease in the Adults

BACKGROUND: This study was to investigate the risk factors for cardiovascular diseases related to the heart rate and the effect of the heart rate on cardiovascular diseases such as hypertension and diabetes in Korean adults. METHODS: A total of 1,603 subjects were selected among males and females from 2,542 adults ages 40-69 years who visited a health promotion center from April, 2004 to April, 2005, excluding 939 adults who were taking medications or had diseases which affected the heart rate and those elderly above the age of 70 years. Past history, present illness, medication history and health status were evaluated using a questionnaire and history taking. Basic physical examinations and laboratory tests were performed the next morning after at least 12 hours fasting. RESULTS: The mean heart rate of male and female adults were 62.5+/-9.03 beats per minute and 64.2+/-8.36 beats per minute, respectively. The mean heart rate was significantly higher in the obesity group assessed by percentage body fat and in the central obesity group assessed by abdominal circumference among males. The mean heart rate was lower in subjects who were regular alcohol drinkers and who exercised regularly among females. In subjects with increasing stage of blood pressure and blood glucose level, the mean heart rate was increased significantly in both males and females. After adjusting for factors affecting hypertension or diabetes, there were increased risks of hypertension with an odds ratio of 1.03 and of diabetes with 1.06, by an increase of 1 beat per minute of heart rate. CONCLUSION: This study showed that indices related to cardiovascular risk factors were increased significantly with increasing heart rate and that the risk of hypertension and diabetes representing cardiovascular diseases was increased even after adjusting for variable index affecting cardiovascular diseases. Therefore, it is needed that clinicians evaluate the cardiovascular risk factors and underlying diseases, considering high heart rate as an important risk factor for cardiovascular diseases.

The Recurrent Psoas Abscess Caused by Two Different Pathogens: A Case Report / 대한정형외과학회잡지

We report a case of a recurrent psoas abscess caused by two different pathogens. The abdominal CT scans revealed a multiseptated cystic mass along the right psoas-iliacus muscle. The patient was treated with antibiotics treatment in combination with CT-guided percutaneous aspiration and drainage using a catheter. The microbiological examination revealed Klebsiella pneumoniae. Six months later, the patient presented with anorexia, malaise, epigastric pain, lower back pain and fever of 37.8 degrees C for a one-week duration. The abdominal CT scans revealed an abscess cavity on the inferior side of the right psoaos-iliacus muscle. This was accompanied by retrocecal appendicitis and a periappendiceal abscess. Magnetic resonance imaging of the pelvis showed that the psoas abscess was located on the right psoas-iliacus muscle. We performed an appendectomy and laparotomy. Subsequently, the culture yielded Escherichia coli in the psoas abscess. To our knowledge, this is the first case of a recurrent psoas abscess caused by two different pathogens.

Relationship of Serum Ferritin with Cardiovascular Risk Factors

BACKGROUND: Sullivan has suggested that higher incidence of coronary heart disease in men and postmenopausal women is due to higher levels of stored iron in these two groups. A few epidemiologic studies in humans have reported the association between iron stores and increased risk of cardiovascular diseases. But there is conflicting evidence regarding the relationship between iron and cardiovascular diseases. The present study evaluated the relationship between ferritin and well established cardiovascular risk factors. METHODS: There were 288 healthy subjects who visited a health promotion center of a general hospital. We collected data by means of self-reported questionnare and measured height, weight and blood pressure. Serum ferritin, fasting blood glucose, lipid profiles, and C-reactive protein were measured at a fasting state. RESULTS: Mean serum ferritin values were 150.1+/-82.2 ng/mL in men and 61.7+/-38.2 ng/mL in women (P<0.001). Serum ferritin level in current smoker was higher than in non-smoker (157.6+/-111.8 ng/mL versus 100.5+/-64.2 ng/mL, P=0.006). Serum ferritin was significantly and positively correlated with body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol and triglyceride. There was no statistical significance in age, C-reactive protein, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. In multiple regression analysis, there was association between ferritin and sex (beta=-80.333, P<0.001) and triglycerides (beta=0.182, P=0.030). CONCLUSION: The serum ferritin level in men is higher than in women in healthy adults. Serum ferritin is positively associated with triglycerides.

Visceral Abdominal Fat as a Determinant of Arterial Stiffness in Overweight and Obese Women

BACKGROUND: Increased abdominal obesity is clearly associated with metabolic diseases and associated with increased risk for atherosclerosis and cardiovascular diseases. But the mechanisms underlying these associations are not completely understood. The aim of this study was to correlate the regional body composition with pulse wave velocity in the overweight and obese women. METHODS: We investigated 104 overweight and obese participants. Regional body composition was distinguished by anthropometry, dual-energy X-ray absorptiometry, and computed tomography (CT). For estimates of arterial stiffness, we measured brachial ankle pulse wave velocity (baPWV). Fasting blood glucose, lipid parameters, CRP, and free fatty acid were measured. Pearson's correlation analysis and multiple regression analysis were conducted to identify the relationship between baPWV and regional body composition. RESULTS: Average age, fasting blood sugar, HDL-cholesterol, triglyceride, HOMA-IR, abdominal visceral fat area measured by CT, visceral fat area/ subcutaneous fat area (VSR), and visceral fat area/midthigh muscle area (VMR) were all significantly higher in the visceral obesity group than the subcutaneous obesity group. BaPWV was positively correlated with age, blood pressure, triglyceride, waist circumference, waist hip ratio, abdominal visceral fat area measured by CT, and VSR and inversely correlated with thigh subcutaneous fat area. In multiple regression models, after adjustment for confounding factors, baPWV was independently correlated with abdominal visceral fat area measured by CT (R2=0.560, P=0.006). CONCLUSION: Abdominal visceral fat area measured by CT was the only measurement positively associated with baPWV which explains the relationship of regional body composition and arterial stiffness.

Relationship between the Metabolic Syndrome and Cognitive Function

BACKGROUND: Several studies have revealed a relationship between the cognitive decline and several cardiovascular diseases. The relationship between the metabolic syndrome and cognitive function has not been studied yet in Korea. The objective of our study was to determine the relationship between the metabolic syndrome and cognitive function in elders above 50 years old. METHODS: We examined subjects who visited the health promotion center of one college hospital in Seoul. The metabolic syndrome was defined according to the National Cholesterol Education Program guidelines and we categorized the two groups by the presence of the metabolic syndrome. We used the Korean version of Mini Mental State Examination to check the cognitive functions and compared scores between these two groups. RESULTS: There were a total of 400 subjects (195 men and 205 women). Compared with those without the metabolic syndrome, elders with the metabolic syndrome had lower mean scores in K-MMSE (26.6+/-2.0-28.2+/-1.8, P<0.001). In subcategories of K-MMSE, the average scores of concentration or calculation were lower in the metabolic syndrome group (3.5+/-1.3) than in the control group (4.3+/-1.0) and the average scores of delayed recall were lower in those with the metabolic syndrome (1.7+/-0.9) than the control group (2.2+/-0.8) (P<0.001). After controlling for age, sex, education, smoking, alcohol, and body mass index, multiple regression yielded the metabolic syndrome to be independent associated factor in cognitive function (P<0.001). CONCLUSION: We found a significant relationship between decreased cognitive function and the metabolic syndrome. There are needs for prospective study about the possible development of dementia in the metabolic syndrome and probable prevention of dementia when cardiovascular risk factors in those are modulated.

The Relation of Pulse Pressure to Insulin-like Growth Factor (IGF)-1

BACKGROUND: Pulse pressure, a clinical marker of arterial stiffness, is an independent and strong predictor of cardiovascular disease, and reflects aging of arterial system. It is a well known fact that serum IGF-1 level is a parameter of growth hormone (GH) secretion and decreased GH secretion is related to aging. The aim of this study was to find out if there was any correlation between pulse pressure and IGF-1 concentration. METHODS: By reviewing the medical records of a hospital in Korea, healthy 194 men and 180 women were studied. We measured serum IGF-1, triglyceride, total cholesterol, HDL cholesterol concentrations and fasting blood sugar (FBS). Also, anthropometric and blood pressure measurements were performed. RESULTS: In men, the pulse pressure was positively correlated with age (r=0.29, P<0.001), systolic blood pressure (SBP) (r=0.70, P<0.001), diastolic blood pressure (DBP) (r=0.22, P=0.003), and body mass index (BMI) (r= 0.28, P<0.001) and inversely with IGF-1 levels (r=-0.27, P<0.001). In women, pulse pressure was positively levels with SBP (r=0.28, P<0.001), BMI (r=0.27, P<0.001), triglyceride (r=0.19, p=0.011), total cholesterol (r=0.15, P=0.049) levels, and FBS (r=0.17, P=0.027) and was not correlated with age, DBP, and serum IGF-1 levels. After adjustment for age, BMI, triglyceride, total cholesterol, and FBS, the pulse pressure was independently negatively correlated with serum IGF-1 levels (beta=-6.052, P=0.007) in men. The multiple regression analysis showed that serum IGF-1 levels (R2=0.04) was the third most powerful factor influencing the pulse pressure. CONCLUSION: There was as independent negative correlation between the pulse pressure and serum IGF-1 levels in healthy men.