Low Muscle Strength as Risk Factor for Non-Alcoholic Fatty Liver Disease in Different Metabolic Conditions.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) recently became a leading liver disease that threatens health worldwide. Low muscle strength, obesity, insulin resistance, and metabolic syndrome are recognized key factors for NAFLD. However, the impact of low muscle strength itself in different metabolic conditions has not been widely studied. METHODS: A cross-sectional analysis was performed of a sample of 5,427 participants from the 2019 Korea National Health and Nutrition Examination Survey. Relative handgrip strength (rHGS, defined as handgrip strength/body mass index) was used to assess muscle strength. The cut-off values for a low rHGS were 1.405 for men and 0.850 for women. NAFLD was diagnosed if the Hepatic Steatosis Index was >36. Participants were stratified according to insulin resistance, metabolic syndrome, and central obesity for the subgroup analyses. RESULTS: Complex sample multivariate logistic regression analysis revealed a significant association between low muscle strength and NAFLD after the adjustment for other confounders (odds ratio [OR], 1.92; P<0.001). In the insulin resistance, metabolic syndrome, and central obesity subgroups, a significant association between low muscle strength and NAFLD remained (OR, 1.66-4.19 depending on subgroup; all P<0.05), whereas it did not in the no central obesity group. CONCLUSION: This study demonstrated that low muscle strength is correlated with a risk of NAFLD. This relationship was independent of insulin resistance and metabolic syndrome but was dependent on the presence of central obesity.

Efficacy and safety of diacerein and celecoxib combination therapy for knee osteoarthritis: A double-blind, randomized, placebo-controlled prospective study.

BACKGROUND: Osteoarthritis is a degenerative disease with a growing burden in South Korea. Corresponding drugs are commonly used for pain relief and joint function improvement. Specifically, symptomatic slow-acting drugs for osteoarthritis are frequently used, with diacerein being the most common symptomatic slow-acting drugs for osteoarthritis in South Korea. In this study, we evaluated the efficacy and safety of diacerein and celecoxib combination therapy in patients with osteoarthritis. METHODS: A total of 71 subjects were randomly assigned to group 1 (diacerein and celecoxib), 2 (diacerein and placebo), or 3 (celecoxib and placebo). The primary outcome measure was the change in the visual analog scale (VAS) score 12 weeks after treatment. RESULTS: The combination therapy group exhibited a significant decrease in the VAS score, alongside the other control monotherapy groups. Although there was no significant difference between the groups, the combination therapy group exhibited a greater decrease in the absolute value of the VAS score than the other groups. Four weeks after treatment, the combination therapy group showed significantly higher improvement in the stiffness and physical function categories of the Western Ontario and McMaster Universities Osteoarthritis Index than the other groups. Additionally, no serious adverse events occurred following combination therapy, with most adverse events being mild and resolving without specific treatment. CONCLUSIONS: Diacerein and celecoxib combination therapy is as safe and effective as corresponding monotherapies. A relatively early improvement in stiffness and physical function following treatment with this combination therapy indicates that physicians should consider this for the early-stage treatment of patients with symptomatic osteoarthritis.

Discussion on the Clinical Course of Adverse Effects after COVID-19 Vaccination: A Retrospective Analysis of Case Series in an Outpatient Department.

BACKGROUND: A total of 8,303 individuals (4.3%) with adverse reactions (n=191,860) after vaccination developed serious conditions or died. Such health developments could cause people not vaccinated yet or waiting for a booster shot to become fearful of the vaccination. METHODS: The 3-month (July-September 2021) clinical data of 41 patients from the family medicine department of a single medical center were analyzed retrospectively to determine risk factors and to investigate the clinical course to identify the cause of symptoms in detail. RESULTS: A significant number of older adults aged over 50 years reported experiencing general weakness (P=0.026) but fewer incidences of fever than patients aged 50 years or younger (P=0.011). Eighteen of the 41 patients were requested to visit more than twice or consult a specialist. In 14 patients, the symptoms were explained by other medical causes. CONCLUSION: The primary physician has a pivotal role in thoroughly evaluating patients who complain of adverse effects after vaccination, considering the broad multitude of symptoms and medical conditions presented. To thoroughly evaluate and appropriately advise patients with adverse reactions to their chosen vaccine, taking detailed medical history and nutritional counseling are required to identify possible underlying causes, resolve symptoms, and educate them on self-care and regarding vaccines.

Experience With and Awareness of Telemedicine Among Korean Outpatients During the COVID-19 Pandemic.

Introduction: Owing to the coronavirus disease 19 pandemic, the demand for telemedicine has increased. However, the awareness of and experience with telemedicine among the Korean population have not been investigated. Therefore, we examined Korean outpatients' experience with and awareness of telemedicine. Methods: From December 2020 to March 2021, we conducted a survey exploring the awareness of and experience with telemedicine of outpatients who were consecutively enrolled by family physicians from four hospitals. The participants completed questionnaires on sociodemographic characteristics and knowledge, experience, satisfaction, preference, and future considerations concerning telemedicine. We evaluated factors associated with satisfaction with telemedicine experiences using multivariate logistic regression analysis. Results: Among the 563 study participants, 364 participants had experience with telemedicine. More than 95% of the telemedicine visits were performed by telephone consultation, and the most common disease type for telemedicine visits was chronic diseases (67.5%). Overall, 82.4% of the participants were satisfied with telemedicine. More than 90% of the participants were satisfied with telemedicine in terms of saving time and money relative to hospital visits, no risk of infection, and convenience. According to the multivariate logistic regression analysis, adults aged ≥65 years (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.44-8.68), residents of a metropolitan city (OR 6.8, 95% CI 1.41-32.55), and those with knowledge of telemedicine (OR 2.96, 95% CI 1.21-7.26) were more likely to be satisfied with their telemedicine experience, compared with their counterparts. For chronic diseases, participants with telemedicine experience were significantly more likely to prefer telemedicine for revisits, compared with those with no telemedicine experience. Nonetheless, most respondents recognized that telemedicine requires improvement. Conclusions: Most Korean outpatients showed high satisfaction with telemedicine. Telemedicine may be considered in various medical situations in the future. Therefore, building a practical system for telemedicine and changes in the medical environment are required.

Exercise Strategies to Prevent Hypoglycemia in Patients with Diabetes.

The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.

Increasing Individual Target Glucose Levels to Prevent Hypoglycemia in Patients with Diabetes.

Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients' contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians' factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%-7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%-8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%-9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

End-of-life care needs for noncancer patients who want to die at home in South Korea.

AIM: The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS: A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS: Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION: By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.

Efficacy and Safety of On Demand Clomipramine for the Treatment of Premature Ejaculation: A Multicenter, Randomized, Double-Blind, Phase III Clinical Trial.

PURPOSE: The aim of the current trial was to assess the efficacy of on demand clomipramine 15 mg administered before sexual intercourse for the treatment of premature ejaculation. MATERIALS AND METHODS: A total of 159 patients at 5 centers in Korea were randomly assigned to 2 groups. The first group of 53 men received placebo and the second group of 106 received clomipramine 15 mg for 12 weeks. All patients were evaluated at the beginning of the study and every 4 weeks thereafter. Patients were instructed to ingest a tablet approximately 2 to 6 hours before sexual intercourse. Efficacy was assessed by scores on the IELT (Intravaginal Ejaculation Latency Time) and the PEDT (Premature Ejaculation Diagnostic Tool). RESULTS: Analyses of the IELT fold change in each group in the intent to treat population revealed that the IELT of the clomipramine 15 mg group was significantly increased 12 weeks after administration compared with the placebo group (mean ± SD 4.40 ± 5.29 vs 2.68 ± 2.03, p <0.05). The IELT fold change in the per protocol population also significantly differed between the clomipramine 15 mg group and the placebo group (mean 4.66 ± 5.64 vs 2.80 ± 2.19, p <0.05). There was a significant difference in the PEDT scores between the 2 groups (p <0.001). The most commonly reported adverse events were nausea in 15.7% of men and dizziness in 4.9%. Adverse events were mild to moderate in severity. CONCLUSIONS: The results of this multicenter, randomized, double-blind, placebo controlled, fixed dose clinical phase III study suggest that administering clomipramine 15 mg on demand to treat premature ejaculation is effective and safe.

Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults.

BACKGROUND: Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB. METHODS: The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008-2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed. RESULTS: Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error=49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the nonPTB group. CONCLUSION: FEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

Tolerability and adequate therapeutic dosage of oral clomipramine for the treatment of premature ejaculation: A randomized, double-blind, placebo-controlled, fixed-dose, parallel-grouped clinical study.

To evaluate the adequate therapeutic dosage of clomipramine 15 mg/day and clomipramine 30 mg/day in male patients with premature ejaculation (PE), this study enrolled men aged 20-65 years who met diagnostic criteria for PE including Intravaginal Ejaculation Latency Time (IELT) less than 2 min for at least 75% of their sexual intercourses. Subjects received placebo, clomipramine 15 mg, or clomipramine 30 mg prn (2~6 h before intercourse) for 4 weeks. Efficacy was assessed using fold change, percentile change, and mean change of IELT, as well as Drug Coitus Interval Time (DCIT). A total of 101 patients were randomized into the placebo group, clomipramine 15 mg group, and clomipramine 30 mg group. Analyses of fold changes of IELT in each group revealed that the IELT of both the clomipramine 15 mg group and clomipramine 30 mg group was significantly increased 4 weeks after administration than the placebo group. Adverse events were reported by 11.76, 32.35, and 57.57% of patients in the placebo group, clomipramine 15 mg group, and clomipramine 30 mg group, respectively. Most common adverse events in the clomipramine treatment groups were gastrointestinal disorders and psychiatric disorders of mild to moderate severity. On-demand regimen of clomipramine 15 mg resulted in a significant improvement in IELT and was superior to a regimen of clomipramine 30 mg in terms of risk-to-benefit ratio.

Risk of Sarcopenia and Osteoporosis in Male Tuberculosis Survivors: Korea National Health and Nutrition Examination Survey.

Short-term prospective studies have suggested that pulmonary tuberculosis (TB) preludes permanent loss of lean tissue and fat mass even when TB treatment is effective. The aim of this study was to estimate the risk of sarcopenia and osteoporosis among Korean male TB survivors. Data of the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008-2011) were analyzed, including 3,228 males aged 50 years or older who underwent chest X-ray (CXR) and dual-energy x-ray absorptiometry (DEXA). TB survivors having both medical history and TB scars on CXR had increased risk of sarcopenia (odds ratio [OR] 3.44, 95% confidence interval [CI] 1.79-6.68) and osteoporosis (OR 1.75, 95% CI 1.04-2.95) after adjusting for age, height, smoking, alcohol, physical activity, serum 25-hydroxyvitamin D, parathyroid hormone level, education, and fat mass index. Having TB scars on CXR without medical history of TB was an independent risk factor of sarcopenia (OR 2.05, 95% CI 1.05-4.00), but not a risk factor of osteoporosis. Sarcopenia and low bone mineral density are prevalent in pulmonary TB survivors with TB scars on CXR. Medical history of TB with TB scars on CXR is an independent risk factor for sarcopenia and osteoporosis.

The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008-2012.

Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008-2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95-2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80-3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07-6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80-2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49-2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74-4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.

Association between serum zinc level and body composition: The Korean National Health and Nutrition Examination Survey.

OBJECTIVE: The aim of this study was to examine the association between serum zinc levels and several body composition factors in Korean adults. METHODS: We used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians. Data from 1896 adults were analyzed. RESULTS: Serum zinc levels in men with elevated waist circumference were higher than in those with normal waist circumference (152.1 ± 3.7 µg/dL versus 137.8 ± 2.2 µg/dL; P < 0.001) and serum zinc levels increased with increasing tertiles of total body fat percentage (134.2 ± 2.8 µg/dL, 142 ± 2.9 µg/dL, and 148 ± 2.7 µg/dL; P = 0.001). Among men with a normal waist circumference, serum zinc levels of those with the highest total body fat percentage were higher than in those with the lowest or medium total body fat percentage values (145.4 µg/dL versus 135.2 µg/dL; P = 0.029). In contrast, in men with an elevated waist circumference, no difference in serum zinc levels according to total body fat percentage was detected. There was no relationship between serum zinc levels and body composition factors in women. CONCLUSIONS: Body zinc status might be associated with the quantity and distribution of body fat in Korean men. Additional sex-specific studies are needed to determine whether the relationship of body zinc status with abdominal obesity and total body fat affects metabolic disorders and cardiovascular diseases.

Relationship between breast-feeding and bone mineral density among Korean women in the 2010 Korea National Health and Nutrition Examination Survey.

Breast-feeding has the deleterious effect of hypoestrogenemia coupled with loss of calcium in the maternal bone mass. It is not clear whether changes in bone metabolism in lactating women lead to changes in maternal bone mineral density (BMD) over a longer period. The aim of the present study was to investigate the relationship between the duration of breast-feeding and BMD in healthy South Korean women. We analyzed data from the 2010 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of Korean citizens. A total of 1342 women older than 19 years were selected for analysis. In postmenopausal women, the duration of breast-feeding per child was associated with low lumbar spine BMD after adjustment for age, body mass index, smoking, alcohol intake, physical activity, serum 25-hydroxyvitamin D level, and daily intake of calcium and calories (P < 0.05, P trend < 0.005). Prolonged breast-feeding for more than 1 year per child was associated with a deleterious effect on lumbar spine BMD compared with never breast-feeding or a shorter duration of breast-feeding (P < 0.05). These effects were not shown in premenopausal women or in femur BMD. In conclusion, the duration of breast-feeding per child is negatively correlated with lumbar spine BMD in postmenopausal women, but not in premenopausal women. Although the cause of the different results between postmenopausal and premenopausal women is not clear, our findings suggest that proper protective strategies should be recommended during prolonged breast-feeding to maintain bone health later in life.

Association between the duration of palliative care service and survival in terminal cancer patients.

PURPOSE: Preliminary studies of early palliative care showed improved quality of life, less medical cost, and better survival time. But, most terminal cancer patients tend to be referred to palliative care late. For the proper care of terminal cancer patients, it is necessary to refer to hospice and palliative care timely. The aim of this study is to analyze the effect of the duration of palliative care services on the survival in terminal cancer patients. METHODS: We reviewed 609 patients who had died from terminal cancer between January 2010 and December 2012. We analyzed correlations of age, first Palliative Performance Scale (PPS) level, duration of palliative care service, and survival time. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. RESULTS: Duration of palliative care services was significantly correlated with survival time. In univariate Cox regression analysis, age, and each group of duration of palliative care service showed significant associations with survival. Final multivariate Cox regression model retained four parameters as independent prognostic factors for survival (age HR = 0.99 (p = 0.002), 1∼10 days HR = 2.64 (p < 0.001), 11∼30 days HR = 2.43 (p < 0.001), 31∼90 days HR = 1.87 (p < 0.001)). CONCLUSIONS: Shorter duration of palliative care services showed poor prognostic factor. Timely referral system from the end of chemotherapy is warranted.

Dietary magnesium intake and metabolic syndrome in the adult population: dose-response meta-analysis and meta-regression.

ncreasing evidence has suggested an association between dietary magnesium intake and metabolic syndrome. However, previous research examining dietary magnesium intake and metabolic syndrome has produced mixed results. Our objective was to determine the relationship between dietary magnesium intake and metabolic syndrome in the adult population using a dose-response meta-analysis. We searched the PubMed, Embase and the Cochrane Library databases from August, 1965, to May, 2014. Observational studies reporting risk ratios with 95% confidence intervals (CIs) for metabolic syndrome in ≥ 3 categories of dietary magnesium intake levels were selected. The data extraction was performed independently by two authors, and the quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). Based on eight cross-sectional studies and two prospective cohort studies, the pooled relative risks of metabolic syndrome per 150 mg/day increment in magnesium intake was 0.88 (95% CI, 0.84-0.93; I(2) = 36.3%). The meta-regression model showed a generally linear, inverse relationship between magnesium intake (mg/day) and metabolic syndrome. This dose-response meta-analysis indicates that dietary magnesium intake is significantly and inversely associated with the risk of metabolic syndrome. However, randomized clinical trials will be necessary to address the issue of causality and to determine whether magnesium supplementation is effective for the prevention of metabolic syndrome.

The Association between Phase Angle of Bioelectrical Impedance Analysis and Survival Time in Advanced Cancer Patients: Preliminary Study.

BACKGROUND: A frequent manifestation of advanced cancer patients is malnutrition, which is correlated with poor prognosis and high mortality. Bioelectrical impedance analysis (BIA) is an easy-to-use and non-invasive technique to evaluate changes in body composition and nutritional status. We investigated BIA-derived phase angle as a prognostic indicator for survival in advanced cancer patients. METHODS: Twenty-eight patients treated at the hospice center of Seoul St. Mary's Hospital underwent BIA measurements from January, 2013 to May, 2013. We also evaluated palliative prognostic index (PPI) and palliative performance scale to compare with the prognostic value of phase angle. Cox's proportional hazard models were constructed to evaluate the prognostic effect of phase angle. The Kaplan Meier method was used to calculate survival. RESULTS: Using univariate Cox analysis, phase angle (hazard ratio [HR], 0.61/per degree increase; 95% confidence interval [CI], 0.42 to 0.89; P = 0.010), PPI (HR, 1.21; 95% CI, 1.00 to 1.47; P = 0.048) were found to be significantly associated with survival. Adjusting age, PPI, body mass index, phase angle significantly showed association with survival in multivariate analysis (HR, 0.64/per degree increase; 95% CI, 0.42 to 0.95; P = 0.028). Survival time of patients with phase angle ≥ 4.4° was longer than patients with phase angle < 4.4° (log rank, 6.208; P-value = 0.013). CONCLUSION: Our data suggest BIA-derived phase angle may serve as an independent prognostic indicator in advanced cancer patients.

Duplicate publication of articles used in meta-analysis in Korea.

With the increasing use of meta-analysis, duplicate publication of original research is particularly problematic. Duplicate publication can result in an inappropriate weighting of the study results. The purpose of our study was to assess the incidence and characteristics of duplicate publications in Korea, and to estimate the impact of duplicate publication on meta-analyses. The meta-analysis literature written by Korean authors was searched using the online search engines PubMed, KMbase, and KoreaMed. Duplication patterns were classified into the following 4 combinations: identical samples and identical outcomes (copy), identical samples and different outcomes (fragmentation), increased samples and identical outcomes (imalas), and decreased samples and identical outcomes (disaggregation). To estimate the multiple publication bias, we performed a meta-analysis with and without duplicated data. We estimated that 6 (6.9%) of the 86 analyzed meta-analyses included duplicate publications, and 6 of the 1,194 articles (0.5%) used in the meta-analyses were duplicate publications. In this study, duplicate publications were usually due to disaggregation and overlapping (imalas) publications. Of 6 duplicated articles, 1 was considered a copy (16.6%); 1, a fragmentation (16.6%); 2, imalas (33.3%); and 2, disaggregations (33.3%). There was an increase in the mean effect size and fail-safe number with duplicated data. Our study found only 6 instances of duplicate publication after analyzing 1,194 articles used in meta-analyses written by Korean authors. However, 6.9% of the meta-analyses included duplicate publications. Our findings suggest that meta-analyses should be interpreted cautiously, taking into account the possibility of duplicated studies.

The associations of epicardial adipose tissue with coronary artery disease and coronary atherosclerosis.

Epicardial adipose tissue (EAT) is presumed to play an important role in the development of coronary artery disease (CAD). The purpose of our study was to examine the influence of EAT volume measured by cardiac CT on the severity and presence of CAD. A total of 209 subjects (114 normal subjects and 95 patients with CAD) underwent cardiac and abdominal computed tomography (CT) scan before diagnostic coronary angiography. Pixels with a threshold range of -190 to -30 Hounsfield units were identified as EAT. CAGE ≥ 20, CAGE ≥ 50, and modified Gensini index were used to define the extent and severity of CAD. While there was no significant difference in BMI and WC between the two groups, the mean EAT volume was higher in the CAD group than in the normal subjects (102.4 ± 41.87 cm(3) versus 125.36 ± 47.64 cm(3), P < 0.001). EAT was significantly associated with CAGE ≥ 20, CAGE ≥ 50, and Gensini score by linear regression analyses after adjusting for age, gender, smoking, and alcohol use. The severity of CAD increased linearly with each tertile increase in EAT volume (P for trend < 0.05). Similarly, the coronary artery calcium (CAC) score was also increased with each increase in EAT tertile (P = 0.002). In multivariate logistic regression models, EAT and VAT were significantly associated with the presence of CAD and CAC in age, gender, smoking, alcohol use, and BMI adjusted models. In conclusion, EAT volume measured by CT is associated with the presence and severity of CAD. EAT may give important information for risk evaluation in CAD.

Relationships of hair mineral concentrations with insulin resistance in metabolic syndrome.

Mineral deficiencies can cause impaired insulin release and insulin resistance. This study was conducted to investigate the relationship between hair mineral concentrations and insulin resistance in patients with metabolic syndrome (MS). A total of 456 subjects (161 patients with MS and 295 subjects without MS) were reviewed, and fasting plasma glucose, triglycerides, HDL-cholesterol, homeostasis assessment model-insulin resistance (HOMA-IR), and hair mineral concentrations were analyzed. While hair sodium and potassium concentrations were significantly higher, the hair calcium, magnesium, and zinc concentrations were lower in the MS group than in the control group. Regarding toxic element measurements, the hair arsenic (As) and lead (Pb) concentrations were higher in the MS group than in the control group. The results of multiple regression analysis, after adjusting for age, showed significant relationships between the Na/Mg and Ca/P ratios and HOMA-IR (R (2) = 0.109, p < 0.05). The Ca, Na, K, and B concentrations were also associated with HOMA-IR (R (2) = 0.116, p < 0.05). The hair Na concentration was significantly associated with MS, even after adjusting for age, visceral adipose tissue, and HOMA-IR (OR 1.020; 95 % CI 1.001-1.040; p = 0.036). Our findings suggest that hair mineral concentrations, such as calcium, magnesium, zinc, sodium, and potassium concentrations, may play a role in the development of insulin resistance.