BACKGROUND/AIMS: Glycated hemoglobin (HbA1c) is widely used as a marker of glycemic control. Translation of the HbA1c level to an average blood glucose level is useful because the latter figure is easily understood by patients. We studied the association between blood glucose levels revealed by the oral glucose tolerance test (OGTT) and HbA1c levels in a Korean population. METHODS: A total of 1,000 subjects aged 30 to 64 years from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort were included. Fasting glucose levels, post-load glucose levels at 30, 60, and 120 minutes into the OGTT, and HbA1c levels were measured. RESULTS: Linear regression of HbA1c with mean blood glucose levels derived using the OGTT revealed a significant correlation between these measures (predicted mean glucose [mg/dL] = 49.4 × HbA1c [%] - 149.6; R2 = 0.54, p < 0.001). Our linear regression equation was quite different from that of the Alc-Derived Average Glucose (ADAG) study and Diabetes Control and Complications Trial (DCCT) cohort. CONCLUSIONS: Discrepancies between our results and those of the ADAG study and DCCT cohort may be attributable to differences in the test methods used and the extent of insulin secretion. More studies are needed to evaluate the association between HbA1c and self monitoring blood glucose levels.
Blood Glucose* ; Cohort Studies ; Diabetes Mellitus ; Fasting ; Glucose ; Glucose Tolerance Test* ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Linear Models ; Metabolic Diseases

BACKGROUND/AIMS: Increased incidence of coronary artery disease has led to the increased use of dual antiplatelet therapy composed of aspirin and clopidogrel. We investigated the incidence of gastrointestinal complications in patients who received single or dual antiplatelet therapy and analyzed their clinical characteristics in order to predict the prognostic factors. METHODS: Between January 2009 and December 2011, we retrospectively reviewed the medical records of patients who underwent coronary angiography at Chung-Ang University Hospital (Seoul, Korea). One hundred and ninety-four patients were classified into two groups: aspirin alone group and dual antiplatelet group. Clinical characteristics, past medical history, and presence of peptic ulcer were analyzed. RESULTS: During the follow-up period, 11 patients had duodenal ulcer; the event rate was 2.02% in the aspirin alone group and 9.47% in the dual antiplatelet group (hazard ratio [HR] 5.24, 95% CI 1.03-26.55, p<0.05). There was no significant difference in the rate of significant upper gastrointestinal bleeding: 0% vs. 4.2% (p=0.78). In patients who received proton pump inhibitor (PPI), 24 patients had gastric ulcer; the event rate was significantly different between the two groups: 4.87% vs. 22.98% (HR 3.40, 95% CI 1.02-11.27, p<0.05). CONCLUSIONS: Dual antiplatelet groups had a higher incidence of duodenal ulcers without significant bleeding compared with the aspirin alone group. In patients who received PPI, the dual antiplatelet therapy group had a higher incidence of gastric ulcers without significant bleeding compared with the aspirin alone group. Therefore, physicians must pay attention to high risk groups who receive dual antiplatelet therapy and aggressive diagnostic endoscopy should also be considered.
Aged ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use/toxicity ; Aspirin/*therapeutic use/toxicity ; Coronary Angiography ; Coronary Artery Disease/*prevention & control ; Drug Therapy, Combination ; Female ; Gastrointestinal Hemorrhage/chemically induced/prevention & control ; Humans ; Incidence ; Male ; Middle Aged ; Peptic Ulcer/*diagnosis/epidemiology/etiology ; Platelet Aggregation Inhibitors/*therapeutic use/toxicity ; Proportional Hazards Models ; Proton Pump Inhibitors/therapeutic use ; Retrospective Studies ; Risk Factors ; Ticlopidine/*analogs & derivatives/therapeutic use/toxicity

We analysed the 49 probands of autosomal dominant polycystic kidney disease (ADPKD) in Korea to elucidate clinical and genetic characteristics. 1) Family history of renal disease or ADPKD was taken from 44% of probands; hypertension 88%, cerebrovascular attack 64%, end stage renal disease 16%. 2) From the family screening with renal ultrasonography, we have confirmed dominant trait in 24 families. We found 2 families which have suspicious new mutations. 3) We performed linkage analysis of 15 families. The PKD-1 to non PKD-1 ratio was 13 : 2. 4) The male to femal ratio was 17 : 32 and age at diagnosis was 41 (24-65)years (mean (range)) in male, 45 (26-68) years in female. 5) The factors leading to the diagnosis of ADPKD were flank pain (23%), incidental finding (17%), palpable abdominal mass (11%), headache (9%) and gross hematuria (9%) 3) Hypertension (80%), azotemia (43%), flank pain (42%), renal calcification (42%), gross hematuria (33%) and cyst hemorrhage (25%) were renal complications. There were 2 renal cell carcinoma cases. 4)Liver cyst (82%) was the most common extrarenal manifestations. There were colonic diverticulosis (13%), cerebral artery aneurysm (7%), adrenal cyst (4%) and pancreatic cyst (2%). Results of our study revealed the clinical and genetic characteristics of ADPKD in Korea. We found only 44% of family history of renal disease, variable initial manifestations, variable renal and extrarenal complications. And we also found the similar percentage of PKD-2 (13%) to that (5-15%) of western countries, but it is necessary to study with more patients and families.
Aneurysm ; Azotemia ; Carcinoma, Renal Cell ; Cerebral Arteries ; Diagnosis ; Diverticulosis, Colonic ; Female ; Flank Pain ; Headache ; Hematuria ; Hemorrhage ; Humans ; Hypertension ; Incidental Findings ; Kidney Failure, Chronic ; Korea* ; Male ; Mass Screening ; Pancreatic Cyst ; Polycystic Kidney, Autosomal Dominant* ; Ultrasonography

PURPOSE: In epidemiological studies, there are various associations of androgen receptor (AR) CAG with several diseases or phenotypes. However, the relationship between CAG repeat length and metabolic syndrome (MS) remains unclear, especially in Asian populations. This study was designed to evaluate the relationship between AR CAG repeat length polymorphism and MS in a Korean male population. MATERIALS AND METHODS: We explored the relationship between AR CAG repeat length polymorphism and MS in a Korean male population (n=337) from 2013 to 2014. AR CAG repeat were determined by microsatellite fragment sizing. Components of MS and laboratory data (lipid profile, fasting glucose, and glycated hemoglobin (HbA1c)) were analyzed with AR CAG repeat length. RESULTS: The mean AR CAG repeat length was 22.3±4.7. Sixty-nine men (20.5%) were diagnosed with MS. Men with MS showed significantly longer AR CAG repeat lengths compared with men without MS (26.2 vs. 21.4, p < 0.001). With increasing CAG repeat, the number of components meeting the NCEP criteria increased significantly. AR CAG repeat length was associated significantly with high density lipoprotein (HDL), triglyceride, and HbA1c levels. In the multivariate analysis, CAG repeat length, waist circumference, and levels of HDL were independently associated with MS. (odds ratio (OR)=1.37, 1.19 and 0.90, p < 0.001, 0.045, and 0.001, respectively). CONCLUSIONS: AR CAG repeat length was associated with MS and laboratory test results, such as those for HDL, triglycerides, and HbA1c, in Korean males. Longer CAG repeat length was identified as a risk factor for MS in Korean males.
Asian Continental Ancestry Group ; Epidemiologic Studies ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Lipoproteins ; Male ; Microsatellite Repeats ; Multivariate Analysis ; Phenotype ; Receptors, Androgen ; Risk Factors ; Triglycerides ; Trinucleotide Repeats ; Waist Circumference

PURPOSE: The aim of this study was to assess the efficacy and safety of tamsulosin, 0.2mg/day on sexual function in Korean BPH patients. Patients and Methods: 116 patients (mean age: 60 yrs) with BPH were enrolled in this study and 0.2mg of tamsulosin was administrated every night for 3 months. Primary efficacy was evaluated with changes of IIEF and GEQ. Secondary efficacy parameters were changes of IPSS and QoL, uroflowmetry, changes of total IIEF and IIEF domain score according to the severity of IPSS, and retrograde ejaculation. RESULTS: Before treatment, patients of moderate IPSS (8-19) and severe IPSS (20-35) were 56% and 44% and QoL<3 and QoL>3 were 33.6% and 66.4%. In primary efficacy evaluation, total IIEF score was significantly increased from 37.0+/- 18.2 to 40.5+/- 18.9 (p<0.01). All domains of IIEF except orgasmic function were significantly improved. GEQ showed improvement of erection in 34.4% and intercourse ability in 30.1%. In secondary efficacy evaluation, IPSS was significantly decreased from 18.4+/- 6.9 to 12.9+/- 6.7 (p<0.01) and QoL was significantly improved from 3.8+/- 1.1 to 2.7+/- 1.4 (p<0.01). Qmax significantly increased from 14.2+/- 8.3 to 16.5+/- 11.3 ml/sec (p<0.01). Total IIEF score and EF domain score were significantly improved from 36.8+/- 18.5 to 41.8+/- 19.1 (p<0.01) and from 13.0+/- 7.1 to 14.7+/- 7.9 (p<0.01) in patients of moderate IPSS but no improvement in severe patients. Retrograde ejaculation occurred in 2 patients (2%). No serious adverse reactions were observed. CONCLUSIONS: Tamsulosin, 0.2mg/day was effective and safe dose for the improvement of LUTS and sexual function for Korean BPH/LUTS patients.
Ejaculation ; Humans ; Male ; Orgasm ; Prospective Studies ; Sulfonamides

OBJECTIVES: In order to evaluate the role of these cytokines in biological response induced by blood interaction with hemodialysis membranes. METHODS: We have investigated the IL-1, TNF and IL-6 concentrations in the supernatant of 24-hours cultured peripheral blood mononuclear cells (PBMC) without(spontaneous group) or with broken cuprophan or P1VMA membranes in 9 chronic hemodialyzed patients and 8 healthy controls. The blood samples were drawn before dialysis using following criteria: (a) in last dialytic treatment with PMMA membranes(HDEl), (b) after two weeks of dialytic treatment wih cuprophan membranes(HDE2). RESULTS: In the both of patient group(HDE1 and HDE2) and controls production of IL-l, TNF and IL-6 of PBMC stimulated with cuprophan or PMMA membrane particles was increased compared to those of spontaneous group. IL-1 production of HDE1 stimulated PMMA(99.31 +/- 30.15fmol/ml) was significantly higher compared to that of cuprophan(48.43 +/- 11.29fmol/ml), TNF production of HDE2 with cuprophan(114.86 +/- 38.5lfmoVml) was significantly high compared to that of spontaneous group(52.42 +/- 29.94fmol/ml). IL-6 production of HDE2(646.70 +/- 103.84fmol/ml) was significantly high compared to that of spontaneous group(385.88 +/- 87.03fmoVml). Comparing cytokine production of PBMC, there was a significant correlation between IL-1 and IL-6(r=0.78), IL-1 and TNF(r=0.78) and TNF and IL-6(r=0,76). CONCLUSION: Our results show that the interaction of cuprophan or PMMA membranes with blood increase the production of IL-1, TNF and IL-6. We suggest that in patients undergoing routine hemodialysis PBMC are primed by exposure to chronic stimulation.
Cytokines ; Dialysis ; Humans ; Interleukin-1* ; Interleukin-6* ; Membranes* ; Polymethyl Methacrylate ; Renal Dialysis

BACKGROUND: Tigecycline resistance has emerged recently and has shown diverse mechanisms. The aim of this study was to assess the role of efflux activity in tigecycline resistance in 120 clinical isolates of A. baumannii using two methods: the H33342 accumulation assay and adeB real-time reverse transcriptase polymerase chain reaction. In addition, we analyzed the correlation between the expression level of adeB and H33342 accumulation level. METHODS: A. baumannii clinical isolates was divided into tigecycline-resistant (49 strains), intermediate (40 strains), and susceptible (31 strains) groups. The H33342 accumulation was measured in the absence or presence of the efflux pump inhibitor carbonyl cyanide 3-chlorophenylhydrazone (CCCP). Real-time RT-PCR was performed to determine the relative expression of the adeB gene in A. baumannii clinical isolates. RESULTS: The level of H33342 accumulation in the resistant group was relatively lower than those in the other groups. The addition of CCCP caused a significantly increased fold change in H33342 accumulation in the tigecycline-resistant group. Significant difference in the fold change level in H33342 accumulation was found between tigecycline-susceptible and resistant isolates. Those findings support the role of efflux pumps of which substrates are H33342 in the resistance of tigecycline. Significant differences in the relative expression levels of adeB were shown between tigecycline-susceptible and resistant groups also. CONCLUSION: The results showed that several efflux pumps of which substrates were H33342 can contribute to tigecycline resistance. The adeB overexpression can also contribute to tigecycline resistance. It is possible that efflux pumps other than adeB efflux pumps contribute to tigecycline resistance because there was no correlation between fold change level in H33342 accumulation and adeB expression level.
Acinetobacter baumannii* ; Acinetobacter* ; Carbonyl Cyanide m-Chlorophenyl Hydrazone ; Reverse Transcriptase Polymerase Chain Reaction

BACKGROUND: ADPKD is one of the most common hereditary renal disease in adult and is a systemic disorder with a variety of cardiovascular manifestations. To elucidate the clinical characteristics of cerebrovascular complications in Korean ADPKD patients, we reviewed the medical records of ADPKD patients who was registered in ADPKD clinic of Seoul National University Hospital. METHODS: A total of 18 adult patients were included and their sex ratio was 8:10. The median age of ADPKD diagnosis was 45.5 year (range 19-85), and age at cerebrovascular accident(CVA) was 52 years(22-82). The median duration from hypertension to CVA was 8 years(0-30). RESULTS: There were 5 cases of infarction, 4 cases of intracerebral hemorrhage, 4 cases of subarachnoid hemorrhage, and 4 cases of transient ischemic attack. Other clinical parameters of ADPKD were not different from patients who were not complicated with CVA. Intracranial aneurysms were detected in 6 patients and their median age at diagnosis was 47.5 years(33-66). Four cases were manifested as subarachnoid hemorrhage. Five cases were diagnosed through TFCA, and two of them were revealed as multiple aneurysms. Five cases received surgical treatment and five of six cases improved without any neurologic sequeale. MR angiography(MRA) were taken in 16 asymptomatic patients, and multiple aneurysms were newly detected in one of them. CONCLUSION: Cerebrovascular complications in Korean ADPKD patients were not significantly different from western patients. Intracranial aneurysms must be included in differential diagnosis in ADPKD patients who manifest an acute neurologic symptoms, and high-risk group need to be screened selectively with MRA.
Adult ; Aneurysm ; Cerebral Hemorrhage ; Diagnosis ; Diagnosis, Differential ; Humans ; Hypertension ; Infarction ; Intracranial Aneurysm ; Ischemic Attack, Transient ; Medical Records ; Neurologic Manifestations ; Polycystic Kidney, Autosomal Dominant* ; Seoul ; Sex Ratio ; Subarachnoid Hemorrhage

Hemorrhagic fever with renal syndrome (HFRS) in Korea is caused by 2 serotypes of hantavirus, Hantaan and Seoul. Even though the number of peripheral CD8' T-lymphocytes is markedly elevated in the acute phase of HFRS, the pathogenetic role of this phenomena is not clear. To elucidate the role of cell-mediated immune response in HFRS, we measured concentrations of cytokines, such as IL-1, IL-2, IL-4, IL-6, IL-10 and IFN-r in plasma samples obtained from 15 patients (15 men, 20-24 years old) at various phase of illness. Cytokines were measured by ELISA in plasma samples. The plasma concentration of IL-10 was elevated in 13/15 patients. The median maximum value, during days 4-8, was 23 ng/L (range, 0-70.2). The maximum values were significantly higher(p=0.005) than the baseline. IL-1 and IL-6 was detected in 6 patients. Other cytokine responses (IL-2, IL-4, IFN-r ) were negligible. There was no significant correlation between maximum levels of IL-10 and maximum serum concentration of creatinine (r=0.118, p=0.675), and lowest plate#let count (r=-0.088, p=0.765). Kinetics of IL-10 were quite similar in HFRS patients with maximum creatinine values >3 mg/dL and in those with values <3 mg/dL. In conclusion, plasma IL-10 levels, but not IL-2, IL-4 or INF-r were elevated in acute phase of HFRS, and it suggests that the systemic immunosuppressive activities of IL-10 might have some pathogenetic role in HFRS.
Creatinine ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Hantavirus ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Interleukin-1 ; Interleukin-10 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Kinetics ; Korea ; Male ; Plasma* ; Seoul ; T-Lymphocytes

BACKGROUND: We noticed an abrupt increase in the isolation of Stenotrophomonas maltophilia from bronchoalveolar lavage (BAL) specimens collected at Chosun University Hospital. We performed surveillance cultures in order to identify the source of what appeared to be a pseudo-outbreak. METHODS: To investigate a possible nosocomial outbreak of S. maltophilia, we performed culture of 11 environmental specimens obtained from a bronchoscopy room and two bronchoscopes. Pulsedfield gel electrophoresis (PFGE) was used to examine the genetic relatedness among the strains of S. maltophilia recovered from BAL specimens of 3 patients and 1 environmental sample, as well as 9 unrelated strains of S. maltophilia as a control. RESULTS: During a 7 day-period in March 2006, S. maltophilia was isolated from the BAL specimens of 7 of 13 (54%) patients, compared to only 5 of 188 (2.6%) patients during the 6-month period prior to that period. S. maltophilia was isolated from 1 of the 11 environmental samples, which was obtained from a fiberoptic bronchoscope suction channel. All 7 patient isolates and one environmental isolate exhibited similar antibiotic susceptibility patterns. PFGE analysis of the genomic DNA from epidemic strains demonstrated an identical banding pattern, whereas each of epidemiologically unrelated strains showed a unique electrophoretic pattern. CONCLUSIONS: Apparently one of the hospital bronchoscopes became contaminated with S. maltophilia during a bronchoscopic procedure. It is likely that subsequent specimen contamination occurred because the bronchoscope had been inadequately cleaned and disinfected. The pseudo-outbreak was controlled successfully by removing the source of infection.
Aged ; Aged, 80 and over ; Bronchoalveolar Lavage Fluid/microbiology ; Bronchoscopes/*microbiology ; *Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; *Equipment Contamination ; Gram-Negative Bacterial Infections/diagnosis/*epidemiology/transmission ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Stenotrophomonas maltophilia/*genetics/isolation & purification