Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Objectives: ：The purpose of this study is to investigate the characteristics of patients referred for delirium and depressive disorder and to find direction of improvement of consultation-liason psychiatry in general hospital. Methods: ：We performed a retrospective computed chart review of the 4,966 inpatients hospitalized at Konkuk University Hospital who were referred to the Department of Psychiatry from August 1, 2005 to December 31, 2011. Results: ：Depressive disorder shows the order of frequency of consultation type Parallel-ComplementaryMending. Delirium shows the order of frequency of consultation type Mending-Parallel-Complementary. When comparing ‘follow up consultation’ and ‘without follow up consultation’ group within the depressive disorder, the proportion of men in the ‘follow up consultation’ group was higher. In the analysis of the consultation type, the ‘follow up consultation’ group showed the order of consultation type Parallel-Mending- Complementary, and type Parallel-Complementary-Mending in the ‘without follow up consultation’ group. When comparing ‘follow up consultation’ and ‘without follow up consultation’ group within the delirium, the proportion of the surgicalfield in the ‘follow up consultation’ group was higher. In the analysis of the consultation type, both group showed the order of consultation type Mending-Parallel- Complementary. Conclusions ：Doctors in each department and psychiatrists should pay attention to delirium symptoms that may occur in surgical inpatients and preventive measures should be taken. Screening tests should be conducted in medical patients to properly evaluate coexisting psychiatric diseases. Risk factors of Delirium and Depressive disorder should be identified from the time of hospitalization, and actively discussing treatment plans and earlyinterventions could improve the quality of medical services.

Refractory status asthmaticus represents the most severe clinical presentations of asthma, and it is typically associated with the presence of hypoxemia, hypercapnia, lactic acidosis, dynamic hyperventilation and altered state of consciousness. Several case reports have demonstrated extracorporeal membrane oxygenation (ECMO) as an alternative treatment method for patients with status asthmaticus that failed to respond to maximal conventional therapy. We experienced a case of pregnant woman with severe asthma attack not relieved by conventional treatment, in whom early administration of ECMO resulted in a good outcome. A 23-year-old woman at, 11 weeks of pregnancy, was admitted with acute asthma attack. Despite maximal rescue therapies with mechanical ventilation, her condition gradually deteriorated. Venovenous ECMO was initiated 4 hours from intubation and gas exchange with lung mechanics was rapidly recovered within hours. She was extubated 45 hours after initiation of ECMO and had successful weaning from ECMO 2 days after extubation. The patient had no complication and gave birth to a healthy baby at 37 weeks of gestation. This is the first case report in Korea on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to mechanical ventilation and maximum pharmacological treatment. Early ECMO application is a useful treatment option for patients with refractory status asthmaticus refractory to conventional therapy.

BACKGROUND: The risk factors for renal cancer include smoking, obesity, hypertension, and exposure to trichloroethylene. Recent studies have shown that low sunlight exposure increases the risk of developing a range of cancers, including renal cancer. Given that most of the daytime is spent at work, a lack of occupational sunlight exposure can be a risk factor for renal cancer. Therefore, this study examined the relationship between occupational sunlight exposure and the incidence of renal cancer. METHODS: This was a university hospital-based case-control study on renal cancer. Of the 706 newly diagnosed patients with renal cell carcinoma (RCC), 633 cases were selected; 73 who had no occupational history were excluded. In addition, 633 controls were selected from the general population after 1:1 matching with respect to sex, age (within 5 years), and residential area (constituency-level). Information on sunlight exposure by the occupational group was referred to data from France. To estimate the association between occupational sunlight exposure and the RCC risk, the odds ratios (ORs) were calculated using conditional logistic regression analysis. RESULTS: Sunlight exposure was divided into quartiles and the risk of RCC was analyzed. The adjusted OR of RCC (OR: 0.664, 95% confidence interval: 0.449–0.983) was significantly lower for the Q4 group than Q1 group but the Q2 and Q3 groups did not show significant results. The risk of RCC tended to decrease with increasing exposure to sunlight (p for trend < 0.028). CONCLUSIONS: Higher occupational sunlight exposure reduces the risk of RCC.
Carcinoma, Renal Cell ; Case-Control Studies ; France ; Humans ; Hypertension ; Incidence ; Kidney Neoplasms ; Logistic Models ; Obesity ; Occupational Groups ; Odds Ratio ; Risk Factors ; Smoke ; Smoking ; Sunlight ; Trichloroethylene

Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.
Adult ; Aged ; Area Under Curve ; *Extracorporeal Membrane Oxygenation/classification ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; ROC Curve ; Republic of Korea ; Research Design/*standards ; Respiratory Distress Syndrome, Adult/mortality/pathology/*therapy ; Retrospective Studies ; Severity of Illness Index

OBJECTIVE: Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS: A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS: On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. CONCLUSION: We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.
Chest Pain ; Depression ; Depressive Disorder, Major* ; Female ; Humans ; Korea ; Male ; Neck ; Outpatients* ; Shoulder Pain ; Suicidal Ideation ; Suicide

Interventional lung assist (iLA) effectively reduces CO2 retention and allows protective ventilation in cases of life-threatening hypercapnia. Despite the clinical efficacy of iLA, there are a few major limitations associated with the use of this approach, such as bleeding, thrombosis, and catheter-related limb ischemia. We presented two cases in which thrombotic complications developed during iLA. We demonstrated the two possible causes of thrombotic complications during iLA; stasis due to low blood flow and inadequate anticoagulation.
Extremities ; Hemorrhage ; Hypercapnia ; Ischemia ; Lung* ; Thrombosis ; Ventilation

PURPOSE: The prevalence of asthma among the elderly has increased in the aging society. However, limited studies have been conducted regarding the characteristics of elderly asthmatics. In this study, we aimed to evaluate control of asthma, comorbidities, depression and anxiety state, and quality of life in elderly asthmatics. METHODS: A total of 281 patients who were diagnosed with asthma and treated more than 1 year were enrolled. We evaluated not only clinical characteristics, but also depression, anxiety, and quality of life by using the Beck Depression Inventory-Korean version (K-BDI), the State-Trait Anxiety Inventory, and Korean asthma quality of life (KAQLQ), respectively. RESULTS: Diabetes mellitus (15.2% vs. 6.6%, P=0.020), hypertension (45.5% vs. 18.7%, P<0.001), and heart disease (18.2% vs. 6.0%, P=0.001) were more prevalent comorbidities in elderly asthmatics than young asthmatics. However, there were no differences in the degree of asthma control and lung function between elderly and young asthmatics. K-BDI scores were higher (12.32 vs. 10.99, P=0.020) and KAQLQ was lower (66.60 vs. 68.83, P=0.046) in the elderly asthmatics than in the young asthmatics. Moreover, the low score of asthma control test was significantly associated with depression in the elderly asthmatics (P=0.01). CONCLUSION: Elderly asthmatics had a higher degree of depression and a lower quality of life. Inadequate control of asthma was associated with depression. To achieve adequate control of asthma, it would be necessary to assess depression in the elderly asthmatics.
Aged* ; Aging ; Anxiety* ; Asthma ; Comorbidity ; Depression* ; Diabetes Mellitus ; Heart Diseases ; Humans ; Hypertension ; Lung ; Prevalence ; Quality of Life

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury