BACKGROUND: Biochemical bone markers have been suggested to reflect postmenopausal high bone turnover. These markers could be useful in following response to hormone replacement therapy (HRT). But we have few studies about the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, and it is unclear whether women with early menopause have different response to HRT from women with normal menopause. The aims of the present study were to see the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, to examine whether a single baseline biochemical bone marker or a change in biochemical bone marker could predict subsequent bone mass, and to determine the difference of response to HRT between women with early menopause and women with normal menopause. METHODS: Postmenopausal women (n=21) were divided with into three groups according to their age at menopause (AAM): the first group with AAM < or = 43 years (early menopause group, n=7), the second group with 43 years < or = AAM < or = 50 years (n=4), and the third group with AAM > or = 50 years (normal menopause group, n=10). For the HRT, conjugated estrogen (0.625mg per day) and continuous or cyclic medroxyprogesterone (2.5-10mg per day) were administered. Bone mineral density (BMD) was measured at baseline and 12 months and biochemical bone markers were measured at baseline and 3, 6, and 12 months during HRT. RESULTS: Deoxypyridinoline, type 1 collagen N-telopeptide, bone alkaline phosphatase, and osteocalcin were significantly decreased at 3 months, and mean percent changes from baseline of bone resorption markers were larger than those of bone formation markers. At 12 months, BMD was significantly increased at lumbar spine and Ward's triangle. But BMD was not significantly increased at femur neck and femur trochanter. Two baseline bone markers (bone alkaline phosphatase and type 1 collagen N-telopeptide) correlated with changes of BMD but any changes of bone markers at 3, 6 months didn't correlate with changes of BMD. In early menopause group, changes of bone markers and BMD were larger than those in normal menopause group, but the difference between the two groups was not significant. CONCLUSION: All four bone markers showed significant reduction at 3 months, but bone resorption markers were decreased more markedly and rapidly, and some baseline bone markers can predict the change of BMD after HRT. The difference of response to HRT between early menopause group and normal menopause group was not significant.
Alkaline Phosphatase ; Bone Density* ; Bone Resorption ; Collagen Type I ; Estrogens ; Female ; Femur ; Femur Neck ; Hormone Replacement Therapy* ; Humans ; Medroxyprogesterone ; Menopause ; Osteocalcin ; Osteogenesis ; Spine

BACKGROUND: QT dispersion(QTd) has been shown to be ventricular electrical instability, especially predictor of ventricular arrythmia and indicator of antiarrythmic effect. It was reported that there was a relationship between acute myocardial infarction and increased QTd in that QTd is dependent of the degree of reperfusion as well as the site and size of infarction. In this study, we intended to verify a significant association between myocardial ischemia and QTd by comparing the changes in QTd with or without chest pain in patients with unstable angina who had proven myocardial ischemic changes. METHOD: We studied 20 patients (12 men and 8 women : mean age, 58+/-3.4 years) with unstable angina who had proven myocardial ischemic changes and perfusion defect by 24 hour Holter monitoring, Treadmill test, or coronary angiography. Each case was measured QTd during chest patin and resting state 24 hours after chest pain. All standard 12-lead ECGs were recorded at a speed of 25 mm/sec and examined retrospectively by one observer. QTd corrected for heart rate (QTcd) was calculated by Bazett's formula. The difference of QTd was assessed by comparing by paired t-test. RESULTS: The mean values of QTd were 117.9+/-49.9 msec and 69.7+/-30.2 msec with existence and the absence of chest pain. There was significant increment of QTd when the paients with unstable angina had chest pain(p<0.01). QTcd also significantly increased with the mean value of 119.7+/-57.1 and 74.9+/-36.6 msec (p=0.015). CONCLUSIONS: The results of this study clarified the change of QTd with myocardial ischemia. We expect QTd using a single, noninvasive method to indicate that the chest pain is induced by myocardial ischemic changes. For the furture, it may be possible to study as to the significance of QTd as a predictor of cardiovascular accidents in patients with unstable angina by measuring the serial QTd.
Angina, Unstable ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Angiography* ; Coronary Stenosis* ; Coronary Vessels* ; Electrocardiography ; Electrocardiography, Ambulatory ; Exercise Test ; Female ; Heart Rate ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Reperfusion ; Retrospective Studies ; Thorax

OBJECTIVE: To evaluate the effectiveness of CC+FSH or CC+hMG in intrauterine insemination (IUI) cycles for the treatment of infertility. METHOD: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days followed by hMG or FSH. A single IUI was performed at 36 h after hCG. Clinical pregnancy was classified if a gestational sac or fetal cardiac activity was seen on ultrasound. RESULTS: The overall clinical pregnancy rate was 19.1% per cycle (17/89) and 21.5% per patient (17/79). More clinical pregnancies were recorded in CC+FSH (23.1%, 6/26) than CC+hMG cycles (17.5%, 11/63), but this difference was not statistically significant. No differences were found in age, duration of infertility, follicle size, levels of estradiol (E2) on the day of hCG injection and total motile sperm counts between pregnant and non-pregnant groups. However, more ampules of gonadotropins were used in pregnant group than non-pregnant group (p<0.05). CONCLUSION: Combination of CC and hMG may economically be more effective to induce ovulation for IUI compared to CC and FSH.
Clomiphene* ; Estradiol ; Female ; Gestational Sac ; Gonadotropins ; Humans ; Infertility ; Insemination* ; Ovulation ; Pregnancy Rate* ; Pregnancy* ; Sperm Count ; Ultrasonography

OBJECTIVE: This study was designed to evaluate the effects of endogenous LH surge, GnRH agonist (GnRH-a) or human chorionic gonadotropin (hCG) as ovulation trigger on pregnancy rate by intrauterine insemination (IUI). METHOD: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days stating on the third day of the menstrual cycle followed by human menopausal gonadotropin (hMG) for ovulation induction. Follicles larger than >16 mm in diameter were present in the ovary, frequent LH tests in urine were introduced to detect an endogenous LH surge. Final follicular maturation and ovulation were induced by GnRH-a 0.1 mg (s.c.) or hCG 5,000~10,000 IU (i.m.) administration except natural ovulation. Pregnancy was classified as clinical if a gestational sac or fetal cardiac activity was seen on ultrasound. RESULTS: There were no differences in age, duration of infertility and follicle size, but more ampules of hMG were used in GnRH-a group compared to hCG 10,000 IU treated group (p<0.05). Lower level of estradiol (E2) on the day of hCG or GnRH-a injection was observed in hCG 10,000 IU group than other treatment groups (p<0.01). The overall clinical pregnancy rate was 19.8% per cycle (32/162) and 22.2% per patient (32/144). Pregnancy rate was higher in natural-endogenous LH surge group (37.5%, 9/24) than GnRH-a (18.8%) or hCG treated group (20.9% & 13.9%), but this difference was not statistically significant. No patient developed ovarian hyperstimulation. Abortion rate was 22.2% (2/9) in hCG 5,000 IU group. Delivery or ongoing pregnancy rate was 37.5% (9/24), 18.8% (3/16), 16.3% (7/43) and 13.9% (11/79) in endogenous LH surge, GnRH-a, hCG 5,000 IU and hCG 10,000 IU treatment groups, respectively. CONCLUSION: These results support the concept that use of natural-endogenous LH surge in stimulated cycles may be more effective to obtain pregnancies by IUI than GnRH-a or hCG administration.
Abortion, Induced ; Chorionic Gonadotropin ; Clomiphene ; Estradiol ; Female ; Gestational Sac ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Infertility ; Insemination* ; Menstrual Cycle ; Ovary ; Ovulation Induction ; Ovulation* ; Pregnancy Rate* ; Pregnancy* ; Ultrasonography

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

BACKGROUND: Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. METHODS: Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. RESULTS: 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. CONCLUSION: Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.
Burns ; Diabetic Neuropathies ; Diagnosis* ; Follow-Up Studies ; Foot ; Humans ; Mass Screening ; Neural Conduction ; Neurologic Examination ; Peripheral Nervous System Diseases* ; Prevalence ; Sensation ; Sensitivity and Specificity ; Surveys and Questionnaires

This study was conducted to investigate the supplementary effects of Suwon 464 developed by Rural Development Administration, which has over two times of dietary fiber content compared with normal rice (Ilpum), on lipid metabolism in diabetic mice. We supplied 5 kinds of experimental diets (corn starch diet as a control (CO), Ilpum polished rice diet (IP), Ilpum brown rice diet (IB), polished rice diet (SP) and brown rice diet (SB) of Suwon 464) to diabetic mice for 8 weeks, after analyzing dietary fiber contents of 5 experimental diets. Diet intake, body weight, organ weights, and lipids levels of serum, liver and feces were measured. The dietary fiber contents in CO, IP, IB, SP, and SB diets were 1.0, 1.2, 1.4, 1.4, and 2.0% respectively. Body weight and liver and epididymal fat pad weights were lower in SB group than the other groups though there was no significant difference in diet intake among experimental groups. The concentrations of serum triglyceride was lower in SP and SB groups than CO and IP groups. The levels of hepatic total lipid and total cholesterol were significantly lower in SP and SB groups than CO group, and the level of hepatic triglyceride was lower in IB, SP and SB groups than CO group. The levels of total lipid and triglyceride excreted in feces were higher in IB, SP and SB, and the level of total cholesterol in feces was higher in SP and SB groups than CO group. These results suggested that the high dietary fiber rice (Suwon 464) decrease the triglyceride or total cholesterol concentrations of serum and liver by increasing of fecal lipid excretion in diabetic mice.
Adipose Tissue ; Animals ; Body Weight ; Cholesterol ; Diet ; Dietary Fiber* ; Feces ; Gyeonggi-do ; Lipid Metabolism* ; Liver ; Mice* ; Organ Size ; Social Planning ; Starch ; Triglycerides ; Weights and Measures

This study was carried out to investigate the supplementary effects of Suwon 464, which has over two times of dietary fiber content compared with normal rice (Ilpum), on blood glucose in diabetic mice. We supplied 5 kinds of experimental diets (corn starch diet as a control (CO), Ilpum polished rice diet (IP), Ilpum brown rice diet (IB), polished rice diet (SP) and brown rice diet (SB) of Suwon 464) to diabetic mice for 8 weeks, after analyzing dietary fiber contents of 5 experimental diets. Diet intake, body weight and contents of blood glucose, hemoglobin A(1c) and insulin were measured. The dietary fiber contents in CO, IP, IB, SP, and SB diets were 1.0, 1.2, 1.4, 1.4, and 2.0% respectively. Body weight was lower in SB group than the other groups though there was no significant difference in diet intake among experimental groups. The concentration of blood glucose in diabetic mice was lower in SB group than the other groups during the supplementary period of experimental diets. The hemoglobin A(1c) and serum insulin levels were lower in SP and SB groups. These results suggested that the brown rice of Suwon 464 with high dietary fiber can control diabetes in diabetic mice by reducing the blood glucose and hemoglobin A(1c).
Animals ; Blood Glucose* ; Body Weight ; Diet ; Dietary Fiber* ; Gyeonggi-do ; Insulin ; Mice* ; Starch

Various cell types in higher multicellular organisms are genetically homogenous, but are functionally and morphologically heterogeneous due to the differential expression of genes during development, which appears to be controlled by epigenetic mechanisms. However, the exact molecular mechanisms that govern the tissue-specific gene expression are poorly understood. Here, we show that dynamic changes in histone modifications and DNA methylation in the upstream coding region of a gene containing the transcription initiation site determine the tissue-specific gene expression pattern. The tissue-specific expression of the transgene correlated with DNA demethylation at specific CpG sites as well as significant changes in histone modifications from a low ratio of methylated H3- lysine 4 or acetylated H3-lysine 9, 14 to acetylated H4 to higher ratios. Based on the programmed status of transgene silenced in cloned mammalian ear-derived fibroblasts, the transgene could be reprogrammed by change of histone modification and DNA methylation by inhibiting both histone deacetylase and DNA methylation, resulting in high expression of the transgene. These findings indicate that dynamic change of histone modification and DNA methylation is potentially important in the establishment and maintenance of tissue-specific gene expression.
Transgenes/*genetics ; Swine ; Organ Specificity/genetics ; Methylation ; Lysine/*metabolism ; Histones/*metabolism ; Histone Deacetylases/metabolism ; Gene Silencing ; *Gene Expression ; Fibroblasts ; Ear ; *DNA Methylation ; Cells, Cultured ; Animals, Genetically Modified ; Animals ; Acetylation

BACKGROUND: Nosocomial candidemia is one of the most common blood-stream infection and associated with a high fatality rate in burn patients. To determine the clinical characteristics, strains of Candida species and to identify contributing factors to death, we analyzed severely burned patients with candidemia. METHODS: 60 cases with candidemia were reviewed retrospectively from January 1999 to December 2003 at a tertiary burn center in Korea. Candidemia was defined as at least one blood culture that grew Candida organisms. RESULTS: Burn size of all patients were 46+/-20.9% of total body surface area burn and overall mortality was 41.7%. 97 strains of Candida species from 60 cases were isolated. Candida albicans was the most frequently isolated species (53.6%), followed by C. tropicalis (20.6%), C. glabrata (15.5%) and C. parapsilosis (10.3%). Among various predisposing factors for candidemia, significant factors associated with death were endotracheal tube insertion or tracheostomy, mechanical ventilation, the use of vasoactive agents, arterial catheterization and nasogastric tube insertion in univariate analysis, but significant independent factors for mortality were mechanical ventilation (OR=26.63, 95% CI; 1.60, 444.18, p=0.022) and the use of vasoactive agents (OR=23.18, 95% CI; 2.80, 192.35, p=0.004) in multivariate analysis. Among 59 patients indwelling central venous catheters, only 24 patients (40.7%) received antifungal therapy with catheter removal while 19 patients (32.2%) had antifungal therapy without catheter removal. CONCLUSIONS: Clinical severity, such as mechanical ventilation or vasoactive agents dependencies, may contribute to high fatality in severely burned patients with candidemia.
Body Surface Area ; Burn Units* ; Burns* ; Candida ; Candida albicans ; Candidemia* ; Catheterization ; Catheters ; Causality ; Central Venous Catheters ; Humans ; Korea ; Mortality* ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Tracheostomy