Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Background and Objectives: Kawasaki disease (KD) is an acute systemic vasculitis that affects the coronary arteries. Abnormal immune reactions are thought to contribute to disease pathogenesis. The effect of immunoglobulin (Ig) isotype (IgG, IgA, IgM, and IgE) on inflammatory data and clinical outcomes of patients with KD was examined. Methods: Ig levels in 241 patients with KD were measured during the acute, subacute, convalescent, and normal phases of the disease. Results: Compared with reference Ig values, IgG, IgA, and IgM levels were significantly higher in the subacute phase, while IgE levels were elevated in 73.9% (178/241) of patients with KD in all clinical phases. However, high IgE levels were not associated with clinical outcomes, including intravenous immunoglobulin unresponsiveness and coronary artery lesions (CALs).Significantly more CALs were observed in the high IgA group than in the normal IgA group (44.7% vs. 20.8%, respectively; p<0.01). In addition, IgA levels in the acute phase (p=0.038) were 2.2-fold higher, and those in the subacute phase were 1.7-fold higher (p <0.001), in the CAL group than in the non-CAL group. IgA concentrations increased along with the size of the coronary artery aneurysm (p <0.001). Furthermore, there was a strong correlation between IgA levels and CAL size (r=0.435, p<0.001), with a high odds ratio of 2.58 (p=0.022). Conclusions High IgA levels in patients with KD are prognostic for the risk of CALs.

Background and Objectives: Kawasaki disease (KD) is an acute systemic vasculitis that affects the coronary arteries. Abnormal immune reactions are thought to contribute to disease pathogenesis. The effect of immunoglobulin (Ig) isotype (IgG, IgA, IgM, and IgE) on inflammatory data and clinical outcomes of patients with KD was examined. Methods: Ig levels in 241 patients with KD were measured during the acute, subacute, convalescent, and normal phases of the disease. Results: Compared with reference Ig values, IgG, IgA, and IgM levels were significantly higher in the subacute phase, while IgE levels were elevated in 73.9% (178/241) of patients with KD in all clinical phases. However, high IgE levels were not associated with clinical outcomes, including intravenous immunoglobulin unresponsiveness and coronary artery lesions (CALs).Significantly more CALs were observed in the high IgA group than in the normal IgA group (44.7% vs. 20.8%, respectively; p<0.01). In addition, IgA levels in the acute phase (p=0.038) were 2.2-fold higher, and those in the subacute phase were 1.7-fold higher (p <0.001), in the CAL group than in the non-CAL group. IgA concentrations increased along with the size of the coronary artery aneurysm (p <0.001). Furthermore, there was a strong correlation between IgA levels and CAL size (r=0.435, p<0.001), with a high odds ratio of 2.58 (p=0.022). Conclusions High IgA levels in patients with KD are prognostic for the risk of CALs.

BACKGROUND: This study was conducted to compare glycaemic control with insulin detemir administered according to two titration algorithms (3-0-3 and 2-4-6-8) after 20 weeks of treatment in subjects with type 2 diabetes mellitus inadequately controlled on metformin. METHODS: This was a 20-week, randomised, multicentre, open-labelled, treat-to-target trial. Forty-six patients were randomised in a 1:1 manner to either the 3-0-3 (G3, n=23) or 2-4-6-8 (G2, n=23) algorithm. The primary endpoint was change of haemoglobin A1c (HbA1c), and the secondary safety endpoint included hypoglycaemic events. RESULTS: After 20 weeks, HbA1c decreased similarly in the G3 and G2 groups, with a mean change of −0.9% from baseline. The mean change in fasting plasma glucose was numerically similar in both groups. The hypoglycaemia event rate per 100-patient-years of exposure (r) in the G2 group (r=1,427) was higher than that in the G3 group (r=807). CONCLUSION Both treatment groups had numerically similar HbA1c reductions. A trend towards fewer hypoglycaemia episodes after dose stabilisation was seen with the simpler G3. Clinically, this may be an important observation, as a simpler titration algorithm may support self-management and maintenance of insulin therapy.

BACKGROUND: Mutations in calreticulin (CALR) have been reported to be key markers in the molecular diagnosis of myeloid proliferative neoplasms. In most previous reports, CALR mutations were analyzed by using Sanger sequencing. Here, we report a new, rapid, and convenient system for screening CALR mutations without sequencing. METHODS: Eighty-three bone marrow samples were obtained from 81 patients with thrombocytosis. PCR primers were designed to detect wild-type CALR (product: 357 bp) and CALR with type 1 (product: 302 bp) and type 2 mutations (product: 272 bp) in one reaction. The results were confirmed by Sanger sequencing and compared with results from fragment analysis. RESULTS: The minimum detection limit of the screening PCR was 10 ng for type 1, 1 ng for type 2, and 0.1 ng for cases with both mutations. CALR type 1 and type 2 mutants were detected with screening PCR with a maximal analytical sensitivity of 3.2% and <0.8%, respectively. The screening PCR detected 94.1% (16/17) of mutation cases and showed concordant results with sequencing in the cases of type 1 and type 2 mutations. Sanger sequencing identified one novel mutation (c.1123_1132delinsTGC). Compared with sequencing, the screening PCR showed 94.1% sensitivity, 100.0% specificity, 100.0% positive predictive value, and 98.5% negative predictive value. Compared with fragment analysis, the screening PCR presented 88.9% sensitivity and 100.0% specificity. CONCLUSIONS: This screening PCR is a rapid, sensitive, and cost-effective method for the detection of major CALR mutations.
Adult ; Aged ; Base Sequence ; Bone Marrow/metabolism ; Calreticulin/chemistry/*genetics/metabolism ; DNA Mutational Analysis ; Female ; Follow-Up Studies ; Genotype ; Humans ; Janus Kinase 2/chemistry/genetics/metabolism ; Male ; Middle Aged ; Mutation ; Myeloproliferative Disorders/complications/*diagnosis/genetics ; Polymerase Chain Reaction ; Thrombocytosis/complications/*diagnosis

Abiotrophia defectiva, a nutritionally variant streptococci can cause bacteremia, brain abscess, septic arthritis and in rare cases, infective endocarditis, which accounts for 5-6% of all cases. A. defectiva is characteristically difficult to diagnose and the mortality, morbidity and complication rates are high. Here, we discuss a case of infective endocarditis caused by A. defectiva. A 62-year-old female had previously undergone prosthetic valve replacement 6 years prior to admission. She developed infective endocarditis after tooth extraction. Her endocarditis was successfully treated with antimicrobial therapy and mitral valve replacement surgery. This is the first case of infective endocarditis caused by A. defectiva reported in Korea. This case shows that A. defectiva could be considered as a causative organism of infective endocarditis in Korea.
Abiotrophia* ; Arthritis, Infectious ; Bacteremia ; Brain Abscess ; Endocarditis* ; Female ; Humans ; Korea* ; Middle Aged ; Mitral Valve ; Mortality ; Tooth Extraction

The incidence of Clostridium difficile infection is increasing worldwide, and its severity and resulting mortality are also on the rise. Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. Furthermore, antibiotic therapy results in recurrence rates of at least 20%. Fecal transplantation may be a feasible treatment option for recurrent C. difficile infection; moreover, it may be an early treatment option for severe C. difficile infection. We report a case of severe C. difficile infection treated with fecal transplantation using a nasoenteric tube during an initial episode. This is the first reported case of fecal transplantation using a nasoenteric tube during an initial episode of C. difficile infection in Korea.
Clostridium difficile* ; Clostridium* ; Incidence ; Korea ; Metronidazole ; Mortality ; Recurrence ; Treatment Failure ; Vancomycin

OBJECTIVES: The current study investigated the risk of smartphone addiction among children and adolescents with or without attention-deficit hyperactivity disorder (ADHD), risk of depression, anxiety, and self-esteem using the Smartphone Addiction Scale Proneness, Kovac's Children's Depression Inventory, State-Trait Anxiety Inventory, and Rosenberg Self-Esteem Scale, commonly used in clinical medicine. METHODS: Ninety five students with ADHD who visited psychiatry outpatient clinics completed the questionnaire. At the same time, 592 middle and high school students living in a similar area regardless of ADHD diagnosis, completed the questionnaire as control subjects. RESULTS: Overall, 40.0% of 95 ADHD and 12.8% of 592 control subjects were classified as the smartphone addiction proneness group, 26.3% of the ADHD subjects and 8.3% of the control group were classified as the depression group, and 32.6% of the ADHD subjects and 16.2% of the control group were classified as the anxiety group. Significant differences were observed between the two groups. CONCLUSION: The results of this study suggest that ADHD subjects are more prone to smartphone addiction, becoming depressed or anxious than those in the control group. From this study, we could suggest that students with ADHD are more easily affected by smartphone addiction than normal control subjects. In addition, we might understand how some psychiatric problems like depression, anxiety, and low self-esteem are related to ADHD and smartphone addiction.
Adolescent ; Ambulatory Care Facilities ; Anxiety ; Child* ; Clinical Medicine ; Depression ; Diagnosis ; Humans ; Smartphone

Antiglobulin test-negative hemolytic anemia, thrombophilia, and marrow failure, such as aplastic anemia and myelodysplastic syndrome - refractory anemia (MDS-RA), are the primary clinical manifestations of paroxysmal nocturnal hemoglobinuria (PNH). Here, we report on a case of a 56-year-old male patient diagnosed with PNH, MDS-RA, and immune hemolytic anemia (IHA). The patient was transferred to the hospital with an impression of hemolytic anemia and pulmonary embolism. Positive results were observed on direct and indirect antiglobulin tests, and alloantibody, anti-C and anti-e, autoantibodies were identified. In addition, C and e antigens were found in Rh subgrouping. Therefore, due to the presence of autoantibodies against C and e antigens, we assumed that the cause of IHA was autoimmune reaction. Spherocytosis, increased osmotic fragility test, and positivity on direct and indirect antiglobulin tests were not considered characteristics of PNH. Therefore, without the presence of pulmonary embolism and MDS-RA, it is possible that autoimmune hemolytic anemia was considered the only reason for the hemolytic anemia, and that PNH could be overlooked. In patients with PH, use of washed RBCs during transfusion is not necessary. PNH screening test is recommended for patients who have experienced a thromboembolic event and intravascular hemolysis or MDS-RA. In order to obtain accurate information regarding the percentage of GPI-AP-deficient RBCs, flow cytometric analysis should be performed prior to transfusion.
Anemia, Aplastic ; Anemia, Hemolytic ; Anemia, Hemolytic, Autoimmune ; Anemia, Refractory ; Autoantibodies ; Bone Marrow ; Coombs Test ; Hemoglobinuria, Paroxysmal ; Hemolysis ; Hepatitis B e Antigens ; Humans ; Hydrogen-Ion Concentration ; Male ; Mass Screening ; Middle Aged ; Myelodysplastic Syndromes ; Osmotic Fragility ; Pulmonary Embolism ; Thrombophilia

This study was researched to provide the accurate nutrition information and the menu. We questionnaired an recognition and necessity of the nutrition labeling to 684 customers in fast-food restaurants. After data cleaning, we used spss package 14.0 and analyzed about the nutrition contents and place that display the nutrition labeling. First, we finded out lower recognition of nutrition labeling in restaurants than processed food. Second, many people hoped that calory and fat in various nutritions were displayed each 100 g or 100 mL. Third, the place displaying the nutrition information was the menu board and the counter to identify easily. Fourth, we analyzed the recognition and necessity of the nutrition labeling in fast-food restaurants by t-test and ANOVA. So, we knew that the recognition and necessity of the nutrition labeling was higher woman than man. And the more they earn much money and learned, the more the nutrition labeling are needed. But house-wife recognized the nutrition labeling lower than others.
Female ; Food Labeling ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Organothiophosphorus Compounds ; Restaurants