BACKGROUND: Bone strength is impaired in patients with type 2 diabetes mellitus despite an increase in bone mineral density (BMD). Thiazolidinedione (TZD), a peroxisome proliferator activated receptor γ agonist, promotes adipogenesis, and suppresses osteoblastogenesis. Therefore, its use is associated with an increased risk of fracture. The aim of this study was to examine the in vitro and in vivo effects of lobeglitazone, a new TZD, on bone. METHODS: MC3T3E1 and C3H10T1/2 cells were cultured in osteogenic medium and exposed to lobeglitazone (0.1 or 1 µM), rosiglitazone (0.4 µM), or pioglitazone (1 µM) for 10 to 14 days. Alkaline phosphatase (ALP) activity, Alizarin red staining, and osteoblast marker gene expression were analyzed. For in vivo experiments, 6-month-old C57BL/6 mice were treated with vehicle, one of two doses of lobeglitazone, rosiglitazone, or pioglitazone. BMD was assessed using a PIXImus2 instrument at the baseline and after 12 weeks of treatment. RESULTS: As expected, in vitro experiments showed that ALP activity was suppressed and the mRNA expression of osteoblast marker genes RUNX2 (runt-related transcription factor 2) and osteocalcin was significantly attenuated after rosiglitazone treatment. By contrast, lobeglitazone at either dose did not inhibit these variables. Rosiglitazone-treated mice showed significantly accelerated bone loss for the whole bone and femur, but BMD did not differ significantly between the lobeglitazone-treated and vehicle-treated mice. CONCLUSION: These findings suggest that lobeglitazone has no detrimental effects on osteoblast biology and might not induce side effects in the skeletal system.
Adipogenesis ; Alkaline Phosphatase ; Animals ; Biology ; Bone and Bones ; Bone Density* ; Diabetes Mellitus, Type 2 ; Femur ; Gene Expression ; Humans ; In Vitro Techniques ; Infant ; Mice* ; Osteoblasts ; Osteocalcin ; Peroxisomes ; RNA, Messenger ; Thiazolidinediones ; Transcription Factors

PURPOSE: While the Trastuzumab for Gastric Cancer (ToGA) trial demonstrated the efficacy and safety of trastuzumab-based chemotherapy in HER2-positive metastatic gastric cancer, the overall survival (OS) benefit was not found in Asian and diffuse-type cancer patients. The aim of the study is to investigate predictive markers for trastuzumab-based chemotherapy. MATERIALS AND METHODS: Data of patients with HER2-positive gastric cancer treated with trastuzumab-based chemotherapy were analyzed retrospectively. RESULTS: A total of 168 Asian patients were included. The median age was 60 years (range, 27 to 85 years) and the male:female ratio was 118 (70.2%):50 (29.8%). Fourteen (8.3%), 63 (37.5%), 75 (44.6%), and 11 (6.5%) patients had well, moderately, poorly-differentiated tubular adenocarcinoma and signet ring cell carcinoma, respectively. With 14 complete responses and 73 partial responses, the response rate was 50.6%. The median progression-free survival (PFS) was 10.2 months (95% confidence interval [CI], 8.7 to 11.7), and the median OS was 18.5 months (95% CI, 16.4 to 50.6). Next, we investigated the effect of poorly-differentiated histology (PDH, poorly-differentiated tubular adenocarcinoma+signet ring cell carcinoma) on clinical outcomes. The median PFS (8.9 months vs. 11.5 months, p=0.16) was slightly inferior in PDH patients, and the median OS was significantly shorter in PDH patients (14.6 months vs. 19.0 months, p=0.025). CONCLUSION: While subset analysis of the ToGA trial demonstrated that trastuzumab-based chemotherapy may not be beneficial for Asians and patients with PDH, our data may suggest that even in Asian patients and patients with PDH, trastuzumab-based chemotherapy could be associated with improved clinical outcomes in patients with HER2-positive gastric cancer.
Adenocarcinoma ; Asian Continental Ancestry Group ; Carcinoma, Signet Ring Cell ; Disease-Free Survival ; Drug Therapy* ; Ethnic Groups ; Humans ; Receptor, erbB-2 ; Retrospective Studies* ; Stomach Neoplasms*

Prevalence of dizziness has been reported to be as high as nearly twenty percent and one half of these population had social handicap to some degree. The diagnostic approach of dizziness heavily relies on the premise that dizziness type predicts the underlying etiology-e.g, vertigo with vestibular causes and presyncope with cardiovascular causes. However, such symptomatological approach sometimes delays correct diagnosis as the presenting symptom of individual patient is typically vague to designate the type. In this paper, a case of a 57-year-old woman who has experienced recurrent rotatory vertigo of cardiovascular origin was discussed. When her head were turned to the left, a fast downbeat nystagmus following a slow upward eye deviation was recorded using video nystagmogram. Hence, we report this single case of syncope presented as peripheral vertigo type with literature review.
Dizziness ; Eye ; Female ; Head ; Humans ; Middle Aged ; Nystagmus, Pathologic ; Prevalence ; Syncope ; Vertigo

BACKGROUND/AIMS: Pain is one of the most troublesome symptoms of pancreatitis. Transdermal fentanyl patches (TFPs) are long-acting analgesics with a reduced risk of dependency. This prospective study evaluated the effect of TFPs on sphincter of Oddi (SO) motility for the management of pain in pancreatitis. METHODS: SO manometry (SOM) was performed using triple-lumen catheters anterogradely inserted through the percutaneous transhepatic route during cholangioscopy in 16 patients. The basal pressure, amplitude, and frequency of the SO were assessed before and after applying a TFP at 24 hour at doses of 25 and 12.5microgram/hr, respectively. RESULTS: Two of 16 patients receiving a 25microgram/hr. TFP were excluded because of adverse side effects (headache and/or nausea). The mean basal pressure, amplitude, and frequency of SOM did not change significantly in the 25microgram/hr TFP group (n=4 patients). Parameters of SO function also did not significantly change in the 12.5microgram/hr TFP group (n=11 patients). CONCLUSIONS: TFPs below a dose of 25microgram/hr may not affect the motility of the SO. Administration of TFPs at lower dosages seems to be a safe analgesic treatment for the pain control of patients with pancreatitis without affecting the function of the SO.
Analgesics ; Catheters ; Dependency (Psychology) ; Fentanyl ; Humans ; Manometry ; Pancreatitis ; Prospective Studies ; Sphincter of Oddi

PURPOSE: To investigate the error tendency between preoperative expected refraction and postoperative manifest refraction based on anterior chamber depth (ACD) and axial length (AXL) in cataract surgery cases and to report how ACD and AXL affect determination of intraocular lens (IOL) power. METHODS: We retrospectively studied 82 eyes of 62 patients who underwent cataract surgery in our hospital between August 2008 and January 2009. Anterior chamber depth and AXL were measured using IOL Master(R), and IOL power was calculated using the SRK II and SRK/T formulae. Patients were divided into three groups based on ACD and into another three based on AXL. Refractive error (RE) was analyzed one month after surgery. RESULTS: Though the RE of each group showed a tendency for hyperopic shifts, only those obtained with the SRK/T formula showed statistically significant differences between groups (p<0.05). Using the SRK/T formula, we found that an increasing AXL was associated with an increased hyperopic shift. This was more pronounced in those with shallow ACD (<2.5 mm), though the difference was not statistically significant. Similarly, an increase in ACD was associated with an increased hyperopic shift, and this difference was more pronounced in those with short AXL (<22.5 mm), and this time the difference was statistically significant. CONCLUSIONS: As ACD and AXL significantly affect RE, both should be considered when investigating postoperative RE tendency and when determining IOL power. Postoperative RE will be greatly affected by a short AXL or a shallow ACD, and therefore these factors should be considered in IOL power determination.
Anterior Chamber ; Cataract ; Eye ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Refractive Errors ; Retrospective Studies

BACKGROUND/AIMS: Propofol is widely used for sedation during endoscopy. Because propofol may cause hepatic encephalopathy, hemodynamic compromise, and respiratory depression, cautious use is required in patients with liver cirrhosis. We evaluated the safety and efficacy of propofol in compensated cirrhosis during endoscopic examination. METHODS: Thirty-nine cirrhotic patients (19 and 20 cases of Child Pugh classes A and B, respectively) and 56 control subjects were included. The initial dose of propofol (40 mg) was increased by 20-mg increments until moderate sedation was achieved. The number connection test, flapping tremor test, blood pressure, heart rate, oxygen saturation, liver enzymes, and prothrombin time were evaluated before and after endoscopy. RESULTS: No significant change was observed in any parameter compared to baseline in either group. The mean dose of propofol was significantly lower in cirrhotic versus control subjects (49.7+/-15.8 versus 65.0+/-17.9 mg, respectively; p<0.001). Scores based on a visual analog scale evaluating patient satisfaction did not differ between groups (72+/-27 versus 64+/-26, respectively; p=0.196), nor did mean recovery time (16.4+/-9.8 versus 14.2+/-6.7 min, respectively; p=0.186). CONCLUSION: Propofol is safe and effective for moderate sedation in compensated liver cirrhosis.
Child ; Conscious Sedation ; Endoscopy ; Fibrosis ; Heart Rate ; Hematologic Tests ; Hemodynamics ; Hepatic Encephalopathy ; Humans ; Liver ; Liver Cirrhosis ; Oxygen ; Patient Satisfaction ; Propofol ; Prothrombin Time ; Respiratory Insufficiency ; Tremor

This study estimates the treated prevalence of schizophrenia and the annual costs associated with the illness in Korea in 2005, from a societal perspective. Annual direct healthcare costs associated with schizophrenia were estimated from National Health Insurance and Medical Aid records. Annual direct non-healthcare costs were estimated for incarceration, transport, community mental health centers, and institutions related to schizophrenia. Annual indirect costs were estimated for the following components of productivity loss due to illness: unemployment, reduced productivity, premature mortality, and caregivers' productivity loss using a human capital approach based on market wages. All costs were adjusted to 2005 levels using the healthcare component of the Consumer Price Index. The treated prevalence of schizophrenia in 2005 was 0.4% of the Korean population. The overall cost of schizophrenia was estimated to be $ 3,174.8 million (3,251.0 billion Won), which included a direct healthcare cost of $ 418.7 million (428.6 billion Won). Total direct non-healthcare costs were estimated to be $ 121 million (123.9 billion Won), and total indirect costs were estimated at $ 2,635.1 million (2,698.3 billion Won). Unemployment was identified as the largest component of overall cost. These findings demonstrate that schizophrenia is not rare, and that represents a substantial economic burden.
Adult ; Aged ; Cost of Illness ; Female ; Health Care Costs ; Health Expenditures ; Humans ; Korea ; Male ; Middle Aged ; Models, Economic ; Models, Theoretical ; Prevalence ; Schizophrenia/*economics/*therapy ; Sensitivity and Specificity

BACKGROUND/AIMS: The removal of esophageal and gastric submucosal tumors is difficult using conventional endoscopic mucosal resection methods. This study examined the usefulness of an endoscopic subtumoral dissection for an en-bloc resection of submucosal tumors. METHODS: An endoscopic subtumoral dissection was attempted for an en-bloc resection in 15 submucosal tumors (M: F=10 : 5, 13 stomach, 2 esophagus). Before the procedures, endoscopic ultrasonography was performed in all cases. The procedure was carried out using various electrosurgical knives, such as an endoscopic submucosal dissection. RESULTS: Pathological and immunohistochemical studies confirmed a gastrointestinal stromal tumor in 6 cases. Other pathological diagnoses were made in 9 patients with submucosal lesions: leiomyoma (4), ectopic pancreas (3), lipoma (1), and hemangioma (1). An en-bloc resection was performed in 13 of the 15 tumors (86.7%). The mean specimen size was 29.5x21.1 mm. The mean procedure time was 49.4 minutes (range: 8~103 minutes). Gastric perforation was a complication in 2 cases with GIST. However, the two perforated cases were treated with endoscopic closure using endoclips and recovered without the need for surgery. CONCLUSIONS: An endoscopic subtumoral dissection technique is useful for an en-bloc resection of esophageal and gastric submucosal tumors. However, sufficient attention should be paid to the detection of perforations in the case of tumors with a proper muscle origin.
Endosonography ; Gastrointestinal Stromal Tumors ; Hemangioma ; Humans ; Leiomyoma ; Lipoma ; Muscles ; Pancreas ; Stomach

The aims of this study are to demonstrate the reliability and the validity of the Korean version of Behavioral Dyscontrol Scale (BDS-K) and to present the normative values of BDS-K among the Korean elderly. The BDS-K was administered in a standardized manner to 1,389 healthy volunteers aged over 65 years recruited from the community. The elderly with serious neurological, medical or psychiatric disorders were excluded using screening tests. BDS-K showed good internal consistency (Cronbach's alpha=0.812), test-retest reliability (r=0.88) and inter-rater reliability (r=0.99). Age and educational level were found to affect BDS-K score. Based on this result, normative values of BDS-K were calculated by age and educational level. The validity of the BDS-K were demonstrated in comparison with MMSE-KC (r=0.72). BDS-K is reliable and valid instrument for measuring executive function of the elderly. The normative values suggested by this study can be widely used as reference values to objectively interpret BDS-K scores of the Korean elderly.
Aged* ; Executive Function ; Healthy Volunteers ; Humans ; Mass Screening ; Reference Values

BACKGROUND/AIMS: Bowel preparation for colonoscopy remains an unpleasant experience because oral solutions have unpleasant tastes and may provoke abdominal pain, nausea, vomiting, and sleep disturbance. Duodenoscopic bowel preparation is an alternative method for patients who are unwilling to take oral preparation solution or for those who are supposed to have both gastroscopic and colonoscopic examination on the same day. We assessed the effectiveness and tolerance of duodenoscopic bowel preparation. METHODS: Patients in group OA (orally administered) ingested 45 mL of sodium phosphate (NaP) in the evening before the day of procedure and in the morning on the day of colonoscopy, whereas patients in group EA (endoscopically administered) were prepared for the procedure by duodenoscopic infusion of 90 mL of NaP diluted with 180 mL of water into the second portion of the duodenum. After 4 hours, we assessed the overall quality of colonic cleansing, using a range of excellent to inadequate. The patients completed a questionnaire on their preparation-associated symptoms, tolerance, and preference. RESULTS: In group EA, sleep disturbance (p<0.05) and nausea (p<0.05) occurred less frequently than in group OA. Overall, the tolerance rating for preparation was higher in group EA. However, the quality of colonic cleansing and cecum intubation time was not different between the two groups. Patients in group EA who had ingested NaP in the past preferred duodenoscopic bowel preparation. CONCLUSIONS: Duodenoscopic bowel preparation may play a role in colonic cleansing especially for patients who are scheduled to undergo gastroscopic and colonoscopic examination on the same day and for those who are unwilling to ingest NaP.
Administration, Oral ; Adult ; Aged ; Cathartics/*administration & dosage/adverse effects ; *Colonoscopy ; *Duodenoscopy ; Female ; Humans ; Image Enhancement ; Irrigation ; Male ; Middle Aged ; Phosphates/*administration & dosage/adverse effects/chemistry ; Questionnaires ; Treatment Outcome