PURPOSE:Ghrelin is an endogenous ligand of the growth hormone secretagogue receptor, and stomach is the major site of ghrelin secretion. The purpose of this study is to compare the serum ghrelin concentrations between patients with type 2 diabetes mellitus (DM) and normal adults. We studied also whether serum ghrelin levels in the patients with type 2 DM are correlated with body mass index (BMI), serum insulin, lipid profiles, and creatinine levels. METHODS:Forty patients with type 2 DM and forty normal adults were included in this study. We measured heights and weights of the subjects and calculated their BMIs. Blood samples were obtained to measure the ghrelin concentration and their sera were stored at -20degreeC until used. In all subjects, serum ghrelin levels were measured using the commercially available Ghrelin(human) EIA kit. RESULTS:No differences of mean values were detected between the control group and the type 2 diabetic group for age, body weight, BMI, and the levels of serum total cholesterol, triglyceride, HDL cholesterol, and creatinine. But ghrelin level of the type 2 diabetic group (71.1+/-30.5 ng/L) was significantly lower than the control group (139.7+/-36.9 ng/L). In the control group, the ghrelin level showed positive correlation with HDL cholesterol (Pearson's correlation coefficient=0.37, P<0.05). In the diabetic group, the ghrelin level showed weakly positive correlation with insulin concentration. However, there was no significant relationship between serum ghrelin and various parameters in the diabetic patients group. CONCLUSION: In this study, ghrelin concentration in type 2 diabetic patients was lower than that in the control group. In the control group, serum ghrelin concentrations were positively correlated with HDL cholesterol. In the type 2 diabetic group, there was no significant correlation between insulin and ghrelin concentrations.
Adult ; Body Mass Index ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Ghrelin* ; Humans ; Insulin ; Receptors, Ghrelin ; Stomach ; Triglycerides ; Weights and Measures

PURPOSE: The purpose of this study is to identify the changes to nursing activities of nurses on patients with DNR (Do-Not-Resuscitate) order and factors associated to the changes. METHODS: Data were collected using a structured questionnaire for 173 nurses at general hospitals. Logistic regression analysis was performed on the data using SAS 9.4. RESULTS: With 39 nursing activities, an average of 60.4 (34.9%) nurses reported an increase in the activities, 102.4 (59.2%) no change and 10.1 (5.9%) a drop. The activity increase was the greatest in the social area, and the physical area was where the activities decreased the most. The activity increase was associated knowledge competency (9 items), attitudes (2 items), practical competency (4 items) and work load (14 items were). CONCLUSION: To offer systematical care for DNR patients, it is necessary to expand nurses' knowledge through end-of-life education and adjust their workload and provide a support system at the department level.
Education ; Hospitals, General ; Humans ; Logistic Models ; Nursing Care ; Nursing* ; Resuscitation Orders ; Terminal Care

An important error in the result of Table 3 was confirmed in the article.

Purpose: Attending physicians in Korea are aware of the existence of the Nutrition Support Team (NST), but even when the NST are consulted, compliance with their recommendations may be low. This study was performed to identify physicians’ compliance with the NST advice and how this affected the outcome of treatment for critically ill patients. Methods: This study was a retrospective observational study. Critically ill patients who were older than 18 years, younger than 90 years, and had been admitted and managed in the intensive care unit were selected for this study. Patients were assigned to either the compliance group or the non-compliance group according to physician compliance with the NST advice. Each group were compared using variables such as calorie supply, protein supply, laboratory findings, hospital stay, 30-day mortality, and survival rate. Results: The compliance group (81% of cases) was supplied with a significantly higher energy (1,146.36 ± 473.45 kcal vs. 832.45 ± 364.28 kcal, p < 0.01) and a significantly higher protein (55.00 ± 22.30 g/day vs. 42.98 ± 24.46 g/day, p = 0.04) compared with the non-compliance group. There was no significant difference in the basic demographics between groups, although the compliance group had a better outcome in the 30-day mortality rate (8% vs. 26%, p = 0.02), and in survival beyond 1 year (Crude model, hazard ratio: 2.42, CI: 1.11-5.29). Conclusion Critically ill patients whose attending physician complied with the NST advice, received an increased energy intake and supply of protein which was positively associated with survival.

PURPOSE: Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-beta family and play an important role in cellular growth. Recent reports suggest that exogenous bone morphogenetic protein-2 (BMP-2) acts as an antiproliferative agent in a variety of cell lines. We will study whether BMP-2 is altered in human colorectal cancer. METHODS: We analyzed 40 colorectal cancer cases and 6 colorectal cancer cell lines by using reverse transcription-polymerase chain reaction (RT-PCR) to determine the expression of BMP-2. RESULTS: Thirteen of 40 colorectal cancers (33%) and 3 of 6 colorectal cancer cell lines (50%) revealed decreased expression of BMP-2. The rates of decreased expression were 0% (0/7), 42.1% (8/19), 28.6% (2/7), 33.3% (2/6), and 100% (1/1) in stages I, II, III, and IV, respectively. Histologically, the rates were 33.3% (2/6), 32.2% (10/21), 50% (1/2), and 0% (0/1) in well-differentiated, moderately-differentiated, poorly-differentiated and mucinous cancers, respectively. As for location, the rates for colon and rectal cancers were 27.8% (5/18) and 36.4% (8/22), respectively. We identified methylation in the CpG island of the BMP-2 gene in 60% of colorectal cancer cells and in 50% of colorectal cancer cell lines. The 13 cases without BMP-2 gene expression showed no significant correlation with clinicopathological factors. Epigenetic silencing through DNA methylation is one of the key steps during carcinogenesis. CONCLUSION: We found, through an analysis using the methylation-specific polymerase chain reaction technique, CpG island methylation of the BMP-2 promoter region in colorectal cancer. Thus, aberrant BMP-2 methylation and the resultant loss of BMP-2 expression may be related to colorectal carcinogenesis.
Bone Morphogenetic Proteins ; Cell Line ; Colon ; Colorectal Neoplasms ; CpG Islands ; DNA Methylation ; Epigenomics ; Gene Expression ; Humans ; Methylation ; Mucins ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Rectal Neoplasms

Spark’s nevus is a compound word composed of Spitz nevus and Clark’s nevus. It is one of the combined melanocytic nevi which is more common in female and usually presents as a sharp circumscribed hyperpigmented macule on the lower extremities. On histopathologic findings, both cytologic features of Spitz nevus characterized as large spindle or epithelioid melanocytes containing large nuclei with abundant cytoplasm, and architecture of Clark’s nevus characterized as elongation of rete ridges, bridging of the nests, concentric and lamellar fibrosis can be seen. A 24-year-old female presented with an asymptomatic, solitary, dark-brown-colored papule surrounded by brownish patch that looked similar to dysplastic nevus or malignant melanoma on the buttock. On dermoscopic examination, it showed brown-to-black globules, diffuse homogenous pigmentation with blue-white structures, and a surrounding brownish reticular pattern that faded away. On histopathologic findings, overall asymmetrical structure, epithelioid large melanocytes containing large nuclei with abundant cytoplasm, and Kamino body were seen in the central portion. Also, lentiginous hyperplasia, bridging of the nests composed of melanocytes containing foamy cytoplasm, concentric and lamellar fibrosis along with the elongation of rete ridge, and perivascular lymphocytic infiltration were seen in the peripheral portion. The diagnosis of Spark’s nevus was made. Following its definition, this combined nevus is diagnosed histopathologically, but the clinicodermoscopic features have not been well described. Herein, we report a case of Spark’s nevus in which dermoscopy was helpful for differentiating it from malignant melanoma.

PURPOSE: This in vitro study was performed to assess the adherence of Porphyromonas gingivalis to a resorbable blast media (RBM) titanium surface pretreated with an ultrasonic scaler or toothbrush and to evaluate the effects of the treatment of the RBM titanium discs on the bacterial removal efficiency of brushing by crystal violet assay and scanning electron microscopy. METHODS: RBM titanium discs were pretreated with one of several ultrasonic scaler tips or cleaned with a toothbrush. Then the titanium discs were incubated with P. gingivalis and the quantity of adherent bacteria was compared. The disc surfaces incubated with bacteria were brushed with a toothbrush with dentifrice. Bacteria remaining on the disc surfaces were quantified. RESULTS: A change in morphology of the surface of the RBM titanium discs after different treatments was noted. There were no significant differences in the adherence of bacteria on the pretreated discs according to the treatment modality. Pretreatment with various instruments did not produce significant differences in the bacterial removal efficiency of brushing with dentifrice. CONCLUSIONS: Within the limits of this study, various types of mechanical instrumentation were shown to cause mechanical changes on the RBM titanium surface but did not show a significant influence on the adherence of bacteria and removal efficiency of brushing.
Bacteria ; Dental Scaling ; Dentifrices ; Gentian Violet ; Microscopy, Electron, Scanning ; Porphyromonas gingivalis ; Surface Properties ; Titanium* ; Toothbrushing ; Ultrasonics*

Weber-Christian disease is a rare inflammatory disease of subcutaneous fat necrosis that may or may not involve systemic disease. We report the results of a breast sonograph of a case diagnosed as a form of an acute lobular panniculitis affecting the breasts and upper limbs.
Breast* ; Necrosis ; Panniculitis ; Panniculitis, Nodular Nonsuppurative* ; Subcutaneous Fat ; Ultrasonography ; Upper Extremity

Metronidazole-induced encephalopathy is a very rare complication of the long standing use of metronidazole. The encephalopathy is bilateral and symmetric in nature. We report on the magnetic resonance imaging (MRI) and clinical course of metronidazole-induced encephalopathy in a 60-year-old female with a persistent anaerobic brain abscess after draining of the abscess. After 3 months of metronidazole administration, the patient complained of dysarthria, tingling sense of all extremities, and left hemiparesis. MRI revealed symmetric hyperintensity lesions in medulla, pons, dentate nuclei of cerebellum, and splenium of corpus callosum, all of which represent typical findings of metronidazole-induced encephalopathy. In addition, asymmetric lesions in midbrain, thalamus, putamen and cerebral subcortical white matter were noted. The patient recovered after discontinuation of metronidazole and the remaining abscess was successfully treated with meropenem and levofloxacine.
Abscess ; Brain ; Brain Abscess ; Brain Diseases, Metabolic ; Cerebellum ; Corpus Callosum ; Dysarthria ; Extremities ; Female ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Metronidazole ; Middle Aged ; Ofloxacin ; Paresis ; Pons ; Putamen ; Thalamus ; Thienamycins

PURPOSE: The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. METHODS: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. RESULTS: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. CONCLUSION: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.
Critical Care* ; Education ; Hospitals, General ; Humans ; Intensive Care Units ; Judgment ; Methods ; Patient Care ; Qualitative Research ; Resuscitation ; Social Control, Formal