Fenofibrate is one of PPAR-alpha (peroxisome proliferator activated receptor alpha) agonists. Fenofibrate decreases effectively triglyceride and increases high density lipoprotein cholesterol level through the effect on lipoprotein lipase, hepatic production and degradation of lipoproteins. Fenofibrate was recommended as the drug for hypertriglyceridemia treatment in European guideline released in 2011. But American heart association guideline in 2013 did not recommend non-statin therapy including fibrate for the prevention of atherosclerotic cardiovascular disease. But fenofibrate is still considered as the important drug for the management of atherogenic dyslipidemia especially in patients with metabolic syndrome and diabetes to reduce the residual risk after statin therapy from the evidence of many studies. Fibrates including bezafibrate, gemfibrozil, and fenofibrate increased serum creatinine level in several studies. But the mechanism of change in renal function is not clear till now. And the reversibility of renal function with drug discontinuation is dependent on the kinds of fibrate. Fenofibrate increased serum creatinine level, decreased albuminuria and renal function was reversible with the drug discontinuation in large clinical trials. In these days renal function change with fenofibrate therapy in Korean patients with hypertriglyceridemia was investigated. Fenofibrate treatment for 2 months increased serum creatinine level significantly and old age was associated with the change of renal function in multivariate analysis. Short-term therapy significantly increased serum creatinine level even within normal range, and this change may be important in some groups especially old age.
Albuminuria ; American Heart Association ; Bezafibrate ; Cardiovascular Diseases ; Cholesterol, HDL ; Creatinine ; Dyslipidemias ; Fenofibrate* ; Fibric Acids ; Gemfibrozil ; Glomerular Filtration Rate ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertriglyceridemia ; Lipoprotein Lipase ; Lipoproteins ; Multivariate Analysis ; Reference Values ; Triglycerides

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multi-factorial disorder due to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, and communication between the gut-brain axis. IBS is traditionally treated with dietary and lifestyle modifications, fiber supplementation, and psychological and pharmacological therapies. Diet therapy including the low FODMAP diet and excluding certain food constituents is often used. Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are first-line drug treatments. 5-Hydroxytryptamine (5-HT) receptors in the gastrointestinal tract, particularly 5-HT3 and 5-HT4 receptors are involved not only in modulating gut motility but in visceral sensory pathways. Drugs that act on both receptor classes appear to reduce visceral sensitivity and have inhibitory effects on motor activity in the distal intestine. 5-HT4 agonists may improve constipation-predominant IBS by normalizing bowel habits and thereby reduce abdominal pain. IBS continues to be a therapeutic challenge because of its diverse symptomatology and lack of a single pathophysiological target for drug intervention.
Abdominal Pain ; Axis, Cervical Vertebra ; Defecation ; Diet ; Diet Therapy ; Gastrointestinal Diseases ; Gastrointestinal Motility ; Gastrointestinal Tract ; Hypersensitivity ; Inflammation ; Intestines ; Irritable Bowel Syndrome* ; Korea ; Life Style ; Motor Activity ; Parasympatholytics ; Receptors, Serotonin, 5-HT4 ; Serotonin ; Serotonin 5-HT4 Receptor Agonists

Hyponatremia results from a relative excess of total body water compared with the sodium content. Except for primary polydipsia, vasopressin activation plays a major role in pathogenesis of water retention. Consequently, the increase of solute-free water clearance by inactivating vasopressin action would be a more reasonable therapeutic approach than the addition of sodium. The V2 vasopressin receptor is mainly localized to the collecting ducts in the kidney and causes water reabsorption via water channels. Selective V2 receptor antagonists or vaptans were recently introduced to clinical practices and may be useful for correcting dilutional hyponatremia. Clinical trials have shown that vaptans are effective in increasing the serum sodium concentration in patients with syndrome of inappropriate anti-diuresis and congestive heart failure and that they might be safe as long as patients are allowed free accesses to water. However, the indications for using vaptans need to be more refined, and the question of their long-term cost-effectiveness should be answered. In addition, the potential roles of vaptans in ameliorating the growth of cysts in polycystic kidney disease, saving diuretics in edematous disorders, and retarding the progression of chronic kidney disease are being explored.
Aquaporins ; Body Water ; Diuretics ; Heart Failure ; Humans ; Hyponatremia ; Kidney ; Polycystic Kidney Diseases ; Polydipsia, Psychogenic ; Receptors, Vasopressin* ; Renal Insufficiency, Chronic ; Sodium ; Vasopressins ; Water

Non-Helicobacter pylori, non-NSAID peptic ulcer disease, termed idiopathic peptic ulcer disease (IPUD), is being increasingly recognized. Current data suggest that the relative proportion of patients with IPUD among those with peptic ulcers has been increasing for the past decade in both the West and East, while the prevalence of H. pylori ulcers has decreased. Potential causative or risk factors of IPUD include cigarette smoking, genetic predisposition, psychological factors, infections other than H. pylori, non-NSAID drugs or toxins, systemic inflammatory disease, and local mucosal defects. Diagnosis is made after confident exclusion of H. pylori infection by at least two different standard tests and accurate exclusion of unrecognized or surreptitious NSAID use by careful history taking and serologic assay. IPUD is characterized by higher complication and recurrence rates than other forms of peptic ulcer disease and has become a main cause of refractory ulcer disease. Maintenance therapy using proton pump inhibitors may be required at higher doses and for longer durations than in H. pylori- or NSAID-associated peptic ulcer diseases. Well-designed nationwide epidemiologic studies are required to fully elucidate this emerging condition.
Diagnosis ; Genetic Predisposition to Disease ; Humans ; Peptic Ulcer* ; Prevalence ; Proton Pump Inhibitors ; Psychology ; Recurrence ; Risk Factors ; Smoking ; Ulcer

Antiplatelet therapies have been widely used to prevent cardiovascular diseases. However, antiplatelet agents cause gastrointestinal (GI) damage and are associated with a greater risk of gastroduodenal ulcers and life-threatening ulcer complications. The first step to reduce the GI risk of antiplatelet therapy is to assess whether the patient requires continuous antiplatelet therapy. The second step is to eliminate risk factors that may place the patient at greater GI risk such as Helicobacter pylori infection, NSAID use, steroid ingestion, and smoking. Continuous aspirin therapy plus a powerful proton pump inhibitor (PPI) is the choice of treatment for antiplatelet-related peptic ulcers. The risk of cardiovascular complications and risk of gastric complication using antiplatelet agents should be evaluated individually.
Aspirin ; Cardiovascular Diseases ; Eating ; Helicobacter pylori ; Humans ; Peptic Ulcer* ; Platelet Aggregation Inhibitors ; Proton Pumps ; Risk Factors ; Smoke ; Smoking ; Ulcer

Nonsteroidal anti-inflammatory drugs (NSAIDs) have analgesic, antipyretic, and anti-inflammatory properties and are widely used for treating musculoskeletal and cardiovascular diseases. Notwithstanding these therapeutic efficacies, gastrointestinal toxicity is the major health problem associated with NSAID use. NSAID-related peptic ulcers are a well-known complication due to direct mucosal injury and cyclooxygenase inhibition. Risk factors for NSAID-related peptic ulcers include a prior history of peptic ulcer; age > 65 years; high-dose NSAID therapy; and concurrent use of aspirin (including low dose), corticosteroids, or anticoagulants. In addition, Helicobacter pylori infection is an independent risk factor; therefore, eradication therapy is recommended in high-risk patients using NSAIDs. Currently, misoprostol, H2-receptor antagonists, proton pump inhibitors, and COX-2 selective inhibitors are used to prevent and treat NSAID-related peptic ulcers. Further, strategic approaches are required through appropriate NSAID use and risk factor stratification to prevent NSAID-related peptic ulcers and associated complications.
Adrenal Cortex Hormones ; Anti-Inflammatory Agents, Non-Steroidal* ; Anticoagulants ; Aspirin ; Cardiovascular Diseases ; Helicobacter pylori ; Humans ; Misoprostol ; Peptic Ulcer* ; Prostaglandin-Endoperoxide Synthases ; Proton Pump Inhibitors ; Risk Factors

Although the worldwide prevalence of Helicobacter pylori (H. pylori) infection has decreased, peptic ulcer disease (PUD) remains prevalent due to increased usage of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin. In recent years, the prevalence of H. pylori infection in PUD cases and the distribution of PUD have changed in Korea. The incidence of idiopathic H. pylori-negative ulcers has increased, and research is needed to determine the cause of these idiopathic ulcers. The eradication of H. pylori infection decreases PUD recurrence, and plays a crucial role in the treatment of PUD. The H. pylori test-and-treat strategy is beneficial for patients starting NSAIDs and long-term aspirin users with a history of bleeding ulcers. Although the H. pylori eradication rate is declining steadily due to antibiotic resistance, especially to clarithromycin, current guidelines still recommend standard triple therapy, including a proton pump inhibitor, amoxicillin, and clarithromycin, as a first-line therapy. Recently, various treatment regimens, including sequential or concomitant therapies, have been developed in an attempt to overcome the low eradication rate observed with standard triple therapy. The aim of this article is to review recent trends in H. pylori-related PUD, focusing on epidemiology and treatment strategies.
Amoxicillin ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Clarithromycin ; Drug Resistance, Microbial ; Epidemiology ; Helicobacter pylori ; Helicobacter* ; Hemorrhage ; Humans ; Incidence ; Korea ; Peptic Ulcer* ; Prevalence ; Proton Pumps ; Recurrence ; Ulcer

No abstract available.
Humans ; Mentors*

PURPOSE: This study examined two overarching topics: to what extent do faculties acknowledge class readiness, execution of lessons, and evaluation of the session; and what core content should be strengthened in a medical school faculty development program? METHODS: In November 2012, 37 faculties completed a detailed survey on the needs of medical school faculty development programs. The 14-item survey assessed the importance, operational frequency, difficulty in accomplishment, class readiness, execution of teaching, and evaluation of the session. RESULTS: Faculties were aware of the importance of class readiness, execution of teaching, and evaluation of the session but had a low level of accomplishment with regard to execution of the instruction and evaluation of the session. Four subitems of session evaluation were considered very important but showed low operational frequency, high difficulty in accomplishment, and low accomplishment ability. The successful discussion class item had the lowest operational frequency and accomplishment ability. The core contents that should be strengthened in medical school faculty development programs are diagnose students' class readiness (prior knowledge) (35.5%) and providing class session with suitable level/content (32.3%). CONCLUSION: Before designing faculty development programs, a needs assessment is useful in providing more tailored content for the faculty.
Needs Assessment ; Schools, Medical

PURPOSE: The purpose of this study was to compare the perception of learning outcomes between faculty and students in medical schools. METHODS: A total of 1,766 medical students and 436 faculty members participated in the survey. They responded to the perception of four learning outcomes: medical knowledge and problem solving, clinical skills, medical ethics, and clinical communication. The participants responded to the education and achievement levels of the learning outcomes. RESULTS: In all four learning outcomes, the student's perception of education level differed by educational system, and the students in mixed systems had the highest scores. Students differed significantly in achievement level of medical ethics between genders, wherein male students perceived their achievement level to be higher than females. Students perceived their achievement level to be lower than the education level. The students' clinical skills were the highest in the education and achievement levels. The faculty perceived the education level to be higher than the student's achievement level. In particular, the faculty's perception of education level of medical knowledge and problem solving was the highest, whereas the students' achievement level of it was lower. The faculty assessed the education level to be higher than students. The students showed higher perception of achievement level than faculty. CONCLUSION: There were perceptual differences in learning outcomes between students and faculty. The results of this study are expected to be used to design outcome-based learning methods.
Clinical Competence ; Education* ; Ethics, Medical ; Female ; Humans ; Learning* ; Male ; Problem Solving ; Schools, Medical* ; Students, Medical