No abstract available.
Avidin*

The universal first step for the treatment of diabetes mellitus, hypertension, dyslipidemia or atherosclerotic disease is therapeutic lifestyle change (TLC). However, in most cases, long-term sincere maintenance of TLC is very difficult. The Look-AHEAD study was initiated based on the results of the Diabetes Prevention Program (DPP) trial that evaluated the effects of TLC on the prevention of diabetes. However, the look-AHEAD trial failed to demonstrate the benefit of intensive lifestyle intervention (ILI) for the prevention of CVD or CVD-associated mortality. Several explanations were suggested, including that the ILI group did not maintain effective weight loss, and that the intervention and control groups both received the same high-quality medical treatments. The participants of the look-AHEAD trial were very highly motivated, and the investigators of the trial systematically pursued their patients to achieve the desired end result, which is quite different from the usual clinical practice setting. Simple advisement for patients to perform diet restriction and moderate intensity regular physical exercise typically fails and is ineffective for the prevention of CVD in actual clinical practice. Concomitant sincere control of other risk factors is necessary for long-term CVD prevention. Further research on practical and effective methods for achievement of successful TLC is needed.
Cardiovascular Diseases* ; Diabetes Mellitus ; Diet ; Dyslipidemias ; Exercise ; Humans ; Hypertension ; Life Style* ; Mortality* ; Research Personnel ; Risk Factors ; Weight Loss

The normal healing of a cutaneous wound is achieved via well-orchestrated integration of complex biological and molecular events of cell migration, proliferation, extracellular matrix deposition and tissue remodeling. Chronic wounds fail to progress through the normal stages of healing, and enter a state of pathologic inflammation. Complicated diabetic patients show delayed wound healing caused by multiple factors including vascular insufficiency, abnormalities of the biochemical environment and hyperglycemia per se. Novel technologies including growth factor therapy, gene therapy, stem cell technologies, synthetic skins and hyperbaric oxygen treatment are under development. In the near future, these therapeutic strategies will be clinically available.
Cell Movement ; Diabetes Mellitus ; Extracellular Matrix ; Genetic Therapy ; Humans ; Hyperglycemia ; Inflammation ; Oxygen ; Skin ; Skin Ulcer ; Stem Cells ; Wound Healing

An ipsilateral supraclavicular lymph node recurrence of breast cancer after surgery has been considered a predecessor to distant metastases. There still is a debate as to whether breast carcinoma patients with the isolated supraclavicular lymph node recurrence should be considered to have disseminated disease or if aggressive treatment, with curative intent, is justified. We report two cases of an isolated ipsilateral supraclavicular lymph node recurrence following modified radical mastectomy, and multimodality treatments with modified radical neck dissection, systemic chemotherapy and involved field radiotherapy. These patients have lived without locoregional recurrence or distant metastases for 3 and 2 years, respectively. Conclusively, we recommend aggressive combined multimodality treatments, including surgery, such as modified radical neck dissection or complete excision of the involved lymph nodes, systemic chemotherapy, and involved field radiotherapy, in patients with isolated supraclavicular lymph node recurrence, but with no other evidence of distant metastases.
Breast Neoplasms ; Drug Therapy ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Neck Dissection ; Neoplasm Metastasis ; Radiotherapy ; Recurrence

BACKGROUND: The accuracy and efficacy of patient-controlled analgesia (PCA) devices are crucial because malfunction of the devices may lead to fatal outcomes. The aim of this study is to evaluate the accuracy and efficacy of Accumate(R) 1100, an electronic PCA pump, in comparison with GemStar(R) infusion system. METHODS: Fifty patients scheduled for gastrectomy or colon resection were assigned to the Accumate or GemStar group (n = 25 in each group). Intraoperatively, backflow, siphonage, autoclamp function, and lockout time were tested. Postoperatively, PCA using either Accumate(R) 1100 or GemStar(R) infusion system according to the assigned group was maintained for 48 hours. For PCA, fentanyl 1,500 ug and ketorolac 180 mg in 100 ml were used (demand bolus 1 ml, background infusion 1 ml/h, lockout time 15 minutes). The accuracy of the total infused dose and the level of satisfaction of the patients and users were assessed. The results were compared between the two groups. RESULTS: Although backflow and auto-clamp backflow were less with GemStar(R) infusion system, their extent was negligible in both groups. Siphonage was not different between both pumps. Autoclamp and lockout time worked without abnormalities. The relative error of total infused volume over 48 hours was -0.26 +/- 1.20% and -0.34 +/- 0.48% in the Accumate group and GemStar group, respectively. The Accumate group showed a higher level of satisfaction in terms of the ease of priming (P < 0.05). CONCLUSIONS: The accuracy and clinical efficacy of Accumate(R) 1100 were comparable to those of GemStar(R) infusion system.
Analgesia, Patient-Controlled* ; Colon ; Equipment Safety ; Fatal Outcome ; Fentanyl ; Gastrectomy ; Humans ; Infusion Pumps* ; Ketorolac ; Passive Cutaneous Anaphylaxis

The analysis of heart rate variability is a useful tool to investigate the physiologic phenomena related with autonomic functions. At first, it was developed to evaluate the relation between cardiovascular disease and autonomic balance. Nowadays, the application of it's use has been considered in psychiatric practice. And its convenient usage and non-invasiveness gathered more interest of clinicians and investigators. However, no systematic review of the studies on the heart rate variability in psychiatric field is tound. Thus we reviewed the literatures on the usage and it's limitations of the heart rate variability in terms of the spplication in psychiaric practice and research. Interviews with experts on autonomic functions were also included to supplement the review. Studies found that patients with schizophrenia showed reduced heart rate variability while taking clozapine, and severely depressed patients showed more reduced heart rate variability than normal control. Patients with various anxiety disorders including panic disorder and posttraumatic stress disorder showed eleated sympathetic autonomic tone compared with normal control subjects. However these findings remained controversial because of many confounding factors including drug effects and individual and situational factors affecting heart rate variability. With further studies after successful control of confounding variables, the analysis of heart rate variability would be a useful physiologic parameter of asessing psychiatric patients in clinical practice and research.
Anxiety Disorders ; Cardiovascular Diseases ; Clozapine ; Confounding Factors (Epidemiology) ; Heart Rate* ; Heart* ; Humans ; Panic Disorder ; Research Personnel ; Schizophrenia ; Stress Disorders, Post-Traumatic

Venous thromboembolism is well known as one of the rare but serious adverse effects of combined oral contraceptives (COCs). The COCs with third and fourth generation progestogens were found to have higher risk of venous thrombosis than those with second generation progestogens. We present a case of pulmonary embolism in a 23-year-old nulligravid woman who was using COCs containing the third generation progestogen (desogestrel). At the time of presentation of the adverse effect, she had been using the COCs for 4 months. She had no additional risk factors for thrombosis such as smoking, surgery, tumor as well as genetic factors. This case demonstrates even young women in otherwise good health may be at risk of venous thromboembolism from low-dose formulations of COCs as an over-the-counter drug. We describe this case with a brief review of literatures.
Contraceptives, Oral* ; Contraceptives, Oral, Combined ; Desogestrel* ; Female ; Humans ; Progestins ; Pulmonary Embolism* ; Risk Factors ; Smoke ; Smoking ; Thrombosis ; Venous Thromboembolism ; Venous Thrombosis ; Young Adult

In this study, we investigated whether the single nucleotide polymorphisms (SNPs) associated with telomere length (TL) were associated with the incidence of hypertension (HTN)/coronary heart disease (CHD) and cardiovascular risk factors in the Korean population. Data from 5,705 (ages 39–70) participants in the Korean Genome Epidemiology Study (rural Ansung and urban Ansan cohorts) were studied. Twelve SNPs known to be associated with telomere biology were tested for an association with HTN/CHD. As results, no significant associations were found between the selected TL-related SNPs and prevalence of HTN and CHD. Among non-alcohol users, subjects with minor alleles in rs1269304 and rs10936601 (TERC and LRRC34, respectively) exhibited a higher rate of CHD occurrence (odds ratio [OR], 1.862; 95% confidence intervals [CIs], 1.137, 3.049; OR, 1.855; 95% CIs, 1.111, 2.985; respectively). However, alcohol users with minor alleles in rs398652 (PELI2) were significantly associated with higher HTN prevalence (OR, 1.179; 95% CIs, 1.040, 1.336). Of the 3 SNPs related to disease outcomes, rs1296304 was significantly associated with increased levels of diastolic blood pressure (β estimate, 0.470; 95% CIs, 0.013, 0.926). The minor allele in rs398652 was significantly associated with higher levels of body mass index (OR, 0.128; 95% CIs, 0.010, 0.246) and γ-glutamyl transpeptidase (OR, 0.013; 95% CIs, 0.001, 0.024). In conclusion, there were no significant associations between the selected TL-related SNPs and the occurrence of HTN/CHD in Koreans. However, the results suggest the presence of a possible interaction between related SNPs and alcohol behavior associated with HTN/CHD occurrence.
Alleles ; Biology ; Blood Pressure ; Body Mass Index ; Coronary Disease* ; Epidemiology ; Genetic Variation* ; Genome ; Gyeonggi-do ; Heart Diseases ; Hypertension* ; Incidence ; Polymorphism, Single Nucleotide ; Prevalence* ; Risk Factors ; Telomere*

The clinical practice guidelines (CPGs) is made step by step. The evidences that have been published were searched and a group of experts make a consensus based in the evidences. The CPGs in the medical field, where utilizations and interests are increasing, must be confirmed in the management of quality. The Korean Appraisal of Guidelines for Research & Evaluation II (K-AGREE II) tool that helps to manage the quality of CPGs and to develop CPGs was translated by the Steering Committee for Clinical Practice Guideline. It is divided into 6 domains and each domains are independent. It is consisted of 23 items as detail and 2 items for the overall evaluation. Only fifteen CPGs are successfully certified using the K-AGREE II tool in the Korean Medical Guideline Information Center from 2013 and 3 CPGs made by the Korea Urological Association and the associated societies are certified successfully. With the level of certification of CPGs is higher, the Korea Urological Association and the associated societies are also try to develop CPGs that meet their level of certification. The Korean clinical practice guideline for the treatment of prostate cancer developed recently is the evidence of effort.
Certification ; Consensus ; Information Centers ; Korea ; Prostatic Neoplasms ; Quality Improvement ; Urology

Purpose: To assess the association between the choroidal vascularity index (CVI) and prelaminar tissue thickness (PTT) in healthy and glaucomatous eyes. Methods: The study included 86 eyes with perimetric glaucoma (PG), 86 with pre‐perimetric glaucoma (PPG), and 43 agematched healthy eyes. Total choroidal area (TCA) and CVI were measured by image binarization of spectral‐domain optical coherence tomography (SD‐OCT) 3.5 mm from the center of Bruch’s membrane opening. The CVI was the percentage of choroidal vasculature to choroidal tissue. The association between CVI and PTT measured on a center‐horizontal scan of enhanced depth imaging SD‐OCT was assessed. Results: The CVI was lowest in PG (61.67% ± 4.11%), followed by PPG (63.36% ± 3.54%), and healthy (64.84% ± 3.13%) eyes (p < 0.001). PG (102.05 ± 44.01 μm) had a significantly thinner PTT than PPG (106.16 ± 38.03 μm) and the healthy (154.98 ± 79.46 μm) eyes (p < 0.001). In a multivariate regression analysis, CVI was associated with PTT and TCA in all subjects, including healthy and glaucomatous eyes (p < 0.05). Conclusions The CVI and PTT had significantly lower values in glaucomatous eyes than in healthy eyes, and the two parameters were positively associated in all subjects, including healthy and glaucomatous eyes.