Background: Thiazolidinediones (TZDs) have been associated with various safety concerns including weight gain, bladder cancer, and congestive heart failure (CHF). This study evaluated the efficacy and safety of lobeglitazone, a novel TZD in patients with type 2 diabetes mellitus (T2DM) in real practice. Methods: In this non-interventional, multi-center, retrospective, and observational study conducted at 15 tertiary or secondary referral hospitals in Korea, a total of 2,228 patients with T2DM who received lobeglitazone 0.5 mg for more than 1 year were enrolled. Results: Overall adverse events (AEs) occurred in 381 patients (17.10%) including edema in 1.97% (n=44). Cerebrovascular and cardiovascular diseases were identified in 0.81% (n=18) and 0.81% (n=18), respectively. One case of CHF was reported as an AE. Edema occurred in 1.97% (n=44) of patients. Hypoglycemia occurred in 2.47% (n=55) of patients. Fracture occurred in 1.17% (n=26) of all patients. Lobeglitazone significantly decreased HbA1c level, resulting in a mean treatment difference of -1.05%± 1.35% (P<0.001), and decreased total cholesterol, triglyceride, and low-density lipoprotein cholesterol. However, it increased high-density lipoprotein cholesterol, regardless of statin administration. The patients who received lobeglitazone 0.5 mg showed an apparent reduction in glycosylated hemoglobin (HbA1c) from baseline during the first 6 months of treatment. The HbA1c levels remained stable between months 6 and 42. Conclusion Lobeglitazone has long-term safety profile, good glycemic-lowering effect and long-term durability of glycemic control in real-world clinical settings.

BACKGROUND/AIMS: Improvements in the endoscopic evaluation and management of gastric cancer have made it possible to determine the depth of invasion during endoscopic examination. The aim of this study was to elucidate the differences between early gastric cancer (EGC) that resembles advanced gastric cancer (AGC) and AGC that resembles EGC. METHODS: We retrieved cases of EGC-like AGC and AGC-like EGC from consecutive gastric cancers that had been completely resected. The endoscopic diagnoses and clinicopathological findings were analyzed. RESULTS: AGC-like EGCs were located mainly in the distal part of the stomach, whereas EGC-like AGCs were located mainly in the proximal part of the stomach (p<0.001). Sixty percent of AGC-like EGCs were moderately differentiated adenocarcinomas, while 64% of EGC-like AGCs were poorly differentiated adenocarcinomas (p=0.015). According to Lauren's classification, 68% of AGC-like EGCs were intestinal type, whereas 71% of EGC-like AGCs were diffuse type (p=0.020). CONCLUSIONS: AGC-like EGCs predominate in the distal part of the stomach, while EGC-like AGCs predominate in the proximal part. When evaluating the depth of a gastric cancer, care should be taken not to underestimate measurements in proximal gastric cancers since they tend to be poorly-differentiated adenocarcinomas, in Lauren's diffuse type, and invade deeper than their endoscopic appearance might suggest.
Adenocarcinoma ; Endoscopy, Gastrointestinal ; Stomach ; Stomach Neoplasms

BACKGROUND/AIMS: Gastric atrophy can be diagnosed by serum pesinogen I/II ratio. The aim of this study was to investigate whether the changes of serum pepsinogen I/II ratio can be predicted by gastroscopy. MATERIALS AND METHODS: Sixty healthy subjects who underwent screening for serum pepsinogen I/II levels, serum Helicobacter pylori (H. pylori) antibody, and gastroscopy for two sequential years were included. Endoscopic findings were classified into four different categories according to the degree of chronic atrophic gastritis; none, mild, moderate, and severe. Changes of the serum pepsinogen I/II ratio, body mass index, H. pylori antibody, and endoscopic findings were analyzed after a year. RESULTS: The serum pepsinogen I/II ratio showed a tendency to decrease after a year in subjects with H. pylori infection (P=0.013) and those with moderate to severe atrophic gastritis (P=0.004), whereas it increased in subjects without H. pylori infection and those with none to mild atrophic gastritis. On multivariate analysis, the degree of atrophic gastritis was the only factor that was related to the changing trends of the serum pepsinogen I/II ratio (odds ratio=5.385, P=0.023). CONCLUSIONS: The degree of atrophic gastritis on endoscopic findings can predict the changes of the serum pepsinogen I/II ratio after a year. Regardless of the current status of H. pylori infection, the serum pepsinogen I/II ratio decreases after a year in subjects with moderate to severe atrophic gastritis.
Atrophy ; Body Mass Index ; Gastritis, Atrophic ; Gastroscopy ; Helicobacter pylori ; Mass Screening ; Multivariate Analysis ; Pepsinogen A

BACKGROUND/AIMS: The expression of sonic hedgehog (Shh) in the colon cancer cell has been implicated in colorectal carcinogenesis. However, the association between Shh expression in the normal colonic mucosa and the recurrence of colorectal neoplasm after tumor resection has not been well documented. The aim of the study was to determine the association between Shh expression in the normal colonic mucosa and in the recurrence of colorectal neoplasm. METHODS: Fifty-five patients who underwent a long-term follow-up colonoscopy after the colorectal neoplasm resection were included. At the time of the tumor resection, Shh expression in the normal colonic mucosa was examined. The association between Shh expression in the normal colonic mucosa and the recurrence of colorectal neoplasm was analyzed. RESULTS: In total, 97 colorectal neoplasms were detected among 41 subjects after a mean follow-up period of 63 weeks (range 27-254 weeks). Of 55 subjects, 26 (47.3%) exhibited positive Shh expression in the normal colonic tissue, and the recurrence rate did not differ with the degree of Shh expression (P=0.238). The degree of Shh expression was not associated with the number (P=0.389), size (P=0.928), location (P=0.410), pathologic types (P=0.127), or time of recurrence (P=0.711) of the recurred colorectal neoplasm. CONCLUSIONS: Most colorectal neoplasm patients show recurrence after the resection and exhibit Shh expression in the normal colonic tissue. The degree of Shh expression in the normal colonic mucosa does not predict the recurrence of colorectal neoplasm.
Colon ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Follow-Up Studies ; Hedgehogs ; Humans ; Mucous Membrane ; Recurrence

BACKGROUND/AIMS: The semiquantitative parameter "standard uptake value" (SUV) of 18Fluorodeoxyglucose (FDG) positron-emission tomography (PET) provides important additional information about colorectal cancer. In general, colorectal cancers exhibit different growth patterns with different clinicopathological characteristics. The aim of this study was to elucidate the link between the macroscopic appearance of colorectal cancers and maximum SUV (SUVmax) FDG uptakes. METHODS: We analyzed 347 patients with colorectal cancer who underwent PET scanning before treatment. The SUVmax of colorectal cancer was analyzed by examining PET images. The macroscopic appearance of each colorectal cancer was classified into three major types: ulcerofungating (n=223), ulceroinfiltrating (n=44), and fungating (n=78). Two cases that were difficult to classify were excluded from the study. RESULTS: The SUVmax was higher in colorectal cancers with an ulcerofungating appearance (12.19+/-5.84, mean+/-standard deviation) and ulceroinfiltrating appearance (11.66+/-5.63) than in those with a fungating appearance (9.58+/-6.67; P=0.005) (ulcerofungating and ulceroinfiltrative vs. fungating, P<0.001). A smaller tumor size (P<0.001) were significantly related to the fungating colorectal cancer. Four out of six colorectal cancers that did not show FDG uptake were the fungating type. CONCLUSIONS: Colorectal cancers with a fungating appearance exhibit a lower SUVmax, shallower invasion and smaller tumor size. Our results indicate that colorectal cancers with a fungating appearance would be less prominent on PET scan than those with an ulcerofungating or ulceroinfiltrating appearance, and thus require more attention.
Aluminum Hydroxide ; Carbonates ; Colorectal Neoplasms ; Electrons ; Humans ; Positron-Emission Tomography

BACKGROUND/AIMS: Although a small amount of fecal material can obscure significant colorectal lesions, it has not been well documented whether bowel preparation status affects the missing risk of colorectal polyps and adenomas during a colonoscopy. METHODS: We prospectively enrolled patients with one to nine colorectal polyps and at least one adenoma of >5 mm in size at the screening colonoscopy. Tandem colonoscopy with polypectomy was carried out within 3 months. RESULTS: A total of 277 patients with 942 polyps and 714 adenomas completed index and tandem examinations. At the index colonoscopy, 187 polyps (19.9%) and 127 adenomas (17.8%) were missed. The per-patient miss rate of polyps and adenomas increased significantly as the bowel cleansing rate declined from excellent to poor/inadequate on the Aronchick scale (polyps, p=0.024; adenomas, p=0.040). The patients with poor/inadequate bowel preparation were independently associated with an increased risk of having missed polyps (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.13 to 9.15) or missed adenomas (OR, 3.04; 95% CI, 1.04 to 8.88) compared to the patients with excellent bowel preparation. CONCLUSIONS: The risk of missing polyps and adenomas during screening colonoscopy is significantly affected by bowel preparation status. It seems appropriate to shorten the colonoscopy follow-up interval for patients with suboptimal bowel preparation.
Adenoma ; Colonoscopy ; Humans ; Mass Screening ; Polyps ; Prospective Studies

No abstract available.
Carcinoembryonic Antigen* ; Colon* ; Exons* ; Humans*

We report a case of synchronous gastric adenocarcinoma and abdominal non-Hodgkin's lymphoma in a 56-year-old man. An explo-laparotomy was performed for the purpose of palliative resection of the stomach and to evaluate the nature of splenic and peri-pancreatic mass lesions. The pathologic stage of the gastric carcinoma was stage IB (T2N0M0) and the clinical stage of the diffuse large cell type lymphoma was IIA2S. Following surgery and chemotherapy, the patient is now in a disease-free state.
Abdominal Neoplasms/pathology ; Abdominal Neoplasms/diagnosis* ; Adenocarcinoma/pathology ; Adenocarcinoma/diagnosis* ; Case Report ; Human ; Lymphoma, Non-Hodgkin/pathology ; Lymphoma, Non-Hodgkin/diagnosis* ; Male ; Middle Age ; Neoplasm Staging ; Neoplasms, Multiple Primary/pathology ; Neoplasms, Multiple Primary/diagnosis* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/diagnosis* ; Tomography, X-Ray Computed

Soluble forms of ICAM-1 (sICAM-1) and VCAM-1 (sVCAM-1) have been reported from the supernatant of cytokine-activated endothelial cells, cancer cells and from sera of cancer patients. We measured sICAM-1 and sVCAM-1 from the serum of 20 healthy volunteers and 142 gastric cancer patients by ELISA assay. Ninety-five patients were operable and 47 patients were in-operable at the time of this study. Particularly in the 28 operable patients, we sampled both portal and peripheral blood simultaneously and measured the levels of the soluble forms of cell adhesion molecules (sCAMs). The sCAMs level and sero-positivity rate increased with cancer progression in order of the healthy controls, operable patients, and inoperable patients. In in-operable cancer, the sICAM-1 level increased more with liver metastasis. sICAM-1 and sVCAM-1 did not correlate with each other in either portal or peripheral blood. A total of 58.3% of patients with liver metastasis and 22.9% of patients without liver metastasis showed synchronous expression of both sCAMs (p = 0.03). Synchronous sero-positivity of sCAMs and alpha FP was higher with liver metastasis (p = 0.01). The median overall survival duration which co-expressed both sCAMs was 9 months. This showed a significant difference compared with the sICAMs non-expressing group, where the median survival was not reached until 24 months follow-up (p = 0.002). The synchronous expression of sCAMs was an independent risk factor in gastric cancer patients. We raise the possibility that synchronous sICAM-1 and sVCAM-1 elevation may be a useful monitor to determine tumor burden in gastric cancer.
Adult ; Aged ; Female ; Human ; Intercellular Adhesion Molecule-1/blood* ; Liver Neoplasms/secondary ; Male ; Middle Age ; Stomach Neoplasms/mortality ; Stomach Neoplasms/blood* ; Survival Rate ; Vascular Cell Adhesion Molecule-1/blood*

PURPOSE: We measured the gastric cancer tissue uPA and plasminogen activator inhibitor-1 (PAI-1) levels and compared them to those of the peripheral and portal blood levels to evaluate the correlation. MATERIALS AND METHODS: Tissue uPA and PAI-1 levels were measured by ELISA assay (Monozyme, Netherland) in paired 85 normal and cancer tissues resected from gastric cancer patients. In 50 patients, blood uPA and PAI-1 levels were measured from pre- operative peripheral and portal blood, post-operative portal blood. RESULTS: Gastric cancer tissue uPA and PAI-1 levels increased from the early stage. The elevated cancer-to-normal ratios of the uPA and PAI-1 were constant from stage I to IV. There were correlations of uPA between normal and cancer tissues (r2=0.38) and between peripheral and pre-resection portal blood level (r2=0.64). There were no correlations between tissue PAI-1 level and blood PAI-1 levels. However, there were correlations in PAI- 1/uPA ratio between cancer tissue and peripheral blood (r2=0.25), peripheral blood and pre- resection portal blood (r2=0.60). CONCLUSION: Even if the cancer tissue levels of uPA and PAI-1 increased from the early stage of gastric cancer, only blood uPA level correlated with tissue uPA level. A modest correlation found in PAI-1/uPA ratio between cancer tissue and blood suggests applicability of blood PAI-1/uPA ratio in predicting tissue uPA, PAI-1 expression.
Enzyme-Linked Immunosorbent Assay ; Humans ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Stomach Neoplasms* ; Urokinase-Type Plasminogen Activator*