Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate

Fibrates, peroxisome proliferator-activated receptor-α agonists, are potent lipid-modifying drugs. Their main effects are reduction of triglycerides and increase in high-density lipoprotein levels. Several randomized controlled trials have not demonstrated their benefits on cardiovascular risk reduction, especially as an “add on” to statin therapy. However, subsequent analyses by major clinical trials, meta-analyses, and real-world evidence have proposed their potential in specific patient populations with atherogenic dyslipidemia and metabolic syndrome. Here, we have reviewed and discussed the accumulated data on fibrates to understand their current status in cardiovascular risk management.

No abstract available.
Pulse Wave Analysis

Since the US Food and Drug Administration issued guidance requiring cardiovascular safety for all antidiabetic drugs in 2008 (US FDA industry guidance for licensing of antidiabetic drugs), the number of cardiovascular outcome trials in diabetes has remarkably increased. Cardiovascular outcome trial is considered a gold standard for establishing the cardiovascular safety of antidiabetic agents. However, there are possible limitations in information gained from cardiovascular outcome trials and other issues such as cost. In this review, we summarize recent cardiovascular outcome trials in type 2 diabetes and provide an overview of the implications and limitations of those trials.
Cardiovascular Diseases ; Diabetes Mellitus ; Hypoglycemic Agents ; Licensure ; United States Food and Drug Administration

During past several years, a novel class of antihyperglycemic agents, dipeptidyl peptidase-4 (DPP-4) inhibitors, has become one of the most important options in the management of type 2 diabetes. These agents have unique insulinotropic actions as well as other advantages such as lower hypoglycemia and a weight-neutral effect compared to traditional insulin secretagogues. To date, 6 different DPP-4 inhibitors have been introduced: sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin and gemiglitin. This review provides a summary of the clinical data for each DPP-4 inhibitor, and discusses the similarities and differences between them.
Adamantane ; Diabetes Mellitus ; Dipeptides ; Dipeptidyl-Peptidase IV Inhibitors ; Hypoglycemia ; Hypoglycemic Agents ; Incretins ; Insulin ; Nitriles ; Piperidines ; Purines ; Pyrazines ; Pyrrolidines ; Quinazolines ; Triazoles ; Uracil ; Linagliptin ; Sitagliptin Phosphate

Dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium glucose co-transporter 2 (SGLT2) inhibitors are newer classes of glucose-lowering agents that are currently widely used in clinical practice. Their glycemic efficacy and cardiovascular safety have been well proven, and recent large clinical trials even have shown cardiovascular benefits of SGLT2 inhibitors. However, data regarding drug-related long-term safety remain inconclusive. Recently, several safety issues related to DPP-4 inhibitors and SGLT2 inhibitors have been raised by cardiovascular outcome trials or post-marketing pharmacoepidemiological studies. In this review, we summarize emerging safety issues regarding the use of DPP-4 inhibitors and SGLT2 inhibitors in type 2 diabetes and suggest how to interpret and apply these results to clinical practice.
Diabetes Mellitus ; Dipeptidyl-Peptidase IV Inhibitors ; Glucose* ; Sodium*

PURPOSE: North Koreans could be at higher risk for their bone health because of previous periods of severe famine and the continuing low availability of food. This study determined the bone mineral density (BMD) status and its relationship with dietary behaviors and nutrient intake of North Korean refugees (NKR) in South Korea (SK). METHODS: This cross-sectional study analyzed 110 female NKR from a NORNS cohort of a non-probability sample of adult NKR in Seoul. BMD examined by DEXA was used to divide participants into the normal group (NG) and the non-normal group (NNG) according to the WHO guideline. A self-administered questionnaire included questions on age, the socioeconomic situation in North Korea (NK) and SK, the food security in NK and SK, and the health behaviors, dietary behaviors, and food frequency questionnaire administered in SK. A one-day 24-hr recall was conducted and the results were analyzed by using CanPro. SPSS was used to analyze whether BMD and related dietary behaviors and nutrient intakes differed according to the groups. RESULTS: NG (62.7%) was significantly younger and had a lower abdominal obesity score than NNG (p < 0.001). While 14.5% of NG reported experiencing menopause, all of NNG reported experiencing menopause. The NG more frequently consumed the dairy group of foods (9.6 times a week) than did the NNG (4.8 times a week) after the statistics were adjusted for age (p < 0.007). The NG consumed significantly more animal protein and animal calcium than did the NNG (p = 0.01, p = 0.009, respectively). Calcium intake was low with 49.3% of NG, and 78.0% of the NNG reported consuming calcium lower than the estimated average requirement. Only calcium showed an index of nutrient quality lower than one in both groups. CONCLUSION: These results showed that NKR women and possibly all North Korean women are at high risk for bone health and they consumed low levels of bone-related nutrients, and this should be considered for the nutrition policy for NKR and North Korea.
Adult ; Animals ; Bone Density ; Calcium ; Cohort Studies ; Cross-Sectional Studies ; Democratic People's Republic of Korea ; Diet ; Female ; Food Supply ; Health Behavior ; Humans ; Korea ; Menopause ; Nutrition Policy ; Nutritional Status ; Obesity, Abdominal ; Refugees ; Seoul ; Starvation

As extensive as the concept of and the resources required for ‘Health for Korean Unification’ are, and due to the limited access to information on the state of health and medical care in North Korea, discussion on ‘Health for Korean Unification’ has tended to be intermittent and lacked concrete action plans. In this article, we specifically distinguished areas of cooperation and selected five executable agenda that meet the goals of international development cooperation: 1) Health security; 2) Easing the burden of major diseases; 3) Resilient healthcare system; 4) R&D cooperation; 5) Sustainable cooperation system. Then we provided corresponding strategic priorities and operative directions, in consideration of future military and political sanctions against North Korea. The strategies we outline are sustainable, preemptive for problems that might affect lives of South and North Korean citizens, and satisfy the unmet needs of the North Korean health system. Throughout the process, we utilized a special platform, the ‘Korean Peninsula Healthcare Cooperation Platform,’ designed to enable continual communication across sectors engaged in public health and medical care. By doing so, we take the first step to actually carry out the 'Health for Korean Unification,’ which tended to have remained on the discussion agenda.

Sodium glucose cotransporter 2 (SGLT2) inhibitors have emerged as powerful medications in the past decade. Numerous clinical trials have reported their cardio-renal protective effects and associated reductions in mortality. The beneficial effects of SGLT2 inhibitors in mediating heart failure and chronic kidney disease progression have been consistent across patients with and without diabetes regardless of ejection fraction. Therefore, SGLT2 inhibitors are not only antidiabetic drugs but also medications for heart failure and chronic kidney disease. However, adverse events such as genital infections and diabetic ketoacidosis should be considered. In this review, we explore the journey of SGLT2 inhibitors, often referred to as the “statins of the 21st century,” from their inception to the present day. We introduce the strengths and weaknesses of this medication and discuss unresolved issues that should be taken into considerations when prescribing SGLT2 inhibitors.