BACKGROUND/OBJECTIVES: Jerusalem artichoke has inhibitory activity against α-glucosidase and decreases fasting serum glucose levels, which may be related to its fructan content. The biological activity of fructan can be influenced by the degree of polymerization. Thus, in this study, the inhibitory effects of original and fermented purple Jerusalem artichoke (PJA) on α-glucosidase were compared in vitro. Additionally, the anti-diabetes effect of Lactobacillus plantarum-fermented PJA (LJA) was studied in a non-insulin-dependent diabetes mellitus animal model (C57BIKsJ db/db). MATERIALS/METHODS: The water extract of PJA was fermented by L. plantarum, and two strains of Bacillus subtilis to compare their anti-α-glucosidase activities in vitro by α-glucosidase assays. The anti-diabetes effect of LJA was studied in a non-insulin-dependent diabetes mellitus animal model (C57BIKsJ db/db) for seven weeks. During the experiment, food intake, body weight, and fasting blood glucose were measured every week. At the end of the treatment period, several diabetic parameters and the intestinal α-glucosidase activity were measured. RESULTS: The LJA showed the highest α-glucosidase inhibitory activity in vitro. In the in vivo study, it resulted in a significantly lower blood glucose concentration than the control. Serum insulin and HDL cholesterol levels were significantly higher and the concentrations of triglycerides, non-esterified fatty acids, and total cholesterol were significant lower in mice treated with LJA after seven weeks. In addition, the intestinal α-glucosidase activity was partially inhibited. CONCLUSIONS: These results suggested that LJA regulates blood glucose and has potential use as a dietary supplement.
Animals ; Bacillus subtilis ; Blood Glucose* ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dietary Supplements ; Eating ; Fasting ; Fatty Acids ; Fermentation* ; Helianthus* ; In Vitro Techniques* ; Insulin ; Lactobacillus ; Lactobacillus plantarum ; Mice* ; Models, Animal ; Polymerization ; Polymers ; Triglycerides ; Water

BACKGROUND/OBJECTIVES: Jerusalem artichoke has inhibitory activity against α-glucosidase and decreases fasting serum glucose levels, which may be related to its fructan content. The biological activity of fructan can be influenced by the degree of polymerization. Thus, in this study, the inhibitory effects of original and fermented purple Jerusalem artichoke (PJA) on α-glucosidase were compared in vitro. Additionally, the anti-diabetes effect of Lactobacillus plantarum-fermented PJA (LJA) was studied in a non-insulin-dependent diabetes mellitus animal model (C57BIKsJ db/db). MATERIALS/METHODS: The water extract of PJA was fermented by L. plantarum, and two strains of Bacillus subtilis to compare their anti-α-glucosidase activities in vitro by α-glucosidase assays. The anti-diabetes effect of LJA was studied in a non-insulin-dependent diabetes mellitus animal model (C57BIKsJ db/db) for seven weeks. During the experiment, food intake, body weight, and fasting blood glucose were measured every week. At the end of the treatment period, several diabetic parameters and the intestinal α-glucosidase activity were measured. RESULTS: The LJA showed the highest α-glucosidase inhibitory activity in vitro. In the in vivo study, it resulted in a significantly lower blood glucose concentration than the control. Serum insulin and HDL cholesterol levels were significantly higher and the concentrations of triglycerides, non-esterified fatty acids, and total cholesterol were significant lower in mice treated with LJA after seven weeks. In addition, the intestinal α-glucosidase activity was partially inhibited. CONCLUSIONS: These results suggested that LJA regulates blood glucose and has potential use as a dietary supplement.
Animals ; Bacillus subtilis ; Blood Glucose* ; Body Weight ; Cholesterol ; Cholesterol, HDL ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Dietary Supplements ; Eating ; Fasting ; Fatty Acids ; Fermentation* ; Helianthus* ; In Vitro Techniques* ; Insulin ; Lactobacillus ; Lactobacillus plantarum ; Mice* ; Models, Animal ; Polymerization ; Polymers ; Triglycerides ; Water

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.
Adolescent ; Adult ; Cerebral Palsy/*complications ; Child ; Child, Preschool ; Female ; Humans ; Intraoperative Complications/*etiology ; Lower Extremity/*surgery ; Male ; Middle Aged ; Orthopedic Procedures/*adverse effects ; Postoperative Complications/*etiology

BACKGROUND/AIMS: Ambulatory blood pressure (BP) monitoring has been widely recommended for evaluating the status of BP, but is lacking in practicality. Determination of the specific time points for BP measurement that are representative of 24-hour mean BP could be useful and convenient in hypertensive patients with chronic kidney disease (CKD). METHODS: A total of 1,317 patients for whom 24-hour ambulatory BP monitoring was performed were enrolled in a multicenter study on hypertensive CKD. We analyzed the time points at which systolic blood pressure (SBP) values exhibited the smallest differences from 24-hour mean SBP (mSBP). We included office mSBP and analyzed the relationships between SBPs at the office and the time points with the smallest differences from 24-hour mSBP using several methods. RESULTS: The time points with the smallest differences from 24-hour mSBP were 7:00 AM, 2:00 PM, and 9:30 PM. In regression analysis, SBPs at 7:00 AM and 9:30 PM were better correlated with 24-hour mSBP than SBPs at 2:00 PM and the office. The proportions of patients with SBPs within 30% of 24-hour mSBP were higher at 7:00 AM and 9:30 PM. The best consistency between the uncontrolled hypertensive groups, defined as > or = 135 mmHg of 24-hour mSBP and higher values of SBPs corresponding to 135 mmHg of 24-hour mSBP, were observed at the 7:00 AM and 9:30 PM time points. CONCLUSIONS: The specific time points for SBPs that correlated well with 24-hour mSBP in hypertensive CKD patients were 7:00 AM and 9:30 PM.
Adult ; Aged ; *Blood Pressure ; Blood Pressure Monitoring, Ambulatory/*methods ; Circadian Rhythm ; Cross-Sectional Studies ; Female ; Humans ; Hypertension/*diagnosis/physiopathology ; Male ; Middle Aged ; Office Visits ; Predictive Value of Tests ; Prospective Studies ; Renal Insufficiency, Chronic/*diagnosis/physiopathology ; Republic of Korea ; Time Factors ; Young Adult

sociated with hyperthyroidism occurs in 2.0% of Graves disease and is characterized by myasthenia or bilateral flaccid paralysis of lower extremity, in some cases, it may be accompanied with cardiac arrhythmias which are mostly due to hypokalemia. The most common type of cardiac arrhythmias associated with hyperthyroidism is sinus tachycardia, 1015% of patients have atrial fibrillation. Rarely, ventricular tachycardia or ventricular fibrillation develop and lead to cardiac arrest in severe case. A 26-year-old man was admitted to the hospital because of weakness of lower extremity. The initial EKG showed ventricular tachycardia. The laboratory results were, TSH 0.08 microunit/mL, free T4 4.11 ng/mL, T3 2.88 ng/mL, serum K 1.9 mEq/L. He was diagnosed as ventricular tachycardia associated with hypokalemic thyrotoxic periodic paralysis. His symptoms improved during the treatment with propylthiouracil and potassium replacement. We report a case of thyrotoxic periodic paralysis presenting as ventricular tachycardia with brief review of literatures.
Adult ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Electrocardiography ; Graves Disease ; Heart Arrest ; Humans ; Hyperthyroidism ; Hypokalemia ; Lower Extremity ; Paralysis* ; Potassium ; Propylthiouracil ; Tachycardia, Sinus ; Tachycardia, Ventricular* ; Ventricular Fibrillation

PURPOSE: We aimed to evaluate the nationwide incidence and risk factors for symptomatic deep vein thrombosis (DVT) after major lower limb orthopedic surgeries. MATERIALS AND METHODS: The Korean Health Insurance Review and Assessment Service database was used to retrospectively identify International Classification of Disease-10 codes for DVT and operation codes representing hip arthroplasty, knee arthroplasty, and hip fracture surgeries. The age- and gender-adjusted annual incidence of DVT, rates of major lower limb orthopedic surgeries, and the postoperative incidence of DVT according to the surgical procedure were assessed. RESULTS: The age- and gender-adjusted annual incidence of DVT was 70.67 per 100000 persons/year. Compared to patients aged <49 years, the relative risk of DVT was five times higher in patients aged 50-69 and 10 times higher in patients aged >70 years (p<0.001). Females showed a greater relative risk for DVT than males (1.08; p<0.001). The incidence of postoperative DVT, according to the type of surgery, was significantly greater for knee replacement arthroplasty than for other forms of surgery (p<0.002). The relative risk of postoperative DVT was higher in females in knee replacement arthroplasty (1.47) and hip fracture surgery (2.25) groups, although relatively lower in those who underwent hip replacement arthroplasty (0.97). CONCLUSION: Among major lower limb surgeries, advanced age, female gender, and undergoing a knee replacement arthroplasty were found to be risk factors for developing postoperative DVT. These findings further emphasize the need for orthopedic surgeons to consider the development of DVT after surgery in high-risk patients.
Adolescent ; Adult ; Age Distribution ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Leg/*surgery ; Male ; Middle Aged ; Orthopedic Procedures/*adverse effects ; Postoperative Complications/epidemiology/etiology ; Registries/*statistics & numerical data ; Republic of Korea/epidemiology ; Risk Factors ; Venous Thrombosis/*epidemiology/*etiology ; Young Adult

A carcinoid tumor of the stomach is a neuroendocrine tumor originating from enterochromaffin cells in the submucosa of the stomach and has no specific clinical symptoms. They are uncommon, accounting for no more than 0.3% of all gastric tumors. However, this frequency has increased markedly due to endoscopic screening. Herein, the case of a 47-year-old man with a polypoid lesion (2 cm diameter) detected on endoscopic examination is reported. It was diagnosed as a carcinoid tumor before an operation. Although the tumor size was slightly larger than 2 cm in diameter, the lesion was treated by wedge resection as there was no lymph node involvement or other distant metastasis. The postoperative has course was uneventful. The patient has continued to do well for over 15 months of follow up.
Carcinoid Tumor* ; Enterochromaffin Cells ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Stomach*

We report the case of a 77-year-old woman who presented with periumbilical pain from perforation of jejunal diverticula. The patient underwent surgery and multiple jejunal diverticula were found distributed from 30 cm to 60 cm distal to the ligament of Treitz. A segment of the jejunum containing all diverticula was resected and end-to-end anastomosis was performed. The postoperative course was uneventful. The patient continued to do well at last follow-up, 26 months after operation. Diverticulum of the jejunum is uncommon and the majority of patients are asymptomatic. Symptoms indicating diverticulum are few and often nonspecific; they may present either as generalized abdominal pain associated with intestinal disturbances or in more serious case, they can lead to complications requiring emergency surgery. In light of these considerations, we thought it useful to report a case of complicated multiple jejunal diverticula and draw attention to its complications that can be a source of gastrointestinal symptoms.
Abdominal Pain ; Aged ; Diverticulum* ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Jejunum ; Ligaments ; Peritonitis*

Eosinophilic gastrointestinal disorder is uncommon and it has rarely been reported. The presence of increased numbers of eosinophils in the biopsy specimens of the gastrointestinal tract, the infiltration of eosionophils in intestinal crypts and gastric glands, the absence of involvement of other organs and the exclusion of other causes of eosinophilia support the diagnosis of eosinophilic gastroenteritis. This is characterized by infiltration of eosinophils in the gastrointestinal wall, and it's associated with protein-losing enteropathy, hypoalbuminemia, motility abnormalities and ascites. Although it is an idiopathic disorder, allergic and immunologic etiologies have been suggested. Steroid is the treatment of choice, but an operation is necessary in case of a surgical abdomen or if the patient is refractory to steroid therapy. Recently, authors experience 2 cases of eosinophilic gastroenteritis causing gastro-intestinal obstruction, and report here with clinical evaluation and literature review.
Abdomen ; Ascites ; Biopsy ; Diagnosis ; Eosinophilia ; Eosinophils* ; Gastric Mucosa ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Hypersensitivity ; Hypoalbuminemia ; Intestinal Obstruction* ; Protein-Losing Enteropathies

Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP.
Cerebral Palsy/diagnostic imaging/*pathology ; Child ; Disease Progression ; Female ; Hip Dislocation ; Humans ; Linear Models ; Male ; Reconstructive Surgical Procedures ; Retrospective Studies ; Severity of Illness Index ; Sex Factors