Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Although patients with cirrhosis are known to be in a state of “rebalance” in that pro- and anticoagulant factors increase the risk for both bleeding and thrombosis, the prevalence of portal vein thrombosis (PVT) in patients with cirrhosis can be up to 26%. Therefore, physicians should consider anticoagulation for the prevention and management of PVT in patients with cirrhosis who are at high risk of PVT. Vitamin K antagonist or low molecular weight heparin is suggested as the standard treatment for PVT in cirrhosis. With the advent of new direct-acting oral anticoagulants (DOACs), there is a paradigm shift of switching to DOACs for the treatment of PVT in patients with cirrhosis. However, the safety and efficacy of DOACs in the treatment of PVT was not well-known in patients with cirrhosis. Therefore, this review focused on the current knowledge about the efficacy, safety concerns, and hepatic metabolism of DOACs in patients with cirrhosis and PVT.

Objective: To investigate changes in blood glucose level after steroid injection in patients with type 2 diabetes mellitus (DM) and factors affecting those changes. Methods: We retrospectively studied 51 patients with type 2 DM who underwent steroid injection for shoulder and back pain. Mean fasting blood sugar (FBS) levels for 7 days before steroid injection was used as the baseline blood glucose level, which was compared with FBS levels for 14 days after steroid injection. We compared the differences in blood glucose changes between HbA1c >7% and HbA1c ≤7% groups and those between insulin and non-insulin treated groups. Demographic data, injection site, and steroid dose were analyzed. Results: Compared to baseline, blood glucose significantly (p=0.012) elevated 1 day after steroid injection but not 2 days after injection. In the HbA1c >7% and insulin groups, blood glucose was significantly increased 1 day after injection compared to that in the HbA1c ≤7% (p=0.011) and non-insulin (p=0.024) groups, respectively. Higher HbA1c level before injection was significantly (p=0.003) associated with the degree of blood glucose increase 1 day after injection. No significant differences were noted in the degree of blood glucose increase according to injection site or steroid dose. Conclusion Higher HbA1c level was associated with greater elevation in blood glucose 1 day after steroid injection. Careful monitoring of blood glucose is required on the first day after steroid injection in patients with poorly controlled DM.

OBJECTIVE: To evaluate the effectiveness of dynamic balance exercise after intra-articular injection of hyaluronic acid (HA) therapy in elderly patients with unilateral knee osteoarthritis.METHOD: 30 patients with unilateral knee osteoarthritis were enrolled in this study. The patients were randomly divided into two groups: dynamic balance exercise after HA injection group (group A) and only HA injection group (group B). Both groups administered intra-articular HA injection and group A patients continued 20-session exercises for 4 weeks. The assessments were measured before injection and 4 weeks after treatment using the visual analog scale (VAS) for pain, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for physical function, Berg balance scale (BBS), and computerized dynamic posturography using SMART Balance Master system for balance function.RESULTS: In both groups, significant improvements in VAS, WOMAC and balance function were observed. Compared between groups, group A showed significant improvements compared to group B in WOMAC and balance function.CONCLUSION: It is suggested that dynamic balance exercise may result in improved balance function and physical function in elderly patients with unilateral knee osteoarthritis.
Aged ; Exercise ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Methods ; Ontario ; Osteoarthritis ; Osteoarthritis, Knee ; Rehabilitation ; Visual Analog Scale

PURPOSE: The objective of this study was to investigate the effects of xyloologosaccharide (XOS)-sugar mixture on glycemic index (GI) and blood glucose in human subjects. METHODS: Randomized double-blind cross-over studies were conducted to examine the effect of sucrose with 14% xyloologosaccharide powder (Xylo 14) and sucrose with 20% xylooligosaccharide powder (Xylo 20) on GI and postprandial glucose response at 15, 30, 45, 60, 90, and 120 min. RESULTS: GIs of Xylo 14 and Xylo 20 were 60.0 +/- 23.5 classified within medium GI range, and 54.3 +/- 17.7 within low GI range, respectively. Xylo 14 and Xylo 20 showed significantly lower area under the glucose curve (AUC) for 0-15 min (p = 0.0113), 0-30 min (p = 0.0004), 0-45 min (p < 0.0001), 0-60 min (p < 0.0001), 0-90 min (p < 0.0001), and 0-120 min (p = 0.0001). In particular, compared with glucose, the blood glucose levels of Xylo 14 and Xylo 20 were significantly lower at every time point between 15 and 120 min. CONCLUSION: The results of this study suggested that Xylo 14 and Xylo 20 had an acute suppressive effect on GI and the postprandial glucose surge.
Adult* ; Blood Glucose* ; Cross-Over Studies ; Glucose ; Glycemic Index* ; Humans ; Sucrose

BACKGROUND/OBJECTIVES: This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS: A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS: When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B₆, β-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B₆, B₁₂, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B₁₂ intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS: When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.
Antioxidants* ; Ascorbic Acid ; Atherosclerosis ; Cerebral Arteries ; Classification ; Folic Acid ; Food Habits ; Fruit ; Homocysteine ; Humans ; Intracranial Arteriosclerosis* ; Korea ; Plasma ; Seoul ; Stroke* ; Vegetables ; Vitamin B Complex* ; Vitamins

PURPOSE: This study was conducted in order to investigate the diuretic effects of Erythritol (ET) salt on urinary electrolyte excretion in Sprague-Dawley Rats. METHODS: Animals were divided into two groups: Salt group (n = 7) and Salt + ET fed group (n = 7). Animals were provided food and water ad libitum. Supplements were administered orally to animals for one week. RESULTS: Body weights were not statistically different between groups either on Day 1 or Day 7. However, water consumption of the Salt + ET group was significantly higher than that of the Salt group on Day 1 and Day 7. Urine volume of the Salt + ET group was approximately 27% and 38% higher than that of the Salt group on Day 1 and Day 7. In addition, we found that the total amounts of urinary electrolytes, such as sodium and potassium, of the Salt + ET group were significantly higher than those of the Salt group on Day 7. We also found that serum electrolyte concentrations did not differ between two groups. These results demonstrated that salt intake with ET was effective in increasing urinary electrolyte excretion, which might be caused by higher water intake and diuretic effect inhibiting reabsorption of water, sodium, and potassium in renal tubules. CONCLUSION: The results suggest that short-term supplementation of ET salt can be a potential diuretic agent by inhibiting sodium and potassium reabsorption and inducing loss of water.
Animals ; Body Weight ; Diuretics ; Drinking ; Electrolytes ; Erythritol ; Hypertension ; Potassium ; Rats* ; Rats, Sprague-Dawley ; Sodium ; Water

PURPOSE: This study was conducted to evaluate the association between intakes of potassium, magnesium, and calcium and diet quality in ischemic stroke patients. METHODS: This study analyzed data from 285 subjects recruited from February 2011 to August 2014 in Seoul, Korea. Nutrition intakes were obtained from a semi-quantitative food frequency questionnaire composed of 111 food items. The subjects were divided into 4 groups by quartiles according to intakes of potassium, magnesium, and calcium. Index of Nutritional Quality (INQ), Mean Adequacy Ratio (MAR), and DQI-International (DQI-I) were analyzed for assessment of diet quality. RESULTS: We found a positive association of intakes of these three minerals with MAR and DQI-I after adjustment for age, sex, education level, smoking, atrial fibrillation, and total energy intake. However, total moderation of DQI-I score in the Q4 group was significantly lower than that of the Q1 group. The age, sex, education level, and smoking, atrial fibrillation, and total energy intake-adjusted odds ratios of extensive cerebral atherosclerosis were inversely associated with intake of magnesium (Ptrend = 0.0204). However, this association did not exist with intakes of potassium and calcium. CONCLUSION: Potassium, magnesium, and calcium rich and high quality diet could be associated with decreased risk of ischemic stroke, in part, via effect on extensive cerebral atherosclerosis.
Atrial Fibrillation ; Calcium ; Diet* ; Education ; Energy Intake ; Humans ; Intracranial Arteriosclerosis* ; Korea ; Magnesium* ; Minerals* ; Nutritive Value ; Odds Ratio ; Potassium ; Surveys and Questionnaires ; Seoul ; Smoke ; Smoking ; Stroke*

We investigated the kinetics of the neutralizing antibody responses to the severe acute respiratory syndrome-coronavirus-2 delta variant over the course of 1 year in 16 patients infected at the beginning of the pandemic. In patients with severe disease, neutralizing responses to the delta variant were detectable, albeit at lower levels than responses to the wild type. Neutralizing responses to the delta variant were undetectable, however, in asymptomatic persons. This finding implies that the vaccination strategy for persons with past natural infection should depend on the severity of the previous infection.

Cerebral venous sinus thrombosis (CVST) is an uncommon cause of cerebral infarction, compared to arterial diseases. It is often unrecognized at initial presentation due to the diversity of causes and clinical manifestations. A 29-year-old female patient complained of severe headache and presented at the emergency room with altered consciousness. Brain computed tomography and brain magnetic resonance image revealed the left sigmoid sinus thrombosis with venous hemorrhagic infarction (VHI) in the left temporal lobe. The patient had no past medical and family history of bleeding diathesis. The laboratory finding at the admission showed severe iron-deficiency anemia (IDA), and protein C and S activities were decreased. After the neurosurgery, iron replacement, and neurorehabilitation, the patient had a good recovery. There has been no known recurrence. We report our therapeutic intervention on a very rare case of CVST and VHI, with IDA as a probable cause of cerebral thrombosis.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Brain ; Cerebral Infarction ; Colon, Sigmoid ; Consciousness ; Disease Susceptibility ; Emergency Service, Hospital ; Female ; Headache ; Hemorrhage ; Humans ; Infarction* ; Intracranial Thrombosis ; Iron ; Neurosurgery ; Protein C ; Recurrence ; Sinus Thrombosis, Intracranial* ; Stroke ; Temporal Lobe