Background: This study investigates the long-term efficacy and safety of evogliptin add-on therapy in patients with inadequately controlled type 2 diabetes mellitus (T2DM) previously received dapagliflozin and metformin (DAPA/MET) combination. Methods: In this multicenter randomized placebo-controlled phase 3 trial, patients with glycosylated hemoglobin (HbA1c) levels 7.0% to 10.5% (n=283) previously used DAPA 10 mg plus MET (≥1,000 mg) were randomly assigned to the evogliptin 5 mg once daily or placebo group (1:1). The primary endpoint was the difference in the HbA1c level from baseline at week 24, and exploratory endpoints included the efficacy and safety of evogliptin over 52 weeks (trial registration: ClinicalTrials.gov NCT04170998). Results: Evogliptin add-on to DAPA/MET therapy was superior in HbA1c reduction compared to placebo at weeks 24 and 52 (least square [LS] mean difference, –0.65% and –0.55%; 95% confidence interval [CI], –0.79 to –0.51 and –0.71 to –0.39; P<0.0001). The proportion of patients achieving HbA1c <7% was higher in the triple combination group at week 52 (32.14% vs. 8.51% in placebo; odds ratio, 5.62; P<0.0001). Evogliptin significantly reduced the fasting glucose levels and mean daily glucose levels with improvement in homeostatic model assessment of β-cell function (LS mean difference, 9.04; 95% CI, 1.86 to 16.21; P=0.0138). Adverse events were similar between the groups, and no serious adverse drug reactions were reported in the evogliptin group. Conclusion Long-term triple combination with evogliptin added to DAPA/MET showed superior HbA1c reduction and glycemic control compared to placebo at 52 weeks and was well tolerated.

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) was introduced to Korea in the 1980s and has since developed rapidly. There have been many changes in ESS over this period. Thus, in this paper, we explore trends in the clinical characteristics of ESS. SUBJECTS AND METHOD: We retrospectively reviewed patients who underwent the ESS at 000 Hospital performed by a single surgeon at a 10-year interval. By comparing 106 patients who underwent ESS in 2003 and 108 patients who underwent ESS in 2013, we investigated changes in ESS in terms of the target group of surgical indications, CT scores, range of operation and complications. RESULTS: With regard to surgical indications, the proportion of patients who underwent surgery due to nasal polyps in 2013 (32.4%) was lower than in 2003 (59.4%), while the proportion of patients undergoing fungal sinusitis surgery in 2013 (13.9%) was higher than in 2003 (0.0%). In terms of preoperative CT evaluation, Lund-Mackay scores for the maxillary sinus, ethmoid sinus, and ostiomeatal unit were lower in 2013 than in 2003. The proportion of ESS performed only in the maxillary sinus in 2013 (20.0%) was higher than in 2003 (10.0%). CONCLUSION: According to this study, the range and extent of sinusitis was favorable in 2013 compared to in 2003. The group of patients requiring treatment for only maxillary sinus disease accounted for a larger proportion of patients in 2013 than in 2003.
Ethmoid Sinus ; Humans ; Korea ; Maxillary Sinus ; Methods ; Nasal Polyps ; Observational Study* ; Polyps ; Retrospective Studies* ; Sinusitis

PURPOSE: The present study analyzed the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on cystoid macular edema in diabetic patients after cataract surgery. METHODS: Among 105 eyes of 84 diabetic patients, 43 patients who were administered Pranopulin(R) (JW pharmaceutical, Korea) starting 3 days before surgery comprised the experimental group. The control group included 41 patients who were not given Pranopulin(R). The results consisted of macular thickness measurements and total macular volume which were quantified by optical coherence tomography (OCT, Carl Zeiss Meditec). RESULTS: Macular thickness of the experimental group was 7.72 +/- 13.04 microm at postoperative 1 month, 7.15 +/- 13.62 microm at postoperative 2 months and was significantly thinner than in the control group (p < 0.05). Macular volume of the experimental group was 0.33 +/- 0.49 mm3 at postoperative 1 month, 0.31 +/- 0.43 mm3 at postoperative 2 months and was also significantly smaller than in the control group (p < 0.05). CONCLUSIONS: Using NSAIDs prophylactically before cataract surgery can effectively reduce the risk of postoperative cystoid macular edema in diabetic patients.
Anti-Inflammatory Agents, Non-Steroidal ; Cataract ; Eye ; Humans ; Macular Edema ; Phacoemulsification ; Tomography, Optical Coherence

Alterations in nitric oxide (NO) release in response to psychostimulants in the striatum cause a plastic change contributing to the development and expression of addiction. In this study, regulation of NO efflux evoked by acute cocaine in the dorsal striatum was investigated using real-time detection of NO in vivo. We found that acute systemic injection of cocaine (20 mg/kg) increased NO efflux, which was reduced by the intrastriatal infusion of the dopamine D1 receptor antagonist, SCH23390 (7.5 nmol), and the dopamine D2 receptor agonist, quinpirole (5 nmol). Increased levels of NO efflux by acute cocaine were also reduced by the intrastriatal infusion of the N-methyl-D-aspartate (NMDA) receptor antagonists, MK801 (2 nmol) and AP5 (2 nmol). These findings suggest that interactions of dopamine D1 receptors and NMDA receptors after acute exposure to cocaine participate in the upregulation of NO efflux in the dorsal striatum.
Benzazepines ; Cocaine ; Dizocilpine Maleate ; Dopamine ; Glutamic Acid ; N-Methylaspartate ; Nitric Oxide ; Plastics ; Quinpirole ; Receptors, Dopamine D1 ; Receptors, Dopamine D2 ; Receptors, N-Methyl-D-Aspartate ; Up-Regulation

BACKGROUND: Microalbuminuria (MA) is independent predictor of cardiovascular disease and it cause mortality regardless of the presence of diabetes (DM) and hypertension (HTN). However, few published studies on this topic have been reported in Korea. Therefore, we investigated the MA prevalence and relationship between MA, insulin resistance and cardiovascular risk factor. METHODS: A total of 5,915 (3,053 men and 2,852 women) health screen examinees were enrolled in this study. We measured the anthropometric and biochemical parameters of the atherogenic indexes. RESULTS: The MA prevalence was 7.7% in all participants. The prevalence of MA in the men and women was 9.5% and 5.7%, respectively. Elevated levels of serum fasting glucose, serum fasting insulin, HOMA index, total cholesterols, LDL cholesterol, TG, Body Mass Index (BMI) and the systolic and diastolic blood pressure were significantly associated with MA. The results of multiple logistic regression analysis about MA showed that frequent drinking, low BMI, newly diagnosed DM and elevated levels of HOMA index and blood pressure were significantly associated with MA prevalence. Also, excluding newly diagnosed diabetic and hypertensive subjects, the MA prevalence was 5.7% (6.9% in men, 4.7% in women) and in multiple logistic regression analysis, the MA prevalence significantly increased in the individuals with pre-HTN rather than in the normotensives. CONCLUSIONS: The MA prevalence was 7.7% in all subjects. Except the newly diagnosed diabetic and hypertensive subjects, it was 5.7%. The MA prevalence was significantly increased in the individuals with pre-HTN rather than in the normotensives and MA was related with insulin resistance.
Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Cross-Sectional Studies* ; Drinking ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Korea ; Logistic Models ; Male ; Mortality ; Prehypertension ; Prevalence* ; Risk Factors

PURPOSE: We analyzed the therapeutic results of 703 cases of urinary calculi treated using an EDAP-Sonolith Praktis, an electroconductive lithotriptor (ECL). MATERIALS AND METHODS: Between January 2000 and June 2004, 703 patients meeting the study inclusion criteria were treated with an EDAP-Sonolith Praktis. The site and size of the stones, session, auxiliary procedure, success rate, causes of failure, complication, efficiency quotient (EQ) and retreatment were analyzed. RESULTS: The records of 703 patients, in whom urinary calculi were treated by extracorporeal shock wave lithotripsy, using an EDAP-Sonolith Praktis, were retrospectively reviewed. The success rates were 99.3, 92.5, 66.7 and 12.5% for stone sizes < or=9, 10-19, 20-29 and > or=30mm, respectively, with an overall success rate of 95.3%. The EQ, mean number of session and retreatment rate were 0.71, 1.7 and 30.6%, respectively. As auxiliary procedures, double-J stenting, ureteroscopic stone removal and open surgery were performed in 6, 15 and 1, respectively. The complications were gross hematuria, flank pain, steinstrasse, nausea and fever, which were successfully controlled by conservative treatment. CONCLUSIONS: EDAP-Sonolith Praktis, an ECL, is an efficient and safe outpatient procedure for initial urinary calculi treatment.
Fever ; Flank Pain ; Hematuria ; Humans ; Lithotripsy* ; Nausea ; Outpatients ; Retreatment ; Retrospective Studies ; Shock* ; Stents ; Urinary Calculi*

Mirror writing is the simultaneous process of reversing individual letters and composing word strings in the reverse direction. This phenomenon appears rarely only after brain damage. We present the case of a 65-year-old, right-handed man with mirror writing following a left temporo-parietal lobe infarction. He preferred to write in the mirror direction with his left hand, but he did not show any visual-spatial disturbance and allochria. We think that damage to the dominant writing program of the brain, releases the normally suppressed contralesional writing program and this uninhibited program induces the mirror writing.
Aged ; Brain ; Functional Laterality* ; Hand* ; Humans ; Infarction* ; Writing

The aim of this study was to establish a multi-center birth defects monitoring system to evaluate the prevalence and the serial occurrence of birth defects in Korea. Ten medical centers participated in this program. A trained nurse collected relevant records from delivery units and pediatric clinics in participating hospitals on a monthly basis. We observed 1,537 cases of birth defects among 86,622 deliveries, which included live births and stillbirths. The prevalence of birth defects was 1.8%, and the sex distribution of the birth defect cases was 55.2% male and 41.6% female. The highest proportion of birth defects was in the cardiovascular system (17.5%), followed by birth defects involving in the genitourinary system (15.6%). Chromosomal anomalies were detected 30.0 per 10,000 births. Of these chromosomal anomalies, Down syndrome was most frequently observed. This study led to an establishment of a multi-center active monitoring system for birth defects. To better understand the serial occurrence of birth defects in Korea, it is necessary to increase the number of participating hospitals and to launch on a nation-wide multi-center study.
Abnormalities/*epidemiology ; Child ; *Chromosome Aberrations ; Female ; Humans ; Korea/epidemiology ; Male ; *Population Surveillance ; Pregnancy ; Pregnancy Outcome ; Research Support, Non-U.S. Gov't

BACKGROUND: The investigations of personality traits have been the issue of many studies on patients with tension-type headache. However, there was few comparison study of personality traits between the patients with episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) using Minnesota Multiphasic Personality Inventory (MMPI). METHODS: The study was consecutively made of the personality profiles of two groups with ETTH (137 patients) and CTTH (115 patients) in accordance with the International Headache Society (IHS) criteria, employing the MMPI. RESULTS: The two groups could be classified into three clusters by a multivariate cluster analysis, which are relatively normal profile (cluster I), somatic profile (cluster II, elevated Hs-D-Hy scales), and psychosomatic profile (cluster III, elevated Pa-Pt-Sc-Si and Hs-D-Hy scales). The proportion of the patients with CTTH in the psychosomatic profile group was stastically more significant (59.6%) than that of the patients with ETTH (40.4%) by a chi-square test. CONCLUSIONS: This study shows that the psychosomatic profile might be more common in the CTTH patients than in the ETTH patients.
Headache ; Humans ; MMPI* ; Tension-Type Headache*

PURPOSE: We studied the changes in the antibiotic sensitivity to the causative organisms of urinary tract infection, between 1979 and 2001, in order to provide useful information on the choice of adequate drugs in the treatment of urinary tract infection (UTI). MATERIALS AND METHODS: We retrospectively analysed 1,370 uropathogens, and their antimicrobial sensitivities, in 647 patients admitted to, or visiting our hospital, between January 1979 and December 2001, that had more than 105cfu/ml in urine culture. RESULTS: The incidence of UTI increased with age, and was highest in the 6th decades (21.0%). Mixed infections increased from 6.1%, in 1979, to 18.4%, by 2001. The common pathogens were E. coli (37.8%), enterococcus (15.0%), Pseudomonas (10.1%) and Klebsiella (9.1%). E. coli was the most important uropathogen during the stated time period. However, the incidence of Gram positive organisms increased from 14.2%, in 1979, to 26.0%, by 2001. In the Gram negative stained uropathogens, the antibiotic sensitivity was changed: ampicillin (11.8 to 14.6%), cephalothin (40.6 to 46.3%) and amikacin (80.5 to 74.8%). For E. coli, trimethoprim/Sulfamethoxazole (TMP/SMX) and ampicillin showed decreased sensitivities of 37.3 and 18.5%, respectively. However, sulbactam/cefoperazone, cefepime and imipenem showed high sensitivities of 96.1, 97.5 and 100%, respectively. CONCLUSIONS: Prior to receiving the bacteriological report, the use of TMP/SMX and ampicillin, as the first choices of treatment for UTI, should be reconsidered. Our results implied that amikacin, which showed the best effects, and was cheaper than fluoroquinolones, can be used as an alternative to these drugs as a primary empirical antibiotic for UTI.
Amikacin ; Ampicillin ; Cephalothin ; Coinfection ; Enterococcus ; Fluoroquinolones ; Humans ; Imipenem ; Incidence ; Klebsiella ; Pseudomonas ; Retrospective Studies ; Urinary Tract Infections* ; Urinary Tract*