Background: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are currently used to treat patients with diabetes. Previous studies have demonstrated that treatment with SGLT-2 inhibitors is accompanied by altered metabolic phenotypes. However, it has not been investigated whether the hypothalamic circuit participates in the development of the compensatory metabolic phenotypes triggered by the treatment with SGLT-2 inhibitors. Methods: Mice were fed a standard diet or high-fat diet and treated with dapagliflozin, an SGLT-2 inhibitor. Food intake and energy expenditure were observed using indirect calorimetry system. The activity of hypothalamic neurons in response to dapagliflozin treatment was evaluated by immunohistochemistry with c-Fos antibody. Quantitative real-time polymerase chain reaction was performed to determine gene expression patterns in the hypothalamus of dapagliflozin-treated mice. Results: Dapagliflozin-treated mice displayed enhanced food intake and reduced energy expenditure. Altered neuronal activities were observed in multiple hypothalamic nuclei in association with appetite regulation. Additionally, we found elevated immunosignals of agouti-related peptide neurons in the paraventricular nucleus of the hypothalamus. Conclusion This study suggests the functional involvement of the hypothalamus in the development of the compensatory metabolic phenotypes induced by SGLT-2 inhibitor treatment.

Background/Aims: To date, there is no prospective study that specifically investigated the efficacy of infliximab in intestinal Behçet’s disease (BD). This study evaluated the efficacy of infliximab in patients with moderate-to-severe active intestinal BD that are refractory to conventional therapies. Methods: This phase 3, interventional, open-label, single-arm study evaluated clinical outcomes of infliximab treatment in patients with moderate-to-severe intestinal BD. The coprimary endpoints were clinical response, decrease in disease activity index for intestinal BD (DAIBD) score ≥20 from weeks 0 to 8 for the induction therapy and week 32 for the maintenance therapy. Results: A total of 33 patients entered the induction therapy and were treated with infliximab 5 mg/kg intravenously at weeks 0, 2, and 6. The mean DAIBD score changed from 90.8±40.1 at week 0 to 40.3±36.4 at week 8, with a significant mean change of 50.5±36.4 (95% confidence interval, 37.5 to 63.4; p<0.001). Thirty-one (93.9%) continued to receive 5 mg/kg infliximab every 8 weeks during the maintenance therapy. The mean change in the DAIBD score after the maintenance therapy was statistically significant (61.5±38.5; 95% confidence interval, 46.0 to 77.1; p<0.001, from weeks 0 to 32). The proportion of patients who maintained a clinical response was 92.3% at week 32. No severe adverse reactions occurred during the induction and maintenance therapies. Conclusions This study provided evidence that infliximab 5 mg/kg induction and maintenance therapies are efficacious and well-tolerated in patients with moderate-to-severe active intestinal BD. (ClinicalTrials.gov identifier: NCT02505568)

Background/Aims: The prospective Crohn’s Disease Clinical Network and Cohort Study is a nationwide multicenter cohort study of patients with Crohn’s disease (CD) in Korea, aiming to prospectively investigate the clinical features and long-term prognosis associated with CD. Methods: Patients diagnosed with CD between January 2009 and September 2019 were prospectively enrolled. They were divided into two cohorts according to the year of diagnosis: cohort 1 (diagnosed between 2009 and 2011) versus cohort 2 (between 2012 and 2019). Results: A total of 1,175 patients were included, and the median follow-up duration was 68 months (interquartile range, 39.0 to 91.0 months). The treatment-free durations for thiopurines (p<0.001) and anti-tumor necrosis factor agents (p=0.018) of cohort 2 were shorter than those of cohort 1. Among 887 patients with B1 behavior at diagnosis, 149 patients (16.8%) progressed to either B2 or B3 behavior during follow-up. Early use of thiopurine was associated with a reduced risk of behavioral progression (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.50 to 0.90), and family history of inflammatory bowel disease was associated with an increased risk of behavioral progression (aHR, 2.29; 95% CI, 1.16 to 4.50). One hundred forty-one patients (12.0%) underwent intestinal resection, and the intestinal resection-free survival time was significantly longer in cohort 2 than in cohort 1 (p=0.003). The early use of thiopurines (aHR, 0.35;95% CI, 0.23 to 0.51) was independently associated with a reduced risk of intestinal resection. Conclusions The prognosis of CD in Korea appears to have improved over time, as evidenced by the decreasing intestinal resection rate. Early use of thiopurines was associated with an improved prognosis represented by a reduced risk of intestinal resection.

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

BACKGROUND/AIMS: C-reactive protein (CRP) is an easily measured index of disease activity, but its ability to predict clinical course is controversial. We therefore designed a study to determine whether the CRP level at Crohn's disease (CD) diagnosis is a valuable indicator of the disease phenotype, activity, and clinical course. METHODS: We retrospectively analyzed 705 CD patients from 32 institutions. The patients were classified into two groups according to CRP level. The patients' demographic and clinical characteristics and their use of immunosuppressive or biological agents were recorded. Disease location and behavior, hospitalization, and surgery were analyzed. RESULTS: A high CRP was associated with younger age, steroid use, colonic or ileocolonic location, high CD activity index, and active inflammation at colonoscopy (p<0.001). As the disease progressed, patients with high CRP were more likely to exhibit strictures (p=0.027). There were significant differences in the use of 5-aminosalicylic acid, antibiotics, corticosteroids, azathioprine, and infliximab (p<0.001, p<0.001, p<0.001, p<0.001, and p=0.023, respectively). Hospitalization was also more frequent in patients with high CRP. CONCLUSIONS: The CRP level at diagnosis is useful for evaluating the phenotype, activity, and clinical course of CD. Closer follow-up strategies, with early aggressive treatment, could be considered for patients with high CRP.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Azathioprine ; Biological Factors ; C-Reactive Protein* ; Colon ; Colonoscopy ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis* ; Follow-Up Studies ; Hospitalization ; Humans ; Inflammation ; Infliximab ; Mesalamine ; Phenotype* ; Retrospective Studies

PURPOSE: Allergic rhinitis (AR) is one of the most common childhood diseases in Korea. In this study, we aimed to investigate the prevalence and allergens of childhood AR in Gwangju. METHODS: From April 2013 to September 2013 in Gwangju, skin prick test and questionnaire survey were performed targeting 2,330 children in total (350 kindergartners, 930 elementary school students, 589 middle school students, and 461 high school students). RESULTS: The overall prevalence of AR was 23.5% (female 21.3%, male 26.1%). According to age groups, prevalence of AR was 14.9% (female 10.7%, male 19.8%) in kindergartners, 24.5% (female 18.8%, male 29.4%) in elementary school students, 23.3% (female 18.1%, male 27.6%) in middle school students, 26.2% (female 27.7%, male 23.2%) in high school students. The most common allergen was Dermatophagoides pteronyssinus (79.7%), followed by Dermatophagoides farina (72.2%), birch (14.0%), alder (12.0%), Japanese hop (9.2%), Alternaria (8.9%), cat fur (7.2%), Japanese cedar (6.9%), ryegrass (6.6%), willow (6.0%), pine (5.4%), oak (4.9%), mugwort (4.3%), orchard grass (4.0%), sheep fescue (3.7%), fat hen (3.4%), ragweed (3.4%), and maple (3.4%). CONCLUSION: This research figures out the prevalence and the detailed allergens of AR in Gwangju children. We suggest that more vegetation data of Japanese cedar should be surveyed in recent future.
Acer ; Adolescent* ; Allergens* ; Alnus ; Alternaria ; Ambrosia ; Animals ; Artemisia ; Asian Continental Ancestry Group ; Betula ; Cats ; Child* ; Cryptomeria ; Dactylis ; Dermatophagoides pteronyssinus ; Gwangju ; Humans ; Humulus ; Korea ; Lolium ; Male ; Prevalence* ; Pyroglyphidae ; Rhinitis* ; Salix ; Sheep ; Skin ; Surveys and Questionnaires

PURPOSE: A high level of air pollutants can increase the number of patients with allergy-related diseases such as asthma and allergic rhinitis (AR). To analyze the association between air pollution and allergic disease, we investigated 2 areas in Korea: Incheon, an industrial area, and Jeju, a non-industrialized area. METHODS: Second grade students at elementary schools (11 schools in Incheon and 45 schools in Jeju) were examined in a cross-sectional study. A questionnaire was used and a skin prick test was performed. The levels of NO2, CO2, O3, particulate matter (PM) PM10/2.5, formaldehyde, tVOCs, and dust mites in the classrooms and grounds were determined. RESULTS: The levels of outdoor CO, PM10, and PM2.5 were significantly higher in Incheon (P<0.01). The levels of indoor CO, CO2, PM10, PM2.5 were significantly higher in Incheon (P<0.01). The prevalence rates of AR symptoms at any time, AR symptoms during the last 12 months, diagnosis of rhinitis at any time, and AR treatment during the last 12 months were significantly higher in Incheon (P<0.01). The prevalence rate of wheezing or whistling at any time, and wheezing during the last 12 months were significantly higher in Incheon (P<0.01). CONCLUSION: We found that the children living in Incheon, which was more polluted than Jeju, had a higher rate of AR and asthma symptoms compared to children in Jeju. To determine the effect of air pollution on the development of the AR and asthma, further studies are needed.
Air Pollutants ; Air Pollution ; Asthma ; Child ; Cross-Sectional Studies ; Dust ; Formaldehyde ; Humans ; Mites ; Particulate Matter ; Prevalence ; Surveys and Questionnaires ; Respiratory Sounds ; Rhinitis ; Rhinitis, Allergic, Perennial ; Singing ; Skin

Coronary embolism is an uncommon cause of myocardial infarction. A 48-year-old male presented with typical chest pain of an MI. There was no definite ST segment change on electrocardiogram (ECG) and no elevation of myocardial enzymes. Coronary angiography (CAG) revealed occlusion of the distal left anterior descending coronary artery (dLAD), the distal left circumflex coronary artery (dLCX), the diagonal branch (D) and the obtuse marginal branch (OM), with a large filling defect in the left main coronary artery (LMA) that caused the myocardial infarction. We considered the possibility that coronary embolization was caused by the migration of a thrombus in the LMA during CAG. We did balloon angioplasty in the dLAD, dLCX, OM and D and treated the patient with glycoprotein IIb/IIIa receptor antagonist. However, thrombi remained in the dLAD, OM, and dLCX. After 3 days of anti-thrombotic treatment, follow-up CAG revealed only slight resolution of thrombi in the LAD. After triple antiplatelet agent medication for 1 year, a follow-up CAG showed a resolution of the thrombi in all coronary arteries.
Angioplasty, Balloon ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Embolism ; Follow-Up Studies ; Glycoproteins ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; Thrombosis

BACKGROUND/AIMS: Despite of increasing numbers of reports on intraductal papillary mucinous tumor (IPMT), there is still difficulty in its' diagnosis, treatment and prediction of prognosis. The purpose of this multicenter study was to evaluate the clinico-pathological features of IPMT in Korea and suggest the prediction criteria of malignancy in IPMT. METHODS: We retrospectively reviewed the clinico-pathological data of 208 patients who underwent operations with IPMT between 1993 and 2002 at 28 institutes in Korea. RESULTS: Of the 208 patients with a mean age of 60.5+/-9.7 years, 147 were men and 61 were women. 124 patients underwent pancreatoduodenectomy, 42 distal pancreatectomy, 17 total pancreatectomy, 25 limited pancreas resection. Benign cases were 128 (adenoma (n=62), borderline (n=66)) and malignant cases were 80 (non-invasive (n=29), invasive (n=51)). A significant difference in 5-year survival was observed between benign and malignant group (92.6% vs. 65.3%; p=0.006). Of the 6 factors (age, location, duct dilatation, tumor appearance, main duct type, and tumor size) that showed the statistical difference in univariate analysis between benign and malignant group, we found three significant factors (tumor appearance (p=0.009), tumor size (p=0.023), and dilated duct size (p=0.010)) by multivariate analysis. CONCLUSION: Although overall prognosis of IPMT is superior to ordinary pancreatic cancer, more curative surgery is recommended in malignant IPMT. Tumor appearance (papillary), tumor size (> or =30 mm) and dilated duct size (> or = 12 mm) can be used as preoperative indicators of malig-nancy in IPMT.
Academies and Institutes ; Diagnosis ; Dilatation ; Female ; Humans ; Korea* ; Male ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies