Background: Thiazolidinediones (TZDs) have been associated with various safety concerns including weight gain, bladder cancer, and congestive heart failure (CHF). This study evaluated the efficacy and safety of lobeglitazone, a novel TZD in patients with type 2 diabetes mellitus (T2DM) in real practice. Methods: In this non-interventional, multi-center, retrospective, and observational study conducted at 15 tertiary or secondary referral hospitals in Korea, a total of 2,228 patients with T2DM who received lobeglitazone 0.5 mg for more than 1 year were enrolled. Results: Overall adverse events (AEs) occurred in 381 patients (17.10%) including edema in 1.97% (n=44). Cerebrovascular and cardiovascular diseases were identified in 0.81% (n=18) and 0.81% (n=18), respectively. One case of CHF was reported as an AE. Edema occurred in 1.97% (n=44) of patients. Hypoglycemia occurred in 2.47% (n=55) of patients. Fracture occurred in 1.17% (n=26) of all patients. Lobeglitazone significantly decreased HbA1c level, resulting in a mean treatment difference of -1.05%± 1.35% (P<0.001), and decreased total cholesterol, triglyceride, and low-density lipoprotein cholesterol. However, it increased high-density lipoprotein cholesterol, regardless of statin administration. The patients who received lobeglitazone 0.5 mg showed an apparent reduction in glycosylated hemoglobin (HbA1c) from baseline during the first 6 months of treatment. The HbA1c levels remained stable between months 6 and 42. Conclusion Lobeglitazone has long-term safety profile, good glycemic-lowering effect and long-term durability of glycemic control in real-world clinical settings.

We studied the efficacy and safety of acarbose in comparison with voglibose in type 2 diabetes patients whose blood glucose levels were inadequately controlled with basal insulin alone or in combination with metformin (or a sulfonylurea). This study was a 24-week prospective, open-label, randomized, active-controlled multi-center study. Participants were randomized to receive either acarbose (n=59, 300 mg/day) or voglibose (n=62, 0.9 mg/day). The mean HbA1c at week 24 was significantly decreased approximately 0.7% from baseline in both acarbose (from 8.43% +/- 0.71% to 7.71% +/- 0.93%) and voglibose groups (from 8.38% +/- 0.73% to 7.68% +/- 0.94%). The mean fasting plasma glucose level and self-monitoring of blood glucose data from 1 hr before and after each meal were significantly decreased at week 24 in comparison to baseline in both groups. The levels 1 hr after dinner at week 24 were significantly decreased in the acarbose group (from 233.54 +/- 69.38 to 176.80 +/- 46.63 mg/dL) compared with the voglibose group (from 224.18 +/- 70.07 to 193.01 +/- 55.39 mg/dL). In conclusion, both acarbose and voglibose are efficacious and safe in patients with type 2 diabetes who are inadequately controlled with basal insulin. (ClinicalTrials.gov number, NCT00970528)
Acarbose/adverse effects/*therapeutic use ; Blood Glucose ; Diabetes Mellitus, Type 2/blood/*drug therapy ; Enzyme Inhibitors/adverse effects/therapeutic use ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hypoglycemic Agents/adverse effects/therapeutic use ; Inositol/adverse effects/*analogs & derivatives/therapeutic use ; Insulin/*blood/therapeutic use ; Male ; Metformin/therapeutic use ; Middle Aged ; Prospective Studies ; alpha-Glucosidases/antagonists & inhibitors

In recent years, the synchronous occurrence of two adjacent but histologically distinct tumors arising in the same organ has been reported. The simultaneous development of gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) is very uncommon. The question raised was whether such a coexistence is a simple incidental finding or whether the two neighboring tumors are caused by a same unknown carcinogenic agent. Many doctors may have an interest in this rare condition and we expect further studies will be done in order to determine if there is any association between the two different tumors. We report a unique case of a synchronous, orthotopic occurrence of an early gastric cancer with GIST in the same location that mimicked advanced gastric cancer.
Adenocarcinoma ; Gastrointestinal Stromal Tumors ; Incidental Findings ; Stomach Neoplasms

PURPOSE: Inappropriate cuff inflations cause many complications. A conventional pilot balloon palpation technique is insufficient to detect high cuff pressures, but is still preferred. Hence, we conducted this study to identify effectiveness, preference and ease of use of a new estimation technique named "passive release technique" for endotracheal tube cuff inflation. METHODS: Twenty-nine nurses inflated cuffs by a pilot balloon palpation technique in manikins inserted with a 7.5 mm endotracheal tube. Then, being educated about passive release techniques, they inflated cuffs using such a passive release technique. Intracuff pressures and air volumes were measured by manometers and syringes. Preference and ease of use between the two methods were scored using a 10-point Likert scale. RESULTS: For the pilot balloon palpation technique, only 4 nurses (13.8%) inflated cuffs within the normal range of pressures (normal: 15 to 30 mb) with an average of 39.3+/-34.0 cmH2O. For the passive release technique, 19 nurses (65.5%) inflated cuffs within the normal range of pressures with an average of 24.2+/-9.3 cmH2O (McNemar's test, p<0.01). In the pilot balloon palpation technique, inflated air volumes of 7.8+/-2.0 ml were not significantly different from inflated air volumes 8.5+/-1.2 ml (p=0.07) for the passive release technique. But the difference was found to be statistically significant in a variance ratio test (F-test) (p<0.01). In view of preference and ease of use between the two methods, mean values were not statistically different, 7.3+/-2.0 vs. 7.0+/-2.0 and 7.0+/-2.3 vs. 7.3+/-2.4, respectively. CONCLUSION: When direct intracuff measurement is not available, a passive release technique using a syringe is an effective and easy method to achieve cuff inflation.
Inflation, Economic ; Intubation ; Manikins ; Palpation ; Reference Values ; Statistics as Topic ; Syringes

PURPOSE: The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures. MATERIALS AND METHODS: The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope. RESULTS: One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing. CONCLUSION: These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.
Adult ; Aged ; Aged, 80 and over ; Autopsy ; Female ; Hernia, Umbilical/pathology ; Humans ; Ligaments/anatomy & histology/pathology ; Male ; Middle Aged ; Umbilicus/*anatomy & histology/pathology

PURPOSE : To investigate the feasibility of intensity modulated radiotherapy (IMRT) as a method of boost radiotherapy following the initial irradiation by the conventional anterior / posterior opposed beams for centrally located non-small-cell lung cancer through the evaluation of dose distributions according to the various boost methods. MATERIALS AND METHODS : Seven patients with T3 or T4 lung cancer and mediastinal node enlargement who previously received radiotherapy were studied. All patients underwent virtual simulation retrospectively with the previous treatment planning CTs. Initial radiotherapy plans were designed to deliver 40 Gy to the primary tumor and involved nodal regions with the conventional anterior / posterior opposed beams. Two radiation dose levels, 24 and 30 Gy, were used for the boost radiotherapy plans, and 4 different boost methods (a three dimensional conformal radiotherapy (3DCRT), 5, 7, and 9-beams IMRT) were applied to each dose level. The goals of the boost plans were to deliver the prescribed radiation dose to 95% of the planning target volume (PTV) and minimize the volumes of the normal lungs and spinal cord irradiated above their tolerance doses. Dose distributions in the PTVs and lungs, according to the four types of boost plans, were compared in the boost and sum plans, respectively. RESULTS : The percentage of lung volumes irradiated >20 Gy (V20) were reduced significantly in the IMRT boost plans compared with the 3DCRT boost plans at the 24 and 30 Gy dose levels (p=0.007 and 0.031 respectively). Mean lung doses according to the boost methods were not different in the 24 and 30 Gy boost plans. The conformity indexes (CI) of the IMRT boost plans were lower than those of the 3DCRT plans in the 24 and 30 Gy plans (p=0.001 in both). For the sum plans, there was no difference of the dose distributions in the PTVs and lungs according to the boost methods. CONCLUSION : In the boost plans the V20s and CIs were reduced significantly by the IMRT plans, but in the sum plans the effects of IMRT to the dose distributions in the tumor and lungs, like CI and V20, were offset. Therefore, in order to keep the beneficial effect of IMRT in radiotherapy for lung cancer, it would be better to use IMRT as a whole treatment plan rather than as a boost treatment
Humans ; Lung Neoplasms* ; Lung* ; Radiotherapy ; Radiotherapy, Conformal ; Retrospective Studies ; Spinal Cord

PURPOSE: The hepatic arteries of transplant recipients are sometimes in too poor a condition to make a good anastomosis in living donor liver transplantation. The aim of this study was to evaluate the outcome of hepatic artery reconstruction using the recipient's right gastroepiploic artery. METHODS: A total of 153 LDLTs were performed at Seoul National University Hospital from January 1999 to December 2003. In 10 cases, arterial reconstruction was performed by anastomosis of the donor's hepatic artery to the recipient's right gastroepiploic artery. Hepatic artery reconstruction was carried out with the aid of an operating microscope and with using the interrupted Carrel's technique. The adequate blood flow was verified during the operation by the Doppler ultrasonography and also daily for seven days after transplantation by means of Doppler ultrasonography. The median length of the follow-up was 40 months (range: 20~60 months). RESULTS: In seven cases out of ten, the recipient's right gastroepiploic artery was initially used due to arterial thrombosis or because of severe endothelial damage of the recipient's hepatic artery. In the remaining three cases, the graft was revascularized using the recipient's right gastroepiploic artery. In all cases, excellent hepatic arterial flow was confirmed by the Doppler ultrasonography during the operation. Complications related to the hepatic artery were not detected during the follow-up period. CONCLUSION: The recipient's right gastroepiploic artery is a suitable alternative for hepatic artery reconstruction in LDLT.
Follow-Up Studies ; Gastroepiploic Artery* ; Hepatic Artery* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Seoul ; Thrombosis ; Transplantation ; Transplants ; Ultrasonography, Doppler

OBJECTIVES: The purpose of this study was to observe the reaction kinetics and the degree of polymerization of composite resins when cured by different light sources and to evaluate the effectiveness of the blue Light Emitting Diode Light Curing Units (LED LCUs) compared with conventional halogen LCUs. MATERIALS AND METHODS: First, thermal analysis was performed by a differential scanning calorimeter (DSC). The LED LCU (Elipar Freelight, 320 mW/cm2) and the conventional halogen LCU (XL3000, 400 mW/cm2) were used in this study for curing three composite resins (SureFil, Z-250 and AEliteFLO). Second, the degree of conversion was obtained in the composite resins cured according to the above curing mode with a FTIR. Third, the measurements of depth of cure were carried out in accordance with ISO 4049 standards. Statistical analysis was performed by two-way ANOVA test at 95% levels of confidence and Duncan's procedure for multiple comparisons. RESULTS: The heat of cure was not statistically different among the LCUs (p > 0.05). The composites cured by the LED (Exp) LCUs were statistically more slowly polymerized than by the halogen LCU and the LED (Std) LCU (p < 0.05). The composite resin groups cured by the LED (Exp) LCUs had significantly greater degree of conversion value than by the halogen LCU and the LED (Std) LCU (p = 0.0002). The composite resin groups cured by the LED (Std) LCUs showed significantly greater depth of cure value than by the halogen LCU and the LED (Exp) LCU (p < 0.05).
Composite Resins* ; Hot Temperature ; Kinetics ; Polymerization* ; Polymers* ; Spectroscopy, Fourier Transform Infrared

OBJECTIVES: The purpose of this study was to determine whether pH and time has any influence on the degradation behavior of composite restoration by analyzing the leached monomers of dental composites qualitatively and quantitatively after storage in acetate buffer solution as a function of time using high performance liquid chromatography (HPLC) / mass spectrometer. MATERIALS AND METHODS: Three commercial composite restorative resin materials (Z-250, Heliomolar and Aeliteflo) with different matrix structure and filler composition were studied. Thirty specimens (7mm diameterx2mm thick) of each material were prepared. The cured materials were stored in acetate buffer solution at different pH (4, 7) for 1, 7 and 45days. As a reference, samples of unpolymerized composite materials of each product were treated with methanol (10 mg/ml). Identification of the various compounds was achieved by comparison of their mass spectra with those of reference compound, with literature data, and by their fragmentation patterns. Data were analysed statistically using ANOVA and Duncan's test. RESULTS: 1. Amounts of leached TEGDMA in Aeliteflo were significantly larger than those of UDMA in Z-250 and Heliomolar at experimental conditions of different storage time and pH variation (p < 0.001). 2. As to comparison of the amounts of leached monomers per sorage time, amounts of leached TEGDMA in Aeliteflo and UDMA in Z-250 and Heliomolar were increased in the pH 4 solution more significantly than in the pH 7 solution after 1day, 7days and 45days, respectively (p < 0.001). 3. In total amounts of all the leached monomers with storage times, the overall amounts of pH 4 extracts were larger than those of pH 7 extracts for all resin groups, but there was no significant difference (p > 0.05).
Chromatography, Liquid ; Composite Resins* ; Hydrogen-Ion Concentration* ; Methanol ; Polymers*

PURPOSE: cDNA microarray provided a powerful alternative, with an unprecedented view scope, in monitoring gene expression levels, and led to the discovery of regulatory pathways involved in complicated biological processes. This study was performed to gain better understanding of the molecular mechanisms underlying the carcinogenesis and progression of lung cancer. MATERIALS AND METHODS: Using a cDNA microarray, representing 4, 600 cDNA clusters, we studied the expression profiles in 10 non-small cell lung cancer (NSCLC) samples and the adjacent noncancerous lung tissues form the same patients. The alterations in the levels of gene expression were confirmed by reverse-transcription PCR in 10 randomly selected genes. RESULTS: Genes that were differently expressed in the cancerous and noncancerous tissues were identified. One hundred and nine genes (of which 68 were known) and 69 cDNAs (of which 32 were known) were up- and down-regulated in>70% of the NSCLC samples, respectively. In the cancerous tissues, the genes related to the cell cycle, metabolism, cell structure and signal transduction, were mostly up-regulated. Furthermore, we identified a few putative tumor suppressor genes that had previously been proposed by other workers. CONCLUSIONS: These results provide, not only a new molecular basis for understanding the biological properties of NSCLC, but also useful resources for the future development of diagnostic markers and therapeutic targets for NSCLC.
Biological Processes ; Carcinogenesis ; Carcinoma, Non-Small-Cell Lung* ; Cell Cycle ; DNA, Complementary ; Gene Expression Profiling* ; Gene Expression* ; Genes, Tumor Suppressor ; Humans ; Lung ; Lung Neoplasms ; Metabolism ; Oligonucleotide Array Sequence Analysis ; Polymerase Chain Reaction ; Signal Transduction