Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Purpose: Increasing levels of domestic fine dust (DFD) have emerged as a serious problem that threatens public health by causing chronic respiratory diseases and skin aging. The present study was performed to investigate the inhibitory effects of Gryllus bimaculatus (the two-spotted cricket), which has recently attracted attention as an edible insect in South Korea, on DFD-induced aging and inflammation. Methods: To verify that DFD causes skin aging and investigate the anti-aging effect of an aqueous ethanolic-Gryllus bimaculatus extract (AE-GBE), human diploid fibroblasts (HDF) were treated with 100 μg/mL of European reference material (ERM)-CZ100 dust for 24 hrs in the presence or absence of 100 μg/ml AE-GBE. Aging and cellular toxicities were assessed by measuring reactive oxygen species (ROS) levels, DNA fragmentation, and β-galactosidase activity. The protein levels of cyclooxygenase (COX) 2, matrix metalloproteinase (MMP)-1, and collagen were measured by western blot, and the mRNA expressions of inflammationrelated genes were assayed by quantitative reverse transcriptase polymerase chain reaction. Results: Treatment with ERM-CZ100 induced an aged phenotype in HDF cells, as evidenced by increased ROS levels, DNA fragmentation, and senescence-associated β-galactosidase activity, but cotreatment with AE-GBE significantly reduced these inductions. The mRNA expressions of pro-inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α, induced by ERM-CZ100 were also reduced by AE-GBE cotreatment, which also reduced COX2 expression. Moreover, ERM-CZ100-induced MMP-1 expression and reduced collagen type I expression were recovered by AE-GBE treatment. Conclusion These results suggest that AE-GBE is a potential treatment for domestic fine dust-induced skin inflammation and inflammaging.

RESULTS: The administration of ADLE to HFD-induced diabetic mice reduced the hyperplasia, 4-hydroxynonenal levels, and the number of apoptotic cells while improving the insulin levels compared to the HFD group. Treatment of INS-1 cells with palmitate reduced insulin secretion, which was attenuated by the ADLE treatment. Furthermore, the ADLE treatment prevented palmitate-induced cell death in INS-1 cells and isolated islets by reducing the apoptotic signaling molecules, including cleaved caspase-3 and PARP, and the Bax/Bcl2 ratio. ADLE also reduced the levels of reactive oxygen species generation, lipid accumulation, and nitrite production in palmitate-treated INS-1 cells while increasing the ATP levels. This effect corresponded to the decreased expression of inducible nitric oxide synthase (iNOS) mRNA and protein. CONCLUSIONS ADLE helps prevent lipotoxic beta-cell death in INS-1 cells and HFD-diabetic mice, suggesting that ADLE can be used to prevent or treat beta-cell damage in glucose intolerance during the development of diabetes.

RESULTS: The administration of ADLE to HFD-induced diabetic mice reduced the hyperplasia, 4-hydroxynonenal levels, and the number of apoptotic cells while improving the insulin levels compared to the HFD group. Treatment of INS-1 cells with palmitate reduced insulin secretion, which was attenuated by the ADLE treatment. Furthermore, the ADLE treatment prevented palmitate-induced cell death in INS-1 cells and isolated islets by reducing the apoptotic signaling molecules, including cleaved caspase-3 and PARP, and the Bax/Bcl2 ratio. ADLE also reduced the levels of reactive oxygen species generation, lipid accumulation, and nitrite production in palmitate-treated INS-1 cells while increasing the ATP levels. This effect corresponded to the decreased expression of inducible nitric oxide synthase (iNOS) mRNA and protein. CONCLUSIONS ADLE helps prevent lipotoxic beta-cell death in INS-1 cells and HFD-diabetic mice, suggesting that ADLE can be used to prevent or treat beta-cell damage in glucose intolerance during the development of diabetes.

PURPOSE: Complementary and alternative medicine (CAM) has recently been spotlighted, and CAM can be defined as methods for treating diseases or ways to maintain physical health that out lie outside the boundaries of conventional medicine. We have conducted research to determine the status of CAM usage among Korean gastric cancer patients and their attitudes toward it, to determine what better can be done about CAM. METHODS: We surveyed those patients in St. Mary Hospital who were diagnosed to gastric cancer and who volunteered to participate in this study. The survey consists of 38 questions and each question covered personal characteristics information as to whether they have used CAM, whether they were satisfied after taking CAM and their intentions for re-use. RESULTS: A total of 195 patients answered the survey. 80 patients (41%) experienced CAM for the purpose of remedying their gastric cancer. The top leading CAM was dietary supplement for 52% of the patients, ginseng for 26% of the patients and Chinese herbal medicine for 10.8% of the patients. 54 patients (67.5%) were satisfied with the results of the CAM and they said that it had an effect on fatigue (45%). The statistics showed positive correlation between the level of education and the CAM users (P=0.001). CONCLUSION: The percentage of patients using CAM among the gastric cancer patients was high, up to 41%. Most of these patients wanted more information and discussion with their physicians about CAM therapies. The interesting thing was that most of the CAM was oral medicine. Based on our findings, research on the safety and effectiveness of CAM is required.
Asian Continental Ancestry Group ; Complementary Therapies* ; Dietary Supplements ; Education ; Fatigue ; Herbal Medicine ; Humans ; Intention ; Oral Medicine ; Panax ; Stomach Neoplasms*

PURPOSE: Sarcomatoid hepatocellular carcinoma (HCC) is a rare neoplasm and it has been found in only 1.8% of the surgically resected HCC patients, and in only 3.4~9.4% of the autopsied HCC cases. The pathogenesis of this tumor has't yet been thoroughly clarified, and such a tumor has been variously referred to as spindle cell carcinoma, sarcomatoid carcinoma, pseudosarcoma, or carcinosarcoma. There is only a little difference between the clinical characteristics of the sarcomatoid HCC and those of ordinary HCC. The diagnosis of the sarcomatoid HCC is made by pathological and immunohistochemical techniques after surgical resection, biopsy, or autopsy. METHODS: We reviewed the 10 cases of pathologically confirmed sarcomatoid HCC that were registered at the Yonsei University Medical Center from 1992 to 2004. RESULTS: Surgical operation was performed in seven cases, and curative resection was done only in five. Three patients were treated with chemotherapy or transarterial chemoem-bolization (TACE) with or without concurrent radiotherapy after the diagnosis of sarcomatoid HCC by liver biopsy. Six patients expired within 4 months after the diagnosis. The 6 month and 12 month survival rates for sarcomatoid HCC were 40% and 20%, respectively. The 6 month survival rates for radical resection and non-radical resection were 60% and 0%, respectively. The difference in cumulative survival according to the treatment of sarcomatoid HCC was statistically significant. CONCLUSION: The prognosis of sarcomatoid HCC is very poor; therefore, curative resection, adjuvant chemoradiotherapy, and close follow-up are necessary for patients suffering with sarcomatoid HCC.
Academic Medical Centers ; Autopsy ; Biopsy ; Carcinoma, Hepatocellular ; Carcinosarcoma ; Chemoradiotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Prognosis ; Radiotherapy ; Survival Rate

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.
Aged ; Diverticulum* ; Duodenum ; Gastrectomy* ; Gastric Bypass* ; Humans ; Laparotomy ; Stomach Neoplasms ; Vital Signs

PURPOSE: The p21(Waf1/Cip1) protein inhibits the cell cycle by inhibiting the phosphorylation at the G1-->S check point, and the p27(Kip1) protein similarly performs the suppressor function by controlling the p27-mediated G1 arrest. In this study, we analysed the clinical status and survival rates in correlations with p21 and p27 expression patterns in gastric cancer. MATERIALS AND METHODS: Between 1993 and 1997, 192 patients who underwent surgeries in Catholic Medical Center were analysed retrospectively in this study. Immunohistochemical staining was performed and if the nuclei of the tumor cells were stained, we assumed those as positive results. Statistical analysis was based on clinicopathological findings and differences in survival rates. RESULTS: The expression rate of p27 was 28.1% and 15.6% in p21 each. The ratio of T1-2(80.0%) was significantly high in p21 (+), but the ratio of T3-4 (50.6%) was slightly high in p21 (-). There was no statistical significance regarding other factors. The results in p27 was not much different from expression rate of p21 in T-stage. In addition, p27 expression in diffuse type (91.3%) was higher than in intestinal type (62.7%) by Lauren's classification (P <0.05). Also, there was no statistical significance in other factors. In the correlation of p21 and p27, p27 was positive when p21 was positive (53.5%). Conversely, p27 was negative when p21 was negative (76.5%, p <0.05). In the p21 and p27 combination test, there was higher rate of T1-2 (87.5%) in p21 (+)/p27 (+), and higher rate of T3-4 (58.1%) in p21 (-)/p27 (-) (P <0.05). Results showed higher rate of intestinal type (100%) in p21 (+)/p27 (+), and diffuse type (87.0%) was dominant in p21 (-)/p27 (-) (P <0.05) by Lauren's classification. Moreover, there was no statistical significance in the 5-year survival rate in the expression of p21 and p27, and the 5-year survival rate was highest in the case of p21 (+)/p27 (+) without statistical significance. CONCLUSION: In our study, p21(Waf1/Cip1) and p27(Kip1) expressed similar patterns. The expression of p21(Waf1/Cip1) and p27(Kip1) affected the degree of invasiveness of the tumor, and. Combined examination result revealed the correlation of p21(Waf1/Cip1) and p27(Kip1) with Lauren's classification and depth of invasion of the tumor. However, we assumed that little difference between the survival rates depending on expression of p21(Waf1/Cip1) and p27(Kip1) has limited their value as predictable prognostic indicators.
Cell Cycle ; Classification ; Humans ; Phosphorylation ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

Hypereosinophilia has been associated with a variety of underlying disorders such as parasitic, fungal and mycobacterial infections, allergic disorders, collagen vascular diseases, or hypereosinophilic syndrome (HES). The association of acute lymphoblastic leukemia (ALL) and symptomatic eosinophilia is rare and only a few cases have been reported. HES probably occurs in less than 1% of all patients with ALL. The chromosomal translocation t (5; 14) (q31; q32) was cloned at the molecular level in ALL with eosinophilia. This translocation joined the immunoglobulin heavy chain region to the promoter region of the interleukin-3 (IL-3) gene in opposite transcriptional orientation. The IL-3 gene translocated with the immunoglobulin heavy chain gene may play a central role in the pathogenesis of this leukemia and the associated eosinophilia. We describe a 8-year-old boy who presented with hypereosinophilia and concurrent ALL with t (5; 14).
Child* ; Clone Cells ; Collagen ; Eosinophilia ; Humans ; Hypereosinophilic Syndrome ; Immunoglobulin Heavy Chains ; Interleukin-3 ; Leukemia ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Promoter Regions, Genetic ; Translocation, Genetic* ; Vascular Diseases

The impairment of host defense mechanisms, particularly of cellular immunity, causes high incidence of mycobacterial infections in the patients with ESRD. Extrapulmonary mycobacterial infections are more frequent in ESRD patients compared to general population. However, there has been rarely reported on the occurrence of hepatic tuberculous abscess as an extrapulmonary mycobacterial infection in ESRD patients. We present a case of ESRD patient manifesting miliary tuberculosis and hepatic tuberculous abscess, which have successfully resolved after anti-tuberculous medications. A 44 years old male admitted with fever, general weakness, night sweating, and cough. Chest X-ray and abdominal CT revealed pulmonary miliary tuberculosis and a solitary tuberculous abscess at S7 of right hepatic lobe with multiple periportal and celiac lymphadenopathy. After the administration of anti-tuberculous medications(isoniazid, rifampicin, ethambutol - eight month, pyrazinamide - two month), miliary tubuculosis disappeared. The size of hepatic tuberculous abscess and lymphadenopathy were reduced in abdominal CT six month later. The patient is followed in outpatient without noticeable symptoms after eight month treatment.
Abscess* ; Adult ; Cough ; Defense Mechanisms ; Ethambutol ; Fever ; Humans ; Immunity, Cellular ; Incidence ; Kidney Failure, Chronic ; Lymphatic Diseases ; Male ; Outpatients ; Pyrazinamide ; Renal Dialysis* ; Rifampin ; Sweat ; Sweating ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Miliary*