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.

BACKGROUND: Influenza causes morbidity and mortality, resulting in the medical and socioeconomic costs. We aimed to analyse whether socioeconomic and medical factors may affect influenza vaccination status divided into 2 groups; one aged 19 to 64 years old and the other aged 65 or over who are eligible for free vaccination. METHODS: The study included 1,412 individuals aged 19 and over who responded to influenza vaccination survey, based on 2013 National Health and Nutrition Examination Survey. Related factors were categorized into socioeconomic factors and medical factors. Univariate analyses were conducted to examine the correlations between vaccination rate and each variables. Multivariate analysis was obtained after adjusting variables which were statistcally significant. RESULTS: Influenza vaccination rate was significantly different in the population aged 19 to 64 (24.9%) and the population aged 65 or over (80.5%). In the former population, high vaccination rate was associated with healthcare usage (odds ratio [OR]=1.37, 95% confidence interval [CI]=1.03-1.83), underlying chronic diseases (OR=2.21, 95% CI=1.43-3.40), and public assistance recipient households (OR=2.21, 95% CI=1.03-4.78), while low vaccination rate was correlated with no use of medical check up (OR=0.70, 95% CI=0.52-0.94) and heavy alcoholics (OR=0.41, 95% CI=0.24-0.70). In the latter population aged 65 or over, high vaccination rate was associated with healthcare usage (OR=1.82, 95% CI=1.28-2.59), and underlying malignancies (OR=4.79, 95% CI=1.07-21.54), whereas low vaccination rate was associated with public assistance recipient households (OR=0.33, 95% CI=0.14-0.76), and no use of medical check up (OR=0.37, 95% CI=0.19-0.73). CONCLUSIONS: In the population below 65 years old, vaccination rate would be expected to rise by the recommendation of medical care providers and expanding the coverage of free vaccination. In elderly, individualized care for those who have less access to medical care and high susceptibility is highly recommended.
Adult* ; Aged ; Alcoholics ; Chronic Disease ; Delivery of Health Care ; Family Characteristics ; Humans ; Influenza Vaccines ; Influenza, Human* ; Mortality ; Multivariate Analysis ; Nutrition Surveys ; Public Assistance ; Socioeconomic Factors ; Vaccination*

Endometrioid stromal sarcoma is a rare malignancy that originates from mesenchymal cells. It is classified into low-grade endometrioid stromal sarcoma (LGESS) and high-grade endometrioid stromal sarcoma. Ultrasonographic findings of LGESS resemble those of submucosal myomas, leading to the possible preoperative misdiagnosis of LGESS as uterine leiomyoma. Electronic morcellation during laparoscopic surgery in women with LGESS can result in iatrogenic intraabdominal dissemination and a poorer prognosis. Here, we report a patient with LGESS who underwent a supracervical hysterectomy and electronic morcellation for a presumed myoma in another hospital. Disseminated metastatic lesions of LGESS in the posterior cul-de-sac and rectal serosal surface were absent on primary surgery, but found during reexploration. In conclusion, when LGESS is found incidentally following previous morcellation during laparoscopic surgery for presumed benign uterine disease, we highly recommend surgical reexploration, even when there is no evidence of a metastatic lesion in imaging studies.
Diagnostic Errors ; Female ; Humans ; Hysterectomy ; Laparoscopy ; Leiomyoma ; Myoma ; Prognosis ; Sarcoma* ; Sarcoma, Endometrial Stromal ; Uterine Diseases ; Uterus

Loperamide has long been known as an opioid-receptor agonist useful as a drug for treatment of diarrhea resulting from gastroenteritis or inflammatory bowel disease as well as to induce constipation. To determine and characterize putative biomarkers that can predict constipation induced by loperamide treatment, alteration of endogenous metabolites was measured in the serum of Sprague Dawley (SD) rats treated with loperamide for 3 days using 1H nuclear magnetic resonance (1H NMR) spectral data. The amounts and weights of stool and urine excretion were significantly lower in the loperamide-treated group than the No-treated group, while the thickness of the villus, crypt layer, and muscle layer was decreased in the transverse colon of the same group. The concentrations of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatinine (Cr) were also slightly changed in the loperamide-treated group, although most of the serum components were maintained at a constant level. Furthermore, pattern recognition of endogenous metabolites showed completely separate clustering of the serum analysis parameters between the No-treated group and loperamide-treated group. Among 35 endogenous metabolites, four amino acids (alanine, glutamate, glutamine and glycine) and six endogenous metabolites (acetate, glucose, glycerol, lactate, succinate and taurine) were dramatically decreased in loperamide-treated SD rats. These results provide the first data pertaining to metabolic changes in SD rats with loperamide-induced constipation. Additionally, these findings correlate the changes in 10 metabolites with constipation.
Amino Acids ; Animals ; Aspartate Aminotransferases ; Biomarkers ; Colon, Transverse ; Constipation* ; Creatinine ; Diarrhea ; Gastroenteritis ; Glucose ; Glutamic Acid ; Glutamine ; Glycerol ; Inflammatory Bowel Diseases ; L-Lactate Dehydrogenase ; Lactic Acid ; Loperamide ; Magnetic Resonance Spectroscopy ; Metabolomics* ; Rats* ; Succinic Acid ; Weights and Measures

Brevundimonas diminuta is a lactose non-fermenting Gram-negative rod associated with infection in immunocompromised patients. In three patients from two general wards, B. diminuta was isolated in blood culture sample. The clinical features of the patients did not coincide with the blood culture result, and pseudo-outbreak was suspected. These isolated were biochemically identified as Brevundimonas diminuta, and 16S rRNA sequencing confirmed their identification. The PFGE result showed a single pattern, and their clonality was assumed.
Electrophoresis, Gel, Pulsed-Field ; Humans ; Immunocompromised Host ; Lactose ; Patients' Rooms

BACKGROUND & OBJECTIVES: A growing body of research has documented that occupational stress is closely associated with increased risk of fatigue. This study was conducted in an effort to assess the relationship of occupational stress to self-perceived fatigue among Korean white collar employees. METHODS: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project, 2002-2004). Among them, a total of 4,502 white collar employees were recruited. A structured questionnaire was employed to evaluate the participants' sociodemographics, job-related factors, health-related behaviors, occupational stress, and self-perceived fatigue. Occupational stress and self-perceived fatigue were assessed using the Korean Occupational Stress Scale-Short form (KOSS-SF) and the Multidimensional Fatigue Scale (MFS), respectively. RESULTS: In logistic regression analyses, occupational stress was associated with an increased risk of fatigue, and some domains of occupational stress had different effects on fatigue by gender (job demand, job insecurity, and lack of reward for men, job demand, lack of reward, and discomfort in occupational climate for women), which indicates that occupational stress may perform a slightly different role in increasing the risk of fatigue by gender. CONCLUSION: The results of this study suggest that occupational stress is a determinant predictor of selfperceived fatigue. Thus, a stress management program for the reduction of occupational stress, and the promotion of white collar worker's health and quality of life is strongly recommended. Some limitations of this study and considerations for future studies were also discussed.
Climate ; Fatigue ; Humans ; Logistic Models ; Male ; Quality of Life ; Questionnaires ; Reward

Nitric oxide synthases (NOSs) that catalyzed the conversion of L-arginine to nitric oxide and L-citrulline play a role in ischemic-reperfusion injury. The purpose of this study was to observe the expression patterns of nNOS, iNOS and eNOS in the rat tibialis anterior and soleus muscles after multiple cyclic episodes of ischemic preconditioning (IP). Nine weeks old male SD rats were divided into control and IP groups. The IP group was further divided into 3 groups based on cycle of IP. For IP, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at 0, 3, 6, 24 and 72 hours of reperfusion and the left tibialis anterior and soleus muscles were removed. The expression of nNOS, iNOS and eNOS were examined with immunohistochemical methods and Western blot analysis. IP increased the expression of nNOS, compared with the control. In the tibialis anterior muscle, the levels of nNOS in the 3IP and 6IP were higher than that in 10IP. IP increased the expression of iNOS, compared with the control, and the levels of iNOS in tibialis anterior muscle were higher than that in soleus muscle. The level of iNOS in the 10IP was higher than those in the 3IP and 6IP. IP increased the expression of eNOS, compared with the control, and the level of eNOS in soleus muscle were higher than that in tibialis anterior muscle. At 0 and 3 hours after reperfusion, the level of eNOS in 6IP and 10IP were higer than that in 3IP. In summary, these results suggest that the ischemic preconditioning increases the expression of nNOS, iNOS and eNOS, and 10 times of ischemic preconditioning may induce ischemic injury through upregulation of iNOS. And tibialis anterior muscle is more susceptabile to ischemic injury than soleus muscle.
Animals ; Arginine ; Blotting, Western ; Humans ; Iliac Artery ; Ischemia ; Ischemic Preconditioning* ; Male ; Muscle, Skeletal ; Muscles* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Reperfusion ; Rodentia ; Up-Regulation

OBJECTIVES: This prospective study was performed to investigate the association between occupational stress and the development of cerebrovascular and cardiovascular diseases. METHODS: A total of 8,429 employees were selected from a nationwide sample, proportional to both the Korean Standard Industrial Classification and the Korean Standard Occupational Classification. A structured self-reported questionnaire was used to access the demographic and socioeconomic characteristics, health behavior and work related characteristics. 43-items of the full version of Korean Occupational Stress Scale (KOSS) were used to access the participants occupational stress. New cases of hospitalization due to cerebrovascular and cardiovascular diseases were evaluated using medical utilization files received from the National Health Insurance Corporation for the period of March 2004 to December 2005. A logistic regression analysis was performed to investigate the association between occupational stress and cerebrovascular and cardiovascular diseases. RESULTS: 43 new cases of hospitalization due to cerebrovascular and cardiovascular diseases were found. According to the results of the logistic regression analysis, job stressors were related with circulatory diseases after adjustment for gender, age, number of workers, employment type, shift work, smoking, alcohol intake, and regular exercise. Of the 8 subscales, insufficient job control (Adj. RR 2.802; 95% CI 1.038-7.564) and occupational climate (Adj. RR 2.365; 95% CI 1.087~5.143) were significantly associated with cerebrovascular and cardiovascular diseases. However, no significant relationships were found between the 6 KOSS subscales and cerebrovascular and cardiovascular diseases. CONCLUSIONS: Despite the short-term follow-up of about two years, the KOSS subscales of insufficient job control and occupational climate were significantly associated with cerebrovascular and cardiovascular diseases.
Cardiovascular Diseases* ; Classification ; Climate ; Employment ; Follow-Up Studies ; Health Behavior ; Hospitalization ; Logistic Models ; National Health Programs ; Prospective Studies ; Questionnaires ; Smoke ; Smoking

The ischemic preconditioning was initially identified as a protective maneuver induced by brief periods of ischemia followed by reperfusion. Although ischemic preconditioning can reduce ischemic injury of heart, skeletal muscle and neuronal tissue, it's protective mechanism remains elusive. Recently, several investigations suggest the associations of nitric oxide with protection from ischemic injury. Nitric oxide synthesized by a member of nitric oxide synthase (NOS) family has been known to increase or decrease the ischemic injury. The purpose of this study was to observe the expression patterns of NOS 1, NOS 2 and NOS 3 in the rat skeletal muscle after cyclic episodes of short ischemia and reperfusion. Nine and thirty-five weeks-old male Sprague-Dawley rats were divided into control and cyclic short ischemia and reperfusion groups. The experimental group was further divided into 3 groups based on cycles of short ischemia and reperfusion. For cyclic short ischemia and reperfusion, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at hours 0, 3, 6, 24 and 72 after reperfusion and the left rectus femoris muscles were removed. The expression profiles and distribution of NOS 1, NOS 2 and NOS 3 were examined with immunohistochemical staining. The results were as follows; In the cyclic of short ischemia and reperfusion groups, the mortality was increased with increasing of cyclic episodes at 72 hours after reperfusion, and aging. In the control group, NOS 1, NOS 2 and NOS 3 immunoreactivities showed no differenes with aging. In the 9 weeks-old rats, NOS 1 immunoreactivities were observed moderate at 24 hours after 6 times of short ischemia and reperfusion, and moderate and strong at 24 hours after 10 times of short ischemia and reperfusion. In the 35 weeks-old rats, NOS 1 immunoreactivities were observed trace or mild at 24 hours after 6 and 10 times of short ischemia and reperfusion. At 3 hours after 3 times of short ischemia and reperfusion, NOS 2 immunoreactivities were observed moderate or strong, and trace in the 9 and 35 weeks-old rats, respectively. At 3 hours after 10 times of short ischemia and reperfusion, NOS 3 immunoreactivities were observed mild or moderate, and trace or negative in the 9 and 35 weeks-old rats, respectively. In summary, the expression profile of NOS 1, NOS 2 and NOS 3 were observed differently with increasing episodes of short ischemia and reperfusion. The alteration was the most prominent in NOS 3 than in NOS 1 and NOS 2. These results suggest that the alteration of NOS 3 known to protect tissue against ischemic injury may be associated with increasing mortality after multiple episodes of short ischemia and reperfusion.
Aging ; Animals ; Heart ; Humans ; Iliac Artery ; Ischemia* ; Ischemic Preconditioning ; Male ; Mortality ; Muscle, Skeletal* ; Muscles ; Neurons ; Nitric Oxide Synthase ; Nitric Oxide* ; Quadriceps Muscle ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Rodentia

OBJECTIVES: The purpose of this study was to identify psychosocial factors associated with biological markers in Korean patients with human immunodeficiency virus (HIV) infection. METHODS: 50 patients with HIV infection were enrolled. We administered Stress Response Inventory (SRI), the Coping Scale, and the Korean version of Smithklein Beecham quality of life scale (QOL) to the 50 patients and measured CD4+ cell count and HIVRNA copies. RESULTS: Simple correlation analysis showed significant correlation between psychosocial factors and CD4+ cell count. Tension, aggression, depression, frustration subscale in SRI and distancing, self controlling in coping scale had negative correlation with CD4+ cell count, whereas QOL showed positive correlation. Multiple regression analysis showed significant negative association between distancing and CD4+ cell count. There were no differences in CD4+ cell count and HIVRNA between homosexual patients and heterosexual patients. However, aggression, confrontation in SRI, and distancing in coping scale scored significantly higher in heterosexual patients than homosexual patients. CONCLUSION: These results suggest that CD4+ cell count may be associated with psychosocial factors in Korean patients with HIV infection, and passive coping strategy like distancing may be one of important factors in the progression of HIV infection. These findings also suggest that psychosocial intervention programs are needed for Korean patients with HIV infection.
Aggression ; Biomarkers* ; CD4 Lymphocyte Count ; Depression ; Frustration ; Heterosexuality ; HIV Infections ; HIV* ; Homosexuality ; Humans ; Humans* ; Psychology* ; Quality of Life