Publications by authors named "Young-Ju Choi"

47 Publications

Residual-Based Graph Convolutional Network for Emotion Recognition in Conversation for Smart Internet of Things.

Big Data 2021 Mar 2. Epub 2021 Mar 2.

Department of IT Engineering, Sookmyung Women's University, Seoul, Republic of Korea.

Recently, emotion recognition in conversation (ERC) has become more crucial in the development of diverse internet of things devices, especially closely connected with users. The majority of deep learning-based methods for ERC combine the multilayer, bidirectional, recurrent feature extractor and the attention module to extract sequential features. In addition to this, the latest model utilizes speaker information and the relationship between utterances through the graph network. However, before the input is fed into the bidirectional recurrent module, detailed intrautterance features should be obtained without variation of characteristics. In this article, we propose a residual-based graph convolution network (RGCN) and a new loss function. Our RGCN contains the residual network (ResNet)-based, intrautterance feature extractor and the GCN-based, interutterance feature extractor to fully exploit the intra-inter informative features. In the intrautterance feature extractor based on ResNet, the elaborate context feature for each independent utterance can be produced. Then, the condensed feature can be obtained through an additional GCN-based, interutterance feature extractor with the neighboring associated features for a conversation. The proposed loss function reflects the edge weight to improve effectiveness. Experimental results demonstrate that the proposed method achieves superior performance compared with state-of-the-art methods.
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http://dx.doi.org/10.1089/big.2020.0274DOI Listing
March 2021

Association Between Serum Bilirubin and the Progression of Carotid Atherosclerosis in Type 2 Diabetes.

J Lipid Atheroscler 2020 Jan 13;9(1):195-204. Epub 2020 Jan 13.

Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute, Seoul, Korea.

Objective: This study investigated whether serum bilirubin levels can predict the progression of carotid atherosclerosis in individuals with type 2 diabetes mellitus (T2DM).

Methods: This observational study included 1,381 subjects with T2DM in whom serial measurements of carotid intima-media thickness (CIMT) were made at 1- to 2-year intervals for 6-8 years. The progression of carotid atherosclerosis was defined as newly detected plaque lesions on repeat ultrasonography. After dividing total serum bilirubin levels into tertiles, the association between total serum bilirubin at baseline and plaque progression status was analyzed.

Results: Among 1,381 T2DM patients, 599 (43.4%) were categorized as having plaque progression in their carotid arteries. Those with plaque progression were significantly older; showed a higher prevalence of hypertension, abdominal obesity, and chronic kidney disease; and had a longer duration of T2DM, higher levels of total cholesterol (TC), triglycerides, and insulin resistance, and lower total bilirubin concentrations than those with no plaque progression. When total serum bilirubin levels were divided into tertiles, the highest tertile group was younger than the lowest tertile group, with higher levels of TC and high-density lipoprotein cholesterol. Multiple logistic regression analysis demonstrated that higher serum bilirubin levels were associated with a significantly lower risk of CIMT progression (odds ratio, 0.584; 95% confidence interval, 0.392-0.870; =0.008). Age (<0.001), body mass index (=0.023), and TC (=0.019) were also associated with the progression of carotid atherosclerosis in T2DM patients.

Conclusion: Total serum bilirubin is independently associated with progression of atherosclerosis in the carotid arteries in T2DM patients.
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http://dx.doi.org/10.12997/jla.2020.9.1.195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379078PMC
January 2020

Children with transient loss of consciousness: Clinical characteristics and the effectiveness of diagnostic tests.

Pediatr Neonatol 2020 12 24;61(6):584-591. Epub 2020 Jun 24.

Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Republic of Korea. Electronic address:

Background: Transient loss of consciousness (TLOC) is common among children and adolescents. The aims of this study were to identify clinical differences between patients with vasovagal syncope and those with epileptic seizures, which account for a large proportion of TLOC cases, and to evaluate the effectiveness of various diagnostic tests.

Methods: The medical records of 160 children and adolescents with TLOC were analyzed retrospectively, and age, sex, clinical symptoms, and trigger factors were recorded. The cardiological and neurological evaluations performed included electrocardiograms, computed tomography scanning, magnetic resonance imaging, electroencephalograms (EEGs), echocardiograms, and head-up tilt tests (HUTTs). Overall assessments of the 160 patients generated final diagnoses.

Results: The mean age of patients was 14.6 years old and TLOC occurred more frequently among girls (59.4%). The most common final diagnosis was vasovagal syncope (n = 102, 63.4%), followed by undetermined (n = 21, 13.1%) and epileptic seizures (n = 17, 10.6%). There were many other diagnoses, including cardiogenic syncope (1.3%). Patients diagnosed with vasovagal syncope were much more likely to have dizziness or light-headedness and blurred vision as pre-symptoms (p < 0.05), whereas patients diagnosed with epileptic seizures were more likely to have convulsions as an accompanying sign (p < 0.05). In addition, standing up was the most significant trigger factor for TLOC among those diagnosed with vasovagal syncope (p < 0.05). The sensitivity, specificity, and accuracy of the HUTT for vasovagal syncope were 95.1%, 75.0%, and 91.8%, respectively. Similarly, the sensitivity, specificity, and accuracy of EEGs for epileptic seizures were 80.0%, 70.6%, and 80.0%, respectively.

Conclusion: Vasovagal syncope and epileptic seizures should be considered as possible causes of most cases of TLOC in children and adolescents. An accurate case history and appropriate evaluation are essential for correct diagnoses.
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http://dx.doi.org/10.1016/j.pedneo.2020.06.006DOI Listing
December 2020

Low muscle mass is associated with carotid atherosclerosis in patients with type 2 diabetes.

Atherosclerosis 2020 07 16;305:19-25. Epub 2020 Jun 16.

Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, Republic of Korea. Electronic address:

Background And Aims: Sarcopenia leads to metabolic and vascular abnormalities. However, little is known regarding the independent relationship between skeletal muscle mass and atherosclerosis in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association between skeletal muscle mass and carotid atherosclerosis in men and women with T2DM.

Methods: In this cross-sectional study, a total of 8202 patients with T2DM were recruited from the Seoul Metabolic Syndrome cohort. Skeletal muscle mass was estimated using bioimpedance analysis, while skeletal muscle mass index (SMI, %) was defined as total skeletal muscle mass (kg)/body weight (kg) × 100. Both carotid arteries were examined by B-mode ultrasound. Carotid atherosclerosis was defined by having a carotid plaque or mean carotid intima-media thickness (IMT) ≥1.1 mm.

Results: Among the entire population, 4299 (52.4%) subjects had carotid atherosclerosis. The prevalence of carotid atherosclerosis increased with decreasing SMI quartiles for both sexes. The odds ratios for carotid atherosclerosis were 2.33 (95% confidence interval [CI], 1.17-4.63) and 2.24 (95% CI, 1.06-4.741) in the lowest versus highest SMI quartile in men and women, respectively, after the adjustment for clinical risk factors. In men, the risk of atherosclerosis increased linearly with decreasing SMI quartiles (p for trend = 0.036).

Conclusions: Low skeletal muscle mass was independently associated with the presence of carotid atherosclerosis in men and women with T2DM.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.05.021DOI Listing
July 2020

Non-alcoholic steatohepatitis and progression of carotid atherosclerosis in patients with type 2 diabetes: a Korean cohort study.

Cardiovasc Diabetol 2020 06 13;19(1):81. Epub 2020 Jun 13.

Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute, Seoul, Korea.

Background: There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. This study was conducted to evaluate whether hepatic steatosis with or without fibrosis is associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.

Methods: From a longitudinal cohort, we enrolled 1120 patients with type 2 diabetes who underwent repeated carotid artery ultrasonography every 1-2 years. Ultrasonographic findings at baseline and after 6-8 years were compared. Presence of hepatic steatosis was mainly assessed by abdominal ultrasonography; patients with hepatic steatosis were further evaluated for hepatic fibrosis according to fibrosis-4 index. We investigated the association between liver status and atherosclerosis progression.

Results: Of 1120 patients, 636 (56.8%) were classified as having hepatic steatosis at baseline. After 6-8 years, 431 (38.5%) showed atherosclerosis progression. Hepatic steatosis was significantly associated with atherosclerosis progression (adjusted odds ratio[AOR]: 1.370, 95% CI 1.025-1.832; p < 0.05). Among patients with hepatic steatosis, only individuals with fibrosis showed significant association with atherosclerosis progression (AOR: 1.615, 95% CI 1.005-2.598; p < 0.05). The association between hepatic fibrosis and atherosclerosis progression was significant in all metabolic subgroups regardless of age, body mass index, presence of metabolic syndrome, or insulin sensitivity (all p < 0.05). Furthermore, subjects with hepatic steatosis & fibrosis and ≥ 4 components of metabolic syndrome criteria showed markedly increased risk of atherosclerosis progression (AOR: 2.430, 95% CI 1.087-5.458; p < 0.05).

Conclusions: Hepatic steatosis with fibrosis is independently associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
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http://dx.doi.org/10.1186/s12933-020-01064-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293796PMC
June 2020

Retrospective Analysis of the Efficacy of Dapagliflozin in Patients with Type 2 Diabetes in a Primary Clinic in Korea.

Endocrinol Metab (Seoul) 2019 03;34(1):70-79

Huh's Diabetes Center and 21st Century Diabetes and Vascular Research Institute, Seoul, Korea.

Background: We aimed to retrospectively analyze the efficacy of 10 mg dapagliflozin (DAPA), which is a sodium-glucose cotransporter-2 inhibitor, in Korean patients with type 2 diabetes who visited a primary diabetes clinic.

Methods: In total, 83 patients with type 2 diabetes, who received treatment with DAPA for the first time in a primary diabetes clinic between January 2015 and October 2015, were included in the study. The effect of DAPA in lowering glycosylated hemoglobin (HbA1c) levels was evaluated via chart review at 6 months follow-up. The patients were categorized into five groups according to add-on to or switched from other glucose-lowering agents: add-on to metformin (MET, =10), add-on to MET+dipeptidyl peptidase 4 inhibitor (DPP4i, =12), switched from sulfonylurea (SU, =13), switched from DPP4i (=11), and switched from thiazolidinedione (TZD, =37). All the participants had already used MET for their regimen.

Results: Treatment with DAPA reduced HbA1c level by 1.2%±0.8%. Moreover, a significant decrease was observed in all subgroups: add-on to MET, -1.2%±0.7%; add-on to MET+DPP4i, -1.4%±0.8%; switched from SU, -1.4%±0.7%; switched from DPP4i, -0.5%±0.7%; and switched from TZD, -1.2%±0.9% (<0.01). A significant decrease in body weight (-3.1±2.6 kg, <0.001) was observed after DAPA administration. Estimated glomerular filtration rate and urine microalbumin were significantly decreased after 6 months of treatment with DAPA (-4.0±13.5 mL/min/1.73 m², =0.03; -23.6±45.9 mg/L, <0.001).

Conclusion: Treatment with DAPA, whether added to or switched from other glucose-lowering agents, significantly decreased HbA1c levels in Korean patients with type 2 diabetes who visited a single primary diabetes clinic. DAPA can be considered as an optimal second-line treatment for patients with type 2 diabetes, as supported by real-world evidence studies.
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http://dx.doi.org/10.3803/EnM.2019.34.1.70DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435850PMC
March 2019

Association between Non-Alcoholic Steatohepatitis and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus.

Diabetes Metab J 2020 04 28;44(2):267-276. Epub 2019 Feb 28.

Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute, Seoul, Korea.

Background: Impaired diastolic heart function has been observed in persons with non-alcoholic fatty liver disease (NAFLD) and/or with type 2 diabetes mellitus (T2DM). However, it is unclear whether NAFLD fibrotic progression, i.e., non-alcoholic steatohepatitis, poses an independent risk for diastolic dysfunction in T2DM. We investigated the association between liver fibrosis and left ventricular (LV) diastolic dysfunction in T2DM.

Methods: We analyzed 606 patients with T2DM, aged ≥50 years, who had undergone liver ultrasonography and pulsed-wave Doppler echocardiography. Insulin sensitivity was measured by short insulin tolerance test. Presence of NAFLD and/or advanced liver fibrosis was determined by abdominal ultrasonography and NAFLD fibrosis score (NFS). LV diastolic dysfunction was defined according to transmitral peak early to late ventricular filling (E/A) ratio and deceleration time, using echocardiography.

Results: LV diastolic dysfunction was significantly more prevalent in the NAFLD versus non-NAFLD group (59.7% vs. 49.0%, =0.011). When NAFLD was stratified by NFS, subjects with advanced liver fibrosis exhibited a higher prevalence of diastolic dysfunction (49.0%, 50.7%, 61.8%; none, simple steatosis, advanced fibrosis, respectively; for trend=0.003). In multivariable logistic regression, liver fibrosis was independently associated with diastolic dysfunction (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.07 to 2.34; =0.022) after adjusting for insulin resistance and cardiometabolic risk factors. This association remained significant in patients without insulin resistance (OR, 4.32; 95% CI, 1.73 to 11.51; =0.002).

Conclusions: Liver fibrosis was associated with LV diastolic dysfunction in patients with T2DM and may be an independent risk factor for diastolic dysfunction, especially in patients without systemic insulin resistance.
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http://dx.doi.org/10.4093/dmj.2019.0001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188976PMC
April 2020

Prevalence and predictors of peripherally inserted central catheter-associated bloodstream infections in adults: A multicenter cohort study.

PLoS One 2019 7;14(3):e0213555. Epub 2019 Mar 7.

National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.

Objective: To evaluate the prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PBSI) and PBSI-related death in hospitalized adult patients.

Materials And Methods: A retrospective multicenter cohort of consecutive patients who underwent PICC placement from October 2016 to September 2017 at four institutes was assembled. Using multivariable logistic and Cox-proportional hazards regression models, all risk factors were analyzed for their association with PBSI. Multivariable logistic models were used to evaluate predictors of PBSI-related death.

Results: During the study period, a total of 929 PICCs were inserted in 746 patients for a total of 17,913 catheter days. PBSI occurred in 58 patients (6.2%), with an infection rate of 3.23 per 1,000 catheter days. Number of catheter lumens [double lumen, odds ratio (OR) 5.295; 95% confidence interval (CI), 2.220-12.627; hazard ration (HR) 3.569; 95% CI, 1.461-8.717], PICC for chemotherapy (OR 4.94; 95% CI, 1.686-14.458; HR 7.635; 95% CI, 2.775-21.007), and hospital length of stay (OR 2.23; 95% CI, 1.234-4.049; HR 1.249; 95% CI, 0.659-2.368) were associated with PBSI. Risk factors, such as receiving chemotherapy (OR 54.911; 95% CI, 2.755-1094.326), presence of diabetes (OR 11.712; 95% CI, 1.513-90.665), and advanced age (OR 1.116; 95% CI 1.007-1.238), were correlated with PBSI-related death.

Conclusion: Our results indicated that risk factors associated with PBSI included the number of catheter lumens, the use of PICCs for chemotherapy, and the hospital length of stay. Furthermore, PBSI-related death was common in patients undergoing chemotherapy, diabetics, and elderly patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213555PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405206PMC
December 2019

Development of Protein-Based High-Oxygen Barrier Films Using an Industrial Manufacturing Facility.

J Food Sci 2019 Feb 8;84(2):303-310. Epub 2019 Jan 8.

Dept. of Biotechnology, College of Life Sciences and Biotechnology, Korea Univ., Seoul, 02841, Republic of Korea.

In this study, protein-based high-oxygen barrier multilayer films were manufactured at a pilot plant scale by a roll-to-roll coating process and an adhesive lamination process. Also, their characteristics were examined to evaluate their industrial feasibility. Oxygen transmission rates (OTRs) of the protein-based films (polyethylene terephthalate [PET]/pea protein isolate [PPI]/nylon/cast polypropylene [CPP], PET/whey protein isolate [WPI]/CPP, PET/WPI/nylon/CPP, and PET/PPI/nylon/low-density polyethylene [LDPE]) were significantly lower than OTR of the PET/nylon/CPP film without a protein-coating layer and that of the commercial high-barrier multilayer film copolymer (PET/aluminum/CPP). In addition, water vapor transmission rates of the films containing protein layer were significantly lower than that of the commercial high-barrier film containing ethylene vinyl alcohol [nylon/nylon/EVOH/easy peel layer [EPL]). Among the tested polymers, the PET/WPI/nylon/LDPE film showed the highest heat-sealing ability, tensile strength, and elastic modulus. Moreover, transparency and haze of the PET/WPI/nylon/CPP film were similar to the film without WPI coating. Taken together, our results indicate that the protein-based coating films showing high-oxygen and high-water barrier properties can be manufactured using industrial facilities and could replace commercial multilayer films based on synthetic materials. PRACTICAL APPLICATION: Oxygen barrier property is an important feature in food packaging materials. Therefore, protein-coated high-oxygen barrier multilayer films were manufactured at a pilot scale to verify the possibility of their mass production. Specifically, high-oxygen and high-moisture barrier coating was produced by pea and whey proteins. Finally, the protein-based multilayer films made by an industrial facility were confirmed to be able to replace current commercial films containing synthetic barrier materials.
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http://dx.doi.org/10.1111/1750-3841.14427DOI Listing
February 2019

Validation of the Clinical Index of Stable Febrile Neutropenia (CISNE) model in febrile neutropenia patients visiting the emergency department. Can it guide emergency physicians to a reasonable decision on outpatient vs. inpatient treatment?

PLoS One 2018 31;13(12):e0210019. Epub 2018 Dec 31.

Center for Breast Cancer, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.

Advances in oncology have enabled physicians to treat low-risk febrile neutropenia (FN) in outpatient settings. This study was aimed to explore the usefulness of the CISNE model and identify better triage in the emergency setting. This is a retrospective cohort study on 400 adult FN patients presenting to the Emergency Department of National Cancer Center, Korea from January 2010 to December 2016. All had been treated with cytotoxic chemotherapy for solid tumors in the previous 30 days. The primary outcome was the frequency of any serious complications during the duration of illness. Apparently stable patients numbered 299 (74.8%) of 400, and the remainder comprised clinically unstable patients. The stable patients fell into three cohorts according to the risk scores: CISNE I (low risk), 56 patients (18.7%); CISNE II (intermediate), 124 (41.5%) and CISNE III (high), 119 (39.8%). The primary outcome occurred in 10.7%, 19.4% and 33.6%, respectively, according to the cohort. Compared with the Multinational Association of Supportive Care in Cancer Risk Index Score (MASCC RIS), CISNE I stratum had significantly lower sensitivity (0.22 vs. 0.95 of MASCC low risk) but higher specificity (0.91 vs. 0.17) to predict zero occurrence of the primary outcome. The CISNE model was useful for identifying low-risk FN patients for outpatient treatment. The combination of the CISNE and MASCC RIS may help emergency physicians cope with FN more confidently.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210019PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312365PMC
May 2019

Color Doppler Ultrasonography Is a Useful Tool for Diagnosis of Peripheral Artery Disease in Type 2 Diabetes Mellitus Patients with Ankle-Brachial Index 0.91 to 1.40.

Diabetes Metab J 2018 Feb;42(1):63-73

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Background: The clinical utility of ankle-brachial index (ABI) is not clear in subjects with less severe or calcified vessel. Therefore, we investigated the usefulness of color Doppler ultrasonography for diagnosing peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) subjects.

Methods: We analyzed 324 T2DM patients who concurrently underwent ABI and carotid intima-media thickness (CIMT) measurements and color Doppler ultrasonography from 2003 to 2006. The degree of stenosis in patients with PAD was determined according to Jager's criteria, and PAD was defined as grade III (50% to 99% stenosis) or IV stenosis (100% stenosis) by color Doppler ultrasonography. Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the risk factors for PAD in patients with ABI 0.91 to 1.40.

Results: Among the 324 patients, 77 (23.8%) had ABI 0.91 to 1.40 but were diagnosed with PAD. Color Doppler ultrasonography demonstrated that suprapopliteal arterial stenosis, bilateral lesions, and multivessel involvement were less common in PAD patients with ABI 0.91 to 1.40 than in those with ABI ≤0.90. A multivariate logistic regression analysis demonstrated that older age, current smoking status, presence of leg symptoms, and high CIMT were significantly associated with the presence of PAD in patients with ABI 0.91 to 1.40 after adjusting for conventional risk factors. CIMT showed significant power in predicting the presence of PAD in patients with ABI 0.91 to 1.40.

Conclusion: Color Doppler ultrasonography is a useful tool for the detection of PAD in T2DM patients with ABI 0.91 to 1.40 but a high CIMT.
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http://dx.doi.org/10.4093/dmj.2018.42.1.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842302PMC
February 2018

Epidemiological Study on Species in Patients with Cancer in the Intensive Care Unit.

Osong Public Health Res Perspect 2017 Dec 31;8(6):384-388. Epub 2017 Dec 31.

Division of Nursing Science, University of Suwon, Hwaseong, Korea.

Objectives: Although cancer survival rates have increased, serious infection complications can arise in cancer patients. can occur in various tissues and has significant effects on the prognosis of patients with cancer. Thus, we conducted an epidemiological study on infections in patients with cancer admitted to the intensive care unit.

Methods: A retrospective study was conducted in adult patients with cancer admitted to the intensive care unit between January 1, 2013, and December 31, 2015. infection status and predictive factors for mortality were examined in 634 patients.

Results: The predictive factors for mortality included the use of steroids, use of a central venous catheter or mechanical ventilator, and identification of in the blood. Patients who stayed in the surgical and intensive care unit for more than 7 days had a lower risk of death than that in those with shorter days.

Conclusion: The present study shows that invasive procedures, bloodstream infections, and the use of steroids increase the risk of mortality in -infected patients with cancer. To improve the quality of life and reduce mortality, further studies are needed on the factors affecting the risk of mortality associated with infection.
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http://dx.doi.org/10.24171/j.phrp.2017.8.6.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749485PMC
December 2017

ApoB/ApoA-I ratio is independently associated with carotid atherosclerosis in type 2 diabetes mellitus with well-controlled LDL cholesterol levels.

Korean J Intern Med 2018 01 28;33(1):138-147. Epub 2017 Dec 28.

Huh's Diabetes Center and 21st Century Diabetes and Vascular Research Institute, Seoul, Korea.

Background/aims: This study aimed to investigate whether the apolipoprotein (Apo) B/ApoA-I ratio is associated with carotid intima-media thickness (CIMT) in type 2 diabetes mellitus (T2DM) subjects with low density lipoprotein cholesterol (LDL-C) levels less than 100 mg/dL.

Methods: This cross-sectional study included 845 subjects aged with T2DM 40 to 75 years who had visited Huh's Diabetes Center in Seoul, Republic of Korea for CIMT measurement. Traditional fasting lipid profiles, ApoB and ApoA-I levels were examined. CIMT was measured at three points on the far wall of 1 cm long section of the common carotid artery in the proximity of the carotid bulb. The mean value of six measurements from right and left carotid arteries were used as the mean CIMT. In this study, carotid atherosclerosis was defined as having a focal plaque or diffuse thickening of the carotid wall (mean CIMT ≥ 1.0 mm).

Results: The prevalence of carotid atherosclerosis increased with ApoB/ApoA-I ratio. The ApoB/ApoA-I ratio, expressed as both quartiles (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.21 to 3.79; for trend = 0.014) and continuous values (OR, 10.05; 95% CI, 3.26 to 30.97; < 0.001), was significantly associated with a higher risk for carotid atherosclerosis, regardless of conventional cardiovascular disease risk factors. The optimal ApoB/ApoA-I ratio cutoff value for detecting carotid atherosclerosis was 0.57, based on receiver operating characteristic curve analysis with a sensitivity of 58.0% and a specificity of 55.1%.

Conclusions: A high ApoB/ApoA-I ratio was significantly associated with carotid atherosclerosis in T2DM patients with LDL-C levels less than 100 mg/dL.
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http://dx.doi.org/10.3904/kjim.2017.396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768554PMC
January 2018

Waist-to-calf circumstance ratio is an independent predictor of hepatic steatosis and fibrosis in patients with type 2 diabetes.

J Gastroenterol Hepatol 2018 May 6;33(5):1082-1091. Epub 2018 Feb 6.

Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA.

Background And Aim: Although a combination of central obesity and decreased skeletal muscle mass has been associated with various cardiometabolic disorders, its influence on the presence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D) is unclear. We investigated whether waist-to-calf circumference ratio (WCR) predicts NAFLD or hepatic fibrosis in T2D.

Methods: Patients with T2D (n = 5507) were enrolled in this study. Hepatic steatosis was diagnosed using abdominal ultrasound and predicting score. NAFLD was defined as 'hepatic steatosis absent other causes of chronic liver disease,' such as virus or alcoholism. Degree of hepatic fibrosis was calculated using non-invasive serum biomarker-based models. Insulin resistance was assessed by short insulin tolerance test.

Results: The prevalence of NAFLD and obesity (BMI ≥ 25 kg/m , Asian definition) were 46.4% and 38.9%, respectively. NAFLD prevalence was higher with increasing WCR tertiles: lowest tertile (36% in men, 28% in women) versus highest tertile (53.8% in men, 58.2% in women, both P < 0.001 after stratification by insulin resistance status. Increasing WCR tertiles were independently associated with presence of NAFLD: odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.22-1.68 and OR = 1.56, 95% CI = 1.31-1.86, in the middle and highest tertiles, respectively. Furthermore, patients with NAFLD and the highest WCR tertile had significant fibrosis (OR = 8.62, 95% CI = 1.39-53.36, P = 0.021). Also, WCR was correlated with risk of sarcopenia (OR = 3.18, 95% CI = 2.50-4.05, P < 0.001, highest tertile).

Conclusions: Higher WCR is associated with increased risk of NAFLD and hepatic fibrosis independent of insulin resistance. This suggests that WCR may be a useful index to predict high risk of hepatic steatosis in T2D.
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http://dx.doi.org/10.1111/jgh.14011DOI Listing
May 2018

Effects of folic acid supplementation on serum homocysteine levels, lipid profiles, and vascular parameters in post-menopausal Korean women with type 2 diabetes mellitus.

Nutr Res Pract 2017 Aug 18;11(4):327-333. Epub 2017 Jul 18.

Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea.

Background/objectives: Complications of diabetes, such as cardiovascular disease, are associated with increased mortality among type 2 diabetes mellitus patients. Homocysteine has been recently identified as a predictor of cardiovascular disease-related complications in diabetes. We investigated whether or not supplementation with folic acid tablets can lower homocysteine levels and improve parameters related with vascular complications.

Subjects/methods: We conducted a non-randomized 8-week trial involving postmenopausal diabetic women (n = 25) supplemented with 800 µg of folic acid (400 µg twice a day) daily. Subjects' serum levels of folate, homocysteine, and vitamin B were measured, along with vascular function and brachial-ankle pulse wave velocity.

Results: Folic acid supplementation significantly increased serum folate levels ( < 0.0001), reduced homocysteine levels ( < 0.0001), and increased vitamin B levels ( = 0.0063). There were significant decreases in low-density lipoprotein cholesterol levels as well as the ratios of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol and total cholesterol to high-density lipoprotein cholesterol. Brachial-ankle pulse wave velocities were not altered by supplementation. Changes in serum vitamin B after folic acid supplementation were negatively correlated with changes in brachial-ankle pulse wave velocity.

Conclusions: In this study on postmenopausal Korean women with type 2 diabetes mellitus, folic acid supplementation reduced serum homocysteine levels, increased serum folate and vitamin B levels, and lowered lipid parameters.
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http://dx.doi.org/10.4162/nrp.2017.11.4.327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537542PMC
August 2017

A Case of Disseminated Infection with Skin Manifestation due to Non-neoformans and Non-gattii Cryptococcus in a Patient with Refractory Acute Myeloid Leukemia.

Infect Chemother 2017 Jun 16;49(2):142-145. Epub 2017 Jan 16.

Hematologic Oncology Clinic, National Cancer Center, Goyang, Korea.

Cryptococcus spp. other than Cryptococcus neoformans or Cryptococcus gattii were previously considered saprophytes and thought to be non-pathogenic to humans. However, opportunistic infections associated with non-neoformans and non-gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have increased over the past four decades. We experienced a case of cryptococcosis caused by non-neoformans and non-gattii spp. in a 47-year-old female with refractory acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. The patient underwent salvage chemotherapy with fluconazole prophylaxis and subsequently developed neutropenic fever with multiple erythematous umbilicated papules. A skin biopsy revealed fungal hyphae and repetitive blood cultures showed yeast microorganisms that were identified later as C. laurentii by Vitek-II®. Skin lesions and fever began to improve with conventional amphotericin B therapy. The treatment regimen was continued for 21 days until the disseminated cryptococcosis was completely controlled.
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http://dx.doi.org/10.3947/ic.2017.49.2.142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500271PMC
June 2017

Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis.

BMC Infect Dis 2016 Jul 15;16:331. Epub 2016 Jul 15.

Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.

Background: The purported value of empirical therapy to cover methicillin-resistant Staphylococcus aureus (MRSA) has been debated for decades. The purpose of this study was to evaluate the effects of inappropriate empirical antibiotic therapy on clinical outcomes in patients with healthcare-associated MRSA bacteremia (HA-MRSAB).

Methods: A prospective, multicenter, observational study was conducted in 15 teaching hospitals in the Republic of Korea from February 2010 to July 2011. The study subjects included adult patients with HA-MRSAB. Covariate adjustment using the propensity score was performed to control for bias in treatment assignment. The predictors of in-hospital mortality were determined by multivariate logistic regression analyses.

Results: In total, 345 patients with HA-MRSAB were analyzed. The overall in-hospital mortality rate was 33.0 %. Appropriate empirical antibiotic therapy was given to 154 (44.6 %) patients. The vancomycin minimum inhibitory concentrations of the MRSA isolates ranged from 0.5 to 2 mg/L by E-test. There was no significant difference in mortality between propensity-matched patient pairs receiving inappropriate or appropriate empirical antibiotics (odds ratio [OR] = 1.20; 95 % confidence interval [CI] = 0.71-2.03). Among patients with severe sepsis or septic shock, there was no significant difference in mortality between the treatment groups. In multivariate analyses, severe sepsis or septic shock (OR = 5.45; 95 % CI = 2.14-13.87), Charlson's comorbidity index (per 1-point increment; OR = 1.52; 95 % CI = 1.27-1.83), and prior receipt of glycopeptides (OR = 3.24; 95 % CI = 1.08-9.67) were independent risk factors for mortality.

Conclusion: Inappropriate empirical antibiotic therapy was not associated with clinical outcome in patients with HA-MRSAB. Prudent use of empirical glycopeptide therapy should be justified even in hospitals with high MRSA prevalence.
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http://dx.doi.org/10.1186/s12879-016-1650-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946186PMC
July 2016

Reappraisal of waist circumference cutoff value according to general obesity.

Nutr Metab (Lond) 2016 5;13:26. Epub 2016 Apr 5.

Huh's Diabetes Center and the 21th Century Diabetes and Vascular Research Institute, Seoul, Republic of Korea.

Background: Current criterion of waist circumference (WC) for abdominal obesity is not enough to demonstrate characteristics of obese and non-obese populations defined by BMI. The aim of this study was to redefine the cutoff values of WC according to general obesity (BMI ≥ 25 kg/m(2)).

Methods: The receiver operating characteristic curve analysis was performed to determine cutoff values of WC for predicting atherosclerosis according to BMI in 1,063 non-diabetic subjects. To validate this new criterion, diabetic patients (n = 3,690) were divided into three groups based on the current (WC of 90/80 cm for men/women) and new cutoff values of WC: 1) group with WC below the lowest value of two criteria; 2) intermediate group defined as having a WC between them; and 3) group with WC more than the highest value of them.

Results: The new cutoff values of WC for predicting atherosclerosis in non-diabetic subjects were 84/76 cm for non-obese men/women, and 93/87 cm for obese men/women, respectively. Of non-obese diabetic patients, the intermediate group (WC 84 ~ 90/76 ~ 80 cm for men/women) was more insulin resistant and showed elevated odds ratio (OR) for having 2 or more metabolic risk factors compared to group with WC below 84/76 cm for men/women [OR 2.48 (95 % CI 1.89-3.25) in men, 2.01 (95% CI 1.45-2.78) in women]. In contrast, among obese diabetic patients, insulin resistance and the likelihood of having 2 or more metabolic risk factors were not different from the intermediate group (WC 90 ~ 93/80 ~ 87 cm for men/women) and group with WC below 90/80 cm for men/women.

Conclusions: The current universal cutoff values of WC may under- or over-estimate the metabolic risks of intermediate groups. Therefore, the WC criteria for abdominal obesity should be applied differently depending on the BMI.
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http://dx.doi.org/10.1186/s12986-016-0085-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820860PMC
April 2016

Association between dietary flavanones intake and lipid profiles according to the presence of metabolic syndrome in Korean women with type 2 diabetes mellitus.

Nutr Res Pract 2016 Feb 3;10(1):67-73. Epub 2015 Dec 3.

Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea.

Background/objectives: This study was aimed at examining the association between dietary flavanones intake and lipid profiles according to the presence of metabolic syndrome (MetS) in Korean women with type 2 diabetes mellitus (T2DM).

Subjects/methods: A cross-sectional analysis was performed among 502 female T2DM patients (non-MetS group; n = 129, MetS group; n = 373) who were recruited from the Huh's Diabetes Clinic in Seoul, Korea between 2005 and 2011. The dietary intake was assessed by a validated semi-quantitative food frequency questionnaire (FFQ) and the data was analyzed using the Computer Aided Nutritional Analysis program (CAN-Pro) version 4.0 software. The intake of flavanones was estimated on the basis of the flavonoid database.

Results: In the multiple linear regression analysis after adjustment for confounding factors, daily flavanones intake was negatively associated with CVD risk factors such as total cholesterol, LDL-cholesterol, and apoB and apoB/apoA1 ratio only in the MetS group but not in the non-MetS group. Multiple logistic regression analysis revealed that the odds ratio for a higher apoB/apoA1 ratio above the median (≥ 0.74) was significantly low in the 4(th) quartile compared to that in the 1(st) quartile of dietary flavanones intake [OR: 0.477, 95% CI: 0.255-0.894, P for trend = 0.0377] in the MetS group.

Conclusions: Dietary flavanones intake was inversely associated with the apoB/apoA1 ratio, suggesting a potential protective effect of flavanones against CVD in T2DM women with MetS.
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http://dx.doi.org/10.4162/nrp.2016.10.1.67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742313PMC
February 2016

Association between fish and shellfish, and omega-3 PUFAs intake and CVD risk factors in middle-aged female patients with type 2 diabetes.

Nutr Res Pract 2015 Oct 13;9(5):496-502. Epub 2015 May 13.

Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea.

Background/objectives: This study was performed to investigate the association between the dietary intake of fish and shellfish, and omega-3 polyunsaturated fatty acids (PUFAs) and cardiovascular disease (CVD) risk factors in the middle-aged Korean female patients with Type 2 diabetes (T2D).

Subjects/methods: A cross-sectional analysis was performed with 356 female patients (means age: 55.5 years), who were recruited from the Huh's Diabetes Clinic in Seoul, Korea between 2005 and 2011. The dietary intake was assessed by a validated semi-quantitative food frequency questionnaire and analyzed using the Computer Aided Nutritional Analysis program (CAN-Pro) version 4.0 software.

Results: In a multiple regression analysis after the adjustment for confounding factors such as age, BMI, duration of diagnosed T2D, alcohol consumption, fiber intake, sodium intake, and total energy intake, fish and shellfish intake of the subjects was negatively associated with triglyceride and pulse wave velocity (PWV). Omega-3 PUFAs intake was negatively associated with triglyceride, systolic blood pressures, diastolic blood pressures, and PWV. The multiple logistic regression analysis with the covariates showed a significant inverse relationship between the omega-3 PUFAs consumption and prevalence of hypertriglyceridemia [OR (95% CI) for greater than the median compared to less than the median: 0.395 (0.207-0.753)].

Conclusions: These results suggest that the consumption of fish and shellfish, good sources of omega-3 PUFAs, may reduce the risk factors for CVD in the middle-aged female patients with T2D.
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http://dx.doi.org/10.4162/nrp.2015.9.5.496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575962PMC
October 2015

Optimal Waist Circumference Cutoff Value Based on Insulin Resistance and Visceral Obesity in Koreans with Type 2 Diabetes.

Diabetes Metab J 2015 Jun 24;39(3):253-63. Epub 2015 Apr 24.

Huh's Diabetes Center and the 21C Diabetes and Vascular Research Institute, Seoul, Korea.

Background: Visceral obesity is the most powerful contributor to the development of metabolic syndrome (MetS) and cardiovascular diseases. In light of visceral obesity, however, there is a paucity of data on the appropriate cutoff point of waist circumference (WC) in subjects with type 2 diabetes. The aim of this study was to investigate the optimal cutoff value for WC that signals insulin resistance (IR) and visceral obesity in Koreans with type 2 diabetes.

Methods: We evaluated 4,252 patients with type 2 diabetes (male 2,220, female 2,032, mean age 57.24 years) who visited our clinic between January 2003 and June 2009. WC was measured at the midpoint between the lower rib and the iliac crest, and insulin sensitivity was assessed by the rate constant of plasma glucose disappearance (Kitt %/min) using an insulin tolerance test. Visceral fat thickness was measured using ultrasonography. Statistical analysis was performed using receiver operating characteristic curve.

Results: The optimal cutoff points for WC for identifying the presence of IR and visceral obesity, as well as two or more metabolic components, were 87 cm for men and 81 cm for women. Moreover, these cutoff points had the highest predictive powers for the presence of visceral obesity. The MetS defined by new criteria correlated with the increased carotid intima-media thickness in female subjects.

Conclusion: Our results suggest that the optimal cutoff values for WC in Koreans with type 2 diabetes should be reestablished based on IR and visceral obesity.
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http://dx.doi.org/10.4093/dmj.2015.39.3.253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483611PMC
June 2015

Veratric acid inhibits iNOS expression through the regulation of PI3K activation and histone acetylation in LPS-stimulated RAW264.7 cells.

Int J Mol Med 2015 Jan 27;35(1):202-10. Epub 2014 Oct 27.

Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan 608-737, Republic of Korea.

In the present study, we investigated regulatory effects of veratric acid on the production of nitric oxide (NO) in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. NO production was significantly decreased by veratric acid in the LPS-stimulated RAW264.7 cells in a dose-dependent manner. The reduction in nitric oxide production was induced by the downregulation of inducible NO synthase (iNOS) expression. Veratric acid suppressed the LPS-induced effects on the regulatory and catalytic subunits of phosphoinositide 3-kinase (PI3K), comprised of p85, p110α, p110β and Akt. The acetylation of p300 and the phosphorylation of activating transcription factor 2 (ATF-2) induced by LPS were downregulated following treatment with veratric acid; similar effects were observed following treatment with LY294002, a specific inhibitor of PI3K/Akt. The LPS-induced expression of histone deacetylase (HDAC)3 decreased to basal levels following treatment with veratric acid, and its expression was also downregulated by LY294002. In the measurement of histone acetylation levels, the LPS-stimulated acetylation of histone H4 was significantly attenuated by veratric acid, and was also reduced following the inhibition of PI3K/Akt with LY294002. From our data, it can be concluded that veratric acid exerts a regulatory effect on LPS-induced iNOS expression. Our results suggest that veratric acid impedes the PI3K/Akt-mediated histone acetyl-transferase (HAT) activation and HDAC expression induced by LPS, thereby abrogating iNOS expression.
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http://dx.doi.org/10.3892/ijmm.2014.1982DOI Listing
January 2015

Anti-inflammatory potential of peat moss extracts in lipopolysaccharide-stimulated RAW 264.7 macrophages.

Int J Mol Med 2014 Oct 6;34(4):1101-9. Epub 2014 Aug 6.

Department of Microbiology, College of Natural Sciences, Pukyong National University, Busan 608-737, Republic of Korea.

The aim of the present study was to identify the anti-inflammatory and anti-oxidative effects of peat moss aqueous extract (PME) on lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages. To demonstrate the anti-inflammatory and antioxidant effects of PME, the levels of nitric oxide (NO) and cytokines were measured using Griess reagent and cytokine ELISA kits, respectively. Reverse transcriptase-polymerase chain reaction (RT-PCR) and western blot analysis were conducted to evaluate the expression of genes and proteins. Immunofluorescence was used to measure the expression and translocation of transcription factors. Pre-treatment with PME inhibited the production of prostaglandin E(2) and NO by suppressing the gene expression of cyclooxygenase-2 and inducible NO synthase, respectively. The LPS-stimulated gene expression and the production of tumor necrosis factor-α and interleukin-1β were significantly reduced by PME. In the LPS-stimulated RAW 264.7 cells, nuclear factor‑κB (NF-κB) translocated from the cytosol to the nucleus, while pre-treatment with PME induced the sequestration of NF-κB in the cytosol through the inhibition of IκBα degradation. In the same manner, PME contributed to the inhibition of the activation of mitogen-activated protein kinases. In addition, the PME-treated RAW 264.7 cells facilitated the activation of nuclear factor-like 2 (Nrf2) , and in turn, enhanced heme oxygenase-1 (HO-1) expression. These results indicate that PME exerts anti-inflammatory and antioxidant effects, and suggest that PME may neutralize inflammation and prevent cellular damage by oxidative stress.
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http://dx.doi.org/10.3892/ijmm.2014.1881DOI Listing
October 2014

Nonalcoholic Fatty liver disease is associated with increased carotid intima-media thickness only in type 2 diabetic subjects with insulin resistance.

J Clin Endocrinol Metab 2014 May 10;99(5):1879-84. Epub 2014 Feb 10.

Department of Internal Medicine (S.-K.K., S.W.P., Y.-W.C.), CHA Bundang Medical Center, CHA University, Seongnam 463-712, Korea; Huh's Diabetes Center and the 21st Century Diabetes and Vascular Research Institute (Y.J.C., B.W.H., K.B.H.), Seoul 121-806, Korea; and Department of Internal Medicine (E.J.L.), Yonsei University College of Medicine, Seoul 120-749, Korea.

Context: The association between nonalcoholic fatty liver disease (NAFLD) and subclinical atherosclerosis in type 2 diabetes is controversial.

Objective: The objective of the study was to investigate the participation of insulin resistance in the association of NAFLD and the carotid atherosclerotic burden in a large cohort of patients with type 2 diabetes.

Design, Setting, And Patients: This was an observational study performed in 4437 consecutively enrolled patients with type 2 diabetes.

Main Outcomes Measures: Hepatic steatosis and mean carotid intima-media thickness (C-IMT) were measured using ultrasonography. Insulin resistance was assessed using the short insulin tolerance test.

Results: The prevalence of NAFLD was 72.7% in the whole study population. Among subjects with NAFLD, 23.2% were not insulin resistant. There were significant differences in C-IMT and the frequency of carotid atherosclerosis between groups classified by insulin resistance within the same NAFLD strata. C-IMT was highest in subjects with both NAFLD and insulin resistance [0.844 ± 0.004 (mean ± SE) mm vs 0.786 ± 0.008, 0.821 ± 0.007, and 0.807 ± 0.006 mm, P for trend <.001, respectively, in insulin sensitive subjects without NAFLD, insulin resistant subjects without NAFLD, and insulin sensitive subjects with NAFLD]. These differences remained after adjusting for potential confounders. However, C-IMT in subjects having only NAFLD or insulin resistance was not higher than that in those with neither NAFLD nor insulin resistance.

Conclusions: NAFLD is very common in subjects with type 2 diabetes, but NAFLD not accompanied by insulin resistance is not associated with a carotid atherosclerotic burden. However, having both NAFLD and insulin resistance seemed to be an independent predictor of increased C-IMT.
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http://dx.doi.org/10.1210/jc.2013-4133DOI Listing
May 2014

Multicenter prospective observational study of the comparative efficacy and safety of vancomycin versus teicoplanin in patients with health care-associated methicillin-resistant Staphylococcus aureus bacteremia.

Antimicrob Agents Chemother 2014 28;58(1):317-24. Epub 2013 Oct 28.

Division of Infectious Diseases, Department of Internal Medicine, Korea University, College of Medicine, Seoul, Republic of Korea.

The purpose of this study was to compare the clinical efficacy and safety of vancomycin to those of teicoplanin for the treatment of adult patients with health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) bacteremia. A multicenter observational study was prospectively conducted in 15 teaching hospitals in Korea between February 2010 and July 2011. Adult patients (≥18 years old) with HA-MRSA bacteremia who were initially treated with vancomycin (VAN) (n = 134) or teicoplanin (TEC) (n = 56) were enrolled. Clinical and microbiological responses and drug-related adverse events were compared between the two treatment groups using univariate and multivariate logistic regression analyses. The vancomycin and teicoplanin MICs were determined by Etest. The MRSA-related mortality, duration of fever, and duration of MRSA bacteremia in the treatment groups were not significantly different. There was no significant difference in the occurrence of drug-related adverse events. Among the 190 MRSA isolates, the VAN MICs ranged from 0.5 to 2 μg/ml (MIC50 and MIC90, 1.5 μg/ml), and the TEC MIC ranged from 0.5 to 8 μg/ml (MIC50, 3 μg/ml; MIC90, 6 μg/ml). In multivariate analyses, the antibiotic type (vancomycin or teicoplanin) was not associated with treatment outcomes. This study indicates that teicoplanin is an effective and safe alternative to vancomycin for the treatment of HA-MRSA bacteremia.
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http://dx.doi.org/10.1128/AAC.00520-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3910721PMC
September 2014

Carbohydrate intake interacts with SNP276G>T polymorphism in the adiponectin gene to affect fasting blood glucose, HbA1C, and HDL cholesterol in Korean patients with type 2 diabetes.

J Am Coll Nutr 2013 ;32(3):143-50

Graduate School of Education, Sangmyung University, Seoul, Korea.

Background/objective: The SNP276G>T polymorphism in the adiponectin gene has been reported to be associated with type 2 diabetes and impaired glucose tolerance. The objective of this study was to examine whether SNP276G>T polymorphism influences the blood glucose levels in relation to dietary carbohydrate intake.

Subjects/methods: In an ongoing, prospective study, 673 patients with type 2 diabetes (339 men and 334 women, aged 40-85 years) were recruited from one of two diabetes clinics in Seoul, Korea. The levels of carbohydrate intake were categorized as <55%, 55%-65%, and >65% of total energy intake.

Results: Significant gene-nutrient interactions between SNP276G>T polymorphism and the level of carbohydrate intake were found, which modulated plasma fasting blood glucose (p=0.0277), HbA1C (p=0.0407), and high-density lipoprotein (HDL) cholesterol (p=0.0134) concentrations. The G allele was associated with higher fasting blood glucose only in subjects consuming a low-carbohydrate diet (<55% of energy). However, when carbohydrate intake was intermediate (55%-65%), carriers of the T allele had greater fasting blood glucose and HbA1C concentrations. When carbohydrate intake was high (>65%), carriers of the T allele had greater HDL cholesterol concentrations. This interaction was significant even when carbohydrate intake was considered a continuous variable (p=0.0200 for fasting blood glucose, p=0.0408 for HbA1C, and p=0.0254 for HDL cholesterol), suggesting a strong dose-response relation.

Conclusions: Our data show that the effect of the SNP276G>T polymorphism on plasma fasting blood glucose, HbA1C, and HDL cholesterol concentrations depends on dietary carbohydrate intake.
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http://dx.doi.org/10.1080/07315724.2013.791795DOI Listing
February 2014

Relationship between milk and calcium intake and lipid metabolism in female patients with type 2 diabetes.

Yonsei Med J 2013 May;54(3):626-36

Department of Nutritional Science and Food Management, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea.

Purpose: This study was conducted to determine the association between intake of milk and dairy products as well as calcium and biomarkers related to lipid metabolism in Korean female patients with type 2 diabetes.

Materials And Methods: A cohort of 509 female subjects (mean age: 59.0 years; range: 35-80 years) was recruited from Huh's Diabetes Clinic in Seoul between 2005 and 2010. Dietary intake was assessed using a validated food-frequency questionnaire. Subjects were divided into three groups on the basis of their daily intake of milk and dairy products [<50 g/day (0<50 g/day), 50-200 g/day, and >200 g/day (>200-1201 g/day)] and then further divided into two groups according to their daily calcium intake: below and above the estimated average requirement (EAR).

Results: After adjustment for age, body mass index, energy intake, exercise, use of nutritional supplements and cholesterol medication, the level of serum high-density lipoprotein (HDL)-cholesterol was significantly higher in subjects with milk and dairy products consumption of >200 g/day than in subjects in the other two groups. Those subjects with a milk and dairy products consumption of >200 g/day had significantly higher levels of apolipoprotein A-1 and a significantly lower atherogenic index than the other two groups. Patients with a calcium intake above the EAR exhibited a significantly greater serum HDL-cholesterol level than those with a calcium intake below the EAR.

Conclusion: Milk and dairy products, good sources of calcium, play a positive role in lipid profiles in female patients with type 2 diabetes.
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http://dx.doi.org/10.3349/ymj.2013.54.3.626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635625PMC
May 2013

Smoking is associated with abdominal obesity, not overall obesity, in men with type 2 diabetes.

J Prev Med Public Health 2012 Sep 28;45(5):316-22. Epub 2012 Sep 28.

Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea.

Objectives: Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes.

Methods: Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI).

Results: Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively.

Conclusions: Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.
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http://dx.doi.org/10.3961/jpmph.2012.45.5.316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469814PMC
September 2012

Mitochondria-specific accumulation of amyloid β induces mitochondrial dysfunction leading to apoptotic cell death.

PLoS One 2012 13;7(4):e34929. Epub 2012 Apr 13.

Department of Biochemistry and Biomedical Sciences, College of Medicine, Seoul National University, Seoul, Korea.

Mitochondria are best known as the essential intracellular organelles that host the homeostasis required for cellular survival, but they also have relevance in diverse disease-related conditions, including Alzheimer's disease (AD). Amyloid β (Aβ) peptide is the key molecule in AD pathogenesis, and has been highlighted in the implication of mitochondrial abnormality during the disease progress. Neuronal exposure to Aβ impairs mitochondrial dynamics and function. Furthermore, mitochondrial Aβ accumulation has been detected in the AD brain. However, the underlying mechanism of how Aβ affects mitochondrial function remains uncertain, and it is questionable whether mitochondrial Aβ accumulation followed by mitochondrial dysfunction leads directly to neuronal toxicity. This study demonstrated that an exogenous Aβ(1-42) treatment, when applied to the hippocampal cell line of mice (specifically HT22 cells), caused a deleterious alteration in mitochondria in both morphology and function. A clathrin-mediated endocytosis blocker rescued the exogenous Aβ(1-42)-mediated mitochondrial dysfunction. Furthermore, the mitochondria-targeted accumulation of Aβ(1-42) in HT22 cells using Aβ(1-42) with a mitochondria-targeting sequence induced the identical morphological alteration of mitochondria as that observed in the APP/PS AD mouse model and exogenous Aβ(1-42)-treated HT22 cells. In addition, subsequent mitochondrial dysfunctions were demonstrated in the mitochondria-specific Aβ(1-42) accumulation model, which proved indistinguishable from the mitochondrial impairment induced by exogenous Aβ(1-42)-treated HT22 cells. Finally, cellular toxicity was directly induced by mitochondria-targeted Aβ(1-42) accumulation, which mimics the apoptosis process in exogenous Aβ(1-42)-treated HT22 cells. Taken together, these results indicate that mitochondria-targeted Aβ(1-42) accumulation is the necessary and sufficient condition for Aβ-mediated mitochondria impairments, and leads directly to cellular death rather than along with other Aβ-mediated signaling alterations.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0034929PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325919PMC
August 2012