Dong Wook Jeong

Serum amylase and risk of the metabolic syndrome in Korean adults.

BACKGROUNDnSerum amylase has recently been shown to be associated with ghrelin and adiponectin as well as obesity. We investigated the relationship between total amylase and metabolic syndrome in adults.nnnMETHODSn4495 adults were enrolled. All subjects denied any medical history or status of a disorder that could influence their serum amylase. Anthropometry, metabolic risk factors and total amylase concentration were measured. Each participant was categorized into one of 4 subgroups according to their total amylase concentration. Multiple logistic regression analysis was used to assess the independent association between amylase concentration and metabolic syndrome. Receiver-operating characteristics (ROC) curves analyses were used for comparison of the diagnostic value of amylase and other biomarkers for metabolic syndrome.nnnRESULTSnThe prevalence of metabolic syndrome by the National Cholesterol Education Program criteria was 13.4%, 15.3%, 19.3%, and 24.2% of those in the fourth, third, second, and lowest quartile of amylase concentration (P for trend <0.001). After adjusting for age, sex, and body mass index, the odds ratios of the lower quartiles were significantly higher compared to the fourth quartile for the presence of metabolic syndrome. In ROC curve analysis, amylase was similar to uric acid as a significant diagnostic indicator for metabolic syndrome, but it had lower diagnostic value than alanine aminotransferase, γ-glutamyltransferase or C-reactive protein.nnnCONCLUSIONSnLower amylase concentration is associated with an increased prevalence of metabolic syndrome. Amylase may contribute to identifying metabolic syndrome, although further research is needed to understand the mechanism behind these associations.

Multiple biomarkers and their relative contributions to identifying metabolic syndrome

BACKGROUNDnSeveral biological markers have been identified as risk factors for cardiovascular disease and are associated with increased risk of metabolic syndrome. We thus compared biomarkers and their association with metabolic syndrome.nnnMETHODSnWe measured the white blood cell count, high-sensitivity C-reactive protein, homeostasis model assessment of insulin resistance (HOMA-IR), homocysteine, cystatin C, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT) and uric acid levels in 4624 adults without a medical history of cardiovascular disease. Metabolic syndrome was defined using criteria from the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF).nnnRESULTSnThe HOMA-IR and GGT were most strongly correlated with metabolic syndrome. The area under the receiver operating characteristic curve was highest for the HOMA-IR (0.773, 95% CI: 0.755-0.791 [men]; 0.792, 95% CI: 0.775-0.808 [women]) and the GGT (0.687, 95% CI: 0.667-0.706 [men]; 0.721, 95% CI: 0.703-0.739 [women]) in AHA/NHLBI criteria. The best cut-off value of HOMA-IR and GGT for identifying metabolic syndrome was (1.22, 30 IU/l [men], 1.28, 15 IU/l [women]).nnnCONCLUSIONnHOMA-IR and GGT are most strongly associated with metabolic syndrome, suggesting that theses biomarkers may contribute to identifying metabolic syndrome more than other factors.

An Open, Randomized, Comparative Clinical and Histological Study of Imiquimod 5% Cream Versus 10% Potassium Hydroxide Solution in the Treatment of Molluscum Contagiosum

BACKGROUNDnAlthough molluscum contagiosum (MC) resolves spontaneously, there are several reasons to treat this dermatological disorder.nnnOBJECTIVEnTo evaluate the safety and efficacy of 5% imiquimod cream versus 10% potassium hydroxide (KOH) solution in treating MC, and to propose the mechanism of cure by observing the histological findings.nnnMETHODSnImiquimod or KOH were applied by the patient or a parent 3 days per week until all lesions cleared. The number of MC lesions was counted and side effects were evaluated at 5 points during the treatment (the initial visit, week 2, week 4, week 8, and week 12). Histological changes were compared between 2 patients of each group, before and after the 2 weeks of application.nnnRESULTSnIn both group, the mean lesion counts decreased all through to week 12, and the reduction in number of lesions were statistically significant in both groups (p <0.005). Over 40% of each group developed local side effects, and no systemic side effects were noted in either group. Before treatment, histological findings showed little or no dermal infiltrates. After treatment, specimens showed dense lymphocytic infiltrates, especially T cells, around the lesions which had resolved.nnnCONCLUSIONnBoth 10% KOH solution and 5% imiquimod cream are effective and safe treatment of MC.

Association of chronic viral hepatitis B with insulin resistance

AIMnTo investigate the relationship between chronic viral hepatitis B (CVHB) and insulin resistance (IR) in Korean adults.nnnMETHODSnA total of 7880 adults (3851 men, 4029 women) who underwent a comprehensive medical examination were enrolled in this study. Subjects diagnosed with either diabetes mellitus, or any other disorder that could influence their insulin sensitivity, were rejected. Anthropometry, metabolic risk factors, hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, fasting plasma glucose and insulin were measured for all subjects. Homeostasis model assessment (HOMA), quantitative insulin check index (QUICKI), and Mf(fm) index were used for determining insulin sensitivity. Each participant was categorized into a negative, recovery, or CVHB group. To compare variables between groups, a t-test and/or one-way analysis of variance were used. Partial correlation coefficients were computed to present the association between insulin resistance and other variables. Multiple logistic regression analysis was used to assess the independent association between CVHB and IR.nnnRESULTSnThe mean age of men and women were 48.9 and 48.6 years, respectively. Subjects in the CVHB group had significantly higher waist circumference [(86.0 ± 7.7 cm vs 87.3 ± 7.8 cm, P = 0.004 in men), (78.3 ± 8.6 cm vs 80.5 ± 8.5 cm, P < 0.001 in women)], cystatin C [(0.96 ± 0.15 mg/dL vs 1.02 ± 0.22 mg/dL, P < 0.001 in men), (0.84 ± 0.15 mg/dL vs 0.90 ± 0.16 mg/dL, P < 0.001 in women)], fasting insulin [(5.47 ± 3.38 μU/mL vs 6.12 ± 4.62 μU/mL, P < 0.001 in men), (4.57 ± 2.82 μU/mL vs 5.06 ± 3.10 μU/mL, P < 0.001 in women)] and HOMA index [(1.24 ± 0.86 vs 1.43 ± 1.24, P < 0.001 in men), (1.02 ± 0.76 vs 1.13 ± 0.87, P = 0.033 in women)] compared to control group. The HOMA index revealed a positive correlation with body mass index (BMI) (r = 0.378, P < 0.001), waist circumference (r =0.356, P < 0.001), percent body fat (r = 0.296, P < 0.001), systolic blood pressure (r = 0.202, P < 0.001), total cholesterol (r = 0.134, P < 0.001), triglycerides (r = 0.292, P < 0.001), cystatin C (r = 0.069, P < 0.001) and uric acid (r = 0.142, P < 0.001). The QUICKI index revealed a negative correlation with BMI (r = -0.254, P < 0.001), waist circumference (r = 0-0.243, P < 0.001), percent body fat (r = -0.217, P < 0.001), systolic blood pressure (r = -0.132, P < 0.001), total cholesterol (r = -0.106, P < 0.001), triglycerides (r = -0.205, P < 0.001), cystatin C (r = -0.044, P < 0.001) and uric acid (r = -0.096, P < 0.001). For subjects identified with IR, the odds ratio of an accompanying diagnosis of chronic hepatitis B was 1.534 (95% CI: 1.158-2.031, HOMA index criteria) or 1.566 (95% CI: 1.124-2.182, QUICKI criteria) after adjustment for age, gender, BMI, and amount of alcohol consumption.nnnCONCLUSIONnOur study demonstrates that CVHB is associated with IR. CVHB may need to be monitored for occurrence of IR and diabetes mellitus.

Effect of Korean Red Ginseng on Insulin Sensitivity in Non-diabetic Healthy Overweight and Obese Adults

BACKGROUNDnKorean red ginseng is one of the most popular herbs worldwide due to the belief that it contains ingredients that possess a variety of health enhancing effects including anti-diabetic effects. The objective of this study was to determine whether Korean red ginseng supplement has an effect on insulin sensitivity in healthy overweight or obese adults without overt diabetes and hypertension.nnnMETHODSnIn a double-blinded, placebo controlled, randomized trial, a total of 68 participants (BMI >=23 kg/m2) received either 6 g of Korean red ginseng rootlets (n=34) or a placebo each day over a 12 week period.nnnRESULTSnSimilar insulin levels and insulin sensitivity index were observed at baseline in the Korean red ginseng and control groups. Korean red ginseng had no significant effect on improving the insulin sensitivity over time. Korean red ginseng does not improve the insulin sensitivity of overweight and obese subjects who do not have diabetes or hypertension.

Omega-3 index and smoking in patients with acute ST-elevation myocardial infarction taking statins: a case-control study in Korea

Backgroundn-3 fatty acids and lifestyle also are closely related to risk of CVD. Most Koreans have higher fish consumption than people of Western populations. However, little is known about the recommended value of omega-3 index in Korean patients with acute ST-elevation myocardial infarction (STEMI) taking statins. Here, we tested the hypothesis that lower omega-3 fatty acids and/or smoking are associated with acute STEMI, even though patients with dyslipidemia who were taking statins and who attained their LDL-C goals.MethodsWe conducted a case-control study in which omega-3 fatty acids and lifestyle factors were determined in 24 consecutive Korean patients taking statins with angiographically confirmed acute STEMI and 68 healthy controls without acute STEMI. The omega-3 index was calculated by the sum of eicosapentaenoic acid and docosahexaenoic acid in erythrocyte membranes. Multivariable adjusted regression analysis was used to assess independent associations between acute STEMI, omega-3 index, and lifestyle factors after adjusting for age, sex, and body mass index (BMI).ResultsThe mean age of total subjects was 59.9 years, and 57.6% of the subjects were male. The omega-3 index was significantly lower in cases (8.83%) than controls (11.13%; P < 0.001); however, total trans-fatty acids were not different between the two groups. The omega-3 index was inversely associated with odds for being a case (OR 0.16 (95% CI 0.03-1.14); P = 0.047), while smoking was positively associated with odds for being a case (OR 6.67 (95% CI 1.77-25.23); P = 0.005) after adjusting for all confounding variables.ConclusionThis study shows that relative to controls, acute STEMI cases are more likely to be smokers and to have a lower omega-3 index, even though the cases were taking statins. An omega-3 index of at least 11% and abstinence from smoking are associated with cardioprotection for Koreans.

Analysis of questioning technique during classes in medical education

BackgroundQuestioning is one of the essential techniques used by lecturers to make lectures more interactive and effective. This study surveyed the perception of questioning techniques by medical school faculty members and analyzed how the questioning technique is used in actual classes.MethodsData on the perceptions of the questioning skills used during lectures was collected using a self‒questionnaire for faculty members (Nu2009=u200933) during the second semester of 2008. The questionnaire consisted of 18 items covering the awareness and characteristics of questioning skills. Recorded video tapes were used to observe the faculty members’ questioning skills.ResultsMost faculty members regarded the questioning technique during classes as being important and expected positive outcomes in terms of the students’ participation in class, concentration in class and understanding of the class contents. In the 99 classes analyzed, the median number of questions per class was 1 (0–29). Among them, 40 classes (40.4u2009%) did not use questioning techniques. The frequency of questioning per lecture was similar regardless of the faculty members’ perception. On the other hand, the faculty members perceived that their usual wait time after question was approximately 10 seconds compared to only 2.5 seconds measured from video analysis. More lecture‒experienced faculty members tended to ask more questions in class.ConclusionsThere were some discrepancies regarding the questioning technique between the faculty members’ perceptions and reality, even though they had positive opinions of the technique. The questioning skills during a lecture need to be emphasized to faculty members.

Step-and-shoot prospectively ECG-gated versus retrospectively ECG-gated with tube current modulation coronary CT angiography using the 128-slice MDCT: comparison of image quality and radiation dose.

Background Little is known regarding image quality and the required radiation dose for step-and-shoot and retrospective coronary computed tomography angiography (CCTA) with tube current modulation (TCM) in 128-slice multidetector CT (MDCT) coronary angiography. Purpose To compare image quality and radiation dose in patients who underwent 128-slice MDCT by the step-and-shoot method with those in patients who underwent 128-slice MDCT with retrospective CCTA with TCM. Material and Methods CCTA obtained with 128-slice MDCT was retrospectively evaluated in 160 patients. Two independent reviewers separately scored the subjective image quality of the coronary artery segments (1, excellent; 4, poor) for step-and-shoot (68, mean heart rate [HR]: 59.3 ± 6.8) and retrospective CCTA with TCM (77, mean HR: 59.1 ± 9.8). Interobserver variability was calculated. Effective radiation doses of both scan techniques were calculated with dose-length product. Results There was good agreement for quality scores of coronary artery segment images between the independent reviewers (κ = 0.72). The number of coronary artery segments that could not be evaluated was 2.85% (27 of 947) in the step-and-shoot and 1.87% (20 of 1071) in retrospective CCTA with TCM. Image quality scores were not significantly different (P > .05). Mean patient radiation dose was 63% lower for step-and-shoot (1.94 ± 0.70 mSv) than for retrospective CCTA with TCM (4.51 ± 1.18 mSv) (P < 0.0001). For patients who underwent step-and-shoot or retrospective CCTA with TCM, an average HR of 63.5 beats per minute was identified as the threshold for the prediction of non-diagnostic image quality for both protocols. There were no significant differences in the image quality of both methods between obese (body mass index [BMI] ≥ 25) and non-obese patients (BMI < 25), but radiation doses were higher in the obesity group than in the non-obesity group for both methods. Conclusion Both step-and-shoot and retrospective CCTA with TCM using 128-slice MDCT had similar subjective image quality scores, but step-and-shoot required a lower radiation dose than retrospective CCTA with TCM.

Effect of Pumpkin Seed Oil on Hair Growth in Men with Androgenetic Alopecia: A Randomized, Double-Blind, Placebo-Controlled Trial

Pumpkin seed oil (PSO) has been shown to block the action of 5-alpha reductase and to have antiandrogenic effects on rats. This randomized, placebo-controlled, double-blind study was designed to investigate the efficacy and tolerability of PSO for treatment of hair growth in male patients with mild to moderate androgenetic alopecia (AGA). 76 male patients with AGA received 400u2009mg of PSO per day or a placebo for 24 weeks. Change over time in scalp hair growth was evaluated by four outcomes: assessment of standardized clinical photographs by a blinded investigator; patient self-assessment scores; scalp hair thickness; and scalp hair counts. Reports of adverse events were collected throughout the study. After 24 weeks of treatment, self-rated improvement score and self-rated satisfaction scores in the PSO-treated group were higher than in the placebo group (P = 0.013, 0.003). The PSO-treated group had more hair after treatment than at baseline, compared to the placebo group (P < 0.001). Mean hair count increases of 40% were observed in PSO-treated men at 24 weeks, whereas increases of 10% were observed in placebo-treated men (P < 0.001). Adverse effects were not different in the two groups.

Association of Breast Arterial Calcifications, Metabolic Syndrome, and the 10-Year Coronary Heart Disease Risk: A Cross-Sectional Case-Control Study

OBJECTIVEnBreast arterial calcifications (BACs) are common but underreported findings on mammography. The purpose of this study was to examine the relationship between BACs, metabolic syndrome (MS), and coronary heart disease (CHD) risk.nnnRESEARCH DESIGN AND METHODSnThis was a case-control study. A total of 101 women with BACs and 101 age-matched controls without BACs were included in the analysis. BACs were calculated using the mammography of both breasts, and then the total BACs were summed. MS was defined by using criteria from the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). The 10-year estimated CHD relative risk (10-year CHD risk) was calculated based on the Framingham Scores. Metabolic characteristics were compared between the BAC positive group and the BAC negative group.nnnRESULTSnDiabetes (P=0.039) and MS (P=0.043) were more frequently observed in the BAC positive group than in the BAC negative group. The only independent factor was MS (P=0.04). The 10-year CHD risk was higher in the BAC positive group than in the negative group (P=0.007). Furthermore, the more extensive the BACs, the greater increase in the 10-year CHD risk (r=0.167, P=0.018).nnnCONCLUSIONSnFindings of BACs on mammogramy are associated with an increased risk of MS and the calculated risk of CHD in women older than 40 years of age.