Hwan-Sik Hwang

Association of Vascular Endothelial Growth Factor Polymorphisms with Nonproliferative and Proliferative Diabetic Retinopathy

CONTEXT Vascular endothelial growth factor (VEGF) is a potent angiogenic and vascular permeability factor, and its polymorphisms are associated with proliferative diabetic retinopathy (PDR) and macular edema. OBJECTIVE We investigated the contributions of VEGF gene polymorphisms to nonproliferative diabetic retinopathy (NPDR) as well as PDR. DESIGN, SETTING, AND SUBJECTS In this study we compared VEGF gene variants in a sample of Korean type 2 diabetes patients with and without diabetic retinopathy (DR) and in healthy controls. Of the diabetes patients, 145 had PDR, 108 had NPDR, and 134 had no retinopathy (noDR). They were all duration matched. Samples were genotyped for rs699947, rs1570360, and rs2010963 polymorphisms. RESULTS We found a significant association between the A allele at rs699947 with DR (odds ratio = 1.84 (95% confidence interval = 1.28-2.66); P = 0.001 vs. noDR). Patients with NPDR, as well as PDR, had increased incidence of the A allele. The AGG haplotype was more frequently found in patients with DR than in patients with noDR (odds ratio = 4.79 (95% confidence interval = 1.42-16.16); P = 0.006). PDR and NPDR patients exhibited an increased incidence of the AGG haplotype. CONCLUSIONS VEGF polymorphisms might be a useful predictive marker for the development and progression of DR at an earlier stage of diabetes.

Diagnostic value of the rapid influenza antigen test for novel influenza A (H1N1)

Abstract We administered both the rapid antigen test and real-time reverse transcriptase polymerase chain reaction (RT-PCR) test to 2154 patients in order to assess the diagnostic value of the rapid antigen test during Korean pandemics of H1N1 2009. The overall sensitivity was 70.0%, specificity was 97.5%, positive predictive value was 97.4%, and negative predictive value was 71.2%. The sensitivity fell and the negative predictive value decreased as the RT-PCR positive rate increased.

The Association between Symptoms of Autonomic Neuropathy and the Heart Rate Variability in Diabetics.

Background There are few tools to detect the diabetic autonomic neuropathy at an earlier stage. This study was conducted to investigate the association between symptoms of autonomic neuropathy and the heart rate variability (HRV) in diabetics. Methods Study subjects consisted of 50 diabetic patients and 30 outpatient hospital control patients at a university family medicine department. The patients completed a Korean version of composite autonomic symptom scale (COMPASS). Electrocardiography was recorded in the supine position, on standing, and during deep breathing, for 5 minutes each. HRV of frequency domain was calculated by power spectral analysis. Results The COMPASS score was higher in female diabetic patients compared with that in controls. Among 50 diabetic patients, the total COMPASS score correlated positively with normalized low frequency (LF) score (normalized units, n.u.) (r = 0.62, P < 0 .001) and low frequency/high frequency (LF/HF) (r = 0.77, P < 0.001), negatively with normalized HF score (n.u.) (r = -0.59, P < 0.001) and RMSSD (square root of the mean of the sum of the square of differences between adjacent NN interval; r = -0.33, P = 0.031). The decrease in LF (n.u) and the increase in HF (n.u) by deep breathing from the supine position were higher in diabetic patients compared with those in controls. The increase in LF (n.u) and the decrease in HF (n.u) by standing from the supine position were lower in diabetic patients compared with those in controls. Conclusion The COMPASS score correlated with some component score of the HRV in diabetics. The HRV may be used as a tool to detect diabetic autonomic neuropathy by augmentation with position change.

The Relationship between Smoking Status and Suicidal Behavior in Korean Adults: The 4th Korea National Health and Nutrition Examination Survey (2007-2009)

Background This study was performed to evaluate the relationship between smoking status and suicidal ideations or suicide attempts in Korean adults. Methods The study used data from the 4th Korea National Health and Nutrition Examination Survey, and involved 17,065 participants. We used multiple logistic regression analysis to evaluate the relationship between smoking status and suicidal behavior. The results were adjusted for covariates including depression and physical disease. Results After adjusting for covariates, current smokers (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.34 to 2.05) and former smokers (OR, 1.39; 95% CI, 1.13 to 1.72) proved more likely to have suicidal ideations than non-smokers. Among women, current smokers (OR, 2.00; 95% CI, 1.47 to 2.72) and former smokers (OR, 1.48; 95% CI, 1.11 to 1.99) were more likely to have suicidal ideations than non-smokers. However, among the men there was no significant relationship between smoking status and suicidal ideations. Among all the participants who had had suicidal ideations, there was a significant relationship between current smoking and suicide attempts (OR, 1.80; 95% CI, 1.05 to 3.07). There was also a relationship between current smoking and suicide attempts among women (OR, 2.40; 95% CI, 1.31 to 4.37), but no significant relationship among men. Conclusion There is a relationship between smoking status and suicidal ideations and suicide attempts in the general population of Korea. This relationship is particularly clear in women, and is independent of comorbid chronic disease and depression. Current smokers and former smokers are more likely to have suicidal ideations than non-smokers; current smokers are also more likely to have attempted suicide.

A simple and rapid LC-MS/MS method for the determination of Enalapril in human plasma for pharmacokinetic and bioequivalence studies in korean healthy volunteers under fasting conditions

A simple and rapid liquid chromatography-tandem mass spectrometry method for Enalapril in human plasma was developed and applied to pharmacokinetic and bioequivalence test for 2 formulations of Enalapril (10 mg) capsules in healthy korean volunteers under fasting state. The analytes were extracted from plasma by simple protein precipitation by acetonitrile, separated on YMC C8 column using methanol-10 mM ammonium formate (80: 20, v/v) as the mobile phase, and detected by tandem mass spectrometry with Turbo IonSpray interface operating in the positive ion mode for Enalapril and Glibenclamide (IS) in MRM mode. The ionization was optimized using electro-spray ionization (ESI) (+) and selectivity was achieved by MS/MS analysis, m/z 376.447 → 234.1 for Enalapril and m/z 494.1 → 369.1 for IS. The assay exhibited good linearity in the concentration ranges of 1.0 ∼ 300 ng/mL for Enalapril in human plasma with lower limit of quantification (LLOQ) of 1.0 ng/mL. The chromatographic run time was approximately 2.0 min. No endogenous compounds were found to interfere with the analysis. The accuracy and precision were acceptable for concentrations over the standard ranges. The method was successfully applied to pharmacokinetic (PK) and bioequivalence (BE) studies by determination of Enalapril in the blood sample taken up to 12 h after oral administration of two Enalapril (10 mg) formulations and results from PK analysis suggested that the 2 types of 10 mg Enalapril tablets should be considered to be bioequivalent for both the extent and rate of absorption in normal volunteers.

Relationship between abdominal obesity and alcohol drinking pattern in normal-weight, middle-aged adults: the Korea National Health and Nutrition Examination Survey 2008–2013

OBJECTIVE Abdominal obesity is associated with obesity-related health risks regardless of body weight. The present study aimed to determine whether alcohol drinking pattern is associated with abdominal obesity in normal-weight, middle-aged adults. DESIGN Cross-sectional study using complex sampling design analyses. SETTING The Korea National Health and Nutrition Examination Survey, which was conducted from 2008 to 2013. SUBJECTS Normal-weight participants aged 40-69 years with BMI of 18·5-25·0 kg/m2 (n 11 289, 4491 men and 6798 women) were included. Abdominal obesity was defined as waist circumference ≥90 cm for men or ≥85 cm for women. Alcohol drinking pattern was assessed by self-report on questionnaires. RESULTS Among 11 289 normal-weight participants, 7·9 % (n 379) of men and 7·6 % (n 609) of women had abdominal obesity. Both men and women who consumed a higher quantity of alcohol per drinking occasion had higher odds (OR; 95 % CI) for abdominal obesity compared with individuals who consumed fewer than 2 drinks (1·86; 1·04, 3·32 for ≥10 drinks/typical occasion in men; and 3·28; 1·13, 9·46 in women). Men who binge drink every day had higher odds for abdominal obesity (2·10; 1·21, 3·63). In both sexes, frequency of alcohol drinking was not associated with normal-weight abdominal obesity. CONCLUSIONS Our study showed that the amount of alcohol drinking per occasion influenced abdominal obesity in normal-weight, middle-aged individuals that may have impacted obesity-related health risks. Healthy alcohol drinking habits need to be controlled for prevention of abdominal obesity even among persons with normal weight.

Relationship between Marital Status and Metabolic Syndrome in Korean Middle-Aged Women: The Sixth Korea National Health and Nutrition Examination Survey (2013–2014)

Background This study aimed to investigate the relationship between marital status and the incidence of metabolic syndrome in Korean middle-aged women. Methods Based on data from the sixth Korea National Health and Nutrition Examination Survey (2013–2014), 3,225 women aged 40–69 years were subjected to the analysis. Marital status was categorized as married, unmarried, separated, widowed, or divorced. The odds ratios (ORs) for metabolic syndrome were calculated based on marital status. After adjustment for age, income level, education level, alcohol intake, smoking status, leisure physical activity, menopause status, daily calories, and fat intake, changes in the OR for metabolic syndrome based on marital status were examined by multivariate logistic regression analysis. Results The OR for metabolic syndrome in the widowed group to the married group was 4.818 (95% confidence interval [CI], 3.861–6.002; P<0.001) and that after adjustment of age, economic level, education level, alcohol intake, smoking status, physical activity, menopause status, total daily calories, and fat intake was 2.141 (CI, 1.432–3.199; P<0.001), both of which were statistically significant. The OR for metabolic syndrome in the unmarried group to the married group was 0.246 (CI, 0.141–0.431; P<0.001) after adjustment of all components. On the contrary, the ORs of the separated group and the divorced group to the married group were not significant. Conclusion In comparison with the married middle-aged group, the widowed middle-aged group tended to have a higher risk of metabolic syndrome, which is speculated to be related to socioeconomic factors and health behavior.

The Effects of Weight Control Behaviors among Korean Obese Adults

Background This study aimed to identify and examine the effects of weight control behaviors correlated with weight loss in obese individuals who attempted to lose weight within the past year. Methods In this cross-sectional study, data from 9,461 obese individuals were collected from the fifth and sixth Korean National Health and Nutrition Examination Survey (2010–2014). Three of nine verified methods of weight control suggested in the survey were selected: diet therapy (reduced food intake), exercise therapy (exercise), and medication therapy (prescribed weight loss medications). Participants were divided into one of seven groups (diet therapy alone; exercise therapy alone; drug therapy alone; combined diet and exercise therapy; combined exercise and drug therapy; combined diet and drug therapy; or combined diet, exercise, and drug therapy). Logistic regression analysis was used to determine whether the group that tried to lose weight in the past year had indeed lost weight compared to the group that did not. Results The odds ratios for weight loss (≥3 but <6 kg vs. ≥6 but <10 kg) for the combined therapies were 2.05 (95% confidence interval, 1.23–3.41) for combined diet and exercise therapy and 5.43 (1.74–16.92) for combined diet, exercise, and drug therapy. Conclusion All levels of weight loss were significantly associated with combined diet and exercise therapy. Weight loss ≥6 kg but <10 kg was significantly associated with combined diet and exercise therapy as well as with combined diet, exercise, and medication therapy among individuals who tried to lose weight in the past year.

Association between Breastfeeding and Prevalence of Diabetes in Korean Parous Women: The Korea National Health and Nutrition Examination Survey, 2010–2014

Background It is well known that breastfeeding has a significant impact on the health of mothers and children. With the growing importance of breastfeeding, the present study aimed to investigate the relationship between breastfeeding and the prevalence of diabetes in Korean parous women. Methods The data of 5,448 premenopausal parous women aged 20–49 years who agreed to participate in the 5th–6th Korea National Health and Nutrition Examination Survey were analyzed in this study. Control group included women who had not breastfed. The subjects who had breastfed were classified into three groups based on the duration of breastfeeding: 0–6 months, 6–12 months, and >12 months. The variables included age, body mass index, education level, income, alcohol drinking, smoking, family history of diabetes, use of oral contraceptives, the number of pregnancies, and regular exercise. Results Among the subjects, the prevalence of diabetes was significantly lower in women who had breastfed compared to those who had not, with an odds ratio of 0.534 (95% confidence interval [CI], 0.289–0.976) in women who breastfed for 0–6 months and 0.575 (95% CI, 0.321–0.990) in women who breastfed for 6–12 months (both P<0.05). Conclusion The present study found a reduced prevalence of diabetes in women who had breastfed compared to those who had not. However, no association between the duration of breastfeeding and the prevalence of diabetes could be found.

Case Report: Space-Occupying Lesion in the Liver Related to Preprandial Hunger and Hepatic Visceral Larva Migrans

Visceral larva migrans (VLM) is one of the clinical syndromes of human toxocariasis. We report a case of hepatic VLM presenting preprandial malaise and epigastric discomfort in a 58-year-old woman drinking raw roe deer blood. The imaging studies of the abdomen showed a 74-mm hepatic mass featuring hepatic VLM. Anti-Toxocara canis immunoglobulin G (IgG) was observed in enzyme-linked immunosorbent assay (ELISA) and western blot. Despite anthelmintic treatment, the patient complained of newly developed cough and skin rash with severe eosinophilia. Hepatic lesion increased in size. The patient underwent an open left lobectomy of the liver. After the surgery, the patient was free of symptoms such as preprandial malaise, epigastric discomfort, cough, and skin rash. Laboratory test showed a normal eosinophilic count at postoperative 1 month, 6 months, 1 year, and 4 years. The initial optical density value of 2.55 of anti-T. canis IgG in ELISA was found to be negative (0.684) at postoperative 21 months. Our case report highlights that a high degree of clinical suspicion for hepatic VLM should be considered in a patient with a history of ingestion of raw food in the past, presenting severe eosinophilia and a variety of symptoms which reflect high worm burdens. Symptom remission, eosinophilia remission, and complete radiological resolution of lesions can be complete with surgery.