Clinical decision support service architecture for EHR perspectives in Korea

We present architecture for implementing independent, extensible, and interoperable clinical decision support service in perspective of EHR. In this architecture, components for implementing independent knowledge service and interface mechanism with EHR service or existing hospital information system are identified. With our architecture, new CDS services can be easily scalable since new knowledge module can added without changing knowledge infrastructure or other hospital information system.

Knowledge translation of SAGE-based guidelines for executing with knowledge engine

SAGE is very powerful knowledge representation for guideline modeling and well-defined knowledge framework to integrate with terminology standard and EMR databases. Therefore, SAGE can be powerful tool for knowledge authoring for clinicians but guideline execution engine is not available yet. Commercial rule engines are verified for availability in clinical area but their authoring tools are not matured for clinical knowledge. In this paper, we suggest knowledge translator to convert SAGE-based guidelines into knowledge which commercial engine can execute. With this translation, we can take both advantages in modeling power of SAGE and interpretation capability of engines.

Anti-inflammatory effects of glycyrol isolated from Glycyrrhiza uralensis in LPS-stimulated RAW264.7 macrophages

The anti-inflammatory effects of glycyrol, a benzofuran coumarin isolated from Glycyrrhizae Radix, were studied. Glycyrol of 5, 25 and 50 microM dose-dependently inhibited nitric oxide (NO) production by down-regulating inducible nitric oxide synthase (iNOS), and alleviated cyclooxygenase-2 (COX-2) expression in LPS-stimulated RAW264.7 macrophages, in both the mRNA and the protein. Furthermore, glycyrol dose-dependently decreased the mRNA of the pro-inflammatory cytokines IL-1beta and IL-6. LPS-induced NF-kappaB activation was prevented in RAW264.7 macrophages by inhibition of I-kappaBalpha phosphorylation. In addition, administration of glycyrol (30 and 100 mg/kg, i.p) reduced the thickness of carrageenan-induced mouse-paw edema swelling. Taken together, our results indicate that glycyrol is an important anti-inflammatory constituent of Glycyrrhizae Radix, and that its anti-inflammatory effect is attributed to the inhibition I-kappaBalpha phosphorylation.

NF-kappaB modulates aquaporin-2 transcription in renal collecting duct principal cells

Renal tubulo-interstitial inflammation is frequently associated with polyuria and urine concentration defects. This led us to investigate the effects of the major pro-inflammatory nuclear factor kappaB (NF-kappaB) pathway on aquaporin 2 (AQP2) expression by the collecting duct. Using immortalized collecting duct principal cells (mpkCCDcl4), we found that, acting independently of vasopressin, activation of NF-kappaB by lipopolysaccharide (LPS) decreased AQP2 mRNA and protein levels in a time- and dose-dependent manner but did not decrease AQP2 mRNA stability. Consistently, constitutively active IkappaB kinase beta decreased AQP2 expression. The LPS-induced decrease in AQP2 mRNA levels was confirmed in rat kidney slices and was reproduced both under conditions of elevated cAMP concentration and V(2) receptor antagonism. Computer analysis of the AQP2 promoter revealed two putative kappaB elements. Mutation of either kappaB element abolished the LPS-induced decrease of luciferase activity in cells expressing AQP2 promoter-luciferase plasmid constructs. Chromatin immunoprecipitation revealed that LPS challenge decreased p65, increased p50 and p52, and had no effect on RelB and c-Rel binding to kappaB elements of the AQP2 promoter. RNA-mediated interference silencing of p65, p50, and p52 confirmed controlled AQP2 transcription by these NF-kappaB subunits. We additionally found that hypertonicity activated NF-kappaB in mpkCCDcl4 cells, an effect that may counteract the Tonicity-responsive enhancer binding protein (TonEBP)-dependent increase in AQP2 gene transcription. Taken together, these findings indicate that NF-kappaB is an important physiological regulator of AQP2 transcription.

NF-kappaB inhibitory activity of compounds isolated from Cantharellus cibarius

The inhibitory activities of the extracts of Cantharellus cibarius and isolated compounds were investigated in an enzyme-based ELISA NF-kappaB assay. Of the tested compounds, ergosterol, ergosterol peroxide and cerevisterol were noted to have the most potent inhibition of NF-kappaB activation. The ability of the active metabolites to inhibit the NF-kappaB translocation from the cytoplasm to the nucleus was assessed using a cell-based NF-kappaB assay. The isolated compounds were elucidated through the analysis of various spectroscopic methods.

Association of abdominal fat distribution and cardiometabolic risk factors among obese Korean adolescents

The association between abdominal fat distribution and cardiometabolic risk factors using direct measures of abdominal fat in adolescents has not been extensively researched. This study was designed to investigate the association between visceral and subcutaneous fat and cardiometabolic risk factors, in obese Korean adolescents. The study enrolled 175 adolescents (72 boys, 103 girls), from ages nine to 19 years, who were referred to the Obesity Clinic of Asan Medical Center. Body mass index (BMI) and waist circumference (WC) were measured for each study participant. Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were calculated by computed tomography. Blood pressure, fasting plasma glucose, total cholesterol, triglycerides, HDL cholesterol, insulin and homeostasis model assessment (HOMA) score were measured. Systolic blood pressure, HDL cholesterol, fasting insulin and the HOMA score were significantly correlated with BMI, WC, VAT and SAT. In addition, VAT was significantly correlated with diastolic blood pressure and triglyceride levels. On multiple regression analysis, VAT was independently correlated with blood pressure, triglycerides, HDL cholesterol, fasting insulin and the HOMA score, while SAT was independently correlated with systolic blood pressure, fasting insulin and the HOMA score. This study determined that cardiovascular risk factors are closely associated with VAT, while insulin resistance is closely associated with both VAT and SAT among obese Korean adolescents.

Optimization of Vi capsular polysaccharide production during growth of Salmonella enterica serotype Typhi Ty2 in a bioreactor

Vi capsular polysaccharide is synthesized during growth of Salmonella typhi Ty2 and is spontaneously released from the bacterial cells into the culture medium during culture. Vi production was dependent on cell growth and the greater the cell mass the greater the production of Vi. Using fed batch culture to optimize bacterial growth resulted is an increase in cell mass and consequently Vi production. The yield of Vi obtained in fed batch culture was 415 mgl(-1), which was over three times that, obtained in batch culture. A proportion of the Vi remained cell associated in the form of a capsule and at least part of this was released from the bacterial surface by sonication. The size of the Vi polysaccharide produced was consistently high and did not change during the different phases of bacterial growth. The synthesis of Vi was also dependent upon the media components and the fermentation conditions. The presence of high concentrations of glucose at the beginning of growth inhibited the production of Vi, particularly during the stationary phase. At a concentration of 400 mM sodium phosphate the synthesis of Vi was strongly inhibited.

21-Methylmelianodiols from Poncirus trifoliata as inhibitors of interleukin-5 bioactivity in Pro-B cells

Interleukin (IL)-5 plays an important role in the progression of allergic inflammation. Here, we have isolated 21alpha-methylmelianodiol and 21beta-methylmelianodiol from Poncirus trifoliata (L.) Raf., a plant of the Rutaceae family, as the inhibitors of IL-5-dependent growth of Y16 pro-B cells by bioassay-guided fractionation. 21alpha-Methylmelianodiol and 21beta-methylmelianodiol inhibited IL-5-dependent growth of Y16 cells in a dose-dependent manner with IC (50) values of 17 microM and 15 microM, respectively. A positive control, tyrphostin AG-490, exhibited an IC (50) value of 23 microM on IL-5 bioactivity. Further, we have documented that 21alpha-methylmelianodiol and 21beta-methylmelianodiol cause G1 arrest of IL-5-induced cell cycle progression of Y16 cells, and also reduce IL-5-dependent survival of the cells by apoptosis. This study could provide a pharmacological potential for P. trifoliata in treatment of IL-5-associated inflammatory disorders.

A novel electroporation method using a capillary and wire-type electrode

Electroporation is widely used to achieve gene transfection. A common problem in electroporation is that it has a lower viability than any other transfection method. In this study, we developed a novel electroporation device using a capillary tip and a pipette that was effective on a wide range of mammalian cells, including cell lines, primary cells, and stem cells. The capillary electroporation system considerably reduced cell death during electroporation because of its wire-type electrode, which has a small surface area. The experimental results also indicated that the cell viability was dependent on the change in pH induced by electrolysis during electroporation. Additionally, the use of a long and narrow capillary tube combined with simple pipetting shortened the overall time of the electroporation process by up to 15 min, even under different conditions with 24 samples. These results were supported by comparison with a conventional electroporation system. The transfection rate and the cell viability were enhanced by the use of the capillary system, which had a high transfection rate of more than 80% in general cell lines such as HeLa and COS-7, and more than 50% in hard-to-transfect cells such as stem or primary cells. The viability was approximately 70-80% in all cell types used in this study.

Protective mechanism of glycyrrhizin on acute liver injury induced by carbon tetrachloride in mice

Glycyrrhizin is the major active component extracted from licorice (Glycyrrhiza glabra) roots, one of the most widely used herbal preparations for the treatment of liver disorders. This study evaluated the potential beneficial effect of glycyrrhizin in a mouse model of carbon tetrachloride (CCl(4))-induced liver injury. The mice were treated intraperitoneally with CCl(4) (0.5 ml/kg). They received glycyrrhizin (50, 100, 200, 400 mg/kg) 24 h and 0.5 h before and 4 h after administering CCl(4). The serum activities of aminotransferase and the hepatic level of malondialdehyde were significantly higher 24 h after the CCl(4) treatment, while the concentration of reduced glutathione was lower. These changes were attenuated by glycyrrhizin. CCl(4) increased the level of circulating tumor necrosis factor-alpha markedly, which was reduced by glycyrrhizin. The levels of hepatic inducible nitric oxide synthase, cyclooxygenase-2, and heme oxygenase-1 protein expression were markedly higher after the CCl(4) treatment. Glycyrrhizin diminished these alterations for inducible nitric oxide and cyclooxygenase-2 but the protein expression of heme oxygenase-1 was further elevated by the treatment of glycyrrhizin. CCl(4) increased the level of tumor necrosis factor-alpha, inducible nitric oxide synthase, cyclooxygenase-2, and heme oxygenase-1 mRNA expressions. The mRNA expression of heme oxygenase-1 was augmented by the glycyrrhizin treatment, while glycyrrhizin attenuated the increase in tumor necrosis factor-alpha, inducible nitric oxide synthase, and cyclooxygenase-2 mRNA expressions. These results suggest that glycyrrhizin alleviates CCl(4)-induced liver injury, and this protection is likely due to the induction of heme oxygenase-1 and the downregulation of proinflammatory mediators.

The effect of beta-cyclodextrin complexation on the bioavailability and hepatotoxicity of clotrimazole

Clotrimazole, a poorly water-soluble antimycotic agent, is a promising therapeutic agent for various diseases including cancer and sickle cell anemia. The oral bioavailability and hepatic toxicity of clotrimazole were compared with its beta-cyclodextrin inclusion form which was prepared by the spray-drying method. The inclusion complex gave significantly higher initial plasma concentrations, Cmax and AUC than did clotrimazole alone, indicating that the drug from the inclusion compound could be more easily absorbed in rats. Furthermore, mice treated with the inclusion compound showed significantly higher GOT/GPT values compared to clotrimazole alone. The inclusion compound also induced hypertrophy of hepatic cells by fat accumulation and disappearance of hepatic sinusoids, indications of pathological changes of liver, suggesting that the inclusion compound could induce more severe tissue damage in the liver than clotrimazole alone. Thus, hepatotoxicity of clotrimazole seems to be correlated with the enhanced oral bioavailability by inclusion complexation. Our results suggest that, in the development of a novel oral product, appearance or enhancement of hepatic toxicity must be considered along with oral bioavailability.

Differential modulation of myosin heavy chain phenotype in an inactive extensor and flexor muscle of adult rats

The effects of chronic neuromuscular inactivity on the phenotype and size of muscle fibres in a fast ankle extensor (medial gastrocnemius, MG) and a fast ankle flexor (tibialis anterior, TA) muscle of the rat hindlimb were determined. Inactivity was produced by spinal cord isolation (SI), i.e. complete spinal cord transections at a mid-thoracic and high sacral level and bilateral deafferentation between the transection sites. After 90 days of SI, the MG and TA muscle weights were 53 and 45% lower than in age-matched controls. Overall mean fibre sizes in the deep (close to the bone) and superficial (away from the bone) regions were approximately 60 and 65% smaller in the MG and approximately 40 and 50% smaller in the TA of SI than control rats, respectively. The myosin heavy chain (MHC) composition shifted towards the faster isoforms after SI: the MG showed an increase in both types IIx (20%) and IIb (23%), whereas the TA showed a marked increase in type IIx (94%) and a decrease in type IIb (18%) MHC. Both muscles in SI rats showed no type IIa and only one MG muscle had approximately 5% type I MHC. These results show that prolonged inactivity has a stronger effect on a fast extensor compared with a fast flexor in the rat hindlimb. The larger decrease in mass and fibre size in the MG than the TA most probably reflects the larger impact of chronic inactivity on the normally more highly recruited extensor than flexor muscle. The primary shift to type IIb MHC in the MG and type IIx MHC in the TA indicate a different default mode for an inactive extensor vs. flexor muscle, and may reflect differing activity-independent neural influences, i.e. neurotrophic factors, on muscle fibre phenotype in extensors vs. flexors.

Evaluation of the Cobra perilaryngeal airway (CPLA) as an airway conduit

BACKGROUND AND OBJECTIVE

The effectiveness of the Cobra perilaryngeal airway as a routine airway device and as a conduit for tracheal intubation has not been prospectively studied to date. This study aimed to evaluate the Cobra perilaryngeal airway for its potential role in an emergency airway rescue, by analysing its use as a bridge to blind or fibre-optic-guided intubation.

METHODS

In 49 patients, the procedure was carried out as follows: fibre-optic view through the Cobra perilaryngeal airway was assessed after the insertion of the Cobra perilaryngeal airway, then blind intubation through the Cobra perilaryngeal airway was attempted. After evaluating the success of blind intubation, fibre-optic-guided intubation was performed through the Cobra perilaryngeal airway. The endotracheal tube was removed after evaluating the success of fibre-optic-guided intubation, and then conventional laryngoscopy was carried out to evaluate the Cormack & Lehane grade and airway trauma.

RESULTS

In all, 95.9% (47/49) of patients had adequate ventilation using the Cobra perilaryngeal airway; the success rates for the blind and fibre-optic-guided intubation were 36.2% and 83.0%, respectively. The patients were divided into two groups according to the fibre-optic view. Group 1 included patients with an obstructed view by an anterior grill of the Cobra perilaryngeal airway head, and a view of the anterior epiglottis (downfolded epiglottis) with or without a visible larynx (16/47, 34.0%). Group 2 included the remaining patients (31/47, 66.0%). The success rates of the blind and fibre-optic intubations were different between the two groups (blind intubation: 12.5% vs. 48.4%, fibre-optic intubation: 62.5% vs. 93.6%, P 0.05). 42.6% of patients had blood staining after removing the device and complications such as trauma and oedema were confirmed under direct laryngoscopy.

CONCLUSION

This study suggests that the Cobra perilaryngeal airway could be a useful airway device as a vehicle for fibre-optic-guided intubation; however, it needs caution against airway trauma.

Effects of sevoflurane on the cAMP-induced short-circuit current in mouse tracheal epithelium and recombinant Cl- (CFTR) and K+ (KCNQ1) channels

BACKGROUND

An optimal level of airway surface liquid is essential for mucociliary clearance in lungs. The cAMP-activated cystic fibrosis transmembrane conductance regulator (CFTR) and KCNQ1 channels in tracheal epithelium play key roles in luminal and basolateral membranes, respectively. The aim of this study was to examine the effects of sevoflurane on cAMP-induced chloride secretion by the mouse tracheal epithelium and the modulation of recombinant CFTR and KCNQ1 channels.

METHODS

The equivalent short-circuit current (Isc) of the mouse tracheal epithelium was measured using a flow-type Ussing chamber technique. Inhibition of Na+ absorption was achieved through the luminal application of amiloride. cAMP-dependent Cl- secretion was evoked by forskolin and isobutylmethylxanthine (Fsk/IBMX) applied to the basolateral side. The effect of sevoflurane on CFTR and KCNQ1 channels was assessed using a whole-cell patch clamp in human embryonic kidney 293T cells expressing CFTR and KCNQ1 channels.

RESULTS

Fsk/IBMX induced a sustained Isc that was suppressed by the application of sevoflurane [decreased by 49 (4.5)% at 190 microM]. The Fsk/IBMX-induced Isc was also blocked by basolateral application of chromanol 293B, a blocker of the KCNQ1 K+ channel. In KCNQ1-expressing cells, sevoflurane 190 microM reduced the outward currents to 59 (4.9)% at 80 mV. The CFTR current was not affected by sevoflurane (approximately 360 microM).

CONCLUSIONS

These results suggest that the inhibition of KCNQ1 underlies sevoflurane-induced decrease in airway secretion.

A multi-channel electroporation microchip for gene transfection in mammalian cells

We developed a multi-channel electroporation microchip made of polydimethylsiloxane (PDMS) and glass for gene transfer in mammalian cells. This chip produces multiple electric field gradients in a single microchip by varying the lengths of the microchannels from 2 to 4 cm. Electric fields of 0.65, 0.57, 0.49, 0.41, and 0.33 kV/cm were simultaneously produced in a single chip when the voltage of 1.3 kV was applied. We transferred enhanced green fluorescent protein genes (pEGFP) into HEK-293 and CHO cells, which were cultured within the microchannels. The feasibility of our device was demonstrated because it was able to produce five different transfection rates and survival rates at different electric fields produced in a single microchip. This system is expected to optimize the experimental conditions in gene transfection research more easily and faster than conventional electroporation methods.

Agent Based Process Management Environment – Mercury

In this article, agent based process management model is proposed, which is for the process management of knowledge worker and service workers in order to establish the basis for the new knowledge management system. In this article, we applied several methods from 6-Sigma and personal software process for personal process definition, process execution and process measurement. This study attempts to improve the process execution accuracy through process visualisation and standardisation and to accumulate the base data to improve the process through measuring the process execution. We proposed guidelines and detail procedures for developing three advisor agents for guiding the process definition, process execution and process measurement. We showed the simple case study applied our guidelines.

Influence of the baricity of a local anaesthetic agent on sedation with propofol during spinal anaesthesia

BACKGROUND

This study examined the effect of different levels of spinal anaesthesia, induced by solutions of different baricity but containing the same amount of local anaesthetic agent, on the requirement for sedation with propofol.

METHODS

Thirty-six patients undergoing varicose vein surgery under spinal anaesthesia were randomly allocated to receive tetracaine 15 mg in 3 ml of either glucose 5% (hyperbaric) or CSF (isobaric). I.V. propofol was started 5 min after the intrathecal injection and was titrated to maintain a bispectral index (BIS) score of 65-75. The propofol requirements to maintain this range in the two groups were compared every 5 min.

RESULTS

The propofol requirement was always lower in the hyperbaric group, with the differences becoming statistically significant 20 min after the intrathecal injection. Total consumption of propofol over the 55 min of the study was also less in the hyperbaric group.

CONCLUSION

The known difference in level of spinal anaesthetic block induced by solutions of different baricity, but the same dose of local anaesthetic, was associated with different requirements for propofol sedation as determined by BIS assessment.

In vitro and in vivo antiallergic effects of Glycyrrhiza glabra and its components

Licorice (Glycyrrhiza glabra L., Leguminosae) is frequently used in traditional medicine to treat inflammatory and allergic diseases. In this study, the main components (glycyrrhizin, 18beta-glycyrrhetinic acid, isoliquiritin, and liquiritigenin) were isolated from licorice, and their anti-allergic effects, such as antiscratching behavior and IgE production-inhibitory activity, were evaluated both in vitro and in vivo. Liquiritigenin and 18beta-glycyrrhetinic acid most potently inhibited the degranulation of RBL-2H3 cells induced by IgE with the antigen (DNP-HSA) and rat peritoneal mast cells induced by compound 48/80. Liquiritigenin and 18beta-glycyrrhetinic acid potently inhibited the passive cutaneous anaphylactic reaction as well as the scratching behavior in mice induced by compound 48/80. These components inhibited the production of IgE in ovalbumin-induced asthma mice but liquiritigenin had little effect. This suggests that the antiallergic effects of licorice are mainly due to glycyrrhizin, 18beta-glycyrrhetinic acid, and liquiritigenin, which can relieve IgE-induced allergic diseases such as dermatitis and asthma.

Expression and role of interleukin-6 in distraction osteogenesis

Distraction osteogenesis is a special form of bone healing in which well-controlled distraction stresses and consequent tensile strains within callus tissue induce very efficient new bone formation. Proinflammatory cytokines are involved during the early phase of fracture healing and callus remodeling. Temporal expression patterns of proinflammatory cytokines were assessed in Sprague-Dawley rat tibial models of distraction osteogenesis and acute lengthening, and only interleukin-6 (IL-6) was found to be specifically induced during the distraction phase. IL-6 immunoreactivity was detected not only in hemopoietic cells and osteoblasts but also in the spindle-shaped cells of the fibrous interzone, where most of the tensile strains are concentrated. In vitro study revealed that IL-6 did not affect the proliferation of C3H10T1/2 cells, mouse bone marrow stromal cells (MSCs), or MC3T3-E1 cells; but its blocking antibody reduced the proliferation of C3H10T1/2 cells and MSCs. The mRNA expression of COL1A1 and osteopontin were not changed by IL-6 or its blocking antibody, but the alkaline phosphatase activities of MC3T3-E1 cells were increased by IL-6 and decreased by its blocking antibody. These findings indicate that IL-6 is a proinflammatory cytokine that responds to tensile strain during distraction osteogenesis. IL-6 negatively affects the proliferation of primitive mesenchymal cells, whereas the differentiation of more mature osteoblastic lineage cells is enhanced by IL-6 in vitro. IL-6 appears to be one of the cytokines involved in the complex network of signal cascades evoked during distraction osteogenesis and may differentially affect immature and mature osteoblastic lineage cells.

Transcriptional activator TonE-binding protein in cellular protection and differentiation

The TonE-binding protein (TonEBP) is a transcriptional activator in the Rel family that includes NFkappaB and NFAT. TonEBP is critical for the development and function of the renal medulla, which is a major regulator of water homeostasis. TonEBP is also implicated in diabetic nephropathy and inflammation. Established methods for biochemical and histochemical detection and functional analysis of TonEBP, including identification of novel TonEBP target genes, are described for those who are interested in investigating function and regulation of TonEBP.

Cut-off values of visceral fat area and waist circumference: diagnostic criteria for abdominal obesity in a Korean population

The aim of this study was to determine the appropriate cut-off values for visceral fat area and waist circumference (WC) associated with an increase in risk for obesity-related disorder, and to validate diagnostic criteria for abdominal obesity and the metabolic syndrome in a Korean adult population. We included 413 subjects (174 men and 239 women) for this study. Subjects were selected among Korean adults who visited the obesity clinic at St. Mary's Hospital and Kangnam St. Mary's Hospital from January 1999 to August 2005. All patients had computed tomography performed. The cut-off value, of visceral fat area associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 103.8 cm2 (sensitivity 74.5%, specificity 64.7%, p<0.001). The cut-off value for the WC was 89.8 cm in men (sensitivity 84.7%, specificity 91.7%, p<0.005) and 86.1 cm in women (sensitivity 83.9%, specificity 62.9%, p<0.001). Based on the results of this study, the visceral fat area associated with an increased risk of obesity-related disorder in Korea was 103.8 cm2 and the WC was 89.8 cm in men and 86.1 cm in women.

The prevalence and risk factors associated with isolated untreated systolic hypertension in Korea: the Korean National Health and Nutrition Survey 2001

Although isolated systolic hypertension (ISH) increases the risk of coronary heart disease and stroke, more than any other hypertension subtype, the prevalence and risk factors associated with ISH in the Korean population are not known. The 2001 Korean National Health and Nutrition Survey was a cross-sectional and nationally representative survey conducted in 2001. The prevalence of ISH by age and body mass index (BMI) was examined in 6601 Korean adults over 20 years of age. After adjusting for age, 4.32+/-0.32% of Korean adults had ISH, 5.28+/-0.37% had isolated diastolic hypertension and 5.82+/-0.36% had systolic/diastolic hypertension. The overall prevalence of ISH was found to increase directly with advancing age and increasing BMI. Although the ISH was found to be more common in men overall (4.81+/-0.50% in men, 4.12+/-0.37% in women), it was more common in women over 70 years of age. Independent variables associated with risk for ISH included advanced age, BMI, triglyceride (TG) levels, monthly income and alcohol intake. However, gender, fasting blood glucose, total cholesterol and high-density lipoprotein cholesterol levels, residential area, education level and smoking were found not to be significantly associated with ISH risk. The findings of the present study demonstrate that the prevalence of untreated ISH in Korea was lower than in Western countries. Age, BMI, TG levels, monthly income and alcohol intake were associated with ISH.