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Zhou YY, Wang J, Sun Z, Sun J, Zhang XJ, Liu Y, Fang ZX, Yang BY. Two new guaiane-type sesquiterpene glycosides from Atractylodes Japonica Koidz. ex Kitam. Nat Prod Res 2024:1-8. [PMID: 39390904 DOI: 10.1080/14786419.2024.2413431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 08/30/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
Two new guaiane-type sesquiterpene glycosides, atractylodes guaianoside I (1) and atractylodes guaianoside II (2), along with eleven known sesquiterpenes (3-13), were isolated from Atractylodes Japonica Koidz. ex Kitam. The structures of these two new compounds were elucidated by extensive spectroscopic analyses and mass spectrometric techniques. And their absolute configurations were confirmed by electronic circular dichroism (ECD) calculations. In addition, the isolated compounds were evaluated for their cytotoxic activities against three cancer cell lines HT-29, A-549, and MCF-7. Results showed that new compound 2 had inhibitory effects on three types of cancer cells, while new compound 1 only had inhibitory effects on HT-29 and MCF-7.
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Affiliation(s)
- Yuan-Yuan Zhou
- Ministry of Education, Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Harbin, China
| | - Jing Wang
- Ministry of Education, Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Harbin, China
| | - Zhao Sun
- Ministry of Education, Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Harbin, China
| | - Jie Sun
- Ministry of Education, Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Harbin, China
| | - Xiao-Juan Zhang
- Academic research department, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yan Liu
- Ministry of Education, Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Harbin, China
| | - Zhen-Xing Fang
- Institute of Nature and Ecology, Heilongjiang Academy of Sciences, Harbin, China
| | - Bing-You Yang
- Ministry of Education, Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Harbin, China
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Hatae A, Watanabe T, Taniguchi C, Kubota K, Katsurabayashi S, Iwasaki K. Ninjinyoeito ameliorates anorexia and changes in peptide YY and ghrelin levels of cisplatin-treated mice. Neuropeptides 2024; 107:102464. [PMID: 39182332 DOI: 10.1016/j.npep.2024.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
We explored the effect of Ninjinyoeito (NYT) on cisplatin-induced anorexia, which reduces cancer patient survival. Both gastrointestinal motility and plasma concentrations of gastrointestinal peptides were assessed. Nine-week-old ICR female mice received intraperitoneal cisplatin injections (10 mg/kg) and daily oral NYT doses of 300 mg/kg (NYT300) or 1000 mg/kg (NYT1000). Plasma levels of gastrointestinal peptides were measured at 3 and 6 days after cisplatin injection. Gastrointestinal motility was assessed by analyzing the concentration of phenol red marker within sections of the gastrointestinal tract. Cisplatin-injected mice showed a decrease in daily food intake, but this effect was attenuated on day 5 with NYT1000 administration. Although plasma ghrelin levels were reduced on day 3 in cisplatin-treated mice, NYT1000 administration ameliorated this decrease. However, there were no differences in ghrelin levels among all groups on day 6. Levels of peptide YY (PYY) were elevated in the plasma of cisplatin-injected mice on days 3 and 6. Administration of NYT300 and NYT1000 suppressed the increase in PYY levels on day 6 but not on day 3. Gastrointestinal motility was impaired on day 6 in cisplatin-treated mice, but NYT1000 administration attenuated this effect. Our results suggest that NYT improves cisplatin-induced anorexia by suppressing alterations in ghrelin and PYY levels and by increasing gastrointestinal motility. Therefore, NYT may be a promising candidate for alleviating cisplatin-induced anorexia.
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Affiliation(s)
- Akinobu Hatae
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takuya Watanabe
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Chise Taniguchi
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Kaori Kubota
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Shutaro Katsurabayashi
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Katsunori Iwasaki
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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Zhou YY, Sun Z, Liu Y, Fang ZX, Gao HR, Liu NY, Zhang XJ, Yang BY, Kuang HX. Two new sesterterpenoids from Atractylodes japonica Koidz. ex Kitam. J Nat Med 2024; 78:702-708. [PMID: 38662303 DOI: 10.1007/s11418-024-01793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 04/26/2024]
Abstract
Two new sesterterpenoids, atractylodes japonica terpenoid acid I (1) and atractylodes japonica terpenoid aldehyde I (2), were isolated from the rhizomes of Atractylodes japonica Koidz. ex Kitam together with ten known compounds (3-12). Their structures were elucidated on the basis of comprehensive spectroscopic analysis (1D/2D NMR, HRESIMS and IR). In addition, all of these isolated compounds were evaluated for their cytotoxic activities against human gastric cancer cell MGC-803 and human hepatocellular cancer cell HepG-2. Most of them exhibited moderate to weak inhibitory effects with IC50 values in the range of 25.15-88.85 μM except for 9-12.
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Affiliation(s)
- Yuan-Yuan Zhou
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China
| | - Zhao Sun
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China
| | - Yan Liu
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China
| | - Zhen-Xing Fang
- Institute of Nature and Ecology, Heilongjiang Academy of Sciences, 150040, Harbin, People's Republic of China
| | - Hui-Rui Gao
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China
| | - Ning-Yu Liu
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China
| | - Xiao-Juan Zhang
- Academic research department, Heilongjiang University of Traditional Chinese Medicine, 150040, Harbin, People's Republic of China
| | - Bing-You Yang
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China.
| | - Hai-Xue Kuang
- Key Laboratory of Basic and Application Research of Beiyao, Ministry of Education, (Heilongjiang University of Chinese Medicine), 150040, Harbin, People's Republic of China.
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Lashgari NA, Roudsari NM, Momtaz S, Niazi Shahraki F, Zandi N, Pazoki B, Farzaei MH, Ghasemi M, Abdollahi M, Abdolghaffari AH. Systematic Review on Herbal Preparations for Controlling Visceral Hypersensitivity in Functional Gastrointestinal Disorders. Curr Pharm Biotechnol 2024; 25:1632-1650. [PMID: 38258770 DOI: 10.2174/0113892010261502231102040149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Visceral hypersensitivity (VH) is an overreaction of the gastrointestinal (GI) tract to various stimuli and is characterized by hyperalgesia and/or allodynia. VH contributes to the etiology of many GI dysfunctions, particularly irritable bowel syndrome (IBS). Although the exact mechanisms underlying VH are yet to be found, inflammation and oxidative stress, psychosocial factors, and sensorimotor alterations may play significant roles in it. OBJECTIVE In this review, we provide an overview of VH and its pathophysiological function in GI disorders. Adverse effects of synthetic drugs may make herbal agents a good candidate for pain management. Therefore, in this review, we will discuss the efficacy of herbal agents in the management of VH with a focus on their anti-inflammatory and antioxidant potentials. METHODS Data were extracted from clinical and animal studies published in English between 2004 and June, 2020, which were collected from PubMed, Google Scholar, Scopus, and Cochrane Library. RESULTS Overall, Radix, Melissia, Glycyrrhizae, Mentha, and Liquorice were the most efficient herbals for VH management in IBS and dyspepsia, predominantly through modulation of the mRNA expression of transient receptor potential vanilloid type-1 (TRPV1) and suppression of 5- hydroxytryptamine 3 (5-HT3) or the serotonin receptors. CONCLUSION Considering the positive effects of herbal formulations in VH management, further research on novel herbal and/or herbal/chemical preparations is warranted.
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Affiliation(s)
- Naser-Aldin Lashgari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Gastrointestinal Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nazanin Momeni Roudsari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Gastrointestinal Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Saeideh Momtaz
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran
- Department of Pharmacology, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Faezeh Niazi Shahraki
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Nadia Zandi
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Pazoki
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts School of Medicine, Worcester, MA 01655, USA
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), and Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Abdolghaffari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Gastrointestinal Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Kim HY, Kim JH. Sesquiterpenoids Isolated from the Rhizomes of Genus Atractylodes. Chem Biodivers 2022; 19:e202200703. [PMID: 36323637 DOI: 10.1002/cbdv.202200703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Atractylodes plants have been used in traditional herbal medicine to treat gastrointestinal diseases and contain various chemical compounds. Sesquiterpenoids are the most important therapeutic compounds in Atractylodes rhizomes. Based on studies reported from 2000 to 2022, we classified sesquiterpenoids by their chemical skeletons and original resources. Moreover, we discussed their biosynthesis and physicochemical and pharmacological features. We reported sesquiterpenoids with skeletal moieties, such as monocyclic sesquiterpenes (bisabolene- and elemene-type), bicyclic sesquiterpenes (eudesmane-, isopterocarpolone-, hydroxycarissone-, eremophilane-, bisesquiterpenoid-, guaiane- and spirovetivane-type and eudesmane lactones) and tricyclic sesquiterpenes (cyperene- and patchoulene-type), with their biosynthetic pathways, chemical modifications and in vivo metabolites. The pharmacological activities of sesquiterpenoids as anti-inflammatory, anti-tumor, anti-diabetic and anti-microbial and for treating gastrointestinal disorders have been reported for this genus.
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Affiliation(s)
- Han-Young Kim
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, 50612, Korea
| | - Jung-Hoon Kim
- Division of Pharmacology, School of Korean Medicine, Pusan National University, Yangsan, 50612, Korea
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Chen GR, Xie XF, Peng C. Treatment of Irritable Bowel Syndrome by Chinese Medicine: A Review. Chin J Integr Med 2021; 29:377-384. [PMID: 34546535 DOI: 10.1007/s11655-021-3521-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) is a common refractory disease. Chinese medicine (CM) has remarkable efficacy and advantages on the treatment of IBS. This review summarized the articles focusing on the treatment of IBS with CM to sum up the latest treatment methods for IBS and the underlying mechanisms. Literature analysis showed that prescriptions, acupuncture, and moxibustion are the primary methods of CM treatment for IBS. The potential mechanism centers on the regulation of the enteric nervous system, the alleviation of visceral hypersensitivity, the stability of intestinal flora, and the regulation of the immune system.
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Affiliation(s)
- Guan-Ru Chen
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.,State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, 611137, China
| | - Xiao-Fang Xie
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.,State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, 611137, China
| | - Cheng Peng
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China. .,State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu, 611137, China.
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Kim JH. Pharmacokinetic analysis of atractylenolide III in rat plasma after oral administration of Atractylodes japonica rhizome extract by ultra-performance liquid chromatography-ion trap mass spectrometry. ACTA CHROMATOGR 2019. [DOI: 10.1556/1326.2018.00503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jung-Hoon Kim
- Division of Pharmacology, School of Korean Medicine, Pusan National University, 50612, Republic of Korea
- KM Medicinal Material-based Research Center, School of Korean Medicine, Pusan National University, 50612, Republic of Korea
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彭 颖, 李 晓. 倍半萜内酯类治疗肠易激综合征的应用前景. Shijie Huaren Xiaohua Zazhi 2017; 25:1624-1632. [DOI: 10.11569/wcjd.v25.i18.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
肠易激综合征(irritable bowel syndrome, IBS)是常见的功能性肠道疾病, 以腹痛或腹部不适、排便习惯异常为特征, 其发病机制尚不明确. 依照罗马Ⅲ标准可将其分为腹泻型、便秘型、混合型和未定型4种亚型. 目前临床治疗原则主要是对症治疗, 迄今尚无特效药物能够有效治疗所有类型IBS. 倍半萜内酯类成分是众多药用植物的生物活性成分, 具有广泛生物学活性, 包括抗肿瘤、抗炎镇痛、抗菌等. 本文就倍半萜内酯类成分可改善IBS症状的相关生物学活性, 及其在IBS治疗中的应用前景进行简要综述.
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Peng Y, Wang S, Wang M, Wang F, Yang J, Wu C, Li X. Dual effects on constipation and diarrhea: protective potential of Radix Inulae lactones on irritable bowel syndrome. RSC Adv 2016. [DOI: 10.1039/c6ra18533a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Radix Inulae (RI) is commonly used to treat upper body pain, emesis, diarrhea and parasitic diseases in China.
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Affiliation(s)
- Ying Peng
- School of Pharmacy
- Shanghai Jiao Tong University
- Shanghai 200240
- China
| | - Siqi Wang
- School of Pharmacy
- Shanghai Jiao Tong University
- Shanghai 200240
- China
- Department of Pharmacology
| | - Mengyue Wang
- School of Pharmacy
- Shanghai Jiao Tong University
- Shanghai 200240
- China
| | - Fang Wang
- Department of Pharmacology
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Jingyu Yang
- Department of Pharmacology
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Chunfu Wu
- Department of Pharmacology
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Xiaobo Li
- School of Pharmacy
- Shanghai Jiao Tong University
- Shanghai 200240
- China
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"Ninjinto" (Ginseng Decoction), a Traditional Japanese Herbal Medicine, Improves Gastrointestinal Symptoms and Immune Competence in Patients with Chronic Intestinal Failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:462586. [PMID: 26495014 PMCID: PMC4606194 DOI: 10.1155/2015/462586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/06/2015] [Accepted: 03/18/2015] [Indexed: 12/13/2022]
Abstract
Background. Treating functional gastrointestinal disorders is extremely difficult. We herein report the effect of the oral administration of Ninjinto (NJT, ginseng decoction), a traditional Japanese Kampo medicine, on chronic intestinal failure. Patients and Methods. Seven patients with chronic intestinal failure treated with NJT were evaluated in this study. The primary diseases included chronic intestinal pseudoobstruction (CIPO: n = 4), short bowel syndrome (SBS: n = 2), and intestinal atresia (n = 1). All patients orally received NJT extract granules at a dose of 0.3 g/kg BW per day. The treatment outcomes were then assessed according to the patients' symptoms and consecutive abdominal X-ray findings. Results. The targeted symptoms were abdominal distension in four patients, diarrhea in three patients, and frequent hospitalization due to infections in two patients. An improvement in the symptoms was observed in six of the seven patients, whereas one patient with SBS did not show any improvement. An improvement in an abdominal roentgenogram was observed in the four patients with remarkably dilated bowel loops due to CIPO. Conclusions. NJT may be effective in controlling functional gastrointestinal disorders associated with chronic intestinal failure. The use of Kampo medicine in the field of pediatric surgery may help to improve the quality of life in children suffering from such conditions.
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Park JJ, Chon NR, Lee YJ, Park H. The Effects of an Extract of Atractylodes Japonica Rhizome, SKI3246 on Gastrointestinal Motility in Guinea Pigs. J Neurogastroenterol Motil 2015; 21:352-60. [PMID: 26130631 PMCID: PMC4496911 DOI: 10.5056/jnm14112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 03/14/2015] [Accepted: 03/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background/Aims There are limited therapeutic options available for irritable bowel syndrome with diarrhea (IBS-D). We tested the effects of Atractylodes japonica rhizome, a perennial plant native to North Asia, on both upper and lower gastrointestinal (GI) motility in guinea pigs. Methods The extract of A. japonica rhizome was administered orally at different doses to test its effects on upper GI motility as determined from charcoal transit in native guinea pigs and in guinea pigs pretreated with thyrotropin-releasing hormone or mustard oil. Regarding its effect on lower GI motility, the removed guinea pig colon was suspended in a chamber containing Krebs-Henseleit solution and the transit time of artificial feces was measured with various dilutions of the extract. As for in vivo assay, weight and number of fecal pellets expelled were determined under the same drug preparation used in upper GI motility experiment. Results The extract of A. japonica rhizome had no significant effect on upper GI motility in either normal or altered physiological states. However, the extract increased colonic transit time in the in vitro model. In the fecal expulsion study, the cumulative weight and number of pellets did not differ significantly between the control group and groups treated with the extracts. In the animals pretreated in vivo with thyrotropin-releasing hormone, however, the weight and number of fecal pellets were significantly decreased in animals treated with 300 mg/kg and 600 mg/kg doses of extract. Conclusions Our findings suggest that the extract of A. japonica rhizome can be a potential agent for IBS-D.
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Affiliation(s)
- Jae Jun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nu Ri Chon
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyojin Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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