Low free T3 to free T4 ratio was associated with low muscle mass and impaired physical performance in community-dwelling aged population

In aged population, the association of thyroid hormones on physical performance, especially within their normal range, has yet to be elucidated. In this study, individuals with low serum free T3/free T4 were likely to have low muscle mass and impaired physical performance.

PURPOSE

We aimed to evaluate the associations of muscle mass, strength, and physical performance with thyroid hormone in an aged euthyroid population from a community-based cohort.

METHODS

We examined 918 men aged over 60 years and 1215 postmenopausal women from the Ansung cohort study. Appendicular skeletal muscle mass divided by square of height (ASM/ht²) was used as the muscle mass index. Hand grip strength was measured using a hydraulic dynamometer. Physical performance was assessed using the short physical performance battery (SPPB).

RESULTS

Participants with higher tertiles of free T3 and free T3/free T4 were younger and had higher ASM/ht², stronger hand grip strength, and higher SPPB scores than those in the lower tertiles. In adjusted models, men within higher tertiles of free T3 had higher ASM/ht² compared with those within lower tertiles (p = 0.033), whereas subjects with higher tertiles of free T4 had lower ASM/ht² compared with those within lower tertiles (p = 0.043). Subjects within higher tertiles of free T3/free T4 had higher ASM/ht² (p < 0.001) and better physical performance (p = 0.048) than those within lower tertiles after adjustments. However, free T3, free T4, or free T3/free T4 was not related to hand grip strength after adjustment for covariates.

CONCLUSION

Our results thus indicate that in an aged euthyroid population, low serum free T3/free T4 was a better index for low muscle mass and impaired physical performance than serum free T3 or free T4 alone.

PI-RADS version 2: optimal time range for determining positivity of dynamic contrast-enhanced MRI in peripheral zone prostate cancer

AIM

To analyse the optimal time cut-off for determining positivity of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in peripheral zone (PZ) prostate cancer (PCa).

MATERIALS AND METHODS

A consecutive series of 89 patients with PZ PCa who had undergone diffusion-weighted imaging (DWI) and subtraction DCE MRI were included. An experienced reader visually analysed the earliest time after contrast medium injection to visualise the best contrast between an index tumour and normal PZ on DCE MRI (i.e., best contrast time). The best contrast time cut-off for clinically significant cancer (csPCa) according to Epstein criteria or International Society of Urological Pathology (ISUP) grade ≥2 was analysed by an experienced reader, and applied to a less-experienced reader. For the index lesion of DWI category 3, the added value of DCE MRI (increased true positive and negative rates of PI-RADSv2 for csPCa) was evaluated using the cut-off time.

RESULTS

The best contrast time cut-off for csPCa was ≤72 seconds for Epstein criteria and ≤56 seconds for ISUP grade ≥2 by an experienced reader. The weighted kappa to determine positivity of DCE MRI was 0.622 for ≤72 seconds and 0.527 for ≤56 seconds between the two readers. The added value of DCE MRI was 55-75% by an experienced reader and 39.1-69.6% by a less-experienced reader.

CONCLUSION

For interpreting PI-RADSv2, imaging findings within 60-72 seconds following contrast media injection seem to reliably determine positivity of DCE MRI in PZ, and have added value for detecting csPCa.

IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045

INTRODUCTION

Since the year 2000, IDF has been measuring the prevalence of diabetes nationally, regionally and globally.

AIM

To produce estimates of the global burden of diabetes and its impact for 2017 and projections for 2045.

METHODS

A systematic literature review was conducted to identify published studies on the prevalence of diabetes, impaired glucose tolerance and hyperglycaemia in pregnancy in the period from 1990 to 2016. The highest quality studies on diabetes prevalence were selected for each country. A logistic regression model was used to generate age-specific prevalence estimates or each country. Estimates for countries without data were extrapolated from similar countries.

RESULTS

It was estimated that in 2017 there are 451 million (age 18-99 years) people with diabetes worldwide. These figures were expected to increase to 693 million) by 2045. It was estimated that almost half of all people (49.7%) living with diabetes are undiagnosed. Moreover, there was an estimated 374 million people with impaired glucose tolerance (IGT) and it was projected that almost 21.3 million live births to women were affected by some form of hyperglycaemia in pregnancy. In 2017, approximately 5 million deaths worldwide were attributable to diabetes in the 20-99 years age range. The global healthcare expenditure on people with diabetes was estimated to be USD 850 billion in 2017.

CONCLUSION

The new estimates of diabetes prevalence, deaths attributable to diabetes and healthcare expenditure due to diabetes present a large social, financial and health system burden across the world.

IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040

AIM

To produce current estimates of the national, regional and global impact of diabetes for 2015 and 2040.

METHODS

A systematic literature review was conducted to identify data sources on the prevalence of diabetes from studies conducted in the period from 1990 to 2015. An analytic hierarchy process was used to select the most appropriate studies for each country, and estimates for countries without data were modelled using extrapolation from similar countries that had available data. A logistic regression model was used to generate smoothed age-specific estimates, which were applied to UN population estimates.

RESULTS

540 data sources were reviewed, of which 196 sources from 111 countries were selected. In 2015 it was estimated that there were 415 million (uncertainty interval: 340-536 million) people with diabetes aged 20-79years, 5.0 million deaths attributable to diabetes, and the total global health expenditure due to diabetes was estimated at 673 billion US dollars. Three quarters (75%) of those with diabetes were living in low- and middle-income countries. The number of people with diabetes aged 20-79years was predicted to rise to 642 million (uncertainty interval: 521-829 million) by 2040.

CONCLUSION

Diabetes prevalence, deaths attributable to diabetes, and health expenditure due to diabetes continue to rise across the globe with important social, financial and health system implications.

Regional body fat depots differently affect bone microarchitecture in postmenopausal Korean women

SUMMARY

In a prospective community-based cohort study, we investigated the relationship between trabecular bone score (TBS) and regional fat depots in 1474 Korean postmenopausal women. TBS was positively related with subcutaneous fat and negatively related with visceral fat.

INTRODUCTION

The effect of fat distribution (visceral/subcutaneous) on bone quality or microarchitecture has rarely been investigated due to measurement difficulty. We aimed to investigate the relationship between TBS reflecting bone microarchitecture and regional fat depots in Korean women.

METHODS

Cross-sectional data evaluation was made from subjects participating in an ongoing prospective community-based cohort study since 2001. A total of 1474 postmenopausal women in the Ansung cohort were analyzed. Regional body fat mass, bone mineral density (BMD) at the lumbar spine, and total hip and lumbar spine TBS were measured by dual energy X-ray absorptiometry (DXA).

RESULTS

In an age-adjusted partial correlation analysis, TBS was not associated with total fat mass, but negatively associated with trunk fat mass. However, TBS was positively related with leg (r = 0.102, P < 0.05) and gynoid fat mass (r = 0.086, P < 0.05) and negatively related with android fat mass (r = -0.106; P < 0.05). In linear regression models controlling age, BMI, and physical activity, android fat was inversely associated with TBS (β = -0.595, P < 0.001), whereas gynoid fat was positively associated with TBS (β = 0.216, P < 0.001). Lumbar spine and total hip BMDs revealed positive associations with total and all regional fat depots regardless of fat distribution.

CONCLUSION

Our findings suggest that relatively large visceral fat and small subcutaneous fat may have a detrimental effect on TBS, a bone microarchitecture index.

High-normal free thyroxine levels are associated with low trabecular bone scores in euthyroid postmenopausal women

Trabecular bone scores (TBS) have recently been developed as a diagnostic tool to assess bone texture. We studied thyroid status and TBS in a population-based cohort and demonstrated that high-normal thyroxine levels are associated with low TBS in healthy euthyroid postmenopausal women.

INTRODUCTION

Increased thyroid hormone levels affect bone mineral density (BMD) and, if untreated, increase the risk of fracture. However, the relationship between thyroid function and bone microarchitecture has not yet been established. Trabecular bone scores (TBS) are gray-level textural measurements of dual energy X-ray absorptiometry (DXA) images. The TBS has been proposed as an indirect index of bone microarchitecture. The goal of this study was to characterize the relationship between thyroid function and TBS in euthyroid men and postmenopausal euthyroid women.

METHODS

A total of 1376 euthyroid subjects (648 postmenopausal women and 728 men) were recruited from a community-based cohort in Korea. Free thyroxine (fT4) levels, thyroid stimulating hormone (TSH) levels, BMD, and TBS were measured and compared.

RESULTS

There was no significant relationship between either fT4 or TSH levels and BMD in men and women. Multiple linear regression analysis showed that high-normal fT4 levels were negatively correlated with TBS (β = -0.111; P = 0.002, after adjusting for both age and body mass index [BMI]) in postmenopausal women. In men, however, there was no significant correlation between fT4 levels and TBS. TSH levels were not significantly associated with TBS in either men or women.

CONCLUSION

Higher fT4 levels within the normal reference range are associated with deterioration of trabecular microarchitecture in healthy euthyroid postmenopausal women.

Pathway analysis of genome-wide association datasets of personality traits

Although several genome-wide association (GWA) studies of human personality have been recently published, genetic variants that are highly associated with certain personality traits remain unknown, due to difficulty reproducing results. To further investigate these genetic variants, we assessed biological pathways using GWA datasets. Pathway analysis using GWA data was performed on 1089 Korean women whose personality traits were measured with the Revised NEO Personality Inventory for the 5-factor model of personality. A total of 1042 pathways containing 8297 genes were included in our study. Of these, 14 pathways were highly enriched with association signals that were validated in 1490 independent samples. These pathways include association of: Neuroticism with axon guidance [L1 cell adhesion molecule (L1CAM) interactions]; Extraversion with neuronal system and voltage-gated potassium channels; Agreeableness with L1CAM interaction, neurotransmitter receptor binding and downstream transmission in postsynaptic cells; and Conscientiousness with the interferon-gamma and platelet-derived growth factor receptor beta polypeptide pathways. Several genes that contribute to top-ranked pathways in this study were previously identified in GWA studies or by pathway analysis in schizophrenia or other neuropsychiatric disorders. Here we report the first pathway analysis of all five personality traits. Importantly, our analysis identified novel pathways that contribute to understanding the etiology of personality traits.

Global estimates of the prevalence of hyperglycaemia in pregnancy

AIMS

We estimated the number of live births worldwide and by IDF Region who developed hyperglycaemia in pregnancy in 2013, including total diabetes in pregnancy (known and previously undiagnosed diabetes) and gestational diabetes.

METHODS

Studies reporting prevalence of hyperglycaemia first-detected in pregnancy (formerly termed gestational diabetes) were identified using PubMed and through a review of cited literature. A simple scoring system was developed to characterise studies on diagnostic criteria, year study was conducted, study design, and representation. The highest scoring studies by country with sufficient detail on methodology for characterisation and reporting at least three age-groups were selected for inclusion. Forty-seven studies from 34 countries were used to calculate age-specific prevalence of hyperglycaemia first-detected in pregnancy in women 20-49 years. Adjustments were then made to account for heterogeneity in screening method and blood glucose diagnostic threshold in studies and also to align with recently published diagnostic criteria as defined by the WHO for hyperglycaemia first detected in pregnancy. Prevalence rates were applied to fertility and population estimates to determine regional and global prevalence of hyperglycaemia in pregnancy for 2013. An estimate of the proportion of cases of hyperglycaemia in pregnancy due to total diabetes in pregnancy was calculated using age- and sex-specific estimates of diabetes from the IDF Diabetes Atlas and applied to age-specific fertility rates.

RESULTS

The global prevalence of hyperglycaemia in pregnancy in women (20-49 years) is 16.9%, or 21.4 million live births in 2013. An estimated 16.0% of those cases may be due to total diabetes in pregnancy. The highest prevalence was found in the South-East Asia Region at 25.0% compared with 10.4% in the North America and Caribbean Region. More than 90% of cases of hyperglycaemia in pregnancy are estimated to occur in low- and middle-income countries.

CONCLUSION

These are the first global estimates of hyperglycaemia in pregnancy and conform to the new WHO recommendations regarding diagnosis and also include estimates of live births in women with known diabetes. They indicate the importance of the disease from a public health and maternal and child health perspective, particularly in developing countries.

The IDF Diabetes Atlas methodology for estimating global prevalence of hyperglycaemia in pregnancy

INTRODUCTION

Hyperglycaemia is one of the most prevalent metabolic disorders occurring during pregnancy. Limited data are available on the global prevalence of hyperglycaemia in pregnancy. The International Diabetes Federation (IDF) has developed a methodology for generating estimates of the prevalence of hyperglycaemia in pregnancy, including hyperglycaemia first detected in pregnancy and live births to women with known diabetes, among women of childbearing age (20-49 years).

METHODS

A systematic review of the literature for studies reporting the prevalence of gestational diabetes was conducted. Studies were evaluated and scored to favour those that were representative of a large population, conducted recently, reported age-specific estimates, and case identification was based on blood test. Age-specific prevalence data from studies were entered to produce estimates for five-year age groups using logistic regression to smooth curves, with age as the independent variable. The derived age-specific prevalence was adjusted for differences in diagnostic criteria in the underlying data. Cases of hyperglycaemia in pregnancy were derived from age-specific estimates of fertility and age-specific population estimates. Country-specific estimates were generated for countries with available data. Regional and global estimates were generated based on aggregation and extrapolation for 219 countries and territories. Available fertility rates and diabetes prevalence estimates were used to estimate the proportion of hyperglycaemia in pregnancy that may be due to total diabetes in pregnancy - pregnancy in women with known diabetes and diabetes first detected in pregnancy.

RESULTS

The literature review identified 199 studies that were eligible for characterisation and selection. After scoring and exclusion requirements, 46 studies were selected representing 34 countries. More than 50% of selected studies came from Europe and North America and Caribbean. The smallest number of identified studies came from sub-Saharan Africa. The majority of studies were for high-income countries, although low- and middle-income countries were also represented.

CONCLUSION

Prevalence estimates of hyperglycaemia in pregnancy are sensitive to the data from which they are derived. The IDF methodology is a transparent, reproducible, and modifiable method for estimating the burden of hyperglycaemia in pregnancy. More data are needed, in particular from developing countries, to strengthen the methodology.

Replication of Caucasian loci associated with bone mineral density in Koreans

SUMMARY

Most bone mineral density (BMD) loci were reported in Caucasian genome-wide association studies (GWAS). This study investigated the association between 59 known BMD loci (+200 suggestive SNPs) and DXA-derived BMD in East Asian population with respect to sex and site specificity. We also identified four novel BMD candidate loci from the suggestive SNPs.

INTRODUCTION

Most GWAS have reported BMD-related variations in Caucasian populations. This study investigates whether the BMD loci discovered in Caucasian GWAS are also associated with BMD in East Asian ethnic samples.

METHODS

A total of 2,729 unrelated Korean individuals from a population-based cohort were analyzed. We selected 747 single-nucleotide polymorphisms (SNPs). These markers included 547 SNPs from 59 loci with genome-wide significance (GWS, p value less than 5 × 10(-8)) levels and 200 suggestive SNPs that showed weaker BMD association with p value less than 5 × 10(-5). After quality control, 535 GWS SNPs and 182 suggestive SNPs were included in the replication analysis.

RESULTS

Of the 535 GWS SNPs, 276 from 25 loci were replicated (p < 0.05) in the Korean population with 51.6 % replication rate. Of the 182 suggestive variants, 16 were replicated (p < 0.05, 8.8 % of replication rate), and five reached a significant combined p value (less than 7.0 × 10(-5), 0.05/717 SNPs, corrected for multiple testing). Two markers (rs11711157, rs3732477) are for the same signal near the gene CPN2 (carboxypeptidase N, polypeptide 2). The other variants, rs6436440 and rs2291296, were located in the genes AP1S3 (adaptor-related protein complex 1, sigma 3 subunit) and RARB (retinoic acid receptor, beta).

CONCLUSION

Our results illustrate ethnic differences in BMD susceptibility genes and underscore the need for further genetic studies in each ethnic group. We were also able to replicate some SNPs with suggestive associations. These SNPs may be BMD-related genetic markers and should be further investigated.

Identifying genes related to radiation resistance in oral squamous cell carcinoma cell lines

Radioresistance is one of the main determinants of treatment outcome in oral cancer, but the prediction of radioresistance is difficult. The authors aimed to establish radioresistant oral squamous cell carcinoma (OSCC) cell lines to identify genes with altered expression in response to radioresistance. To induce radioresistant cell lines, the authors treated OSCC cell lines with an accumulated dosage of 60Gy over 30 cycles of radiotherapy. They compared the results from cDNA arrays and proteomics between non-radiated and radioresistant cell lines in order to identify changes in gene expression. Western blot analysis was used to validate the results. The cDNA array revealed 265 commonly up-regulated genes and 268 commonly down-regulated genes in radioresistant cell lines, 30 of which were cancer-related genes. Proteomics identified 51 proteins with commonly altered expression in radioresistant cell lines, 18 of which were cancer-related proteins. Both the cDNA array and proteomics indicated that NM23-H1 and PA2G4 were over-expressed. Western blot analysis showed increased expression of NM23-H1, but not PA2G4, in radioresistant cell lines. The authors concluded that NM23-H1 may be a radioresistance-related gene and over-expression of NM23-H1 could serve as a biomarker to predict radioresistance in OSCC.

Association between arachidonate 5-lipoxygenase-activating protein (ALOX5AP) and lung function in a Korean population

Arachidonate 5-lipoxygenase-activating protein (ALOX5AP) plays a role in the 5-lipoxygenase (LO) pathway, which includes the LTC(4), LTD(4), LTE(4) and LTB(4). These leukotrienes are known causative factors of asthma, allergy, atopy and cardiovascular diseases. ALOX5AP lacks enzyme activity and acts by helping 5-LO function. In this study, healthy and general subjects who live in rural and urban areas of Korea were tested for the association of ALOX5AP polymorphisms with lung function. Lung function was also estimated by calculating the predicted values for forced expiratory volume in one second (FEV(1) _%PRED) and the proportion of the forced vital capacity exhaled in the first second (FEV(1) /FVC_PRED). The linear regression was adjusted for residence area, gender, age, height and smoking status. The analysis revealed associations between FEV(1) and the single-nucleotide polymorphism (SNP) rs9506352 and the haplotype TCAC (permuted P-value < 0.05). The linkage disequilibrium block that included the significant SNPs overlapped with SNPs that were revealed previously to associate with myocardial infarction and asthma and to affect lung function. This study is the first to demonstrate the association between lung function and ALOX5AP polymorphisms in a healthy and general population.

Fat mass is negatively associated with bone mineral content in Koreans

SUMMARY

Although obesity and osteoporosis are important public health problems, the effect of fat mass on bone mass remains controversial. This study demonstrated that fat mass was inversely related to bone mineral content, and abdominal obesity was significantly associated with bone mineral content independent of total fat mass.

INTRODUCTION

Obesity and osteoporosis, two disorders of body composition, have become increasingly important public health problems throughout the world. However, the effect of fat mass on bone mass remains controversial. This study investigates the effect of fat mass and regional fat distribution on bone mass within a community-dwelling cohort.

METHODS

A total of 3,042 subjects (1,284 men, 362 premenopausal women, and 1,396 postmenopausal women) were studied. Fat mass, percent fat mass, lean mass, percent lean mass, and bone mineral content (BMC) were measured by dual energy X-ray absorptiometry.

RESULTS

Fat mass and percent fat mass decreased significantly across increasing tertiles of BMC in all three subgroups (men, premenopausal and postmenopausal women). In contrast, lean mass and percent lean mass increased significantly across tertiles of BMC in men, and a similar trend was also identified in postmenopausal women. Interestingly, although correlation analysis showed a positive association between fat mass and BMC (p < 0.05), this association became negative after controlling for age and weight (p < 0.05). Finally, in premenopausal and postmenopausal women, subjects with the lowest waist circumference (WC) had the highest BMC in the higher three quartiles of percent fat mass after adjusting for age and weight (p < 0.05), indicating that abdominal obesity is associated with BMC independent of total fat mass.

CONCLUSION

This study demonstrated that fat mass was inversely related to BMC after removing the mechanical loading effect in Korean men and women. Moreover, abdominal obesity as measured by WC was significantly associated with BMC independent of total fat mass.

The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community

There are few data available regarding the association between hallux valgus and pain or functional limitation. We determined the prevalence of hallux valgus in a rural Korean population aged between 40 and 69 years, and its association with pain and function. A total of 563 subjects was examined using the foot health status questionnaire, the Short Form-36 questionnaire and weight-bearing anteroposterior radiographs. Hallux valgus was present in 364 subjects (64.7%). It did not significantly correlate with age and was more common in women. Of the 364 subjects, 48 (13.2%) had moderate or greater deformity, defined as a hallux valgus angle > 25 degrees . This was significantly associated with pain, worse function and worse foot health. The putative risk factors associated with painful hallux valgus were female gender, low educational attainment and the presence of pain in the knee.

Significant invasion depth of early oral tongue cancer originated from the lateral border to predict regional metastases and prognosis

In oral tongue cancer, tumor depth is crucial for cervical lymph node metastasis. There is no standardized method to predict tumor invasion or deciding who should undergo selective neck dissection. In this study, calculated MRI invasion depth was compared with histopathologic (HP) invasion depth to find a correlation, and determine a cutoff value of invasion depth that predicts occult neck node metastasis. 50 patients, diagnosed with T1 or T2 oral tongue cancer originating from the lateral border of the tongue, underwent MRI screening and received surgical excision as primary treatment. MRI and HP invasion depths were compared and the cutoff value determined. The invasion depth to determine the presence of nodal metastasis where summation of specificity and sensitivity was greatest was 8.5mm HP, 10.5mm in T1 weighted enhanced axial image, and 11.5mm in T2 weighted MRI axial image. The relation coefficient of T2 weighted MRI invasion depth and HP depth was 0.851, and accuracy 84%, all of which showed higher correlation compared with T1 weighted enhanced axial image. HP depth was significantly correlated with survival rate. The measurement of invasion depth using MRI is a prerequisite for determining a surgical plan in early oral tongue cancer.

Phase transition and physical features of nano-grained BaTiO3 ceramics Prepared by two-step sintering

Nano-grained BaTiO3 ceramics were prepared by two-step sintering; nanoscale BaTiO3 powders of 100 and 500 nm in size were used as starting materials. The phase transition and physical features of the BaTiO3 ceramics were investigated as a function of the grain size and the boundary decoration. With increasing the grain size, the relative volume fraction of a tetragonal phase was increased; this seems to be due to the variation in boundary tension with grain size. The relation of the physical features of the nano-grained BaTiO3 ceramics with the structural variation is discussed in terms of process parameters.

Targeted RNA interference of phosphatidylinositol 3-kinase p110-beta induces apoptosis and proliferation arrest in endometrial carcinoma cells

Phosphatidylinositol 3-kinase (PI3K) signalling plays a pivotal role in intracellular signal transduction pathways involved in cell growth, cellular transformation, and tumourigenesis. PI3K is overexpressed in many human cancers, including endometrial carcinomas, one of the most common female genital tract malignancies. Here, we used small interfering RNA (siRNA) targeted to PI3K p110-beta to determine whether inhibition of the beta isoform could be a potential therapeutic target for endometrial carcinoma. In this study, treatment of HEC-1B endometrial cancer cells with PI3K p110-beta-specific siRNA resulted in increased apoptosis and decreased tumour cell proliferation. Depletion of PI3K p110-beta decreased the protein levels of AKT1, AKT2, pAKT, and mTOR-downstream targets of PI3K. Knock-down of PI3K p110-beta by siRNA also induced decreased expression of cyclin E and Bcl-2, suggesting that PI3K p110-beta stimulates tumour growth, at least in part by regulating cyclin E and Bcl-2. Thus, our results indicate that siRNA-mediated gene silencing of PI3K p110-beta may be a useful therapeutic strategy for endometrial cancers overexpressing PI3K p110-beta.

No ancillary finding is valid to distinguish a primary ovarian hepatoid carcinoma from metastatic hepatocellular carcinoma

Primary ovarian hepatoid carcinomas (POHC) are extremely rare. Especially rare are those with phenotypic properties of hepatocellular carcinoma (HCC) and an absence of clinical evidence of hepatic tumor. We report a case of a POHC with a common microscopic, immunophenotypic, and ultrastructural property of HCC in the absence of a liver mass. It is extremely difficult to differentiate POHC from metastatic HCC using any kinds of ancillary studies, with the exception of clinical identification of a hepatic tumor.

Multinucleation of koilocytes is actually multilobation

In order to clarify the complete cytomorphology of cytopathic changes as a consequence of human papillomavirus (HPV) infection, we performed three-dimensional (3D) reconstruction from confocal fluorescent images. After confirming 22 HPV types using a DNA chip, we performed 3D confocal image restoration in human uterine cervical swab samples and corresponding tumor tissues. On restoration of 3D confocal images, the multinucleated feature of koilocytes was revealed to be multilobation of a single nucleus, as opposed to true multinucleation.

A rural-urban comparison of the characteristics of the metabolic syndrome by gender in Korea: the Korean Health and Genome Study (KHGS)

The number of cases of the metabolic syndrome is increasing dramatically in Western countries. However, the evaluation of the metabolic syndrome is limited in Asian countries. Thus, our objectives were: 1) to investigate parameters of the metabolic syndrome defined by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII) in the subjects representing Korean general population and 2) the modification of which factor is most effective in reducing the metabolic syndrome. A total of 10,044 (5024 rural and 5020 urban) Korean men and women in the age range 40-69 yr voluntarily participated in this community-based cross-sectional study (a rural and an urban community was selected). Anthropometric parameters (weight, height, waist and hip circumference and blood pressure), social factors (smoking, alcohol, exercise and education status) as well as biochemical parameters (fasting glucose and insulin, lipids and body composition) were measured. Twenty-six point one per cent of the total subjects were classified as having the metabolic syndrome. Age- and sex-adjusted prevalences were 29.3 and 22.3% in the rural and urban community, respectively (p< 0.01). Abdominal obesity (46.9%) and high blood pressure (45.2%) were major components in the rural community; hypertriglyceridemia (37.6%) and low HDL-cholesterolemia (37.0%) in the urban community. In conclusion, abdominal obesity in the rural community and dyslipidemia in the urban community should be a main subject of intervention, aimed at reducing the prevalence of the metabolic syndrome in Korea. Given the rapid progression of the Korean economy over the past 30 yr, the prevalence of the metabolic syndrome is expected to increase continuously. A strategy to prevent this expected extraordinary event should be conducted at a national level.

Prevalence of erectile dysfunction in Korean men with Type 2 diabetes mellitus

AIMS

We investigated the prevalence and risk factors for developing erectile dysfunction (ED) in 1312 Korean men with diabetes in a multicentre study.

METHODS

We used the modified International Index for Erectile Function-5 criteria to identify mild, moderate and complete ED. A standardized face-to-face questionnaire was used by trained interviewers, and validated against telephone interviews. We recorded the duration of diabetes, level of glycaemic control, vital signs, complications, exercise and alcohol and smoking habits, and diabetes treatments used. Results The mean age and median duration of diabetes were 53.8 +/- 6.65 and 6 years (range 1-43), respectively. The mean HbA(1c) and fasting glucose levels were 7.9 +/- 1.65% and 8.6 +/- 2.82 mmol/l, respectively. The overall prevalences of mild, moderate, complete ED and all ED (mild-to-complete) were 20.1, 19.5, 25.8 and 65.4%, respectively. ED was more common with age, reaching 79.3% in men aged > 60 years. Subjects aged > 60 years and with a duration of diabetes > 10 years were at greatest risk for all ED (OR = 10.4, 95% CI 5.8-18.5, P < 0.001) and complete ED (OR = 13.2, 95% CI 7.3-23.9, P < 0.001) when compared with the reference group (age 40-50 years with duration < 6 years). Age, duration of diabetes, HbA(1c), insulin use, neuropathy and macrovascular complications were positively associated with ED, but alcohol consumption and exercise habits were negatively associated.

CONCLUSIONS

The prevalence of complete ED was approximately six times higher than in the general population.

C-reactive protein level as an independent risk factor of metabolic syndrome in the Korean population. CRP as risk factor of metabolic syndrome

Interrelationship between C-reactive protein (CRP) and metabolic syndrome (MS) was evaluated in a community-based cohort of 9773 Koreans aged 40-69 years. Metabolic syndrome was defined by criteria of the National Cholesterol Education Program. CRP was measured by validated high-sensitivity assay. The median CRP level was 1.4 mg/1, and significantly increased as the number of components of MS increased (P trend <0.001). CRP levels were significantly but marginally correlated with waist circumference (r=0.18), triglyceride (r=0.14), blood pressure (r=0.11), HDL-cholesterol (r=-0.10), and fasting glucose (r=0.09) (all P values<0.01). Odds ratios of the highest quartile of CRP for each component of MS; i.e., waist circumference, triglyceride, glucose metabolism, blood pressure, and HDL-cholesterol were 2.36, 1.79, 1.70, 1.32 and 1.28, respectively. The highest quartile of CRP was independently associated with 1.72-fold increased risk of MS in our logistic regression model adjusted for age, sex, BMI, and smoking. This study demonstrated that CRP is a strong associating factor of MS in Korean population. We recommend further evaluation of CRP levels in the other Asian ethnic groups to establish biological plausibility as the risk factor for MS in all ethnic groups.

Multinucleation of koilocytes is in fact multilobation and is related to aberration of the G2 checkpoint

AIMS

To clarify the fine structure of koilocytes and correlate this with genetic aberration of the G2 checkpoint.

METHODS

Three dimensional reconstruction from confocal fluorescent images, together with functional assays for key molecules of the G2 checkpoint-cdc2 and cyclin B1-was performed in human uterine cervical samples. After confirming 22 human papillomavirus (HPV) types using a DNA chip from 30 cervical swabs, previously confirmed as 15 cervical low grade and 15 high grade intraepithelial lesions, the activity of molecules involved in the G2 checkpoint was evaluated using western blotting for cyclin B1, cdc2, and phospho-cdc2 (Y15 and T161), a nuclear extraction fractional assay, and a reverse transcription polymerase chain reaction assay. In addition, three dimensional confocal image restoration was performed on confirmed cervical intraepithelial neoplasia tissue samples.

RESULTS

T161 phospho-cdc2 and cyclin B1 expression was higher in HPV infected cervical lesions than in normal samples. Immunofluorescence, revealed that cyclin B1 was present predominantly in the nuclei of HPV infected cells, confirming the results of the nuclear fractional assay. On restoration of three dimensional confocal images, the multinucleation of koilocytes was revealed to be multilobation of a single nucleus, rather than true multinucleation. This multilobation appeared to be associated with chromosomal instability and aberration of the G2 checkpoint.

CONCLUSIONS

The multiple nuclei of koilocytes are in fact multilobation of a single nucleus, and this phenomenon is associated with upregulation of gene products related to the G2 checkpoint.

Relation between deranged antioxidant system and cervical neoplasia

The purpose of this study was to compare the plasma levels of the anti-oxidant system and oxidative stress between a cervical neoplasia group and a normal control group and to investigate the relationship between the levels of micronutrients of antioxidant system and various clinicopathological parameters of cervical carcinoma. A cross-sectional sample of 180 women, including 90 normal controls, was recruited from November 2000 to January 2001. Plasma concentration of malondialdehyde (MDA) was spectrophotometrically measured as the parameter of lipid peroxidation. Plasma levels of antioxidant vitamins were analyzed with the help of reverse-phase, high-pressure liquid chromatography, whereas glutathione peroxidase activity was evaluated by using coupled enzyme procedure. While the activity of glutathione peroxidase and the plasma levels of antioxidant vitamins, such as lutein, beta-carotene, lycopene, and zeaxanthin, were all significantly lower, the concentration of MDA was significantly higher in women with cervical intraepithelial neoplasia (CIN) or invasive cervical cancer, compared to those of the normal control group. The status of the plasma antioxidant system showed no significant correlation with the prognostic factors of cervical cancer. These findings suggest a potential role of oxidative stress-induced lipid peroxidation and the impairment of the anti-oxidant system in the pathogenesis of CIN and carcinoma of the uterine cervix.

Relation between deranged antioxidant system and cervical neoplasia

The purpose of this study was to compare the plasma levels of the anti-oxidant system and oxidative stress between a cervical neoplasia group and a normal control group and to investigate the relationship between the levels of micronutrients of antioxidant system and various clinicopathological parameters of cervical carcinoma. A cross-sectional sample of 180 women, including 90 normal controls, was recruited from November 2000 to January 2001. Plasma concentration of malondialdehyde (MDA) was spectrophotometrically measured as the parameter of lipid peroxidation. Plasma levels of antioxidant vitamins were analyzed with the help of reverse-phase, high-pressure liquid chromatography, whereas glutathione peroxidase activity was evaluated by using coupled enzyme procedure. While the activity of glutathione peroxidase and the plasma levels of antioxidant vitamins, such as lutein, β-carotene, lycopene, and zeaxanthin, were all significantly lower, the concentration of MDA was significantly higher in women with cervical intraepithelial neoplasia (CIN) or invasive cervical cancer, compared to those of the normal control group. The status of the plasma antioxidant system showed no significant correlation with the prognostic factors of cervical cancer. These findings suggest a potential role of oxidative stress-induced lipid peroxidation and the impairment of the anti-oxidant system in the pathogenesis of CIN and carcinoma of the uterine cervix.

Lack of excess maternal transmission of type 2 diabetes in a Korean population

The purpose of this study was to assess the familial clustering of type 2 diabetes and to investigate the presence of excess maternal transmission of type 2 diabetes in Korea. The medical records of 56,492 subjects (31,680 men and 24,812 women), who attended the Health Promotion Center were examined. The subjects were questioned about their parents' diabetes status. All study subjects were classified into the three groups (normal fasting glucose (NFG), impaired fasting glucose (IFG), and diabetes). Offspring with paternal diabetes (odds ratio 2.54, 95% CI 2.22-2.91, P < 0.001) and those with maternal diabetes (odds ratio 3.10, 95% CI 2.76-3.49, P < 0.001) were at increased risk for diabetes when compared to subjects without parental diabetes and adjusted for other clinical and biochemical variables. Offspring with bilineal parental diabetes were at a greater risk for diabetes (odds ratio 6.09, 95% CI 4.55-8.16, P < 0.001) when compared to subjects without parental diabetes. In both genders, offspring with maternal diabetes showed no increased risk for diabetes (odds ratio 1.22, 95% CI 0.92-1.37, P + 0.266 in men; odds ratio 1.31, 95% CI 0.95-1.81, P = 0.104 in women) when compared with those with paternal diabetes. The data suggested that parental type 2 diabetes was an independent risk factor for offspring type 2 diabetes in this Korean population. Excess maternal transmission of type 2 diabetes was not observed.

Malignant mixed mullerian tumor of fallopian tube with multiple distinct heterologous components

We experienced a case of primary malignant mixed müllerian tumors (MMMTs) of the fallopian tube of FIGO stage I. In addition to endometrioid adenocarcinomas, multiple apparent heterologous elements encompassing myxoid chondrosarcoma, osteosarcoma, myxoid liposarcoma, and well-differentiated angiosarcoma were recognized separately in each nodule. Those findings that divergent sarcomatoid differentiations are apparently present masquerading malignant mesenchymoma have not been described in MMMTs of the female genital tract.

Malignant mixed müllerian tumor of fallopian tube with multiple distinct heterologous components

We experienced a case of primary malignant mixed müllerian tumors (MMMTs) of the fallopian tube of FIGO stage I. In addition to endometrioid adenocarcinomas, multiple apparent heterologous elements encompassing myxoid chondrosarcoma, osteosarcoma, myxoid liposarcoma, and well-differentiated angiosarcoma were recognized separately in each nodule. Those findings that divergent sarcomatoid differentiations are apparently present masquerading malignant mesenchymoma have not been described in MMMTs of the female genital tract.

Development of rat prostatitis model by oral administration of isoflavone and its characteristics

Inflammation of the prostate can be induced experimentally in rats by the subcutaneous administration of estrogen. However, it is usually achieved at the price of some alteration in the sex steroid hormone balance and morphological changes in the prostate. In this study, a soy-extracted isoflavone mixture with weak estrogenic activity was administered orally in an attempt to induce prostatitis in a more physiologic way and to characterize the inflammation induced. A total of 36 male Sprague-Dawley rats, 8 weeks old, were divided into 2 groups. The control group was fed with only an AIN-76A diet containing no detectable phytoestrogen and the experimental group was fed with AIN-76A and a soy- extracted isoflavone mixture (genistein 60.0% and daidzein 19.6%), 300 mg/kg body weight for 9 weeks. The sequential body weight and prostate weight at necropsy were measured. A histologic examination and histomorphometry assessed the changes in the prostate. The serum concentrations of testosterone and dihydrotestosterone were measured to estimate the effects on the androgen level. Intraprostatic concentrations of genistein and daidzein were measured by gas chromatography/ mass spectroscopy (GC/MS). While no sign of prostate inflammation was apparent in the control group, severe inflammatory changes in the stroma, increased epithelial detachment and inflammatory exudates within the glandular lumen of the dorsolateral prostate were observed in more than 80%(15/18) of the experimental group. However, there was no significant difference in the ventral prostate between the two groups. The daidzein and genistein concentrations in both the lateral and ventral prostates were significantly higher in the experimental group than in the control group where no isoflavone was detectable. In addition, the concentrations were much higher in the dorsolateral than in the ventral prostate. Although the body weight gain was not consistent in the experimental group, there were no significant differences in the prostate weight and serum androgen level between groups. In summary, when a soy-extracted genistein and daidzein-rich isoflavone mixture was administered orally into rats, prostatic inflammation with characteristic lobe specificity developed. The present method of inducing prostatitis seems to be a more physiologic than an estrogen-induced experimental model, and sequential pharmacokinetic studies might help in establishing this model as a more valuable tool in assisting future research in this field.

Expression of chemokine genes in human dermal microvascular endothelial cell lines infected with Orientia tsutsugamushi

Scrub typhus, caused by Orientia tsutsugamushi, is characterized by local as well as systemic inflammatory manifestations. The main pathologic change is focal or disseminated multiorgan vasculitis, which is caused by the destruction of endothelial cells and perivascular infiltration of leukocytes. We investigated the regulation of chemokine induction in transformed human dermal microvascular endothelial cells (HMEC-1) in response to O. tsutsugamushi infection. The monocyte chemoattractant protein-1 (MCP-1) and interleukin 8 (IL-8) mRNAs were induced, and their levels showed a transitory peak at 3 and 6 h, respectively. The RANTES transcript was detected at 6 h after infection, with increased levels evident by 48 h. The induction of the MCP-1 and IL-8 genes was not blocked by cycloheximide, suggesting that de novo protein synthesis of host cell proteins is not required for their transcriptional activation. Heat- or UV-inactivated O. tsutsugamushi induced a similar extent of MCP-1 and IL-8 responses. The induction of MCP-1 and IL-8 transcripts in the endothelial cells by O. tsutsugamushi was not blocked by the inhibitors of NF-kappaB. Furthermore, the activation of NF-kappaB was not detected in HMEC-1 stimulated with O. tsutsugamushi. These results demonstrate that heat-stable molecules of O. tsutsugamushi induce the MCP-1 and IL-8 genes and the induction of the chemokine genes may be mediated by an NF-kappaB independent mechanism. We also showed that another major transcription factor, activator protein-1 (AP-1), was up-regulated in HMEC-1 after O. tsutsugamushi infection. This suggests the possible involvement of AP-1 in the chemokine gene expression.

Prognostic role of cyclin D1 in retroperitoneal sarcomas

PURPOSE

Cyclin D1 regulates the G1 checkpoint of the cell cycle and is overexpressed in a number of cancers. This study was designed to determine if cyclin D1 overexpression had prognostic value in patients undergoing surgery with curative intent for primary retroperitoneal soft-tissue sarcoma.

METHODS

Tissue was available for analysis on 79 patients who underwent resection between September 1983 and May 1997. Clinicopathologic data and follow-up was obtained from a prospective sarcoma database and a patient and family interview. Immunohistochemical analysis was used to determine overexpression (> or = 5% of nuclei labeled). Survival was analyzed using the Kaplan-Meier method, and statistical analysis was performed by using log rank testing and the Cox regression model.

RESULTS

Median follow-up was 3.5 years. On univariate analysis of disease-specific mortality, significant prognostic factors were high grade (n = 42, 53%), positive microscopic margins (n = 36, 46%) or macroscopic margins (n = 15, 19%), and cyclin D1 overexpression (n = 37, 47%). On multivariate analysis, macroscopically positive margins (P = 0.02) and the combination of high grade and cyclin D1 overexpression (P = 0.04) both were associated independently with poor survival.

CONCLUSION

High grade retroperitoneal sarcomas demonstrating cyclin D1 overexpression have had an extremely poor prognosis. Continued study of multiple biological markers, exemplified by cyclin D1, may aid characterization of tumor behavior and response to treatment in this diverse group of tumors.

How reliable is the ultrasound densitometer for community screening to diagnose osteoporosis in spine, femur, and forearm?

Dual X-ray absorptiometry (DXA) is the most widely used noninvasive, quantitative diagnostic method of measuring bone density, but it exhibits several limitations for the purpose of general screening and community-based study. Thus, we evaluated the feasibility of the ultrasound densitometer SoundScan Compact for screening the osteoporosis community. We compared the reliability of the SoundScan Compact's measurement to predict both osteopenia and osteoporosis at the spine, femur, and forearm measured by the XR-36. World Health Organisation criteria and Korean reference were used for the diagnosis of osteopenia and osteoporosis. Of the 1827 subjects screened in the community, we randomly selected and invited 106 subjects to our university hospital center for clinical epidemiology for further evaluation of their bone health using DXA. The site-specific relationships among speed of sound and bone mineral density at L2-L4 spine, femoral neck, trochanter, Ward's triangle, distal radius + ulna, proximal radius + ulna, and proximal radius were highly correlated with r values of 0.633, 0.632, 0.674, 0.632, 0.668, 0.78, and 0.777 respectively (all p < 0.0001). Of the 42 subjects defined as normal in the spine by SoundScan Compact's, 27 (64.3%) were also in agreement as the normal by the XR-36. However, an agreement of 43.5% (10/23) in osteopenia and 53.7% (22/41) in osteoporosis was less sensitive. Reliability tested by kappa statistics (kappa = 0.35; t = 5.3; p < 0.0001) revealed that the degree of agreement was not coincidental. On the femur, 54.8% (23/42) agreed as normal, 73.9% (17/23) as osteopenia, and 39% (16/41) as osteoporosis (kappa = 0.33; t = 5.5; p < 0.0001). Higher reliability was found in the forearm, with a kappa value of 0.48, t = 7.2, and p < 0.0001. A magnitude of agreement was also greater in the forearm, with 83.3% (35/42) agreement in normal, 52.2% (12/23) in osteopenia, and 64% (16/25) in osteoporosis. Although the SoundScan Compact's measures different bone properties and measurements are taken at different sites, it is a very useful instrument with a high correlation and high degree of variation and reliability to predict bone health at other sites such as the spine, femur, and forearm. The ultrasound densitometer such as SoundScan Compact's merits its use for community screening and in the primary care setting to detect osteopenia and osteoporosis for the purpose of early detection and prevention.

Expression of cyclin E in placentas with hydropic change and gestational trophoblastic diseases: implications for the malignant transformation of trophoblasts

BACKGROUND

Although much is known about the morphologic, cytogenetic, and clinical characters of gestational trophoblastic diseases, little information has appeared concerning the parameters related to their persistence or neoplastic transformation. Cell cycle alterations in tumor tissue were examined in this study in light of obvious changes in the clinical behavior of malignant cells. There is an increasing body of evidence suggesting that the abnormal expression of cyclins is considered one of the most important events in malignant transformation of various human cancers. Among these cell cycle regulators, the role of cyclin E in the neoplastic transformation of trophoblast populations has been poorly defined.

METHODS

Using formalin fixed, paraffin embedded trophoblastic tissues, the authors investigated the expression of cyclin E by immunohistochemistry in placentas with hydropic change and gestational trophoblastic diseases. The specimens examined included tissue from 29 patients with complete hydatidiform mole, 18 patients with partial hydatidiform mole, and 6 patients with choriocarcinoma after term pregnancy or abortion. The authors also studied four cases of hydropic abortion.

RESULTS

The cyclin E indexes (CEI) were as follows: 25.7% +/- 6.2% for hydropic change, 35.3% +/- 12.7% for triploid partial moles, 42.2% +/- 13.1% for diploid/tetraploid complete moles, and 63.6% +/- 9.5% for choriocarcinomas. There was a significant difference in CEI between placentas with hydropic change and partial mole (P = 0.04) and placentas with hydropic change and complete mole (P = 0.003). Choriocarcinomas had significantly higher cyclin E expression compared with placentas, partial moles, and complete moles, respectively. A significant correlation between the expression of cyclin E and S-phase fraction was observed in gestational trophoblastic diseases (rank correlation coefficient = 0.45, P < 0. 05). The relation between cyclin E expression and proliferation was abrogated in placentas with hydropic change, suggesting that cyclin E up-regulation represents a genuine aberration.

CONCLUSIONS

The results of this study were consistent with the concept that cyclin E overaccumulation may play an important role in the uncontrolled proliferation and neoplastic transformation of trophoblasts.

Correlations between the intrauterine metabolic environment and blood pressure in adolescent offspring of diabetic mothers

OBJECTIVE

To investigate associations between maternal diabetes and blood pressure (BP), obesity, impaired glucose tolerance, and serum lipids in offspring and whether these parameters correlate with metabolism during pregnancy.

STUDY DESIGN

Body mass index, BP, serum glucose, and insulin during an oral glucose tolerance test, and lipid concentrations were measured in 99 offspring of diabetic mothers (ODM) and 80 members of a control group.

RESULTS

ODM were more obese (body mass index 22.5 +/- 5.6 vs 20.3 +/- 4.0 kg/m(2)) and had higher systolic (8 mm Hg) and mean arterial BP (4 mm Hg) but similar diastolic BP compared with the control group. ODM had higher 2-hour glucose (6.6 +/- 1.3 vs 5.7 +/- 0.9 mmol/L) and insulin (580 +/- 544 vs 377 +/- 239 pmol/L) concentrations but lower fasting concentrations of low-density lipoprotein (2.54 +/- 0.67 vs 2.82 +/- 0.70 mmol/L) and total cholesterol (4.01 +/- 0.80 vs 4.40 +/- 0.78 mmol/L). In both groups body mass index, triglycerides, and fasting and 2-hour glucose concentrations showed correlations with BP measurements. Fasting insulin was correlated with BP readings only in the ODM. Correlations were found between second- and third-trimester maternal free fatty acid concentrations and diastolic and mean arterial BP. Third-trimester beta-hydroxybutyrate was correlated with mean arterial BP.

CONCLUSIONS

In ODM, abnormalities in weight and glucose tolerance are associated with abnormal maternal metabolism. Higher BP is an additional abnormality associated with fetal overnutrition.

Androgen receptor gene mutation identified by PCR-SSCP and sequencing in 4 patients with complete androgen insensitivity syndrome

To study the genetic defect of the human androgen receptor (hAR) gene in the complete androgen insensitivity syndrome (CAIS), we amplified each of the eight exons by PCR in genomic DNA extracted from the paraffin blocks of the resected gonads. We analyzed using SSCP, and directly sequenced the abnormally shifted bands. Mutations were found in 4 cases of CAIS. Patient 1 carried a point mutation; a G to A transition in exon 7 resulted in a change from arginine to glutamine at codon 831. Patient 2 carried a point mutation; a C to T transition in exon 7 resulted in a change from arginine to stop at codon 831. Patient 3 carried a point mutation and deletion in exon 7. A point mutation was an A to G transition that caused a glutamine to be substituted for the asparagine present at codon 819. A deletion of a G at codon 820 resulted in a frameshift and consequently in the introduction of a premature stop at codon 821. Patient 4 carried a mutation in 5' splice donor site of intron 7; a G to T transition might have caused an abnormal splicing of the exon 7. All of the mutations were found in exon 7. These mutations of hAR gene might be related to the pathogenesis of CAIS.