Patterns of malignant non-mass enhancement on 3-T breast MRI help predict invasiveness: using the BI-RADS lexicon fifth edition.

Background Non-mass enhancements (NME) with invasive components account for 10-42% of total malignant NMEs. The factors associated with invasiveness on magnetic resonance imaging (MRI) could be useful for clinical assessment and treatment. Purpose To evaluate the clinical significances of the distributions and internal enhancement patterns (IEP) of malignant NMEs on 3-T breast MRI. Material and Methods A total of 448 consecutive women with newly diagnosed breast cancer that had undergone preoperative MRI and surgery between February 2013 and March 2016 were identified. After exclusions, 72 malignant NMEs without a mass in 72 women (mean age = 51.5 years) were included. Two readers independently assessed distributions and IEPs of NME, according to the Breast Imaging Reporting and Data System lexicon fifth edition. Collected data included the presence of invasion and histopathologic factors. Results A clustered ring IEP was significantly associated with invasive cancer (75.0%, P = 0.001, Reader1; 72.9%, P < 0.001, Reader 2), absence of necrosis (79.0%, P < 0.001; 72.1%, P < 0.001, respectively), and high Ki-67 expression (74.2%, P = 0.048; 74.2%, P = 0.003, respectively). A clumped IEP was related to ductal carcinoma in situ (33.3%, P = 0.025; 50.0%, P = 0.001, respectively), absence of lymph node metastasis (24.1%, P = 0.029; 31.5%, P = 0.030, respectively), and presence of necrosis (34.5%, P = 0.003; 44.8%, P = 0.001, respectively). Conclusion The presence of a clustered ring IEP in patients with breast cancer was found to be significantly associated with invasive breast cancer and high Ki-67 expression.

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea.

BACKGROUND: This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. METHOD: At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. RESULTS: Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p <  0.001); however, the new system registers lower patient out-of-pocket expenses (p <  0.001). CONCLUSION: The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.

Comparison of the image qualities of filtered back-projection, adaptive statistical iterative reconstruction, and model-based iterative reconstruction for CT venography at 80 kVp.

PURPOSE: To evaluate the subjective and objective qualities of computed tomography (CT) venography images at 80 kVp using model-based iterative reconstruction (MBIR) and to compare these with those of filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) using the same CT data sets. MATERIALS AND METHODS: Forty-four patients (mean age: 56.1 ± 18.1) who underwent 80 kVp CT venography (CTV) for the evaluation of deep vein thrombosis (DVT) during 4 months were enrolled in this retrospective study. The same raw data were reconstructed using FBP, ASIR, and MBIR. Objective and subjective image analysis were performed at the inferior vena cava (IVC), femoral vein, and popliteal vein. RESULTS: The mean CNR of MBIR was significantly greater than those of FBP and ASIR and images reconstructed using MBIR had significantly lower objective image noise (p < .001). Subjective image quality and confidence of detecting DVT by MBIR group were significantly greater than those of FBP and ASIR (p < .005), and MBIR had the lowest score for subjective image noise (p < .001). CONCLUSION: CTV at 80 kVp with MBIR was superior to FBP and ASIR regarding subjective and objective image qualities. KEY POINTS: • MBIR provides superior image quality compared with FBP and ASIR • CTV at 80kVp with MBIR improves diagnostic confidence in diagnosing DVT • CTV at 80kVp with MBIR presents better image quality with low radiation.

Diagnostic performance and radiation dose of lower extremity CT angiography using a 128-slice dual source CT at 80 kVp and high pitch.

BACKGROUND: Multi-detector computed tomography (MDCT) angiography is now used for the diagnosing patients with peripheral arterial disease. The dose of radiation is related to variable factors, such as tube current, tube voltage, and helical pitch. PURPOSE: To assess the diagnostic performance and radiation dose of lower extremity CT angiography (CTA) using a 128-slice dual source CT at 80 kVp and high pitch in patients with critical limb ischemia (CLI). MATERIAL AND METHODS: Twenty-eight patients (mean, 64.1 years; range, 39-80 years) with CLI were enrolled in this retrospective study and underwent CTA using a 128-slice dual source CT at 80 kVp and high pitch and subsequent intra-arterial digital subtraction angiography (DSA), which was used as a reference standard for assessing diagnostic performance. RESULTS: For arterial segments with significant disease (>50% stenosis), overall sensitivity, specificity, and accuracy of lower extremity CTA were 94.8% (95% CI, 91.7-98.0%), 91.5% (95% CI, 87.7-95.2%), and 93.1% (95% CI, 90.6-95.6%), respectively, and its positive and negative predictive values were 91.0% (95% CI, 87.1-95.0%), and 95.1% (95% CI, 92.1-98.1%), respectively. Mean radiation dose delivered to lower extremities was 266.6 mGy.cm. CONCLUSION: Lower extremity CTA using a 128-slice dual source CT at 80 kVp and high pitch was found to have good diagnostic performance for the assessment of patients with CLI using an extremely low radiation dose.

Urinary Malondialdehyde Is Associated with Visceral Abdominal Obesity in Middle-Aged Men.

The purpose of the present study was to investigate multiple anthropometric parameters used to evaluate obesity, particularly visceral abdominal fat area, and various metabolic parameters including malondialdehyde (MDA) as an oxidative stress marker. We evaluated various measures of obesity, including body mass index (BMI), waist circumference (WC), sagittal abdominal diameter, fat percentages using dual-energy X-ray absorptiometry, visceral fat area (VFA), subcutaneous fat area, multiple biomarkers related to metabolic disease, and urinary MDA, in 73 asymptomatic middle-aged men who were not severely obese. We examined relationships between multiple measures of obesity, metabolic markers, and urinary MDA levels and evaluated associations between VFA and urinary MDA. In the visceral obesity group, γ-glutamyl transferase (GGT), uric acid, and urinary MDA levels were significantly higher than in the nonvisceral obesity group (P = 0.008, P = 0.002, and P = 0.018). Urinary MDA (r = 0.357, P = 0.002) and uric acid (r = 0.263, P = 0.027) levels were only significantly positively correlated with VFA among measures of obesity. Urinary MDA, serum GGT, and serum CRP were significantly positively associated with VFA (P = 0.001, P = 0.046, and P = 0.023, resp.), even after adjusting for BMI and WC.

The association between 25-hydroxyvitamin D and mammographic density in healthy pre- and postmenopausal women regardless of the menstrual cycle phase: a cross-sectional study.

Vitamin D deficiency is a known risk factor of breast cancer. An association between vitamin D and breast density has been suggested; however, it remains controversial. The aim of this study was to determine the association between serum 25-hydroxyvitamin D [25(OH)D] level and mammographic density. Subjects in our study included 517 patients who visited the health promotion center of the University Hospital. Mammographic density was classified using the American College of Radiology, Breast Imaging Reporting and Data System. Analysis of variance was performed to clarify the association of serum 25(OH)D level and mammographic density, and odds ratio was calculated by ordinal logistic regression analysis. The mean serum 25(OH)D level was 14.3 ± 7.0 ng/mL in all subjects. In correlation analysis, weak negative correlation was observed between serum 25(OH)D level and mammographic density groups (r = -0.09, P = 0.049). However, ordinal logistic regression analysis showed no statistically significant association between serum 25(OH)D level and mammographic density (odds ratio: 0.75, 95% confidence interval: 0.50-1.13). Results of our study showed that there is no significant association between serum 25(OH)D level and mammographic density. It is thought to be an another mechanism of serum 25(OH)D level on breast cancer risk in addition to breast density.

The association between a low urine pH and the components of metabolic syndrome in the Korean population: Findings based on the 2010 Korea National health and nutrition examination survey.

BACKGROUND: Low urine pH is related to obesity and insulin resistance, which are components of metabolic syndrome (MS). The aim of this study was to identify the relation between a low urine pH and MS after controlled for other covariates including demographic and lifestyle factors in adult Korean population. MATERIALS AND METHODS: We analyzed data from the 2010 Korea National Health and Nutrition Examination Survey, a cross-sectional and nationally representative survey and 1960 men and 2702 women were included in this study. Study subjects were divided into the group with urine pH <5.5 and the group with urine pH ≥5.5 refer to literature. We then evaluated the association between low urine pH and MS. RESULTS: After adjusting for age, sex, smoking status, drinking status, regular exercise, and blood urea nitrogen level, the odds ratio (OR) for the presence of MS in the group with urine pH <5.5 was 1.350 (95% confidence interval [95% CI]: 1.158-1.573) using the American Heart Association/National Heart, Lung, and Blood Institute criteria or 1.304 (95% CI: 1.082-1.572) using the International Diabetes Federation criteria. Among MS components, elevated fasting glucose (OR: 1.231, 95% CI: 1.058-1.433, P = 0.007) and elevated triglyceride (TG) (OR: 1.389, 95% CI: 1.189-1.623, P < 0.001) showed a significantly high OR. CONCLUSION: The findings confirmed that low urine pH is associated with MS in the Korean population. Among MS components, elevated fasting glucose and elevated TG showed a significantly high OR.

Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve.

BACKGROUND: Coronary CT angiography (CCTA) allows accurate evaluation of coronary artery stenosis but has limitations in information on hemodynamic significance of stenotic lesions. PURPOSE: To determine the feasibility of adenosine-stress low-dose single-scan CT myocardial perfusion imaging (MPI) using a 128-slice dual-source CT scanner for the diagnosis of hemodynamically significant coronary artery stenosis as defined by fractional flow reserve (FFR). MATERIAL AND METHODS: This study was proved by the Institutional Review Board and informed consent was obtained from the patients before enrollment in the study. Ninety-seven patients with chest pain and low-to-intermediate pretest probability of coronary artery disease were prospectively enrolled. Adenosine-stress CCTA using ECG-correlated maximum tube current modulation (Mindose(®)) with 128-slice dual-source CT was performed in all 97 patients. In 37 patients (38.1%; 28 men, nine women; mean age, 61.7 ± 20.5 years; mean heart rate, 74.6 ± 2.8 bpm) with significant stenosis at CCTA (lumen diameter reduction >50%), FFR was performed after CCTA, as a reference standard for the evaluation of myocardial perfusion. FFR value ≤0.75 was considered as positive. CTMPI and CCTA were read by two experienced radiologists with consensus, respectively. RESULTS: The effective radiation dose of adenosine-stress single-scan CTMPI was 4.63 ± 2.57 mSv. Compared with FFR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying significant coronary stenoses were 93.1%, 82.7%, 75.0%, and 95.6%, respectively, on CCTA and 93.1%, 90.3%, 84.4%, and 95.9%, respectively, on CTMPI. On combined CCTA and CTMPI, sensitivity, specificity, PPV, and NPV were 93.1%, 94.2%, 90.0%, and 96.0%, respectively. CONCLUSION: Adenosine-stress low-dose single scan CTMPI using a 128-slice dual-source CT can provide complementary information on the hemodynamical significance of coronary artery stenosis as well as anatomical information of coronary arteries.

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

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

Differential expression of ghrelin mRNA according to anatomical portions of human stomach.

BACKGROUND/AIMS: The detailed ghrelin distribution on mRNA level in different anatomical portions of adult stomach and its association with plasma ghrelin levels are not yet well established. We investigated the ghrelin mRNA and peptide expression in different anatomical portions of stomach in human adults. METHODOLOGY: Stomach tissue samples were obtained from 16 patients with gastric cancer who underwent total gastrectomy. The normal stomach tissues were taken from the upper (gastric fundus and upper body), middle (gastric middle and lower body) and lower (gastric antrum and pylorus) portions of stomach, respectively. The expression of ghrelin mRNA and peptide in stomach tissue samples were measured using RT-PCR and immunohistochemistry. RESULTS: The ghrelin/actin ratio was 0.78 (range 0-3.38; n=16) at the upper portion, 0.20 (range 0-1.28; n=16) at the middle portion and 0.07 (range 0-0.67; n=16) at the lower portion of the stomach (p=0.001). Ghrelin-positive cells were seen in all parts of the gastric mucosa and were most numerous in the glandular compartment compared to foveolar compartment. Gastric body or fundic mucosa showed ghrelin-positive cells most abundantly as compared to other portions of the gastric mucosa (p<0.001). CONCLUSIONS: Ghrelin mRNA expression and immunoreactivity is highest at the upper portion of the human stomach.

Analysis of questioning technique during classes in medical education.

BACKGROUND: Questioning is one of the essential techniques used by lecturers to make lectures more interactive and effective. This study surveyed the perception of questioning techniques by medical school faculty members and analyzed how the questioning technique is used in actual classes. METHODS: Data on the perceptions of the questioning skills used during lectures was collected using a self-questionnaire for faculty members (N = 33) during the second semester of 2008. The questionnaire consisted of 18 items covering the awareness and characteristics of questioning skills. Recorded video tapes were used to observe the faculty members' questioning skills. RESULTS: Most faculty members regarded the questioning technique during classes as being important and expected positive outcomes in terms of the students' participation in class, concentration in class and understanding of the class contents. In the 99 classes analyzed, the median number of questions per class was 1 (0-29). Among them, 40 classes (40.4 %) did not use questioning techniques. The frequency of questioning per lecture was similar regardless of the faculty members' perception. On the other hand, the faculty members perceived that their usual wait time after question was approximately 10 seconds compared to only 2.5 seconds measured from video analysis. More lecture-experienced faculty members tended to ask more questions in class. CONCLUSIONS: There were some discrepancies regarding the questioning technique between the faculty members' perceptions and reality, even though they had positive opinions of the technique. The questioning skills during a lecture need to be emphasized to faculty members.

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

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

Step-and-shoot prospectively ECG-gated vs. retrospectively ECG-gated with tube current modulation coronary CT angiography using 128-slice MDCT patients with chest pain: diagnostic performance and radiation dose.

BACKGROUND: With increasing awareness for radiation exposure, the study of diagnostic accuracy of coronary CT angiography (CCTA) with low radiation dose techniques is mandatory to both radiologist and clinician. PURPOSE: To compare diagnostic performance and effective radiation dose between step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with tube current modulation (TCM) CCTA using 128-slice multidetector computed tomography (MDCT). MATERIAL AND METHODS: We retrospectively evaluated 60 patients who underwent CCTA with either of two different low-dose techniques using 128-slice MDCT (23 patients for step-and shoot-prospectively ECG-gated and 37 patients for retrospectively ECG-gated with TCM CCTA) followed by conventional coronary angiography. All coronary arteries and all segments thereof, except anatomical variants or small size (< 1.5 mm) ones, were included in analysis. RESULTS: In per-segment analysis, sensitivity, specificity, positive predictive value, and negative predictive value were 91/96%, 95/94%, 75/73%, and 98/99% for step-and-shoot prospectively ECG-gated and retrospectively ECG gated with TCM CCTA, respectively, relative to conventional coronary angiography. Effective radiation dose were 1.75 ± 0.83 mSv, 4.91 ± 1.71 mSv in the step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with TCM CCTA groups, respectively. CONCLUSION: The two low-radiation dose CCTA techniques using 128-slice MDCT yields comparable diagnostic performance for coronary artery disease in symptomatic patients with low heart rates.

Multidetector CT evaluation of total anomalous pulmonary venous connections: comparison with echocardiography.

BACKGROUND: Although echocardiography is the first-line imaging modality in the diagnosis of total anomalous pulmonary venous connection (TAPVC), multidetector CT (MDCT) could have advantages in the diagnosis of TAPVC in certain cases. OBJECTIVE: To compare MDCT with echocardiography in the evaluation of TAPVC. MATERIALS AND METHODS: Enrolled in the study were 23 patients with surgically proven TAPVC. The echocardiography and MDCT findings were independently interpreted by a paediatric cardiologist and cardiac radiologist in terms of: (1) the drainage site of the common pulmonary vein, (2) stenosis of the vertical vein, and (3) the course of the atypical vessel into the systemic vein in the case of vertical vein stenosis. The findings from both modalities were correlated with the results obtained at surgery (n=22) or autopsy (n=1). RESULTS: In all patients, MDCT correctly depicted the drainage site of the common pulmonary vein, stenosis of the vertical vein and the course of the atypical vessel into the systemic vein (sensitivity 100%, specificity 100%). The specificity of echocardiography was 100% for the three defined findings. The sensitivity of echocardiography, however, was 87%, 71% and 0%, respectively. CONCLUSION: MDCT can facilitate the diagnosis of TAPVC in certain cases.

The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes.

BACKGROUND: The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes. METHODS: We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation. RESULTS: Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009- 3.236) and 1.834 (95% confidence interval, 1.162-2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline. CONCLUSION: In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.

The Association of Body Fat and Arterial Stiffness Using the Brachial-Ankle Pulse Wave Velocity.

BACKGROUND: BMI alone may not serve as an index of obesity because it does not reflect body composition. The present study aimed to compare arterial stiffness as assessed by the brachial-ankle pulse wave velocity (ba-PWV) among groups defined by body fat percentage (pBF) and BMI. METHODS: This cross-sectional study was based on 1,700 participants (1,044 men and 656 women) who completed a health screening examination at a national hospital between January 2011 and February 2016. Participants were divided into four groups according to BMI and pBF: normal fat and normal weight (NFNW); excessive fat and normal weight (EFNW); normal fat and obese (NFO); and excessive fat and obese (EFO). The ba-PWV and other cardiometabolic factors were compared among the four groups in men and women separately. RESULTS: For both sexes, the NFNW group had a lower metabolic risk compared to that in the other groups (EFNW, NFO, and EFO). After adjusting for multiple variables, the NFO males had a significantly lower ba-PWV compared to those in the other groups, including NFNW males. The NFO group had significantly more skeletal muscle mass and muscle mass compared the other groups (P<0.05). Among women, the NFNW group had a significantly lower ba-PWV compared the other groups, even after adjusting for multiple variables. CONCLUSION: Lower pBF in obese men may be associated with improved cardiovascular risk.

Shift Work Is Associated with Metabolic Syndrome in Young Female Korean Workers.

BACKGROUND: Shift work is associated with health problems, including metabolic syndrome. This study investigated the association between shift work and metabolic syndrome in young workers. METHODS: A total of 3,317 subjects aged 20-40 years enrolled in the 2011-2012 Korean National Health and Nutrition Examination Survey were divided into shift and day workers. We conducted a cross-sectional study and calculated odds ratios using multivariate logistic regression analysis in order to examine the association between shift work and metabolic syndrome. RESULTS: The prevalence of metabolic syndrome was 14.3% and 7.1% among male and female shift workers, respectively. After adjusting for confounding factors, shift work was associated with metabolic syndrome in female workers (odds ratio, 2.53; 95% confidence interval, 1.12 to 5.70). CONCLUSION: Shift work was associated with metabolic syndrome in young women. Timely efforts are necessary to manage metabolic syndrome in the workplace.

Association Between Serum 25-Hydroxyvitamin D Levels and Dry Eye in Korean Adults: A Study Based on Korean National Health and Nutrition Examination Survey, 2010-2011.

BACKGROUND: Dry eye is a common disease. Many patients continue to experience residual symptoms despite optimal treatment. Thus, new treatment options are required. The purpose of this study was to evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and dry eye. METHODS: This study was performed using data from the fifth Korean National Health and Nutrition Examination Survey, which is a cross-sectional study of the Korean population that was conducted from 2010 to 2011. We included adults aged >19 years who underwent ophthalmologic interviews and examinations. We excluded subjects who had comorbid conditions (rheumatoid arthritis, thyroid disease, chronic kidney disease, or depression) that are associated with dry eye. The subjects were divided into normal and dry eye groups. The dry eye group consisted of those who had clinically diagnosed dry eye syndrome or symptoms. Multiple logistic regression analysis was conducted to determine the association between serum 25(OH)D levels and dry eye. RESULTS: In the univariate model, the 25(OH)D levels were lower in the dry eye group than in the normal group (P=0.01). A significant association was found between severe vitamin D deficiency (<10 ng/mL) and dry eye (P=0.04). However, after multivariate adjustment, the statistical significance of the association disappeared (P-values= 0.49, vitamin D insufficiency; P=0.33, vitamin D deficiency; P=0.18, severe vitamin D deficiency). CONCLUSION: Severe vitamin D deficiency was associated with dry eye in an unadjusted model, but the association was not statistically significant after adjustment.

Metabolic Syndrome is Associated with Lower Plasma Levels of Desacyl Ghrelin and Total Ghrelin in Asymptomatic Middle-aged Korean Men.

BACKGROUND: Desacyl ghrelin is acylated by ghrelin O-acyltransferase (GOAT) and converted to acyl ghrelin. To date, little is known about the relationship among the levels of these two forms of ghrelin, GOAT level, and insulin resistance in Asian individuals. The purpose of this study was to determine the relationship between insulin resistance and the levels of plasma acyl ghrelin, desacyl ghrelin, and GOAT in asymptomatic middle-aged Korean men. METHODS: This cross-sectional study evaluated 78 asymptomatic middle-aged Korean men with metabolic syndrome (MS). We examined the correlation between the plasma levels of acyl ghrelin, desacyl ghrelin, and GOAT and sociodemographic, dietary, anthropometric, and metabolic parameters, as well as the association between insulin resistance and plasma levels of acyl ghrelin, desacyl ghrelin, and GOAT. RESULTS: The levels of desacyl ghrelin and total ghrelin were significantly lower in the MS group than in the non-MS group (P<0.017, P=0.01, respectively). HOMA-IR values showed a significant negative correlation with desacyl ghrelin (r=-0.271, P=0.017) and total ghrelin (r=-0.271, P=0.016) levels. Acyl ghrelin and GOAT were not significantly correlated with HOMA-IR, and no correlation was found between the plasma levels of the two ghrelin types and GOAT. CONCLUSION: The plasma levels of desacyl ghrelin and total ghrelin in middle-aged Korean men with MS were lower than in those without MS. A significant negative correlation was observed between desacyl ghrelin level and HOMA-IR; however, no correlation was found between plasma levels of acyl ghrelin and GOAT and HOMA-IR.

Prevalence of Reduced Kidney Function by Estimated Glomerular Filtration Rate Using an Equation Based on Creatinine and Cystatin C in Metabolic Syndrome and Its Components in Korean Adults.

BACKGROUND: It is known that metabolic syndrome (MetS) is associated with chronic kidney disease. We evaluated and compared the prevalence of reduced kidney function in MetS and its components by estimated glomerular filtration rate (eGFR) using an equation based on creatinine (eGFRcr), cystatin C (eGFRcys), and combined creatinine-cystatin C (eGFRcr-cys) in Korean adults. METHODS: We analyzed data from 3,649 adults who participated in a comprehensive health examination. RESULTS: Mean values of eGFRcys were higher compared with mean values of eGFRcr (96.1±18.2 mL/min/1.73 m² vs. 91.2±13.6 mL/min/1.73 m²) in total subjects. The prevalence of reduced kidney function increased with age (9.6% for eGFRcys vs. 5.8% for eGFRcr-cys vs. 4.9% for eGFRcr, in subjects aged ≥60 years), and significantly increased with MetS, abdominal obesity, hypertension, high triglyceride, low high density lipoprotein (HDL), and high insulin resistance. The prevalence of MetS, abdominal obesity, hypertension, high insulin resistance, low HDL, and hepatic steatosis was significantly increased in subjects with reduced kidney function. This increased prevalence and the odds ratio of reduced kidney function for prevalence of MetS was highest for eGFRcys, followed by those of eGFRcr-cys, and eGFRcr. CONCLUSION: The prevalence of reduced kidney function by eGFR was significantly increased in subjects with MetS and its related components. eGFRcys and eGFRcr-cys were superior to eGFRcr in detecting reduced kidney function.