Solitary osteolytic skull metastasis as the only recurrence of advanced gastric cancer: a case report and literature review.

Bone metastases from gastric cancer are very rare, and skull metastases develop in only 11.2% among patients who develop bone metastases from gastric cancer. We report a case of solitary osteolytic skull metastasis as the only recurrence of advanced gastric cancer. A 67-year-old man was referred to us with a two-month history of headache and progressive scalp swelling in the left parietal region. A right hemiparesis developed a week before admission. Thirteen months previously, he had undergone radical total gastrectomy with Roux-en-Y reconstruction. Pathological analysis indicated well-differentiated adenocarcinoma of the gastric cardia (stage IIIA: pT3N2M0). Brain magnetic resonance imaging showed a large skull metastasis in the left parietal region (approximately 65 × 54 mm). An extensive search did not reveal any other tumors. Gross total tumor resection was performed, and the biopsy revealed an adenocarcinoma, suggesting metastasis of the gastric cancer.

Identification of metabolic syndrome using phenotypes consisting of triglyceride levels with anthropometric indices in Korean adults.

BACKGROUND: The metabolic syndrome (MetS) has shown strong associations with the hypertriglyceridemic waist (HW) phenotype. The best anthropometric indicator of MetS remains controversial. Furthermore, no studies have investigated alternative indices that could replace waist circumference in the HW phenotype. The objectives of this study were to find the best indicator of MetS among anthropometric indices and to examine the predictive power of phenotypes consisting of triglyceride levels with anthropometric indices. METHODS: A total of 12,025 subjects participated in this retrospective cross-sectional study. All subjects were recruited between November 2016 and August 2007 from hospitals in 28 urban and rural regions in South Korea. The data analyzed in this study were obtained from the Korean Health and Genome Epidemiology Study database and the Korea Institute of Oriental Medicine. RESULTS: The proportion of patients with MetS ranged from 9 to 57% according to age and gender groups. Waist circumference (WC) was best indicator of MetS in men of all age groups. However, in women aged 40-49 years, the waist-to-height ratio (WHtR) was the best indicator of MetS. Rib circumference and chest circumference were the strongest indicators in women aged 50-59 years and 70-79 years, respectively. The combination of WC and triglyceride (TG) was the best indicator of MetS in men and women overall. However, interestingly, the best indicator was TG + WHtR in women aged 40-49 years and TG + forehead-to-waist ratio in women aged 70-79 years. CONCLUSIONS: The best indicator of MetS in terms of individual anthropometric indices and the various phenotypes combining a single anthropometric index with TG may differ subtly according to age group in women, but not in men. Our findings provide insight into a simple and inexpensive method that could be used to identify MetS in initial health screening efforts in epidemiology and public health.

Identification of five novel genetic loci related to facial morphology by genome-wide association studies.

BACKGROUND: Face morphology is strongly determined by genetic factors. However, only a small number of genes related to face morphology have been identified to date. Here, we performed a two-stage genome-wide association study (GWAS) of 85 face morphological traits in 7569 Koreans (5643 in the discovery set and 1926 in the replication set). RESULTS: In this study, we analyzed 85 facial traits, including facial angles. After discovery GWAS, 128 single nucleotide polymorphisms (SNPs) showing an association of P < 5 × 10- 6 were selected to determine the replication of the associations, and meta-analysis of discovery GWAS and the replication analysis resulted in five genome-wide significant loci. The OSR1-WDR35 [rs7567283, G allele, beta (se) = -0.536 (0.096), P = 2.75 × 10- 8] locus was associated with the facial frontal contour; the HOXD1-MTX2 [rs970797, A allele, beta (se) = 0.015 (0.003), P = 3.97 × 10- 9] and WDR27 [rs3736712, C allele, beta (se) = 0.293 (0.048), P = 8.44 × 10- 10] loci were associated with eye shape; and the SOX9 [rs2193054, C allele, beta (se) (ln-transformed) = -0.007 (0.001), P = 6.17 × 10- 17] and DHX35 [rs2206437, A allele, beta (se) = -0.283 (0.047), P = 1.61 × 10- 9] loci were associated with nose shape. WDR35 and SOX9 were related to known craniofacial malformations, i.e., cranioectodermal dysplasia 2 and campomelic dysplasia, respectively. In addition, we found three independent association signals in the SOX9 locus, and six known loci for nose size and shape were replicated in this study population. Interestingly, four SNPs within these five face morphology-related loci showed discrepancies in allele frequencies among ethnic groups. CONCLUSIONS: We identified five novel face morphology loci that were associated with facial frontal contour, nose shape, and eye shape. Our findings provide useful genetic information for the determination of face morphology.

Body composition and personality traits in so-Yang type males.

BACKGROUND: The purpose of the present study was to examine the body composition of So-Yang type males according to Sasang constitutional medicine, which is popular in Korea. Different Sasang constitutional types are associated with different muscle distributions, body shapes, and disease susceptibilities. We used the Sasang Personality Questionnaire (SPQ) as a measure of the temperament of each Sasang type. METHODS: In total, 953 subjects aged over 20 years were recruited in Korea. We collected anthropometric parameters and bioimpedence information from the subjects and administered the SPQ. A logistic regression was conducted to calculate propensity scores. RESULTS: The percentage of skeletal muscle mass in So-Yang (SY) and non-So-Yang (non-SY) males was 45.8 ± 2.7 and 44.2 ± 3.3, respectively, before matching and 45.8 ± 2.6 and 44.9 ± 3.0, respectively, after propensity score matching. The extracellular water (ECW)/intracellular water (ICW) and extracellular water (ECW)/total body water (TBW) ratios and SPQ scores were significantly different between the SY and non-SY types. CONCLUSIONS: This study suggested that the SY type may be significantly and independently associated with body composition and could be associated with personality.

Sasang constitutional types for the risk prediction of metabolic syndrome: a 14-year longitudinal prospective cohort study.

BACKGROUND: To examine whether the use of Sasang constitutional (SC) types, such as Tae-yang (TY), Tae-eum (TE), So-yang (SY), and So-eum (SE) types, increases the accuracy of risk prediction for metabolic syndrome. METHODS: From 2001 to 2014, 3529 individuals aged 40 to 69 years participated in a longitudinal prospective cohort. The Cox proportional hazard model was utilized to predict the risk of developing metabolic syndrome. RESULTS: During the 14 year follow-up, 1591 incident events of metabolic syndrome were observed. Individuals with TE type had higher body mass indexes and waist circumferences than individuals with SY and SE types. The risk of developing metabolic syndrome was the highest among individuals with the TE type, followed by the SY type and the SE type. When the prediction risk models for incident metabolic syndrome were compared, the area under the curve for the model using SC types was significantly increased to 0.8173. Significant predictors for incident metabolic syndrome were different according to the SC types. For individuals with the TE type, the significant predictors were age, sex, body mass index (BMI), education, smoking, drinking, fasting glucose level, high-density lipoprotein (HDL) cholesterol level, systolic and diastolic blood pressure, and triglyceride level. For Individuals with the SE type, the predictors were sex, smoking, fasting glucose, HDL cholesterol level, systolic and diastolic blood pressure, and triglyceride level, while the predictors in individuals with the SY type were age, sex, BMI, smoking, drinking, total cholesterol level, fasting glucose level, HDL cholesterol level, systolic and diastolic blood pressure, and triglyceride level. CONCLUSIONS: In this prospective cohort study among 3529 individuals, we observed that utilizing the SC types significantly increased the accuracy of the risk prediction for the development of metabolic syndrome.

Predictors of metabolic abnormalities in phenotypes that combined anthropometric indices and triglycerides.

BACKGROUND: The hypertriglyceridemic waist (HW) phenotype has been shown to be strongly associated with metabolic abnormalities; however, to date, no study has reported the prediction of metabolic abnormalities using the HW phenotype along with waist circumference (WC) and the triglyceride (TG) level or various phenotypes consisting of an individual anthropometric index combined with the TG level. The objectives of this study were to assess the association of the HW phenotype with metabolic abnormalities in Korean women and to evaluate the predictive powers of various phenotypes with regard to metabolic abnormalities. METHODS: Total cholesterol (TC), high- and low-density lipoprotein (HDL and LDL) cholesterol, and TG levels, systolic and diastolic blood pressures (SBP and DBP), and anthropometric indices were measured in 7661 women. The Naive Bayes algorithm and logistic regression were used to determine the predictive powers of the models using different phenotypes. RESULTS: The HW phenotype demonstrated the strongest association with all metabolic components. The best phenotypic predictors were the forehead-to-rib circumference ratio + TG for the HDL level, age + TG for the LDL level, age + TG for SBP, and rib circumference + TG and neck circumference + TG for DBP. The associations between TG and TC or HDL were higher compared with those between WC and TC or HDL, whereas the associations between WC and SBP or DBP were higher compared with those between TG and SBP or DBP. Age was strongly associated with hypercholesterolemia, the HDL and LDL cholesterol levels, and SBP and had good predictive power, but not with respect to DBP. CONCLUSIONS: We have determined that the HW phenotype is a useful indicator of metabolic abnormalities in Korean women; although HW had the strongest association with metabolic abnormalities, the best phenotype combination consisting of a single anthropometric index and the TG level may differ depending on the metabolic factors in question. Our findings provide insights into the detection of metabolic abnormalities in complementary and alternative medicine.

The obesity-risk variant of FTO is inversely related with the So-Eum constitutional type: genome-wide association and replication analyses.

BACKGROUND: Body constitutional types described in the traditional Korean medicine system, Sasang constitutional medicine, are heritable, as has been revealed by twin and family studies. Thus, individuals with the same constitution type usually have similar pathophysiological and psychological traits. In several recent genome-wide association (GWA) analyses performed to identify constitution-associated variants, the association signals were not replicated due to small sample size and dissimilar, non-objective methods for classification of the constitutional types. METHODS: We conducted GWA analysis and followed replication analysis in two large populations (5,490 subjects: 3,810 subjects at discovery stage and 1,680 subjects at replication stage) to identify the replicable constitution-associated variants, wherein subjects with the highest tertile of constitution probability values versus the reference with the lowest tertile of the values obtained from a recently developed constitution analysis tool were compared. RESULTS: We found that the obesity-risk variant in intron 1 of the fat mass and obesity-associated (FTO) gene was replicably inversely associated with the So-Eum (SE) type, characterized by reduced appetite, slim body, and cautious personality (rs7193144 in combined samples: odds ratio = 0.729, p = 1.47 × 10(-7)), and substantial association signal remained after controlling for body mass index (BMI). In contrast, the association of the variant with the Tae-Eum type, characterized by high body mass, disappeared after controlling BMI. CONCLUSIONS: In summary, the obesity-risk variant in FTO intron 1 was inversely associated with the SE type, independent of BMI, which corresponded well with the characteristics of the SE type, such as the lowest body mass and lowest susceptibility to metabolic disorders among the constitutional types. Therefore, the obesity-risk variant of FTO associated with body mass increase might be involved in the determination of body constitution type.

Non-alcoholic fatty liver disease among sasang constitutional types: a population-based study in Korea.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and is highly prevalent in populations with metabolic conditions such as obesity and type II diabetes. Specific types of Sasang constitution can act as a risk factor for metabolic diseases, but there are no studies addressing the association between the Sasang constitutional types (SCTs) and NAFLD. METHODS: A total of 1184 individuals (508 males, 676 females) that enrolled in the Korean Genome and Epidemiology Study were included in the present study. Classification of SCTs was done with an integrated diagnostic model. NAFLD was diagnosed when the liver attenuation index (LAI) value was <5 Hounsfield units using computed tomography. Relationships between the SCTs and NAFLD were analyzed using multiple logistic regressions. RESULTS: The average LAI was 13.3±6.0 in the So-eum (SE) type, 12.3±7.0 in the So-yang (SY) type, and 6.5±9.9 in the Tae-eum (TE) type. Prevalence of NAFLD was 4.7% in the SE type, 14.0% in the SY type, and 34% in the TE type. Even after adjusting for possible confounders, the SY and TE types continued to show a 3.90-fold (95% CI, 1.60-9.51; P=0.0028) and 3.36-fold (95% CI, 1.42-7.92; P=0.0057) increase in chance of having NAFLD, respectively, compared with the SE type. In the additional analysis including only non-obese subjects, the odds ratio of NAFLD was 3.27 (95% CI, 1.29-8.29; P=0.0126) in the SY type and 3.53 (95% CI, 1.30-9.58; P=0.0134) in the TE type compared with SE type. In the multivariate analysis to determine which parameter had an independent association with NAFLD, higher body mass index, alanine aminotransferase (ALT), triglyceride (TG), and low high-density lipoprotein cholesterol were independently associated with developing NAFLD in the SY type. In contrast, male sex, alcohol consumption, higher ALT, TG, and fasting glucose were risk factors for NAFLD in the TE type. CONCLUSIONS: These results indicated that the SY and TE types are independent risk factors for NAFLD.

Association of hypertension with physical factors of wrist pulse waves using a computational approach: a pilot study.

BACKGROUND: The objectives of this pilot study were to examine the association between hypertension and physical factors of wrist pulse waves to avoid subjective diagnoses in Traditional Chinese Medicine (TCM) and Traditional Korean Medicine (TKM). An additional objective was to assess the predictive power of individual and combined physical factors in order to identify the degree of agreement between diagnosis accuracies using physical factors and using a sphygmomanometer in the prediction of hypertension. METHODS: In total, 393 women aged 46 to 73 years participated in this study. Logistic regression (LR) and a naïve Bayes algorithm (NB) were used to assess statistically significant differences and the predictive power of hypertension, and a wrapper-based machine learning method was used to evaluate the predictive power of combinations of physical factors. RESULTS: In both wrists, L-PPI and R-PPI (maximum pulse amplitudes in the left Gwan and right Gwan) were the factors most strongly associated with hypertension after adjusting for age and body mass index (p = <0.001, odds ratio (OR) = 2.006 on the left and p = <0.001, OR = 2.504 on the right), and the best predictors (NB-AUC = 0.692, LR-AUC = 0.7 on the left and NB-AUC = 0.759, LR-AUC = 0.763 on the right). Analyses of both individual and combined physical factors revealed that the predictive power of the physical factors in the right wrist was higher than for the left wrist. The predictive powers of the combined physical factors were higher than those of the best single predictors in both the left and right wrists. CONCLUSION: We suggested new physical factors related to the sum of the area on the particular region of pulse waves in both wrists. L-PPI and R-PPI among all variables used in this study were good indicators of hypertension. Our findings support the quantification and objectification of pulse patterns and disease in TCM and TKM for complementary and alternative medicine.

Predicting visceral obesity based on facial characteristics.

BACKGROUND: Visceral obesity is associated with facial characteristics and chronic disease, but no studies on the best predictor of visceral obesity based on facial characteristics have been reported. The aims of the present study were to investigate the association of visceral obesity with facial characteristics, to determine the best predictor of normal waist and visceral obesity among these characteristics, and to compare the predictive power of individual and combined characteristics. METHODS: Cross-sectional data were obtained from 11347 adult Korean men and women ranging from 18 to 80 years old. We examined 15 facial characteristics to identify the strongest predictor of normal and viscerally obese subjects and assessed the predictive power of the combined characteristics. RESULTS: FD_94_194 (the distance between both inferior ear lobes) was the best indicator of the normal and viscerally obese subjects in the following groups: Men-18-50 (p ≤ 0.0001, OR = 4.610, AUC = 0.821), Men-50-80 (p ≤ 0.0001, OR = 2.624, AUC = 0.735), and Women-18-50 (p ≤ 0.0001, OR = 2.979, AUC = 0.76). In contrast, FD_43_143 (mandibular width) was the strongest predictor in Women-50-80 (p ≤ 0.0001, OR = 2.099, AUC = 0.679). In a comparison of the combined characteristics, the area under the receiver operating characteristic curve (AUC) and the kappa values of the 4 groups ranged from 0.826 to 0.702 and from 0.483 to 0.279, respectively. The model for Men-18-50 showed the strongest predictive values and the model for Women-51-80 had the lowest predictive value for both the individual and combined characteristics. CONCLUSIONS: In both men and women, the predictive power of the young and middle-age groups was better than that of the elderly groups for predicting normal waist and viscerally obese subjects for both the individual and combined characteristics. The predictive power appeared to increase slightly with the combined characteristics.

Genetic loci associated with changes in lipid levels leading to constitution-based discrepancy in Koreans.

BACKGROUND: Abnormal lipid concentrations are risk factors for atherosclerosis and cardiovascular disease. The pathological susceptibility to cardiovascular disease risks such as metabolic syndrome, diabetes mellitus, hypertension, insulin resistance, and so on differs between Sasang constitutional types. METHODS: We used multiple regression analyses to study the association between lipid-related traits and genetic variants from several genome-wide association studies according to Sasang constitutional types, considering that the Tae-Eum (TE) has predominant cardiovascular risk. RESULTS: By analyzing 26 variants of 20 loci in two Korean populations (8,597 subjects), we found that 12 and 5 variants, respectively, were replicably associated with lipid levels and dyslipidemia risk. By analyzing TE and non-TE type (each 2,664 subjects) populations classified on the basis of Sasang constitutional medicine, we found that the minor allele effects of three variants enriched in TE type had a harmful influence on lipid risk (near apolipoprotein A-V (APOA5)-APOA4-APOC3-APOA1 on increased triglyceride: p = 8.90 × 10(-11), in APOE-APOC1-APOC4 on increased low-density lipoprotein cholesterol: p = 1.63 × 10(-5), and near endothelial lipase gene on decreased high-density lipoprotein cholesterol: p = 4.28 × 10(-3)), whereas those of three variants (near angiopoietin-like 3 gene, APOA5-APOA4-APOC3-APOA1, and near lipoprotein lipase gene on triglyceride and high-density lipoprotein cholesterol) associated in non-TE type had neutral influences because of a compensating effect. CONCLUSIONS: These results implied that the minor allele effects of lipid-associated variants may predispose TE type subjects to high cardiovascular disease risk because of their genetic susceptibility to lipid-related disorders.

Constitution-specific features of perspiration and skin visco-elasticity in SCM.

BACKGROUND: Human skin properties have been used as an important diagnostic component in traditional medicine as they change with health conditions. Sasang constitutional medicine (SCM) puts emphasis on the recognition of the constitution-specific skin features prior to the diagnostic decision of health. In this work, in search of skin-characteristics effectively reflecting SCM features, we compared several skin properties such as perspiration, visco-elasticity, elasticity, and elasticity hysteresis, in several candidate body parts. METHODS: We conducted a clinical study in which a total of 111 healthy females aged 50 - 70 years participated with their Sasang constitution (SC) types determined objectively by the Sasang constitutional analytic tool. Perspiration on the skin surface was estimated by using a capacitance sensor to measure the amount of moisture on the palm, forehead, and philtrum before and after a heating stimulus. We acquired the visco-elasticity, elasticity, and elasticity hysteresis at the forearm by Dermalab's elasticity sensing device. An analysis of covariance (ANCOVA) was conducted to evaluate the effect of SC on the nine skin features acquired. RESULTS: The visco-elasticity of the forearm of the Soeum-in (SE) group was significantly lower than that of the Taeeum-in (TE) group (F = 68.867, p < 0.001), whereas the elasticity hysteresis of the SE group was higher than that of the TE group (F = 10.364, p < 0.01). The TE group had more perspiration on the forehead than the SE group (F = 9.050, p < 0.01). The SE group had a large perspiration difference between the philtrum and the forehead compared with the TE group (F = 7.892, p < 0.01). CONCLUSIONS: We found four significant skin features that reflect the inherent constitutional attributes of the TE and SE groups in accordance with SCM literature; the visco-elasticity, elasticity hysteresis, perspiration on the forehead and philtrum. Our findings are based on a novel interpretation of the SCM literature and will contribute to developing the constitutional health status evaluation system in SCM.

A practical approach to Sasang constitutional diagnosis using vocal features.

BACKGROUND: Sasang constitutional medicine (SCM) is a type of tailored medicine that divides human beings into four Sasang constitutional (SC) types. Diagnosis of SC types is crucial to proper treatment in SCM. Voice characteristics have been used as an essential clue for diagnosing SC types. In the past, many studies tried to extract quantitative vocal features to make diagnosis models; however, these studies were flawed by limited data collected from one or a few sites, long recording time, and low accuracy. We propose a practical diagnosis model having only a few variables, which decreases model complexity. This in turn, makes our model appropriate for clinical applications. METHODS: A total of 2,341 participants' voice recordings were used in making a SC classification model and to test the generalization ability of the model. Although the voice data consisted of five vowels and two repeated sentences per participant, we used only the sentence part for our study. A total of 21 features were extracted, and an advanced feature selection method-the least absolute shrinkage and selection operator (LASSO)-was applied to reduce the number of variables for classifier learning. A SC classification model was developed using multinomial logistic regression via LASSO. RESULTS: We compared the proposed classification model to the previous study, which used both sentences and five vowels from the same patient's group. The classification accuracies for the test set were 47.9% and 40.4% for male and female, respectively. Our result showed that the proposed method was superior to the previous study in that it required shorter voice recordings, is more applicable to practical use, and had better generalization performance. CONCLUSIONS: We proposed a practical SC classification method and showed that our model having fewer variables outperformed the model having many variables in the generalization test. We attempted to reduce the number of variables in two ways: 1) the initial number of candidate features was decreased by considering shorter voice recording, and 2) LASSO was introduced for reducing model complexity. The proposed method is suitable for an actual clinical environment. Moreover, we expect it to yield more stable results because of the model's simplicity.

Total nasal resistance among Sasang constitutional types: a population-based study in Korea.

BACKGROUND: There have been many attempts to find an objective phenotype by Sasang constitutional types (SCTs) on an anatomical, physiological, and psychological basis, but there has been no research on total nasal resistance (TNR) among SCTs. METHODS: We assessed the value of the TNR in the SCTs classified by an integrated diagnostic model. Included in the study were 1,346 individuals (701 males, 645 females) who participated in the Korean Genome and Epidemiology Study (KoGES). The TNR was measured by active anterior rhinomanometry (AAR) at transnasal pressures of 100 and 150 Pascal (Pa). RESULTS: The average TNR was 0.186 ± 0.004 Pa/cm3/second at 100 Pa in the Tae-eum (TE), 0.193 ± 0.007 in the So-eum (SE), and 0.208 ± 0.005 in the So-yang (SY) types. Under condition of 150 Pa the TE type had a TNR value of 0.217 ± 0.004, the SE type was 0.230 ± 0.008, and the SY type was 0.243 ± 0.005. Higher values of TNR were more likely to be reported in the SY type at 100 Pa and 150 Pa. In the stratified analysis by sex, the SY type in males and females tended to have higher TNR value than the TE and SE types at transnasal pressure of both 100 Pa and 150 Pa. CONCLUSIONS: These results provide new approaches to understand the functional characteristics among the SCTs in terms of nasal physiology. Further studies are required to clarify contributing factors for such a difference.

Extracts of Scutellaria baicalensis reduced body weight and blood triglyceride in db/db Mice.

Scutellaria baicalensis has been extensively employed for the clinical treatment of hyperlipidemia, atherosclerosis, hypertension, dysentery, inflammatory diseases, and the common cold. The present study was performed to investigate the anti-obesity and anti-dyslipidemia effect of Scutellaria baicalensis extracts (SBE) in type 2 diabetic db/db mice. Male db/db mice were divided into three groups (n = 5) and orally administrated vehicle (control), SBE 10, and 100 mg/kg body weight/day for 4 weeks everyday. Administration of SBE improves weight gain, hypertriglyceridemia, and hyperinsulinemia in db/db mice. In obese db/db mice, SBE treatment also reduced plasma alanine aminotransferase levels. In the livers of db/db mice, SBE promoted 5' AMP-activated protein kinase activity and restored metabolic process and insulin signaling pathways. Our data demonstrate that SBE exerts potent anti-obesity and anti-hypertriglyceride effects suggesting its useful potential function as adjuvant therapeutic agent for the treatment of weight gain and hypertriglyceridemia.

Genome-wide association of serum bilirubin levels in Korean population.

A large-scale, genome-wide association study was performed to identify genetic variations influencing serum bilirubin levels using 8841 Korean individuals. Significant associations were observed at UGT1A1 (rs11891311, P = 4.78 x 10(-148)) and SLCO1B3 (rs2417940, P = 1.03 x 10(-17)), which are two previously identified loci. The two single-nucleotide polymorphisms (SNPs) were replicated (rs11891311, P = 3.18 x 10(-15)) or marginally significant (rs2417940, P = 8.56 x 10(-4)) in an independent cohort of 1096 individuals. In a conditional analysis adjusted for the top UGT1A1 variant (rs11891311), another variant in UGT1A1 (rs4148323, P = 1.22 x 10(-121)) remained significant; this suggests that in UGT1A1 at least two independent genetic variations influence the bilirubin levels in the Korean population. The protein coding variant rs4148323, which is monomorphic in European-derived populations, may be specifically associated with serum bilirubin levels in Asians (P = 2.56 x 10(-70)). The SLCO1B3 variant (rs2417940, P = 1.67 x 10(-18)) remained significant in a conditional analysis for the top UGT1A1 variant. Interestingly, there were significant differences in the associated variations of SLCO1B3 between Koreans and European-derived populations. While the variant rs2417940 at intron 7 of SLCO1B3 was more significantly associated in Koreans, variants rs17680137 (P = 0.584) and rs2117032 (P = 2.76 x 10(-5)), two of the top-ranked SNPs in European-derived populations, did not reach the genome-wide significance level. Also, variants in SLCO1B1 did not reach genome-wide significance in Koreans. Our result supports the idea that there are considerable ethnic differences in genetic association of bilirubin levels between Koreans and European-derived populations.

A classification method of normal and overweight females based on facial features for automated medical applications.

Obesity and overweight have become serious public health problems worldwide. Obesity and abdominal obesity are associated with type 2 diabetes, cardiovascular diseases, and metabolic syndrome. In this paper, we first suggest a method of predicting normal and overweight females according to body mass index (BMI) based on facial features. A total of 688 subjects participated in this study. We obtained the area under the ROC curve (AUC) value of 0.861 and kappa value of 0.521 in Female: 21-40 (females aged 21-40 years) group, and AUC value of 0.76 and kappa value of 0.401 in Female: 41-60 (females aged 41-60 years) group. In two groups, we found many features showing statistical differences between normal and overweight subjects by using an independent two-sample t-test. We demonstrated that it is possible to predict BMI status using facial characteristics. Our results provide useful information for studies of obesity and facial characteristics, and may provide useful clues in the development of applications for alternative diagnosis of obesity in remote healthcare.

A new method of diagnosing constitutional types based on vocal and facial features for personalized medicine.

The aim of the present study is to develop an accurate constitution diagnostic method based solely on the individual's physical characteristics, irrespective of psychologic traits, characteristics of clinical medicine, and genetic factors. In this paper, we suggest a novel method for diagnosing constitutional types using only speech and face characteristics. Based on 514 subjects, the area under the receiver operating characteristics curve (AUC) values of classification models in age and gender groups ranged from 0.64 to 0.89. We identified significant features showing statistical differences among three constitutional types by performing statistical analysis. Also, we selected a compact and discriminative feature subset for constitution diagnosis in each age and gender group. Our method may support the direction of improved diagnosis prediction and will serve to develop a personal and automatic constitution diagnosis software for improvement of the effectiveness of prescribed medications and development of personalized medicine.

Prevalence of Metabolic Syndrome according to Sasang Constitutional Medicine in Korean Subjects.

Metabolic syndrome (MS) is a complex disorder defined by a cluster of abdominal obesity, atherogenic dyslipidemia, hyperglycemia, and hypertension; the condition is recognized as a risk factor for diabetes and cardiovascular disease. This study assessed the effects of the Sasang constitution group (SCG) on the risk of MS in Korean subjects. We have analyzed 1,617 outpatients of Korean oriental medicine hospitals who were classified into three SCGs, So-Yang, So-Eum, and Tae-Eum. Significant differences were noted in the prevalence of MS and the frequencies of all MS risk factors among the three SCGs. The odds ratios for MS as determined via multiple logistic regression analysis were 2.004 for So-Yang and 4.521 for Tae-Eum compared with So-Eum. These results indicate that SCG may function as a significant risk factor of MS; comprehensive knowledge of Sasang constitutional medicine may prove helpful in predicting susceptibility and developing preventive care techniques for MS.

Association of the Apolipoprotein A5 Gene -1131T>C Polymorphism with Serum Lipids in Korean Subjects: Impact of Sasang Constitution.

Apolipoprotein A5 (APOA5) was identified as a strong modulator of serum lipids. Moreover, an APOA5 gene -1131T>C polymorphism has been associated with serum lipids, but the results are inconsistent according to ethnic and racial groups. We have genotyped and analyzed 1,619 outpatients of Korean oriental medicine hospitals who were classified into three Sasang constitution groups (SCGs), So-Yang (SY), So-Eum (SE), and Tae-Eum (TE). There were no significant difference in the distribution of the APOA5 -1131T>C genotype among the three SCGs. Subjects with the C allele in SY and TE showed significantly lower serum high-density lipoprotein cholesterol (HDL-C) and higher triglyceride (TG) levels than noncarriers of the C allele. These results show the differences in the prevalence of decreasing serum HDL-C and elevating serum TG levels along with APOA5 -1131T>C polymorphism according to SCG and suggest that SCG may act as a significant risk factor for hypo-HDL-C-emia and hypertriglyceridemia susceptibility.