Association between Irritable Bowel Syndrome and Risk of Osteoporosis in Korean Premenopausal Women.

OBJECTIVE: The objective of this study is to evaluate irritable bowel syndrome (IBS) as a risk factor for osteoporosis and osteoporotic fracture in Korean women after controlling for basic confounding factors and considering detailed demographic and clinical information. SUBJECTS AND METHODS: We performed a nationwide population-based retrospective cohort analysis and matched every IBS case with a non-IBS case at a 1:4 frequency ratio based on age. The population consisted of female patients with data in the Health Insurance Review and Assessment (HIRA) database from 2002 to 2010. To determine the risk of osteoporosis and osteoporotic fracture in IBS and non-IBS patients, hazard ratios (HRs) with 95% confidence intervals (CI) were estimated using Cox proportional hazards regression models, adjusting for confounding variables, such as the area of residence, health insurance type, and economic status. RESULTS: We identified 1,017,468 patients in the HIRA database with data from 2002 to 2010 who could potentially be included in the cohort. Among these, we identified 1,545 (11.4%) women (age >19 years) with newly diagnosed IBS (IBS group). Additionally, 6,180 patients without IBS and age-matched to the IBS group were selected. Cox modeling revealed that the crude HRs for osteoporosis and osteoporotic fractures in patients with IBS were 1.476 (95% CI, 1.241-1.754) and 1.427 (95% CI, 1.086-1.876), respectively. CONCLUSION: Our data showed an increased incidence of osteoporosis and osteoporotic fractures in women with IBS compared with age-matched controls.

The relationship between the level of serum 25-hydroxyvitamin D and renal function in patients without chronic kidney disease: a cross-sectional study.

OBJECTIVES: Low level of vitamin D has been suggested as a risk factor for chronic kidney disease (CKD). However, little is known about the effect of vitamin D on renal function in healthy subjects. Our aim was to investigate the question of whether vitamin D status is associated with renal function in subjects without CKD. METHODS: In this cross-sectional study, 1,648 subjects aged older than 20 years were recruited as study participants. Subjects diagnosed with either CKD or other conditions that could influence serum vitamin D were excluded. Estimated glomerular filtration rate (eGFR) from serum creatinine (sCr) was used for the determination of renal function. Vitamin D status was determined by the measurement of serum 25-hydroxyvitamin D [25(OH)D] levels. RESULTS: In men, 25(OH)D showed significant positive correlation with age (r = 0.127, P < .001), skeletal muscle mass (r = 0.077, P = .017), sCr (r = 0.128, P < .001), and negative correlation with body fat (r = -0.065, P = .044), eGFR (r = -0.152, P < .001). In women, 25(OH)D showed negative correlation with eGFR (r = -0.085, P = .026), but not with age and body composition. In multiple linear regression analysis, 25(OH)D (ß = 0.114, P < .001), total muscle mass (ß = 0.202, P = .026), and age (ß = 0.117, P = .003) were an independent determinant of sCr in men; in women, 25(OH)D (ß = 0.086, P = .023), total muscle mass (ß = 0.152, P < .001) were variables showing significant association with sCr. CONCLUSIONS: Higher level of 25(OH)D is independently associated with sCr elevation. We suggest that a positive correlation between 25(OH)D and muscle mass could be attributed to sCr. It is thought to be another mechanism of serum 25(OH)D level in renal function in populations without CKD.

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.

Eradication of Helicobacter pylori increases ghrelin mRNA expression in the gastric mucosa.

It has been suggested that Helicobacter pylori eradication may influence production of some peptides in the stomach, which can affect appetite. This hypothesis is controversial. To verify the hypothesis, we conducted this randomized controlled trial using H. pylori infected subjects without any gastrointestinal symptoms. The treatment group received triple H. pylori eradication therapy for 7 days and the control group received no medication. We measured ghrelin, obestatin and the tumor necrosis factor-alpha (TNF-alpha) mRNA levels in endoscopic biopsy specimens and the changes from baseline to follow-up. The plasma active n-octanoyl ghrelin and obestatin levels were measured in both groups. The ghrelin/obestatin ratios in plasma and gastric mRNA expression were calculated at baseline and follow-up. Ghrelin mRNA expression in the fundic mucosa after H. pylori eradication increased significantly compared to the control group (4.47+/-2.14 vs. 1.79+/-0.96, P=0.009), independent of inflammatory changes. However, obestatin mRNA expression decreased in the antral mucosa (-0.57+/-1.06 vs. 0.41+/-0.72, P=0.028). The treatment group showed a marginal increase (P=0.060) in plasma ghrelin/obestatin ratio. The TNF-alpha mRNA expression also decreased significantly with treatment. This randomized controlled trial demonstrates that H. pylori eradication increases ghrelin mRNA expression, independent of inflammatory cell changes.

Metabolic syndrome and arterial pulse wave velocity.

OBJECTIVE: The metabolic syndrome is associated with increased risk of cardiovascular disease. It is important to examine the relation of the metabolic syndrome with the early stages of atherosclerosis. We sought to determine the impact of the metabolic syndrome, defined with International Diabetes Federation criteria, on arterial pulse wave velocity. METHODS AND RESULTS: Four hundred fifty-eight Korean adults (aged 26-77 years) were recruited into this cross-sectional study. Subjects were not taking any drugs other than antihypertensive or antidiabetic medication. All subjects were examined for body mass index, blood pressure, lipid profile, hs-CRP, uric acid, cystatin C, fasting glucose, and brachial-ankle pulse wave velocity. The prevalence of the metabolic syndrome by International Diabetes Federation definition was 20.7%. A positive correlation was observed between blood pressure, total cholesterol, triglycerides, uric acid, cystatin C, waist circumference, fasting glucose, and the brachial-ankle pulse wave velocity (P < 0.05). Subjects with metabolic syndrome had significantly higher arterial pulse wave velocity than subjects without metabolic syndrome. Multivariate logistic regression analysis adjusted for sex, age, and current smoking status showed that metabolic syndrome was associated with increased risk of high arterial pulse wave velocity (odds ratio: 3.31) (P < 0.05). CONCLUSIONS: Metabolic syndrome is associated with arterial stiffness by arterial pulse wave velocity. Monitoring of arterial pulse wave velocity in patients with metabolic syndrome may be helpful in identifying persons at high risk for subclinical atherosclerosis.

An association between colonic adenoma and abdominal obesity: a cross-sectional study.

BACKGROUND: Colorectal adenoma is a precursor lesion of colorectal cancer and thus, it is an important target for preventing colorectal cancer. Only a few studies suggest an association between colorectal adenoma and obesity, but results show considerable heterogeneity. In this study, we investigated the association between colorectal adenoma and waist circumference. METHODS: 165 adenoma cases and 365 polyp-free controls with a normal colon were compared in this cross-sectional study. Subjects underwent screening colonoscopy by experienced endoscopists. Demographic data, including smoking habit, were obtained by interview and waist circumference and anthropometric measurements were examined. Dietary intakes were evaluated using a food frequency questionnaire, and abdominal obesity was evaluated by measuring waist circumference. Statistical analysis was performed using SPSS for 13.0. RESULTS: Age, waist circumference, and BMI were significantly higher in cases than controls. And smokers and men were more prevalent among cases than controls.Among the abdominal obese subjects, 45.6% had 1 or more adenoma, and 9.0% of these had advanced adenoma, whereas among subjects with a normal waist circumference, only 25.7% had 1 or more adenomas. The prevalence of adenoma was higher among abdominal obese group (P < 0.05). Logistic regression analysis showed that abdominal obesity was associated with an increased risk of colorectal adenoma (OR, 2.74; 95% CI, 1.66~4.51 in men, OR, 2.58; 95% CI, 1.08~6.12 in women). These associations persisted even after adjusting for BMI. While BMI was found to be weekly associated with the risk of adenoma among men at the highest BMI levels. However, BMI was not associated with the risk for adenoma after adjusting for waist circumference. CONCLUSION: Our data suggest that abdominal obesity is associated with an increased risk of colorectal adenoma.

Effects of exercise-induced weight loss on acylated and unacylated ghrelin in overweight children.

OBJECTIVE: Controversial data on ghrelin concentration during exercise in human subjects have been published. We tested the hypothesis that exercise could affect acylated ghrelin (AG) and unacylated ghrelin (UAG), which could partly explain the previously reported inconsistent findings on the association of exercise with changes in ghrelin. DESIGN: A prospective randomized study. PATIENTS AND MEASUREMENTS: We randomized 17 overweight volunteers (11-year-old boys) to a 12-week combined exercise group (EG, n = 8) or control group (CG, n = 9). At baseline, 1, 4 and 12 weeks, we measured body weight and composition, insulin, leptin, total ghrelin and acylated ghrelin. RESULTS: Compared with the CG, body weight, percentage body fat and homeostatic model assessment (HOMA) indices were significantly lower throughout the 12 weeks in the EG. Total ghrelin and UAG levels gradually increased to 131.9 +/- 5.2% and 130.4 +/- 5.2% of baseline, respectively, at week 12 in the EG, whereas AG concentration remained unchanged throughout the 12 weeks both within each group and between the groups. At week 12, there were differences in the total ghrelin level and UAG level between the groups. CONCLUSIONS: This study shows an increase in unacylated acylated ghrelin and unchanged acylated ghrelin after a 12-week combined exercise programme in overweight children. These findings provide evidence of favourable effects of exercise on improving energy metabolism.

n-3 Polyunsaturated fatty acids and trans fatty acids in patients with the metabolic syndrome: a case-control study in Korea.

n-3 and Trans fatty acids are considered to be the important modifiable factors of the metabolic syndrome. The purpose of this study was to test the hypothesis that lower Omega-3 fatty acids and/or higher trans fatty acids of erythrocytes (RBC) are associated with the risk of the metabolic syndrome. Forty-four patients with the metabolic syndrome, defined by three or more risk factors of the modified Adult Treatment Panel III criteria, and eighty-eight age- and sex-matched controls with less than three risk factors were recruited for the study. The mean age was 54.5 (sem 0.8) years and 45 % of subjects were female. Trans fatty acids of RBC were higher in patients than controls (0.82 (sem 0.04) v. 0.73 (sem 0.03) %; P = 0.043), while their Omega-3 indexes, the sum of EPA and DHA in RBC, did not significantly differ (11.78 (sem 0.04) v. 12.39 (sem 0.02) %). Multivariable-adjusted regression analysis showed positive association between trans fatty acid and risk of the metabolic syndrome (OR 7.13; 95 % CI 1.53, 33.27; P = 0.013). Fasting serum insulin (7.9 (sem 0.7) v. 4.9 (sem 0.3) muU/ml; P < 0.001) and high sensitivity C-reactive protein (18 (sem 3) v. 11 (sem 17) mg/l; P = 0.042) were also higher in patients than controls. There were significant positive relationships between trans fatty acids and waist circumference, and between trans fatty acids and BMI. The results suggested that RBC trans fatty acids might be a predictor of increased risk for the metabolic syndrome, but n-3 fatty acids were not in this population.

Waist circumference, dual-energy X-ray absortiometrically measured abdominal adiposity, and computed tomographically derived intra-abdominal fat area on detecting metabolic risk factors in obese women.

OBJECTIVES: We investigated which abdominal adiposity measurements, waist circumference (WC), dual-energy X-ray absorptiometry (DXA)-measured abdominal fat, and computed tomography (CT)-derived intra-abdominal fat areas (IAF), were the most predictive in identifying metabolic risk factors. METHODS: Ninety-five Korean women (body mass index 27.5 +/- 3.2 kg/m(2), WC 90.2 +/- 6.8 cm, age 42 +/- 10.6 y) with abdominal obesity (WC > or = 80 cm) were examined in this study. Abdominal adiposity was assessed using DXA (absolute values and percentages of trunk and android fat, trunk-to-leg fat ratio, and android-to-gynoid fat ratio) and CT (IAF and ratio of IAF to subcutaneous abdominal fat [SAF]). Metabolic indicators were blood pressure, high-density lipoprotein cholesterol, triacylglycerol, fasting glucose, insulin, and high-sensitivity C-reactive protein. Metabolic syndrome (MS) was defined as the presence of at least two of the following: triacylglycerol level > or = 150 mg/dL, high-density lipoprotein cholesterol level <50 mg/dL, blood pressure > or = 130/85 mmHg, and/or fasting glucose level > or = 100 mg/dL. RESULTS: The correlations between adiposity measurements and metabolic indicators were stronger in premenopausal compared with postmenopausal women. Areas under the curve for MS and all abdominal adiposity measurements (WC, DXA-measured abdominal fat, and CT-derived IAF) were significant. Areas under the curve were not significantly different among measurements. The sensitivity and specificity at the threshold value of each abdominal adiposity measurement to predict MS were 38-93% and 34-96%, respectively. Women with 1 SD higher abdominal adiposity were 1.6-3.4 times more likely to have MS. CONCLUSION: No single abdominal adiposity measurement, i.e., WC, DXA-measured abdominal fat, and CT-assessed IAF, was a stronger predictor of metabolic risk factors than the other.

Evaluation of plasma leptin levels & BMI as predictor of postpartum weight retention.

BACKGROUND & OBJECTIVE: Plasma leptin level during pregnancy has been reported as a biochemical predictor of postpartum weight retention. The objective of this study was to determine the relationship between pregnancy-related factors including plasma leptin and postpartum weight retention in Korean women. METHODS: A convenience sampling method was used among women attending a high-risk pregnancy clinic in Pusan National University Hospital, Busan, between March 2002 and February 2003. We investigated 75 women during pregnancy and 6 months postpartum. Plasma leptin levels were measured using an ELISA. The weight gain during pregnancy and postpartum weight retention, and the correlation between the plasma leptin levels and body weight were evaluated. RESULTS: The plasma leptin levels at the 1(st) trimester and body weight at 24 wk of gestation, 6 wk, and 6 months postpartum differed significantly between the underweight and overweight groups and between the normal and overweight groups. Plasma leptin levels during the first trimester correlated with the initial BMI at first visit and term, and body weight at term, while the initial BMI significantly correlated with the body weight at term, 6 months postpartum, and 6 months postpartum. INTERPRETATION & CONCLUSION: Our findings suggest that the plasma leptin level in the first trimester is a predictor of maternal weight at term, while initial BMI is a better predictor of maternal weight at 6 wk and 6 months postpartum. Further, postpartum weight retention was more dependent on first pre-natal visit factors rather than weight changes during pregnancy. Anthropometric measures at first pre-natal visit to prevent postpartum obesity can be recommended.

Health behaviors of Korean adults with hepatitis B: Findings of the 2016 Korean National Health and Nutrition Examination Survey.

AIM: To assess the frequencies of five health-related behaviors (smoking, alcohol consumption, body weight, sleep duration, and physical activity) in Korean adults with chronic hepatitis B. METHODS: Data were obtained from the 2016 Korean National Health and Nutrition Examination Survey. In total, 5887 subjects (2568 males, 3319 females) over 19 years old were enrolled in this study. Interviews were performed to obtain information on demographic characteristics and medical conditions. A selfadministered questionnaire and medical examination were used to assess the smoking history, alcohol use, physical activity, sleep duration, and body weight of the subjects. Chronic hepatitis B was diagnosed based on detection of hepatitis B surface antigen (HBsAg). The subjects were categorized into HBsAg positive and negative groups, and a complex sampling analysis was conducted to compare the health behaviors between these groups. RESULTS: Among males, the current smoking rate in the HBsAg positive group was higher than that in the negative group (45.5% vs 38.5%). In the positive group, the rates of monthly and high-risk alcohol use were 70.4% and 17.6% in males and 45.9% and 3.8% in females, respectively. The rate of alcohol use was similar between the two groups [P = 0.455 (males) and P = 0.476 (females)]. In the HBsAg positive group, 32.3% and 49.9% of males and 26.5% and 49.6% of females were overweight and physically inactive, respectively. High-risk alcohol consumption and physical inactivity were significantly associated with self-perceived health status. CONCLUSION: Our data demonstrate that a large proportion of Korean adults with chronic hepatitis B have poor health behaviors. Further studies are needed to confirm our results.

Association of Handgrip Strength with Dietary Intake in the Korean Population: Findings Based on the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-1), 2016.

To evaluate associations between handgrip strength (HGS) and dietary nutrients, this study of a representative Korean population of 1553 adults aged ≥60 years (706 men and 847 women) analyzed data from the Korea National Health and Nutrition Examination Survey (2016). HGS was measured in both hands three times using a digital grip strength dynamometer. Dietary intake data were collected by the 24-h recall method through computer-assisted personal interviews. The study population had a mean age of 70.1 years, body mass index (BMI) of 24.2 kg/m², and HGS of 35.7 kg in men, 21.2 kg in women. Total energy (r = 0.411), protein (r = 0.217), polyunsaturated fatty acid (PUFA) (r = 0.269), fiber (r = 0.272), and vitamin C (r = 0.098) were positively correlated with HGS. In multivariable regression analysis, PUFA (ß = 0.083) and vitamin C (ß = 0.003) were positively associated with HGS among women. Fiber (ß = 0.071) and vitamin C (ß = 0.006) showed a positive association with HGS among men. Community-dwelling older men and women with higher levels of PUFA, fiber, and vitamin C in their diet were more likely to have greater HGS even after adjusting for age, total calorie intake, BMI, chronic diseases and health-related habits.

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.

Serum 25-hydroxyvitamin D levels and testosterone deficiency in middle-aged Korean men: a cross-sectional study.

Previous studies have demonstrated that male hypogonadism is associated with a low level of vitamin D. However, no reports have investigated the effects of vitamin D on testosterone levels in Korean men. Our aim was to investigate whether testosterone levels are associated with serum vitamin D levels and whether seasonal variation exists. This cross-sectional study analyzed serum 25-hydroxyvitamin D [25(OH)D], total testosterone (TT), and free testosterone (FT) in 652 Korean men over 40 years of age who had undergone a comprehensive medical examination. The average age of the subjects was 56.7 ± 7.9 years, and the mean serum 25(OH)D, TT and FT levels were 21.23 ± 7.9 ng ml-1 , 4.70 ± 1.6 ng ml-1 , and 8.12 ± 3.3 pg ml-1 , respectively. In the multiple linear regression model, 25(OH)D showed positive association with TT (ß =0.137, P< 0.001) and FT (ß =0.103, P= 0.008). 25(OH)D and FT showed similar seasonal or monthly variation after adjustment for age. A vitamin D deficiency [25(OH)D < 20 ng ml-1 ] was associated with an increased risk of deficiencies of TT (<2.30 ng ml-1 ) (odds ratio [OR]: 2.65; 95% confidence interval [CI]: 1.21-5.78, P= 0.014) and FT (<6.50 pg ml-1 ) (OR: 1.44; 95% CI: 1.01-2.06 P= 0.048) after adjusting for age, season, body mass index, body composition, chronic disease, smoking, and alcohol use. In conclusion, we demonstrated a positive correlation between 25(OH)D and testosterone, which showed similar seasonal variation in Korean men.

Changes in plasma ghrelin concentration immediately after gastrectomy in patients with early gastric cancer.

Although the majority of circulating ghrelin originates from the stomach, no prospective study of the proportion of ghrelin derived from the stomach has been reported. Patients with early gastric cancer who underwent gastric resection were divided into three groups according to the extent and site of gastric resection: subtotal gastrectomy group (n = 24), proximal gastrectomy group (n = 4), and total gastrectomy group (n = 12). Patients with advanced gastric cancer who underwent gastrojejunostomy without gastrectomy served as the bypass group (n = 5). Blood samples were collected from all patients preoperatively, at 1 h after gastric resection or gastrojejunostomy, and on postoperative d 1, 3, and 7. The plasma ghrelin level was determined in all samples and expressed as a percentage of the preoperative level. In the bypass group, no significant drop in the ghrelin level was observed at 1 h after gastrojejunostomy, and the ghrelin level remained stable through postoperative d 7. In the subtotal gastrectomy group, the ghrelin concentration reached a nadir of 38.8 +/- 12.9% of preoperative levels at 1 h after gastric resection and then gradually increased to 88.1 +/- 13.2% by postoperative d 7. In the proximal gastrectomy group, the nadir ghrelin level was 24.5 +/- 15.4% at 1 h after gastric resection and was followed by a gradual recovery. However, the recovery rate was slower than that in the subtotal gastrectomy group, with the ghrelin level reaching only 47.6 +/- 18.8% by postoperative d 7 (P < 0.05). In the total gastrectomy group, the nadir ghrelin level was 28.6 +/- 11.1% at 1 h after gastric resection and remained at 30.0 +/- 13.2% until postoperative d 7. These results suggest that compensatory ghrelin production can occur in the remnant stomach after the surgical removal of part of the stomach and that the proximal fundus is more important than the distal antrum and body in terms of the capacity for ghrelin production. The principal site of ghrelin production is clearly the stomach, which contributes 70% of the circulating ghrelin concentration.

Perspectives on Medical Services Integration among Conventional Western, Traditional Korean, and Dual-Licensed Medical Doctors in Korea.

The aim of this study was to examine the perspectives on the options for the integration of western and traditional Korean medical services among three types of medical doctors with different disciplines in Korea. We surveyed and analyzed responses from 167 conventional Western medicine (WM), 135 traditional Korean medicine (KM), and 103 dual-licensed (DL) doctors who can practice both. All three kinds of doctors shared similar attitude toward license unitarization. KM doctors most strongly agreed on the need of the cooperative practice (CP) between KM and WM and on the possibility of license unitarization among three groups. DL doctors believed that CP is currently impracticable and copractice is more efficient than CP. WM doctors presented the lowest agreement on the need of CP and showed lower expectation for DL doctors as mediators between WM and KM than others. This study showed the difference of perspectives on the options for the integrative medical services among three different doctor groups in Korea. More studies are required to explore the underlying reasons for these discrepancies among WM, KM, and DL doctors.

Pyogenic liver abscess following acupuncture and moxibustion treatment.

Acupuncture treatment is generally regarded as a relatively safe procedure. However, most procedures have some complications and acupuncture treatment is no exception. Reported complications of acupuncture treatment were mostly mild or temporary symptoms, but certain severe adverse effects were also observed. We report here for the first time a case of liver abscess following acupuncture and moxibustion treatment.

A case of incidentally discovered subclinical cushing syndrome in a patient with chronic fatigue and anxiety.

Subclinical Cushing syndrome (SCS) is a hypothalamic-pituitary-adrenal axis abnormality characterized by autonomous cortisol secretion in patients with no typical signs or symptoms of Cushing syndrome. SCS patients may have adverse metabolic and cardiovascular effects due to slight, but continuous glucocorticoid secretion. Glucocorticoids also affect behavior, mood, neural activity, and a number of specific biochemical processes in the central nervous system. Here, we report a case of SCS due to an adrenal incidentaloma in a hypertensive diabetic patient who presented with chronic fatigue and anxiety that disappeared after the removal of the adrenal adenoma.

Association of chronic viral hepatitis B with insulin resistance.

AIM: To investigate the relationship between chronic viral hepatitis B (CVHB) and insulin resistance (IR) in Korean adults. METHODS: A total of 7880 adults (3851 men, 4029 women) who underwent a comprehensive medical examination were enrolled in this study. Subjects diagnosed with either diabetes mellitus, or any other disorder that could influence their insulin sensitivity, were rejected. Anthropometry, metabolic risk factors, hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, fasting plasma glucose and insulin were measured for all subjects. Homeostasis model assessment (HOMA), quantitative insulin check index (QUICKI), and Mf(fm) index were used for determining insulin sensitivity. Each participant was categorized into a negative, recovery, or CVHB group. To compare variables between groups, a t-test and/or one-way analysis of variance were used. Partial correlation coefficients were computed to present the association between insulin resistance and other variables. Multiple logistic regression analysis was used to assess the independent association between CVHB and IR. RESULTS: The mean age of men and women were 48.9 and 48.6 years, respectively. Subjects in the CVHB group had significantly higher waist circumference [(86.0 ± 7.7 cm vs 87.3 ± 7.8 cm, P = 0.004 in men), (78.3 ± 8.6 cm vs 80.5 ± 8.5 cm, P < 0.001 in women)], cystatin C [(0.96 ± 0.15 mg/dL vs 1.02 ± 0.22 mg/dL, P < 0.001 in men), (0.84 ± 0.15 mg/dL vs 0.90 ± 0.16 mg/dL, P < 0.001 in women)], fasting insulin [(5.47 ± 3.38 µU/mL vs 6.12 ± 4.62 µU/mL, P < 0.001 in men), (4.57 ± 2.82 µU/mL vs 5.06 ± 3.10 µU/mL, P < 0.001 in women)] and HOMA index [(1.24 ± 0.86 vs 1.43 ± 1.24, P < 0.001 in men), (1.02 ± 0.76 vs 1.13 ± 0.87, P = 0.033 in women)] compared to control group. The HOMA index revealed a positive correlation with body mass index (BMI) (r = 0.378, P < 0.001), waist circumference (r =0.356, P < 0.001), percent body fat (r = 0.296, P < 0.001), systolic blood pressure (r = 0.202, P < 0.001), total cholesterol (r = 0.134, P < 0.001), triglycerides (r = 0.292, P < 0.001), cystatin C (r = 0.069, P < 0.001) and uric acid (r = 0.142, P < 0.001). The QUICKI index revealed a negative correlation with BMI (r = -0.254, P < 0.001), waist circumference (r = 0-0.243, P < 0.001), percent body fat (r = -0.217, P < 0.001), systolic blood pressure (r = -0.132, P < 0.001), total cholesterol (r = -0.106, P < 0.001), triglycerides (r = -0.205, P < 0.001), cystatin C (r = -0.044, P < 0.001) and uric acid (r = -0.096, P < 0.001). For subjects identified with IR, the odds ratio of an accompanying diagnosis of chronic hepatitis B was 1.534 (95% CI: 1.158-2.031, HOMA index criteria) or 1.566 (95% CI: 1.124-2.182, QUICKI criteria) after adjustment for age, gender, BMI, and amount of alcohol consumption. CONCLUSION: Our study demonstrates that CVHB is associated with IR. CVHB may need to be monitored for occurrence of IR and diabetes mellitus.