Pectobacterium jejuense sp. nov. Isolated from Cucumber Stem Tissue.

A single Pectobacterium-like strain named 13-115T was isolated from a specimen of diseased cucumber stem tissue collected on Jeju Island, South Korea. The strain presented a rod-like shape and was negative for Gram staining. When grown on R2A medium at 25 °C, strain 13-115T formed round, convex and white colonies. This strain showed growth at temperatures ranging from 10 to 30 °C and tolerated a pH range of 6-9. The strain could also tolerate NaCl concentrations up to 5%. Analysis of the 16S rRNA gene sequence revealed that strain 13-115T exhibited similarity of over 99% with Pectobacterium brasiliense, P. carotovorum, P. polaris, and P. parvum. By conducting multilocus sequence analyses using dnaX, leuS, and recA genes, a separate phylogenetic lineage was discovered between strain 13-115T and other members of the genus Pectobacterium. Moreover, the strain showed relatively low in silico DNA-DNA hybridization (<60.6%) and average nucleotide identity (ANI) (<94.9%) values with recognized Pectobacterium species. The isolate has a genome size of 5,069,478 bp and a genomic G + C content of 52.04 mol%. Major fatty acids identified in the strain included C16:0 (28.99%), summed feature 3 (C16:1 ω7c and/or C16:1 ω6c; 28.85%), and C18:1 ω7c (19.01%). Pathogenicity assay confirmed that the novel strain induced soft rot symptoms in cucumber plants and Koch's postulates were fulfilled. Molecular analysis and phenotypic data indicated that strain 13-115T could be classified as a new species within the Pectobacterium genus, which has been named Pectobacterium jejuense. The type strain is 13-115T (= KCTC 92800T = JCM 35940T).

Pedobacter segetis sp. nov., a Novel Bacterium Isolated from Soil.

A Gram-negative, motile by gliding, rod-shaped, aerobic bacterium, designated SD-bT, was isolated from a soil sample collected on Dokdo Island, South Korea. A polyphasic approach based on phenotypic, phylogenetic, and genomic analyses was used to characterize the new isolate. Phylogenetic analysis of 16S rRNA gene sequence showed that strain SD-bT belonged to the family Sphingobacteriaceae and most closely related to Pedobacter psychrophilus P4487AT (95.9% similarity). The isolate contained MK-7 as the predominant respiratory quinone; its main polar lipid was phosphatidylethanolamine; and the major fatty acids were summed feature 3 (C16:1 ω7c/C16:1 ω6c; 32.0%), C15:0 iso (19.1%), C17:0 iso 3-OH (8.3%), and C16:0 (8.2%). The draft genome had a length of 3,842,102 bp with a G+C content of 36.0 mol%, predicting 3282 coding sequences, 3 rRNA genes, 3 ncRNAs, and 36 tRNAs genes. The digital DNA-DNA hybridization and average nucleotide identity values between strain SD-bT and P. psychrophilus LMG 29436T were 22.0% and 78.9%, respectively. The results of phenotypic properties, genotypic distinctiveness, and chemotaxonomic features support the discrimination of SD-bT from its phylogenetic relatives. Pedobacter segetis sp. nov. is therefore proposed with SD-bT (= KCTC 82351T = JCM 34283T) as the type strain.

Phylogenetic and Morphological Analysis of a Novel Tolypocladium Species Isolated from Soil in South Korea.

A fungal strain designated KNUF-22-014, belonging to the family Ophiocordycipitaceae, was isolated from a soil sample collected in Sobaeksan National Park, South Korea. Phylogenetic trees based on the combined sequences of internal transcribed spacer (ITS) regions and the large subunit of 28S rRNA (LSU) gene, as well as on five concatenated loci (LSU, ITS, translation elongation factor 1α, ß-tubulin, and subunit 1 of RNA polymerase II), revealed that the isolate falls within the clade containing the genus Tolypocladium but occupies a distinct phylogenetic position. Its closest relative is T. tropicale. Morphologically, strain KNUF-22-014 can be distinguished from T. tropicale by the shape of its phialides (subcylindrical vs. lageniform), its conidiophore type (arborescent or unbranched vs. trichodermatoid), and its larger conidia size (2.1 ± 0.1 µm vs. 1.5 ± 0.1 µm). Phylogenetic analysis and morphological observations indicate that KNUF-22-014 represents a novel species in the genus Tolypocladium, for which the name Tolypocladium sobaeksanense sp. nov. is proposed.

Neocucurbitaria chlamydospora sp. nov.: A Novel Species of the Family Cucurbitariaceae Isolated from a Stink Bug in Korea.

The fungal strain KNUF-22-18B, belonging to Cucurbitariaceae, was discovered from a stink bug (Hygia lativentris) during the investigation of insect microbiota in Chungnam Province, South Korea. The colonies of the strain KNUF-22-18B were wooly floccose, white to brown in the center on oatmeal agar (OA), and the colonies were buff, margin even, and colorless, reverse white to yellowish toward the center on malt extract agar (MEA). The strain KNUF-22-18B produced pycnidia after 60 days of culturing on potato dextrose agar, but pycnidia were not observed on OA. On the contrary, N. keratinophila CBS 121759T abundantly formed superficial pycnidia on OA and MEA after a few days. The strain KNUF-22-18B produced chlamydospores subglobose to globose, mainly in the chain, with a small diameter of 4.4-8.8 µm. At the same time, N. keratinophila CBS 121759T displayed a globose terminal with a diameter of 8-10 µm. A multilocus phylogeny using the internal transcribed spacer regions, 28S rDNA large subunit, ß-tubulin, and RNA polymerase II large subunit genes further validated the uniqueness of the strain. The detailed description and illustration of the proposed species as Neocucurbitaria chlamydospora sp. nov. from Korea was strongly supported by molecular phylogeny.

Molecular Phylogeny and Morphology of Tolypocladium globosum sp. nov. Isolated from Soil in Korea.

In this study, fungal strains designated as KNUF-22-14A and KNUF-22-15A were isolated from soil samples in Korea. These two strains were identified based on cultural and morphological characteristics as well as phylogenetic analyses and were found to be morphologically and phylogenetically identical. Upon their morphological comparison with closely related species, such as Tolypocladium album, T. amazonense, T. endophyticum, T. pustulatum, and T. tropicale, a difference in the size of short phialides [0.6-2.4(-9.3) × 0.8-1.4 µm] was observed. Meanwhile, these strains had larger conidia (1.2-3.0 × 1.2-3.0 µm) than T. album, T. amazonense, T. endophyticum, and T. tropicale and smaller conidia than T. pustulatum. Phylogenetic analyses using a multi-locus datasets based on ITS, LSU, and SSU showed that KNUF-22-14A and KNUF-22-15A formed a distinct cluster from previously identified Tolypocladium species. Thus, these fungal strains isolated from soil in Korea are proposed as a novel species according to their characteristics and are named Tolypocladium globosum sp. nov.

Morphological and Phylogenetic Analyses Reveal a New Species of Genus Monochaetia Belonging to the Family Sporocadaceae in Korea.

The fungal strain belonging to the genus Monochaetia of the family Sporocadaceae was isolated from hairy long-horned toad beetle (Moechotypa diphysis) during the screening of microfungi associated with insects from Gangwon Province, Korea. The strain KNUF-6L2F produced white, light brown to dirty black surface, and olivaceous green colonies with the higher growth, while the closest strain M. ilicis KUMCC 15-0520T were light brown to brown, and M. schimae SAUCC 212201T light brown to brown toward center. The strain KNUF-6L2F produced shorter (5.7-14.0 µm) apical appendages than M. ilicis (6.0-24.0 µm), but similar to M. schimae (7.0-12.5 µm). Three median cells of KNUF-6L2F were light brown to olivaceous green, whereas brown and olivaceous cells were observed from M. ilicis and M. schimae, respectively. And the strain KNUF-6L2F produced larger conidiogenous cells than M. ilicis and M. schimae. Additionally, phylogenetic analyses based on molecular datasets of internal transcribed spacer (ITS) regions, translation elongation factor 1-alpha (TEF1α), and ß-tubulin (TUB2) genes corroborated the strain's originality. Thus, the strain is different from other known Monochaetia species, according to molecular phylogeny and morophology, hence we suggested the new species Monochaetia mediana sp. nov. and provided a descriptive illustration.

Taxonomy of Botryotrichum luteum sp. nov. based on Morphology and Phylogeny Isolated from Soil in Korea.

In this study, a fungal strain KNUF-22-025 belonging to the genus Botryotrichum was isolated from the soil in Korea. The cultural and morphological characteristics of this strain differed from those of closely related species. On malt extract agar, strain KNUF-22-025 showed slower growth than most of the related species, except B. domesticum. The conidia size (9.6-21.1 × 9.9-18.4 µm) of strain KNUF-22-025 was larger than those of B. piluliferum, B. domesticum, and B. peruvianum but smaller than those of B. atrogriseum and B. iranicum. Conidiophores in strain KNUF-22-025 (137 µm) were longer than those in other closely related species but shorter than those in B. atrogriseum. Multi-locus analysis of molecular markers, such as ITS, 28S ribosomal DNA, RBP2, and TUB2 revealed that strain KNUF-22-025 was distinct from other Botryotrichum species. Thus, this strain is proposed as a novel species based on morphological characteristics along with molecular phylogeny and named Botryotrichum luteum sp. nov.

Oxytocin: A Potential Therapeutic for Obesity.

Oxytocin is a neuropeptide involved in the homeostasis of food consumption and energy; it affects hedonic eating. Studies in obese or binge-eating patients reported the hypophagic effect of oxytocin, which reduced caloric intake after administration. Several studies have demonstrated the effect of oxytocin's increasing energy intake, decreasing food consumption, and contributing to weight loss. Oxytocin's effects on food intake and metabolism suggest its therapeutic potential for treating obesity and binge eating.

Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report.

In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of -2.5 and -2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.

Relationships among Body Mass Index, Body Image, and Depression in Korean Adults: Korea National Health and Nutrition Examination Survey 2014 and 2016.

BACKGROUND: This study extends the findings of our previous examination of the relationship between obesity and depression in Korean adults. Here, we further investigate the relationships among body image perception, weight control method, and depression based on data from the Korea National Health and Nutrition Examination Survey in 2014 and 2016. METHODS: In total, we analyzed 11,782 participants. We classified them into four groups according to body mass index (BMI): underweight (BMI <18.5 kg/m2), normal-to-overweight (BMI 18.5-24.9 kg/m2), obesity stage I (BMI 25.0-29.9 kg/m2), and obesity stage II (BMI >30.0 kg/m2). Current depression was defined as a score of at least 10 on the nine-item Patient Health Questionnaire. We performed chi-square tests and multivariate logistic regression analyses to examine the relationships among BMI, body image perception, method of weight control, and depression. RESULTS: Depression was diagnosed in 6.5% of the study participants. The underweight group had the highest odds ratio (OR) for depression (OR, 1.94; 95% confidence interval [CI], 1.42-2.65). Further, participants in the extremely lean subgroup within the underweight group had an even higher OR for depression (OR, 3.06; 95% CI, 2.28-4.10). Regarding weight management methods, the rate of depression was higher for fasting and for skipping or reducing a meal than for exercise. CONCLUSION: Biased BMI and body image perception are associated with increased incidence of depression. In addition, specific weight control methods, such as fasting, skipping a meal, and reducing food consumption, are also associated with increased incidence of depression.

Prevalence and Risk Factors for Periodontitis Among Patients with Metabolic Syndrome.

BACKGROUND: The incidence of periodontitis is higher when metabolic syndrome (MS) is present. However, only few Korean studies have compared the risk factors for MS and periodontitis. Therefore, this study aimed to investigate the prevalence and risk factors for periodontitis relative to the presence of MS. METHODS: The data collected from 13,196 respondents of the 2010-2015 Korea National Health and Nutrition Examination Survey in South Korea, which include periodontitis and MS parameters, were analyzed after propensity score matching of sex and age. RESULTS: A total of 29% of the participants had periodontitis. The periodontitis group had more males (53%), lower number of participants who had a high educational level (66.6%), and higher body mass index (24.3 ± 3.2) and waist circumference (83.8 ± 9.2) than the nonperiodontitis group. Moreover, the periodontitis group exhibited higher systolic blood pressure and fasting plasma glucose and plasma triglyceride levels, but lower high-density lipoprotein cholesterol levels than the nonperiodontitis group (P < 0.001). Several patients in the periodontitis group had hypertension (43.3%) and diabetes mellitus (17.3%), but only few had chronic kidney disease (3.4%). Multiple regression analysis showed that the risk of periodontitis increased when MS, diabetes mellitus, and smoking history were present. Particularly, the risk of periodontitis increased as the number of MS components increased (P < 0.001). CONCLUSIONS: Patients with MS had 1.12-fold higher risk of periodontitis than those without. Additionally, patients who had diabetes mellitus and were smokers had a particularly high risk of periodontitis. The risk of periodontitis increased as the number of MS components increased.

Mapping three-dimensional surface deformation caused by the 2010 Haiti earthquake using advanced satellite radar interferometry.

Mapping three-dimensional (3D) surface deformation caused by an earthquake is very important for the environmental, cultural, economic and social sustainability of human beings. Synthetic aperture radar (SAR) systems made it possible to measure precise 3D deformations by combining SAR interferometry (InSAR) and multiple aperture interferometry (MAI). In this paper, we retrieve the 3D surface deformation field of the 2010 Haiti earthquake which occurred on January 12, 2010 by a magnitude 7.0 Mw by using the advanced interferometric technique that integrates InSAR and MAI data. The surface deformation has been observed by previous researchers using the InSAR and GPS method, but 3D deformation has not been measured yet due to low interferometric coherence. The combination of InSAR and MAI were applied to the ALOS PALSAR ascending and descending pairs, and were validated with the GPS in-situ measurements. The archived measurement accuracy was as little as 1.85, 5.49 and 3.08 cm in the east, north and up directions, respectively. This result indicates that the InSAR/MAI-derived 3D deformations are well matched with the GPS deformations. The 3D deformations are expected to allow us to improve estimation of the area affected by the 2010 Haiti earthquake.

Relationship between obesity and depression in Korean adults: Korea National Health and Nutrition Examination Survey 2014.

Previous studies on the relationship between obesity and depression have produced conflicting results. And only a limited number of studies have been conducted in Asians, and few large-scale nationwide studies have been conducted in Korean populations.We investigated the relationship between obesity and depression in Korean adults using data from a population-based sample from the 2014 Korea National Health and Nutritional Examination Survey (KNHANES) by cross-sectional study.In total, 4026 subjects (1692 men, 2334 women) aged 19 to 69 years participated in the 2014 KNHANES. Current depression was defined as a score ≥10 on the 9-item Patient Health Questionnaire. Height and weight were measured and the body mass index (BMI) was calculated. The participants were asked to complete questionnaires about socio-demographic factors and disease comorbidities, and health-related behaviors. The chi-squared test and multivariate logistic regression analyses were performed to examine the relationship between obesity and depression.Depression was diagnosed in 5.7% of the study participants (3.9% of men, 7.0% of women). According to body weight status, there was a significant difference in the prevalence of depression (underweight: 16.2%, normal weight: 5.5%, overweight: 4.3%, obese [BMI ≥30]: 6.9%). Compared with the normal weight group, the underweight group had a higher adjusted odds ratio (OR) for depression (OR = 3.27, 95% confidence interval [CI]: 1.22, 8.75 in men; OR = 2.00, 95% CI: 1.12, 3.57 in women). Overweight (OR = 0.60, 95% CI: 0.32, 1.13) and obese (OR = 0.62, 95% CI: 0.17, 2.27) men had lower ORs for depression, but this trend was not significant. Compared with normal weight women, obese women had higher adjusted ORs for depression (OR = 1.75, 95% CI: 0.79, 3.88), while overweight women had lower ORs for depression (OR = 0.90, 95% CI: 0.56, 1.45), but these trends were not significant.This study shows differences in the risk of depression depending upon body weight status. Being underweight was correlated with a high risk of developing depression in both men and women, but obesity cannot be ruled out as a risk factor for this condition.

Deoxyactein protects pancreatic ß-cells against methylglyoxal-induced oxidative cell damage by the upregulation of mitochondrial biogenesis.

Methylglyoxal (MG) is one of the major precursors of advanced glycation end products (AGEs), which are considered to be one of the causes of diabetes and its complications. The root and rhizomes of black cohosh (Cimicifuga racemosa) have long been used medicinally, and deoxyactein is one of its major constituents. In the present study, the protective effects of deoxyactein against MG-induced oxidative cell damage were investigated in insulin-producing pancreatic ß-cells. We found that deoxyactein protected the pancreatic ß-cells against MG-induced cell death. Pre-treatment with deoxyactein significantly reduced the levels of intracellular reactive oxygen species (ROS), interleukin-1ß (IL-1ß), cardiolipin peroxidation, and protein adduct accumulation induced by MG. Pre-treatment of the cells with deoxyactein restored glyoxalase I activity and insulin secretion which were reduced by MG, and increased the mRNA expression of insulin 2 (INS2) and pancreatic and duodenal homeobox protein-1 (PDX-1). It also increased the levels of endogenous antioxidant enzymes, including superoxide dismutase (SOD) and glutathione peroxidase (GPX). Furthermore, treatment with deoxyactein increased the levels of sirtuin 1 (SIRT1) and peroxisome proliferator-activated receptor-γ co-activator-1α (PGC-1α). These findings indicate that deoxyactein may exert beneficial effects on pancreatic ß-cells via the upregulation of mitochondrial biogenesis. Taken together, these results suggest that deoxyactein may be used for the prevention of pancreatic ß-cell damage.

Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity and Metabolic Syndrome among Korean Children and Adolescents: Korea National Health and Nutrition Examination Survey, 2010-2014.

The aims of this study were to assess the diagnostic value of the weight-to-height ratio (WHtR) for the detection of obesity and metabolic syndrome (MS) in Korean children and adolescents, and to determine the advantages of WHtR as a population-based screening tool in comparison with other obesity indicators, such as body mass index (BMI) and waist circumference (WC). We performed a cross-sectional analysis of data from 3057 children and adolescents (1625 boys, 1332 girls) aged 10-19 years who were included in the fifth Korean National Health and Nutrition Examination Survey (KNHANES, 2010-2012) up to the second year of the sixth KNHANES (2013-2014). Receiver operation characteristic (ROC) curves were generated to determine the optimal cutoff value and accuracy of WHtR for predicting individual obesity indicators or more than two non-WC components of MS. The area under the ROC curve (AUC) is a measure of the diagnostic power of a test. A perfect test will have an AUC of 1.0, and an AUC equal to 0.5 means that the test performs no better than chance. The optimal WHtR cutoff for the evaluation of general obesity and central obesity was 0.50 in boys and 0.47-0.48 in girls, and the AUC was 0.9. Regarding the assessment of each MS risk factor, the optimal WHtR cutoff was 0.43-0.50 in boys and 0.43-0.49 in girls, and these cutoffs were statistically significant only for the detection of high triglyceride and low High-density lipoprotein (HDL) cholesterol levels. When a pairwise comparison of the AUCs was conducted between WHtR and BMI/WC percentiles to quantify the differences in power for MS screening, the WHtR AUC values (boys, 0.691; girls, 0.684) were higher than those of other indices; however, these differences were not statistically significant (boys, p = 0.467; girls, p = 0.51). The WHtR cutoff value was 0.44 (sensitivity, 67.7%; specificity, 64.6%) for boys and 0.43 (sensitivity, 66.4%; specificity, 66.9%) for girls. There was no significant difference between the diagnostic power of WHtR and that of BMI/WC when screening for MS. Although the use of WHtR was not superior, WHtR is still useful as a screening tool for metabolic problems related to obesity because of its convenience.

Perfluorooctanoic acid induces oxidative damage and mitochondrial dysfunction in pancreatic ß-cells.

Several environmental contaminants have been linked to the development of diabetes and increased diabetes­associated mortality. Perfluorooctanoic acid (PFOA) is a widely used perfluoroalkane found in surfactants and lubricants, and in processing aids used in the production of polymers. Furthermore, PFOA has been detected in humans, wildlife and the environment. The present study investigated the toxic effects of PFOA on rat pancreatic ß­cell­derived RIN­m5F cells. Cell viability, apoptosis, reactive oxygen and nitrogen species, cytokine release and mitochondrial parameters, including membrane potential collapse, reduced adenosine triphosphate levels, cardiolipin peroxidation and cytochrome c release were assessed. PFOA significantly decreased RIN­m5F cell viability and increased apoptosis. Exposure to PFOA increased the formation of reactive oxygen species, mitochondrial superoxide, nitric oxide and proinflammatory cytokines. Furthermore, PFOA induced mitochondrial membrane potential collapse and reduced adenosine triphosphate levels, cardiolipin peroxidation and cytochrome c release. These results indicate that PFOA is associated with the induction of apoptosis in RIN-m5F cells, and induces cytotoxicity via increased oxidative stress and mitochondrial dysfunction.

Glabridin Alleviates the Toxic Effects of Methylglyoxal on Osteoblastic MC3T3-E1 Cells by Increasing Expression of the Glyoxalase System and Nrf2/HO-1 Signaling and Protecting Mitochondrial Function.

Methylglyoxal (MG) contributes to the pathogenesis of age- and diabetes-associated complications. The present study investigated the effects of glabridin on MG-induced cytotoxicity in MC3T3-E1 osteoblastic cells. MC3T3-E1 cells were treated with glabridin in the presence of MG, and markers of mitochondrial function and oxidative damage were examined. Pretreatment of MC3T3-E1 osteoblastic cells with glabridin prevented MG-induced cell death, the production of intracellular reactive oxygen species and mitochondrial superoxides, cardiolipin peroxidation, and the production of inflammatory cytokines. The soluble form of receptor for advanced glycation end products (sRAGEs)/RAGE ratio increased upon MG treatment, but less so after pretreatment with glabridin, which also increased the level of reduced glutathione and the activities of glyoxalase I and heme oxygenase-1, all of which were reduced by MG. In addition, glabridin elevated the level of nuclear factor erythroid 2-related factor 2. These findings suggest that glabridin protects against MG-induced cell damage by inhibiting oxidative stress and increasing MG detoxification. Pretreatment of MC3T3-E1 osteoblastic cells with glabridin reduced MG-induced mitochondrial dysfunction. Additionally, the nitric oxide level significantly increased upon glabridin pretreatment. Together, these data show that glabridin may potentially serve to prevent the development of diabetic bone disease associated with MG-induced oxidative stress.

Effects of Rebamipide on Gastrointestinal Symptoms in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Gastrointestinal (GI) symptoms are common in patients with type 2 diabetes mellitus (T2DM). Rebamipide is an effective gastric cytoprotective agent, but there are few data on its usefulness in T2DM. The aim of this study is to evaluate the improvement of GI symptoms after rebamipide treatment in patients with T2DM. METHODS: Patients with T2DM and atypical GI symptoms were enrolled. They took rebamipide (100 mg thrice daily) for 12 weeks and filled out the diabetes bowel symptom questionnaire (DBSQ) before and after rebamipide treatment. The DBSQ consisted of 10 questions assessing the severity of GI symptoms by a 1 to 6 scoring system. Changes in the DBSQ scores before and after rebamipide treatment were analyzed to evaluate any improvements of GI symptoms. RESULTS: A total of 107 patients were enrolled, and 84 patients completed the study. The mean age was 65.0±7.8, 26 patients were male (24.8%), the mean duration of T2DM was 14.71±9.12 years, and the mean glycosylated hemoglobin level was 6.97%±0.82%. The total DBSQ score was reduced significantly from 24.9±8.0 to 20.4±7.3 before and after rebamipide treatment (P<0.001). The DBSQ scores associated with reflux symptoms, indigestion, nausea or vomiting, abdominal bloating or distension, peptic ulcer, abdominal pain, and constipation were improved after rebamipide treatment (P<0.05). However, there were no significant changes in symptoms associated with irritable bowel syndrome, diarrhea, and anal incontinence. No severe adverse events were reported throughout the study. CONCLUSION: Rebamipide treatment for 12 weeks improved atypical GI symptoms in patients with T2DM.

Hypoglycemia and Medical Expenses in Patients with Type 2 Diabetes Mellitus: An Analysis Based on the Korea National Diabetes Program Cohort.

BACKGROUND AND AIMS: Hypoglycemia is one of the most important adverse events in individuals with type 2 diabetes mellitus (T2DM). However, hypoglycemia-related events are usually overlooked and have been documented less in clinical practice. MATERIALS AND METHODS: We evaluated the incidence, clinical characteristics, and medical expenses of hypoglycemia related events in T2DM patients based on the Korea National Diabetes Program (KNDP), which is the largest multi-center, prospective cohort in Korea (n = 4,350). For accurate outcomes, the KNDP data were merged with claims data from the Health Insurance Review and Assessment Service (HIRA) of Korea. RESULTS: During a median follow-up period of 3.23 years (95% CI: 3.14, 3.19), 88 subjects (2.02%) were newly diagnosed with hypoglycemia, and the incidence of hypoglycemia was 6.44 cases per 1,000 person-years (PY). Individuals with hypoglycemia were significantly older (59.7±10.7 vs. 53.3±10.4 years, p < 0.001), had more hospital visits (121.94±126.88 days/PY, p < 0.001), had a longer hospital stays (16.13±29.21 days/PY, p < 0.001), and incurred greater medical costs ($2,447.56±4,056.38 vs. $1,336.37±3,403.39 /PY, p < 0.001) than subjects without hypoglycemia. CONCLUSION: Hypoglycemia-related events were infrequently identified among the medical records of T2DM subjects. However, they were associated significantly with poor clinical outcomes, and thus, hypoglycemia could have a substantial burden on the Korean national healthcare system.

A Smartphone Application Significantly Improved Diabetes Self-Care Activities with High User Satisfaction.

BACKGROUND: We developed for the first time a smartphone application designed for diabetes self-management in Korea and registered a patent for the relevant algorithm. We also investigated the user satisfaction with the application and the change in diabetes related self-care activities after using the application. METHODS: We conducted a questionnaire survey on volunteers with diabetes who were using the application. Ninety subjects responded to the questionnaire between June 2012 and March 2013. A modified version of the Summary of Diabetes Self-Care Activities (SDSCA) was used in this study. RESULTS: The survey results exhibited a mean subject age of 44.0 years old, and males accounted for 78.9% of the subjects. Fifty percent of the subjects had diabetes for less than 3 years. The majority of respondents experienced positive changes in their clinical course after using the application (83.1%) and were satisfied with the structure and completeness of the application (86.7%). Additionally, the respondents' answers indicated that the application was easy to use (96.7%) and recommendable to others (97.7%) and that they would continue using the application to manage their diabetes (96.7%). After using the Diabetes Notepad application, diabetes related self-care activities assessed by SDSCA displayed statistically significant improvements (P<0.05), except for the number of days of drinking. CONCLUSION: This smartphone-based application can be a useful tool leading to positive changes in diabetes related self-care activities and increase user satisfaction.