Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes.

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (ß = 0.001, P < 0.001), serum triglyceride (ß = 0.001, P < 0.001), CCr (ß = -0.003, P = 0.001), hsCRP (ß = 0.157, P = 0.001), fibrinogen (ß = 0.001, P < 0.001) and BMI (ß = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.

Novel chemical scaffolds of the tumor marker AKR1B10 inhibitors discovered by 3D QSAR pharmacophore modeling.

AIM: Recent evidence suggests that aldo-keto reductase family 1 B10 (AKR1B10) may be a potential diagnostic or prognostic marker of human tumors, and that AKR1B10 inhibitors offer a promising choice for treatment of many types of human cancers. The aim of this study was to identify novel chemical scaffolds of AKR1B10 inhibitors using in silico approaches. METHODS: The 3D QSAR pharmacophore models were generated using HypoGen. A validated pharmacophore model was selected for virtual screening of 4 chemical databases. The best mapped compounds were assessed for their drug-like properties. The binding orientations of the resulting compounds were predicted by molecular docking. Density functional theory calculations were carried out using B3LYP. The stability of the protein-ligand complexes and the final binding modes of the hit compounds were analyzed using 10 ns molecular dynamics (MD) simulations. RESULTS: The best pharmacophore model (Hypo 1) showed the highest correlation coefficient (0.979), lowest total cost (102.89) and least RMSD value (0.59). Hypo 1 consisted of one hydrogen-bond acceptor, one hydrogen-bond donor, one ring aromatic and one hydrophobic feature. This model was validated by Fischer's randomization and 40 test set compounds. Virtual screening of chemical databases and the docking studies resulted in 30 representative compounds. Frontier orbital analysis confirmed that only 3 compounds had sufficiently low energy band gaps. MD simulations revealed the binding modes of the 3 hit compounds: all of them showed a large number of hydrogen bonds and hydrophobic interactions with the active site and specificity pocket residues of AKR1B10. CONCLUSION: Three compounds with new structural scaffolds have been identified, which have stronger binding affinities for AKR1B10 than known inhibitors.

Factors related to community ambulation in patients with chronic stroke.

BACKGROUND: The focus of gait rehabilitation for walking in real-life settings should vary according to different aspects of gait performance. Investigation of factors related to impairments specific to community ambulation or activity participation may be helpful in determining and targeting appropriate treatment for gait rehabilitation. Objective To investigate the relationship between community ambulation and factors determining gait ability. Methods Forty-six outpatients with a previous stroke participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included impairments (strength, sensation, muscle tone, and balance) and ambulatory activity limitations (self-paced and maximum 10-m gait speed, 6-minute walking test, and concurrent manual/cognitive dual-task walking speed). Ability to increase speed and the dual-tasks cost were calculated. Multivariate analysis of variance and multiple regression analyses were used to determine differences in walking and identify important factors related to community ambulation. Results Pearson and Spearman analyses revealed that impairments (balance, r = .665; muscle strength, r = 0.653) and ambulatory activity limitation (gait speed, r = 0.684; walking distance, r = 0.654; ability to increase speed, r = 0.413) were significantly positively correlated with community ambulation level. Balance was an important factor in predicting increasing speed (P < 0.001). Muscle strength and tone were positive contributors to gait speed (P = 0.001 for both) and distance (P = 0.019 and P = 0.002, respectively). Cognitive and manual dual tasks showed no significant relationship to other variables. Stepwise multivariate regression analysis showed that important determinants of community ambulation level were strength (P < 0.001) and gait endurance (P = 0.001). Conclusions Muscle strength and walking distance are contributing factors in community ambulation for patients with chronic stroke.

Effect of lifestyle modification on serum chemerin concentration and its association with insulin sensitivity in overweight and obese adults with type 2 diabetes.

OBJECTIVE: Chemerin, a recently identified adipokine, has been linked to adiposity, insulin resistance, metabolic syndrome risk factors and inflammation. Here, we evaluated whether a 12-week lifestyle intervention in overweight and obese adults with type 2 diabetes could significantly affect the average blood glucose and serum chemerin levels over time. DESIGN: Thirty-five overweight or obese subjects with type 2 diabetes were randomized to receive intensive lifestyle modification including supervised exercise sessions or usual care for 12 weeks. Anthropometric and clinical data were collected before the intervention and after 12 weeks. RESULTS: Lifestyle intervention induced a significant decrease in HbA1c (-1·0 ± 0·5 vs 0·1 ± 0·6%, P < 0·001), BMI, total body fat content, serum lipocalin-2 and chemerin levels (-8·1 ± 21·6 vs + 8·2 ± 15·9 ng/ml, P = 0·021) and a significant increase in VO2 max after 12 weeks compared to the usual care group. Baseline chemerin levels were positively correlated with the homoeostasis model of assessment of insulin resistance (HOMA-IR), fasting insulin and the high-sensitivity C-reactive protein (hsCRP) and negatively correlated with insulin sensitivity index (ISI). Changes in the chemerin concentration during 12 weeks were independently negatively correlated with changes in ISI and positively correlated with changes in fasting plasma glucose, total cholesterol and lipocalin-2 levels. CONCLUSIONS: A 12-week intensive lifestyle intervention significantly decreased serum chemerin level compared to usual care. Decrease in serum chemerin level was associated with improved insulin sensitivity, and this may be involved in the beneficial effects of lifestyle intervention in overweight and obese type 2 diabetic patients.

Measurement of diabetes-related emotional distress using the Problem Areas in Diabetes scale: psychometric evaluations show that the short form is better than the full form.

BACKGROUND: The Problem Areas in Diabetes (PAID) scale is widely used for measuring diabetes-related emotional distress. There has been debate over the last 2 decades about the underlying factorial-construct validity of the PAID, with one- to four-factor structures being reported. A short form of the PAID, which comprises five items (PAID-5), was recently developed using Western patients with type 2 diabetes. This study measured the psychometric properties of the full and short forms of the PAID in Korean patients with type 2 diabetes, with the aim of determining which form is preferable. METHODS: The PAID and PAID-5 were translated into Korean (K-PAID and K-PAID-5, respectively) using a forward-and-backward translation technique. The study participants were recruited from university hospitals. The factorial-construct, convergent, and known-groups validity, and internal-consistency and test-retest reliability of both the K-PAID and K-PAID-5 were evaluated. RESULTS: For the K-PAID, confirmatory factor analysis revealed a marginal fit to the one-, two-, three-, and four-factor models. The three- and four-factor models of the K-PAID partially satisfied the internal-consistency and test-retest reliability, and convergent and known-groups validity. For the K-PAID-5, confirmatory factor analysis demonstrated an excellent fit to the one-factor model, with a Cronbach's alpha of 0.87 and an intraclass correlation coefficient of 0.89. The K-PAID-5 satisfied the convergent validity, as evaluated using the Center for Epidemiologic Studies Depression Scale and hemoglobin A1c. Known-groups validity by gender was also satisfied. CONCLUSIONS: The K-PAID-5 demonstrated excellent psychometric properties as a one-factor scale. The brevity of the K-PAID-5 represents a major advantage in a practical context in that it may impose a minimum burden upon patients with diabetes.

Measurement equivalence of touch-screen computerized and paper-based diabetes-specific quality-of-life questionnaires.

Current advances in technology have enabled the development of a computer-based questionnaire that provides advantages over the paper-based mode of administration, such as automatic data entry, storage and calculations. However, before implementing a computer-based questionnaire, its equivalence with the original paper-based questionnaire must first be demonstrated. The purpose of this study was to evaluate the measurement equivalence of the computerized Diabetes-Specific Quality-of-Life questionnaire (cD-QOL) with its original paper-based counterpart. A two-period crossover design was used in this study. The measurement equivalence was evaluated using quadratic weighted kappa coefficients, intraclass correlations and Cronbach's alpha comparisons. The cD-QOL was equivalent to its original paper-based counterpart. Participants preferred the cD-QOL over the paper-based questionnaire and reported that it was easy to use.

Effect of Laser Scan Speed on Defects and Texture Development of Pure Chromium Metal Fabricated via Powder Bed Fusion-Laser Beam.

Chromium (Cr) metal has garnered significant attention in alloy systems owing to its exceptional properties, such as a high melting point, low density, and superior oxidation and corrosion resistance. However, its processing capabilities are hindered by its high ductile-brittle transition temperature (DBTT). Recently, powder bed fusion-laser beam for metals (PBF-LB/M) has emerged as a promising technique, offering the fabrication of net shapes and precise control over crystallographic texture. Nevertheless, research investigating the mechanism underlying crystallographic texture development in pure Cr via PBF-LB/M still needs to be conducted. This study explored the impact of scan speed on relative density and crystallographic texture. At the optimal scan speed, an increase in grain size attributed to epitaxial growth was observed, resulting in the formation of a <100> cubic texture. Consequently, a reduction in high-angle grain boundaries (HAGB) was achieved, suppressing defects such as cracks and enhancing relative density up to 98.1%. Furthermore, with increasing densification, Vickers hardness also exhibited a corresponding increase. These findings underscore the efficacy of PBF-LB/M for processing metals with high DBTT properties.

Detecting oxidized contaminants in water using sulfur-oxidizing bacteria.

For the rapid and reliable detection of oxidized contaminants (i.e., nitrite, nitrate, perchlorate, dichromate) in water, a novel toxicity detection methodology based on sulfur-oxidizing bacteria (SOB) has been developed. The methodology exploits the ability of SOB to oxidize elemental sulfur to sulfuric acid in the presence of oxygen. The reaction results in an increase in electrical conductivity (EC) and a decrease in pH. When oxidized contaminants were added to the system, the effluent EC decreased and the pH increased due to the inhibition of the SOB. We found that the system can detect these contaminants in the 5-50 ppb range (in the case of NO(3)(-), 10 ppm was detected), which is lower than many whole-cell biosensors to date. At low pH, the oxidized contaminants are mostly in their acid or nonpolar, protonated form which act as uncouplers and make the SOB biosensor more sensitive than other whole-cell biosensors which operate at higher pH values where the contaminants exist as dissociated anions. The SOB biosensor can detect toxicity on the order of minutes to hours which can serve as an early warning so as to not pollute the environment and affect public health.

Efficacy and Safety of Voglibose Plus Metformin in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

BACKGROUND: Combination of metformin to reduce the fasting plasma glucose level and an α-glucosidase inhibitor to decrease the postprandial glucose level is expected to generate a complementary effect. We compared the efficacy and safety of a fixed-dose combination of voglibose plus metformin (vogmet) with metformin monotherapy in drug-naïve newly-diagnosed type 2 diabetes mellitus. METHODS: A total of 187 eligible patients aged 20 to 70 years, with a glycosylated hemoglobin (HbA1c) level of 7.0% to 11.0%, were randomized into either vogmet or metformin treatments for 24 weeks. A change in the HbA1c level from baseline was measured at week 24. RESULTS: The reduction in the levels of HbA1c was -1.62%±0.07% in the vogmet group and -1.31%±0.07% in the metformin group (P=0.003), and significantly more vogmet-treated patients achieved the target HbA1c levels of <6.5% (P=0.002) or <7% (P=0.039). Glycemic variability was also significantly improved with vogmet treatment, estimated by M-values (P=0.004). Gastrointestinal adverse events and hypoglycemia (%) were numerically lower in the vogmet-treated group. Moreover, a significant weight loss was observed with vogmet treatment compared with metformin (-1.63 kg vs. -0.86 kg, P=0.039). CONCLUSION: Vogmet is a safe antihyperglycemic agent that controls blood glucose level effectively, yields weight loss, and is superior to metformin in terms of various key glycemic parameters without increasing the risk of hypoglycemia.

The effect of lowering the threshold for diagnosis of impaired fasting glucose.

PURPOSE: The aim of this study was to evaluate the effect of lowering the fasting plasma glucose (FPG) criteria for impaired fasting glucose (IFG) on the prevalence of IFG and the risk for the development of diabetes associated with IFG in Koreans. MATERIALS AND METHODS: A total of 7,211 subjects who had normal glucose tolerance (NGT) or IFG were recruited. Subjects were evaluated at baseline and after two years follow up. Clinical data including total cholesterol, FPG and blood pressure were examined. RESULTS: Lowering the criteria for IFG from 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL) increased the prevalence of IFG from 6.6% (494 subjects) to 24.4% (1829 subjects). After the 2 years follow up period, 91 subjects (1.3%) developed diabetes. Twenty one (0.3%) subjects developed diabetes among 5,382 NGT subjects and 70 (3.8%) subjects developed diabetes among 1,829 IFG (5.6-7.0 mmol/L) subjects. Lowering the IFG threshold from 6.1 mmol/L to 5.6 mmol/L resulted in a 18.4% decrease in specificity and 23.9% increase in sensitivity for predicting diabetes. The baseline FPG for predicting the development of diabetes after 2 years at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 5.7 mmol/L (103 mg/dL). CONCLUSION: Lowering the FPG criterion of IFG should have benefits in predicting new onset type 2 diabetes mellitus in Koreans. The economic and health benefits of applying the new IFG criteria should be evaluated in future studies.

Antiageing properties of Damaurone D in Caenorhabditis elegans.

OBJECTIVES: This study was conducted to evaluate the longevity potential of damaurone D (DaD), a component of the damask rose, in the animal model Caenorhabditis elegans. METHODS: To investigate the effect of DaD on the longevity, lifespan assay was carried out. Fluorescence intensity of transgenic mutants was quantified to test the expression levels of stress proteins. A genetic study using single gene knockout mutants was designed to determine the target genes of DaD. KEY FINDINGS: DaD prolonged the mean lifespan of wild-type nematodes by 16.7% under normal conditions and also improved their stress endurance under thermal, osmotic, and oxidative stress conditions. This longevity-promoting effect could be attributed to in vivo antioxidant capacity and its up-regulating effects on the expressions of stress-response proteins such as SOD-3 and HSP-16.2. In addition, DaD treatment attenuated food intake, body length, lipofuscin accumulation and age-dependent decline of motor ability. Gene-specific mutant studies showed the involvement of genes such as daf-2, age-1, and daf-16. CONCLUSIONS: These results suggest that DaD has beneficial effects on the longevity, and thus it can be a valuable plant origin lead compound for the development of nutraceutical preparations targeting ageing and ageing-related diseases.

Factors influencing As(V) stabilization in the mine soils amended with iron-rich materials.

Chemical stability of As(V) in amended mine-impacted soils was assessed according to functions of incubation period (0, 1, 2, 4, and 6 months), amendment dose (2.5 and 5%), and application timing (0 and 3rd month). Six soils contaminated with 26-209 mg kg-1 of As(V) were collected from two abandoned mine sites and were treated with two alkaline iron-rich materials (mine discharge sludge (MS) and steel-making slag (SS)). Seventeen to 23% of As(V) in soils was labile. After each designated time, As(V) stability was assessed by the labile fractions determined with sequential extraction procedures (F1-F5). Over 6 months, a reduction (26.9-70.4%) of the two labile fractions (F1 and F2) and a quantitative increase (7.4-29.9%) of As(V) in F3 were observed (r 2 = 0.956). Two recalcitrant fractions (F4 and F5) remained unchanged. Temporal change of As(V) stability in a sample was well described by the two-domain model (k fast, k slow, and Ffast). The stabilization (%) correlated well with the fast-stabilizing domain (Ffast), clay content (%), and Fe oxide content (mg kg-1), but correlated poorly with kinetic rate constants (k fast and k slow). Until the 3rd month, the 2.5%-MS amended sample resulted in lower As(V) stabilization (25-40%) compared to the 5% sample (50-60%). However, the second 2.5% MS addition on the 2.5% sample upon the lapse of the 3rd month led to a substantial reduction (up to 38%) of labile As(V) fraction in the following 4th and 6th months. As a result, an additional 15-25% of As(V) stability was obtained when splitting the amendment dose into 3-month intervals. In conclusion, the As(V) stabilization by Fe-rich amendment is time-dependent and its efficacy can be improved by optimizing the amendment dose and its timing.

The Lazy S Design: A Novel Skin Closure Design in Skin-Sparing Mastectomy for Implant-Based Breast Reconstruction.

Preservation of the breast skin envelope during immediate implant-based breast reconstruction is important for producing symmetrical and natural-looking breasts. We propose the lazy S design for the closure of round-shaped wounds with the hope of improving the aesthetic outcomes and reducing the tension on the wound by preserving the skin. Additionally, the direction of tension is dispersed due to the shape of this design. Patients undergoing implant reconstruction after skin-sparing mastectomy may benefit from the lazy S design.

Delay of insulin initiation in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycemic agents (analysis of patient- and physician-related factors): A prospective observational DIPP-FACTOR study in Korea.

AIMS/INTRODUCTION: To assess the time to initiation of insulin therapy, and concurrently investigate both patient- and physician-related factors associated with delaying insulin therapy in Korean patients with type 2 diabetes uncontrolled by oral hypoglycemic agents (OHAs). MATERIALS AND METHODS: This prospective, observational disease registry study was carried out across 69 centers in Korea. Type 2 diabetes patients who had received two or more OHAs within the past 5 years, had a glycated hemoglobin ≥8% in the past 6 months and had not received insulin were included. Data recorded on data collection forms during a 12-month period were analyzed. RESULTS: Of 2168 patients enrolled, 1959 were evaluated and classified as the insulin-initiated or insulin-delayed group. Insulin was prescribed for just 20% of the patients during a 1-year follow-up period, and less than half (44.5%) of the patients who were taking two OHAs started insulin after 6 years. Patient-related factors for delay in insulin initiation included older age, shorter duration of diabetes and lower glycated hemoglobin. Physician-related factors included age (~50 to <60 years), sex (women) and number (<1000) of patients consulted per month. Patient refusal (33.6%) and physicians' concerns of patient non-compliance (26.5%) were the major physician-reported reasons for delaying insulin therapy. Inconvenience of insulin therapy (51.6%) and fear of injection (48.2%) were the major reasons for patient refusal. CONCLUSIONS: Insulin initiation is delayed in patients with type 2 diabetes uncontrolled by two or more OHAs in Korea. Patient- and physician-related factors associated with this delay need to be addressed for better diabetes management.

Influence of an iron-rich amendment on chemical lability and plant (Raphanus sativus L.) availability of two metallic elements (As and Pb) on mine-impacted agricultural soils.

Variation of the chemical extractability and phytoavailability of two metallic elements (e.g., As and Pb) on amendment-treated soils was investigated. Four mine-impacted agricultural soils contaminated with both As (174-491 mg kg-1) and Pb (116-357 mg kg-1) were amended with an iron-rich sludge at the rate of 5 % (w/w). After a 4-, 8-, and 16-week incubation, the extractability of metallic elements was assessed by sequential extraction procedure (SEP; F1-F5). The control without amendment was also run. In amended soils, the labile element mass (i.e., F1 + F2) promptly decreased (15-48 % of As and 5-10 % of Pb) in 4 weeks, but the decrement was continued over 16 weeks up to 70 and 28 % for As and Pb, respectively. The labile mass decrement was quantitatively corresponded with the increment of F3 (bound to amorphous metal oxides). In plant test assessed by radish (Raphanus sativus) grown on the 16-week soils, up to 57 % of As and 28 % of Pb accumulation was suppressed and 10-43 % of growth (i.e., shoot/root elongation and fresh weight) was improved. For both the control and amended soils, element uptake by plant was well correlated with their labile soil concentrations (r 2 = 0.799 and 0.499 for As and Pb, respectively). The results confirmed that the iron-rich material can effectively suppress element uptake during R. sativus seedling growth, most likely due to the chemical stabilization of metallic elements in growth medium.

The effects of adiponectin and inflammatory cytokines on diabetic vascular complications in obese and non-obese patients with type 2 diabetes mellitus.

AIMS: To evaluate the associations between inflammatory cytokines and adiponectin and various vascular complications in type 2 diabetes mellitus (T2DM). METHODS: A total of 761 patients with T2DM were divided into a non-obese group and an obese group to enable the effects of obesity and T2DM on vascular complications to be differentiated. The serum levels of circulating inflammatory cytokines, that is, tumor necrosis factor (TNF)-α, and interleukin (IL)-6, total adiponectin, and high molecular weight (HMW) adiponectin were measured, and carotid intima media thickness (IMT), the presence of carotid plaque, and the severities of retinopathy and nephropathy, were assessed. RESULTS: The obese group had significantly lower serum total and HMW adiponectin levels than the non-obese group. In the obese group, serum levels of total and HMW adiponectin, and TNF-α were significantly higher in patients with proliferative retinopathy than in those without retinopathy after adjusting for covariates. In the non-obese group, only IL-6 levels were significantly higher in patients with proliferative retinopathy than in those without. Serum levels of total and HMW adiponectin were significantly higher in patients with macroalbuminuria than in those with normoalbuminuria. No significant difference of three cytokines levels were observed depending on the carotid IMT or the presence of plaque. Logistic regression analysis revealed that serum total adiponectin (OR=1.209, P=0.038), diabetes duration (OR=1.230, P=0.014), and HbA1c (OR=2.359, P=0.006) were significantly associated with proliferative retinopathy in the obese group. CONCLUSION: The study shows total adiponectin may influence proliferative retinopathy in obese patient with T2DM.

Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma.

Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.

Metformin-associated lactic acidosis: predisposing factors and outcome.

BACKGROUND: Metformin is considered the first choice oral treatment for type 2 diabetes patients in the absence of contraindications. Rarely, life-threatening complications associated with metformin treatment are seen in some patients with underlying diseases. The aim of this study was to further investigate the clinical profiles and risk factors for metformin-associated lactic acidosis (MALA) and the treatment modalities according to survival. METHODS: To identify MALA, we performed a retrospective study in seven diabetic patients who were taking metformin and had been diagnosed with lactic acidosis at Inha University Hospital between 1995 and 2012. For each patient, we recorded the age, sex, daily metformin dosage, laboratory test results, admission diagnosis, and risk factors. Also, concurrent conditions, treatment modalities, and outcomes were evaluated. RESULTS: Six patients had risk factors for lactic acidosis before admission. All patients had renal impairment on admission as a precipitating risk factor. Five patients survived and two patients died despite early renal replacement therapy. Older patients tended to have a poorer prognosis. CONCLUSION: Renal function must be monitored in elderly type 2 diabetes mellitus patients with underlying diseases and conditions causing renal impairment who begin metformin treatment. Accurate recognition of MALA and initiation of renal replacement are essential for treatment.

A Korean version of the Appraisal of Diabetes Scale (ADS-K): psychometric evaluation with a population of Koreans with type 2 diabetes.

The purpose of this study was to evaluate the psychometric properties of the Appraisal of Diabetes Scale (ADS) in Korean patients with Type 2 diabetes. The English-language version of the ADS was translated into Korean using a forward-and-backward translation technique. The Korean version of the ADS (ADS-K) was administered to 250 patients who were recruited from two university hospitals. The data were analyzed using principal-component analysis, Cronbach's alpha, analysis of variance, t test, and Pearson's correlation. Six of seven items were meaningfully clustered into a two-factor structure by principal-component analysis, these factors accounting for 63.75% of the total variance. The underlying structure was consistent regardless of either gender or the presence of complications. The Cronbach's alpha of the subscales ranged from .71 to .79, indicating an acceptable internal consistency reliability. As hypothesized, the ADS-K score was moderately correlated with the diabetes-specific quality of life and had satisfactory convergent validity. The known-groups validity of the ADS-K was established using depression groups and HbA1c control status. The ADS-K demonstrated good psychometric properties. In addition, it possessed satisfactory practical properties, such as acceptability and feasibility. Therefore, the ADS-K appears to be suitable for use in both clinical research and clinical practice.

Metastatic follicular thyroid carcinoma to the thymus in a 35-year-old woman.

Clinically detectable metastatic follicular thyroid carcinoma to the thymus is very rare in the literature and sometimes confused with false positive uptake of Iodine(131) (I(131)) in the normal thymus or hilar lymph node. The authors report a 35-year-old woman with metastatic follicular carcinoma to the thymus. She underwent total thyroidectomy and I(131) ablation with 200 mCi. Six months later, a follow-up I(131) whole body scan showed continued radioactive iodine uptake in the retrosternal area and the serum thyroglobulin level remained continuously elevated with levothyroxine suppression therapy (22.3 and 36.4 ng/ml, 6 and 10 months after total thyroidectomy, respectively). CT scan of the chest revealed several aggregated cystic lesions in the retrosternal mediastinum, suspected to represent mediastinal metastasis. The surgically resected retrosternal mass was confirmed as a metastatic follicular carcinoma to the thymus. After surgical excision, the serum thyroglobulin level was below 1.0 ng/ml and I(131) whole body scan showed no radioactive iodine uptake in the mediastinum. The patient showed no evidence of recurrence after excision of thymic metastasis during one year of 0.2 mg levothyroxine suppression therapy. We report a case of metastatic follicular thyroid carcinoma to the thymus without bone or pulmonary involvement.