Rapid Differentiation of Human Embryonic Stem Cells into Testosterone-Producing Leydig Cell-Like Cells In vitro

BACKGROUND@#Leydig cells (LCs) are testicular somatic cells that are the major producers of testosterone in males.Testosterone is essential for male physiology and reproduction. Reduced testosterone levels lead to hypogonadism and are associated with diverse pathologies, such as neuronal dysfunction, cardiovascular disease, and metabolic syndrome. LC transplantation is a promising therapy for hypogonadism; however, the number of LCs in the testis is very rare and they do not proliferate In vitro. Therefore, there is a need for an alternative source of LCs. @*METHODS@#To develop a safer, simple, and rapid strategy to generate human LC-like cells (LLCs) from stem cells, we first performed preliminary tests under different conditions for the induction of LLCs from human CD34/CD73 double positive-testis-derived stem cells (HTSCs). Based on the embryological sequence of events, we suggested a 3-step strategy for the differentiation of human ESCs into LLCs. We generated the mesendoderm in the first stage and intermediate mesoderm (IM) in the second stage and optimized the conditions for differentiation of IM into LLCs by comparing the secreted testosterone levels of each group. @*RESULTS@#HTSCs and human embryonic stem cells can be directly differentiated into LLCs by defined molecular compounds within a short period. Human ESC-derived LLCs can secrete testosterone and express steroidogenic markers. @*CONCLUSION@#We developed a rapid and efficient protocol for the production of LLCs from stem cells using defined molecular compounds. These findings provide a new therapeutic cell source for male hypogonadism.

Trajectories of Handgrip Strength and Their Associations with Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging / 가정의학회지

Background@#Handgrip strength (HGS) is a good predictor of adverse health outcomes in later life. This prospective study aimed to investigate whether HGS trajectory patterns were associated with all-cause mortality among older adults in Korea. @*Methods@#This study used the database of the 2006–2016 Korean Longitudinal Study of Aging. Study participants included 3,069 adults aged ≥65 years without a previous history of cancer. The trajectory model was developed to identify different homogeneous trajectory patterns of HGS according to study period. Cox proportional hazards models were then applied to investigate the association between HGS and all-cause mortality. @*Results@#The survival probability according to HGS during the follow-up period decreased as base HGS weakened. We identified four distinct trajectory groups of HGS among men and three among women. The risk of mortality increased as the HGS of both males and females decreased. Compared with the highest HGS group, the adjusted hazard ratios for all-cause mortality of the lowest, lower-mid, and upper-mid HGS groups among males were 3.46 (95% confidence interval [CI], 2.17–6.69), 2.26 (95% CI, 1.47–3.48), and 1.58 (95% CI, 1.07–2.32). Those of the low and mid HGS groups among females were 2.69 (95% CI, 1.39–5.21) and 1.97 (95% CI, 1.05–3.69). @*Conclusion@#The faster HGS declined over time, the greater the all-cause mortality risk increased compared with the slowly decreasing or maintained HGS groups among men and women. HGS measurement among older adults will be helpful in assessing their health statuses and pre-assessing disease-associated morbidity.

Distinct Repopulation Activity in Hu-Mice between CBand LPB-CD34＋ Cells by Enrichment of Transcription Factors

Background and Objectives@#Human CD34＋hematopoietic stem cells can reconstitute the human hematopoietic system when transplanted into immunocompromised mice after irradiation. Human leukapheresis peripheral blood (LPB)-and cord blood (CB)-derived CD34＋ cells have a similar capacity to reconstitute myeloid lineage cells in a humanized mice (hu-mice) model. However, potent stem cells, such as CB-CD34＋ cells, efficiently reconstitute the lymphoid system in vivo compared to LPB-CD34 ＋ cells. Modeling the human hematolymphoid system is vital for studying immune cell crosstalk in human xenografted mice, with CB-CD34＋ cells used as an optimized cell source because they are essential in reconstituting lymphoid lineage cells. @*Methods@#and Results: In this study, we established hu-mice that combined human characteristics with long-term survival and investigated the efficiency of the engraftment of lymphoid lineage cells derived from LPB- and CB-CD34＋cells in the bone marrow, spleen, and LPB. We found an overall increase in the transcriptional activity of lymphoid lineage genes in CB-CD34＋ cells. Our results revealed that potent CB-CD34＋ cells displaying a general upregulation of the expression of genes involved in lymphopoiesis could contribute to the hematolymphoid system in the humanized mice model with longevity. @*Conclusions@#Our data suggest that humanized mouse model by usage of CB-CD34 ＋ cells displaying high expression of TFs for lymphoid lineage cells can contribute to study the immune response against lymphocytes.

Rapid Differentiation of Human Embryonic Stem Cells into Testosterone-Producing Leydig Cell-Like Cells In vitro

BACKGROUND@#Leydig cells (LCs) are testicular somatic cells that are the major producers of testosterone in males.Testosterone is essential for male physiology and reproduction. Reduced testosterone levels lead to hypogonadism and are associated with diverse pathologies, such as neuronal dysfunction, cardiovascular disease, and metabolic syndrome. LC transplantation is a promising therapy for hypogonadism; however, the number of LCs in the testis is very rare and they do not proliferate In vitro. Therefore, there is a need for an alternative source of LCs. @*METHODS@#To develop a safer, simple, and rapid strategy to generate human LC-like cells (LLCs) from stem cells, we first performed preliminary tests under different conditions for the induction of LLCs from human CD34/CD73 double positive-testis-derived stem cells (HTSCs). Based on the embryological sequence of events, we suggested a 3-step strategy for the differentiation of human ESCs into LLCs. We generated the mesendoderm in the first stage and intermediate mesoderm (IM) in the second stage and optimized the conditions for differentiation of IM into LLCs by comparing the secreted testosterone levels of each group. @*RESULTS@#HTSCs and human embryonic stem cells can be directly differentiated into LLCs by defined molecular compounds within a short period. Human ESC-derived LLCs can secrete testosterone and express steroidogenic markers. @*CONCLUSION@#We developed a rapid and efficient protocol for the production of LLCs from stem cells using defined molecular compounds. These findings provide a new therapeutic cell source for male hypogonadism.

Trajectories of Handgrip Strength and Their Associations with Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging / 가정의학회지

Background@#Handgrip strength (HGS) is a good predictor of adverse health outcomes in later life. This prospective study aimed to investigate whether HGS trajectory patterns were associated with all-cause mortality among older adults in Korea. @*Methods@#This study used the database of the 2006–2016 Korean Longitudinal Study of Aging. Study participants included 3,069 adults aged ≥65 years without a previous history of cancer. The trajectory model was developed to identify different homogeneous trajectory patterns of HGS according to study period. Cox proportional hazards models were then applied to investigate the association between HGS and all-cause mortality. @*Results@#The survival probability according to HGS during the follow-up period decreased as base HGS weakened. We identified four distinct trajectory groups of HGS among men and three among women. The risk of mortality increased as the HGS of both males and females decreased. Compared with the highest HGS group, the adjusted hazard ratios for all-cause mortality of the lowest, lower-mid, and upper-mid HGS groups among males were 3.46 (95% confidence interval [CI], 2.17–6.69), 2.26 (95% CI, 1.47–3.48), and 1.58 (95% CI, 1.07–2.32). Those of the low and mid HGS groups among females were 2.69 (95% CI, 1.39–5.21) and 1.97 (95% CI, 1.05–3.69). @*Conclusion@#The faster HGS declined over time, the greater the all-cause mortality risk increased compared with the slowly decreasing or maintained HGS groups among men and women. HGS measurement among older adults will be helpful in assessing their health statuses and pre-assessing disease-associated morbidity.

Distinct Repopulation Activity in Hu-Mice between CBand LPB-CD34＋ Cells by Enrichment of Transcription Factors

Background and Objectives@#Human CD34＋hematopoietic stem cells can reconstitute the human hematopoietic system when transplanted into immunocompromised mice after irradiation. Human leukapheresis peripheral blood (LPB)-and cord blood (CB)-derived CD34＋ cells have a similar capacity to reconstitute myeloid lineage cells in a humanized mice (hu-mice) model. However, potent stem cells, such as CB-CD34＋ cells, efficiently reconstitute the lymphoid system in vivo compared to LPB-CD34 ＋ cells. Modeling the human hematolymphoid system is vital for studying immune cell crosstalk in human xenografted mice, with CB-CD34＋ cells used as an optimized cell source because they are essential in reconstituting lymphoid lineage cells. @*Methods@#and Results: In this study, we established hu-mice that combined human characteristics with long-term survival and investigated the efficiency of the engraftment of lymphoid lineage cells derived from LPB- and CB-CD34＋cells in the bone marrow, spleen, and LPB. We found an overall increase in the transcriptional activity of lymphoid lineage genes in CB-CD34＋ cells. Our results revealed that potent CB-CD34＋ cells displaying a general upregulation of the expression of genes involved in lymphopoiesis could contribute to the hematolymphoid system in the humanized mice model with longevity. @*Conclusions@#Our data suggest that humanized mouse model by usage of CB-CD34 ＋ cells displaying high expression of TFs for lymphoid lineage cells can contribute to study the immune response against lymphocytes.

Anti-fracture Efficacy of Monthly Risedronate Compared with That of Weekly Risedronate in Postmenopausal Korean Women with Osteoporosis: A Nationwide Cohort Study / 가정의학회지

Background@#Intermittent dosing regimens for oral risedronate (once-monthly and once-weekly) were developed for patient convenience. While several studies have reported the anti-fracture efficacy of weekly dosing, few have assessed monthly dosing. The lower efficacy of monthly dosing has been previously suggested. The aim of this study was to compare the anti-fracture efficacy of monthly and weekly dosing. @*Methods@#We obtained information from the Korea National Health Insurance Service database from 2012 to 2017 of Korean women of ≥50 years of age who used weekly or monthly risedronate. We compared the time of occurrence of the first osteoporotic fracture after the first prescription of risedronate. Using a Cox proportional model, we assessed incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for fractures at any site, and the hip, vertebral, and non-vertebral sites between both regimens. Propensity score weighting was used to balance the treatment groups. @*Results@#The study populations were distributed according to dosing frequency (monthly, 27,329; weekly, 47,652). There was no significant difference in the incidence rate of new fractures in any site (IRR, 1.008; 95% CI,0.963– 1.055; P=0.737), hip (IRR, 0.999; 95% CI, 0.769–1.298; P=0.996), vertebral (IRR, 0.962; 95% CI, 0.890–1.040; P=0.330), or non-vertebral (1.022; 95% CI, 0.968–1.078; P=0.439) sites between monthly and weekly risedronate. @*Conclusion@#The anti-fracture efficacy at any site and the examined individual sites was similar for the monthly and weekly risedronate regimens. Large-scale randomized controlled trials are required for confirmation.

Fear of Falling and Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging / 가정의학회지

Background@#The fear of falling (FOF) has been reported in a high percentage of elderly people. An excessive FOF is a major concern among the elderly because it can lead to permanent disability. However, the impact of FOF on mortality has been insufficiently studied. The aim of this study was to investigate the impact of FOF on mortality among the elderly in Korea. @*Methods@#This was a prospective study carried out using the database of the Korean Longitudinal Study of Aging, a nationwide study of community-dwelling adults in Korea. Study participants included 3,421 adults, aged 65 years or older, without either severe cognitive impairment (Korean version of Mini-Mental Status Examination ≥10), or previous history of cancer. We used Cox proportional hazards models to investigate the association between FOF and all-cause mortality. @*Results@#This study included 1,474 men and 1,947 women. Cox regression showed that participants with FOF had an increased risk of mortality (mild: hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.01−1.54; moderate: HR, 1.59; 95% CI, 1.23−2.05) after adjusting for confounding variables. In a subgroup analysis, FOF was still a significant risk factor of mortality for patients with no previous history of falling after adjusting for other risk factors, as in the full model, except for history of falling (HR, 1.65; 95% CI, 1.27−2.13). @*Conclusion@#We found that FOF was a significant risk factor for mortality in the elderly in Korea. Further studies on the effects and mechanism of FOF on mortality are needed.

The Relationship between Handgrip Strength and Cognitive Function in Elderly Koreans over 8 Years: A Prospective Population-Based Study Using Korean Longitudinal Study of Ageing / 가정의학회지

BACKGROUND: Decreased physical performance, such as weakened handgrip strength and cognitive decline, is associated with disability and premature death in old age. We investigated the association between handgrip strength and cognitive impairment in Korean elderly adults with normal cognitive function. METHODS: This prospective study used the database from the Korean Longitudinal Study of Ageing. The participants included 2,378 adults aged 65 years or older with normal cognitive function (Korean Mini-Mental Status Evaluation [K-MMSE] score ≥21). Using a mixed-effects model, we examined the associations at baseline and over an 8-year follow-up period between handgrip strength and K-MMSE score. We investigated handgrip strength as a predictor of change in cognitive function. RESULTS: This study included 1,138 women (mean maximum handgrip strength 19.2 kg, mean K-MMSE score 25.1) and 1,240 men (mean maximum handgrip strength 30.7 kg, mean MMSE score 26.2). The baseline handgrip strength was positively associated with the baseline K-MMSE score (β=0.18, P < 0.001). Using a mixed-effects model, we found that higher handgrip strength at baseline can predict MMSE scores positively over time (β=0.14, P < 0.001) and the change of handgrip strength over time was a predictor of high MMSE scores over the study period (β=0.01, P < 0.01). CONCLUSION: We observed significant associations between baseline handgrip strength and baseline and change of cognition, as well as the longitudinal influence of handgrip strength on the change of cognitive function in elderly Korean adults with normal cognitive function.

Transcriptional regulatory networks underlying the reprogramming of spermatogonial stem cells to multipotent stem cells

Spermatogonial stem cells (SSCs) are germline stem cells located along the basement membrane of seminiferous tubules in testes. Recently, SSCs were shown to be reprogrammed into multipotent SSCs (mSSCs). However, both the key factors and biological networks underlying this reprogramming remain elusive. Here, we present transcriptional regulatory networks (TRNs) that control cellular processes related to the SSC-to-mSSC reprogramming. Previously, we established intermediate SSCs (iSSCs) undergoing the transition to mSSCs and generated gene expression profiles of SSCs, iSSCs and mSSCs. By comparing these profiles, we identified 2643 genes that were up-regulated during the reprogramming process and 15 key transcription factors (TFs) that regulate these genes. Using the TF-target relationships, we developed TRNs describing how these TFs regulate three pluripotency-related processes (cell proliferation, stem cell maintenance and epigenetic regulation) during the reprogramming. The TRNs showed that 4 of the 15 TFs (Oct4/Pou5f1, Cux1, Zfp143 and E2f4) regulated cell proliferation during the early stages of reprogramming, whereas 11 TFs (Oct4/Pou5f1, Foxm1, Cux1, Zfp143, Trp53, E2f4, Esrrb, Nfyb, Nanog, Sox2 and Klf4) regulated the three pluripotency-related processes during the late stages of reprogramming. Our TRNs provide a model for the temporally coordinated transcriptional regulation of pluripotency-related processes during the SSC-to-mSSC reprogramming, which can be further tested in detailed functional studies.

Knowledge, Current Status, and Barriers toward Healthcare Worker Vaccination among Family Medicine Resident Participants in a Web-Based Survey in Korea / 가정의학회지

BACKGROUND: We investigated the knowledge, status, and barriers toward healthcare workers receiving vaccinations among Korean family medicine residents. To date, a systematic study has not been conducted among medical practitioners examining these variables. METHODS: A web-based, anonymous, self-administered questionnaire was distributed to all 942 family medicine residents working in 123 training hospitals in Korea. A multiple logistic regression analysis was performed to investigate factors affecting vaccination completion. RESULTS: Korean family medicine residents (N=242, 25.7%) from 54 training hospitals (43.9%) participated in the survey. Only 24 respondents (9.9%) had correct knowledge on all the recommended vaccinations by the Korean Society of Infectious Diseases. The complete vaccination rates against hepatitis B virus and influenza were relatively high (69.4% and 83.0%, respectively), whereas they were relatively low against other infections (e.g., 16.5%– 53.1%). The most common reason for not receiving a vaccination was the belief that there was little possibility of infection from the vaccine-preventable diseases. CONCLUSION: Knowledge and vaccination coverage were poor among family medicine residents in Korea. Medical schools should provide vaccination information to healthcare workers as part of their mandatory curriculum. Further research should confirm these findings among primary care physicians and other healthcare workers.

Effect of Fenofibrate Medication on Renal Function / 가정의학회지

BACKGROUND: Fibrates are widely used to treat hypertriglyceridemia, a risk factor for arteriosclerosis, but these compounds have been associated with renal dysfunction. This study aimed to investigate the effects of fibrates on renal function in relatively healthy adult subjects with no cardiovascular diseases. METHODS: This retrospective study included 558 outpatients who were prescribed 160 mg fenofibrate (fenofibrate group) or 10 mg atorvastatin (control group) between August 2007 and October 2015. The groups were randomly matched using propensity scores at a 1:1 ratio. Serum creatinine levels and estimated glomerular filtration rates before and after treatment were compared between the two groups. RESULTS: Patients in the fenofibrate group showed greater changes in serum creatinine levels than those in the control group (9.73%±9.83% versus −0.89%±7.37%, P<0.001). Furthermore, 55.1% of patients in the fenofibrate group, but only 6.1% of those in the control group, exhibited a serum creatinine level increase ≥0.1 mg/dL (P<0.001). The fenofibrate group showed significantly greater declines in the estimated glomerular filtration rate than the control group (−10.1%±9.48% versus 1.42%±9.42%, P<0.001). Moreover, 34.7% of the fenofibrate group, but only 4.1% of the control group, exhibited an estimated glomerular filtration rate decrease ≥10 mL/min·1.73 m² (P<0.001). CONCLUSION: Fenofibrate treatment resulted in increased serum creatinine levels and reduced estimated glomerular filtration rates in a primary care setting. Therefore, regular renal function monitoring should be considered essential during fibrate administration.

Association Between Exposure to Environmental Tobacco Smoke at the Workplace and Risk for Developing a Colorectal Adenoma: A Cross-Sectional Study

PURPOSE: A colorectal adenoma (CRA) is a well-defined precursor to colorectal cancer (CRC). Additionally, smoking is a potent risk factor for developing a CRA, as well as CRC. However, the association between exposure to environmental tobacco smoke (ETS) and the risk for developing a CRA has not yet been fully evaluated in epidemiologic studies. We performed a cross-sectional analysis on the association between exposure to ETS at the workplace and the risk for developing a CRA. METHODS: The study was conducted on subjects who had undergone a colonoscopy at a health promotion center from January 2012 to December 2012. After descriptive analyses, overall and subgroup analyses by smoking status were performed by using a multivariate logistic regression. RESULTS: Among the 1,129 participants, 300 (26.6%) were diagnosed as having CRAs. Exposure to ETS was found to be associated with CRAs in all subjects (fully adjusted odds ratio [OR], 1.95; 95% confidence interval [CI], 1.08-2.44; P = 0.001). In the subgroup analysis, exposure to ETS in former smokers increased the risk for developing a CRA (fully adjusted OR, 4.44; 95% CI, 2.07-9.51; P < 0.001). CONCLUSION: Exposure to occupational ETS at the workplace, independent of the other factors, was associated with increased risk for developing a CRA in all subjects and in former smokers. Further retrospective studies with large sample sizes may be necessary to clarify the causal effect of this relationship.

Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles / 대한생식의학회지

OBJECTIVE: Assisted reproductive technology has been associated with an increase in multiple pregnancies. The most effective strategy for reducing multiple pregnancies is single embryo transfer. Beginning in October 2015, the National Supporting Program for Infertility in South Korea has limited the number of embryos that can be transferred per in vitro fertilization (IVF) cycle depending on the patient's age. However, little is known regarding the effect of age and number of transferred embryos on the clinical outcomes of Korean patients. Thus, this study was performed to evaluate the effect of the number of transferred blastocysts on clinical outcomes. METHODS: This study was carried out in the Fertility Center of CHA Gangnam Medical Center from January 2013 to December 2014. The clinical outcomes of 514 women who underwent the transfer of one or two blastocysts on day 5 after IVF and of 721 women who underwent the transfer of one or two vitrified-warmed blastocysts were analyzed retrospectively. RESULTS: For both fresh and vitrified-warmed cycles, the clinical pregnancy rate and live birth or ongoing pregnancy rate were not significantly different between patients who underwent elective single blastocyst transfer (eSBT) and patients who underwent double blastocyst transfer (DBT), regardless of age. However, the multiple pregnancy rate was significantly lower in the eSBT group than in the DBT group. CONCLUSION: The clinical outcomes of eSBT and DBT were equivalent, but eSBT had a lower risk of multiple pregnancy and is, therefore, the best option.

Application of serum anti-Müllerian hormone levels in selecting patients with polycystic ovary syndrome for in vitro maturation treatment / 대한생식의학회지

OBJECTIVE: The purpose of this study was to identify useful clinical factors for the identification of patients with polycystic ovary syndrome (PCOS) who would benefit from in vitro maturation (IVM) treatment without exhibiting compromised pregnancy outcomes. METHODS: A retrospective cohort study was performed of 186 consecutive patients with PCOS who underwent human chorionic gonadotropin-primed IVM treatment between March 2010 and March 2014. Only the first IVM cycle of each patient was included in this study. A retrospective case-control study was subsequently conducted to compare pregnancy outcomes between IVM and conventional in vitro fertilization (IVF) cycles. RESULTS: Through logistic regression analyses, we arrived at the novel finding that serum anti-Müllerian hormone (AMH) levels and the number of fertilized oocytes in IVM were independent predictive factors for live birth with unstandardized coefficients of 0.078 (95% confidence interval [CI], 1.005-1.164; p=0.037) and 0.113 (95% CI, 1.038-1.208; p=0.003), respectively. Furthermore, these two parameters were able to discriminate patients who experienced live births from non-pregnant IVM patients using cut-off levels of 8.5 ng/mL and five fertilized oocytes, respectively. A subsequent retrospective case-control study of patients with PCOS who had serum AMH levels ≥8.5 ng/mL showed that IVM had pregnancy outcomes comparable to conventional IVF, and that no cases of ovarian hyperstimulation syndrome were observed. CONCLUSION: Serum AMH levels are a useful factor for predicting pregnancy outcomes in PCOS patients before the beginning of an IVM cycle. IVM may be an alternative to conventional IVF for PCOS patients if the patients are properly selected according to predictive factors such as serum AMH levels.

Comparison of the Efficacy and Safety of Sodium Phosphate Tablets and Polyethylene Glycol Solution for Bowel Cleansing in Healthy Korean Adults

PURPOSE: Bowel cleansing is generally regarded as time-consuming and unpleasant among patients. Patients commonly state that bowel preparation provokes more discomfort than the actual colonoscopic examination. The purpose of this study was to compare two regimens of sodium phosphate (NaP) tablets versus polyethylene glycol (PEG) solution for bowel preparation in healthy Korean adults. MATERIALS AND METHODS: This was a single center, prospective, open-label, investigator-blinded, randomized, controlled-pilot study. A total of 62 healthy Korean subjects were randomly assigned to two groups (NaP vs. PEG). Efficacy, safety, and patient-related outcomes, as well as procedural parameters, were evaluated. RESULTS: Although there were no significant differences in total Ottawa bowel quality score, fluid scores and the rate of adequate bowel preparation were significantly better in the NaP group than the PEG group. Additionally, the NaP group showed better results regarding patient tolerance, satisfaction, preference, and rate of adverse events than the PEG group. Significant fluctuations in specific serum electrolytes were common and of a greater magnitude in the NaP group than the PEG group. However, these abnormalities were transient and did not result in serious complications and side effects. CONCLUSION: In this study, NaP tablets were shown to be an effective, well-tolerated, and acceptable regimen for bowel preparation. Also, our study suggests that NaP tablets may be safe and can be used as a bowel cleansing agent in healthy adults undergoing elective colonoscopy. Further multicenter, large scale studies are needed to confirm these findings.

New Reference Data on Bone Mineral Density and the Prevalence of Osteoporosis in Korean Adults Aged 50 Years or Older: The Korea National Health and Nutrition Examination Survey 2008-2010

This cross-sectional study was performed to investigate the reference values for bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and the prevalence of osteoporosis in the Korean population by applying domestic reference data. In total, 25,043 Korean adults > or =20 yr of age (11,792 men and 13,251 women) participated in the study. The BMDs of the total hip, femoral neck, and lumbar spine were measured by DXA (Discovery-W, Hologic Inc.), and subjects with a BMD - 2.5 standard deviations or lower than the mean BMD for young adults (20-29 yr old) were considered to have osteoporosis. When applying the new reference values determined in this study from Korean subjects, the overall prevalence of osteoporosis increased in men aged > or =50 yr compared with that provided by the DXA manufacturer from Japanese subjects (12.2% vs. 7.8%, P or =50 yr (32.9% vs. 38.7%, P<0.001). According to the findings of this study, use of the reference values provided by the DXA manufacturer has resulted in the underdiagnosis of osteoporosis in Korean men and the overdiagnosis of osteoporosis in Korean women. Our data will serve as valuable reference standards for the diagnosis and management for osteoporosis in the Korean population.

A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Comparison of Research Trends in Korean and International Family Medicine in Journals of Family Medicine / 가정의학회지

BACKGROUND: Research is important for the development of family medicine as a professional field in primary care. The aim of this study was to suggest directions for the development of family medicine research by analyzing research trends in original papers published in the Korean Journal of Family Medicine (KJFM) and international journals. METHODS: We investigated original research papers published in KJFM and 4 international journals from August 2009 to July 2010. Analysis was conducted according to research topics, authors, methods, participants, and data sources. RESULTS: 'Clinical research' was the most common research topic in both the KJFM (88.3%) and international journals (57.3%); however, international journals had more studies in other domains ('education and research,' 'health service,' and 'family medicine'). More authors other than family physicians participated in international journals than in the KJFM (58% and 3.3%, respectively). Most studies were 'cross-sectional' in KJFM (77.0%) and international journals (51.5%): however, the latter had more 'qualitative' studies, 'cohort' studies, and 'systematic reviews' than the former. The largest study population was 'visitors of health promotion center' in the KJFM and 'outpatients' in international journals. Most of the study sources were 'survey' and 'medical records' in both. CONCLUSION: There were limitations of diversity in the papers of the KJFM. Future investigation on papers of other than family medicine journals should be planned to assess research trends of family physicians.

Correlation between Expression of Glucose Transporters in Granulosa Cells and Oocyte Quality in Women with Polycystic Ovary Syndrome

BACKGROUND: The glucose transporters (GLUTs) exhibit different tissue-specific expression. This study aimed to investigate the types of GLUTs expressed in human granulosa cells (GCs) obtained from women with polycystic ovary syndrome (PCOS) and their relationship with insulin resistance (IR) and the outcomes of in vitro maturation (IVM) of immature oocytes. METHODS: Expression of GLUTs was evaluated in GCs from women with PCOS with or without IR. Thirty-six women with PCOS undergoing an IVM program were included. Differential gene expression between the insulin sensitive (IS) and IR group was measured by reverse transcription polymerase chain reaction. RESULTS: Expression of GLUTs 1, 3, 5, 8, and 13 was constitutive, whereas expression of GLUTs 2 and 7 was not observed in human GCs. The remaining GLUTs, 4, 6, 9, 10, 11, and 12, were differentially expressed among patients according to metabolic status, such as insulin sensitivity. A higher number of GCs from patients with IR (92%) expressed GLUT6 than GCs from IS PCOS patients (46.3%). Logistic regression showed that expression of GLUTs 9, 11, and 12 correlates with rates of IVM at 48 hours, fertilization, and implantation, respectively. CONCLUSION: This is the first report describing the expression pattern of all 13 members of the GLUT family in human GCs. Results of the present study suggest that patients' insulin sensitivity regulates GLUT expression in GCs in PCOS patients, and this may control oocyte quality for IVM and subsequent processes such as fertilization and implantation in patients taking part in an in vitro fertilization program.