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1.  Optimal Waist Circumference Cutoff Value Reflecting Insulin Resistance as a Diagnostic Criterion of Metabolic Syndrome in a Nondiabetic Korean Population Aged 40 Years and Over: The Chungju Metabolic Disease Cohort (CMC) Study 
Yonsei Medical Journal  2010;51(4):511-518.
We aimed at determining the cutoff value of waist circumference with respect to its ability to reflect insulin resistance in a Korean population.
Materials and Methods
A total of 8,817 subjects aged 40 years and over were analyzed. Insulin resistant individuals were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population. Receiver operating characteristic (ROC) curve analysis and multiple logistic regression analysis were applied.
The cutoff value of waist circumference reflecting insulin resistance from the ROC analysis was 84.4 cm for men and 80.6 cm for women. Sensitivity and specificity were 70.0% and 54.2% in men and 71.1% and 59.3% in women, respectively. After being controlled for other covariates, the odds ratio for the risk of insulin resistance using < 70 cm of waist circumference as a reference increased significantly in the category of 85.0-89.9 cm for men and 80.0-84.9 cm for women. In addition, statistically significant associations were consistently observed over the category of 85.0-89.9 cm for men and 80.0-84.9 cm for women.
The optimal cutoff value for waist circumference reflecting insulin resistance is considered to be 85 cm for men and 80 cm for women, suggesting that the Asian criterion of abdominal obesity (90 cm for men and 80 cm for women) as a component of metabolic syndrome (MetS) might not be applicable for middle-aged to older men in Korea.
PMCID: PMC2880262  PMID: 20499415
Metabolic syndrome; waist circumference; insulin resistance
2.  Age- and Sex-Specific Relationships between Household Income, Education, and Diabetes Mellitus in Korean Adults: The Korea National Health and Nutrition Examination Survey, 2008-2010 
PLoS ONE  2015;10(1):e0117034.
To investigate the effects of age and sex on the relationship between socioeconomic status (SES) and the prevalence and control status of diabetes mellitus (DM) in Korean adults.
Data came from 16,175 adults (6,951 men and 9,227 women) over the age of 30 who participated in the 2008-2010 Korea National Health and Nutrition Examination Survey. SES was measured by household income or education level. The adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) for the prevalence or control status of diabetes were calculated using multiple logistic regression analyses across household income quartiles and education levels.
The household income-DM and education level-DM relationships were significant in younger age groups for both men and women. The adjusted ORs and 95% CI for diabetes were 1.51 (0.97, 2.34) and 2.28 (1.29, 4.02) for the lowest vs. highest quartiles of household income and education level, respectively, in women younger than 65 years of age (both P for linear trend < 0.05 with Bonferroni adjustment). The adjusted OR and 95% CI for diabetes was 2.28 (1.53, 3.39) for the lowest vs. highest quartile of household income in men younger than 65 (P for linear trend < 0.05 with Bonferroni adjustment). However, in men and women older than 65, no associations were found between SES and the prevalence of DM. No significant association between SES and the status of glycemic control was detected.
We found age- and sex-specific differences in the relationship of household income and education with the prevalence of DM in Korea. DM preventive care is needed for groups with a low SES, particularly in young or middle-aged populations.
PMCID: PMC4306546  PMID: 25622031
3.  Insulin Resistance Is Associated with Intraocular Pressure Elevation in a Non-Obese Korean Population 
PLoS ONE  2015;10(1):e112929.
Based on reports of an association between elevated intraocular pressure (IOP) and metabolic syndrome (MetS), and the major role of insulin resistance (IR) in MetS pathogenesis, a positive association between IOP and IR has been hypothesized. Although Asian populations tend to have lower body mass indices (BMIs) than Western populations, they tend to have a higher risk of developing MetS. This study examined the hypothesis that the association between IOP and IR differs by obesity status in an Asian population, by examining a nationally representative sample of South Korean adults. Data collected from 4,621 South Korean adults regarding demographic, lifestyle, and laboratory parameters by the 2010 Korea National Health and Nutrition Examination Survey were subjected to linear regression analysis to evaluate the relationship between IOP and metabolic profiles. After adjusting for confounding factors, the data were subjected to multiple linear regression analysis to examine the association between IR, as measured by the homeostasis model assessment of insulin resistance (HOMA-IR), and IOP. Obesity was defined as BMI≥27.5 kg/m2, and the subjects were divided into obese vs. non-obese groups for investigation of the association between IR and IOP according to obesity status. IOP was found to correlate with fasting blood sugar, total cholesterol, insulin, and HOMA-IR values in non-obese men; and with BMI, waist circumference, triglycerides, total cholesterol, HOMA-IR, and low-density lipoprotein cholesterol values in non-obese women, whereas no association between IOP and IR was found in obese men or women. IOP was significantly associated with IR in non-obese men and women after adjusting for age, and in non-obese men after adjusting for age, BMI, and lifestyle and demographic factors. These findings indicate that a positive and independent relationship exists between IOP and IR in non-obese individuals only, suggesting that other factors likely contribute to IOP elevation in obese individuals.
PMCID: PMC4283958  PMID: 25559470
4.  RNA editing in RHOQ promotes invasion potential in colorectal cancer 
Novel A-to-I RNA editing in the coding sequence of RHOQ leads to an amino acid substitution that promotes invasion in colorectal cancer.
RNA editing can increase RNA sequence variation without altering the DNA sequence. By comparing whole-genome and transcriptome sequence data of a rectal cancer, we found novel tumor-associated increase of RNA editing in ras homologue family member Q (RHOQ) transcripts. The adenosine-to-inosine (A-to-I) editing results in substitution of asparagine with serine at residue 136. We observed a higher level of the RHOQ RNA editing in tumor compared with normal tissue in colorectal cancer (CRC). The degree of RNA editing was associated with RhoQ protein activity in CRC cancer cell lines. RhoQ N136S amino acid substitution increased RhoQ activity, actin cytoskeletal reorganization, and invasion potential. KRAS mutation further increased the invasion potential of RhoQ N136S in vitro. Among CRC patients, recurrence was more frequently observed in patients with tumors having edited RHOQ transcripts and mutations in the KRAS gene. In summary, we show that RNA editing is another mechanism of sequence alteration that contributes to CRC progression.
PMCID: PMC3978269  PMID: 24663214
5.  Prevalence of Systemic Lupus Erythematosus in South Korea: An Administrative Database Study 
Journal of Epidemiology  2014;24(4):295-303.
Systemic lupus erythematosus (SLE) is a rare autoimmune disease for which a population-based survey on the prevalence of the disease in South Korea has not yet been conducted. Our goal was to estimate the nationwide prevalence of SLE.
The International Classification of Diseases, Tenth Revision (ICD-10) code for SLE diagnosis—M32—was tentatively given when patients were suspected to have SLE before 2009. As such, the positive predictive value (PPV) of the M32 code shown in medical bills reflecting true SLE was uncertain. We attempted to estimate the prevalence of SLE in South Korea using national administrative database data from 2004–2006. We approximated the actual number of SLE patients by analyzing a list of SLE-coded patients provided by the National Health Insurance (NHI) and Health Insurance Review and Assessment Service. Prevalence was estimated by multiplying the PPV of the M32 diagnostic code by the number of patients receiving the code. The PPV was determined by three methods: direct investigation of the medical records of patients randomly selected from the SLE-coded patients list; assessment of all SLE patients treated at 56 selected hospitals in South Korea; and extrapolation from sub-groups at a single institute to the sub-groups of the national NHI data.
The estimated number of national SLE cases was between 9000 and 11 000, depending on the method of ascertainment, corresponding to a prevalence of 18.8–21.7 per 100 000 people.
This is the first report of a nationwide prevalence survey of SLE in South Korea. National databases may serve as a resource for epidemiologic studies of rare autoimmune diseases like SLE.
PMCID: PMC4074634  PMID: 24857955
systemic lupus erythematosus; prevalence; epidemiology
6.  Epigenetic regulation of cholinergic receptor M1 (CHRM1) by histone H3K9me3 impairs Ca2+ signaling in Huntington’s disease 
Acta neuropathologica  2013;125(5):727-739.
Huntington’s disease (HD) is an autosomal dominant neurodegenerative disease caused by an expanded trinucleotide CAG repeat in the gene coding for huntingtin (Htt). Deregulation of chromatin remodeling is linked to the pathogenesis of HD but the mechanism remains elusive. In order to identify what genes are deregulated by trimethylated histone H3K9 (H3K9me3)-dependent heterochromatin, we performed H3K9me3-ChIP genome-wide sequencing combined with RNA-sequencing followed by platform integration analysis in stable striatal HD cell lines (STHdhQ7/7 and STHdhQ111/111 cells). We found that genes involving neuronal synaptic transmission including cholinergic receptor M1 (CHRM1), cell motility, and neuronal differentiation pathways are down regulated while their promoter regions are highly occupied with H3K9me3 in HD. Moreover, we found that repression of CHRM1 gene expression by H3K9me3 impairs Ca2+-dependent neuronal signal transduction in stable cell lines expressing mutant HD protein. Thus, our data indicates that the epigenetic modifications, such as aberrant H3K9me3-dependent heterochromatin plasticity, directly contribute to the pathogenesis of HD.
PMCID: PMC3633717  PMID: 23455440
H3K9me3; epigenomes; Huntington’s disease; cholinergic receptor M1; heterochromatin
7.  Predicting the Development of Diabetes Using the Product of Triglycerides and Glucose: The Chungju Metabolic Disease Cohort (CMC) Study 
PLoS ONE  2014;9(2):e90430.
To determine whether the TyG index, a product of the levels of triglycerides and fasting plasma glucose (FPG) might be a valuable marker for predicting future diabetes.
A total of 5,354 nondiabetic subjects who had completed their follow-up visit for evaluating diabetes status were selected from a large cohort of middle-aged Koreans in the Chungju Metabolic Disease Cohort study. The risk of diabetes was assessed according to the baseline TyG index, calculated as ln[fasting triglycerides (mg/dL) × FPG (mg/dL)/2]. The median follow-up period was 4.6 years.
During the follow-up period, 420 subjects (7.8%) developed diabetes. The baseline values of the TyG index were significantly higher in these subjects compared with nondiabetic subjects (8.9±0.6 vs. 8.6±0.6; P<0.0001) and the incidence of diabetes increased in proportion to TyG index quartiles. After adjusting for age, gender, body mass index, waist circumference, systolic blood pressure, high-density lipoprotein (HDL)-cholesterol level, a family history of diabetes, smoking, alcohol drinking, education level and serum insulin level, the risk of diabetes onset was more than fourfold higher in the highest vs. the lowest quartile of the TyG index (relative risk, 4.095; 95% CI, 2.701–6.207). The predictive power of the TyG index was better than the triglyceride/HDL-cholesterol ratio or the homeostasis model assessment of insulin resistance.
The TyG index, a simple measure reflecting insulin resistance, might be useful in identifying individuals at high risk of developing diabetes.
PMCID: PMC3938726  PMID: 24587359
8.  Sarcopenia as a Determinant of Blood Pressure in Older Koreans: Findings from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2008–2010 
PLoS ONE  2014;9(1):e86902.
Blood pressure (BP) is directly and causally associated with body size in the general population. Whether muscle mass is an important factor that determines BP remains unclear.
To investigate whether sarcopenia is associated with hypertension in older Koreans.
We surveyed 2,099 males and 2,747 females aged 60 years or older.
Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight (ASM/Wt) that was <1 SD below the gender-specific mean for young adults. Obesity was defined as a body mass index (BMI) ≥25 kg/m2. Subjects were divided into four groups based on presence or absence of obesity or sarcopenia. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg, a diastolic BP (DBP) ≥90 mmHg, or a self-reported current use of antihypertensive medications.
The overall prevalence of hypertension in the four groups was as follows 49.7% for non-obese non-sarcopenia, 60.9% for non-obese sarcopenia, 66.2% for obese non-sarcopenia and 74.7% for obese sarcopenia. After adjustment for age, gender, regular activity, current smoking and alcohol use, the odds ratio (OR) for having hypertension was 1.5 (95% confidence interval (CI) = 1.23–1.84) in subjects in the non-obese sarcopenia group, 2.08 (95% CI = 1.68–2.57) in the obese non-sarcopenia group and 3.0 (95% CI = 2.48–3.63) in the obese sarcopenia group, compared with the non-obese non-sarcopenia group (p for trend <0.001). Controlling further for body weight and waist circumference did not change the association between hypertension and sarcopenia. The association between sarcopenia and hypertension was more robust in the subjects with diabetes mellitus.
Body composition beyond BMI has a considerable impact on hypertension in elderly Koreans. Subjects with sarcopenic obesity appear to have a greater risk of hypertension than simply obese or sarcopenia subjects.
PMCID: PMC3906091  PMID: 24489804
9.  Gender Difference in the Association of Metabolic Syndrome and Its Components with Age-Related Cataract: The Korea National Health and Nutrition Examination Survey 2008-2010 
PLoS ONE  2014;9(1):e85068.
To explore the relationship of the metabolic syndrome (MetS) and its components with age-related cataract in a representative Korean population.
We analyzed the data from the Korea National Health and Nutrition Examination Surveys (2008–2010). A total of 11,076 adults (4,811 men and 6,265 women) aged 40 and over who completed ophthalmologic examination were evaluated. Cataract was defined as the presence of cortical, nuclear, anterior (sub)capsular or posterior subcapsular cataract, from slit-lamp examination or previous cataract surgery. MetS was defined according to the Joint Interim Statement proposed in 2009 from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute.
The prevalence of cataract and MetS in this population was 39.4% (37.1% for men and 41.6% for women) and 38.5% (37.6% for men and 39.4% for women), respectively. Cataract prevalence tended to increase with the number of MetS components in both genders (both P< 0.001). After being controlled for confounders, however, MetS was significantly associated with cataract only in women (adjusted odds ratio (aOR), 1.24; 95% confidence interval (CI), 1.02–1.50]. Reduced HDL cholesterol, elevated fasting glucose, and elevated triglycerides were also significantly associated with cataract in women (aOR, 95% CI; 1.27 (1.07–1.50), 1.23 (1.01–1.50), and 1.26 (1.04–1.52), respectively). In the subgroup analysis for cataract subtype, MetS and reduced HDL cholesterol were significantly associated with nuclear cataract in women (aOR, 95% CI; 1.25 (1.07–1.55) and 1.25 (1.03–1.52), respectively). However, such associations were not found in men.
Our results suggest that MetS and its components appear to be associated with age-related cataract only among Korean women, especially in nuclear cataract.
PMCID: PMC3885677  PMID: 24416342
10.  The Effect of Obturator Nerve Block on Hip Lateralization in Low Functioning Children with Spastic Cerebral Palsy 
Yonsei Medical Journal  2013;55(1):191-196.
Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP.
Materials and Methods
The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation.
The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs.
ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.
PMCID: PMC3874912  PMID: 24339306
Cerebral palsy; hip dislocation; nerve block; obturator nerve
11.  Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness 
Metabolic syndrome is defined as a cluster of glucose intolerance, hypertension, dyslipidemia and central obesity with insulin resistance as the source of pathogenesis. Although several different combinations of criteria have been used to define metabolic syndrome, a recently published consensus recommends the use of ethnic‐specific criteria, including waist circumference as an indicator of central obesity, triglyceride and high‐density lipoprotein (HDL) cholesterol as indicators of dyslipidemia, and blood pressure greater than 130/85 mmHg. The definition of dysglycemia, and whether central obesity and insulin resistance are essential components remain controversial. Regardless of the definition, the prevalence of metabolic syndrome is increasing in Western and Asian countries, particularly in developing areas undergoing rapid socioenvironmental changes. Numerous clinical trials have shown that metabolic syndrome is an important risk factor for cardiovascular disease (CVD), type 2 diabetes mellitus and all‐cause mortality. Therefore, metabolic syndrome might be useful as a practical tool to predict these two major metabolic disorders. Comprehensive management of risk factors is very important to the improvement of personal and public health. However, recent studies have focused on the role metabolic syndrome plays as a risk factor for CVD; its importance in the prediction of incident diabetes is frequently overlooked. In the present review, we summarize the known evidence supporting metabolic syndrome as a predictor for type 2 diabetes mellitus and CVD. Additionally, we suggest how metabolic syndrome might be useful in clinical practice, especially for the prediction of diabetes.
PMCID: PMC4020225  PMID: 24843675
Metabolic syndrome; Risk factor; Type 2 diabetes mellitus
12.  Targeted Sequencing of Cancer-Related Genes in Colorectal Cancer Using Next-Generation Sequencing 
PLoS ONE  2013;8(5):e64271.
Recent advance in sequencing technology has enabled comprehensive profiling of genetic alterations in cancer. We have established a targeted sequencing platform using next-generation sequencing (NGS) technology for clinical use, which can provide mutation and copy number variation data. NGS was performed with paired-end library enriched with exons of 183 cancer-related genes. Normal and tumor tissue pairs of 60 colorectal adenocarcinomas were used to test feasibility. Somatic mutation and copy number alteration were analyzed. A total of 526 somatic non-synonymous sequence variations were found in 113 genes. Among these, 278 single nucleotide variations were 232 different somatic point mutations. 216 SNV were 79 known single nucleotide polymorphisms in the dbSNP. 32 indels were 28 different indel mutations. Median number of mutated gene per tumor was 4 (range 0–23). Copy number gain (>X2 fold) was found in 65 genes in 40 patients, whereas copy number loss (
PMCID: PMC3660257  PMID: 23700467
We have designed a five-year multicentre prospective cohort study in women who are both human papillomavirus (HPV)-positive with either atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) of cervix. This study aimed to analyze the risk of developing a high-grade squamous intraepithelial lesion (HSIL) from either ASCUS or LSIL in HPV-positive women, so called 'progression' rate, to investigate differences in the progression rates according to HPV type-specific infection, and to evaluate the various factors associated with the persistence or clearance of HPV infection in the Korean population. At present, the study protocol composed of cervical cytology, HPV DNA testing, and questionnaire have been conducted actively since the first participant was enrolled in 2010. This study is the first nationwide Korea HPV cohort study. Our data will provide valuable information about not only the ambiguous cytology results of ASCUS and LSIL but also the effect of the specific HPV type and other various factors on the progression to HSIL. Finally, the results of our study will be helpful and applicable to determine the primary cervical cancer prevention strategies.
PMCID: PMC3549509  PMID: 23346315
Cervical intraepithelial neoplasms; Cohort studies; Human papillomavirus; Uterine cervical neoplasms
Journal of Korean Medical Science  2012;27(6):636-643.
There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged ≤ 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.
PMCID: PMC3369450  PMID: 22690095
Vitamin D; Intact Parathyroid Hormone; Bone Density; Age; Sex
Journal of Korean Medical Science  2012;27(Suppl):S70-S75.
Screening can effectively reduce mortality and morbidity in some diseases. In Korea, a practical national screening program for chronic disease was launched in 1995 and several problems were discussed. The program focused primarily on disease detection without follow-up care. In addition, the test items were uniform regardless of subject's age, sex, or risk factors; and people with low socioeconomic status were excluded. To improve the quality of program, a new national screening program called the "National Screening Program for Transitional Ages (NSPTA)" was initiated in 2007. It targeted two age groups, ages 40 and 66, because these ages are important transition periods in one's lifecycle. Follow-up care and education for lifestyle modification has been intensified; screening tests for mental health problems and osteoporosis have been introduced. The pool of eligible participants has been expanded to include people supported by Medicaid. This review aimed to describe the contents, process, and characteristics of the NSPTA and to compare it with the previous program. In addition, some preliminary results from 2007 to 2009 were presented. Lastly, we suggest several points that need to be considered to improve the program such as enhancement of participation rates, necessity of specialized committee and research for current screening program to be supported by evidence.
PMCID: PMC3360178  PMID: 22661875
Mass Screening; Transitional Age; National Health Screening; Korea; Follow-up; Primary Prevention; Secondary Prevention; Health Risk Appraisal; Lifestyle
PLoS ONE  2012;7(3):e33238.
Cancer surivors have limited knowledge about second primary cancer (SPC) screening and suboptimal rates of completion of screening practices for SPC. Our objective was to test the efficacy of an educational material on the knowledge, attitudes, and screening practices for SPC among cancer survivors.
Randomized, controlled trial among 326 cancer survivors from 6 oncology care outpatient clinics in Korea. Patients were randomized to an intervention or an attention control group. The intervention was a photo-novel, culturally tailored to increase knowledge about SPC screening. Knowledge and attitudes regarding SPC screening were assessed two weeks after the intervention, and screening practices were assessed after one year.
At two weeks post-intervention, the average knowledge score was significantly higher in the intervention compared to the control group (0.81 vs. 0.75, P<0.01), with no significant difference in their attitude scores (2.64 vs. 2.57, P = 0.18). After 1 year of follow-up, the completion rate of all appropriate cancer screening was 47.2% in both intervention and control groups.
While the educatinal material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population.
Trial Registration NCT00948337
PMCID: PMC3315564  PMID: 22479375
Epidemiology and Health  2011;33:e2011009.
We aimed to determine the characteristics affecting insulin resistance in non-obese middle-aged adults in a rural community.
A total of 1,270 non-diabetic adults aged between 40 and 64 years old with body mass index (BMI) less than 25 kg/m2 were analyzed. Subjects with insulin resistance were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population.
A total of 217 subjects (20.6%) had insulin resistance. Prevalence of metabolic syndrome was significantly higher in insulin-resistant subjects in both men (29.3% vs. 10.3%) and women (34.1% vs. 15.6%). Among metabolic syndrome components, elevated waist circumference and elevated triglyceride were higher in insulin-resistant subjects in both genders. After being controlled for socioeconomic status and lifestyle related covariates, the association between insulin resistance and BMI was statistically significant in the category of 23.0-24.9 kg/m2 in men (adjusted OR, 4.63; 95% confidence interval [95% CI], 1.77-12.15) using the category of 18.5-20.9 kg/m2 as a reference. In addition, the association between insulin resistance and abdominal obesity was statistically significant only for men (adjusted OR, 2.57; 95% CI, 1.29-5.11).
Insulin resistance appears to be highly associated with high BMI and abdominal obesity, even in non-obese, non-diabetic middle-aged men.
PMCID: PMC3195816  PMID: 22025967
Abdominal obesity; BMI; Insulin resistance
Psychiatry Investigation  2011;8(3):194-200.
The study was conducted to investigate the association between economic status and depressive symptoms by comparing the prevalence rates of depressive symptoms at community level and analyzing the possibility of depressive symptoms at individual level.
A survey was conducted from November, 2006 to November, 2007 on 966 and 992 representative subjects recruited by stratified clustered sampling in two regions located in Seoul. We used a standardized questionnaire including the Center for Epidemiologic Studies-Depression and questions on the socioeconomic characteristics. The adjusted prevalence rates of depressive symptoms were compared at community level, and multiple logistic regression analysis was performed to determine the association between depressive symptoms and economic statuses at individual level among each region.
The adjusted prevalence of depressive symptoms was higher in the region with a high socioeconomic status (23.1%) than in the region with a lower economic status (16.6%)(p<0.001). However, logistic regression analysis of individual level revealed that a higher economic status was significantly associated with a lower possibility of depressive symptoms among the females in the low economic status region. This tendency was not observed among the males in both of the regions.
The association between economic status and depressive symptoms was found to be different when it was approached at community level or individual level. In addition, the association of two variables was different by gender at individual level. Further studies that consider the third mediators are needed to determine the association between the two variables.
PMCID: PMC3182383  PMID: 21994505
Depression; Prevalence; SES
Journal of Korean Medical Science  2011;26(8):1068-1073.
This study was aimed to investigate the prevalence of diabetic retinopathy and its associated factors in rural Korean patients with type 2 diabetes. A population-based, cross-sectional diabetic retinopathy survey was conducted from 2005 to 2006 in 1,298 eligible participants aged over 40 yr with type 2 diabetes identified in a rural area of Chungju, Korea. Diabetic retinopathy was diagnosed by a practicing ophthalmologist using funduscopy. The overall prevalence of diabetic retinopathy in the population was 18% and proliferative or severe non-proliferative form was found in 5.0% of the study subjects. The prevalence of retinopathy was 6.2% among those with newly diagnosed type 2 diabetes and 2.4% of them had a proliferative or severe non-proliferative diabetic retinopathy. The odds ratio of diabetic retinopathy increased with the duration of diabetes mellitus (5-10 yr: 5.2- fold; > 10 yr: 10-fold), postprandial glucose levels (> 180 mg/dL: 2.5-fold), and HbA1c levels (every 1% elevation: 1.34-fold). The overall prevalence of diabetic retinopathy in rural Korean patients was similar to or less than that of other Asian group studies. However, the number of patients with proliferative or severe non-proliferative diabetic retinopathy was still high and identified more frequently at the time of diagnosis. This emphasizes that regular screening for diabetic retinopathy and more aggressive management of glycemia can reduce the number of people who develop diabetic retinopathy.
PMCID: PMC3154343  PMID: 21860558
Diabetic Retinopathy; Prevalence; Risk Factors
Nucleic Acids Research  2010;39(Database issue):D883-D888.
High-throughput genomic technologies have been used to explore personal human genomes for the past few years. Although the integration of technologies is important for high-accuracy detection of personal genomic variations, no databases have been prepared to systematically archive genomes and to facilitate the comparison of personal genomic data sets prepared using a variety of experimental platforms. We describe here the Total Integrated Archive of Short-Read and Array (TIARA; database, which contains personal genomic information obtained from next generation sequencing (NGS) techniques and ultra-high-resolution comparative genomic hybridization (CGH) arrays. This database improves the accuracy of detecting personal genomic variations, such as SNPs, short indels and structural variants (SVs). At present, 36 individual genomes have been archived and may be displayed in the database. TIARA supports a user-friendly genome browser, which retrieves read-depths (RDs) and log2 ratios from NGS and CGH arrays, respectively. In addition, this database provides information on all genomic variants and the raw data, including short reads and feature-level CGH data, through anonymous file transfer protocol. More personal genomes will be archived as more individuals are analyzed by NGS or CGH array. TIARA provides a new approach to the accurate interpretation of personal genomes for genome research.
PMCID: PMC3013693  PMID: 21051338
Despite rapid evolution of shunt devices, the complication rates remain high. The most common causes are turning from obstruction, infection, and overdrainage into mainly underdrainage. We investigated the incidence of complications in a consecutive series of hydrocephalic patients.
From January 2002 to December 2009, 111 patients underwent ventriculoperitoneal (VP) shunting at our hospital. We documented shunt failures and complications according to valve type, primary disease, and number of revisions.
Overall shunt survival time was 268 weeks. Mean survival time of gravity-assisted valve (GAV) was 222 weeks versus 286 weeks for other shunts. Survival time of programmable valves (264 weeks) was longer than that of pressure-controlled valves (186 weeks). The most common cause for shunt revision was underdrainage (13 valves). The revision rate due to underdrainage in patients with GAV (7 of 10 patients) was higher than that for other valve types. Of 7 patients requiring revision for GAV underdrainage, 6 patients were bedridden. The overall infection rate was 3.6%, which was lower than reported series. Seven patients demonstrating overdrainage had cranial defects when operations were performed (41%), and overdrainage was improved in 5 patients after cranioplasty.
Although none of the differences was statistically significant, some of the observations were especially notable. If a candidate for VP shunting is bedridden, GAV may not be indicated because it could lead to underdrainage. Careful procedure and perioperative management can reduce infection rate. Cranioplasty performed prior to VP shunting may be beneficial.
PMCID: PMC2966728  PMID: 21082054
Hydrocephalus; Gravity-assisted valve; Survival time; Complication; Shunt
Although colorectal adenoma is reported to recur frequently, this may result from missing it at baseline. However, few studies of recurrence have considered the miss rate. This study evaluated the recurrence rate prospectively and clinical predictors of recurrence in colorectal adenoma after lowering the miss rate.
The study population comprised 128 patients who underwent baseline colonoscopy with resection of colorectal adenomas. Re-examination to lower the miss rate was performed within 2 months. Follow-up colonoscopy to detect recurrence was done more than 1 year after removal.
The mean follow-up period was 35.1 months (range, 12 to 84 months). Thirty patients had a recurrent adenoma, for a recurrence rate of 23.4%. Older patients (over 60 years) had a two-fold greater risk of recurrence than younger patients (hazard ratio, 2.39; 95% confidence interval [CI], 1.16-4.90). Patients with three or four adenomas at baseline colonoscopy had a two-fold greater risk than those with one adenoma (hazard ratio, 2.44; 95% CI, 1.11-5.35). Patients with advanced adenoma had a two-fold greater risk than those with no advanced adenoma (hazard ratio, 2.88; 95% CI, 1.40-5.95). In multivariate analysis, only the presence of three or four adenomas independently predicted the recurrence of adenoma (hazard ratio, 3.19; 95% CI, 1.04-9.79).
The recurrence rate of colorectal adenoma corrected by lowering the miss rate was lower than reported rates. The presence of multiple adenomas on initial colonoscopy was an important predictor of recurrence.
PMCID: PMC2732778  PMID: 19721855
Colorectal adenoma; Recurrence rate; Miss rate
BMC Genomics  2008;9:440.
Ubiquitination is an important post-translational modification involved in diverse biological processes. Therefore, genomewide representation of the ubiquitination system for a species is important.
SCUD is a web-based database for the ubiquitination system in Saccharomyces cerevisiae (Baker's yeast). We first searched for all the known enzymes involved in the ubiquitination process in yeast, including E1, E2, E3, and deubiquitination enzymes. Then, ubiquitinated substrates were collected by literature search. Especially, E3 and deubiquitination enzymes are classified into classes and subclasses by their shared domains and unique functions. As a result, 42 different E3 enzymes were grouped into corresponding classes and subclasses, and 940 ubiquitinated substrates including mutant substrates were identified. All the enzyme and substrate information are interconnected by hyperlinks, which makes it easy to view the enzyme-specific ubiquitination information.
This database aims to represent a comprehensive yeast ubiquitination system, and is easily expandable with the further experimental data. We expect that this database will be useful for the research on the ubiquitination systems of other higher organisms.
SCUD is accessible at
PMCID: PMC2567349  PMID: 18811980
The aim of this study was to analyze the prevalence and clinical characteristic of the metabolic syndrome of adults, over 40 years old, living in Korea.
This study was carried out for 2 years, 2003-2004, on total 5,330 individuals (2,197 men and 3,133 women) selected by the stratified random cluster sampling among adults over 40 years old. Metabolic syndrome was defined based on both the NCEP-ATP III criteria and Modified ATP III criteria applying the WHO-APR (Asian Pacific Region)'s abdominal obesity criteria (waist circumference > 90 cm in men, 80 cm in women) instead of NCEP-ATP III criteria.
Using NCEP-ATP III criteria, the age-adjusted overall prevalence of metabolic syndrome was 24.8% (17.6% in men, 30.0% in women). Age-adjusted overall prevalence of metabolic syndrome as defined by modified-ATP III criteria was 34.3% (26.3% in men, 40.1% in women). The prevalence of metabolic syndrome for each age group (40-49, 50-59, 60-69, ≥ 70) in men was as follows: 18.8%, 17.4%, 18.3%, 14.5%. In women: 22.3%, 32.7%, 39.9%, 39.3%. The prevalence of hypertriglyceridemia (triglycerides ≥ 1.7 mmol/l) was well correlated with the changing pattern of the prevalence of metabolic syndrome both in men and women.
The peak age of metabolic syndrome in men was age 40 through 49, and the prevalence decreased with aging. Therefore, early intervention for risk factors of metabolic syndrome might be required in men. On the other hand, prevention for cardiovascular disease will be needed for perimenopausal women due to considerably increased prevalence in the age 50 through 59.
PMCID: PMC3891077  PMID: 16491829
Prevalence; Metabolic syndrome
Nature Communications  2014;5:5619.
Reprogramming of somatic cells to induced pluripotent stem cells involves a dynamic rearrangement of the epigenetic landscape. To characterize this epigenomic roadmap, we have performed MethylC-seq, ChIP-seq (H3K4/K27/K36me3) and RNA-Seq on samples taken at several time points during murine secondary reprogramming as part of Project Grandiose. We find that DNA methylation gain during reprogramming occurs gradually, while loss is achieved only at the ESC-like state. Binding sites of activated factors exhibit focal demethylation during reprogramming, while ESC-like pluripotent cells are distinguished by extension of demethylation to the wider neighbourhood. We observed that genes with CpG-rich promoters demonstrate stable low methylation and strong engagement of histone marks, whereas genes with CpG-poor promoters are safeguarded by methylation. Such DNA methylation-driven control is the key to the regulation of ESC-pluripotency genes, including Dppa4, Dppa5a and Esrrb. These results reveal the crucial role that DNA methylation plays as an epigenetic switch driving somatic cells to pluripotency.
Somatic cell reprogramming can induce distinct pluripotent states. Here the authors perform time-resolved whole-genome bisulfite sequencing during the reprogramming of mouse embryonic fibroblasts and report dynamic global DNA methylation changes.
PMCID: PMC4284806  PMID: 25493341

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