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Background Phosphodiesterase type 5 inhibitors restore nitric oxide signaling, that plays a significant role in erectile function, and appears to counteract insulin resistance in animal and human models. This study was aimed to evaluate the glycemic and metabolic effects of low-dose tadalafil once daily in patients with type 2 diabetes and erectile dysfunction. Methods A 6-month, randomized, double-blind, placebo-controlled pilot trial was conducted. Eligible patients were randomly assigned in a ratio of 2:1 to the tadalafil 5 mg and placebo groups; all patients received either tadalafil or placebo once a day. The primary efficacy endpoint was the absolute change in glycated hemoglobin (HbA1c) levels during the 6-month study period. The secondary efficacy endpoints included metabolic parameters and erectile function. Results Of the 68 patients who completed this study, 45 and 23 patients were allocated to the tadalafil and placebo groups, respectively. The mean HbA1c level was significantly different between the groups over the 6-month study period ( P  = 0.021). After 6 months of treatment, the HbA1c decrement in the tadalafil group was greater than that in the placebo group (− 0.14 ± 0.53% vs. 0.20 ± 0.69%, P  = 0.030). The International Index of Erectile Function-5 scores improvement was significantly greater in the tadalafil group than in the placebo group at 6 months ( P  = 0.003). Conclusion This prospective pilot study showed that low-dose tadalafil administered once a day was effective in improving glycemic control and erectile function in patients with type 2 diabetes and erectile dysfunction. Trial registration KCT0005666

ObjectiveType 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.DesignMulticentre, retrospective, observational, new-user, active-comparator cohort study.SettingElectronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.ParticipantsPatients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.InterventionsPropensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.ResultsThe study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.ConclusionsSGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.

Anemia is an independent risk factor for the development of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). Hemoglobin levels may also be associated with DR. We investigated the association between hemoglobin levels and DR risk. This cross-sectional, population-based study utilized data from 2,123 type 2 DM patients aged ≥30 years who participated in the Korea National Health and Nutrition Examination Survey from 2008 to 2012. Participants underwent an ophthalmic examination, including fundus photographs. A multiple logistic regression analysis was performed to evaluate the relationship between hemoglobin levels and DR risk. The mean hemoglobin levels in patients with and without DR were 13.76 ± 0.12 and 14.33 ± 0.05 g/dL, respectively, with anemia observed in 16.2 (2.4)% and 7.8 (0.8)%, respectively. A 19% decrease in DR risk was found with a 1.0-g/dL increase in hemoglobin level. DR risk exhibited a decreasing trend with increasing hemoglobin levels ( P for trend <0.0001). The adjusted odds ratio of DR was significantly lower in the highest hemoglobin quartile. Our findings indicate that high hemoglobin levels are significantly related to a decreased DR risk in Korean type 2 diabetes.

Albuminuria is closely associated with diabetic retinopathy (DR), but the precise role of the albumin-to-creatinine ratio (ACR) in screening for DR remains to be determined. This study aimed to investigate an ACR threshold for predicting DR in patients with type 2 diabetes. A cross-sectional study was conducted on 1,102 type 2 diabetes patients, aged ≥30 years and recruited from the Korea National Health and Nutrition Examination Survey, 2010–2011. Participants were grouped by stage of DR: mild-to-moderate nonproliferative DR (NPDR), severe NPDR, and proliferative diabetic retinopathy (PDR). An early morning spot urine sample was obtained for ACR measurement. ROC curve analysis revealed that the optimal cut-off value of ACR for predicting DR was 2.26 mg/mmol (20 μg/mg). The prevalence of ACR ≥ 2.26 mg/mmol tended to increase with severity of DR. The risk for DR in patients with ACR ≥ 2.26 mg/mmol was higher than in those with ACR < 2.26 mg/mmol. The risk for severe NPDR and PDR also increased at ACR ≥ 2.26 mg/mmol. Normal-to-mildly increased albuminuria (an ACR of 2.26 mg/mmol) may predict the risk for DR development and progression in patients with type 2 diabetes.

Abstract Context Iodinated contrast media (ICM) is a common source of excess iodine in medical settings, given the common use of iodinated radiologic procedures. Objective To determine the long-term risks of thyroid dysfunction following iodinated contrast administration in a prospective study. Methods A longitudinal cohort study was conducted of patients in the United States Veterans Affairs medical system who received ICM. Serum thyroid function, thyroid antibody, and inflammatory markers were measured at baseline. Thyroid function tests were repeated at 1 month, 3 months, and every 6 months thereafter until 36 months. Risk of thyroid dysfunction and longitudinal changes in thyroid hormone levels were assessed using mixed effect models. Results There were 122 participants (median age, 70.0 [interquartile range 62.2-74.0] years; 98.4% male). At baseline, 6 subjects had subclinical thyroid dysfunction prior to ICM receipt. During median follow-up of 18 months, iodine-induced thyroid dysfunction was observed in 11.5% (14/122); 6 (4.9%) developed hyperthyroidism (including 1 with overt hyperthyroidism) and 8 (6.6%) subclinical hypothyroidism. At last follow-up, 10 of 20 subjects with thyroid dysfunction (14 new-onset cases and 6 with preexisting thyroid dysfunction) had persistent subclinical hyperthyroidism or hypothyroidism. There were also subtle changes in thyroid hormones observed longitudinally within the reference ranges in the overall cohort. Conclusion There is a rare long-term risk of an excess iodine load on thyroid dysfunction even among individuals from an overall iodine-sufficient region, supporting the need for targeted monitoring following iodinated contrast administration.

Context:Small papillary thyroid cancer (PTC) generally has an excellent prognosis. However, long-term recurrence is not uncommon and sometimes leads to morbidity or mortality.Objective:To identify high-risk factors for long-term recurrence in patients with small PTC by stratifying their pathologic characteristics.Design, Setting, and Patients:We conducted a nationwide, retrospective, multicenter study of 3282 patients with PTC sized ≤2 cm from 9 high-volume hospitals in Korea.Main Outcome Measures:The maximally selected χ2 method was used to find the best cutoff points of tumor size, the number of metastatic lymph nodes (LNs), and the ratio of metastatic/examined LNs (LNR) to predict recurrence. Kaplan-Meier analysis and the Cox proportional hazards regression model were used to analyze recurrence and risk factors.Results:The optimal tumor size cutoff was 1.8 cm (10-year recurrence rates for tumors sized 0.1 to 1.7 cm and 1.8 to 2.0 cm: 7.7% vs 17.2%, respectively). Metastatic LNs ≤1 and ≥2 provided optimal estimates of recurrence (10-year recurrence rates: 4.0% vs 16.8%, respectively). The LNR of 0.19 was the optimal cutoff point for predicting the risk of recurrence (10-year recurrence rates for LNRs of 0 to 0.18 and 0.19 to 1: 2.7% vs 16.2%, respectively). LN metastasis, lobectomy, tumor size ≥1.8 cm, and bilateral tumors were independent risk factors for recurrence.Conclusions:Long-term recurrence was increased in patients who underwent lobectomy or with tumor sized ≥1.8 cm, 2 or more metastatic LNs, or bilateral tumors. For patients with these high-risk features, total thyroidectomy could be considered to avoid reoperation.Lobectomy, tumor size ≥1.8 cm, 2 or more metastatic lymph nodes, and bilateral tumors were independent risk factors for recurrence in patients with papillary thyroid cancer sized ≤2.0 cm.

Background Amiodarone is commonly associated with thyroid dysfunction. Incidence of amiodarone induced thyroid dysfunction is variable in the literature and prognosis of patients who developed amiodarone induced thyroid dysfunction compared to euthyroid patients is still unclear. Results During a mean follow up of 7.4 years, 777 (3.9%) developed thyrotoxicosis (incidence rate 3.96 per 1000 person years) and 2,225 (11.3%) developed hypothyroidism (incidence rate 11.93 per 1000 person years). Patients with thyrotoxicosis or hypothyroidism had a lower MACE rate compared to euthyroid patients (45.2% vs. 50.2% and 48.5% vs. 50.2%). Multivariate analysis revealed that older age (>65 years), chronic kidney, ischemic heart disease and chronic obstructive lung disease were independent risk factors of MACE. Patients who developed thyrotoxicosis or hypothyroidism had a lower risk of MACE than euthyroid patients (HR=0.75 [95% CI: 0.68-0.83] and HR=0.73 [95% CI: 0.69-0.77]). Conclusion The incidence of amiodarone-induced thyrotoxicosis was higher compared to hypothyroidism. The patients with thyrotoxicosis or hypothyroidism had lower cardiovascular events in patients treated with amiodarone. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Background Metabolic syndrome is associated with type 2 diabetes and its prevalence is increasing worldwide in young adults. We aimed to determine whether cumulative exposure to metabolic syndrome is associated with type 2 diabetes risk in young adults. Methods Data of 1,376,540 participants aged 20–39 years without a history of type 2 diabetes and who underwent four annual health check-ups were collected. In this large-scale prospective cohort study, we evaluated the incidence rates and hazard ratios (HRs) of diabetes according to cumulative frequencies of metabolic syndrome over 4 years of consecutive annual health check-ups (burden score 0–4). Subgroup analyses were performed by sex and age. Results During 5.18 years of follow-up, 18,155 young adults developed type 2 diabetes. The incidence of type 2 diabetes increased with burden score ( P  < 0.0001). The multivariable-adjusted HRs for type 2 diabetes were 4.757, 10.511, 18.288, and 31.749 in participants with a burden score of 1 to 4, respectively, compared to those with 0. In subgroup analyses, the risk of incident diabetes was greater in women than men and in the 20–29 years age group than the 30–39 years age group. The HRs were 47.473 in women and 27.852 in men with four burden scores. Conclusion The risk of type 2 diabetes significantly increased with an increase in the cumulative burden of metabolic syndrome in young adults. Additionally, the association between cumulative burden and diabetes risk was stronger in women and the 20s age group.

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Background Although papillary thyroid carcinoma (PTC) often presents as multifocal or bilateral tumors, but whether multifocality or bilaterality is associated with disease recurrence/persistence is controversial. We evaluated the association between multifocality and bilaterality of PTC and disease recurrence/persistence. We also analyzed the location and number of tumors in multifocal PTC. Methods We reviewed the medical records of 2,095 patients who underwent total thyroidectomy for PTC. Tumors were classified as solitary or multifocal PTC according to the number of tumors present. Multifocal PTCs were subdivided into multifocal-unilateral and multifocal-bilateral PTC based on the tumor location. Solitary tumor or multifocal tumors located in one lobe were classified as unilateral PTC, and tumors in both lobes were classified as bilateral PTC. We analyzed the clinicopathologic features and clinical outcomes in each classification. Logistic regression models were used to assess the relation between multifocality or bilaterality and disease recurrence/persistence. Results Extrathyroidal invasion, cervical lymph node metastasis, and advanced TNM stage were significantly more frequent in multifocal PTC than in solitary PTC. Extrathyroidal invasion, cervical lymph node metastasis, advanced TNM stage, and distant metastasis were significantly more frequent in bilateral PTC than in unilateral PTC. The clinicopathologic parameters did not differ significantly between patients with multifocal-unilateral and multifocal-bilateral PTC. Multifocality was found to be an independent predictor of disease recurrence/persistence [odds ratio (OR) 1.45, 95 % confidence interval (CI) 1.01–2.10, p  = 0.04]. However, there was no association between bilaterality and disease recurrence/persistence (OR 0.98, 95 % CI 0.64–1.48, p  = 0.92). In multifocal PTC, the number of tumors (OR 1.75, 95 % CI 1.04–2.97, p  = 0.04), but not the location of tumors (OR 0.56, 95 % CI 0.31–1.02, p  = 0.06), was significantly associated with disease recurrence/persistence. Conclusions Although multifocal and bilateral PTC had aggressive pathologic features, only multifocality was associated with an increased risk of disease recurrence/persistence. This suggests that the number of tumor foci, but not their location, is a significant predictor of clinical outcomes.