Correlation of Sarcopenic Obesity on Various Cardiometabolic Risk Factors and Fracture Risk in Mid-Aged Korean Women

Objectives@#This study aimed to investigate the correlation of sarcopenic obesity with various cardiometabolic risk factors and fracture risk in middle-aged Korean women. @*Methods@#In this cross-sectional study, the medical records of 1,775 women who had visited Pusan National University Hospital for routine health screenings from 2010 to 2016 were reviewed. The patients were divided into four groups as follows: group 1, nonsarcopenic, nonobese (NS-NO); group 2, nonsarcopenic, obese (NS-O); group 3, sarcopenic, nonobese (S-NO); and group 4, sarcopenic, obese (S-O). Each patient was assessed based on self-reported questionnaires and individual interviews with a healthcare provider. The Fracture Risk Assessment Tool (FRAX) was used to assess bone fracture risk. @*Results@#Postmenopausal women accounted for 68.5% of the total patient population. The proportion of each group was as follows:NS-NO, 71.2%; NS-O, 17.9%; S-NO, 10.2%; and S-O, 0.7%. Statistical analysis of various parameters associated with metabolic and cardiovascular risks revealed that the S-O group had more patients with hypertension, diabetes, osteopenia, and metabolic syndrome.The FRAX scores were significantly higher in the S-O group than in other groups. @*Conclusions@#Middle-aged women with obesity and reduced muscle mass, known as sarcopenic obesity, are at increased risk of hypertension, diabetes, and metabolic syndrome. Furthermore, sarcopenic obesity, individual cardiometabolic risks, and menopause can increase the bone fracture risk.

Correlations between Obtaining Fever Management Information from the Internet and Knowledge and Practices of Fever Management by Mothers of Infants and Toddlers

Purpose@#This study was conducted to identify correlations between how much fever management information mothers obtained from the internet and their actual knowledge and practices of fever management. @*Methods@#This was a descriptive survey of 172 mothers with children aged between 0 and 3 attending five daycare centers located in the city of Daegu. Descriptive statistics, the independent t-test or one-way analysis of variance, and Pearson correlation coefficients were used for data analysis. @*Results@#In total, 75% of the mothers had searched the internet for information on fever management. The overwhelming majority (92.2%) used information from the internet to help manage fever in their children. Positive correlations were found between acquiring fever management information from the internet and fever management practices (r=.18, p=.038), and between mother’s knowledge and practices of fever management (r=.27, p<.001). @*Conclusion@#Based on the results of this study, to improve fever management practices, it is necessary to increase mothers’ knowledge. Therefore, resources should be developed to augment mothers’ knowledge of fever management through the internet.

The Significance of TROP2 Expression in Predicting BRAF Mutations in Papillary Thyroid Carcinoma

BACKGROUND: Trophoblast antigen 2 (TROP2) is a human trophoblast cell-surface glycoprotein that is overexpressed in several types of epithelial cancers, and is suggested to be associated with an unfavorable prognosis. BRAF mutations are the most common genetic alteration in papillary thyroid carcinoma (PTC). We evaluated the correlation between TROP2 expression and BRAF mutation in PTC. METHODS: First, we carried out pyrosequencing for BRAF mutations and immunohistochemistry for TROP2 expression with a tissue microarray consisting of 52 PTC cases. Membranous staining in at least 5% of tumor cells was designated as positive staining and we analyzed the relationship between TROP2 expression and diverse clinicopathological factors, including BRAF mutation. Second, we tested TROP2 mRNA expression in three thyroid cancer cell lines with BRAF mutations (BCPAP, SNU790, and 8505C) and a normal thyroid cell line. Additionally, we checked TROP2 protein levels in a normal thyroid cell line after introduction of the BRAF V600E mutation. RESULTS: In this study, 21 of 26 cases with BRAF mutation showed TROP2 immunoreactivity, whereas all 26 cases without BRAF mutation showed no immunoreactivity for TROP2 with a statistically significant difference (p<.001). Upregulation of TROP2 mRNA was observed in all three thyroid cancer cell lines, but not in the normal thyroid cell line. Interestingly, however, the TROP2 expression was increased in the normal thyroid cell line after introduction of the BRAF V600E mutation. CONCLUSIONS: Based on these results, we concluded that TROP2 expression is significantly associated with BRAF mutation and that TROP2 immunohistochemistry could be used for predicting BRAF mutations or diagnosing papillary thyroid carcinoma.

Sympathetic Overactivity Based on Heart-Rate Variability in Patients with Obstructive Sleep Apnea and Cerebral Small-Vessel Disease

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is associated with cerebral white-matter changes (WMC), but the underlying mechanisms are not completely understood. Our aim was to identify the cardiovascular autonomic characteristics during sleep that are associated with cerebral WMC in OSA patients. METHODS: We recruited subjects from our sleep-center database who underwent both polysomnography and brain MRI within a 1-year period. Sixty patients who had OSA with WMC (OSA+WMC), 44 patients who had OSA without WMC (OSA−WMC), and 31 control subjects who had neither OSA nor WMC were analyzed. Linear and nonlinear indices of heart-rate variability (HRV) were analyzed in each group according to different sleep stages and also over the entire sleeping period. RESULTS: Among the nonlinear HRV indices, the Poincaré ratio (SD12) during the entire sleep period was significantly increased in the OSA+WMC group, even after age adjustment. Meanwhile, detrended fluctuation analysis 1 during non-rapid-eye-movement sleep tended to be lowest in the OSA+WMC group. These indices were altered regardless of the presence of hypertension or diabetes. In the subgroup analysis of middle-aged OSA patients, approximate entropy during rapid-eye-movement sleep was significantly lower in OSA+WMC patients than in OSA−WMC patients. Overall, the nonlinear HRV indices suggest that sympathetic activity was higher in the OSA+WMC group than in the OSA−WMC and control groups. CONCLUSIONS: Our findings suggest that dysregulation of HRV, especially overactivation of sympathetic tone, could be a pathophysiologic mechanism underlying the development of WMC in OSA patients.

Structural and Functional Alterations at Pre-Epileptic Stage Are Closely Associated with Epileptogenesis in Pilocarpine-induced Epilepsy Model

Pilocarpine-induced rat epilepsy model is an established animal model that mimics medial temporal lobe epilepsy in humans. The purpose of this study was to investigate neuroimaging abnormalities in various stages of epileptogenesis and to correlate them with seizure severity in pilocarpine-induced rat epilepsy model. Fifty male Sprague-Dawley rats were subject to continuous video and electroencephalographic monitoring after inducing status epilepticus (SE) and seizure severity was estimated by frequency and total durations of class 3 to 5 spontaneous recurrent seizures (SRS) by modified Racine's classification. The 7.0 Tesla magnetic resonance imaging (MRI) with high resolution flurodeoxyglucose positron emission tomography (FDG-PET) was performed at 3 hours, 1, 3, 7 days and 4 weeks after the initial insult. The initial SRS was observed 9.7±1.3 days after the pilocarpine injection. MRI revealed an abnormal T2 signal change with swelling in both hippocampi and amygdala in acute (day 1 after injection) and latent phases (days 3 and 7), in association with PET hypometabolism in these areas. Interestingly, the mean frequency of class 3 to 5 SRS was positively correlated with abnormal T2 signals in hippocampal area at 3 days. SRS duration became longer with more decreased glucose metabolism in both hippocampi and amygdala at 7 days after pilocarpine injection. This study indicates that development and severity of SRS at chronic phase could be closely related with structural and functional changes in hippocampus during the latent period, a pre-epileptic stage.

The Role of Notch1 Signaling in Anaplastic Thyroid Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The Notch signaling pathway is widely expressed in normal, reactive, and neoplastic tissues; however, its role in thyroid tissues has not been fully elucidated. Therefore, this study was conducted to characterize the expression of the Notch signaling pathway in papillary thyroid cancer (PTC) cells and anaplastic thyroid cancer (ATC) cells. MATERIALS AND METHODS: Expression of activated Notch1 in ATC and PTC paraffin-embedded tissues was determined by immunohistochemistry. The small interfering RNA techniquewas employed to knock down Notch1 expression in ATC and PTC cell lines. RESULTS: The expression of activated Notch1 was higher in ATC cases than in PTC cases. Inhibition of Notch1 significantly reduced proliferation and migration of ATC cells, but not PTC cells. In addition, inhibition of Notch1 in ATC cells significantly reduced the expression of key markers of epithelial-mesenchymal transition and cancer stem cells. Conversely, changes in the expression of these proteins were not observed in PTC cells. CONCLUSION: The results of this study suggest that Notch1 expression plays different roles in tumor progression in ATC and PTC cells. We also found that Notch1 expression was significantly related to the highly invasive or proliferative activity of ATC cells.

Analysis of Natural History of Upper Gastrointestinal Subepithelial Tumors and Factors Related to Tumor Growth Demonstrated by Endoscopic Ultrasonography

BACKGROUND/AIMS: Small subepithelial tumors (SETs) are often found incidentally during esophagoduodenoscopy, and EUS is a useful tool for assessing SETs. This study aimed to evaluate the natural history of SETs and to clarify the predictive factors of growth using EUS. MATERIALS AND METHODS: We retrospectively investigated SETs less than 30 mm and identified the EUS features. A significant increase in SET size was defined as a lengthening of more than 25% of the longest diameter in the last follow-up EUS features compared with the initial study. RESULTS: A total of 99 patients with 105 upper gastrointestinal SETs were enrolled. The mean follow-up period for SETs was 22.8 months. Among the 105 SETs, 12 (11.4%) were significantly larger at follow-up. Univariate analysis revealed that the presence of hypoechoic areas was associated with significant SET growth (P=0.021). In multivariate analysis, the presence of hypoechoic areas (OR, 8.96; 95% CI, 1.89~42.54) and anechoic areas (OR, 7.85; 95% CI, 1.09~56.37) were related with significant growth of SETs. Six of the 12 SETs showing significant growth were removed, and identified as gastrointestinal stromal tumors. CONCLUSIONS: Majority of small SETs showed no significant increase during follow-up. Presence of hypoechoic areas and anechoic areas were associated with SET growth. Therefore, small SETs with hypoechoic area or anechoic area may be considered for regular follow-up in the clinical field.

The Influence of Iron Deficiency on Helicobacter pylori Eradication

BACKGROUND/AIMS: Helicobacter pylori is a distinctive pathogen that lives in the gastric mucosa and is a well known risk factor of gastric adenocarcinoma. Iron deficiency aggravates the development of H. pylori-induced premalignant and malignant lesions in a cagA-dependent manner, enhancing H. pylori virulence. The aim of this study was to identify the relationship between iron deficiency and H. pylori eradication rates. MATERIALS AND METHODS: Participants who received 7 days of first-line triple therapy with serum iron level measured in parallel were retrospectively investigated between 2005 and 2014. H. pylori eradication was confirmed by the rapid urease test or 13C-urea breath test at least 4 weeks after completion of triple therapy. Iron deficiency was defined as either a serum iron level less than 50 µg/dL or a serum ferritin level less than 12 ng/mL. RESULTS: A total of 194 patients received 7 days of first-line triple therapy along with parallel serum iron level measurements over the 10-year period. The mean average age was 53.3 years (range, 21~86 years), and 135 patients (69.6%) were male. The overall H. pylori eradication rate was 83.5%. Proportions of eradication success with ferritin level less than 12 ng/mL and iron less than 50 µg/dL were 90.5% and 88.6%, respectively. However, there was no statistical difference in eradication rates according to iron deficiency. CONCLUSIONS: Iron deficiency might not be related with H. pylori eradication rates in this study. Further large-scale studies are needed to confirm this result.

Acute disseminated encephalomyelitis with tremor as the initial symptom

Multiple neurological deficits can occur in acute disseminated encephalomyelitis (ADEM) but rarely movement disorders. A 24-year-old female patient was admitted because of tremor in bothupper limbs. After admission, her mental status progressively declined into coma. Brain magnetic resonance imaging and cerebrospinal fluid analysis were compatible with ADEM. Tests for central nervous system infection and autoimmune diseases were all negative. She was given steroid and IVIG, and the patient fully improved. We report here the first case of adult ADEM, who presented with tremor as the initial neurological manifestation.

Lactoferrin Combined with Retinoic Acid Stimulates B1 Cells to Express IgA Isotype and Gut-homing Molecules

It is well established that TGF-beta1 and retinoic acid (RA) cause IgA isotype switching in mice. We recently found that lactoferrin (LF) also has an activity of IgA isotype switching in spleen B cells. The present study explored the effect of LF on the Ig production by mouse peritoneal B cells. LF, like TGF-beta1, substantially increased IgA production in peritoneal B1 cells but little in peritoneal B2 cells. In contrast, LF increased IgG2b production in peritoneal B2 cells much more strongly than in peritoneal B1 cells. LF in combination with RA further enhanced the IgA production and, interestingly, this enhancement was restricted to IgA isotype and B1 cells. Similarly, the combination of the two molecules also led to expression of gut homing molecules alpha4beta7 and CCR9 on peritoneal B1 cells, but not on peritoneal B2 cells. Thus, these results indicate that LF and RA can contribute to gut IgA response through stimulating IgA isotype switching and expression of gut-homing molecules in peritoneal B1 cells.

Impact of Vascular Risk Factors, Axial Medial Temporal Atrophy, White Matter Hyperintensity on Cognitive Outcome in Alzheimer's Diseases

BACKGROUND: There is epidemiologic evidence to support vascular disease as a possible cause of Alzheimer's dementia (AD). The primary aim of this study was to determine the prevalence of vascular risk factors (vRFs) with respect to various clinical measures, such as axial-rated medial temporal lobe atrophy (MTA), ischemic white-matter changes, and cognition. The secondary aim was to determine the most significant clinical measure associated with cognitive outcome. METHODS: The study subjects comprised 198 probable AD and 38 subjective memory impairment-no cognitive impairment controls (SMI-NCI), for whom medical data including history vRF-related blood tests, clinical dementia evaluation, cognitive assessment, and brain MRI, were available. The grading of white-matter hyperintensities (WMHs) was achieved using Fazekas' method. MTA was graded by two neurologists independently based on axial T1-weighted MRI images. The prevalence of risk factors for Koreans aged > or =65 years was reviewed for comparison. RESULTS: All vRFs except smoking were more severe in the AD group than in both the SMI-NCI group and Koreans aged > or =65 years, but the high prevalence of vRFs had no impact on WMH lesions, axial MTA, or cognitive outcome. Both white-matter changes and MTA were significantly worse in AD than in SMI-NCI (p<0.001). The degree of MTA was negatively correlated with WMH grade (p<0.001), but the severity of clinical dementia was correlated only with increased axial MTA in AD (Instrumental Activities of Daily Living and Clinical Dementia Rating scores, p<0.001; Clinical Dementia Rating-Sum of Boxes score, p<0.005). CONCLUSIONS: WMHs and axial MTA were significantly more severe in the AD group than in the SMI-NCI subjects. The findings of this study indicate that worsening of cognitive dysfunction in AD appears to be driven by MTA, which is evident even in axial MTA visual grading, irrespective of WMH severity and the presence of vRFs.

Painful Ophthalmoplegia as a Presenting Sign of Internal Carotid Artery Occlusion

No abstract available.

Painful Ophthalmoplegia as a Presenting Sign of Internal Carotid Artery Occlusion

No abstract available.

Dynamic roles of angiopoietin-like proteins 1, 2, 3, 4, 6 and 7 in the survival and enhancement of ex vivo expansion of bone-marrow hematopoietic stem cells

Recent advances in hematopoietic stem cells (HSCs) expansion by growth factors including angiopoietin-like proteins (Angptls) have opened up the possibility to use HSCs in regenerative medicine. However, the unavailability of true in vitro HSCs expansion by these growth factors has limited the understanding of the cellular and molecular mechanism of HSCs expansion. Here, we report the functional role of mouse Angptls 1, 2, 3, 4, 6 and 7 and growth factors SCF, TPO, IGF-2 and FGF-1 on purified mouse bone-marrow (BM) Lineage(-)Sca-1(+)(Lin-Sca-1(+)) HSCs. The recombinant retroviral transduced-CHO-S cells that secrete Angptls in serum-free medium were used alone or in combination with growth factors (SCF, TPO, IGF-2 and FGF-1). None of the Angptls stimulated HSC proliferation, enhanced or inhibited HSCs colony formation, but they did support the survival of HSCs. By contrast, any of the six Angptls together with saturating levels of growth factors dramatically stimulated a 3- to 4.5-fold net expansion of HSCs compared to stimulation with a combination of those growth factors alone. These findings lead to an understanding of the basic function of Angptls on signaling pathways for the survival as well as expansion of HSCs in the bone marrow niche.

2-(4-Hydroxyphenyl)-5-(3-Hydroxypropenyl)-7-Methoxybenzofuran, a Novel Ailanthoidol Derivative, Exerts Anti-Inflammatory Effect through Downregulation of Mitogen-Activated Protein Kinase in Lipopolysaccharide-Treated RAW 264.7 Cells

We reported that ailanthoidol, a neolignan from Zanthoxylum ailanthoides and Salvia miltiorrhiza Bunge, inhibited inflammatory reactions by macrophages and protected mice from endotoxin shock. We examined the anti-inflammatory activity of six synthetic ailanthoidol derivatives (compounds 1-6). Among them, compound 4, 2-(4-hydroxyphenyl)-5-(3-hydroxypropenyl)-7-methoxybenzofuran, had the lowest IC50 value concerning nitric oxide (NO) release from lipopolysaccharide (LPS)-stimulated RAW264.7 cells. Compound 4 suppressed the generation of prostaglandin (PG) E2 and the expression of inducible NO synthase and cyclooxygenase (COX)-2 induced by LPS, and inhibited the release of LPS-induced pro-inflammatory cytokines from RAW264.7 cells. The underlying mechanism of compound 4 on anti-inflammatory action was correlated with the down-regulation of mitogen-activated protein kinase and activator protein-1 activation. Compound 4 is potentially an effective functional chemical candidate for the prevention of inflammatory diseases.

Dual Fistulas of Ascending Aorta and Coronary Artery to Pulmonary Artery

Coronary artery fistula to pulmonary artery is common. However, to the best of our knowledge, a case of coronary artery fistula to pulmonary artery associated with aortopulmonary fistula remains unreported. We herein report a 64-year-old female with a left anterior descending coronary artery and ascending aorta to pulmonary artery fistulas, and conduct a brief review of the literature.

A Rare Case with Primary Undifferentiated Carcinoma of Pericardium

A primary pericardial tumor is very rare. A 77-year-old woman was admitted to our hospital with chief complaint of exertional dyspnea due to large amount of pericardial effusion. She was finally diagnosed as pericardial undifferentiated carcinoma without definite histopathologial, immunochemistry feature. Despite palliative radiation therapy, the patient died of multiple organ failure. The prognosis of primary pericardial undifferentiated carcinoma is known to be very poor, especially in old people.

LDL cholesterols levels after statin treatment: A comparison of measured vs. estimated values / 대한내과학회지

BACKGROUND/AIMS: Lowering low-density lipoprotein cholesterol (LDL-C) is the primary target for the prevention of cardiovascular disease. Previous studies have shown that estimated LDL-C levels calculated using Friedewald's formula (FLDL-C) are closely correlated with directly measured LDL-C levels (DLDL-C). However, because statins not only reduce LDL-C, but also alter the levels of parameters used to calculate FLDL-C (i.e., total cholesterol, triglycerides, and high-density lipoprotein cholesterol), whether calculated LDL-C levels remain a reliable estimate of actual levels after statin treatment is unclear. METHODS: Subjects included 985 patients at high risk of cardiovascular disease who had taken statins for more than 6 months. FLDL-C data were compared to DLDL-C data. RESULTS: A strong correlation was observed between DLDL-C and FLDL-C data (R2=0.879). However, the absolute values for FLDL-C and DLDL-C differed significantly according to a paired t-test, and 42.3% of patients showed a difference of greater than 10% between these two values. Among patients with diabetes, the percentage of patients deemed to have achieved target LDL-C levels differed significantly according to the method of LDL-C determination (p=0.007). CONCLUSIONS: FLDL-C and DLDL-C data remained well correlated after statin treatment, although the absolute values differed significantly according to the LDL-C determination method. Furthermore, the percentage of subjects deemed to achieve target LDL-C levels differed significantly according to the method of determination among patients with diabetes.

A case of intraluminal gallbladder hematoma and subsequent cholecystitis after percutaneous liver biopsy / 대한내과학회지

The liver biopsy has been well established for the diagnosis and prognosis of many liver diseases. The percutaneous liver biopsy is generally considered a safe procedure, especially under ultrasonography guidance. Known complications of percutaneous liver biopsy include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax, and sepsis. We report the case of a 45?year?old woman who developed an intraluminal gallbladder hematoma and subsequent cholecystitis after a percutaneous liver biopsy. The patient underwent a laparoscopic cholecystectomy and her postoperative course was uneventful.

Assessing the Myocardial Function of Postmenopausal Women with Fibromyalgia / 대한류마티스학회지

BACKGROUND: Aberrations of cardiovascular regulation have been reported in patients who suffer with fibromyalgia (FM). Abnormalities of the cardiovascular autonomic regulation, as well as the correlation between coronary heart disease and depression, have been considered to be the causative factors. The clinical features of transient left apical ballooning syndrome with the patients under acute stress have been clearly described, but the effect of chronic stress such as FM on the myocardium is unknown. We investigated the cardiac strain in FM patients by strain imaging with using the 2D grayscale images, and we quantified the regional myocardial deformation properties. METHODS: We investigated 30 consecutive postmenopausal women (mean age: 48+/-8 years) who satisfied the criteria for fibromyalgia with atypical chest pain by performing standard and 2-dimensional strain echocardiography (2DS). Those patients with hypertension, coronary heart disease or diabetes were excluded. The global and segmental longitudinal deformation parameters of the LV from 3 apical views were analyzed, and the patients underwent a manual tender point survey for determining the number of tender points and tender point counts, and the patients completed the fibromyalgia impact questionnaire (FIQ), the brief fatigue inventory (BFI), and Beck depression inventory (BDI). RESULTS: The global longitudinal LV strain was significantly reduced in the FM patients with a high FIQ score (>40) as compared to the patients with a low FIQ score (-18.61% vs. -22.72%). Also, both the global and segmental longitudinal LV strains were negatively associated with fatigue or the tender point counts. However, there was no significant association between depression and the LV strain. CONCLUSION: This study showed the reduced myocardial longitudinal deformation in FM patients. This suggested that strain imaging is a feasible approach to assess the regional ventricular function in FM patients.