ABSTRACT
Background@#Fatty liver is associated with increased risk of developing type 2 diabetes. We aimed to evaluate whether the severity of hepatic steatosis is associated with incident diabetes. @*Methods@#We conducted a longitudinal analysis using data from 1,798 participants who underwent a comprehensive health checkup and abdominal computed tomography (CT). We assessed the association between baseline liver attenuation value on non-contrast CT images and risk of incident diabetes. All the participants were categorized into three groups based on the baseline liver attenuation value on non-contrast CT images: without hepatic steatosis (>57 Hounsfield unit [HU]), mild hepatic steatosis (41–57 HU), and moderate to severe hepatic steatosis (≤40 HU). @*Results@#During a median follow-up period of 5 years, 6.0% of the study participants progressed to diabetes. The incidence of diabetes was 17.3% in the moderate to severe hepatic steatosis group, 9.0% in the mild steatosis group, and 2.9% in those without hepatic steatosis. In a multivariate adjustment model, as compared with participants without hepatic steatosis, those with moderate to severe steatosis had a hazard ratio (HR) of 3.24 (95% confidence interval [CI], 1.64 to 4.2) for the development of diabetes, and those in the mild steatosis group had a HR of 2.33 (95% CI, 1.42 to 3.80). One standard deviation decrease in mean CT attenuation values of the liver was associated with a 40% increase in the development of diabetes (multivariate adjusted HR, 1.40; 95% CI, 1.2 to 1.63). @*Conclusion@#We found a positive association between severity of hepatic steatosis and risk of incident diabetes. Greater severity of steatosis was associated with a higher risk of incident diabetes.
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Hand-foot-and-mouth disease (HFMD) is a viral infectious disease that occurs in children under 5 years of age. Its main causes are coxsackievirus (CV) and enterovirus (EV). Since there are no efficient therapeutics for HFMD, vaccines are effective in preventing the disease. To develop broad coverage against CV and EV, the development of a bivalent vaccine form is needed. The Mongolian gerbil is an efficient and suitable animal model of EV71 C4a and CVA16 infection used to investigate vaccine efficacy following direct immunization. In this study, Mongolian gerbils were immunized with a bivalent inactivated EV71 C4a and inactivated CVA16 vaccine to test their effectiveness against viral infection. Bivalent vaccine immunization resulted in increased Ag-specific IgG antibody production; specifically, EV71 C4a-specific IgG was increased with medium and high doses and CVA16-specific IgG was increased with all doses of immunization. When gene expression of T cell-biased cytokines was analysed, Th1, Th2, and Th17 responses were found to be highly activated in the high-dose immunization group. Moreover, bivalent vaccine immunization mitigated paralytic signs and increased the survival rate following lethal viral challenges. When the viral RNA content was determined from various organs, all three doses of bivalent vaccine immunization were found to significantly decrease viral amplification. Upon histologic examination, EV71 C4a and CVA16 induced tissue damage to the heart and muscle. However, bivalent vaccine immunization alleviated this in a dose-dependent manner. These results suggest that the bivalent inactivated EV71 C4a/CVA16 vaccine could be a safe and effective candidate HFMD vaccine.
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Objective@#This study employs machine learning and population-based data to examine major factors of antidepressant medication including nitrogen dioxides (NO2) seasonality. @*Methods@#Retrospective cohort data came from Korea National Health Insurance Service claims data for 43,251 participants with the age of 15–79 years, residence in the same districts of Seoul and no history of antidepressant medication during 2002–2012. The dependent variable was antidepressant-free months during 2013–2015 and the 103 independent variables for 2012 or 2015 were considered, e.g., particulate matter less than 2.5 micrometer in diameter (PM2.5), PM10, NO2, ozone (O3), sulphur dioxide (SO2) and carbon monoxide (CO) in each of 12 months in 2015. @*Results@#It was found that the Cox hazard ratios of NO2 were statistically significant and registered values larger than 10 for every three months: March, June–July, October, and December. Based on random forest variable importance and Cox hazard ratios in brackets, indeed, the top 20 factors of antidepressant medication included age (0.0041 [1.69–2.25]), migraine and sleep disorder (0.0029 [1.82]), liver disease (0.0017 [1.33–1.34]), exercise (0.0014), thyroid disease (0.0013), cardiovascular disease (0.0013 [1.20]), asthma (0.0008 [1.19–1.20]), September NO2 (0.0008 [0.01]), alcohol consumption (0.0008 [1.31–1.32]), gender - woman (0.0007 [1.80–1.81]), July NO2 (0.0007 [14.93]), July PM10 (0.0007), the proportion of the married (0.0005), January PM2.5 (0.0004), September PM2.5 (0.0004), chronic obstructive pulmonary disease (0.0004), economic satisfaction (0.0004), January PM10 (0.0003), residents in welfare facilities per 1,000 (0.0003 [0.97]), and October NO2 (0.0003). @*Conclusion@#Antidepressant medication has strong associations with neighborhood conditions including NO2 seasonality and welfare support.
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Objective@#To investigate the effects of long-acting injectable 3-monthly paliperidone palmitate on the clinical and social functioning of patients with schizophrenia. @*Methods@#This study enrolled patients with schizophrenia receiving long-acting injectable 1-monthly paliperidone palmitate for at least 4 months and who subsequently received 3-monthly paliperidone palmitate. Accordingly, 418 patients were followed up for 24 weeks. Their clinical symptoms and social functioning were measured using the Clinical Global Impression-Severity of Illness and Personal and Social Performance scales. @*Results@#The Personal and Social Performance total score was significantly higher after 3-monthly paliperidone palmitate treatment than at baseline (baseline vs. week 24: 54.3 ± 18.0 vs. 61.0 ± 14.5 [mean ± standard deviation]; p ＜ 0.001; Wilcoxon signed-rank test); the proportion of patients in the mildly ill group (scores 71−100) also increased significantly (baseline vs. week 24: 16.5% vs. 20.6%; p＜ 0.001; McNemar-Bowker test). The mean Clinical Global Impression-Severity of Illness score decreased significantly (baseline vs. week 24: 3.7 ± 1.0 vs. 3.4 ± 0.9; p＜ 0.001; Wilcoxon signed-rank test), as did the proportion of patients in the severely ill group (baseline vs. week 24: 4.1% vs. 2.1%; p ＜ 0.001; McNemar-Bowker test). @*Conclusion@#Continuous 3-monthly paliperidone palmitate treatment significantly enhances the personal and social performance of patients with schizophrenia and reduces the proportion of those with severe illness. These findings suggest that long-acting injectable antipsychotic administration at intervals longer than 1 month might improve the social functioning of and promote return to activities of daily living in patients with schizophrenia.
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Purpose@#The purpose of this study was to prepare guidelines for the treatment of COVID-19-positive hip fractures based on the treatment experience of patients with COVID-19-positive hip fractures admitted to a COVID-19-dedicated hospital. @*Materials and Methods@#A retrospective analysis was performed on COVID-19-positive elderly hip fracture patients treated at a COVIDdedicated hospital when the number of domestic COVID-19 infections increased rapidly. The treatment results were analyzed by comparing the complications of patients who underwent surgery at a COVID-dedicated hospital and those who did not, the time taken from surgery to surgery, and the number of visits to medical institutions. @*Results@#The average surgery time for COVID-19 hip fracture patients in the author’s hospital was 3.74 days from the date of injury, and it took an average of 12.8 days for surgery at other hospitals. The average number of patients who visited medical institutions was 3.33 locations in the group who did not undergo surgery at the author’s hospital, which was significantly higher than the 2.83 locations in the group who had surgery. Among the patients unable to undergo surgery, no patient could not undergo surgery due to serious reasons. @*Conclusion@#The explosive increase in COVID-19 infections has delayed the time of surgery for COVID-19-positive elderly patients with hip fractures and increased the transfer rate of medical institutions, even for relatively non-dangerous causes. Clear criteria for treatment and effective policies are needed to prevent delay delays in treatment.
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Background@#High-alert medications (HAMs) are medications that bear a heightened risk of causing significant patient harm if used in error. To facilitate safe use of HAMs, identifying specific HAM lists for clinical setting is necessary. We aimed to develop the national level HAM list for acute care setting. @*Methods@#We used three-step process. First, we compiled the pre-existing lists referring HAMs. Second, we analyzed medication related incidents reported from national patient safety incident report data and adverse events indicating medication errors from the Korea Adverse Event Reporting System (KAERS).We also surveyed the assistant staffs to support patient safety tasks and pharmacist in charge of medication safety in acute care hospital. From findings from analysis and survey results we created additional candidate list of HAMs. Third, we derived the final list for HAMs in acute care settings through expert panel surveys. @*Results@#From pre-existing HAM list, preliminary list consisting of 42 medication class/ingredients was derived. Eight assistant staff to support patient safety tasks and 39 pharmacists in charge of medication safety responded to the survey. Additional 44 medication were listed from national patient safety incident report data, KAERS data and common medications involved in prescribing errors and dispensing errors from survey data. A list of mandatory and optional HAMs consisting of 10 and 6 medication classes, respectively, was developed by consensus of the expert group. @*Conclusion@#We developed national level HAM list for Korean acute care setting from pre-existing lists, analyzing medication error data, survey and expert panel consensus.
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Background@#Securing an available healthcare workforce is critical to respond to coronavirus disease 2019 (COVID-19); however, research investigating Korea’s COVID-19 staffing response is rare. To present the fundamental data of healthcare staff in response to the surge in COVID-19 cases, we investigated the healthcare workforce response in Daegu, South Korea, which experienced the first largest outbreak of COVID-19 outside of China. @*Materials and Methods@#In response to the COVID-19 outbreak, this retrospective crosssectional study analyzed data on the scale and characteristics of healthcare workers (HCWs). Additionally, it analyzed the clinical and epidemiological characteristics of HCWs infected with COVID-19 in six major teaching hospitals (five tertiary and one secondary) in Daegu from January 19 to April 30, 2020. @*Results@#During this study period, only 1.3% (n = 611) of the total hospitalized patients (n = 48,807) were COVID-19 inpatients, but they occupied 6.0% (n = 303) of the total hospital beds (n = 5,056), and 23.7% (n = 3,471) of all HCWs (n = 14,651) worked in response to COVID-19.HCWs participating in COVID-19-related works comprised 50.6% (n = 1,203) of doctors (n = 2,379), 26.3% (n = 1,571) of nurses (n = 5,982), and 11.4% (n = 697) of other HCWs (n = 6,108).Only 0.3% (n = 51) of HCWs (n = 14,651) developed COVID-19 infections from communityacquired (66.7%) or hospital-acquired (29.4%). Nurses were affected predominantly (33.3%), followed by doctors (9.8%), caregivers (7.8%), radiographers (5.9%), and others (45.1%), including nurse aides and administrative, facility maintenance, telephone appointment centers, and convenience store staff. All HCWs infected with COVID-19 recovered completely. The 32.7% (n = 333) of individuals (n = 1,018) exposed to HCWs who had COVID-19 were quarantined, and only one case of secondary transmission among them occurred. @*Conclusion@#The COVID-19 pandemic has necessitated significant staffing and facility usage, which is disproportionate to the relatively low number of COVID-19 inpatients, imposing a substantial burden on healthcare resources. Therefore, beyond the current reimbursement level of the Korean National Health Insurance, a new type of rewarding system is needed to prepare hospitals for the emerging outbreaks of infectious diseases. Keeping HCWs safe from COVID-19 is crucial for maintaining the healthcare workforce during a sudden massive outbreak. Further studies are needed to determine the standards of required HCWs through detailed research on the working hours and intensity of HCWs responding to COVID-19.
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Background/Aims@#Sarcopenia is an independent prognostic factor of liver cirrhosis (LC). However, the association between LC-related systemic inflammation and sarcopenia is unclear. @*Methods@#Sprague-Dawley rats were treated with thioacetamide (TAA) or saline as a control. Rifaximin was administered to TAA-induced LC rats. Enzyme-linked immunosorbent assay was performed to measure inflammatory mediators in rat serum. RT-PCR was performed to measure the molecular expression in tissues. Hematoxylin and eosin (H&E) staining and immunohistochemistry were performed to investigate tissue pathology. Serum tumor necrosis factor-α levels, liver stiffness (LS), and the L3 skeletal muscle index (L3SMI) were measured in 60 patients with chronic liver disease. @*Results@#LC and sarcopenia were successfully induced by TAA. Serum TNF-α levels were increased in LC rats and correlated with myostatin expression, muscle weight, and myofiber diameter. The expression of intestinal occludin and zona occludens-1 was reduced in LC rats and associated with serum TNF-α levels and sarcopenia. In patients with LS ≥7 kPa or sarcopenia, serum TNF-α levels were significantly increased, which was also confirmed when we raised the LS cutoff to 10 kPa. The L3SMI was inversely correlated with serum TNF-α levels in patients with LS ≥7 kPa. TNF-α was reduced by rifaximin, which might have resulted in reduced expression of muscular MuRF1 and myostatin and improvements in myofiber diameters within muscle tissues. @*Conclusions@#These results suggest that serum TNF-α is associated with LC-related sarcopenia. Rifaximin might be effective in reducing serum TNF-α levels and improving sarcopenia in LC, but these results need to be validated in future studies.
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Background@#Although survival outcomes of multiple myeloma (MM) have improved with the development of new and effective agents, infection remains the major cause of morbidity and mortality. Here, we evaluated the efficacy of levofloxacin prophylaxis (in a real-world setting) during bortezomib, melphalan, and prednisone (VMP) therapy in elderly patients with newly diagnosed MM. @*Methods@#This study retrospectively analyzed the records of patients with newly diagnosed MM treated with the VMP regimen between February 2011 and September 2020 at three institutes of the Republic of Korea. @*Results@#Of a total of 258 patients, 204 (79.1%) received levofloxacin prophylaxis during VMP therapy. The median number of levofloxacin prophylaxis cycles was 4 (range, 1‒9), but 10 patients did not complete the planned prophylaxis because of side effects. Sixty-six patients (25.5%) experienced severe infections during VMP therapy, most of which (74.7%) occurred within the first four cycles of VMP therapy regardless of levofloxacin prophylaxis status. Early severe infection was significantly associated with poor survival.In multivariate analysis, levofloxacin prophylaxis was significantly associated with a lower risk in early severe infection. @*Conclusion@#Our findings suggest that levofloxacin prophylaxis should be considered at least during the first four cycles of VMP therapy in elderly patients with newly diagnosed MM.
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Objective@#This study investigated whether sleep duration and working hours were associated with the risk of suicidal ideation. @*Methods@#Data from 13,628 shift workers (age ≥19) were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2007–2018. We included healthy shift workers without depressive disorders and chronic medical illnesses. Sleep duration, working hours, and suicidal ideation were assessed using a self-reported questionnaire. Logistic regressions were used to examine the association of sleep duration and working hours with the risk of suicidal ideation. We examined interactions between sleep duration and working hours in association with suicidal ideation. In addition, interactions of sex or age were also analyzed. @*Results@#Shift workers sleeping for 52 hours/week had a higher risk of suicidal ideation compared with those working ≤40 hours/week. In terms of interaction by sex or age groups in the association between working hours and the risk of suicidal ideation, the relationship was stronger for men than for women and for those aged <45 years than for those aged ≥45 years. @*Conclusion@#Shorter or longer sleep durations, and long working hours were associated with a higher risk of suicidal ideation. Under long working hours, male shift workers or those aged <45 years were more vulnerable to suicidal ideation.
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Objective@#This study evaluated whether insomnia, anxiety, and depression differ by type of gynecological or breast cancer. @*Methods@#From September 7, 2011, to July 14, 2015, this study included 232 patients who were diagnosed with gynecological or breast cancer for the first time. The severity of insomnia, anxiety, and depression was measured with the National Cancer Center Psychological Symptom inventory (NCC-PSI), a self-reported scale, at the first outpatient visit after surgery. Multivariate logistic regression analyses were used to identify which diagnosis was associated with significant symptom levels. @*Results@#Patients with ovarian cancer and breast cancer reported more severe insomnia and problems with daily life compared with cervical cancer patients. Anxiety symptoms were more distressing among breast cancer patients than cervical cancer patients, and the degree of interference in daily life was severe. Finally, compared to those with cervical cancer, ovarian cancer and breast cancer patients reported more severe depression, and their daily life was disrupted more often than reported by cervical cancer patients. @*Conclusion@#Many female cancer patients are suffering distress but are not looking for specialized care. Psychiatric approach in the early stages of cancer diagnosis is needed and will require overcoming the stigmas of mental illness and cancer.
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Primary cilia on kidney tubular cells play crucial roles in maintaining structure and physiological function. Emerging evidence indicates that the absence of primary cilia, and their length, are associated with kidney diseases. The length of primary cilia in kidney tubular epithelial cells depends, at least in part, on oxidative stress and extracellular signal-regulated kinase 1/2 (ERK) activation. Hydrogen sulfide (H2S) is involved in antioxidant systems and the ERK signaling pathway. Therefore, in this study, we investigated the role of H2S in primary cilia elongation and the downstream pathway. In cultured Madin-Darby Canine Kidney cells, the length of primary cilia gradually increased up to 4 days after the cells were grown to confluent monolayers. In addition, the expression of H2S-producing enzyme increased concomitantly with primary cilia length. Treatment with NaHS, an exogenous H2S donor, accelerated the elongation of primary cilia whereas DL-propargylglycine (a cystathionine γ-lyase inhibitor) and hydroxylamine (a cystathionine-β-synthase inhibitor) delayed their elongation. NaHS treatment increased ERK activation and Sec10 and Arl13b protein expression, both of which are involved in cilia formation and elongation. Treatment with U0126, an ERK inhibitor, delayed elongation of primary cilia and blocked the effect of NaHS-mediated primary cilia elongation and Sec10 and Arl13b upregulation. Finally, we also found that H 2 S accelerated primary cilia elongation after ischemic kidney injury. These results indicate that H2S lengthens primary cilia through ERK activation and a consequent increase in Sec10 and Arl13b expression, suggesting that H2S and its downstream targets could be novel molecular targets for regulating primary cilia.
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Vibrio cholerae is a pathogen known to cause the waterborne epidemic disease cholera. Overall, V. cholerae O1 or O139 strains produce the cholera toxin that cause gastroenteritis, resulting in watery diarrhea. Most of the enterocolitis caused by V. cholerae can be easily treated with fluid therapy and conservative care. However, V. cholerae non-O1/O139 strains can cause extraintestinal infections, such as wound infection or sepsis, in immunocompromised patients. The clinical course of these infections is very similar to that of V. vulnificus infection. We report about a 52-year-old man without previous underlying disease who was diagnosed with V. cholerae non-O1/O139 infection and died within 72 hours after admission to the intensive care unit.
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Stroke causes systemic immunosuppression. T lymphocytes are involved in infarct size in the early stages of stroke. However, the phenotypes of T lymphocytes and their functions in peripheral immune organs and the brain have not been well analyzed in the acute and chronic phases of stroke. Here, we investigated pathological phenotypic alterations in the systemic immune response, especially changes in T lymphocytes, from one day to six months after ischemic stroke in mice. Impairment in thymocyte numbers, development, proliferation, and apoptosis were observed for up to two weeks. The number of mature T cells in the spleen and blood decreased and showed reduced interferon-γ production. Increased numbers of CD4-CD8-CD3+ double-negative T cells were observed in the mouse brain during the early stages of stroke, whereas interleukin (IL)-10+Foxp3+ regulatory T lymphocytes increased from two weeks during the chronic phase. These phenotypes correlated with body weight and neurological severity scores. The recovery of T lymphocyte numbers and increases in IL-10+Foxp3+ regulatory T lymphocytes may be important for long-term neurological outcomes. Dynamic changes in T lymphocytes between the acute and chronic phases may play different roles in pathogenesis and recovery. This study provides fundamental information regarding the T lymphocyte alterations from the brain to the peripheral immune organs following stroke.
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Charted-particle therapy (CPT) benefits cancer patients by localizing doses in the tumor volume while minimizing the doses delivered to normal tissue through its unique physical and biological characteristics. The world’s first CPT applied on humans was proton beam therapy (PBT), which was performed in the mid-1950s. Among heavy ions, carbon ions showed the most favorable biological characteristics for the treatment of cancer patients. Carbon ions show coincidence between the Bragg peak and maximum value of relative biological effectiveness. In addition, they show low oxygen enhancement ratios. Therefore, carbon-ion radiotherapy (CIRT) has become mainstream in the treatment of cancer patients using heavy ions. CIRT was first performed in 1977 at the Lawrence Berkeley Laboratory. The CPT technology has advanced in the intervening decades, enabling the use of rotating gantry, beam delivery with fast pencil-beam scanning, image-guided particle therapy, and intensity-modulated particle therapy. As a result, as of 2019, a total of 222,425 and 34,138 patients with cancer had been treated globally with PBT and CIRT, respectively. For more effective and efficient CPT, many groups are currently conducting further studies worldwide. This review summarizes recent technological advances that facilitate clinical use of CPT.
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Mitochondrial NADP+-dependent isocitrate dehydrogenase 2 (IDH2) produces NADPH, which is known to inhibit mitochondrial oxidative stress. Ureteral obstruction induces kidney inflammation and fibrosis via oxidative stress. Here, we investigated the role and underlying mechanism of IDH2 in unilateral ureteral obstruction (UUO)-induced kidney inflammation using IDH2 gene deleted mice (IDH2–/–). Eight- to 10-week-old female IDH2–/– mice and wild type (IDH2+/+) littermates were subjected to UUO and kidneys were harvested 5 days after UUO. IDH2 was not detected in the kidneys of IDH2–/– mice, while UUO decreased IDH2 in IDH2+/+ mice. UUO increased the expressions of markers of oxidative stress in both IDH2+/+ and IDH2–/– mice, and these changes were greater in IDH2–/– mice compared to IDH2+/+ mice. Bone marrow-derived macrophages of IDH2–/– mice showed a more migrating phenotype with greater ruffle formation and Rac1 distribution than that of IDH2+/+ mice. Correspondently, UUO-induced infiltration of monocytes/macrophages was greater in IDH2–/– mice compared to IDH2+/+ mice. Taken together, these data demonstrate that IDH2 plays a protective role against UUO-induced inflammation through inhibition of oxidative stress and macrophage infiltration.
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Objective@#This study investigated whether sleep duration and working hours were associated with the risk of suicidal ideation. @*Methods@#Data from 13,628 shift workers (age ≥19) were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys conducted in 2007–2018. We included healthy shift workers without depressive disorders and chronic medical illnesses. Sleep duration, working hours, and suicidal ideation were assessed using a self-reported questionnaire. Logistic regressions were used to examine the association of sleep duration and working hours with the risk of suicidal ideation. We examined interactions between sleep duration and working hours in association with suicidal ideation. In addition, interactions of sex or age were also analyzed. @*Results@#Shift workers sleeping for 52 hours/week had a higher risk of suicidal ideation compared with those working ≤40 hours/week. In terms of interaction by sex or age groups in the association between working hours and the risk of suicidal ideation, the relationship was stronger for men than for women and for those aged <45 years than for those aged ≥45 years. @*Conclusion@#Shorter or longer sleep durations, and long working hours were associated with a higher risk of suicidal ideation. Under long working hours, male shift workers or those aged <45 years were more vulnerable to suicidal ideation.
ABSTRACT
Objective@#This study evaluated whether insomnia, anxiety, and depression differ by type of gynecological or breast cancer. @*Methods@#From September 7, 2011, to July 14, 2015, this study included 232 patients who were diagnosed with gynecological or breast cancer for the first time. The severity of insomnia, anxiety, and depression was measured with the National Cancer Center Psychological Symptom inventory (NCC-PSI), a self-reported scale, at the first outpatient visit after surgery. Multivariate logistic regression analyses were used to identify which diagnosis was associated with significant symptom levels. @*Results@#Patients with ovarian cancer and breast cancer reported more severe insomnia and problems with daily life compared with cervical cancer patients. Anxiety symptoms were more distressing among breast cancer patients than cervical cancer patients, and the degree of interference in daily life was severe. Finally, compared to those with cervical cancer, ovarian cancer and breast cancer patients reported more severe depression, and their daily life was disrupted more often than reported by cervical cancer patients. @*Conclusion@#Many female cancer patients are suffering distress but are not looking for specialized care. Psychiatric approach in the early stages of cancer diagnosis is needed and will require overcoming the stigmas of mental illness and cancer.
ABSTRACT
Vibrio cholerae is a pathogen known to cause the waterborne epidemic disease cholera. Overall, V. cholerae O1 or O139 strains produce the cholera toxin that cause gastroenteritis, resulting in watery diarrhea. Most of the enterocolitis caused by V. cholerae can be easily treated with fluid therapy and conservative care. However, V. cholerae non-O1/O139 strains can cause extraintestinal infections, such as wound infection or sepsis, in immunocompromised patients. The clinical course of these infections is very similar to that of V. vulnificus infection. We report about a 52-year-old man without previous underlying disease who was diagnosed with V. cholerae non-O1/O139 infection and died within 72 hours after admission to the intensive care unit.
ABSTRACT
Stroke causes systemic immunosuppression. T lymphocytes are involved in infarct size in the early stages of stroke. However, the phenotypes of T lymphocytes and their functions in peripheral immune organs and the brain have not been well analyzed in the acute and chronic phases of stroke. Here, we investigated pathological phenotypic alterations in the systemic immune response, especially changes in T lymphocytes, from one day to six months after ischemic stroke in mice. Impairment in thymocyte numbers, development, proliferation, and apoptosis were observed for up to two weeks. The number of mature T cells in the spleen and blood decreased and showed reduced interferon-γ production. Increased numbers of CD4-CD8-CD3+ double-negative T cells were observed in the mouse brain during the early stages of stroke, whereas interleukin (IL)-10+Foxp3+ regulatory T lymphocytes increased from two weeks during the chronic phase. These phenotypes correlated with body weight and neurological severity scores. The recovery of T lymphocyte numbers and increases in IL-10+Foxp3+ regulatory T lymphocytes may be important for long-term neurological outcomes. Dynamic changes in T lymphocytes between the acute and chronic phases may play different roles in pathogenesis and recovery. This study provides fundamental information regarding the T lymphocyte alterations from the brain to the peripheral immune organs following stroke.