Treatment of Hidradenitis Suppurativa Patient with Klinefelter Syndrome by Adalimumab

Hidradenitis suppurativa (HS) is a chronic, inflammatory and painful skin disease with recurrent nodules and tracts involving the intertriginous regions. It is known that the patient with HS shows an increased risk of metabolic disorders such as diabetes, metabolic syndrome and autoimmune diseases. Klinefelter syndrome (KS) is a sex chromosomal disorder occurring in males due to an abnormality of sexual differentiation, characterized by 47, XXY karyotype. Also, KS is related with somatic comorbidities such as metabolic syndrome, autoimmune and rheumatologic disorders as HS is. We report a HS patient with KS who shows a big improvement while on tumor necrosis factor-alpha inhibitor treatment.

Activated Leukocyte Cell Adhesion Molecule Modulates Th2 Immune Response in Atopic Dermatitis

PURPOSE: Activated leukocyte cell adhesion molecule (ALCAM), a member of the immunoglobulin superfamily, is highly expressed on dendritic cells. ALCAM and its receptor CD6 are co-stimulatory molecules in the immunological synapse; their interaction is required for T cell activation. While atopic dermatitis (AD) is recognized as a T helper 2 (Th2)-mediated allergic disease, the role of ALCAM in its pathogenesis is unclear. METHODS: ALCAM levels were measured in the serum of AD patients and AD-induced murine model by ovalbumin treatment. We next investigated transepidermal water loss, clinical score, Th2-immune responses, skin barrier gene expression and T-cell activation using wild-type (WT) and ALCAM deficiency mice. An oxazolone-induced AD-like model was also established and analyzed using WT- and ALCAM-deficient mice. RESULTS: We found that serum ALCAM levels were elevated in pediatric AD patients as well as WT AD mice, whereas Th2-type cytokine production and AD symptoms were suppressed in ALCAM-deficient mice. In addition, CD4+ effector T-cell counts in murine skin and skin-draining lymph nodes were lower in ALCAM-deficient mice than in their WT counterparts. ALCAM deficiency was also linked to higher expression of skin barrier genes and number of lamellar bodies. CONCLUSIONS: These findings indicate that ALCAM may contribute to AD pathogenesis by meditating a Th2-dominant immune response and disrupting the barrier function of the skin.

German Cockroach Extract Induces Matrix Metalloproteinase-1 Expression, Leading to Tight Junction Disruption in Human Airway Epithelial Cells

PURPOSE: Cockroach exposure is a pivotal cause of asthma. Tight junctions are intercellular structures required for maintenance of the barrier function of the airway epithelium, which is impaired in this disease. Matrix metalloproteinases (MMPs) digest extracellular matrix components and are involved in asthma pathogenesis: MMP1 is a collagenase with a direct influence on airway obstruction in asthmatics. This study aimed to investigate the mechanism by which German cockroach extract (GCE) induces MMP1 expression and whether MMP1 release alters cellular tight junctions in human airway epithelial cells (NCI-H292). MATERIALS AND METHODS: mRNA and protein levels were determined using real-time PCR and ELISA. Tight junction proteins were detected using immunofluorescence staining. Epithelial barrier function was measured by transepithelial electrical resistance (TEER). The binding of a transcription factor to DNA molecules was determined by electrophoretic mobility shift assay, while the levels of tight junction proteins and phosphorylation were determined using Western blotting. RESULTS: GCE was shown to increase MMP1 expression, TEER, and tight junction degradation. Both an inhibitor and small interfering RNA (siRNA) of MMP1 significantly decreased GCE-induced tight junction disruption. Furthermore, transient transfection with ETS1 and SP1 siRNA, and anti-TLR2 antibody pretreatment prevented MMP1 expression and tight junction degradation. An extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase (MAPK) inhibitor also blocked MMP1 release, ETS1/SP1 DNA binding, and tight junction alteration. CONCLUSION: GCE treatment increases MMP1 expression, leading to tight junction disruption, which is transcriptionally regulated and influenced by the ERK/MAPK pathway in airway epithelial cells. These findings may contribute to developing novel therapeutic strategies for airway diseases.

Antibody to FcεRIα Suppresses Immunoglobulin E Binding to High-Affinity Receptor I in Allergic Inflammation

PURPOSE: High-affinity receptor I (FcεRI) on mast cells and basophils plays a key role in the immunoglobulin E (IgE)-mediated type I hypersensitivity mediated by allergen cross-linking of the specific IgE-FcεRI complex. Thus, prevention of IgE binding to FcεRI on these cells is an effective therapy for allergic disease. We have developed a strategy to disrupt IgE binding to FcεRI using an antibody targeting FcεRIα. MATERIALS AND METHODS: Fab fragment antibodies, which lack the Fc domain, with high affinity and specificity for FcεRIα and effective inhibitory activity against IgE-FcεRI binding were screened. IgE-induced histamine, β-hexosaminidase and Ca2+ release in basophils were determined by ELISA. A B6.Cg-Fcer1a(tm1Knt) Tg(FCER1A)1Bhk/J mouse model of passive cutaneous anaphylaxis (PCA) was used to examine the inhibitory effect of NPB311 on allergic skin inflammation. RESULTS: NPB311 exhibited high affinity to human FcεRIα (KD=4 nM) and inhibited histamine, β-hexosaminidase and Ca2+ release in a concentration-dependent manner in hFcεRI-expressing cells. In hFcεRIα-expressing mice, dye leakage was higher in the PCA group than in controls, but decreased after NPB311 treatment. NPB311 could form a complex with FcεRIα and inhibit the release of inflammation mediators. CONCLUSION: Our approach for producing anti-FcεRIα Fab fragment antibody NPB311 may enable clinical application to a therapeutic pathway in IgE/FcεRI-mediated diseases.

Antibody to FcεRIα Suppresses Immunoglobulin E Binding to High-Affinity Receptor I in Allergic Inflammation

PURPOSE: High-affinity receptor I (FcεRI) on mast cells and basophils plays a key role in the immunoglobulin E (IgE)-mediated type I hypersensitivity mediated by allergen cross-linking of the specific IgE-FcεRI complex. Thus, prevention of IgE binding to FcεRI on these cells is an effective therapy for allergic disease. We have developed a strategy to disrupt IgE binding to FcεRI using an antibody targeting FcεRIα. MATERIALS AND METHODS: Fab fragment antibodies, which lack the Fc domain, with high affinity and specificity for FcεRIα and effective inhibitory activity against IgE-FcεRI binding were screened. IgE-induced histamine, β-hexosaminidase and Ca2+ release in basophils were determined by ELISA. A B6.Cg-Fcer1a(tm1Knt) Tg(FCER1A)1Bhk/J mouse model of passive cutaneous anaphylaxis (PCA) was used to examine the inhibitory effect of NPB311 on allergic skin inflammation. RESULTS: NPB311 exhibited high affinity to human FcεRIα (KD=4 nM) and inhibited histamine, β-hexosaminidase and Ca2+ release in a concentration-dependent manner in hFcεRI-expressing cells. In hFcεRIα-expressing mice, dye leakage was higher in the PCA group than in controls, but decreased after NPB311 treatment. NPB311 could form a complex with FcεRIα and inhibit the release of inflammation mediators. CONCLUSION: Our approach for producing anti-FcεRIα Fab fragment antibody NPB311 may enable clinical application to a therapeutic pathway in IgE/FcεRI-mediated diseases.

Diagnostic utility of skin prick test to cooked egg in children with egg allergy

PURPOSE: Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy. METHODS: We studied 36 children with egg allergy. Skin prick tests (SPTs) for the uncooked or cooked form of egg white and egg yolk, whole egg, ovomucoid (OVM), and ovalbumin (OVA) were performed at diagnosis. The reagents of cooked egg for SPT were prepared by baking for 25 minutes in 200 degree oven. We also examined specific IgE levels to whole egg, egg white, egg yolk, OVM, and OVA. RESULTS: Patients with history of allergic reaction to extensively heated egg showed significantly increased wheal size for cooked egg white (median [interquartile range]), 10.5 [7.0-14.6] vs. 4.2 [0.0-5.6], P<0.001) and OVM (9.6 [7.3-13.8] vs. 5.6 [0.0-7.8], P=0.001) than those without the history. The strongest positive correlation was found between wheal size for cooked egg white and OVM (r=0.788, P<0.001). SPT wheal size for cooked egg white were positively correlated with serum OVM-specific IgE levels (r=0.691, P<0.001). Cutoff value was 7.0 mm in SPT wheal size for cooked egg white, the sensitivity was 73.1% and specificity was 99.0%. SPT for cooked egg white showed significantly higher area under curve than serum egg white specific IgE. CONCLUSION: Our results suggest that SPT to cooked egg white may be useful predictor of allergic reaction to cooked egg. Further investigations will be needed.

ERRATUM: Acknowledgments. Diagnostic utility of skin prick test to cooked egg in children with egg allergy

In this paper, acknowledgments section for grant support was omitted unintentionally.

The effect of heat treatment or hydrolysis on cow's milk protein distributions and antigenicities

PURPOSE: Cow's milk protein is one of the most common and strongest food allergen. We investigated the effects of heat treatment on the distribution and antigenicities of major allergens from cow's milk. We also compared the protein distribution and antigenicities among cow's milk formula and its substitutes. METHODS: We heated alpha-casen, beta-lactoglobulin (BLG), alpha-lactalbumin (ALA), and crude extract of cow's milk in 100degrees C boiling water for 1 hour. We prepared crude extracts from cow's milk formula, partially hydrolyzed milk formula (pHF) and extensively hydrolyzed milk formula (eHF). The protein compositions of all the samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The antigenicities were determined by IgE immunoblotting with pooled serum collected from 11 patients with milk allergy. RESULTS: After heating, no significant alteration was found in casein, and the aggregates of ALA and BLG were detected with molecular weights of about 30 and 45 kDa, respectively. The antigenicities of newly detected aggregates were increased. The new aggregates of BLG with increased antigenicities were also found in heated milk total protein. Major milk allergens were not found in pHF, and residual components with a molecular weight below 10 KDa did not show IgE-binding activity. We failed to observe the residual components and antigenicities of eHF. CONCLUSION: Changes in protein distribution and antigenicity of milk total protein induced by heat treatment may not be significantly different from those of each major allergen. The residual components of pHF could have little IgE-binding capacity, and there may be few or no antigenic components in eHF.

Production of Egg Yolk Antibodies Specific to House Dust Mite Proteins

PURPOSE: House dust mites (HDMs) are an important source of indoor allergens associated with asthma, rhinitis and atopic dermatitis. Chicken immunoglobulin (Ig) Y is known to be a good alternative to mice and rabbit antibody production. In this study, we produced IgYs specific to HDMs and investigated their IgE immunoreactivities. MATERIALS AND METHODS: Total IgYs were isolated from the yolks of White Leghorn hens immunized with either Dermatophagoides pteronyssinus or D. farinae protein extract. Control antibodies were separated from the yolks of immunized hens with phosphate buffered saline. IgYs specific to HDMs were analyzed using enzyme-linked immunosorbent assay and Western blotting analysis. RESULTS: The concentration of egg IgY specific to D. farinae in an immunized hen increased and the highest achieved was 661.3 ug/mg (per an egg) on day 47, compared with 760 ug/mg IgY specific to D. pteronyssinus on day 16. The D. pteronyssinus or D. farinae-specific IgY was detected by binding of each mite proteins, and their immunoreactivities were elevated dependent of the specific IgY concentration. CONCLUSION: IgY specific to HDMs may be a promising antibody for immunological diagnosis as well as identification of possible resistance relating to HDM allergy.

Relationship Between Symptoms of Depression and Smoking and Obesity in Korean Office Workers Younger than 40 Years

BACKGROUND: Though many factors have been found to be associated with depression, still many others remain uncovered. There are few studies that have focused on the younger population whose depressive symptoms are socioeconomically more important than that of the older population. This study is designed to clarify if there is a relationship between depression and smoking and obesity in the young population. METHODS: Office workers from 40 companies who underwent medical check-ups in 2011 were initially selected. Of these, 65,309 subjects had responded to self-reported questionnaires on depressive symptoms with 4,187 subjects being excluded on the basis of past medical history and current medication. Logistic regression was performed to evaluate the relationship between depression and the selected variables. RESULTS: The proportion of high risk groups for depression was significantly high in females. Statistically significant results were only seen in females. Smoking and obesity were related to depression in females as assessed by the Center for Epidemiological Studies-Depression Scale score. Logistic regression analysis also showed that smoking (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.62-2.05) and obesity (OR, 1.48; 95% CI, 1.18-1.82) were related to depressive symptoms in females. CONCLUSIONS: Depressive symptoms in young female office workers under 40 years of age are related to smoking and obesity. By acting towards stopping smoking and being in a healthy weight category, females may lessen their risk for depression, and thereby lessen their socioeconomic losses.

Relationship Between Symptoms of Depression and Smoking and Obesity in Korean Office Workers Younger than 40 Years

BACKGROUND: Though many factors have been found to be associated with depression, still many others remain uncovered. There are few studies that have focused on the younger population whose depressive symptoms are socioeconomically more important than that of the older population. This study is designed to clarify if there is a relationship between depression and smoking and obesity in the young population. METHODS: Office workers from 40 companies who underwent medical check-ups in 2011 were initially selected. Of these, 65,309 subjects had responded to self-reported questionnaires on depressive symptoms with 4,187 subjects being excluded on the basis of past medical history and current medication. Logistic regression was performed to evaluate the relationship between depression and the selected variables. RESULTS: The proportion of high risk groups for depression was significantly high in females. Statistically significant results were only seen in females. Smoking and obesity were related to depression in females as assessed by the Center for Epidemiological Studies-Depression Scale score. Logistic regression analysis also showed that smoking (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.62-2.05) and obesity (OR, 1.48; 95% CI, 1.18-1.82) were related to depressive symptoms in females. CONCLUSIONS: Depressive symptoms in young female office workers under 40 years of age are related to smoking and obesity. By acting towards stopping smoking and being in a healthy weight category, females may lessen their risk for depression, and thereby lessen their socioeconomic losses.

Relationship Between Symptoms of Depression and Smoking and Obesity in Korean Office Workers Younger than 40 Years

BACKGROUND: Though many factors have been found to be associated with depression, still many others remain uncovered. There are few studies that have focused on the younger population whose depressive symptoms are socioeconomically more important than that of the older population. This study is designed to clarify if there is a relationship between depression and smoking and obesity in the young population. METHODS: Office workers from 40 companies who underwent medical check-ups in 2011 were initially selected. Of these, 65,309 subjects had responded to self-reported questionnaires on depressive symptoms with 4,187 subjects being excluded on the basis of past medical history and current medication. Logistic regression was performed to evaluate the relationship between depression and the selected variables. RESULTS: The proportion of high risk groups for depression was significantly high in females. Statistically significant results were only seen in females. Smoking and obesity were related to depression in females as assessed by the Center for Epidemiological Studies-Depression Scale score. Logistic regression analysis also showed that smoking (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.62-2.05) and obesity (OR, 1.48; 95% CI, 1.18-1.82) were related to depressive symptoms in females. CONCLUSIONS: Depressive symptoms in young female office workers under 40 years of age are related to smoking and obesity. By acting towards stopping smoking and being in a healthy weight category, females may lessen their risk for depression, and thereby lessen their socioeconomic losses.

Effect of Cholesterol Depletion on Interleukin-8 Production in Human Respiratory Epithelial Cells

PURPOSE: The lipid entities of cell membranes are components of the immune system and important mediators of inflammation. Despite increasing interest in the function of epithelial cells in inflammation, the role of cholesterol in this process has not been described. Here, we investigated the effect of cholesterol depletion on the inflammatory process in airway epithelial cells via the expression of interleukin (IL)-8 as a marker of inflammation. METHODS: A 549 cells were treated with 0.5% methyl-beta-cyclodextrin as a selective cholesterol extractor. The IL-8 level was assessed by enzyme-linked immunosorbent assay and reassessed after cholesterol repletion. Mitogen-activated protein kinase (MAPK) inhibitors were used to determine the upstream signaling pathway for IL-8 production in cholesterol-depleted cells. RESULTS: We found a relationship between the amount of cholesterol in A 549 cells and inflammation of the airway. IL-8 production was increased in cholesterol-depleted A 549 cells and restored by cholesterol repletion. IL-8 production was decreased by pretreatment with the extracellular signal-regulated kinase (ERK) inhibitor U0126 but not with JNK inhibitor II or the p38 MAPK inhibitor SB202190. CONCLUSIONS: Our findings suggest that inflammatory responses are increased in cholesterol-depleted epithelial cells via the MAPK signaling system, predominantly by the ERK pathway. We conclude that the lipid components of airwayepithelial cells may play a role in the inflammatory process.

Effect of Cholesterol Depletion on Interleukin-8 Production in Human Respiratory Epithelial Cells

PURPOSE: The lipid entities of cell membranes are components of the immune system and important mediators of inflammation. Despite increasing interest in the function of epithelial cells in inflammation, the role of cholesterol in this process has not been described. Here, we investigated the effect of cholesterol depletion on the inflammatory process in airway epithelial cells via the expression of interleukin (IL)-8 as a marker of inflammation. METHODS: A 549 cells were treated with 0.5% methyl-beta-cyclodextrin as a selective cholesterol extractor. The IL-8 level was assessed by enzyme-linked immunosorbent assay and reassessed after cholesterol repletion. Mitogen-activated protein kinase (MAPK) inhibitors were used to determine the upstream signaling pathway for IL-8 production in cholesterol-depleted cells. RESULTS: We found a relationship between the amount of cholesterol in A 549 cells and inflammation of the airway. IL-8 production was increased in cholesterol-depleted A 549 cells and restored by cholesterol repletion. IL-8 production was decreased by pretreatment with the extracellular signal-regulated kinase (ERK) inhibitor U0126 but not with JNK inhibitor II or the p38 MAPK inhibitor SB202190. CONCLUSIONS: Our findings suggest that inflammatory responses are increased in cholesterol-depleted epithelial cells via the MAPK signaling system, predominantly by the ERK pathway. We conclude that the lipid components of airwayepithelial cells may play a role in the inflammatory process.

Erratum: Involvement of Human Histamine N-Methyltransferase Gene Polymorphisms in Susceptibility to Atopic Dermatitis in Korean Children

We found an error in our published article, Table 3.

Involvement of Human Histamine N-Methyltransferase Gene Polymorphisms in Susceptibility to Atopic Dermatitis in Korean Children

PURPOSE: Histamine N-methyltransferase (HNMT) catalyzes one of two major histamine metabolic pathways. Histamine is a mediator of pruritus in atopic dermatitis (AD). The aim of this study was to evaluate the association between HNMT polymorphisms and AD in children. METHODS: We genotyped 763 Korean children for allelic determinants at four polymorphic sites in the HNMT gene: -465T>C, -413C>T, 314C>T, and 939A>G. Genotyping was performed using a TaqMan fluorogenic 5' nuclease assay. The functional effect of the 939A>G polymorphism was analyzed. RESULTS: Of the 763 children, 520 had eczema and 542 had atopy. Distributions of the genotype and allele frequencies of the HNMT 314C>T polymorphism were significantly associated with non-atopic eczema (P=0.004), and those of HNMT 939A>G were significantly associated with eczema in the atopy groups (P=0.048). Frequency distributions of HNMT -465T>C and -413C>T were not associated with eczema. Subjects who were AA homozygous or AG heterozygous for 939A>G showed significantly higher immunoglobulin E levels than subjects who were GG homozygous (P=0.009). In U937 cells, the variant genotype reporter construct had significantly higher mRNA stability (P<0.001) and HNMT enzyme activity (P<0.001) than the common genotype. CONCLUSIONS: Polymorphisms in HNMT appear to confer susceptibility to AD in Korean children.

A Case Report of Food-Dependent Exercise-Induced Anaphylaxis in a Patient who was Sensitive to Pork / 소아알레르기및호흡기학회지

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods. In particular, it is rare occurrence for FDEIA to be associated with meat in Korea. A 15-year-old female had generalized urticaria, dyspnea, severe cough, headache, dizziness, and vomiting after singing and dancing for 1 hour and after ingesting grilled pork. Skin prick tests showed a strong positive reaction to pork, whereas the results of an oral food challenge and exercise provocation tests were negative. However, the exercise provocation test after pork ingestion showed a positive reaction manifested by generalized urticaria, cough, mild dyspnea, and a 23% decreased peak expiratory flow rate. Three allergens to pork (67 kDa, 90 kDa, and 15 kDa) reacted with the patient's serum on immunoglobulin E immunoblotting. We report a case of pork-dependent exercise-induced anaphylaxis in a patient who was sensitive to pork.

Induction of Vascular Endothelial Growth Factor Protein by Mycoplasma pneumoniae / 소아알레르기및호흡기학회지

PURPOSE: Mycoplasma pneumoniae is an extracellular pathogen that attaches to and destroys the ciliated epithelial cells of the respiratory tract. The vascular endothelial growth factor (VEGF) is a critical angiogenic factor that manages the formation and function of vascular networks. Thus, we examined whether M. pneumoniae lysate (MPL) induces VEGF and MPL-induced VEGF expression is regulated by the activation of mitogen-activated protein kinase (MAPK) pathways in airway epithelial cells. METHODS: Cells were treated with MPL in dose and time dependent manners or pretreated with chemical inhibitors of MAPK signaling molecules before the addition of MPL. The supernatants were measured by a specific human VEGF enzyme-linked immunosorbent assay (ELISA). The RNAs were extracted and synthesized into cDNAs for VEGF gene expression by polymerase chain reaction. RESULTS: MPL considerably increased VEGF mRNA 2 hours after treatment, which was gradually reduced thereafter. On the other hand, VEGF protein was continuously amplified for 12 hours after both 5 and 10 microg/mL MPL treatment. Pretreatment with U0126 (a specific extracellular signal-regulated kinase inhibitor) and SB202190 (a specific p38 inhibitor) abolished MPL-stimulated VEGF protein close to basal level (-85%), whereas JNK inhibitor II (a specific c-Jun N-terminal kinase inhibitor) partially decreased VEGF protein (57%). CONCLUSION: We concluded that MPL induces VEGF expression through the activation of MAPK signaling molecules (ERK, p38 and JNK) in airway epithelial cells.

Work-related Musculoskeletal Diseases and Occupational Injuries in Health Care Workers

Recently, the health care system of Korea has grown bigger, specialized and modernized, but the healthcare workers' physical well-being is pushed back on the priority list. Musculoskeletal disorders (MSDs) involving days away from work per 10,000 full-time workers are 2.6 according to the statistics of Ministry of Labor, but it is much lesser compared to US statistics, which is 60.5. The smaller number is mainly due to the different method of calculation between Korea and U.S.; the proportion of all the parties of hospital care system is not calculated in Korea and the real portion is underestimated. Even though there was no exact figure regarding MSDs and occupational injuries, MSDs must be acknowledged that lower back pain and trip are most commonly developed due to an excessive strain and unstable position, and the important factor are acknowledged by their occupation, task, psychosocial factor; on the other hand, the occurrence of occupational injuries are influenced by the tenure, psychosocial state, and the level of education. In addition, for the treatment of the health care workers, its work-relatedness must be concerned, and prevention that takes their variable conditions into consideration can have a higher effectiveness.

The Relationship between Job Stress and Liver Dysfunction among Male White-Collar Workers / 대한산업의학회지

OBJECTIVES: We wanted to investigate the relationship between job stress and liver dysfunction in Korean male white collar workers. METHODS: A total of 700 male white collar workers who worked at one electronic institute and who participated in an annual surveillance program were recruited: 664(94.9%) workers were initially recruited and the data for 36 workers was excluded due to poor responses and a past history of liver disease. The questionnaire survey included the participants' general characteristics, the job-related factors, the health-related behaviors and job stress. Job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF). We merged the job stress data with the individual liver function results by conducting annual surveillance. Multiple logistic regression analysis with adjusting it for the confounding variables, including alcohol drinking and the body mass index (BMI), was used to evaluate the relationship between job stress and liver dysfunction. RESULTS: After adjustment for the confounding variables, the proportion of liver dysfunction cases was significantly higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. After conducting a stratified analysis with considering alcohol drinking and the BMI, the prevalence odds ratio of liver dysfunction was higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. CONCLUSIONS: The results of this study suggest that the level of job stress (and especially that assessed by the job demands and total score) is related to liver dysfunction. Thus, further preventive efforts and studies are needed to reduce job stress and address liver dysfunction.