Association of sarcopenia and its components with clinical outcomes in patients undergoing peritoneal dialysis

Further studies are needed to identify whether muscle mass, muscle strength, or sarcopenia is the best indicator of survival in patients undergoing peritoneal dialysis (PD). We aimed to compare the association of sarcopenia and its components with survival in patients undergoing PD. Methods: We identified all patients with PD (n = 199). We routinely recommended handgrip strength (HGS) and lean mass measurements using dual energy X-ray absorptiometry in all patients with PD. Sarcopenia was defined using cutoff values from the Asian Working Group for Sarcopenia. We evaluated the patient and technique survival rates. Results: The number of patients with low HGS was 95 (47.7%). The median follow-up interval was 17 months (interquartile range, 13–21 months). Kaplan-Meier curve analysis showed that patients with low HGS or sarcopenia had poorer patient and technique survival compared with patients with normal HGS or without sarcopenia. Cox regression analysis showed that patients with low HGS had greater hazard ratios for patient death and technique failure compared with those with normal HGS. However, patients with low muscle mass were not significantly higher hazard ratios for patient death or technique failure compared with those with normal muscle mass. Patients with sarcopenia had significantly greater hazard ratios for patient death or technique failure than those without sarcopenia only in univariate analysis. Conclusion: The present study demonstrated that HGS may be superior to muscle mass or sarcopenia for predicting patient or technique survival in patients undergoing PD.

Factors Influencing Quality of Life Among Breast Cancer Patients Following Immediate Breast Reconstruction

Purpose@#The purpose of this study was to identify factors that influence quality of life (QoL) of breast cancer patients who underwent immediate breast reconstruction. @*Methods@#A total of 113 patients were enrolled. Patients' operative satisfaction and QoL were measured using satisfaction with breast and the European Organization for Research and Treatment of Cancer Breast-Cancer-Specific Quality of Life questionnaires. @*Results@#The mean operative satisfaction was 54.41±15.57 out of 100. For QoL, the mean functional score was 45.25±20.10 and the symptom score was 25.26±15.79. Significant correlation was seen between operative satisfaction and functional QoL (r=.47, p<.001), and between operative satisfaction and symptom QoL (r=−.35, p<.001). The operative satisfaction and method of reconstruction were identified as influencing factors for functional QoL with explanatory power of 34.1%. The operative satisfaction, method of reconstruction, marital status and neoadjuvant chemotherapy were identified as influencing factors for symptom QoL with explanatory power of 28.6%. @*Conclusion@#The results confirmed operative satisfaction and QoL among breast cancer patients who underwent immediate breast reconstruction, and the factors influencing their QoL. The results of this study are expected to help towards the decision making of patients under consideration for immediate breast reconstruction.

Association between Chronic Kidney Disease or Acute Kidney Injury and Clinical Outcomes in COVID-19 Patients

Background@#A population-based study would be useful to identify the association between chronic kidney disease (CKD) or acute kidney injury (AKI) and prognosis of coronavirus disease 2019 (COVID-19) patients. @*Methods@#This retrospective study utilized the claim data from Korea. Patients who underwent COVID-19 testing and were confirmed to be positive were included and divided into the following three groups based on the presence of CKD or requirement of maintenance dialysis: Non-CKD (participants without CKD), non-dialysis CKD (ND-CKD), and dialysisdependent CKD (DD-CKD) patients. We collected data on the development of severe clinical outcomes and death during follow-up. Severe clinical outcomes were defined as the use of inotropics, conventional oxygen therapy, high-flow nasal cannula, mechanical ventilation, or extracorporeal membrane oxygenation and the development of AKI, cardiac arrest, myocardial infarction, or acute heart failure after the diagnosis of COVID-19. AKI was defined as the initiation of renal replacement therapy after the diagnosis of COVID-19 in patients not requiring maintenance dialysis. Death was evaluated according to survival at the end of follow-up. @*Results@#Altogether, 7,341 patients were included. The median duration of data collection was 19 (interquartile range, 11–28) days. On multivariate analyses, odds ratio (OR) for severe clinical outcomes in the ND-CKD group was 0.88 (95% confidence interval [CI], 0.64–1.20;P = 0.422) compared to the Non-CKD group. The DD-CKD group had ORs of 7.32 (95% CI, 2.14–33.90; P = 0.004) and 8.32 (95% CI, 2.37–39.21;P = 0.002) compared to the Non-CKD and ND-CKD groups, respectively. Hazard ratio (HR) for death in the ND-CKD group was 0.79 (95% CI, 0.49–1.26; P = 0.318) compared to the Non-CKD group. The DD-CKD group had HRs of 2.96 (95% CI, 1.09–8.06; P = 0.033) and 3.77 (95% CI, 1.29–11.06; P = 0.016) compared to the Non-CKD and ND-CKD groups, respectively. DD-CKD alone was associated with severe clinical outcomes and higher mortality. There was no significant difference in frequency of severe clinical outcomes or mortality rates between the Non-CKD and ND-CKD groups. In patients not requiring maintenance dialysis, AKI was associated with old age, male sex, and high Charlson's comorbidity index score but not with the presence of CKD. HRs for patients with AKI were 11.26 (95% CI, 7.26–17.45; P < 0.001) compared to those for patients without AKI in the multivariate analysis. AKI was associated with severe clinical outcomes and patient survival, rather than underlying CKD. @*Conclusion@#CKD requiring dialysis is associated with severe clinical outcomes and mortality in patients with COVID-19; however, the development of AKI is more strongly associated with severe clinical outcomes and mortality.

Association between Chronic Kidney Disease or Acute Kidney Injury and Clinical Outcomes in COVID-19 Patients

Background@#A population-based study would be useful to identify the association between chronic kidney disease (CKD) or acute kidney injury (AKI) and prognosis of coronavirus disease 2019 (COVID-19) patients. @*Methods@#This retrospective study utilized the claim data from Korea. Patients who underwent COVID-19 testing and were confirmed to be positive were included and divided into the following three groups based on the presence of CKD or requirement of maintenance dialysis: Non-CKD (participants without CKD), non-dialysis CKD (ND-CKD), and dialysisdependent CKD (DD-CKD) patients. We collected data on the development of severe clinical outcomes and death during follow-up. Severe clinical outcomes were defined as the use of inotropics, conventional oxygen therapy, high-flow nasal cannula, mechanical ventilation, or extracorporeal membrane oxygenation and the development of AKI, cardiac arrest, myocardial infarction, or acute heart failure after the diagnosis of COVID-19. AKI was defined as the initiation of renal replacement therapy after the diagnosis of COVID-19 in patients not requiring maintenance dialysis. Death was evaluated according to survival at the end of follow-up. @*Results@#Altogether, 7,341 patients were included. The median duration of data collection was 19 (interquartile range, 11–28) days. On multivariate analyses, odds ratio (OR) for severe clinical outcomes in the ND-CKD group was 0.88 (95% confidence interval [CI], 0.64–1.20;P = 0.422) compared to the Non-CKD group. The DD-CKD group had ORs of 7.32 (95% CI, 2.14–33.90; P = 0.004) and 8.32 (95% CI, 2.37–39.21;P = 0.002) compared to the Non-CKD and ND-CKD groups, respectively. Hazard ratio (HR) for death in the ND-CKD group was 0.79 (95% CI, 0.49–1.26; P = 0.318) compared to the Non-CKD group. The DD-CKD group had HRs of 2.96 (95% CI, 1.09–8.06; P = 0.033) and 3.77 (95% CI, 1.29–11.06; P = 0.016) compared to the Non-CKD and ND-CKD groups, respectively. DD-CKD alone was associated with severe clinical outcomes and higher mortality. There was no significant difference in frequency of severe clinical outcomes or mortality rates between the Non-CKD and ND-CKD groups. In patients not requiring maintenance dialysis, AKI was associated with old age, male sex, and high Charlson's comorbidity index score but not with the presence of CKD. HRs for patients with AKI were 11.26 (95% CI, 7.26–17.45; P < 0.001) compared to those for patients without AKI in the multivariate analysis. AKI was associated with severe clinical outcomes and patient survival, rather than underlying CKD. @*Conclusion@#CKD requiring dialysis is associated with severe clinical outcomes and mortality in patients with COVID-19; however, the development of AKI is more strongly associated with severe clinical outcomes and mortality.

Regulation of synaptic architecture and synaptic vesicle pools by Nervous wreck at Drosophila Type 1b glutamatergic synapses

Nervous wreck (Nwk), a protein that is present at Type 1 glutamatergic synapses that contains an SH3 domain and an FCH motif, is a Drosophila homolog of the human srGAP3/MEGAP protein, which is associated with mental retardation. Confocal microscopy revealed that circles in Nwk reticulum enclosed T-shaped active zones (T-AZs) and partially colocalized with synaptic vesicle (SV) markers and both exocytosis and endocytosis components. Results from an electron microscopic (EM) analysis showed that Nwk proteins localized at synaptic edges and in SV pools. Both the synaptic areas and the number of SVs in the readily releasable (RRPs) and reserve (RPs) SV pools in nwk2 were significantly reduced. Synergistic, morphological phenotypes observed from eag¹;nwk² neuromuscular junctions suggested that Nwk may regulate synaptic plasticity differently from activity-dependent Hebbian plasticity. Although the synaptic areas in eag¹;nwk² boutons were not significantly different from those of nwk², the number of SVs in the RRPs was similar to those of Canton-S. In addition, three-dimensional, high-voltage EM tomographic analysis demonstrated that significantly fewer enlarged SVs were present in nwk² RRPs. Furthermore, Nwk formed protein complexes with Drosophila Synapsin and Synaptotagmin 1 (DSypt1). Taken together, these findings suggest that Nwk is able to maintain synaptic architecture and both SV size and distribution at T-AZs by interacting with Synapsin and DSypt1.

Excision of Second Branchial Cleft Cyst Via Retroauricular Approach without Assistance of Endoscopic or Robotic System / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Traditionally, the surgical approach for the excision of second branchial cleft cysts involves performing a transverse cervical incision on the skin overlying the mass. Recently, there has been a significant interest on the cosmetic outcomes of this surgery, and it has been found that the retroauricular approach produces better results. The purpose of this study was to evaluate the feasibility of a retroauricular approach for the excision of second branchial cleft cysts without the assistance of endoscopic or robotic system. SUBJECTS AND METHOD: From August 2013 to May 2016, a total of 12 patients with second branchial cleft cysts underwent surgery for the excision of the cyst via retroauricular approach, which involved an incision along the retroauricular sulcus and hairline. The surgical outcomes, complications, and subjective satisfaction with incision scars were assessed. RESULTS: In all 12 cases, the second branchial cleft cysts were removed successfully under direct vision and without the requirement of endoscopic assistance. The mean operation time was 80.3 min (range, 65-105 min). No significant complications were reported, such as skin flap necrosis, hematoma, seroma, or serious cranial nerve injury. The mean visual analogue scale score for subjective satisfaction with the incision scar was 8.8 (range, 7-10). CONCLUSION: The excision of second branchial cleft cysts via retroauricular approach without the assistance of endoscopic or robotic system is technically feasible and it provides a favorable cosmetic outcome.

Effect of Oral Water Intake to Globus Pharyngeus with Non-Organic Diseases

BACKGROUND AND OBJECTIVES: Globus pharyngeus is a sensation of foreign body in the throat. There are many studies evaluate relationships between globus pharyngeus and organic diseases such as laryngopharyngeal reflux, esophageal motility disorders as well as psychotic causes. But, Also many patients without etiologic causes complain of globus sensation. The authors performed a study that evaluate association between oral water intake and symptoms of globus sensation on the basis of a belief that pharyngeal dehydration due to lack of oral water intake causes globus sensation. MATERIALS AND METHODS: A survey using visual analogue scale to evaluate symptoms was performed with 73 patients with globus pharyngeus. RESULTS: Patients who drink water less than 500 mL per day (p=0.04) and less than five times per day (p=0.02) were improved after 6 months due to education and doctor's recommendation. CONCLUSION: Frequent and enough water intake should be recommended to resolve symptoms of globus sensation.

Regulation of Adipocyte Differentiation via MicroRNAs

Adipocyte differentiation, termed adipogenesis, is a complicated process in which pluripotent mesenchymal stem cells differentiate into mature adipocytes. The process of adipocyte differentiation is tightly regulated by a number of transcription factors, hormones and signaling pathway molecules. Recent studies have demonstrated that microRNAs, which belong to small noncoding RNA species, are also involved in adipocyte differentiation. In vivo and in vitro studies have revealed that various microRNAs affect adipogenesis by targeting several adipogenic transcription factors and key signaling molecules. In this review, we will summarize the roles of microRNAs in adipogenesis and their target genes associated with each stage of adipocyte differentiation.

Clinical Characteristics of Allergic Fungal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The diagnosis of the allergic fungal sinusitis (AFS) can be established by demonstrating type I hypersensitivity, nasal polyposis, characteristic CT scans, eosinophilic mucin and a positive fungal stain of mucus. There are certain conditions may also present clinically just like AFS, but in these cases, neither the presence of fungus nor the allergy can be documented. Some authors termed this condition as "AFS-like syndrome". Whether the AFS-like syndrome is a spectrum of AFS or different disease entity remains unclear. The objective of this study was to analyze the clinical features of allergic fungal sinusitis and to compare clinical features of AFS with those of AFS-like syndrome. SUBJECTS AND METHOD: Five patients with AFS and six patients with AFS-like syndromes were analyzed in terms of clinical manifestations, presence of associated diseases, radiologic findings, allergic test, treatment, and treatment outcome. RESULTS: Patients with AFS were younger than those with AFS-like syndrome. All patients of AFS group had histories of allergic disease. Eighty percent of AFS group patients had unilateral lesions, while 18 percent of AFS-like syndrome patients had unilateral lesions. Serum total IgE was more elevated in AFS group. On CT scan, characteristic findings such as heterogeneous soft tissue density, erosion of bony septa, and expansion of sinus wall were more frequently found in AFS group. There was no difference in treatment outcome between two groups. CONCLUSION: These results may suggest that AFS-like syndrome is a different disease entity from AFS.

The Inhibitory Effect of Anti-P-Selectin, Anti-PSGL-1 and Anti-CD49d Antibodies on Experimental Allergic Airway Inflammation in Mice

BACKGROUND AND OBJECTIVES: Eosinophil recruitment in allergic inflammation is dependent on the interactions between adhesion molecules. The objective of this study was to determine whether blocking of P-selectin glycoprotein ligand-1 (PSGL-1), P-selectin or CD49d adhesion molecules using monoclonal antibodies can reduce eosinophil recruitment in mice with the airway allergy. MATERIALS AND METHODS: Seven different groups of mice were used. One experimental group of mice (group A) served as naive control and sensitized with phosphate-buffered saline (PBS). Six experimental groups of mice (groups B to G) were sensitized to ovalbumin (OVA). The mice in group B were treated with PBS before OVA aerosol challenge and served as positive controls. The mice in other remaining groups were treated with monoclonal antibodies (mAb) against specific adhesion molecules before OVA challenge; anti-P-selectin mAb (group C), anti-PSGL-1 mAb (group D), anti-CD49d mAb (group E), anti-P-selectin mAb & anti-CD49d mAb (group F), anti PSGL-1 mAb & anti-CD49d mAb (group G). Eosinophils in the nasal mucosa and bronchoalveolar lavage (BAL) fluid in each animal group were measured. RESULTS: Mucosal eosinophilic infiltrations were significantly reduced at the mice in the group C, F or G compared with group B. Eosinophils in BAL fluid were significantly reduced only at the group C mice. CONCLUSION: These results suggest that blockade of P-selectin is superior to blockade of PSGL-1 or CD49d in the inhibitory effect against eosinophil recruitment.

The Effects of Adenoidectomy on Nasal Airway Resistance and Nasal Geometry

The primary objective of this study was to determine whether adenoid hypertrophy and subsequent adenoidectomy affect pediatric nasal airway resistance and nasal geometry. The secondary objective was to evaluate the relationships between the degree of adenoid hypertrophy and nasal airway resistance or nasal geometry. Fifty-one children, aged 5 to 10 years, selected for adenoidectomy due to chronic nasal obstruction and mouth breathing were enrolled. The size of adenoid was evaluated by cephalometric radiograph. Nasal airway resistance and nasal geometry were evaluated by active anterior rhinomanometry and acoustic rhinometry respectively. These measurements were repeated 3 months after operation. The size of adenoid was found well correlated to preoperative nasal airway resistance but was not to preoperative nasal geometry. Nasal geometry was not changed after operation. However, nasal airway resistance was reduced significantly at 3 months after operation and the size of adenoid was found well correlated to postoperative changes of nasal airway resistances.

Inverted Papilloma of the Nose and Paranasal Sinuses: An Analysis of 102 Cases / 대한이비인후과학회지

OBJECTIVES: Inverted papilloma is characterized by a high rate of recurrence, local aggressiveness and association with malignancy. We reviewed the 16-year experience of our institution in clinical presentation, history and the recurrence rate according to the tumor stage and surgical modalities. MATERIALS AND METHOD: A retrospective study was conducted on 102 patients diagnosed as inverted papilloma between January, 1986 through August, 2002. Demographic data, clinical presentations, and association with malignancy were analyzed. All patients with inverted papilloma were staged according to the Krouse's staging system. Sixty eight patients followed up at least 6 months were divided into endoscopic and conventional surgery groups. We compared the recurrence rate between the two groups according to the tumor stage. RESULT AND CONCLUSION: Patients were aged 19 to 81 years, and 73.5% were male. The most frequent presenting complaint was nasal obstruction. The most common site of involvement was the lateral nasal wall in the region of the middle meatus. The overall malignancy rate was 8.8% (9 cases), with synchronous tumors accounting for 7 cases and metachronous tumors accounting for 2 cases. When patients were first diagnosed, the most common stage was T2 (52.7%). The recurrence rates of T1, T2 and T3 were 10%, 11.1% and 4.8%, respectively, with no significant difference. Also the recurrence rates in endoscopic and conventional surgery group according to the stage had no significant difference.