Nutrient Intake and Depression Based on Sleep Duration in Adult Women -Analysis of the Korea National Health and Nutrition Examination Survey, 2016 and 2018 Data-

This study evaluated the nutrient adequacy ratio (NAR) and depression based on the sleep duration of adult women using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016 and 2018. A total of 4,507 subjects were divided into two groups: sleep hours＜7 (lack of sleep, LS) and 7≤ sleep hours (normal sleep, NS). For a more detailed analysis, the subjects were further divided into normal sleep with no depression (NSND) and lack of sleep with depression (LSWD) groups. When compared with NS group, the nutrient intake of the LS group was observed to be higher in carbohydrates (P＜0.05) and thiamine (P＜0.01), but had a significantly lower mean nutrient adequacy ratio (P＜0.05). Also, the LS group showed a higher frequency of early menopause (P＜0.001) and depression (P＜0.05) than the NS group. In the analysis of anthropometry and blood parameters of the subjects based on their sleep duration, the LS group showed a lower body mass index (BMI, P＜0.05), lower blood creatinine (P＜0.01), glycated hemoglobin (P＜0.05), and high-density lipoprotein (HDL) cholesterol (P＜0.01) levels adjusted by age and menopause than the NS group. When compared to the NSND group, the LSWD group had a lower intake of cholesterol (P＜0.05), vitamin A (P＜0.05), vitamin C (P＜0.05), and folic acid (P＜0.05). There was no variation in the menopausal status, NAR, and mean nutrient adequacy ratio between the NSND and LSWD groups. However, there were differences in total blood cholesterol (P＜0.05) and depression based on sleep duration. Apart from nutritional status, differences in BMI and blood parameters were observed based on sleep duration.

Long working hours and overweight and obesity in working adults

BACKGROUND: Previous studies have identified a link between gender and the various risk factors associated with obesity. We examined obesity risk factors in working adults to identify the effects of differences in body mass index (BMI) and percentage body fat (PBF) between women and men. METHODS: A total of 1,120 adults agreed to participate in the study. Data from 711 participants, including 411 women and 300 men, were analyzed. Multiple logistic regression analysis was used to estimate the effects of risk factors on obesity and being overweight. In addition, the least-squares (LS) means of both BMI and PBF were estimated by analysis of covariance (ANCOVA) in a generalized linear model.  RESULTS: Increases in BMI and PBF were significantly related to an age > 50 years and long working hours in women after compensating for confounding factors. Using the PBF criterion, the odds ratio (OR) of being overweight or obese in women > 50 years of age who worked for > 9 h a day was 3.9 (95% confidence interval [CI], 1.05–11.00). For BMI, women who were > 50 years of age and worked for > 9 h a day were 3.82 times (95% CI, 1.31–11.14) more likely to be overweight or obese than those who were 50 years of age and long working hours in women. Further studies are needed to investigate the underlying mechanisms of this relationship and its potential implications for the prevention and management of excess weight and obesity.

Effect of a Dose-Escalation Regimen for Improving Adherence to Roflumilast in Patients with Chronic Obstructive Pulmonary Disease / 결핵및호흡기질환

BACKGROUND: The adverse effects of the phosphodiesterase-4 inhibitor roflumilast, appear to be more frequent in clinical practice than what was observed in chronic obstructive pulmonary disease (COPD) clinical trials. Thus, we designed this study to determine whether adverse effects could be reduced by starting roflumilast at half the dose, and then increasing a few weeks later to 500 microg daily. METHODS: We retrospectively investigated 85 patients with COPD who had taken either 500 microg roflumilast, or a starting dose of 250 microg and then increased to 500 microg. We analyzed all adverse events and assessed differences between patients who continued taking the drug after dose escalation and those who had stopped. RESULTS: Adverse events were reported by 22 of the 85 patients (25.9%). The most common adverse event was diarrhea (10.6%). Of the 52 patients who had increased from a starting dose of 250 microg roflumilast to 500 microg, 43 (82.7%) successfully maintained the 500 microg roflumilast dose. No difference in factors likely to affect the risk of adverse effects, was detected between the dose-escalated and the discontinued groups. Of the 26 patients who started with the 500 microg roflumilast regimen, seven (26.9%) discontinued because of adverse effects. There was no statistically significant difference in discontinuation rate between the dose-escalated and the control groups (p=0.22). CONCLUSION: Escalating the roflumilast dose may reduce treatment-related adverse effects and improve tolerance to the full dose. This study suggests that the dose-escalated regimen reduced the rate of discontinuation. However, longer-term and larger-scale studies are needed to support the full benefit of a dose escalation strategy.

Postoperative Abdominal Infection Caused by Corynebacterium minutissimum

Corynebacterium minutissimum is a non-spore forming, gram-positive, aerobic or facultative anaerobic bacillus. It is the causative organism of erythrasma, a common superficial infection of skin, which typically presents as reddish-brown macular patches. To date, it has rarely been found to cause invasive disease, although other non-diphtheria corynebacteria are becoming increasingly common as opportunistic pathogens. We report on a rare case of abdominal infection due to C. minutissimum in an immunocompetent adult who was successfully treated with intravenous amoxicillin/sulbactam.

Comparison of Keratometry and Corneal Higher Order Aberrations between Scout Videokeratoscope and Pentacam Scheimpflug Camera

PURPOSE: To investigate the correlations of keratometry and corneal high order aberrations (HOAs) between the Keratron Scout videokeratoscope and the Pentacam HR Scheimpflug camera. METHODS: From December 2012 to February 2013, keratometry and corneal HOAs were determined using the Keratron Scout videokeratoscope and Pentacam HR Scheimpflug camera in 23 healthy individuals (46 eyes). RESULTS: Average keratometry showed high correlation with 95% confidence interval -0.155 +/- 0.37 between the Keratron Scout and Pentacam HR. When comparing HOAs of the Keratron Scout and total corneal HOAs of Pentacam HR, total root-mean-square (RMS), and spherical aberration were positively correlated between the 2 devices (r = 0.67, p < 0.001 and r = 0.74, p < 0.001, respectively). When comparing HOAs of Keratron Scout and anterior corneal HOAs of Pentacam HR, total RMS, spherical aberration and coma were positively correlated between the 2 devices (r = 0.62, p < 0.001, r = 0.81, p < 0.001, and r = 0.52, p = 0.047, respectively). CONCLUSIONS: Although the 2 devices are based upon different principles, the Keratron Scout videokeratoscope and Pentacam HR Scheimpflug camera showed positive correlations in keratometry, total RMS, spherical aberration, and coma. Both devices may be useful for clinical applications.

Comparison of Keratometry and Corneal Higher Order Aberrations between Scout Videokeratoscope and Pentacam Scheimpflug Camera

PURPOSE: To investigate the correlations of keratometry and corneal high order aberrations (HOAs) between the Keratron Scout videokeratoscope and the Pentacam HR Scheimpflug camera. METHODS: From December 2012 to February 2013, keratometry and corneal HOAs were determined using the Keratron Scout videokeratoscope and Pentacam HR Scheimpflug camera in 23 healthy individuals (46 eyes). RESULTS: Average keratometry showed high correlation with 95% confidence interval -0.155 +/- 0.37 between the Keratron Scout and Pentacam HR. When comparing HOAs of the Keratron Scout and total corneal HOAs of Pentacam HR, total root-mean-square (RMS), and spherical aberration were positively correlated between the 2 devices (r = 0.67, p < 0.001 and r = 0.74, p < 0.001, respectively). When comparing HOAs of Keratron Scout and anterior corneal HOAs of Pentacam HR, total RMS, spherical aberration and coma were positively correlated between the 2 devices (r = 0.62, p < 0.001, r = 0.81, p < 0.001, and r = 0.52, p = 0.047, respectively). CONCLUSIONS: Although the 2 devices are based upon different principles, the Keratron Scout videokeratoscope and Pentacam HR Scheimpflug camera showed positive correlations in keratometry, total RMS, spherical aberration, and coma. Both devices may be useful for clinical applications.

A Case of Fungal Keratitis Caused by Paecilomyces lilacinus after Penetrating Keratoplasty

PURPOSE: To report a case of corneal ulcer caused by Paecilomyces lilacinus after penetrating keratoplasty. CASE SUMMARY: A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplasty in the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye 3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to the hospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement was observed. Three days later, fungal culture confirmed Paecilomyces lilacinus and topical voriconazole was prepared from the intravenous formulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty. CONCLUSIONS: Keratitis caused by Paecilomyces lilacinus is difficult to eradicate and refractory to amphotericin B. We suggest early use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patients with Paecilomyces lilacinus keratitis.

Posterior Polymorphous Corneal Dystrophy (PPCD) Combined with Traumatic Descemet's Membrane Fold

PURPOSE: To present a case of a 72-year-old woman with posterior polymorphous corneal dystrophy (PPCD) combined with traumatic Descemet's membrane fold due to forceps injury in Birth. CASE SUMMARY: A 72-year-old woman without significant ocular history presented complaining of ocular discomfort in her right eye. She had a history of birth that required forceps delivery and poor vision in the right eye since childhood. The rest of perinatal ophthalmic history was unremarkable (no past ophthalmic or family history). The best corrected visual acuity was 20/20 in both eyes. Slit-lamp biomicroscopy showed distinctive, vertical, semitranslucent Descemet's membrane breaks situated on the superior temporal side of the posterior surface of the cornea in her right eye. Also, a horizontal, tram-track line appearance of posterior cornea surface was detected at middle and inferior side of cornea. The fellow eye was normal. The endothelial cell densities were 945 cells/mm2 and 2481 cells/mm2 in right and left eyes, respectively. After 11 years later, (routine follow up exams every 1 year), the endothelial cell densities were 901 cells/mm2 and 2481 cells/mm2 in right and left eyes, respectively, which means there were no significant changes of endothelial densities in both eyes. CONCLUSIONS: We report a case of a patient with posterior polymorphous corneal dystrophy (PPCD) combined with traumatic Descemet's membrane fold due to forceps injury in Birth. The disease does not seem to progress or aggravated in long term follow up and no specific treatment was required.

Extremely Increased Serum Carbohydrate Antigen 19-9 Levels Caused by New or Resistant Infections to Previous Antibiotics in Chronic Lung Diseases / 결핵및호흡기질환

In this paper, we describe 72-year-old female patient without evidence of malignant disease presented with significantly elevated serum carbohydrate antigen (CA) 19-9 levels by respiratory infections. She was diagnosed with respiratory infections due to Mycobacterium avium complex and Pseudomonas aeruginosa. The serum CA 19-9 levels remarkably increased (1,453-5,300 U/mL; reference range, <37 U/mL) by respiratory infection and abruptly decreased (357-534 U/mL) whenever infection was controlled by specific treatments. This case suggests that serum CA 19-9 levels may be used as a diagnostic marker to indicate new or resistant infections to previous antibiotics in chronic lung diseases without significant changes in chest X-ray findings.

Acute Pulmonary Toxicity and Body Distribution of Inhaled Metallic Silver Nanoparticles

The purpose of this study was to determine the acute pulmonary toxicity of metallic silver nanoparticles (MSNPs, 20.30 nm in diameter). Acute pulmonary toxicity and body distribution of inhaled MSNPs in mice were evaluated using a nose-only exposure chamber (NOEC) system. Bronchoalveolar lavage (BAL) fluid analysis, Western blotting, histopathological changes, and silver burdens in various organs were determined in mice. Mice were exposed to MSNPs for 6 hrs. The mean concentration, total surface area, volume and mass concentrations in the NOEC were maintained at 1.93 x 10(7) particles/cm3, 1.09 x 10(10) nm2/cm3, 2.72 x 10(11) nm3/cm3, and 2854.62 microg/m3, respectively. Inhalation of MSPNs caused mild pulmonary toxicity with distribution of silver in various organs but the silver burdens decreased rapidly at 24-hrs post-exposure in the lung. Furthermore, inhaled MSNPs induced activation of mitogen-activated protein kinase (MAPK) signaling in the lung. In summary, single inhaled MSNPs caused mild pulmonary toxicity, which was associated with activated MAPK signaling. Taken together, our results suggest that the inhalation toxicity of MSNPs should be carefully considered at the molecular level.

A Case of Pulmonary Sequestration Infected by Mycobacterium tuberculosis / 결핵및호흡기질환

Pulmonary sequestration is a rare anomaly, in which a local area of a lung is supplied separately by an anomalous artery that arises from the aorta or one of its branches. Infection, mainly bacterial, is a major complication of sequestration. We report the case of a 17-year-old male patient, who presented with cough and fever. The contrast-enhanced chest computer tomomgraphy (CT) scans revealed an aberrant artery that originated from the descending thoracic aorta. He underwent a left-lower lobectomy. Macroscopically, the abnormal segment presented as multiple heterogenous cystic and solid lesions, and the cysts were filled with mucoid and pus-like material. Histology showed that the pulmonary parenchyma had been replaced by caseating epitheloid granulomas. The mycobacterial culture of his sputum was positive. On the basis of these results, the diagnosis of tuberculosis was established. The patient was treated with anti-tuberculous medication for 6 months, and 1 year later, his clinical status remained excellent.

Aerosol delivery of kinase-deficient Akt1 attenuates Clara cell injury induced by naphthalene in the lungs of dual luciferase mice

Conventional lung cancer therapies are associated with poor survival rates; therefore, new approaches such as gene therapy are required for treating cancer. Gene therapies for treating lung cancer patients can involve several approaches. Among these, aerosol gene delivery is a potentially more effective approach. In this study, Akt1 kinase-deficient (KD) and wild-type (WT) Akt1 were delivered to the lungs of CMV-LucR-cMyc-IRES-LucF dual reporter mice through a nose only inhalation system using glucosylated polyethylenimine and naphthalene was administrated to the mice via intraperitoneal injection. Aerosol delivery of Akt1 WT and naphthalene treatment increased protein levels of downstream substrates of Akt signaling pathway while aerosol delivery of Akt1 KD did not. Our results showed that naphthalene affected extracellular signal-regulated kinase (ERK) protein levels, ERK-related signaling, and induced Clara cell injury. However, Clara cell injury induced by naphthalene was considerably attenuated in mice exposed to Akt1 KD. Furthermore, a dual luciferase activity assay showed that aerosol delivery of Akt1 WT and naphthalene treatment enhanced cap-dependent protein translation, while reduced cap-dependent protein translation was observed after delivering Akt1 KD. These studies demonstrated that our aerosol delivery is compatible for in vivo gene delivery.

Characteristics of Pulmonary Tuberculosis in Elderly People / 결핵및호흡기질환

BACKGROUND: Pulmonary tuberculosis remains a health concern in Korea despite major progress in the development of new strategies for diagnosing and treating tuberculosis. In particular, the diagnosis of newly developed pulmonary tuberculosis is on the rise in elderly persons. The aim of this study was to investigate the clinical, radiographic characteristics, and treatment outcomes of pulm onary tuberculosis in the elderly. METHODS: The medical records of 113 young ( or =65 years old) pulmonary tuberculosis patients diagnosed at Chungnam National University hospital between January 2007 and December 2008 were reviewed. RESULTS: There was no difference in the prevalence of typical symptoms between the younger and the elderly group. Dypsnea was the only symptom that occurred more frequently in the elderly group (16.8% vs 5.5%, p=0.008). On radiological study, pneumonic infiltration type was more common in the elderly group (28.6% vs 16.8%, p=0.035). Sputum Acid fast bacilli smear positivity rate was similar between the 2 groups. Elderly patients with anti-tuberculosis medication had more frequent adverse drug reactions; however, there was no significant difference between the 2 groups in the number of patients required to stop medication due to an adverse drug reaction. There were more patients lost to follow-up in the elderly group (22/112, 19.6% vs 11/113, 9.7%, p=0.036). CONCLUSION: The majority of elderly patients did not complete the treatment, resulting in a poorer outcome. Therefore, we need to make an effort to support the continued screening of elderly patients by making this economically feasible.

Characteristics of Pulmonary Tuberculosis in Elderly People / 결핵및호흡기질환

BACKGROUND: Pulmonary tuberculosis remains a health concern in Korea despite major progress in the development of new strategies for diagnosing and treating tuberculosis. In particular, the diagnosis of newly developed pulmonary tuberculosis is on the rise in elderly persons. The aim of this study was to investigate the clinical, radiographic characteristics, and treatment outcomes of pulm onary tuberculosis in the elderly. METHODS: The medical records of 113 young ( or =65 years old) pulmonary tuberculosis patients diagnosed at Chungnam National University hospital between January 2007 and December 2008 were reviewed. RESULTS: There was no difference in the prevalence of typical symptoms between the younger and the elderly group. Dypsnea was the only symptom that occurred more frequently in the elderly group (16.8% vs 5.5%, p=0.008). On radiological study, pneumonic infiltration type was more common in the elderly group (28.6% vs 16.8%, p=0.035). Sputum Acid fast bacilli smear positivity rate was similar between the 2 groups. Elderly patients with anti-tuberculosis medication had more frequent adverse drug reactions; however, there was no significant difference between the 2 groups in the number of patients required to stop medication due to an adverse drug reaction. There were more patients lost to follow-up in the elderly group (22/112, 19.6% vs 11/113, 9.7%, p=0.036). CONCLUSION: The majority of elderly patients did not complete the treatment, resulting in a poorer outcome. Therefore, we need to make an effort to support the continued screening of elderly patients by making this economically feasible.

A Case of Lupus-like Glomerulonephritis in an HIV-infected Patient

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.

A Case of Lupus-like Glomerulonephritis in an HIV-infected Patient

Many types of glomerulonephritis are associated with human immunodeficiency virus (HIV) infection. We present a case of a 50-year-old Korean man with an HIV infection, who developed nephrotic syndrome and progressive renal failure. Renal biopsy showed lupus-like glomerulonephritis without clinical or serologic evidence of systemic lupus erythematosus. After the administration of antiretroviral agents and steroids, there was reduction in the amount of proteinuria and improvement in renal function.

Low dietary inorganic phosphate affects the lung growth of developing mice

Inorganic phosphate (Pi) plays a critical role in diverse cellular functions, and regulating the Pi balance is accomplished by sodium-dependent Pi co-transporter (NPT). Pulmonary NPT has recently been identified in mammalian lungs. However, to date, many of the studies that have involved Pi have mainly focused on its effect on bone and kidney. Therefore, current study was performed to discover the potential effects of low Pi on the lung of developing transgenic mice expressing the renilla/firefly luciferase dual reporter gene. Two-weeks old male mice divided into 2 groups and these groups were fed either a low PI diet or a normal control diet (normal: 0.5% Pi, low: 0.1% Pi) for 4 weeks. After 4 weeks of the diet, all the mice were sacrificed. Their lungs were harvested and analyzed by performing luciferase assay, Western blotting, kinase assay and immunohistochemistry. Our results demonstrate that low Pi affects the lungs of developing mice by disturbing protein translation, the cell cycle and the expression of fibroblast growth factor-2. These results suggest that optimally regulating Pi consumption may be important to maintain health.

Erdheim-Chester Disease with Hepatitis, Glomerulonephritis, Aplastic Anemia and Lung Involvement / 결핵및호흡기질환

Erdheim-Chester disease (ECD) is a proliferative non-Langerhans cell histiocytosis of multiple organs. This is a rare disease of unknown etiology with a high mortality. We present the case report of a 26-year-old man diagnosed with ECD. He was referred to our hospital with elevated levels of aminotransferases. Although the diagnosis was uncertain, the patient was lost to follow up at that time. One year later, the patient returned to the hospital with generalized edema. Although a specific bone lesion was not found, the patient was experiencing the following: glomerulonephritis, aplastic anemia, hepatitis, and lung involvement. A lung biopsy was performed: the immunohistochemical stain were positive for CD68 and negative for S-100 protein and CD1a. We diagnosed as the patient as havinf ECD. Approximately 50% of ECD cases present with extraskeletal involvement. ECD should be considered as part of the differential diagnosis when multiple organs are involved.

Synergistic effect of ERK inhibition on tetrandrine-induced apoptosis in A549 human lung carcinoma cells

Tetrandrine (TET), a bis-benzylisoquinoline alkaloid from the root of Stephania tetrandra, is known to have anti-tumor activity in various malignant neoplasms. However, the precise mechanism by which TET inhibits tumor cell growth remains to be elucidated. The present studies were performed to characterize the potential effects of TET on phosphoinositide 3-kinase/Akt and extracellular signal-regulated kinase (ERK) pathways since these signaling pathways are known to be responsible for cell growth and survival. TET suppressed cell proliferation and induced apoptosis in A549 human lung carcinoma cells. TET treatment resulted in a down-regulation of Akt and ERK phosphorylation in both time-/concentration-dependent manners. The inhibition of ERK using PD98059 synergistically enhanced the TET-induced apoptosis of A549 cells whereas the inhibition of Akt using LY294002 had a less significant effect. Taken together, our results suggest that TET: i) selectively inhibits the proliferation of lung cancer cells by blocking Akt activation and ii) increases apoptosis by inhibiting ERK. The treatment of lung cancers with TET may enhance the efficacy of chemotherapy and radiotherapy and increase the apoptotic potential of lung cancer cells.

Validation of a modified ECRHS questionnaire for diagnosing asthma in patients with chronic cough / 대한내과학회지

BACKGROUND/AIMS: Chronic cough may be the only manifestation of asthma. This study prospectively evaluated the validation of a modified European Community Respiratory Health Survey (ECRHS) questionnaire (including postnasal drip and GERD) in patients with chronic cough. METHODS: We recruited patients with a chronic cough exceeding 8 weeks from Oct. 2004 to March 2008. The patients had undergone an assessment using the modified ECRHS questionnaire, methacholine challenge test, chest PA, and PNS series, as well as the MAST and skin prick test in some patients. RESULTS: A total of 1518 patients were recruited. A total of 511 patients (33.6%) were physician diagnosed with asthma. Wheezing (53%, odds ratio [OR]: 2.989), nocturnal cough or dyspnea (57.3%,OR: 1.751), resting dyspnea (43.8%, OR: 2.216), post-exercise dyspnea (63.4%,OR: 2.297), esophageal reflux symptoms (34.1%, OR: 1.107) and postnasal drip (13.1%, OR: 1.116) are symptoms that have been reported. As the number of asthmatic symptoms included in the questionnaire increased, the number of patients diagnosed with asthma by a physician increased. The correlation between bronchial hyperresoponsiveness (BHR) and physician diagnosed asthma was evaluated by the area under the receiver operator characteristic (ROC) curve. The questionnaire was more correlated with BHR than with physician diagnosed asthma (area: 0.852 vs. 0.631). CONCLUSIONS: The Modified ECRHS questionnaire is an available method to assist in the diagnosis of asthma and to evaluate BHR in patients with chronic cough.