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Objective@#This study investigated associations of life stressors and serum ghrelin levels with suicidal ideation (SI), and evaluated the potential mediating effect of ghrelin on associations between life stressors and SI in patients with acute coronary syndrome (ACS). @*Methods@#In total, 969 ACS patients recruited from a tertiary university hospital in Korea within 2 weeks of disease onset were evaluated in terms of life stressors (using the List of Threatening Events Questionnaire), serum ghrelin levels, and SI (using the “suicidal thoughts” item of the Montgomery–Asberg Depression Rating Scale). Covariates included sociodemographics, depression, vascular risk factors, and disease severity. After 1 year, 711 patients were re-evaluated in terms of SI; logistic regression was performed with adjustment for covariates. @*Results@#Life stressors were significantly associated with SI at baseline and follow-up. Serum ghrelin showed no such associations, but high levels thereof mediated associations of life stressors with SI; significant interaction terms were also observed after adjustment for covariates. @*Conclusion@#By evaluating life stressors and serum ghrelin levels, clinical prediction of SI in the acute and chronic phases of ACS could be improved.
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Objective@#We investigated effects of serum serotonin and interleukin 18 levels on suicidal ideation (SI) at acute and chronic phases of acute coronary syndrome (ACS). @*Methods@#Recent-onset 969 ACS patients were evaluated for serum serotonin and interleukin 18 levels; and SI by the“suicidal thoughts” item of the Montgomery–Åsberg Depression Rating Scale. After 1-year, 711 patients were re-evaluated for SI. Logistic regression models were used adjustment for potential covariates. @*Results@#Associations between serum interleukin 18 and SI at both phases were significant only in the lower serotonin group. @*Conclusion@#By evaluating serum serotonin and interleukin 18 levels, the clinical prediction of SI of ACS may be improved.
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BACKGROUND@#Hair follicles are among a handful of organs that exhibit immune privilege. Dysfunction of the hair follicle immune system underlies the development of inflammatory diseases, such as alopecia areata. @*METHODS@#Quantitative reverse transcription PCR and immunostaining was used to confirm the expression of major histocompatibility complex class I in human dermal papilla cells. Through transcriptomic analyses of human keratinocyte stem cells, major histocompatibility complex class I was identified as differentially expressed genes. Organ culture and patch assay were performed to assess the ability of WNT3a conditioned media to rescue immune privilege. Lastly, CD8? T cells were detected near the hair bulb in alopecia areata patients through immunohistochemistry. @*RESULTS@#Inflammatory factors such as tumor necrosis factor alpha and interferon gamma were verified to induce the expression of major histocompatibility complex class I proteins in dermal papilla cells. Additionally, loss of immune privilege of hair follicles was rescued following treatment with conditioned media from outer root sheath cells. Transcriptomic analyses found 58 up-regulated genes and 183 down-regulated genes related in MHC class I? cells. Using newborn hair patch assay, we demonstrated that WNT3a conditioned media with epidermal growth factor can restore hair growth. In alopecia areata patients, CD8? T cells were increased during the transition from mid-anagen to late catagen. @*CONCLUSION@#Identification of mechanisms governing epithelial and mesenchymal interactions of the hair follicle facilitates an improved understanding of the regulation of hair follicle immune privilege.
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Objective@#Sudden traumatic physical injuries often cause psychological distress, which may be associated with chronic disability. Although considerable effort has been expended to identify genetic predictors of post-traumatic stress disorder (PTSD) after traumatic events, genetic predictors of psychological distress in response to severe physical injuries have been yet to be elucidated using whole exome sequencing (WES). Here, the genetic architecture of post-traumatic syndrome (PTS), which encompasses a broad range of psychiatric disorders after traumatic events including depression, anxiety disorder, acute stress disorder, and PTSD, was explored using WES in severely physically injured patients, focusing on secondary findings and potential PTS-related variants. @*Methods@#In total, 141 severely physically injured patients were consecutively recruited, and PTS was evaluated within 1 month of the injury. Secondary findings were analyzed according to PTS status. To identify PTS-related variants, genome-wide association analyses and the optimal sequencing kernel association test were performed. @*Results@#Of the 141 patients, 88 (62%) experienced PTS. There were 108 disease-causing variants in severely physically injured patients. As secondary findings, the stress- and inflammation-related signaling pathways were enriched in the PTS patients, while the glucose metabolism pathway was enriched in those without PTS. However, no significant PTS-related variants were identified. @*Conclusion@#Our findings suggest that genetic alterations in stress and inflammatory pathways might increase the likelihood of PTS immediately after severe physical injury. Future studies with larger samples and longitudinal designs are needed.
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Background@#Particulate matters (PM) comprise a heterogeneous mixture of particles suspended in air. A recent study found that urban PMs may penetrate into hair follicles via transfollicular and transdermal routes in dorsal skin. @*Objective@#To investigate the effects of PM on ex vivo cultured human scalp hair follicles and hair follicular keratinocytes in vitro. @*Methods@#TUNEL staining was employed to check cells undergoing apoptosis in cultured hair follicles after PM treatment. MTT assay was employed to check cell viability after PM treatment. Quantitative real-time PCR analysis was employed to quantitate the expression of inflammatory genes, matrix metalloproteinases (MMPs), and Duox1. Inflammatory cytokine levels were measured by ELISA after PM treatment. The level of reactive oxygen species (ROS) production was measured using a chemical fluorescent probe by a fluorescence plate reader. Results: Abundant TUNEL-positive cells were observed in the keratinocyte region of hair including the epidermis, sebaceous gland, outer root sheath (ORS), inner root sheath (IRS), and bulb region. The viability of follicular cells, including the ORS, was found to be decreased upon PM exposure. mRNA expression and protein levels of inflammatory response genes and MMPs were upregulated in a dose-dependent manner by PM treatment. ROS levels were also increased by PM. @*Conclusion@#These data strongly suggest that penetrated PMs from air pollution may cause apoptotic cell death to follicular keratinocytes by increased production of ROS and inflammatory cytokines, which could impair hair growth.
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Purpose@#The occurrence of trauma-related delirium following postoperative abdominal surgery is associated with a poor prognosis. The purpose of this study was to identify predictive risk factors for trauma-related delirium. @*Methods@#Trauma patient data from a regional trauma center were retrospectively collected from August 2015 to December 2016. The primary inclusion criteria were patients diagnosed with traumarelated delirium following abdominal trauma surgery. Head trauma patients and those under 18 years of age were excluded from this study. A multivariate logistic regression analysis was performed to identify the risk factors associated with trauma-related delirium. @*Results@#Of the 255 trauma patients who met the inclusion criteria, 32 (12.5%) were diagnosed with delirium. The mean values for the age of the patients, Injury Severity Score, Glasgow Coma Scale score, and length of intensive care unit stay were 52.1 ± 17.8 years, 16.9, 14, and 7.1 days, respectively. Among the measured parameters, age [odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01-1.06; p = 0.022)], sex (OR, 0.125; 0.03-0.55; p = 0.006), hemoglobin level (OR, 0.875; CI, 0.68-0.98; p = 0.03), length of stay in the intensive care unit (OR, 1.12; CI, 1.03-1.22; p = 0.01), and having an abdominal operation (OR, 2.92; CI, 1.10-7.23; p = 0.011) showed strong correlations with trauma-related delirium. @*Conclusion@#This study showed that abdominal surgery was strongly associated with delirium in patients with traumatic abdominal injury. Thus, changes in consciousness should be carefully monitored following surgery.
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Purpose@#The occurrence of trauma-related delirium following postoperative abdominal surgery is associated with a poor prognosis. The purpose of this study was to identify predictive risk factors for trauma-related delirium. @*Methods@#Trauma patient data from a regional trauma center were retrospectively collected from August 2015 to December 2016. The primary inclusion criteria were patients diagnosed with traumarelated delirium following abdominal trauma surgery. Head trauma patients and those under 18 years of age were excluded from this study. A multivariate logistic regression analysis was performed to identify the risk factors associated with trauma-related delirium. @*Results@#Of the 255 trauma patients who met the inclusion criteria, 32 (12.5%) were diagnosed with delirium. The mean values for the age of the patients, Injury Severity Score, Glasgow Coma Scale score, and length of intensive care unit stay were 52.1 ± 17.8 years, 16.9, 14, and 7.1 days, respectively. Among the measured parameters, age [odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01-1.06; p = 0.022)], sex (OR, 0.125; 0.03-0.55; p = 0.006), hemoglobin level (OR, 0.875; CI, 0.68-0.98; p = 0.03), length of stay in the intensive care unit (OR, 1.12; CI, 1.03-1.22; p = 0.01), and having an abdominal operation (OR, 2.92; CI, 1.10-7.23; p = 0.011) showed strong correlations with trauma-related delirium. @*Conclusion@#This study showed that abdominal surgery was strongly associated with delirium in patients with traumatic abdominal injury. Thus, changes in consciousness should be carefully monitored following surgery.
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PURPOSE: This study aimed to investigate the incidence and risk factors of early postoperative small bowel obstruction (EPSBO) after laparotomy for trauma patients. METHODS: From 2009 to 2016, consecutive patients who had undergone laparotomy for trauma were retrospectively evaluated. EPSBO was defined as the presence of signs and symptoms of obstruction between postoperative days 7 and 30, or obstruction occurring anytime within 30 days and lasting more 7 days. RESULTS: Among 297 patients who met the inclusion criteria, 72 (24.2%) developed EPSBO. The length of hospital stay was significantly longer in patients with EPSBO than in those without EPSBO (median [interquartile range], 34 [21–48] days 24 [14–38] days, P < 0.001). Multivariate logistic analysis identified male sex (adjusted odds ratio [AOR], 3.026; P = 0.008), intraoperative crystalloid (AOR, 1.130; P = 0.031), and Abbreviated Injury Scale (AIS) score for mesenteric injury (AOR, 1.397; P < 0.001) as independent risk factors for EPSBO. The incidence of adhesive small bowel adhesion after 30 days postoperatively did not significantly differ between the 2 groups (with EPSBO, 5.6% without EPSBO, 5.3%; P = 0.571). Most of the patients with EPSBO were recovered by conservative treatment (95.8%). CONCLUSION: After laparotomy for trauma patients, the incidence of EPSBO was 24.2% in our study. EPSBO was associated with a longer hospital stay. Male sex, use of intraoperative crystalloid, and AIS score for mesenteric injury were significant independent risk factors for EPSBO. Patients with these risk factors should be followed-up more carefully.
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Humans , Male , Abbreviated Injury Scale , Abdominal Injuries , Adhesives , Ileus , Incidence , Laparotomy , Length of Stay , Odds Ratio , Retrospective Studies , Risk FactorsABSTRACT
PURPOSE: Pancreatic trauma is infrequent because of its central, deep anatomical position. This contributes to a lack of surgeon experience and many debates exist about its standard care. This study aimed to investigate the postoperative pancreatic fistula (POPF) and mortality of pancreatic trauma after operation. METHODS: We reviewed records in the trauma registry of our institution submitted from January 2006 to December 2016. The grade of pancreatic injury, surgical management, morbidity, mortality, and other clinical variables included in the analyses. RESULTS: Data from a total of 26,072 trauma patients admitted to the Emergency Department were analyzed. Pancreatic trauma was observed in 114 of these patients (0.44%). Laparotomy was performed in 81 patients (2 pan creatico duodenectomies, 2 pancreaticogastrostomies, peripancreatic drainage in 41 patients, distal pancreatectomies in 34 patients, and 9 patients who underwent surgery for damage control). The incidence of POPF was 38.3%. The overall mortality was 8.8% (7 of 81). In multivariate analysis, pancreas injury grade IV (≥4) (adjusted odds ratio [AOR], 4.071; P = 0.029) and preoperative peritonitis signs (AOR, 2.903; P = 0.039) were independent risk factors for POPF. All patients who died had also another major abdominal injury (≥grade 3). Multiorgan failure was a major cause of death (6 of 7, 85.7%). The mortality rate of isolated pancreas injury was 0%. CONCLUSION: The pancreas injury grade and preoperative peritonitis were significant risk factors of POPF. The mortality rate of isolated pancreatic trauma was very low.
Subject(s)
Humans , Abdominal Injuries , Cause of Death , Drainage , Emergency Service, Hospital , Incidence , Intraoperative Complications , Laparotomy , Mortality , Multivariate Analysis , Odds Ratio , Pancreas , Pancreatectomy , Pancreatic Fistula , Peritonitis , Risk Factors , Trauma CentersABSTRACT
Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play important roles in autoimmunity, infectious diseases and cancers. However, little is known about the roles of these invariant T cells in multiple trauma. The purposes of this study were to examine MAIT and NKT cell levels in patients with multiple trauma and to investigate potential relationships between these cell levels and clinical parameters. The study cohort was composed of 14 patients with multiple trauma and 22 non-injured healthy controls (HCs). Circulating MAIT and NKT cell levels in the peripheral blood were measured by flow cytometry. The severity of injury was categorised according to the scoring systems, such as Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, and Injury Severity Score (ISS). Circulating MAIT and NKT cell numbers were significantly lower in multiple trauma patients than in HCs. Linear regression analysis showed that circulating MAIT cell numbers were significantly correlated with age, APACHE II, SAPS II, ISS category, hemoglobin, and platelet count. NKT cell numbers in the peripheral blood were found to be significantly correlated with APACHE II, SAPS II, and ISS category. This study shows numerical deficiencies of circulating MAIT cells and NKT cells in multiple trauma. In addition, these invariant T cell deficiencies were found to be associated with disease severity. These findings provide important information for predicting the prognosis of multiple trauma.
Subject(s)
Humans , APACHE , Autoimmunity , Cell Count , Cohort Studies , Communicable Diseases , Flow Cytometry , Injury Severity Score , Linear Models , Multiple Trauma , Natural Killer T-Cells , Physiology , Platelet Count , Prognosis , T-LymphocytesABSTRACT
PURPOSE: Splenic injury management has shifted to non-surgical treatment to preserve the spleen because of the postoperative risks of overwhelming post-splenectomy infection. In this study, we analyzed risk factors of therapeutic options for splenic injury, using medical records of Chonnam National University Hospital. METHODS: We reviewed the medical records of 110 consecutive patients with traumatic splenic injuries admitted from January 2009 to December 2013. Demographic characteristics and therapeutic options such as conservative treatment, angiographic embolization and emergency operation and clinical parameters were analyzed in this study. RESULTS: Thirty-four patients were treated surgically and seventy-six were managed with nonsurgical treatment. Multivariate logistic regression identified age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.009~1.072; p=0.01), hematocrit (OR, 0.878; 95% CI, 0.806~0.957; p=0.003), contrast extravasation (OR, 7.644; 95% CI, 2.248~25.986; p=0.001), spleen grade (OR, 2.08; 95% CI, 1.128~ 3.836; p=0.019) as significant risk factors of emergent splenectomy. CONCLUSION: Age, hematocrit, contrast extravasation, spleen grade were significant risk factors for emergent splenectomy.
Subject(s)
Humans , Emergencies , Hematocrit , Logistic Models , Medical Records , Risk Factors , Spleen , Splenectomy , Splenic RuptureABSTRACT
Hemorrhage is a major cause of death in trauma patients. The medical definition of hemorrhagic shock is tissue hypoperfusion resulting from a reduction of blood volume. Decreased blood pressure resulting from acute blood loss induces cardiac stimulation, systemic vasoconstriction, and volume redistribution. These effects are due to the baroreceptor reflex, the humoral compensatory mechanisms including the renin angiotensin system, and the release of catecholamine and vasopressin. Hemorrhagic shock causes acidosis, hypothermia, and coagulopathy, known as ‘the lethal triad.’ Tissue hypoxia induces metabolic acidosis by producing lactic acid. The three components of the lethal triad amplify each other and form a vicious cycle, eventually causing the death of the patient. To reduce the risk of mortality in severely bleeding patients, we need to understand the pathophysiology of hemorrhagic shock and the related complications.
Subject(s)
Humans , Acidosis , Hypoxia , Baroreflex , Blood Pressure , Blood Volume , Cause of Death , Disseminated Intravascular Coagulation , Hemorrhage , Hypothermia , Lactic Acid , Mortality , Renin-Angiotensin System , Shock, Hemorrhagic , Vasoconstriction , VasopressinsABSTRACT
Default from tuberculosis (TB) treatment could exacerbate the disease and result in the emergence of drug resistance. This study identified the risk factors for default from TB treatment in Korea. This single-center case-control study analyzed 46 default cases and 100 controls. Default was defined as interrupting treatment for 2 or more consecutive months. The reasons for default were mainly incorrect perception or information about TB (41.3%) and experience of adverse events due to TB drugs (41.3%). In univariate analysis, low income (< 2,000 US dollars/month, 88.1% vs. 68.4%, P = 0.015), absence of TB stigma (4.3% vs. 61.3%, P < 0.001), treatment by a non-pulmonologist (74.1% vs. 25.9%, P < 0.001), history of previous treatment (37.0% vs. 19.0%, P = 0.019), former defaulter (15.2% vs. 2.0%, P = 0.005), and combined extrapulmonary TB (54.3% vs. 34.0%, P = 0.020) were significant risk factors for default. In multivariate analysis, the absence of TB stigma (adjusted odd ratio [aOR]: 46.299, 95% confidence interval [CI]: 8.078-265.365, P < 0.001), treatment by a non-pulmonologist (aOR: 14.567, 95% CI: 3.260-65.089, P < 0.001), former defaulters (aOR: 33.226, 95% CI: 2.658-415.309, P = 0.007), and low income (aOR: 5.246, 95% CI: 1.249-22.029, P = 0.024) were independent predictors of default from TB treatment. In conclusion, patients with absence of disease stigma, treated by a non-pulmonologist, who were former defaulters, and with low income should be carefully monitored during TB treatment in Korea to avoid treatment default.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antitubercular Agents/therapeutic use , Case-Control Studies , Medication Adherence , Multivariate Analysis , Odds Ratio , Republic of Korea , Risk Factors , Socioeconomic Factors , Tuberculosis/drug therapyABSTRACT
Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play crucial roles in a variety of diseases, including autoimmunity, infectious diseases, and cancers. However, little is known about the roles of these invariant T cells in acute cholecystitis. The purposes of this study were to examine the levels of MAIT cells and NKT cells in patients with acute cholecystitis and to investigate potential relationships between clinical parameters and these cell levels. Thirty patients with pathologically proven acute cholecystitis and 47 age- and sex-matched healthy controls were enrolled. Disease grades were classified according to the revised Tokyo guidelines (TG13) for the severity assessment for acute cholecystitis. Levels of MAIT and NKT cells in peripheral blood were measured by flow cytometry. Circulating MAIT and NKT cell numbers were significantly lower in acute cholecystitis patients than in healthy controls, and these deficiencies in MAIT cells and NKT cell numbers were associated with aging in acute cholecystitis patients. Notably, a reduction in NKT cell numbers was found to be associated with severe TG13 grade, death, and high blood urea nitrogen levels. The study shows numerical deficiencies of circulating MAIT and NKT cells and age-related decline of these invariant T cells. In addition, NKT cell deficiency was associated with acute cholecystitis severity and outcome. These findings provide an information regarding the monitoring of these changes in circulating MAIT and NKT cell numbers during the course of acute cholecystitis and predicting prognosis.