Proliferative Diabetic Retinopathy Requiring Vitrectomy Over Clinic Management During COVID-19: Impact of Delayed Care

Purpose@#This study aimed to investigate the impact of delayed retinal clinical care during the COVID-19 pandemic on the severity of proliferative diabetic retinopathy (PDR) and drivers of follow-up delay. We compared disease severity and follow-up rates of PDR patients requiring vitrectomy to those managed nonsurgically, and identified factors associated with need for vitrectomy. @*Methods@#The study included 739 patients diagnosed with PDR between January 1, 2018, and March 4, 2021, categorized into two groups based on outcome: vitrectomy nonvitrectomy. Statistical methods such as t-tests and chi-square tests were used to analyze differences in disease severity and follow-up rates before and after COVID-19 shutdown. A multivariate regression evaluated factors leading to vitrectomy by comparing initial ETDRS (Early Treatment of Diabetic Retinopathy Study) DR staging, disease stability, DR progression, proliferative complications, appointment intervals, follow-up variance, rescheduling rate, and no-show rate. @*Results@#Of the 739 patients, 202 required vitrectomy, 537 were managed nonsurgically. The vitrectomy group had more severe or unstable disease before shutdown. The interval between patient visits preshutdown was 29.76 ± 45.11 days in the vitrectomy group and 40.23 ± 56.73 days in the nonvitrectomy group (p < 0.001). Both groups experienced a significant increase in appointment intervals after shutdown, with the vitrectomy group having a greater increase. Both groups had significantly increased rescheduling rate and minimally increased no-show rate. Patient-directed rescheduling was the main driver of appointment delays. Disease factors, such as tractional retinal detachment and higher ETDRS DR staging, increased the odds of vitrectomy, while appointment burden and follow-up variability had a minimal impact. @*Conclusions@#Patients with more severe PDR and greater delay in appointments due to the pandemic were more likely to require vitrectomy for proliferative complications. Patient-directed rescheduling was identified as the main driver of care delays, as opposed to clinic-directed rescheduling. This study highlights the importance of maintaining regular follow-up appointments for PDR patients during pandemics.

The Effects of Hyperbaric Oxygen Therapy in Patients with Central Retinal Artery Occlusion: A Retrospective Study, Systematic Review, and Meta-analysis

Purpose@#Central retinal artery occlusion (CRAO) is a vision-threatening condition with a potentially poor visual prognosis. Many different treatment modalities are suggested but controversy remains regarding effectiveness of these treatments. The purpose of this study is to perform a systematic review and meta-analysis in addition to analyzing retrospective data at our own tertiary care center regarding effectiveness of hyperbaric oxygen therapy (HBOT) in treatment of CRAO. @*Methods@#The PubMed, Scopus, and the Cochrane Library are searched from the date of database inception to September 2021 to conduct a review based on the PRISMA (preferred reporting items for systematic review and meta-analysis), evaluating the role of HBOT in visual recovery of CRAO patients. In addition, a retrospective chart review of patients clinically diagnosed with CRAO at our university-based hospital (University of Texas Health, San Antonio, TX, USA) from year 2011 to 2021 was conducted. @*Results@#After a review of 376 articles, three articles met the inclusion criteria for meta-analysis, where a total of 207 patients received HBOT versus 89 patients that did not receive any form of oxygen therapy. Analysis of these results demonstrate that HBOT in CRAO patients does not enhance the final visual outcome (p = 0.83). Similar conclusion was also drawn from retrospective analysis of 48 patients (15 HBOT versus 33 controls) at our tertiary care center, where no visual benefit was observed in the HBOT group. @*Conclusions@#HBOT does not appear to improve final visual outcome and concerns remain regarding adverse reactions such as barotrauma and generalized seizures. Large, randomized studies are required for further understanding of the role of HBOT in treatment of CRAO.

Application of convolutional neural networks for distal radio-ulnar fracture detection on plain radiographs in the emergency room

Objective@#Recent studies have suggested that deep-learning models can satisfactorily assist in fracture diagnosis. We aimed to evaluate the performance of two of such models in wrist fracture detection. @*Methods@#We collected image data of patients who visited with wrist trauma at the emergency department. A dataset extracted from January 2018 to May 2020 was split into training (90%) and test (10%) datasets, and two types of convolutional neural networks (i.e., DenseNet-161 and ResNet-152) were trained to detect wrist fractures. Gradient-weighted class activation mapping was used to highlight the regions of radiograph scans that contributed to the decision of the model. Performance of the convolutional neural network models was evaluated using the area under the receiver operating characteristic curve. @*Results@#For model training, we used 4,551 radiographs from 798 patients and 4,443 radiographs from 1,481 patients with and without fractures, respectively. The remaining 10% (300 radiographs from 100 patients with fractures and 690 radiographs from 230 patients without fractures) was used as a test dataset. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DenseNet-161 and ResNet-152 in the test dataset were 90.3%, 90.3%, 80.3%, 95.6%, and 90.3% and 88.6%, 88.4%, 76.9%, 94.7%, and 88.5%, respectively. The area under the receiver operating characteristic curves of DenseNet-161 and ResNet-152 for wrist fracture detection were 0.962 and 0.947, respectively. @*Conclusion@#We demonstrated that DenseNet-161 and ResNet-152 models could help detect wrist fractures in the emergency room with satisfactory performance.

Protective Role of 360° Laser Retinopexy in Patients with Rhegmatogenous Retinal Detachment: a Systematic Review and Meta-analysis

Purpose@#Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. @*Methods@#The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. @*Results@#Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. @*Conclusions@#Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.

Factors that Predict Smoking Cessation among Older Koreans: Based on the Korea National Health and Nutrition Examination Survey 2016–2018 / 가정의학회지

Background@#Tobacco smoking is associated with several diseases and deaths in older Koreans. This study aimed to evaluate the factors associated with smoking cessation in older Koreans. @*Methods@#We selected 579 subjects who started smoking before the age of 65 years from the Korea National Health and Nutrition Examination Survey 2016–2018. We excluded the subjects who quit smoking before the age of 65 years, and then categorized the rest of subjects into those who stopped smoking after the age of 65 years and those who are constant smokers. Multivariable logistic analysis was performed to evaluate the factors related to smoking cessation among older Koreans. @*Results@#Among the participants, 66.1% were persistent smokers. After multivariable analysis, the factors significantly associated with smoking cessation were as follows: being in the age group of 75–79 years (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 2.12–7.83), being in the age group of 70–74 years (aOR, 3.10; 95% CI, 1.72–5.61), a family history of ischemic heart disease (aOR, 3.36; 95% CI, 1.09–10.35), and having had no cancer screening (aOR, 0.36; 95% CI, 0.18–0.70). @*Conclusion@#Further efforts to identify the factors related to smoking cessation will help formulate a smoking cessation policy.

Application of convolutional neural networks for distal radio-ulnar fracture detection on plain radiographs in the emergency room

Objective@#Recent studies have suggested that deep-learning models can satisfactorily assist in fracture diagnosis. We aimed to evaluate the performance of two of such models in wrist fracture detection. @*Methods@#We collected image data of patients who visited with wrist trauma at the emergency department. A dataset extracted from January 2018 to May 2020 was split into training (90%) and test (10%) datasets, and two types of convolutional neural networks (i.e., DenseNet-161 and ResNet-152) were trained to detect wrist fractures. Gradient-weighted class activation mapping was used to highlight the regions of radiograph scans that contributed to the decision of the model. Performance of the convolutional neural network models was evaluated using the area under the receiver operating characteristic curve. @*Results@#For model training, we used 4,551 radiographs from 798 patients and 4,443 radiographs from 1,481 patients with and without fractures, respectively. The remaining 10% (300 radiographs from 100 patients with fractures and 690 radiographs from 230 patients without fractures) was used as a test dataset. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DenseNet-161 and ResNet-152 in the test dataset were 90.3%, 90.3%, 80.3%, 95.6%, and 90.3% and 88.6%, 88.4%, 76.9%, 94.7%, and 88.5%, respectively. The area under the receiver operating characteristic curves of DenseNet-161 and ResNet-152 for wrist fracture detection were 0.962 and 0.947, respectively. @*Conclusion@#We demonstrated that DenseNet-161 and ResNet-152 models could help detect wrist fractures in the emergency room with satisfactory performance.

Protective Role of 360° Laser Retinopexy in Patients with Rhegmatogenous Retinal Detachment: a Systematic Review and Meta-analysis

Purpose@#Visual impairment from retinal re-detachment could be debilitating. The aim of this review is to evaluate the role of 360° laser retinopexy on success rate of rhegmatogenous retinal detachment (RRD) repair by a meta-analysis study. @*Methods@#The PubMed, Scopus, and the Cochrane Library databases were searched comprehensively from the date of database inception to January 2021, evaluating the role of 360° laser retinopexy in visual and anatomical success rate of RRD repair. This review was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. @*Results@#Among 202 articles screened for eligibility, six studies were found to be eligible for inclusion in our final analysis. Our meta-analysis demonstrates that prophylactic treatment with circumferential laser photocoagulation has no significant effect on the initial rate of retinal re-detachment or final best-corrected visual acuity following pars plana vitrectomy repair of RRD. Subgroup analysis of studies (n = 3) with 23-gauge pars plana vitrectomy, however, favors attachment rate in patients undergoing 360° prophylactic laser treatment. @*Conclusions@#Three hundred and sixty degree laser retinopexy appears to have favorable outcomes in patients undergoing 23-gauge retinal detachment repair. This protective effect, however, is not apparent with inclusion of 20-gauge vitrectomy studies.

Factors that Predict Smoking Cessation among Older Koreans: Based on the Korea National Health and Nutrition Examination Survey 2016–2018 / 가정의학회지

Background@#Tobacco smoking is associated with several diseases and deaths in older Koreans. This study aimed to evaluate the factors associated with smoking cessation in older Koreans. @*Methods@#We selected 579 subjects who started smoking before the age of 65 years from the Korea National Health and Nutrition Examination Survey 2016–2018. We excluded the subjects who quit smoking before the age of 65 years, and then categorized the rest of subjects into those who stopped smoking after the age of 65 years and those who are constant smokers. Multivariable logistic analysis was performed to evaluate the factors related to smoking cessation among older Koreans. @*Results@#Among the participants, 66.1% were persistent smokers. After multivariable analysis, the factors significantly associated with smoking cessation were as follows: being in the age group of 75–79 years (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 2.12–7.83), being in the age group of 70–74 years (aOR, 3.10; 95% CI, 1.72–5.61), a family history of ischemic heart disease (aOR, 3.36; 95% CI, 1.09–10.35), and having had no cancer screening (aOR, 0.36; 95% CI, 0.18–0.70). @*Conclusion@#Further efforts to identify the factors related to smoking cessation will help formulate a smoking cessation policy.

Validation and modification of HEART score components for patients with chest pain in the emergency department

Objective@#This study aimed to clarify the relative prognostic value of each History, Electrocardiography, Age, Risk Factors, and Troponin (HEART) score component for major adverse cardiac events (MACE) within 3 months and validate the modified HEART (mHEART) score. @*Methods@#This study evaluated the HEART score components for patients with chest symptoms visiting the emergency department from November 19, 2018 to November 19, 2019. All components were evaluated using logistic regression analysis and the scores for HEART, mHEART, and Thrombolysis in Myocardial Infarction (TIMI) were determined using the receiver operating characteristics curve. @*Results@#The patients were divided into a derivation (809 patients) and a validation group (298 patients). In multivariate analysis, age did not show statistical significance in the detection of MACE within 3 months and the mHEART score was calculated after omitting the age component. The areas under the receiver operating characteristics curves for HEART, mHEART and TIMI scores in the prediction of MACE within 3 months were 0.88, 0.91, and 0.83, respectively, in the derivation group; and 0.88, 0.91, and 0.81, respectively, in the validation group. When the cutoff value for each scoring system was determined for the maintenance of a negative predictive value for a MACE rate >99%, the mHEART score showed the highest sensitivity, specificity, positive predictive value, and negative predictive value (97.4%, 54.2%, 23.7%, and 99.3%, respectively). @*Conclusion@#Our study showed that the mHEART score better detects short-term MACE in high-risk patients and ensures the safe disposition of low-risk patients than the HEART and TIMI scores.

Differences in prognosis by p53 expression after neoadjuvant chemotherapy in triple-negative breast cancer

Purpose@#Our previous studies suggested that p53-positive triple-negative breast cancer (TNBC) should be more sensitive to chemotherapy than p53-negative TNBC. The aim of this study was to determine whether p53 expression in TNBC could predict response to neoadjuvant chemotherapy and the resulting prognosis. @*Methods@#From January 2009 to December 2017, TNBC patients who underwent neoadjuvant chemotherapy were reviewed, including a total of 31 TNBC patients who had clinical lymph node metastasis. The status of p53 expression in patients before and after chemotherapy was evaluated. @*Results@#Two patients (22.2%, 2 of 9) achieved pCR in p53(+) TNBC and 4 patients (50%, 5 of 10) achieved pCR in p53(-) TNBC. There was no correlation between pCR rate and p53 expression (P = 0.350). Based on prechemotherapy p53 expression, there was no significant difference in disease-free survival (DFS) between p53(+) TNBC and p53(-) TNBC (P = 0.335). However, after chemotherapy, p53(+) TNBC had shown higher DFS than p53(-) TBNC (P = 0.099). Based on prechemotherapy p53 expression, p53(+) TNBC had better overall survival (OS) than p53(-) TNBC, but the difference was not statistically significant (P = 0.082). After chemotherapy, p53(+) TNBC showed significantly better OS than p53(-) TNBC (P = 0.018). @*Conclusion@#Immunohistochemically detected p53 expression in TNBC could not predict the response to neoadjuvant chemotherapy. However, p53(+) TNBC had a better OS than p53(-) TNBC in patients who underwent neoadjuvant chemotherapy.

Differences in prognosis by p53 expression after neoadjuvant chemotherapy in triple-negative breast cancer

Purpose@#Our previous studies suggested that p53-positive triple-negative breast cancer (TNBC) should be more sensitive to chemotherapy than p53-negative TNBC. The aim of this study was to determine whether p53 expression in TNBC could predict response to neoadjuvant chemotherapy and the resulting prognosis. @*Methods@#From January 2009 to December 2017, TNBC patients who underwent neoadjuvant chemotherapy were reviewed, including a total of 31 TNBC patients who had clinical lymph node metastasis. The status of p53 expression in patients before and after chemotherapy was evaluated. @*Results@#Two patients (22.2%, 2 of 9) achieved pCR in p53(+) TNBC and 4 patients (50%, 5 of 10) achieved pCR in p53(-) TNBC. There was no correlation between pCR rate and p53 expression (P = 0.350). Based on prechemotherapy p53 expression, there was no significant difference in disease-free survival (DFS) between p53(+) TNBC and p53(-) TNBC (P = 0.335). However, after chemotherapy, p53(+) TNBC had shown higher DFS than p53(-) TBNC (P = 0.099). Based on prechemotherapy p53 expression, p53(+) TNBC had better overall survival (OS) than p53(-) TNBC, but the difference was not statistically significant (P = 0.082). After chemotherapy, p53(+) TNBC showed significantly better OS than p53(-) TNBC (P = 0.018). @*Conclusion@#Immunohistochemically detected p53 expression in TNBC could not predict the response to neoadjuvant chemotherapy. However, p53(+) TNBC had a better OS than p53(-) TNBC in patients who underwent neoadjuvant chemotherapy.

The Effects of Chronic Intermittent Hypoxia in Bleomycin-Induced Lung Injury on Pulmonary Fibrosis via Regulating the NF-κB/Nrf2 Signaling Pathway / 결핵및호흡기질환

Background@#Obstructive sleep apnea (OSA) is associated with pulmonary fibrosis. Chronic intermittent hypoxia (CIH) is considered to be a surrogate of OSA. However, its exact role in pulmonary fibrosis remains uncertain. Therefore, we investigated the mechanism underlying CIH-induced pulmonary fibrosis and the role of the anti-fibrotic agent in bleomycin (BLE) induced lung injury. @*Methods@#Mice were divided into eight groups: the normoxia (NOR), CIH, NOR plus BLE, CIH plus BLE, NOR plus pirfenidone (PF), CIH plus PF, NOR plus BLE and PF, and CIH plus BLE and PF groups. BLE was administered intratracheally on day 14 following CIH or NOR exposure. Subsequently, the mice were exposed to CIH or NOR for an additional 4 weeks. PF was administered orally on day 5 after BLE instillation once daily for 3 weeks. @*Results@#In the BLE-treated groups, CIH-induced more collagen deposition in lung tissues than NOR, and significantly increased hydroxyproline and transforming growth factor-β expression. The CIH and BLE-treated groups showed increased lung inflammation compared to NOR or CIH groups. Following CIH with BLE treatment, nuclear factor-κB (NF-κB) protein expression was significantly increased, whereas nuclear factor-erythroid-related factor 2 (Nrf2) and heme oxygenase-1 protein levels were decreased. After PF treatment, NF-κB and Kelch-like ECH-associated protein 1 expression were suppressed, and Nrf2 expression was increased. @*Conclusion@#CIH accelerated lung fibrosis in BLE-induced lung injury in mice, potentially by regulating the NF-κB/Nrf2 signaling pathway. Our results implicate PF as a potential therapeutic agent for treating pulmonary fibrosis in individuals with OSA and idiopathic pulmonary fibrosis.

Qualification and application of liquid chromatography-quadrupole time-offlight mass spectrometric method for the determination of carisbamate in rat plasma and prediction of its human pharmacokinetics using physiologically based pharmacokinetic modeling

Carisbamate is an antiepileptic drug and it also has broad neuroprotective activity and anticonvulsant reaction. In this study, a liquid chromatography-quadrupole time-of-flight mass spectrometric (LC-qTOF-MS) method was developed and applied for the determination of carisbamate in rat plasma to support in vitro and in vivo studies. A quadratic regression (weighted 1/concentration2), with an equation y = ax2 + bx + c, was used to fit calibration curves over the concentration range from 9.05 to 6,600 ng/mL for carisbamate in rat plasma. Preclinical in vitro and in vivo studies of carisbamate have been studied through the developed bioanalytical method. Based on these study results, human pharmacokinetic (PK) profile has been predicted using physiologically based pharmacokinetic (PBPK) modeling. The PBPK model was optimized and validated by using the in vitro and in vivo data. The human PK of carisbamate after oral dosing of 750 mg was simulated by using this validated PBPK model. The human PK parameters and profiles predicted from the validated PBPK model were similar to the clinical data. This PBPK model developed from the preclinical data for carisbamate would be useful for predicting the PK of carisbamate in various clinical settings.

Current Status of Sanitary and Nutritional Food Service in Elderly Day Care Center / 대한지역사회영양학회지

Objectives@#This study was conducted to examine the status of foodservice management, with special interest on sanitary and nutritional food service in elderly day care centers. @*Methods@#A total of 79 employees who managed foodservice facilities in elderly day care centers were included in the survey. The contents of the questionnaire consisted of general characteristics, importance and performance of sanitary and nutrition management, the reasons for poor performance, factors necessary for improvement, and the employee's demand for support. Data analysis was conducted using the SPSS v25.0. @*Results@#Sanitary management showed an average importance score of 4.84 ± 0.40 and a performance score of 4.70 ± 0.61 (t-value: 8.260). The item with the lowest performance score was personal sanitary management (4.58 ± 0.71). In nutrition management, the average importance score was 4.52 ± 0.68, and the performance score was 4.20 ± 1.00 (t-value: 9.609). There were significant differences between the average score of importance and performance in both areas. As a result of an Importance-Performance Analysis, items that were recognized as important but had relatively low performance was “personal hygiene”, “ventilation” and “food storage”. Also in the nutritional management area, “menu planning for disease management” and “checking the saltiness in the soup” etc. had very low performance with low importance recognition. The items shown in the “low priority” quadrant were those that required professional management skills. In the areas that demanded support in foodservice management, education about sanitary and safe institutional food service had the highest score (4.42 ± 0.74), and all other items showed a demand of 4 points or more. @*Conclusions@#Foodservice managers recognize the importance of foodservice facility management but performance is relatively low. Institutional support is, therefore, needed to improve performance. For items with low importance, it seems necessary to improve awareness of the necessity of these items and to provide education in this regard. To gradually improve foodservice management, continuous provision of education and training in these areas are of great importance.

Morule-like features in pulmonary adenocarcinoma associated with epidermal growth factor receptor mutations: two case reports with targeted next-generation sequencing analysis

Morules, or morule-like features, can be identified in benign and malignant lesions in various organs. Morular features are unusual in pulmonary adenocarcinoma cases with only 26 cases reported to date. Here, we describe two cases of pulmonary adenocarcinoma with morule-like features in Korean women. One patient had a non-mucinous-type adenocarcinoma in situ and the other had an acinarpredominant adenocarcinoma with a micropapillary component. Both patients showed multiple intra-alveolar, nodular, whorled proliferative foci composed of atypical spindle cells with eosinophilic cytoplasm. Targeted next-generation sequencing was performed on DNA extracted from formalin-fixed paraffin-embedded samples of the tumors. Results showed unusual epidermal growth factor receptor (EGFR) mutations, which are associated with drug resistance to EGFR tyrosine kinase inhibitors, revealing the importance of identifying morule-like features in pulmonary adenocarcinoma and the need for additional study, since there are few reported cases.

Factors Associated with the Intention to Quit Smoking in Elderly Korean Men: The Korea National Health and Nutrition Examination Survey 2010-2015 / 가정의학회지

Background@#Tobacco smoking is the most preventable cause of diseases and death in older adults. This study aimed to evaluate the factors associated with the intention to quit smoking in elderly Korean men. @*Methods@#We investigated 813 male smokers aged 65 years or more from the 5th and 6th Korea National Health and Nutrition Examination Survey 2010–2015. Multiple logistic regression analysis was performed to identify factors related with smoking cessation intention. @*Results@#Of the respondents, 26.3% had the intention to quit smoking. After adjustment for confounding factors, the intention to quit smoking was significantly associated with a history of ischemic heart disease (adjusted odds ratio, 1.88; 95% confidence interval, 1.02–3.48). @*Conclusion@#Identifying the factors related to the intention to quit smoking among older adults can help in developing effective smoking cessation strategies for this section of the population.

Factors Associated with Persistent Smoking in Diabetic Patients: The Seventh Korea National Health and Nutrition Examination Survey

Background@#Smoking increases total mortality and the risk of complications in patients with diabetes; however, smokers tend to smoke persistently even after the diagnosis of diabetes mellitus. The purpose of this study was to analyze risk factors predicting persistent smoking in Korean adults with diabetes. @*Methods@#This study included 265 persistent-smokers and 146 quit-smokers among the participants with diabetes from the seventh Korea National Health and Nutrition Examination Survey. The subjects were smokers at the time of diagnosis of diabetes and were categorized into two groups according to the change in smoking status between the time of diabetes diagnosis and survey. Factors associated with persistent smoking were evaluated using multiple logistic regression analysis. @*Results@#The prevalence of persistent-smokers with diabetes in this study was 65.3%. After adjusting for covariates, persistent smoking in Korean adults with diabetes was significantly associated with a history of cancer (adjusted odds ratio [aOR], 0.322; 95% confidence interval [CI], 0.116–0.889), strength exercise (aOR, 2.753; 95% CI, 1.361–5.566), stress (aOR, 2.036; 95% CI, 1.046–3.950), non-medical treatment for diabetes (aOR, 6.814; 95% CI, 1.661–27.957), and duration of diabetes (aOR, 0.952; 95% CI, 0.919–0.987). @*Conclusion@#Identifying the risk factors related to persistent smoking among Korean adults with diabetes can help in developing effective smoking cessation strategies.

The Effects of Chronic Intermittent Hypoxia in Bleomycin-Induced Lung Injury on Pulmonary Fibrosis via Regulating the NF-κB/Nrf2 Signaling Pathway / 결핵및호흡기질환

Background@#Obstructive sleep apnea (OSA) is associated with pulmonary fibrosis. Chronic intermittent hypoxia (CIH) is considered to be a surrogate of OSA. However, its exact role in pulmonary fibrosis remains uncertain. Therefore, we investigated the mechanism underlying CIH-induced pulmonary fibrosis and the role of the anti-fibrotic agent in bleomycin (BLE) induced lung injury. @*Methods@#Mice were divided into eight groups: the normoxia (NOR), CIH, NOR plus BLE, CIH plus BLE, NOR plus pirfenidone (PF), CIH plus PF, NOR plus BLE and PF, and CIH plus BLE and PF groups. BLE was administered intratracheally on day 14 following CIH or NOR exposure. Subsequently, the mice were exposed to CIH or NOR for an additional 4 weeks. PF was administered orally on day 5 after BLE instillation once daily for 3 weeks. @*Results@#In the BLE-treated groups, CIH-induced more collagen deposition in lung tissues than NOR, and significantly increased hydroxyproline and transforming growth factor-β expression. The CIH and BLE-treated groups showed increased lung inflammation compared to NOR or CIH groups. Following CIH with BLE treatment, nuclear factor-κB (NF-κB) protein expression was significantly increased, whereas nuclear factor-erythroid-related factor 2 (Nrf2) and heme oxygenase-1 protein levels were decreased. After PF treatment, NF-κB and Kelch-like ECH-associated protein 1 expression were suppressed, and Nrf2 expression was increased. @*Conclusion@#CIH accelerated lung fibrosis in BLE-induced lung injury in mice, potentially by regulating the NF-κB/Nrf2 signaling pathway. Our results implicate PF as a potential therapeutic agent for treating pulmonary fibrosis in individuals with OSA and idiopathic pulmonary fibrosis.

Qualification and application of liquid chromatography-quadrupole time-offlight mass spectrometric method for the determination of carisbamate in rat plasma and prediction of its human pharmacokinetics using physiologically based pharmacokinetic modeling

Carisbamate is an antiepileptic drug and it also has broad neuroprotective activity and anticonvulsant reaction. In this study, a liquid chromatography-quadrupole time-of-flight mass spectrometric (LC-qTOF-MS) method was developed and applied for the determination of carisbamate in rat plasma to support in vitro and in vivo studies. A quadratic regression (weighted 1/concentration2), with an equation y = ax2 + bx + c, was used to fit calibration curves over the concentration range from 9.05 to 6,600 ng/mL for carisbamate in rat plasma. Preclinical in vitro and in vivo studies of carisbamate have been studied through the developed bioanalytical method. Based on these study results, human pharmacokinetic (PK) profile has been predicted using physiologically based pharmacokinetic (PBPK) modeling. The PBPK model was optimized and validated by using the in vitro and in vivo data. The human PK of carisbamate after oral dosing of 750 mg was simulated by using this validated PBPK model. The human PK parameters and profiles predicted from the validated PBPK model were similar to the clinical data. This PBPK model developed from the preclinical data for carisbamate would be useful for predicting the PK of carisbamate in various clinical settings.

Factors Associated with Unmet Healthcare Needs of the Older Korean Population: The Seventh Korea National Health and Nutrition Examination Survey 2017

BACKGROUND@#South Korea has the fastest growing aging population in the world, and older people require more healthcare services. Unmet healthcare needs still exist in Korea due to several complex reasons. This study aimed to evaluate the factors associated with unmet healthcare needs of the older Korean population.@*METHODS@#This cross-sectional study included 1,194 older adults, aged 65 years and older, who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2017. Sociodemographic factors, lifestyle and health status, comorbidity, and unmet healthcare needs were included in this study's analysis. Multiple logistic regression analysis was used to evaluate the association between unmet healthcare needs and other factors.@*RESULTS@#The prevalence of unmet healthcare needs in this study population was 7.8%. After adjusting for age, sex, education level, household income, living alone, private health insurance, regular walking, body mass index, unintended weight loss, and osteoarthritis, women (adjusted odds ratio [aOR], 1.921; 95% confidence interval [CI], 1.061–3.479) and unintended weight loss (aOR, 2.218; 95% CI, 1.105–4.453) were more likely to have unmet healthcare needs than their counterparts. The group with general obesity (aOR, 1.691; 95% CI, 1.015–2.816) was more likely to have unmet healthcare needs than the group with normal body mass index.@*CONCLUSIONS@#Among the older Korean population, being a woman, general obesity, and unintended weight loss may be risk factors for unmet healthcare needs.