A Positive Association between the Atherogenic Index of Plasma and White Matter Hyperintensity / 가정의학회지

Background@#White matter hyperintensity (WMH) is a risk factor for dementia and ischemic stroke. The atherogenic index of plasma (AIP) is a simple and cost-effective marker for the prediction of various vascular diseases. In this study, we evaluated the relationship between AIP and WMH in adults without cerebrovascular accidents. @*Methods@#We analyzed the data of 281 adults, aged ≥26 years, who underwent brain magnetic resonance imaging (MRI) at the health promotion center of an education hospital between January 2014 and December 2018. Participants were divided into three categories according to tertiles of the AIP scores (T1: 0.48). WMH was defined as a modified Fazekas scale score of 1–3 on brain MRI. A cubic spline curve was used to determine the linearity of the relationship between AIP and WMH. Multiple logistic regression analysis was used to evaluate the relationship between the AIP and WMH. @*Results@#The prevalence of WMH was 45.7% in T1, 57.0% in T2, and 66.0% in T3 (T3 vs. T1, P for post-hoc analysis=0.005). The increased odds of WMH were associated with increased AIP. The odds ratio (OR) with a 95% confidence interval (CI) for WMH of T2 and T3 compared with T1 were 1.57 (0.88–2.80) and 2.30 (1.28–4.14), respectively. After adjusting for confounding variables, the OR with a 95% CI for WMH in the T2 and T3 groups vs. the referent T1 were 1.55 (0.76–3.13) and 2.27 (1.06–4.84), respectively. @*Conclusion@#AIP is independently and positively associated with WMH in a healthy population.

The efficacy of the “no zone” approach for the assessment of traumatic neck injury: a case-control study

Purpose@#Recently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries. @*Methods@#Medical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach. @*Results@#Out of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60). @*Conclusion@#Traumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

Relationship of Low Density Lipoprotein Cholesterol Level and Interest Nutrition on Nutrition Label in Korean Adults: 2008–2011 Korea National Health and Nutrition Examination Survey

Background@#Low density lipoprotein (LDL) cholesterol is an important metabolic marker, and it is suggested to be closely related with dietary habits.The use of nutrition labels is beneficial for making healthier food choices. In addition, dietary habits and nutrients of interest vary among nutrient label users. This study investigated the association between different nutrients of interest and LDL cholesterol levels in Korean adults. @*Methods@#This cross-sectional study included 21,870 adults from the 2008–2011 Korea National Health and Nutrition Examination Survey (KNHANES). Participants were divided into five groups according to the nutrients they were most interested in: 1) total calories, 2) carbohydrates, 3) protein, 4) fat, and 5) non-users of nutrition label. LDL cholesterol target level was set according to individual cardiovascular risk level. Multivariate logistic regression analysis was used to verify which nutrient of interest is related to the achievement of LDL cholesterol target level. @*Results@#Participants who were interested in total calories consumed lesser total calories and carbohydrates daily than those in the other groups did. Moreover, compared with the “not reading nutrition label” group, the odds ratios (95% confidence intervals) for achieving LDL cholesterol target level was 1.29 (1.05–1.58, P=0.015) in the “total calories” group after adjusting for confounding variables. @*Conclusion@#Participants who were interested in total calories were more likely to achieve optimal LDL cholesterol levels than those who did not read nutrition labels. Therefore, reading nutrition labels, especially focusing on total calories, can be helpful for reducing cardiovascular risk.

Difference of Low Skeletal Muscle Index According to Recommended Protein Intake in Korean

BACKGROUND: Sarcopenia has become a major concern owing to its association with a high risk of fall or fracture and metabolic impairments. There is insufficient evidence to support the role of dietary protein intake in reducing the prevalence of sarcopenia. This study was conducted to investigate the variation in low skeletal muscle index (SMI) with the dietary levels of protein intake.METHODS: This study analyzed data of 3,482 male and 4,838 female aged 50 years or older from the Korean National Health and Nutrition Examination Survey (KNHNES) database (2008–2011). Low SMI was indicated by a value <0.789 in male and <0.512 in female. Multiple logistic regression was performed to analyze the association of SMI with protein intake, whereby it was tested whether the dietary intake of proteins met the estimated average requirement (EAR) or the reference nutrient intake (RNI) as stated in the dietary reference intake (DRI) for Koreans, 2015.RESULTS: Irrespective of sex, the prevalence of low SMI was significantly high when the protein intake did not meet the EAR or RNI. Following adjustment for covariates, the odds ratio (OR) for low SMI in subjects with unmet EARs was 1.63 (1.28–2.09) in male and 1.35 (1.10–1.66) in female. The OR for low SMI in subjects with unmet RNI was 1.74 (1.38–2.18) in male and 1.39 (1.14–1.69) in female.CONCLUSION: The prevalence of low SMI was significantly higher when the protein intake did not meet the EAR or RNI as stated in the DRI for Koreans.

Participation of Opioid Pathway in the Central Antinociceptive Effects of Eugenol

The aim of the present study was to evaluate the central antinociceptive effects of eugenol after intraperitoneal administration. Experiments were carried out using male Sprague-Dawley rats. Subcutaneous injection of 5% formalin-induced nociceptive behavioral responses was used as the pain model. Subcutaneous injection of 5% formalin significantly produced nociceptive responses by increasing the licking time during nociceptive behavior. Subsequent intraperitoneal injection of 100 mg/kg of eugenol led to a significant decrease in the licking time. However, low dose of eugenol (50 mg/kg) did not affect the nociceptive behavioral responses produced by subcutaneous injection of formalin. Intrathecal injection of 30 µg of naloxone, an opioid receptor antagonist, significantly blocked antinociceptive effects produced by intraperitoneal injection of eugenol. Neither intrathecal injection of methysergide (30 µg), a serotonin receptor antagonist nor phentolamine (30 µg), an α-adrenergic receptor antagonist influenced antinociceptive effects of eugenol, as compared to the vehicle treatment. These results suggest that central opioid pathway participates in mediating the antinociceptive effects of eugenol.

Effect of Udenafil on MUC5B Expression in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucus hypersecretion in the airway may lead to increased frequency and duration of infection, declined lung function, and increased morbidity and mortality in inflammatory respiratory diseases. Udenafil, a phosphodiesterase (PDE) 5 inhibitor, is an oral medication for erectile dysfunction. Recent studies show that PDE5 inhibitor has various anti-inflammatory properties. However, the effect of udenafil on mucus secretion in human airway epithelial cells is unclear. Therefore, the effect and brief signaling pathway of udenafil on MUC5B expression were investigated in human airway epithelial cells. MATERIALS AND METHOD: We analyzed the effects and brief signaling pathway of udenafil on the lipopolysaccharide (LPS) induced MUC5B expression in mucin-producing NCI-H292 epithelial cells using reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, and immunoblot analysis. RESULTS: Udenafil attenuated the LPS-induced MUC5B mRNA expressions and glycoprotein production in NCI-H292 epithelial cells. It also attenuated LPS-induced toll like receptor 4 (TLR4) mRNA expression and phosphorylation of extracellular regulated kinase1/2 (ERK1/2) and p38 in NCI-H292 epithelial cells. CONCLUSION: These results suggest that udenafil attenuates the LPS induced MUC5B expression via TLR4, ERK1/2 and p38 mitogen activated protein kinase (MAPK) pathway in human airway epithelial cells, and that it could be a novel therapeutic agent for controlling chronic airway disease.

The Comparison of Medical and Surgical Treatment for Gallbladder Dyskinesia

PURPOSE: The purpose of this study was to compare outcomes for surgical treatment with those for medical treatment of GB dyskinesia. METHODS: Retrospective analysis of medical records and telephone interviews of 67 patients diagnosed with GB dyskinesia was done at Pohang St. Mary's Hospital between January 2004 and December 2009. Group 1 (n=18) patients received laparoscopic cholecystectomy. Group 2 (n=49) patients received medical treatment. GB dyskinesia was the diagnosis if the patient had typical biliary colic symptoms without GB stones or other GI disease, and if the ejection fraction was less than 35% on Tc-99m-DISIDA scans. RESULTS: The average age of patients diagnosed with GB dyskinesia was 45.8 years old. The sex ratio was 15:52 (male:female). The average symptom duration was 25.4 days. All had RUQ and, or epigastric pain. There were no significant between group differences in age, sex ratio, symptom duration, symptoms, follow up period, and ejection fraction. In group 1, patient symptoms improved after treatment in 16 cases (88.9%); in group 2, patient symptoms improved in 19 cases (38.8%). Surgical treatment was significantly more effective than medical treatment. The reasons for choosing medical treatment were predominantly the preference of the doctors. CONCLUSION: Surgical treatment is a more effective treatment for GB dyskinesia than medical treatment. Therefore, laparoscopic cholecystectomy should be considered as the 1st line treatment of choice for GB dyskinesia.

Prognosis of Isolated Local Recurrence after Modified Radical Mastectomy for Early Breast Cancer

PURPOSE: Isolated local recurrence (ILR) after mastectomy is associated with increased risk of cancer-specific survival. This study evaluated the long-term survival and prognostic factors after ILR. METHODS: Between January 1988 and December 2004, 1,169 patients with early breast cancer (stage I or II) were treated with modified radical mastectomy at Kyungpook hospital. Retrospectively, 40 patients with isolated local recurrence (ILR) were found by medical records and we investigated their clinicopathologic factors and conducted analyses of prognostic factors, calculated overall survival, and relapse-free survival. RESULTS: The median follow-up times after initial operation and ILR were each 91 (range, 18~219) months and 40 (range, 1~205) months. There were 18 patients of 2nd recurrence and 15 expired by distant metastasis. The overall survivals at 5 years and 10 years after ILR were 65% and 49%. The relapse-free survivals at 5 years and 10 years after ILR were 54% and 29%. After 2nd recurrence, the mean survival time was 21 months and the 3-year overall survival rate was 21%. By univariate and multivariate analyses, the time interval between initial operation and ILR was only statistically significant independent prognostic factor of overall survival after ILR. The 10 year-overall survival rates of 24 months to ILR were each 26% and 70%. There was no independent prognostic factor of relapse-free survival after ILR. CONCLUSION: For patients who developed isolated local recurrence after modified radical mastectomy for early breast cancer, shorter time interval to ILR is a poor prognostic factor of overall survival after ILR.

Etiology and Early Treatment Results of Acute Mesenteric Ischemia

PURPOSE: Acute abdominal pain can be the result of many different pathophysiological processes. Among the many possible causes, acute mesenteric ischemia is a life threatening condition if the diagnosis is delayed. Generally, the mortality rate for other disease has gradually decreased; however, the mortality rate for acute mesenteric ischemia has not changed significantly and it continues to be 75% to 80% for acute mesenteric arterial embolism or thrombosis and 44% for acute mesenteric venous thrombosis. The aim of this study was to conduct an analysis of the clinical characteristics and mortality of the patients with acute mesenteric ischemia according to the etiology. METHOD: From 1989 to 2004, 43 patients were treated for acute mesenteric ischemia. Their mean age was 59 years, ranging from 24 to 81, and the male to female gender ratio was 24:19. We retrospectively analyzed their initial symptoms, the age and gender distribution, the treatment modalities and the mortality rates. RESULT: The causes of acute mesenteric ischemia were arterial embolism in 27 cases, arterial thrombosis including arterial dissection in 7 cases and venous thrombosis in 9 cases. Almost all of the patients complained of acute abdominal pain and abdominal tenderness. The overall mortality rate was 30.2% and the rates were 37.0% for mesenteric artery embolism, 42.9% for mesenteric artery thrombosis and 0% for mesenteric venous thrombosis. CONCLUSION: In this study, the causes of acute mesenteric ischemia were mesenteric artery embolism and thrombosis, including dissection and mesenteric venous thrombosis. The factors influencing the mortality were the cause of the acute mesenteric ischemia, the extent of involvement of the mesenteric vessels and the extent of bowel necrosis. Thus the most important things for the treatment of acute mesenteric ischemia are early diagnosis and proper treatment.

Effects of Electroacupuncture with Different Frequencies on the Spinal c-fos and Inotropic Glutamate Receptor Expression in Carrageenan-injected Rat / 체질인류학회지

We investigated the comparative effects of electroacupuncture (EA) with different frequency on the spinal c-fos and inotropic glutamate receptor expression in carrageenan-injected rats. Bilateral EA stimulation with 2, 15 and 120 Hz were delivered at those acupoints corresponding to Zusanli and Sanyinjiao in man via the needles. The inhibitory effects of the EA on the inflammatory process were investigated in the central nociceptive sites by immunohistochemical analysis. Three hours after carrageenan injection, the number of c-fos-like immunoreactive (LI) neurons was significantly increased in all layers of the ipsilateral spinal cord at L4-5 segment. But these immunoreactive neurons were markedly reduced in the spinal gray matter, especially in the superficial laminae, by all kinds of EA stimulation. The number of NMDA (NR-1 and NR-2A) and AMPA receptors (GluR-1, GluR-2/3) -LI neurons was also increased by carrageenan injection. But NR-2A-LI neuron was significantly reduced in superficial laminae of dorsal horn by 2 Hz EA stimulation. While GluR-1-LI neuron of 15 Hz and 120 Hz EA was increased in the nucleus proprius compared with carrageenan-injected group, GluR-2/3-LI neuron of these EA stimulated groups significantly reduced in superficial laminae of dorsal horn. In conclusion, EA treatment can attenuate spinal c-fos expression in carrageenan injected rats and regulates spinal inotropic glutamate receptor expression.

Effects of Electroacupuncture with Different Frequencies on the Spinal c-fos and Inotropic Glutamate Receptor Expression in Carrageenan-injected Rat / 체질인류학회지

We investigated the comparative effects of electroacupuncture (EA) with different frequency on the spinal c-fos and inotropic glutamate receptor expression in carrageenan-injected rats. Bilateral EA stimulation with 2, 15 and 120 Hz were delivered at those acupoints corresponding to Zusanli and Sanyinjiao in man via the needles. The inhibitory effects of the EA on the inflammatory process were investigated in the central nociceptive sites by immunohistochemical analysis. Three hours after carrageenan injection, the number of c-fos-like immunoreactive (LI) neurons was significantly increased in all layers of the ipsilateral spinal cord at L4-5 segment. But these immunoreactive neurons were markedly reduced in the spinal gray matter, especially in the superficial laminae, by all kinds of EA stimulation. The number of NMDA (NR-1 and NR-2A) and AMPA receptors (GluR-1, GluR-2/3) -LI neurons was also increased by carrageenan injection. But NR-2A-LI neuron was significantly reduced in superficial laminae of dorsal horn by 2 Hz EA stimulation. While GluR-1-LI neuron of 15 Hz and 120 Hz EA was increased in the nucleus proprius compared with carrageenan-injected group, GluR-2/3-LI neuron of these EA stimulated groups significantly reduced in superficial laminae of dorsal horn. In conclusion, EA treatment can attenuate spinal c-fos expression in carrageenan injected rats and regulates spinal inotropic glutamate receptor expression.

Glycoconjugates of the Duodenal Mucosa in Cold-treated Chipmunks / 체질인류학회지

To investigate changes of glycoconjugates (GC) on the duodenal mucosa of Korean chipmunks (Tamias sibiricus) after cold-treatment, chipmunks were maintained in cold conditions (6 C) for 3, 5 or 9 months in an attempt to mimic conditions occurring during seasonal hibernation. Most chipmunks were active as before until 3 months in the cold room and since then were hibernated. Although there was significant decrease in neutral GC in cold-treated chipmunks compared with warm chipmunks, acid GC changed little. As for histochemical properties of acid GC in the duodenum, the cold-treated chipmunk showed some differences, such as appearance of villus goblet cells which contained the mixture of sulfated and nonsulfated GC. The affinities for all lectins used in this study were shown in the columnar cells of the duodenal villus and crypt, more intensive DBA, SBA, PNA, BSL-1, RCA-1 and sWGA affinities were demonstrated in the Golgi zone of columnar cells. These affinities decreased in the cold-treated groups, especially in the Golgi zone of columnar cells. The affinities with DBA, RCA-1, sWGA and BSL-1 was demonstrated in the goblet cells of the duodenum, but these affinities except DBA decreased in the cold-treated chipmunks. All lectin affinities except UEA-1 detected in duodenal gland, but cold-treatment induced a decrease of these affinities. The changes in amount and properties of GC in the present experimental model for hibernation may be due to the different intestinal environment associated with food intake. However, the present experimental model for hibernation, especially 9 months cold-treated chipmunks, stills need to be demonstrated during seasonal hibernation in the wild.

Risk Factors and Prognosis of Recurrent Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Differentiated thyroid cancer is known to be one of cancers which have a favorable prognosis and long-term survival resulting from slow growth of tumor and late distant metastasis. Patients are nearly cured of thyroid cancer after first operation. But, some of those have high risk factors of recurrence. Practically it has been reported that 20% of those have recurrence of cancer and 50~60% of patients died of recurrence. We analyzed factors involving to recurrence after initial treatment, frequency and site of recurrence, disease-free interval, and results of treatment. Based on this information, we investigated therapeutics to decrease the rate of recurrence and prognostic factors to expect death. METHODS: 1803 patients were primarily operated for thyroid cancer in Kyungpook National University Hospital between 1985 and 2003. Among the cases, we reviewed the clinical records of 124 patients (6.9%) who had recurrent thyroid cancer. We analyzed the difference in frequency of recurrence on the basis of sex, age, histologic types, risk groups, and lymph node metastases when they had a first operation. The correlation between these factors and mortality rate was analyzed statistically by using Chi-square test and Fisher's exact probability test. RESULTS: Post-operative recurrence of thyroid cancer was highly observed in over 40 years old at first operation (8.4% vs. 4.9%), men (17.1% vs. 3.9%). Similarly, in the case of medullary or poorly-differentiated thyroid cancers, the groups of patients with high-risk (12.3% vs. 3.9%) or with lymph node metastases (13.5% vs. 3.7%) have high frequency of recurrence. Among the 124 patients, 53.3% cases have regional recurrence sites and 20.1% have local, 17.7% distant metastases, and 1.6% combined locoregional. The number of patients who died of recurrent cancer was 32 of 124 cases. Major cause of the death was distant metastases. In the case of 104 patients who had recurrent differentiated thyroid cancer, significant prognostic indicators of low survival rates are age greater than 45 years, neck dissection at second operation and distant metastases. CONCLUSION: In order to decrease the rate of local and regional recurrence in thyroid cancer, we conclude that complete resections of thyroid tissue and cervical lymph nodes have to be operated specially in the group with high-risk. Although adjacent organs are infiltrated, active treatment should be carried out. The treatment of most medullary or poorly-differentiated thyroid cancers which result in the death of distant metastases still remains to be studied.

Evaluation of clinical course in patients with eosinophilic bronchitis: A prospective follow up study / 천식및알레르기

BACKGROUND: Eosinophilic bronchitis (EB) presents as a chronic cough and sputum eosinophilia without airflow limitation and bronchial hyperreactivity. The long-term clinical courses remain unknown. OBJECTIVE AND METHOD: The aim of this study was to evaluate how frequently EB recurs and whether it develops into chronic airway obstruction. Cough severity, FEV1, PC20 methacholine and sputum eosinophil percentages were serially measured in 36 subjects for up to 48 months. RESULT: Five subjects developed recurrent episodes of EB (RG) between 4 to 6 months after the first episode of EB. Asthma developed in the 9th month of the study in one of these subjects and a progressive FEV1 reduction exceeding 20% was observed in two. Nineteen subjects had no recurrence of EB (NRG). However, sputum eosinophilia recurred between 4 and 24 months in 10 subjects of the NRG, though this was without cough or FEV1 reduction. The follow-up eosinophil percentages were significantly higher in the RG than NRG group with recurrent sputum eosinophilia. CONCLUSION: About 14% of EB cases experience repeated episodes of EB and in about 30%, the EB recurs as asymptomatic sputum eosinophilia. Moreover, the extent of sputum eosinophilia was found to be associated with the recurrence of eosinophilic bronchitis, which leads to an airflow rate deterioration. These results suggest that repeated episode of EB is a risk factor for the development of asthma or chronic airway obstruction.

Immunohistochemical Expression of Inducible Nitric Oxide Synthase on the LPS-induced Shock and Wound Healing in Rats / 체질인류학회지

Inducible nitric oxide synthase (iNOS) expression of several organs on the lipopolysaccharides (LPS)-injected rats and on excisional wound was observed by immunohistochemical methods to investigate iNOS-positive cells during inflammation. iNOS expression was induced in response to LPS in the brain and these reactions were observed in the choroidal epithelium, ependymal cells and a few of nerve cells and fiber. A more intensive reaction of nerve cell and fiber was mainly observed in the corpus callosum and hypothalamus. Induction of iNOS of the lung was observed in alveolar macrophage, smooth muscle, pneumocytes and inflammatory cells infilterated in the alveolar septum. iNOS expression of the liver was detected in Kupffer cells, hepatocytes, bile duct and inflammatory cells of spotty necrosis. The cardiac muscle and endothelial cell of the heart showed positive iNOS expression. In the excisional wound, inflammatory cells including macrophages, neutrophil and fibrobast showed iNOS expression and mainly detected necrobiotic layer. Collectively, iNOS expression was induced in the several cell types during inflammatory process. So for better understanding the function of iNOS, more research should be done in relation to each cell type of organ.