Recent Updates on Electro-Convulsive Therapy in Patients with Depression

Objective@#Electro-convulsive therapy (ECT) has been established as a treatment modality for patients with treatment-resistant depression and with some specific subtypes of depression. This narrative review intends to provide psychiatrists with the latest findings on the use of ECT in depression, devided into total eight sub-topics. @*Methods@#We searched PubMed for English-language articles using combined keywords and tried to analyze journals published from 1995–2020. @*Results@#Pharmacotherapy such as antidepressants or maintenance ECT is more effective than a placebo as prevention of recurrence after ECT. The use of ECT in treatment-resistant depression, depressed patients with suicidal risks, elderly depression, bipolar depression, psychotic depression, and depression during pregnancy or postpartum have therapeutic benefits. As possible mechanisms of ECT, the role of neurotransmitters such as serotonin, dopamine, gamma-aminobutyric acid (GABA), and other findings in the field of neurophysiology, neuro-immunology, and neurogenesis are also supported. @*Conclusion@#ECT is evolving toward reducing cognitive side effects and maximizing therapeutic effects. If robust evidence for ECT through randomized controlled studies are more established and the mechanism of ECT gets further clarified, the scope of its use in the treatment of depression will be more expanded in the future.

Correlation of Serum Inflammatory Cytokine Levels with Clinical Characteristics Including Severity in Korean Patients with Psoriasis / 대한피부과학회지

Background@#Psoriasis is a chronic relapsing inflammatory disease, with several cytokines related to its pathophysiology and clinical manifestations, such as disease activity, severity, and clinical subtype. However, there is limited information regarding Korean psoriasis patients.Objective We investigated the association between serum inflammatory cytokines and clinical characteristics of psoriasis, including treatment modalities. @*Methods@#We evaluated the serum Th17-related cytokine levels of 70 patients diagnosed with psoriasis using a multiplex immunoassay. All clinical information of patients was collected by reviewing electronic medical records and photo documentation in a retrospective manner. @*Results@#The serum IL-23 level was significantly higher in the young age group (＜40 years), and the IL-6, TNFβ, and IL-28A levels were significantly higher in the early onset group (＜40 years). In addition, patients with moderate-to-severe psoriasis (PASI≥10 and body surface area ≥10%) exhibited significantly lower serum IL-28A levels. We observed high serum TNF-α and CCL20 levels in patients with metabolic comorbidities and those with psoriatic arthritis, respectively, and biologics use and systemic treatment modality were also significantly associated with the serum levels of some cytokines. @*Conclusion@#Disease severity, comorbidities, presence of psoriatic arthritis, and treatment responsiveness might affect the inflammatory cytokine levels in psoriasis patients. Therefore, the serum cytokine levels can be used to predict the severity or treatment responsiveness of psoriasis patients.

Clinical, Histopathological, and Immunohistochemical Differences between Men and Women with Psoriasis According to Disease Severity: Possible Role of Estrogen / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic inflammatory skin disorder histopathologically characterized by epidermal hyperplasia, vascular proliferation, and inflammatory infiltrates. It runs a less severe course in women than in men. The role of estrogen in the pathogenesis of psoriasis remains unclear. OBJECTIVE: We investigated the clinicohistopathological differences between men and women with psoriasis and examined whether serum estrogen levels and immunohistochemical findings correlate with gender and disease severity. METHODS: We retrospectively reviewed the medical records of 500 patients with psoriasis. Among these patients, 60 who consented to participate in the study were classified into four groups as follows: 10 men showing psoriasis on < 10% of their body surface area (BSA) with psoriasis area severity index (PASI) < 10; 20 men showing psoriasis on ≥10% of their BSA with PASI≥10; 10 women showing psoriasis on < 10% of their BSA with PASI < 10; and 20 women showing psoriasis on ≥10% of their BSA with PASI ≥10. Serum estrogen levels were measured using radioimmunoassay. Immunohistochemical staining of skin biopsy tissues was performed using ERα, ERβ, and CCL5. RESULTS: Men diagnosed with psoriasis showed higher BSA and PASI scores than women. Women aged ≥60 years showed higher BSA and PASI scores than women aged < 60 years. There were no histological differences between the four groups. Serum estrogen levels were higher in the patients presenting with mild psoriasis, as well as in women. ERα, ERβ, and CCL5 showed a stronger staining tendency in patients with more severe psoriasis. CONCLUSION: Gender influences the severity of psoriasis, and estrogen plays an important role. This finding is explained by the fact that estrogen decreases inflammation in psoriasis possibly via its action on estrogen receptors in epidermal keratinocytes.

Development of a Novel Subunit Vaccine Targeting Fusobacterium nucleatum FomA Porin Based on In Silico Analysis

Selecting an appropriate antigen with optimal immunogenicity and physicochemical properties is a pivotal factor to develop a protein based subunit vaccine. Despite rapid progress in modern molecular cloning and recombinant protein technology, there remains a huge challenge for purifying and using protein antigens rich in hydrophobic domains, such as membrane associated proteins. To overcome current limitations using hydrophobic proteins as vaccine antigens, we adopted in silico analyses which included bioinformatic prediction and sequence-based protein 3D structure modeling, to develop a novel periodontitis subunit vaccine against the outer membrane protein FomA of Fusobacterium nucleatum. To generate an optimal antigen candidate, we predicted hydrophilicity and B cell epitope parameter by querying to web-based databases, and designed a truncated FomA (tFomA) candidate with better solubility and preserved B cell epitopes. The truncated recombinant protein was engineered to expose epitopes on the surface through simulating amino acid sequence-based 3D folding in aqueous environment. The recombinant tFomA was further expressed and purified, and its immunological properties were evaluated. In the mice intranasal vaccination study, tFomA significantly induced antigen-specific IgG and sIgA responses in both systemic and oral-mucosal compartments, respectively. Our results testify that intelligent in silico designing of antigens provide amenable vaccine epitopes from hard-to-manufacture hydrophobic domain rich microbial antigens.

Revision of the Target Pattern based on Single Serving Size of Dishes for Korean Adolescent Meal Plan / 대한지역사회영양학회지

OBJECTIVES: Maintaining a balanced diet is very crucial for adolescents. However, adolescents, who may have a short notion about the amount of food, find it difficult to plan daily meals by applying the target pattern proposed by the Korean Nutrition Society. This study was carried out to revise the target pattern based on cooked dishes instead of raw material food groups as an easier way for Korean adolescents to plan their meals. METHODS: Target pattern for Korean adolescents were revised based on the following: 1st, categorize dish groups, 2nd, calculate representative values of each dish based on the adolescent' intake amount. 3rd, assign the recommended number of intake for each dish. Validity of the target pattern for Korean adolescent meal plan was examined by the energy content, energy contribution ratio, and NAR & INQ of nutrients. RESULTS: The 11 dish groups categorized were bab; gook.tang.gigae; side dishes of meat, fish, egg, legume, kimchi, vegetable, seaweed; and between meal of fruit, and milk.dairy product. Based on the representative energy values, recommended number of intake were assigned to each dish. For boys, bab and gook.tang.gigae: 3 each; meat, fish, egg, and legume: 1 each; kimchi and vegetable: 3 each; seaweed: 1; fruit and milk.dairy product: 2 each were assigned. For girls, bab and gook.tang.gigae: 2 each; meat, fish, egg, and legume: choice of 3 dishes, 1 each; kimchi and vegetable: 3 each; seaweed: 1; fruit and milk.dairy product: 2 each were assigned. Energy contents, energy contribution ratio of carbohydrate, protein, and fat for boys and girls were in adequate range. The NARs were 1.0 and INQs were > or = 1.0 for all nutrients examined. CONCLUSIONS: Revised dish-based, instead of food-based adolescent target patterns for boys and girls were easier and a valid way of Korean adolescent meal planning.

Proposition and Application of a Dish-Based Target Pattern for Korean Adolescent Girls / 대한지역사회영양학회지

OBJECTIVES: Maintaining a balanced diet and thus health is crucial for adolescents, and the first step for balanced diet practice is meal planning. Adolescents, however, find it difficult to plan their meals. This study thus was set out to design an easier way of planning meals for adolescent girls. METHODS: A dish-based target pattern for adolescent girls was tabulated, and validity of this was examined. Meal plan applying a dish-based target pattern was prepared by 150 female middle school students, and nutritional adequacies of those meal plans were examined. Validity and adequacy were tested by energy content, energy contribution ratio, nutrient adequacy ratio (NAR), probability of nutrient inadequacy, index of nutritional quality (INQ) calculation. RESULTS: A dish-based target pattern with 11 dish groups was validated for nutritional adequacy. Though the NAR of calcium was 0.96, the INQ of calcium was 1.00. The average energy supply from the meal plans was 2,379 kcal, higher than the estimated energy requirement of a female middle school student, but the energy contribution ratio of carbohydrates, proteins, and fats were all adequate according to the acceptable macronutrient distribution range (AMDR). NAR of all nutrients examined were 1.0, except for calcium. The NAR and INQ of calcium were 0.87 and 0.75, respectively, and the meal plans at risk for calcium inadequacy was 19.30%. CONCLUSIONS: A dish-based target pattern proposed for adolescent girls was valid, but the meal plan prepared by female middle school students using this approach was high in energy and low in calcium supply. To cut down the energy supply from the meal plan, it is necessary to recommend dishes low in fat and use low fat cooking methods. To increase the calcium supply, it is important to recommend seaweed and legume group dishes with higher Ca INQ food items.

Destructive Intestinal Translocation of Vibrio vulnificus Determines Successful Oral Infection

Vibrio vulnificus causes primary septicemia as a result of the consumption of contaminated seafood. The intestinal epithelial layer is the first host barrier encountered by V. vulnificus upon oral intake; however, epithelial translocation (invasion) of V. vulnificus has not been extensively studied. In this study, we investigated in vivo translocation of V. vulnificus using clinical (CMCP6) and environmental isolates (96-11-17M). And we analyzed physiological changes of intestinal epithelium concurrent with bacterial translocation by using polarized HCA-7 transwell culture system. The efficiency of epithelial translocation of 97-11-17M strains was significantly lower than that of pathogenic clinical isolate CMCP6 in a murine ligated ileal loop model. In an oral infection model, the survival rate was reciprocally related with efficacy of in vivo epithelial translocation. These results indicate that efficient translocation of V. vulnificus through intestinal epithelium is highly correlated with successful oral infection. We determined translocation of the bacteria from upper to lower chamber, changes of transepithelial electric resistance (TER) and cytotoxicity of the polarized HCA-7 cells to understand general features of V. vulnificus invasion. Bacterial translocation was accompanied by big decrease of TER (about 90%) and about 50% cytotoxicity of the epithelial cells. Taken together, these results indicate that V. vulnificus actively translocates the epithelium by destruction of epithelium and the efficiency of intestinal invasion by V. vulnificus is critical for successful oral infection. From this result, it is suggested that integrity of intestinal barrier is an important factor for susceptibility to oral infection of V. vulnificus.

Social Inequality in Birth Outcomes in Korea, 1995-2008

Social inequality in adverse birth outcomes has been demonstrated in several countries. The present study examined the separate and joint effects of parental education and work in order to investigate the causal pathways of social class effects on adverse birth outcomes in Korea. The occurrence of low birth weight, preterm births, and intrauterine growth retardation was examined among 7,766,065 births in Korea from 1995 to 2008. The effect of social inequality, as represented by parental education and work, was examined against adverse birth outcomes using multivariate logistic regression after controlling for other covariates. Parental education had the most significant and greatest effect on all three adverse outcomes, followed by parental work and employment, which had lesser effects. For adverse birth outcomes, the gap between educational levels increased steadily in Korea from 1995 to 2008. Throughout the analysis, the effect of maternal manual work on adverse birth outcomes was apparent in the study results. Given this evidence of social inequality in education and employment, social interventions should aim at more in-depth and distal determinants of health.

Effect of Psychosocial Work Environment and Self-efficacy on Mental Health of Office Workers / 한국직업건강간호학회지

PURPOSE: This study aims to assess the effects of psychosocial work environment and self-efficacy on stress, depression, and burn-out among office workers. METHODS: Survey data were collected from 331 office workers who worked in one workplace from April 10 to 30, 2012. The impact of psychosocial work environment and self-efficacy on stress, depression, and burn-out was analyzed with hierarchical multiple regression using SAS version 9.3. RESULTS: Work-family conflicts and emotional demands were identified as main factors influencing mental health. Other work environment factors influencing mental health were role clarity for stress, possibilities for development, meaning-of work, social support-from supervisors and job insecurity for depression, and social community at work for burn-out. Self-efficacy was correlated with most psychosocial work environment and factor with independent influence on stress and depression. The final models including general characteristics, psychosocial work environment, and self-efficacy accounted for 34%, 44%, and 36% for stress, depression, and burn-out respectively. CONCLUSION: To promote mental health in office workers, there is a need to decrease work-family conflicts and emotional demands and to improve work organization and job contents, social support, and self-efficacy.

Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study / 예방의학회지

OBJECTIVES: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.