Genetic approaches toward understanding the individual variation in cardiac structure, function and responses to exercise training

Cardiovascular disease (CVD) accounts for approximately 30% of all deaths worldwide and its prevalence is constantly increasing despite advancements in medical treatments. Cardiac remodeling and dysfunction are independent risk factors for CVD. Recent studies have demonstrated that cardiac structure and function are genetically influenced, suggesting that understanding the genetic basis for cardiac structure and function could provide new insights into developing novel therapeutic targets for CVD. Regular exercise has long been considered a robust nontherapeutic method of treating or preventing CVD. However, recent studies also indicate that there is inter-individual variation in response to exercise. Nevertheless, the genetic basis for cardiac structure and function as well as their responses to exercise training have yet to be fully elucidated. Therefore, this review summarizes accumulated evidence supporting the genetic contribution to these traits, including findings from population-based studies and unbiased large genomic-scale studies in humans.

Genetic approaches toward understanding the individual variation in cardiac structure, function and responses to exercise training

Cardiovascular disease (CVD) accounts for approximately 30% of all deaths worldwide and its prevalence is constantly increasing despite advancements in medical treatments. Cardiac remodeling and dysfunction are independent risk factors for CVD. Recent studies have demonstrated that cardiac structure and function are genetically influenced, suggesting that understanding the genetic basis for cardiac structure and function could provide new insights into developing novel therapeutic targets for CVD. Regular exercise has long been considered a robust nontherapeutic method of treating or preventing CVD. However, recent studies also indicate that there is inter-individual variation in response to exercise. Nevertheless, the genetic basis for cardiac structure and function as well as their responses to exercise training have yet to be fully elucidated. Therefore, this review summarizes accumulated evidence supporting the genetic contribution to these traits, including findings from population-based studies and unbiased large genomic-scale studies in humans.

Suggested Assessments for Sarcopenia in Patients With Stroke Who Can Walk Independently

Objective@#To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke. @*Methods@#Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status. @*Results@#For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p<0.001) among the other muscles. Regarding muscle strength, the MRC sum score correlated with the HG (r=0.660, p<0.001). For physical performance, the BBS correlated with the 4MGS (r=0.834, p<0.001). The same result was obtained after adjusting for factors of stroke severity, comorbidity, and nutritional status. @*Conclusion@#These results suggest that ultrasonographic muscle thickness of the tibialis anterior, the MRC sum score, and BBS might be alternatives to SMI, HG, and usual gait speed for sarcopenia in stroke patients.

Therapeutic potential of alpha-1 antitrypsin in human disease

Alpha-1 antitrypsin (AAT), an alpha globulin glycoprotein, is a member of the serine protease inhibitor (serpin) superfamily. The clinical significance of AAT is highlighted by AAT deficiency. Genetic deficiency of AAT can present as several neutrophilic diseases associated with emphysema, liver cirrhosis, panniculitis, and systemic vasculitis. Recently, animal and human studies have shown that AAT can control inflammatory, immunological, and tissue-protective responses. In addition, AAT treatment can prevent overt hyperglycemia, increase insulin secretion, and reduce cytokine-mediated apoptosis of pancreatic β-cells in diabetes. These multifunctional roles of AAT draw attention to the glycoprotein's therapeutic potential for many inflammatory and autoimmune diseases beyond AAT deficiency. As underlying mechanisms, recent studies have suggested the importance of serine protease inhibitory activity of AAT in obesity-associated insulin resistance, chronic obstructive pulmonary disease, and cystic fibrosis. In this review, we explore the multiple functions of AAT, in particular, the anti-inflammatory and serine protease inhibitory functions, and AAT's therapeutic potential in a variety of human diseases through published literature.

The relationship between non-cognitive student attributes and academic achievements in a flipped learning classroom of a pre-dental science course / 한국의학교육

PURPOSE: The purpose of this study was to examine whether non-cognitive student attributes such as learning style and personality type affected academic performance in a flipped learning classroom of a pre-dental undergraduate science course. METHODS: ‘Biodiversity and Global Environment,’ a 15-week, 3-credit course, was designed as a flipped class in Seoul National University School of Dentistry in 2017. Second-year pre-dental students were required to enroll in the course and to engage in online learning and in-class discussion. The Kolb's Learning Style Inventory and the Myers-Briggs Type Indicator were conducted to measure non-cognitive student factors. Independent samples t-test and multivariate regression analyses were used to examine the relationships between self-rated measurements and academic achievement. RESULTS: More than half of the students enrolled in the flipped science course had an assimilator learning style (50%), followed by convergers (24%), accommodators (16%), and divergers (10%), and their personality types were dominated by the introverted, sensing, thinking, and judging types, respectively. Examining group differences using the t-test demonstrated a significant relationship between the diverger group and higher academic success. In particular, the multivariate regression analysis indicated that both thinking types and female students performed better in discussion than feeling types and male students. CONCLUSION: To operate the flipped learning classroom more effectively in medical and dental education, the instructor should carefully develop and apply a more tailored facilitation and relevant assessment by considering student learning styles and personality types.

Myelodysplastic Syndrome (RAEB-II) Development 2 Months after Chemotherapy for a Primary Non-seminomatous Mediastinal Germ Cell Tumor / 대한내과학회지

Here, we report on a 20-year-old patient with a primary nonseminomatous mediastinal germ cell tumor (MGCT) who developed myelodysplastic syndrome (MDS) 2 months following chemotherapy with cisplatin, etoposide, ifosfamide, and paclitaxel. Bone marrow examinations revealed that the MDS was a refractory anemia with excess type II blasts and complex chromosomal abnormalities. With the onset of MDS occurring rapidly following chemotherapy, it is unlikely to have been caused by the therapy. We discuss the association between primary nonseminomatous MGCTs and hematological malignancies, including the possibility of a common clonal origin.

A call for action from workers, local residents, and consumers: a safe society from toxic chemicals

No abstract available.

Optimal effect-site concentration of remifentanil when combined with dexmedetomidine in patients undergoing cystoscopy / 대한마취과학회지

BACKGROUND: Cystoscopic procedure is a very common practice in the field of urology due to its ability to survey the bladder for a variety of indications. However, patients who undergo cystoscopy feel intense pain and discomfort. This study investigated the half maximal effective concentration (EC50) of remifentanil in preventing cystoscope insertion pain under sedation using dexmedetomidine. METHODS: The study was prospectively conducted on 18 male patients, aged 18 to 65. Remifentail infusion was initiated together with dexmedetomidine, and started at a dose of 2.4 ng/ml on the first patient. The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml. Patients received a loading dose of 1.0 microg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.6 microg/kg/hr. After the patient's OAA/S score (Observer's Assessment of Alertness/Sedation scale) reached 3-4, and the Ce of remifentanil reached target concentration, the urologist was allowed to insert the cystoscope and the pain responses were observed. RESULTS: The effect-site concentration of remifentanil required to prevent cystoscope insertion pain in 50% of patients under sedation using dexmedetomidine was 1.30 +/- 0.12 ng/ml by Dixon's up-and-down method. The logistic regression curve of the probability of response showed that the EC50 and EC95 values (95% confidence limits) of remifentanil were 1.33 ng/ml (1.12-1.52 ng/ml) and 1.58 ng/ml (1.44-2.48 ng/ml), respectively. CONCLUSIONS: Cystoscopic procedure can be carried out successfully without any pain or adverse effects by optimal remifentanil effect-site concentration (EC50, 1.33 ng/ml; EC95, 1.58 ng/ ml) combined with sedation using dexmedetomidine.

Effect of Treadmill Exercise Training and Dietary Intake of Garcinia Cambogia Extract, Soypeptide and L-Carnitine Mixture on Body Weight Reduction in Rats Fed High-Fat Diet

This study was undertaken to examine effects of dietary intake of garcinia cambogia extract, soy peptide and L-carnitine mixture on body weight gain and obesity-related bio-markers in rats fed high-fat diet for 9 weeks with or without regular treadmill exercise. Forty 5-week-old male Sprague-Dawley rats were randomly divided into four groups; sedentary control group (SC), exercised control group (EC), sedentary formula-fed group (SF), and exercised formula-fed group (EF). The SC and EC rats were fed high-fat control diet (fat comprises 40% of total caloris), and SF and EF rats were fed high-fat formula (composed of garcinia cambogia, soy peptide and L-carnitine) supplemented diet. Statistical analyses by two-way ANOVA indicated that the regular treadmill exercise significantly lowered cumulative body weight gain, total visceral fat mass, and epididymal, perirenal and retroperitoneal fat pad weights, and serum concentrations of total cholesterol and LDL + VLDL cholesterol, insulin, c-peptide and leptin. Feeding the formula also resulted in significant reductions in cumulative body weight gain and visceral fat pad weights, along with other related parameters including serum total and LDL + VLDL cholesterol levels, and hepatic enzyme activities involved in fatty acid synthesis. Statistical analyses by one-way ANOVA revealed that the formula consumption significantly improved body weight gain (18% reduction), total visceral fat weight (20% reductions), and serum total (43% reduction) and LDL + VLDL cholesterol (54% reduction) levels, as well as serum levels of insulin (49% reduction), and c-peptide (41% reduction) in sedentary rats, but failed to exhibit significant reductions in these indices in animals under treadmill exercise program. Taken together, these results suggest that the treadmill exercise per se exhibited significant improvements in body fat reduction and other related bio-markers, and so the formula consumption did not achieve a further significant reductions in these bio-markers in exercised rats. Nevertheless, animals fed the formula with regular exercise showed the most efficient weight reduction compared to other groups either fed formula without exercise or received regular exercise without dietary supplementation.