Recent Advances in Anti-Aging Medicine / 가정의학회지

A rapidly aging population in Korea has led to increased attention in the field of anti-aging medicine. The purpose of anti-aging medicine is to slow, stop, or reverse the aging process and its associated effects, such as disability and frailty. Anti-aging medicine is emerging as a growing industry, but many supplements or protocols are available that do not have scientific evidence to support their claims. In this review, the mechanisms of action and the clinical implications of anti-aging interventions were examined and explained. Calorie restriction mimetics define compounds that imitate the outcome of calorie restriction, including an activator of AMP protein kinase (metformin), inhibitor of growth hormone/insulin-like growth factor-1 axis (pegvisomant), inhibitor of mammalian target of rapamycin (rapamycin), and activator of the sirtuin pathway (resveratrol). Hormonal replacement has also been widely used in the elderly population to improve their quality of life. Manipulating healthy gut microbiota through prebiotic/probiotics or fecal microbiota transplantation has significant potential in anti-aging medicine. Vitamin D is expected to be a primary anti-aging medicine in the near future due to its numerous positive effects in the elderly population.

Activation of Autophagy Pathway Suppresses the Expression of iNOS, IL6 and Cell Death of LPS-Stimulated Microglia Cells

Microglia play a role in maintaining and resolving brain tissue homeostasis. In pathological conditions, microglia release pro-inflammatory cytokines and cytotoxic factors, which aggravate the progression of neurodegenerative diseases. Autophagy pathway might be involved in the production of pro-inflammatory cytokines and cytotoxic factors in microglia, though details of the mechanism remain largely unknown. In the present study, we examined the role of the autophagy pathway in activated BV2 microglia cells. In BV2 cells, rapamycin treatment activated the formation of anti-LC3-labeled autophagosomes, whereas the ATG5 depletion using siRNA-ATG5 prevented the formation of LC3-labeled autophagosomes, indicating that BV2 cells exhibit an active classical autophagy system. When treated with LPS, BV2 cells expressed an increase of anti-LC3-labeled dots. The levels of LC3-labeled dots were not suppressed, instead tended to be enhanced, by the inhibition of the autophagy pathway with siRNA-ATG5 or wortmannin, suggesting that LPS-induced LC3-labeled dots in nature were distinct from the typical autophagosomes. The levels of LPS-induced expression of iNOS and IL6 were suppressed by treatment with rapamycin, and conversely, their expressions were enhanced by siRNA-ATG5 treatment. Moreover, the activation of the autophagy pathway using rapamycin inhibited cell death of LPS-stimulated microglia. These results suggest that although microglia possess a typical autophagy pathway, the glial cells express a non-typical autophagy pathway in response to LPS, and the activation of the autophagy pathway suppresses the expression of iNOS and IL6, and the cell death of LPS-stimulated microglia.

Expression of the plant viral protease NIa in the brain of a mouse model of Alzheimer's disease mitigates Abeta pathology and improves cognitive function

The plant viral protease, NIa, has a strict substrate specificity for the consensus sequence of Val-Xaa-His-Gln, with a scissoring property after Gln. We recently reported that NIa efficiently cleaved the amyloid-beta (Abeta) peptide, which contains the sequence Val-His-His-Gln in the vicinity of the cleavage site by alpha-secretase, and that the expression of NIa using a lentiviral system in the brain of AD mouse model reduced plaque deposition levels. In the present study, we investigated whether exogenous expression of NIa in the brain of AD mouse model is beneficial to the improvement of cognitive deficits. To address this question, Lenti-NIa was intracerebrally injected into the brain of Tg-APPswe/PS1dE9 (Tg-APP/PS1) mice at 7 months of age and behavioral tests were performed 15-30 days afterwards. The results of the water maze test indicated that Tg-APP/PS1 mice which had been injected with Lenti-GFP showed an increased latency in finding the hidden-platform and markedly enhanced navigation near the maze-wall, and that such behavioral deficits were significantly reversed in Tg-APP/PS1 mice injected with Lenti-NIa. In the passive avoidance test, Tg-APP/PS1 mice exhibited a severe deficit in their contextual memory retention, which was reversed by NIa expression. In the marble burying test, Tg-APP/PS1 mice buried marbles fewer than non-transgenic mice, which was also significantly improved by NIa. After behavioral tests, it was verified that the Tg-APP/PS1 mice with Lenti-NIa injection had reduced Abeta levels and plaque deposition when compared to Tg-APP/PS1 mice. These results showed that the plant viral protease, NIa, not only reduces Abeta pathology, but also improves behavioral deficits.

Parathyroid hormone accelerates decompensation following left ventricular hypertrophy

Parathyroid hormone (PTH) treatment was previously shown to improve cardiac function after myocardial infarction by enhancing neovascularization and cell survival. In this study, pressure overload-induced left ventricular hypertrophy (LVH) was induced in mice by transverse aortic banding (TAB) for 2 weeks. We subsequently evaluated the effects of a 2-week treatment with PTH or saline on compensated LVH. After another 4 weeks, the hearts of the mice were analyzed by echocardiography, histology, and molecular biology. Echocardiography showed that hearts of the PTH-treated mice have more severe failing phenotypes than the saline-treated mice following TAB with a greater reduction in fractional shortening and left ventricular posterior wall thickness and with a greater increase in left ventricular internal dimension. Increases in the heart weight to body weight ratio and lung weight to body weight ratio following TAB were significantly exacerbated in PTH-treated mice compared to saline-treated mice. Molecular markers for heart failure, fibrosis, and angiogenesis were also altered in accordance with more severe heart failure in the PTH-treated mice compared to the saline-treated mice following TAB. In addition, the PTH-treated hearts were manifested with increased fibrosis accompanied by an enhanced SMAD2 phosphorylation. These data suggest that the PTH treatment may accelerate the process of decompensation of LV, leading to heart failure.

The Outcome of Laparoscopic Retroperitoneal Ureterolithotomy for the Management of Upper Ureteral Stones Larger than 10 mm: A Comparison with Rigid Ureteroscopic Removal of Stones with Lithoclast(R)

PURPOSE: We evaluated the outcome of laparoscopic retroperitoneal ureterolithotomy (LRU) and compared the results with the rigid ureteroscopic removal of stones with the Lithoclast(R) (rigid URS) for the management of large upper ureteral stones (> or =10 mm). MATERIALS AND METHODS: Between July 2002 and March 2008, rigid URS and LRU were performed in 37 and 24 patients, respectively. We evaluated the outcomes of each procedure and compared the success rate according to the location (above and below the L3 level by the third intervertebral disc of the lumbar spine) and size of the stones (10-15 mm and > or =15 mm in diameter). RESULTS: The overall success rate for rigid URS and LRU were 70.3% (26/37) and 91.7% (22/24), respectively (p=0.059). For rigid URS, the success rate was 50.0% (8/16) and 85.7% (18/21) for stones above and below the L3 level (p=0.030), respectively, and 85.7% (23/28) and 33.3% (3/9) for stones 10-15 mm and > or =15 mm in diameter, respectively (p=0.011). For LRU, the success rate was 92.3% (12/13) and 90.9% (10/11) for stones above and below the L3 level, respectively (p=0.902), and 50.0% (1/2) and 95.5% (21/22) for stones 10-15 mm and > or =15 mm in diameter, respectively. CONCLUSIONS: LRU demonstrated a high success rate regardless of the location and size of the stones. The outcomes with rigid URS were more varied. These results suggest that LRU is a feasible alternative for large upper ureteral stones that are 15 mm or more in size or located above the intervertebral disc between the third and fourth lumbar vertebrae.

Factors Related to Occupational Injuries and Health Problems for Some Female Workers in Non-standard Employment / 대한산업의학회지

OBJECTIVES: The purpose of this study was to examine certain factors associated with occupational injuries and health problems for some female workers in non-standard employment. METHODS: We enrolled 754 female workers that were selected from 1,040 people who had agreed to be surveyed as part of a group or company in either the Seoul and the Kyonggi area. We performed univariate logistic regression on survey data and again performed multivariate logistic regression on those variables that were statistically significant. RESULTS: In this study, the overall incidence of occupational injury for all workers was 12.5%. The incidence rates by position were as follows: 12.9%(insurance saleswoman), 7.4%(telemarketer), 9.2%(visiting teacher), 22%(golf caddy). The most frequent complaint was lower back pain(12.8%) in insurance saleswomen, voice symptoms(37%) in telemarketers, knee and ankle symptoms(33.8%) in golf caddies, and voice symptoms(14.4%) in visiting teachers. The factors related to occupational injuries included job type, and age. The factors related to health problems were job type, psychosocial stress, accident risk, and social support. The percentage of the cases that occurred without fringe benefits including social welfare was 30.4%, and the percentage of "paid out of the person's own pocket" of ways to arrange costs of accidents was 32.5%. CONCLUSIONS: In this study, some female workers in non-standard employment had relatively high level of occupational injuries, accompanied by various health problems. In these occupational classes, the conditions for social insurance and social welfare were poor. It is necessary to expand the application of social insurances including industrial accident compensation insurance. Regardless of job category, psychosocial stress and social support were statistically significant for many symptoms. We believe that measurement of these factors is necessary. In the future, additional studies are required with the use of objective methods for additional job categories.

Occupational Stress in Relation to Cerebrovascular and Cardiovascular Disease: Longitudinal Analysis from the NSDSOS Project / 대한산업의학회지

OBJECTIVES: This prospective study was performed to investigate the association between occupational stress and the development of cerebrovascular and cardiovascular diseases. METHODS: A total of 8,429 employees were selected from a nationwide sample, proportional to both the Korean Standard Industrial Classification and the Korean Standard Occupational Classification. A structured self-reported questionnaire was used to access the demographic and socioeconomic characteristics, health behavior and work related characteristics. 43-items of the full version of Korean Occupational Stress Scale (KOSS) were used to access the participants occupational stress. New cases of hospitalization due to cerebrovascular and cardiovascular diseases were evaluated using medical utilization files received from the National Health Insurance Corporation for the period of March 2004 to December 2005. A logistic regression analysis was performed to investigate the association between occupational stress and cerebrovascular and cardiovascular diseases. RESULTS: 43 new cases of hospitalization due to cerebrovascular and cardiovascular diseases were found. According to the results of the logistic regression analysis, job stressors were related with circulatory diseases after adjustment for gender, age, number of workers, employment type, shift work, smoking, alcohol intake, and regular exercise. Of the 8 subscales, insufficient job control (Adj. RR 2.802; 95% CI 1.038-7.564) and occupational climate (Adj. RR 2.365; 95% CI 1.087~5.143) were significantly associated with cerebrovascular and cardiovascular diseases. However, no significant relationships were found between the 6 KOSS subscales and cerebrovascular and cardiovascular diseases. CONCLUSIONS: Despite the short-term follow-up of about two years, the KOSS subscales of insufficient job control and occupational climate were significantly associated with cerebrovascular and cardiovascular diseases.

Laparoscopic Partial Cystectomy for Adenocarcinoma of the Bladder / 대한비뇨기과학회지

From February 2004 to August 2005, 3 patients with muscle invasive bladder adenocarcinoma were identified as candidates for partial cystectomy, and they underwent laparoscopic partial cystectomy. Case 1 and case 2 were primary bladder adenocarcinoma with a pathologic stage of T3aN0M0 and T2bN0M0, respectively, and case 3 was metastatic bladder adenocarcinoma from gastric cancer. The mean surgical time was 213 minutes(range: 140-300). The blood loss was 117cc(range: 60-220), respectively. There were no significant complications after surgery. During a mean follow-up period of 22 months, case 1 and case 2 with primary adenocarcinoma did not have local or systemic recurrence, but case 3 with metastatic adenocarcinoma had intra-abdominal recurrence without local recurrence. Laparoscopic partial cystectomy is a safe, feasible, minimally invasive alternative to open partial cystectomy for treating selected cases of patients with muscle invasive bladder adenocarcinoma.

Serum Prostate-Specific Antigen as a Predictor of Prostate Volume in Men with Benign Prostatic Hyperplasia

PURPOSE: The purpose of this study was to assess the utility of total prostate-specific antigen(PSA) as a predictor of the prostatic volume in men with symptomatic benign prostate hyperplasia(BPH). MATERIALS AND METHODS: From 1999 to 2003, data were collected from 942 patients complaining of lower urinary tract symptoms(LUTS). Baseline prostatic volume(PV) and serum PSA were measured using transrectal sonography and ELSA-PSA2 kit. Patients with a history of prostate surgery, prostatic cancer and conditions other than BPH at baseline were excluded. Transrectal prostatic biopsy was performed in 162 of patients with a serum PSA >4.0 ng/ml to exclude prostatic cancer. A log-transformed linear regression model was used to estimate threshold PVs in men with BPH, and to select the optimal serum PSA cut-off values. RESULTS: The analyses included 942 patients with a mean age of 63.8 years, mean baseline PV 29.59 ml, and mean baseline PSA value 2.37 ng/ml. PV as well as serum PSA increased with age. Linear regression analyses showed that PV and serum PSA have an age-dependent log-linear relationship. Optimal serum PSA cut-off values for the overall study population irrespective of age was 1.7 ng/ml (AUC: 0.800+/-0.053) to detect PV >30 ml and 2.2 ng/ml (AUC: 0.805+/-0.027) to detect PV >40 ml. The age-specific criteria for detecting men with prostate glands exceeding 40 ml are PSA >1.9 ng/ml (AUC: 0.800+/-0.053), >2.2 ng/ml (AUC: 0.805+/-0.027), and >3.4 ng/ml (AUC: 0.763+/-0.039) for men with BPH in their 50 s, 60 s, and 70 s, respectively. CONCLUSION: This study suggests that PV is strongly related to serum PSA in men with BPH and the relationship depends on age. The age-specific criteria for detecting men with prostate glands exceeding 40 ml are PSA >1.9 ng/ml, >2.2 ng/ml, and >3.4 ng/ml for men with BPH in their 50 s, 60 s, and 70 s, respectively. And in the absence of reliable direct measurement of PV, serum PSA can estimate the degree of prostate enlargement accurately to be useful for therapeutics, especially medical management.

A Comparative Study of the Subjective Symptoms of Bioabsorbable and Metallic Osteofixation System in Zygomatic Bone Fracture

The surgical treatment of craniofacial disorders, using metallic internal osteofixation system has inspired an evolution with advanced operative technique and fixation devices over past two decades. As any other surgical procedures, this procedure also associates problems such as infection, palpability, loosening, and restrict craniofacial skeleton growth, which lead to undue secondary operations for removal. These problems are improved by using bioabsorbable osteofixation system. We compared the patient's subjective symptoms using bioaborbable system versus metallic osteofixation system in zygomatic bone fracture. we should take the individual steps (postoperative 2 weeks, and 1 year) in treating fractured zygoma. From August, 2001 to August, 2003, we used bioabsorbable osteofixation system in 28 patients in zygomatic fracture (Biosorb(TM) FX(R)) and compared 23 patients who were treated with metallic osteofixation system. There was no significant difference in the both groups in subjective symptoms and postoperative result.