Effects of Living Alone and Sedentary Behavior on Quality of Life in Patients With Multimorbidities: A Secondary Analysis of Cross-Sectional Survey Data Obtained From the National Community Database.

BACKGROUND: Having multimorbidities may increase health problems. Moreover, health-related quality of life correlates negatively with the number of chronic conditions a patient has. Living alone has been identified as a predictor of poorer quality of life, and a sedentary lifestyle is widely known to increase health problems and mortality. PURPOSE: This study was designed to identify the effects of living alone and of sedentary behavior on health-related quality of life in patients with multimorbidities using nationally representative community data. METHODS: A secondary data analysis of the Korea National Health and Nutrition Examination Survey was conducted. In this study, 1,725 adult patients aged 19 years and above with two or more chronic diseases were selected for the analysis. Health-related quality of life was measured using the European Quality of Life-5 Dimensions. Multiple logistic regression was performed to identify the effects of living alone and of sedentary behavior on health-related quality of life. The statistical analyses took into account the components of the complex sampling design such as the strata, clusters, weights, and adjustment procedures, and missing data were treated in a valid manner. RESULTS: After adjusting for gender, age, employment status, and number of chronic diseases, it was found that the odds of having a high health-related quality of life were lower in single households than in multiperson households (odds ratio = 0.62, 95% confidence interval [0.46, 0.84]). In addition, after adjusting for gender, age, employment status, number of chronic diseases, and living arrangement, the odds of having a high health-related quality of life decreased as sedentary time increased (odds ratio = 0.93, 95% confidence interval [0.89, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: To improve quality of life in patients with multimorbidities, nursing interventions that support patients who live alone and have complicated disease-related issues and that reduce sedentary behavior should be developed.

Maintaining Antiviral Efficacy after Switching to Generic Entecavir 1 mg for Antiviral-resistant Chronic Hepatitis B.

Background/Aims: Clinical equivalence of generic antiviral agents for chronic hepatitis B (CHB) has not been demonstrated, particularly in cases with previous antiviral resistance. Entecavir 1 mg is prescribed frequently as a mono- or combination therapy in antiviral-resistant CHB patients. This study evaluated the efficacy and safety of switching to generic entecavir 1 mg (Baracle®) in CHB patients taking brand-name entecavir 1 mg (Baraclude®) alone or in combination with other nucleotide analogs after the development of antiviral resistance. Methods: This study was a single-arm prospective study. The primary endpoint was undetectable HBV DNA (<20 IU/mL) at 12 months after switching treatment. The biochemical and serologic responses, virologic breakthrough, and antiviral resistance rates were also evaluated. Results: Forty CHB patients with undetectable HBV DNA through the brand-name entecavir 1 mg treatment as a mono- or combination therapy after developing antiviral resistance to nucleos(t)ide analogs were enrolled in this study. No significant difference in the HBV DNA non-detection rate was observed between the baseline and 12 months after switching therapy (p=0.324). Furthermore, non-inferiority of the generic entecavir 1 mg to the brand-name entecavir 1 mg with 10% margin in maintaining undetectable HBV DNA was demonstrated (95% CI -2.80 to 8.20%). Similarly, no difference in the biochemical response rate was observed after switching therapy. Serum hepatitis B e antigen loss was observed in 12.5%. No virologic breakthrough was reported. Conclusions: Generic entecavir 1 mg is a reasonable alternative to the brand-name entecavir 1 mg in antiviral-resistant CHB patients with viral suppression.

Comparison of Sorafenib versus Hepatic Arterial Infusion Chemotherapy-Based Treatment for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis.

BACKGROUND/AIMS: Sorafenib is the first approved systemic treatment for advanced hepatocellular carcinoma (HCC). However, its clinical utility is limited, especially in Asian countries. Several reports have suggested the survival benefits of hepatic arterial infusion chemotherapy (HAIC) for advanced HCC with main portal vein tumor thrombosis (PVTT). This study aimed to compare the efficacy of sorafenib-based therapy with that of HAIC-based therapy for advanced HCC with main PVTT. METHODS: Advanced HCC patients with main PVTT treated with sorafenib or HAIC between 2008 and 2016 at Korea University Medical Center were included. We evaluated overall survival (OS), time-to-progression (TTP), and the disease control rate (DCR). RESULTS: Seventy-three patients were treated with sorafenib (n=35) or HAIC (n=38). Baseline characteristics were not significantly different between groups, except the presence of solid organ metastasis (46% vs 5.3%, p<0.001). The median OS time was not significantly different between the groups (6.4 months vs 10.0 months, p=0.139). TTP was longer in the HAIC group than in the sorafenib group (2.1 months vs 6.2 months, p=0.006). The DCR was also better in the HAIC group than in the sorafenib group (37% vs 76%, p=0.001). Subgroup analysis, which excluded patients with extrahepatic solid organ metastasis, showed the same trends for the median OS time (8.8 months vs 11.1 months, p=0.097), TTP (1.9 months vs 6.0 months, p<0.001), and DCR (53% vs 81%, p=0.030). CONCLUSIONS: HAIC-based therapy may be an alternative to sorafenib for advanced HCC with main PVTT by providing longer TTP and a better DCR.

Nitric Oxide Produced by Macrophages Inhibits Adipocyte Differentiation and Promotes Profibrogenic Responses in Preadipocytes to Induce Adipose Tissue Fibrosis.

Fibrosis of adipose tissue induces ectopic fat accumulation and insulin resistance by inhibiting adipose tissue expandability. Mechanisms responsible for the induction of adipose tissue fibrosis may provide therapeutic targets but are poorly understood. In this study, high-fat diet (HFD)-fed wild-type (WT) and iNOS(-/-) mice were used to examine the relationship between nitric oxide (NO) produced by macrophages and adipose tissue fibrosis. In contrast to WT mice, iNOS(-/-) mice fed an HFD were protected from infiltration of proinflammatory macrophages and adipose tissue fibrosis. Hypoxia-inducible factor 1α (HIF-1α) protein level was increased in adipose tissue of HFD-fed WT mice, but not iNOS(-/-) mice. In contrast, the expression of mitochondrial biogenesis factors was decreased in HFD-fed WT mice, but not iNOS(-/-) mice. In studies with cultured cells, macrophage-derived NO decreased the expression of mitochondrial biogenesis factors, and increased HIF-1α protein level, DNA damage, and phosphorylated p53 in preadipocytes. By activating p53 signaling, NO suppressed peroxisome proliferator-activated receptor γ coactivator 1α expression, which induced mitochondrial dysfunction and inhibited preadipocyte differentiation in adipocytes. The effects of NO were blocked by rosiglitazone. The findings suggest that NO produced by macrophages induces mitochondrial dysfunction in preadipocytes by activating p53 signaling, which in turn increases HIF-1α protein level and promotes a profibrogenic response in preadipocytes that results in adipose tissue fibrosis.

Two Cases of Cerebral Air Embolism That Occurred during Esophageal Ballooning and Endoscopic Retrograde Cholangiopancreatography.

Cerebral air embolism is an extremely rare complication of endoscopic procedure and often life threatening. We present two cases of cerebral infarction due to air embolization caused by an endoscopic intervention. The first case occurred during esophageal balloon dilatation for the treatment of a stricture of an anastomosis site in a 59-year-old man and the second case occurred during endoscopic papillary balloon dilatation in a 69-year-old man who had distal common bile duct stones. After the procedure, cardiopulmonary instability and altered mental status were observed in both patients, and cerebral air embolism was diagnosed in both cases. Hyperbaric oxygen therapy was started in the first case, and high FiO2 therapy was applied in the second case. Although this complication is rare, patient outcomes can be improved if physicians are aware of this potential complication, and immediately begin proper management.

IL-1beta promotes the ciliogenesis of human middle ear epithelial cells: possible linkage with the expression of mucin gene 8.

CONCLUSIONS: These findings suggest that IL-1beta, increases ciliogenesis in NHMEE cells and that MUC8 protein may play a role in this process. OBJECTIVES: The morphology of the middle ear epithelium changes under various pathologic conditions. We compared the density of ciliated cells and the level of mucin gene 8 (MUC8) mRNA in the middle ear epithelial cells of mucoid otitis media (MOM) patients with those of normal controls. We also investigated the effect of IL-1beta on the ciliogenesis and expression of MUC8 mRNA in cultured normal human middle ear epithelial (NHMEE) cells. In addition, we localized the MUC8 protein in cultured NHMEE cells. MATERIAL AND METHODS: The surface morphology of NHMEE cells was examined using scanning electron microscopy. Reverse transcriptase polymerase chain reaction was performed to determine the level of MUC8 mRNA expression. After synthesis of MUC8 polyclonal antibody, we performed immunohistochemical staining. RESULTS: The density of ciliated cells was increased in the middle ear epithelium of both MOM patients and IL-1beta-treated cultures. Similarly, the expression of MUC8 was increased in both cases. MUC8 antibody was primarily stained on the ciliated cells of NHMEE cells.