Vertebral fracture is associated with myocardial infarction in incident hemodialysis patients: a Korean nationwide population-based study.

Chronic kidney disease (CKD)-mineral and bone disorder suggests that fragile bone and vascular disorder might be connected closely in CKD patients. In this study, fracture event was significantly associated with myocardial infarction (MI) in end-stage renal disease patients on hemodialysis (HD), especially for vertebral fractures. INTRODUCTION: CKD-mineral and bone disorder is characterized by biochemical abnormalities, bone disorders, and vascular calcification. We aimed to verify the association between fracture and MI in CKD patients. METHODS: Records for incident CKD stage 3 to 5 patients and patients who initiated HD between July 2014 and June 2018 were retrieved from the Korean Health Insurance Review & Assessment Service Database. Fractures were defined using diagnostic codes and were classified into vertebral, femoral, and other site fractures. MI was defined using a combination of MI diagnostic codes and related procedure codes. Multiple logistic regressions and 1:1 propensity score matching analysis were conducted. RESULTS: A total of 38,935 patients (HD, 11,379; pre-dialysis CKD, 27,556) were included in this study. A total of 5,057 (13.0%) patients experienced fracture, and 1,431 (3.7%) patients had MI. Multiple logistic regression analysis showed that fracture was significantly associated with MI in the HD group (odds ratio (OR) 1.34, P = 0.024), but not in the pre-dialysis CKD group (OR 1.04, P = 0.701). After propensity score matching for age, gender, and diabetes mellitus between patients with and without fracture, fracture still significantly correlated with MI in HD patients (OR 1.47, P = 0.034) but not in patients with pre-dialysis CKD (OR 1.04, P = 0.751). Subgroup analysis by fracture site found that vertebral fracture was associated with MI in HD patients (OR 2.11, P = 0.024), but femoral or other site fractures were not. CONCLUSION: In HD patients, fracture was significantly associated with MI, especially for vertebral fractures patients.

Development of Novel Continuous and Interval Exercise Programs by Applying the FITT-VP Principle in Dogs.

Although proper exercise training induces positive physiological effects, improper exercise can lead to injury, fatigue, and poor performance. The frequency, intensity, time/duration, type, volume, and progression (FITT-VP) are the essential components of exercise training to maintain or improve physical fitness and health. The purpose of this study was to develop specific exercise programs by applying the FITT-VP principle and to examine the effects on heart rate (HR) and hematological and biochemical parameters in dogs. The healthy male Beagles (n = 4) included in this study performed continuous and interval exercises, comprising 12 protocols. The HR monitoring elicited an affirmative response to activities but varied depending on the protocols. The hematologic parameters (e.g., red blood cell count, white blood cell count, hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration) were within the reference ranges both before and after exercise. The creatine kinase level significantly increased, and the cholesterol level decreased after exercises. In conclusion, the continuous and interval exercise program elicits an appropriate HR reaction, has no adverse effects on the serum parameters, and provides valuable insight for healthcare in dogs.

The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis.

Bone mineral density (BMD) is significantly decreased after gastrectomy in patients with gastric cancer. Calcium malabsorption, secondary hyperparathyroidism, and dominant bone resorption appear to contribute to bone loss in these patients. Patients should undergo early surveillance and nutritional or pharmacologic intensive interventions for bone health. PURPOSE: Survivorship care, including bone health, has become an important issue in gastric cancer. We performed a meta-analysis of the available observational studies to determine whether and how osteoporosis risk is increased after gastrectomy in patients with gastric cancer. METHODS: A total of 1204 patients (802 men) from 19 cohort studies were included. We evaluated the prevalence of osteoporosis in postgastrectomy patients, comparing the incidence according to the type of gastrectomy and sex. Additionally, we evaluated changes in bone mineral density (BMD) and bone metabolism-related markers pre- to postoperatively and between patients who underwent gastrectomy and matched controls. Proportion meta-analysis was performed and pooled odds ratios (ORs) were calculated. RESULTS: The pooled incidence estimate was 36% [95% confidence interval (CI), 32-40]. The incidence of osteoporosis was significantly higher in women than in men (OR = 1.90, p < 0.001) but was similar between partial and total gastrectomy groups (OR = 0.983, p = 0.939). BMD was significantly decreased, and calcium, phosphorous, and parathyroid hormone levels were significantly increased in patients after gastrectomy compared to those before gastrectomy. BMD and calcium and 25OH-vitamin D levels were significantly decreased, and parathyroid hormone and 1,25OH-vitamin D levels were significantly increased in the gastrectomy group compared to that in the control group. CONCLUSION: We found that BMD is significantly decreased after gastrectomy in patients with gastric cancer. Vitamin D deficiency and secondary hyperparathyroidism are suggested to be common mechanism underlying BMD impairment. After resection, patients should undergo long-term nutritional and bone health surveillance, in addition to their oncological follow-up.

Public Sense of Water Fluoridation as Reflected on Twitter 2009-2017.

Though controversial, water fluoridation has been hailed as one of the top-ten public-health achievements of the 20th century in the United States of America. In this article, we aim to investigate the public sense of water fluoridation as reflected on Twitter, using data from 2009 to 2017. To this end, tweets related to water fluoridation were collected using queries such as "fluoridated water or fluoride water," "water fluoridation or fluoridation of water," and hashtags related to water fluoridation. The collected tweets (n = 218,748) were examined through informetric, linguistic (word sentiment, word frequency, and word network analyses), and issue tweet analyses. We found that Twitter users who tweeted about water fluoridation in English between 2009 and 2017 constituted about <0.01% of all users including non-English users. In their tweets, words such as "poison" and "waste" were the strong negative sentiment words most often used. Of the top 30 words most frequently used, words related to information sources on water fluoridation and the safety of water fluoridation appeared more often than words related to its efficacy. Additionally, the words related to information sources on water fluoridation and the safety of water fluoridation were found to be core terms in the sentences of tweet mentions. Our linguistic analyses indicate that Twitter users responded sensitively to words that emphasize negative aspects of fluoridation. This is clearly shown in our issue tweet analysis, where tweet mentions expressing negative opinions about water fluoridation accounted for at least 59.2% of all mentions. By contrast, <15% of tweet mentions were found to be positive. These findings suggest that professionals need to reevaluate the current state of online information about water fluoridation, and improve it in a way so that the public can easily access reliable information sources.

0.5% 5-Fluorouracil/10% Salicylic Acid for the Treatment of Distal Actinic Keratoses Under Daily Practice Conditions

Background: Actinic keratosis (AKs) are sun-induced skin lesions that are at risk to progress to invasive squamous cell carcinoma (SCC). Treatments have shown to be effective on face or balding scalp area but limited data support their efficacy on distal extremities. Objective: To describe the efficacy of 0.5% 5-fluorouracil/10% salicylic acid (5FU/AS) in the treatment of distally-located AKs in daily clinical practice. Additional objectives were to review tolerance and adherence to this treatment. Methods: Retrospective review of 23 patients with distal grade II to III AKs who were treated with 5FU/AS under daily practice conditions. Primary endpoint included local skin response according to percentage on AKs reduction at week 20 (8 weeks after ending the treatment). Results: 75% (30/40) treatment areas showed a percentage reduction in AKs from to 75% to 100% at week 20. Complete response (100% clearance) was recorded in more than half of the cases (53%, 21/40). Good, partial, and low responses were respectively observed in 22% (9/40), 20% (8/40), and 5% (2/40) of patients. Most adverse events were graded as low, and adherence to treatment was considered correct in 25 patients (63%). In addition, a correct adherence to treatment was significantly related to a better response (P=0.001). Conclusion: Findings indicate that topical 5FU/AS is an effective treatment for multiple distal AKs, with a proper safety profile. J Drugs Dermatol. 2019;18(3):285-288.

Clinical management of cutaneous adverse events in patients on targeted anticancer therapies and immunotherapies: a national consensus statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncology.

Progress in the understanding of many tumors has enabled the development of new therapies, such as those targeted at specific molecules involved in cell growth (targeted therapies) or intended to modulate the immune system (immunotherapy). However, along with the clinical benefit provided by these new treatments, new adverse effects have also appeared. Dermatological toxicities such as papulopustular eruptions, xerosis, and pruritus are common with EGFR inhibitors. Other adverse effects have also been described with PDGFR, BCR-ABL, and MAPK tyrosine kinase inhibitors, antiangiogenic drugs, and inhibitors at immune checkpoints such as CTLA-4 and PD-1/PD-L1. Onset of these adverse effects often causes dose reductions and/or delays in administering the prescribed therapy, which can affect patient survival and quality of life. It is, therefore, important to prevent the occurrence of these adverse effects, or to treat unavoidable ones as soon as possible. This requires cooperation between medical oncologists and dermatologists. This article reviews the various dermatological toxicities associated with targeted therapies and immunotherapies, along with their diagnosis and therapeutic management.

Estimating the impact of a television campaign on tuberculosis knowledge and intention to test for TB in South Korea.

OBJECTIVE: To examine the effectiveness of a television campaign for preventing tuberculosis (TB) executed in South Korea in 2015. DESIGN: We used a genetic matching method to accurately test the effect of the campaign on changing people's knowledge and behaviour in a nationwide sample of 1000 adults; information was collected using face-to-face interviews. RESULTS: After matching individuals in treatment and controlled conditions using 11 covariates, we found that the campaign significantly improved people's knowledge about TB, and enhanced people's intention to undertake a TB test when they recognised the signs of TB. CONCLUSION: These data highlight the potential usefulness of genetic matching for enhancing statistical rigour when evaluating the effectiveness of a health campaign using a cross-sectional observational study.

The association between muscle mass deficits and arterial stiffness in middle-aged men.

BACKGROUND AND AIMS: Early diagnosis of arteriosclerosis is fundamental for the prevention of cardiovascular morbidity and mortality. The current study was performed to identify major predictors of arteriosclerosis and to assess the association between arterial stiffness as measured by cardio-ankle vascular index (CAVI) and muscle mass deficit (MMD) estimated by bioelectrical impedance analysis (BIA) in middle-aged men. METHODS AND RESULTS: Data were gathered from 3356 middle-aged men who visited a health promotion center. CAVI was measured as an index of arterial stiffness. Body composition analysis was performed using BIA. MMD was positively associated with CAVI in the regression model. The odds ratios for high-CAVI (≥9.0) rose with MMD grade in a dose-dependent manner after adjusting for age, lifestyle factors and current medication use. The estimated mean CAVI rose as MMD grade increased (P for trend >0.001). CONCLUSIONS: MMD estimated from BIA was positively associated with arterial stiffness in middle-aged men. These findings show a close interaction between low muscle mass and cardiovascular risk.

Chronologic Trends in Studies on Fluoride Mechanisms of Action.

Fluoride has been widely used for the prevention of dental caries since the mid-20th century. The aim of this study was to investigate the chronologic trends in studies on fluoride mechanisms of action against dental caries during the years 1950 to 2015. To this aim, queries such as "fluoride," "fluoride and demineralization," "fluoride and remineralization," "fluoride and (plaque or biofilms)," and "fluoride and (bacteria or microbials)" were submitted to PubMed to collect research article information, including titles, abstracts, publication dates, author affiliations, and publication journals. The article information that PubMed produced was then collected by an automatic web crawler and examined through informetrics and linguistic analyses. We found that the number of articles concerned with fluoride mechanisms of action against dental caries was 6,903 and gradually increased over time during the years 1950 to 2015. They were published by 1,136 journals-most notably, Caries Research and Journal of Dental Research. Of the articles published, those related to bacteria/microbials had a higher percentage (44%) than those dealing with plaque/biofilms, demineralization, and remineralization. With regard to the geographic distribution of authors, Europe and North America accounted for 65% of the articles during the years 1987 to 2015, although the number of authors in Asia sharply increased in recent years. Among the fluoride compounds, NaF was mentioned more frequently than SnF2, Na2PO3F, amine fluoride, and acidulated phosphate fluoride during the years 1986 to 2015. Water fluoridation received the most attention among the various fluoride application methods (toothpastes, mouthwashes, fluoride varnishes, and fluoride gels) during the same period. These results, obtained from employing informetrics and linguistic analyses, suggest that in studies on fluoride mechanisms of action, 1) the unbalanced geographic distribution of articles and 2) the heavy concentration of articles on particular fluoride compounds and application methods should be overcome in future research.

Successful tracheostomy decannulation after complete or sensory incomplete cervical spinal cord injury.

STUDY DESIGN: Retrospective study. OBJECTIVES: To report the successful tracheostomy decannulation/extubation in cervical spinal cord injury (C-SCI) patients. SETTING: Tertiary university hospital, pulmonary rehabilitation center. METHODS: Complete or sensory incomplete C-SCI patients who had received invasive acute phase respiratory management, and succeeded in decannulation/extubation became candidates of this study. Retrospective review was conducted on the transitions of the respiratory status. RESULTS: Sixty-two patients (M: 55, F: 7) were identified. Traumatic etiologies accounted for 93.5%, and mean onset age was 47.6±15.8 years. Sixty patients (96.8%) had undergone tracheostomy and the other two received endotracheal intubation during acute phase. All patients succeeded in decannulation/extubation after employing mechanically assisted coughing and noninvasive mechanical ventilation (NIV). Mean time since tracheostomy to decannulation was 7.0±14.5 months. Of the 60 tracheostomized patients, 12 succeeded in decannulation without applying long-term NIV, 31 switched to continuous NIV after decannulation. Fifteen patients totally weaned off from ventilators after NIV. Two patients who once succeeded in decannulation were re-tracheostomized. For the 31 patients with continuous NIV, mean hours of daily need for ventilatory support had reduced from 15.3±8.0 to 5.7±5.7 h at final follow-ups. CONCLUSION: Complete or sensory incomplete C-SCI patients, even with high neurological level can be successfully decannulated through NIV and aggressive use of mechanically assisted coughing. Undesirable tracheostomy can be avoided by employing the noninvasive respiratory management.

Renal outcomes after liver transplantation in fulminant hepatitis A with acute kidney injury: comparison with hepatorenal syndrome.

BACKGROUND: Liver transplantation (LT) is the treatment of choice for hepatorenal syndrome (HRS). Recently, acute kidney injury (AKI) due to acute hepatitis A (HA) is increasing, but the outcome of LT is not well established. We investigated the outcomes of LT in patients with AKI due to acute HA compared with those of patients with HRS due to other causes. METHODS: We investigated the outcomes of LT in 20 patients with AKI associated with acute HA (HAV group) compared with 76 patients with hepatorenal syndrome (HRS) due to other causes (HRS group) at 3 Korea centers. RESULTS: Preoperative mean prothrombin time and serum creatinine level were higher in the HAV group than in the HRS group. But mean total bilirubin level was lower in the HAV group. There was no difference in Model for End-Stage Liver Disease scores. Post-transplantation patient and graft survival rates were similar between the 2 groups. More patients in the HAV group needed post-transplantation hemodialysis than in the HRS group (65.0% vs 38.2%; P = .043). However, post-transplantation estimated glomerular filtration rate was significantly higher in the HAV group after post-transplantation month 2 (P < .05). CONCLUSIONS: Peri-transplantation kidney function of the HAV group was poorer than that of HRS group. However, post-transplantation long-term renal outcome could be better in the HAV group.

Fabrication of GaAs/Al0.3Ga0.7As multiple quantum well nanostructures on (100) si substrate using a 1-nm InAs relief layer.

Nanometer scale thin InAs layer has been incorporated between Si (100) substrate and GaAs/Al0.3Ga0.7As multiple quantum well (MQW) nanostructure in order to reduce the defects generation during the growth of GaAs buffer layer on Si substrate. Observations based on atomic force microscopy (AFM) and transmission electron microscopy (TEM) suggest that initiation and propagation of defect at the Si/GaAs interface could be suppressed by incorporating thin (1 nm in thickness) InAs layer. Consequently, the microstructure and resulting optical properties improved as compared to the MQW structure formed directly on Si substrate without the InAs layer. It was also observed that there exists some limit to the desirable thickness of the InAs layer since the MQW structure having thicker InAs layer (4 nm-thick) showed deteriorated properties.

Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea.

OBJECTIVE: To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea. METHOD: Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression. RESULTS: The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.

Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy.

BACKGROUND: Epidural administration of dexamethasone might reduce postoperative pain in adults. We evaluated whether a caudal block of 0.1 mg kg(-1) dexamethasone combined with ropivacaine improves analgesic efficacy in children undergoing day-case orchiopexy. METHODS: This randomized, double-blind study included 80 children aged 6 months to 5 yr who underwent day-case, unilateral orchiopexy. Patients received either 1.5 ml kg(-1) of 0.15% ropivacaine (Group C) or 1.5 ml kg(-1) of 0.15% ropivacaine in which dexamethasone of 0.1 mg kg(-1) was mixed (Group D) for caudal analgesia. Postoperative pain scores, rescue analgesic consumption, and side-effects were evaluated 48 h after operation. RESULTS: Postoperative pain scores at 6 and 24 h post-surgery were significantly lower in Group D than in Group C. Furthermore, the number of subjects who remained pain free up to 48 h after operation was significantly greater in Group D [19 of 38 (50%)] than in Group C [four of 37 (10.8%); P<0.001]. The number of subjects who received oral analgesic was significantly lower in Group D [11 of 38 (28.9%)] than in Group C [20 of 37 (54.1%); P=0.027]. Time to first oral analgesic administration after surgery was also significantly longer in Group D than in Group C (P=0.014). Adverse events after surgery including vomiting, fever, wound infection, and wound dehiscence were comparable between the two groups. CONCLUSIONS: The addition of dexamethasone 0.1 mg kg(-1) to ropivacaine for caudal block can significantly improve analgesic efficacy in children undergoing orchiopexy. Clinical trial registration NCT01604915.

Novedades en el diagnóstico de las toxicodermias / Advances in the Diagnosis of Drug Eruptions

Las erupciones medicamentosas que afectan a la piel y las mucosas, o toxicodermias, se sitúan en primer lugar entre las reacciones adversas a medicamentos y suponen uno de los desafíos diagnósticos habituales para el dermatólogo. Los avances en el conocimiento de los mecanismos patogénicos implicados en las reacciones adversas a fármacos, en farmacogenética y en farmacoepidemiología, nos permitirán dar respuesta a los principales interrogantes planteados y así anticipar, e incluso prevenir, dichas reacciones. Muchas de las toxicodermias resultan de reacciones de hipersensibilidad mediadas por células T, con activación de diferentes mecanismos pro-inflamatorios que contribuyen a su heterogeneidad clínica. Algunos aspectos desafían el concepto habitual de procesado y presentación antigénica, habiéndose planteado nuevas hipótesis, como el «concepto p-i», que complementan la teoría hapténica y que permiten explicar, al menos en parte, por ejemplo la preferencia de la localización cutánea de las reacciones a fármacos o cómo algunas infecciones virales incrementan el riesgo de toxicodermia. En este trabajo se realiza una revisión de estos aspectos patogénicos, del papel de los genes HLA en la predisposición a algunas reacciones adversas graves, así como de otros avances en el diagnóstico de las toxicodermias. Algunos cuadros llamativos de descripción reciente en relación con nuevas medicaciones son comentados someramente (AU)

Drug eruptions affecting the skin or mucosas (toxicoderma) are the most common adverse effects of drugs and represent one of the more common diagnostic challenges for the dermatologist. A better understanding of the pathogenic mechanisms of drug reactions, pharmacogenetics, and pharmacoepidemiology will help us to resolve the main dilemmas and to anticipate and even prevent such reactions. Many drug eruptions are due to T cell–mediated hypersensitivity reactions that can involve activation of different proinflammatory mechanisms, which would explain the varied manifestations. Some aspects defy the classical understanding of antigen processing and presentation. New immunological hypotheses, such as the «p-i concept», have been introduced to complement the hapten theory and, at least in part, help to explain why drug reactions tend to affect the skin and why certain viral infections increase the risk of drug eruptions. In this paper we analyze these pathogenic concepts and the role of HLA genes in the susceptibility to certain severe adverse drug reactions, and also examine other advances in the diagnosis of drug eruptions. We briefly discuss a number of recently described reactions to new drugs (AU)

Advances in the diagnosis of drug eruptions.

Drug eruptions affecting the skin or mucosas (toxicoderma) are the most common adverse effects of drugs and represent one of the more common diagnostic challenges for the dermatologist. A better understanding of the pathogenic mechanisms of drug reactions, pharmacogenetics, and pharmacoepidemiology will help us to resolve the main dilemmas and to anticipate and even prevent such reactions. Many drug eruptions are due to T cell-mediated hypersensitivity reactions that can involve activation of different proinflammatory mechanisms, which would explain the varied manifestations. Some aspects defy the classical understanding of antigen processing and presentation. New immunological hypotheses, such as the «p-i concept¼, have been introduced to complement the hapten theory and, at least in part, help to explain why drug reactions tend to affect the skin and why certain viral infections increase the risk of drug eruptions. In this paper we analyze these pathogenic concepts and the role of HLA genes in the susceptibility to certain severe adverse drug reactions, and also examine other advances in the diagnosis of drug eruptions. We briefly discuss a number of recently described reactions to new drugs.

Comparison of cell proliferation and epigenetic modification of gene expression patterns in canine foetal fibroblasts and adipose tissue-derived mesenchymal stem cells.

OBJECTIVES: This study compared rate of cell proliferation, viability, cell size, expression patterns of genes related to pluripotency and epigenetic modification between canine foetal fibroblasts (cFF) and canine adipose tissue-derived mesenchymal stem cells (cAd-MSC). MATERIALS AND METHODS: Proliferation pattern, cell viability as well as cell size at each passage of cFF and cAd-MSC were measured when cultures reached confluence. In addition, real-time PCR was performed to investigate expression of Dnmt1, HDAC1, OCT4, SOX2, BAX, BCL2 genes with reference to ß-actin gene expression as an endogenous control in both cell lines. RESULTS: cFF and cAd-MSC differed in number of generations, but not in doubling times, at all passages. Mean cell size of cAd-MSC was significantly smaller than that of cFF. Cell viability was significantly lower in cFFs and apoptotic level was significantly lower in cAd-MSC compared to passage-matched cFF. In the expression of genes related to pluripotency and epigenetic modification, level of HDAC1 in cAd-MSC was significantly higher than in cFF, but expression of Dnmt1 did not differ between the two groups. OCT4 and SOX2 were significantly more highly expressed in cAd-MSC compared to cFF. CONCLUSIONS: cAd-MSC have higher stem-cell potential than cFF in terms of proliferation patterns, epigenetic modification and pluripotency, thus cAd-MSC could be more appropriate than cFF as donors of nuclei in somatic cell nuclear transfer for transgenesis.