Association between the Urine Cotinine Level and Blood Pressure in Korean Adults with Secondhand Smoke Exposure: Korea National Health and Nutritional Examination Survey 2016-2018.

BACKGROUND: Similar to smoking, exposure to secondhand smoke is a risk factor for developing hypertension and cardiovascular diseases; however, there is no standardized method for measuring smoke exposure. Measuring urine cotinine levels is one possible means for determining the degree of exposure to secondhand smoke. This study investigated the association between urinary cotinine levels and blood pressure in Korean adults exposed to secondhand smoke. METHODS: Data from the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2018 were used. A total of 9,273 participants aged ≥19 years self-reported as current non-smokers, which was cotinine- verified. A complex sample general linear model regression analysis was performed to analyze the association between urine cotinine and blood pressure. A P-value of <0.05 was considered statistically significant. RESULTS: Corrected urine cotinine levels were positively associated with systolic and diastolic blood pressure in female participants (P<0.001 and P=0.040, respectively). Furthermore, a 10-fold increase in the corrected urine cotinine level of those in contact with secondhand smoke was independently associated with 2.085 mm Hg and 0.575 mm Hg increases in systolic and diastolic blood pressure, respectively. However, there was no association between systolic and diastolic blood pressure in male participants (P=0.226 and P=0.256, respectively). CONCLUSION: Urinary cotinine levels were positively associated with increased blood pressure in females exposed to secondhand smoke. Therefore, urinary cotinine may be used as an indicator to quantify and monitor the effects of blood pressure elevation in females exposed to secondhand smoke.

Associations Between Korean Coronary Heart Disease Risk Score and Cognitive Function in Dementia-Free Korean Older Adults.

BACKGROUND: Cardiovascular risk is a modifiable factor that can help prevent dementia. Given the dearth of optimal treatment options, managing dementia risk factors is crucial. We examined the association between cardiovascular risk, as measured by the Korean coronary heart disease risk score (KRS), and cognitive function in dementia-free elderly individuals. METHODS: We enrolled 8,600 individuals (average age: 69.74 years; 5,206 women) who underwent a medical evaluation from the National Health Insurance Service. KRS was calculated using age, sex, blood pressure, lipid profile, diabetes, and smoking status. Cognitive function was evaluated using Korean Dementia Screening Questionnaire-Cognition (KDSQ-C). Scores of ≥ 6 indicated a cognitive decline. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Weight, height, stroke history, coronary heart disease history, alcohol consumption, and physical activity engagement were adjusted. RESULTS: The lowest, middle, and highest groups, according to the KRS, were 5,923 (68.9%), 2,343 (27.2%), and 334 (3.9%), respectively. The highest KRS group in all participants exhibited a greater risk of cognitive decline than the lowest KRS group (OR, 1.339; 95% CI, 1.034-1.734; P = 0.027). The highest KRS female group aged 71-75 years old exhibited greater cognitive decline than the corresponding lowest KRS group (OR, 1.595; 95% CI, 1.045-2.434; P = 0.031). CONCLUSION: Individuals with high cardiovascular risk were associated with poorer cognitive function than those with low risk, especially older women. Cardiovascular risk factors should be carefully managed to promote healthy mental aging in dementia-free elderly individuals.

Comparison between the International Classification of Primary Care and the International Classification of Diseases Classifications in Primary Care in Korea.

BACKGROUND: The International Classification of Primary Care-2 (ICPC-2) is a classification method designed for primary care. Although previous studies have found that ICPC-2 is a useful tool for demonstrating the relationship between patients' expectations and health providers' diagnoses, its utility of ICPC-2 has yet to be fully studied in Korea. This study aimed to evaluate the practicality of ICPC-2 in Korean primary care. METHODS: The study was conducted at primary care clinics in Seoul and Gyeonggi areas from October to November 2015. Third-year family medicine residents examined and analyzed the medical records of patients who visited primary care physicians using ICPC-2, and the results were compared with those obtained using the International Classification of Diseases-10 (ICD-10) (Korean version: Korean Standard Classification of Diseases-7). RESULTS: A total of 26 primary care physicians from 23 primary care clinics participated in the study. Furthermore, 2,458 ICD-10 codes and 6,091 ICPC-2 codes were recorded from the data of 1,099 patients. The common disease codes were vasomotor and allergic rhinitis (J30), according to ICD-10, and acute upper respiratory infection (R74) in ICPC-2. Comparing disease status by body systems, the proportion of gastrointestinal disease with ICD-10 codes was significantly higher than that with ICPC-2 codes (P<0.001). Furthermore, patients with >4 diagnoses accounted for 36% of the ICD-10 classifications, whereas those with >4 diagnoses accounted for 4% of the ICPC-2 classifications. CONCLUSION: Introducing ICPC as a complementary means for diagnosing common diseases could be a practical approach in Korean primary care.

Defining Essential Topics and Procedures for Korean Family Medicine Residency Training.

BACKGROUND: This study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea. METHODS: Three e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited. RESULTS: Of 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively. CONCLUSION: This national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.

Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings.

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and "healthy aging" become more and more important, these guidelines are also expected to increase in clinical usefulness.

Korean Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer.

CONTEXT: The goal of palliative care is to maximize the quality of life and thus maintain the dignity of patients facing problems associated with a life-threatening illness. The Patient Dignity Inventory (PDI) is an instrument used to measure various sources of distress that can impact patients' sense of dignity at the end of life. OBJECTIVES: We aimed to obtain a Korean translation of the PDI (PDI-K) and evaluate its psychometric properties in patients with advanced cancer. METHODS: Translation and cultural adaptation of the PDI were performed to obtain the Korean version. In a sample of 131 inpatients and outpatients with advanced cancer, psychometric properties, including factor structure, internal consistency, and concurrent validity, were examined. Concurrent validity was evaluated using the Edmonton Symptom Assessment System, the Hospital Anxiety and Depression Scale, and the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being. RESULTS: Cronbach's α for the PDI-K was 0.96. Four factors were identified by exploratory factor analysis, accounting for 68.7% of the overall variance: Dependency and Physical Symptoms, Psychological Distress, Existential Distress, and SocialSupport. Concurrent validity was confirmed by significant correlations between PDI-K and Edmonton Symptom Assessment System (r = 0.40 to 0.59, P < 0.001), Hospital Anxiety and Depression Scale (r = 0.78 to 0.81, P < 0.001), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (r = -0.32 to -0.57, P < 0.001). CONCLUSION: Our findings indicate that the PDI-K is a valid and reliable instrument to measure dignity-related distress in patients with advanced cancer. This tool provides a four-factor Korean language alternative to the PDI.

An Updated Meta-analysis on the Risk of Urologic Cancer in Patients with Systemic Lupus Erythematosus.

BACKGROUND: The risk of urologic cancers in patients with systemic lupus erythematosus (SLE) remains uncertain. We investigated the association between SLE and incident urologic cancers through a systematic review and meta-analysis. METHODS: We searched the PubMed, EMBASE, and the Cochrane Library to identify articles that recorded prostate, bladder, or kidney cancers in SLE patients from inception to August 31, 2018. We included observational, case-control, or cohort studies with no language restriction. Two investigators screened and extracted the data independently. RESULTS: Fourteen cohort studies with 83,860 SLE patients were finally analyzed. Overall, SLE patients were at increased risk of bladder cancer (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.15-3.21) but not of prostate or kidney cancer. However, subgroup analyses showed a reduced risk of prostate cancer in <10-year follow-up studies (HR, 0.68; 95% CI, 0.51-0.89) and an elevated risk of kidney cancer in patients with SLE in Western studies (HR, 2.00; 95% CI, 1.02-3.92), community-based studies (HR, 4.54; 95% CI, 2.17-9.52), prospective studies (HR, 6.84; 95% CI, 2.71-17.26), <10-year follow-up studies (HR, 1.88; 95% CI, 1.38-2.57), and low-quality studies (HR, 2.05; 95% CI, 1.50-2.80). CONCLUSION: This study indicates that SLE increases the risk of bladder cancer but not prostate or kidney cancer. Well-designed long-term studies are required to confirm these associations.

Adult height is not associated with the risk of stomach cancer in a meta-analysis.

BACKGROUND: Adult height has been suggested as a biomarker for a wide range of diseases. However, there are epidemiologic inconsistencies regarding the association between adult height and stomach cancer risk. METHODS: We retrieved PubMed, EMBASE and Cochrane library databases to identify relevant studies assessing the relationship between height and risk of stomach cancer, published from inception to June 4, 2019. We pooled effect sizes for 5-cm height increments using a random-effect model and obtained the cumulative relative risk (RR) and 95% confidence interval (CI). Additionally, we performed subgroup investigation with sensitivity analysis and tested for publication bias using the Begg rank correlation test. RESULTS: We analyzed 11 studies involving 137,451 cases. The summary of effect size (95% CI) of stomach cancer for a 5-cm-increase in adult height was 0.99 (0.95-1.02). A "leave-one-out" sensitivity analysis indicated that the heterogeneity decreased by a half and the result showed significance (RR, 0.972; 95% CI, 0.948-0.997). Subgroup analyses found no significant associations, with one exception. The exception also depended entirely on one study. We found no significant publication bias (P=0.276). CONCLUSIONS: Height is not associated with increased stomach cancer risk. Epidemiologic studies of potential confounders are needed to clarify the association.

Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study.

BACKGROUND: Although palliative care providers, patients, and their families rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention. METHODS: As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to a single hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independent prognostic factors. RESULTS: Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. The median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatremia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15-2.04), poor performance status (HR = 1.45, 95% CI: 1.09-1.94), leukocytosis (HR = 1.98, 95% CI: 1.47-2.66), hypoalbuminemia (HR = 2.06, 95% CI: 1.49-2.73), and hypernatremia (HR = 1.55, 95% CI: 1.18-2.03) emerged as significant predictors of poor prognosis. CONCLUSION: Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further large-scale prospective studies are needed to corroborate this finding.

Nonalcoholic Fatty Liver Disease as a Risk Factor for Prolonged Corrected QT Interval in Apparently Healthy Korean Women.

BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) is clinically important because of its association with an increased risk of sudden cardiac death as well as liver-related mortality. Most cases of sudden cardiac death could be mediated by an arrhythmogenic process. Thus, we aimed to determine the association between NAFLD and corrected QT (QTc) interval in apparently healthy Korean women. METHODS: This cross-sectional study included 764 women aged 20 to 74 years old who underwent a health examination program between 2014 and 2015. The QTc interval was calculated using Bazett's formula (QTc = QT/√RR). Multiple linear and logistic regression analysis were performed to assess independent relationships between NAFLD and QTc interval and prolonged QTc (≥ 450 milliseconds) was calculated after adjusting for confounding variables. RESULTS: The overall prevalence of NAFLD was 23.5% in general healthy women. The standardized ß coefficient (95% confidence interval) of the QTc increment in patients with NAFLD was 6.4 milliseconds (1.2-11.8) through multiple linear regression analysis after adjusting for age, body mass index, smoking status, and regular exercise as well as mean arterial pressure, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, calcium, potassium levels and menopause status. Similarly, the odds ratio (95% confidence interval) of NAFLD for prolonged QTc was 2.05 (1.13-3.71) according to multiple logistic regression analysis after adjusting for the same covariables in women aged 20 to 74 years old. CONCLUSION: We demonstrated the arrhythmogenic potential of NAFLD, implying that careful monitoring of patient electrocardiograms is necessary to evaluate the possible arrhythmic risk in general healthy women with NAFLD.

Clinical Practice Guideline for Care in the Last Days of Life.

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

Anemia in Association with Cognitive Impairment: A Systematic Review and Meta-Analysis.

BACKGROUND: Prevalence of both anemia and cognitive impairment tends to increase with age. Individual studies have recently shown that anemia could be associated with cognitive impairment. OBJECTIVE: To investigate the association between anemia and cognitive impairment including dementia. METHODS: Two of the authors systematically searched PubMed, EMBASE, and the Cochrane library to retrieve observational studies reporting a relationship between anemia and cognitive impairment from 1964 to July 10, 2019. Case-control and cohort studies were included, and odds ratios (ORs) or relative risks (RRs) with 95% confidence intervals (CIs) for the risk of cognitive impairment were calculated using a random-effects model. RESULTS: In total, 16 observational studies including eight case-control studies and eight cohort studies were included in the final analysis. Anemia was significantly linked to cognitive impairment (OR or RR 1.51; 95% CI: 1.32-1.73) in a random-effects meta-analysis, albeit with medium heterogeneity (I2 = 47.8%). Meta-estimates of dementia from prospective population-based cohort studies were similar (RR 1.46; 95% CI: 1.22-1.76) without substantial heterogeneity (I2 = 23.2%). CONCLUSION: Our meta-analysis indicates that anemia is associated with cognitive impairment. Further prospective research is warranted to determine the cause-effect relationship of anemia with cognitive impairment and whether treatment of anemia might reduce the risk of dementia.

Association between serum carcinoembryonic antigen (CEA) levels and leukoaraiosis in middle-aged and older adults: A cross-sectional study.

BACKGROUND: Leukoaraiosis refers to lesions of high signal intensities in periventricular and subcortical white matter, which result from chronic microvascular ischemic damage of the brain. Emerging evidence suggests that serum carcinoembryonic antigen (CEA) is elevated in cardiometabolic diseases, which are closely related with microangiopathy. Thus, we hypothesized that serum CEA levels could be associated with leukoaraiosis and aimed to examine this association among middle-aged and older adults. METHODS: This cross-sectional study included 2164 Korean adults aged ≥ 45 years who underwent a health examination program at a single hospital between 2010 and 2015. Serum CEA levels were quantified by chemiluminescence immunoassay and categorized as quartiles: Q1: ≤ 1.1, Q2: 1.2-1.6, Q2: 1.7-2.4, and Q4: ≥ 2.5 µg/L. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for leukoaraiosis based on brain MRI scans were calculated across serum CEA quartiles using multiple logistic regression analysis after adjusting for age, sex, body mass index, smoking status, fasting plasma glucose, triglyceride, HDL-cholesterol, hypertension, type 2 diabetes, and leukocyte count. RESULTS: The overall prevalence of leukoaraiosis was 5.4% and increased with serum CEA quartiles: 3.3% for Q1, 5.0% for Q2, 5.8% for Q3, and 7.6% for Q4 (P < 0.001). The OR (95% CI) of the highest CEA quartile, compared to the lowest quartile, for leukoaraiosis was 2.164 (1.169-4.006) after adjusting for confounding variables. CONCLUSIONS: Serum CEA levels were positively and independently associated with leukoaraiosis. Our findings indicate that serum CEA level might be useful additional measure in assessing leukoaraiosis in clinical settings.

Risk of pancreatic cancer in patients with systemic lupus erythematosus: a meta-analysis.

OBJECT: Accumulating evidences suggest that the incidence of several cancers is higher in systemic lupus erythematosus (SLE) than in general population. However, the finding on pancreatic cancer risk is inconsistent. This meta-analysis aimed to determine whether SLE patients are at risk for pancreatic cancer. METHODS: We searched PubMed, Embase, and the Cochrane database to screen the studies meeting our criteria. The hazard ratios (HRs) and its 95% confidence interval (CIs) were calculated from a meta-analysis. RESULTS: Eleven cohort studies were included in the final analysis. Overall, patients with SLE had an increased risk of pancreatic cancer (HR = 1.42, CI = 1.32-1.53). In subgroup analysis, hospital-based (HR = 1.43, CI = 1.32-1.54), retrospective (HR = 1.42, CI = 1.32-1.54), over 10 years followed (HR = 1.44, CI = 1.33-1.55), and low-quality studies (HR = 1.42, CI = 1.31-1.53) remained robust. Significant publication bias was not observed among the studies (p = 0.533). CONCLUSIONS: The synthesized evidence from our meta-analysis demonstrated that SLE was associated with increased risk for pancreatic cancer. A well-designed, long-period followed study is needed to confirm this association. Key Points • Cancer incidence in SLE patients is increasing, but the data concerning pancreatic cancer remains inconclusive. • Our meta-analysis indicated that the risk of pancreatic cancer was significantly increased in SLE patients. • A well-designed, long-period followed study is needed to confirm the association.

The impact of the sleep duration on NAFLD score in Korean middle-aged adults: a community-based cohort study.

BACKGROUND: Accumulated evidences indicates that sleep duration and sleep quality may potentially trigger the development of non-alcoholic fatty liver disease (NAFLD), but no studies have explored this causality. In this study, we aimed to investigate the effect of sleep duration on the incidence of NAFLD in Korean middle-aged adults. METHODS: All participants were selected from the cohort of the Korean Genome and Epidemiology Study (KoGES) for a 10-year period. NAFLD was defined by Fatty Liver Index (FLI), NAFLD liver fat score (NLFS), Hepatic Steatosis Index (HSI) and Lipid Accumulation Product (LAP). Multiple logistic regression analysis was used to assess the relationship between sleep duration and NAFLD defined by NAFLD scores. ANCOVA and Spline curve was also used to verify the differences in means of NAFLD scores according to the four sleep duration groups. RESULTS: In comparison with those of individuals in the reference group, the OR (95% CI) for NAFLD was 2.230 (1.304-3.813) for group of people who slept more than 8 h, 1.869 (1.298-2.691) for 7-8 h after adjusting for several confounding factors. The odds ratio for the incidence of NAFLD was 1.462 (1.029-2.077) for the group of people who sleep more than 8 h, 1.271 (1.001-1.615) for 7-8 h after adjusting for age, sex, BMI, SBP, DBP, TG, HDL, FDG, smoking, physical activity, daytime napping and night-time shifting (p < 0.01). CONCLUSION: These findings indicate a relationship between long sleep duration and the elevation of NAFLD scores and support the causality of sleep duration and incidence of NAFLD in Korean middle-aged adults.

Relationship between serum alkaline phosphatase level, C-reactive protein and leukocyte counts in adults aged 60 years or older.

Serum alkaline phosphatase (ALP), a useful marker of hepatobiliary or bone disorders, has been known to be associated with cardiovascular disease (CVD), which is increasingly being viewed as an inflammatory disease. C-reactive protein level and leukocyte count have also been highlighted as independent risk markers of CVD. Thus, the mechanism underlying the link between elevated ALP and CVD could be subclinical low-grade inflammation. This study aimed to examine associations of serum ALP level with inflammatory markers. This cross-sectional study included 2403 participants (1324 men and 1079 women) aged ≥60 years who participated in a health examination program. Serum ALP quartiles were categorized as follows: Q1: ≤51, Q2: 52-61, Q3: 62-74 and Q4: ≥75 U/L. The odds ratios (ORs) and 95% confidence intervals (CIs) for high CRP and leukocyte count (≥75th percentiles) were calculated after adjusting for confounding variables across serum ALP quartiles using multiple logistic regression analysis. Median CRP level and mean leukocyte count increased in accordance with serum ALP quartiles. Compared to the lowest quartile, the ORs (95% CI) of the highest quartile for high CRP and leukocyte count were 2.03 (1.50-2.76) and 1.54 (1.13-2.10) after adjusting for age, sex, body mass index, smoking status, alcohol intake, fasting plasma glucose, log-transformed triglyceride and HDL-cholesterol levels. Serum ALP level was positively and independently associated with inflammatory markers in adults aged 60 years or older.

High triglyceride to high-density lipoprotein cholesterol ratio and arterial stiffness in postmenopausal Korean women.

The ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL) is positively linked to insulin resistance, and it has emerged as an independent predictor of cardiovascular disease. Menopause is characterized by various detrimental metabolic and vascular changes that may lead to high TG with low HDL cholesterol and arterial stiffness. Several epidemiological studies have reported that high TG/HDL ratio has a positive association with arterial stiffness in both adult and adolescent populations; it is not known whether TG/HDL ratio is related to brachial-ankle PWV (baPWV) in postmenopausal women. Thus, the authors aimed to investigate the association between TG/HDL ratio and arterial stiffness as measured by baPWV in 434 postmenopausal women. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for high baPWV were calculated after adjusting for confounding variables across TG/HDL ratio quartiles using multiple logistic regression analysis. The mean values of meaningful cardiometabolic variables increased with TG/HDL ratio quartiles. The adjusted baPWV (SEs) significantly increased with TG/HDL quartiles: Q1 = 1412 (22.1), Q2 = 1469 (21.4), Q3 = 1482 (21.0), and Q4 = 1505 (21.6) cm/s after adjusting for age, body mass index (BMI), and systolic blood pressure. The OR (95% CI) of the highest TG/HDL ratio quartile as compared to the lowest TG/HDL ratio quartile for high PWV was 2.77 (1.16-6.63) after adjusting for age, BMI, smoking status, regular exercise, mean arterial pressure, fasting plasma glucose, total cholesterol level, hypertension, log-transformed C-reactive protein, and the use of antihypertensive and lipid-lowering drugs. The TG/HDL ratio was positively and independently associated with arterial stiffness in postmenopausal Korean women.

Long-Term Exposure to Air Pollutants and Cancer Mortality: A Meta-Analysis of Cohort Studies.

The aim of this study was to examine the relationship between main air pollutants and all cancer mortality by performing a meta-analysis. We searched PubMed, EMBASE (a biomedical and pharmacological bibliographic database of published literature produced by Elsevier), and the reference lists of other reviews until April 2018. A random-effects model was employed to analyze the meta-estimates of each pollutant. A total of 30 cohort studies were included in the final analysis. Overall risk estimates of cancer mortality for 10 µg/m³ per increase of particulate matter (PM)2.5, PM10, and NO2 were 1.17 (95% confidence interval (CI): 1.11⁻1.24), 1.09 (95% CI: 1.04⁻1.14), and 1.06 (95% CI: 1.02⁻1.10), respectively. With respect to the type of cancer, significant hazardous influences of PM2.5 were noticed for lung cancer mortality and non-lung cancer mortality including liver cancer, colorectal cancer, bladder cancer, and kidney cancer, respectively, while PM10 had harmful effects on mortality from lung cancer, pancreas cancer, and larynx cancer. Our meta-analysis of cohort studies indicates that exposure to the main air pollutants is associated with increased mortality from all cancers.

Safety and tolerability of Korean Red Ginseng in healthy adults: a multicenter, double-blind, randomized, placebo-controlled trial.

BACKGROUND: Korean Red Ginseng (KRG) has been used in Asia for its various biological effects, but no studies have investigated the safety of its long-term intake. Therefore, the present study evaluated the safety of KRG intake for 24 weeks. METHODS: We randomized 1,000 participants in a 1:1 ratio into two groups, which were treated daily with 2 g of KRG or a placebo for 24 weeks. The primary endpoint was all adverse events and adverse drug reactions (ADRs) that occurred after KRG or placebo administration, which were reported at week 4, 12, and 24 after the baseline visit. RESULTS: In total, 192 and 211 participants experienced adverse events in the KRG and placebo groups (39.2% and 42.0%, respectively; p = 0.361), and 59 and 57 KRG- and placebo-treated individuals reported ADRs (12.0% and 11.4%, respectively; p = 0.737). The frequently occurring ADRs were pruritus (2.0%), headache (1.6%), diarrhea (1.4%), and dizziness (1.2%) in the KRG group and pruritus (2.0%), headache (1.8%), dizziness (1.6%), rash (1.4%), and diarrhea (1.2%) in the placebo group. Discontinuation of drug administration due to ADRs was reported in 13 participants, six (1.2%) and seven (1.4%) in the KRG and placebo groups, respectively (p = 0.814). No significant abnormal changes were revealed by anthropometric, laboratory, and vital sign measurements in the KRG group compared with those in the placebo group. CONCLUSION: The present study confirms the safety and tolerability of daily intake of 2 g of KRG for 24 weeks by healthy adults.

Comparative Evaluation of Recombinant Human Bone Morphogenetic Protein-2/Hydroxyapatite and Bovine Bone for New Bone Formation in Alveolar Ridge Preservation.

PURPOSE: Hydroxyapatite treated with recombinant human bone morphogenetic protein-2/Hydroxyapatite (rhBMP-2/HA) or bovine bone was applied on extraction sockets for alveolar ridge preservation, and the results were compared with respect to clinical and histological bone formation. MATERIALS AND METHODS: This was a prospective, randomized controlled clinical trial performed on 20 implant placement sites (10 in the experimental and 10 in the control group). rhBMP-2/HA was applied on extraction sockets in the experimental group and bovine bone on those of the control group. The bone at the corresponding sites was biopsied 3 months later, and clinical, histological, and histomorphometric analyses were performed. RESULTS: The alveolar bone height was well preserved in both groups with relatively less change in width in the experimental group compared with the control group. The percentage of new bone was 25.37% ± 17.23% in the experimental group and 6.13% ± 4.32% in the control group; the difference was statistically significant. CONCLUSIONS: The alveolar ridge was preserved clinically and histologically in both groups. rhBMP-2/HA resulted in greater new bone formation than bovine bone 3 months after the surgery.