Trauma Exposure and Suicidal Ideation among Korean Male Firefighters: Examining the Moderating Roles of Organizational Climate.

Background: This study investigated the relationship between trauma exposure and suicidal ideation. Moreover, this study examines the moderating roles of organizational climate on the association between trauma exposure and suicidal ideation in Korean male firefighters. Methods: A total of 15,104 male firefighters who completed a questionnaire were analyzed. The data were obtained using an online self-administered questionnaire from the Firefighter Research on Enhancement of Safety and Health Study. Poisson regression analysis was performed to determine the effects of trauma exposure on suicidal ideation and the moderating effect of organizational climate. Results: The results showed that 389 firefighters (2.6%) responded that they had experienced suicidal ideation. In the final model, trauma exposure was positively related to suicidal ideation (adjusted risk ratio [aRR], 1.076; 95% confidence interval [CI]: 1.051-1.103), and organizational climate was negatively associated with suicidal ideation (aRR, 0.772; 95% CI: 0.739-0.806). Additionally, the interaction term (trauma exposure × organizational climate) was related to suicidal ideation (aRR, 1.016; 95% CI: 1.009-1.023). Conclusions: This study suggests that trauma exposure might play a significant role in developing suicidal ideation and that positive organizational climate moderates the negative effects of trauma exposure on suicidal ideation among firefighters. It is necessary to perform a follow-up study of various intervention strategies to maintain a healthy organizational climate or work environment. Such interventions should promote lasting trust within teams, provide social support and belonging, and nurture job value.

Relation of Dietary n-3 and n-6 Fatty Acid Intakes to Metabolic Syndrome in Middle-Aged People Depending on the Level of HbA1c: A Review of National Health and Nutrition Survey Data from 2014 to 2016.

Background and Objectives: The relation of dietary n-6 fatty acid to metabolic syndrome has not been examined and clearly defined. To improve health in the general population, this study was to investigate the role of n-3 and n-6 fatty acids in the reduction in metabolic syndrome and to observe changes in the effects of these fatty acids depending on the level of insulin resistance. Materials and Methods: This cross-sectional study utilized national health and nutrition survey data from 2014 to 2016. From the data, a relation of n-3 and n-6 fatty acid intakes to metabolic syndrome and Hemoglobin A1c (HbA1c)'s role in the relation was evaluated and analyzed for 4852 patients between 40 and 64 years old. Intake frequency of 112 nutrition and daily consumption amounts were identified, and intakes of n-3 and n-4 fatty acids were calculated from this data. Metabolic syndrome was determined for each participant using diagnostic standards for the Asian population published by the National Cholesterol Education Program. Results: Among the total 4852 subjects, 1583 (32.6%) had metabolic syndrome; 736 of 1875 (39.3%) males and 847 of 2977 (28.5%) females had the syndrome. In males, when their HbA1c was low (<5.4%), intakes of both n-3 and n-6 fatty acids were related to a 43−63% decreased prevalence of metabolic syndrome with significance, and a similar negative tendency was also observed in females. On the contrary, for both males and females, no statistically significant correlation was present when HbA1c was high. Conclusion: It was considered that consistent and regular dietary intakes of n-3 and n-6 fatty acids may contribute greatly to prevent or treat metabolic syndrome in healthy males with normal insulin sensitivity, but the effect of their dietary intakes was found to be limited in a group with strong insulin resistance. The conclusion of this study presents a valuable reference and knowledge to provide nutritional education to the general population.

Effects of Emergency Duties on Cardiovascular Diseases in Firefighters: A 13-Year Retrospective Cohort Study.

OBJECTIVES: This study aimed to examine the effects of firefighters' emergency duties on the incidence of cardiovascular disease (CVD). METHODS: We used a 13-year follow-up in a nationwide retrospective cohort study. A total of 363,137 employees were recruited. The sex-and age-specific incidence of CVD (hypertension, angina pectoris, and acutemyocardial infarction [AMI]) in firefighters and public officials was estimated. RESULTS: The overall age-specific sex-based incidence of CVD, except for hypertension, was higher in firefighters than in public officials. The age-stratified hazard ratios for the three types of CVD in male firefighters were also higher. AMI was more common in younger firefighters, whereas angina pectoris and hypertension were common in older firefighters. CONCLUSIONS: Firefighters' duties are more likely to increase the risk of CVD, and preventive strategies with proven benefits are required.

Regional Gray Matter Volume Related to High Occupational Stress in Firefighters.

BACKGROUND: Firefighters inevitably encounter emotionally and physically stressful situations at work. Even firefighters without diagnosed post-traumatic stress disorder receive clinical attention because the nature of the profession exposes them to repetitive trauma and high occupational stress. This study investigated gray matter abnormalities related to high occupational stress in firefighters using voxel-based morphometry (VBM) and surface-based morphometry (SBM). METHODS: We assessed 115 subjects (112 males and 3 females) using magnetic resonance imaging and evaluated occupational stress by the Korean Occupational Stress Scale-26 (KOSS-26). Subjects were classified into highly or lowly stressed groups based on the median value of the KOSS-26. RESULTS: In VBM analysis, we found that firefighters with high occupational stress had lower gray matter volume (GMV) in both sides of the insula, the left amygdala, the right medial prefrontal cortex (mPFC), and the anterior cingulate cortex than firefighters with low occupational stress. In SBM analysis based on regions of interest, the GMV of the bilateral insula and right mPFC were also lower in the highly stressed group. Within the highly stressed group, low GMV of the insula was significantly correlated with the length of service (left: r = -0.347, P = 0.009; right: r = -0.333, P = 0.012). CONCLUSION: Our findings suggest that regional GMV abnormalities are related to occupational stress. Regional gray matter abnormalities and related emotional dysregulation may contribute to firefighter susceptibility to burnout.

Differential relationship between dietary fat and cholesterol on total mortality in Korean population cohorts.

BACKGROUND: Associations among dietary fat, cholesterol intake and total mortality remain controversial, and most available data cover Western populations. The aim of this study was to assess associations for dietary fat and cholesterol in relation to total mortality in Koreans. METHODS: This study used data from three prospective Korean Genome and Epidemiology studies (conducted between June 2001 and December 2013). A total of 194,295 middle-aged and older Korean adults were included. Dietary fat intake was classified into quintiles. Dietary cholesterol intake was categorized into three groups based on cholesterol intake as follows: <200 mg, 200-299 mg and ≥300 mg. A multivariable Cox frailty model with random effects was applied to calculate hazard ratios (HR) and 95% confidence intervals (CIs) after adjusting for confounders. RESULTS: We documented 3866 deaths across a mean (min-max) follow-up period of 8.15 years (3-13 years). Higher fat intake was associated with lower total mortality (Q5 vs. Q1, HR 0.82 [95% CI 0.69, 0.98]; p trend < 0.01) after adjusting for age, sex, body mass index, alcohol, smoking, exercise and total calorie and protein (%) intake. Higher dietary cholesterol intake (≥300 mg/day) was associated with a higher risk of total mortality (HR 1.19 [95% CI 1.04, 1.37]) than lower cholesterol intake (<200 mg/day) in the multivariate model. CONCLUSIONS: In Koreans, high dietary fat intake is associated with a lower risk of total mortality, while dietary cholesterol intake above 300 mg/day is associated with a higher risk of total mortality.

Organizational Climate Effects on the Relationship Between Emotional Labor and Turnover Intention in Korean Firefighters.

BACKGROUND: The purpose of this study is to examine the combined effects of organizational climate (OC) with emotional labor (EL) on turnover intention in Korean firefighters. METHODS: The data were obtained from the study Firefighters Research: Enhancement of Safety and Health. A total of 4,860 firefighters whose main duty was providing "emergency medical aid" were included. To examine the effects of OC on the relationships between five subscales of EL and turnover intention, four groups were created using various combinations of OC ("good" vs. "bad") and EL ("normal" vs. "risk"): (1) "good" and "normal" (Group I), (2) "bad" and "normal" (Group II), (3) "good" and "risk" (Group III), and (4) "bad" and "risk" (Group IV). Multivariate logistic regression analyses were performed to estimate the risk of turnover intention for the combinations of OC and EL. RESULTS: The results showed turnover intention was significantly higher in the group with "bad" OC (17.7%) than in that with "good" OC (7.6%). Combined effects of OC and EL on turnover intention were found in all five subscales with the exception of Group I for emotional demands and regulation. Groups II, III, and IV were more likely to experience risks of turnover intention than Group I (p for trend <0.001). CONCLUSIONS: A positive and cooperative OC plays a role in decreasing the risk of turnover intention and in attenuating the negative effects of EL on turnover intention in firefighters.

Mediating Effects of Burnout in the Association Between Emotional Labor and Turnover Intention in Korean Clinical Nurses.

BACKGROUND: The current lack of the number of nurses and high nurse turnover rate leads to major problems for the health-care system in terms of cost, patient care ability, and quality of care. Theoretically, burnout may help link emotional labor with turnover intention. The purpose of this study was to investigate the mediating effect of burnout in the association between emotional labor and turnover intention in Korean clinical nurses. METHODS: Using data collected from a sample of 606 nurses from six Korean hospitals, we conducted a multiple regression analysis to determine the relationships among clinical nurses' emotional labor, burnout, and turnover intention, looking at burnout as a mediator. RESULTS: The results fully and partially support the mediating role of burnout in the relationship between the subfactors of emotional labor and turnover intention. In particular, burnout partially mediated the relationship between emotional disharmony and hurt, organizational surveillance and monitoring, and lack of a supportive and protective system in the organization. In addition, we found that burnout has a significant full mediation effect on the relationship between overload and conflicts in customer service and turnover intention. Although the mediating effect of burnout was significantly associated with the demands and regulation of emotions, no significant effects on turnover intention were found. CONCLUSION: To reduce nurses' turnover, we recommend developing strategies that target both burnout and emotional labor, given that burnout fully and partially mediated the effects of emotional labor on turnover intention, and emotional labor was directly associated with turnover intention.

Does Emotional Labor Increase the Risk of Suicidal Ideation among Firefighters?

PURPOSE: To investigate whether emotional labor is associated with suicidal ideation in Korean firefighters. MATERIALS AND METHODS: Data were obtained from the Firefighter Research: Enhancement of Safety & Health (FRESH) Study, which was designed to investigate the effects of job characteristics on mental and physical health among Korean firefighters. A total of 18101 firefighters were chosen from a nationwide sample. The Korean Emotional Labor Scale (K-ELS) was used to evaluate exposure to emotional labor, which consisted of five sub-factors: emotional demand and regulation, overload and conflict in customer service, emotional disharmony and hurt, organizational surveillance and monitoring, and lack of a supportive and protective system in the organization. RESULTS: Firefighters who were in the risk group were more likely to experience suicidal ideation than those in the normal group for each of the five sub-scales of emotional labor. The estimated mean values for suicidal ideation in the risk group were significantly higher than those in the normal group: 1.667 (95% CI: 1.344-2.069) for emotional demand and regulation, 1.590 (95% CI: 1.243-2.033) for overload and conflict in customer service, 2.409 (95% CI: 1.954-2.969) for emotional disharmony and hurt, 2.214 (95% CI: 1.832-2.676) for organizational surveillance and monitoring, and 1.665 (95% CI: 1.387-1.999) for lack of a supportive and protective system in the organization. CONCLUSION: These results suggest that experience and exposure to chronic and excessive emotional labor might play a crucial role in the development of suicidal ideation among firefighters.

Blood pressure and the risk of major adverse cardiovascular events among firefighters.

OBJECTIVE: No long-term follow-up study has investigated the effect of blood pressure (BP) on cardiovascular disease mortality and morbidity in firefighters. To investigate the effects of BP on the risk of major adverse cardiovascular events (MACEs) using a national representative population-matched cohort. METHODS: We enrolled all firefighters (N = 8242) and 28 678 referent controls aged more than 40 years who underwent baseline health examinations in 2002 and 2003. Records of hospitalization and mortality until 2015 were checked. To evaluate the causal effect of BP on MACE, subcohort analysis using a propensity score-matched (PSM) cohort with respect to job classification (firefighter vs. control) was performed. RESULTS: Hypertension significantly increased the risk of MACEs compared with normal BP in both firefighters and the age--sex matched cohort, but in participants with elevated BP, significantly increased risk of MACEs [hazards ratio 1.41, 95% confidence interval (CI) 1.06-1.88] was observed only among firefighters. In the PSM cohort, firefighters had a significantly higher risk of death or hospitalization from MACEs (hazard ratio 1.29, 95% CI 1.14-1.47), myocardial infarction (hazard ratio 1.24, 95% CI 1.07-1.43), and ischemic stroke (hazard ratio 1.43, 95% CI 1.12-1.82) than controls. Firefighters with elevated BP (hazard ratio 1.58, 95% CI 1.04-2.40), stage 1 (hazard ratio 1.24, 95% CI 1.00-1.52), and stage 2 (hazard ratio 1.39, 95% CI 1.13-1.71) hypertension had higher risk of MACEs than PSM controls. CONCLUSION: Firefighters showed significantly higher cardiovascular risk than referent controls when comparing those within the same BP category, suggesting that firefighters with elevated BP and hypertension may be at high risk of adverse prognosis.

Effect of Burnout on Post-traumatic Stress Disorder Symptoms Among Firefighters in Korea: Data From the Firefighter Research on Enhancement of Safety & Health (FRESH).

OBJECTIVES: It is well-known that post-traumatic stress disorder (PTSD) among firefighters contributes to their job-related stress. However, the relationship between burnout and PTSD in firefighters has rarely been studied. This study therefore explored the association between burnout and its related factors, such as trauma and violence, and PTSD symptoms among firefighters in Korea. METHODS: A total of 535 firefighters participated in the Firefighter Research on Enhancement of Safety & Health study at 3 university hospitals from 2016 to 2017. The 535 participants received a baseline health examination, including questionnaires assessing their mental health. A Web-based survey was also conducted to collect data on job-related stress, history of exposure to violence, burnout, and trauma experience. The associations among burnout, its related factors, and PTSD symptoms were investigated using structural equation modeling. RESULTS: Job demands (ß=0.411, p<0.001) and effort-reward balance (ß=-0.290, p<0.001) were significantly related to burnout. Burnout (ß=0.237, p<0.001) and violence (ß=0.123, p=0.014) were significantly related to PTSD risk. Trauma (ß=0.131, p=0.001) was significantly related to burnout; however, trauma was not directly associated with PTSD scores (ß=0.085, p=0.081). CONCLUSIONS: Our results show that burnout and psychological, sexual, and physical violence at the hands of clients directly affected participants' PTSD symptoms. Burnout mediated the relationship between trauma experience and PTSD.

Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users.

We aimed to test the association between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD), cancer, and all-cause mortality in non-statin users. A total of 347,971 subjects in Kangbuk Samsung Health Study (KSHS.57.4% men, mean follow up: 5.64 ± 3.27 years) were tested. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES, 182,943 subjects). All subjects treated with any lipid-lowering therapy and who died during the first 3 years of follow up were excluded. Five groups were defined according to baseline LDL-C concentration (<70, 70-99, 100-129, 130-159, ≥160 mg/dL). A total of 2028 deaths occurred during follow-up in KSHS. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55-2.47), CVD mortality (HR 2.02, 1.11-3.64), and cancer mortality (HR 2.06, 1.46-2.90) compared to the reference group (LDL 120-139 mg/dL). In the validation cohort, 2338 deaths occurred during follow-up. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44-2.28) compared to the reference group. Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD, and all-cause mortality. These findings suggest that more attention is needed for subjects with no statin-induced decrease in LDL-C concentrations.

Association between the symptoms of benign prostatic hyperplasia and social disparities: Does social capital promote prostate health?

This cross-sectional study investigated the relationships between socioeconomic factors and social capital and benign prostatic hyperplasia symptoms. The participants were 100,000 adult men who participated in the Korea Community Health Survey. The surveyors used the International Prostate Symptom Score. As regards occupation, the prevalence of benign prostatic hyperplasia was higher in men with blue-collar occupations or those who were unemployed than in those with white-collar jobs. In terms of marital status, the prevalence of benign prostatic hyperplasia was 1.319 times higher among divorced men than married men. As regards social capital, the prevalence of benign prostatic hyperplasia in men with positive attitudes towards one's community scores that reflected good, poor and very poor community scores was 1.228, 1.246 and 1.447 times higher than that of men who had very good scores respectively. The groups with good, poor, and very poor community participation scores had 1.115, 1.202 and 1.364 times higher prevalence of benign prostatic hyperplasia than the group with very good scores. Social disparities and social capital of a community were associated with the prevalence of benign prostatic hyperplasia. Thus, the use of social capital in the community setting will be effective in the management of the condition.

Association of Emotional Labor, Self-efficacy, and Type A Personality with Burnout in Korean Dental Hygienists.

The purpose of this study was to examine the relationship between emotional labor and burnout, and whether the levels of self-efficacy and type A personality characteristics increase the risk of burnout in a sample of Korean female dental hygienists. Participants were 807 female dental hygienists with experience in performing customer service for one year or more in dental clinics, dental hospitals, or general hospitals in Korea. Data were collected using a structured self-administered questionnaire. A hierarchical multiple linear regression analysis was used to examine the effects of emotional labor on burnout, and to elucidate the additive effects of self-efficacy and type A personality on burnout. The results showed that "overload and conflict in customer service," "emotional disharmony and hurt," and "lack of a supportive and protective system in the organization" were positively associated with burnout. With reference to the relationship between personality traits and burnout, we found that personal traits such as self-efficacy and type A personality were significantly related to burnout, which confirmed the additive effects of self-efficacy and type A personality on burnout. These results indicate that engaging in excessive and prolonged emotional work in customer service roles is more likely to increase burnout. Additionally, an insufficient organizational supportive and protective system toward the negative consequences of emotional labor was found to accelerate burnout. The present findings also revealed that personality traits such as self-efficacy and type A personality are also important in understanding the relationship between emotional labor and burnout.

[Association between Emotional Labor, Emotional Dissonance, Burnout and Turnover Intention in Clinical Nurses: A Multiple-Group Path Analysis across Job Satisfaction].

PURPOSE: This study was conducted to investigate the influence of emotional labor, emotional dissonance, and burnout on nurse's turnover intention and examine the effect of job satisfaction on the relationships among emotional labor, emotional dissonance, burnout, and turnover intention. METHODS: The sample consisted of 350 nurses recruited from 6 general hospitals in 2 cities in Korea. A multiple-group analysis was utilized. Data were analyzed using SPSS statistics 23 and AMOS 20. RESULTS: In the path analysis, turnover intention was directly related to burnout in clinical nurses who had a high job satisfaction (ß=.24, p=.003), while it was indirectly related to emotional dissonance (ß=.13, p=.002). In the multiple-group path analysis, turnover intention was directly related to emotional dissonance (ß=.18, p=.033) and burnout (ß=.26, p=.002) for nurses with low job satisfaction. CONCLUSION: These results indicate that manuals and guidelines to alleviate the negative effects of emotional labor, emotional dissonance, and burnout, and to increase job satisfaction are strongly required to reduce turnover intention in nurses at the organizational level as well as at the individual level.

A prospective study of the association between total sleep duration and incident hypertension.

The aim of this prospective study was to evaluate total sleep duration as a potential risk factor for the development of hypertension after a mean of 2.6 years of follow-up. The study participants comprised 1715 Korean adults aged 40 to 70 years. The participants were without hypertension at baseline (2005-2008) and during follow-up (2008-2011) to determine the incident cases of hypertension. Based on a self-reported questionnaire, the individuals were stratified according to total sleep duration (<6 hours, 6-7.9 hours, 8-9.9 hours, ≥10 hours). Hypertension was defined according to the Eighth Joint National Committee (JNC 8) guidelines. After an average of 2.6 years of follow-up, 164 (9.56%) participants developed hypertension. In multivariate adjusted models, the odds ratio for new-onset hypertension was 1.71 (95% confidence interval, 1.01-2.89) in participants with a short sleep duration (<6 hours) compared with those who reported 6 to 7.9 hours of sleep. Long sleep duration (more than 8 hours) did not have any significant difference on incident hypertension. Among middle-aged and elderly Korean adults, short sleepers were independently associated with a higher risk of developing hypertension.

Epithelial-mesenchymal transition in patients of pulmonary adenocarcinoma: correlation with cancer stem cell markers and prognosis.

Adenocarcinoma is the most common histologic type of non-small cell lung carcinomas. The existence of lung cancer stem cells (CSCs) and epithelial-mesenchymal transition (EMT) in human tissue is controversy. The aim of this study is to investigate the expression and clinical significance of CSCs and EMT markers and evaluate the correlation between the two in lung adenocarcinoma. A total of 97 cases comprise the tissue microarray from surgical resection for primary lung adenocarcinoma. Immunohistochemistry for ALDH1 and CD44 as CSC markers and E-cadherin, vimentin, fibronectin, SMA as EMT markers was performed. High ALDH1A1 expression was statistically associated with female gender (P=0.001), smoker (P=0.012), and high pT stages (P=0.046). High CD44 expression was statistically associated with female gender (P=0.008), non-smoker (P=0.000), and no pleural invasion (P=0.039). High expression of ALDH1 was associated with good overall survival (P=0.021). High expression of CD44 was correlated with both good overall survival (P=0.024) and disease-free survival (P=0.000). Vimentin expression was associated with pT stage (P=0.001) and pleural invasion (P=0.028). E-cadherin, fibronectin and SMA were not associated with clinicopathologic correlation and all EMT markers were not correlated with survival of lung adenocarcinoma. CSC markers expression was not related to EMT. Our results showed that the expression of CSCs was associated with a good prognosis in lung adenocarcinoma. The prognostic significance of EMT markers was skeptical in this study. There is a need for more research about CSC, EMT, and the relation between these two in human lung adenocarcinoma.

Detection of EGFR mutations in circulating free DNA by PNA-mediated PCR clamping.

BACKGROUND: Epidermal growth factor receptor (EGFR)-activating mutations are major determinants in predicting the tumor response to EGFR tyrosine kinase inhibitors in non-small cell lung cancer (NSCLC). Noninvasive test for the detection of EGFR mutations is required, especially in NSCLC patients from whom tissue is not available. In this study, we assessed the feasibility of detection of EGFR mutations in free DNA circulating in plasma. METHODS: Plasma samples of 60 patients with partial response to gefitinib were analyzed to detect EGFR-activating mutations in exons 19 and 21. Forty (66.7%) of patients had tumor EGFR mutation results. EGFR mutations in plasma were detected using the peptide nucleic acid (PNA)-mediated polymerase chain reaction (PCR) clamping method. All clinical data and plasma samples were obtained from 11 centers of the Korean Molecular Lung Cancer Group (KMLCG). RESULTS: Of the 60 patients, 39 were female and the median age was 62.5 years. Forty-three patients never smoked, 53 had adenocarcinomas, and seven had other histologic types. EGFR-activating mutation was detected in plasma of 10 cases (exon 19 deletion in seven and exon 21 L858R point mutation in three). It could not be found in plasma after treatment for 2 months. When only patients with confirmed EGFR mutation in tumor were analyzed, 17% (6 of 35) of them showed positive plasma EGFR mutation and the mutation type was completely matched with that in tumor. There was no statistically significant difference in clinical parameters between patients with EGFR mutations in plasma and those without EGFR mutations. CONCLUSIONS: The detection rate of EGFR mutations from plasma was not so high despite highly sensitive EGFR mutation test suggesting that more advances in detection methods and further exploration of characteristics of circulating free DNA are required.

Patient's perception of symptoms related to morning activity in chronic obstructive pulmonary disease: the SYMBOL Study.

BACKGROUND/AIMS: Patients with chronic obstructive pulmonary disease (COPD) experience more problematic respiratory symptoms and have more trouble performing daily activities in the morning. The aim of this study was to assess the perception of COPD symptoms related to morning activities in patients with severe airflow limitation. METHODS: Data of 133 patients with severe airflow limitation were analyzed in a prospective, non-interventional study. A clinical symptom questionnaire was completed by patients at baseline. In patients having morning symptoms, defined by at least one or more prominent or aggravating symptom during morning activities, a morning activity questionnaire was also completed at baseline and following 2 months of COPD treatment. RESULTS: The most frequently reported COPD symptom was breathlessness (90.8%). Morning symptoms were reported in 76 (57%) patients; these had more frequent and severe clinical COPD symptoms. The most frequently reported morning activity was getting out of bed (82.9%). The long acting muscarinic antagonist (odds ratio [OR], 6.971; 95% confidence interval [CI], 1.317 to 11.905) and chest tightness (OR, 0.075; 95% CI, 0.011 to 0.518) were identified as significantly related to absence of morning symptoms. There was no significant correlation between the degree of forced expiratory volume in 1 second improvement and severity score differences of all items of morning activity after 2-month treatment. CONCLUSIONS: Fifty-seven percent of COPD patients with severe airflow limitation have morning symptoms that limit their morning activities. These patients also have more prevalent and severe COPD symptoms. The results of this study therefore provide valuable information for the development of patient-reported outcomes in COPD.

Lymphocytic interstitial pneumonia in primary Sjögren's syndrome: a case report.

Sjögren's syndrome (SS) is an autoimmune disorder in which lymphocytes infiltrate the exocrine glands, resulting in the development of sicca symptoms. Lymphocytes may also invade various other organs and cause diverse symptoms. Interstitial pneumonia has been observed frequently in SS patients. Typically, the pneumonia responds well to systemic steroids, and fatal cases are rare. We experienced a case of lymphocytic pneumonia accompanied by SS and treated with cyclophosphamide pulse therapy, and we present details of the case herein.

Anti-fibrotic effect of thalidomide through inhibiting TGF-beta-induced ERK1/2 pathways in bleomycin-induced lung fibrosis in mice.

OBJECTIVES: This study is designed to confirm the anti-fibrotic effect of thalidomide on bleomycin-induced lung fibrosis in a mouse model and to identify whether this anti-fibrotic effect is associated with inhibition of the transforming growth factor-beta (TGF-beta)-induced extracellular signal-regulated kinase1/2 (ERK1/2). METHODS AND MATERIALS: C57BL/6 female mice were administered blomycin sulfate. In cultured human lung fibroblasts, expressions of type I collagen, fibronectin, and either TGF-beta or IL-6 were measured after thalidomide treatment by reverse transcription-polymerase chain reaction (RT-PCR). Expressions of ERK1/2, type I collagen, fibronectin, and TGF-beta1 from lung tissues of blomycin-induced mice and from mouse lung fibroblasts were evaluated using RT-PCR and western blotting. RESULTS: Thalidomide administration significantly inhibits TGF-beta1 mRNA expression in a dose-dependant manner following administration of IL-6 and IL-6R. In the analysis of BAL fluids, total BAL inflammatory cell counts, TGF-beta1, and IL-6 levels in thalidomide-treated mice were significantly reduced when compared with bleomycin-treated mice (p < 0.01, p < 0.01, and p < 0.001, respectively). Thalidomide inhibited total ERK1/2 and phospho-ERK1/2 expression after TGF-beta1 stimulation in the RT-PCR and western blotting. CONCLUSION: The results of our study suggest that the anti-fibrotic effect of thalidomide on lung fibrosis may be related to suppression of the TGF-beta1-induced ERK1/2 signaling pathway.