The impact of the policy of expanding coverage for 4 major diseases on out-of-pocket payments

In South Korea, Cancers, cardiac disease, cerebrovascular diseases and rare incurable disease cause high medical expenses which are putting a heavy burden on the household economy. They are called '4 Major Severe Diseases'. The government has established the plan of Expanding Coverage for Four Major Severe Diseases. The Policy of Expanding Coverage for the 4 Major Severe Diseases is to apply the necessary medical services including coverage for uncovered services to national health insurance payments in stages. This study aims to evaluate the effects of the policy implemented from 2013 to 2015 by comparing the changes in the out-of-pocket payments before and after the policy. Using the data from the Korea Health Panel(2012, 2016), the policy effect was evaluated by the Difference-In-Difference analysis. A total of 4,686 patients (2,343 in 2012 and 2,343 in 2016) were included, who are enrolled in National Health Insurance, and have at least one chronic disease. People who are under 20 years old were excluded. In addition, severity of disease was adjusted by CCI(Charson's comorbidity index). Compared to before the policy was implemented, the Out-of-pocket payments significantly decreased. In addition, there were significant differences in gender, types of health care system, disabled, economic activity, income level, and CCI. According to previous studies, the policy of Expanding health insurance coverage since 2005 has been criticized for its low effectiveness. However, It is revealed that the Policy of Expanding Coverage for 4 Major Severe Diseases has an effect in this study. Given that the policy needs time to work, this study showed the effect of the policy more comprehensively compared to previous studies evaluating the effectiveness for just one year.

Key messages

Due to the Policy of Expanding Coverage for 4 Major Severe Diseases, the out-of-pocket health expenditure were reduced in the policy group. Given that the policy needs time to work, this study has shown more comprehensive results than previous studies that evaluated the effect of policy carried out over a short period.

Differentiation of follicular carcinomas from adenomas using histogram obtained from diffusion-weighted MRI

AIM

To evaluate the role of histogram analysis of apparent diffusion coefficient (ADC) maps from diffusion-weighted imaging (DWI) in the differentiation of follicular thyroid carcinoma (FTC) from follicular adenoma (FA) in nodules indeterminate on ultrasound-guided core needle biopsy (USCNB).

MATERIALS AND METHODS

This study was performed with institutional review board approval. Seventeen patients who were planned to undergo diagnostic lobectomy for an indeterminate thyroid nodule (atypical of unknown significance/follicular lesion of undetermined significance [AUS/FLUS] or suspicious for follicular neoplasm/follicular neoplasm [SFN]) on USCNB were enrolled prospectively. All patients underwent DWI on the day before surgery. Histogram parameters were derived from ADC values obtained from the whole extent of the tumours. The parameters were compared with the final diagnosis based on histopathological examination after surgery. The accuracy of the parameters in differentiating FTC from FA was evaluated using receiver operating characteristic (ROC) curve analysis.

RESULTS

Twelve patients were confirmed as having FA and five patients as having FTC. Histogram parameters including the 10^th (ADC₁₀), 25^th (ADC₂₅), and 50^th (ADC₅₀) percentiles of the ADC values were significantly lower in FA than in FTC (p < 0.05, all). ROC curve analysis revealed that ADC₂₅ resulted in the highest AUC (0.867; confidence interval, 0.616-0.980), with a cut-off value of 0.352×10^-3 mm²/s.

CONCLUSION

Histogram parameters from ADC maps could differentiate FTC from FA effectively in indeterminate nodules on USCNB, with ADC₂₅ being the most promising parameter.

Thin-Section MR Imaging for Carotid Cavernous Fistula

BACKGROUND AND PURPOSE

Carotid-cavernous fistulas are abnormal vascular shunts that can cause various neurologic or orbital symptoms. The purpose of this retrospective study was to evaluate the diagnostic performance of thin-section MR imaging for carotid cavernous fistula in patients with clinically suspected carotid cavernous fistula, and to identify possible imaging predictors of carotid cavernous fistula.

MATERIALS AND METHODS

A total of 98 patients who were clinically suspected of having carotid cavernous fistula (according to their symptoms and physical examinations) between January 2006 and September 2018 were included in this study. The patients underwent pretreatment thin-section MR imaging and DSA. Thin-section MR imaging consisted of 2D coronal T1- and T2WI with 3-mm thickness and 3D contrast-enhanced T1WI with 0.6 mm thickness. The diagnostic performance of thin-section MR imaging for carotid cavernous fistula was evaluated with the reference standard of DSA. Univariate logistic regression analysis was performed to determine possible imaging predictors of carotid cavernous fistula.

RESULTS

Among the 98 patients, DSA confirmed 38 as having carotid cavernous fistula. The overall accuracy, sensitivity, and specificity of thin-section MR imaging were 88.8%, 97.4%, and 83.3%, respectively. Possible imaging predictors on thin-section MR imaging included abnormal contour of the cavernous sinus (OR: 21.7), internal signal void of the cavernous sinus (OR: 15.3), prominent venous drainage flow (OR: 54.0), and orbital/periorbital soft tissue swelling (OR: 40.4).

CONCLUSIONS

Thin-section MR imaging provides high diagnostic performance and possible imaging predictors of carotid cavernous fistula in patients with clinically suspected carotid cavernous fistula. Thin-section MR imaging protocols could help decide appropriate management plans for patients with clinically suspected carotid cavernous fistula.

Diagnostic Accuracy of MRI-Based Morphometric Parameters for Detecting Olfactory Nerve Dysfunction

BACKGROUND AND PURPOSE

Although olfactory dysfunction is a common cranial nerve disorder, there are no simple objective morphometric criteria to assess olfactory dysfunction. The aim of this study was to evaluate the diagnostic performance of MR imaging morphometric parameters for detecting olfactory dysfunction.

MATERIALS AND METHODS

This prospective study enrolled patients from those presenting with olfactory symptoms who underwent both an olfactory function test and MR imaging. Controls without olfactory dysfunction were recruited during the preoperative work-up for pituitary adenoma. Two independent neuroradiologists measured the olfactory bulb in 3D and assessed olfactory bulb concavity on MR imaging while blinded to the clinical data. Diagnostic performance was assessed using receiver operating characteristic curve analysis.

RESULTS

Sixty-four patients and 34 controls were enrolled. The patients were significantly older than the controls (mean age, 57.8 ± 11.9 years versus 47.1 ± 12.1 years; P < .001). Before age adjustment, the olfactory bulb height was the only olfactory bulb parameter showing a significant difference between patients and controls (1.6 ± 0.3 mm versus 2.0 ± 0.3 mm, P < .001). After age adjustment, all parameters and olfactory bulb concavity showed significant intergroup differences, with the olfactory bulb height having the highest area under the curve (0.85). Olfactory bulb height was confirmed to be the only significant parameter showing a difference in the detection of olfactory dysfunction in 22 pairs after matching for age and sex (area under the curve = 0.87, P < .001). Intraclass correlation coefficients revealed moderate-to-excellent degrees of inter- and intrareader agreement.

CONCLUSIONS

MR imaging morphometric analysis can differentiate patients with olfactory dysfunction, with the olfactory bulb height having the highest diagnostic performance for detecting olfactory dysfunction irrespective of age.

Food-derived coagulase-negative Staphylococcus as starter cultures for fermented foods

Food safety is of significant concern to consumers and is a major issue for the food industry. As such, the industry is aware of the importance of safety assessments of starters used in the production of fermented foods. Coagulase-negative staphylococci (CNS) are the predominant bacteria found in fermented foods worldwide. Because of this, food-derived CNS are used as starters for cheese and meat fermentation, and have been investigated for use as starters in soybean fermentation. Although food-derived CNS are generally considered non-pathogenic, their safety remains uncertain following the isolation of CNS from skin infections in humans and animals, and because they belong to the same genus as the highly pathogenic species Staphylococcus aureus. This review explores what is known about the safety of food-derived CNS, focusing on antibiotic resistance, enterotoxin genes, and biogenic amine production, to aid in the selection of starter candidates.

Benign postoperative hepaticojejunostomy stricture: percutaneous recanalisation using the reverse end of a microwire

AIM

To evaluate the technical feasibility and safety of percutaneous recanalisation of benign postoperative hepaticojejunostomy strictures using the reverse end of a microwire.

MATERIALS AND METHODS

Twenty-one patients with benign postoperative hepaticojejunostomy strictures that had failed to recanalise following management with conventional percutaneous techniques from January 2012 to March 2019 were included in the study. The stricture was punctured by the reverse end of a microwire. Subsequently, serial balloon dilatation and covered stent placement was performed. Technical as well as clinical success, complications, and patency of the hepaticojejunostomy were evaluated.

RESULTS

Technical success was achieved in 19 of 21 (90.5%) patients. The mean number of treatment sessions was 1.2 (range, 1-2). The obstructive symptoms were resolved within 3 days after the procedure in 19 patients (100%). There were no major complications. The 1-year and 3-year patency rates were 76.9% and 61.5%, respectively.

CONCLUSION

Percutaneous recanalisation using the reverse end of a microwire is technically feasible and safe in the treatment of benign postoperative hepaticojejunostomy strictures. This technique is useful when the conventional percutaneous technique cannot be used to cross the stricture.

Physical activity status in relation to quality of life and dietary habits in breast cancer survivors: subset analyses of KROG 14-09 nationwide questionnaire study

PURPOSE

We investigated the relationship of physical activity with dietary habits and quality of life (QoL) in breast cancer survivors in accordance with the recommendations of the American Cancer Society.

METHODS

Data of 928 breast cancer survivors were obtained from the KROG 14-09 study to measure QoL in early phase after adjuvant radiotherapy. According to the extent of physical activity, survivors were divided into four groups: inactivity (0-149 min/week, N = 144), regular activity (150-450 min/week, N = 309), moderate activity (451-900 min/week, N = 229), and marked activity (901-1800 min/week, N = 164) excluding hyperactivity (> 1800 min/week, N = 82) as it is a difficult condition to recommend to survivors. Global physical activity questionnaire, 5-dimensional questionnaire by EuroQoL (EQ-5D-3L), QoL Questionnaire-breast cancer (QLQ-BR23) from EORTC, and dietary habits were surveyed. A linear-to-linear association test for EQ-5D-3L and Kruskal-Wallis analysis for QLQ-BR23 and dietary habit were conducted.

RESULTS

Overall, 15.5% respondents (144/928) were classified as physically inactive. The trends of frequent intake of fruits (p = 0.001) and vegetable (p = 0.005) and reluctance toward fatty food (p < 0.001) were observed in physically active groups. Mobility (p = 0.021) and anxiety (p = 0.030) of EQ-5D-3L, and systemic therapy side effect (p = 0.027) and future perspective (p = 0.008) of QLQ-BR23 were better in physically active groups besides body image (p = 0.003) for the survivors with breast-conserving surgery. However, moderate and marked activities did not further improve QoL than regular activity.

CONCLUSION

Physicians and care-givers have to pay attention to inactive survivors to boost their physical activity, thereby facilitating a better QoL and dietary habit.

Transverse Single-Spin Asymmetry for Very Forward Neutral Pion Production in Polarized p+p Collisions at sqrt[s]=510 GeV

Transverse single-spin asymmetries of very forward neutral pions generated in polarized p+p collisions allow us to understand the production mechanism in terms of perturbative and nonperturbative strong interactions. During 2017, the RHICf Collaboration installed an electromagnetic calorimeter in the zero-degree region of the STAR detector at the Relativistic Heavy Ion Collider (RHIC) and measured neutral pions produced at pseudorapidity larger than 6 in polarized p+p collisions at sqrt[s]=510  GeV. The large nonzero asymmetries increasing both in longitudinal momentum fraction x_{F} and transverse momentum p_{T} have been observed at low transverse momentum p_{T}<1  GeV/c for the first time, at this collision energy. The asymmetries show an approximate x_{F} scaling in the p_{T} region where nonperturbative processes are expected to dominate. A non-negligible contribution from soft processes may be necessary to explain the nonzero neutral pion asymmetries.

Mental health states and influencing factors of risky and problem drinking in South Korean female adolescents

OBJECTIVES

Alcohol is one of the most used and abused psychoactive substances by adolescents. We investigated influencing factors of risky and problem drinking in Korean female adolescents.

STUDY DESIGN

The study design used is a cross-sectional modeling.

METHODS

We used data from the 13th Korean Youth Risk Behavior Web-based Survey (KYRBS) conducted in 2017. KYRBS data were obtained from a stratified, multistage, clustered sample. Risky drinking was binge drinking and problem drinking was drinking with several conflicts association with alcohol consumption.

RESULTS

Among 62,276 participants, the rates of current, risky, and problem drinking among all participants were 16.1%, 8.3%, and 6.1%, respectively. Although all of these rates were higher in males, risky and problem drinking rates among current female drinkers were higher than those of males (55.4 vs 48.5%, 38.9 vs 37.2%, respectively). Problem drinking was most strongly associated with risky drinking (adjusted odds ratio: 17.53 [95% confidence interval: 14.63-21.00]), similarly, risky drinking was most strongly associated with problem drinking in female current drinkers (17.76 [14.84-21.27]). Current smoking was the second strongest risk factor for risky and problem drinking in females (5.22 [3.92-6.95] and 2.93 [2.21-3.89], respectively).

CONCLUSION

Many female adolescents in Korea drink alcohol in an unhealthy manner. The female risky and problem drinking rates among current drinkers were higher than those of males. Risky drinking and problem drinking was most significant influencing factor among females, reciprocally. Public education on abstinence in female adolescents is warranted.

The effects of hidden female smokers on the association between smoking and chronic obstructive pulmonary disease in Korean adults

OBJECTIVE

Smoking is an important causative factor of chronic obstructive pulmonary disease (COPD), and females are considered more susceptible to the effects of smoking than males. However, in previous Korean studies, the effects of sex differences on the association between smoking and COPD have been controversial. In this study, the effects of sex differences on the association between smoking and COPD and the effects of female hidden smokers on that association in Korean adults were investigated.

METHODS

Data were acquired from the Korea National Health and Nutrition Examination Surveys (KNHANES).

RESULTS

The multivariate logistic regression analysis showed that self-reported smoking status for ex-smoker and current smoker correlated with COPD (odds ratio, OR: 1.67 and OR: 2.41, respectively). Self-reported smoking status for ex-smoker and current smoker correlated with COPD in men (OR: 1.61, OR: 2.43, respectively). Female self-reported current smoking status correlated with COPD (OR: 2.52), but female ex-smoker status was not significantly correlated with COPD. The ratios of cotinine-verified to self-reported smoking rates were 1.95 for women and 1.07 for men.

CONCLUSION

The results of this study were that sex differences might affect the association between COPD and smoking and that female hidden smoking might affect the association between smoking and COPD in Korean adults.

First Measurement of Λ_{c} Baryon Production in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the first measurement of the charmed baryon Λ_{c}^{±} production at midrapidity (|y|<1) in Au+Au collisions at sqrt[s_{NN}]=200  GeV collected by the STAR experiment at the Relativistic Heavy Ion Collider. The Λ_{c}/D^{0} [denoting (Λ_{c}^{+}+Λ_{c}^{-})/(D^{0}+D[over ¯]^{0})] yield ratio is measured to be 1.08±0.16  (stat)±0.26  (sys) in the 0%-20% most central Au+Au collisions for the transverse momentum (p_{T}) range 3<p_{T}<6  GeV/c. This is significantly larger than the pythia model calculations for p+p collisions. The measured Λ_{c}/D^{0} ratio, as a function of p_{T} and collision centrality, is comparable to the baryon-to-meson ratios for light and strange hadrons in Au+Au collisions. Model calculations including coalescence hadronization for charmed baryon and meson formation reproduce the features of our measured Λ_{c}/D^{0} ratio.

Anticancer and immunomodulatory activity of egg proteins and peptides: a review

Eggs are widely recognized as a highly nutritious food source that offer specific health benefits for humans. Eggs contain all of the proteins, lipids, vitamins, minerals, and growth factors necessary for embryonic development. In particular, egg white and yolk proteins are considered functional food substances because they possess biological activities such as antimicrobial, antioxidant, metal-chelating, antihypertensive, anticancer, and immunomodulatory activities. Peptides produced via processes such as enzymatic hydrolysis, fermentation by microorganisms, and some chemical and physical treatments of egg proteins have been shown to enhance the functional properties and solubility of these peptides. Peptide activity is strongly related to amino acid sequence, composition, and length. At present, cancer remains among the leading causes of mortality worldwide, and therefore research aimed at developing new treatments for cancer immunotherapy is of great interest. The present review focuses primarily on the anticancer and immunomodulatory activities of egg proteins and their peptides and provides some insight into their underlying mechanisms of action. A number of egg proteins and peptides have been reported to induce apoptosis in cancer cells, protect against DNA damage, decrease the invasion ability of cancer cells, and exhibit cytotoxic and antimutagenic activity in various cancer cell lines. Furthermore, egg proteins and peptides can stimulate or suppress pro- or anti-inflammatory cytokines, as well as affect the production of inflammatory mediators in a variety of cell lines. In addition, the composition of eggs and the processes of egg proteins and peptides production will be discussed.

Diagnostic performance of MRI to detect metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis

AIM

To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of metastatic cervical lymph nodes.

MATERIALS AND METHODS

Ovid-MEDLINE and EMBASE databases were searched up until 12 June 2018. Eleven articles were included in the qualitative systematic review and nine of the 11 in the quantitative analysis. Two radiologists independently performed data extraction and methodological quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A qualitative systematic review and quantitative analysis were performed, followed by a meta-regression analysis to determine factors causing heterogeneity.

RESULTS

The pooled sensitivity and specificity in the diagnosis of metastatic cervical lymph nodes were 80% (95% confidence interval [CI]: 68-88%) and 85% (95% CI: 63-95%), respectively. The sensitivity and false-positive rate (correlation coefficient, 0.655) showed a positive correlation due to a threshold effect, which was responsible for heterogeneity across the studies, as indicated by a Q-test (p<0.01) and Higgins I² statistic (sensitivity, I²=90.11%; specificity, I²=92.49%). In the meta-regression analysis, fat-suppressed imaging, and the analysis method were significant factors influencing the heterogeneity in diagnostic performance.

CONCLUSIONS

MRI shows moderate diagnostic performance in the diagnosis of metastatic lymph nodes in patients with thyroid cancer in the neck. MRI may be an optional or complementary imaging method to ultrasound or computed tomography (CT) in thyroid cancer patients.

Two genes involved in clindamycin resistance of Bacillus licheniformis and Bacillus paralicheniformis identified by comparative genomic analysis

We evaluated the minimum inhibitory concentrations of clindamycin and erythromycin toward 98 Bacillus licheniformis strains isolated from several types of fermented soybean foods manufactured in several districts of Korea. First, based on recent taxonomic standards for bacteria, the 98 strains were separated into 74 B. licheniformis strains and 24 B. paralicheniformis strains. Both species exhibited profiles of erythromycin resistance as an acquired characteristic. B. licheniformis strains exhibited acquired clindamycin resistance, while B. paralicheniformis strains showed unimodal clindamycin resistance, indicating an intrinsic characteristic. Comparative genomic analysis of five strains showing three different patterns of clindamycin and erythromycin resistance identified 23S rRNA (adenine 2058-N6)-dimethyltransferase gene ermC and spermidine acetyltransferase gene speG as candidates potentially involved in clindamycin resistance. Functional analysis of these genes using B. subtilis as a host showed that ermC contributes to cross-resistance to clindamycin and erythromycin, and speG confers resistance to clindamycin. ermC is located in the chromosomes of strains showing clindamycin and erythromycin resistance and no transposable element was identified in its flanking regions. The acquisition of ermC might be attributable to a homologous recombination. speG was identified in not only the five genome-analyzed strains but also eight strains randomly selected from the 98 test strains, and deletions in the structural gene or putative promoter region caused clindamycin sensitivity, which supports the finding that the clindamycin resistance of Bacillus species is an intrinsic property.

Comparative Genomic Analysis of Food-Originated Coagulase-Negative Staphylococcus: Analysis of Conserved Core Genes and Diversity of the Pan-Genome

To shed light on the genetic differences among food-originated coagulase-negative Staphylococcus (CNS), we performed pan-genome analysis of five species: Staphylococcus carnosus (two strains), Staphylococcus equorum (two strains), Staphylococcus succinus (three strains), Staphylococcus xylosus (two strains), and Staphylococcus saprophyticus (one strain). The pan-genome size increases with each new strain and currently holds about 4,500 genes from 10 genomes. Specific genes were shown to be strain dependent but not species dependent. Most specific genes were of unknown function or encoded restriction-modification enzymes, transposases, or prophages. Our results indicate that unique genes have been acquired or lost by convergent evolution within individual strains.

Clinical features and prognosis of patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease

<sec> <title>BACKGROUND</title> Idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) share common risk factors. They could therefore be expressed in a single patient. However, the prevalence, clinical characteristics and prognosis of individuals with comorbid IPF and COPD are not known. </sec> <sec> <title>METHOD</title> From 2003 to 2007, the Korean Interstitial Lung Disease Study Group created a register for idiopathic interstitial pneumonia using 2002 ATS/ERS (American Thoracic Society/European Respiratory Society) criteria. Of the 1546 IPF patients assessed, 143 had decreased lung function consistent with COPD (IPF-COPD). COPD was diagnosed based on age (≥40 years) and pulmonary function (forced expiratory volume in 1 sec [FEV₁]/forced vital capacity [FVC] ratio < 0.7). </sec> <sec> <title>RESULTS</title> The median age of the IPF-COPD group was 71.0 years (interquartile range 66.0-76.0); most patients were male (88.1%). FVC (%) was significantly higher in the IPF-COPD group; however, FEV₁ (%) was significantly lower in the IPF-COPD group (P < 0.001). Diffusing capacity of the lung for carbon monoxide (DL_CO) was not significantly different between the two groups. In survival analysis, age and FVC (%), but not COPD, were significantly associated with prognosis (respectively P = 0.003, 0.001 and 0.401). COPD severity was also not related to prognosis (P = 0.935). </sec> <sec> <title>CONCLUSION</title> The prevalence of IPF-COPD was estimated to be ∼9.2% among all IPF patients; prognosis of patients with IPF-COPD was not worse than those with IPF alone. </sec>.

Low free T3 to free T4 ratio was associated with low muscle mass and impaired physical performance in community-dwelling aged population

In aged population, the association of thyroid hormones on physical performance, especially within their normal range, has yet to be elucidated. In this study, individuals with low serum free T3/free T4 were likely to have low muscle mass and impaired physical performance.

PURPOSE

We aimed to evaluate the associations of muscle mass, strength, and physical performance with thyroid hormone in an aged euthyroid population from a community-based cohort.

METHODS

We examined 918 men aged over 60 years and 1215 postmenopausal women from the Ansung cohort study. Appendicular skeletal muscle mass divided by square of height (ASM/ht²) was used as the muscle mass index. Hand grip strength was measured using a hydraulic dynamometer. Physical performance was assessed using the short physical performance battery (SPPB).

RESULTS

Participants with higher tertiles of free T3 and free T3/free T4 were younger and had higher ASM/ht², stronger hand grip strength, and higher SPPB scores than those in the lower tertiles. In adjusted models, men within higher tertiles of free T3 had higher ASM/ht² compared with those within lower tertiles (p = 0.033), whereas subjects with higher tertiles of free T4 had lower ASM/ht² compared with those within lower tertiles (p = 0.043). Subjects within higher tertiles of free T3/free T4 had higher ASM/ht² (p < 0.001) and better physical performance (p = 0.048) than those within lower tertiles after adjustments. However, free T3, free T4, or free T3/free T4 was not related to hand grip strength after adjustment for covariates.

CONCLUSION

Our results thus indicate that in an aged euthyroid population, low serum free T3/free T4 was a better index for low muscle mass and impaired physical performance than serum free T3 or free T4 alone.

Correction: Lung epithelial cell-derived extracellular vesicles activate macrophage-mediated inflammatory responses via ROCK1 pathway

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Bodyweight variability and the risk of psoriasis: a nationwide population-based cohort study

BACKGROUND

Bodyweight variability has been suggested to exacerbate chronic inflammation and increase the risk of adverse cardiovascular events. Little is known whether high variability in bodyweight affects the development of psoriasis.

OBJECTIVE

To investigate the association between weight variability and the risk of psoriasis.

METHODS

Using a representative cohort enrolled in the national health examination programme conducted by the Korean National Health Insurance Service, 8 016 907 people who were free of psoriasis and who underwent at least three health examinations between 2010 and 2015 were followed until the end of 2017. We classified participants numerically according to the variability indices and defined high variability (Q4) as the highest quartile of variability. Cox proportional hazard regression models were used to evaluate the risk of psoriasis according to the quartile groups of bodyweight variability.

RESULTS

In total, 187 128 (2.33%) participants developed psoriasis during a median follow-up of 3.4 years. There was an association between baseline body mass index and the risk of psoriasis. In the multivariable model adjusting for confounding variables, an incrementally increased risk of psoriasis was observed for higher quartiles compared with the lowest quartile group (Q1). The hazard ratio (HR) and 95% confidence intervals comparing the highest (Q4) and lowest quartiles (Q1) of bodyweight variability were 1.06 (1.05-1.07) for psoriasis.

CONCLUSION

High bodyweight variability was significantly associated with an increased risk of psoriasis. These findings imply that clinicians should encourage patients to maintain proper bodyweight to help prevent psoriasis.

Recovery of Dementia Syndrome following Treatment of Brain Inflammation

Aim/Background

This research aims to prevent progression from mild cognitive impairment (MCI) to Alzheimer's disease. A Japanese study of leprosy patients revealed that the incidence of dementia in leprosy patients was lower than that in patients taking dapsone who had never been treated. But a similar study the following year refuted the finding of less dementia in leprosy patients taking dapsone. According to conflicting reports, Mycobacterium leprae was a factor in reducing the incidence of Alzheimer's disease. Thus, we formed a hypothesis that if dapsone is administered to patients without leprosy but with MCI and the prophylactic effect of dementia syndrome is observed over a long period of time, we can determine whether dapsone can prevent the progression of MCI to dementia syndrome. If dementia does not occur after treating inflammation in brain cells while dementia develops after a certain long-term period (usually within 2–3 years), brain cell inflammation can be demonstrated as the cause of dementia.

Methods

This is a prospective cohort research. We report on an elderly patient diagnosed with MCI from February 2008 to January 2019. The patient took dapsone 100 mg once a day from 2010 to 2015 for the treatment of MCI. Since 2016, the production of dapsone has ceased in Korea. In June 2018, the patient was diagnosed with Alzheimer's disease. The patient took Aricept for the treatment of Alzheimer's disease but complained of serious side effects. And dapsone was re-administered to the patient from November 2018.

Results

The patient recovered to MCI and improved her daily life owing to the treatment with dapsone. The drug controls the inflammatory response in the brain, irrespective of whether proteins are deposited in neurons.

Conclusions

This finding means that dementia syndrome is an inflammatory disease. This research suggests that diagnostic criteria for Alzheimer's disease should be based on the presence or absence of inflammation in neurons. Because inflammation in neurons can occur in middle age due to various causes, we can treat inflammation in neurons and prevent and treat dementia syndrome, including Alzheimer's disease.

Retarding Ion Exchange between Conducting Polymers and Ionic Liquids for Printable Top Electrodes in Semitransparent Organic Solar Cells

Semitransparent organic solar cells (ST-OSCs) are considered to be an influential tool for aesthetic and economic building-integrated photovoltaics, which can be fabricated by the printing technology. A poly(3,4-ethylenedioxythiophene):polystyrenesulfonate (PEDOT:PSS) and ionic liquid (IL) composite has been considered as an electrode for ST-OSCs because of its high electrical conductivity, high transparency, and printability. However, we found that the introduction of IL into the PEDOT:PSS solution for enhancing its electrical conductivity results in (1) nonreliable printing of PEDOT:PSS/IL composite films because of gradual gelation of the mixture solution and (2) the production of chemically reactive ion pairs during ion exchange between PSS and IL, which induces the oxidation of the underlying organic semiconductors during printing. To solve these problems, we developed a sequential printing method using pristine PEDOT:PSS and IL solutions to retard ion exchange, thus preventing chemical doping of organic semiconductors by newly generated ion pairs. Finally, by using only solution processes, we demonstrate efficient ST-OSCs with a printed PEDOT:PSS/IL composite as the top electrode, exhibiting a power conversion efficiency of 6.32% at an average visible transmittance of 35.4%.

Assessing the Patient Safety Culture in Dentistry

OBJECTIVES

Medical errors are among the leading causes of death within the United States. Studies have shown that patients can be harmed while receiving care, sometimes resulting in permanent injury or, in extreme cases, death. To reduce the risk of patient safety incidents, it is imperative that a robust culture of safety be established. The primary objective of this study was to evaluate the patient safety culture among providers at 4 US dental institutions, comparing the results with their medical counterparts in 2016.

METHODS

This cross-sectional study uses the Medical Office Survey on Patient Safety Culture that was modified for dentistry and administered at 4 US dental institutions during the 2016 calendar year. All dental team members were invited to complete electronic or paper-based versions of the questionnaire.

RESULTS

Among 1,615 invited participants, 656 providers responded (rate, 40.6%). Medical institutions outperformed the dental institutions on 9 of the 10 safety culture dimensions, 6 of the 6 overall quality items, and 8 of the 9 patient safety and quality issues. The surveyed dental institutions reported the strongest average percentage positive scores in organizational learning (85%) and teamwork (79%).

CONCLUSION

These findings suggest that the patient safety culture progressed over time. However, there is still heterogeneity within safety culture among academic dental, private (nonacademic), and medical clinics.

KNOWLEDGE TRANSFER STATEMENT

Patient safety is the first dimension of quality improvement. Administering the Medical Office Survey on Patient Safety Culture within dental clinics represents a key measure to understand where improvements can be made with respect to patient care safety.

Analytical methods for determination of carbonyl compounds and nicotine in electronic No-Smoking aid refill solutions

The present investigation aimed to develop analytical methods to determine carbonyl compounds and nicotine and to assess the carbonyl compounds and nicotine concentrations in commercial refill solutions for electronic no-smoking aids (ENSAs). The analytical methods for carbonyl compounds and nicotine in refill solutions for ENSAs were developed and analyzed from 30 popular branded products by gas chromatography and liquid chromatography. They were then validated in terms of linearity of the calibration curve, limit of detection (LOD), limit of quantification (LOQ), accuracy (%), and precision (%). Further, the existence of carbonyl compounds and nicotine in the refill solutions for ENSAs was also evaluated. None of the samples contained nicotine, but carbonyl compounds were sensed in a concentration range from 0.9 to 11.65 μg/mL. Manufacturers of ENSA refill solutions have advertised no-smoking aids as less harmful than tobacco cigarettes and as free from harmful substances. However, carbonyl compounds were detected in all 30 samples. The investigation of ENSA refill solutions needs to be broadened to gain a better accepting of the existence of harmful materials in ENSA refill solutions and prevent unsuspected ill-health effects.

P1603 Changes of cardiac function in cirrhotic patients after liver transplantation

Funding Acknowledgements

This study was supported by the grant of CJ healthcare 2016 research fund.

Background

Liver cirrhosis (LC) has been known to affect cardiovascular performance. Limited study have evaluated the alteration of myocardial function in patients with LC after liver transplantation (LT).

Purpose

The aim of study was to evaluate changes of cardiac function in patients with cirrhosis following LT using conventional and speckle-tracking echocardiography and late gadolinium enhancement (LGE) of cardiac magnetic resonance (MR).

Methods

Thirty-five patients with cirrhosis (mean age, 57.1 ± 9.0; male, 75%) who were listed for LT were prospectively enrolled. Patients underwent conventional, speckle-tracking echocardiography, and cardiac MR imaging with LGE. Echocardiography and cardiac MR were performed at pre and 1 year after LT. Cirrhotic patients were compared with normal control (n = 20, mean age, 65.0 ± 14.8; men, 11(55%)) and echocardiographic and cardiac MR data were compared pre and post LT.

Results

Conventional and speckle-tracking echocardiography and Cardiac MR imaging demonstrated hyperdynamic left ventricular (LV) function in patients with cirrhosis (LV ejection fraction (EF) with cardiac MR 67.8 ± 7.0% in LC vs. 63.4 ± 6.4% in control, P = 0.028; global longitudinal strain (GLS) -24.3 ± 2.6% in LC vs. -18.6 ± 2.2% in control, P &lt; 0.001). There were no LGE in patients with cirrhosis and no significant differences in LV size, LV wall thickness, LV mass index, and diastolic function between cirrhotic patients and control group (all P &gt; 0.1). Corrected QT interval (QTc) in electrocardiogram was prolonged in LC patients (P &lt; 0.001). One-year after LT, LV end-diastolic diameter and LV end-diastolic volume significantly decreased (P = 0.016 and 0.022, respectively). Although LVEF showed no significant changes 1 year post-LT (P = 0.362), LV-GLS (from -24.7 ± 1.8% to -20.8 ± 3.4%, P &lt; 0.001) significantly decreased. QTc interval also decreased 1 year after LT (from 470.4 ± 29.6msec to 428.2 ± 31.6msec, P = 0.001).

Conclusions

The present study demonstrated that cirrhotic patients showed hyperdynamic circulation and prolonged QTc interval compared with normal controls. After 1 year LT, LV size reduced and augmented LV function was normalized. Given that no LGE in cardiac MR and normalized GLS and QTc after LT, cardiac dysfunction in LC patients could be reversed by LT.

P1478 Evaluation of reversibility of alcoholic cardiomyopathy using doubaimine stress echocardiography

Alcoholic cardiomyopathy (CM) is known as a reversible CM. Appropriate medications with cessation of alcohol may lead to full recovery of chamber size and contractility. But there is not much information about morphologic and hemodynamic changes over the course of treatment, and predictors of reversibility. We experienced the patient with alcoholic CM who was admitted with heart failure and recovered over 1 year and 5 months. He consumed daily 180g alcohol for 6 months before admission. On initial echocardiography, left atrial (LA) dimension, left ventricular (LV) systolic dimension (SD) and diastolic dimension (DD), inferior vena cava (IVC) size, and ejection fraction (EF) were 50 mm, 69 mm, 78 mm, 27 mm and 22%, respectively. Doppler examination revealed a restrictive pattern in tansmitral flow, and a systolic peak velocity/diastolic peak velocity (S/D) ratio of less than 1 in pulmonary vein flow (PVF). Pressure gradient through tricuspid regurgitation was 29 mmHg. Coronary angiogram confirmed no significant stenosis. Within 1 week after medications, LVEF increased mainly by decrease of enlarged LVSD which might be partly caused by volume overload, evidenced by respiratory variation of transmitral flow. On 8th day, we performed dobutamine stress echocardiography (DSE) to evaluate reversibility because LVEF slightly decreased despite decrease of LVDD. During dobutamine infusion, both LVDD and LVSD decreased along with increase of LVEF according to dose escalation. From 1 to 2 months, LVEF slightly increased with decrease of LVDD and LVSD. Afterwards, LVEF was normalized mainly with decrease of LVSD, and LVEF was completely normalized at 1 year and 5 month after initiation of treatment. Initial increase of LVEF might reflect decrease of LVSD by relief of volume overload rather than improving LV contractility. Based on this observation of serial change of chambers and LVEF, we speculate that increased LV wall tension, which is induced by increase of preload as a compensating mechanism for increasing stroke volume, might aggravate LVEF in later stage of heart failure with reduced EF. The sequence of normalization in chamber size was IVC, and then LA, and then LVDD. Transmitral flow as an indicator of diastolic dysfunction changed from restrictive (transiently existed only for 1 week) to abnormal relaxation pattern (no change since that time). PVF pattern showed S/D ratio &lt; 1 until 1 week, and then triphasic pattern at 1 month, finally biphasic pattern at 8 month after initiation of medications. We observed a serial change of echocardiographic findings in patient with alcoholic CM, which might provide an insightful information to understand reverse of LV or LA remodeling associated with hemodynamic parameters, and DSE might be helpful to evaluate reversibility of LV systolic function and convince patients who are reluctant to medications.

CT and MRI Findings of Glomangiopericytoma in the Head and Neck: Case Series Study and Systematic Review

Glomangiopericytoma is a rare sinonasal mesenchymal tumor of borderline or low malignant potential. We reviewed the CT and MR imaging findings of head and neck glomangiopericytoma via a retrospective case series study and systematic review. Our study revealed that glomangiopericytoma is a well-defined lobulated avidly enhancing soft-tissue mass with erosive bony remodeling that is most commonly found in the sinonasal cavity. Typically, it is hyperintense on T2-weighted images with vascular signal voids, has a high mean ADC value, and a wash-in and washout pattern on dynamic contrast-enhanced MR imaging. Although the CT findings are nonspecific, typical MR imaging findings, including those on the ADC map and dynamic contrast-enhanced MR imaging, may be helpful for differentiating glomangiopericytomas from other hypervascular tumors in the head and neck.

430 Relation of blood pressure to coronary artery calcium and mortality

Background

Diastolic blood pressure has a J-curve relation with coronary heart disease and death, but it is debating whether a J-curve association exists in general population. We aimed to assess the relation of blood pressure to mortality, and whether their association is interacted with presence of high coronary artery calcium (CAC).

Methods

The KOICA registry is a retrospective, multicenter observational study designed to investigate the effectiveness and prognostic value of CAC score for primary prevention of cardiovascular disease in asymptomatic Korean adults. The association between CAC score and blood pressure was assessed. Patients were divided into 2 groups according to the baseline CACS (&gt; 300 and ≤ 300), and all-cause mortality was assessed.

Results

The study population composed 48903 subjects with a mean age of 54 ± 9. There were 425 (0.9%) deaths during follow-up. At baseline, SBP (systolic blood pressure) more than 110 mmHg and DBP (diastolic blood pressure) more than 80 mmHg was associated with increased risk for CACS &gt; 300. In patients with baseline CACS ≤ 300, all-cause mortality was increased in patients with SBP of 110-119 mmHg (HR 1.47, p = 0.023), 130-139 mmHg (HR 1.72, p = 0.002) and ≥ 140 mmHg (HR 1.47, p = 0.042) compared to SBP of 120-129 mmHg, whereas DBP did not predict all-cause mortality. In contrast, SBP was not associated to all-cause mortality in patients with CACS &gt; 300, whereas DBP &lt; 60 mmHg (HR 3.53, p =0.018) and 70-79 mmHg (HR 2.21, p = 0.042) was associated with increased risk for all-cause mortality compared to DBP of 80-89 mmHg.

Conclusion

Low DBP was associated with increased risk for all-cause mortality in subjects with high CAC score, suggesting high-risk for coronary artery disease. However, this J-curve relation was not shown in the population with low CAC score.

Lung function as a predictor of incident type 2 diabetes in community-dwelling adults: A longitudinal finding over 12 years from the Korean Genome and Epidemiology Study

AIM

Reduced lung function is associated with type 2 diabetes (T2D), but there are limited data in East Asian populations on the relationship between them. For this reason, this study investigated the longitudinal relationship of lung function with incident T2D in Korean adults.

METHODS

The study included 7583 non-diabetic adults aged 40-69 years from the Korean Genome and Epidemiology Study. Participants were divided into four groups according to gender-specific quartiles (Q1-Q4) of %PFVC and %PFEV₁. Also, HRs with 95% CIs for incident T2D were prospectively analyzed as per American Diabetes Association criteria using multivariate Cox proportional-hazards regression models.

RESULTS

During a 12-year follow-up, 1403 (18.5%) participants presented with newly developed T2D. HRs (95% CIs) of incident T2D in Q1 vs. Q4 (reference) of %PFVC were 1.67 (1.35-2.07) for men and 1.77 (1.39-2.24) for women and, of %PFEV₁, 1.58 (1.28-1.95) for men and 1.61 (1.27-2.03) for women, after adjusting for age, waist circumference, smoking status, alcohol intake, regular exercise, education levels, monthly household income, family history of diabetes, HOMA-IR, triglycerides, HDL cholesterol and high-sensitivity C-reactive protein levels.

CONCLUSION

Reduced lung function precedes and significantly predicts the future development of T2D independently of obesity, smoking and inflammation in community-dwelling middle-aged and elderly people.

Management of isolated recurrence after surgery for pancreatic adenocarcinoma

BACKGROUND

Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established.

METHODS

Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities.

RESULTS

Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83·6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27·2 per cent), distant multifocal in 251 (18·6 per cent), distant isolated in 188 (14·0 per cent), locoregional plus distant in 153 (11·4 per cent) and peritoneal seeding in 388 (28·8 per cent). Of the 1346 patients with recurrence, 197 (14·6 per cent) had isolated recurrence; of these, 48 (24·4 per cent of all isolated recurrences; 3·6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14·7 months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23·5 versus 12·0 months; P = 0·014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33·3 months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28·0 versus 12·0 months, P = 0·010) and lung (median 36·5 versus 9·5 months; P = 0·010) than in those who did not undergo resection.

CONCLUSION

Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.

Impact of genomic alterations on lapatinib treatment outcome and cell-free genomic landscape during HER2 therapy in HER2+ gastric cancer patients

Background

To identify predictive markers for responders in lapatinib-treated patients and to demonstrate molecular changes during lapatinib treatment via cell-free genomics.

Patients and methods

We prospectively evaluated the efficacy of combining lapatinib with capecitabine and oxaliplatin as first line neoadjuvant therapy in patients with previously untreated, HER2-overexpressing advanced gastric cancer. A parallel biomarker study was conducted by simultaneously performing immunohistochemistry and next-generation sequencing (NGS) with tumor and blood samples.

Results

Complete response was confirmed in 7/32 patients (21.8%), 2 of whom received radical surgery with pathologic-confirmed complete response. Fifteen partial responses (46.8%) were observed, resulting in a 68.6% overall response rate. NGS of the 16 tumor specimens demonstrated that the most common co-occurring copy number alteration was CCNE1 amplification, which was present in 40% of HER2+ tumors. The relationship between CCNE1 amplification and lack of response to HER2-targeted therapy trended toward statistical significance (66.7% of non-responders versus 22.2% of responders harbored CCNE1 amplification; P = 0.08). Patients with high level ERBB2 amplification by NGS were more likely to respond to therapy, compared with patients with low level ERBB2 amplification (P = 0.02). Analysis of cfDNA showed that detectable ERBB2 copy number amplification in plasma was predictive to the response (100%, response rate) and changes in plasma-detected genomic alterations were associated with lapatinib sensitivity and/or resistance. The follow-up cfDNA genomics at disease progression demonstrated that there are emergences of other genomic aberrations such as MYC, EGFR, FGFR2 and MET amplifications.

Conclusions

The present study showed that HER2+ GC patients respond differently according to concomitant genomic aberrations beyond ERBB2, high ERBB2 amplification by NGS or cfDNA can be a positive predictor for patient selection, and tumor genomic alterations change significantly during targeted agent therapy.

Diagnostic value of bronchoalveolar lavage and bronchial washing in sputum-scarce or smear-negative cases with suspected pulmonary tuberculosis: a randomized study

OBJECTIVES

Bronchoalveolar lavage (BAL) and bronchial washing (BW) are two major methods used to obtain high-quality respiratory specimens from patients with suspected pulmonary tuberculosis (TB) but a sputum-scarce or smear-negative status. We aimed to compare the value of BAL and BW in the diagnosis of TB in such patients.

METHODS

We enrolled patients with suspected pulmonary TB but with a sputum-scarce or smear-negative status who were referred for bronchoscopy between October 2013 and January 2016. Participants were randomized into the BAL and BW groups for evaluation. The primary outcome was the diagnostic yield for TB detection. Secondary outcomes included culture positivity, positivity of nucleic acid amplification tests (NAATs) for Mycobacterium tuberculosis and procedure-related complications.

RESULTS

A total of 94 patients were assessed and 91 (43 in the BAL group, 48 in the BW group) were analysed. Twenty-one patients (48.8%) in the BAL group and 30 (62.5%) in the BW group had a final diagnosis of pulmonary TB. The detection rate of M. tuberculosis by culture or NAAT was significantly higher in BAL specimens than in BW specimens (85.7% vs 50.0%, p 0.009). The procedure-related complications were hypoxic events, 2/43 (4.7%) in the BAL group and 5/48 (10.4%) in the BW group; and post-bronchoscopic fever, 3/43 (7.0%) in the BAL group and 4/48 (8.3%) in the BW group.

DISCUSSION

As long as it is tolerable, BAL rather than BW, should be used to obtain specimens for the diagnosis of pulmonary TB in sputum-scarce or smear-negative cases.

TRPM8 Mediates Hyperosmotic Stimuli-Induced Nociception in Dental Afferents

Hyperosmolar sweet foods onto exposed tooth dentin evoke sudden and intense dental pain, called dentin hypersensitivity. However, it remains unclear how hyperosmolar stimuli excite dental primary afferent (DPA) neurons and thereby lead to dentin hypersensitivity. This study elucidated whether TRPM8, which is well known as a cold temperature- or menthol-activated receptor, additionally mediates nociception in response to hyperosmolar stimuli in adult mouse DPA neurons, which are identified by a fluorescent retrograde tracer: DiI. Single-cell reverse transcription polymerase chain reaction revealed that TRPM8 was expressed in subsets of DPA neurons and that TRPM8 was highly colocalized with TRPV1 and Piezo2. Immunohistochemical analysis also confirmed TRPM8 expression in DPA neurons. By using Fura-2-based calcium imaging, application of hyperosmolar sucrose solutions elicited calcium transients in subsets of the trigeminal ganglion neurons, which was significantly abolished by a selective TRPM8 antagonist: N-(3-Aminopropyl)-2-[(3-methylphenyl)methoxy]-N-(2-thienylmethyl)benzamide (AMTB) hydrochloride. When we further examined changes of c-fos expression (a neuronal activation marker) in the spinal trigeminal nucleus after hyperosmolar stimulation onto exposed tooth dentin, c-fos mRNA and protein expression were increased and were also significantly reduced by AMTB, especially in the spinal trigeminal interpolaris-caudalis transition zone (Vi/Vc). Taken together, our results provide strong evidence that TRPM8 expressed in DPA neurons might mediate dental pain as a hyperosmosensor in adult mice.

Anti-elastase and anti-hyaluronidase activity of phosvitin isolated from hen egg yolk

1. Phosvitin, a major phosphoprotein found in egg yolk, has strong antioxidant activity. Activation of elastase, collagenase, and hyaluronidase by reactive oxygen species are related to the degradation of ECM and skin aging. The objective of this study was to determine the anti-elastase and anti-hyaluronidase activity of phosvitin.2. Elastase from porcine pancreas and hyaluronidase from bovine testes were used to study the inhibitory activity of phosvitin. To elucidate the mechanism of enzyme inhibition, a Lineweaver-Burk plot was constructed.3. Phosvitin inhibited elastase and hyaluronidase activity in a dose-dependent manner. The IC₅₀ value of phosvitin was 31.6 μg/ml and 1,270 μg/ml against elastase and hyaluronidase, respectively. The analysis of elastase and hyaluronidase kinetics indicated that the apparent Michaelis constant (_appK_m) was increased by phosvitin but the V_max value was not affected.4. In conclusion, phosvitin exhibited competitive inhibitory activity against elastase and hyaluronidase. Thus, phosvitin could be used as a natural anti-aging agent in the cosmetics industry.

Genomic Insight into the Salt Tolerance of Enterococcus faecium, Enterococcus faecalis and Tetragenococcus halophilus

To shed light on the genetic basis of salt tolerance in Enterococcus faecium, Enterococcus faecalis, and Tetragenococcus halophilus, we performed comparative genome analysis of 10 E. faecalis, 11 E. faecium, and three T. halophilus strains. Factors involved in salt tolerance that could be used to distinguish the species were identified. Overall, T. halophilus contained a greater number of potassium transport and osmoprotectant synthesis genes compared with the other two species. In particular, our findings suggested that T. halophilus may be the only one among the three species capable of synthesizing glycine betaine from choline, cardiolipin from glycerol and proline from citrate. These molecules are well-known osmoprotectants; thus, we propose that these genes confer the salt-tolerance of T. halophilus.

First Observation of the Directed Flow of D^{0} and D^{0}[over ¯] in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report the first measurement of rapidity-odd directed flow (v_{1}) for D^{0} and D^{0}[over ¯] mesons at midrapidity (|y|<0.8) in Au+Au collisions at sqrt[s_{NN}]=200  GeV using the STAR detector at the Relativistic Heavy Ion Collider. In 10-80% Au+Au collisions, the slope of the v_{1} rapidity dependence (dv_{1}/dy), averaged over D^{0} and D^{0}[over ¯] mesons, is -0.080±0.017(stat)±0.016(syst) for transverse momentum p_{T} above 1.5  GeV/c. The absolute value of D^{0} meson dv_{1}/dy is about 25 times larger than that for charged kaons, with 3.4σ significance. These data give a unique insight into the initial tilt of the produced matter, and offer constraints on the geometric and transport parameters of the hot QCD medium created in relativistic heavy-ion collisions.

P3617Systolic blood pressure, glycemic control and clinical outcome in diabetic patients with acute myocardial infarction

Background

Recent blood pressure guidelines recommend intensive blood pressure control in diabetic patients with cardiovascular disease.

Purpose

We sought to investigate combined impact of intensive blood glucose lowering and blood pressure control on clinical outcome in diabetic patients with acute myocardial infarction (AMI) has not been fully investigated yet.

Method

Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database included 12,179 patients (9,046 men; mean age = 63.6±12.6 year-old) who were discharged alive. Among them, 3,430 (28.2%) had a diabetes mellitus (DM). MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations at 1 year. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Result

We determined cut-off value of discharge systolic blood pressure (SBP) to predict 1-year MACCE in DM and non-DM patients. Discharge SBP of less than 130mmHg was associated with a lower MACCE at 1 year compared to SBP level of 130mmHg or greater (10.8% versus 15.4%; log-rank p=0.001) in DM patients, whereas discharge SBP cut-off level was 140mmHg to discriminate 1-year MACCE in non-DM patients (6.4% versus 8.5%, log-rank p=0.045). In DM patients, there were no significant difference in 1-year MACCEs between patients with HbA1c less than 7% versus 7% or greater (12.0% versus 10.7%; log-rank p=0.325). DM patients were categorized into 4 groups; discharge SBP <130mmHg and HbA1c <7% (Group 1); discharge SBP <130mmHg and HbA1c ≥7% (Group 2); discharge SBP ≥130mmHg and HbA1c <7% (Group 3); discharge SBP ≥130mmHg and HbA1c ≥7% (Group 4). Intensive BP control was associated lower 1-year MACCEs in patients with good glycemic control (Group 1 & 3; 10.7% versus 16.7%; log-rank p=0.009). However, in patients with poor glycemic control, intensive BP control did not improve 1-year MACCEs (Group 2 & 4; 10.6% versus 11.1%; log-rank p=0.761).

Conclusion

Strict BP control is more important than glycemic control to improve short-term clinical outcome in DM patients with AMI. However, in patients with poor glycemic control, strict BP control did not improve clinical outcome.

P3583Optimal procedural strategy to improve clinical outcome in primary percutaneous coronary intervention

Background

Current guideline recommends potent antiplatelet agents and transradial intervention. However, it is uncertain whether routine use of IVUS, thrombus aspiration and glycoprotein IIB-IIIA inhibitor is beneficial for improving clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI).

Purpose

The aim of this study was to investigate optimal procedural strategy to improve clinical outcome.

Methods

A total of 6,046 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were analyzed from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database. MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Results

During the primary PCI, potent antiplatelet agents such as prasugrel and ticagrelor were used in 2342 (38.4%). PCI was performed through transradial approach in 1490 (25.2%). Thrombus aspiration and intravascular ultrasound (IVUS) examination was done in 2204 (36.1%) and 1079 (18.1%), respectively. Glycoprotein IIB-IIIA inhibitor was administered in 1295 (21.7%). Among them, potent antiplatelet agents, transradial intervention, IVUS, and thrombus aspiration significantly reduced MACCEs at 1 year. Glycoprotein IIB-IIIA inhibitor was not effective to improved clinical outcome. In Cox-proportional hazards model, potent antiplatelet agents (hazard ratio 0.82, 95% confidence interval 0.67–0.99; p=0.045) and transradial intervention (hazard ratio 0.61, 95% confidence interval 0.47–0.78; p<0.001) was an independent predictor of MACCEs after adjusting for confounding variables. Combined use of potent antiplatelet agents and transradial intervention (hazard ratio 0.54; 95% confidence interval 0.37–0.80; p=0.002) substantially reduced MACCEs at 1 year.

Conclusion

Among evidence based procedures during the primary PCI, combined use of potent antiplatelet agents and transradial intervention was optimal procedural strategy to improve clinical outcome.

Polarization of Λ (Λ[over ¯]) Hyperons along the Beam Direction in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

The Λ (Λ[over ¯]) hyperon polarization along the beam direction has been measured in Au+Au collisions at sqrt[s_{NN}]=200  GeV, for the first time in heavy-ion collisions. The polarization dependence on the hyperons' emission angle relative to the elliptic flow plane exhibits a second harmonic sine modulation, indicating a quadrupole pattern of the vorticity component along the beam direction, expected due to elliptic flow. The polarization is found to increase in more peripheral collisions, and shows no strong transverse momentum (p_{T}) dependence at p_{T} greater than 1  GeV/c. The magnitude of the signal is about 5 times smaller than those predicted by hydrodynamic and multiphase transport models; the observed phase of the emission angle dependence is also opposite to these model predictions. In contrast, the kinematic vorticity calculations in the blast-wave model tuned to reproduce particle spectra, elliptic flow, and the azimuthal dependence of the Gaussian source radii measured with the Hanbury Brown-Twiss intensity interferometry technique reproduce well the modulation phase measured in the data and capture the centrality and transverse momentum dependence of the polarization signal.

Observation of Excess J/ψ Yield at Very Low Transverse Momenta in Au+Au Collisions at sqrt[s_{NN}]=200 GeV and U+U Collisions at sqrt[s_{NN}]=193 GeV

We report on the first measurements of J/ψ production at very low transverse momentum (p_{T}<0.2  GeV/c) in hadronic Au+Au collisions at sqrt[s_{NN}]=200  GeV and U+U collisions at sqrt[s_{NN}]=193  GeV. Remarkably, the inferred nuclear modification factor of J/ψ at midrapidity in Au+Au (U+U) collisions reaches about 24 (52) for p_{T}<0.05  GeV/c in the 60%-80% collision centrality class. This noteworthy enhancement cannot be explained by hadronic production accompanied by cold and hot medium effects. In addition, the dN/dt distribution of J/ψ for the very low p_{T} range is presented for the first time. The distribution is consistent with that expected from the Au nucleus and shows a hint of interference. Comparison of the measurements to theoretical calculations of coherent production shows that the excess yield can be described reasonably well and reveals a partial disruption of coherent production in semicentral collisions, perhaps due to the violent hadronic interactions. Incorporating theoretical calculations, the results strongly suggest that the dramatic enhancement of J/ψ yield observed at extremely low p_{T} originates from coherent photon-nucleus interactions. In particular, coherently produced J/ψ's in violent hadronic collisions may provide a novel probe of the quark-gluon plasma.

Nonambipolar Transport due to Electrons with 3D Resistive Response in the KSTAR Tokamak

A small nonaxisymmetric (3D) magnetic field can induce nonambipolar transport of the particle species confined in a tokamak and thus a significant change of plasma rotation. This process can be in a favor of instability control in the region where the tokamak plasma is sufficiently collisional and resistive, as observed in the applications of n=1 resonant magnetic perturbations to the KSTAR tokamak. The plasma rotation can be globally accelerated due to radially drifting electrons and constrained to the electron root, if the radial transport is enhanced by an amplified 3D response. This mechanism is verified by a kinetically self-consistent magnetohydrodynamic modeling for both response and transport, which offers the quantitative explanations on the internal n=1 structure detected by electron-cyclotron-emission imaging and the cocurrent plasma spinning observed in the experiments.

Detection of Local Recurrence in Patients with Head and Neck Squamous Cell Carcinoma Using Voxel-Based Color Maps of Initial and Final Area under the Curve Values Derived from DCE-MRI

BACKGROUND AND PURPOSE

Early detection of local recurrence is important to increase the chance of cure because local recurrence is the main cause of treatment failure in head and neck squamous cell carcinoma. We evaluated the added value of voxel-based color maps of dynamic contrast-enhanced MR imaging compared with conventional MR imaging alone for detecting local recurrence of head and neck squamous cell carcinoma.

MATERIALS AND METHODS

We retrospectively enrolled 63 consecutive patients with head and neck squamous cell carcinoma after definitive treatment and posttreatment surveillance MR imaging studies that demonstrated focal enhancement at the primary site. Three independent readers assessed conventional MR imaging and a pair of color maps of initial and final 90-second time-signal intensity areas under the curve from dynamic contrast-enhanced MR imaging. The sensitivities, specificities, and accuracies of both conventional MR imaging alone and combined interpretation of conventional and dynamic contrast-enhanced MR imaging were assessed using the clinicopathologic diagnosis as the criterion standard. κ statistics were used to evaluate interreader agreement.

RESULTS

There were 28 patients with subsequently documented local recurrence and 35 with posttreatment change. Adding dynamic contrast-enhanced MR imaging to conventional MR imaging significantly increased the diagnostic accuracies for detecting local recurrence (48%-54% versus 87%-91%; P < .05), with excellent interreader agreement (κ = 0.8; 95% CI, 0.67-0.92 to κ = 0.81; 95% CI, 0.69-0.93). By all 3 readers, the specificities were also significantly improved by adding dynamic contrast-enhanced MR imaging to conventional MR imaging (22%-43% versus 87%-91%; P < .001) without sacrificing the sensitivities (68%-82% versus 86%-89%; P > .05).

CONCLUSIONS

Adding voxel-based color maps of initial and final 90-second time-signal intensity areas under the curve from dynamic contrast-enhanced MR imaging to conventional MR imaging increases the diagnostic accuracy to detect local recurrence in head and neck squamous cell carcinoma by improving the specificity without sacrificing the sensitivity.

Genomic insights into the non-histamine production and proteolytic and lipolytic activities of Tetragenococcus halophilus KUD23

Tetragenococcus halophilus KUD23, a non-histamine producer, was isolated from a traditional Korean high-salt fermented soybean paste, doenjang. The strain was safe in terms of antibiotic susceptibility, hemolytic activity and biofilm formation. It could grow on De Man-Rogosa-Sharpe agar containing 21% (w/v) NaCl, exhibited acid production at 15% NaCl, and had strain-specific proteolytic and lipolytic activities under salt stress. Complete genome analysis of T. halophilus KUD23 and comparative genomic analysis shed light on the genetic background behind these phenotypic characteristics, including non-production of histamine and proteolytic and lipolytic activities.

Staphylococcus succinus 14BME20 Prevents Allergic Airway Inflammation by Induction of Regulatory T Cells via Interleukin-10

Asthma is a common chronic inflammatory disease, which is characterized by airway hyperresponsiveness (AHR), high serum levels of immunoglobulin (Ig)E, and recruitment of various inflammatory cells such as eosinophils and lymphocytes. Korean traditional fermented foods have been reported to exert beneficial effects against allergic diseases such as asthma and atopic dermatitis. In this study, we investigated whether Staphylococcus succinus strain 14BME20 (14BME20) isolated from doenjang, a traditional high-salt-fermented soybean food of Korea, exerts suppressive effects on allergic airway inflammation in a murine model. Mice were orally administered with 14BME20, then sensitized and challenged with ovalbumin as an allergen. Administration of the 14BME20 significantly suppressed AHR and influx of inflammatory cells into the lungs and reduced serum IgE levels. Moreover, the proportion of T helper type 2 (Th2) cells and the production of Th2 cytokines were decreased in 14BME20-treated mice, whereas dendritic cells (DCs) with tolerogenic characteristics were increased. In contrast, oral administration of 14BME20 increased the proportion of CD4⁺CD25⁺Foxp3⁺ regulatory T (Treg) cells and the level of interleukin (IL)-10 in 14BME20-treated mice. Furthermore, 14BME20 induced maturation of tolerogenic DCs, and 14BME20-treated DCs increased Treg cell population in a co-culture system of DCs and CD4⁺ T cells. The addition of a neutralizing anti-IL-10 mAb to the culture of cells that had been treated with 14BME20 decreased the enhanced Treg cell population, thereby indicating that 14BME20-treated DCs increase Treg cell population via DC-derived IL-10. These results demonstrate that oral administration of 14BME20 suppresses airway inflammation by enhancing Treg responses and suggest that the 14BME20 isolated from doenjang may be a therapeutic agent for allergic asthma.

A Scoring System for Prediction of Cervical Lymph Node Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

BACKGROUND AND PURPOSE

An accurate and comprehensive assessment of lymph node metastasis in patients with head and neck squamous cell cancer is crucial in daily practice. This study constructed a predictive model with a risk scoring system based on CT characteristics of lymph nodes and tumors for patients with head and neck squamous cell carcinoma to stratify the risk of lymph node metastasis.

MATERIALS AND METHODS

Data included 476 cervical lymph nodes from 191 patients with head and neck squamous cell carcinoma from a historical cohort. We analyzed preoperative CT images of lymph nodes, including diameter, ratio of long-to-short axis diameter, necrosis, conglomeration, infiltration to adjacent soft tissue, laterality and T-stage of the primary tumor. The reference standard comprised pathologic results. Multivariable logistic regression analysis was performed to develop the risk scoring system. Internal validation was performed with 1000-iteration bootstrapping.

RESULTS

Shortest axial diameter, ratio of long-to-short axis diameter, necrosis, and T-stage were used to develop a 9-point risk scoring system. The risk of malignancy ranged from 7.3% to 99.8%, which was positively associated with increased scores. Areas under the curve of the risk scoring systems were 0.886 (95% CI, 0.881-0.920) and 0.879 (95% CI, 0.845-0.914) in internal validation. The Hosmer-Lemeshow goodness-of-fit test indicated that the risk scoring system was well-calibrated (P = .160).

CONCLUSIONS

We developed a comprehensive and simple risk scoring system using CT characteristics in patients with head and neck squamous cell carcinoma to stratify the risk of lymph node metastasis. It could facilitate decision-making in daily practice.