The Correlation between Carotid Intima-Media Thickness and Neutrophil to Lymphocyte Ratio in Prediabetes Patients

Background

Prediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients.

Methods

From January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT.

Results

In prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT.

Conclusion

NLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients.

The Impact of Depression on Cardiovascular Disease: A Nationwide Population-Based Cohort Study in Korean Elderly

Background

Depression is suggested to be associated with cardiovascular disease, including ischemic heart disease and cerebrovascular disease. This study investigated the impact of depression on cardiovascular disease in the elderly population in Korea.

Methods

This retrospective cohort study was performed using the Senior Cohort database released by the Korean National Health Insurance Services from January 1, 2008 to December 31, 2012, or January 1, 2009 to December 31, 2013. The study group constituted participants newly diagnosed with depression, but not cardiovascular disease. The control group constituted participants with no past history of depression or cardiovascular disease, and were not diagnosed with depression during the follow-up period. During the 5-year follow-up period, development of ischemic heart disease or cerebrovascular disease was assessed. Depression and cardiovascular disease were identified using the International Classification of Diseases, 10th revision, Clinical Modification codes. The data was analyzed using Cox proportional hazards model.

Results

The hazard ratio (HR) between depression and ischemic heart disease was 1.38 (95% confidence interval [CI], 1.23 to 1.55) and the HR between depression and cerebrovascular disease was 1.46 (95% CI, 1.32 to 1.62), after adjusting all confounding variables.

Conclusion

Independent of other cardiovascular risk factors, depression increased the risk of ischemic heart disease by 38% and cerebrovascular disease by 46% among older adults in Korea. Since depression may increase the risk of cardiovascular disease, future research should focus on the diagnosis and prevention of cardiovascular disease in people with depression.

Survival Analysis of Patients with Alzheimer's Disease: A Study Based on Data from the Korean National Health Insurance Services' Senior Cohort Database

BACKGROUND

Korea's rapidly aging population has experienced a sharp rise in the prevalence of dementia. Patients with Alzheimer's disease (AD), which is estimated to be about three-quarters of all patients with dementia, tend to have higher mortality rates compared with patients without Alzheimer's disease. In this study, a survival analysis of patients with AD was conducted in order to provide knowledge to those who provide medical care to these patients.

METHODS

Data on individuals over 65 years old in 2004 were extracted from the Korean National Health Insurance Services' Senior Cohort database (2002-2013). The subjects were 209,254 patients, including 2,695 who were first diagnosed with AD (the AD group) and 206,559 that had not been diagnosed with the disease (non-AD group). To investigate the independent effect of AD on survival, the Cox proportional-hazards model, hazard ratios (confidence interval of 95%), and the Kaplan-Meier method were used.

RESULTS

Mean survival time in the AD group was 5.3±3.3 years, which was about 2.5 years shorter than that in the non-AD group (7.8±2.4 years). The mortality rate in the AD group (66.3%) was higher than that in the non-AD group (26.3%). The adjusted hazard ratio in the AD group was 2.5 and, therefore, it was found that the AD group had a 2.5-fold higher risk of death than the non-AD group.

CONCLUSION

Overall, AD has a large, independent impact on survival. Survival time was shorter, and the mortality rate and risk were generally higher in the AD group, compared with the non-AD group.

Abstract WMP59: Association of Glycated Hemoglobin Testing Interval on Stroke and Cardiovascular Disease Among Newly Diagnosed Type 2 Diabetes Patients

Background: Although guidelines recommend regular glycated hemoglobin (HbA1c) testing every 6 months for type 2 diabetes patients, whether adherence to these guidelines leads to improved health outcomes is unclear. We aimed to determine the association of HbA1c testing intervals on stroke and cardiovascular disease (CVD) risk among newly diagnosed type 2 diabetes patients.

Methods: The study population consisted of 31,041 newly diagnosed type 2 diabetes patients during 2003-2011 from the Korean National Health Insurance Service. Average HbA1c testing interval was calculated during 3 years after type 2 diabetes diagnosis. Participants were categorized into average HbA1c testing intervals of ≤6, >6 to ≤12, >12 to ≤18, and >18 months, after which they were followed-up for stroke and CVD until 2015. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were determined by Cox proportional hazards regression for the risk of stroke and CVD according to HbA1c testing interval.

Results: Compared to patients with HbA1c testing intervals of ≤6 months, patients with >6 to ≤12 (aHR 1.40, 95% CI 1.10-1.78), >12 to ≤18 (aHR 1.43, 95% CI 1.12-1.84), and >18 (aHR 1.64, 95% CI 1.32-2.04) month intervals had elevated risk for stroke ( p trend <0.001). Similarly, patients with >12 to ≤18 (aHR 1.28, 95% CI 1.10-1.50), and >18 (aHR 1.38, 95% CI 1.21-1.58) month intervals had increased risk for CVD ( p trend <0.001) compared to those with intervals of ≤6 months. There was no significant association between HbA1c testing intervals of ≤3 and >3 to ≤6 months on stroke and CVD risk. The risk-increasing effect of stroke and CVD by longer HbA1c testing intervals was preserved among subgroups divided by fasting serum glucose, initial diabetes medication, outpatient department visits, and Charlson comorbidity index.

Conclusions: HbA1c testing interval of more than 6 months was associated with increased risk of stroke and CVD among newly diagnosed type 2 diabetes patients. Type 2 diabetes patients who undergo biannual HbA1c testing may benefit from reduced stroke and CVD risk.

Night Shift Work and Risk of Depression: Meta-analysis of Observational Studies

This study aimed to assess whether night shift work is associated with the risk of depression by using a meta-analysis of observational studies. We searched PubMed and EMBASE in August, 2016 to locate eligible studies and investigated the association between night shift work and the risk of depression, reporting outcome measures with adjusted odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs). In the meta-analysis of a total of 11 observational studies with 9 cross-sectional study, 1 longitudinal study, and 1 cohort study, night shift work was significantly associated with an increased risk of depression (OR/RR, 1.43; 95% CI, 1.24-1.64; I² = 78.0%). Also, subgroup meta-analyses by gender, night shift work duration, type of occupation, continent, and type of publication showed that night shift work was consistently associated with the increased risk of depression. The current meta-analysis suggests that night shift work is associated with the increased risk of depression. However, further large prospective cohort studies are needed to confirm this association.

The relationship between suicidal behaviors and atopic dermatitis in Korean adolescents

Atopic dermatitis is a common skin disease in adolescents, which may have a negative effect on the mental and emotional health. We investigated the relationship between atopic dermatitis and suicidal behaviors in Korean adolescents. Participants included 74,186 adolescents (38,221 boys and 35,965 girls) in middle and high school who completed the Eighth Korea Youth Risk Behavior Web-Based Survey. There were significant associations between atopic dermatitis and suicidal behaviors for girls. The overestimation of weight perception might have an additive impact on suicidal risk among girls. However, there were no significant associations between atopic dermatitis and suicidal behaviors in boys.

Development of the Perceived Stress Inventory: A New Questionnaire for Korean Population Surveys

Background

Given emerging evidence of the association between stress and disease, practitioners need a tool for measuring stress. Several instruments exist to measure perceived stress; however, none of them are applicable for population surveys because stress conceptualization can differ by population. The aim of this study was to develop and validate the Perceived Stress Inventory (PSI) and its short version for use in population surveys and clinical practice in Korea.

Methods

From a pool of perceived stress items collected from three widely used instruments, 20 items were selected for the new measurement tool. Nine of these items were selected for the short version. We evaluated the validity of the items using exploratory factor analysis of the preliminary data. To evaluate the convergent validity of the PSI, 387 healthy people were recruited and stratified on the basis of age and sex. Confirmatory analyses and examination of structural stability were also carried out. To evaluate discriminatory validity, the PSI score of a group with depressive symptoms was compared with that of a healthy group. A similar comparison was also done for persons with anxious mood.

Results

Exploratory factor analysis supported a three-factor construct (tension, depression, and anger) for the PSI. Reliability values were satisfactory, ranging from 0.67 to 0.87. Convergent validity was confirmed through correlation with the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. People with depressive or anxious mood had higher scores than the healthy group on the total PSI, all three dimensions, and the short version.

Conclusion

The long and short versions of the PSI are valid and reliable tools for measuring perceived stress. These instruments offer benefits for stress research using population-based surveys.

A placebo-controlled randomised trial to assess the effect of TGF-ß1-expressing chondrocytes in patients with arthritis of the knee

The aim of this study was to assess the effect of injecting genetically engineered chondrocytes expressing transforming growth factor beta 1 (TGF-β1) into the knees of patients with osteoarthritis. We assessed the resultant function, pain and quality of life.

A total of 54 patients (20 men, 34 women) who had a mean age of 58 years (50 to 66) were blinded and randomised (1:1) to receive a single injection of the active treatment or a placebo. We assessed post-treatment function, pain severity, physical function, quality of life and the incidence of treatment-associated adverse events. Patients were followed at four, 12 and 24 weeks after injection.

At final follow-up the treatment group had a significantly greater improvement in the mean International Knee Documentation Committee score than the placebo group (16 points; -18 to 49, vs 8 points; -4 to 37, respectively; p = 0.03). The treatment group also had a significantly improved mean visual analogue score at final follow-up (-25; -85 to 34, vs -11 points; -51 to 25, respectively; p = 0.032). Both cohorts showed an improvement in Western Ontario and McMaster Osteoarthritis Index and Knee Injury and Osteoarthritis Outcome Scores, but these differences were not statistically significant. One patient had an anaphylactic reaction to the preservation medium, but recovered within 24 hours. All other adverse events were localised and resolved without further action.

This technique may result in improved clinical outcomes, with the aim of slowing the degenerative process, leading to improvements in pain and function. However, imaging and direct observational studies are needed to verify cartilage regeneration. Nevertheless, this study provided a sufficient basis to proceed to further clinical testing.

Cite this article: Bone Joint J 2015;97-B:924–32.

Effectiveness of ultrasonographic screening for thyroid cancer: round-table conference in the National Evidence- based Healthcare Collaborating Agency (NECA) in conjunction with the Korean Thyroid Association

BACKGROUND

The incidence rate of thyroid cancer has been increasing worldwide in recent years, and it is also the most prevalent cancer when it comes to the number of patients among Korean women. With it, ultrasonographic screening test has also become very common. However, there is still controversy over the performance of this screening test. Therefore, the National Evidence-based Healthcare Collaborating Agency (NECA) organized a Round-table Conference on the issues regarding ultrasonographic screening for thyroid cancer in Korea. The objective of the conference was mainly about delivering worthwhile information reflecting social value for the current situation, which was based on evidence surrounding thyroid cancer screening that relevant experts investigated and agreed on. The significance of this Round-table Conference lies in the fact that we reviewed the current evidence, and we were able to discuss the social value and future direction for ultrasonographic screening in Korea.

Relationship between sarcopenic obesity and cardiovascular disease risk as estimated by the Framingham risk score

This study was conducted to assess the association between sarcopenic obesity and cardiovascular disease (CVD) risk in Korean adults (n=3,320; ≥40 yr) who participated in the 5th Korean National Health and Nutrition Examination Survey in 2010. The appendicular skeletal muscle mass divided by body weight was calculated for each participant; participants with values <1 standard deviation below the mean reference value (i.e., aged 20-39 yr) were considered sarcopenic. Subjects were further classified into 4 groups according to their obesity (i.e., body mass index ≥25 kg/m(2)) and sarcopenic status. Individuals' 10-yr CVD risk was determined using the Framingham risk model. The sarcopenic obese group had more participants (43.8% men, 14.6% women) with a high risk of CVD (≥20%). The sarcopenic obese group was associated with an increased 10-yr CVD risk than the non-sarcopenic, non-obese group (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.53-4.06, P<0.001 in men; OR, 1.87; 95% CI, 1.02-3.41, P=0.041 in women). Sarcopenic non-obese and non-sarcopenic obese subjects were not associated with an increased 10-yr CVD risk. Sarcopenic obesity, but not non-sarcopenic obesity, was closely associated with an increased CVD risk in Korean adults.

Diagnostic performance of body mass index using the Western Pacific Regional Office of World Health Organization reference standards for body fat percentage

Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (≥25 kg/m(2)) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m(2)) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m(2) difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.

Bone regeneration at dental implant sites with suspended stem cells

During the maintenance of bone marrow-derived mesenchymal stem cells (BMMSCs), suspended cells are discarded normally. We noted the osteogenic potential of these cells to be like that of anchorage-dependent BMMSCs. Therefore, we characterized suspended BMMSCs from rabbit bone marrow by bioengineering and applied the suspended BMMSCs to double-canaled dental implants inserted into rabbits. After primary isolation of BMMSCs, we collected the suspended cells during primary culture on the third day. The cells were transferred and maintained on an extracellular-matrix-coated culture plate. The cells were characterized and compared with BMMSCs by colony-forming-unit fibroblast (CFU-f) and cell proliferation assay, fluorescence-activated cell sorter (FACS), in vitro multipotency, and reverse transcription polymerase chain reaction (RT-PCR). We also analyzed the osteogenic potential of cells mixed with hydroxyapatite/tricalcium phosphate (HA/TCP) and transplanted into immunocompromised mice. We compared the viability and proliferation of the suspended BMMSCs and BMMSCs on the titanium implant surface and observed cell morphology. Then, the cells mixed with HA/TCP were applied to the double-canaled implants during installation into rabbit tibia. Four weeks later, we analyzed bone formation inside the canal by histomorphometry. The suspended cells showed higher CFU-f on the extracellular matrix (ECM)-coated culture plate and similar results of proliferation capacity compared with BMMSCs. The cells also showed osteogenic, adipogenic, and chondrogenic ability. The suspended cells showed levels of attachment survival and proliferation on the surfaces of titanium implant discs to be higher than or similar to those of BMMSCs. The suspended cells as well as BMMSCs showed stronger bone formation ability in both upper and lower canals of the implants compared with controls on double-canaled implants inserted into rabbit tibia. In this study, we showed that suspended cells after primary BMMSC isolation have bone regeneration capacity like that of BMMSCs, not only in vitro but also in vivo. ECM was valuable for propagation of MSCs for cell-based bone regeneration. Therefore, the suspended cells could also be useful tools for bone regeneration after implant surgery.

Comparability and utility of body composition measurement vs. anthropometric measurement for assessing obesity related health risks in Korean men

BACKGROUND

Obesity is commonly assessed by body mass index (BMI) of which limitations come from an inability to distinguish body fat mass from lean mass. Several anthropometric measurements, including BMI, waist circumference, waist-to-height ratio and waist-to-hip ratio have been used to predict metabolic syndrome. The purpose of this study was to evaluate the utility of FMI or BF% combined with previous known anthropometric indices to assess the risk of metabolic syndrome in clinical practice.

METHODS

In 5534 men visiting a hospital for health check-ups, blood tests, anthropometric measurements and body composition analysis using BIA were performed. Logistic regression analysis was performed to compare the odds ratios for metabolic syndrome and each component of metabolic syndrome among BMI, waist-to-height ratio, waist-to-hip ratio, FMI and BF%. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) for metabolic syndrome was compared between several measurements. The net reclassification improvement with integrated discrimination improvement was used for assessing value of body composition measurement.

RESULTS

The adjusted odds ratios of metabolic syndrome was 1.80 (95% CI, 1.71-1.89) for FMI and 1.15 (95% CI, 1.13-1.17) for BF%. Odds ratio of each metabolic component was highest for FMI among several anthropometric and body composition measurements. AUCs using the ROC curve for metabolic syndrome was highest for waist-to-height ratio, 0.823 (95% CI, 0.808-0.837) by National Cholesterol Education Program criteria. FMI caused a mild increase in integrated discrimination improvement when combined with waist-to-height ratio.

CONCLUSIONS

Waist-to-height ratio seems to be the best screening tool for evaluating metabolic syndrome in Korean men, and adding FMI could result in a modest increase in integrated discrimination improvement.

Anti-elastase and anti-hyaluronidase of phenolic substance from Areca catechu as a new anti-ageing agent

We have previously screened 150 medicinal plants for the inhibition of elastase and found significant inhibitory effects of the extracts of Areca catechu L. on the ageing and inflammation of skin tissues. To isolate and identify the compounds having biological activity, they were further purified by each fraction of solvents, silica gel column chromatography, preparative TLC and reversed-phase HPLC. The peak in HPLC, which coincided with the inhibitory activity against elastase, was identified as a phenolic substance by using various colorimetric methods, UV and IR. IC(50) values of this phenolic substance were 26.9 mug mL(-1) for porcine pancreatic elastase (PPE) and 60.8 mug mL(-1) for human neutrophil elastase (HNE). This phenolic substance showed more potent activity than that of reference compounds, oleanolic acid (76.5 mug mL(-1) for PPE, 219.2 mug mL(-1) for HNE) and ursolic acid (31.0 mug mL(-1) for PPE, 118.6 mug mL(-1) for HNE). According to the Lineweaver-Burk plots, the inhibition against both PPE and HNE by this phenolic substance was competitive inhibition with the substrate. The phenolic substance from A. catechu effectively inhibited hyaluronidase activity (IC(50) : 210 mug mL(-1) ). These results suggest that the phenolic substance purified from A. catechu has an anti-ageing effect by protecting connective tissue proteins.

Correlation of CPX Scores with the Scores on Written Multiple-Choice Examinations on the Certifying Examination for Family Medicine in 2009 to 2011

PURPOSE

Recently, the clinical practice examination (CPX) using standardized patients has been introduced into several specialty certifying examinations in Korea. The purpose of this paper was to determine the correlation of a resident's performance on the CPX with the comprehensive written multiple-choice question (MCQ) examination on the certifying examination for family medicine.

METHODS

The subjects of this study were 1,023 residents who completed the 1st and 2nd certifying examination for family medicine between 2009 and 2011. We determined the correlation between the total scores and 4 domain scores (history taking, physical examination, patient education, and patient-physician interaction) on the CPX with the MCQ scores of the 1st written test and 2nd slide examination and the correlation between the total CPX score and scores on the CPX domains.

RESULTS

The correlation between CPX score with each MCQ examination (0.21~0.45 with 1st written MCQ, 0.15~0.33 with 2nd slide MCQ) was lower than that between each MCQ examination (0.46~0.59). The CPX score on patient education did not correlate with the 1st written and 2nd MCQ scores. The CPX scores on history taking and physical examination correlated slightly with the 1st written MCQ scores. The global ratings of preceptor examiners had the highest correlation (r=0.68~0.82) with the total CPX scores.

CONCLUSION

Considering the mild correlation of CPX scores with each MCQ examination, the CPX is more likely to measure other qualities, such as critical thinking and communication skills.

Self-reported exposure to second-hand smoke and positive urinary cotinine in pregnant nonsmokers

PURPOSE

This cross-sectional study aimed to examine the association between self-reported exposure status to second-hand smoke and urinary cotinine level in pregnant nonsmokers.

MATERIALS AND METHODS

We recruited pregnant nonsmokers from the prenatal care clinics of a university hospital and two community health centers, and their urinary cotinine concentrations were measured.

RESULTS

Among a total of 412 pregnant nonsmokers, the proportions of self-reported exposure to second-hand smoke and positive urinary cotinine level were 60.4% and 3.4%, respectively. Among those, 4.8% of the participants who reported exposure to second-hand smoke had cotinine levels of 40 ng/mL (the kappa value = 0.029, p = 0.049). Among those who reported living with smokers (n = 170), "smoking currently permitted in the whole house" (vs. not permitted at home) was associated with positive urinary cotinine in the univariable analysis. Furthermore, this variable showed a significant association with positive urinary cotinine in the stepwise multiple logistic regression analysis [Odds ratio (OR), 15.6; 95% Confidence interval (CI) = 2.1-115.4].

CONCLUSION

In the current study, the association between self-reported exposure status to second-hand smoke and positive urinary cotinine in pregnant nonsmokers was poor. "Smoking currently permitted in the whole house" was a significant factor of positive urinary cotinine in pregnant nonsmokers. Furthermore, we suggest that a complete smoking ban at home should be considered to avoid potential adverse effects on pregnancy outcomes due to second-hand smoke.

The estimation of cardiovascular risk factors by body mass index and body fat percentage in Korean male adults

The aim of the study was to assess cardiovascular risk in men with high body fat percentage (BF%) and normal body mass index (BMI) and men with normal BF% and high BMI. This study was a cross-sectional study using data on 5534 Korean male adults. Body mass index, BF%, and waist circumference were measured as adiposity indices. Bioelectrical impedance analysis was used for measuring BF%. Blood pressure, fasting plasma glucose, total cholesterol, triglyceride, and high-density lipoprotein cholesterol were measured routinely. Information regarding alcohol consumption, smoking, exercise, and past/current medical history was obtained by structured questionnaires. Subjects were categorized into 4 groups by means of BMI and BF% (group 1, BMI <25 kg/m(2) and BF% <25%; group 2, BMI <25 kg/m(2) and BF% > or =25%; group 3, BMI > or =25 kg/m(2) and BF% <25%; group 4, BMI > or =25 kg/m(2) and BF% > or =25%). Cardiovascular risk factors (CVRFs) such as high blood pressure, hyperglycemia, and dyslipidemia were estimated in each group. As might be expected, the prevalences of high blood pressure, hyperglycemia, and dyslipidemia were lowest in group 1 and were highest in group 4. Multivariate analyses showed that subjects in group 2 or group 4 had a 1.8 times increased risk of clustering of 2 or more CVRFs compared with subjects in group 1 (P < .001). The adjusted odds ratio (1.15; 95% confidence interval, 0.94-1.40) of subjects in group 3 on clustering of 2 or CVRFs was not significantly increased (P = .180). High BF% was related to increase of cardiovascular risk regardless of the level of BMI in Korean men. However, cardiovascular risk of men with high BMI without high BF% was not significantly increased.

Effect of immature dendritic cell injection before heterotropic cardiac allograft

Although dendritic cells (DCs) are unrivaled for initiation of immune responses, the immunomodulatory capacity of chemically fixed DC has not been thoroughly evaluated. We monitored the tolerogenic capacity of chemically fixed DCs using allogeneic heart transplantations. Bone marrow progenitors were differentiated into immature DCs which were then chemically fixed and injected intravenously into recipient mice at 14 days before allogeneic heart transplantation. Chemically fixed DCs markedly prolonged graft survival in the major histocompatibility complex (MHC) I/II mismatch cardiac transplantation (B6 --> B10.A; median survival time [MST] 12.5 days vs >70 days). T cells that encountered chemically fixed DCs showed attenuated apoptotic cell death and inactivated phenotypes after allogeneic heterotropic heart transplantation. Furthermore, when DCs from interleukin (IL)-10-/- mice were treated, the in vitro T-cell response was greater than that from IL-12-/- mice. We have suggested that the chemically fixed DCs may mediate peripheral T-cell tolerance, with therapeutic potential for allogeneic transplantation.

[Correlates of self-rated fatigue in Korean employees]

OBJECTIVE

To elucidate the correlates of self-rated fatigue in Korean employees.

METHODS

The data for 10,176 (men, 7984; women, 2192; mean age, 34.2; SD: 8.8) employees recruited from a nation-wide sample were examined. A structured questionnaire was used to measure the participants' fatigue, sociodemographics (sex, age, education, and marital status), job-related characteristics (work duration, grade at work, work hours, shiftwork, employment type, and magnitude of workplace), and health-related habits (smoking, drinking, coffee intake, and exercise). Two types of measurement for fatigue were used to evaluate the magnitude of fatigue: self-rated question and a standardized measurement tool (Multidimensional Fatigue Scale: MFS).

RESULTS

According to the self-rated fatigue, 32% of employees reported that they felt fatigue for the past two weeks, and 9.6% of males and 8.7% of females had experienced excessive fatigue (6 months or more). Hierarchical multiple regression analysis showed that fatigue measured by MFS was more common in women, younger, college or more graduated, single, and employees who do not regularly exercise. Fatigue was also associated with long work hours, and the size of the workplace (< 1000 employees).

CONCLUSIONS

These results suggest that fatigue has been considered as a common complaint, and that it is affected by job-related factors like work hours and the workplace size as well as sociodemographics or health-related behaviors. Further research is needed to clarify the effects of fatigue on adverse health,outcomes, work performance, work disability, sick absence and medical utilization, and to examine the relationship of job characteristics (e.g.: work demand, decision latitude) to fatigue.

[Epidemiology of psychosocial distress in Korean employees]

OBJECTIVE

To estimate the magnitude of psychosocial distress and examine eligible factors associated with the development of psychosocial distress in Korean employees, using a nationwide sample.

METHODS

A total of 6977 workers were recruited from 245 companies. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, social support at work, personality traits (locus of control, type A behavior pattern), self-esteem, and psychosocial distress.

RESULTS

The results showed that 23% of workers were categorized as high stress, 73% as moderate, and 5% as normal. Hierarchical multiple regression analysis showed that psychosocial distress was more common in younger workers, both male and female. Regular exercise was negatively associated with increase of psychosocial distress. In job characteristics, as expected, low decision latitude, high job insecurity, and low social support at work were related to high psychosocial distress. Personality traits such as locus of control and type A behavior pattern, and self-esteem were more powerful predictors of psychosocial distress than general characteristics, health-related behavior, and job characteristics. There were some gender differences. While men who are less educated and single (unmarried, divorced, and separated) experienced higher levels of psychosocial distress than those who are educated and married, women who feel high job demand experienced higher levels of psychosocial distress than those who feel low job demand.

CONCLUSIONS

The proportion of the high stress group was higher than expected, and psychosocial factors like social support and personality characteristics (e.g. locus of control, type A behavior pattern and self-esteem) were more significant factors for psychosocial distress than other variables. This finding suggests that some psychosocial factors, especially inadequate social support, low self-esteem and lack of internal locus of control for the development of psychosocial distress, will also operate as an intervention strategy in the worksite stress reduction program. It is strongly required that worksite stress reduction programs should be established in at both occupational and level as well as in individual levels.

Effects of Paeonia lactiflora root extracts on the secretions of monocyte chemotactic protein-1 and -3 in human nasal fibroblasts

In the field of Oriental medicine, the root of Paeonia lactiflora (Paeoniae Radix) has been prescribed usually to treat the common cold, and it was thought to alleviate upper respiratory infection or nasal inflammation. Monocyte chemotactic proteins (MCP)-1 and MCP-3 are known as the most potent chemokines to mediate allergic inflammation. The object of the study was to investigate the effect of Paeoniae Radix on the release of the chemokines such as MCP-1 and MCP-3. To detect the secretion of MCPs, an enzyme-linked immunosorbent assay was performed for human nasal mucosal fibroblasts after stimulation with several cytokines such as tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and interleukin-1beta (IL-1beta). The secretion of MCP-1 was increased after stimulation with TNF-alpha or IL-1beta treatment. Co-treatment of TNF-alpha and IFN-gamma, or IL-1beta and IFN-gamma increased the secretion of MCP-1 and MCP-3. Paeoniae Radix was tested with inflammatory cytokines, and the results showed that the Paeoniae Radix significantly decreased the secretion of MCP-1 and MCP-3. In our study, Paeoniae Radix may play an important role in nasal inflammation with a modulation of MCP-1 and MCP-3.

Antifibrotic effect of silymarin in rat secondary biliary fibrosis is mediated by downregulation of procollagen alpha1(I) and TIMP-1

BACKGROUND/AIMS

Silymarin reduces hepatic collagen accumulation by 35% in rats with secondary biliary cirrhosis. The aim of the present study was to explore its antifibrotic mechanism.

METHODS

Thirty female adult Wistar rats were allocated to (1) bile duct occlusion, (2) bile duct occlusion and oral silymarin at 50 mg/kg per day, and (3) sham operation and oral silymarin at 50 mg/kg per day. Steady-state mRNA levels for procollagen alpha1(I), tissue inhibitor of metalloproteinases-1 (TIMP-1), and transforming growth factor (TGF) beta1 were determined by multi-probe ribonuclease protection assay.

RESULTS

After 6 weeks of bile duct occlusion, liver collagen content was increased 12-fold, when compared with the sham-operated controls. These animals displayed 17-, 6.5- and 16-fold higher transcript levels for procollagen alpha1(I), TIMP-1 and TGFbeta1 (P < 0.01). Silymarin downregulated elevated procollagen alpha1(I), TIMP-1 and TGFbeta1 mRNA levels by 40-60% (P < 0.01). These lowered hepatic profibrogenic transcript levels correlated with decreased serum levels of the aminoterminal propeptide of procollagen type III.

CONCLUSIONS

Silymarin suppresses expression of profibrogenic procollagen alpha1(I) and TIMP-1 most likely via downregulation of TGFbeta1 mRNA in rats with biliary fibrosis. The serum procollagen type III propeptide level mirrors profibrogenic mRNA expression in the liver.

CDNA for an immune response gene encoding low molecular weight polypeptide from flounder, Paralichthys olivaceus

The cDNA for an immune response gene encoding the low molecular weight polypeptide (LMP7) was cloned and sequenced from a flounder (Paralichthys olivaceus) leukocyte cDNA library. The cDNA clone was 1,160 bp, and composed of an open reading frame of 822 bp that corresponded to a protein of 273 amino acid residues with a calculated mass of 30.5 kDa. The ScanProsite search indicated that the deduced amino acid sequence from the flounder LMP7 contains a proteasome beta-type subunit signature, which is well conserved during evolution. The sequence shares a high degree of identity with other LMP7 sequences varying from a 66% identity with zebra fish (Danio renio) to a 57% identity with the African clawed frog (Xenopus laevis), which was confirmed from a phylogenetic tree. A reverse transcription-polymerase chain reaction (RT-PCR) was used to determine tissue specificity, and the expression of LMP7 was detected from the liver, kidney, leukocyte, and spleen of the flounder.

Activation of the hepatic endothelin-system in rats with biliary liver fibrosis

Circulating plasma endothelin-1 (ET-1) is elevated in liver cirrhosis, in a disease-stage-dependent manner. However, ET-1 exerts its effects mainly via paracrine and autocrine pathways. Therefore, the aim of the present study was to analyze the hepatic endothelin (ET) system in liver cirrhosis resulting from bile duct obstruction (BDO). Wistar rats were subjected for 6 weeks to either sham operation (control) or BDO. Thereafter, hepatic ET-1 concentrations were elevated 7.2-fold in BDO compared to control (p <0.001), whereas big ET-1 was unchanged. The density of both ET receptor subtypes was upregulated in BDO (ETA: 7.4-fold and ETB: 4.9-fold vs control, p < 0.001, respectively). The affinity of both receptor subtypes was significantly reduced in BDO. In conclusion, our data demonstrated for the first time that the hepatic ET system in liver cirrhosis is characterized by a simultaneous upregulation of both ET-1 tissue concentration as well as the density of hepatic ETA- and ETB-receptors, suggesting a synergistic activation of the hepatic ET system in rats with BDO. The increased ET-1 tissue concentration is not a result of an altered big ET-1 synthesis in biliary liver fibrosis, suggesting an increased activity of endothelin-converting enzyme (ECE) in liver cirrhosis.

Regulation of the hepatic endothelin system in advanced biliary fibrosis in rats

The aim of the present study was to analyze the hepatic endothelin system and its regulation in liver cirrhosis due to bile duct obstruction. Wistar rats were subjected for 6 weeks to: 1) sham operation; 2) bile duct obstruction; 3) bile duct obstruction and the selective oral endothelin A receptor antagonist LU 135252; 4) bile duct obstruction and oral silymarin, a hepatoprotective and antifibrotic compound. We determined tissue concentrations of endothelin-1 and big-endothelin-1 by ELISA and the density of both endothelin receptor subtypes in plasma membrane fractions by Scatchard analysis. The hepatic endothelin system in liver cirrhosis due to chronic bile duct obstruction is characterized by a simultaneous up-regulation of both endothelin-1 tissue concentration (7.2 fold compared to sham operation; p<0.001) as well as the density of both endothelin receptor subtypes (ET(A) 7.4-fold, ET(B) 4.9-fold, p<0.001, respectively) suggesting a synergistic activation of the hepatic endothelin system in this rat model of non-inflammatory cirrhosis. Treatment with proven antifibrotic agents such as silymarin or a selective endothelin-A-receptor blocker (LU 135252) did not reduce the activity of the hepatic endothelin system, suggesting that the hepatic endothelin system is not activated by the fibrotic process itself.

An oral endothelin-A receptor antagonist blocks collagen synthesis and deposition in advanced rat liver fibrosis

BACKGROUND & AIMS

Endothelin 1 induces contraction, proliferation, and collagen synthesis of hepatic stellate cells in vitro, which may be mediated via the endothelin A receptor. It is unknown if specific blockade of the endothelin A receptor inhibits hepatic fibrosis in vivo.

METHODS

Groups of 10-20 rats with bile duct occlusion were treated with the nonpeptide endothelin-A receptor antagonist LU 135252 at 80 mg. kg(-1). day(-1) from week 1-6 or from week 4-6, or with LU at 10 mg. kg(-1). day(-1) from week 1-6. Animals with bile duct occlusion alone and sham-operated rats without or with LU at 80 mg. kg(-1). day(-1) over 6 weeks served as controls. After 6 weeks, parameters of fibrogenesis were determined.

RESULTS

LU treatment led to improved histology, paralleled by a dose-dependence up to 60% reduction of liver collagen, even when administered at an advanced fibrosis stage. This was accompanied by a decreased messenger RNA of hepatic procollagen alpha1(I) and tissue inhibitor of metalloproteinase 1, 2 major effectors of fibrosis, and of serum procollagen type III, a surrogate marker of liver fibrogenesis.

CONCLUSIONS

Selective endothelin-A receptor blockade can dramatically reduce collagen accumulation in rat secondary biliary fibrosis, a model refractory to most potential antifibrotic agents. Endothelin-A receptor antagonists are promising antifibrotic agents in chronic liver disease.

Ellipsometric determination of universal critical adsorption scaling functions

In this paper we determine and compare a number of theoretical models which describe the universal scaling functions for critical adsorption in the strong surface field limit. The P1 and P3 models, which are continuous up to and including the first and third derivatives, respectively, provide excellent descriptions of the ellipsometric data for four different critical binary liquid mixtures. The exponential-Pade model, initially proposed by Liu and Fisher [Phys. Rev. A 40, 7202 (1989)], provides a reasonable but less accurate description of the one-phase experimental data. This later model has the advantage, however, that it is continuous in all derivatives.

Identification of PCR-based markers flanking the recessive LMV resistance gene mo1 in an intraspecific cross in lettuce

Molecular markers flanking the recessive resistance gene mo1 were identified following analysis of two segregating populations. Generation of a population from a crisphead × crisphead cross of Lactuca sativa that segregated for resistance conferred by the mo12allele, but not morphological traits, was required for accurate mapping of the gene. Resistance was best assessed by symptom development after inoculating F3families with the common pathotype II isolate of lettuce mosaic virus (LMV). Bulked segregant analysis for RAPD (random amplified polymorphic DNA) markers using one population, followed by linkage analysis using another, identified markers on either side of the mo1 gene, approximately 8 cM apart. These markers will be useful for more efficient introgression of this resistance gene into additional lettuce cultivars.Key words: lettuce, lettuce mosaic virus, molecular marker, disease resistance gene, bulked segregant analysis.

Complementary DNA Encoding nm23/NDP Kinase Gene from the Korean Tiger Shark Scyliorhinus torazame

: A new tumor suppressor gene, snm23, homologous to the gene for human nucleoside diphosphate kinase nm23/NDP was first cloned from Korean tiger shark (Scyliorhinus torazame) skin lambda ZAP-II complementary DNA library. The gene (named snm23) containing the tumor metastasis suppressor protein was sequenced. The nucleotide and deduced amino acid sequences of snm23 revealed an open reading frame of 450 bp that corresponded to a protein of 150 amino acid residues, with a calculated molecular mass of 16.8 kDa. Sequence comparison of snm23 with nm23/NDP kinases was performed. In order to determine tissue specificity, reverse transcription-polymerase chain reaction was used. The expression of snm23/NDP kinase was detected in tissues from skin, cartilage, and liver of Korean tiger shark.

Identification and characterization of the inducible murine mast cell gene, imc-415

Activation of mast cells results in the generation and release of bioactive mediators which in turn initiate allergic inflammation. Mast cell function is enhanced following stimulation in part because of the induction of specific genes and their products. To identify additional genes induced in mast cells that support this process, we thus constructed an activation-specific mast cell subtraction library. To date, we have isolated 26 novel inducible murine mast cell (imc) cDNA clones. Among them, a full-coding region of the murine gene imc-415 was found to have a greater than 90% nucleotide sequence homology and a 97.5% amino acid sequence homology to both a human beta4 integrin-binding protein (p27(BBP)) and a human translation initiation factor 6 (eIF6), which in turn are identical. In vitro translation of the imc-415 gene yielded a band of an approximately 26 kDa. This is the same as the calculated molecular weight of murine IMC-415 protein based on the predicted amino acid sequence and is the molecular weight of p27(BBP)/eIF6. Murine imc-415 message was also induced in inflamed lung tissues in a mouse model of asthma. These results suggest a role for murine imc-415 in allergic inflammation where it may enhance protein synthesis. Human eIF6/p27(BBP) may also play a role in allergic diseases based on the similarities in sequence and in gene expression patterns.

Enzyme-linked immunosorbent assay for serum procollagen type III peptide in rats with hepatic fibrosis

The process of hepatic fibrosis, and the changes in contents of hepatic hyproxyproline (HYP) and serum procollagen type III peptide (PIIINP) were examined in two rat models for hepatic fibrosis, i.e. bile duct ligation/scission (BDL/s)- and dimethylnitrosamine (DMN)-induced models. In addition, an expression of type III collagen mRNA in the liver of BDL/s model was also examined. In BDL/s model, hepatic fibrosis started at 2 weeks after operation (WAO) and cirrhosis with prominent bile duct hyperplasia was detected at and after 5 WAO. Serum PIIINP content measured using a modified double armed inhibition enzyme-linked immunosorbent assay (ELISA) method proposed by us started to increase at 1 WAO and continued to increase thereafter. Hepatic HYP content measured colorimetrically started to increase at 3 WAO and it continued to increase until 7 WAO. An expression of type III collagen mRNA in the liver was enhanced at and after 2 WAO, especially at 4 and 5 WAO. In DMN model, marked hepatic fibrosis was detected at 1 week after the last DMN administration (WAA), and the degree of fibrosis was apparently reduced at 4 WAA. Serum PIIINP content prominently increased at 1 WAA and decreased at and after 3 WAA. Hepatic HYP content showed a marked increase at 1 WAA and decreased thereafter. The present results indicated that the sequences of hepatic fibrosis, hepatic HYP content and serum PIIINP content were well correlated with each other in both BDL/s and DMN models. In conclusion, ELISA system for the detection of serum PIINP content is considered to be reliable method for assessment of cirrhotic liver, and the present two rat models for liver fibrosis/cirrhosis seems to be a good tool for researching antifibrotic agents.

Artemisinin derivatives in the treatment of falciparum malaria in pregnancy

An artemisinin derivative (artesunate or artemether) was used for the treatment of multidrug-resistant Plasmodium falciparum malaria in 83 Karen pregnant women in Thailand; 55 women were treated for recrudescent infection following quinine or mefloquine, 12 for uncomplicated hyperparasitaemic episodes, and 16 had not declared their pregnancy when treated. The women were followed weekly until delivery. Artesunate and artemether were well tolerated and there was no drug-related adverse effect. Recrudescence within 42 d occurred in 16% of the treated episodes. Overall 73 pregnancies (88%) resulted in live births, 3 (4%) in abortions and 2 (3%) in still births, and 5 women were lost to follow-up before delivery. There was no congenital abnormality in any of the newborn children, and the 46 children followed for more than one year all developed normally.

Identification and categorization of inducible mast cell genes in a subtraction library

Mast cells play an important role in allergic inflammation by releasing inducible proinflammatory cytokines. While many inducible genes have been identified, we hypothesized that a significant number remain to be identified. We thus constructed an activation-specific mast cell subtraction library to establish a profile of induced genes in mast cells following allergic stimulation. To date, we have sequenced 150 cDNA clones. Among them, we have isolated 22 known genes whose expression has not been reported in mast cells, and an additional 26 cDNA clones which do not have significant homology to known genes in the Genbank database. We next selected 10 cDNA clones with strong signals by differential plaque hybridization. Of these cDNA clones, five genes were induced in mast cells upon Fc epsilon RI-mediated stimulation. They are cofilin, annexinVI, interferon (IFN)-beta, serglycin, and a novel inducible mast cell (IMC) gene, IMC-415. Characterization and relevant studies of this novel gene and other inducible known genes in mast cells will provide insight into the functions of mast cells in mammalian biology.

Two different negative regulatory elements control the transcription of T-cell activation gene 3 in activated mast cells

T-cell activation gene 3 (TCA3) encodes a beta-chemokine that is transcriptionally regulated in mast cells; the gene has a functional NF-kappaB element at positions -194 to -185. The 5'-flanking region of this gene is also known to have a negative regulatory region between -2057 and -1342. To characterize the negative regulatory elements (NREs), this region was sequenced and then digested by HindIII enzyme into two fragments, NRE-1 (-2057 to -1493) and NRE-2 (-1492 to -1342). Both NRE-1 and NRE-2 in the 5'-3' orientation inhibited chloramphenicol acetyltransferase (CAT)-protein synthesis by a TCA3-CAT construct transfected into mast cells that were then activated. Only NRE-1 inhibited CAT-protein synthesis in the 3'-5' orientation. Further deletion of the 5' region of NRE-1 partially abolished the inhibitory activity. Both NRE-1 and NRE-2 inhibited the activity of a CD20-CAT construct independent of cell activation. Electrophoretic mobility shift assays showed DNA-protein complex formation with subsequences (CCCCCATTCT) of NRE-1 (NRE-1a) and (CCATGA) of NRE-2 (NRE-2b). NRE-1a appears to be novel. NRE-2b is identical with a putative silencer motif in the alphaIIb integrin gene. Site-directed mutagenesis demonstrated that both NRE-1a and NRE-2b are important in the negative regulation of TCA3 promoter activity. In vivo ligation-mediated PCR footprinting of the NRE-2 region revealed protection between -1372 and -1354, which contains NRE-2b. The data thus demonstrate identity of a silencer motif, here termed NRE-2b, in both the alphaIIb integrin gene and the TCA3, and that this silencer region in mast cells is functional both in vivo and in vitro. Further, evidence is presented that the promoter for TCA3 contains a novel silencer motif, termed NRE-1a, characterized by a CT-rich sequence.

The physicians' recognition and attitude about patient education in practice

The purpose of this study was to investigate the current status of physicians' recognition and their attitude towards patient education in actual clinical practice. We sent surveys containing self-questionnaires to one-hundred and fifty physicians in five university hospitals and one general hospital from the period of April to July 1995. The self-questionnaire was designed to evaluate the physicians' recognition and attitude towards patient education at his or her clinical practice. A total of 137 answered-sheets were returned and they were subsequently analyzed. 1) The frequency of physicians' recognition of patient education as an essential component in practice was 76.6%. There was a significant difference between family physicians and other physicians, 97.1% 69.6%, respectively (p = 0.03). 2) The frequency of physicians' accomplishment of a satisfactory doctor-patient relationship was 51.1%; board certified physicians and residents, 79.4%, 43.3%, respectively (p = 0.001). 3) The percentage of physicians who explained details about examinations and procedures was 73.0%, who interpreted the findings of exams, tests and x-rays 72.3%, but who assessed patient readiness to modify behavior was only 29.9%. The frequency of physicians' education to patient about the biomedical diagnosis and treatment was high, but that of physicians' approach towards patient as a biopsychosocial model was relatively low. Therefore, it is concluded that much more time and emphasis should be placed on patient education in the undergraduate and postgraduate medical education curricula.

Nutritional requirements and biochemical activities of pineapple pink disease bacterial strains from Hawaii

Bacteria which cause pink disease of pineapple, identified on the basis of their nutritional and biochemical activities, were found to belong to three genera. These bacteria include the following species: Gluconobacter oxydans, Acetobacter aceti, and Erwinia herbicola. Several pink disease strains required one to three vitamins for growth. Both G. oxydans strains 303D and 180 required biotin, nicotinic acid, and pantothenic acid for growth; E. herbicola 189 required only nicotinic acid; however, A aceti 295 was able to grow without any added supplements in glucose mineral salts medium. Optimal vitamin concentrations for maximal growth and optimal pH for the maximal number of generations per hour was established for a few pink disease strains.