Comprehensive evaluation of ocular complications in atopic dermatitis: insights from a contemporary cohort study in Korean population

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with various systemic and ocular complications. This study aimed to investigate the prevalence, risk factors, and clinical characteristics of ocular complications in a cohort of Korean AD patients.

METHODS

A retrospective review of medical records was conducted for AD patients who visited the dermatology and ophthalmology clinics at the same institution. Demographic data, clinical characteristics, and types of ocular complications were recorded. Logistic regression analysis was performed to identify factors associated with ocular complications.

RESULTS

A total of 212 AD patients were included in the study. The intraocular complications had a prevalence of 1.9%, whereas ocular surface diseases were observed more frequently, with prevalence of 13.2%. Among the ocular complications, blepharitis was the most prevalent, followed by atopic keratoconjunctivitis. Subcapsular cataract, atrophic hole, and retinal detachment were also observed. The head and neck score in the Eczema Area and Severity Index (EASI) emerged as a significant predictor for intraocular complications, independent of age, gender, total EASI score, and family history. No significant association was found between total EASI score and ocular surface disease.

CONCLUSION

This study provides insights into the prevalence and risk factors of ocular complications in Korean AD patients. The head and neck score in EASI was identified as a significant predictor for intraocular complications. These findings emphasize the importance of comprehensive evaluation and interdisciplinary care for AD patients, particularly in identifying and managing potential vision-threatening complications.

A technique to quantify very low activities in regions of interest with a collimatorless detector

We present a new method to measure sub-microcurie activities of photon-emitting radionuclides in organs and lesions of small animals in vivo. Our technique, named the collimator-less likelihood fit, combines a very high sensitivity collimatorless detector with a Monte Carlo-based likelihood fit in order to estimate the activities in previously segmented regions of interest along with their uncertainties. This is done directly from the photon projections in our collimatorless detector and from the region of interest segmentation provided by an x-ray computed tomography scan. We have extensively validated our approach with 225Ac experimentally in spherical phantoms and mouse phantoms, and also numerically with simulations of a realistic mouse anatomy. Our method yields statistically unbiased results with uncertainties smaller than 20% for activities as low as ~111 Bq (3 nCi) and for exposures under 30 minutes. We demonstrate that our method yields more robust recovery coefficients when compared to SPECT imaging with a commercial pre-clinical scanner, specially at very low activities. Thus, our technique is complementary to traditional SPECT/CT imaging since it provides a more accurate and precise organ and tumor dosimetry, with a more limited spatial information. Finally, our technique is specially significant in extremely low-activity scenarios when SPECT/CT imaging is simply not viable.

Two novel non-coding single nucleotide variants in the DNase1 hypersensitivity site of PRDM13 causing North Carolina macular dystrophy in Korea

Purpose

Pathogenic variants in North Carolina macular dystrophy (NCMD) have rarely been reported in the East Asian population. Herein, we reported novel variants of NCMD in 2 Korean families.

Methods

The regions associated with NCMD were analyzed with genome sequencing, and variants were filtered based on the minor allele frequency (0.5%) and heterozygosity. Non-coding variants were functionally annotated using multiple computational tools.

Results

We identified two rare novel variants, chr6:g.99,598,914T>C (hg38; V17) and chr6:g.99,598,926G>A (hg38; V18) upstream of PRDM13 in families A and B, respectively. In Family 1, Grade 2 NCMD and a best-corrected visual acuity of 20/25 and 20/200 in the right and left eyes, respectively, were observed. In Family B, all affected individuals had Grade 1 NCMD with characteristic confluent drusen at the fovea and a best-corrected visual acuity of 20/20 in both eyes. These two variants are 10-22 bp downstream of the reported V10 variant within the DNase1 hypersensitivity site. This site is associated with progressive bifocal chorioretinal atrophy and congenital posterior polar chorioretinal hypertrophy and lies in the putative enhancer site of PRDM13.

Conclusion

We identified two novel NCMD variants in the Korean population and further validated the regulatory role of the DNase1 hypersensitivity site upstream of PRDM13.

HDAC6 preserves BNIP3 expression and mitochondrial integrity by deacetylating p53 at lysine 320

HDAC6 has been reported as a deacetylase of p53 at multiple lysine residues, associated with the canonical functions of p53, such as apoptosis and tumor suppression. We have previously reported that p53 acetylation at the lysine 320 site accumulates due to the genetic ablation of HDAC6 in mice liver. However, the biological processes affected by K320 acetylation of p53 are yet to be elucidated. In this study, we demonstrate that K320 acetylation of p53 is regulated by HDAC6 deacetylase activity. HDAC6 knockout mouse brains exhibit a significant accumulation of K320 acetylated p53 compared to other tissues. The level of K320 acetylation of p53 inversely correlates with the level of BNIP3, a direct target of p53 and essential for mitophagy. Notably, overexpressing the deacetylation mimic K320R mutant p53 restored BNIP3 expression in HDAC6 knockout MEFs. Furthermore, we observed that neurons are particularly susceptible to the genetic ablation of HDAC6, impacting BNIP3 expression, which inversely correlates with the accumulation of abnormal mitochondria characterized by swollen cristae. Our findings suggest that HDAC6 plays a crucial role in maintaining BNIP3 expression by deacetylating p53 at the K320 site, which is linked to the structural integrity of mitochondria.

Dosimetry Reconstruction in Radiopharmaceutical Therapy Using a Sparse Network of External γ-Sensors

PURPOSE/OBJECTIVE(S)

Radiopharmaceutical therapy (RPT) has demonstrated promise in the treatment of neuroendocrine and prostate cancer. Due to the highly varied biodistribution and non-homogeneity of total integrated dose across cancer patients, a system for real-time dosimetry based on continuous measurement is desirable to deliver sufficient dose for tumor ablation while preventing toxicity from off-target uptake by organs at risk (OAR). Single time point imaging (mostly SPECT)-based dosimetry offers a snapshot of the body-wide dose distribution at a given time point, but even single SPECT imaging is generally limited in availability, often leading to significant inaccuracies in estimating total integrated dose. Therefore, accurate personalized dosimetry in RPT is an unmet need and requires continuous dosimetry measurements of tumors and OARs across multiple half-lives of the therapeutic radiopharmaceutical. Using a priori knowledge of tumor and OAR locations from pretherapy imaging, we have developed a novel algorithm that utilizes a network of custom uncollimated, optical fiber-based γ-counting probes to isolate the real-time in vivo tumor and OAR uptake in 177Lu-PSMA-617 and 225Ac-MACROPA-YS5 therapy.

MATERIALS/METHODS

The proposed system was successfully validated in athymic mice models bearing varying numbers of tumors from two human prostate cancer cell lines (PC3-pip, PC3-flu). Uncollimated γ counts using the developed probes were acquired outside of the mice for 10 minutes, starting at 0 hr, 6 hrs, 12 hrs, 24 hrs, and 48 hrs after the injection of 177Lu-PSMA-617. The percent injected activity per mL of tissue (%IA/mL) of each tumor and OAR was reconstructed at every time point and compared to the %IA/mL extracted from SPECT/CT immediately after the recording.

RESULTS

The developed system's %IA/mL reconstruction in PC3-pip tumors, PC3-flu tumors, kidneys, and bladders is highly correlative with the %IA/mL extracted from state-of-art in vivo dosimetry techniques, with %IA/mL ranging from 0.1% to 160% assuming a 29.6 MBq 177Lu-PSMA-617 administration. The least squares linear regression fit between the reconstructed activity and the activity measured from SPECT/CT is given by Estimated %IA/mL = 0.91 x SPECT %IA/mL, with an R2 of 0.991, and Pearson's r of 0.9975. There is a nearly 1:1 mapping between the proposed model and SPECT/CT.

CONCLUSION

A novel dose reconstruction algorithm for personalized dosimetry in RPT that utilizes a sparse set of external γ-counters and a priori knowledge of tumor and OAR locations was developed and validated in in vivo human prostate cancer murine models. The proposed system enables continuous dosimetry measurements of multiple tumors and OAR noninvasively, with high accessibility, high temporal resolution, and across multiple classes of ɑ and β-based RPT. Similar experiments using 225Ac-MACROPA-YS5 are ongoing and additional results will be reported.

MSH2-MSH3 promotes DNA end resection during homologous recombination and blocks polymerase theta-mediated end-joining through interaction with SMARCAD1 and EXO1

DNA double-strand break (DSB) repair via homologous recombination is initiated by end resection. The extent of DNA end resection determines the choice of the DSB repair pathway. Nucleases for end resection have been extensively studied. However, it is still unclear how the potential DNA structures generated by the initial short resection by MRE11-RAD50-NBS1 are recognized and recruit proteins, such as EXO1, to DSB sites to facilitate long-range resection. We found that the MSH2-MSH3 mismatch repair complex is recruited to DSB sites through interaction with the chromatin remodeling protein SMARCAD1. MSH2-MSH3 facilitates the recruitment of EXO1 for long-range resection and enhances its enzymatic activity. MSH2-MSH3 also inhibits access of POLθ, which promotes polymerase theta-mediated end-joining (TMEJ). Collectively, we present a direct role of MSH2-MSH3 in the initial stages of DSB repair by promoting end resection and influencing the DSB repair pathway by favoring homologous recombination over TMEJ.

Expanding SPG7 dominant optic atrophy phenotype: Infantile nystagmus and optic atrophy without spastic paraplegia

Spastic paraplegia is a neurodegenerative disorder characterized by progressive leg weakness and spasticity due to degeneration of corticospinal axons. SPG7 encodes paraplegin, and pathogenic variants in the gene cause hereditary spastic paraplegia as an autosomal recessive trait. Various ophthalmological findings including optic atrophy, ophthalmoplegia, or nystagmus have been reported in patients with spastic paraplegia type 7. We report a 15-year-old male patient with a novel heterozygous variant, c.1224T>G:p.(Asp408Glu) in SPG7 (NM_003119.3) causing early onset isolated optic atrophy and infantile nystagmus prior to the onset of neurological symptoms. Therefore, SPG7 should be considered a cause of infantile nystagmus with optic atrophy.

Factors Related to Axial Length Elongation in Myopic Children Who Received 0.05% Atropine Treatment

Purpose: To evaluate the longitudinal changes of axial length (AL) and factors associated with AL growth in myopic children receiving 0.05% atropine. Methods: This single-center retrospective study included children aged 4-13 years with myopia of at least -0.5 diopters (D) treated with 0.05% atropine eye drops from November 2016 to May 2021. Predictive factors for AL change were evaluated using linear mixed models. Results: Among 109 patients (218 eyes), 58 (53.2%) were male and the mean age at treatment was 8.5 ± 2.0 years. At baseline measurement, the mean spherical equivalent was -4.05 ± 2.34 diopters (D), and AL was 25.00 ± 0.97 mm. The mean follow-up duration was 25.4 (12-58) months, and the mean AL elongation was 0.23 ± 0.17 mm/year during the follow-up periods. AL shortening of ≥0.05 mm at subsequent visit occurred in 18 patients (26 eyes). The mean AL change in the group without initial AL shortening was statistically larger than that in the group with initial AL shortening (0.26 ± 0.16 mm/year vs. 0.02 ± 0.17 mm/year, P < 0.001). In linear mixed model, the age at atropine treatment and initial AL shortening were significantly associated with respect to AL growth (beta coefficient: -0.032 and -0.122, respectively, P < 0.001 for both). Conclusions: Our study found that older age and initial AL shortening are predictors of favorable response after 0.05% atropine treatment. Children with AL shortening at initial subsequent visit may be associated with good long-term response, and younger children may require higher concentration of atropine for optimal response.

Genetic spectrum and characteristics of autosomal optic neuropathy in Korean: Use of next-generation sequencing in suspected hereditary optic atrophy

Aims

To evaluate the clinical characteristics and causative genetic variants in autosomal optic atrophy diagnosed using next-generation sequencing (NGS).

Methods

A cohort of 57 unrelated families affected with bilateral optic atrophy were recruited from two university-based tertiary referral hospitals from May 2016 to April 2022. Genetic variants were detected using a target enrichment panel consisting of 429 or 595 genes and known deep intronic variants associated with inherited eye diseases, exome sequencing, or genome sequencing. The results of detailed clinical examinations, disease-causing variants, and clinical diagnoses were analyzed.

Results

Among the 57 probands, 33 (57.9%) were men, and the median age at genetic testing was 19.1 years (interquartile range, 7.6–42.5 years). We identified 22 likely causative variants in 18 families and corresponding diagnostic yields of 31.6% (95% confidence interval, 21.0–44.5%). The diagnostic rate of NGS was higher in patients with infantile or early childhood onset optic atrophy than in those with late-onset or unknown optic atrophy (18/39, 46.2% vs. 0/18, 0%, P &lt; 0.001). Among the 22 variants, 15 were novel in our cohort. The OPA1 variants (n = 7) were found to be the major genetic causes, followed by the NR2F1 variant (n = 4). The causative variants in PTPN23, TMEM126A, NBAS, and WFS1 genes were identified in 4 probands with a recessive form of optic atrophy.

Conclusions

Based on the results of diagnostic NGS for optic atrophy, the causative variant could be detected in 31.6% of patients. Our study also demonstrated that NGS is unlikely to help identify molecular causes in late-onset unexplained optic atrophy.

The importance of genome sequencing: unraveling SSBP1 variant missed by exome sequencing

BACKGROUND

Single-stranded DNA-binding protein 1 (SSBP1) plays an essential role in mitochondrial DNA (mtDNA) replication and maintenance, as well as development of retina. Here, we describe the clinical findings and genetic basis of a family with two members affected with bilateral optic atrophy.

MATERIALS AND METHODS

Clinical data were retrospectively collected from an electronic medical record system. Genetic results were obtained using exome sequencing (ES) and genome sequencing (GS).

RESULTS

A 36-year-old man presented with low vision in both eyes since early childhood, with a best-corrected visual acuity of 20/500 in both eyes. He exhibited generalized optic atrophy and diffuse retinal nerve fiber layer thinning without retinal degeneration in both eyes. The family history was consistent with autosomal dominant traits. ES was performed; however, we did not identify any pathogenic variants in the known dominant optic atrophy genes. Subsequently, GS was performed, and it revealed a novel heterozygous c.364A>G p.(Lys122Glu) variant in SSBP1. In silico prediction supported it as deleterious, while segregation analysis detected it in his affected mother and his unaffected sister. No foveopathy or retinal degeneration was observed in the patient's family members.

CONCLUSIONS

We report a novel pathogenic heterozygous SSBP1 variant in a family with autosomal dominant optic atrophy and incomplete penetrance. Furthermore, we demonstrated that GS is advantageous over ES even for the discovery of coding variants, providing uniform coverage. Therefore, GS should be emphasized to improve the molecular diagnostic rate of inherited optic neuropathy.

Opposing roles of HDAC6 in liver regeneration and hepatocarcinogenesis

Histone deacetylase 6 (HDAC6), a deacetylase of p53, has emerged as a privileged inhibitory target for cancer therapy because of its deacetylating activity for p53 at K120 and K373/382. However, intricate roles of HDAC6 in hepatocellular carcinogenesis have been suggested by recent evidence, namely that HDAC6 ablation suppresses innate immunity, which plays critical roles in tumor immunosurveillance and antitumor immune responses. Therefore, it is valuable to determine whether HDAC6 ablation inhibits hepatocellular carcinogenesis using in vivo animal models. Here, we firstly showed that HDAC6 ablation increased K320 acetylation of p53, known as pro‐survival acetylation, in all tested animal models but did not always increase K120 and K373/382 acetylation of p53, known as pro‐apoptotic acetylation. HDAC6 ablation induced cellular senescence in primary MEFs and inhibited cell proliferation in HepG2 cells and liver regeneration after two‐thirds partial hepatectomy. However, the genetic ablation of HDAC6 did not inhibit hepatocarcinogenesis, but instead slightly enhanced it in two independent mouse models (DEN + HFD and DEN + TAA). Notably, HDAC6 ablation significantly promoted hepatocarcinogenesis in a multiple DEN treatment hepatocellular carcinoma (HCC) mouse model, mimicking chronic DNA damage in the liver, which correlated with hyperacetylation at K320 of p53 and a decrease in inflammatory cytokines and chemokines. Our data from three independent in vivo animal HCC models emphasize the importance of the complex roles of HDAC6 ablation in hepatocellular carcinogenesis, highlighting its immunosuppressive effects.

We provide the first evidence that HDAC6 is a p53 deacetylase at K320, which is especially important for cancer cell survival in chronic DNA damage conditions. Contrary to the general assumption that HDAC6 inhibition leads to hyperacetylation of p53 at K120, resulting in tumor suppression, our findings from in vivo animal HCC modelsemphasize the importance of the opposing roles of HDAC6 ablation in hepatocellular carcinogenesis by highlighting the K320 acetylation of p53 and immunosuppressive effects.

Perceived Neighborhood Environment Associated with Sarcopenia in Urban-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

Sarcopenia is associated with adverse health outcomes among older individuals. However, little is known about its association with neighborhood environmental factors. We explored the relationship between sarcopenia and perceived neighborhood environmental factors among community-dwelling older adults aged 70-84 years. We analyzed 1778 participants (mean age of 75.9 ± 3.8 years; 54.0% women) who lived in urban areas and underwent dual-energy X-ray absorptiometry from the Korean Frailty and Aging Cohort Study. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 definition. Perceived neighborhood environmental factors were assessed using the Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). In the multivariate analysis, compared to the fifth quintile of the IPAQ-E score, the odds ratios (ORs) and 95% confidence intervals (CIs) for sarcopenia in the first, second, third, and fourth quintiles were 2.13 (1.40-3.24), 1.72 (1.12-2.64), 1.75 (1.15-2.66), and 1.62 (1.06-2.47), respectively. These neighborhood environmental characteristics were linked with an increased likelihood of sarcopenia: no public transportation access (OR = 2.04; 95% CI = 1.19-3.48), poor recreational facilities access (OR = 1.39; 95% CI = 1.01-1.90), absence of destination (OR = 1.53; 95% CI = 1.06-2.20), many hill hazards (OR = 1.36; 95% CI = 1.03-1.78), and lack of traffic safety (OR = 1.35; 95% CI = 1.02-1.78). Thus, better neighborhood environmental strategies may help prevent sarcopenia among urban-dwelling older adults.

Fermented milk with Lactobacillus curvatus SMFM2016-NK alleviates periodontal and gut inflammation, and alters oral and gut microbiota

This study aimed to analyze the effect of milk fermented with Lactobacillus curvatus SMFM2016-NK on periodontal diseases and gut health in a rat model. To improve the effect of Lb. curvatus SMFM2016-NK-fermented milk administration for relieving periodontitis, the periodontitis rat models were treated with the following for 4 wk: 10% skim milk (normal), periodontitis + 10% skim milk (negative control), periodontitis + Lactobacillus rhamnosus GG-fermented milk (positive control), and periodontitis + Lb. curvatus SMFM2016-NK-fermented milk (PD+LCFM). Transcriptional analysis of inflammatory cytokines [tumor necrosis factor α (TNF-α), IL-1β, IL-6, and IL-10] was performed via quantitative reverse-transcription PCR. The changes in the oral and gut microbiomes after administering Lb. curvatus SMFM2016-NK-fermented milk were analyzed with metagenomics sequencing using DNA extracted from the oral gingival tissues and feces from the cecum of the rat models. After treatment with Lb. curvatus SMFM2016-NK-fermented milk, the relative gene expression levels of TNFA and IL1B in the gingiva decreased in the PD+LCFM group compared with those in the negative control group. In the oral microbiome, the proportion of the phylum Proteobacteria in the PD+LCFM group was lower than that in the negative control after treatment with Lb. curvatus SMFM2016-NK-fermented milk. For the effect in the gut, the relative gene expression levels of inflammatory cytokines in the colon between the normal and negative control groups were not different; however, the expression levels of TNFA and IL1B in the PD+LCFM and positive control groups, respectively, were lower than those in the negative control group. The composition and diversity of the gut microbiome differed among normal, periodontitis, and Lb. curvatus SMFM2016-NK-fermented milk treatment groups. These results indicate that Lb. curvatus SMFM2016-NK-fermented milk could alleviate periodontal and gut inflammation and change oral and gut microbiota.

Subepithelial neutrophil infiltration as a predictor of the surgical outcome of chronic rhinosinusitis with nasal polyps

BACKGROUND

Neutrophils present as major inflammatory cells in refractory chronic rhinosinusitis with nasal polyps (CRSwNP), regardless of the endotype. However, their role in the pathophysiology of CRSwNP remains poorly understood. We investigated factors predicting the surgical outcomes of CRSwNP patients with focus on neutrophilic localization.

METHODS

We employed machine-learning methods such as the decision tree and random forest models to predict the surgical outcomes of CRSwNP. Immunofluorescence analysis was conducted to detect human neutrophil elastase (HNE), Bcl-2, and Ki-67 in NP tissues. We counted the immunofluorescence-positive cells and divided them into three groups based on the infiltrated area, namely, epithelial, subepithelial, and perivascular groups.

RESULTS

On machine learning, the decision tree algorithm demonstrated that the number of subepithelial HNE-positive cells, Lund-Mackay (LM) scores, and endotype (eosinophilic or non-eosinophilic) were the most important predictors of surgical outcomes in CRSwNP patients. Additionally, the random forest algorithm showed that, after ranking the mean decrease in the Gini index or the accuracy of each factor, the top three ranking factors associated with surgical outcomes were the LM score, age, and number of subepithelial HNE-positive cells. In terms of cellular proliferation, immunofluorescence analysis revealed that Ki-67/HNE-double positive and Bcl-2/HNE-double positive cells were significantly increased in the subepithelial area in refractory CRSwNP.

CONCLUSION

Our machine-learning approach and immunofluorescence analysis demonstrated that subepithelial neutrophils in NP tissues had a high expression of Ki-67 and could serve as a cellular biomarker for predicting surgical outcomes in CRSwNP patients.

World Health Organization Integrated Care for Older People (ICOPE) and the Integrated Care of Older Patients with Frailty in Primary Care (ICOOP_Frail) Study in Korea

The World Health Organization (WHO) recently endorsed the proposal for a Decade of Healthy Ageing (2020–2030). The WHO defines “healthy aging” as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” Among the strategies for the Decade of Healthy Ageing, the WHO has suggested enhancing intrinsic capacity, promoting functional ability, and implementing the Integrated Care for Older People (ICOPE) package. The WHO has defined steps for ICOPE evaluation and scale-up and is performing a prospective study in 2–3 countries (low and middle income, high income) to test its feasibility in 2021–2022 and a multinational randomized study to validate its clinical efficacy and effectiveness in 2022–2024. Intrinsic capacity and frailty represent two faces of the same coin, with one indicating the reserves of the individual and the other indicating the deficits that accumulate with age. The Integrated Care of Older Patients with Frailty in Primary Care (ICOOP_Frail) study is the first integrated care program for frailty or functional decline in primary care in Korea. The results suggest that the ICOOP_Frail study can be utilized as a reference for ICOPE studies in Korea or at least to provide important findings for the forthcoming ICOPE implementation study in Korea.

Engineered ionizable lipid nanoparticles for targeted delivery of RNA therapeutics into different types of cells in the liver

Ionizable lipid nanoparticles (LNPs) have been widely used for in vivo delivery of RNA therapeutics into the liver. However, a main challenge remains to develop LNP formulations for selective delivery of RNA into certain types of liver cells, such as hepatocytes and liver sinusoidal endothelial cells (LSECs). Here, we report the engineered LNPs for the targeted delivery of RNA into hepatocytes and LSECs. The effects of particle size and polyethylene glycol-lipid content in the LNPs were evaluated for the hepatocyte-specific delivery of mRNA by ApoE-mediated cellular uptake through low-density lipoprotein receptors. Targeted delivery of RNA to LSECs was further investigated using active ligands. Incorporation of mannose allowed the selective delivery of RNA to LSECs, while minimizing the unwanted cellular uptake by hepatocytes. These results demonstrate that engineered LNPs have great potential for the cell type-specific delivery of RNA into the liver and other tissues.

Risk Factors Influencing the Occurrence and Severity of Symptomatic Dry Eye Syndrome: A Cross-sectional Study

Propose: We aimed to investigate the prevalence and risk factors of dry eye syndrome (DES) among a population-based cohort study.Methods: This cross-sectional study was conducted on 475 subjects (184 men and 291 women) enrolled in the Study Group for Environmental Eye Disease at July 2013. Using the ocular surface disease index (OSDI), we measured the DES severity and defined DES as OSDI score ≥13. Current symptoms of DES and possible risk factors such as body mass index, occupations, comorbidities, exercise, smoking and drinking status were assessed by multivariate logistic regression.Results: Prevalence of DES was significantly higher in women (52.6%) than in men (41.9%) (p < .001). Compared to white-collar workers, blue-collar workers and unemployed persons showed significantly higher DES prevalence and severity. Compared to those with low BMI (<23.0 kg/m²), people with extremely high BMI (≥30.0 kg/m²) had significantly higher odds ratio (OR) of having DES after fully adjusted for sex, age, hypertension, diabetes, menopausal status, hormone replacement therapy, occupation, and lifestyle factors (OR: 2.83, 95% confidence interval: 1.04-7.71).Conclusions: We found some novel factors which have been unknown to the relationship with DES through the five years observation of the cohort. The positive associations of unemployment status, blue-collar work, alcohol habit, and obesity with DES suggests a person's comprehensive condition, not individual factors, contribute significantly in developing DES. Further studies will be helpful to understand the underlying mechanisms.

Social Frailty Is Associated With the Risk of Malnutrition Among Community-Dwelling Older Adults

Social frailty does not merely affect the level of socialization, but also the means of obtaining resources for the daily lives of older adults. It is highly associated with the quality of life during advanced age. In this study, we analyzed the association between the Mini-Nutritional Assessment (MNA®) score (range 0-30) and 18 singular items and social frailty status of community-dwelling older adults. A total of 2,552 community-dwelling older adults aged 70-84 years (mean age 76.9±4.0, 51.8% female) from the Korean Frailty and Aging Cohort Study (KFACS) were assessed. The social frailty status was assessed in four categories- absence of economic resources, social resources, social activities, and social interactions. A higher MNA® score indicates better nutritional status. The prevalence of social frailty in older adults was 27.9% (mean age 78.1±4.0, 67.7% female). Approximately 40% of the participants were at risk of malnutrition or malnourished (p<0.001), while socially robust group accounted for 23% (p<0.001). They were at a higher risk of a lower MNA® score (odds ratio [OR] 0.90, 95% confidence interval [CI], 0.84-0.96). Socially-frail older adults have a higher possibility of not eating three full meals a day (OR 2.33, 95% CI 1.19-4.55) which increases the risk of malnutrition. In conclusion, social frailty, as a means of linking resources -including economic and social capitals- to the older adult population directly impacts the risk of malnutrition and requires an appropriate intervention.

Motoric Cognitive Risk Syndrome Using 3-Items Recall Test and Its Association With Falls

Motoric cognitive risk (MCR) syndrome is defined by the presence of subjective cognitive complaints (SCCs) and slow gait. Its components have synergistic effects to predict various adverse health outcomes. However, some studies reported SCCs might be influenced by cultural differences. Therefore, we devised another criterion to assess the cognitive aspect of MCR to enhance its utility irrespective of the cultural background of the subject by examining the association of MCR and its components with fall-related outcomes. This cross-sectional analysis included 2,641 community-dwelling older adults aged 70-84 years from the Korean Frailty and Aging Cohort Study. These participants did not have dementia and had no difficulties in performing activities of daily living. The newly devised criterion for cognitive aspects of MCR is based on three items recall test on Mini-Mental State Examination. One-hundred-ninety participants (7.2%) met the criteria of MCR using three items recall test. Unlike MCR using SCCs, newly defined MCR showed synergistic effects with fall-related outcomes. Participants with MCR using three items recall test showed a higher risk for falls in the past 1-year (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.08-2.34), recurrent falls (OR 1.86, 95% CI 1.10-3.13), fall with injury (OR 1.60, 95% CI 1.10-2.34), fear of falling (OR 2.77, 95% CI 1.90-4.03), and low activities-specific balance confidence (OR 2.86, 95% CI 1.78-4.60) compared to each component, except for fall with fracture. We found MCR with three items recall test helped predict fall-related outcomes in clinical settings regardless of the cultural context.

Ideal Cardiovascular Health Is Associated With Slowness Among Community-Dwelling Older Adults

Slowness is associated with increased disability and mortality in older people. However, the relation between ideal cardiovascular health (CVH) and slowness in community-dwelling older adults is uncertain. We examined the prevalence of ideal CVH in Korean older adults and its association with slowness in community-dwelling older adults. We analyzed 2,597 participants (mean age 76.0±3.9 years, 54.4% women) without cardiovascular disease from the Korean Frailty and Aging Cohort Study. The usual gait speed over a distance of 4 m was measured using an automatic timer, and slowness was defined as a speed <1.0 m/s. Ideal CVH was described as attainment of ideal health behaviors (no smoking, regular physical activity, ideal body mass index, and healthy diet) and optimal health factors (blood pressure, HDL-cholesterol, and glycated hemoglobin). Multiple logistic regression analysis was used to examine the association between the CVH score and slowness. Ideal CVH was present in 785(30.2%) subjects. Considering those with poor level of CVH were as the reference group, the odds ratios [OR] for slowness were 0.55 (95% confidence interval [CI], 0.39-0.77) for those with intermediate level of CVH, and 0.28 (95% CI, 0.17-0.45) for those with ideal level of CVH after adjustment for potential confounders. Among ideal CVH components, behavioral CVH score (OR 0.65, 95% CI 0.58-0.74) was significantly associated with slowness vs. the biological CVH score (OR 0.95, 95% CI 0.84-1.07). This study indicates that ideal CVH is significantly associated with a lower risk of slowness in community-dwelling older adults. A better CVH may help prevent slowness.

Perceived Neighborhood Environmental Factors Related to Sarcopenia in Urban-Dwelling Older Adults

Sarcopenia is common among older individuals and has adverse health outcomes. However, little is known about its association with neighborhood environmental factors. We explored the relationship between sarcopenia and neighborhood environmental factors among community-dwelling older adults aged 70–84 years in urban areas in the Korean Frailty and Aging Cohort Study. There were 1,776 participants in this cross-sectional study (mean age 75.9±3.8 years, 54.1% women). Sarcopenia was defined using the Asian Working Group for Sarcopenia guidelines. The neighborhood environmental factors were assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The prevalence of sarcopenia was 22.5%. In the multivariate analysis adjusted for potential confounders, compared to the 5th quintile of the IPAQ-E score, the odds ratio (OR and 95% confidence interval [CI]) for sarcopenia in the 1st, 2nd, 3rd and 4th quintile were 2.14 (1.41-3.26), 1.70 (1.11-2.61), 1.76 (1.16-2.68) and 1.62 (1.07-2.47), respectively. Sarcopenia was associated with environmental factors including access to destinations (β = -0.015) and neighborhood safety (β = -0.008) (all p&lt;0.05). Furthermore, no access to public transportation (OR 2.05, 95% CI 1.20-3.50), poor access to recreational facilities (OR 1.40, 95% CI 1.02-1.92), no presence of destination (OR 1.53, 95% CI 1.07-2.21), hill hazard (OR 1.34, 95% CI 1.02-1.77), and lack of safety from traffic (OR 1.35, 95% CI 1.02-1.79) was associated with an increased risk of sarcopenia. Our study suggests that neighborhood environmental characteristics are associated with sarcopenia and better neighborhood environmental strategies can help prevent sarcopenia among older adults.

Clinical features, risk factors, and prognosis of anthracycline-induced cardiotoxicity in patients with malignant lymphoma who received a CHOP like regimen

Background

Anthracycline-induced cardiotoxicity is a serious complication in patients with malignant lymphoma (ML) who received chemotherapy, which threatens life prognosis and quality of life of patients. However, incidence and risk factors of cardiotoxicity in patients with ML who undergo intensive chemotherapy which aims complete remission is not clarified. Furthermore, prognosis after cardiotoxicity and that after recovery from cardiotoxicity have not been elucidated.

Method

We screened 443 ML patients who received either rituximab (R)-CHOP or CHOP regimen between January 2008 and December 2017 at Nagoya City University Hospital. Two handled forty-four patients who underwent echocardiography before and after chemotherapy were enrolled and data were analyzed retrospectively. Cardiotoxicity was defined as a decline in left ventricular ejection fraction (LVEF) of 10% or greater and an LVEF was below 50%. Partial recovery was defined as a 5% or more of increase in LVEF and an LVEF was ≥50% after cardiotoxicity. Complete recovery was defined as an increase in LVEF became more than 95% of the baseline value. Patient's basic characteristics, chemotherapeutic regimen, laboratory data, echocardiographic data, and prognosis were collected from the medical records by two cardiologists and two hematologists.

Result

At baseline, the median age was 71 years, the median cumulative dose of doxorubicin was 302 mg/m2 and the median LVEF was 69%. During the follow-up period, cardiotoxicity was observed in 52 out of 244 patients (21%), 30 patients (12%) had a symptomatic heart failure, and 5 patients died from cardiovascular cause. Thirty-five patients developed cardiotoxicity during the first year of chemotherapy. Multivariate analysis identified that only the baseline LVEF (HR 0.949, 95% CI 0.919–0.981, p=0.002) was an independent risk factor for cardiotoxicity. In our study, patients who received more than 200 mg/m2 of doxorubicin developed cardiotoxicity frequently. Among 52 patients who experienced cardiotoxicity, partial recovery and full recovery were observed in 18 (35%) and 4 (8%) patients, respectively. Four patients without recovery died due to heart failure and 1 patient with partial recovery died suddenly. Six out of 18 patients with partial recovery developed re-cardiotoxicity.

Conclusion

ML patients who undergo more than 200 mg/m2 of doxorubicin need a watchful follow-up. Only a baseline LVEF was an independent risk factor for cardiotoxicity. one third of patients with partial recovery developed re-cardiotoxicity.

Funding Acknowledgement

Type of funding source: None

Differences in the Association of Neighborhood Environment With Physical Frailty Between Urban and Rural Older Adults: The Korean Frailty and Aging Cohort Study (KFACS)

OBJECTIVE

We examined the difference in the relationship between perceived neighborhood environments and physical frailty between urban and rural older adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Urban and rural community in South Korea; a total of 2593 community-dwelling older adults aged 70-84 years (mean age: 76.0 years, 51.0% women) in the Korean Frailty and Aging Cohort Study (KFACS).

METHODS

The neighborhood environment was assessed using the 17-item Environmental Module of the International Physical Activity Questionnaire (IPAQ-E). The IPAQ-E had 7 environmental factors (residential density, access to destinations, neighborhood infrastructure, neighborhood safety, social environment, aesthetic qualities, and street connectivity). Physical frailty was defined using the Fried frailty criteria with modified cutoffs.

RESULTS

The number of participants residing in urban and rural areas was 1902 and 691, respectively. The prevalence of frailty was 5.3% and 12.0% in urban and rural areas, respectively. In urban areas, frailty was associated with the total IPAQ-E score (β = -0.007, P = .009) after adjusting for confounding factors. There was no association in the rural areas (β = -0.003, P = .535). In urban older adults, logistic regression showed that absence of destination [odds ratio (OR) 2.58, 95% confidence interval (CI) 1.36-4.90] and no crime safety at night (OR 2.00, 95% CI 1.12-3.57) were associated with a higher risk of frailty. In rural older adults, poor access to recreational facilities (OR 2.17, 95% CI 1.07-4.40) and no aesthetics (OR 2.49, 95% CI 1.22-5.10) were associated with frailty.

CONCLUSIONS AND IMPLICATIONS

Our study indicated that the presence of destination and crime safety at night was significantly associated with physical frailty among older adults living in urban areas, whereas aesthetics and recreational facilities were significantly associated with physical frailty in rural older adults.

Diagnostic accuracy of left ventricular diastolic transverse strain imaging by speckle tracking echocardiography for diagnosing chest pain in diabetic patients

Background

Two-dimensional speckle tracking echocardiography (2D-STE) has been reported to be useful for the diagnosis of myocardial ischemia by detecting delayed relaxation (diastolic stunning) after an episode of angina. 2D-longitudinal strain is not specific besides ischemia such as diastolic dysfunction, and diabetes have been associated with abnormal longitudinal fibers. The aim is to evaluate the diagnostic accuracy of Left ventricular (LV) diastolic transverse strain imaging by STE to detect the presence of acute coronary syndrome (ACS) in diabetic patients with acute chest pain.

Methods

385 consecutive patients with acute chest pain and without wall motion abnormality, who were admitted to an emergency department (ED) at 1 of 12 clinical sites in Japan, were enrolled and underwent 2D-STE at ED. Left ventricular (LV) transverse strain values at aortic valve closure (A) and one-third of diastole duration (B) were measured. The strain imaging diastolic index (SI-DI) was value was determined as: (A − B)/A × 100% to assess the LV diastolic strain imaging and was used to identify the regional LV delayed relaxation. All patients underwent coronary CT or coronary angiography to establish the diagnosis of ACS. Clinicians were blinded to the 2D-STE results.

Results

Out of 385 patients, 2D-STE analysis was possible in 365 patients (94%). 76 patients were diabetic (DM+), and 289 patients were non-diabetic (DM-). With assessment of coronary CT or coronary angiography, ACS was diagnosed in 125 patients (34%). 2D-STE was obtained at a mean of 5.3 hours after chest pain episode. Transverse SI-DI of ischemic segments were significantly lower than those of non-ischemic segments (p value &lt;0.001) in both diabetic and non-diabetic patients, and transverse SI-DI of both diabetic and non-diabetic patients demonstrated high area under curve (AUC) for detection of myocardial ischemia (Figure: RCA; right coronary artery, LAD; left anterior descending artery, LCX; left circumferencial artery). In diabetic patients, sensitivity, specificity, and negative predictive value for ACS of transverse SI-DI are 100%, 95%, 100% in RCA (a cut-off value of 36.2), and 86.4%, 95%, 93% in LAD (a cut-off value of 50.2), and 75%, 85%, 94% in LCX (a cut-off value of 52), respectively.

Conclusion

LV diastolic transverse strain imaging by 2D-STE at ED increase the sensitivity, specificity and accuracy to predict the presence of ACS in diabetic patients with chest pain, as well as non-diabetic patients. (UMIN000013859).

Figure 1. Transverse Strain (SI-DI): AUC (95% CI)

Funding Acknowledgement

Type of funding source: None

Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population

Background

Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population.

Purpose

We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population.

Methods

Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC).

Results

A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI.

Conclusions

The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals.

Funding Acknowledgement

Type of funding source: None

Maternal nutrition intervention focused on the adjustment of salt and sugar intake can improve pregnancy outcomes

Due to the increasing age of pregnant women, maternal nutrition management is becoming more important. Since pregnant women are more likely to consume sodium and sugars than nonpregnant women of the same age, we investigated whether maternal nutrition intervention focused on the adjustment of salt and sugar intake can help pregnancy outcome. This randomized controlled trial was performed on 142 pregnant women within 22 weeks of gestational age for at least 16 weeks until childbirth. Subjects were unequally assigned to the intervention group (n = 98) and the control group (n = 44). Dietary changes based on perceived taste preferences were evaluated by 24-hr dietary recall and food frequency questionnaires (FFQ) at pre- and postintervention. In the intervention group, while the intakes of energy, protein, and vitamins were maintained, the intakes of sodium (p < .001) and sugar from processed food (p < .05) were significantly reduced after the intervention. The decreases in salt and sugar consumption were more pronounced in the mothers who had a high preference for saltiness and sweetness. The mean neonatal birth weight of the intervention group was significantly greater than the weight of control group, (3,251.5 ± 402.2 g vs. 2,974.5 ± 294.8 g, p < .05). Through this study, nutrition intervention was found to be effective for the formation of healthy eating habits such as reduced salt and sugar intake in pregnant women especially with a high preference for saltiness and sweetness. Also, such specialized maternal nutrition intervention during pregnancy promotes the birth of healthy newborn babies of normal weight.

P743 Right ventricular function is important for exercise capacity in patients at risk of heart failure

Background and Purpose

It is important to evaluate exercise capacity to detect the development of heart failure (HF) in patients with heart disease. The pathology of exercise capacity is multi-factorial, and cardiac function is recognized as one of the most important determinants. However, the correlation between right ventricular (RV) function and exercise capacity is not fully understood in the subjects without HF. Therefore, we assessed the relationship between RV function and exercise capacity, both in patients with HF (HF+) and in patients with heart disease but not developed HF (HF-).

Methods

Two hundred and fifty-two patients with heart disease who underwent both Doppler echocardiography at rest and cardio-pulmonary exercise testing (CPET) for the assessment of heart function were enrolled (HF+: n = 142, HF-: n = 110). We measured left ventricular ejection fraction (LVEF), peak early diastolic transmitral flow velocity (E), peak late diastolic transmitral flow velocity (A), early diastolic mitral annular velocity (e’), left atrial volume (LAV), and tricuspid annular plane systolic excursion (TAPSE) by echocardiography. After echocardiographic examination, symptom-limited exercise testing was performed with simultaneous respiratory gas analysis, and peak oxygen consumption (pVO2) was determined. Blood examination including hemoglobin (Hb) and brain natriuretic peptide (BNP) was done on the same day.

Results

There were significant relationships between pVO2 and LVEF (r = 0.16, p = 0.005), e" (r = 0.51, p &lt; 0.0001), E/e" (r=-0.47, p &lt; 0.0001), LAV (r=-0.21, p = 0.0002), and TAPSE (r = 0.33, p &lt; 0.0001) in the whole subjects. In the multiple regression analyses, age, Hb, E/e" and TAPSE were selected as significant determinants for pVO2 both in HF+ (R²=0.39, p &lt; 0.0001) and HF- (R²=0.33, p &lt; 0.0001).

Conclusion

RV function is the prime determinant of exercise capacity in patients at risk of HF, as well as in patients with HF.

Abstract P743 Figure.

1225 Diagnostic accuracy of left ventricular diastolic strain imaging by speckle tracking echocardiography in detecting ischemic etiology of acute chest pain

Funding Acknowledgements

none

OnBehalf

A TRAC-SI Multicenter Trial

Background

Two-dimensional speckle tracking echocardiography (2D-STE) has been reported to be useful for the diagnosis of myocardial ischemia by detecting delay in regional myocardial expansion (diastolic stunning) up to many hours after an episode of angina. The aim is to evaluate the diagnostic accuracy of Left ventricular (LV) diastolic longitudinal, circumferential, transverse and radial strain imaging by STE to detect the presence of acute coronary syndrome (ACS) in patients with acute chest pain.

Methods

388 consecutive patients with acute chest pain and without wall motion abnormality, who were admitted to an emergency department (ED) at 1 of 12 clinical sites in Japan, were enrolled and underwent 2D-STE at ED. Left ventricular (LV) longitudinal, circumferential, transverse and radial strain values at aortic valve closure (A) and one-third of diastole duration (B) were measured. The strain imaging diastolic index (SI-DI) was value was determined as: (A-B)/A × 100% to assess the LV diastolic strain imaging and was used to identify the regional LV delayed relaxation. All patients underwent coronary CT or coronary angiography to establish the diagnosis of ACS. Clinicians were blinded to the 2D-STE results.

Results

Out of 388 patients, 2D-STE analysis was possible in 358 patients (92%). With assessment of coronary CT or coronary angiography, ACS was diagnosed in 118 patients (33%). 2D-STE was obtained at a mean of 5.3 hours after chest pain episode. SI-DI of longitudinal, circumferential, transverse and radial strain of ischemic segments were significantly lower than those of non-ischemic segments (p value &lt; 0.001), and transverse and radial SI-DI demonstrated high diagnostic accuracy, compared with longitudinal SI-DI (Figure 1). Sensitivity, specificity, and negative predictive value for ACS of transverse SI-DI are 87%, 88%, % and 95%, respectively, using a cut-off value of 63.3.

Conclusion

LV diastolic strain imaging by 2D-STE at ED increase the sensitivity, specificity and accuracy to predict the presence of ACS in patients with chest pain. Compared with longitudinal diastolic strain imaging, transverse diastolic strain imaging is more sensitive marker to detect the myocardial ischemic episode (UMIN000013859).

Abstract 1225 Figure 1

Effects of Orbital Decompression on Lamina Cribrosa Depth in Patients with Graves' Orbitopathy

Purpose

We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography.

Methods

Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups—a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan—and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated.

Results

At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01).

Conclusions

The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.

Relationship between Alcohol Consumption and Ocular Pressure according to Facial Flushing in Korean Men with Obesity

Background

This study aimed to examine the relationship between alcohol consumption and intraocular pressure (IOP) according to facial flushing in Korean men with obesity.

Methods

The study included 479 Korean men with a body mass index of ≥25 kg/m² (75 non-drinkers, 174 with drinking-related facial flushing, and 230 without facial flushing) who underwent health check-ups between October 1, 2016 and March 31, 2017. Multivariate logistic regression was used to assess the relationship between alcohol consumption and high IOP (≥21 mm Hg).

Results

Flushers consuming ≤16 drinks per week had a significantly higher risk of high IOP than non-drinkers, depending on alcohol consumption (≤8 standard drinks: odds ratio [OR], 4.49; 95% confidence interval [CI], 1.05– 19.25; >8 but ≤16 standard drinks: OR, 8.14; 95% CI, 1.37–48.45). However, when the consumption was >16 drinks per week, the high IOP risk did not significantly increase (OR, 0.71; 95% CI, 0.05–10.69). In addition, there was no significant relationship between alcohol consumption and high IOP among non-flushers consuming ≤8 drinks per week (OR, 2.07; 95% CI, 0.52–8.19). However, a significantly increased risk of high IOP was observed among non-flushers consuming >8 drinks per week, depending on alcohol consumption (>8 but ≤16 standard drinks: OR, 4.84; 95% CI, 1.14–20.61; >16 standard drinks: OR, 4.08; 95% CI, 1.02–16.26).

Conclusion

This study suggests that obese men with alcohol flush reactions may have an increased risk of high IOP with the consumption of smaller amounts of alcohol than non-flushers.

A Case Series of Asymptomatic Hemodialysis Catheter-Related Right Atrial Thrombi That Are Incidentally Detected Prior to Kidney Transplantation

A hemodialysis (HD) catheter-related right atrial thrombus (RAT) is rarely encountered prior to kidney transplantation (KT) but necessitates a decision about whether to anticoagulate and/or delay the surgery. There is controversy surrounding the clinical implications of a RAT in this situation. It is sometimes considered fatal but other opinions consider it to be benign, especially when incidentally detected. We reviewed the clinical characteristics, management, and outcomes of a patient series with HD catheter-related RAT detected prior to KT and speculated on its clinical significance. Among 3677 cases of KT performed on 3607 patients between January 1997 and September 2015 in our single tertiary center, 11 cases of HD catheter-related RAT detected on transthoracic echocardiography (TTE) prior to KT were included for analysis. The average maximal diameter of the RAT was 23.2 ± 16.3 (SD in mm) and 9 (81.8%) of these 11 patients had no symptoms associated with the RAT. Four patients (36.3%) had their catheters replaced, 5 patients (45.5%) had their catheters removed, and the catheters were maintained in the remaining 2 patients (18.2%). Six patients (54.5%) were anticoagulated with either heparin or warfarin. However all 11 patients had a successful KT suggesting that a HD catheter-related RAT incidentally detected prior to this surgery may not be as serious as previously considered and should not be a reason for delaying the transplantation.

A comparative study of dietary habits and nutritional intakes among Korean adults according to current depression status

INTRODUCTION

Data regarding the association between depression and dietary factors in Korean adults are limited. We hypothesized that Korean men and women with depression would have poorer nutritional intakes and different dietary habits than those without depression.

METHODS

This study was based on data from the Korea National Health and Nutrition Examination Survey conducted during 2012 to 2014. Overall, 10 591 subjects (4308 men, 6529 women) aged 19 to 64 years were selected and categorized according to current depression status. Food and nutrient intakes were estimated using semi-quantitative food frequency questionnaires.

RESULTS

Compared with non-depression, depression was associated with a higher body mass index and likelihood of a separated/divorced/widowed status, in addition to lower physical activity and employment rates. After adjusting for multiple variables, men with depression had lower intakes of rice cakes (P = 0.017) and eggs (P = 0.039) and a higher intake of chocolate (P = 0.040) than their non-depressed counterparts. Women with depression had a higher intake of carbonated drinks than those without depression (P = 0.015). However, the groups did not differ significantly in terms of nutrient intakes. A multivariable logistic regression analysis of dietary habits showed that depression correlated inversely with eating out (≥1 time/day vs <1 time/month) among men [odds ratio (OR) = 0.23, 95% confidence interval (CI): 0.10-0.55] and women (OR = 0.14, 95% CI: 0.05-0.35) and positively with a lower number of daily meals (<3 vs ≥3) among women (OR = 1.45, 95% CI: 1.01-2.11).

DISCUSSION

Current depression status was associated with differences in some specific dietary intakes and habits in a sample of Korean adults.