Antioxidant Activity and Mechanism of Action of Amwaprin: A Protein in Honeybee (Apis mellifera) Venom

Bee venom contains several bioactive components, including enzymatic and non-enzymatic proteins. There is increasing interest in the bioactive components of bee venom since they have exhibited various pharmacological effects. Recently, Apis mellifera waprin (Amwaprin) was identified as a novel protein in Apis mellifera (honeybee) venom and characterized as an antimicrobial agent. Herein, the novel biological function of Amwaprin as an antioxidant is described. In addition, the antioxidant effects of Amwaprin in mammalian cells were investigated. Amwaprin inhibited the growth of, oxidative stress-induced cytotoxicity, and inflammatory response in mammalian NIH-3T3 cells. Amwaprin decreased caspase-3 activity during oxidative stress and exhibited protective activity against oxidative stress-induced cell apoptosis in NIH-3T3 and insect Sf9 cells. The mechanism underlying the cell protective effect of Amwaprin against oxidative stress is due to its direct binding to the cell membrane. Furthermore, Amwaprin demonstrated radical-scavenging activity and protected against oxidative DNA damage. These results suggest that the antioxidant capacity of Amwaprin is attributed to the synergistic effects of its radical-scavenging action and cell shielding, indicating its novel role as an antioxidant agent.

CRISPR-Cas9 and beyond: identifying target genes for developing disease-resistant plants

Throughout the history of crop domestication, desirable traits have been selected in agricultural products. However, such selection often leads to crops and vegetables with weaker vitality and viability than their wild ancestors when exposed to adverse environmental conditions. Considering the increasing human population and climate change challenges, it is crucial to enhance crop quality and quantity. Accordingly, the identification and utilization of diverse genetic resources are imperative for developing disease-resistant plants that can withstand unexpected epidemics of plant diseases. In this review, we provide a brief overview of recent progress in genome-editing technologies, including zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (Cas9) technologies. In particular, we classify disease-resistant mutants of Arabidopsis thaliana and several crop plants based on the roles or functions of the mutated genes in plant immunity and suggest potential target genes for molecular breeding of genome-edited disease-resistant plants. Genome-editing technologies are resilient tools for sustainable development and promising solutions for coping with climate change and population increases.

Validating the Korean shorter Diagnostic Thinking Inventory in medical education: a pilot study

PURPOSE

Developing clinical reasoning across the medical curriculum requires valid, reliable, and feasible assessment tools. However, few validated tools are available for the convenient and efficient quantification of clinical reasoning. Thus, this study aimed to create a shorter version of the Diagnostic Thinking Inventory (DTI) and validate it in the Korean medical education context (DTI-SK).

METHODS

The DTI-SK was constructed using content validity and a translation and back-translation process. It comprises two subcategories and 14 items. Its validity and reliability were explored using exploratory and confirmatory factor analyses, mean comparisons of four medical student groups (med 1 to med 4), and internal consistency using Cronbach's α. Two hundred medical students were invited to participate through email, and the survey was administered for 2 weeks.

RESULTS

Data from 136 students were analyzed. Exploratory factor analysis revealed two factors with eigenvalues greater than 1.0 and they together explained 54.65% of the variance. Confirmatory factor analysis demonstrated that the model had acceptable level of fit and convergent validity. Discriminant validity was confirmed using heterotrait-monotrait criterion. Group comparisons demonstrated that the med 4 students showed significantly higher scores than the med 1 and 2 students. The inventory exhibited strong internal consistency for all items (Cronbach's α=0.906).

CONCLUSION

The findings indicated that the DTI-SK is a reliable and valid tool for measuring medical students' clinical reasoning in the context of Korean medical education.

The Impact of Withdrawing or Withholding of Life-Sustaining Treatment: A Nationwide Case-Control Study Based on Medical Cost Analysis

This study measured the impact of the Decisions on Life-Sustaining Treatment Act by analyzing medical cost data from the National Health Insurance Service-National Sample Cohort. After identifying the patients who died in 2018 and 2019, the case and control groups were set using the presence of codes for managing the implementation of life-sustaining treatment with propensity score matching. Regarding medical costs, the case group had higher medical costs for all periods before death. The subdivided items of medical costs with significant differences were as follows: consultation, admission, injection, laboratory tests, imaging and radiation therapy, nursing hospital bundled payment, and special equipment. This study is the first analysis carried out to measure the impact of the Decision on Life-Sustaining Treatment Act through a cost analysis and to refute the common expectation that patients who decided to withhold or withdraw life-sustaining treatment would go through fewer unnecessary tests or treatments.

An Integrated Approach for Biofortification of Carotenoids in Cowpea for Human Nutrition and Health

Stress-resilient and highly nutritious legume crops can alleviate the burden of malnutrition and food security globally. Here, we focused on cowpea, a legume grain widely grown and consumed in regions at a high risk of micronutrient deficiencies, and we discussed the past and present research on carotenoid biosynthesis, highlighting different knowledge gaps and prospects for increasing this micronutrient in various edible parts of the crop. The literature survey revealed that, although carotenoids are important micronutrients for human health and nutrition, like in many other pulses, the potential of carotenoid biofortification in cowpea is still underexploited. We found that there is, to some extent, progress in the quantification of this micronutrient in cowpea; however, the diversity in content in the edible parts of the crop, namely, grains, pods, sprouts, and leaves, among the existing cowpea genetic resources was uncovered. Based on the description of the different factors that can influence carotenoid biosynthesis and accumulation in cowpea, we anticipated that an integrated use of omics in breeding coupled with mutagenesis and genetic engineering in a plant factory system would help to achieve a timely and efficient increase in carotenoid content in cowpea for use in the food systems in sub-Saharan Africa and South Asia.

Urothelial Carcinoma of the Renal Pelvis with Synchronous Ipsilateral Collecting Duct Carcinoma: Two Case Reports

Synchronous renal malignancies are seldom encountered or diagnosed post-renal resection. A combination of renal cell carcinoma (RCC) and urothelial carcinoma (UC) is most commonly reported. Typically, the RCC subtype is clear-cell RCC; however, a combination of collecting duct carcinoma (CDC) and UC has rarely been reported in the existing literature. Here, we present two cases of synchronous renal malignancy, specifically a combination of CDC and UC, in the ipsilateral kidney.

Association between statin compliance and risk of dementia among patients with chronic periodontitis

OBJECTIVES

We investigated the association between statin compliance and the risk of dementia among patients with chronic periodontitis.

METHODS

Chronic periodontitis patients were extracted from the National Health Insurance Service-Health Screening Cohort Database, covering the period from 2002 to 2019. A total of 22,089 subjects were included in the study and divided into three groups based on their compliance with statin administration. The Cox proportional hazard model was utilized to calculate hazard ratios and 95% confidence intervals for analyzing the risk of dementia.

RESULTS

In the restricted cubic spline of the multivariable-adjusted model, the hazard ratio for dementia decreased prominently with a higher medication possession ratio. The hazard ratios and 95% confidence intervals in the multivariable-adjusted model for dementia risk in the middle and high medication possession ratio groups, compared to the low medication possession ratio group, were confirmed as 0.70 (0.57-0.87) and 0.57 (0.45-0.72), respectively. In the subgroup analysis, a significant association between dementia and good statin medication possession ratio was found in both severe periodontitis and mild periodontitis cases.

CONCLUSIONS

Our findings suggest that a group of patients with chronic periodontitis who maintain good statin compliance are associated with a reduced risk of dementia.

The Utility of Narrow-Band Imaging International Colorectal Endoscopic Classification in Predicting the Histologies of Diminutive Colorectal Polyps Using I-Scan Optical Enhancement: A Prospective Study

(1) Background: This study aimed to evaluate the accuracy of predicting the histology of diminutive colonic polyps (DCPs) (≤5 mm) using i-scan optical enhancement (OE) based on the narrow-band imaging international colorectal endoscopic (NICE) classification. The study compared the diagnostic accuracy between experts who were already familiar with the NICE classification and trainees who were not, both before and after receiving brief training on the NICE classification. (2) Method: This prospective, single-center clinical trial was conducted at the Dong-A University Hospital from March 2020 to August 2020 and involved two groups of participants. The first group comprised two experienced endoscopists who were proficient in using i-scan OE and had received formal training in optical diagnosis and dye-less chromoendoscopy (DLC) techniques. The second group consisted of three endoscopists in the process of training in internal medicine at the Dong-A University Hospital. Each endoscopist examined the polyps and evaluated them using the NICE classification through i-scan OE. The results were not among the participants. Trained endoscopists were divided into pre- and post-training groups. (3) Results: During the study, a total of 259 DCPs were assessed using i-scan OE by the two expert endoscopists. They made real-time histological predictions according to the NICE classification criteria. For the trainee group, before training, the area under the receiver operating characteristic curves (AUROCs) for predicting histopathological results using i-scan OE were 0.791, 0.775, and 0.818. However, after receiving training, the AUROCs improved to 0.935, 0.949, and 0.963, which were not significantly different from the results achieved by the expert endoscopists. (4) Conclusions: This study highlights the potential of i-scan OE, along with the NICE classification, in predicting the histopathological results of DCPs during colonoscopy. In addition, this study suggests that even an endoscopist without experience in DLC can effectively use i-scan OE to improve diagnostic performance with only brief training.

Effectiveness of Simulation-Based Education for Caring Patients with COVID-19

PURPOSE

The role of medical staff gained immense significance in the context of the prolonged coronavirus disease (COVID-19) pandemic. However, few studies had explored the impact of simulation-based education on the ability of nursing students to care for the patients of COVID-19. This study provided nursing students with simulation-based education in caring for the patients of COVID-19 and confirmed its effectiveness.

METHODS

This study used a non-equivalent control group pretest-posttest design. The participants were recruited from the nursing departments of two universities in Korea through convenience sampling. A total of 79 participants were included: 37 in the intervention group and 42 in the control group. The intervention group received four sessions of simulation training based on the National League for Nursing Jeffries simulation theory.

RESULTS

The intervention group showed an improvement compared to the control group in terms of knowledge related to coronavirus, confidence in performing infection control skills, and perception of preparedness for caring for the patients of COVID-19, with a high-level of satisfaction and self-confidence in learning. There was no significant difference between the two groups in terms of anxiety.

CONCLUSION

This simulation is expected to be a significant strategy for alleviating the global burden in terms of staff safety and patient outcomes by improving the competencies of prospective medical staff in responding to pandemics.

The feasibility of early response evaluation using superb microvascular imaging one day after transcatheter arterial chemoembolization for hepatocellular carcinoma

PURPOSE

The purpose of this study was to determine the feasibility of early Superb microvascular imaging (SMI) for prediction of the effect of HCC treatment after transcatheter arterial chemoembolization (TACE).

MATERIALS AND METHODS

A total of 96 HCCs (70 patients) treated with TACE between September 2021 and May 2022 were included in this study. SMI, Color Doppler imaging (CDI), and Power Doppler imaging (PDI) were performed the day after TACE for evaluation of intratumoral vascularity of the lesion using an Aplio500 ultrasound scanner (Toshiba Medical Systems, Corporation, Tochigi, Japan). Grading of the vascular presence was performed using a five-point scale. A dynamic CT image taken after 29-42 days was used for comparison of sensitivity, specificity, and accuracy for detection of tumor vascularity between SMI, CDI, and PDI. Univariate and multivariate analysis were performed for assessment of factors affecting intratumoral vascularity.

RESULTS

Fifty-eight lesions (60%) showed complete remission (CR) and 38 lesions (40%) showed partial response (PR) or no response at 29-42 days on Multi-detector Computed Tomography (MDCT) after TACE. SMI showed sensitivity of 86.84% for detection of intratumoral flow, which was significantly higher compared with that of CDI (10.53%, p < 0.001) and PDI (36.84%, p < 0.001). The results of multivariate analysis indicated that tumor size was a significant factor in detection of blood flow using the SMI technique.

CONCLUSION

Early SMI may be utilized as an adjunctive diagnostic test for evaluation of treated lesions after TACE, particularly when the location of the tumor is in an area of the liver where a suitable sonic window can be identified.

Clustered Microcysts Detected on Breast US in Asymptomatic Women

Purpose

To investigate the incidence, outcomes, and imaging characteristics of clustered microcysts detected on breast US in asymptomatic women, and suggest appropriate management guidelines.

Materials and Methods

We identified and reviewed the lesions recorded as "clustered microcysts" on breast US performed in asymptomatic women between August 2014 and December 2019. The final diagnosis was based on pathology and imaging follow-up results for at least 12 months.

Results

The incidence was 1.5% and 100 patients with 117 lesions were included. Among 117 lesions, 3 (2.6%), 2 (1.7%), and 112 (95.7%) were malignant, high-risk benign, and benign lesions, respectively. The malignant lesions included two cases of ductal carcinoma in situ and one invasive ductal carcinoma. Two of them were assessed as category 4, showing mammographic suspicious microcalcifications and internal vascularity on Doppler US. The remainder was a false negative case and showed echo pattern change on the 12-month follow-up US.

Conclusion

The incidence of clustered microcysts on breast US in asymptomatic women was 1.5% and malignancy rate was 2.6% (3 of 117). Knowledge of outcomes and imaging features of benign and malignant clustered microcysts may be helpful for radiologists, thereby aiding categorization and management recommendations.

Effect of cation alkyl chain length on 3-sulfopropylmethacrylate-based draw solutes having lower critical solution temperature

We investigated the effect of change in alkyl chain length of cation in tributylalkylphosphonium 3-sulfopropyl methacrylate ([P444#][C3S], # = 4, 6, and 8) ionic liquids (ILs) on their osmolality and recovery properties as the draw solute in the forward osmosis (FO) process. The ILs aqueous solutions exhibited a characteristic of the lower critical solution temperature (LCST)-type phase separation, which allowed for the easy recovery of the draw solute or clean water from the diluted draw solution. The LCSTs of 31, 26, 22, and 18 °C were obtained from 2.5, 5.0, 7.5, and 10.0 wt% aqueous solutions of [P4446][C3S]. When deionized water, 2000 ppm NaCl solution, and 10.0 wt% orange juice aqueous solution were used as feed solution, the water fluxes of the aqueous [P4446][C3S] solutions were approximately 4.49, 3.87, and 1.55 LMH, respectively, in the active layer facing the draw solution mode at 7.5 wt% of draw solution. This study demonstrates the applicability of a thermoresponsive ionic structure material as a draw solute for the FO process.

Risk of chronic periodontitis in patients with obstructive sleep apnea in Korea: a nationwide retrospective cohort study

OBJECTIVES

The aim of this study was to determine whether the development of chronic periodontitis is more likely among patients who have been newly diagnosed with obstructive sleep apnea (OSA) through an analysis of representative data from the general population.

METHODS

A nationwide, population-based, retrospective cohort study was conducted using patient records from the Korean National Health Insurance Service database. For the period 2004-2019, patient data were categorized into 2 groups: a diagnosis of OSA (747 subjects) and no diagnosis of OSA (1,494 subjects). Subsequently, 1:2 propensity score matching was performed to ensure the homogeneity of the 2 groups. To analyze the risk of incident chronic periodontitis, a Cox proportional-hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

In the Kaplan-Meier curve, the disease-free probability was significantly lower in the OSA group than in the non-OSA group (p for log-rank test=0.001). The crude HR for the association between OSA and chronic periodontitis was 1.29 (95% CI, 1.16 to 1.43). The multivariable-adjusted HR was calculated at 1.28 (95% CI, 1.15 to 1.42).

CONCLUSIONS

This study confirmed a relationship between OSA and chronic periodontitis. Therefore, OSA patients require oral care to prevent the progression of chronic periodontitis from mild to severe.

Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea

BACKGROUND

In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19.

METHODS

This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient's EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports. The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ² test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19.

RESULTS

A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 (P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021.

CONCLUSION

After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported. However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

Differences in clinical significance of bronchodilator responses measured by forced expiratory volume in 1 second and forced vital capacity

BACKGROUND

The clinical implication of bronchodilator response (BDR) is not fully understood. However, BDR is frequently present in patients with chronic obstructive pulmonary disease (COPD). We identified the differences in clinical features regarding BDR. In addition, we divided BDR into BDR for forced expiratory volume in 1 s (FEV1) and BDR for forced vital capacity (FVC; i.e., BDR-FEV1 and BDR-FVC, respectively) and analyzed clinical significance.

METHODS

We used data from the Korea COPD Subgroup Study, a multicenter cohort study of COPD patients recruited from 54 centers in South Korea since April 2012. We analyzed differences in baseline characteristics, 1-year exacerbation rate, and 3-year FEV1 decline between BDR negative and positive patients. Moreover, we analyzed the differences in clinical features between BDR-FEV1 positive and negative patients and between BDR-FVC positive and negative patients.

RESULTS

Of the 2,181 patients enrolled in this study, 366 (16.8%) were BDR positive. BDR positive patients were more likely to be ever-smokers and to have a lower body mass index and higher symptom scores compared to BDR negative patients. Baseline FEV1 and FEV1/FVC were lower in the BDR positive compared to the BDR negative group (1.7 ± 0.6 and 1.6 ± 0.5, respectively, p < 0.01; 50.9 ± 12.1 and 46.5 ± 14.8, respectively, p < 0.01). BDR positive patients were more likely to have been diagnosed with asthma-COPD overlap and to receive inhaled corticosteroids (ICS) than BDR negative patients. BDR-FVC patients were more likely to be smokers, suffer from worse symptoms and have lower lung function than those with no BDR-FVC. BDR had no significant effect on 1-year moderate to severe or severe exacerbation rates or 3-year annual FEV1 decline. Interactive effects of ICS and BDR on the exacerbation rate were not significant in any group.

CONCLUSIONS

In this study, BDR positive patients were more likely to be ever-smokers and to have worse symptoms and lung function than BDR negative patients. BDR-FVC was associated with worse symptom control and lung function compared to BDR-FEV1. However, there were no significant differences in exacerbation rate or decline in lung function in any BDR group. In addition, the effects of ICS on exacerbations were not significant in any group.

Adult-Onset Type 1 Diabetes Development Following COVID-19 mRNA Vaccination

During the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination-induced hyperglycemia and related complications have been reported. However, there have been few reports of type 1 diabetes triggered by COVID-19 vaccines in subjects without diabetes. Here, we report the case of a 56-year-old female patient who developed hyperglycemia after the second dose of COVID-19 mRNA-based vaccination without a prior history of diabetes. She visited our hospital with uncontrolled hyperglycemia despite administration of oral hyperglycemic agents. Her initial glycated hemoglobin level was high (11.0%), and fasting serum C-peptide level was normal. The fasting serum C-peptide level decreased to 0.269 ng/mL 5 days after admission, and the anti-glutamic acid decarboxylase antibody was positive. The patient was discharged in stable condition with insulin treatment. To our knowledge, this is the first case of the development of type 1 diabetes without diabetic ketoacidosis after mRNA-based COVID-19 vaccination, and is the oldest case of type 1 diabetes development under such circumstances.

Effect of the Alkyl Chain Length on Assessment as Thermo-Responsive Draw Solutes for Forward Osmosis

A series of thermo-responsive tetrabutylphosphonium 1-alkanesulfonates (abbreviated as [P₄₄₄₄][C _n S], n = 6, 8, 10, and 12), where n is the number of carbon atoms in the alkyl group on the 1-alkanesulfonate anion, were prepared by an ion-exchange reaction to investigate their potential ability toward the application of draw solutes in forward osmosis (FO). We systematically studied the recovery properties and FO performance of [P₄₄₄₄][C _n S]. This series exhibited lower critical solution temperature (LCST) characteristics, which offer a clear advantage of being energy-efficient for recovering draw solutes; however, [P₄₄₄₄][C₆S] was only observed at 20 wt %. The LCSTs of the 20 wt % [P₄₄₄₄][C₆S], [P₄₄₄₄][C₈S], [P₄₄₄₄][C₁₀S], and [P₄₄₄₄][C₁₂S] draw solutions were approximately 83, 54, 49, and 56 °C, respectively. Moreover, when the orientation of the active layer was heading toward the draw solution (AL-DS mode), the water and reverse solute flux of [P₄₄₄₄][C₁₀S] were about 1.58 LMH and 0.81 gMH, respectively, at 20 wt % aqueous solutions. When the membrane was used in the active layer facing the feed solution (AL-FS) system, the water and reverse solute flux of [P₄₄₄₄][C₁₀S] were approximately 0.71 LMH and 0.38 gMH, respectively, at 20 wt % aqueous solutions. Thus, this study is the first to examine the structural transformations of the bulkier alkyl group on the sulfonate anion moiety and its feasibility as the new draw solute for the FO system.

Pictorial Essay: Understanding of Persistent Left Superior Vena Cava and Its Differential Diagnosis

Persistent left superior vena cava (PLSVC) is a rare congenital, thoracic, and vascular anomaly. Although PLSVCs generally do not have a hemodynamic effect, several types of PLSVC and some cardiac anomalies may manifest with clinical symptoms. The presence of PLSVC can render catheterization via left subclavian access difficult when placing a pacemaker or central venous catheter. As such, recognizing a PLSVC that is typically incidentally discovered can prevent complications such as vascular injury. Differentiating vessels found in a similar location as PLSVC is necessary when performing thoracic vascular procedures. This pictorial essay explains the multi-detector CT findings of a PLSVC, and provides a summary of other blood vessels that require differentiation during thoracic vascular procedures.

Approaches to Sustainability in Chemical Mechanical Polishing (CMP): A Review

Chemical mechanical polishing (CMP) is an essential planarization process for semiconductor manufacturing. The application of CMP has been increasing in semiconductor fabrication for highly integrated devices. Recently, environmental burden caused by the CMP process was assessed because of interest in the global environment. In this study, the previously reported impacts of CMP on the environment and studies conducted on developing various methods to reduce environmental burden are reviewed. In addition to analyzing the impacts of CMP, this paper introduces a method for treating CMP wastewater and improving the material removal efficiency through the improvement of CMP consumables. Finally, the authors review research on hybridization of the CMP process and discuss the direction in which CMP technology will progress to improve sustainability in the future.

The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea

BACKGROUND

Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea.

METHODS

This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients.

RESULTS

A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00-24:00, P < 0.001), and the presence of an initial shockable rhythm was increased (pre-COVID-19 vs. COVID-19, 7.97% vs. 11.95%, P = 0.004). The number of tracheal intubations decreased (5.27% vs. 1.22%, P < 0.001), and the use of mechanical chest compression devices (30.53% vs. 44.59%, P < 0.001) and EMS response time (median [quartile 1-quartile 3], 7 [5-10] vs. 8 [6-11], P < 0.001) increased. After propensity score matching, the survival at admission rate (22.52% vs. 18.24%, P = 0.025), survival to discharge rate (7.77% vs. 5.52%, P = 0.056), and favorable neurological outcome (5.97% vs. 3.49%, P < 0.001) decreased. In the propensity score matching analysis of the impact of COVID-19, odds ratios of 0.768 (95% confidence interval [CI], 0.592-0.995) for survival at admission and 0.693 (95% CI, 0.446-1.077) for survival to discharge were found.

CONCLUSION

During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.

Real-world Effectiveness and Safety of Direct-acting Antiviral Agents in Patients with Chronic Hepatitis C Genotype 2 Infection: Korean Multicenter Study

BACKGROUND

The advancement of treatment with direct-acting antiviral (DAA) agents has improved the cure rate of hepatitis C virus (HCV) infection close to 100%. The aim of our study was to assess the real-world effectiveness and safety of DAA regimens for the treatment of patients with chronic HCV genotype 2.

METHODS

We retrospectively analyzed the clinical data of patients treated with sofosbuvir plus ribavirin (SOF + RBV) or glecaprevir/pibrentasvir (G/P) for chronic HCV genotype 2 infection at seven university hospitals in the Korean southeast region.

RESULTS

SOF + RBV therapy produced an 89% and 98.3% sustained virologic response 12 week (SVR12) after treatment completion in the full analysis set and per-protocol set, respectively, and the corresponding values for G/P therapy were 89.5% and 99.2%, respectively. The difference between the treatments was probably because 6.2% (59/953) of patients in the SOF + RBV group did not complete the treatment and 9.8% (14/143) in the G/P group did not test HCV RNA after treatment completion. Adverse events (A/Es) were reported in 59.7% (569/953) and 25.9% (37/143) of the SOF + RBV and G/P groups, respectively. In the SOF + RBV group, 12 (1.26%) patients discontinued treatment owing to A/Es, whereas no patients discontinued treatment because of A/Es in the G/P group.

CONCLUSION

In both treatment groups, SVR was high when treatment was completed. However, there was a high dropout rate in the SOF + RBV group, and the dropout analysis showed that these were patients with liver cirrhosis (LC; 43/285, 15.1%), especially those with decompensated LC (12/32, 37.5%). Therefore, an early initiation of antiviral therapy is recommended for a successful outcome before liver function declines. Furthermore, patients with decompensated LC who are considered candidates for SOF + RBV treatment should be carefully monitored to ensure that their treatment is completed, especially those with low hemoglobin and high alanine transaminase.

Hand Gesture Recognition Using EGaIn-Silicone Soft Sensors

Exploiting hand gestures for non-verbal communication has extraordinary potential in HCI. A data glove is an apparatus widely used to recognize hand gestures. To improve the functionality of the data glove, a highly stretchable and reliable signal-to-noise ratio sensor is indispensable. To do this, the study focused on the development of soft silicone microchannel sensors using a Eutectic Gallium-Indium (EGaIn) liquid metal alloy and a hand gesture recognition system via the proposed data glove using the soft sensor. The EGaIn-silicone sensor was uniquely designed to include two sensing channels to monitor the finger joint movements and to facilitate the EGaIn alloy injection into the meander-type microchannels. We recruited 15 participants to collect hand gesture dataset investigating 12 static hand gestures. The dataset was exploited to estimate the performance of the proposed data glove in hand gesture recognition. Additionally, six traditional classification algorithms were studied. From the results, a random forest shows the highest classification accuracy of 97.3% and a linear discriminant analysis shows the lowest accuracy of 87.4%. The non-linearity of the proposed sensor deteriorated the accuracy of LDA, however, the other classifiers adequately overcame it and performed high accuracies (>90%).

Smoking may be more harmful to vasospastic angina patients who take antiplatelet agents due to the interaction: Results of Korean prospective multi-center cohort

Background

The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated.

Methods

VA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1.

Results

Patients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales.

Conclusions

Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.

Relationship between heavy metal exposure and type 2 diabetes: a large-scale retrospective cohort study using occupational health examinations

OBJECTIVES

To investigate the associations between heavy metal exposure and serum ferritin levels, physical measurements and type 2 diabetes mellitus (DM).

DESIGN

A retrospective cohort study.

SETTING

Changwon, the location of this study, is a Korean representative industrial city. Data were obtained from medical check-ups between 2002 and 2018.

PARTICIPANTS

A total of 34 814 male subjects were included. Of them, 1035 subjects with lead exposure, 200 subjects with cadmium exposure and the 33 579 remaining were assigned to cohort A, cohort B and the control cohort, respectively. Data including personal history of alcohol and smoking, age, height, weight, the follow-up duration, haemoglobin A1c (HbA1c), fasting blood sugar (FBS), ferritin levels, and lead and cadmium levels within 1 year after exposure were collected.

PRIMARY OUTCOME MEASURE

In subjects without diabetes, changes in FBS and HbA1c were analysed through repeated tests at intervals of 1 year or longer after the occupational exposure to heavy metals.

RESULTS

In Cohort A, DM was diagnosed in 33 subjects. There was a significant difference in lead concentrations between the subjects diagnosed with DM and those without DM during the follow-up period (3.94±2.92 mg/dL vs 2.81±2.03 mg/dL, p=0.002). Simple exposure to heavy metals (lead and cadmium) was not associated with DM in Cox regression models (lead exposure (HR) 1.01, 95% CI: 0.58 to 1.77, p 0.971; cadmium exposure HR 1.48, 95% CI: 0.61 to 3.55, p=0.385). Annual changes in FBS according to lead concentration at the beginning of exposure showed a positive correlation (r=0.072, p=0.032).

CONCLUSION

Our findings demonstrated that simple occupational exposure to heavy metals lead and cadmium was not associated with the incidence of DM. However, lead concentrations at the beginning of the exposure might be an indicator of DM and glucose elevations.

Hybrid Lead-Halide Polyelectrolytes as Interfacial Electron Extraction Layers in Inverted Organic Solar Cells

A series of lead-halide based hybrid polyelectrolytes was prepared and used as interfacial layers in organic solar cells (OSCs) to explore their effect on the energy band structures and performance of OSCs. Nonconjugated polyelectrolytes based on ethoxylated polyethylenimine (PEIE) complexed with PbX2 (I, Br, and Cl) were prepared as polymeric analogs of the perovskite semiconductors CH3NH3PbX3. The organic/inorganic hybrid composites were deposited onto Indium tin oxide (ITO) substrates by solution processing, and ultraviolet photoelectron spectroscopy (UPS) measurements confirmed that the polyelectrolytes allowed the work function of the substrates to be controlled. In addition, X-ray photoelectron spectroscopy (XPS) results showed that Pb(II) halide complexes were present in the thin film and that the Pb halide species did not bond covalently with the cationic polymer and confirmed the absence of additional chemical bonds. The composite ratio of organic and inorganic materials was optimized to improve the performance of OSCs. When PbBr2 was complexed with the PEIE material, the efficiency increased up to 3.567% via improvements in open circuit voltage and fill factor from the control device (0.3%). These results demonstrate that lead-halide based polyelectrolytes constitute hybrid interfacial layers which provide a novel route to control device characteristics via variation of the lead halide composition.

Influence of combined exposure to perceived risk at work and unstable employment on self-rated health: a comparison of two cross-sectional surveys in Europe and Korea

OBJECTIVES

The purpose of this study was to investigate the combined effect of exposure to perceived risk at work and unstable employment on self-rated health in both Korea and the European Union.

DESIGN

Cross-sectional study.

SETTING

We conducted the analyses using employees data from the third Korean Working Conditions Survey (KWCS) conducted in 2011 and the fifth European Working Conditions Survey (EWCS) conducted in 2010.

PARTICIPANTS

Employees of the third KWCS and the fifth EWCS from 35 European countries were the participants of the study.

PRIMARY OUTCOME MEASURES

Employment status was divided into two categories: stable and unstable employment. Perceived risk regarding safety and health at work were assessed. Primary health outcomes were poor or moderate self-rated health. Exposures and health status were assessed via a questionnaire.

RESULTS

Among Korean employees, the OR of poor self-rated health was 2.00 (95% CI: 1.80 to 2.22) for those with perceived risk at work, 1.18 (95% CI: 1.09 to 1.28) for those with unstable employment and 3.22 (95% CI: 2.72 to 3.81) for those with both perceived risk at work and unstable employment. Relative excess risk due to interaction (RERI) was 1.03 (95% CI: 0.48 to 1.58). Among European employees, the OR for poor self-rated health was 3.20 (95% CI: 2.93 to 3.49) for those with perceived risk at work, 1.04 (95% CI: 0.97 to 1.13) for those with unstable employment and 3.41 (95% CI: 2.93 to 3.98) for those with both perceived risk at work and unstable employment. The RERI was 0.18 (95% CI: -0.36 to 0.71).

CONCLUSIONS

Among Korean employees, a supra-additive interaction between perceived risk at work and unstable employment on poor self-rated health was observed. Conversely, a supra-additive interaction was not observed among European employees.

Diabetes and Cancer: Cancer Should Be Screened in Routine Diabetes Assessment

Cancer incidence appears to be increased in both type 1 and type 2 diabetes mellitus (DM). DM represents a risk factor for cancer, particularly hepatocellular, hepatobiliary, pancreas, breast, ovarian, endometrial, and gastrointestinal cancers. In addition, there is evidence showing that DM is associated with increased cancer mortality. Common risk factors such as age, obesity, physical inactivity and smoking may contribute to increased cancer risk in patients with DM. Although the mechanistic process that may link diabetes to cancer is not completely understood yet, biological mechanisms linking DM and cancer are hyperglycemia, hyperinsulinemia, increased bioactivity of insulin-like growth factor 1, oxidative stress, dysregulations of sex hormones, and chronic inflammation. However, cancer screening rate is significantly lower in people with DM than that in people without diabetes. Evidence from previous studies suggests that some medications used to treat DM are associated with either increased or reduced risk of cancer. However, there is no strong evidence supporting the association between the use of anti-hyperglycemic medication and specific cancer. In conclusion, all patients with DM should be undergo recommended age- and sex appropriate cancer screenings to promote primary prevention and early detection. Furthermore, cancer should be screened in routine diabetes assessment.

Baicalein as a Potential Inhibitor against BACE1 and AChE: Mechanistic Comprehension through In Vitro and Computational Approaches

One of the major neurodegenerative features of Alzheimer's disease (AD) is the presence of neurotoxic amyloid plaques composed of amyloid beta peptide (Aβ). β-Secretase (BACE1) and acetylcholinesterase (AChE), which promote Aβ fibril formation, have become attractive therapeutic targets for AD. P-glycoprotein (P-gp), the major efflux pump of the blood-brain barrier (BBB), plays a critical role in limiting therapeutic molecules. In pursuit of discovering a natural anti-AD candidate, the bioactivity, physicochemical, drug-likeness, and molecular docking properties of baicalein, a major compound from Scutellaria baicalensis, was investigated. Baicalein exhibited strong BACE1 and AChE inhibitory properties (IC50 23.71 ± 1.91 µM and 45.95 ± 3.44 µM, respectively) and reacted in non-competitive and competitive manners with substrates, respectively. in Silico docking analysis was in full agreement with the in vitro results, demonstrating that the compound exhibited powerful binding interaction with target enzymes. Particularly, three continuous hydroxyl groups on the A ring demonstrated strong H-bond binding properties. It is also noteworthy that baicalein complied with all requirements of Lipinski's rule of five by its optimal physicochemical properties for both oral bioavailability and blood-brain barrier permeability. Overall, the present study strongly demonstrated the possibility of baicalein having in vivo pharmacological efficacy for specific targets in the prevention and/or treatment of AD.

The burden of care and the understanding of disease in Parkinson's disease

Background and objective

Education of disease plays an important role in management of Parkinson's disease (PD). However, little is known about the link between the understanding of disease and the burden of care. This study was carried out to find the correlation between the burden of care and the understanding of disease in caregivers for PD patients.

Methods

Non-demented patients with PD and their caregivers participated in structured interviews. Understanding of patients and caregivers was evaluated through newly-devised questions. The caregiver burden inventory was used to assess the burden of care.

Results

A total of 142 pairs of patients and their caregivers were recruited. A correlation analysis showed that the burden of care was positively associated with low understanding of the disease by the caregiver. Daily care time and female patients were revealed to be independently associated with the burden of care through a multivariate analysis. Further analyses were performed in the caregiver group according to relationship with patients. The spouse group showed an increased burden of care and poor understanding compared to the offspring group. A multivariate analysis revealed that daily care time and understanding were independent predictors for the burden of care in the spouse group. There was no significant association in the offspring group.

Conclusion

The burden of care was associated with higher daily caregiving time and female gender of the patient, and was significantly increased in the spouse of the patient. In the spouse group, better understanding of the caregiver correlated with less burden of care.

Dual BACE1 and Cholinesterase Inhibitory Effects of Phlorotannins from Ecklonia cava-An In Vitro and in Silico Study

Alzheimer's disease (AD) is one of the most common neurodegenerative diseases with a multifactorial nature. β-Secretase (BACE1) and acetylcholinesterase (AChE), which are required for the production of neurotoxic β-amyloid (Aβ) and the promotion of Aβ fibril formation, respectively, are considered as prime therapeutic targets for AD. In our efforts towards the development of potent multi-target, directed agents for AD treatment, major phlorotannins such as eckol, dieckol, and 8,8'-bieckol from Ecklonia cava (E. cava) were evaluated. Based on the in vitro study, all tested compounds showed potent inhibitory effects on BACE1 and AChE. In particular, 8,8'-bieckol demonstrated the best inhibitory effect against BACE1 and AChE, with IC50 values of 1.62 ± 0.14 and 4.59 ± 0.32 µM, respectively. Overall, kinetic studies demonstrated that all the tested compounds acted as dual BACE1 and AChE inhibitors in a non-competitive or competitive fashion, respectively. In silico docking analysis exhibited that the lowest binding energies of all compounds were negative, and specifically different residues of each target enzyme interacted with hydroxyl groups of phlorotannins. The present study suggested that major phlorotannins derived from E. cava possess significant potential as drug candidates for therapeutic agents against AD.

Anti-Neuroinflammatory Property of Phlorotannins from Ecklonia cava on Aβ25-35-Induced Damage in PC12 Cells

Alzheimer disease (AD) is a neurodegenerative disorder characterized by excessive accumulation of amyloid-beta peptide (Aβ) and progressive loss of neurons. Therefore, the inhibition of Aβ-induced neurotoxicity is a potential therapeutic approach for the treatment of AD. Ecklonia cava is an edible brown seaweed, which has been recognized as a rich source of bioactive derivatives, mainly phlorotannins. In this study, phlorotannins including eckol, dieckol, 8,8'-bieckol were used as potential neuroprotective candidates for their anti-apoptotic and anti-inflammatory effects against Aβ25-35-induced damage in PC12 cells. Among the tested compounds, dieckol showed the highest effect in both suppressing intracellular oxidative stress and mitochondrial dysfunction and activation of caspase family. Three phlorotannins were found to inhibit TNF-α, IL-1β and PGE₂ production at the protein levels. These result showed that the anti-inflammatory properties of our compounds are related to the down-regulation of proinflammatory enzymes, iNOS and COX-2, through the negative regulation of the NF-κB pathway in Aβ25-35-stimulated PC12 cells. Especially, dieckol showed the strong anti-inflammatory effects via suppression of p38, ERK and JNK. However, 8,8'-bieckol markedly decreased the phosphorylation of p38 and JNK and eckol suppressed the activation of p38. Therefore, the results of this study indicated that dieckol from E. cava might be applied as a drug candidate for the development of new generation therapeutic agents against AD.

Cloning, purification, and characterization of an organic solvent-tolerant chitinase, MtCh509, from Microbulbifer thermotolerans DAU221

BACKGROUND

The ability to use organic solvents in enzyme reactions offers a number of industrially useful advantages. However, most enzymes are almost completely inactive in the presence of organic solvents. Thus, organic solvent-tolerant enzymes have potential applications in industrial processes.

RESULTS

A chitinase gene from Microbulbifer thermotolerans DAU221 (mtch509) was cloned and expressed in Escherichia coli BL21 (DE3). The molecular weight of the expressed MtCh509 protein was approximately 60 kDa, and it was purified by His-tag affinity chromatography. Enzymatic assays showed that the optimum temperature for MtCh509 chitinase activity was 55 °C, and the enzyme was stable for 2 h at up to 50 °C. The optimum pH for MtCh509 activity was in the sub-acidic range, at pH 4.6 and 5.0. The activity of MtCh509 was maintained in presence of 1 M salt, gradually decreasing at higher concentrations, with residual activity (20%) detected after incubation in 5 M salt. Some organic solvents (benzene, DMSO, hexane, isoamyl alcohol, isopropyl alcohol, and toluene; 10-20%, v/v) increased the reactivity of MtCh509 relative to the aqueous system. When using NAG3, as a substrate, MtCh509 produced NAG2 as the major product, as well as NAG4, demonstrating that MtCh509 has transglycosylation activity. The K m and V max values for MtCh509 using colloidal chitin as a substrate were 9.275 mg/mL and 20.4 U/mg, respectively. Thus, MtCh509 could be used in extreme industrial conditions.

CONCLUSION

The results of the hydrolysate analysis and the observed increase in enzyme activity in the presence of organic solvents show that MtCh509 has industrially attractive advantages. This is the first report on an organic solvent-tolerant and transglycosylating chitinase from Microbulbifer species.

Impact of Blood or Erythrocyte Membrane Fatty Acids for Disease Risk Prediction: Focusing on Cardiovascular Disease and Chronic Kidney Disease

Fatty acids (FAs) are essential nutrients and main constituents of cell membranes that are involved in the signaling pathway and associated with health conditions. We investigated if blood or erythrocyte membrane FAs can predict the risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and related complications. Omega-3 (n-3) FAs are important predictors for metabolic syndrome, diabetes, CVD, and CKD risks, and the n-3 index is also a good biomarker for sudden cardiac death in coronary artery disease. Linoleic acid, which is one of the major n-6 FAs reflecting recent dietary FA intake, may predict CVD risk and mortality in the general population and patients with CKD. Monounsaturated FAs (MUFAs) are also related to diabetes or diabetic nephropathy. Oleic acid, a major MUFA, is an emerging marker that is related to acute coronary syndrome, low glomerular filtration rate, and vascular calcification in patients with CKD, and can be modified by n-3 FA supplementation. Saturated FAs, trans-FAs, and FA desaturation/elongation are associated with CVD risk; however, few studies have been conducted on patients with CKD. In summary, blood or erythrocyte membrane FA measurements are important for CVD and CKD risk prediction and management. Further studies are needed to elucidate the FAs for their risk predictions.

Relationship between serum bilirubin levels and cardiovascular disease

We tested the hypothesis that higher levels of bilirubin, a bile pigment with antioxidant properties, are associated with a decreased risk of cardiovascular disease (CVD). This study analyzed data from the Korean Health and Genome Study to examine the association between serum total bilirubin (TB) on CVD and CVD death. Serum TB was measured in a total of 8,844 subjects (4,196 males and 4,648 females) and evaluated for the development of new onset CVD from 2001 to 2012 (mean 8.1 years of follow-up). During the follow-up period, 689 cases of incident CVD (7.8%) were identified, and the prevalence of metabolic syndrome (MetS) at baseline was 26.1%. The prevalence of MetS decreased across bilirubin tertile categories. In addition to MetS itself, individual components of MetS significantly decreased with increased bilirubin tertiles. Moreover, the incidence of CVD decreased across bilirubin tertile categories. The hazard ratios (HRs) for developing coronary heart disease (CHD, HR 0.769, 95% CI 0.655–1.000) and CVD death (HR 0.513, 95% CI 0.267–0.985) was significantly lower in the highest tertile group (> 0.63 mg/dL) in comparison to the lowest tertile group (< 0.44 mg/dL) after adjusting for all confounding variables. In the present longitudinal study, a significant negative relationship was demonstrated between baseline bilirubin levels and incident CHD and CVD death.

Glucocorticoid-Induced Diabetes Mellitus: An Important but Overlooked Problem

Glucocorticoids are widely used as potent anti-inflammatory and immunosuppressive drugs to treat a wide range of diseases. However, they are also associated with a number of side effects, including new-onset hyperglycemia in patients without a history of diabetes mellitus (DM) or severely uncontrolled hyperglycemia in patients with known DM. Glucocorticoid-induced diabetes mellitus (GIDM) is a common and potentially harmful problem in clinical practice, affecting almost all medical specialties, but is often difficult to detect in clinical settings. However, scientific evidence is lacking regarding the effects of GIDM, as well as strategies for prevention and treatment. Similarly to nonsteroid-related DM, the principles of early detection and risk factor modification apply. Screening for GIDM should be considered in all patients treated with medium to high doses of glucocorticoids. Challenges in the management of GIDM stem from wide fluctuations in postprandial hyperglycemia and the lack of clearly defined treatment protocols. Together with lifestyle measures, hypoglycemic drugs with insulin-sensitizing effects are indicated. However, insulin therapy is often unavoidable, to the point that insulin can be considered the drug of choice. The treatment of GIDM should take into account the degree and pattern of hyperglycemia, as well as the type, dose, and schedule of glucocorticoid used. Moreover, it is essential to instruct the patient and/or the patient's family about how to perform the necessary adjustments. Prospective studies are needed to answer the remaining questions regarding GIDM.

Depression Is a Mediator for the Relationship between Physical Symptom and Psychological Well-being in Obese People

This present study aimed to investigate the association effect of obesity status, physical symptom, insecure attachment, and depression on psychological well-being in non-diabetic healthy Koreans. Height, weight, waist circumference, blood pressure, and socio-psychological questionnaires (insecure attachment, depression, and physical symptom psychological well-being, etc.) were examined in 123 healthy Koreans. Student t-test, correlation analysis, and mediation analysis were performed. Study subjects were divided into 2 groups based on body mass index (BMI, kg/m2): obesity (BMI ≥ 25, n = 36) and non-obesity (BMI < 25, n = 87). Obese people were older and showed higher proportion of males than non-obese ones. Regarding the values of socio-psychological test, obesity group showed lower insecure attachment, and higher physical symptom than non-obesity group. In correlation and mediation analyses, depression was positively related to insecure attachment and physical symptom in both BMI groups. Positive relationship between physical symptom and insecure attachment was observed only in non-obesity group, but not in obesity group. The effect of insecure attachment on psychological well-being was completely mediated by depression in both BMI groups. On the other hand, the effect of physical symptom on psychological well-being was completely mediated by depression in obesity group, but not in non-obesity group. In conclusion, this study presented that the effects of physical symptom and insecure attachment on psychological well-being were completely mediated by depression in obese healthy Koreans, but not in non-obese ones. It will provide useful data for extending the knowledge on the relationship between the physical health and mental health.

Prognostic Value of Extranodal Extension in Thyroid Cancer: A Meta-Analysis

PURPOSE

Thyroid cancer is the most common endocrine cancer and its incidence has continuously increased in the last three decades all over the world. We aimed to evaluate the prognostic value of extranodal extension (ENE) of thyroid cancer.

MATERIALS AND METHODS

We performed a systematic search of MEDLINE (from inception to June 2014) and EMBASE (from inception to June 2014) for English-language publication. The inclusion criteria were studies of thyroid cancer that reported the prognostic value of ENE in thyroid cancer. Reviews, abstracts, and editorial materials were excluded, and duplicate data were removed. Two authors performed the data extraction independently.

RESULTS

6 studies including 1830 patients were eligible for inclusion in the study. All patients included in the meta-analysis had papillary thyroid cancer (PTC). Recurrence-free survival was analyzed based on 3 studies. The pooled hazard ratio for recurrence was 2.01 [95% confidence interval (CI) 1.19-3.40, p=0.009]. Disease-specific survival was analyzed based on 3 studies with 973 patients. Patients of PTC with ENE showed 3.37-fold higher risk of death from the disease (95% CI 1.55-7.32, p=0.002).

CONCLUSION

ENE should be considered to be a poor prognostic marker in thyroid cancer; such knowledge might improve the management of individual patients. This might facilitate the planning of appropriate ablation therapy and tailored patient follow-up from the beginning of treatment.

Genetic Association for P2X7R rs3751142 and CARD8 rs2043211 Polymorphisms for Susceptibility of Gout in Korean Men: Multi-Center Study

The aim of this study was to determine the association between P2X7R rs3751142 and CARD8 rs2043211 polymorphisms and gout susceptibility in male Korean subjects. This study enrolled a total of 242 male patients with gout and 280 healthy controls. The polymorphisms of two individual genes including rs3751142(C>A) in the P2X7R gene and rs2043211(A>T) in the CARD8 gene were assessed using Taq-Man analysis. Statistical analyses were performed using the Chi-square test, Kruskal-Wallis test, and logistic regression analyses. A difference in genotypic frequency of the P2X7R rs3751142 and CARD8 rs2043211 genes was not detected between gout and control patients. Clinical parameters including age, onset age, disease duration, body mass index, and serum uric acid levels were not different among the three genotypes for either P2X7R or CARD8 (P > 0.05 for all). A pair-wise comparison of P2X7R rs3751142 and CARD8 rs2043211 genotype combinations revealed that subjects with the CA P2X7R rs3751142 genotype and the TT CARD8 rs2043211 genotype had a trend toward a higher risk of gout compared to the CC/AA combination (P = 0.056, OR = 2.618, 95% CI 0.975 - 7.031). In conclusion, this study revealed that genetic variability of the P2X7R rs3751142 and CARD8 rs2043211 genes might, in part, be associated with susceptibility for gout.