Testing the Reliability and Validity of the Korean Version of the Pittsburgh Sleep Quality Index Using Fitbit Devices: A Cross-Sectional Analysis

Background

Sleep disorders and insomnia are prevalent worldwide, with negative health outcomes. The Pittsburgh Sleep Quality Index (PSQI) is a widely used self-report assessment tool for evaluating sleep quality, comprising seven subdomains. The Korean version of the PSQI (PSQI-K) has been tested for reliability and validity in small sample sizes but lacks large-scale validation using objective measures.

Methods

This study was conducted with 268 Korean adults attending health check programs. Participants completed the PSQI-K questionnaire and wore Fitbit devices (Fitbit Inc., USA) to ascertain sleep parameters. Reliability was analyzed using the Cronbach's α coefficient, and construct validity was determined through factor analysis. Criteria validity was assessed by correlating their index scores with Fitbit sleep parameters. We identified the optimal cutoff for detecting sleep disorders.

Results

The Cronbach's α coefficient was 0.61, indicating adequate internal consistency. Factor analysis revealed three factors, explaining 48.2% of sleep quality variance. The index scores were negatively correlated with Fitbit sleep efficiency, total sleep time, and number of awakenings (P<0.05). The optimal cutoff point for identifying sleep disorder groups was ≥6.

Conclusion

The PSQI-K demonstrated good reliability and validity when correlated with Fitbit sleep parameters, offering a practical screening tool for identifying sleep disorders among Korean adults. Cutoff scores can help identify patients for sleep interventions. However, further large-scale studies are required to validate these findings.

Metabolic Obesity Phenotypes and Incident Cardiovascular Outcomes in Middle-Aged and Older Korean Adults: A Longitudinal 10-Year Analysis of the Korean Genome and Epidemiology Study

Background: This study investigated the association of four metabolic obesity phenotypes with incident coronary artery disease and stroke in a large-scale, community population-based, prospective Korean cohort observed for over 10 years. Methods: The study participants included 7374 adults aged 40-69 years, drawn from the Korean Genome and Epidemiology Study. Participants with different metabolic obesity phenotypes were categorized according to body weight and metabolic health status into four groups: metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy nonobese (MUHNO), and metabolically unhealthy obese (MUHO). Combined cardiovascular events were defined as coronary artery disease and stroke. We used multivariate Cox proportional hazards regression models to prospectively assess hazard ratios (HRs) with 95% confidence intervals (CIs) for incident coronary artery disease or stroke over 10 years after the baseline survey. Results: During the follow-up period, newly developed coronary artery disease, stroke, and combined cardiovascular events were diagnosed in 151 (2.0%), 137 (1.9%), and 283 (3.8%) participants, respectively. After adjusting for confounding variables, the HRs (95% CIs) for incident combined cardiovascular events were 1.81 (1.34-2.46) in the MUHO group, 1.29 (0.92-1.81) in the MUHNO group, and 1.21 (0.81-1.79) in the MHO group compared with those in the MHNO group. Conclusions: This study revealed distinct risks associated with four metabolic obesity phenotypes concerning incident coronary artery disease and stroke. After adjusting for potential confounding variables, the results indicated that MUHO, but not MUHNO or MHO, showed a higher risk of developing coronary artery disease and stroke than MHNO.

COVID-19 Mortality and Severity in Cancer Patients and Cancer Survivors

BACKGROUND

We aimed to investigate mortality, severity, and risk of hospitalization in coronavirus disease 2019 (COVID-19) patients with cancer.

METHODS

Data of all patients aged 40-79 years from the Korean Disease Control and Prevention Agency-COVID19-National Health Insurance Service who were diagnosed with COVID-19 between January 1, 2020 and March 31, 2022, in Korea were included. After 1:1 propensity score matching, 397,050 patients with cancer and 397,050 patients without cancer were enrolled in the main analysis. A cancer survivor was defined as a patient who had survived 5 or more years since the diagnosis of cancer. Multiple logistic regression analysis was performed to compare the risk of COVID-19 according to the diagnosis of cancer and time since diagnosis.

RESULTS

Cancer, old age, male sex, incomplete vaccination against COVID-19, lower economic status, and a higher Charlson comorbidity index were associated with an increased risk of hospitalization, hospitalization with severe state, and death. Compared to patients without cancer, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hospitalization, hospitalization with severe state, and death in patients with cancer were 1.09 (1.08-1.11), 1.17 (1.11-1.24), and 1.94 (1.84-2.05), respectively. Compared to patients without cancer, the ORs (95% CIs) for hospitalization in cancer survivors, patients with cancer diagnosed 2-5 years, 1-2 years, and < 1 year ago were 0.96 (0.94-0.98), 1.10 (1.07-1.13), 1.30 (1.25-1.34), and 1.82 (1.77-1.87), respectively; the ORs (95% CIs) for hospitalization for severe disease among these patients were 0.90 (0.85-0.97), 1.22 (1.12-1.32), 1.60 (1.43-1.79), and 2.29 (2.09-2.50), respectively.

CONCLUSION

The risks of death, severe state, and hospitalization due to COVID-19 were higher in patients with cancer than in those without; the more recent the diagnosis, the higher the aforementioned risks. Cancer survivors had a lower risk of hospitalization and hospitalization with severe disease than those without cancer.

Early Osteogenic-Induced Adipose-Derived Stem Cells and Canine Bone Regeneration Potential Analyzed Using Biodegradable Scaffolds

The complex process of bone regeneration is influenced by factors such as inflammatory responses, tissue interactions, and progenitor cells. Currently, multiple traumas can interfere with fracture healing, causing the prolonging or failure of healing. In these cases, bone grafting is the most effective treatment. However, there are several drawbacks, such as morbidity at the donor site and availability of suitable materials. Advantages have been provided in this field by a variety of stem cell types. Adipose-derived stem cells (ASCs) show promise. In the radiological examination of this study, it was confirmed that the C/S group showed faster regeneration than the other groups, and Micro-CT also showed that the degree of bone formation in the defect area was highest in the C/S group. Compared to the control group, the change in cortical bone area in the defect area decreased in the sham group (0.874), while it slightly increased in the C/S group (1.027). An increase in relative vascularity indicates a decrease in overall bone density, but a weak depression filled with fibrous tissue was observed outside the compact bone. It was confirmed that newly formed cortical bone showed a slight difference in bone density compared to surrounding normal bone tissue due to increased distribution of cortical bone. In this study, we investigated the effect of bone regeneration by ADMSCs measured by radiation and pathological effects. These data can ultimately be applied to humans with important clinical applications in various bone diseases, regenerative, and early stages of formative differentiation.

The role of a photographic atlas in reducing unanticipated healthcare utilization following circumcision

INTRODUCTION

Circumcision is a common procedure that can evoke caregiver anxiety in the postoperative period due to unfamiliarity with the healing process. To mitigate unnecessary healthcare utilization such as phone calls and unanticipated clinic or emergency department (ED) visits, photographic atlases have been developed to better prepare caregivers for the recovery process. The objective of our study is to further investigate the efficacy of a photographic atlas in its ability to decrease postoperative healthcare utilization using an increased sample size and extended study period compared to previous studies.

MATERIALS AND METHODS

In this study, we compared a prospective intervention cohort of patients undergoing circumcision at our institution who received a photographic atlas during postoperative teaching to a retrospective cohort of patients who had not received it. Our primary outcome was unanticipated healthcare utilization, defined as postoperative telephone calls and unanticipated presentations to the urology clinic or ED.

RESULTS

The retrospective no-atlas cohort included 105 patients, and the prospective intervention atlas cohort included 80 patients. Both groups were similar with respect to age (p = 0.47) and other demographics. There was no statistically significant difference in healthcare utilization between the no-atlas and atlas cohort. Specifically, we identified no difference in the number of phone calls to clinic staff (12 [11.4%] vs. 11 [13.8%], p = 0.64) or unanticipated postoperative clinic or ED visits (2 [1.9%] vs. 4 [5.0%], p = 0.41).

DISCUSSION

The use of a photographic atlas as part of caregiver support for circumcision patients did not demonstrate a statistically significant reduction in either postoperative phone calls or clinic/ED visits. The decrease in absolute number of caregiver phone calls was minimal (12-11), with a small increase in follow-up presentations (2-4). The lack of significant change may be due to the already infrequent occurrence of these events following circumcision, as demonstrated by the no-atlas cohort. Other potential advantages of the atlas, such as improved caregiver confidence and satisfaction, may have been present, but were not measured in this study.

CONCLUSIONS

Adding to the mixed results of previous studies, these findings do not support that photographic atlases decrease unanticipated healthcare utilization in children undergoing a circumcision. However, utilization was found to be low. Additionally, further studies are needed to determine other significant benefits of this form of education, such as improved caregiver confidence and satisfaction.

α-Synuclein colocalizes with AP180 and affects the size of clathrin lattices

α-Synuclein and family members β- and γ-synuclein are presynaptic proteins that sense and generate membrane curvature, properties important for synaptic vesicle (SV) cycling. αβγ-synuclein triple knockout neurons exhibit SV endocytosis deficits. Here, we investigated if α-synuclein affects clathrin assembly in vitro. Visualizing clathrin assembly on membranes using a lipid monolayer system revealed that α-synuclein increases clathrin lattices size and curvature. On cell membranes, we observe that α-synuclein is colocalized with clathrin and its adapter AP180 in a concentric ring pattern. Clathrin puncta that contain both α-synuclein and AP180 were significantly larger than clathrin puncta containing either protein alone. We determined that this effect occurs in part through colocalization of α-synuclein with the phospholipid PI(4,5)P2 in the membrane. Immuno-electron microscopy (EM) of synaptosomes uncovered that α-synuclein relocalizes from SVs to the presynaptic membrane upon stimulation, positioning α-synuclein to function on presynaptic membranes during or after stimulation. Additionally, we show that deletion of synucleins impacts brain-derived clathrin-coated vesicle size. Thus, α-synuclein affects the size and curvature of clathrin structures on membranes and functions as an endocytic accessory protein.

Artificial Intelligence Literacy: Developing a Multi-institutional Infrastructure for AI Education

RATIONALE AND OBJECTIVES

To evaluate the effectiveness of an artificial intelligence (AI) in radiology literacy course on participants from nine radiology residency programs in the Southeast and Mid-Atlantic United States.

MATERIALS AND METHODS

A week-long AI in radiology course was developed and included participants from nine radiology residency programs in the Southeast and Mid-Atlantic United States. Ten 30 minutes lectures utilizing a remote learning format covered basic AI terms and methods, clinical applications of AI in radiology by four different subspecialties, and special topics lectures on the economics of AI, ethics of AI, algorithm bias, and medicolegal implications of AI in medicine. A proctored hands-on clinical AI session allowed participants to directly use an FDA cleared AI-assisted viewer and reporting system for advanced cancer. Pre- and post-course electronic surveys were distributed to assess participants' knowledge of AI terminology and applications and interest in AI education.

RESULTS

There were an average of 75 participants each day of the course (range: 50-120). Nearly all participants reported a lack of sufficient exposure to AI in their radiology training (96.7%, 90/93). Mean participant score on the pre-course AI knowledge evaluation was 8.3/15, with a statistically significant increase to 10.1/15 on the post-course evaluation (p= 0.04). A majority of participants reported an interest in continued AI in radiology education in the future (78.6%, 22/28).

CONCLUSION

A multi-institutional AI in radiology literacy course successfully improved AI education of participants, with the majority of participants reporting a continued interest in AI in radiology education in the future.

Association between obesity and osteoarthritis in the South Korean older population: A nationwide population-based study

There are few studies on the association between obesity and radiologically-confirmed osteoarthritis (OA) in the South Korean older population. We investigated the association between obesity and radiologically-confirmed OA in a nationally-representative sample of the South Korean older population. The study population comprised 5811 participants (2530 men and 3281 women) aged ≥60 years selected from the 2010 to 2012 Korea National Health and Nutrition Examination Survey. Radiographic OA was defined as Kellgren-Lawrence grade ≥ 2 on either the knee or hip area in radiographic images. The odds ratios and 95% confidence intervals for OA were determined using multiple logistic regression analyses after adjusting for confounding factors. Overall, 7.9% and 29.6% of older men and women had OA, respectively. A U-shaped curve with the nadir in the appropriate body weight (body mass index 18.5-23 kg/m2) revealed that 9.0%, 6.8%, 8.1%, and 9.1% of older men and 24.5%, 21.6%, 27.1%, and 38.4% of older women who were underweight, normal weight, overweight, and obese, respectively, had OA. Compared with normal-weight people, the odds ratios (95% confidence intervals) for OA in obese subjects were 1.73 (1.13-2.64) and 2.76 (2.13-3.56) for older men and women, respectively, after adjusting for age, comorbidities, lifestyle behaviors, and socioeconomic status. Obesity was significantly associated with an increased risk of OA in the South Korean older population. This finding suggests that efforts to maintain appropriate body weight and reduce excessive body weight should be considered to reduce the risk of OA in older adults.

Fasudil alleviates the vascular endothelial dysfunction and several phenotypes of Fabry disease

Fabry disease (FD), a lysosomal storage disorder, is caused by defective α-galactosidase (GLA) activity, which results in the accumulation of globotriaosylceramide (Gb3) in endothelial cells and leads to life-threatening complications such as left ventricular hypertrophy (LVH), renal failure, and stroke. Enzyme replacement therapy (ERT) results in Gb3 clearance; however, because of a short half-life in the body and the high immunogenicity of FD patients, ERT has a limited therapeutic effect, particularly in patients with late-onset disease or progressive complications. Because vascular endothelial cells (VECs) derived from FD-induced pluripotent stem cells display increased thrombospondin-1 (TSP1) expression and enhanced SMAD2 signaling, we screened for chemical compounds that could downregulate TSP1 and SMAD2 signaling. Fasudil reduced the levels of p-SMAD2 and TSP1 in FD-VECs and increased the expression of angiogenic factors. Furthermore, fasudil downregulated the endothelial-to-mesenchymal transition (EndMT) and mitochondrial function of FD-VECs. Oral administration of fasudil to FD mice alleviated several FD phenotypes, including LVH, renal fibrosis, anhidrosis, and heat insensitivity. Our findings demonstrate that fasudil is a novel candidate for FD therapy.

RIPK1 Regulates Microglial Activation in Lipopolysaccharide-Induced Neuroinflammation and MPTP-Induced Parkinson's Disease Mouse Models

Increasing evidence suggests a pivotal role of receptor-interacting protein kinase 1 (RIPK1), an initiator of necroptosis, in neuroinflammation. However, the precise role of RIPK1 in microglial activation remains unclear. In the present study, we explored the role of RIPK1 in lipopolysaccharide (LPS)-induced neuroinflammation and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD model mice by using RIPK1-specific inhibitors necrostatin-1 (Nec-1) and necrostatin-1 stable (Nec-1s). Nec-1/Nec-1s or RIPK1 siRNA inhibited the production of proinflammatory molecules and the phosphorylation of RIPK1-RIPK3-MLKL and cell death in LPS-induced inflammatory or LPS/QVD/BV6-induced necroptotic conditions of BV2 microglial cells. Detailed mechanistic studies showed that Nec-1/Nec-1s exerted anti-inflammatory effects by modulating AMPK, PI3K/Akt, MAPKs, and NF-κB signaling pathways in LPS-stimulated BV2 cells. Subsequent in vivo studies showed that Nec-1/Nec-1s inhibited microglial activation and proinflammatory gene expression by inhibiting the RIPK1 phosphorylation in the brains of LPS-injected mice. Furthermore, Nec-1/Nec-1s exert neuroprotective and anti-inflammatory effects in MPTP-induced PD mice. We found that p-RIPK1 is mainly expressed in microglia, and thus RIPK1 may contribute to neuroinflammation and subsequent cell death of dopaminergic neurons in MPTP-induced PD model mice. These data suggest that RIPK1 is a key regulator of microglial activation in LPS-induced neuroinflammation and MPTP-induced PD mice.

Lifestage Sex-Specific Genetic Effects on Metabolic Disorders in an Adult Population in Korea: The Korean Genome and Epidemiology Study

Although many genome-wide association studies (GWASs) have evaluated the association with metabolic disorders, the current study is the first attempt to analyze the genetic risk factors for various metabolic disorders according to sex and age groups of the life course in Korean adults. A total population of 50,808 people were included in this GWAS. The genetic traits for eight metabolic phenotypes were investigated in peri-, and postmenopausal women compared to a younger group or men of corresponding age groups. The metabolic phenotypes include general obesity, abdominal obesity, hypertension, type 2 diabetes, hypercholesterolemia, hypertriglyceridemia, hypo-high-density lipoprotein cholesterolemia, and metabolic syndrome. In the total participants, GWAS results for eight metabolic phenotypes found 101 significant loci. Of these, 15 loci were the first reported to be associated with the risk of metabolic disorder. Interestingly, some of the significant loci presented the association with the various phenotypes, which presented when there was a correlation between phenotypes. In addition, we analyzed divided by gender and age (young adult, peri-menopausal group, older adult), and specifically identified specific loci in peri-menopausal women. Meanwhile, several genetic factors associated with metabolic disorders were newly reported in our study. In particular, several genes were significantly associated with one of the metabolic phenotypes in only a single specific group. These findings suggest that menopausal transition rather than aging itself potentiates the influence of genetic risks on metabolic disorders. In addition, some genetic loci with low frequencies may play a role in the metabolic disturbances in a specific sex and age group. The genetic traits derived from our study may contribute to understanding the genetic risk factors for metabolic disorders in the Korean population.

Serum leptin level and incidence of CKD: a longitudinal study of adult enrolled in the Korean genome and epidemiology study(KoGES)

Background

Chronic kidney disease(CKD) is a major public health issue and is highly prevalent in the general population. Leptin is an adipose tissue-derived endocrine factor that has been associated with several metabolic factors involved in cardiovascular diseases. Several studies have investigated the association between leptin and renal diseases so far. But the results are conflicting between the studies. The objective of our study was to verify the direct association of serum leptin level with CKD development.

Methods

This prospective cohort study included 2646 adult aged 40–70 without CKD in the Korean Genome and Epidemiology Study(KoGES) across South Korea from November 2005 to February 2012. The primary outcome was the development of CKD as defined by National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI). Multivariate stepwise logistic regression analysis was done to assess the independent associations, for with the incident of CKD as the dependent variable, in tertiles of leptin values.

Results

Among 1100 men and 1546 women with 2.8 mean years of follow-up, incidence of CKD was 18(1.63%) for men and 50(3.23%) for women. In the multivariate logistic regression models, individuals in the highest serum leptin tertile showed significant associations with risk of CKD after adjustment compared to the lowest tertiles in the population. The crude odds ratio for trend was 2.95(p = 0.004) for men. After adjusting for age, baseline eGFR variables showed correlation with statistical significance (OR for trend = 2.25, p = 0.037) for men. The same trends were also seen observed in all population and women also, but no statistical significance was found.

Conclusions

Higher plasma leptin levels are associated with the incidence of CKD, independent of traditional factors such as age, baseline eGFR. Our results suggest that leptin may partly explain part of the reported association between obesity and kidney disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02795-7.

Association between Relative Handgrip Strength and Insulin Resistance in Korean Elderly Men without Diabetes: Findings of the 2015 Korea National Health Nutrition Examination Survey

BACKGROUND

Evidence regarding the association between handgrip strength (HGS) and insulin resistance in a non-diabetic population is scarce. This study aimed to investigate the association between relative HGS and insulin resistance in older men without diabetes, using a representative sample of the Korean male population.

METHODS

The study population comprised 206 participants aged 65-80 years, selected from the 2015 Korea National Health and Nutrition Examination Survey. Insulin resistance was defined as the upper tertile of the homeostatic model assessment of insulin resistance (HOMA-IR). Odds ratios and 95% confidence intervals for insulin resistance were assessed using multiple logistic regression analyses after adjusting for confounding variables.

RESULTS

The prevalence of insulin resistance decreased with increasing relative HGS. The prevalence in the T1, T2, and T3 groups was 46.0%, 32.2%, and 26.4%, respectively. Compared with the individuals in the highest tertile of relative HGS, the odds ratio (95% confidence interval) for insulin resistance in individuals in the lowest quartile was 2.82 (1.10-7.21) after adjusting for age, smoking, alcohol consumption, aerobic exercise, resistance exercise, systolic blood pressure, total cholesterol, residential area, household income, and education level.

CONCLUSION

Lower relative HGS was inversely associated with an increased risk of insulin resistance in older Korean men without diabetes. In clinical practice, relative HGS, which is a simple and inexpensive tool, could be a useful measure for identifying older men with insulin resistance. Moreover, these findings suggest that muscle strengthening exercises should be considered to reduce insulin resistance and increase insulin sensitivity.

Inverse Association of Serum Folate Level with Metabolic Syndrome and Its Components in Korean Premenopausal Women: Findings of the 2016–2018 Korean National Health Nutrition Examination Survey

Research on the association of serum folate levels with metabolic syndrome (MetS) in premenopausal women is lacking. This study was aimed to investigate this association in 1730 premenopausal women using the 2016 to 2018 Korean National Health and Nutrition Examination Survey data. Participants’ mean age and BMI were 35.9 years and 22.7 kg/m2, respectively. Participants were divided into three groups according to serum folate tertiles. Odds ratios (OR) and 95% confidence intervals (CIs) for abdominal obesity, elevated blood pressure (BP), high fasting plasma glucose (FPG), high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), and MetS were calculated in multiple logistic regression models adjusted for possible confounders, by serum folate level tertiles. Prevalence of MetS (14.9, 11.0, and 8.6%); abdominal obesity (17.8, 16.0, and 11.4%); high TG (17.5, 14.0, and 11.1%); and low HDL-C (50.3, 44.6, and 42.5%) decreased with increasing folate level tertile. Prevalence of elevated BP (14.3, 12.0, and 11.7%) and high FPG (11.9, 15.8, and 13.0%) showed no significant differences according to serum folate level tertiles. The multivariate-adjusted ORs (95% CIs) for MetS, abdominal obesity, elevated BP, high TG, and low HDL-C in the highest folate level tertile were 2.17 (1.46–3.22), 1.80 (1.25–2.60), 1.77 (1.16–2.70), 1.90 (1.35–2.67), and 1.49 (1.14–1.94), respectively. The ORs for high FPG did not show significant differences according to serum folate level tertiles. In conclusion, serum folate levels were inversely associated with an increased risk of MetS in Korean premenopausal women. These results suggest that MetS can be prevented and managed by improving the serum folate levels in premenopausal women.

Genome-wide association of individual vulnerability with alcohol-associated liver disease: A Korean genome and epidemiology study

BACKGROUND AND AIMS

The quantity of alcohol leading to alcohol-associated liver disease (ALD) varies individually. Genetic backgrounds contributing to the divergence in individual susceptibility to alcohol-induced liver damage have not been elucidated in detail.

APPROACH AND RESULTS

Based on the Korean Genome and Epidemiology Study Health Examination (KoGES_HEXA) cohort data, 21,919 participants (40-79 years old) were included and divided into cases and controls based on the ALD diagnostic criteria proposed by the American College of Gastroenterology. Data generated by a genome wide-association study were analyzed using logistic regression to assess the risk of ALD development in nondrinkers, light drinkers, and heavy drinkers. We detected three loci, gamma-glutamyltransferase 1 (GGT1), zinc protein finger 827 (ZNF827) and HNF1 homeobox A (HNF1A), which were significantly associated with ALD risk. The GGT1 rs2006227 minor allele was strongly associated with all groups. Among the minor alleles of single nucleotide polymorphisms (SNPs) in HNF1A, rs1183910 had the strongest association with a protective effect from ALD in light drinkers. However, this association was not observed in heavy drinkers. Five SNPs on chromosome 11 showed suggestive significance in protective effects against ALD.

CONCLUSIONS

SNPs, including HNF1A rs1183910 minor allele, are the most promising genetic candidates for protection against ALD. The expression of genes contributing to ALD development may be altered by the amount of alcohol consumed.

The role of Sirtuin 2 in sustaining functional integrity of the liver

AIM

Sirtuin 2 (SIRT2) is a NAD+-dependent deacetylase involved in various biological functions via deacetylation of proteins, including histone protein. Hepatic fat accumulation from aging and excess caloric intake contribute to development of non-alcoholic fatty liver disease. The study aim was to elucidate the role of SIRT2 in lipid metabolism homeostasis.

MATERIALS AND METHODS

SIRT2^+/+ (C57BL/6) and SIRT2^-/- were randomly assigned to normal diet or high-fat diet (HFD) groups and fed for 6 weeks. Histological features of the livers were evaluated by hematoxylin and eosin and Masson's trichrome staining, and the levels of selected factors were determined by quantitative reverse transcription-polymerase chain reaction and western blot analysis.

KEY FINDINGS

Although the SIRT2^-/- mice were viable, their livers exhibited higher glycogen accumulation, and skeletal muscle showed features of increased metabolic demand. The SIRT2^-/- mice attenuated HFD-induced weight gain, visceral adipose tissue formation, and fat accumulation in the liver in which the expressions of genes involved in metabolic substrate transport were modified. Additionally, the hepatocellular senescence and upregulated cell-cycle factors upon HFD intake in SIRT2^-/- livers suggested a role of SIRT2 in gene expression during abnormal metabolism. Moreover, the fibrotic phenotype of liver tissue without fat accumulation and the increased expression of genes involved in liver fibrosis in the HFD-fed SIRT2^-/- mice indicated that SIRT2 had a role in hepatocyte and hepatic stellate cell activation.

SIGNIFICANCE

Our results indicated that SIRT2 has a critical role in regulating lipid metabolic homeostasis and in sustaining liver integrity by modulating related gene expression.

Characterization of Proteins Regulated by Androgen and Protein Kinase a Signaling in VCaP Prostate Cancer Cells

Androgen signaling via the androgen receptor (AR) is involved in normal prostate development and prostate cancer progression. In addition to androgen binding, a variety of protein kinases, including cyclic AMP-dependent protein kinase A (PKA), can activate the AR. Although hormone deprivation, especially that of androgen, continues to be an important strategy for treating prostate cancer patients, the disease ultimately progresses to castration-resistant prostate cancer (CRPC), despite a continuous hormone-deprived environment. To date, it remains unclear which pathways in this progression are active and targetable. Here, we performed a proteomic analysis of VCaP cells stimulated with androgen or forskolin to identify proteins specific for androgen-induced and androgen-bypassing signaling, respectively. Patterns of differentially expressed proteins were quantified, and eight proteins showing significant changes in expression were identified. Functional information, including a Gene Ontology analysis, revealed that most of these proteins are involved in metabolic processes and are associated with cancer. The mRNA and protein expression of selected proteins was validated, and functional correlations of identified proteins with signaling in VCaP cells were assessed by measuring metabolites related to each enzyme. These analyses offered new clues regarding effector molecules involved in prostate cancer development, insights that are supported by the demonstration of increased expression levels of the eight identified proteins in prostate cancer patients and assessments of the progression-free interval. Taken together, our findings show that aberrant levels of eight proteins reflect molecular changes that are significantly regulated by androgen and/or PKA signaling pathways, suggesting possible molecular mechanisms of CRPC.

Integrative Multi-Omics Approaches in Cancer Research: From Biological Networks to Clinical Subtypes

Multi-omics approaches are novel frameworks that integrate multiple omics datasets generated from the same patients to better understand the molecular and clinical features of cancers. A wide range of emerging omics and multi-view clustering algorithms now provide unprecedented opportunities to further classify cancers into subtypes, improve the survival prediction and therapeutic outcome of these subtypes, and understand key pathophysiological processes through different molecular layers. In this review, we overview the concept and rationale of multi-omics approaches in cancer research. We also introduce recent advances in the development of multi-omics algorithms and integration methods for multiple-layered datasets from cancer patients. Finally, we summarize the latest findings from large-scale multi-omics studies of various cancers and their implications for patient subtyping and drug development.

Clinical Outcomes and Safety of Meropenem-Colistin versus Meropenem-Tigecycline in Patients with Carbapenem-Resistant Acinetobacter baumannii Pneumonia

This study compared the clinical outcomes and safety of meropenem–colistin versus meropenem–tigecycline in the treatment of adult patients with carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia. A retrospective observational study of patients with CRAB pneumonia was performed at a 1048-bed university-affiliated hospital in the Republic of Korea between June 2013 and January 2020. All adult patients initially treated with meropenem–colistin were compared with those treated with meropenem–tigecycline to evaluate in-hospital mortality and adverse events. Altogether, 66 patients prescribed meropenem–colistin and 24 patients prescribed meropenem–tigecycline were included. All patients had nosocomial pneumonia, and 31.1% had ventilator-associated pneumonia. The minimum inhibitory concentrations of meropenem ≤ 8 μg/mL and tigecycline ≤ 2 μg/mL were 20.0% and 81.1%, respectively. The in-hospital and 28-day mortality rates were 40% and 32%, respectively. In the Cox proportional hazard regression analysis, predictors associated with in-hospital mortality included procalcitonin ≥ 1 ng/mL (adjusted hazard ratio (aHR), 3.39; 95% confidence interval (CI) 1.40–8.19; p = 0.007) and meropenem–colistin combination therapy (aHR, 2.58; 95% CI, 1.07–6.23; p = 0.036). Episodes of nephrotoxicity were significantly more common in the meropenem–colistin group than in the meropenem–tigecycline group (51.5% vs. 12.5%, p = 0.001). Meropenem–tigecycline combination therapy might be a valuable treatment option for patients with CRAB pneumonia.

Effects of Semi-Immersive Virtual Reality-Based Cognitive Training Combined with Locomotor Activity on Cognitive Function and Gait Ability in Community-Dwelling Older Adults

This study aimed to investigate the effects of semi-immersive virtual reality-based cognitive training (VRCT) combined with locomotor activity on cognitive function, balance, and gait ability in older adults. Eighteen community-dwelling older adults participated in this study. Subjects who met the selection criteria were assigned to an experimental group (n = 9) and a control group (n = 9). The experimental group received VRCT combined with locomotor activity for 30 min a day, three times a week, for 6 weeks. The control group received tabletop activity-based cognitive training for the same amount of time. Before and after the training, the Korean Mini-Mental State Examination (K-MMSE), Trail Making Test (TMT; A and B), and Digit Span Test (DST; forward and backward) were used to evaluate cognitive function; and the Timed Up and Go (TUG) test and 10-m Walking Test (10MWT) were used to evaluate the improvement in the balance and gait ability parameters. After the intervention, the experimental group showed a significantly greater improvement in the TMT-A (p = 0.045) and DST-backward (p = 0.012) scores compared with the control group. Regarding the gait ability variable, the experimental group showed a significant improvement in the 10MWT test (p = 0.001). This study confirmed that semi-immersive VRCT combined with locomotor activity is useful for improving cognitive function and gait ability in older adults. Therefore, VRCT combined with locomotor activity can be used as a simultaneous intervention for cognitive rehabilitation and functional capacity improvement in older adults.

Osteological Development of the Larvae and Juvenile of Favonigobius gymnauchen (Pisces:Gobiidae)

This study was carried out to observe the development of the autonomous skeletal development of the Favonigobius gymnauchen. Total length (TL) of larvae 3 days after hatching (DAH) were mean TL of 3.34 mm, with a line-shaped parasphenoid ossification in the cranium and basioccipital ossification in the back. The 10 DAH larvae had a mean TL of 5.20 mm, with the number of caudal vertebrae increasing to 15. The urostyle and two hypural bones in the lower part also began to ossify. The 23 DAH juveniles had a mean TL of 8.47 mm. The pectoral girdle’s skeleton was completed as the scapula and coracoid were ossified. The pelvic girdle also fully supported the ventral fin as its ossification was completed. Favonigobius gymnauchen and Tridentiger obscurus showed similar characteristics in terms of the anus location of hatched larvae, number of myotomes, and melanophore distribution during the morphological development of the larvae and juveniles. However, this study confirmed differences in the development of the vertebrae and urostyle bone.

Effects of losartan and l-serine in a mouse liver fibrosis model

Hepatic fibrosis is a common liver disease caused by excessive collagen deposition in the liver. Since liver transplantation is the only current treatment for cirrhosis with worsened fibrosis, a new strategy to develop anti-fibrosis drugs with no adverse effects is necessary. In recent studies, amino acids have been applied as a type of therapy in various fields. l-serine plays a major role in antioxidant production via the maintenance of nicotinamide adenine dinucleotide phosphate hydride production in the mitochondria. l-serine may reduce fibrotic lesions in a mouse model of chronic liver injury. This study used 27 six-week-old C57BL/6 mice and injected them three times a week for eight weeks with carbon tetrachloride (CCl₄) (1.5 mg/kg, 10% v/v CCl₄ in olive oil) to create a hepatic fibrosis mouse model. The mice, which weighed approximately 20-30 g, were randomly classified into four groups: 1) the olive oil group, which received intraperitoneal injection of olive oil (1.5 mg/kg, 3 times per week for 8 weeks); 2) the CCl4-only group; 3) the CCl4 + losartan (10 mg/kg, PO, 5 days on, weekend off for 8 weeks) group; and 4) the CCl4 + l-serine (100 g/L, free access for 8 weeks) group. Hematoxylin and eosin staining and Masson's trichrome staining showed reduced inflammatory cell deposition and collagen deposition in the liver tissue in the l-serine supplemented group. l-serine was found to reduce the spread of hepatic fibrosis and has potential use in clinical settings. Based on these histopathological observations, l-serine is a potential anti-fibrosis drug.

White Blood Cell Count as a Predictor of Incident Type 2 Diabetes Mellitus Among Non-Obese Adults: A Longitudinal 10-Year Analysis of the Korean Genome and Epidemiology Study

Purpose

Limited evidence is available on whether the white blood cell (WBC) count is a predictor of type 2 diabetes mellitus (T2DM) in non-obese individuals. This study aimed to determine whether WBC count could be used as an indicator for the prediction of incident T2DM among non-obese individuals using a large, community-based Korean cohort that was observed over 10 years.

Patients and methods

A total of 4211 non-obese adults without diabetes aged 40-69 years were selected from the Korean Genome and Epidemiology Study. The participants were divided into four groups according to WBC count quartiles. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident T2DM, based on the American Diabetes Association criteria, using multivariate Cox proportional hazards regression models over 10 years after the baseline survey.

Results

During the follow-up period, 592 (14.1%) participants had newly developed T2DM. The higher quartile of WBC count groups showed significantly higher cumulative T2DM incidence over 10 years after the baseline survey (log-rank test, P < 0.001). Compared with the HRs for individuals in the referent lowest quartile, the HR (95% CI) for incident T2DM in individuals in the highest quartile was 1.55 (1.10-2.18) after adjusting for confounding variables.

Conclusion

A higher WBC count predicts future incident T2DM among community-dwelling non-obese Korean adults. This study suggests that WBC count could facilitate the prediction of non-obese individuals susceptible to T2DM.

Effects of Light Regulation on Proteome Expression in Rhodobacter sphaeroides 2.4.1

Light plays an important role in the transcriptional regulation of photosynthetic apparatus. The influence of oxygen and light conditions on the protein expression of Rhodobacter sphaeroides was investigated using a proteomic approach. The R. sphaeroides was grown aerobically under dark cultivation (D24) and light cultivation (L24) for 24 h. An average of 950 distinguishable spots were obtained on 2-D analytic gel for D24 and L24 conditions, of which 48 proteins exhibited significant changes in protein expression levels. Among the 48, 31 proteins were upregulated and 17 proteins were downregulated in L24 when compared with D24. The results depict the comparative protein expression in R. sphaeroides mediated through growth under light or dark conditions. The data suggest that the overexpressed proteins, phosphoribosyl-ATP pyrophosphatase (HisE), in the D24/aerobic culture are involved in the positive regulation of PAC production can be functionally applied in metabolic engineering and industrial processes.

Identification of susceptibility loci for cardiovascular disease in adults with hypertension, diabetes, and dyslipidemia

BACKGROUND

Hypertension (HTN), diabetes mellitus (DM), and dyslipidemia (DL) are well-known risk factors of cardiovascular disease (CVD), but not all patients develop CVDs. Studies have been limited investigating genetic risk of CVDs specific to individuals with metabolic diseases. This study aimed to identify disease-specific and/or common genetic loci associated with CVD susceptibility in chronic metabolic disease patients.

METHODS

We conducted a genome-wide association study (GWAS) of a multiple case-control design with data from the City Cohort within Health EXAminees subcohort of the Korean Genome and Epidemiology Study (KoGES_HEXA). KoGES_HEXA is a population-based prospective cohort of 173,357 urban Korean adults that had health examinations at medical centers. 42,393 participants (16,309 HTN; 5,314 DM; 20,770 DL) were analyzed, and each metabolic disease group was divided into three CVD case-controls: coronary artery disease (CAD), ischemic stroke (IS), and cardio-cerebrovascular disease (CCD). GWASs were conducted for each case-control group with 7,975,321 imputed single nucleotide polymorphisms using the Phase 3 Asian panel from 1000 Genomes Project, by logistic regression and controlled for confounding variables. Genome-wide significant levels were implemented to identify important susceptibility loci.

RESULTS

Totaling 42,393 individuals, this study included 16,309 HTN (mean age [SD], 57.28 [7.45]; 816 CAD, 398 IS, and 1,185 CCD cases), 5,314 DM (57.79 [7.39]; 361 CAD, 153 IS, and 497 CCD cases), and 20,770 DL patients (55.34 [7.63]; 768 CAD, 295 IS, and 1,039 CCD cases). Six genome-wide significant CVD risk loci were identified, with relatively large effect sizes: 1 locus in HTN (HTN-CAD: 17q25.3/CBX8-CBX4 [OR, 2.607; P = 6.37 × 10^-9]), 2 in DM (DM-IS: 4q32.3/MARCH1-LINC01207 [OR, 5.587; P = 1.34 × 10^-8], and DM-CCD: 17q25.3/RPTOR [OR, 3.511; P = 1.99 × 10^-8]), and 3 in DL (DL-CAD: 9q22.2/UNQ6494-LOC101927847 [OR, 2.282; P = 7.78 × 10^-9], DL-IS: 3p22.1/ULK4 [OR, 2.162; P = 2.97 × 10^-8], and DL-CCD: 2p22.2/CYP1B1-CYP1B1-AS1 [OR, 2.027; P = 4.24 × 10^-8]).

CONCLUSIONS

This study identified 6 susceptibility loci and positional candidate genes for CVDs in HTN, DM, and DL patients using an unprecedented study design. 1 locus (17q25.3) was commonly associated with CAD. These associations warrant validation in additional studies for potential therapeutic applications.

Relationship between internal accuracy and load-bearing capacity of minimally invasive lithium disilicate occlusal veneers

PURPOSE

To test whether internal accuracy affects the load-bearing capacity of 0.5-mm-thick occlusal veneers made out of milled or heat-pressed lithium disilicate (LS2).

MATERIALS AND METHODS

Extracted human molars (N = 80) were divided into four groups (n = 20 each) depending on the bonding substrate (enamel [E] or dentin [D]) and the fabrication method (milling [CAD] or heat pressing [PRE]) for the occlusal LS2 veneers: (1) E-CAD, (2) D-CAD, (3) E-PRE, or (4) D-PRE. After restoration fabrication, the abutment teeth and the corresponding restorations were scanned and superimposed in order to measure the marginal and internal accuracy. After adhesive cementation, the specimens were thermomechanically aged and thereafter loaded until fracture. The load-bearing capacities (F_max) were measured. F_max and the marginal and internal accuracy between the groups were compared using Kruskal-Wallis test (P < .05) and pairwise group comparisons. In addition, the relationship between F_max and the internal accuracy was analyzed using Spearman rank correlation.

RESULTS

Median F_max values (and first and third quartiles) per group were as follows: 1,495 N (Q1: 932; Q3: 2'318) for E-CAD; 1,575 N (Q1: 1,314; Q3: 1,668) for E-PRE; 1,856 N (Q1: 1,555; Q3: 2,013) for D-CAD; and 1,877 N (Q1: 1,566; Q3: 2,131) for D-PRE. No statistical difference was found between the groups (P = .0981). Overall, the internal accuracy in the areas of the cusp (P < .0007) and fossa (P < .0001) showed significant differences. While no significant differences were detected in the marginal area (P = .3518), a significant correlation with a negative linear relationship was found between the 3D internal accuracy and the F_max values (P = .0007).

CONCLUSION

An increase in the internal accuracy raised the load-bearing capacity of minimally invasive LS2 occlusal veneers. In general, the restorations bonded to dentin in the occlusal regions showed a better accuracy compared to those bonded to enamel.

Early Life History of Lefua costata (Cypriniformes : Balitoridae) from Korea

The purpose of this study is to observe the early life history of Korean Lefua costata and use the result as basic taxonomic research data for balitorid fish. The fertilized eggs were light green color with completely circle shape and mean size was 1.21±0.06 mm (n=30). Immediately after hatching, the size of the larvae was 2.81±0.11 mm (n=5) in mean length, with egg yolk. On the 3rd day after hatching, the preflexion larvae had a mean length of 4.64±0.09 mm (n=5), and their mouth was opened to start feeding. On the 8th day after hatching, a mean length of the postflexion larvae was 9.43±0.46 mm (n=5), the distal part of the notochord was bent to 45°, and 16 fin rays were developed on the caudal fin. On the 31st day after hatching, a mean length of juveniles was 22.3±0.85 mm (n=5), and the number of fin rays was the same as that of adult fish with (iv8) dorsal fins and (iii8) anal fins.

Understanding the genetic architecture of the metabolically unhealthy normal weight and metabolically healthy obese phenotypes in a Korean population

Understanding the mechanisms underlying the metabolically unhealthy normal weight (MUHNW) and metabolically healthy obese (MHO) phenotypes is important for developing strategies to prevent cardiometabolic diseases. Here, we conducted genome-wide association studies (GWASs) to identify the MUHNW and MHO genetic indices. The study dataset comprised genome-wide single-nucleotide polymorphism genotypes and epidemiological data from 49,915 subjects categorised into four phenotypes-metabolically healthy normal weight (MHNW), MUHNW, MHO, and metabolically unhealthy obese (MUHO). We conducted two GWASs using logistic regression analyses and adjustments for confounding variables (model 1: MHNW versus MUHNW and model 2: MHO versus MUHO). GCKR, ABCB11, CDKAL1, LPL, CDKN2B, NT5C2, APOA5, CETP, and APOC1 were associated with metabolically unhealthy phenotypes among normal weight individuals (model 1). LPL, APOA5, and CETP were associated with metabolically unhealthy phenotypes among obese individuals (model 2). The genes common to both models are related to lipid metabolism (LPL, APOA5, and CETP), and those associated with model 1 are related to insulin or glucose metabolism (GCKR, CDKAL1, and CDKN2B). This study reveals the genetic architecture of the MUHNW and MHO phenotypes in a Korean population-based cohort. These findings could help identify individuals at a high metabolic risk in normal weight and obese populations and provide potential novel targets for the management of metabolically unhealthy phenotypes.

Nogo-A regulates myogenesis via interacting with Filamin-C

Among the three isoforms encoded by Rtn4, Nogo-A has been intensely investigated as a central nervous system inhibitor. Although Nogo-A expression is increased in muscles of patients with amyotrophic lateral sclerosis, its role in muscle homeostasis and regeneration is not well elucidated. In this study, we discovered a significant increase in Nogo-A expression in various muscle-related pathological conditions. Nogo^−/− mice displayed dystrophic muscle structure, dysregulated muscle regeneration following injury, and altered gene expression involving lipid storage and muscle cell differentiation. We hypothesized that increased Nogo-A levels might regulate muscle regeneration. Differentiating myoblasts exhibited Nogo-A upregulation and silencing Nogo-A abrogated myoblast differentiation. Nogo-A interacted with filamin-C, suggesting a role for Nogo-A in cytoskeletal arrangement during myogenesis. In conclusion, Nogo-A maintains muscle homeostasis and integrity, and pathologically altered Nogo-A expression mediates muscle regeneration, suggesting Nogo-A as a novel target for the treatment of myopathies in clinical settings.

Relationship between sedentary time and central obesity in adult Korean men: Korean National Health and Nutrition Examination Survey, 2014

Background

. We aimed to examine the association between sedentary time and central obesity in a nationally representative sample of adult Korean men.

Methods

. We included 1269 participants from the Korean National Health and Nutrition Examination Survey. Central obesity was defined as having a waist circumference (WC) ≥90 cm. The ORs and 95% CIs for central obesity were calculated using multiple logistic regression analysis.

Results

. The mean values of WC tended to increase proportionally with increasing sedentary time quartiles. The prevalence of central obesity increased significantly in accordance with sedentary time quartiles. Compared to individuals in the lowest sedentary time quartile (≤4 hours for a day), the OR for central obesity for individuals in the highest quartile (≥11 hours for a day) was 1.81 after adjusting for confounding variables.

Conclusion

. We confirmed a relationship between sedentary time and the risk prevalence of central obesity in a representative sample of adult Korean men. A public health intervention to reduce sedentary time is needed to prevent central obesity.

Serum oestradiol levels are inversely associated with C-reactive protein levels in premenopausal women, but not postmenopausal women

OBJECTIVE

Epidemiological studies on the association of serum oestradiol levels and inflammatory markers have reported inconsistent and conflicting results. Therefore, we investigated the association between serum oestradiol and high-sensitivity C-reactive protein (CRP) levels in women on the basis of their menopausal status.

METHODS

This cross-sectional study examined the association between serum oestradiol and CRP levels on the basis of menopausal status in 151 premenopausal women aged 42.7 ± 6.7 years and 394 postmenopausal women aged 58.1 ± 6.7 years who participated in a health examination program. Multiple linear regression analysis was conducted using CRP levels as the dependent variable.

RESULTS

Multiple linear regression analysis showed that serum oestradiol levels were inversely associated with CRP levels in premenopausal women (β coefficient = -0.298) after adjusting for age, body mass index, smoking, mean arterial pressure, and levels of fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, aspartate aminotransferase, and alanine aminotransferase. However, this association was not found in postmenopausal women after adjusting for the same confounding factors.

CONCLUSIONS

Serum oestradiol levels are inversely associated with CRP levels in premenopausal women, but not in postmenopausal women. Lower oestrogenic activity may at least partly contribute to the pathogenesis of chronic inflammation, particularly in premenopausal women.

Longitudinal Observation of Muscle Mass over 10 Years According to Serum Calcium Levels and Calcium Intake among Korean Adults Aged 50 and Older: The Korean Genome and Epidemiology Study

The aim of this study was to investigate the longitudinal change in muscle mass over 10 years according to serum calcium levels and calcium intake. A total of 1497 men and 1845 women aged 50 years and older were included. Significant muscle loss (SML) was defined as a 5% or greater loss from baseline, while time-dependent development of SML was assessed according to quartiles for corrected calcium level and daily calcium intake using Cox regression models. The incidence of SML was 6.7 and 7.7 per 100-person-years among men and women, respectively. Groups with the lowest corrected calcium levels had more prominent SML than those with higher calcium levels, regardless of sex. The relationship between SML and calcium intake was significant only among women. The hazard ratio for SML per 1 mmol/L increase in corrected calcium level was 0.236 and 0.237 for men and women, respectively. In conclusion, low serum calcium levels may predict SML among adults aged ≥ 50 years, while low calcium intake may be a predictor for muscle loss among women. Therefore, encouraging dietary calcium intake among middle-aged and older adults for preservation of muscle mass should be considered.

Clinical Practice Guideline for Care in the Last Days of Life

A clinical practice guideline for patients in the dying process in general wards and their families, developed through an evidence-based process, is presented herein. The purpose of this guideline is to enable a peaceful death based on an understanding of suitable management of patients' physical and mental symptoms, psychological support, appropriate decision-making, family care, and clearly-defined team roles. Although there are limits to the available evidence regarding medical issues in patients facing death, the final recommendations were determined from expert advice and feedback, considering values and preferences related to medical treatment, benefits and harms, and applicability in the real world. This guideline should be applied in a way that takes into account specific health care environments, including the resources of medical staff and differences in the available resources of each institution. This guideline can be used by all medical institutions in South Korea.

Identification of Genetic Factors Underlying the Association between Sodium Intake Habits and Hypertension Risk

The role of sodium in hypertension remains unresolved. Although genetic factors have a significant impact on high blood pressure, studies comparing genetic susceptibility between people with low and high sodium diets are lacking. We aimed to investigate the genetic variations related to hypertension according to sodium intake habits in a large Korean population-based study. Data for a total of 57,363 participants in the Korean Genome and Epidemiology Study Health Examination were analyzed. Sodium intake was measured by a semi-quantitative food frequency questionnaire. We classified participants according to sodium intake being less than or greater than 2 g/day. We used logistic regression to test single-marker variants for genetic association with a diagnosis of hypertension, adjusting for age, sex, body mass index, exercise, alcohol, smoking, potassium intake, principal components 1, and principal components 2. Significant associations were defined as p < 5 × 10⁻⁸. In participants whose sodium intake was greater than 2 g/day, chromosome 6 open reading frame 10 (C6orf10)-human leukocyte antigen (HLA)-DQB1 rs6913309, ring finger protein (RNF)213 rs112735431, glycosylphosphatidylinositol anchored molecule-like (GML)- cytochrome P450 family 11 subfamily B member 1(CYP11B1) rs3819496, myosin light chain 2 (MYL2)-cut like homeobox 2 (CUX2) rs12229654, and jagged1 (JAG1) rs1887320 were significantly associated with hypertension. In participants whose intake was less than 2 g/day, echinoderm microtubule-associated protein-like 6(EML6) rs67617923 was significantly associated with hypertension. Genetic susceptibility associated with hypertension differed according to sodium intake. Identifying gene variants that contribute to the dependence of hypertension on sodium intake status could make possible more individualized nutritional recommendations for preventing cardiovascular diseases.

Osteological Development of the Larvae and Juvenile of Luciogobius grandis (Pisces: Gobiidae)

This study is intended to be used as the basic material for the taxonomic research by observing the stages of skeletal development of Luciogobius grandis larvae compared to the skeletal development patterns of the same fish family of Gobiidae. 3 days after hatching (DAH), the preflexion larvae was 4.01±0.11 mm (n=5) in average total length (TL) and the frontal began to ossify in the skull. 17 DAH, the advanced postflexion larvae was 5.37±0.05 mm (n=5) in average TL the supraoccipital and epiotic were ossified in the cranial bone. 36 DAH, the juvenile was 12.2±0.20 mm (n=5) in average TL and the urohyal was ossified in the hyoid arch. In addition to one hypural bone being ossified, the first, second, third and fourth were combined and were made three bone fragments and then, the bone ossification of all skeletons was completed.

Early Life History of Coreoperca herzi in Han River, Korea

This study aimed to investigate early life of Coreoperca herzi living in Han River and compare morphological differences between different groups during the development in order to provide basic data for relevant taxonomic research. On average, one female individual spawned 541 to 861 eggs (average 701) at once. After 259 hours, the tail broke out of the egg membrane and hatching began. Immediately after hatching, the larvae were average 7.81±0.10 mm (n=5) in total length. 60 days the juvenile was average 35.9±1.30 mm (n=5) in total length. The white spots spread to the rest of the body, rending the same pattern as that on the body of their broodstock fish.

Development of a senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 model of care

Background

In the age of aging, Korea’s current medical delivery system threatens to increase the number of medical and caring refugees. This study attempts to develop an integrated senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and inducing well-being, wellness, and well-dying.

Methods

To develop the integrated healthcare system, data collection and analyses were conducted through a systematic review, literature review, benchmarking, focus group interviews, and expert consultation.

Results

The senior-specific, citizen-oriented healthcare service system developed in this study is designed to screen patients aged 65 or older within 24 h of being admitted, using the Geriatric Screening for Care-10. If there is reason for concern as a result of the screening, further evaluation is performed through assessment. Doctors and nurses create a care plan and a discharge plan based on the results from the screening and assessment. The nurse further uses the screening to monitor the patient’s condition before discharge. Based on the screening results at the time of discharge, a transitional care plan is prepared and provided to elderly patients and/or their families. This process enables a systematic link between medical institutions and community resources, aiming for the continuous management of health issues. It also establishes a multidisciplinary treatment plan that considers patients and their families so that diseases common to the elderly are diagnosed and treated promptly.

Conclusions

The most important issue for the elderly is to be able to live healthily and independently for the rest of their lives through well-being, wellness, and well-dying. The senior-specific, citizen-oriented healthcare service proposed in this study is an integrated medical treatment system for elderly users the implementation of which requires the daily care, professional care, and rehabilitation of elderly members of society to be organically organized according to the role of the patients, their families, and the caregiver.

Association of Geriatric Syndromes with Urinary Incontinence according to Sex and Urinary-Incontinence-Related Quality of Life in Older Inpatients: A Cross-Sectional Study of an Acute Care Hospital

Background

Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. We investigated the relationship between geriatric syndromes and UI according to gender and UI-related QOL among older inpatients.

Methods

This study was conducted among 444 older inpatients (aged 65 years and older) between October 2016 and July 2017. We examined geriatric syndromes and related factors involving cognitive impairment, delirium, depression, mobility decline, polypharmacy, undernutrition, pain, and fecal incontinence. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations.

Results

Geriatric syndromes and related factors were associated with UI. Mobility decline (odds ratio [OR], 4.16; 95% confidence interval [CI], 2.29–7.56), polypharmacy (OR, 3.35; 95% CI, 1.89–5.92), and pain (OR, 6.80; 95% CI, 3.53–13.09) were related to UI in both genders. Especially, delirium (OR, 7.55; 95% CI, 1.61–35.44) and fecal incontinence (OR, 10.15; 95% CI, 2.50–41.17) were associated with UI in men, while cognitive impairment (OR, 4.19; 95% CI, 1.14–15.44) was significantly associated with UI in women. Patients with depression were more likely to have poor UI-related QOL (OR, 8.54; 95% CI, 1.43–51.15).

Conclusion

UI was associated with different geriatric syndromes and related factors according to gender. Care for patients with depression, related to poor UI-related QOL, should be considered in primary care to improve the UI-related QOL of these individuals.

Morphological Development of Egg, Larvae and Juvenile in Korean shinner, Coreoleuciscus splendidus from the Ungcheon-Stream of Korea

The purpose of this study is to investigate the development of Coreoleuciscus splendidus egg and larvae morphology in the Ungcheon-stream. C. splendidus eggs were round and ranged in size from 1.86–2.01 mm (mean 1.91±0.14 mm). Immediately after hatching, the larvae had egg yolk in the abdomen with a total length of 5.27–6.63 mm (mean 5.95±0.96 mm). On the 10 days after hatching, the latter was 8.44–8.65 mm (mean 8.54±0.14 mm) in total length, and 5 dorsal fin rays were formed in dorsal fin and 8 caudal fin soft rays were formed in caudal fin. At 88 days after hatching, total length was 26.2–25.7 mm (mean 25.9±0.35 mm), and scales were formed throughout the body. The fin rays of each part were iii.7 in dorsal fin and iii.6 in anal fin, and finally the external form was the same as the adult fish.

Atomic layer deposition and tellurization of Ge-Sb film for phase-change memory applications

We studied the atomic layer deposition (ALD) and the tellurization of Ge–Sb films to prepare conformal crystalline Ge–Sb–Te (GST) films and to achieve void-free gap filling for emerging phase-change memory applications. ALD Ge–Sb film was prepared by alternating exposures to GeCl₂-dioxane and Sb(SiEt₃)₃ precursors at 100 °C. The growth rate was 0.021 nm per cycle, and the composition ratio of Ge to Sb was approximately 2.2. We annealed the ALD Ge–Sb films with a pulsed feeding of di(tert-butyl)tellurium. The ALD Ge–Sb films turned into GST films by the tellurization annealing. When the tellurization temperature was raised to 190 °C or higher temperatures, the Raman peaks corresponding to Ge–Sb bond and amorphous Ge–Ge bond disappeared. The Raman peaks corresponding to Ge–Te and Sb–Te bonds were evolved at 200 °C or higher temperatures, resulting in the phase transition temperature of 123 °C. At 230 °C or higher temperatures, the entire film was fully tellurized to form a GST film having a relatively uniform composition of Ge₃Sb₂Te₆, and the carbon impurities in the as-deposited ALD Ge–Sb film were eliminated. As the tellurization temperature increases, the volume of the ALD film is expanded owing to the incorporation of tellurium, resulting in complete filling of a trench pattern by GST film after the tellurization at 230 °C.

We studied the atomic layer deposition (ALD) and the tellurization of Ge–Sb films to prepare conformal crystalline Ge–Sb–Te (GST) films and to achieve void-free gap filling for emerging phase-change memory applications.

The relationship between employment status and insulin resistance in the Korean elderly population

BACKGROUND/AIMS

This study aimed to investigate the relationship between employment status and insulin resistance in the Korean elderly population.

METHODS

The study included 2325 healthy participants (862 men and 1463 women) who did not have diabetes, were 60-74 years old, and participated in the 2007-2010 Korea National Health and Nutrition Examination Survey. Their employment status was categorized as employed or unemployed. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to assess insulin sensitivity. Insulin resistance was defined as values greater than the 75th percentile of the HOMA-IR (> 2.67 in men and > 2.87 in women).

RESULTS

Mean HOMA-IR values were significantly higher for both sexes in the unemployed group than in the employed group. Compared with the unemployed group, the odds ratios (95% confidence intervals) for insulin resistance in the employed group were 0.55 (0.34-0.87) in men and 0.68 (0.47-0.98) in women after adjusting for confounders.

CONCLUSIONS

Being employed was significantly associated with a lower risk of insulin resistance in the Korean elderly population. These findings suggest that insulin sensitivity could be increased by increasing physical activity through occupational activities in the elderly population.

Osteological Development of the Larvae and Juvenile of Trident Goby, Tridentiger obscurus

This study is to observe the developmental process of the larval skeleton according to the growth of the trident goby, Tridentiger obscurus belonging to the larvae and juveniles and use it as the basic data of the taxonomic study. 8 days after hatching, the parasphenoid was ossified with an average total length of 3.62 mm, and basioccipital began to ossify. Caudal vertebrae and neural spine ossified in vertebra. 17 days after hatching, the average total length of the long hairs was 4.32 mm, pterotic and epiotic were ossified, and interhyal and subopercle were ossified. 52 days after hatching, the average total length of the juvenile was 18.2 mm, and lateral ethmoid, hypohyal ossified, vertebrae were parapophysis, and epural bone was osseous to the bone.

Assessment of pain in the elderly: A literature review

BACKGROUND

Pain perception is highly subjective, and effective pain management can be challenging in the elderly. We aimed to identify a set of practical measures that could be used to assess pain in elderly patients with or without cognitive impairment, as the first step towards effectively managing their pain.

METHODS

We used the PRISMA guidelines for this literature review. Two reviewers independently assessed titles, abstracts and full-text articles, and a third reviewer resolved any disagreements.

RESULTS

A total of 11 285 abstracts and 103 full-text articles were assessed. Forty-one studies met the inclusion criteria. The Numeric Rating Scale, Visual Analogue Scale, Face Pain Scale and Verbal Descriptor Scale have proven valid in the elderly. The Abbey pain scale, Doloplus-2, Pain Assessment in Advanced Dementia scale, Pain Assessment Checklist for Seniors with Limited Ability to Communicate, Checklist of Nonverbal Pain Indicators, Pain Assessment for the Dementing Elderly rating tool and the Clinical Utility of the CNA Pain Assessment Tool are used in elderly patients with cognitive impairment.

CONCLUSIONS

We identified a number of reliable and valid methods for pain assessment in the elderly. Elderly patients can receive treatment in a variety of settings, and frequently it is administered by a caregiver or family member, rather than a medical employee. The development of a pain assessment tool that is not subject to variations arising from differences in settings or caregivers is needed to assess pain accurately in elderly patients, and provide timely treatment. Natl Med J India 2017;30:203-7.

Association of High-Risk Drinking with Metabolic Syndrome and Its Components in Elderly Korean Men: The Korean National Health and Nutrition Examination Survey 2010-2012

Background

Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010–2012 Korean National Health and Nutrition Examination Survey.

Methods

Among 25,534 subjects, 2,807 were men >60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0–7), intermediate risk (8–14), and high risk (≥15 points).

Results

Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95%confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03–1.89), 1.82 (1.28– 2.60), and 1.77 (1.30–2.41) after adjustment for confounding variables.

Conclusion

AUDIT score was correlated with most MetS components in elderly Korean men.

Incidence of psoriasiform diseases secondary to tumour necrosis factor antagonists in patients with inflammatory bowel disease: a nationwide population-based cohort study

BACKGROUND

There are increasing reports of paradoxical psoriasiform diseases secondary to anti-tumour necrosis factor (TNF) agents.

AIMS

To determine the risks of paradoxical psoriasiform diseases secondary to anti-TNF agents in patients with inflammatory bowel disease (IBD).

METHODS

A nationwide population study was performed using the Korea National Health Insurance Claim Data. A total of 50 502 patients with IBD were identified between 2007 and 2016. We compared 5428 patients who were treated with any anti-TNF agent for more than 6 months (anti-TNF group) and 10 856 matched controls who had never taken anti-TNF agents (control group).

RESULTS

Incidence of psoriasis was significantly higher in the anti-TNF group (36.8 per 10 000 person-years) compared to the control group (14.5 per 10 000 person-years) (hazard ratio [HR] 2.357, 95% confidence interval [CI] 1.668-3.331). Palmoplantar pustulosis (HR 9.355, 95% CI 2.754-31.780) and psoriatic arthritis (HR 2.926, 95% CI 1.640-5.218) also showed higher risks in the anti-TNF group. In subgroup analyses, HRs for psoriasis by IBD subtype were 2.549 (95% CI 1.658-3.920) in Crohn's disease and 2.105 (95% CI 1.155-3.836) in ulcerative colitis. Interestingly, men and younger (10-39 years) patients have significantly higher risks of palmoplantar pustulosis (HR 19.682 [95% CI 3.867-100.169] and HR 14.318 [95% CI 2.915-70.315], respectively), whereas women and older (≥40 years) patients showed similar rates between the two groups.

CONCLUSIONS

The risks of psoriasiform diseases are increased by anti-TNF agents in patients with IBD. Among psoriasiform diseases, the risk of palmoplantar pustulosis shows the biggest increase particularly in male and younger patients.

Detection and classification of the breast abnormalities in digital mammograms via regional Convolutional Neural Network

Automatic detection and classification of the masses in mammograms are still a big challenge and play a crucial role to assist radiologists for accurate diagnosis. In this paper, we propose a novel computer-aided diagnose (CAD) system based on one of the regional deep learning techniques: a ROI-based Convolutional Neural Network (CNN) which is called You Only Look Once (YOLO). Our proposed YOLO-based CAD system contains four main stages: mammograms preprocessing, feature extraction utilizing multi convolutional deep layers, mass detection with confidence model, and finally mass classification using fully connected neural network (FC-NN). A set of training mammograms with the information of ROI masses and their types are used to train YOLO. The trained YOLO-based CAD system detects the masses and classifies their types into benign or malignant. Our results show that the proposed YOLO-based CAD system detects the mass location with an overall accuracy of 96.33%. The system also distinguishes between benign and malignant lesions with an overall accuracy of 85.52%. Our proposed system seems to be feasible as a CAD system capable of detection and classification at the same time. It also overcomes some challenging breast cancer cases such as the mass existing in the pectoral muscles or dense regions.

Catalyzed Atomic Layer Deposition of Silicon Oxide at Ultralow Temperature Using Alkylamine

We report the catalyzed atomic layer deposition (ALD) of silicon oxide using Si₂Cl₆, H₂O, and various alkylamines. The density functional theory (DFT) calculations using the periodic slab model of the SiO₂ surface were performed for the selection of alternative Lewis base catalysts with high catalytic activities. During the first half-reaction, the catalysts with less steric hindrance such as pyridine would be more effective than bulky alkylamines despite lower nucleophilicity. On the other hand, during the second half-reaction, the catalysts with a high nucleophilicity such as triethylamine (Et₃N) would be more efficient because the steric hindrance is less critical. The in situ process monitoring shows that the calculated atomic charge is a good indicator for expecting the catalyst activity in the ALD reaction. The use of Et₃N in the second half-reaction was essential to improving the growth rate as well as the step coverage of the film because the Et₃N-catalyzed process deposited a SiO₂ film with a step coverage of 98% that is better than 93% of the pyridine-catalyzed process. The adsorption of pyridine, ammonia (NH₃), or trimethylamine (Me₃N) salts was more favorable than that of Et₃N, n-Pr₃N, or ⁱPr₃N salts. Therefore, Et₃N was expected to incorporate less amine salts in the film as compared to pyridine, and the compositional analyses confirmed that the concentrations of Cl and N by the Et₃N-catalyzed process were significantly lower than those by the pyridine-catalyzed process.

Osteological Development of the Larvae and Juvenile of Bullhead torrent catfish, Liobagrus obesus

This study was conducted to investigate the skeletal development of bullhead torrent catfish, Liobagrus obesus larvae and to utilize them as basic data for the taxonomic study of Liobagrus larvae. Skeletal development was observed by being divided into cranium, visceral skeleton, shoulder girdle bone, pelvic girdle bone and vertebra. On the first day after hatching, the pre-larvae had an average total length of 7.92 mm, and a line-shaped parasphenoid ossified in the cranium. In the jaw bone, the dentary supporting the lower jaw and the maxillary supporting the upper jaw were ossified. In the anterior abdominal vertebrae of the vertebra, seven centrums began to ossify and five neural spines ossified simultaneously. On the 3 day after hatching, pre-larvae had an average total length of 8.95 mm, and the prefrontal ossified in cranium. The number of abdominal vertebrae was increased to 14, and three parapophysis developed from the front side. On the 24th day after hatching, post-larvae had an average total length of 15.2 mm and the epural bone ossified in coccyx. The parhypural bone was ossified, and ossification of coccyx and pelvic girdle bone was completed. On the 30th day after hatching, the average total length of the juvenile was 17.8 mm, and the ossification of cranium and visceral skeleton was all completed while the preorbital and three suborbitals were ossified in the orbital region of the cranium.