Objectives
The aim of this study was to investigate the association between chronic laryngitis (CL) and insulin resistance (IR) in South Korea using data from the 2010 Korea National Health and ...Nutrition Examination Surveys (KNHANES).
Design, setting and participants
Cross-sectional data of 4,261 adults who completed KNHANES were analyzed. CL was considered when participants experienced a voice change and demonstrated flexible laryngoscopic findings of diffuse laryngeal inflammation. All participants were assessed for IR using the homeostasis model assessment of insulin resistance (HOMA-IR).
Results
Among the Korean population older than 19 years, the prevalence of chronic laryngitis was 3.8±0.7%. Univariate analysis demonstrated that CL was significantly associated with smoking and systolic and diastolic blood pressure in men and with age, diastolic blood pressure, HDL cholesterol, insulin, and HOMA-IR in women. Multiple regression analysis demonstrated that the mean value of HOMA-IR was significantly associated with CL in women only. In addition, CL was more prevalent in the highest compared with the lowest HOMA-IR quartile (OR 95% CI: 2.268 1.053-4.884 after adjusting for age, OR 95% CI: 2.235 1.040-6.181 after adjusting for confounding factors of age, body mass index, smoking status, alcohol intake, regular exercise, education, and income).
Conclusions
These findings indicate that IR characterized by HOMA-IR is significantly associated with CL in Korean women only. Our results suggest that HOMA-IR could be an early predictive factor of increased risk of CL in Korean women.
Abstract Background For many highly allosensitized renal transplant candidates, an acceptable donor is never identified, and the patient remains on dialysis indefinitely. In an attempt to ameliorate ...this situation, several desensitization protocols have been developed that permit positive-crossmatch kidney transplantation. Here, we report our experiences of living donor kidney transplantation in highly sensitized patients. Methods We treated seven highly sensitized patients between March 2003 and September 2009. All patients underwent desensitization using pretransplant plasmapheresis (PP) and low-dose intravenous immunoglobulin (IVIG; 100 mg/kg) with rituximab (six patients) or without rituximab (one patient). Demographics, immunologic characteristics of patients, allograft function, acute rejection (AR) episodes, survival, and adverse events were evaluated. Results Seven patients with positive-crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Their mean age was 51.4 ± 3.3 years. The average number of human leukocyte antigen mismatchs was 3.4 ± 0.5. The mean percent PRA was 41.7% ± 6.1%. Six patients were crossmatch-positive, and one patient was crossmatch-negative but had high PRA levels. The mean follow-up period was 33.2 ± 5.4 months after transplantation. The all patients showed no AR episodes for follow-up period, and the patient and graft survival rates were 100%. The mean serum creatinine concentration at last follow-up was 0.92 ± 0.11 mg/dL. Conclusions Our experiences suggest that the combination of PP and low-dose IVIG with or without rituximab may prove effective as a desensitization regimen for positive-crossmatch and/or highly sensitized living donor renal transplant recipients. Further investigations are needed to evaluate the long-term clinical efficacy and safety of this approach.
BackgroundMutations in TRPV4, a gene that encodes a Ca2+ permeable non-selective cation channel, have recently been found in a spectrum of skeletal dysplasias that includes brachyolmia, ...spondylometaphyseal dysplasia, Kozlowski type (SMDK) and metatropic dysplasia (MD). Only a total of seven missense mutations were detected, however. The full spectrum of TRPV4 mutations and their phenotypes remained unclear.Objectives and methodsTo examine TRPV4 mutation spectrum and phenotype−genotype association, we searched for TRPV4 mutations by PCR-direct sequencing from genomic DNA in 22 MD and 20 SMDK probands.ResultsTRPV4 mutations were found in all but one MD subject. In total, 19 different heterozygous mutations were identified in 41 subjects; two were recurrent and 17 were novel. In MD, a recurrent P799L mutation was identified in nine subjects, as well as 10 novel mutations including F471del, the first deletion mutation of TRPV4. In SMDK, a recurrent R594H mutation was identified in 12 subjects and seven novel mutations. An association between the position of mutations and the disease phenotype was also observed. Thus, P799 in exon 15 is a hot codon for MD mutations, as four different amino acid substitutions have been observed at this codon; while R594 in exon 11 is a hotspot for SMDK mutations.ConclusionThe TRPV4 mutation spectrum in MD and SMDK, which showed genotype−phenotype correlation and potential functional significance of mutations that are non-randomly distributed over the gene, was presented in this study. The results would help diagnostic laboratories establish efficient screening strategies for genetic diagnosis of the TRPV4 dysplasia family diseases.
Advances in genomic technologies and the development of targeted therapeutics are making the use of precision medicine increasingly possible. In this study, we explored whether precision medicine can ...be applied for the management of refractory/relapsed pediatric solid tumors by discovering actionable alterations using targeted panel sequencing. Samples of refractory/relapsed pediatric solid tumors were tested using a targeted sequencing panel covering the exonic DNA sequences of 381 cancer genes and introns across 22 genes to detect clinically significant genomic aberrations in tumors. The molecular targets were tiered from 1 to 5 based on the presence of actionable genetic alterations, strength of supporting evidence, and drug availability in the Republic of Korea. From January 2016 to October 2018, 55 patients were enrolled. The median time from tissue acquisition to drug selection was 29 d (range 14-39), and tumor profiling was successful in 53 (96.4%) patients. A total of 27 actionable alterations in tiers 1-4 were detected in 20 patients (36.4%), and the majority of actionable alterations were copy number variations. The tiers of molecular alterations were tier 1 (clinical evidence) in 4 variants, tier 2 (preclinical evidence) in 8 variants, tier 3 (consensus opinion) in 2 variants, and tier 4 (actionable variants with a drug that is available in other countries but not in the Republic of Korea) in 9 variants. In one patient with relapsed neuroblastoma with ALK F1174L mutation and ALK amplification, lorlatinib was used in a compassionate use program, and it showed some efficacy. In conclusion, using a targeted sequencing panel to discover actionable alterations in relapsed/refractory pediatric solid tumors was practical and feasible.
Transanal endoscopic microsurgery (TEM) has been shown to be highly effective for early rectal cancer, and endoscopic submucosal dissection (ESD) has been introduced to treat noninvasive colorectal ...neoplasia. The aim of this study was to compare the outcomes of ESD and TEM for superficial early rectal cancer.
We retrospectively analyzed 63 patients with nonpolypoid rectal high grade dysplasia or submucosa-invading cancer who were treated with ESD or TEM, and compared clinical outcomes and safety between the treatment groups.
30 patients underwent ESD and 33 underwent TEM. For ESD compared with TEM, en bloc resection rates were 96.7% vs. 100% (P = 0.476) and R0 resection rates were 96.7 % vs. 97.0 % (P = 1.000). There were no cases of local recurrence or distant metastasis in either group. Antibiotics were required in 11 patients (36.7%) in the ESD group and 33 (100%) in the TEM group (P < 0.001). There was no difference in net procedure time although ESD was associated with shorter total procedure time and hospital stay than TEM, with mean (standard deviation SD) 84.0 (51.2) vs. 116.4 (58.5) min (P = 0.0023), and 3.6 (1.2) vs. 6.6 (3.5) days (P < 0.001), respectively. There were no significant differences in complications between the two groups.
Both ESD and TEM are effective and oncologically safe for treating nonpolypoid rectal high grade dysplasia and submucosa-invading cancers. ESD has the additional advantages of minimal invasiveness and avoidance of anesthesia. Therefore, ESD could be recommended as a treatment option for superficial early rectal cancers.
Since 2007, the Korean government has provided a free health screening to the elderly starting at the age of 66 years. The purpose of this study was to evaluate the association between this general ...health screening and the incidences of stroke and myocardial infarction and mortality.
The study design used in this study is a retrospective cohort study.
The study was conducted using the universe of insurance claims data of Korea and followed a cohort of individuals aged 66 years in 2009 from 2006 through 2016 (n = 354,194). We assessed the association between receipt of the national health screening and health outcomes using propensity matching and Cox proportional hazard models.
We found that the receipt of the national health screening was associated with a reduction in negative health outcomes. The hazard ratio for stroke was 0.89 (P < 0.001), 0.88 (P < 0.001) for myocardial infarction and 0.58 for death (P < 0.001).
Korea's national health screening was associated with reductions in cardiovascular morbidity and mortality in the elderly.
The receipt of the national health screening in the elderly was associated with a reduction in negative health outcomes including stroke, myocardial infarction, and death. Display omitted
•Many studies have claimed that health screening has little effect.•This study shows that the national health screening may be helpful for the elderly.•However, the cost-effectiveness can vary from country to country.
Objectives:Genetic susceptibility is known to play a large part in the predisposition to the inflammatory bowel diseases (IBDs) known as Crohn’s disease (CD) and ulcerative colitis (UC). The IL2/IL21 ...locus on 4q27 is known to be a common risk locus for inflammatory disease (shown in coeliac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus and psoriasis), while the roles that interleukin 2 (IL2) and IL21 play in the immune response also make them attractive candidates for IBD. The objective of this study was to test for association between the IL2/IL21 locus and the IBDs.Methods:The four single nucleotide polymorphisms (SNPs) in the IL2/IL21 locus most associated with coeliac disease were genotyped in 1590 subjects with IBD and 929 controls from The Netherlands, and then replicated in a North American cohort (2387 cases and 1266 controls) and an Italian cohort (805 cases and 421 controls), yielding a total of 4782 cases (3194 UC, 1588 CD) and 2616 controls. Allelic association testing and a pooled analysis using a Cochran–Mantel–Haenszel test were performed.Results:All four SNPs were strongly associated with UC in all three cohorts and reached genome-wide significance in the pooled analysis (rs13151961 p = 1.35×10−10, rs13119723 p = 8.60×10−8, rs6840978 p = 3.07×10−8, rs6822844 p = 2.77×10−9). A moderate association with CD was also found in the pooled analysis (p value range 0.0016–9.86×10−5).Conclusions:A strong association for the IL2/IL21 locus with UC was found, which also confirms it as a general susceptibility locus for inflammatory disease.
For various reasons, the Earth's outer radiation belt often exhibits dramatic and sudden increases or decreases in the observed particle flux. In this paper, we report three dropout events of ...energetic electrons observed by multiple spacecraft while traveling across the outer radiation belt. The three events were first identified based on observations of a significant dropout in the >2 MeV electron flux at geosynchronous orbit. Subsequently, for each event, we analyzed the energetic electron data obtained near the magnetic equator by THEMIS spacecraft to determine the responses of the entire outer radiation belt. Our analysis is mainly based on the electron fluxes measured at energies of 52 keV, 203 keV, and 719 keV, and on the phase space densities estimated for the first adiabatic invariant μ values of 100 MeV/G, 200 MeV/G, and 300 MeV/G. The main shared feature among the three events is that while, for the lowest energy, sources from the convection and/or particle injections of plasma sheet electrons dominate over losses, the higher energies exhibit a dramatic dropout effect that penetrates deeply into L ~ 4.5 – 5. In terms of the phase space density, a similar dropout effect is clearly seen for the μ values of 200 MeV/G and 300 MeV/G, while the convection effect and/or injections dominates for μ = 100 MeV/G. What is astonishing about this dropout phenomenon is that the three events are all associated with only very weak magnetic storms with a SYM‐H minimum of ‐40 nT or larger. This implies that a significant loss of electrons deep inside the outer radiation belt can occur even during a very weak magnetic storm. Low‐altitude observations of electrons by NOAA POES satellites indicate no significant atmospheric precipitation due to strong diffusion. Our simulations with various conditions suggest that radial diffusion effect in combination with the magnetopause shadowing are responsible for the observed dropouts to a large extent for all of the three events, although the contribution by the weak atmospheric precipitation that might have been missed by the NOAA POES observations can be non‐negligible.
Key Points
Identified three dropout events by multiple satellites
The dropouts penetrate deep into L ~4‐5
Suggest magnetopause shadowing plus radial diffusion as a main cause
ABSTRACT The millimeter transient sky is largely unexplored, with measurements limited to follow-up of objects detected at other wavelengths. High-angular-resolution telescopes, designed for ...measurement of the cosmic microwave background (CMB), offer the possibility to discover new, unknown transient sources in this band-particularly the afterglows of unobserved gamma-ray bursts (GRBs). Here, we use the 10 m millimeter-wave South Pole Telescope, designed for the primary purpose of observing the CMB at arcminute and larger angular scales, to conduct a search for such objects. During the 2012-2013 season, the telescope was used to continuously observe a 100 deg2 patch of sky centered at R.A. 23h30m and decl. −55° using the polarization-sensitive SPTpol camera in two bands centered at 95 and 150 GHz. These 6000 hr of observations provided continuous monitoring for day- to month-scale millimeter-wave transient sources at the 10 mJy level. One candidate object was observed with properties broadly consistent with a GRB afterglow, but at a statistical significance too low (p = 0.01) to confirm detection.
Summary
Refractory intra‐operative cardiac arrest is a challenging issue for anaesthetists. In this study, we analysed the outcomes of adult patients who received extracorporeal cardiopulmonary ...resuscitation for refractory intra‐operative cardiac arrest between 2005 and 2016, using data from our institutional extracorporeal membrane oxygenation registry. We defined refractory intra‐operative cardiac arrest as the failure of a return of spontaneous circulation after 30 min of cardiopulmonary resuscitation. The primary outcome measure was neurologically intact survival with a cerebral performance category score of 1 or 2 at hospital discharge. Between 2005 and 2016, extracorporeal cardiopulmonary resuscitation was used to treat 23 patients who experienced refractory cardiac arrest in the operating room. The survival rates of neurologically‐intact subjects were 9/23 (39%) and 6/23 (26%) at 24 h postoperatively and at hospital discharge, respectively. The main cause of refractory‐intra‐operative cardiac arrest was haemorrhagic shock in 13 out of 23 (57%) patients, and the neurologically‐intact survival rate in these patients was 3/13 (23%) at discharge. Our study showed that approximately a quarter of patients with refractory intra‐operative cardiac arrest caused by haemorrhage would receive survival benefit from extracorporeal cardiopulmonary resuscitation. Therefore, extracorporeal cardiopulmonary resuscitation may be a possible option in this clinically‐challenging situation.
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