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The prevalence of neurodegenerative dementia is increasing owing to the rapid growth of the older population. We investigated risks and causes of mortality in Korean patients with neurodegenerative dementia using data from the Korean Health Insurance Review and Assessment Service-National Sample Cohort with the aim to improve their care. From a pool of 1,125,691 patients, 11,215 patients aged ≥60 years who were diagnosed with dementia between 2002 and 2013 were examined along with 44,860 matched controls. A Cox proportional hazard model was used to calculate crude and adjusted hazard ratios (HRs). During the follow-up period, 34.5% and 18.8% of individuals in the neurodegenerative dementia and control groups, respectively, died ( P < 0.001). The adjusted HR for mortality in the neurodegenerative dementia group was 2.11 (2.41 and 1.96 in men and women, respectively). Moreover, the adjusted HRs in patients with neurodegenerative dementia were 3.25, 2.77, and 1.84 for those diagnosed at ages 60-69, 70-79, and ≥80 years, respectively. The highest odds ratio for mortality was noted among patients with neurologic disease (15.93) followed by those with mental disease (4.89). These data show that the risk of mortality increased regardless of age and sex in Korean patients with neurodegenerative dementia., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2022 Hyo Geun Choi et al.)

The incidence of severe inflammatory diseases caused by chronic inflammation has increased owing to unprecedented changes brought about by industrialization. In this study, we aimed to assess the effect of treatment of lipopolysaccharide- (LPS-) induced murine macrophages with Commelina communis Linne extract (CCE) on synthesis of nitric oxide (NO), hypersecretion of proinflammatory cytokines, intranuclear transition of the p65 subunit of nuclear factor- (NF-) κ B, and degradation of the NF- κ B inhibitor I κ B α . Notably, CCE treatment did not affect cell viability even at a final concentration of 1.5 mg/mL. At a high concentration of CCE, the LPS-induced high levels of NO, tumor necrosis factor- α , interleukin- (IL-) 1 β , and IL-6 were decreased via downregulation of inducible NO synthase and proinflammatory cytokine mRNA expression. Furthermore, phosphorylation of I κ B α was significantly decreased upon CCE treatment, and the intranuclear transition of NF- κ B p65 triggered by LPS was inhibited at a high concentration of CCE. Polyphenols and flavonoids, secondary metabolites in CCE that regulate the NF- κ B pathway, may be responsible for its anti-inflammatory activity. We suggest that CCE has anti-inflammatory effects related to suppression of the NF- κ B pathway and can be used to treat chronic inflammation., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Ji-Hee Kim et al.)

Purpose: To determine the effect of age on sagittal cervical alignment after cervical laminoplasty procedure so as to identify the group with the greatest degree of variation. Study Setting . Single-center retrospective chart review in a tertiary referral hospital. Outcome Measures . The s agittal vertical axis (SVA) (C2-7), T1 slope, and cervical lordosis., Methods: We included patients who underwent cervical laminoplasty between 2014 and 2018 and divided 60 consecutive patients into two groups using the cut-off age of 65 years. The Paired t -test and Mann-Whitney U test were used to compare changes between preoperative radiographic cervical sagittal parameters and those 1 year after surgery., Results: Mean patient ages in the older and younger groups were 71 years and 52 years, respectively. The difference of C2-7 SVA was greater in the older group., Conclusion: Postoperative cervical balance can be worse when laminoplasty is performed in elderly patients., Competing Interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2020 Hyun Woong Mun et al.)

Objective: This study was performed to assess neurosurgery patients' preference for surgeon's attire and appearance in the hospital., Methods: A total of 100 patients were investigated using a questionnaire comprising 13 questions. We first asked patients about neurosurgeon's appearance including accessories, hair color, mustache, and beard. Then, based on their preferences, they were asked to rank a series of photographs which illustrated a variety of neurosurgeon attires worn by a doctor., Results: Professional attire with white coat was the most ideal for patients compared to any other attire (preference scale 5.28 ± 1.24), and there was a significant preference gap between wearing a white coat and not wearing a white coat (p <0.01). Patients expressed a preference for neurosurgeon's shoes (30%) but the majority of the respondents answered that it does not matter which shoes their neurosurgeon wears (43%). Furthermore, the patients did not have any preferences regarding accessories, dyeing, and mustache or beard (58%, 67%, and 51%, respectively), and they did not have negative view towards doctor wearing accessories (71.7%) and growing mustache or beard (71.6%)., Conclusion: The patients in this study preferred professional attire along with a white coat compared to any other form of outfit. This result is similar to those of many other studies conducted in other departments or other countries. However, patients did not have a strong negative view on accessories, dyeing, and facial hair. With regard to medical training, patients did not show a preference for their neurosurgeon's educational background.

Purpose: The purpose of this study was to investigate the association of exercise capacity, cardiac function, and coronary artery calcification (CAC) with components of metabolic syndrome in Korean adults., Method: Medical records of healthy adults who underwent exercise tolerance test (ETT), coronary CT angiography (CTA), and echocardiography of the heart for cardiac health check-up were retrospectively reviewed. Patients who had a history of severe cardiovascular disease or could not perform ETT due to other musculoskeletal problems were excluded. Subjects were classified into groups based on the number of components for metabolic syndrome: no component (Group 1, n=90), 1, 2 components (Group 2, n=321), and 3 or more components (Group 3, n=154). Exercise capacity was assessed using the symptom-limited ETT, and CAC score was obtained using the coronary CTA and Agatston score. Cardiac structure and function were assessed using echocardiography., Results: A total of 565 patients (mean (SD) age 59.5 (9.1), 340 men, 225 women) were selected. Exercise capacity was significantly lower in Group 3 than in the other groups (p<0.05). The CAC score was significantly higher in Group 3 than in the other groups (p<0.05). Compared to the other groups, echocardiography findings in Group 3 showed a greater hypertrophy of the left ventricle and reduction in the diastolic function (p<0.05). Exercise capacity, CAC score, cardiac structure, and function were different between the 3 groups, where a tendency to worsen was observed from Group 1 to Group 3., Conclusion: Metabolic syndrome decreases exercise capacity of the patient and contributes to CAC, thereby increasing the risk for cardiovascular diseases and deterioration in cardiac structure and function. Therefore, early detection of metabolic syndrome and subsequently the prevention and management of heart disease are necessary.

Crocin is a water-soluble carotenoid pigment that is primarily used in various cuisines as a seasoning and coloring agent, as well as in traditional medicines for the treatment of edema, fever, and hepatic disorder. In this study, we demonstrated that crocin markedly induces the expression of heme oxygenase-1 (HO-1) which leads to an anti-inflammatory response. Crocin inhibited inducible nitric oxide synthase (iNOS) expression and nitric oxide production via downregulation of nuclear factor kappa B activity in lipopolysaccharide- (LPS-) stimulated RAW 264.7 macrophages. These effects were abrogated by blocking of HO-1 expression or activity. Crocin also induced Ca(2+) mobilization from intracellular pools and phosphorylation of Ca(2+)/calmodulin-dependent protein kinase 4 (CAMK4). CAMK4 knockdown and kinase-dead mutant inhibited crocin-mediated HO-1 expression, Nrf2 activation, and phosphorylation of Akt, indicating that HO-1 expression is mediated by CAMK4 and that Akt is a downstream mediator of CAMK4 in crocin signaling. Moreover, crocin-mediated suppression of iNOS expression was blocked by CAMK4 inhibition. Overall, these results suggest that crocin suppresses LPS-stimulated expression of iNOS by inducing HO-1 expression via Ca(2+)/calmodulin-CAMK4-PI3K/Akt-Nrf2 signaling cascades. Our findings provide a novel molecular mechanism for the inhibitory effects of crocin against endotoxin-mediated inflammation.

Background: The goal of this study was to evaluate the effect of 2 different strategies for parenteral amino acid (AA) supplementation in the range of standard doses (>1.0-1.5 g/kg/d) on growth outcomes in very low birth weight (VLBW) infants., Materials and Methods: The unit policy of AA doses on the first day of life changed from 1.5 g/kg/d (n = 56; standard protein group, SP, in 2008) to 3.0 g/kg/d (n = 53; high protein group, HP, in 2009) with a daily advance to a target dose of 3.5-4.0 g/kg/d. Daily nutritive and laboratory profiles were collected for the initial 14 days, and patient weight, height, and head circumference on postnatal day 14 and again at 36 weeks, 6 months, and 12 months of corrected age were evaluated., Results: During the first 14 days, AA intake was greater in the HP group than in the SP group (2.9 ± 0.4 vs 2.6 ± 0.4 g/kg/d, P < .001). The HP group demonstrated a lower peak plasma glucose level during the first 3 days (116 ± 24 vs 137 ± 39 mg/dL) and a higher serum urea nitrogen level for the first 14 postnatal days than the SP group (19.2 ± 7.0 vs 14.8 ± 6.7 mg/dL) (both P < .01). From birth to postnatal 14 days and to 36 weeks, 6 months, and 12 months of corrected age, the z score changes in all growth parameters did not differ between the 2 groups., Conclusion: In the range of the standard AA protocol, there was no dose-response relationship between the early AA doses and the growth outcomes in VLBW infants.