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Purpose: The purpose of this study was to investigate the effects of anxiety and smartphone dependency on sleep quality in pregnant women with preterm labor. Methods: The participants of this study were 111 pregnant women who were between 20 and 37 weeks of gestation and experienced preterm labor. The data were collected from October 1, 2018 to October 25, 2019. The collected data were analyzed using descriptive statistics (frequency, percentage, and standard deviation), as well as the t-test, Pearson correlation coefficients, and hierarchical multiple regression. Results: Significant negative correlations were found between anxiety and sleep quality and between smartphone dependency and sleep quality. Participants’ history of preterm birth, pregnancy method, bowel movements, anxiety, and smartphone dependency significantly affected sleep quality, with an explanatory power of 18%.Conclusion: In order to improve the quality of sleep, which is an important health-related factor for pregnant women experiencing preterm labor, it will be necessary to identify a history of premature birth, pregnancies achieved using artificial reproductive technology, bowel problems, and smartphone dependency in advance and to provide nursing interventions accordingly.

Background/aim We investigated the clinical role of the molecular targets, APEX1 and Jagged-1, and the Apex1 - Jagged-1 cascade in gastric cancer cells. Materials and methods We used 6 human gastric cancer cell lines (SNU-1, SNU-5, SNU-16, NCI-N87, KATO- III and AGS), and demonstrated the chemosensitivity of APEX1 and Jagged-1 through the MTT assay and immunoblotting. Tumor growth was assayed following cisplatin and 5-FU treatment using a xenograft model injected with KATO-III cells. Moreover, gastric tumor samples from 9 patients, divided in 2 groups according to chemotherapy response, were examined by immunocytochemical (IHC) staining, and protein expression levels were scored. Results Following APEX1 knockdown, the MTT assay revealed that the IC50 of cisplatin and 5-FU in AGS cells was decreased approximately 7% and 15%, respectively, however, their decrease in chemoresistant KATO-III cells was decreased by approximately 21% and 67% for cisplatin and 5-FU, respectively. The tumor volume of KATO-III/sicontrol mice treated with cisplatin and 5-FU was affected less, compared with KATO-III/siAPEX1 mice treated with cisplatin and 5-FU. Also, the expression levels of APEX1, Jagged-1 and CD133, assayed by IHC staining, were higher in the chemorefractory group than in the chemoresponsive group. Conclusion Jagged-1-activated signaling by APEX1 plays a role in advanced gastric cancer.

BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of solid organ transplantation or allogenic hematopoietic stem cell transplantation that is associated with immunosuppressive therapy. Potential manifestations are diverse, ranging from reactive lymphoid hyperplasia to high-grade lymphoma. PTLD is usually of B-cell origin and associated with Epstein-Barr virus (EBV) infection. Herein, we describe a case of PTLD involving the peritoneal omentum. There has been only case of PTLD as a diffuse large B-cell lymphoma (DLBCL) in the peritoneum. CASE SUMMARY The patient was a 62-year-old man who had been receiving immunosuppressive therapy with tacrolimus since undergoing a liver transplant 15 years prior. He reported that he had experienced abdominal discomfort and anorexia 1 month prior to the current admission. Abdominal pelvic computed tomography (CT) revealed peritoneal and omental mass-like lesions without bowel obstruction. Ultrasonography-guided biopsy was performed, and he was histologically diagnosed with EBV-negative DLBCL. Positron emission tomography (PET)-CT depicted peritoneum and omentum involvement only, without any lymphadenopathy or organ masses, including in the gastrointestinal tract. Six cycles of chemotherapy with a “R-CHOP“ regimen (rituximab-cyclophosphamide, doxorubicin, vincristine, prednisolone) were administered, and PET-CT performed thereafter indicated complete remission. CONCLUSION This is the first report of isolated peritoneal lymphomatosis defined as PTLD in a liver transplant recipient.

BACKGROUND Bronchobiliary fistula (BBF) is a rare disease characterized by an abnormal connection between the biliary system and bronchi. Traditional causes of BBF include trauma and infections, and more recent causes include malignancies and certain cancer treatments. Ramucirumab is an antivascular endothelial growth factor receptor 2 monoclonal antibody, currently used as a second-line treatment for gastric cancer. CASE SUMMARY A 43-year-old man visited our hospital with the complaint of jaundice. He was diagnosed with inoperable advanced gastric cancer owing to invasion of the hepatic hilum by the tumor. After percutaneous transhepatic biliary drainage (PTBD) and stent placement, capecitabine and oxaliplatin were administered as first-line palliative chemotherapy. The tumor progressed, and paclitaxel and ramucirumab were administered as second-line chemotherapy. However, on the first day of the second cycle, the patient suddenly developed dyspnea and pneumonia. BBF was diagnosed on the basis of the presence of bilious sputum and the results of computed tomography, and PTBD was repeated. CONCLUSION This is the first report of BBF after administration of the new antiangiogenic agent ramucirumab.

Warty carcinoma (WC), known as condylomatous carcinoma, generally derives from genito-urethral area. Its symbolic lesion is the exophytic and verruciform mass associated with human papillomavirus infection. A 90-year-old female presented with growing cauliflower-like mass in her back. A wide excision was performed for two masses. It was finally confirmed as WC throughout histopathological findings—arborescent papillomatosis, hyperkeratosis and acanthosis. The patient was an ordinary housewife and there was no recurrence and any postoperative complication 6 month after the surgery. Accordingly, careful physical examination and history-taking as well as wide-excision securing safety margin are essential, especially for senile patients.

Purpose: This study aimed to identify personal listening device (PLD) usage habits, listening belief, and perceived change in hearing, and to investigate how the variables related to perceived change in hearing among adolescents. Methods: The participants were 183 middle school students and 233 high school students from Ulsan. Data were collected by self-reported questionnaires from August 1, 2019, to October 22, 2019, and analyzed with descriptive statistics, χ2 test, Mann–Whitney U test, and hierarchical multiple logistic regression. Results: Most students started to use PLDs from elementary school, and mean preferred listening level was 70.13 dB. Mean perceived susceptibility to music-induced hearing loss (MIHL) and perceived barriers to prevent MIHL were 5.18 and 3.40, respectively. Perceived change in hearing was reported on 14.2% of middle school students and 32.2% of high school students, and as the average score of perceived barriers to prevent MIHL increases by one point, the odds of decrease in hearing increase by 2.05 times (p

The separation of oil by a suitable technique from the Pacific oyster muscle is important for the utilization of the oil as a ω-3 polyunsaturated fatty acids (ω-3 PUFAs) source and production of bio-functional peptides/ oligosaccharides from oil-free residue. This study was conducted to prepare ω-3 PUFAs concentrate from supercritical carbon dioxide (SC-CO2) extracted Pacific oyster oil by enzyme-catalyzed ethanolysis reactions. SC-CO2 extractions were done at different temperatures and pressures to optimize suitable extraction conditions and extracted oils were compared with Soxhlet (n-hexane) extracted oil to evaluate the yield and quality. Oil extracted by SC-CO2 at optimized conditions was used for ethanolysis reaction catalyzed by immobilized sn-1,3 specific lipases, namely Novozymes-435, Lipozyme TLIM, and Lipozyme RMIM to produce 2-monoacylglycerols (2-MAG) rich in ω-3 PUFAs. The optimum temperature and pressure for SC-CO2 extractions of oyster oil was 50°C and 30 MPa. In this condition, the yield of oil was 5.96% and the acid, peroxide, free fatty acid, and p-anisidine values were 4.49 mg KOH/g, 4.72 meq/kg, 3.42%, and 10.03, respectively. The ω-3 PUFAs content significantly increased in 2-MAG obtained from Novozymes 435, Lipozyme TLIM, and Lipozyme RMIM to 43.03 ± 0.36, 45.95 ± 0.29, and 40.50 ± 0.77%, respectively (p < 0.05). A thin layer chromatography (TLC) analysis confirmed the production and separation of 2-MAG in the ethanolysis process. The ratio of total ω-3 to ω-6 fatty acids was almost twice in 2-MAG of SC-CO2 extracted oyster oil. SC-CO2 extracted Pacific oyster oil can be used for sn-1,3 specific lipases catalyzed ethanolysis to produce ω-3 PUFAs rich in 2-MAG.

This retrospective study aimed to evaluate the levels of coagulation factors and presence of disseminated intravascular coagulation (DIC) in patients with scrub typhus. We included patients confirmed to have scrub typhus at the Chosun University Hospital between September 2004 and December 2009. The DIC scores were evaluated in 365 patients and 36 healthy controls. The median concentrations of fibrinogen, d-dimer, and fibrin/fibrinogen degradation products (FDP) were compared between patients and healthy controls (p

Hypernatremia develops commonly in critically ill patients during hospitalization, and is associated with adverse outcomes. However, community acquired hypernatremia (CAH) has been rarely studied. We conducted a study in patients who presented to an urban referral hospital, and were admitted with CAH. We retrospectively analyzed patients admitted to an urban tertiary care hospital from January 1, 2012 to December 31, 2014. CAH is defined as more than 147 mEq/L at admission in patients not transferred from other hospitals. Severity of hypernatremia is categorized as mild (148-150 mEq/L), moderate (151-154 mEq/L) or severe (≥155 mEq/L). All data were extracted from electronic medical records and the major outcome is hospital mortality. During the study period, 79,998 patients were admitted to the hospital. Of them, 178 patients (0.2%) had hypernatremia at the time of admission. 121 (68.0%) had mild hypernatremia, 33 (18.5%) had moderate hypernatremia, and 24 (13.5%) had severe hypernatremia at admission. During the hospital stay, 91 (51.1%) developed mild hypernatremia, 31 (17.4%) developed moderate hypernatremia and 56 (31.5%) developed severe hypernatremia. Mean duration of hypernatremia was 2.3 ± 2.0 days. The length of hospital stay was 7 (interquartile range 3-23) days and hospital mortality was 24.3%. Multivariate analysis shows that a peak sodium level that qualified as moderate [OR = 11.50, 95% CI (2.67-49.42)] or severe hypernatremia [OR = 5.18, 95% CI (1.43-18.79)] is an independent risk factor for hospital mortality compared to mild hypernatremia. Admission from the emergency department (ED), oral intake restriction, mean arterial pressure (MAP) and respiratory rate (RR) at admission time are also independently associated with hospital mortality. Maximum sodium level in CAH is independently associated with hospital mortality.

악성 빈혈은 위점막의 위축 혹은 위벽세포의 자가면역성손상으로 내인자가 결핍되며 비타민 B12의 흡수 장애가 일어나 거대적혈모구빈혈이 발생한 것을 의미한다. 악성 빈혈의 치료는 비타민 B12 근육주사나 스테로이드의 투여이나, 저자들은 악성 빈혈로 진단된 후 특별한 치료 없이 자연적으로 호전된 악성 빈혈의 증례를 경험하였기에 이를 보고하는 바이다.

Background/aim Colorectal cancer (CRC) is one of the most common in the world and its prevalence is rapidly increasing. Jagged-1-activated Notch signaling by apurinic/apyrimidinic endodeoxyribonuclease 1 (APEX1) promotes CRC, and high expression of Jagged-1 is associated with poor prognosis. However, its clinical implication is unknown. The aim of this study was to investigate the clinical role of Jagged-1-activated Notch signaling by APEX1. Materials and methods The 5-dimethylthiazol-2-yl) 2, 5-diphenyltetrazolium bromide (MTT) assay was used to evaluate the anti-cancer efficacy of 5-fluorouracil (5-FU), oxaliplatin, and irinotecan. Tissue from CRC patients was analyzed to assess the clinical specificity of Jagged-1 activated by APEX1. Results The half-maximal inhibitory concentration (IC50) in cells co-expressing APEX1 and Jagged-1 cells was higher than that in cells expressing only APEX1. These results indicated that the simultaneous expression of APEX1 and Jagged-1 might be associated with chemoresistance toward 5-FU, oxaliplatin, and irinotecan. Analysis of tissue from CRC patients revealed that high expression of Jagged-1 was associated with a statistically significantly low response to chemotherapy. Conclusion Overexpression of Jagged-1 by APEX1 might serve as a predictor of response to chemotherapy and of poor prognosis, and moreover may be a therapeutic target for chemotherapy of advanced CRC.

Aims: Hepatic fibrosis results from chronic liver injury and inflammatory responses. Sestrin 2 (Sesn2), an evolutionarily conserved antioxidant enzyme, reduces the severities of acute hepa...

Background: It is expected that artificial intelligence (AI) will be used extensively in the medical field in the future. Objective: The purpose of this study is to investigate the awareness of AI among Korean doctors and to assess physicians’ attitudes toward the medical application of AI. Methods: We conducted an online survey composed of 11 closed-ended questions using Google Forms. The survey consisted of questions regarding the recognition of and attitudes toward AI, the development direction of AI in medicine, and the possible risks of using AI in the medical field. Results: A total of 669 participants completed the survey. Only 40 (5.9%) answered that they had good familiarity with AI. However, most participants considered AI useful in the medical field (558/669, 83.4% agreement). The advantage of using AI was seen as the ability to analyze vast amounts of high-quality, clinically relevant data in real time. Respondents agreed that the area of medicine in which AI would be most useful is disease diagnosis (558/669, 83.4% agreement). One possible problem cited by the participants was that AI would not be able to assist in unexpected situations owing to inadequate information (196/669, 29.3%). Less than half of the participants(294/669, 43.9%) agreed that AI is diagnostically superior to human doctors. Only 237 (35.4%) answered that they agreed that AI could replace them in their jobs. Conclusions: This study suggests that Korean doctors and medical students have favorable attitudes toward AI in the medical field. The majority of physicians surveyed believed that AI will not replace their roles in the future.

Purpose We report the case of a patient with IgG4-related disease with multiple organ involvement, especially myocardium, that was successfully treated with prednisone. Methods We performed several serological tests, electrocardiogram, echocardiography, computed tomography and inguinal lymph node biopsy. Results We diagnosed the patient with IgG4-related disease by the elevated serum IgG4 level and histological lymph node findings. Conclusions This is the first reported case of IgG4-related disease with dilated cardiomyopathy.

Multiple enchondromas are well described in the literature, however, the associated spectrum of MR imaging findings remains unclear. Secondary chondrosarcoma of the hand and feet associated with multiple enchondromas is extremely rare. Herein, we reported a case of multiple enchondromas of intramedullary, intracortical, and periosteal location with associated low-grade chondrosarcomas in the lower extremities on MR imaging in a 57-year-old woman.

Bioactive polysaccharide was extracted from Pacific oyster Crassostrea gigas using subcritical water (SW) and the extraction process was optimize by response surface methodology (RSM). The optimum condition was found to be temperature 125.01 °C, extraction time 14.93 min, and liquid to solid ratio of 44.69:1 (ml:g). At this condition, the yield of the C. gigas polysaccharides (CGPs) was found to be 18.66%. The polysaccharide was characterized for its chemical, physical, thermal, and structural properties using HPLC, GPC, XRD, FTIR, TGA, UV–Vis spectroscopy, and NMR and the results of this characterization showed a characteristic feature of a typical polysaccharide. The CGPs was found to be a d -glucan with α-(1 → 4) configuration. The CGPs was also evaluated for its antioxidant, antihypertensive, and hypoglycemic activity and the IC50 (mg/ml) values were found to be 2.06 ± 0.33, 1.58 ± 0.03, and 2.77 ± 0.01 respectively. The current study demonstrated that SWE could be used as an effective process to extract bioactive polysaccharides from C. gigas.

Oriental melon (Cucumis melo L. var. makuwa) is one of six subspecies of melon and is cultivated widely in East Asia, including China, Japan, and Korea. Although oriental melon is economically valuable in Asia and is genetically distinct from other subspecies, few reports of genome-scale research on oriental melon have been published. We generated 30.5 and 36.8 Gb of raw RNA sequence data from the female and male flowers, leaves, roots, and fruit of two oriental melon varieties, Korean landrace (KM) and Breeding line of NongWoo Bio Co. (NW), respectively. From the raw reads, 64,998 transcripts from KM and 100,234 transcripts from NW were de novo assembled. The assembled transcripts were used to identify molecular markers (e.g., single-nucleotide polymorphisms and simple sequence repeats), detect tissue-specific expressed genes, and construct a genetic linkage map. In total, 234 single-nucleotide polymorphisms and 25 simple sequence repeats were screened from 7,871 and 8,052 candidates, respectively, between the KM and NW varieties and used for construction of a genetic map with 94 F2 population specimens. The genetic linkage map consisted of 12 linkage groups, and 248 markers were assigned. These transcriptome and molecular marker data provide information useful for molecular breeding of oriental melon and further comparative studies of the Cucurbitaceae family.

Background Hesperidin is a flavonoid with antioxidant, anti-inflammatory, and immune modulatory activities. Photoaging is a consequence of chronic exposure to the sun and ultraviolet (UV) radiation. This study was designed to evaluate the efficacy of hesperidin against photoaging of dorsal skin in hairless mice. Methods Hairless male mice (6-week-old) were divided into three groups (n = 7): control, UVB-treated vehicle, and UVB-treated hesperidin groups. UVB-irradiated mice from hesperidin group were orally administered 0.1 mL of water containing 100 mg/kg body weight per day hesperidin. Results The mean length and depth of wrinkles in the UVB-treated hesperidin group significantly improved after the oral administration of hesperidin, which significantly inhibited the increase in epidermal thickness and epidermal hypertrophy (P < 0.05). UVB irradiation of mice induced epidermal barrier dysfunction including an increase in the transepidermal water loss (TEWL); however, hesperidin decreased the TEWL. UVB irradiation increased the expression of MMP-9 and pro-inflammatory cytokines whereas UVB-treated hesperidin group showed reduced expression. These results indicate that hesperidin showed anti-photoaging activity in the UVB-irradiated hairless mice. In conclusion, hesperidin inhibited the UVB-induced increase in skin thickness, wrinkle formation, and collagen fiber loss in male hairless mice. Conclusions These results suggest that hesperidin shows potent anti-photoaging activity by regulating MMP-9 expression through the suppression of MAPK-dependent signaling pathways.

Background Proton pump inhibitor use is associated with incident chronic kidney disease, chronic kidney disease progression and end-stage renal disease. However, the extent of proton pump inhibitor prescriptions to chronic kidney disease patients is still unclear. Method In a retrospective study, we enrolled patients (>18 years old) who received proton pump inhibitor in the out-patient setting from 2014 through 2015. All data was obtained from electronical medical records of Soonchunhyang Medical Center. The prescription patterns and characteristics of proton pump inhibitors were analyzed according to individual estimated glomerular filtration rate of the patients. Result During the study period 178,228 patients visited the out-patient clinic. Proton pump inhibitors were prescribed to 9,109 (5.11%) patients. In our sample, 50% were females and 9.8% were chronic kidney disease (eGFR

In this study, marine tunicate Styela clava hydrolysate was produced by an environment friendly and green technology, pressurized hot water hydrolysis (PHWH) at different temperatures (125–275 °C) and pressure 50 bar. A wide range of physico-chemical and bio-functional properties such as color, pH, protein content, total carbohydrate content, reducing sugar content, and radical scavenging activities of the produced hydrolysates were evaluated. The appearance (color) of hydrolysates varied depending on the temperature; hydrolysates obtained at 125–150 °C were lighter, whereas at 175 °C gave reddish-yellow, and 225 °C gave dark brown hydrolysates. The L* (lightness), a* (red–green), and b* (yellow–blue) values of the hydrolysates varied between 35.20 and 50.21, −0.28 and 9.59, and 6.45 and 28.82, respectively. The pH values of S. clava hydrolysates varied from 6.45 (125 °C) to 8.96 (275 °C) and the values were found to be increased as the temperature was increased. The hydrolysis efficiency of S. clava hydrolysate was ranged from 46.05 to 88.67% and the highest value was found at 250 °C. The highest protein, total carbohydrate content, and reducing sugar content of the hydrolysates were found 4.52 mg/g bovine, 11.48 mg/g and 2.77 mg/g at 175, and 200 and 200 °C, respectively. Hydrolysates obtained at lower temperature showed poor radical scavenging activity and the highest DPPH, ABTS, and FRAP activities were obtained 10.25, 14.06, and 10.91 mg trolox equivalent/g hydrolysate (dry matter basis), respectively. Therefore, S. clava hydrolysate obtained by PHWH at 225–250 °C and 50 bar is recommended for bio-functional food supplement preparation.

Beta2-adrenergic receptor (&beta, 2AR) agonists can have protective effects targeting macrophage activation, but research on human subjects has not been done. This study was designed to assess the relationship between the use of &beta, 2AR agonists and diabetic vascular complications. Using data from the Korean National Health Insurance Service, adults first diagnosed with diabetes in 2004 (n = 249,222) were followed up until 31 December 2015. Propensity score matching was performed between case and control groups (n = 5179 in each), and multivariate analysis was conducted. The &beta, 2AR agonist group was divided into quartiles according to the duration of &beta, 2AR agonist use. During the follow-up, the incidence of vascular complications gradually decreased as the duration of &beta, 2AR agonist administration increased. Multivariate analysis revealed that the hazard ratio for all composite vascular complications was 0.80 (95% CI, 0.75&ndash, 0.86, p &lt, 0.001) in the longest quartile of &beta, 2AR agonist use as compared with the control group after adjusting for confounding variables. The association between the duration of &beta, 2AR agonist use and the risk of each vascular complication including cerebrovascular, peripheral vascular, peripheral neural, renal, and ophthalmic complications was consistent, and the risks were significantly lower in the longest users than the control group. Long-term use of &beta, 2AR agonists may exert a protective effect against diabetic vascular complications.

Background Mucormycosis is a rare and life-threatening invasive fungal infection. Pulmonary mucormycosis commonly occurs in patients with severe neutropenia. Typically, pulmonary mucormycosis causes tissue necrosis resulting from angioinvasion and subsequent thrombosis, so most cases can occur with necrotizing pneumonia and/or hemoptysis. Some complex cases may invade adjacent organs, such as the mediastinum, pericardium, and chest wall. However, to the best our knowledge there is little known regarding bronchoesophageal fistula due to pulmonary mucormycosis after induction chemotherapy for acute myeloid leukemia. We present a case report about this unusual presentation. Case presentation A 51-year-old Korean man was diagnosed as having acute myeloid leukemia and received induction chemotherapy. After prolonged severe neutropenia, he complained of coughing with aspiration. Imaging showed a bronchoesophageal fistula with extensive necrotizing pneumonia in the middle and lower lobes of his right lung. Bronchoscopy showed near total tissue necrosis in the middle lobe of his right lung, creating an orifice. A bronchial scope was passed through and was able to be connected with his esophagus; a bronchial wall biopsy was performed. Esophagoscopy revealed a large linear defect of his esophageal wall 30 cm from the incision that may have connected with the bronchus. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating pulmonary mucormycosis. He was given amphotericin B, and a wide excision of lung and esophagus was planned. However, he suddenly died due to massive hemoptysis. Conclusion Here we present an extremely rare case of bronchoesophageal fistula with severe necrotizing pneumonia due to pulmonary mucormycosis.

Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding. (Korean J Gastroenterol 2016;67:153-157)

Tenofovir disoproxil fumarate (TDF) is widely used to treat patients with hepatitis B virus (HBV) infection. We investigated the effect of TDF on renal insufficiency in patients with chronic hepatitis B (CHB). A consecutive cohort analysis was applied to CHB patients taking prescribed TDF from January 2012 to May 2016 at Soonchunhyang University Seoul Hospital. Alterations over time in corrected calcium, phosphate, creatinine, and estimated glomerular filtration rate (eGFR) were analyzed using the generalized estimating equation method. The percentage increase in creatinine from baseline to the maximum creatinine level (delta creatinine) was compared according to the underlying disease using the Mann–Whitney U test. Cox proportional hazard regression model was used to determine risk factors associated with renal insufficiency. The baseline creatinine, eGFR, corrected calcium, and phosphate levels were 0.72 ± 0.01 mg/dL (mean ± SD), 106.37 ± 1.06 mL/min/1.73 m2, 8.82 ± 0.04 mg/dL, and 3.42 ± 0.05 mg/dL, respectively. The creatinine level had increased significantly at 12, 24, 48, 72, and 96 weeks, while the eGFR level had decreased significantly at these 5 time points. Multivariate analysis confirmed that age ≥60 years and the baseline bilirubin level were independently associated with the risk of renal insufficiency. Delta creatinine was significantly higher in patients with diabetes mellitus (DM) than in patients without DM. Renal function was decreased from baseline in CHB patients receiving TDF therapy, which indicates that the renal function of patients undergoing treatment with TDF should be monitored regularly. Old age, DM, and serum bilirubin were risk factors for the development of renal insufficiency in CHB patients receiving TDF therapy.

Betaine is widely distributed in plants, microorganisms, in several types of food and in medical herbs, including Lycium chinense. The administration of 100 mg betaine/kg body weight/day is an effective strategy for preventing ultraviolet irradiation‑induced skin damage. The present study aimed to determine the preventive effects of betaine on ultraviolet B (UVB) irradiation‑induced skin damage in hairless mice. The mice were divided into three groups: Control (n=5), UVB‑treated vehicle (n=5) and UVB‑treated betaine (n=5) groups. The level of irradiation was progressively increased between 60 mJ/cm2 per exposure at week 1 (one minimal erythematous dose = 60 mJ/cm2) and 90 mJ/cm2 per exposure at week 7. The formation of wrinkles significantly increased following UVB exposure in the UVB‑treated vehicle group. However, treatment with betaine suppressed UVB‑induced wrinkle formation, as determined by the mean length, mean depth, number, epidermal thickness and collagen damage. Furthermore, oral administration of betaine also inhibited the UVB‑induced expression of mitogen‑activated protein kinase kinase (MEK), extracellular signal‑regulated kinase (ERK), and matrix metalloproteinase‑9 (MMP‑9). These findings suggested that betaine inhibits UVB‑induced skin damage by suppressing increased expression of MMP‑9 through the inhibition of MEK and ERK.