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Background We investigated the change of coronary atherosclerosis with long-term exposure to fine particulate matter of aerodynamic diameter Methods Subjects undergoing serial CCTAs between January 2007 and December 2017 (n = 3,127) were analyzed. Each individual's cumulative amount of PM2.5 exposure between the two CCTAs was evaluated by Kriging interpolation and zonal analysis, considering the time interval between the two CCTAs. The main outcome was progression of coronary artery calcium (CAC) with additional semiquantitative analysis on the changes in the severity and composition of atherosclerotic plaques. Results The CAC scores increased by 30.8 Agatston units per-year under a median PM2.5 concentration 24.9μg/m3 and tended to increase with the cumulative amount of PM2.5 exposure (r = 0.321, p Conclusions Cumulative exposure to air pollution is associated with the progression of diffuse coronary calcification, the importance of which may be more significant than other traditional cardiovascular risk factors. Further investigations into the causality between PM2.5 and coronary atherosclerosis are warranted to improve global cardiovascular health.

Objectives: Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population.Methods: In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index.Results: The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p

Pleomorphic adenoma occurs primarily in the major salivary glands, but very rarely in the nose. Treatment of nasal pleomorphic adenoma, like pleomorphic adenoma of the major salivary gland, is also a complete resection. Since most are confined to the nasal cavity and do not invade cartilage or other tissues, it can be removed relatively simply by nasal endoscopic surgery. We report a case where a pleomorphic adenoma arising from the right nasal ala invades the lateral crus of lower lateral cartilage, where a part of the cartilage was excised along with removal of the tumor and reconstructed with nasal septal cartilage. Eight months after surgery, the external deformity of nose was not observed and there was no recurrence.

Stickler syndrome is a genetic disorder of connective tissue. One of the major symptoms associated with this disorder is an oro-facial malformation, which may cause a submucous cleft or a complete cleft of the hard palate. A 32-year-old man diagnosed with Stickler syndrome and a submucosal cleft palate (SMCP) visited our hospital with a chief complaint of excessive daytime sleepiness. The patient was diagnosed with severe obstructive sleep apnea (OSA), and administration of a polysomnography test revealed an apnea-hypopnea index (AHI) of 30.9 events/hour (h). Auto-titrating continuous positive airway pressure was initiated to control the OSA symptoms and subsequently the patient showed some improvement. However, due to continuous velopharyngeal insufficiency symptoms, intravelar veloplasty was performed. Three months after surgery, the AHI had decreased to 12.4 events/h. Recent studies have described a greater risk for OSA in individuals with cleft palate, than in the general population. The present case demonstrates surgical success in a patient with OSA and SMCP, suggesting that palatal surgery may be considered an optional surgical treatment for OSA patients with SMCP.

Tantalizing connections between type 2 diabetes and degenerative lumbar spine disorders have become increasingly evident. However, the association of type 2 diabetes with degenerative lumbar spine disorders remains unclear. We sought to clarify the association between type 2 diabetes and lumbar spine disorders using nationwide data in Korea. Furthermore, we explored the association of diabetes with the prevalence of spinal procedures. The data in this study was obtained from Korean health claim database. Between 2016 and 2019, totals of 479,680 diabetes and 479,680 age- and sex-matched control subjects were enrolled. Patients with diabetes had more likely to have degenerative lumbar spine disorders and spinal procedures than controls. Using multivariate-adjusted analysis, patients with diabetes were at increased risk of being concomitantly affected by lumbar disc disorder [adjusted odds ratio 1.11 (95% confidence interval 1.10–1.12)], lumbar spondylotic radiculopathy [1.12 (1.11–1.13)], spondylolisthesis [1.05 (1.02–1.08)] and spinal stenosis [1.16 (1.15–1.18)], compared to controls. Furthermore, diabetic patients had an increased risk of undergoing lumbar spinal injection [1.13 (1.12–1.14)], laminectomy [1.19 (1.15–1.23)], and fusion surgery [1.35 (1.29–1.42)]. We demonstrated that type 2 diabetes was significantly associated with lumbar spine disorders and frequent spinal procedures. Our results suggest diabetes as a predisposing factor for lumbar spine disorders.

Objectives The aim of this study was to investigate the trends of the incidence of and mortality from necrotizing enterocolitis (NEC) in South Korea. Methods Claim data were extracted with diagnosis code, including all stage of NEC. Kaplan-Meier curves for cumulative mortality rates are presented by birth weight (Bwt) and gestational age (GA). Result The total number of NEC cases was 5840. The ratio of males to females was 1.2:1. There were 11.9 cases per 10,000 births. There were approximately 10 cases per 1000 preterm births and 50 per 1000 very preterm births. The mortality of patients born under 37 weeks decreased from 38.7% in 2007 to 20.9% in 2017. Male sex, lower GA, and lower Bwt were risk factors for mortality. Conclusions NEC incidence and mortality have been decreasing over time in South Korea. Male sex, lower GA, and Bwt were risk factors for mortality.

Background and Objectives: The purpose of this study was to investigate the prevalence of incidental paranasal sinus (PNS) opacification in nasal septal deviation (NSD) using computed tomography (CT) and to identify contributing factors.Subjects and Method: We analyzed 216 patients who underwent septoplasty for the correction of NSD and who underwent preoperative PNS CT. We assessed the prevalence of incidental PNS opacification in these patients and determined the type of NSD according to Mladina classification. We also evaluated whether the direction of NSD affected the presence of PNS opacification on CT, and whether the presence of PNS opacification was associated with other rhinologic symptoms.Results: Of 216 patients with NSD, 86 showed opacified PNS on CT. According to Mladina classification, NSD patients were classified as type I (24.1%), type II (36.1%), type III (20.8%), type IV (5.6%), type V (9.7%), type VI (2.3%), or type VII (1.4%). Patients with type II NSD showed a significantly higher incidence of PNS opacification compared with other types of NSD (p=0.001). However, the direction of NSD did not significantly influence the presence of incidental PNS opacification. Furthermore, regardless of the presence of PNS opacification, there was no significant difference in rhinologic symptoms such as olfactory dysfunction, among others.Conclusion: We found that incidental PNS opacification on CT was common in NSD patients, especially in patients with type II NSD. Thus, we suggest that CT evaluation of patients with NSD may be helpful for assessing comorbid PNS pathologies as well as objectively identifying nasal septal deformities.

BackgroundExposure to extremely or moderate low temperatures is associated with increased morbidity and mortality risk. Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. Given that cold temperature causes constriction of the small arteries and veins in the skin, patients who suffer from peripheral circulation problems, like PVD, may be vulnerable to cold injuries. This study aimed to investigate the association between PVD and cold-induced injuries in the winter among Korean adults. We further analyzed the association stratified by body mass index (BMI) classification.MethodsWe used the 2002–2015 National Health Insurance Service-National Sample Cohort data and included a total of 535,186 adults as the study population. Patients with underlying PVD were identified by ICD-10 code I73. Cold-related illnesses were defined by ICD-10 codes (T690, T691, T698, T699, T330 ~ T339, T340 ~ T349, and T350 ~ T357). Body mass index (BMI) was categorized into underweight, normal weight, overweight, and obese.ResultsA total of 23.21% (n = 124,224) were PVD patients, and 0.59% (n = 3154) had cold-induced injuries. PVD patients were more likely to be diagnosed with cold injuries, but it was valid only in the underweight or normal weight groups. After adjusting for age, sex, income, cigarette smoking, alcohol consumption, regular exercise, high blood pressure, and hyperglycemia, PVD patients had a significantly increased odds ratio (OR) for cold injuries [adjusted OR = 1.11; 95% confidence intervals (95% CI): 1.01–1.21]. Increased OR for cold injuries in PVD patients was also observed in adults (adjusted OR = 1.14; 95% CI: 1.03–1.25 in Model 2), but not in the elderly. When we classified study subjects into the four BMI groups, the adjusted OR of cold injuries in PVD patients was significant in the underweight group (OR = 1.83; 95% CI, 1.26–2.66) and normal weight group (OR = 1.15; 95% CI, 1.03–1.27), not in those with overweight and obese. In adults, a consistent result was found in adults in the underweight group (OR = 1.63; 95% CI, 1.08–2.47 in Model 2) and normal weight group (OR = 1.19; 95% CI, 1.07–1.33 in Model 2). In the elderly, the adjusted OR for cold injuries was only significant in the underweight group (OR = 3.37; 95% CI, 1.08–10.53 in Model 2).ConclusionsWe found a significant association between PVD and cold-induced injuries in the general population. BMI modified the association. Thus, the association observed appears to be clinically applicable to PVD patients being low to normal BMI.

Background and Objectives Although patients with chronic rhinosinusitis (CRS) present a similar degree of olfactory dysfunction, their impairments in threshold, discrimination, and identification test results may vary. We investigated factors related to each of these components using the Korean version of the Sniffin’ Sticks test II in CRS patients.Subjects and Method A total of 120 CRS patients with olfactory dysfunction were enrolled and assigned to hyposmia and anosmia groups. Correlation between the three components were examined in both groups. We also subdivided patients into higher- and lower-score groups according to the threshold, discrimination, and identification scores within the hyposmia and anosmia groups to determine associated factors among the demographic factors, CRS severity on computed tomography (CT) and endoscopic findings.Results Threshold, discrimination, and identification scores were significantly correlated in hyposmia patients. Age [odds ratio (OR), 0.94] was associated with the threshold score, and the anterior olfactory cleft opacification score (OR, 1.31) on CT was associated with identification difficulties in hyposmia patients. The posterior olfactory cleft opacification score was associated with threshold (OR, 2.76) and identification difficulties (OR, 1.68) in anosmia patients. However, we could not identify significant risk factors for discrimination in both groups.Conclusion We demonstrated that the three components of the olfactory function test for CRS are significantly correlated in patients with hyposmia. Age was associated with threshold score in hyposmia patients and CRS severity, and with discrimination scores in both hyposmia and anosmia patients. These findings will help the understanding of pathophysiology of CRSrelated olfactory dysfunction.Korean J Otorhinolaryngol-Head Neck Surg 2020;63(8):358-68

The purpose of this study was to investigate the outcomes after appendectomy in children according to hospital size. The records of 11,565 patients with the diagnosis-related group code for appendectomy were extracted from HIRA-Pediatric Patient Sample from 2012 to 2016. The number of hospital visits and the length of stay in hospital within 30 days after appendectomy were analyzed. Patients who were treated at large-sized hospitals were more likely to be younger, more likely to reside in metropolitan areas, and tended to receive laparoscopic surgery. The number of hospital visits within 30 days in patients managed by medium- and large-sized hospitals decreased in comparison to small-sized hospitals. The length of hospital stay in large-sized hospitals was decreased in comparison to small- and medium-sized hospitals. A subgroup analysis revealed that complicated appendectomy did not have a significant impact on the difference in the length of hospital stay between hospital sizes. The number of hospital visits and the length of hospital stay was higher in small-sized hospitals in comparison to large-sized hospitals. Appendectomy performed in the larger hospital showed better outcomes in pediatric patients. We recommend that pediatric surgical procedures be performed in large hospitals, and that proper incentives be given for procedures to be performed by pediatric specialists.

Objectives The purpose of this study was to determine whether eating non-home-prepared meals (NHPM), including fast food, ready-to-eat foods, and frozen foods, was associated with self-reported infertility in the United States women. Methods Data on diet and infertility from women aged 20-49 years who participated in the 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys were analyzed (n=2143). Dietary information, including the number and types of NHPM consumed, was obtained from a self-reported questionnaire, and infertility status was analyzed using the following question, "Have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?" Results The frequency of NHPM consumption was positively associated with self-reported infertility after adjusting for confounding effects (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.48 to 5.38 of g1 vs. 0 NHPM/d). The odds of infertility were 2-3 times higher in women who consumed fast food than in those who did not consume fast food (OR, 2.73; 95% CI, 1.15 to 6.48 of g1 vs. 0 times/d). Conclusions The frequency and types of NHPM may be a factor contributing to infertility. Although our findings require confirmation, they suggest that eating out may be deleterious to women fecundity.

Background Chloroform is a water disinfection by-product associated with hepatic, renal and neurotoxicity. High concentrations of chloroform are known to cause central nervous system depression; however, the association between blood chloroform levels and cognitive function in the general elderly population is unknown. In this study, we investigated the association between blood chloroform levels and cognitive function in the elderly US population (n=782). Methods We analyzed blood chloroform levels and cognitive function, as measured by the digit symbol substitution test (DSST), from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES) for participants aged 60 years and older. Blood chloroform levels were measured using capillary gas chromatography and mass spectrometry with selected-ion monitoring detection and istotope-dilution. Results After adjusting for all covariates, increases in log-transformed blood chloroform levels were significantly associated with decreased DSST scores (β = -1.56, SE = 0.57, p-value 0.010). Compared with individuals in the lowest quartile of blood chloroform, the regression coefficients were significantly lower among those in the second and third tertile (tertile 2 β = -3.00 (SE = 1.25, p-value 0.022); tertile 3 β = -4.05 (SE = 1.22, p-value 0.002)). After stratification by obesity status, increases in log-transformed chloroform levels showed borderline significant associations with decreased DSST scores among the obese (β = -1.71, SE = 0.85, p-value 0.052). Conclusions Our finding suggest a possible link between blood chloroform levels and cognitive function in the US elderly population.

(1) Background: Previous studies have suggested the association between lipid profiles and cognitive function in older adults. However, they generated inconsistent results. We aim to determine the relationship between lipid profiles and cognitive performance in older adults. (2) Methods: We used the 2011–2014 National Health and Nutrition Examination Survey. This study included 2215 participants who were aged more than 60 years old and free of coronary heart disease or stroke. Lipid profiles included total cholesterol (TC), low density lipid cholesterol (LDL), high density lipid cholesterol (HDL), and triglyceride (TG). Cognitive function was assessed using the digit symbol substitution test (DSST). (3) Results: Positive correlations of DSST were observed with TC (r = 0.111, p &lt, 0.0001), HDL (r = 0.127, 0.0001), and LDL (r = 0.107, p = 0.0005). However, there was no significant relationship between TG and DSST. A one-unit increase in HDL was associated with an increase in DSST score (beta coefficient: 0.036, p = 0.018), but the association was not significant for LDL, TG, and TC. In the categorical analysis, the high HDL group had a higher DSST score than the low HDL group (beta = 3.113, 0.0001) and the low TG group was more likely to show a lower DSST score than the high TC group (beta = −1.837, p = 0.0461). However, LDL and TC showed no statistically significant associations. Moreover, HDL was only associated with a 0.701 times increased risk of cognitive impairment (95% CI = 0.523–0.938) in the logistic regression analysis. (4) Conclusions: Higher blood concentrations of HDL levels were positively associated with DSST scores in older adults. We suggest that the high levels of HDL may be a protective factor against cognitive impairment.

Background Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes. Methods Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and Lund-Mackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes. Results In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis (P < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and P (the value of prediction probability) = 1 / (1 + exp [−0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) − 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed. Conclusion Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS., Graphical Abstract

Fungus ball (FB) is the most common type of fungal rhinosinusitis and the prevalence of FB has increased over the past 10 years. The aim of this study was to compare the clinical characteristics of Korean adult patients with FB and chronic rhinosinusitis (CRS) without FB. We retrospectively analyzed data on 1362 patients (147 FB and 1215 CRS) who underwent endoscopic sinus surgery at nine Korean medical centers in 2005, 2010, and 2016. We evaluated the prevalence of FB and compared the clinical characteristics of FB and CRS. Medical records, computed tomography (CT) findings, atopic status, concomitant diseases, tissue, and blood eosinophil count were assessed. The prevalence of FB was significantly higher in 2016 (15.9%) than in the other years (7.8% in 2005 and 7.5% in 2010). The FB patients were more likely to be female, older, have unilateral disease and less likely to have allergy compared to the CRS patients. The most common main complaint related to CRS and FB was nasal obstruction. CT determined that unilateral disease and maxillary sinus dominancy were common in patients with FB. The incidence of concomitant diseases was much higher in FB, with lower tissue and blood eosinophilia. FB is commonly encountered in older women with the increased prevalence. FB had a different clinical presentation, radiological findings, and prognosis than CRS. Further studies are needed to understand the pathophysiologic mechanisms underlying the development of FB.

Objectives The aim of this study is to examine the association of successful aging with mortality and further find gender differences in the effect of components of successful aging on mortality risks. Design Retrospective cohort study. Setting and participants A total of 3848 adults aged 65 and older from the Korean Longitudinal Study of Aging (2006-2014) data. Measures Successful aging was defined as success in the following 7 components: absence of major disease, no depression, no freedom from disability, high cognitive and physical function, active social engagement, and satisfaction with life. All-cause mortality was measured by death certificate and family interview. Results In both genders, the mortality rate was higher in the older adults who did not achieve successful aging than in their counterparts (men: hazard ratio [HR] = 1.69, 95% confidence interval [CI] 1.18-2.43; and women: HR = 2.37, 95% CI 1.21-4.63). All components of no successful aging were associated with an increased risk of mortality except for no satisfaction with life in females. Mortality rates were predominant in major disease (HR = 1.86, 95% CI 1.54-2.25) and depressive symptoms (HR = 1.62, 95% CI 1.26-2.10) in males, and disability (HR = 2.08, 95% CI 1.68-2.57) and low physical functioning (HR = 2.31, 95% CI 1.79-2.98) were predominant in females. Conclusion/Implication We found that older Koreans who did not achieve successful aging had a higher risk of all-cause mortality than successful agers. There were gender differences in mortality risks across all components of successful aging.

Background Self-employed business owners in Korea make up one-quarter of the working population, and half of those who are self-employed are in micro and small businesses. Compared to the significant research interest in business management and economics, to date, there has been little interest in the health of small business owners. We investigated the health status of self-employed small business owners compared to standard workers. Methods The third Korean Working Conditions Survey, which included a total of 32 630 adults aged 20 to 59 years, was analyzed. A small business was defined as an enterprise with between 0 and 4 workers. Standard employment included full-time employment with a permanent or 1-year contract. Health outcomes included eight types of physical health and mental health problems assessed using the WHO-5 Wellbeing Index. Results Small business groups were found to have an increased prevalence of depression after controlling for all potential covariates (odds ratio [OR] = 1.37; 95% confidence interval [CI] 1.29-1.47). In addition, the prevalence of work-related physical health problems was significantly higher among self-employed small business owners in a full adjusted model: backache (OR = 1.16; 95% CI, 1.06-1.26), muscular pains in upper limbs (OR = 1.19; 95% CI, 1.12-1.27), and muscular pains in lower limbs (OR = 1.14; 95% CI, 1.07-1.22). Conclusion We found a positive association between small business entrepreneurs and increased prevalence of mental and physical illness in adults in the Republic of Korea.

Objective Sleep hygiene-related conditions are factors that affect the symptoms experienced by patients with obstructive sleep apnea (OSA). However, very few studies have investigated the association between sleep hygiene and sleep symptoms, especially in patients with mild or moderate OSA. This study evaluated the relationship between factors related to sleep hygiene and clinical symptoms in patients with mild to moderate OSA. Methods One hundred and seventy-four patients who visited the Sleep Breathing Disorder Center at a tertiary academic center to evaluate suspected OSA were included. All patients underwent standard polysomnography (PSG) and the Epworth sleepiness scale (ESS) and questionnaires related to daytime and nighttime symptoms and sleep hygiene. Medical records were reviewed for demographic, clinical, and PSG parameters. Correlation analysis between sleep hygiene-related conditions and clinical symptoms in patients with mild to moderate OSA was performed. Results The correlation analysis between the nine categories of sleep hygiene and the three categories of clinical symptoms showed that, in the case of inadequate temperature and humidity conditions, the three categories of clinical symptoms were more severe (daytime symptoms r = 0.382, nighttime symptoms r = 0.568, ESS score r = 0.321). Drinking alcohol before sleep (daytime symptoms r = 0.457, nighttime symptoms r = 0.649, ESS score r = 0.301) and emotional excitement or arousal (daytime symptoms r = 0.378, nighttime symptoms r = 0.545, ESS score r = 0.341) were correlated with greater severity of each of the clinical symptoms (p Conclusion Among the factors of sleep hygiene-related conditions, inadequate temperature and humidity, drinking alcohol before sleep, and emotional excitement or arousal were associated with symptoms of mild to moderate OSA. This study supports the hypothesis that patients with mild to moderate OSA can experience symptom relief if they are trained to correct lifestyle habits to maintain adequate sleep hygiene-related conditions.

Background: The aim of this study was to examine the correlation between the number of remaining natural teeth (NRT) and the appendicular skeletal muscle mass index (SMI) in older adults. Methods: This study was based on data from the 2008–2010 Korea National Health and Nutritional Examination Surveys. The participants were 2,378 older participants (984 men and 1,394 women) aged over 65 years. Survey dentists conducted oral health examinations, and ASM was measured using dual-energy X-ray absorptiometry. Results: The participants with NRT≥20 had more ASM and SMI than those with NRT＜20 in both sexes. SMI was correlated with NRT in men (r=0.018, p＜0.001) and in women (r=- 0.007, p＜0.001). The positive correlation between the NRT and SMI remained significant in men even after adjusting for age, marital status, income, smoking, drinking, physical activity, protein intake, energy intake, calcium intake, body mass index, fasting blood glucose level, medications, and prostheses (β=0.011, p=0.001). In women, the correlation disappeared after adjustment for smoking, alcohol, physical activity, protein intake, energy intake, calcium intake, marital status, income, fasting basal glucose, medication administration, and prostheses. Conclusion: This study showed a correlation between NRT and SMI in those ≥65 years of age in Korea. The relationship persisted in men, but not in women, even after adjusting for confounders.

Background: Exposure to noise poses auditory and non-auditory effects on health. The gastrointestinal tract is considered as the site of adverse reactions to noise-induced stress; little attention has been paid to a potential link between noise and peptic ulcers. Objectives: The aim of this study was to investigate whether cumulative exposure to environmental noise affects the incidence of peptic ulcer in adults. Methods: We analyzed the data from the National Health Insurance Service-National Sample Cohort (2002−2013). The final study sample comprised 217,308 adults assessed for gastric ulcer and 249,514 adults assessed for duodenal ulcer. The diagnosis of gastric (ICD-10: K25) and duodenal (ICD-10: K26) ulcers during an 8-year follow-up (2006–2013). Environmental noise data was obtained from the National Noise Information System, a nationwide monitors system of noise. Results: During the follow-up period, gastric ulcers occurred in 32.1% subjects and duodenal ulcers occurred in 10.7% subjects. The rate of diagnosis for gastric and duodenal ulcers was increased with the increases in cumulative mean levels of nighttime environmental noise. With increases in the increase in interquartile range (IQR) of nighttime noise, the hazard ratio (HR) was significantly increased by 12% (HR = 1.12; 95% CI, 1.10–1.13) for gastric ulcer and 17% (HR = 1.17; 95% CI, 1.15–1.20) for duodenal ulcer based on the fully adjusted model. Conclusion: Our finding supports previous reports on the damaging effect of environmental noise on the gastrointestinal tract and suggests that cumulative exposure to environmental nighttime noise affects the development of peptic ulcers. Keywords: Environmental noise, Cumulative exposure, Stressor, Gastrointestinal tract, Ulcer

Background Recent evidence suggests that sodium imbalances may be associated with cognitive impairment; however, the association between specific domains of cognition remains unclear. This study examines the association between serum sodium levels and immediate and delayed verbal memory as measured by the CERAD Word Learning Test (CERAD WLT), executive function as measured by the Animal Fluency test (AFT), and sustained attention, working memory, and processing speed as measured by the Digit Symbol Substitution test (DSST) in the elderly population of the US aged 60 and older who participated in the 2011–2014 National Health and Nutrition Examination Surveys (n = 2,541). Methods Cognitive function tests were performed by trained interviewers and sodium levels were measured using indirect ion selective electrode methodology. Results After adjusting for all covariates, quintiles of CERAD WLT scores showed significant positive associations with log-transformed sodium levels (Immediate recall (IR) β = 4.25 (SE = 1.83, p-value 0.027); Delayed recall (DR) β = 6.54 (SE = 1.82, p-value 0.001)). Compared to normal sodium levels, hyponatremia was significantly associated with lower CERAD WLT-IR (β = -0.34, SE = 0.15, p-value 0.035) and CERAD WLT-DR scores (β -0.48, SE = 0.10, p-value Conclusions Our cross-sectional study showed that lower sodium levels were associated with cognitive change, especially regarding memory and executive function.

BackgroundGiven that low income worsens health outcomes, income differences may affect health disparities in weather-related illnesses. The aim of this study was to investigate the association between income levels and prevalence of heat- and cold-related illnesses among Korean adults.MethodsThe current study comprised 535,186 participants with all variables on income and health behaviors. Patients with temperature-related illnesses were defined as individuals with outpatient medical code of heat- and cold-related illnesses. We categorized individual income into three levels: “low” for the fourth quartile (0–25%), “middle” for the second and the third quartiles (25–75%), and “high” for the first quartile (75–100%). To examine income-related health disparities, Cox proportional hazard regression was performed. Hazard ratios (HRs) and 95% CI (confidence interval) for heat- and cold-related illnesses were provided. The model adjusted for age, sex, smoking status, alcohol drinking, exercise, body mass index, hypertension, hyperglycemia, and local income per capita.ResultsA total of 5066 (0.95%) and 3302 (0.62%) cases identified patients with heat- and cold-related illnesses, respectively. Compared with high income patients, the adjusted HR for heat-related illnesses was significantly increased in the low income (adjusted HR = 1.103; 95% CI: 1.022–1.191). For cold-related illnesses, participants with low income were likely to have 1.217 times greater likelihood than those with high income (95% CI: 1.107–1.338), after adjusting for other covariates. In the stratified analysis of age (20–64 years and over 65 years) and sex, there was no difference in the likelihood of heat-related illnesses according to income levels. On the other hand, an HR for cold-related illnesses was higher in patients aged 20 to 64 years than in those aged over 65 years. Male with low income had also a higher HR for cold-related illnesses than female with low income.ConclusionsOur results showed that heat- or cold-related illnesses were more prevalent in Koreans with low income than those with high income. Strategies for low-income subgroups were needed to reduce greater damage due to the influence of extreme temperature events and to implement effective adaptation.

Background The burden of infectious diseases in infants is substantial. Parental education has been considered as a critical factor for predicting infant mortality. However, even though some studies have been done about relationship between infectious disease and parent’s education level, no researches have been conducted specifically about vaccine-preventable and non-vaccine-preventable disease mortality by parent’s educational level. Purpose This study aimed to compare infant mortality rates from all-infectious diseases, vaccine-preventable and non-vaccine-preventable diseases by mother’s and father’s education levels. Methods We used 2017 US Linked Birth and Infant Death Data from National Center for Health Statistics, which included 3,153,574 live births and 13,870 deaths. To identify the association between each mother’s and father’s education level and all-infectious disease, vaccine-preventable disease, and non-vaccine-preventable disease infant mortality, logistic regression analyses were conducted by using educational level 1 as the reference. All-infectious diseases, vaccine-preventable and non-vaccine-preventable diseases were identified by vaccination recommendation of 2017 CDC guideline. Education levels were classified into four groups: level 1, through 12th grade with no diploma; Level 2, high school graduate or GED completed; Level 3, some college credit but no degree or associate degree; and Level 4, bachelor’s degree, master’s degree, doctorate or professional degree. Results Higher parents’ education level was appreciably associated with lower infant mortality from all-cause, all-infectious diseases, vaccine-preventable diseases, and non-vaccine-preventable diseases. Moreover, each mother’s and father’s education level was correlated to infant mortality due to vaccine-preventable diseases on the whole education level, while all-infectious disease and non-vaccine-preventable disease mortality is related with parent’s education level only if their education level is fairly high. In other words, the adjusted odds for vaccine-preventable disease mortality were significantly lower than that for all-infectious and non-vaccine-preventable disease mortality at education level 2 and 3 and still smaller at education level 4. Conclusion These finding implies that each mother’s and father’s higher education level was associated with lower infant mortality rate from all-infectious diseases, vaccine-preventable diseases, and non-vaccine-preventable diseases. Furthermore, each level of mother’s and father’s education was more likely to be related to infant mortality by vaccine-preventable diseases than that of infant mortality by all-infectious diseases, and non-vaccine-preventable diseases.

The association between longest-held lifetime occupation and late-life cognitive impairment: Korean Longitudinal Study of Aging (2006&ndash, 2016). Backgrounds: Our study hypothesized that occupation in adulthood may be one of the modifiable factors in cognitive performance. This follow-up study aimed to examine whether there was an association between the longest-held occupation in a lifetime and cognitive impairment. Methods: This study used data from the 2006, 2012, and 2016 waves of the Korean Longitudinal Study of Aging, and a total of 1733 subjects aged over 65 were included. Longest-held occupation in a lifetime was classified into blue-collar, pink-collar, and white-collar. Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination. Results: In males, no significant associations were observed. In females, on the contrary, risk of cognitive impairment in the blue-collar occupation was consistently higher than in the white-collar occupation over the 10-year follow-up (2006, OR = 2.49, 95% CI 1.05&ndash, 5.88, 2016, OR = 2.17, 95% CI 1.02&minus, 4.65). Conclusions: Lifetime occupation should be taken into consideration in the process of screening for cognitive decline in the elderly, especially females. This study needs to be interpreted cautiously in view of inherent data and methodological limitations.

The relationship between caffeine and insulin resistance (IR) has been assessed only in terms of caffeine intake, and the association between caffeine and beta cell function (BCF) remains unclear. This study examines the association between urinary caffeine and its metabolites, IR, and BCF in nondiabetic, noninstitutionalized US adults in order to account for the inter-individual differences in caffeine metabolism. Data on urinary caffeine and its metabolites, IR and BCF from adults aged 20 years and older who participated in the 2009&ndash, 2010 and 2011&ndash, 2012 National Health and Nutrition Examination Surveys were analyzed (n for caffeine = 994). IR and BCF were assessed using homeostatic model assessment (HOMA) and urinary caffeine and its metabolites were measured using high-performance liquid chromatography-electrospray ionization-tandem quadrupole mass spectrometry. After adjusting for all covariates, increases in urinary 1,3-DMU, 1,7-DMU, 1,3,7-TMU, theophylline, paraxanthine, caffeine, and AAMU were significantly associated with increased HOMA-IR and HOMA-&beta, (HOMA of insulin resistance and beta cell function). Compared with individuals in the lowest quartile of urinary 1,3-DMU, 1,7-DMU, 1,3,7-TMU, theophylline, paraxanthine, caffeine, and AAMU, the regression coefficients for HOMA-IR and HOMA-&beta, were significantly higher among those in the highest quartile. After stratification by prediabetes status, HOMA-IR and HOMA-&beta, showed significant positive associations with urinary caffeine and its metabolites among subjects with normal fasting plasma glucose levels. Our cross-sectional study showed that caffeine and its metabolites were positively related to IR and BCF.

Background Synchronous cancer in patients with abdominal aortic aneurysm (AAA) increases morbidity and mortality after AAA repair. However, little is known about the impact of the history of cancer on mortality after AAA repair. Methods Patients with intact AAA who were treated with endovascular aneurysm repair or open surgical repair were selected from the Health Insurance and Review Assessment data in South Korea between 2007 and 2016. Primary endpoints included the 30- and 90-day mortality and long-term mortality after AAA repair. The Cox proportional hazards models were constructed to evaluate independent predictors of mortality. Results A total of 1999 patients (17.0%, 1999/11785) were diagnosed with cancer prior to the AAA repair. History of cancer generally had no effect in short-term mortality at 30 and 90 days. However, short-term mortality rate of patients with a history of lung cancer was more than twice that of patients without it (3.07% vs. 1.06%, P = 0.0038, 6.14% vs. 2.69%, P = 0.0016). Furthermore, the mortality rate at the end of the study period was significantly higher in AAA patients with a history of cancer than in those without a history of cancer (21.21% vs. 17.08%, P Conclusions The history of cancer in AAA patients increases long-term mortality but does not affect short-term mortality after AAA repair. However, AAA repair could increase both short- and long-term mortality in patients with lung cancer history, and those cases should be more carefully selected.

Study Objectives This study investigated the association between ambient nighttime temperature and sleep problems assessed by the prescription dose of sleeping pills in South Korean adults. Methods We used the 2002–2015 National Health Insurance Service-National Sample Cohort. A total of 711,079 adults who were 20 years old or older were included, wherein 42,858 adults (~6%) had been prescribed hypnotic medications including zolpidem (N05CF02) and triazolam (N05CD05). Ambient temperature data was calculated as the mean highest temperature of nighttime (23:00–07:00) for every month from January to December. We combined the drug-prescribed date with the administrative districts-level daily nighttime temperature between 2002 and 2015. Results We found that a non-linear, U-shaped relationship between nighttime temperature and hypnotic medication prescription. With an increase per 1°C temperature or an increase in a square per 1°C, the prescription dose of sleeping pills was significantly increased (both p < 0.05). At each 5°C nighttime temperature, subjects belonging to low (≤0°C and 0–5°C) or high (20–25°C and ≥25°C) temperature categories had significantly higher doses of sleeping pills than those at the reference temperature (10–15°C). Changes in nighttime temperature had a significant non-linear effect on the prescribed dosage of hypnotic medications for both adults (p < 0.0001) and the elderly (p = 0.0006). Conclusion We found that either a high or low nighttime temperature was significantly associated with a high daily dose of hypnotic medications in the Korean population.

Introduction While there has been some gerontological research on healthy aging, few studies have identified a reasonable health status for the older adults. Guided by the four healthy aging concepts in studies from the US and Spain, this study sought to determine a useful definition for Korean older adults by examining the associations between each of the four healthy aging definitions and mortality. Methods A longitudinal analysis was conducted based on the 2,960 older people (65 years or older) who participated in the Korean Longitudinal Study of Aging (2006–2014). Four healthy aging gradient definitions (Rowe and Kahn, Group Ⅰ, Group II, and Group III) were determined: absence of disease, free of disability, physical and cognitive function, and engagement with life. Results The young old who failed to achieve healthy aging were found to have a higher risk of mortality in all four healthy aging gradient definitions in both males (HR range from 4.15 to 5.39) and females (HR range from 4.07 to 9.55). In old old, however, the unhealthy aging mortality risk in Rowe and Kahn's definition was disappeared, but predominant mortality risks were found in Group III for both male (HR = 3.16, 95% CI 1.67 – 5.98) and female (HR = 3.65, 95% CI 1.36 – 9.81) Conclusion To promote healthy aging, we suggest that the definition for the young old includes rigid disease criteria, and old old emphasize functional ability. Age-specific aims for healthy aging may be useful for defining healthy aging.

Lead and cadmium are known to be potential female reproductive toxins. However, studies on the relationship between these metals and infertility are limited. This study examines the association between self-reported infertility and blood lead and cadmium levels in US women by comparing metal levels in infertile and pregnant women. Data on blood lead, blood cadmium, and infertility from women aged 20&ndash, 39 years who participated in the 2013&ndash, 2014 and 2015&ndash, 2016 National Health and Nutrition Examination Surveys were analyzed (n = 124, &lsquo, pregnant&rsquo, n = 42, &lsquo, infertile&rsquo, n = 82). Blood lead and cadmium levels were measured using inductively coupled plasma mass spectrometry, and infertility and pregnancy status were assessed using a self-reported questionnaire. Low blood lead and cadmium levels (geometric mean of blood lead = 0.50 &micro, g/dL and blood cadmium = 0.26 &micro, g/L) were positively associated with self-reported infertility after adjusting for confounding effects (odds ratio (OR) for lead per two-fold increase in blood metal levels = 2.60, 95% confidence interval (95% CI), 1.05&ndash, 6.41 and OR for cadmium per two-fold increase = 1.84, 95% CI, 1.07&ndash, 3.15). Although our findings require confirmation, they suggest that even low blood cadmium and lead levels may be deleterious to female fecundity.

Objectives A cross-sectional study was conducted to investigate whether working hours mismatch is associated with workaholism. Material and methods This study used the data from the 17th wave (2014) of the nationwide Korean Labor and Income Panel Study. Workaholism was evaluated using the Workaholism Analysis Questionnaire. The final study involved 3157 subjects who answered questions regarding both workaholism and working hours mismatch. To identify the association between working hours mismatch and workaholism according to weekly working hours, a stratification analysis was conducted by dividing the number of working hours/week into 3 groups (≤40 h, 41-59 h, and ≥60 h). The odds ratios were calculated using a multiple logistic regression model, which was adjusted for potential confounders. Results The workers working more hours than desired showed the greatest frequency of workaholism. As regards workaholism, in all weekly working hours groups, the odds ratios of the group working more hours than desired were 4.28, 95% CI: 2.29-7.99 (≥40 h), 2.14, 95% CI: 1.34-3.43 (41-59 h), 3.40, 95% CI: 1.60-7.21 (≤60 h), which were statistically significant compared to the reference (matched) group. There was no statistically significant relationship between working hours and workaholism when stratified according to the mismatch in working hours. Conclusions The workers' working hours mismatch can be significantly related to workaholism. Int J Occup Med Environ Health. 2020;33(2):187-94.

Objectives: This study investigated whether the biomarkers present in nasal fluid reflect the severity of symptoms in patients with persistent allergic rhinitis (PAR). Methods: We enrolled 29 PAR patients complaining of nasal symptoms and testing positive to skin prick test. Patients’ total nasal symptom score (TNSS) was measured and their nasal lavage fluid (NALF) was collected. The levels of biomarkers including Clara cell protein 16 (CC16), tryptase, and interleukin 5 (IL-5) in NALF were determined via enzyme-linked immunosorbent assay (ELISA). Results: PAR patients were classified into persistent mild and persistent moderate-to-severe groups according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. The CC16 alone was significantly negatively correlated with TNSS ( P Conclusions: The levels of CC16 alone among several NALF biomarkers showed an inverse correlation with symptoms of PAR patients.

Genioglossal advancement, which is one of the treatments for obstructive sleep apnoea, can be effective only if it contains enough genial tubercle for an osteotomy. The aim of this study was to establish the position of the genial tubercle and of the optimal osteotomy during genioglossal advancement. Twenty-four adult cadavers with intact bony mandibular structures were included. Five variables were measured: the width and height of the genial tubercle (GTW); the distance from its inferior border to the inferior border of the mandible (IGT-IBM); the distance from the superior border of the genial tubercle to the inferior border of the mandible (SGT-IBM); and the width of the intermental foramen (IMFW). The following mean (SD) (range) measurements were obtained: GTW 7.38 (1.43) (4.5-10.0); GTH 7.94 (1.45) (5.0-10.0); IGT-IBM 7.96 (2.29) (4.0-12.0); SGT-IBM 15.90 (2.29) (12.0-20.0); and IMFW 56.65 (6.44) (43.0-67.0) mm. Of the 24 cadavers, 22 showed evidence of optimal positioning when the osteotomy was placed 2mm higher than the SGT-IBM measured on the inner table. This suggests that an optimal osteotomy, which includes the genial tubercle, may be possible in most patients when the osteotomy is positioned 2mm higher at the SGT-IBM.

Background Noise is defined as "sound that is unwanted, unpleasant, or harmful to health." It may induce negative emotions and mental health problems and even may leads to increased suicide risk. Little attention has been paid so far to a potential link between noise and suicide. We investigated the association between nighttime environmental noise and suicide death in adults in the Republic of Korea. Methods We analyzed the data from the National Health Insurance Service-National Sample Cohort, with a 4-year baseline (2002-2005) and an 8-year follow-up (2006-2013) assessment. A total of 155,492 adults constituted the study sample: younger adults (20-54 years, n = 124,994), or older adults (≥55 years, n = 30,498), and adults with mood and anxiety disorders (n = 34,615). Suicide death was defined as per International Classification of Diseases-10 code X60-X84. Data on nighttime noise were obtained from the National Noise Information System. Results During the study period, 315 (0.2%) died of suicide. The incidence of suicide per 100,000 person-years was 25.71. With interquartile range increases in nighttime noise, the adjusted hazard ratio (HR) for suicide death was significantly increased: 1.32 (95% confidence interval [CI]: 1.02-1.70) for younger adults, 1.43 (95% CI: 1.01-2.02) for older adults, and 1.55 (95% CI: 1.10-2.19) for adults with mental illness. In the penalized regression spline models, the HRs for suicide death were gradually increased with environmental noise levels, and the risk was the highest for adults with mental illness. Conclusions We found a significant association between exposure to nighttime noise and the risk of suicide death in adults in the Republic of Korea.

Objective Over 24% of older American adults (approximately 14 million) are estimated to have reduced olfactory sensitivity. Previous studies have provided evidence that patients with diabetes mellitus (DM) or its complications are at increased risk of olfactory dysfunction. We therefore investigated whether smell dysfunction was associated with DM-related biomarkers, including fasting blood glucose, glycohemoglobin, serum insulin, and homeostasis model assessment of insulin sensitivity (HOMA-IR), in older US adults. Methods Data from 9,678 older adults who had participated in the 2013 to 2014 National Health and Nutrition Examination Survey were available for this study. We used the eight-item, self-administered scratch-and-sniff smell test (Sensonics, Inc., Haddon Heights, NJ) for assessing smell. Smell dysfunction was defined as the condition with an odor identification score of ≤ 5. Results Of the 978 participants, 20% of older adults (n = 193) were defined as having smell dysfunction. After adjustment for potential confounding variables, participants in the highest HOMA-IR quintile had approximately two-fold increased odds (odds ratio = 2.25; 95% confidence interval: 1.25-4.05) of smell dysfunction compared with those in the lowest HOMA-IR quintile. In contrast, the odds of smell dysfunction were not associated with the quintiles for fasting blood glucose, glycohemoglobin (HbA1c), or serum insulin levels. Conclusion We found a significant association between smell dysfunction and severe insulin resistance in older US adults. Our data suggests that insulin resistance may be mechanistically linked to loss of smell function. Level of evidence 4. Laryngoscope, 128:1992-1996, 2018.

Background and Objective Abnormal eating behaviors and decreased appetite are usually found in children with adenotonsillar hypertrophy (ATH). The aim of this study was to examine eating behaviors and appetite using Korean–Children’s Eating Behavior Questionnaire (K-CEBQ) in ATH children and compare the subgroups according to combined problems. Methods Parents of 147 children (boy 97, girl 50) aged 2.4–14.1 years (6.8 ± 6.86 yrs) completed a validated K-CEBQ from December 2015 to December 2016. Patients were categorized and compared between allergy (n = 41) and non-allergy (n = 104); with frequent upper respiratory tract infection (URI, n = 65) and without frequent URI (n = 82); with obstruction problems only (n = 57), with infectious problems only (n = 7) and with both problems (n = 83). Analyses were conducted to examine correlations between scores of the subscales, K-CEBQ and children subgroups. Results All subscales of K-CEBQ except food fussiness were not significantly different between allergy and non-allergy groups. However, food fussiness was significantly different between the two groups (p = 0.015). There were no significant differences in subscales of K-CEBQ for other comparisons. Conclusions ATH itself or sleep disordered breathing due to ATH might have a major contribution to appetite and eating behavior irrespective of allergy, recurrent URI, or surgical indications. Further study is needed to determine changes of appetite and eating behavior after adenotonsillectomy.

Background Pyrethroids, one of the most commonly used pesticide classes, are considered to be selectively toxic toward insects rather than toward humans. However, there are accumulating data about pyrethroids toxicity in humans, especially sex organs. Thus, we investigated whether pyrethroids affected reproductive organs, especially the prostate gland. Methods With 1305 subjects who participated in the National Health and Nutrition Examination Survey, several measurements were performed: 3-phenoxybenzoic acid (3-PBA), a common metabolite of pyrethroids; prostate-specific antigen (PSA); and other covariates. Both logistic and linear regression analyses were performed after stratifying according to kidney function, which was evaluated based on the estimated glomerular filtration rate (eGFR). Results By logistic regression, the ORs (95% CIs) of the highest quantile to the reference group for higher total PSA were 2.039 (1.018 – 4.084) in the total study population and 2.219 (1.083–4.548) in the high eGFR group. The ORs (95% CIs) of the highest quantile to the reference group for a lower PSA ratio were 1.979 (1.057 – 3.707) in the total study population and 2.101 (1.086 – 4.064) in the high eGFR group. By linear regression, a marginally significant positive correlation between urinary 3-PBA and total PSA (β ± Standard Error = 0.049 ± 0.026, p = 0.0712) and a significant positive correlation between urinary 3-PBA and PSA ratio (β ± Standard Error = 0.018 ± 0.007, p = 0.0191) among the low eGFR group were observed. Conclusion This study showed that exposure to pyrethroids was associated with either increased levels of total PSA or alterations in the PSA ratio.

Objective In this paper, we investigated the recovery of the lactate level, muscular fatigue, and heart rate recovery (HRR) with respect to whole body vibration (WBV) during the rest stage after a gait exercise. Methods A total of 24 healthy subjects with no medical history of exercise injury participated. The participants were divided into a training group with vibration during rest and a control group with the same conditions but without vibration. The subjects performed a gait exercise with a slope of 15% and velocity of 4 km/h to consume 450 kcal in 30 min. Then, they rested on a vibrating chair or on a chair without vibrations for 30 min. The vibration protocol consists of a frequency of 10 Hz and amplitude of 5 mm. To estimate the recovery effect, we measured the lactate levels in blood, spectral edge frequency (SEF) of MVIC, and HRR before, immediately after exercise, and after rest. Results The results showed that the lactate level in the training group decreased more (93.8%) than in the control group (32.8%). Also, HRR showed a similar trend with a recovery of 88.39% in the training group but 64.72% in the control group. We considered that whole-body vibrations during rest would help remove lactic acid by improving the level of lactic acid oxidation with stimulated blood vessels in the muscles and by helping to maintain blood flow. Also, WBV would lead to compensation to actively decrease the fast excess post-exercise oxygen consumption from blood circulation. Conclusions We suggest that whole-body vibrations during rest can provide fast, efficient fatigue recovery as a cool down exercise for women, the elderly, and patients without other activity after intense exercise.

Background Noise is associated with poor reproductive health. A number of animal studies have suggested the possible effects of exposure to high noise levels on fertility; to date, a little such research has been performed on humans. Objectives We examined an association between daytime and nocturnal noise exposures over four years (2002–2005) and subsequent male infertility. Methods We used the National Health Insurance Service-National Sample Cohort (2002–2013), a population-wide health insurance claims dataset. A total of 206,492 males of reproductive age (20–59 years) with no history of congenital malformations were followed up for an 8-year period (2006–2013). Male infertility was defined as per ICD-10 code N46. Data on noise exposure was obtained from the National Noise Information System. Exposure levels of daytime and night time noise were extrapolated using geographic information systems and collated with the subjects' administrative district code, and individual exposure levels assigned. Results During the study period, 3293 (1.6%) had a diagnosis of infertility. Although there was no association of infertility with 1-dB increments in noise exposure, a non-linear dose-response relationship was observed between infertility and quartiles of daytime and night time noise after adjustment for confounding variables (i.e., age, income, residential area, exercise, smoking, alcohol drinking, blood sugar, body mass index, medical histories, and particulate pollution). Based on WHO criteria, adjusted odds for infertility were significantly increased (OR = 1.14; 95% CI, 1.05–1.23) in males exposed to night time noise ≥ 55 dB. Conclusion We found a significant association between exposure to environmental noise for four years and the subsequent incidence of male infertility, suggesting long-term exposure to noise has a role in pathogenesis of male infertility.

// Eun Hee Han 1, 2, 6, * , Jin-Young Min 1, 3, * , Shin-Ae Yoo 1 , Sung-Joon Park 1 , Yun-Jeong Choe 1, 2 , Hee Sub Yun 1 , Zee-Won Lee 1 , Sun Woo Jin 4 , Hyung Gyun Kim 4 , Hye Gwang Jeong 4 , Hyun Kyoung Kim 5 , Nam Doo Kim 5 and Young-Ho Chung 1, 3, 6 1 Drug & Disease Target Research Team, Division of Bioconvergence Analysis, Korea Basic Science Institute (KBSI), Cheongju 28119, South Korea 2 Immunotherapy Convergence Research Center, Korean Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, South Korea 3 Graduate School of Analytical Science and Technology (GRAST), Chungnam National University, Daejeon 34134, South Korea 4 Department of Toxicology, College of Pharmacy, Chungnam National University (CNU), Daejeon 34133, South Korea 5 New Drug Development Center, Daugu Gyeoungbuk Medical Innovation Foundation (DGMIF), Daegu 41061, South Korea 6 Department of Bioanalytical Science, Korea University of Science and Technology (UST), Daejeon 34113, South Korea * These authors have contributed equally to this work Correspondence to: Young-Ho Chung, email: chungyh@kbsi.re.kr Keywords: AURKC, protein–protein interaction, IκBα, small-molecule inhibitor, breast cancer Received: December 29, 2016 Accepted: June 05, 2017 Published: June 29, 2017 ABSTRACT The Aurora kinases, Aurora A (AURKA), Aurora B (AURKB), and Aurora C (AURKC), are serine/threonine kinases required for the control of mitosis (AURKA and AURKB) or meiosis (AURKC). Several Aurora kinase inhibitors are being investigated as novel anticancer therapeutics. Recent studies demonstrated that AURKC activation contributes to breast cancer cell transformation. Therefore, AURKC is both a promising marker and therapeutic target for breast cancer; however, its signaling network has not been fully characterized. Using translocation-based cellular assays, we identified IκBα as a binding partner of AURKC, and found that AURKC phosphorylates IκBα at Ser32, thereby activating it. In silico modeling and computational analyses revealed a small-molecule inhibitor (AKCI) that blocked the AURKC–IκBα interaction and exerted antitumor activity in MDA-MB-231 breast cancer cells. Specifically, AKCI induced G2/M cell-cycle arrest through modulation of the p53/p21/CDC2/cyclin B1 pathways. In addition, the drug significantly inhibited MDA-MB-231 cell migration and invasion, as well as decreasing colony formation and tumor growth. Via its interaction with IκBα, AURKC indirectly induced NF-κB activation; accordingly, AKCI decreased PMA-induced activation of NF-κB. Thus, the small-molecule inhibitor AKCI represents a first step towards developing targeted inhibitors of AURKC protein binding, which may lead to further advances in the treatment of breast cancer.

Objective To evaluate if molecular markers of eosinophilia in olfactory-enriched mucosa are associated with olfactory dysfunction. Study Design Cross-sectional study of tissue biopsies from 99 patients, and an additional 30 patients who underwent prospective olfactory testing prior to sinonasal procedures. Methods Tissue biopsies were processed for analysis of inflammatory markers using quantitative real time polymerase chain reaction (qRT-PCR). Ipsilateral olfactory performance was assessed using the Sniffin' Sticks (Burghart, Wedel, Germany) threshold component and the University of Pennsylvania Smell Identification Test (Sensonics, Haddon Heights, NJ). Age-adjusted data was correlated with inflammatory marker expression and clinical measures of obstruction from computed tomography and endoscopy. Results Gene expression of the eosinophil marker CLC (Charcot Leyden crystal protein) was elevated in superior turbinate (ST) tissue in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) compared to ST and inferior turbinate tissue in CRS without nasal polyps (CRSsNP) and control patients (all P < 0.001, respectively). CLC in ST tissue was correlated with IL-5 and eotaxin-1 expression (all P < 0.001; P = 0.65, and 0.49, respectively). CLC expression was strongly correlated with eosinophilic cationic protein levels (P < 0.001; r = −0.76), and ST CLC expression was inversely related to olfactory threshold (P = 0.002, r = −0.57) and discrimination scores (P = 0.05, r = −0.42). In multiple linear regression of CLC gene expression, polyp status, and radiographic and endoscopic findings with olfactory threshold, CLC was the only significantly correlated variable (P < 0.05). Conclusion Markers of eosinophils are elevated in the ST of patients with CRSwNP and correlate with olfactory loss. These findings support the hypothesis that olfactory dysfunction in CRS correlates local eosinophil influx into the olfactory cleft. Level of Evidence NA. Laryngoscope, 2017

Obesity is a major risk factor for chronic diseases and arises from the interactions between environmental factors and multiple genes. Psychosocial stress may affect the risk for obesity, modifying food intake and choice. A recent study suggested regulator of G-protein signaling 6 (RGS6) as a novel candidate gene for obesity in terms of reward-related feeding under stress. In this study, we tried to verify the unidentified connection between RGS6 and human obesity with psychosocial stress in a Korean population. A total of 1,462 adult subjects, who participated in the Korean Association Resource cohort project, were included for this analysis. Obesity-related traits including waist circumference, body mass index, and visceral adipose tissue were recorded. A total of 4 intronic SNPs for the RGS6 gene were used for this study. We found that interactions between SNP rs2239219 and psychosocial stress are significantly associated with abdominal obesity (p = 0.007). As risk allele of this SNP increased, prevalence of abdominal obesity under high-stress conditions gradually increased (p = 0.013). However, we found no SNPs-by-stress interaction effect on other adiposity phenotypes. This study suggests that RGS6 is closely linked to stress-induced abdominal obesity in Korean adults.

Background: Despite a potential link between immunoglobulin E (IgE) levels and cardiovascular disease, the effect of elevated total IgE levels on long-term mortality risk remains unclear. We prospectively investigated the association between total serum IgE levels and all-cause and cardiovascular mortality in US adults. Methods: We analyzed data from the 2005&ndash, 2006 National Health and Nutrition Examination Survey (NHANES) and the NHANES (2005&ndash, 2006) Linked Mortality Public File. The 2005&ndash, 2006 NHANES data of 1496 older adults aged &ge, 50 years and who underwent a serum total IgE antibody test in the initial survey were included. Results: After a median follow-up of 119 months, a significant association was observed between total serum IgE levels and cardiovascular mortality, with subjects with the highest total IgE exhibiting a 3.19-fold (HR = 3.19, 95% confidence interval: 1.71&ndash, 5.96) increase in the risk of cardiovascular mortality compared with those with the lowest total IgE (&le, 16.80 kU/L). Furthermore, the mortality rate increased with an increase in total IgE levels, regardless of baseline history of cardiovascular diseases (e.g., myocardial infarction, stroke, and noninvasively diagnosed large-vessel peripheral arterial disease). Conclusions: This finding suggests that the elevation of IgE levels may be a risk factor for increased cardiovascular mortality.

Purpose We investigated whether exposure to air pollution, particularly to particles with a mass median aerodynamic diameter of ≤10 μm (PM10), is associated with diagnosis of childhood glaucoma. Design Retrospective cohort study. Methods From the National Health Insurance Service–National Sample Cohort, a total of 9004 infants born between January 2002 and December 2002 were included and followed-up for an 11-year period (2003–2012). Patients with glaucoma were defined as International Classification of Diseases, 10th revision code H40. Exposure levels of PM10 were extrapolated using geographic information systems, and individual exposure levels were assigned. Results During the study period, glaucoma occurred in 85 patients (0.94%). The probability of developing childhood glaucoma increased with the increase in PM10 quartiles. Increases in 1 μg/m3 of long-term PM10 were significantly associated with increased hazard ratios (HRs) for childhood glaucoma (HR = 1.22 [95% confidence interval {CI} 1.15–1.28]). Compared with risk of the lowest PM10 exposure group (quartile 1), the adjusted HRs for childhood glaucoma were significant in the highest PM10 exposure group of quartile 4 (HR = 2.84 [95% CI 1.37–5.89]) in model 3. Regarding the long-term PM10 exposure, the estimated hazard was considerably elevated in quartile 4 (HR = 6.61 [95% CI 2.96–14.75]). Conclusions Short-term and long-term exposure to PM10 was associated with the incidence of childhood glaucoma. This finding confirms previous reports on the link between air pollution and ocular disease and suggests that PM10 exposure may be a risk for childhood glaucoma.

Background Self-employed professionals are responsible for the major part of the labor market. It is essential to understand the characteristics of the self-employed to promote "decent work" for this segment of workers. The current study aimed to describe the personal and work-related attributes of the self-employed group in South Korea. # Methods We used data from the 2006, 2010, and 2014 Korean Working Condition Survey (KWCS). For the current study, a total of 41,775 subjects included and classified them into for self-employed workers (small business owners with 0-4 employees and middle to large business owners with more than 5 employees) and workers with standard full-time employment. Socio-demographic variables included age, gender, educational attainment, income per month, and occupation. Work-related attributes included work time, weekend work, "presenteeism", and work--life balance. # Results The percentage of self-employed people increased to 32.78% in 2010 and then decreased to 32.2% in 2014 to return to the same level in 2006. In comparison to middle to large business owners or workers in standard employment, small business owners were more likely to be older and male, earn lower levels of monthly income, attain lesser levels of education, and were engaged in manual and service positions. They worked longer weekday hours, worked more often on the weekends, and worked even when they were sick. Small business owners were particularly susceptible to imbalances between work and other aspects of their lives. # Conclusions Our descriptive investigation showed that self-employed individuals, especially those heading small businesses, were more likely to be exposed to socioeconomic disadvantages and to the worst working conditions than standard waged workers.

Background Although self-employed persons have greater autonomy, schedule flexibility, and control over their work than employees, they may be among the most vulnerable workers due to the lack of social benefits and protection from labor law and regulations. We compared suicidal behaviors between the self-employed and standardly employed workers. Methods This study used the 2008 Korean Community Health Survey data and included a total of 64 802 working population. Self-employed persons were classified into "small business self-employed persons" with zero to four employees and "middle to large business" with more than five employees. The outcomes were suicidal ideation and suicide attempts. Results Of the 64 802 participants, 40 422 were engaged in standard employment, and 24 380 were self-employed, with almost 90% (n = 21 970) being engaged in small businesses. Persons self-employed, compared with standard workers, were more likely to report suicidal ideation in both small (odds ratio [OR] = 1.25; 95% confidence interval [CI], 1.15-1.35) and middle to large businesses (OR = 1.32; 95% CI, 1.09-1.61). On the other hand, the likelihood for suicide attempt was only significant in persons self-employed in small businesses (OR = 1.67; 95% CI, 1.11-2.45). Conclusion Self-employed persons were associated with greater odds of reporting suicidal behaviors than workers with standard employment. Among the self-employed, small business owners were particularly vulnerable to suicide attempts.

Given the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) as a global health threat, understanding the risk factors for MRSA infection in the community may be a reasonable strategy to prevent it. We investigated the associations between serum homocysteine levels and prevalence of nasal colonization with S aureus and MRSA among United States adults. We conducted a cross-sectional analysis of a nationally representative sample of 7832 adults (20 years or older). The main outcome variables were nasal colonization with S aureus and MRSA. Percentages of colonization with S aureus and MRSA were calculated by the quartiles of serum homocysteine. A total of 7832 of 2051 subjects (26.2%) were culture positive for S aureus, 98 (4.8%) of whom had nasal colonization with MRSA. In comparison with subjects having the lowest serum homocysteine, the odds of nasal colonization with MRSA were significantly higher in those with the highest homocysteine (odds ratio, 3.09; 95% confidence interval, 1.11–8.61) in multivariate analysis, adjusted for all confounding variables. By contrast, homocysteine elevation was not significantly associated with S aureus colonization. Nasal colonization with MRSA in the general community was significantly associated with increases in serum homocysteine levels.

In this study, we hypothesized that infant mortality varies among health insurance status. Furthermore, we examined whether there are racial and ethnic disparities in the association between infant death and payment source for delivery. Our study used US national linked birth and infant death data for 2013 and 2017 collected by the National Center for Health Statistics and included 3,311,504 and 3,218,168 live births for each year. The principal source of payment for delivery was classified into three groups: Medicaid, private insurance, and self-payment. The outcome measures were infant mortality, neonatal mortality, and postneonatal mortality. Subgroup analysis for race and ethnicity was also performed. Overall infant mortality was lower in mothers who paid with private insurance than in those who paid with Medicaid insurance (RR = 0.87, 95% CI 0.84–0.90 in 2013; RR = 0.91, 95% CI 0.87–0.94 in 2017), but it was higher in self-paid women than in Medicaid-insured women at delivery (RR = 1.25, 95% CI 1.17–1.33 in 2013; RR = 1.16, 95% CI 1.08–1.24 in 2017). Non-Hispanic black (RR = 1.67, 95% CI 1.47–1.90 in 2013; RR = 1.16, 95% CI 1.00–1.35 in 2017) and Hispanic (RR = 1.30, 95% CI 1.17–1.44 in 2013; RR = 1.22, 95% CI 1.09–1.36 in 2017) mothers with self-payment had a higher risk for infant mortality than those with Medicaid at delivery. Newborns whose mothers have no health insurance would be more vulnerable to infant mortality than Medicaid beneficiaries, and non-white ethnic groups with self-payment would have an elevated risk of infant mortality among other racial and ethnic groups.

Background: This study investigates differences in antibiotic prescribing rates for pediatric upper respiratory infections (URIs) between physicians and nurse practitioners (NPs). Methods: Visits by children Results: Upper respiratory infections accounted for approximately 439 ± 21.5 million visits. Patients seen by NPs were more likely to have Medicaid, live in the lowest median household income quartile zip codes and micropolitan locations, and live in the South compared to patients seen by physicians. Nurse practitioners prescribed antibiotics 66.7% ± 4.2% of the time versus physicians at 52.8% ± 0.8% for URI visits (unadjusted P-value = .002). Adjusted by specialty, URI type, and chronic diseases, NPs had marginally significantly different odds of prescribing antibiotics (OR = 1.6, 95% CI, 1.0-2.6, P-value = .048), but the association with prescribing broad-spectrum antibiotics is not as strong (adjusted P-value = .063). Patient visits to a pediatric (OR = 0.54, 95% CI, 0.43-0.67) or ENT/surgery practice (OR = 0.11, 95% CI, 0.06-0.18) had lower odds of antibiotic prescribing compared to general/family medicine practices. Year (2001-2010) was not significantly associated with antibiotic or broad-spectrum antibiotic prescribing rates for physicians, but rates for NPs fell for otitis media ( P-value = .007) from 90.2% ± 8.2% (2001-2002) to 74.8% ± 6.8% (2009-2010) of visits. Conclusions: Nurse practitioners have higher rates of antibiotic prescribing compared to physicians for pediatric patients with URIs; however, this difference is less after adjusting for specialty. Examining comparative antibiotic prescribing is important to promote evidence-based practice and adoption of clinical guidelines.

Background This study explored whether precarious workers have difficulties in health care access as compared with non-precarious workers. Methods The 2008 Korean Community Health Survey data were used for this study. Information was obtained on 51,322 participants (40,514 non-precarious workers and 10,808 precarious workers). Precarious workers were defined as part-time or contingent workers. Results Precarious workers had significantly higher risk of limited access to hospitals (OR = 1.14; 95% CI: 1.06–1.22) and dentists (OR = 1.28; 95% CI: 1.21–1.36) than non-precarious workers; disparities in doctor contacts among precarious workers were mostly linked to not having enough money. The risk of not receiving preventive care—medical checkups (OR = 0.52; 95% CI: 0.49–0.55) or cancer screenings (OR = 0.82; 95% CI: 0.77–0.86)—was also significantly elevated among precarious workers. Conclusion We found that precarious workers had more difficulty accessing health care or receiving health checkups or cancer screenings than their non-precarious counterparts. Am. J. Ind. Med. © 2016 Wiley Periodicals, Inc.