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Background Previous studies have examined the association between alcohol consumption and metabolic syndrome (MetS) in adults, but studies in the elderly are lacking. We examined the relationship between high-risk alcohol consumption and MetS in elderly Korean men using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire from the 2010-2012 Korean National Health and Nutrition Examination Survey. METHODS Among 25,534 subjects, 2,807 were men >60 years of age; after exclusions, we included 2,088 men in the final analysis. We categorized the study participants into three groups according to AUDIT score: low risk (0-7), intermediate risk (8-14), and high risk (≥15 points). RESULTS Among the study population, 17.0% of the men were high-risk drinkers, who had the highest mean waist circumference, systolic and diastolic blood pressure (BP), fasting plasma glucose (FPG), and triglyceride (TG) levels. The overall prevalence of MetS was 41.9% in the elderly men, and it was significantly higher in the group with high (48.3%) versus low (31.9%) AUDIT scores. The prevalence of MetS components (elevated BP, high FPG, high TG, and low high-density lipoprotein cholesterol) was associated with a high AUDIT score. The odds ratios (95% confidence interval) of the high-risk group for MetS, elevated BP, and high TG were 1.40 (1.03-1.89), 1.82 (1.28- 2.60), and 1.77 (1.30-2.41) after adjustment for confounding variables. CONCLUSION AUDIT score was correlated with most MetS components in elderly Korean men.

A new approach for using extracellular vesicles (EVs) to deliver tyrosine kinase inhibitors (TKIs) to enhance iodine avidity in radioactive iodine-refractory thyroid cancer is needed. We isolated and characterized primary human adipose-derived stem cells (ADSCs) and isolated their EVs. The EVs were characterized by transmission electron microscopy, nanoparticle tracking analysis, and western blotting. A new TKI was loaded into the EVs by incubation (37 °C, 10 min) or sonication (18 cycles, 4 s per cycle) with 2 s intervals and a 2 min ice bath every six cycles. TKI loading was confirmed and measured by mass spectrometry. EV uptake into radioactive iodine-refractory thyroid cancer cells (SW1736 cells) was confirmed by microscopy. We treated the SW1736 cells with vehicle, TKI, or TKI-loaded EVs (sonication TKI-loaded EVs [EVsTKI(S)]) and examined the expression of iodide-metabolizing proteins and radioiodine uptake in the SW1736 cells. ADSCs cells showed &gt, 99% of typical stem cell markers, such as CD90 and CD105. The EVs displayed a round morphology, had an average size of 211.4 ± 3.83 nm, and were positive for CD81 and Alix and negative for cytochrome c. The mass spectrometry results indicate that the sonication method loaded ~4 times more of the TKI than did the incubation method. The EVsTKI(S) were used for further experiments. Higher expression levels of iodide-metabolizing mRNA and proteins in the EVsTKI(S)-treated SW1736 cells than in TKI-treated SW1736 cells were confirmed. EVsTKI(S) treatment enhanced 125I uptake in the recipient SW1736 cells compared with free-TKI treatment. This is the first study that demonstrated successful delivery of a TKI to radioactive iodine-refractory thyroid cancer cells using EVs as the delivery vehicle. This approach can revert radioiodine-resistant thyroid cancer cells back to radioiodine-sensitive thyroid cancer cells.

Background Smoking is a well-known risk factor of cancer, chronic disease, and cerebrovascular disease. Hospital admission is a good time to quit smoking but patients have little opportunity to take part in an intensive smoking cessation intervention. The purpose of this study was to identify the factors of successful smoking cessation among stroke patients who undergo an intensive cessation intervention during the hospitalization period. Methods Thirty-nine male smokers who were admitted with stroke were enrolled in the study. They participated in a smoking cessation intervention during hospitalization. Smoking status was followed up by telephone 3 months later. Nicotine dependence, sociodemographic factors, and other clinical characteristics were assessed. Results After 3 months post-intervention, the number of patients who stopped smoking was 27 (69.2%). In addition, there was no significant difference in nicotine dependence, sociodemographic factors, and clinical characteristics. Only the stages of readiness for smoking cessation were a significant predictor (odds ratio, 18.86; 95% confidence interval, 1.59–223.22). Conclusion This study shows that a patient's willingness to quit is the most significant predictor of stopping smoking after Inpatient cessation Intervention for stroke Patients.

Background: Overactive bladder syndrome is characterized by urinary urgency, usually accompanied by Frequent urination and nocturia, with or without urgent urinary incontinence. There must be the absence of causative infection or pathological conditions. Overactive bladder syndrome is related to mental disorders, particularly depression and anxiety. However, obsessive-compulsive symptoms are investigated much less frequently. The purpose of the present study was thus to assess obsessive-compulsive symptoms in overactive bladder syndrome patients. Methods: Fifty-seven women patients with overactive bladder syndrome and fifty-seven women without it (age matched control group) were prospectively enrolled. They completed the overactive bladder syndrome-validated 8-question screener and the Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire at the same time they visited the clinic. Patients were compared with controls on the Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire and its checking, tidiness, doubting, and fear of contamination components. Results: Patients showed more obsessive traits than controls on the Korean version of the Maudsley ObsessionalCompulsive Inventory Questionnaire total score (P = 0.006) and on the checking subscale (P = 0.001). Odds ratio for the overactive bladder syndrome group’s obsessive-compulsive symptoms traits (score ≥ 14) was 5.47 (P = 0.001). The Korean version of the Maudsley Obsessional-Compulsive Inventory Questionnaire total score was associated with the overactive bladder syndrome-validated 8-question screener score in patients (P = 0.03). Conclusion: Obsessive-compulsive symptoms may constitute an important aspect of the psychiatric profile of overactive bladder syndrome patients. The severity of obsessive-compulsive symptoms seems to be related to the degree of the overactive bladder syndrome severity. Clinicians may consider screening women with overactive bladder syndrome for obsessive-compulsive symptoms.

Patients with chronic obstructive pulmonary disease (COPD) exhibit airflow limitation and suboptimal lung function, and they are at high risk of developing postoperative pulmonary complications (PPCs). We aimed to determine the factors that would decrease PPC risk in patients with COPD. We retrospectively analyzed 419 patients with COPD who were registered in our institutional PPC database and had undergone an abdominal surgery under general anesthesia. PPCs comprised respiratory failure, pleural effusion, atelectasis, respiratory infection, and bronchospasm, the presence or type of PPC was diagnosed by respiratory physicians and recorded in the database before this study. Binary logistic regression was used for statistical analysis. Of the 419 patients, 121 patients (28.8%) experienced 200 PPCs. Multivariable analysis showed three modifiable anesthetic factors that could decrease PPC risk: low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced neuromuscular blockade reversal. We found that the 90-day mortality risk was significantly greater in patients with PPC than in those without PPC (5.8% vs. 1.3%, p = 0.016). Therefore, PPC risk in patients with COPD can be decreased if low tidal volume ventilation, restricted fluid infusion, and sugammadex-induced reversal during abdominal surgery are efficiently managed, as these factors result in decreased postoperative mortality.

Myofibroblasts play a central role in matrix formation and wound contraction during wound healing and undergo apoptosis at the end of the healing. Hypertrophic scarring is a pathologic condition in which myofibroblasts persist in the tissue. It has been hypothesized that abnormalities in epidermal–dermal crosstalk underlie this pathology. Therefore, in this study, we investigated whether myofibroblasts are affected by keratinocytes. Transforming growth factor beta-induced myofibroblasts (Imyo) and myofibroblasts from hypertrophic scar tissue (Hmyo) were characterized using microarrays. Keratinocytes were co-cultured with myofibroblasts, and quantitative PCR analysis was performed. We found that numerous extracellular matrix- and smooth muscle cell-associated genes were upregulated in Imyo and Hmyo respectively, and these findings suggest that Hmyo are fully differentiated myofibroblasts and that Imyo are less differentiated than Hmyo. Decreased collagen type 1 gene expression was found in keratinocytes co-cultured with Imyo and Hmyo; further, α-smooth muscle actin expression in Imyo increased in the presence of keratinocytes. These observations indicate that keratinocytes play a role in the development of pathological fibrosis in hypertrophic scar tissue by regulating the behavior of dermal fibroblasts and myofibroblasts. We believe that this study provides the basis for understanding the pathophysiology of hypertrophic scarring and identifying new therapeutic approaches for this dysfunction. No Level Assigned This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors - www.springer.com/00266 .

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24-48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered.

For bone regeneration from KUSA-A1 oesteoblast cells (KUSA), chitosan (CS) scaffolds possessing different surface properties, sponge-type (CSS) and nonwoven-type (CSNW), were manufactured. Surface area and pore size of CSNW were larger than those of CSS. On the other hand, the pore volume of CSNW was smaller than that of CSS. Cell attachment evaluation showed CSNW was more adequate then CSS, and this was attributed to the large surface area. For in vivo investigation, KUSA were seeded into CS scaffolds in wells followed by a week of cell culture. Obtained CS scaffolds with KUSA were implanted on the subcutaneous tissue of BALB/C nude mice. After surgery, implanted scaffolds were harvested and assayed by immunological staining. Network stability of CSS was better than that of CSNW, even if CSS scaffolds were destroyed between 4 and 6 weeks. Calcification was observed after 4 and 8 weeks for CSNW and CSS, respectively.

Purpose: The increasing incidence of thyroid cancer worldwide has drawn attention to the needs for assessing and managing health-related quality of life (HRQoL) of thyroid cancer survivors. We conducted this study to validate the Korean version of the thyroid cancer-specific quality of life (THYCA-QoL) questionnaire. Methods: Data obtained from 227 thyroid cancer survivors were analyzed using standard validity and reliability analysis techniques. Reliability was assessed by measuring internal consistency via Cronbach α coefficient, and validity was assessed by determining the Pearson correlation coefficient between the THYCA-QoL questionnaire and the following relevant assessment tools: the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30), the Korean version of Brief Fatigue Inventory (BFI-K), the Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), Goldberg Short Screening Scale for Anxiety and Depression, and a nine-item Patient Health Questionnaire (PHQ-9). A multitrait scaling analysis was performed to assess each item’s convergent and discriminant validity. Results: The reliability of the THYCA-QoL questionnaire was confirmed by Cronbach α coefficients for multiple-item scales which ranged from 0.54 (sensory) to 0.82 (psychological). Except for a single item (sexual interest), the questionnaire’s validity was established by significant correlation observed between scales in the THYCA-QoL questionnaire and scales used in other assessment tools. A multitrait scaling analysis confirmed that all scales met the recommended psychometric standards. Conclusion: The Korean version of the THYCA-QoL questionnaire is a reliable and valid assessment tool that can be used in combination with the EORTC QLQ-C30 to assess the HRQoL of thyroid cancer survivors in Korea.

Acceptable macronutrient distribution ranges (AMDRs) for carbohydrate, fat, and protein have been set by considering epidemiological evidences that suggest consumption within these ranges plays a role in reducing risk of chronic diseases. Little evidence has been presented on the relationship between the intake outside the AMDR for macronutrient and hypertension. Therefore, this study was performed to examine the association between the intake outside the AMDR and hypertension in Korean adults. This study was based on data obtained from the fifth Korean National Health and Nutrition Examination Survey. The AMDR for carbohydrate is 55-70%, for fat is 15-25%, and for protein is 7-20% of the energy intake for adults. The subjects who did not meet the AMDRs for carbohydrate, fat and protein were considered to be the non-AMDR group. The odds ratio of the non-AMDR group was 1.25 (95% CI, 1.02-1.53) in the hypertensive subjects without anti-hypertensive medication and 1.25 (95% CI, 1.06-1.48) in the hypertensive subjects with anti-hypertensive medication after adjustment for age, sex, current smoking, heavy drinking, physical inactivity, obesity, diabetes mellitus, dyslipidemia, total energy intake, high sodium intake, and vitamin D deficiency. The intake outside the AMDR was significantly associated with hypertension in Korean adults. The AMDR might be useful nutritional requirement for dietary management of hypertension. In the future, these findings need to be verified through prospective population-based studies.

Arthrogryposis multiplex congenita (AMC) is a rare clinical syndrome characterized by congenital, non-progressive, multiple and persistent joint contractures with generalized muscle wasting. Patients with AMC undergo frequent anesthetic care in the correction of musculoskeletal deformities or other associated anomalies [1]. We retrospectively reviewed our perioperative experience with 10 patients with AMC from 2005 to 2013 in a single center. These patients underwent a total of 31 inductions of general anesthesia, of which 28 cases were for orthopedic surgeries. Each patient received multiple exposures to anesthesia, from one to 10 times. In 25 anesthetic cases, general anesthesia was induced with thiopental and maintained with inhalation anesthetics. In another six cases, induction was performed with total intravenous anesthesia (TIVA) using propofol and remifentanil. The reasons for adopting TIVA were various: 1) Patients had mitochondrial myopathy (2 patients, 3 operations), 2) To allow neurologic monitoring during surgery to correct scoliosis (1 patient, 1 operation), and 3) To prevent malignant hyperthermia (MH) according to the anesthesiologist's preference (2 patients, 2 operations). Difficult intubation was observed in one patient. The patient was a 3-year-old girl in a bedridden state due to muscle weakness. Her weight was 8.5 kg. She was scheduled for orthopedic correction of club foot. She had micrognathia and a high-arched palate, but no cervical vertebral anomalies. The opening of the patient's mouth was very narrow (2 fingers). Under direct laryngoscopy, the vocal cords were located anteriorly and obscured by excessive secretions. After oral suction, intubation was successfully performed with a stylet by an expert anesthesiologist. The patient's laryngeal grade was III according to the Cormack-Lehane scoring system. There were nine cases of intraoperative hyperthermia in which patients' temperatures rose above 37.5℃. In every case but one, the temperatures were restored to the normal range by conservative treatments such as cooling the operating room and turning off the warming blanket. In one case, a 4-year-old boy was presumed to be experiencing MH. The patient's associated anomalies included osteochondromatosis, developmental delay, and mitochondrial myopathy. He weighed 16.8 kg and was scheduled for orthopedic surgery for hip joint and lower leg abnormalities. General anesthesia was induced with TIVA. Thirty minutes after induction, the patient's heart rate gradually increased from 100 to 180 beats per minute (bpm). Simultaneously, his temperature rose from 36.5 to 37.2℃. When the patient's temperature reached 37.2℃, we turned the warming blanket off and lowered the temperature of the operating room. However, the patient's body temperature continued to rise, to a maximum of 38.1℃. As MH had not been completely ruled out, dantrolene was injected intravenously. Following the injection, the patient's heart rate decreased to 140 bpm and his temperature decreased from 38.1 to 37.5℃. After the conclusion of the operation, in the intensive care unit, the patient's heart rate again increased to 160-190 bpm and his body temperature rose to 38.4℃. In response, the pediatrician ordered dantrolene 17 mg to be given to the patient as an intravenous injection four times a day from postoperative day (POD) 0. After the second injection of dantrolene, the patient's heart rate decreased to 120-140 bpm, but his high fever persisted. On POD 2, the patient's body temperature decreased to normal. Although the case did not completely fit the criteria for MH, we had a clinical impression of MH and treated the patient with injections of dantrolene, which appeared to be effective. Fortunately, most cases of anesthesia finished uneventfully, except for the several cases mentioned above. Associated anomalies of the patients are summarized in Table 1. Table 1 Associated Anomalies in 10 Patients with Arthrogryposis Multiplex Congenita AMC is usually associated with multiple congenital anomalies, such as skeletal deformities, congenital heart disease, and abnormalities of the respiratory and genitourinary systems. The problems faced by anesthesiologists in dealing with patients with this syndrome include difficult airway, MH associated with myopathy, cardiorespiratory problems, difficult regional blockade, difficult IV access, and difficult positioning [2]. The most important issue is the possibility of difficult intubation. The most common maxillofacial findings in patients with AMC include decreased mandibular opening, micrognathia, a high arched palate, and deficient musculature of the orofacial complex. For these reasons, direct laryngoscopy or tracheal intubation may be difficult or impossible. There are many reports detailing how these problems were overcome with the use of LMAs, fiberoptic intubation, or fiberoptic-guided intubation via the LMA [3]. Postoperative airway problems are also important. Patients with AMC are more susceptible to respiratory depression due to associated anomalies such as myopathy, pulmonary hypoplasia, and thoracic and spine deformities. Patients with AMC are also vulnerable to perioperative aspiration because of loss of normal muscle movement and gastroesophageal reflux. Another concern for anesthesiologists is MH. It is controversial whether AMC is associated with MH or not [4]. However, several myopathies themselves have strong relations to MH. About 8% of the etiology of AMC is related to neuromuscular disorders, myopathic processes such as congenital muscular dystrophies, mitochondrial disturbances, or abnormalities of the biochemistry of the muscles [5]. In patients displaying symptoms of MH, the Association of Anaesthetists of Great Britain & Ireland has recommended dantrolene injection 2.5 mg/kg immediately, and repeat 1 mg/kg boluses as required to a maximum of 10 mg/kg, until the improvement of symptoms. We encountered one suspected case of MH despite the use of TIVA. Evidently non-triggering anesthetics cannot completely prevent the occurrence of MH. Therefore, anesthesiologists should be aware of the risk of MH in patients with AMC and should closely monitor these patients. In addition, multiple contractures of the extremities make it difficult to maintain intraoperative positioning. Careful attention is required and appropriate measures, such as padding for reducing compression pressure, must be taken. Moreover, peripheral IV access is difficult in these patients because of tense, glossy skin, and scanty subcutaneous tissues. In summary, the patient with AMC needs meticulous anesthetic care during corrective surgery. Various associated anomalies, rather than AMC itself, pose challenges to anesthesiologists. The anesthesiologists should consider not only the joint problems but also the associated anomalies - cardiac, gastrointestinal, genitourinary, respiratory, myopathic, neurogenic, and facial anomalies. In our cases, most patients with AMC experienced no adverse events during surgery. The most important concerns are the possibilities of difficult airway management and hyperthermia, especially combined with myopathies. Careful airway evaluation, perioperative monitoring of body temperature, tachycardia, and hypercarbia, and preparation for emergencies are needed to avoid critical events.

Background Non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) share common pathogenic mechanisms and many risk factors, and both are linked to an increased risk of cardiovascular diseases. The aim of this study was to assess the association between NAFLD and CKD according to the presence of hypertension and diabetes mellitus in Koreans aged 50 years or older. Methods A cross-sectional study of 1,706 subjects who received their routine health examination was conducted between May 2008 and April 2010 at Konkuk University medical center. Biochemical tests for liver and abdominal ultrasonography were performed. CKD was defined as either proteinuria or glomerular filtration rate ≤60 mL/min per 1.73 m(2). Results Among the 1,706 subjects, There were 545 (31.9%) with non-alcoholic fatty liver disease and 424 (24.9%) with chronic kidney disease. In univariate logistic regression analysis, NAFLD was significantly associated with CKD (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.34 to 2.12). In multivariate logistic regression analysis adjusted for age, sex, current smoking, abdominal obesity, aspartate aminotransferases, alanine aminotransferases, γ-glutamyltransferase, hypertension, diabetes mellitus, hypertriglyceridemia, and low high-density lipoprotein cholesterol, NAFLD was associated with CKD (adjusted OR, 1.68; 95% CI, 1.27 to 2.24). This relationship remained significant after classification according to the presence of hypertension or diabetes mellitus. Conclusion NAFLD diagnosed by ultrasonography was significantly associated with CKD in Koreans aged 50 years or older.