Search

Hyperuricemia might have neuroprotective or neurodegenerative effects on dementia via oxidative stress or inflammatory response regulation. Few studies have explored the association of hyperuricemia or gout with dementia. This retrospective cohort study aimed to investigate the association between gout and dementia in Korea.Altogether, 5,052 gout patients and 25,260 age- and sex-matched controls were selected from the National Health Insurance Service (NHIS)-National Sample Cohort database. The incidence and risk of dementia were evaluated by reviewing the NHIS record. We also performed a subgroup analysis according to age group (age 65 or ≥65 years) using the standard age of 65 years for elderly and nonelderly groups and sex.During follow-up, 81 and 558 participants in the gout and control cohorts developed dementia, respectively. The mean follow-up duration was 4.38 years in gout patients and 4.94 years in controls. Gout patients had a hazard ratio (HR) of 0.79 for overall dementia (95% confidence interval [95% CI] 0.62-1.00) and significantly lower Alzheimer's disease risk (HR 0.73 [95% CI 0.54-0.98]) after adjusting for age, sex, household income, and comorbidities. In subgroup analysis stratified by age and sex, the inverse association between gout and the risk of overall dementia (HR 0.71 [95% CI 0.52-0.97]) and Alzheimer's disease (HR 0.67 [95% CI 0.46-0.97]) were observed in the elderly male group. On the other hand, age- and sex-adjusted analysis showed that the HR for vascular dementia of gout patients was 2.31 (95% CI 1.02-5.25) in the nonelderly male group.Gout decreased the risk of incident Alzheimer's disease-type dementia, especially in elderly patients. The association between gout and dementia risk may differ according to age and disease duration.

Exposure to diesel exhaust particles (DEPs) and urban particles (UPs) increases the incidence of degenerative brain diseases as well as respiratory diseases. However, there is limited evidence on the mechanism of neurotoxicity on exposure to these particles. In the present study, the damage to blood–brain barrier (BBB) function by DEP or UP exposure was evaluated in bEnd.3 cells, which are derived from the brain tissue of Balb/c mice. It was demonstrated that DEP and UP exposure may induce oxidative stress via increasing reactive oxygen species (ROS) and decreasing total antioxidant capacity (TAC) level in bEnd.3 cells. In addition, cells exposed to DEP and UP demonstrated a resistance value of about 50% each compared to the value noted prior to exposure; additionally, Claudin-5 and ZO-1 expression levels were significantly decreased compared to the corresponding levels in the control. It was inferred that DEP or UP exposure diminishes the expression of tight junction proteins in endothelial cells through ROS generation, thereby enhancing endothelial membrane permeability. This study showed that DEPs or UPs induced cell permeability and oxidative stress by increasing ROS generation in bEnd.3 cells. This suggests the possibility that exposure to DEPs or UPs may compromise the integrity of the BBB and induce adverse effects in the CNS.

Cadmium (Cd) is a ubiquitous environmental pollutant with an exceptionally long biological half-life. The liver is a major organ for Cd metabolism, but the toxicity of Cd is unclear. This study sought to determine whether blood Cd (BCd) level (representing recent exposure [months] to Cd) was associated with liver function in Korean adults, both cross-sectionally and longitudinally. The baseline cross-sectional study involved 2,086 adults (male: 908, female: 1,178) in 2010−2011, and 503 of them (male: 207, female: 296) were followed up in 2014−2015. BCd was measured by graphite-furnace atomic absorption spectrometry, and liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and γ-glutamyltransferase [GGT]) were determined. Liver damage was defined as an abnormal elevation of more than one liver function index. The geometric mean of BCd (1.07 µg/L) was higher in females than in males (1.16 vs. 0.96 µg/L). Liver function indices increased significantly in a dose-dependent manner according to the BCd levels, except for ALT in males, and were higher in males than in females. BCd level was also associated with the risk of liver damage in both sexes. No significant changes in BCd were observed between baseline and follow-up. The liver function indices in 2014−2015 were comparable to those in 2010−2011 in males, while ALT and GGT were significantly increased in 2014−2015 compared to 2010−2011 in females with relatively high BCd. These findings suggest that even a low level of environmental Cd exposure, short- and long-term, may affect liver function, and females appear more susceptible than males.

Background This study used various tools, including a self-assessment questionnaire, the Clinical Assessment of Driver-Related Skills (CADReS), and a driving simulation, to discriminate between older and non-older drivers. Methods We evaluated driving habits, driving-related health behaviors, and morbidities using a self-assessment questionnaire and examined visual, motor, and cognitive functions using the CADReS and a vehicle simulator of four junction scenarios that are typical of accidents involving older drivers. The areas under the receiver operating characteristic curves (AUCs) were calculated to compare the age-related discriminating ability of these tools between older (≥65 years) and non-older participants. Results Thirty of the 40 participants (75%) were older. Older drivers were slower than non-older drivers according to the rapid walking pace (8.0 vs. 6.1 seconds), and their cognitive function was poorer based on the trail-making test (117 vs. 51 seconds). While driving on the vehicle simulator, the rate of violating traffic rules was higher and the maximal velocity was slower in the older group than in the non-older group. The AUC values for CADReS and driving simulation outcomes ranged from 0.59 to 0.95, while the rapid walking pace, trail-making test, and velocity of the left turn at an acute junction in the dark showed high discriminatory power (AUC>0.9).Conclusions: The rapid walking pace and trail-making test in CADReS, as well as the driving simulation, were useful tools to discriminate between older and non-older drivers.

1-Nitropyrene (1-NP) is a major nitro-polycyclic aromatic hydrocarbon (nitro-PAH), and a common constituent in diesel exhaust particles (DEPs). Absorbed 1-nitropyrene is partly metabolized to 1-aminopyrene and excreted in urine. Recently, the number of diesel cars has been increasing, which could be a major cause of air pollution, resulting elevated levels of traffic-related DEPs around cities. The aim of this study was to investigate the usability of 1-aminopyrene (1-AP) as a biomarker for DEP exposure by examining the association between urinary 1-AP concentration and the amount of exposure to atmospheric 1-NP. The study subjects included 65 individuals who work on vehicular roads or bus terminals. Their 24 h urine samples were collected, and atmospheric air was sampled using a personal air sampler for 24 h. Urinary 1-AP and atmospheric nitro-PAH levels were measured using a high-pressure liquid chromatography-fluorescence detector (HPLC-FD). The average urine 1-AP concentration was 0.334 pg/g creatinine. Urinary 1-AP levels were significantly correlated with 1-NP level exposure (r = 0.385, p = 0.002) but not with the other nitro-PAHs. When the subjects were classified into high-and low-exposure groups, a significant association was only found in the high exposure group (r = 0.357, p = 0.045). In conclusion, there was a significant correlation between 1-NP exposure and urinary 1-AP concentration; therefore, urinary 1-AP level could be used as an exposure biomarker for DEP. Supplementary Information The online version contains supplementary material available at 10.1007/s43188-021-00096-z.

People living near abandoned mines are at increased risk of exposure to toxic metals. We surveyed 4500 inhabitants with the mean age of 68.5 years old (male: 1768, female: 2732) living near 104 abandoned metal mines from 2013 to 2017 (the 2nd phase health survey in Korea). We conducted personal interviews, blood and urine sampling, and analyzed the concentrations of lead (Pb) and cadmium (Cd) in whole blood and Cd in urine using a graphite furnace atomic absorption spectrometer. The geometric means of blood Pb, blood Cd, and urine Cd were 2.27 μg/dL, 1.42 μg/L, and 1.66 μg/g creatinine, respectively. The level of metal exposure was lower than that reported from the first phase health survey in Korea (2008‒2011) but was higher than in the general population of Korea. Blood Pb was higher in males while blood Cd and urine Cd were significantly higher in females. Blood Pb was highest in the 40‒59 age group, while blood and urine Cd levels continuously increased until age 80 or older. The Cd levels in blood and urine were affected by consumption of locally produced rice and duration of residence near abandoned mines. Furthermore, negative correlations were observed between blood Pb and blood and urine Cd levels. Additionally, 252 of the 4500 subjects exceeded the thresholds of blood Cd or urine Cd levels. Together, these findings suggest that Cd has more sustainable and adverse health effects on the abandoned mine inhabitants, who are mostly aged. Therefore, continuous biomonitoring and risk assessment to environmental health risks are necessary for environmental pollution control and health promotion.

Three industrial waste incinerators (IWIs) were built in 1999, 2001, and 2010, within a 3 km radius of a town with a population of around 5000 in Korea. This study evaluated whether residents near these three IWIs had increased cancer incidence than those from other areas in Korea using regional health data.Standardized incidence ratios (SIR) were calculated using the frequency of cancer cases in the National Cancer Registry of the exposed area (Buki-myeon), Chungcheongbuk-do (Chungbuk, state including Buki-myeon), and whole Korea from 1999 to 2017. A retrospective cohort was created using National Health Insurance System data from 2002 to 2018. The exposed group was defined as those having a residential history in the exposed area. The control group was defined as those having a residential history in nearby towns or counties in Chungbuk, excluding counties having living and cultural areas in other provinces and cities. Hazard ratio (HR) and 95% confidence intervals (CI) were estimated using the Cox proportional hazard model adjusted for age, level of health insurance fee, and smoking history.In the ecological study using National Cancer Registry data, the risk of all cancers, all cancers excluding thyroid, esophageal, stomach, and lung cancers in the exposed area were 1.13 (95% CI 1.03-1.24), 1.15 (95% CI 1.04-1.26), 1.91 (95% CI 1.13-2.89), 1.39 (95% CI 1.14-1.66), and 1.29 (95% CI 1.03-1.57) times higher than in whole Korea among exposed males, respectively. In the retrospective cohort, 4300 males (26,821 person-years) and 3796 females (24,746 person-years) in exposed group, 150,964 males (1,212,010 person-years) and 134,535 females (1,104,025 person-years) in control group were analyzed. After adjusting for several confounding factors, the risks for gallbladder cancer among males and kidney cancer among females were 2.65 (95% CI 1.38-5.06) and 2.82 (95% CI 1.13-7.03) times higher in the exposed group versus the control group, respectively.Cancer risk was higher in Koreans having residential history living near IWIs compared to the other areas. Further study warrants nationwide effects and longer follow-up of WIs for cancers in Korea.

Purpose This cross-sectional study aimed to assess the effect of environmental cadmium (Cd) exposure and essential metal imbalance on renal tubular damage and oxidative stress in 979 adults living in a Cd-polluted area near an abandoned copper (Cu) refinery. Methods We analyzed urinary Cd concentrations, renal tubular damage and oxidative stress markers, such as beta-2 microglobulin (β2-MG) and N-acetyl-β-d-glucosaminidase (NAG) activity and urine malondialdehyde (MDA) levels. The serum copper-to-zinc ratio (CZR) was used as an essential metal imbalance indicator. We divided the subjects into two Cd exposure groups based on the reference level of urinary Cd for renal dysfunction (2 μg/g creatinine). Results The geometric mean concentration of urinary Cd in all subjects was 2.25 μg/g creatinine. In both low and high Cd exposure groups, urinary Cd levels were positively correlated with urinary NAG activity, but not with serum CZR. After multivariate adjustment, serum CZR was strongly associated with urinary β2-MG levels in the low Cd exposure group (β = 1.360, P = 0.019) and was significantly associated with urinary MDA levels, regardless of Cd exposure level. In addition, the risk of renal tubular damage was significantly associated with urinary Cd level, particularly in the lowest or highest CZR tertile groups. Conclusions Essential metal imbalance may be a determinant of oxidative stress and renal tubular damage in a chronically Cd-exposed population, and proper zinc supplementation will be effective in preventing adverse health effects due to Cd exposure.

BACKGROUND AND OBJECTIVES The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI. METHODS Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10-30 cases/year), and below the 25th percentile (

Arsenic is a human carcinogen. Data on urinary arsenic species analyses of Koreans is limited. This study evaluated the arsenic exposure level, contributing factors, and health effects in Korean adults. Dietary intake information and urine samples were obtained from 2,044 participants. Arsenic exposure was assessed based on urinary concentrations of arsenic species, such as inorganic arsenic, As(III) and As(V), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and arsenobetaine (AsB), using high-performance liquid chromatography with inductively coupled plasma mass spectrometry, followed by determination of biomarkers, malondialdehyde and c-peptide. The geometric mean concentrations were 30.9 ㎍/L for the sum of inorganic arsenic and their metabolites, and 84.7 ㎍/L for the total sum of arsenic measured. Urinary concentrations of arsenic species were influenced by age, inhabitant area (inland or coastal), and seafood intake, which was positively correlated with inorganic arsenic, DMA, and AsB. Rice intake was positively correlated with inorganic arsenic and its metabolites but not with AsB. Additionally, malondialdehyde and c-peptide levels were significantly associated with urinary concentrations of various arsenic species. Seafood and rice are major sources of organic/inorganic arsenic exposure in Korean adults; however, it is necessary to evaluate whether their overconsumption could have a potentially detrimental effect on human health.

Although particulate matter (PM) is a Group 1 carcinogen, few studies have evaluated the effect of PM exposure after a cancer diagnosis on survival. Herein, we evaluated the effect of exposure to ambient PM10 after a cancer diagnosis on survival using data from the Regional Cancer Registry cohort in Chungbuk Province, Korea. A total of 44,432 patients with cancer who survived for >1 year after being diagnosed between 2005 and 2018 were followed until 31 December 2019; there were 32,734 survivors (73.7%) and 11,698 deceased (26.3%). The average follow-up period was 67.7 months, and the cumulative average concentration of PM10 exposure of patients with cancer after a diagnosis was 49.0 µg/m3. When PM10 concentration increased by 1 standard deviation (5.2 µg/m3), the all-cause mortality risk increased 2.06-fold (95% CI: 2.02–2.11). This trend was most pronounced in the younger patient group and in patients with local-stage cancer. This study demonstrates that exposure to PM10 after cancer diagnosis might influence the survival of patients with cancer, requiring environmental preventive measures such as lower pollutant exposure.

Exposure to fine particulate matter increases the risk of cardiovascular morbidity and mortality. Few studies have tested the beneficial effect of indoor air filtration intervention in patients with cardiovascular disease. The aim of this study is to investigate the effect of air filtration on mitigating cardiovascular health in patients with coronary artery disease. This randomized, double-blind, crossover study is conducted with 38 coronary artery disease patients. The intervention consists of the following three periods: two-week active and sham air filtration interventions, with a two-week washout period. The indoor PM2.5 concentration is continuously monitored during the entire study period. We measure the blood pressure, heart rate variability, baroreflex sensitivity, autonomic function test results, and endothelial function. The two-week active air filtration intervention for two weeks reduces the average indoor concentration of PM2.5 by 33.9%. The indoor PM2.5 concentration is significantly correlated to cross-correlation baroreflex sensitivity. Active air filtration is significantly associated with a decrease in the indicator of oxidative stress represented as 8-hydroxy-2′-deoxyguanosine. This study shows that a short-term air filtration intervention improved baroreflex sensitivity and might reduce oxidative stress in coronary artery disease patients. These findings suggest that the use of an air purifier could mitigate the recurrence of cardiovascular disease events in patients with coronary artery disease.

Supplemental material, sj-pdf-1-tar-10.1177_1753466620977408 for The clinical effect of smoking and environmental factors in spontaneous pneumothorax: a case-crossover study in an Inland province by Dohun Kim, Sang-Yong Eom, Chang-Seob Shin, Yong-Dae Kim, Si-Wook Kim and Jong-Myeon Hong in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-pdf-2-tar-10.1177_1753466620977408 for The clinical effect of smoking and environmental factors in spontaneous pneumothorax: a case-crossover study in an Inland province by Dohun Kim, Sang-Yong Eom, Chang-Seob Shin, Yong-Dae Kim, Si-Wook Kim and Jong-Myeon Hong in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-pdf-3-tar-10.1177_1753466620977408 for The clinical effect of smoking and environmental factors in spontaneous pneumothorax: a case-crossover study in an Inland province by Dohun Kim, Sang-Yong Eom, Chang-Seob Shin, Yong-Dae Kim, Si-Wook Kim and Jong-Myeon Hong in Therapeutic Advances in Respiratory Disease

Background:Dementia is a common mental illness associated with aging. Alzheimer’s disease (AD) and Vascular dementia (VaD) are the most common causes of dementia in the elderly. In previous studies, hyperuricemia was suggested to have anti-oxidant effects and possible neuroprotective effects [1,2].Objectives:Hyperuricemia is the most important factor in the pathogenesis of gout. This study aims to investigate association between gout and dementia.Methods:We conducted a nationwide population-based study using the NHIS-NSC database of the Korean populations consisted of 1 million individuals between 2002 and 2013. Gout patients were defined by International Classification of Diseases (ICD)-10 code for gout (M10) and prescriptions for urate lowering therapy including allopurinol, febuxostat and benzbromarone at least 30days. Dementia was also defined by ICD-10 codes for dementia; Alzheimer’s disease (AD; F00), vascular dementia (VaD; F01).Results:Excluded 40 patients with previous diagnosed dementia, total 5,496 gout patients were compared to 27,480 age- and sex-matched control group. The analysis results showed that gout patients had a lower risk of overall dementia [odds ratio (OR): 0.79; 95% confidence interval (CI): 0.63-0.99; p < 0.05] after adjusted for age, sex, household income, comorbidities. The risk of VaD (OR: 0.77; 95% CI: 0.32-1.9; p=0.68) and AD (OR; 0.8; 95% CI: 0.53-1.19; p=0.06) tended to be lower in gout group but these were not significant.Conclusion:Gout patients had a lower risk of dementia. This result tended to exist for both AD and VaD type of dementia.References:[1]Hooper DC, Spitsin S, Kean RB, et al. Uric acid, a natural scavenger of peroxynitrite, in experimental allergic encephalomyelitis and multiple sclerosis. Proc Natl Acad Sci USA. 1998; 95: 675–80.[2]Bowman GL, Shannon J, Frei B, et al. Uric acid as a CNS antioxidant. J Alzheimer’s Dis. 2010; 19: 1331–6.Disclosure of Interests:None declared

Background This study investigated the relationship between job type and the risk for spontaneous abortion to assess the reproductive toxicity of female workers in the semiconductor industry. Methods A questionnaire survey was administered to current female workers of two semiconductor manufacturing plants in Korea. We included female workers who became pregnant at least 6 months after the start of their employment with the company. The pregnancy outcomes of 2,242 female workers who experienced 4,037 pregnancies were investigated. Personnel records were used to assign the subjects to one of three groups: fabrication process workers, packaging process workers, and clerical workers. To adjust for within-person correlations between pregnancies, a generalized estimating equation was used. The logistic regression analysis was limited to the first pregnancy after joining the company to satisfy the assumption of independence among pregnancies. Moreover, we stratified the analysis by time period (pregnancy in the years prior to 2008 vs. after 2009) to reflect differences in occupational exposure based on semiconductor production periods. Results The risk for spontaneous abortion in female semiconductor workers was not significantly higher for fabrication and packaging process workers than for clerical workers. However, when we stratified by time period, the odds ratio for spontaneous abortion was significantly higher for packaging process workers who became pregnant prior to 2008 when compared with clerical workers (odds ratio: 2.21; 95% confidence interval: 1.01–4.81). Conclusions When examining the pregnancies of female semiconductor workers that occurred prior to 2008, packaging process workers showed a significantly higher risk for spontaneous abortions than did clerical workers. The two semiconductor production periods in our study (prior to 2008 vs. after 2009) had different automated processes, chemical exposure levels, and working environments. Thus, the conditions prior to 2008 may have increased the risk for spontaneous abortions in packaging process workers in the semiconductor industry. Electronic supplementary material The online version of this article (10.1186/s40557-017-0204-x) contains supplementary material, which is available to authorized users.

Portland cement contains carcinogens such as chromium and free silica, and hence, inhalation of cement dust can cause respiratory tract cancers. The purpose of this study was to determine whether living near a cement plant increases the risk of respiratory tract cancers. The study population consisted of 341,793 people, all of whom lived in administrative districts within 3-km radius of ten cement plants in Korea. The respiratory tract cancer incidence data (International Classification of Diseases, ten revision code C00-C14 and C30-C34) for 2008–2012 were obtained from regional cancer registries. Standardized incidence ratios (SIRs) for each cancer site in the respiratory tract were calculated using an indirect standardization method. Compared with the general Korean population, the incidence of lung and bronchus cancer (C33–C34) was significantly higher in all subjects [SIR 1.15, 95% confidence interval (CI) 1.02–1.29] and especially in the men subjects (SIR 1.47, 95% CI 1.29–1.68) in our study population. In addition, the incidence of larynx cancer in men (SIR 1.64, 95% CI 0.97–2.59) and salivary gland cancer in women (SIR 3.03, 95% CI 0.98–7.07) living near cement plants was marginally increased. These results suggest that environmental exposure to Portland cement dust is a risk factor for respiratory tract cancers.

The aim of this study was to assess changes in bone mineral density (BMD) and cadmium (Cd) levels in blood and urine in individuals living in a Cd-contaminated area according to the type of osteoporosis medication over a three-year period. This follow-up study included 204 residents living in the vicinity of a closed copper refinery, who had been found to have elevated urinary or blood Cd levels. Cd levels in the blood and urine, as well as BMD, were measured every 6 months. After the first BMD measurement, individuals were prescribed antiresorptives such as alendronate or vitamin D and calcium, according to their BMD. Subjects were classified according to the type of medicine provided over the previous 6 months. General linear models controlling for other factors were used to evaluate the effects of each type of medication on the participants' Cd levels and BMD. Spinal BMD showed a significant increase in the antiresorptive group compared to the nontreatment group. Significant decreases in blood Cd levels were found in the vitamin D and calcium group, in comparison to the nontreatment group, as well as a marginally significant decrease in the antiresorptive group. The vitamin D and calcium group showed a significantly greater decrease in urinary Cd levels than the nontreatment group. In contrast, antiresorptive medication was found to have a negative effect on urinary Cd excretion. These results suggest that vitamin D and calcium treatment for osteoporosis lowers blood Cd levels more effectively and improves urinary Cd excretion.

In December 2007, the Hebei Spirit oil spill occurred on the west coast of South Korea. Association between crude oil exposure and the levels of urinary oxidative stress biomarkers was reported among the local residents, 1.5 years after the accident. The aim of this study was to follow-up possible longer-term effects of the oil spill among the residents near the oil spill. Six years after the accident, urinary oxidative stress biomarkers of the residents were associated with surrogates of oil exposure. The target subjects were divided into two groups based on the distance of their residence to the spill site, i.e., those near the spill site (‘Near’ group, n = 476), and those far from the spill (‘Far’ group, n = 152). A questionnaire was administered by trained interviewers or self-reporting, and demographic information and other parameters of the participants, such as socioeconomic status, smoking and drinking behaviors, disease history, and duration of clean-up activities after the spill, were collected. The participants' levels of 8–hydroxy–2–deoxyguanosine (8–OHdG) and malondialdehyde (MDA) in 12 h urine samples were measured as indicators of oxidative DNA damage and lipid peroxidation, respectively. A general linear model was used for statistical analysis. Urinary MDA and 8-OHdG levels measured from ‘Near’ group, i.e., geometric mean of 2.19 μmol/g creatinine, and 5.41 μg/g creatinine, respectively, were higher than those of ‘Far’ group. Especially, urinary 8-OHdG levels in the ‘Near’ group were significantly higher than those of ‘Far’ after adjusting relevant covariates. In addition, the duration of clean–up activities showed a significant association with both urinary 8–OHdG and MDA levels. Even 6 years after the oil spill, positive associations between oxidative stress biomarkers and surrogates of oil exposure were evident. While the present study design lacks biomarkers of exposure, the results of this study suggest that the consequences of oil pollution may last for years.

Farmers are frequently exposed to ultraviolet (UV) radiation which causes various diseases by inducing oxidative stress. This study aimed to assess the effects of sunblock on oxidative stress in the body. Eighty-seven farmers were divided into two groups: those who wore sunblock for five days and those who did not. The total antioxidant capacity (TAC) in urine, which is an antioxidant indicator, and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels in urine, an oxidative stress indicator, were measured. The urinary TAC of sunblock users was significantly higher than that of non-users, but urinary 8-OHdG levels were not significantly different. Even after adjustment for potential confounders, urinary TAC was found to be markedly increased with sunblock usage. These results suggest that sunblock is effective in preventing oxidative stress among farmers. In addition, they show that urinary TAC can be used as a good effect marker of oxidative stress caused by UV exposure.

The prognostic significance of atrial fibrillation (AF) on mortality in ST-segment elevation myocardial infarction (STEMI) patients is not clearly understood. To elucidate the clinical significance of AF on mortality for 1 year in STEMI patients, we retrospectively analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) database, which spans January 2008 to September 2010 and includes 14,329 patients with acute myocardial infarction. We selected 5,556 patients with marked ECG rhythm (NSR, normal sinus rhythm or AF) on emergency room arrival, < 12 hours of symptom onset, and who underwent primary percutaneous coronary intervention (PCI) within 90 minutes of arriving at the hospital. Patients who had been followed-up for at least for 1 year were analyzed (2,636 of NSR, 119 of AF). At enrollment, AF patients were older (70.7 versus 65.5 years, P < 0.001) and had lower systolic blood pressure (120.6 versus 125.9 mmHg, P = 0.050), a higher heart rate (80.4 versus 75.6/minute, P = 0.009), and a higher rate of Killip III, IV (25.0 versus 14.2%, P = 0.002). Patients with AF showed clearly higher all-cause mortality (22.7 versus 9.5%, HR 2.51, 95%CI 1.68~3.76, P < 0.001) and cardiac death rate (17.7 versus 7.5%, HR 2.49, 95%CI 1.59~3.90, P < 0.001) at 1 year after admission compared patients with NSR. AF induced significantly higher all-cause mortality and cardiac mortality rate in STEMI patients who were appropriately revascularized with primary PCI compared to NSR at 1 year.

Objectives There are insufficient evidences supporting the use of spirometric indices along with tests for airway inflammation to improve diagnostic accuracy for asthma. We aimed to study the utility of combination of spirometric indices and fractional exhaled nitric oxide (FeNO) measured at the initial visit in diagnosing asthma. Methods Consecutive children aged 8-16 years who were referred for evaluation of possible asthma were included. At referral, all participants completed FeNO measurements and spirometry. The diagnosis of asthma was established with conventional criteria. Diagnostic performance of the spirometric indices and FeNO was determined using receiver-operator characteristic (ROC) curve analyses. Results Of 275 participants, 191 children were diagnosed with asthma and showed lower spirometric indices and higher FeNO than non-asthmatics. In the ROC curve analyses, forced expiratory flow between 25% and 75% of vital capacity (FEF25-75 ) percent predicted demonstrated diagnostic performance with the area under the ROC curve (AUC) value of 0.81 (95% CI: 0.76-0.87) which was significantly higher than those for forced expiratory volume in the first second (FEV1 ) percent predicted and FEV1 /forced vital capacity. The combined use of FEF25-75 percent predicted and FeNO improved the AUC to 0.90 (95% CI: 0.86-0.93). In addition, compared to FEF25-75 percent predicted or FeNO alone, this combination improved sensitivity with comparable specificity. Conclusions FEF25-75 percent predicted had a better diagnostic value in detection of childhood asthma than other standard spirometric indices and its combination with FeNO improves the diagnostic accuracy for childhood asthma.

Objectives Systemic rheumatic disease is characterized by autoimmunity and systemic inflammation and affects multiple organs. Few studies have investigated whether autoimmune diseases increase the risk of dementia. Herein, we evaluate the relationship between systemic rheumatic disease and dementia through a population-based study using the Korean National Health Insurance Service (NHIS) claims database. Methods We conducted a nationwide population-based study using the Korean NHIS database, consisting of individuals who submitted medical claims from 2002–2013. Dementia was defined as having an acetylcholinesterase inhibitors (AChEIs) prescription along with symptoms satisfying the Alzhemier’s disease (AD) International Classification of Diseases (ICD)-10 codes (F00 or G30), or vascular dementia (VaD; ICD-10 or F01) criteria. Control subjects were matched to the dementia patients by age and sex. The study group was limited to those diagnosed with rheumatic disease at least 6 months prior to diagnosis of dementia. Rheumatic disease was defined by the following ICD-10 codes: Rheumatoid arthritis (RA: M05), Sjögren’s syndrome (SS: M35), systemic lupus erythematosus (SLE: M32), and Behcet’s disease (BD: M35.2). Results Of the 6,028 dementia patients, 261 (4.3%) had RA, 108 (1.6%) had SS, 12 (0.2%) had SLE, and 6 (0.1%) had BD. SLE history was significantly higher in dementia patients (0.2%) than in controls (0.1%) and was associated with dementia (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.19–5.15). In subgroup analysis, SLE significantly increased dementia risk, regardless of dementia type (AD: OR, 2.29; 95% CI, 1.06–4.91; VaD: OR, 4.54; 95% CI, 1.36–15.14). However, these associations were not sustained in the mild CCI or elderly group. Conclusion SLE was independently associated with a higher risk of dementia, including AD and VaD when compared to the control group, even after adjustment. SLE patients (

Objective Muscle depletion in patients undergoing liver transplantation affects the recipients' prognosis and therefore cannot be overlooked. We aimed to evaluate whether changes in muscle and fat mass during the preoperative period are associated with prognosis after deceased donor liver transplantation (DDLT). Materials and Methods This study included 72 patients who underwent DDLT and serial computed tomography (CT) scans. Skeletal muscle index (SMI) and fat mass index (FMI) were calculated using the muscle and fat area in CT performed 1 year prior to surgery (1 yr Pre-LT), just before surgery (Pre-LT), and after transplantation (Post-LT). Simple aspects of serial changes in muscle and fat mass were analyzed during three measurement time points. The rate of preoperative changes in body composition parameters were calculated (preoperative ΔSMI [%] = [SMI at Pre-LT − SMI at 1 yr Pre-LT] / SMI at Pre-LT × 100; preoperative ΔFMI [%] = [FMI at Pre-LT − FMI at 1 yr Pre-LT] / FMI at Pre-LT × 100) and assessed for correlation with patient survival. Results SMI significantly decreased during the preoperative period (mean preoperative ΔSMI, −13.04%, p < 0.001). In the multivariable analysis, preoperative ΔSMI (p = 0.016) and model for end-stage liver disease score (p = 0.011) were independent prognostic factors for overall survival. The mean survival time for patients with a threshold decrease in the preoperative ΔSMI (≤ −30%) was significantly shorter than for other patients (p = 0.007). Preoperative ΔFMI was not a prognostic factor but FMI increased during the postoperative period (p = 0.009) in all patients. Conclusion A large reduction in preoperative SMI was significantly associated with reduced survival after DDLT. Therefore, changes in muscle mass during the preoperative period can be considered as a prognostic factor for survival after DDLT.

Background and objective Recognition of patients at risk of asthma exacerbation is important for future asthma care and improved outcome. The aim of the present study was to see whether measurements of bronchodilator response (BDR) and fractional exhaled nitric oxide (FeNO) in combination provide prognostic information superior to either measurement alone in children with atopic asthma. Methods A total of 201 atopic children aged 8–16 years with intermittent or mild persistent asthma were included. Pulmonary function tests including BDR and FeNO were serially monitored 10 times or more over 2 years when subjects were not receiving controller medications. After completion of monitoring, 1-year observation for a loss of asthma control was performed. Results During the monitoring period, positive BDRs (≥12% in forced expiratory volume in 1 s (FEV1 ) from pre-bronchodilator value) and FeNO higher than 35 parts per billion (ppb) were observed at least once in 59% and 77% of participants. When analysed as continuous variables, both BDR (hazard ratio (HR): 1.21; 95% CI: 1.04–1.41; P = 0.014) and FeNO (HR: 1.27; 95% CI: 1.09–1.49; P = 0.003) were associated with increased risks for a control loss. Compared with patients showing either positive BDRs (HR: 3.19; 95% CI: 1.05–9.64) or FeNO higher than 35 ppb (HR: 4.70; 95% CI: 1.68–13.11), patients with both findings (HR: 7.08; 95% CI: 2.57–19.49) had greater risks for a control loss. Conclusion These data support that combined use of BDR and FeNO measurements can modify predictive risk obtained from either measurement alone.

Although several studies reported genetic polymorphisms in protein kinase AMP‐activated alpha 1 catalytic subunit (PRKAA1) and their associations with gastric cancer risk, few have evaluated associations between Helicobacter pylori infection and PRKAA1 gene‐environment interactions. Here, we evaluated the effects of interactions between H. pylori infection and PRKAA1 polymorphisms on gastric cancer risk in Koreans. In this hospital‐based case–control study, PRKAA1 genotypes were analyzed and H. pylori infection and CagA status were examined using a serologic method in 846 pairs of gastric cancer patients and controls matched for age and sex. H. pylori seropositivity was associated with a 1.43‐fold [95% confidence interval: 1.12–1.81] increase in the risk of gastric cancer, and CagA low‐positive titers during H. pylori infection increased the risk by 1.85‐fold (95% confidence interval, 1.38–2.48). Significant positive interaction between the PRKAA1 rs13361707 genotype and H. pylori infection was verified on an additive scale [relative excess risk due to interaction, 0.55; 95% confidence interval, 0.05–1.04; P = 0.030], and the gene‐environment interaction between PRKAA1 rs13361707 and CagA status was also statistically significant (relative excess risk due to interaction, 0.50; 95% confidence interval, 0.30–0.70; P

This study was performed to select single nucleotide polymorphisms (SNPs) related to the body burden of heavy metals in Koreans, to provide Korean allele frequencies of selected SNPs, and to assess the difference in allele frequencies with other ethnicities. The candidate-gene approach method and genome-wide association screening were used to select SNPs related to the body burden of heavy metals. Genotyping analysis of the final 192 SNPs selected was performed on 1,483 subjects using the VeraCode Goldengate assay. Allele frequencies differences and genetic differentiations between the Korean population and Chinese (CHB), Japanese (JPT), Caucasian (CEU), and African (YIR) populations were tested by Fisher’s exact test and fixation index (FST), respectively. The Korean population was genetically similar to the CHB and JPT populations (FST < 0.05, for all SNPs in both populations). However, a significant difference in the allele frequencies between the Korean and CEU and YIR populations were observed in 99 SNPs (60.7%) and 120 SNPs (73.6%), respectively. Ten (6.1%) and 26 (16.0%) SNPs had genetic differentiation (FST > 0.05) among the Korean-CEU and Korean-YIR comparisons, respectively. The SNP with the largest FST value between the Korean and African populations was cystathionine-β-synthase rs234709 (FST: KOR-YIR, 0.309; KOR-CEU, 0.064). Our study suggests that interethnic differences exist in SNPs associated with heavy metals of Koreans, and it should be considered in future studies that address ethnic differences in heavy-metal concentrations in the body and genetic susceptibility to the body burden of heavy metals.

Background: Cumulative inflammation correlates with coronary plaque increase and cardiovascular disease (CVD) events in rheumatoid arthritis (RA). Coronary plaque progression predicts CVD risk beyond baseline burden in general patients. Statins inhibit plaque progression and are effective for CVD prevention in general patients. Nevertheless, their impact on coronary plaque trajectory and CVD risk in RA are less clear. Objectives: To explore if statin treatment may reduce CVD event risk, inhibit new plaque formation or promote the regression or protective calcification of prevalent atherosclerotic lesions in RA. We also evaluated whether statins moderate the effects of inflammation (CRP) on CVD risk and on coronary plaque progression. Methods: One hundred-fifty patients underwent computed tomography angiography for coronary atherosclerosis evaluation (total, non-calcified, mixed/calcified plaque); 101 had repeat assessments within 6.9±0.3 years to evaluate plaque progression. CVD events were prospectively recorded, including cardiac death, myocardial infarction, unstable angina, revascularization, stroke, claudication, and heart failure hospitalization. Framingham-D’Agostino score assessed clinical risk. Plaque burden was measured as segment stenosis score (cumulative stenosis). Robust cox proportional hazards regression models evaluated the effects of time-varying statin use, log-transformed time-varying CRP (mg/dL) and their interaction on CVD risk controlling for Framingham-D’Agostino score, plaque burden and time-varying bDMARD use. Per-segment robust logistic regression assessed the effect of statin duration (years), log-transformed time-averaged CRP, and their interaction on likelihood of plaque formation in segments without plaque, and plaque regression or calcification in segments with non-calcified lesions. Models accounted for clustering of coronary segments within patients and controlled for Framingham-D’Agostino score, total prednisone dose, bDMARD duration, and time between scans. Results: Sixteen patients incurred 19 CVD events. There was no main effect of current statin use on CVD risk (adjusted HR 1.10, 95% CI 0.33-3.67). However, there was an interaction between current statin use and time-varying CRP (p-interaction=0.030); higher time-varying CRP predicted greater CVD risk in patients not receiving statins (adjusted HR 2.78, 95% CI 1.01-7.65), but not current statin users (Figure 1A). Likewise, current statin use associated with lower CVD risk when patients had higher time-varying CRP (>0.5 mg/dL) but not when CRP was lower ( Conclusion: In RA, statins moderated the effect of CRP on CVD event risk and new plaque formation in coronary segments without plaque. Longer statin duration was also associated with an increased likelihood of protective calcification of non-calcified plaque. Disclosure of Interests: George Karpouzas Grant/research support from: Pfizer, Consultant of: Sanofi-Genzyme-Regeneron, Janssen, Speakers bureau: Sanofi-Genzyme-Regeneron, BMS, Sarah Ormseth: None declared, Elizabeth Hernandez: None declared, Matthew Budoff: None declared

Background: The factors that trigger spontaneous pneumothorax have not been sufficiently evaluated. The purpose of this study is to analyze the relationship between the development of spontaneous pneumothorax and meteorological parameters, including air pollutants. Methods: This is a retrospective study using the medical records of 379 patients who were admitted for spontaneous pneumothorax (SP) over a period of 4 years. Meteorological and air pollution data were obtained from the National Meteorological Office and the Ministry of Environment. We employed a case-crossover design to evaluate the short-term association between SP and meteorological factors including air pollutants. Conditional logistic regression was used to analyze bi-directional matched data. Results: Increase of relative humidity (RH) and of carbon monoxide (CO) were associated with the risk of pneumothorax, with odds ratio (OR) for RH = 1.18 (1.02–1.36), CO = 1.23 (1.02–1.48). Moreover, as air pressure (AP) decreased, risk of pneumothorax increased, with OR = 1.30 (1.05–1.59) but others did not. In the stratified analysis, the effect of RH was positive in ex-smokers (OR = 3.31) and non-smokers (OR = 1.32), but negative in current smokers (OR = 0.72). The effect of AP was significant in younger patients (OR = 1.33), males (OR = 1.40), and non-smokers (OR = 1.36). CO was related only with non-smokers (OR = 1.35) Conclusion: The triggering factors for spontaneous pneumothorax were relative humidity, carbon monoxide, and air pressure. The effect of the trigger was prominent in patients who were younger (