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Background Non-adherence to angiotensin receptor blockers (ARB) or statin is one of major reasons of insufficient treatment for patients with hyperlipidemia and hypertension. We investigated whether fixed-dose combination (FDC) of ARB and statin improved adherence compared to traditional free combination (FC). Methods In this retrospective nationwide cohort study, adherence of 128,369 patients who started ARB and stain including atorvastatin or rosuvastatin between July 2014 and June 2015 was investigated. Primary endpoint was proportion of days covered (PDC) per 180 days up to day 540. Good compliance defined by PDC≥80% and persistency rate defined by patients remaining on medication were also investigated. Results Patients were 62.9 years of mean age with 48.2% female gender. Compared to FC (N=90,759, 70.7%), FDC (N=37,610, 29.3%) showed higher PDC at day 180 (86% vs 70%), 360 (77% vs 62%), and 540 (74% vs 55%, p Conclusions In this real-world data analysis, FDC resulted in higher medication adherence and persistence compared to FC among patients who started both ARB and atorvastatin or rosuvastatin. Persistence rate btw FDC and FC Funding Acknowledgement Type of funding source: None

The black pine bast scale, (Hemiptera: Margarodidae), is a serious pest of the Japanese black pine, , in Korea. The distribution of the black pine bast scale was examined, looking overall at 686 towns (eup), townships (myeon) or neighborhoods (dong). There were Japanese black pine ( ) forests in 91 cities, counties (gun) and borough (gu), in seven provinces and three metropolitan cities during 2010. Black pine bast scale were found in 64.8% of cities or counties or borough (59) in 7 provinces and 3 metropolitan cities, and were distributed in all South Costal regions, Pohang in East Costal region and Boryeong in West Costal region. Chungcheongbukdo, Daejeon and Jeju did not have black pine bast scale. All the gu regions in Busan had black pine bast scale, of which the area with the highest prevalence was Haenam in Jeollanamdo (1.713 crawlers/0.785 ). Songji-myeon had the highest occurrence rate (6.36 crawlers/0.785 ) from the towns, township and dong. The density of black pine bast scale in twigs was highly correlated with percentage of the sample with scale (Correlation coefficacy

Background and objective: Many genetic variations are thought to be risk factors for the development of pulmonary tuberculosis (TB). The association of interferon-γ (IFN-γ) and IFN-γ receptor 1 (IFN-γR1) gene polymorphisms with pulmonary TB is controversial. This study examined the association between IFN-γ and IFN-γR1 gene polymorphisms and pulmonary TB among Koreans. Methods: Eighty patients with culture-confirmed pulmonary TB and 80 controls were studied. Polymorphisms of the IFN-γ gene at position +874 were determined using the amplification refractory mutation system PCR assay, and the IFN-γR1 gene was genotyped at positions −611, −270, −56 and +95 employing matrix-assisted laser desorption/ionization time-of-flight mass spectrometry using genomic DNA. Results: The genotype and allele frequencies of the IFN-γ and IFN-γR1 gene polymorphisms did not differ significantly between the patients with pulmonary TB and controls. Conclusions: The IFN-γ and IFN-γR1 gene polymorphisms do not appear to be responsible for host susceptibility to pulmonary TB in the Korean population.

Different concentrations of estradiol (E2)-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles (E2-PLGA-NPs) were synthesized using the emulsion-diffusion method. Transmission electron microscopy results showed that the average particle size of E2-PLGA-NPs was 98 ± 1.9 nm when stabilized with polyvinyl alcohol and 103 ± 4.9 nm when stabilized with Tween-80. Fourier transform-infrared spectroscopy with diamond attenuated total reflectance was used to identify the presence or absence of E2 molecules in PLGA nanocapsules. Cell proliferation was assessed after treating SH-SY5Y neuroblastoma cells with 1 nM-1 μM of E2 and E2-PLGA-NPs. The neuroprotective efficacy against glutamate-induced excitotoxicity was also investigated in SH-SY5Y neuroblastoma cells. Neuroprotection was greater in E2-PLGA-NP-treated cells than in cells treated with the same concentration of E2. Furthermore, E2- and E2-PLGA-NP-treated cells expressed more p-ERK1/2 and p-CREB than cells treated with glutamate only. Moreover, the expression of p-ERK1/2 was higher than that of p-CREB. In this study, p-ERK1/2 had a greater influence on the neuroprotective effect of E2 and E2-PLGA-NPs than p-CREB.

The final aim of this study was to confirm the neuroprotective effects of recombinant human erythropoietin (rhEPO)-loaded poly(lactic-co-glycolic acid) (PLGA) nanoparticles stabilized by sodium cholate (rhEPO-Ch-NP) and compare their effects with those of rhEPO using an in vitro model of cerebral ischemia. Glutamate-induced excitotoxic damage on SH-SY5Y cells, a human neuroblastoma cell line, with or without rhEPO-Ch-NPs was quantitatively evaluated. The rhEPO-Ch-NPs were carefully prepared using a water-in-oil-in-water (w/o/w) emulsion solvent evaporation technique with PLGA, sodium cholate hydrate, and ethyl acetate. The rhEPO-Ch-NPs were fully characterized by both transmission electron microscopy (TEM) and differential scanning calorimetry (DSC). In addition, significant intracellular uptake of these particles was monitored by confocal microscopy. Notably, the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay and nuclear changes observed by 4',6-diamidino-2-phenylindole (DAPI) staining in SH-SY5Y cells demonstrated that rhEPO-Ch-NPs were safer at any concentration investigated and rescued more neuronal cells, while preserving normocytic features against glutamate-induced excitotoxic damages compared to rhEPO.

Objective: Repeated derecruitments of previously recruited lungs can exacerbate lung injuries during mechanical ventilation. The aim of this study was to assess lung injury associated with repeated derecruitments and to assess whether this type of injury could be attenuated by recruitment maneuvers. Design: Prospective, randomized, experimental animal study. Setting: University laboratory. Subjects: New Zealand White rabbits. Interventions: Twenty-one rabbits were ventilated in pressure-controlled mode with constant tidal volume (10 mL/kg). After lung injury was induced by repeated saline lavage, positive end-expiratory pressure (PEEP) at a lower inflection point was applied for 3 hrs. The control group (n = 7) received ventilation with the same PEEP for 3 hrs without derecruitments. In the derecruitment group (n = 7), derecruitment was repeatedly induced by intentional disconnection of the ventilatory circuit for 1 min every 10 mins for 3 hrs. In the recruitment maneuver group (n = 7), continuous positive airway pressure of 30 cm H 2 O was applied for 30 sees after each derecruitment. Measurements and Main Results: After PEEP levels were increased to lower the inflection point value, PaO 2 increased to >500 mm Hg in all groups. Increased PaO 2 persisted at >450 mm Hg in the control and recruitment maneuver groups, whereas progressive declines in arterial oxygen levels were observed in the derecruitment group (median, 381.1 mm Hg [interquartile range, 350.1-466.7 mm Hg] at 2 hrs and 318.2 mm Hg [214.3-414.9 mm Hg] at 3 hrs, p

목적: 임신 중 tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) 접종의 효과 및 안전성에도 불구하고, 아직 국내 임신 중 Tdap 접종률은 낮다. 이에 저자들은 임신 중 Tdap 접종에 대한 임부들의 인식, 태도 및 행동에 대한 조사를 하였다. 방법: 본 연구는 서울 및 경기 소재 대학병원 산부인과를 방문한 임부를 대상으로 개별적인 설문지를 통해 임신 중 Tdap 접종에 대한 인식, 태도 및 행동을 수집한 단면 설문조사다. 결과: 총 184명의 임부들이 설문지 작성을 완료하였다. 이 중 158명(86%)의 임부들은 의사로부터 백일해 및 Tdap 백신에 대한 정보를 안내 받지 못했고, 166명(90%)의 임부들은 임신 중 Tdap 접종의 필요성을 알지 못했다. 현 임신기간 중 Tdap 접종을 하지 않을 것이라고 답한 임부 중 7%만이 백일해 및 백신에 대한 이해를 묻는 5문항 중 3문항 이상 올바르게 답하였다. 로지스틱 회귀분석에서 의사의 추천(adjusted odds ratio [OR], 236.2; 95% confidence interval [CI], 12.6-4,432), 백신이 효과적이라는 믿음(adjusted OR, 40.21; 95% CI, 2.35-687.7), 백신이 안전하다는 믿음(adjusted OR, 19.83; 95% CI, 1.54-255.9) 등이 Tdap 접종을 결정하는데 유의하게 중요한 요인이었다. 결론: 대부분의 임부들이 Tdap 접종에 대하여 적절하게 안내를 받지 못하거나, 추천받지 못하는 것으로 보인다. 임부들의 Tdap 접종률을 향상시키는 데에 의료기관 종사자에 의해 제공되는 정보가 매우 중요하다.

Objectives The aim of our study was to assess whether repeated derecruitments induced by the repetitive withdrawal of high positive end-expiratory pressure could induce lung injury in a swine model. Design Prospective, randomized, experimental animal study. Setting University laboratory. Subjects Specific pathogen-free pigs (Choong-Ang Laboratory Animals, Seoul, Korea) weighing around 30 kg. Interventions After lung injury was induced by repeated saline lavage, pigs were ventilated in pressure-limited mode with the highest possible positive end-expiratory pressure with a tidal volume of 8 mL/kg and maximum inspiratory pressure of 30 cm H2O. With this initial ventilator setting, the control group (n = 5) received ventilation without derecruitments for 4 hours, and in the derecruitment group (n = 5), derecruitments were repeatedly induced by intentional disconnection of the ventilatory circuit for 30 seconds every 5 minutes for 4 hours. Measurements and main results After the initial increase in positive end-expiratory pressure, the PaO2 increased to greater than 450 mm Hg in both groups. The PaO2 remained at greater than 450 mm Hg in the control group persistently, but in the derecruitment group, PaO2 significantly decreased to 427.7 mm Hg (adjusted p = 0.03) after 2 hours and remained significant for the rest of the study. PaCO2, oxygenation index, and alveolar-arterial oxygen gradient also significantly increased after 2 hours compared with the control group. However, the variables of respiratory mechanics except for minute volume at 2-hour point showed no difference between the two groups for the duration of the study. Histologically, significant bronchiolar injury was observed in the dependent portion of the derecruitment group compared with the controls (p = 0.03), but not in the nondependent area of the lung. Conclusions Repeated derecruitments exacerbated lung injury, particularly at the bronchiolar level in the dependent portion. Strategies to minimize this type of injury should be incorporated when designing optimal ventilator strategies in acute respiratory distress syndrome patients.

pH monitoring of the esophagus has been considered as the gold standard for the measurement of acid reflux. However, it has several limitations related to its inability to detect nonacid reflux. We conducted this study to characterize the proportion of acid and non-acid reflux events in children using pH-multichannel intraluminal impedance (MII) monitoring and to determine the correlation of the symptom index with non-acid and acid reflux events.Seventy-five children, aged from 9 days to 12 years, underwent 24 hour pH-MII monitoring at Asan Medical Center from March 2006 to June 2007. We investigated the underlying disease and main problems related to gastroesophageal reflux (GER) of the patients, the number of acid and nonacid reflux, symptom index, symptom sensitivity index in pH monitoring only and pH-MII monitoring.While 2,247 reflux events were detected by MII, and only 967 reflux events were detected by pH probe alone. The percentage of acid reflux was 43% (967) and that of non-acid was 57% (1,280). The non-acid reflux increased at postprandial time (p0.001). The symptom index increased when measured by pH-MII (31.1%) compared with those by pH probe alone (8.2%) (p=0.003).This study suggests that significant number of GER include non-acid reflux which cannot be detected by pH probe alone, therefore combining pH with MII monitoring is a valuable diagnostic tool for diagnosing GER in children.

Nontuberculous mycobacteria (NTM) are intracellular pathogens that elicit a specific T-cell response characterized by the production of proinflammatory cytokines, including interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-12. However, little information exists regarding the levels of specific cytokines in patients with NTM lung disease. Therefore, we compared cytokine production in peripheral blood mononuclear cells (PBMCs) from patients with NTM lung disease with that in PBMCs from healthy controls. Pro- and anti-inflammatory cytokine production was measured by enzyme-linked immunosorbent assay in the PBMCs of 29 patients with NTM lung disease and 15 healthy controls. Phytohemagglutinin (PHA)-induced IFN-gamma production and lipopolysaccharide (LPS)-induced production of TNF-alpha and IL-12p40 were significantly lower in the PBMCs of patients with NTM lung disease than in those of the healthy controls. The production of these cytokines did not differ significantly between patients infected with Mycobacterium avium complex (MAC) and those infected with Mycobacterium abscessus; however, IL-10 production was lower in patients infected with M. abscessus than in those infected with MAC. Decreased IFN-gamma, TNF-alpha, and IL-12 production may be associated with host susceptibility to the development of MAC and M. abscessus lung disease.

Octapeptide R2 (KVLDGQDP), which has anti-transglutaminas (TGase) activity, decreases inflammation in allergic conjunctivitis model in guinea pigs. The authors examined the effect of R2 on lipopolysaccharide (LPS)-induced lung injury in BALB/c mice. R2 inhalation significantly decreased neutrophil count and cytokine mRNA expression in the lungs of LPS (25 mg/kg)-treated mice (P.05). It also showed a tendency for decreased tumor necrosis factor (TNF)-alpha-immunoreactive protein in lung homogenates and significantly decreased TNF-alpha-immunoreactive protein in the serum of LPS-injected mice (P.05). These results indicate that TGase may be a new therapeutic target in LPS-induced lung inflammation.

Interferon-gamma (IFN-gamma) is crucial for host defense against mycobacterial infections. Recent studies have indicated that IFN-gamma and IFN-gamma receptor 1 (IFN-gammaR1) gene polymorphisms are associated with susceptibility to pulmonary tuberculosis. The aim of this study was to test the hypothesis that IFN-gamma and IFN-gammaR1 gene polymorphisms influence susceptibility to lung disease caused by non-tuberculous mycobacteria (NTM). Seventy-six patients with the nodular bronchiectatic form of NTM lung disease (37 patients with Mycobacterium avium complex infection and 39 patients with Mycobacterium abscessus infection) and 80 controls were included. Polymorphisms of the IFN-gamma gene at position +874 were determined by the amplification refractory mutation system (ARMS) polymerase chain reaction assay and IFN-gammaR1 gene at positions -611, -270, -56 and +95 was genotyped by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry using genomic DNA. IFN-gammaR1 -270 and +95 polymorphisms were not present in any of the patients or controls. The patients with NTM lung disease showed no significant difference from controls in genotype and allele frequencies of the IFN-gamma +874 and IFN-gammaR1 -611 and -56 polymorphisms. The IFN-gamma +874 and IFN-gammaR1 -611 and -56 polymorphisms do not appear to be responsible for host susceptibility to NTM lung disease, at least in the Korean population.

Background : Interferon-gamma () is essential in the immune response to mycobacterial infections, and a complete or partial deficiency in the receptor 1 () or the receptor 2 () have been reported to confer susceptibility to a disseminated infection with nontuberculous mycobacteria. However, similar mutations in the receptor have not been specifically examined in the patients with clinical tuberculosis. Methods : This study searched for mutations in the receptor gene that resulted in a partial receptor deficiency in six patients with disseminated tuberculosis. The previously identified and coding regions were sequenced after amplification. Results : There was no partial deficiency including a homozygous recessive missense mutation causing an amino-acid substitution in the extracellular domain of the receptor (I87T) and a hotspot for small deletions (818delT, 818del4, 818insA) found in any of the patients. In addition, a partial deficiency of the homozygous missense mutation (R114C) was not found in any of the patients. Conclusion : Genetic defects causing a partial receptor deficiency were not identified in our patients with disseminated tuberculosis.