Exposure to residential traffic and trajectories of unhealthy ageing: results from a nationally-representative cohort of older adults.

BACKGROUND: Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown. METHODS: Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces. RESULTS: At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities. CONCLUSIONS: Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age.

Interobserver Variability and Diagnostic Performance in Predicting Malignancy of Pancreatic Intraductal Papillary Mucinous Neoplasm with MRI.

Background The 2017 international consensus guidelines for intraductal papillary mucinous neoplasm (IPMN) of the pancreas are widely used. Purpose To evaluate the interobserver agreement and diagnostic performance of MRI assessment in predicting the malignant potential of IPMN according to radiologists' experience. Materials and Methods This multicenter retrospective study included 100 patients with pathologically proven pancreatic IPMN (77 patients with surgery, 23 patients with biopsy) who underwent contrast-enhanced MRI between 2016 and 2021. Eight post-fellowship radiologists (four more-experienced [8-20 years] and four less-experienced [1-4 years] reviewers) evaluated MRI for high-risk stigmata and worrisome features identified by the most recent 2017 guidelines. Interobserver agreement was determined using Fleiss κ statistics according to radiologist experience. The diagnostic performance for malignant IPMN was assessed using receiver operating characteristic curve analysis. Results Among 100 patients (mean age, 66 years ± 10 [SD]; 57 men), 52 (52%) had malignant IPMN. For high-risk stigmata, interobserver agreement was substantial for main pancreatic duct size of at least 10 mm (κ = 0.78; 95% CI: 0.75, 0.82), enhancing mural nodule of at least 5 mm (κ = 0.70: 95% CI: 0.66, 0.74), and at least one high-risk stigmata (κ = 0.73: 95% CI: 0.69, 0.76). The worrisome features showed fair to substantial interobserver agreement (κ range, 0.22-0.80). More-experienced reviewers demonstrated better agreement in the assessment of at least one high-risk stigmata than less-experienced reviewers (κ = 0.77 vs κ = 0.69, P < .001). The overall diagnostic performance of each reviewer was good for the prediction of malignant pancreatic IPMN (area under the receiver operating characteristic curve [AUC] range, 0.77-0.84; median AUC, 0.82), with substantial agreement (κ = 0.76). Conclusion The 2017 international consensus guidelines enabled good diagnostic performance and substantial interobserver agreement for high-risk stigmata but not worrisome features on the evaluation of the malignant pancreatic IPMN using MRI. Agreement tended to be better among more-experienced reviewers than among less-experienced reviewers. © RSNA, 2023 Supplemental material is available for this article.

Exposures to humidifier disinfectant and various health conditions in Korean based on personal exposure assessment data of claimants for compensation.

BACKGROUND: Humidifier disinfectants (HDs) were commonly used household chemicals to prevent microbial growth in a humidifier water tank in South Korea. A growing body of evidence has indicated that its airborne exposure can induce severe lung injury. However, there has been low awareness of other health outcomes in HD users. This study aimed to evaluate health conditions appealed by claimants for compensation in relation with an increased exposure to HD. METHODS: From survey data of personal HD exposure assessment of claimants for compensation in Korea, we included a total of 4,179 subjects [cases in each dataset were defined by nine reported health conditions, i.e., pneumonia, asthma, cardiovascular disease, respiratory disease, otorhinolaryngologic disease, brain disease (including cerebrovascular disease), dermatological disease, lung cancer, and all cancers]. HD exposures was considered as the following exposure criteria: exposure duration, exposure proximity, exposure direction, chemical type, cumulative exposure time, indoor air concentration, and cumulative exposure level. Logistic regression models were used to evaluate the associations between HD exposure and health conditions. RESULTS: After adjusting for sociodemographic and health behavioral factors and other chemical exposures (households, environmental, and occupational exposures), an increase in cumulative HD exposure time was significantly associated with risks of all nine diseases (all p-trends < 0.05). An increase in HD exposure duration was associated with asthma, respiratory disease, otorhinolaryngologic disease, dermatological disease, all cancers, and lung cancer (p-trends < 0.05). Indoor HD concentration was associated with only pneumonia (p-trend = 0.015). CONCLUSIONS: Our findings suggest that cumulative exposures to airborne HD might potentially increase the risk of various reported health outcomes.

Long-term exposure to ambient air pollutants and age-related macular degeneration in middle-aged and older adults.

Absract In developed countries, age-related macular degeneration (AMD) is a leading cause of irreversible blindness in adults. The key pathways of AMD are suggested to be excessive oxidative stress and inflammation in the central retina. Because air pollution has been found capable of inducing oxidative stress and inflammation, it may play a role in development of AMD. This study investigated the association between ambient air pollution and AMD in 15,115 middle-aged and older adults (≥40 years) from Korean National Health and Nutrition Examination Survey 2008-2012. After controlling for important confounders, ambient NO2 and CO in current-to-5 prior years and PM10 in 2-to-5 prior years were significantly associated with higher prevalence of early AMD, while O3 in current-to-5 prior years was significantly associated with lower prevalence of early AMD. When modeled air pollution within administrative division units, its ORs with an IQR increase in NO2, CO, and O3 at current year were 1.24 (95% CI: 1.05-1.46), 1.22 (95% CI: 1.09-1.38), and 0.80 (95% CI: 0.70-0.92), respectively. Overall, results from air pollution at local/town units were consistent with those at administrative division units. Long-term exposures to ambient air pollution may play a role in the risk of AMD in middle-aged and older adults.

Misclassification and characterization of exposure to humidifier disinfectants using a questionnaire.

BACKGROUND: Lung disease caused by exposure to chemical substances such as polyhexamethylene guanidine (PHMG) used in humidifier disinfectants (HDs) has been identified in Korea. Several researchers reported that exposure classification using a questionnaire might not correlate with the clinical severity classes determined through clinical diagnosis. It was asserted that the lack of correlation was due to misclassification in the exposure assessment due to recall bias. We identified the cause of uncertainty to recognize the limitations of differences between exposure assessment and clinical outcomes assumed to be true value. Therefore, it was intended to check the availability of survey using questionnaires and required to reduce misclassification error/bias in exposure assessment. METHODS: HDs exposure assessment was conducted as a face-to-face interview, using a questionnaire. A total of 5245 applicants participated in the exposure assessment survey. The questionnaire included information on sociodemographic and exposure characteristics such as the period, frequency, and daily usage amount of HDs. Based on clinical diagnosis, a 4 × 4 cross-tabulation of exposure and clinical classification was constructed. When the values of the exposure rating minus the clinical class were ≥ 2 and ≤ - 2, we assigned the cases to the overestimation and underestimation groups, respectively. RESULTS: The sex ratio was similar in the overestimation and underestimation groups. In terms of age, in the overestimation group, 90 subjects (24.7%) were under the age of 10, followed by 52 subjects (14.2%) in their 50s. In the underestimation group, 195 subjects (56.7%) were under the age of 10, followed by 80 subjects (23.3%) in their 30s. The overestimation group may have already recovered and responded excessively due to psychological anxiety or to receive compensation. However, relatively high mortality rates and surrogate responses observed among those under 10 years of age may have resulted in inaccurate exposure in the underestimation group. CONCLUSIONS: HDs exposure assessment using a questionnaire might not correlate with adverse health effects due to recall bias and various other causes such as recovery of injury and psychological anxiety. This study revealed exposure misclassification and characteristics affected by HDs and proposed a questionnaire-based exposure assessment methodology to overcome the limitations of past exposure assessment.

Serum 25-hydroxyvitamin D and hypertension in premenopausal and postmenopausal women: National Health and Nutrition Examination Surveys 2007-2010.

OBJECTIVE: A recent meta-analysis suggested that the association between vitamin D and risk of hypertension was markedly stronger in women aged <55 years in observational data, while the association became null in women aged ≥55 years. We therefore hypothesized that this difference in associations might potentially be caused by the change in oestrogen around menopause. Our objective was to investigate associations between vitamin D status and hypertension risk and to evaluate those associations as they may differ according to menopausal status. DESIGN: A cross-sectional population survey conducted by the US Centers for Disease Control and Prevention, National Center for Health Statistics. SETTING: The National Health and Nutrition Examination Surveys (NHANES) 2007-2010 formed the setting for the present study. PARTICIPANTS: We analysed data from 2098 premenopausal women and 2298 postmenopausal women. RESULTS: After adjustment for sociodemographic, behavioural and dietary factors, higher concentrations both of serum total 25-hydroxyvitamin D (25(OH)D) and serum 25-hydroxycholecalciferol (25(OH)D3) revealed significant dose-dependent trends with lower risk of hypertension (Ptrend = 0·005 and 0·014, respectively) in premenopausal women. In those women, 25(OH)D ≥ 50 nmol/l (sufficient; in contrast to deficient, vitamin D < 30 nmol/l) appeared to have a protective effect against hypertension (OR = 0·64, 95 % CI 0·39, 1·02 for total 25(OH)D and OR = 0·60, 95 % CI 0·36, 1·00 for 25(OH)D3). Neither association with hypertension was observed in postmenopausal women. CONCLUSIONS: Serum 25(OH)D concentrations were associated with lower risk of hypertension in premenopausal women, but not in postmenopausal women.

Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an emerging threat worldwide. It remains unclear how comorbidities affect the risk of infection and severity of COVID-19. METHODS: This is a nationwide retrospective case-control study of 219,961 individuals, aged 18 years or older, whose medical costs for COVID-19 testing were claimed until May 15, 2020. COVID-19 diagnosis and infection severity were identified from reimbursement data using diagnosis codes and on the basis of respiratory support use, respectively. Odds ratios (ORs) were estimated using multiple logistic regression, after adjusting for age, sex, region, healthcare utilization, and insurance status. RESULTS: The COVID-19 group (7,341 of 219,961) was young and had a high proportion of female. Overall, 13.0% (954 of 7,341) of the cases were severe. The severe COVID-19 group had older patients and a proportion of male ratio than did the non-severe group. Diabetes (odds ratio range [ORR], 1.206-1.254), osteoporosis (ORR, 1.128-1.157), rheumatoid arthritis (ORR, 1.207-1.244), substance use (ORR, 1.321-1.381), and schizophrenia (ORR, 1.614-1.721) showed significant association with COVID-19. In terms of severity, diabetes (OR, 1.247; 95% confidential interval, 1.009-1.543), hypertension (ORR, 1.245-1.317), chronic lower respiratory disease (ORR, 1.216-1.233), chronic renal failure, and end-stage renal disease (ORR, 2.052-2.178) were associated with severe COVID-19. CONCLUSION: We identified several comorbidities associated with COVID-19. Health care workers should be more careful while diagnosing and treating COVID-19 when patients have the abovementioned comorbidities.

Environmental pyrethroid exposure and diabetes in U.S. adults.

Pyrethroid insecticides have been used widely as replacements for organophosphate insecticides over the past decades. While several animal studies suggest that exposure to pyrethroids can alter glucose homeostasis, there is only limited evidence of the association between environmental pyrethroid exposure and diabetes risk in human populations. Therefore, we examined the National Health and Nutrition Examination Survey (NHANES) 2007-2010 data to determine the association between environmental pyrethroid exposure and the prevalence of diabetes in the general U.S. population. Using data on 2796 participants aged 20-79 years from NHANES 2007-2010, we estimated odds ratios (ORs) and 95% confidence intervals (CI) of the association between diabetes and urinary metabolite concentration of pyrethroids using logistic regression. The weighted prevalence of diabetes was 10.3%. The weighted geometric means and detection rate of 3-phenoxybenzoic acid (3-PBA), the most common nonspecific pyrethroid metabolite, were 0.41 µg/L (95% CI: 0.38, 0.45) and 72.0%, respectively. After adjusting for sociodemographic, behavioral, and metabolic factors, we found a significant dose-response relationship between urinary 3-PBA as quartile and prevalent diabetes (p-trend=0.007). Compared to the lowest quartile of 3-PBA, the highest quartile had OR of 2.18 (95% CI: 1.18, 4.03) for diabetes. Our finding suggests pyrethroid insecticides as a potential risk factor for diabetes. Further studies should be conducted to confirm our finding and to determine if this association is causal.

Imaging Features of Gadoxetic Acid-enhanced and Diffusion-weighted MR Imaging for Identifying Cytokeratin 19-positive Hepatocellular Carcinoma: A Retrospective Observational Study.

Purpose To determine the preoperative magnetic resonance (MR) imaging findings potentially most useful for predicting cytokeratin 19 (CK19)-positive hepatocellular carcinoma (HCC) and to evaluate the prognosis after curative resection in patients with a single HCC lesion positive for CK19 compared with patients with HCC who are negative for CK19. Materials and Methods The institutional review board approved this study and waived the requirement for informed consent. Two hundred four patients with CK19-negative HCC and 38 with CK19-positive HCC who underwent curative resection after gadoxetic acid-enhanced and diffusion-weighted MR imaging were retrospectively evaluated in a single institution. Two radiologists evaluated preoperative findings at MR imaging. Significant findings for differentiating the two groups were identified at univariate and multivariate analyses. By using receiver operating characteristic analysis, the optimal cut-off values for quantitative variables were determined. Recurrence-free survival rates after surgery were also compared between groups. Results At multivariate analysis, irregular tumor margin (P = .024), arterial rim enhancement (P < .001), lower tumor-to-liver signal intensity (SI) ratio on hepatobiliary phase (HBP) images (≤0.522; P = .01), and lower tumor-to-liver apparent diffusion coefficient (ADC) ratio (≤0.820; P < .001) were independent significant factors to predict CK19-positive HCC. When three of these four criteria were combined, 63.2% (24 of 38; 95% confidence interval: 46.0%, 78.2%) of CK19-positive HCCs were identified with a specificity of 90.7% (185 of 204; 95% confidence interval: 46.0%, 78.2%). When all four criteria were satisfied, specificity was 99.5% (203 of 204; 95% confidence interval: 97.3%, 100%). Recurrence-free survival rates were significantly lower in patients with CK19-positive HCCs compared with those with CK19-negative HCCs after curative resection (63.9% vs 90.0% at 1 year, 63.9% vs 79.9% at 2 years, and 54.8% vs 70.2% at 3 years, P = .001 by log-rank test). Conclusion At gadoxetic acid-enhanced and diffusion-weighted MR imaging, irregular margin, arterial phase rim enhancement, lower tumor-to-liver ADC ratio, and lower tumor-to-liver SI ratio at HBP imaging may be helpful to predict CK19-positive HCC with early recurrence (<2 years) after curative resection. © RSNA, 2017 Online supplemental material is available for this article.

Simplified Prediction Model for Accurate Assessment of Dental Caries Risk among Participants Aged 10-18 Years.

Dental caries assessment needs to be targeted at specific age groups, as many risk factors are related to patient age. Pre-teen and teenage patients, who are still at risk of occurrence of new carious lesions, need more individualized caries management strategies. Therefore, this study aimed to identify caries-related risk factors and develop a simplified risk prediction model for dental caries. Risk factors for caries were assessed in 171 participants aged 10-18 years, based on a questionnaire survey, previous history of caries, oral hygiene, microorganism colonization, saliva secretion, saliva buffer capacity examinations, and the acidogenicity of dental biofilms. These risk factors were entered into a computer-based risk assessment program (the Cariogram), and correlations between these factors and Cariogram scores were investigated. Significant risk predictors were used to develop a simplified risk prediction model. The performance of this model in predicting dental caries incidence was evaluated using receiver operating characteristic analysis, to determine its applicability to the management of caries. Our simplified prediction model included three predictors that were significantly associated with caries incidence: use of fluoride-containing toothpaste, the acidogenicity of dental biofilms, and saliva secretion (p < 0.001). The resulting model had a sensitivity and specificity of 60.5 and 85.0%, respectively, with a cut-off value of 69.41 as the threshold. The area under the curve of this model was 0.782 (95% confidence interval = 0.681-0.884, p < 0.001). Our new caries risk prediction model is expected to allow clinicians to accurately and easily predict patients' risk of occurrence of new caries.

Preoperative Serum Alkaline Phosphatase and Clinical Outcome of Off-Pump Coronary Artery Bypass Surgery.

BACKGROUND: Serum alkaline phosphatase (ALP) is related to vascular calcification. In a recent study on percutaneous coronary intervention (PCI) with a drug-eluting stent, higher ALP was associated with poor clinical outcomes in terms of mortality, myocardial infarction, and stent thrombosis. The aim of this study was to evaluate the relationship between preoperative ALP and clinical outcome of off-pump coronary artery bypass surgery (OPCAB).Methods and Results:We retrospectively enrolled and reviewed a total of 1,335 patients who underwent OPCAB. Patients were divided into tertiles based on preoperative serum ALP (<60, 60-76, and >76 IU/L). As preoperative ALP increased, the HR of mortality remained constant after adjusting for confounders. On Cox proportional hazards regression analysis, there was no association between ALP and all-cause mortality. The adjusted HR for all-cause mortality for the middle tertile was 0.882 (95% CI: 0.592-1.314, P=0.537), and 0.915 (95% CI: 0.605-1.383, P=0.672) for the highest tertile. In addition, no associations between ALP and cardiovascular mortality, myocardial infarction, revascularization, or major adverse cardiac events were found. CONCLUSIONS: Unlike after PCI, high ALP is not related to adverse clinical events, such as mortality, myocardial infarction, or revascularization after OPCAB. ALP might be considered when determining the optimal revascularization technique.

Objectively measured sedentary behavior and moderate-to-vigorous physical activity on the health-related quality of life in US adults: The National Health and Nutrition Examination Survey 2003-2006.

BACKGROUND: Health-related quality of life (HRQOL) represents an individual's perception of physical, mental, and social well-being and is a strong predictor of health status. Few studies have examined associations of sedentary behavior (SB) and moderate-to-vigorous physical activity (MVPA) with HRQOL in the general population. PURPOSE: This study aimed to determine combined associations of objectively measured SB and MVPA on the risk of poor HRQOL in the general US population, after controlling for potential confounding factors. METHODS: We analyzed data from 5359 adults from the National Health and Nutrition Examination Survey 2003-2006. HRQOL was measured using a HRQOL-4 consisting of four questions focused on the self-perception of general health, physical health, mental health, and activity limitation. We dichotomized each HRQOL-4 component as good versus poor and defined poor overall HRQOL when participants had any poor HRQOL components. SB and MVPA were measured using an accelerometer. Survey logistic models were examined to estimate the odds ratio (OR) and 95% confidence interval (CI) for poor HRQOL by SB and MVPA as tertiles. RESULTS: When examined as a combination of SB and MVPA, a substantial decrease in the risk of poor overall HRQOL was found in individuals with low SB/high MVPA [OR 0.69 (95% CI 0.51-0.94) and moderate SB/high MVPA (OR 0.56 (95% CI 0.40-0.78)], but no significant decrease was found in individuals with high SB/high MVPA (vs. high SB/low MVPA). CONCLUSION: Our findings suggest that both increasing MVPA and reducing time spent in SB may be useful strategies to improve HRQOL.

Determination of the optimal depth of a left internal jugular venous catheter in infants: A prospective observational study.

BACKGROUND: Few reports exist regarding the optimal depth of a left-sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight. METHODS: A two-stage study was conducted. In the first observational study, infants aged ≤1 year and scheduled for elective surgery requiring a central venous catheter were enrolled. The tip of the central venous catheter was confirmed using transthoracic echocardiography. Linear regression modeling was performed to determine the association between the insertion depth of the central venous catheter and the I-A-B distance (I, the insertion point; A, the sternal head of the left clavicle; B, the midpoint of the perpendicular line drawn between the sternal head of the right clavicle and an imaginary line between the nipples), based on age, height, and weight. In the second study, the results of the first study were validated in another group of consecutive infants. RESULTS: In the first study, the data of 67 patients were analyzed. The infant's height and I-A-B distance were highly correlated with the level of the central venous catheter tip (R2 =0.763 and 0.772, respectively; all P < .01), using the regression equations 0.11 ×  height (cm) + 0.19 and 1.02 ×  I-A-B (cm) + 1.55, respectively. In the second study, height was also highly correlated with the insertion depth of the central venous catheter in another 42 infants (r = .938, P = <.001). In a Bland-Altman's analysis, the mean bias and precision of the actual insertion depth and predicted depth using height were 0.09 and 0.15 cm, respectively. The limits of agreement were -0.19 and 0.38 cm, respectively. CONCLUSION: In infants, the optimal depth of a central venous catheter at the left internal jugular vein can be determined with a simple formula using height.

Outdoor Air Pollution and Pterygium in Korea.

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008-2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 µm [PM10], ozone [O3], nitrogen dioxide [NO2], and sulfur dioxide levels [SO2]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM10 after adjusting for covariates (odds ratio [OR] 1.23; [per 5 µg/m³ PM10 increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.

Differentiating Mass-Forming Autoimmune Pancreatitis From Pancreatic Ductal Adenocarcinoma on the Basis of Contrast-Enhanced MRI and DWI Findings.

OBJECTIVE: The purpose of this study was to assess value of contrast-enhanced MRI, MRCP, and DWI for differentiating mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS: This study included 15 patients with mass-forming AIP and 79 with PDAC who underwent gadoxetic acid-enhanced MRI with DWI and MRCP. Two radiologists evaluated the MRI findings in consensus. Statistically significant imaging findings were identified through univariate and multivariate analyses, and their diagnostic performance for predicting mass-forming AIP was analyzed. RESULTS: In the univariate analysis, multiplicity, similar or high signal intensity on portal phase and 3- and 20-minute delayed phase images, homogeneous enhancement, no peripancreatic fat infiltration, no internal cystic or necrotic portion, capsulelike rim, no upstream pancreatitis, no vascular invasion, and duct penetrating sign were more frequently observed (p < 0.05) in mass-forming AIP. The apparent diffusion coefficient (ADC) value was also significantly lower for mass-forming AIP than for PDAC (0.96 ± 0.14 versus 1.13 ± 0.23 × 10(-3) mm(2)/s; p < 0.001). The optimal cutoff value of ADC for differentiating mass-forming AIP from PDAC was 0.9407 × 10(-3) mm(2)/s. In multivariate analysis, homogeneous enhancement (p = 0.001), duct penetrating sign (p < 0.001), and ADC value less than 0.9407 × 10(-3) mm(2)/s (p < 0.001) were significant for differentiating mass-forming AIP from PDAC. When two of these three criteria were combined, 80% (12/15) of mass-forming AIPs were identified with specificity of 98.7%. When all three criteria were satisfied, specificity was 100%. CONCLUSION: Contrast-enhanced MRI with MRCP and DWI may be helpful for differentiating mass-forming AIP from PDAC.

Urinary phthalate metabolites and depression in an elderly population: National Health and Nutrition Examination Survey 2005-2012.

Previous animal studies have demonstrated that phthalate exposure is associated with depression-like behaviors. However, no human study has explored this relationship. We explored the association between urinary phthalate metabolite concentrations and depression in a nationally representative sample of the U.S. elderly population. We analyzed 2030 participants aged 60 years or older with available data on phthalates and depression from the 2005 to 2012 National Health and Nutrition Examination Survey (NHANES). We selected 10 urinary phthalate metabolites with a weighted detection rate >60%. Depression was defined as a 9-item Patient Health Questionnaire score ≥10. The models were adjusted for age, sex, race/ethnicity, education level, income-to-poverty ratio, health insurance coverage, marital status, smoking status, alcohol consumption, moderate physical activity, body mass index, comorbidity status, NHANEs cycle, and urinary creatinine levels. One-unit increases in log-transformed mono-(3-carboxypropyl) phthalate (MCPP) (odds ratio [OR]=1.24, 95% confidence interval [CI]=1.02-1.52) and mono(carboxynonyl) phthalate (MCNP) (OR=1.42, 95% CI=1.15-1.75) were positively associated with depression. When we stratified the urinary phthalate metabolites into quartiles, the highest quartiles (Q4) of MCNP (OR=2.57, 95% CI=1.25-5.27) and mono-n-butyl phthalate (MBP) (OR=2.40, 95% CI=1.10-5.22) were associated with depression compared with the lowest quartiles (Q1). Concentrations of urinary phthalate metabolites MCPP, MCNP, and MBP were positively associated with the risk of depression in a representative sample of the U.S. elderly population. However, the present cross-sectional study is hypothesis generating and the associations need to be investigated through further longitudinal studies.

Association between phthalate exposure and lower handgrip strength in an elderly population: a repeated-measures study.

BACKGROUND: Decreased muscle strength can lead to adverse health outcomes in the elderly. A potential association between phthalate exposure and muscle strength was suggested previously, but has not been investigated directly. We hypothesized that phthalate exposure is associated with lower handgrip strength and that the association is modified by the dietary omega-6 to omega-3 ratio. METHODS: We analyzed 1,228 participants (≥60 years of age) recruited in Seoul and Asan, Republic of Korea. The study participants were surveyed up to three times between 2012 and 2015. At every survey, we collected urine samples and measured handgrip strength twice for each hand. The associations between urine phthalate metabolite concentrations and handgrip strength were evaluated using linear mixed models. Based on dietary information from 391 individuals who participated in the first survey in Seoul, we evaluated the heterogeneity of the association for those with high and low omega-6 to omega-3 ratios, using 8.81 (the 75th quantile) as a cutoff value. RESULTS: Log-transformed creatinine-adjusted concentrations of mono-(2-ethyl-5-oxohexyl phthalate (MEOHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono-n-butyl phthalate (MnBP) were inversely associated with all measured handgrip strengths (ß = -0.69 to -0.42, all p-values < 0.05). Associations between phthalate biomarkers and handgrip strength did not differ by sex. When the dietary subgroup was stratified by the omega-6 to omega-3 ratio, the associations were stronger among participants with high ratios. CONCLUSIONS: We found inverse associations between phthalate biomarkers and handgrip strength in the elderly; this association was modified by the dietary omega-6 to omega-3 ratio.

Physical activity, dietary vitamin C, and metabolic syndrome in the Korean adults: the Korea National Health and Nutrition Examination Survey 2008 to 2012.

OBJECTIVES: Metabolic syndrome is a global public health problem, and regular physical activity is a well-known critical factor in its management. A recent study suggests that the effect of exercise on metabolic syndrome may be enhanced by sufficient plasma vitamin C concentrations. We therefore examined the combined effect of physical activity and dietary vitamin C on the risk of metabolic syndrome in the general Korean population. STUDY DESIGN: Cross-sectional study. METHODS: We analyzed data from 22,671 adults aged 20 years or older from the Korea National Health and Nutrition Examination Survey 2008-2012. Physical activity was computed as the total metabolic equivalent (METs-hr/week) summed from MET scores of walking, moderate activity, and vigorous activity. Vitamin C intake was assessed using a 24-h dietary recall. Participants were classified into four combined groups based on median values of physical activity and vitamin C intake. RESULTS: After adjustment for potential confounders, the odds ratio (OR) for metabolic syndrome in individuals with both high physical activity and vitamin C intake (vs. both low physical activity and vitamin C intake) was 0.79 (95% confidence interval (CI), 0.71-0.87). The estimated combined effect was more than either high physical activity alone (OR, 0.81 (95% CI, 0.73-0.90)) or high vitamin C intake alone (OR, 0.89 (95% CI, 0.80-0.99)), although each of those was beneficial. CONCLUSIONS: Physical activity and dietary intake of vitamin C are both associated with a lower risk of metabolic syndrome. Our findings suggest further that a combination of physical activity and a diet rich in vitamin C may help in preventing metabolic syndrome.

The interactive association of smoking and drinking levels with presence of periodontitis in South Korean adults.

BACKGROUND: Periodontitis is a chronic and long-lasting low-grade inflammatory disease. Numerous studies have shown that the severity of periodontitis rose when there was an increase in the amount of smoking or alcohol consumption. However, as periodontitis known as a chronic disease, it is important to consider not only the amount but "duration" with frequency i.e., rates, of smoking or drinking. This study assessed impacts of the amount and duration of smoking and drinking on periodontal health in Korean adults. We also investigated whether or not there is an interactive effect of smoking and drinking on periodontal health. METHODS: Under a cross-sectional study design, we used data from the fourth and fifth the Korean National Health and Nutrition Examination Survey (KNHANES) sessions (2008-2010). A total of 18,488 subjects (over 19 years) answered both smoking and drinking status and were given the periodontal examination. Periodontal health status was determined by the community periodontal index (CPI) developed by the World Health Organization (WHO). According to the WHO guidelines, if a participant's CPI was 3 or larger, we classified the person as a case of periodontitis. Participants with a CPI < 3 were assigned to the control group. RESULTS: Prevalence of periodontitis for self-reported smokers or drinkers in South Korea was 35.0 or 28.0 %, respectively. We observed 1.20 (0.93~1.56) of odds ratio (95 % CI) for prevalence (POR) of periodontitis for those smoked <13 pack-year (PY) and drank ≥6.8 glass-year (GY). And we had POR of 1.91 (1.34~2.73) for those smoked ≥13 PY and drank <6.8 GY, compared to those nonsmoking nondrinkers. The observed POR of 2.41 (95 % CI: 1.94-3.00), for those smoked ≥13 PY and drank ≥6.8 GY, was higher than a multiplicative effect estimated, i.e., 1.20 (0.93~1.56) [those smoked <13 PY and drank ≥6.8 GY] × 1.91 (1.34~2.73) [those smoked ≥13 PY and drank <6.8 GY], or 2.29. CONCLUSIONS: We observed a multiplicative interactive effect of smoking and drinking on periodontal status among Korean adults.