Genome-wide association study of occupational attainment as a proxy for cognitive reserve.

Occupational attainment, which represents middle-age cognitive activities, is a known proxy marker of cognitive reserve for Alzheimer's disease. Previous genome-wide association studies have identified numerous genetic variants and revealed the genetic architecture of educational attainment, another marker of cognitive reserve. However, the genetic architecture and heritability for occupational attainment remain elusive. We performed a large-scale genome-wide association study of occupational attainment with 248 847 European individuals from the UK Biobank using the proportional odds logistic mixed model method. In this analysis, we defined occupational attainment using the classified job levels formulated in the UK Standard Occupational Classification system considering the individual professional skill and academic level. We identified 30 significant loci (P < 5 × 10-8); 12 were novel variants, not associated with other traits. Among them, four lead variants were associated with genes expressed in brain tissues by expression quantitative trait loci mapping from 10 brain regions: rs13002946, rs3741368, rs11654986 and rs1627527. The single nucleotide polymorphism-based heritability was estimated to be 8.5% (standard error of the mean = 0.004) and partitioned heritability was enriched in the CNS and brain tissues. Genetic correlation analysis showed shared genetic backgrounds between occupational attainment and multiple traits, including education, intelligence, leisure activities, life satisfaction and neuropsychiatric disorders. In two-sample Mendelian randomization analysis, we demonstrated that high occupation levels were associated with reduced risk for Alzheimer's disease [odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.65-0.92 in inverse variance weighted method; OR = 0.73, 95% CI = 0.57-0.92 in the weighted median method]. This causal relationship between occupational attainment and Alzheimer's disease was robust in additional sensitivity analysis that excluded potentially pleiotropic single nucleotide polymorphisms (OR = 0.72, 95% CI = 0.57-0.91 in the inverse variance weighted method; OR = 0.72, 95% CI = 0.53-0.97 in the weighted median method). Multivariable Mendelian randomization confirmed that occupational attainment had an independent effect on the risk for Alzheimer's disease even after taking educational attainment into account (OR = 0.72, 95% CI = 0.54-0.95 in the inverse variance weighted method; OR = 0.68, 95% CI = 0.48-0.97 in the weighted median method). Overall, our analyses provide insights into the genetic architecture of occupational attainment and demonstrate that occupational attainment is a potential causal protective factor for Alzheimer's disease as a proxy marker of cognitive reserve.

Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: a case report and literature review.

BACKGROUND: An abdominal pseudohernia is a rare clinical entity that consists of an abnormal bulging of the abdominal wall that can resemble a true hernia but does not have an associated underlying fascial or muscle defect. Abdominal pseudohernia is believed to result from denervation of the abdominal muscles in cases of herpes zoster infection, diabetes mellitus, lower thoracic or upper lumbar disc herniation, surgical injuries, and rib fracture. To date, nine cases of abdominal pseudohernia caused by disc herniation at the lower thoracic or upper lumbar levels have been reported. CASE PRESENTATION: A 35-year-old man with no underlying disease or traumatic event presented with chief complaints of left flank pain and a protruding left lower abdominal mass that had formed one day earlier. There was no true abdominal hernia on abdominal computed tomography (CT), although CT and magnetic resonance imaging (MRI) showed a herniated soft (non-calcified) disc into the left neural foramen at the T11-12 level. A nonsteroidal anti-inflammatory drug was prescribed for the flank pain, and the patient was followed on a regular basis for six months. Follow-up MRI taken at the last visit showed complete resorption of the herniated disc. Abdominal pseudohernia and flank pain were also completely resolved. CONCLUSION: We report a rare case of monoradiculopathy-induced abdominal pseudohernia caused by foraminal soft disc herniation at the T11-12 level. In patients who have an abdominal pseudohernia without herpes zoster infection, diabetes mellitus, or traumatic events, lower thoracic disc herniations should be included in differential diagnosis.

Balancing Electrolyte Donicity and Cathode Adsorption Capacity for High-Performance LiS Batteries.

LiS batteries with high theoretical capacity are attracting attention as next-generation energy storage systems. Much effort has been devoted to the introduction of cathode materials with strong adsorption to sulfide species, but it is presented that this selection should be refined in the application of high donicity electrolytes. The oxides with different adsorption capacities are explored while controlling the electrolyte donicity, confirming the trade-off effect between the donicity and the adsorption capacity for sulfur conversion. Specifically, a cathode substrate containing oxide nanoparticles of MgO, NiO, Fe2 O3 , Co3 O4 , and V2 O5 is prepared with spectra in adsorption capacity as well as low and high donicity electrolytes by controlling the concentration of LiNO3 salt. Strong adsorbent oxides such as Co3 O4 and V2 O5 cause competitive adsorption of electrolyte salts in high donicity electrolytes, resulting in poor cell performance. High cell performance is achieved on weakly adsorbing oxides of MgO or NiO with high donicity electrolytes; the MgO-containing cathode cell delivers a high discharge capacity of 1394 mAh g-1 at 0.2 C. It is believed that understanding the interactions between electrolytes and adsorbent substrates will be the cornerstone of high-performance LiS batteries.

Development and Evaluation of Sn Foil Anode for Sodium-Ion Batteries.

Metal foil electrodes are simple to prepare and have a high active material loading, making them well suited for the fabrication of inexpensive high-energy-density batteries. Herein, Sn metal foil is used as a binder- and conductive additive-free anode for sodium-ion batteries, achieving a high reversible specific capacity of 692 mAh g-1 and coulombic efficiency of 99% after 100 cycles at a rate of 0.1 C. During the first discharge process, the anode undergoes area expansion. It then splits into multiple parts during the first-charge process. Upon cycling, the separated parts reconnect and form a single piece with a porous and robust coral structure owing to the self-healing nature of the anode. A full cell with a Sn foil anode and Na3 V2 (PO4 )3 cathode shows a stable cycle life of 100 mAh g-1 for 300 cycles. Thus, the cracking or pulverization of the Sn anode is not the principal origin of poor cycling properties. The adopted strategy will promote the development and commercialization of high-capacity metal foil anodes that undergo volume changes during charge/discharge cycling.

Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review.

BACKGROUND: Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. CASE PRESENTATION: An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. CONLCUSIONS: If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.

Effect of lumbar spinal stenosis on bone mineral density in osteoporosis patients treated with ibandronate.

BACKGROUND: Lumbar spinal stenosis (LSS) can cause various neurological symptoms and reduce the daily activity of patients. Many studies have shown that free physical activities and exercise can improve bone mineral density (BMD) in patients with osteoporosis. However, the effect of LSS on BMD has not been reported. The purpose of this study was to investigate the effects of LSS on BMD in patients treated with ibandronate for newly diagnosed osteoporosis. METHODS: Group 1 included 83 patients treated for osteoporosis alone, and group 2 included 76 patients treated for both osteoporosis and symptomatic LSS. We confirmed four BMD values presented as T-score at initial, and 1-, 2-, and 3-year follow-ups. Mean BMD and annual changes of BMD for three years were compared between the two groups. Correlations between initial BMD and total change of BMD, and related factors for continuous BMD improvement for three years were also evaluated. RESULTS: Mean annual BMDs were significantly higher in group 1 compared than in group 2 (-3.39 vs. -3.58 at 1-year; -3.27 vs. -3.49 at 2-year; -3.13 vs. -3.45 at 3-year; all p < 0.05). Annual change of BMD at 1-year follow-up (0.32 vs. 0.21, p = 0.036) and total change of BMD for three years (0.57 vs. 0.35, p = 0.002) were significantly higher in group 1. Group 1 had a strong negative correlation (r = -0.511, P = 0.000) between initial BMD and total change of BMD, whereas group 2 showed a weak negative correlation (r = -0.247, p = 0.032). In multivariate analysis, symptomatic LSS was the only independent risk factor for continuous BMD improvement (Odds ratio = 0.316, p = 0.001). CONCLUSIONS: Symptomatic LSS may interfere with BMD improvement in the treatment of osteoporosis with ibandronate. Active treatment for LSS with more potent treatment for osteoporosis should be taken to increase BMD for patients with osteoporosis and LSS.

Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: a case report and review of literature.

BACKGROUND: Charcot spinal arthropathy, also known as Charcot spine and neuropathic spinal arthropathy, is a progressive and destructive condition that affects an intervertebral disc and the adjacent vertebral bodies following loss of spinal joint innervation. We report the first case of Charcot spinal arthropathy (CSA) associated with cerebrospinal fluid (CSF)-cutaneous fistula. CASE PRESENTATION: A 54-year-old male who underwent T10-L2 posterior instrumented spinal fusion seven years prior for treatment of T11 burst fracture and accompanying T11 complete paraplegia visited our department complaining of leakage of clear fluid at his lower back. The patient had also undergone various types of skin graft and myocutaneous flap surgeries for treatment of repetitive pressure sores around his lumbosacral area. The patient presented with persistent CSF leakage from a cutaneous fistula (CSF-cutaneous fistula) formed in a lumbosacral pressure sore. The CSF-cutaneous fistula arose from the L5 post-traumatic CSA. Surgery was planned for management of CSF-cutaneous fistula and post-traumatic L5 CSA. We successfully treated the CSF-cutaneous fistula with ligation and transection of the dural sac and cauda equina at the L2-L3 level. In addition, the post-traumatic L5 CSA was successfully treated with a posterior four-rod spinopelvic fixation from T9 to ilium and S2 foramina. After surgery, the CSF leakage stopped and no other adverse neurological changes were found. The four-rod spinopelvic construct was well maintained five years later. CONCLUSIONS: CSA associated with CSF-cutaneous fistula is a very rare disorder. Only surgical treatment for both CSA and CSF-cutaneous fistula with ligation and transection of the dural sac and posterior four-rod spinopelvic fixation can bring satisfactory results.

Pre-treatment peripheral biomarkers associated with treatment response in panic symptoms in patients with major depressive disorder and panic disorder: A 12-week follow-up study.

OBJECTIVE: Peripheral biomarkers have been studied to predict treatment response of panic symptoms. We hypothesized that depressive disorder (MDD) vs. panic disorder (PD) would exhibit different peripheral biomarkers, and their correlation with severity of panic attacks (PA) would also differ. METHODS: Forty-one MDD patients, 52 PD patients, and 59 healthy controls were followed for 12 weeks. We measured peripheral biomarkers along with the Panic Disorder Severity Scale (PDSS) at each visit-pre-treatment, 2, 4, 8, and 12 weeks on a regular schedule. Peripheral biomarkers including serum cytokines, plasma and serum brain-derived neurotrophic factor (BDNF), leptin, adiponectin, and C-reactive protein (CRP) were quantified using enzyme-linked immunosorbent assay (ELISA). RESULTS: Patients with MDD and PD demonstrated significantly higher levels of pre-treatment IL-6 compared to controls, but no differences were seen in plasma and serum BDNF, leptin, adiponectin, and CRP. Pre-treatment leptin showed a significant clinical correlation with reduction of panic symptoms in MDD patients at visit 5 (p=0.011), whereas pre-treatment IL-6 showed a negative correlation with panic symptom reduction in PD patients (p=0.022). An improvement in three panic-related items was observed to be positively correlated with pre-treatment leptin in MDD patients: distress during PA, anticipatory anxiety, and occupational interference. CONCLUSION: Higher pre-treatment leptin was associated with better response to treatment regarding panic symptoms in patients with MDD, while higher IL-6 was associated with worse response regarding panic symptoms in PD patients. Different predictive peripheral biomarkers observed in MDD and PD suggest the need for establishing individualized predictive biomarkers, even in cases of similar symptoms observed in different disorders.

Psychopharmacology and Psychotherapy Research.

With vigorous researches related to novel treatment in psychiatric field, paradigm shift is emerging with its design and assessment. Comprehension of the psychiatric phenomenon expanded beyond disease model, with dimensional approach. Assessment of patients' clinical state includes subjective reports related to problematic symptoms, functional change, and quality of life. They also include objective findings collected from mobile e-wearable monitoring system and advanced neuroimaging modalities. Novel treatment protocols are not just limited to pharmacology itself or psychotherapy itself, but the approach is integrated with stratification; pharmacological treatment enhanced by cognitive behavioral management and psychotherapeutic intervention has been emerged and studied for its impact. Numerous studies were conducted to understand placebo response and to differentiate this phenomenon with novel treatments. Trials to draw good adherence to research protocol with good compliance to treatment in real are strengthened by integrated approach, so-called psychopharmacology. With these paradigm shifts observed from recent researches, it is promising for great advance in quality of life and our mental health.

Does arthroscopic preemptive extensive rotator interval release reduce postoperative stiffness after arthroscopic rotator cuff repair?: a prospective randomized clinical trial.

BACKGROUND: To investigate whether preemptive extensive rotator interval (RI) release during arthroscopic rotator cuff repair (ARCR) would reduce postoperative stiffness. METHODS: From July 2015 to September 2016, a total of 80 patients who were scheduled for ARCR were enrolled and randomly allocated into 2 groups: the preemptive extensive RI release group (group 1, n=40) and the RI nonrelease group (group 2, n=40). The American Shoulder and Elbow Surgeons scale, Constant score, Korean Shoulder Scale (KSS), visual analog scale (VAS) pain score, and range of motion (ROM) were evaluated before surgery; 3, 6, and 12 months after surgery; and at last follow-up. Magnetic resonance imaging was performed at postoperative 12 months. RESULTS: The mean follow-up period was 26.5 months. The functional and pain scores in both groups were significantly improved at the last follow-up (P < .05). Group 1 showed a significantly higher sum of ROM with a difference of 27° and 1.6 vertebral level of internal rotation compared to group 2 at postoperative 3 months (P < .05). Constant score and KSS were significantly higher in group 1 than in group 2 at this time point (P < .05). Functional scores and ROM were not significantly different between 2 groups at postoperative 6 or 12 months or at the last follow-up (P > .05). The retear rate and pathologic change of the long head of the biceps tendon during follow-up were not significantly different between the 2 groups (P > .05). CONCLUSION: Arthroscopic preemptive extensive RI release can reduce early postoperative shoulder stiffness after ARCR but does not significantly change the overall clinical outcome after surgery.

Comparison of the regeneration induced by acellular nerve allografts processed with or without chondroitinase in a rat model.

There have been various studies about the acellular nerve allograft (ANA) as the alternative of autologous nerve graft in the treatment of peripheral nerve defects. As well as the decellularization process methods of ANA, the various enhancement methods of regeneration of the grafted ANA were investigated. The chondroitin sulfate proteoglycans (CSPGs) inhibit the action of laminin which is important for nerve regeneration in the extracellular matrix of nerve. Chondroitinase ABC (ChABC) has been reported that it enhances the nerve regeneration by degradation of CSPGs. The present study compared the regeneration of ANA between the processed without ChABC group and the processed with ChABC group in a rat sciatic nerve 15 mm gap model. At 12 weeks postoperatively, there was not a significant difference in the histomorphometric analysis. In the functional analysis, there were no significant differences in maximum isometric tetanic force, wet muscle weight of tibialis anterior. The processed without ChABC group had better result in ankle contracture angle significantly. In conclusion, there were no significant differences in the regeneration of ANA between the processed without ChABC group and the processed with ChABC group.

The First Report of Polymorphisms and Genetic Features of the prion-like Protein Gene (PRND) in a Prion Disease-Resistant Animal, Dog.

Prion disease has displayed large infection host ranges among several species; however, dogs have not been reported to be infected and are considered prion disease-resistant animals. Case-controlled studies in several species, including humans and cattle, indicated a potent association of prion protein gene (PRNP) polymorphisms in the progression of prion disease. Thus, because of the proximal location and similar structure of the PRNP gene among the prion gene family, the prion-like protein gene (PRND) was noted as a novel candidate gene that contributes to prion disease susceptibility. Several case-controlled studies have confirmed the relationship of the PRND gene with prion disease vulnerability, and strong genetic linkage disequilibrium blocks were identified in prion-susceptible species between the PRNP and PRND genes. However, to date, polymorphisms of the dog PRND gene have not been reported, and the genetic linkage between the PRNP and PRND genes has not been examined thus far. Here, we first investigated dog PRND polymorphisms in 207 dog DNA samples using direct DNA sequencing. A total of four novel single nucleotide polymorphisms (SNPs), including one nonsynonymous SNP (c.149G>A, R50H), were identified in this study. We also found two major haplotypes among the four novel SNPs. In addition, we compared the genotype and allele frequencies of the c.149G>A (R50H) SNP and found significantly different distributions among eight dog breeds. Furthermore, we annotated the c.149G>A (R50H) SNP of the dog PRND gene using in silico tools, PolyPhen-2, PROVEAN, and PANTHER. Finally, we examined linkage disequilibrium between the PRNP and PRND genes in dogs. Interestingly, we did not find a strong genetic linkage between these two genes. To the best of our knowledge, this was the first genetic study of the PRND gene in a prion disease-resistant animal, a dog.

Enhanced Photoelectrochemical Water Splitting through Bismuth Vanadate with a Photon Upconversion Luminescent Reflector.

As the performance of photoanodes for solar water splitting steadily improves, the extension of the absorption wavelength in the photoanodes is highly necessary to substantially improve the water splitting. We use a luminescent back reflector (LBR) capable of photon upconversion (UC) to improve the light harvesting capabilities of Mo:BiVO4 photoelectrodes. The LBR is prepared by dispersing the organic dye pair meso-tetraphenyltetrabenzoporphine palladium and perylene capable of triplet-triplet annhilation-based UC in a polymer film. The LBR converts the wavelengths of 600-650 nm corresponding to the sub-band gap of Mo:BiVO4 and the wavelengths of 350-450 nm that are not sufficiently absorbed in Mo:BiVO4 to a wavelength that can be absorbed by a Mo:BiVO4 photoelectrode. The LBR improves the water splitting reaction of Mo:BiVO4 photoelectrodes by 17 %, and consequently, the Mo:BiVO4 /LBR exhibits a photocurrent density of 5.25 mA cm-2 at 1.23 V versus the reversible hydrogen electrode. The Mo:BiVO4 /LBR exhibits hydrogen/oxygen evolution corresponding to the increased photocurrent density and long-term operational stability for the water splitting reaction.

Initial Discharge Behavior of an Ultra High Loading 3D Sulfur Cathode for a Room-Temperature Na/S Battery.

A 3D sulfur cathode for a large-scale room-temperature (RT) Na/S battery with a high sulfur loading of 14.63 mg cm-2 was fabricated. The first discharge was tested in order to understand the macroscopic changes. A first discharge capacity of 865 mAh g-1 was obtained at 1/1000 C-rate along with a discharge curve with two clear plateaus at 2.29 V and 1.78 V, respectively. A visual change occurs in the 3D sulfur cathode. A thick layer of discharge products at the solid electrolyte separator face of the 3D sulfur cathode was observed and analyzed using a scanning electron microscope (SEM) coupled with energy dispersive X-ray spectroscopy (EDS).

Electrochemical Properties of Micron-Sized SnO Anode Using a Glyme-Based Electrolyte for Sodium-Ion Battery.

Tin monoxide (SnO) anodes are promising candidates for use in sodium-ion batteries because of their high theoretical capacities and stable cycle performance. In previous reports, electrodes with excellent performance have been prepared by using nano-sized SnO particles. However, the synthesis of nano-sized SnO particles is complex, time-consuming, and expensive. In this paper, an anode of micron-sized SnO is prepared by using commercial micron-sized SnO particles. The electrode exhibits a reversible capacity of 450 mAh g-1 in the 1st cycle at a current rate of 100 mA g-1. We used a tetraethylene glycol dimethyl ether (TEGDME)-based electrolyte, which is well known for its superior electrochemical performance in sodium-ion batteries. The mechanism of operation of the anode containing micron-sized SnO particles has been confirmed by a detailed study using X-ray diffraction (XRD), scanning electron microscopy (SEM), and electrochemical impedance spectroscopy (EIS). During initial discharge, the SnO changed to Sn and sodium oxide, and the surface of the electrode became covered with a film. The electrode composed of micron-sized SnO is a potential candidate for use in sodium-ion batteries.

Effect of Ball Milling on Electrochemical Properties of Sulfur/Polyacrylonitrile (SPAN) Cathode in Li/S Battery.

Ball-milling process was applied to increase sulfur content in sulfur/polyacrylonitrile (SPAN) composites and improve electrochemical properties of Li/S batteries. In contrast to as-received PAN, pre-heated PAN was pulverized by the ball-milling, resulting in the continuous size reduction with increasing the milling time. Sulfur contents in SPAN composites synthesized with a pre-heated and milled PAN were increased with prolonging the milling time and the maximum content reached 44.5% for the milling time of 10 h. Li/S cells with SPAN electrodes delivered the first discharge capacities of 1356, 1409, 1512, and 1610 mAh/g-sulfur for milling times of 0, 1, 5, and 10 h. The 10 h-milled SPAN electrode with the highest sulfur content exhibited poor initial efficiency and low capacity retention at 100 cycles, whereas from a comprehensive viewpoint of the specific capacity and capacity retention, the 6 h-milled SPAN electrode exhibited the best electrochemical performance due to the suitable size and sulfur content.

Internet Game Addiction, Depression, and Escape From Negative Emotions in Adulthood: A Nationwide Community Sample of Korea.

The aim of this study was to investigate the association between adult Internet game addiction (IGA) and mental disorders. A total of 1401 adults aged between 18 and 74 years participated in this study. The IGA group had significantly younger patients, and it showed a higher proportion of unmarried and unemployed adults, and higher rates of suicidal ideation, plan, and attempt than the non-IGA group. Multivariate logistic regression indicated that IGA was significantly associated with major depressive disorder, dysthymia, and depressive disorders adjusting for all variables. The Patient Health Questionnaire-9 score was significantly higher in the IGA group than in the non-IGA group for both young adults and middle groups. "Escape from negative emotions like nervousness, sadness, and anger" was the only significant item associated with depression among symptoms of IGA. This study suggests that adults with IGA and depression may use Internet games to escape from negative emotions.

Quadriplegia caused by an epidural abscess occurring at the same level of cervical destructive spondyloarthropathy: a case report.

BACKGROUND: Destructive spondyloarthropathy (DSA) is one of the major complications in patients undergoing long-term hemodialysis. To the best of our knowledge, an epidural abscess occurring at the level of preexisting cervical DSA has not been well described in the literature. We report a unique case of quadriplegia caused by an epidural abscess occurring at the same level of preexisting cervical DSA. CASE PRESENTATION: A 49-year-old woman was transferred to our emergency department with 5 days of sepsis, drowsy mental status, and quadriplegia below the C5 level. The patient had a medical history of hemodialysis for 10 years. Magnetic resonance imaging showed spinal cord compression by an epidural abscess at the level of preexisting cervical DSA. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Infection of the arteriovenous (AV) shunt was considered as the primary focus of sepsis and pyogenic spondylitis. We performed an emergent open door laminoplasty and the vascular team debrided the infected AV shunt site. Approximately 8 months after surgery, the patient was able to perform activities of daily living somewhat independently. CONCLUSIONS: Emergent surgical decompression and intensive medical care led to successful recovery from a septic and quadriplegic state in this patient. When diagnosing a patient who has undergone long-term hemodialysis presenting with neurologic deficits, the possibility of infectious spondylitis at the same level as DSA should be considered.

HL156A, a novel AMP-activated protein kinase activator, is protective against peritoneal fibrosis in an in vivo and in vitro model of peritoneal fibrosis.

HL156A is a novel AMP-activated protein kinase (AMPK) activator. We aimed to investigate the protective mechanism of HL156A against peritoneal fibrosis (PF) in in vivo and in vitro models. The rat PF model was induced by daily intraperitoneally injection of chlorhexidine (CHX) solution containing 0.1% CHX gluconate and 15% ethanol for 4 wk. The rats in the treatment group were treated with HL156A (1 mg·kg(-1)·day(-1)). Control rats were injected with vehicle alone. In vitro, cultured rat peritoneal mesothelial cells (RPMCs) were treated with either high glucose (HG; 50 mM), normal glucose (NG; 5 mM), NG+HL156A, or HG+HL156A. HL156A in supplemented rats ameliorated peritoneal calcification, cocoon formation, bowel obstruction, and PF. Immunohistochemistry showed reduced fibronectin accumulation in the peritoneum of HL156A-treated rats compared with those injected with CHX alone. HL156A treatment of RPMCs inhibited HG-induced myofibroblast transdifferentiation and markers of epithelial-mesenchymal transition (EMT). Moreover, HL156A ameliorated HG-induced transforming growth factor-ß1, Smad3, Snail, and fibronectin expression in the RPMCs via AMPK upregulation. These results suggest that HL156A exhibits a protective effect in PF progression. Further research is warranted to seek the therapeutic potential of HL156A as an antifibrotic agent in peritoneal dialysis patients.

Preoperative anxiety about spinal surgery under general anesthesia.

PURPOSE: No study has investigated preoperative anxiety about spinal surgery under general anesthesia. The purposes of this study were (1) to determine how many patients have preoperative anxiety about spinal surgery and general anesthesia, (2) to evaluate the level of anxiety, (3) to identify patient factors potentially associated with the level of anxiety, and (4) to describe the characteristics of the anxiety that patients experience during the perioperative period. METHODS: This study was performed in 175 consecutive patients undergoing laminectomy for lumbar stenosis or discectomy for herniated nucleus pulposus under general anesthesia. Demographic data, information related to surgery, and characteristics of anxiety were obtained using a questionnaire. The level of anxiety was assessed using a visual analog scale of anxiety (VAS-anxiety). Patient factors potentially associated with the level of anxiety were investigated using multiple stepwise regression analysis. RESULTS: Of 157 patients finally included in this study, 137 (87%) had preoperative anxiety (VAS-anxiety > 0). The mean VAS-anxiety score for spinal surgery was significantly higher than that for general anesthesia (4.6 ± 3.0 vs. 3.2 ± 2.7; P < 0.001). Sex and age were significant patient factors related to the level of anxiety about spinal surgery (P = 0.009) and general anesthesia (P = 0.018); female patients had a higher level of anxiety about spinal surgery, and elderly patients had a higher level of anxiety about general anesthesia. The most helpful factors in overcoming anxiety before surgery and in reducing anxiety after surgery were faith in the medical staff (48.9 %) and surgeon's explanation of the surgery performed (72.3%), respectively. CONCLUSIONS: Patients awaiting laminectomy or discectomy feared spinal surgery more than general anesthesia. This study also found that medical staff and surgeons play important roles in overcoming and reducing patient anxiety during the perioperative period.