Protective Effects of Lanostane Triterpenoids from Chaga Mushroom in Human Keratinocytes, HaCaT Cells, against Inflammatory and Oxidative Stresses.

Inotodiol, a lanostane-type triterpenoid, and many phytochemicals from Chaga mushrooms have been investigated for various allergic diseases. However, the anti-aging and anti-inflammatory activities of inotodiol under different types of oxidative stress and the impact of inotodiol on collagen and hyaluronan synthesis have not been sufficiently studied. Lanostane triterpenoids-rich concentrate, which contained 10% inotodiol as major (inotodiol concentrate), was prepared from Chaga and compared with pure inotodiol in terms of anti-inflammatory activities on a human keratinocyte cell line, HaCaT cells, under various stimulations such as stimulation with ultraviolet (UV) B or tumor necrosis factor (TNF)-α. In stimulation with TNF-α, interleukin (IL)-1ß, IL-6, and IL-8 genes were significantly repressed by 0.44~4.0 µg/mL of pure inotodiol. UVB irradiation induced the overexpression of pro-inflammatory cytokines, but those genes were significantly suppressed by pure inotodiol or inotodiol concentrate. Moreover, pure inotodiol/inotodiol concentrate could also modulate the synthesis of collagen and hyaluronic acid by controlling COL1A2 and HAS2/3 expression, which implies a crucial role for pure inotodiol/inotodiol concentrate in the prevention of skin aging. These results illuminate the anti-inflammatory and anti-aging effects of pure inotodiol/inotodiol concentrate, and it is highly conceivable that pure inotodiol and inotodiol concentrate could be promising natural bioactive substances to be incorporated in therapeutic and beautifying applications.

Unhealthy Weight Control Behaviors according to the Status of Combustible Cigarette and Noncombustible Nicotine or Tobacco Product Use among Korean Adolescents with Experience Attempting to Reduce or Maintain Their Body Weight: The 15th Korea Youth Risk Behavior Survey, 2019.

BACKGROUND: Noncombustible nicotine or tobacco product (NNTP) use, and cigarette smoking are associated with a high likelihood of unhealthy weight control behaviors (UWCBs) among adolescents. However, no study has addressed the differences in UWCBs among non-users, single users of combustible cigarettes (CCs) or NNTPs and dual users. This study compared the frequencies of weight control behaviors according to the status of CC and NNTP use among Korean adolescents. METHODS: This was a cross-sectional study of 25,094 adolescents who had attempted to reduce or maintain their body weight during the past 30 days, using data from the 15th Korea Youth Risk Behavior Survey, 2019. Data on the status of CC and NNTP use, weight status, and weight control behaviors were obtained using self-report questionnaires. Subjects were categorized into four groups: non-users, cigarette-only users, NNTP-only users, and dual users. RESULTS: Among boys and girls, current smokers and NNTP users were 8.9%±0.3% and 5.5%±0.3%, and 4.2%±0.2% and 1.7%±0.1%, respectively. Among boys, NNTP-only users were more likely to engage in extreme weight control behaviors than non-users. Among girls, users of either CCs or NNTPs were more likely to engage in extreme weight control behaviors and less extreme weight control behaviors than non-users. CONCLUSION: This study shows that users of either CCs or NNTPs are more likely to engage in UWCBs, and NNTP-only users are the most likely to do so.

Efficient biotransformation of docosahexaenoic acid-rich oils into the lipid mediator resolvin D5 by cells expressing 15S-lipoxygenase using a bioreactor.

Resolvin D5 (RvD5), 7S,17S-dihydroxy-4Z,8E,10Z,13Z,15E,19Z-docosahexaenoic acid (DHA) is a specialized pro-resolving mediator (SPM) generated in human macrophages. It is implicated in the resolution of inflammation and synthesized using an inefficient chemical process. Here, DHA-enriched oil hydrolysate was prepared from oils by lipase with resin treatment and solvent extraction. The reaction factors on the biotransformation of oil hydrolysate into RvD5 were optimized using Escherichia coli expressing arachidonate double-oxygenating 15S-lipoxygenase. After optimization, the cells converted 5.0 mM (1.64 g/L) DHA in oil hydrolysate into 4.0 mM (1.44 g/L) RvD5 in a bioreactor for 3.0 h, which was 15-fold higher than that in a flask before optimization, and RvD5 with a purity of > 97% was prepared from reaction solution by treatments of resins. This is the first trial for the production of C22-dihydroxy fatty acid using a bioreactor. This study will contribute to the large-scale production of SPMs from oils.

Physicians' Agreement on and Implementation of the 2019 European Alliance of Associations for Rheumatology Vaccination Guideline: An International Survey.

Objective: To evaluate the perspective of healthcare professionals towards the 2019 European Alliance of Associations for Rheumatology (EULAR) vaccination guideline in patients with autoimmune inflammatory rheumatic diseases (AIIRD). Methods: Healthcare professionals who care for patients with AIIRD were invited to participate in an online survey regarding their perspective on the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD. Level of agreement and implementation of the 6 overarching principles and 9 recommendations were rated on a 5-point Likert scale (1~5). Results: Survey responses of 371 healthcare professionals from Asia (42.2%) and North America (41.6%), Europe (13.8%), and other countries were analyzed. Only 16.3% of participants rated their familiarity with the 2019 EULAR guideline as 5/5 ("very well"). There was a high agreement (≥4/5 rating) with the overarching principles, except for the principles applying to live-attenuated vaccines. There was a high level of agreement with the recommendations regarding influenza and pneumococcal vaccinations; implementation of these recommendations was also high. Participants also reported a high level of agreement with the remaining recommendations but did not routinely implement these recommendations. Conclusion: The 2019 update of EULAR recommendations for the vaccination of adult patients with AIIRD is generally thought to be important by healthcare professionals, although implementation of adequate vaccination is often lacking. Better education of healthcare providers may be important to optimize the vaccination coverage for patients with AIIRD.

Physician Perspectives on Vaccination in Patients With Autoimmune Inflammatory Rheumatic Diseases: An International Survey.

OBJECTIVE: To evaluate the perspective of physicians who care for patients with autoimmune inflammatory rheumatic disease (AIIRD) toward vaccination. METHODS: Physicians who care for patients with AIIRD were invited to participate in an online survey regarding their vaccination perspectives in adult patients with AIIRD. RESULTS: Survey responses of 370 physicians from Asia (41.1%), North America (41.6%), Europe (13.8%), and other countries (3.5%) were analyzed. Participants stated that rheumatologists (58.2%) should be primarily responsible for vaccination coverage, followed by general internists (19.3%) and family medicine practitioners (12.8%). Additionally, 96.7% of participants considered vaccination very important (≥ 4/5 rating) for patients with AIIRD. Despite these sentiments, only one-third (37%) reported vaccinating the majority (≥ 60%) of their patients. CONCLUSION: Physicians who care for patients with AIIRD agree that vaccines are effective and safe in patients with AIIRD. Unfortunately, they often do not ensure that their patients are adequately vaccinated. Further studies are needed to investigate how to improve vaccination coverage for this high-risk patient population.

Korean guidelines for the management of gout.

Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.

Korean guidelines for the management of gout.

Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.

Prevalence of dietary supplement use in Korean children and adolescents: insights from Korea National Health and Nutrition Examination Survey 2007-2009.

The purpose of this study was to estimate the prevalence of dietary supplement (DS) use in Korean children and adolescents and to examine the related factors associated with DS use from the 4th Korea National Health and Nutrition Examination Survey. Total 6,131 participants aged between 2 and 18 yr were included in the analysis. We estimated the prevalence of DS use mainly from the DS questionnaire data of the Nutrition Survey. Reported supplements were classified according to the Health Functional Food Code. We also assessed the relationship between DS use and anthropometry, socioeconomic factors, health behaviors, and chronic diseases. Approximately 34% of Korean children and adolescent was taking DS. Younger age (P = 0.003), higher household income (P < 0.001), presence of chronic diseases (P = 0.05), regular meal consumption (P = 0.002), frequent snack consumption (P = 0.001), and normal body mass index rather than overweight (P = 0.10) or obesity (P = 0.03) were associated with the DS use after adjustment for related factors. Vitamin/mineral supplements (343.5/10(3) persons) were the most commonly taken DS in Korean children and adolescents, followed by Omega-3 (28.8), ginseng (18.3), colostrums (14.1) and chlorella/spirulina (10.0). In conclusion, DS use is common as much as in 34% of Korean children and adolescents and is associated with age, household income level, chronic diseases, meal regularity, and obesity status.

The Difference in the Prevalence of Metabolic Syndrome According to Meeting Guidelines for Aerobic Physical Activity and Muscle-Strengthening Exercise: A Cross-Sectional Study Performed Using the Korea National Health and Nutrition Examination Survey, 2014-2019.

Physical activity and muscle strengthening are essential for preventing and managing metabolic syndrome. This study was conducted to investigate the relationship between the prevalence of metabolic syndrome and meeting the guidelines for aerobic physical activity (APA), muscle strengthening exercise (MSE), and combined exercise. We used data from 22,467 Koreans aged 40 years or older, who participated in in the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2019. We used the Global Physical Activity Questionnaire (GPAQ) to measure physical activity and surveyed frequency of MSE through a questionnaire. Metabolic syndrome was defined according to the American heart association and the National Heart, Lung, and Blood Institute. Compared with none exercise group, odds ratios of APA, MSE, and combined exercise group (CEG) on metabolic syndrome prevalence were 0.85 (95% confidence interval (CI), 0.74-0.98), 0.81 (95% CI, 0.67-0.99), and 0.65 (95% CI, 0.54-0.78) among men, respectively. Among women, ORs of APA, MSE, and CEG were 0.83 (95% CI, 0.73-0.93), 0.73 (95% CI, 0.58-0.91), and 0.74 (95% CI, 0.58-0.93), respectively. This study showed that meeting guidelines for APA and MSE was associated with lower prevalence of metabolic syndrome. Furthermore, subjects who met both APA and MSE had the lowest metabolic syndrome prevalence.

Evaluation of the accuracy of serum human epididymis protein 4 in combination with CA125 for detecting ovarian cancer: a prospective case-control study in a Korean population.

BACKGROUND: This study aimed to determine the serum concentrations of CA125 and human epididymis protein 4 (HE4) in patients with ovarian cancer, and to evaluate the sensitivity and specificity of these biomarkers for differentiating between patients with benign gynecological disease and those with ovarian cancer, when used alone and in combination in a Korean population. METHODS: We consecutively recruited 159 women with an adnexal mass, including 78 women with ovarian cancer. A total of 224 healthy women served as controls. The serum concentrations of HE4 and CA125 were analyzed using immunochemiluminescence assays. The concentrations of the markers were compared among the different subgroups, and the diagnostic accuracy of each marker and the combination of the two markers was assessed by plotting receiver operating characteristic (ROC) curves. In addition, the Risk of Ovarian Malignancy Algorithm (ROMA) was utilized to categorize patients into low- and high-risk groups for epithelial ovarian cancer. RESULTS: Serum HE4 and CA125 concentrations were significantly higher in the ovarian cancer patients compared with those seen in patients with benign disease or in the healthy controls (p<0.0001 in both). In patients with an adnexal mass, the area under the ROC curve was higher when the combination of the markers was used compared with use of CA125 only. Using ROMA, patients could be successfully classified into high- and low-risk group, with 87.5% sensitivity at a specificity of 93.8%. CONCLUSIONS: These findings suggest that measuring serum HE4 concentrations along with CA125 concentrations may provide higher accuracy for detecting ovarian cancer.

Fruit Intake to Prevent and Control Hypertension and Diabetes.

Fruits are considered healthy because of their high antioxidant, vitamin, mineral, fiber, and phytochemical contents. However, their high sugar content is a concern for glucose, lipid, and uric acid metabolism. We reviewed related articles published in the last 10 years and summarized evidence that relates fruit intake to the prevention and control of hypertension and diabetes mellitus. Clinicians should familiarize themselves with appropriate fruit intake to counsel at-risk patients on hypertension and diabetes.

Reliability and Validity of an Ultrasonic Device for Measuring Height in Adults.

BACKGROUND: The ultrasonic stadiometer was originally developed as a device to measure and monitor children's height. However, an ultrasonic stadiometer (InLab S50; InBody Co., Seoul, Korea) was used to measure adults' height in the 2018 Korea Community Health Survey (KCHS). This study was conducted to assess the reliability and validity of the InLab S50 in adults. METHODS: The study subjects were 120 adults (reliability test, n=20; validity test, n=100) who had visited a health screening center. The intra- and inter-rater reliabilities of InLab S50 were assessed using the intraclass correlation coefficient (ICC). The agreement between InLab S50 and an automatic stadiometer (HM-201; Fanics, Busan, Korea) was assessed using Pearson's correlation coefficient and Bland-Altman analysis. RESULTS: The intra- and inter-rater reliabilities of the InLab S50 were excellent (ICC=0.9999 and 0.9998, respectively). The correlation coefficient of the height measured by the two measurement devices was very high (r=0.996). The difference (Δheight [HM-201-InLab S50]) was -0.15±0.78 cm (95% limit of agreement [LOA], -1.69 to 1.38). After excluding the values outside 95% LOA, the difference was further reduced to -0.05±0.59 cm (95% LOA, -1.20 to 1.10). CONCLUSION: This study showed that the InLab S50 is a reliable and valid device for the measurement of adults' height. Therefore, we think that InLab S50 could be used to measure adults' height in household health surveys such as the KCHS.

Variation of Triterpenic Acids in 12 Wild Syzygium formosum and Anti-Inflammation Activity on Human Keratinocyte HaCaT.

Syzygium formosum (Wall.) Masam leaf is known as a Vietnamese traditional herbal medicine used to treat atopic dermatitis and stomach ulcers. Recently, its potent anti-allergic effects were reported with possible active compounds analysis. Here, we collected S. formosum leaves from 12 wild trees and compared compositions of triterpenic acids (TA) with Centella asiatica. Anti-inflammatory activities of S. formosum leaf extract (SFLE) was compared with C. asiatica extract (CAE) using human keratinocyte, HaCaT. In this study, up to seven TAs were identified in SFLE, while only madecassic and asiatic acids were detected in the CAE. Total TA content varied among SFLE, but asiatic, corosolic, and betulinic acids were the major components. Surprisingly, wild tree sample 12 (S12) contained total TA of 27.2 mg/g dry-leaves that was 5-fold greater than that in the C. asiatica sample, and S4 had the highest content of asiatic acid (12.6 mg/g dry-leaves) that accounted for 50% of the total TA. S4 and S12 showed more than 3-fold higher anti-oxidative power than the CAE. In the UVB irradiation model, S4 and S12 (5 µg/mL) strongly repressed mRNA levels of pro-inflammatory cytokines (IL-1ß, IL-6, and IL-8) and COX-2, while the CAE at the same condition showed moderate or weak repression. The difference in anti-inflammation effects between the SFLE and the CAE was also confirmed by protein quantifications. Taken together, SFLE has great potentials as a new cosmeceutical ingredient with a higher amount of skin-active phytochemicals.

Correlation between the rotational degree of the dial test and arthroscopic and physical findings in posterolateral rotatory instability.

Diagnosing posterolateral rotatory instability (PLRI) is difficult because it occurs rarely, takes time to manifest, and no single definitive tool exists in diagnosing posterolateral corner injuries. We sought to evaluate the correlation between rotational degrees in the dial test and physical and arthroscopic findings that surgically verified PLRI in the knee joint. Patients (n = 67) who were diagnosed as having PLRI and received posterolateral reconstruction (n = 57) and repair (n = 10) from 1998 to 2006 were recruited. Preoperative physical findings were evaluated under anesthesia, and arthroscopic findings during surgeries were analyzed. A dial test with post-anesthesia (spinal or general) was conducted. We divided patients into three subgroups (A: <15 degrees, B: 15-20 degrees, and C: >20 degrees), according to differences in rotational degrees in the dial test. All tests showed significant differences among the three groups and positive findings increased as the rotational degrees increased. No test showed a statistically significant difference in the specific group. All tests except for popliteal hiatus widening showed significant differences among the three groups and positive findings also increased as the rotational degrees increased. The total incidence and positive rate of each physical examination and the popliteal hiatus arthroscopic findings in PLRI significantly increased as the rotational degree in the dial test increased. The number of positive findings on physical examination was larger than the number of positive findings by arthroscopy in all three groups.

Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study.

OBJECTIVES AND DESIGN: Guideline-directed medical therapy (GDMT) with renin-angiotensin system (RAS) inhibitors and beta-blockers has improved survival in patients with heart failure with reduced ejection fraction (HFrEF). As clinical trials usually do not include very old patients, it is unknown whether the results from clinical trials are applicable to elderly patients with HF. This study was performed to investigate the clinical characteristics and treatment strategies for elderly patients with HFrEF in a large prospective cohort. SETTING: The Korean Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients hospitalised for acute HF from 10 tertiary university hospitals in Korea. PARTICIPANTS: In this study, 2045 patients with HFrEF who were aged 65 years or older were included from the KorAHF registry. PRIMARY OUTCOME MEASUREMENT: All-cause mortality data were obtained from medical records, national insurance data or national death records. RESULTS: Both beta-blockers and RAS inhibitors were used in 892 (43.8%) patients (GDMT group), beta-blockers only in 228 (11.1%) patients, RAS inhibitors only in 642 (31.5%) patients and neither beta-blockers nor RAS inhibitors in 283 (13.6%) patients (no GDMT group). With increasing age, the GDMT rate decreased, which was mainly attributed to the decreased prescription of beta-blockers. In multivariate analysis, GDMT was associated with a 53% reduced risk of all-cause mortality (HR 0.47, 95% CI 0.39 to 0.57) compared with no GDMT. Use of beta-blockers only (HR 0.57, 95% CI 0.45 to 0.73) and RAS inhibitors only (HR 0.58, 95% CI 0.48 to 0.71) was also associated with reduced risk. In a subgroup of very elderly patients (aged ≥80 years), the GDMT group had the lowest mortality. CONCLUSIONS: GDMT was associated with reduced 3-year all-cause mortality in elderly and very elderly HFrEF patients. TRIAL REGISTRATION NUMBER: NCT01389843.

Characteristics and outcomes of HFpEF with declining ejection fraction.

OBJECTIVE: Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF). METHODS: We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis. RESULTS: Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42-7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13-2.96, P = 0.015). The use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF. CONCLUSIONS: HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843.

Different Associations of Socioeconomic Status on Protein Intake in the Korean Elderly Population: A Cross-Sectional Analysis of the Korea National Health and Nutrition Examination Survey.

Socioeconomic status affects food choices. This study examined the relationships between socioeconomic status (SES) and animal and plant protein intake in the Korean elderly population whose protein intake is insufficient. We used cross-sectional data from 3512 Koreans aged 60 years or older, who had participated in the Nutrition Survey of the 2013-14 Korea National Health and Nutrition Examination Survey (KNHANES). One day 24-h recall data was used to estimate the daily total, animal, and plant protein intake. Household income and educational attainment were assessed by trained interviewers. After making adjustment, household income was positively associated with animal protein intake with a statistical significance in females (p = 0.030) and with a marginal significance in males (p = 0.069). However, plant protein intake did not show any significant association. In both sexes, educational attainment was positively associated with animal protein intake (p = 0.007 for males, p = 0.001 for females). Association of educational attainment with plant protein intake was negative in males (p = 0.037) and non-significant in females. (p = 0.945). High SES was associated with higher total protein intake and animal protein intake in the Korean elderly. Health policies and nutrition education are needed to improve protein intake of the vulnerable Korean elderly with low SES.

Incidence, Risk Factors and Prognosis of Contrast-Induced Acute Kidney Injury in Acute Heart Failure Patients Undergoing Coronary Angiography.

Background and Objectives: Heart failure (HF) is a well-known risk factor for contrast-induced acute kidney injury (CI-AKI). We sought to evaluate the risk factors and prognostic impact of CI-AKI in patients with AHF who undergo coronary angiography (CAG). Methods: A total 594 patients with AHF underwent CAG from May 1, 2011 to December 31, 2013. CI-AKI was defined as an increase ≥25% or ≥0.5 mg/dL in serum creatinine at 48 hours after CAG or the initiation of dialysis after CAG. The deviation of body weight on CAG day from the dry weight (ΔBWTCAG, %) was calculated for each patient. Results: Overall, CI-AKI was observed in 24.7% of patients. Patients with CI-AKI had higher in-hospital death (16.3% vs. 5.1%, p<0.001; relative risk [RR], 2.50; 95% confidence interval [CI], 1.45-4.31) and 1-year post-discharge death (38.1% vs. 17.4%, p<0.001; hazard ratio, 2.16; 95% CI, 1.40-3.34) than those without CI-AKI. Patients with CI-AKI had greater ΔBWTCAG than those without CI-AKI (5.5±5.7% vs. 3.7±4.0%, p<0.001). A J-shaped association between the risk of CI-AKI and ΔBWTCAG was noted. In patients with weight excess (n=179), an increase of ΔBWT by 1% was associated with 9% (RR, 1.09; 95% CI, 1.03-1.16), while in patients with weight deficiency (n=86), a decrease of ΔBWT by 1% was associated with 11% increased risk for CI-AKI (RR, 1.11; 95% CI, 1.05-1.17). Conclusions: In AHF patients undergoing CAG CI-AKI is common and associated with worse clinical outcomes. Achieving optimum body weight before CAG may reduce the risk of CI-AKI. Trial Registration: ClinicalTrials.gov Identifier: NCT01389843.

Physalis peruviana L. inhibits ovalbumin­induced airway inflammation by attenuating the activation of NF­κB and inflammatory molecules.

Physalis peruviana L. (PP) is well known for its various properties, including its antioxidant property. In our previous study, the protective effects of PP against cigarette smoke­induced airway inflammation were confirmed. The purpose of the present study was to evaluate the anti­inflammatory effect of PP against ovalbumin (OVA)­induced airway inflammation. Treatment with PP inhibited the numbers of eosinophils and the levels of inflammatory cytokines, including interleukin (IL)­4, IL­5 and IL­13, in the bronchoalveolar lavage fluid (BALF) of animal models with OVA­induced allergic asthma. PP also significantly decreased the production of total immunoglobulin E in the serum. Lung sections stained with hematoxylin and eosin revealed that the influx of inflammatory cells was decreased in the lungs of mice treated with PP compared with cells in the OVA group. The increased expression levels of monocyte chemoattractant protein­1 (MCP­1) and T cell marker KEN­5 were also reduced following PP treatment in the lung tissues compared with those in the OVA group. The PAS staining results showed that PP attenuated the overproduction of mucus in the lung. Additionally, western blot analysis revealed that PP significantly downregulated the activation of nuclear factor­κB/p38 mitogen­activated protein kinase/c­Jun N­terminal kinase, and upregulated the expression of heme oxgenase­1 in the lungs. In an in vitro experiment, PP effectively reduced the levels of LPS­stimulated MCP­1 in a concentration­dependent manner. Taken together, these results indicate that PP has considerable potential in the treatment of allergic asthma.

Characteristics, Outcomes, and Treatment of Heart Failure With Improved Ejection Fraction.

Background Many patients with heart failure ( HF ) with reduced ejection fraction ( HF r EF ) experience improvement or recovery of left ventricular ejection fraction ( LVEF ). Data on clinical characteristics, outcomes, and medical therapy in patients with HF with improved ejection fraction (HFiEF) are scarce. Methods and Results Of 5625 consecutive patients hospitalized for acute HF in the KorAHF (Registry [Prospective Cohort] for Heart Failure in Korea) study, 5103 patients had baseline echocardiography and 2302 patients had follow-up echocardiography at 12 months. HF phenotypes were defined as persistent HF r EF ( LVEF ≤40% at baseline and at 1-year follow-up), HF i EF ( LVEF ≤40% at baseline and improved up to 40% at 1-year follow-up), HF with midrange ejection fraction (LVEF between 40% and <50%), and HF with preserved ejection fraction ( LVEF ≥50%). The primary outcome was 4-year all-cause mortality from the time of HF i EF diagnosis. Among 1509 HF r EF patients who had echocardiography 1 year after index hospitalization, 720 (31.3%) were diagnosed as having HF i EF . Younger age, female sex, de novo HF , hypertension, atrial fibrillation, and ß-blocker use were positive predictors and diabetes mellitus and ischemic heart disease were negative predictors of HF i EF . During 4-year follow-up, patients with HF i EF showed lower mortality than those with persistent HF r EF in univariate, multivariate, and propensity-score-matched analyses. ß-Blockers, but not renin-angiotensin system inhibitors or mineralocorticoid receptor antagonists, were associated with a reduced all-cause mortality risk (hazard ratio: 0.59; 95% CI , 0.40-0.87; P=0.007). Benefits for outcome seemed similar among patients receiving low- or high-dose ß-blockers (log-rank, P=0.304). Conclusions HF i EF is a distinct HF phenotype with better clinical outcomes than other phenotypes. The use of ß-blockers may be beneficial for these patients. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT01389843.