Efficacy Assessment of Five Policosanol Brands and Damage to Vital Organs in Hyperlipidemic Zebrafish by Six-Week Supplementation: Highlighting the Toxicity of Red Yeast Rice and Safety of Cuban Policosanol (Raydel®).

Policosanol is a mixture of long-chain aliphatic alcohols (LCAAs) derived from various plant and insect origins that are marketed by various companies with distinct formulations and brand names. Policosanols offer several beneficial effects to treat dyslipidemia and hypertension; however, a comprehensive functionality comparison of various policosanol brands has yet to be thoroughly explored. In the present study five distinct policosanol brands from different origins and countries, Raydel-policosanol, Australia (PCO1), Solgar-policosanol, USA (PCO2), NutrioneLife-monacosanol, South Korea (PCO3), Mothernest-policosanol, Australia (PCO4), and Peter & John-policosanol, New Zealand (PCO5) were compared via dietary supplementation (1% in diet, final wt/wt) to zebrafish for six weeks to investigate their impact on survivability, blood lipid profile, and functionality of vital organs under the influence of a high-cholesterol diet (HCD, final 4%, wt/wt). The results revealed that policosanol brands (PCO1-PCO5) had a substantial preventive effect against HCD-induced zebrafish body weight elevation and hyperlipidemia by alleviating total cholesterol (TC) and triglycerides (TG) in blood. Other than PCO3, all the brands significantly reduced the HCD's elevated low-density lipoprotein cholesterol (LDL-C). On the contrary, only PCO1 displayed a significant elevation in high-density lipoprotein cholesterol (HDL-C) level against the consumption of HCD. The divergent effect of PCO1-PCO5 against HCD-induced hepatic damage biomarkers, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), was observed. PCO1, PCO2, and PCO4 efficiently curtailed the AST and ALT levels; however, PCO3 and PCO5 potentially aggravated the HCD's elevated plasma AST and ALT levels. Consistently, the hepatic histology outcome revealed the least effectiveness of PCO3 and PCO5 against HCD-induced liver damage. On the contrary, PCO1 exhibited a substantial hepatoprotective role by curtailing HCD-induced fatty liver changes, cellular senescent, reactive oxygen species (ROS), and interleukin-6 (IL-6) production. Likewise, the histological outcome from the kidney, testis, and ovary revealed the significant curative effect of PCO1 against the HCD-induced adverse effects. PCO2-PCO5 showed diverse and unequal results, with the least effective being PCO3, followed by PCO5 towards HCD-induced kidney, testis, and ovary damage. The multivariate interpretation based on principal component analysis (PCA) and hierarchical cluster analysis (HCA) validated the superiority of PCO1 over other policosanol brands against the clinical manifestation associated with HCD. Conclusively, different brands displayed distinct impacts against HCD-induced adverse effects, signifying the importance of policosanol formulation and the presence of aliphatic alcohols on the functionality of policosanol products.

Exposure assessment for pesticide residues in agricultural products consumed in the Republic of Korea during 2016-2020.

Pesticide residues in food comprise compounds such as insecticides, fungicides, herbicides, miticides, and plant activators. The insecticides diazinon (O, O-diethyl O-2-isopropyl-6-methylpyrimidin-4-yl phosphorothioate) and malathion (O, O-dimethyl dithiophosphate of diethyl-mercaptosuccinate) are classified as probably carcinogenic (Group 2A) and the fungicides chlorothalonil (2,4,5,6-tetrachloro-1,3-benzenedicarbonitrile) and hexachlorobenzene (pentachlophenyl chloride) as possibly carcinogenic to humans (Group 2B) by the International Agency for Research on Cancer under the World Health Organization. In this study, gas chromatographic and gas chromatography-tandem mass spectrometric analyses were used to determine the concentrations of pesticide residues in agricultural products and assess the effects of chronic human exposure to pesticide residues through the consumption of agricultural products during 2018-2020. Food consumption data were obtained from the Korea National Health and Nutrition Examination Survey of 2016-2018. The chronic exposures determined using mean consumption data for the whole population and mean concentrations of the pesticide residues were 5.15E-11 to 2.08E-05 [lower bound (LB)] and 2.41E-07 to 4.69E-05 mg/kg bw/day [upper bound (UB)], corresponding to 0.00012-2.16% of the hazard index (HA). Exposures to pesticide residues, calculated using the 95th percentile of the consumption data, were 0-8.76E-05 (LB) and 9.26E-07 to 1.56E-04 mg/kg bw/day (UB), corresponding to 0.00045-9.41% of the HA. Based on the result of current exposure assessment, it could be considered that the pesticide residues in agricultural products are properly controlled by the regulatory authorities.

Probiogenomic In-Silico Analysis and Safety Assessment of Lactiplantibacillus plantarum DJF10 Strain Isolated from Korean Raw Milk.

The whole genome sequence of Lactiplantibacillus plantarum DJF10, isolated from Korean raw milk, is reported, along with its genomic analysis of probiotics and safety features. The genome consists of 29 contigs with a total length of 3,385,113 bp and a GC content of 44.3%. The average nucleotide identity and whole genome phylogenetic analysis showed the strain belongs to Lactiplantibacillus plantarum with 99% identity. Genome annotation using Prokka predicted a total of 3235 genes, including 3168 protein-coding sequences (CDS), 59 tRNAs, 7 rRNAs and 1 tmRNA. The functional annotation results by EggNOG and KEGG showed a high number of genes associated with genetic information and processing, transport and metabolism, suggesting the strain's ability to adapt to several environments. Various genes conferring probiotic characteristics, including genes related to stress adaptation to the gastrointestinal tract, biosynthesis of vitamins, cell adhesion and production of bacteriocins, were identified. The CAZyme analysis detected 98 genes distributed under five CAZymes classes. In addition, several genes encoding carbohydrate transport and metabolism were identified. The genome also revealed the presence of insertion sequences, genomic islands, phage regions, CRISPR-cas regions, and the absence of virulence and toxin genes. However, the presence of hemolysin and antibiotic-resistance-related genes detected in the KEGG search needs further experimental validation to confirm the safety of the strain. The presence of two bacteriocin clusters, sactipeptide and plantaricin J, as detected by the BAGEL 4 webserver, confer the higher antimicrobial potential of DJF10. Altogether, the analyses in this study performed highlight this strain's functional characteristics. However, further in vitro and in vivo studies are required on the safety assurance and potential application of L. plantarum DJF10 as a probiotic agent.

Assessment of malignant potential in intraductal papillary mucinous neoplasms of the pancreas using MR findings and texture analysis.

OBJECTIVES: To investigate the utility of MR findings and texture analysis for predicting the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs). METHODS: Two hundred forty-eight patients with surgically confirmed IPMNs (106 malignant [invasive carcinoma/high-grade dysplasia] and 142 benign [low/intermediate-grade dysplasia]) and who underwent magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) were included. Two reviewers independently analyzed MR findings as proposed by the 2017 international consensus guidelines. Texture analysis of MRCP was also performed. A multivariate logistic regression analysis was used to identify predictors for malignant IPMNs. Diagnostic performance was also analyzed using receiver operating curve analysis. RESULTS: Among MR findings, enhancing mural nodule size ≥ 5 mm, main pancreatic duct (MPD) ≥ 10 mm or MPD of 5 to 9 mm, and abrupt change of MPD were significant predictors for malignant IPMNs (p < 0.05). Among texture variables, significant predictors were effective diameter, surface area, sphericity, compactness, entropy, and gray-level co-occurrence matrix entropy (p < 0.05). At multivariate analysis, enhancing mural nodule ≥ 5 mm (odds ratios (ORs), 6.697 and 6.968, for reviewers 1 and 2, respectively), MPD ≥ 10 mm or MPD of 5 to 9 mm (ORs, 4.098 and 4.215, and 2.517 and 3.055, respectively), larger entropy (ORs, 1.485 and 1.515), and smaller compactness (ORs, 0.981 and 0.977) were significant predictors for malignant IPMNs (p < 0.05). When adding texture variable to MR findings, diagnostic performance for predicting malignant IPMNs improved from 0.80 and 0.78 to 0.85 and 0.85 in both reviewers (p < 0.05), respectively. CONCLUSIONS: MRCP-derived texture features are useful for predicting malignant IPMNs, and the addition of texture analysis to MR features may improve diagnostic performance for predicting malignant IPMNs. KEY POINTS: • Among the MR imaging findings, an enhancing mural nodule size ≥ 5 mm and dilated main pancreatic ducts are independent predictors for malignant IPMNs. • Greater entropy and smaller compactness on MR texture analysis are independent predictors for malignant IPMNs. • The addition of MR texture analysis improved the diagnostic performance for predicting malignant IPMNs from 0.80 and 0.78 to 0.85 and 0.85, respectively.

Relative Effects of Demographic, Psychological, Behavioral, and Social Factors on the Initiation and Maintenance of Leisure-time Physical Activity: Results From a Confirmatory Path Analysis in a Longitudinal Study.

BACKGROUND: There is a lack of evidence of the complicated pathways of underlying determinants in the phases of physical activity. The purpose of this study was to evaluate simultaneously a set of potential determinants on the initiation and maintenance phases of leisure-time physical activity (LTPA). METHODS: The longitudinal data of 54,359 Korean adults aged 40-69 years from the Health Examinees study were used. The median follow-up duration was 4.2 years. The self-reported durations per week of LTPA was repeatedly assessed. Based on previous longitudinal studies, the potential determinants were selected, and hypothetical models were constructed that consider the complex associations between the determinants. The standardized coefficients for direct and indirect effects were estimated using path analysis to differentiate contributions of mediation from the total effects. RESULTS: In the total population, age, education, chronic diseases, smoking, depression symptoms, and self-rated health were significantly associated with both initiation and maintenance phases. Income (B = 0.025) and social supports (B = 0.019) were associated only with the initiation phase. Waist-to-hip ratio (B = -0.042) and stress (B = -0.035) were associated only with the maintenance phase. After stratifying by sex, the significant effects of education, chronic diseases, and smoking were found only in men. The initiation phase-specific effects of income and social supports and the maintenance phase-specific effects of stress were found only in women. It was estimated that indirect effects contributed approximately 15% of the total effect. CONCLUSION: The findings suggested that there were initiation- or maintenance-specific determinants of leisure-time physical activity according to sex.

Disparity in Accessibility to and Prognosis of Kidney Transplantation According to Economic Inequality in South Korea: A Widening Gap After Expansion of Insurance Coverage.

BACKGROUND: Nationwide studies on the effects of wealth inequality on kidney transplantation are rare, particularly in a country with an expanded National Health Insurance Service and in Asian countries. METHODS: In this nationwide, population-based cohort study, we reviewed the national claims database of Korea in which details of nationwide health insurance are provided. From 2007 to 2015, 9 annual cohorts of end-stage renal disease patients were included. The annual financial statuses were collected and stratified into 5 subgroups in each year: the aided group in which insurance fee was waived and the 4 other groups divided by quartiles of their medical insurance fee. Time trends of incidence proportion of kidney transplantation among end-stage renal disease patients in each year were initially assessed. The risk of graft failure, both including death-censored graft failure and death with a functioning graft, was analyzed as a prognostic outcome within the transplant recipients. RESULTS: Significant disparity in the accessibility of kidney transplantation was present, and it was further widening, particularly from 2009 in which the National Health Insurance Service started to cover desensitized kidney transplantation. Desensitized or preemptive transplantation was less common in the poorest group who were more frequently receiving transplantation after 5 years of dialysis in the latter years. The prognosis of kidney transplantation was significantly worse in the poorer people, and this disparity also worsened during the study period. CONCLUSIONS: Prominent disparity regarding accessibility to and prognosis of kidney transplantation was observed in Korea according to wealth inequality, and this disparity was worsening.

Socioeconomic dependency and kidney transplantation accessibility and outcomes: a nationwide observational cohort study in South Korea.

BACKGROUND: Socioeconomic status is an important determinant for patients' accessibility to, and prognosis of, kidney transplantation. However, the association between socioeconomic dependency and kidney transplantation accessibility or prognosis after kidney transplantation remains unclear. METHODS: In this nationwide cohort study, based on the claims database of South Korea, we included 12,889 kidney transplant recipients from 2007 to 2015 and stratified them according to health insurance categories that reflect socioeconomic dependency: workplace-independent (employed, N = 3257), workplace-dependent (dependent to the workplace-independent, N = 3661), community-representative (heads of the household but self-employed or unemployed, N = 2479), community-member (N = 1618), aided-representative (heads of household receiving medical aid from the government, N = 1580), and aided-member (N = 294). The incidence of kidney transplantation was calculated to evaluate its accessibility. The risk of graft failure was assessed using the Cox regression analysis, adjusted for clinicodemographic variables, including financial status. RESULTS: End-stage kidney disease patients who were employed (workplace-independent group) had the highest incidence proportion of kidney transplantation. The dependent groups' prognoses were worse than those of their independent counterparts [workplace-dependent versus workplace-independent, HR 1.26 (1.11-1.43) and community-dependent versus community-independent, HR 1.46 (1.23-1.74)], although no difference was observed between the aided subgroups [aided-dependent versus aided-independent, adjusted HR 1.16 (0.90-1.50)]. CONCLUSION: Disparities in kidney transplantation accessibility were present in South Korea according to socioeconomic dependency; these differences may have an impact on prognosis.

Exposure assessment and safe intake guidelines for heavy metals in consumed fishery products in the Republic of Korea.

Heavy metals in food are non-intentional pollutants such as lead (Pb), cadmium (Cd), and mercury (Hg). Pb, a neurotoxic substance, is classified as a possible carcinogen for humans (group 2B) by the International Agency for Research on Cancer (IARC) under the World Health Organization (WHO). Cd, a substance that causes kidney damage, is classified as a substance that causes human cancer (group 1). In this study, inductively coupled plasma atomic emission spectrometry (ICP-AES) and a mercury analyzer (MA) were used to identify the concentrations of heavy metals (Pb, Cd, Hg) in fishery products and to assess the effects of chronic human exposure to heavy metals via fisheries consumption. Food consumption data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES 2010-2015), and the mean exposure concentrations for Pb, Cd, and Hg were 0.0067 µg/kg bw/day, 1.1277 µg/kg bw/month, and 0.0872 µg/kg bw/week, respectively. Exposures to Pb, Cd, and Hg using the 95th percentile of the consumption data were 0.0183 µg/kg bw/day, 4.0230 µg/kg bw/month, and 0.2268 µg/kg bw/week, respectively, corresponding to 3, 16, and 6% of the human exposure safety standard. Safe guidelines for the intake of fishery products are proposed to reduce the exposure to and accumulation of heavy metals in humans.

Assessment of Memory Function in Pilocarpine-induced Epileptic Mice.

Cognitive impairment is one of the most common comorbidities in temporal lobe epilepsy. To recapitulate epilepsy-associated cognitive decline in an animal model of epilepsy, we generated pilocarpine-treated chronic epileptic mice. We present a protocol for three different behavioral tests using these epileptic mice: novel object location (NL), novel object recognition (NO), and pattern separation (PS) tests to evaluate learning and memory for places, objects, and contexts, respectively. We explain how to set the behavioral apparatus and provide experimental procedures for the NL, NO, and PS tests following an open field test that measures the animals' basal locomotor activities. We also describe the technical advantages of the NL, NO, and PS tests with respect to other behavioral tests for assessing memory function in epileptic mice. Finally, we discuss possible causes and solutions for epileptic mice failing to make 30 s of good contact with the objects during the familiarization sessions, which is a critical step for successful memory tests. Thus, this protocol provides detailed information about how to assess epilepsy-associated memory impairments using mice. The NL, NO, and PS tests are simple, efficient assays that are appropriate for the evaluation of different kinds of memory in epileptic mice.

Dissociation between the growing opioid demands and drug policy directions among the U.S. older adults with degenerative joint diseases.

We aim to examine temporal trends of orthopedic operations and opioid-related hospital stays among seniors in the nation and states of Oregon and Washington where marijuana legalization was accepted earlier than any others.As aging society advances in the United States (U.S.), orthopedic operations and opioid-related hospital stays among seniors increase in the nation.A serial cross-sectional cohort study using the healthcare cost and utilization project fast stats from 2006 through 2015 measured annual rate per 100,000 populations of orthopedic operations by age groups (45-64 vs 65 and older) as well as annual rate per 100,000 populations of opioid-related hospital stays among 65 and older in the nation, Oregon and Washington states from 2008 through 2017. Orthopedic operations (knee arthroplasty, total or partial hip replacement, spinal fusion or laminectomy) and opioid-related hospital stays were measured. The compound annual growth rate (CAGR) was used to quantify temporal trends of orthopedic operations by age groups as well as opioid-related hospital stays and was tested by Rao-Scott correction of χ for categorical variables.The CAGR (4.06%) of orthopedic operations among age 65 and older increased (P < .001) unlike the unchanged rate among age 45 to 64. The CAGRs of opioid-related hospital stays among age 65 and older were upward trends among seniors in general (6.79%) and in Oregon (10.32%) and Washington (15.48%) in particular (all P < .001).Orthopedic operations and opioid-related hospital stays among seniors increased over time in the U.S. Marijuana legalization might have played a role of gateway drug to opioid among seniors.

Assessment of functional improvement with temporalis myofascial flap after condylectomy in elderly patients with anterior disc displacement without reduction and an erosive condylar surface.

BACKGROUND: The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). METHODS: A total of 15 joints from 11 elderly patients (71-78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. RESULTS: No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. CONCLUSION: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.

Assessment at the single-cell level identifies neuronal glutathione depletion as both a cause and effect of ischemia-reperfusion oxidative stress.

Oxidative stress contributes to neuronal death in brain ischemia-reperfusion. Tissue levels of the endogenous antioxidant glutathione (GSH) are depleted during ischemia-reperfusion, but it is unknown whether this depletion is a cause or an effect of oxidative stress, and whether it occurs in neurons or other cell types. We used immunohistochemical methods to evaluate glutathione, superoxide, and oxidative stress in mouse hippocampal neurons after transient forebrain ischemia. GSH levels in CA1 pyramidal neurons were normally high relative to surrounding neuropil, and exhibited a time-dependent decrease during the first few hours of reperfusion. Colabeling for superoxide in the neurons showed a concurrent increase in detectable superoxide over this interval. To identify cause-effect relationships between these changes, we independently manipulated superoxide production and GSH metabolism during reperfusion. Mice in which NADPH oxidase activity was blocked to prevent superoxide production showed preservation of neuronal GSH content, thus demonstrating that neuronal GSH depletion is result of oxidative stress. Conversely, mice in which neuronal GSH levels were maintained by N-acetyl cysteine treatment during reperfusion showed less neuronal superoxide signal, oxidative stress, and neuronal death. At 3 d following ischemia, GSH content in reactive astrocytes and microglia was increased in the hippocampal CA1 relative to surviving neurons. Results of these studies demonstrate that neuronal GSH depletion is both a result and a cause of neuronal oxidative stress after ischemia-reperfusion, and that postischemic restoration of neuronal GSH levels can be neuroprotective.

Prominent protein Z-induced thrombin inhibition in cirrhosis: a new functional assay for hypercoagulability assessment.

BACKGROUND AND AIMS: Protein Z (PZ) is an anticoagulant that accelerates the inhibitory effect of PZ-dependent protease inhibitor (ZPI) on coagulation factor Xa. We assessed functional status of PZ system in 158 patients with liver cirrhosis and 59 healthy controls. METHODS: Plasma PZ and ZPI levels were measured by enzyme immunoassay. Thrombin generation assays (TGA) were performed with and without thrombomodulin (TM) or PZ, and the ratios were calculated by dividing TGA values with TM or PZ by values without TM or PZ. RESULTS: PZ and ZPI levels were reduced and elevated in advanced cirrhosis, respectively. The lag time ratio-PZ was significantly higher in cirrhosis patients than controls and correlated with the model for end-stage liver disease score. The peak thrombin ratio-PZ and endogenous thrombin potential (ETP) ratio-PZ were significantly lower in cirrhosis patients than controls and correlated with the severity of liver cirrhosis. The peak thrombin ratio-PZ was dramatically reduced in advanced cirrhosis. Cirrhosis patients had a significantly higher ETP ratio-TM than the controls, although the ratio was not correlated with cirrhosis severity. The lag time ratio-PZ and peak time ratio-PZ were significantly correlated with the levels of all coagulation and anticoagulation factors. Interestingly, the lag time ratio-PZ and peak thrombin ratio-PZ were significantly associated with thrombotic events. CONCLUSION: The anticoagulant role of PZ is insufficient in advanced stages of cirrhosis. Our newly developed functional assay for measuring the PZ system is expected to reflect the ongoing hypercoagulability of cirrhosis.

Burden of facial cellulitis: estimates from the Nationwide Emergency Department Sample.

OBJECTIVE: Multitude of maxillofacial infections from odontogenic and nonodontogenic origins can progress to facial cellulitis, which may require an emergency department (ED) visit for appropriate care. The aim of this study was to investigate national prevalence of ED visits attributed primarily to facial cellulitis, to quantify the associated hospital charges, and to identify a cohort of population presenting to the ED with facial cellulitis. STUDY DESIGN: The Nationwide Emergency Department Sample (NEDS) for the year 2007, a component database of the health care cost and utilization project was used for this study. All ED visits that had a primary diagnosis of facial cellulitis (ICD-9-CM code 682.0) were selected for analysis. All estimates were projected to national levels using the discharge weight variables. RESULTS: In 2007, a total of 302,507 ED visits were attributed primarily to facial cellulitis in the USA. The average age of the patients was 35.0 years. The mean hospital charge for each ED visit was $1,024, with a total charge of $241,541,694. A total of 17.8% of ED visits were admitted into the same hospital for inpatient care, and 78.5% of ED visits were discharged routinely; 67.6% of ED visits occurred on weekdays. Private insurance payers comprised the largest proportion (31.6%). CONCLUSIONS: This study highlights the prevalence of hospital-based ED visits primarily due to facial cellulitis in the USA in year 2007, its significant associated hospital resource utilization for treatment, and characteristics of the patient population who are likely to visit a hospital-based ED for treatment of facial cellulitis.

Initial assessment of dual-energy CT in patients with gallstones or bile duct stones: can virtual nonenhanced images replace true nonenhanced images?

OBJECTIVE: The purpose of our study was to investigate whether virtual nonenhanced images can replace true nonenhanced images for the evaluation of biliary stones and to compare two virtual nonenhanced images obtained from dual-energy data sets during the late arterial phase (LAP) and portal venous phase (PVP) with true nonenhanced images. MATERIALS AND METHODS: One hundred patients with gallstones (n = 77) or bile duct stones (n = 23) who had undergone dual-source dual-energy CT (using 80kVp and 140kVp with the ratio of dose-partitioning, 1:1.3), were included. The CT numbers for the stone, liver, and bile; stone size; and image noise were assessed for each image set. The conspicuity and size of the stones, image quality, and acceptability of the virtual nonenhanced images as a replacement for true nonenhanced images were assessed. RESULTS: Virtual nonenhanced images from both LAP (VNE(LAP)) and PVP showed lower CT numbers for the stone and smaller stone size than did true nonenhanced images (p < 0.05). VNE(LAP) images failed to show stones in 16 patients (16%) with relatively radiolucent bile duct stones (< 78 HU) or small gallstones (< 9 mm(2), < 1.7 mm). There was no difference between the two virtual nonenhanced image sets except for the contrast-to-noise ratio of stone to bile and the image noise (CT numbers for the stone, liver, and muscle; stone size; and contrast-to-noise ratio of stone to liver, p = 1; the CT number for the bile, p = 0.1618; and effective dose, p = 0.7478). VNE(LAP) images were considered acceptable as a replacement for true nonenhanced images in 89% and 90% by reviewers 1 and 2, respectively. CONCLUSION: Virtual nonenhanced images allow the detection of biliary stones with moderate accuracy, irrespective of the dual-energy contrast-enhanced phase. The detection of gallbladder stones of 9 mm(2) or smaller and of relatively radiolucent bile duct stones of 78 HU or lower is limited.

Health impact assessment as a strategy for intersectoral collaboration.

OBJECTIVES: This study examined the use of health impact assessment (HIA) as a tool for intersectoral collaboration using the case of an HIA project conducted in Gwang Myeong City, Korea. METHODS: A typical procedure for rapid HIA was used. In the screening step, the Aegi-Neung Waterside Park Plan was chosen as the target of the HIA. In the scoping step, the specific methods and tools to assess potential health impacts were chosen. A participatory workshop was held in the assessment step. Various interest groups, including the Department of Parks and Greenspace, the Department of Culture and Sports, the Department of Environment and Cleansing, civil societies, and residents, discussed previously reviewed literature on the potential health impacts of the Aegi-Neung Waterside Park Plan. RESULTS: Potential health impacts and inequality issues were elicited from the workshop, and measures to maximize positive health impacts and minimize negative health impacts were recommended. The priorities among the recommendations were decided by voting. A report on the HIA was submitted to the Department of Parks and Greenspace for their consideration. CONCLUSIONS: Although this study examined only one case, it shows the potential usefulness of HIA as a tool for enhancing intersectoral collaboration. Some strategies to formally implement HIA are discussed.

Assessment of bronchodilator responsiveness following methacholine-induced bronchoconstriction in children with asthma.

PURPOSE: The aim of this study was to investigate bronchodilator responsiveness (BDR) following methacholine-induced bronchoconstriction and to determine differences in BDR according to clinical parameters in children with asthma. METHODS: The methacholine challenge test was performed in 145 children with mild to moderate asthma, and the provocative concentration causing a 20% decline in FEV1 (PC20) was determined. Immediately after the challenge test, patients were asked to inhale short-acting ß2-agonists (SABAs) to achieve BDR, which was assessed as the change in FEV1% predicted×100/post-methacholine FEV1% predicted. For each subject, the asthma medication, blood eosinophil count, serum total IgE, serum eosinophil cationic protein level, and skin prick test result were assessed. RESULTS: The FEV1 (mean±SD) values of the 145 patients were 90.5±10.9% predicted, 64.2±11.5% predicted, and 86.2±11.2% predicted before and after methacholine inhalation, and following the administration of a SABA, respectively. The BDR did not differ significantly according to asthma medication, age, or gender. However, BDR in the atopy group (37.4±17.7%) was significantly higher than that in the non-atopy group (30.5±10.7%; P=0.037). Patients with blood eosinophilia (38.6±18.1%) displayed increased BDR compared with patients without eosinophilia (32.0±13.8%; P=0.037). CONCLUSIONS: In children with mild to moderate asthma, the responsiveness to short-acting bronchodilators after methacholine-induced bronchoconstriction was not related to asthma medication, but was higher in children with atopy and/or peripheral blood eosinophilia.

Outcome of pandemic H1N1 pneumonia: clinical and radiological findings for severity assessment.

BACKGROUND/AIMS: Pandemic influenza A (H1N1) virus infection presents with variable severity. However, little is known about clinical predictors of disease severity. We studied the clinical predictors of severe pandemic H1N1 pneumonia and their correlation with radiological findings. METHODS: We reviewed medical and radiological records of adults with pandemic H1N1 pneumonia. After classification of patients into severe and non-severe groups, the following data were evaluated: demographic data, pneumonia severity index (PSI), CURB65, risk factors, time to first dose of antiviral medication, routine laboratory data, clinical outcome, and radiological characteristics. RESULTS: Of 37 patients with pandemic H1N1 pneumonia, 12 and 25 were assigned to the severe and non-severe groups, respectively. PSI score, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dyhydrogenase (LDH) levels were higher in the severe group than in the non-severe group (p = 0.035, 0.0003, 0.0023, and 0.0002, respectively). AST, ALT, and LDH levels were positively correlated with the radiological findings (p < 0.0001, 0.0003, and < 0.0001, respectively) and with the number of involved lobes (p = 0.663, 0.0134, and 0.0019, respectively). The most common finding on high resolution computed tomography (HRCT) scans was ground-glass attenuation with consolidation (n = 22, 60%), which had a predominantly patchy distribution (n = 31). CONCLUSIONS: We demonstrated a positive correlation between clinical findings, such as serum AST, ALT, and LDH levels, and radiological findings. A combination of clinical and HRCT indicators would be useful in predicting the clinical outcome of pandemic H1N1 pneumonia.