Sex-related disparities in cough-associated symptoms across different age groups.

BACKGROUND: Sex-related disparities in the prevalence of chronic cough have been consistently reported globally, with varying male-to-female ratios. OBJECTIVES: This study aimed to evaluate sex-related differences by comparing correlations between cough-related symptoms in males and females of different age groups. DESIGN: Adult patients with chronic cough who completed the Leicester Cough Questionnaire (LCQ) were recruited from 16 respiratory centers. METHODS: Correlation networks were constructed based on Spearman's correlation coefficients in males and females of various age groups. The distinct relationships of cough-related symptoms between subgroups were validated by an independent cohort. RESULTS: A total of 255 patients were enrolled in this study (male-to-female ratio, 1:1.71). The following LCQ items were highly correlated: embarrassment and interference with daily work, anxiety, and interference with overall life enjoyment/feeling of being fed up, interference with daily work and overall life enjoyment, interference with overall life enjoyment and feeling of being fed up, and feeling of being fed up and annoyance to partner/family/friends. The patterns of these correlations between LCQ items varied in males and females of different ages. The strongest interrelationship was observed in male patients aged >50 years old, which was similar to those in the validation cohort. CONCLUSION: The correlation patterns between cough-related symptoms vary significantly according to age and sex. Understanding the mechanisms underlying the development of cough-related symptoms may facilitate sex- and age-specific strategies for chronic cough.

Precise individual muscle segmentation in whole thigh CT scans for sarcopenia assessment using U-net transformer.

The study aims to develop a deep learning based automatic segmentation approach using the UNETR(U-net Transformer) architecture to quantify the volume of individual thigh muscles(27 muscles in 5 groups) for Sarcopenia assessment. By automating the segmentation process, this approach improves the efficiency and accuracy of muscle volume calculation, facilitating a comprehensive understanding of muscle composition and its relationship to Sarcopenia. The study utilized a dataset of 72 whole thigh CT scans from hip fracture patients, annotated by two radiologists. The UNETR model was trained to perform precise voxel-level segmentation and various metrics such as dice score, average symmetric surface distance, volume correlation, relative absolute volume difference and Hausdorff distance were employed to evaluate the model's performance. Additionally, the correlation between Sarcopenia and individual thigh muscle volumes was examined. The proposed model demonstrated superior segmentation performance compared to the baseline model, achieving higher dice scores (DC = 0.84) and lower average symmetric surface distances (ASSD = 1.4191 ± 0.91). The volume correlation between Sarcopenia and individual thigh muscles in the male group. Furthermore, the correlation analysis of grouped thigh muscles also showed negative associations with Sarcopenia in the male participants. This thesis presents a deep learning based automatic segmentation approach for quantifying individual thigh muscle volume in sarcopenia assessment. The results highlights the associations between Sarcopenia and specific individual muscles as well as grouped thigh muscle regions, particularly in males. The proposed method improves the efficiency and accuracy of muscle volume calculation, contributing to a comprehensive evaluation of Sarcopenia. This research enhances our understanding of muscle composition and performance, providing valuable insights for effective interventions in Sarcopenia management.

PEGylated Gold Nanoparticle Toxicity in Cardiomyocytes: Assessment of Size, Concentration, and Time Dependency.

Gold Nanoparticles (GNPs) have shown promising capabilities for use in many in-vivo applications such as gene and drug delivery, photothermal ablation of tumors, and tracking in many imaging modalities. Yet GNPs have thus far had limited use in cardiovascular medicine. Polyethylene glycol functionalized (PEGylated) GNPs have been extensively studied in a wide array of in vitro and in vivo models with results showing no apparent toxicity, but to our knowledge an investigation has never been performed to determine direct cardiomyocyte toxicity. In this study, we assessed if PEGylated GNPs exhibited direct toxicity to a primary culture of neonatal rat cardiomyocytes in order to establish PEGylated GNPs for potential future use in cardiovascular medicine applications. We present novel results that demonstrate both a particle size and concentration dependent relationship on cell viability. Cell viability was found to be significantly enhanced for many concentrations and sizes as compared to the control and increased linearly as a function of particle diameter. Additionally, viability increased in a parabolically dependent manner as a function of decreasing particle concentration. These new results could advance understanding of nanoparticle-cell interactions and lead to the development of new applications involving the use of gold nanoparticles in cardiovascular medicine.

Differential features of chronic cough according to etiology and the simple decision tree for predicting causes.

Finding etiology of chronic cough is an essential part of treatment. Although guidelines include many laboratory tests for diagnosis, these are not possible in many primary care centers. We aimed to identify the characteristics and the differences associated with its cause to develop a clinical prediction model. Adult subjects with chronic cough who completed both Korean version of the Leicester Cough Questionnaire (K-LCQ) and COugh Assessment Test (COAT) were enrolled. Clinical characteristics of each etiology were compared using features included in questionnaires. Decision tree models were built to classify the causes. A total of 246 subjects were included for analysis. Subjects with asthma including cough variant asthma (CVA) suffered from more severe cough in physical and psychological domains. Subjects with eosinophilic bronchitis (EB) presented less severe cough in physical domain. Those with gastro-esophageal reflux disease (GERD) displayed less severe cough in all 3 domains. In logistic regression, voice hoarseness was an independent feature of upper airway cough syndrome (UACS), whereas female sex, tiredness, and hypersensitivity to irritants were predictors of asthma/CVA; less hoarseness was a significant feature of EB, and feeling fed-up and hoarseness were less common characteristics of GERD. The decision tree was built to classify the causes and the accuracy was relatively high for both K-LCQ and COAT, except for UACS. Voice hoarseness, degree of tiredness, hypersensitivity to irritants and feeling fed-up are important features in determining the etiologies. The decision tree may further assists classifying the causes of chronic cough.

Aging Is Positively Associated with Peri-Sinus Lymphatic Space Volume: Assessment Using 3T Black-Blood MRI.

OBJECTIVES: Aging is a major risk factor for many neurological disorders and is associated with dural lymphatic dysfunction. We sought to evaluate the association of aging with the volume of the peri-sinus lymphatic space using contrast-enhanced 3T T1-weighted black-blood magnetic resonance imaging (MRI). METHODS: In this retrospective study, 165 presumed neurologically normal subjects underwent brain MRIs for cancer staging between April and November 2018. The parasagittal peri-sinus lymphatic space was evaluated using contrast-enhanced 3D T1-weighted black-blood MRIs, and volumes were measured with semiautomatic method. We compared the volumes of normalized peri-sinus lymphatic spaces between the elderly (≥65 years, n = 72) and non-elderly (n = 93) groups and performed multivariate logistic regression analyses to assess if aging is independently associated with the volume of normalized peri-sinus lymphatic spaces. RESULTS: The normalized peri-sinus lymphatic space volume was significantly higher in the elderly than in the non-elderly (mean, 3323 ± 758.7 mL vs. 2968.7 ± 764.3 mL, p = 0.047). After adjusting the intracranial volume, age age was the strongest factor independently associated with peri-sinus lymphatic space volume (ß coefficient, 28.4 (5.7-51.2), p = 0.015) followed by male sex (ß coefficient, 672.4 (113.5-1230.8), p = 0.019). CONCLUSIONS: We found that the peri-sinus dural lymphatic space volume was higher in the elderly group than in the non-elderly group, and the increased peri-sinus lymphatic space was independently associated with aging. These findings indicate that the peri-sinus lymphatic space may be related with the aging process and lymphatic system dysfunction as well.

Treatment versus Punishment: Understanding Racial Inequalities in Drug Policy.

CONTEXT: Many observers believe that the policy response to the opioid crisis is less punitive than the crack scare and that the reason is that victims are (stereotypically) white. METHODS: To assess this conjecture, we compile new longitudinal data on district-level drug-related deaths and (co)sponsorship of legislation on drug abuse in the House of Representatives over the past four decades. Using legislator fixed effects models, we then test how changes in drug-related death rates in legislators' districts predict changes in (co)sponsorship of treatment-oriented or punitive legislation in the subsequent year and assess whether these relationships vary by race of victim or drug type. FINDINGS: Policy makers were more likely to introduce punitive drug-related bills during the crack scare and are more likely to introduce treatment-oriented bills during the current opioid crisis. The relationship between district-level drug deaths and subsequent sponsorship of treatment-oriented legislation is greater for opioid deaths than for cocaine-related deaths and for white victims than for black victims. By contrast, district-level drug deaths are not significantly related to sponsorship of punishment-oriented bills. CONCLUSIONS: These results suggest that the racial inequalities and double standards of drug policy still persist but in different forms.

Assessment of Korea's Orthopedic Research Activities in the Top 15 Orthopedic Journals, 2008-2017.

BACKGROUND: Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. This study aims to update Korea's worldwide research productivity in the field of orthopedics using bibliometric methods and to provide Korean surgeons and researchers with insights into such research. METHODS: Articles published in the top 15 orthopedic journals between 2008 and 2017 were retrieved using the Web of Science. The number of articles, citations and h-index (Hirsch index), funding sources, institutions, and journal patterns were analyzed. RESULTS: Of the total 39,494 articles, Korea's contribution accounted for 5.6% (2,161 articles), ranking fifth in the world in the number of publications. Korea ranked sixth (with 29,456) for total citations worldwide but ranked 17th (13.64) in terms of average citation per item and 14th (55) in terms of h-index. Korea showed the most prolific productivity in the field of sports medicine and arthroscopy. The institution that produced the highest number of publications was Seoul National University (n = 386, 17.9%). CONCLUSIONS: Orthopedic research in South Korea demonstrated high productivity in terms of the number of publications in high-quality journals between 2008 and 2017. However, total citations and average citations per article were still relatively low. Efforts should be made to increase citation rates for further improvement in research productivity in the field of orthopedics.

Development and validation of the COugh Assessment Test (COAT).

BACKGROUND AND OBJECTIVE: A cough-specific quality-of-life questionnaire is recommended to assess the impact of cough; however, a simple instrument to quantify cough is required for everyday clinical practice. This study was aimed to develop a short patient-completed questionnaire (COugh Assessment Test, COAT). METHODS: The COAT was developed and validated by comparison with the Korean version of Leicester Cough Questionnaire (K-LCQ) and cough numeric rating scale (NRS, 0-10, 11-point scale) for chronic cough patients. RESULTS: Item selection identified five items regarding cough frequency, daily activity, sleep disturbance, fatigue and cough hypersensitivity (0-4 scaling of items, 0-20 score range) through reliability test cohort (n = 78). Test-retest reliability was strong (intra-class correlation coefficient = 0.88). The final COAT was compared with K-LCQ and cough NRS in a validation cohort (n = 323). In Rasch analysis, COAT fitted well to a unidimensional model. Pearson correlations of COAT versus K-LCQ (i) before treatment, (ii) after treatment; COAT versus cough NRS (iii) before treatment, (iv) after treatment; (v) delta-COAT versus delta-cough NRS, (vi) delta-COAT versus delta-K-LCQ were (i) -0.71, (ii) -0.81, (iii) 0.69, (iv) 0.82, (v) -0.66 and (vi) 0.72, respectively. CONCLUSION: The COAT is a useful, simple questionnaire for assessing and monitoring cough.

Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD.

BACKGROUND AND OBJECTIVE: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, either a modified Medical Research Council (mMRC) dyspnea score of ≥2 or a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score of ≥10 is considered to represent COPD patients who are more symptomatic. We aimed to identify the ideal CAT score that exhibits minimal discrepancy with the mMRC score. METHODS: A receiver operating characteristic curve of the CAT score was generated for an mMRC scores of 1 and 2. A concordance analysis was applied to quantify the association between the frequencies of patients categorized into GOLD groups A-D using symptom cutoff points. A κ-coefficient was calculated. RESULTS: For an mMRC score of 2, a CAT score of 15 showed the maximum value of Youden's index with a sensitivity and specificity of 0.70 and 0.66, respectively (area under the receiver operating characteristic curve [AUC] 0.74; 95% confidence interval [CI], 0.70-0.77). For an mMRC score of 1, a CAT score of 10 showed the maximum value of Youden's index with a sensitivity and specificity of 0.77 and 0.65, respectively (AUC 0.77; 95% CI, 0.72-0.83). The κ value for concordance was highest between an mMRC score of 1 and a CAT score of 10 (0.66), followed by an mMRC score of 2 and a CAT score of 15 (0.56), an mMRC score of 2 and a CAT score of 10 (0.47), and an mMRC score of 1 and a CAT score of 15 (0.43). CONCLUSION: A CAT score of 10 was most concordant with an mMRC score of 1 when classifying patients with COPD into GOLD groups A-D. However, a discrepancy remains between the CAT and mMRC scoring systems.

Survey of attitudes on professionalism in plastic and reconstructive surgery.

BACKGROUND: The purpose of this study is to analyze the current attitudes toward professionalism, the core values, and the type of professionalism among plastic surgeons in Korea to establish a code of ethics regarding the role of professionalism for plastic and reconstructive surgeons. METHODS: From March 9, to July 1, 2012, face-to-face and mail surveys were conducted targeting the 325 participants (256 specialists and 69 residents) who are registered members of the Korean Society of Plastic and Reconstructive Surgeons. The proportion of each response given to an item was obtained through statistical processing through frequency analysis. The Mann-Whitney U test was used to compare the differences in the responses between the resident group and the specialist group. RESULTS: The survey results on the perception of professionalism in plastic surgery showed that a high proportion (90.5%) of the respondents viewed the future of plastic surgeons as bright. Through evaluation of the importance of the value items,"professional dominance" (4.58 pts), "autonomy" (4.45 pts), "lifestyle" (4.34 pts), and "commercialism" (4.31 pts) were assessed as critical values. "Altruism" (3.84 pts), "interpersonal competence" (3.79 pts), and "social justice" (3.61 pts) were viewed as lesser values. This difference showed the characteristics of an entrepreneurial outlook. CONCLUSIONS: Plastic surgeons should pursue excellence, humanism, accountability, and altruism in order to overcome the crisis of professionalism in plastic surgery. In order to develop the necessary competencies of professionals, vocational education should be arranged by the Korean Society of Plastic Surgeons, and an appropriate code of ethics should be established.

Comprehensive assessment of DNA copy number alterations in human prostate cancers using Affymetrix 100K SNP mapping array.

Although multiple recurrent chromosomal alterations have been identified in prostate cancer cells, the specific genes driving the apparent selection of these changes remain largely unknown. In part, this uncertainty is due to the limited resolution of the techniques used to detect these alterations. In this study, we applied a high-resolution genome-wide method, Affymetrix 100K SNP mapping array, to screen for somatic DNA copy number (CN) alterations among 22 pairs of samples from primary prostate cancers and matched nonmalignant tissues. We detected 355 recurrent deletions and 223 recurrent gains, many of which were novel. As expected, the sizes of novel alterations tend to be smaller. Importantly, among tumors with increasing grade, Gleason sum 6, 7, and 8, we found a significant trend of larger number of alterations in the tumors with higher grade. Overall, gains are significantly more likely to occur within genes (74%) than are deletions (49%). However, when we looked at the most frequent CN alterations, defined as those in > or =4 subjects, we observed that both gains (85%) and deletions (57%) occur preferentially within genes. An example of a novel, recurrent alteration observed in this study was a deletion between the ERG and TMPRSS2 genes on chromosome 21, presumably related to the recently identified fusion transcripts from these two genes. Results from this study provide a basis for a systematic and comprehensive cataloging of CN alterations associated with grades of prostate cancer, and the subsequent identification of specific genes that associated with initiation and progression of the disease. This article contains supplementary material available via the Internet at http://www.interscience.wiley.com/jpages/1045-2257/suppmat