Evaluation of Caspase-3 and Ki-67 expression in squamous cell hyperplasia of the stomach induced by Platycodi radix water extract in Sprague-Dawley rats.

Platycodi radix is widely used in traditional herbal medicine for the treatment of bronchitis, asthma, pulmonary tuberculosis, hypertension, hyperlipidemia, and diabetes. This study aimed to investigate cell proliferation (Ki-67) and apoptosis (Caspase-3) potential in squamous cell hyperplasia of the stomach induced by a Platycodi radix water extract in a subchronic toxicity study. One hundred formalin-fixed, paraffin-embedded stomach tissues of rats treated with Platycodi radix at doses of 0, 500, 1,000, and 3,000 mg/kg body weight/day were used for the analysis. They were conventionally stained using hematoxylin and eosin (H&E) and immunohistochemically (IHC) stained using caspase-3 and Ki-67 antibodies. The incidence of squamous cell hyperplasia was significantly increased in the 3,000 mg/kg b.w./day treatment group in both sexes (p<0.01). However, the hyperplastic change was completely repaired after 4 weeks of recovery period. Ki-67 expression was similar in all groups, with no statistically significant differences among the groups. Caspase-3 expression was significantly increased in both sexes in the 3,000 mg/kg b.w./day treatment group (p<0.01), compared with the vehicle control groups, and then reduced to normal levels in the recovery groups in both sexes. In conclusion, this study showed that squamous cell hyperplasia induced by the Platycodi radix water extract in the limiting ridge of the stomach is not considered to be abnormal proliferative change; as a result, squamous cell hyperplasia is considered to be a non-adverse effect when induced by the oral administration of the Platycodi radix water extract once daily for 13 weeks in rats.

Smoking and the Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.

INTRODUCTION: It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection. METHODS: A matched case-control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status. RESULTS: A total of 4167 patients with SARS-CoV-2 infection and 20 937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50-0.62). When ex-smokers and current smokers were analyzed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28-0.38; ex-smoker OR = 0.81, CI = 0.72-0.91). CONCLUSIONS: This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution. IMPLICATIONS: It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.

Factors associated with electronic cigarette use among adolescents asthma in the Republic of Korea.

OBJECTIVES: Despite the rapid increase in electronic cigarette (e-cigarette) smoking, little is known about the factors associated with their use, particularly in adolescents with asthma. Our study investigated the prevalence of, and factors associated with asthma. METHODS: We analyzed data from the Korean Youth Risk Behavior Web-based Survey of 44,479 adolescents with physician-diagnosed asthma and 445,692 subjects without asthma. Sociodemographic factors, psychosocial factors, and e-cigarette smoking patterns were investigated by self-report questionnaires. Multiple logistic regression was used to investigate the factors associated with ever or current e-cigarette risks in adolescents with asthma, with adjustment for confounding factors. RESULTS: Significantly more subjects had a smoking habit in the asthma group than in the non-asthma group. Among the adolescents with asthma, 4,420 (9.9%) smoked e-cigarettes (ever-users), and 1,962 (4.4%) smoked e-cigarettes within the last 30 days (current users). Multiple logistic regression showed that both ever and current e-cigarette use were significantly associated with male gender, higher family income, residence in an urban area, alcohol drinking, substance use experience, sexual experience, and friends' smoking. Current e-cigarette use was also significantly associated with high caffeine intake, no regular exercise, and experience of violence in adolescents with asthma. CONCLUSIONS: E-cigarette smoking behavior was significantly more frequent in adolescents with asthma than in those without asthma, and multiple psychosocial factors were associated with e-cigarette smoking. Our results could inform e-smoking control programs and help identify adolescents with asthma at high risk of e-cigarette smoking, to ultimately prevent and reduce this behavior.

Development and validation of a nomogram to predict pulmonary function and the presence of chronic obstructive pulmonary disease in a Korean population.

BACKGROUND: Early suspicion followed by assessing lung function with spirometry could decrease the underdiagnosis of chronic obstructive pulmonary disease (COPD) in primary care. We aimed to develop a nomogram to predict the FEV1/FVC ratio and the presence of COPD. METHODS: We retrospectively reviewed the data of 4241 adult patients who underwent spirometry between 2013 and 2019. By linear regression analysis, variables associated with FEV1/FVC were identified in the training cohort (n = 2969). Using the variables as predictors, a nomogram was created to predict the FEV1/FVC ratio and validated in the test cohort (n = 1272). RESULTS: Older age (ß coefficient [95% CI], - 0.153 [- 0.183, - 0.122]), male sex (- 1.904 [- 2.749, - 1.056]), current or past smoking history (- 3.324 [- 4.200, - 2.453]), and the presence of dyspnea (- 2.453 [- 3.612, - 1.291]) or overweight (0.894 [0.191, 1.598]) were significantly associated with the FEV1/FVC ratio. In the final testing, the developed nomogram showed a mean absolute error of 8.2% between the predicted and actual FEV1/FVC ratios. The overall performance was best when FEV1/FVC < 70% was used as a diagnostic criterion for COPD; the sensitivity, specificity, and balanced accuracy were 82.3%, 68.6%, and 75.5%, respectively. CONCLUSION: The developed nomogram could be used to identify potential patients at risk of COPD who may need further evaluation, especially in the primary care setting where spirometry is not available.

Association of asthma and sleep insufficiency among South Korean adolescents: analysis of web-based self-reported data from the Korean youth risk behavior web-based survey.

Objectives: Weekend oversleep or catch-up sleep is common among adolescents, but relatively few data are available with regard to its effects on asthma. Our aim was to investigate whether weekend oversleep is associated with ever having asthma among Korean adolescents. Methods: We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 25,927 physician-diagnosed adolescent asthma cases and 266,160 non-asthma cases. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors and sleep patterns. Multiple logistic regression after adjusting for factors was used to determine the association between sleep and asthma. Results: The asthma group slept less (≤5 hours: 23.9% vs. 22.8%) had a later weekend bedtime (≥1:00 AM: 58.1% vs. 57.8%), and an earlier weekend wake time (≤7:00 AM: 18.1% vs. 17.0%) compared to the non-asthma group. After multiple logistic regression, a sleep duration ≤5 hours (odds ratio (OR), 1.09; 95% confidence interval (CI), 1.04-1.14) and weekend "early bird" (weekend wake time ≤7:00 AM: OR, 1.03; 95% CI, 1.00-1.07) were significantly associated with an increased frequency of asthma. Long weekend catch-up sleep (weekend sleep duration minus weekday sleep duration ≥2 hours) was significantly associated with a decreased frequency of asthma (OR, 0.98; 95% CI, 0.94-0.99). Conclusion: Long weekend catch-up sleep, as an indicator of insufficient weekday sleep, is associated with a decreased frequency of asthma in Korean adolescents.

Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea: a nationwide population-based study.

BACKGROUND: Epidemiologic characteristics of nontuberculous mycobacterial (NTM) disease remain largely unknown. The objective of this study was to evaluate incidence, prevalence, and mortality of NTM infection in a large nationwide population-based cohort in Korea. METHODS: Data of the National Health Insurance Service database, an extensive health-related database including most Korean residents, were used. Adults with a primary diagnosis of NTM as determined by International Classification of Disease-Tenth Revision coding (A31) were identified between 2003 and 2016. Incidence, prevalence, and mortality of NTM infection were analyzed. RESULTS: A total of 46,194 individuals had a primary diagnosis of NTM infection. Their mean age was 55.8 years. Of these subjects, 61.1% were females. Annual age-adjusted incidence and prevalence of NTM infection tended to increase rapidly from 2003 to 2016. Age-adjusted incidence and prevalence was 17.9 and 33.3 per 100,000 population in 2016. The incidence and prevalence were higher in females and the elderly. The 5-year mortality rate in the population with NTM infection was 17.8%. The standardized mortality ratio of patients with NTM infection to the general population was 2.16 (95% confidence interval: 2.10 to 2.22). CONCLUSIONS: This large population-based study showed that the incidence and prevalence of NTM infection in Korea increased rapidly from 2003 to 2016. They were higher in women and the elderly. The mortality rate in the population with NTM infection was higher than that in the general population.

The Association between Male Asthma and Lower Urinary Tract Symptoms Evaluated by the International Prostate Symptom Score: A Population-Based Study.

OBJECTIVES: We explored the association between asthma severity and lower urinary tract symptoms (LUTS) using the International Prostate Symptom Score in a population-based study of males (aged ≥19 years) and evaluated voiding and urine storage symptoms. METHODS: This was a cross-sectional study of 101,848 males, 2,544 of whom had asthma, who participated in the 2011 Korean Community Health Survey. All subjects were assessed in terms of sociodemographic data, pre-existing conditions, and the presence of LUTS. Logistic regression was used to identify risk factors for LUTS in asthmatics. RESULTS: Urine storage symptoms (frequency, urgency, and nocturia) and voiding symptoms (straining, a weak stream, intermittency, and incomplete emptying) were significantly higher in the asthma group than in the non-asthma group (all p < 0.001). Moderate and severe LUTS were significantly more common in the asthma group (moderate, 24.3%; severe, 22.5%) than in the nonasthma group (moderate, 9.5%; severe, 2.9%). Compared to the mild LUTS group, the odds ratio (OR) for asthma was 2.21 (95% confidence interval [CI] 1.99-2.46) in the moderate LUTS group, and 3.04 (95% CI 2.64-3.51) in the severe LUTS group. In a model evaluating multiple variables, the OR for asthma in the moderate LUTS group was 1.95 (95% CI 1.74-2.16) and that in the severe LUTS group was 2.17 (95% CI 1.87-2.53). Asthma was associated with both voiding and storage symptoms. CONCLUSIONS: Male asthma was associated with moderate-to-severe LUTS. More aggressive urological diagnosis and treatment are needed for patients with asthma.

Health related quality of life in relation to asthma - Data from a cross sectional study.

Objective: The aim of this study was to examine the effect of adult asthma on health-related quality of life (HRQoL) and psychological factors using the results of a cross-sectional nationwide survey. Methods: Data were obtained from 229,131 participants (5,989 with asthma and 223,142 without asthma) in the 2010 Korean Community Health Survey. We compared EuroQol (EQ)-5D and EQ-visual analogue scale (VAS) scores after adjusting for sociodemographic and psychosocial factors, as well as for comorbidities. Multiple logistic regression analysis was used to explore determinants of the lowest quartile HRQoL in the asthma group. Results: The mean EQ-5D and EQ-VAS scores were significantly lower in the asthma group (EQ-5D, 0.82; EQ-VAS, 64.2) compared with the non-asthma group (EQ-5D, 0.90; EQ-VAS, 73.2) (P < 0.001). The multivariate odds ratio (OR) for the lowest quartile of EQ-VAS in the asthma group versus the non-asthma group was 1.17 (95% confidence interval (CI), 1.04-1.32) and the OR for the lowest quartile of EQ-5D in the asthma group versus the non-asthma group was 1.47 (95% CI, 1.18-1.84). Asthma subjects were more likely than those without asthma to have some or severe problems with pain (OR, 1.34; 95% CI, 1.16-1.56) and anxiety/depression (OR, 1.08; 95% CI, 1.03-1.56). Conclusion: We found that asthma was associated with impaired HRQoL, in particular the presence of some or severe problems with anxiety/depression.

Association between asthma and falls: A nationwide population-based study.

OBJECTIVES: We evaluated the relationship between asthma and falls in Koreans using data from a large population-based cross-sectional survey. METHODS: Data were obtained from 228,642 participants, of whom 6,372 had asthma, who participated in the 2013 Korean Community Health Survey. We explored the risk of falls after adjusting for sociodemographic factors and comorbidities. Logistic regression was used to identify risk factors for falls in asthmatics. Patients with asthma who had been diagnosed by a physician were included after excluding those who did not respond to the self-reported questionnaire. RESULTS: In all, 1,733/6,372 (27.1%) asthma patients and 258/788 (32.7%) patients with uncontrolled asthma (who had visited the emergency room because of asthma exacerbation in the prior 12 months) reported histories of falls. In asthmatics, the crude odds ratio (OR) for falls was 1.57 (95% confidence interval [CI]: 1.48-1.67); the OR for falls in the group with uncontrolled asthma was 2.13 (95% CI: 1.83-2.47). The multivariate OR for falls in the asthma group (compared to the non-asthma group) was 1.27 (95% CI, 1.18-1.35) and the OR for falls in the uncontrolled asthma group (again compared to the non-asthma group) was 1.55 (95% CI, 1.32-1.82). Subgroup analysis of the adjusted ORs for falls in asthmatics by age group revealed a significant difference between the presence of asthma and uncontrolled asthma, and falls, in each age group, similar to the relationship evident in the total adult population. CONCLUSION: Asthma is associated with falls, even after adjusting for sociodemographic and comorbid variables.

Factors influencing influenza vaccination among South Korean adult asthma patients: A nationwide population-based cross-sectional study.

BACKGROUND: It is important to identify factors associated with influenza vaccination. This study was performed to investigate factors associated with vaccination coverage among asthma patients in Korea. METHODS: Data were obtained from 229,121 participants (5,989 with asthma and 223,132 without asthma) in the 2010 Korean Community Health Survey. The demographic characteristics and socioeconomic status of respondents with and without asthma were compared. Univariate and multiple logistic regression analyses were used to evaluate socioeconomic status and other demographic variables potentially related to influenza vaccination in asthma patients. RESULTS: The vaccination rates of young (19-49 years) and middle-aged (50-64 years) asthma patients were only 28.3 and 49.5%, respectively, whereas that of elderly (≥65 years) asthma patients was 81.5%. After regression, older age (odds ratio [OR], 5.53; 95% confidence interval [95% CI], 3.56-8.59), poor self-rated health status (OR, 1.43; 95% CI, 1.01-2.03), and regular health check-ups (OR, 2.07, 95% CI, 1.64-2.60) were associated with increased influenza vaccination rates in asthma patients. CONCLUSIONS: It is important to improve influenza vaccination coverage for non-elderly patients with asthma, especially those who do not engage in regular exercise or undergo regular health check-ups and those who consider themselves to be healthy.

Association between Sarcopenic Obesity and Bone Mineral Density in Middle-Aged and Elderly Korean.

OBJECTIVES: To identify the prevalence of osteosarcopenic obesity and to evaluate the association between sarcopenic obesity and bone mineral density in middle-aged and elderly Korean. METHODS: This study included 3,385 males and 4,064 females (age ≥50 years and in the stage of menopause) who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011. The cutoff value for sarcopenia was 7.26 kg/m2 for men and 5.45 kg/m2 for female. The fat mass was >30% for men and 40% for female; these values were used to define obesity. Based on the combination of sarcopenia and obesity status, all subjects were classified as sarcopenic obese (SO), sarcopenic nonobese (SNO), nonsarcopenic obese (NSO), or nonsarcopenic nonobese. RESULTS: The incidence rates of sarcopenia, sarcopenic obesity, and osteosarcopenic obesity were 31.5, 5.1, and 4.1%, respectively. Following adjustment, the ORs for osteoporosis were 8.67 in the SO group (95% CI 4.19-17.94), 3.85 in the SNO group (95% CI 2.61-5.67), and 1.88 in the NSO group (95% CI 0.72-4.91) in men and 2.93 in the SO group (95% CI 1.99-4.32), 1.71 in the SNO group (95% CI 1.31-2.23), and 0.58 in the NSO group (95% CI 0.43-0.78) in women. CONCLUSIONS: Sarcopenic obesity is associated with the development of osteoporosis among the middle-aged and elderly Korean population.

Association between sarcopenia and metabolic syndrome in chronic obstructive pulmonary disease: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011.

AIM: It is not clear whether the restrictive or obstructive pattern of spirometry is associated with metabolic syndrome. We investigated the associations between restrictive and obstructive spirometric patterns and metabolic risk factors using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Additionally, we investigated whether sarcopenia is associated with metabolic syndrome in patients with chronic obstructive pulmonary disease (COPD). METHODS: Using data from KNHANES between 2008 and 2011, we enrolled 8,145 subjects (normal lung function: 6,077, obstructive spirometric pattern: 1,039, restrictive pattern: 1,029) aged ≥40 years who underwent anthropometric measurement, laboratory tests, spirometry and estimation of appendicular muscle mass. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight squared <2 SD below the sex-specific mean for the young reference group. RESULTS: Sarcopenia was found in 32.8% of male and 12.2% of female patients with COPD. The odds ratio (OR) of metabolic syndrome for the restrictive spirometric pattern in male was 1.29 (95% confidence interval [CI], 1.02-1.65), and that for obstructive pattern in males was 0.99 (95% CI, 0.79-1.26) after adjustments for covariables (female restrictive pattern (ORs, 1,45; 95% CI, 1.09-1.91) and female obstructive pattern (ORs 0.73; 95% CI, 0.49-1.09). After adjustment for other confounding factors, the risk of metabolic syndrome was higher in sarcopenic male (OR, 1.88; 95% CI, 1.27-2.77) with COPD than in those without sarcopenia. CONCLUSIONS: The restrictive spirometric pattern is associated with metabolic syndrome, and sarcopenia may contribute to the risk of metabolic syndrome in male patients with COPD.

Clinical and financial impact of immune checkpoint inhibitors following platinum chemotherapy in patients with advanced or metastatic non-small cell lung cancer: a nationwide population-based study.

Background: Although various studies have demonstrated that the clinical efficacy of immune checkpoint inhibitors (ICIs) improves the prognosis of patients with non-small cell lung cancer (NSCLC), studies on the financial aspects based on large population-based data are needed. This study aimed to analyze the differences in medical expenses and the effect of ICIs on the prognosis of patients with advanced or metastatic NSCLC. Methods: Patients newly diagnosed with stage IIIB or IV NSCLC who received palliative chemotherapy between 2013 and 2020 were selected from the nationwide database of the population covered by the Korean National Health Insurance Service. Interrupted time-series analysis was performed to evaluate the effects of subsequent ICI use after platinum-based cytotoxic chemotherapy (CC) on overall mortality. Progression-free survival and medical expenditure were also assessed. Results: In the final study population, 2,485 and 4,812 patients were included in the ICI and non-ICI groups, respectively. ICI treatment significantly lowered the risk of death [adjusted hazard ratio, 0.79; 95% confidence interval (CI): 0.75-0.84]. And the ICI-treated patients were less likely to experience disease progression (adjusted odds ratios, 0.92; 95% CI: 0.85-0.99). Furthermore, after the introduction of ICIs, both total and cancer-related medical expenses per capita showed an increasing trend [ß: $4.56K, standard error (SE): $0.27K, P<0.0001 and ß: $4.54K, SE: $0.27K, P<0.0001, respectively]. Conclusions: Subsequent ICI use after platinum-based CC improved the overall survival rate of patients with advanced NSCLC. With the increasing burden of individual medical expenses, further research is required to identify patients for whom ICI treatment may be effective.

Association between COVID-19 lockdown and sleep behaviors in Korean adolescents.

To find the effect of coronavirus disease 2019 (COVID-19)-related sleep behavior changes using school-based self-reported data from a nationally representative Korean adolescent population. We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 98,126 participants (51,651 in 2019 [before the COVID-19 pandemic]; 46,475 in 2020 [during COVID-19 pandemic] 12 through 18 years old were included in this study. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors, and sleep patterns. During the COVID-19 pandemic, Korean adolescents had a later weekend bedtime (≥1:00 am: 68.2% vs 71.5%, P < .001) and late weekend wake time (≤7:00 am: 13.3% vs 10.7%, P < .001) compared to before COVID-19 pandemic. Average sleep duration (434.7 ± 102.6 vs 428.2 ± 100.4 minutes; P < .001) was significantly lower during the COVID-19 pandemic and weekend catch-up sleep >2 hours (42.1% vs 43.7%; P < .001), late chronotype (17.1% vs 22.9%, P < .001) were significantly higher during COVID-19 pandemic. After adjusting for multiple confounding variables, short sleep duration (≦5 hours, odds ratio [OR] 1.14; 95% confidence interval [CI] 1.10-1.19), 6 hours, OR 1.07; 95% CI 1.03-1.12), long weekend catch-up sleep (OR, 1.08; 95% CI, 1.06-1.11) and late chronotype (OR, 1.43; 95% CI, 1.38-1.47) were significantly associated with COVID-19 pandemic. The COVID-19 pandemic was associated with changes in sleep behavior among Korean adolescents, resulting in later bed and wake-up times, increased weekend catch-up sleep, and a shift of chronotype toward eveningness.

Effects of Cudrania tricuspidata and Sargassum fusiforme extracts on hair growth in C57BL/6 mice.

BACKGROUND: Cudrania tricuspidata is a perennial plant, and Sargassum fusiforme is a brown seaweed with numerous potential benefits, including anticancer, anti-inflammatory, and antioxidant activities. However, the efficacies of C. tricuspidata and S. fusiforme on hair growth have not yet been elucidated. Therefore, the present study examined the effects of C. tricuspidata and S. fusiforme extracts on hair growth in C57BL/6 mice. RESULTS: ImageJ demonstrated that drinking and skin application of C. tricuspidata and/or S. fusiforme extracts significantly increased the hair growth rate in the dorsal skin of C57BL/6 mice compared to the control group. Histological analysis confirmed that drinking and skin application of C. tricuspidata and/or S. fusiforme extracts for 21 days significantly increased the length of hair follicles on the dorsal skin of treated C57BL/6 mice compared to that in the control mice. RNA sequencing analysis revealed that hair growth cycle-related factors (anagen factors) such as Catenin Beta 1 (Ctnnb1) and platelet-derived growth factor (Pdgf) were upregulated (> twofold) only by C. tricuspidate extracts, whereas vascular endothelial growth factor (Vegf) and Wnts were upregulated by both C. tricuspidata or S. fusiforme applications in treated mice (compared to the control mice). In addition, oncostatin M (Osm, a catagen-telogen factor) was downregulated (< 0.5 fold) by C. tricuspidata when administered via both skin and drinking mode in treated mice compared to that in control mice. CONCLUSIONS: Our results suggest that C. tricuspidata and/or S. fusiforme extracts show potential hair growth efficacy by upregulating anagen factor genes, including ß-catenin, Pdgf, Vegf, and Wnts, and downregulating catagen-telogen factor genes, including Osm, in C57BL/6 mice. The findings suggest that C. tricuspidata and/or S. fusiforme extracts are potential drug candidates to treat alopecia.

Radiologic Assessment of Lung Edema Score as a Predictor of Clinical Outcome in Children with Acute Respiratory Distress Syndrome.

PURPOSE: The radiographic assessment of lung edema (RALE) score enables objective quantification of lung edema and is a valuable prognostic marker of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the validity of RALE score in children with ARDS. MATERIALS AND METHODS: The RALE score was measured for its reliability and correlation to other ARDS severity indices. ARDS-specific mortality was defined as death from severe pulmonary dysfunction or the need for extracorporeal membrane oxygenation therapy. The C-index of the RALE score and other ARDS severity indices were compared via survival analyses. RESULTS: Among 296 children with ARDS, 88 did not survive, and there were 70 ARDS-specific non-survivors. The RALE score showed good reliability with an intraclass correlation coefficient of 0.809 [95% confidence interval (CI), 0.760-0.848]. In univariable analysis, the RALE score had a hazard ratio (HR) of 1.19 (95% CI, 1.18-3.11), and the significance was maintained in multivariable analysis adjusting with age, ARDS etiology, and comorbidity, with an HR of 1.77 (95% CI, 1.05-2.91). The RALE score was a good predictor of ARDS-specific mortality, with a C-index of 0.607 (95% CI, 0.519-0.695). CONCLUSION: The RALE score is a reliable measure for ARDS severity and a useful prognostic marker of mortality in children, especially for ARDS-specific mortality. This score provides information that clinicians can use to decide the proper time of aggressive therapy targeting severe lung injury and to appropriately manage the fluid balance of children with ARDS.

STROBE: The relationship between asthma and early menarche in Korean adolescents.

ABSTRACT: We explored the relationship between asthma and early menarche in a representative sample of Korean adolescents.Web-based self-reported data collected from 2006 to 2015 by the Korean Youth Risk Behavior Web-based Survey were used. Menarche status was divided into "early" (<12 years of age, n = 69,520) and "not early" (≥12 years of age, n = 234,065).Adolescent girls with early menarche exhibited a higher incidence of asthma (8.1% vs 7.4%, P < .001), more frequent school absences because of asthma (10.8% vs 8.7%), and more frequent ≤4-day stretches of school absence (4.6% vs 2.4%) compared with girls with "not early" menarche (all P < .001). Multivariate analysis performed after adjusting for multiple confounders revealed a 1.04-fold (95% confidence interval [CI] 1.00-1.07) greater likelihood of asthma in the early menarche than not early menarche group. In addition, the odds ratios for missing school due to asthma for 1 to 3 and ≥4 days per year in the early menarche group were 1.00 (95% CI 1.00-1.02) and 1.21 (95% CI 1.01-1.46), respectively.Adolescents with early menarche exhibited increased incidences of asthma and severe asthma.

: Short-term effects of exposure to particulate matter on hospital admissions for asthma and chronic obstructive pulmonary disease.

We investigated the effects of particulate matter (PM) factors on hospitalization rates for asthma and chronic obstructive pulmonary disease (COPD). We obtained data on pollutants-PM10, PM2.5-in Seoul, South Korea. We also investigated data for asthma and COPD exacerbation that required hospitalization from 2006 to 2016. We used a time-stratified case-crossover design and generalized additive models with log transformation to assess adjusted risk, and conditional logistic regression was performed to analyze these data. Our study showed that PM10 and PM2.5, on different best lag days, were associated with increased risks of COPD or asthma hospitalization. The odds ratios (ORs) for each per-unit increase in PM10 and PM2.5 were higher in patients with male asthma (PM10: OR, 1.012; 95% confidence interval [CI], 1.008-1.016 and PM2.5: OR, 1.015; 95% CI, 1008-1.023), preschool asthma (PM10: OR, 1.015; 95% CI, 1.006-1.015 and PM2.5: OR, 1.015; 95% CI, 1.009-1.024), male COPD (PM10: OR, 1.012; 95% CI, 1.005-1.019 and PM2.5: OR, 1.013; 95% CI, 1.000-1.026), and senior COPD (PM10: OR, 1.016; 95% CI, 1.008-1.024 and PM2.5: OR, 1.022; 95% CI, 1.007-1.036). Increasing PM levels increased hospitalizations for asthma and COPD. Additionally, the consequences may be different according to age and sex, and PM2.5 may have a more significant effect on airway disease patients than PM10.