Biotransformation of whey by Weissella cibaria suppresses 3T3-L1 adipocyte differentiation.

Biotransformation, the structural modification of chemical compounds, has proved to be an indispensable tool in providing beneficial health effects. Although the health benefits of biotransformation using plant sources has been widely studied, the anti-adipogenic effect of biotransformed dairy products, such as whey, have not yet been demonstrated. Here, we investigated the anti-adipogenic effect of whey biotransformed by Weissella cibaria in 3T3-L1 adipocytes. Weissella cibaria-biotransformed whey considerably reduced the accumulation of lipid droplets and intracellular triglycerides in 3T3-L1 cells. In the presence of W. cibaria-biotransformed whey, the mRNA and protein expression of a key transcription factor, peroxisome proliferator-activated receptor γ (PPARγ), for adipogenesis was markedly suppressed in 3T3-L1 cells. Additionally, W. cibaria-biotransformed whey also decreased the mRNA and protein expressions of lipoprotein lipase and adipocyte fatty acid-binding protein, which are regulated by PPARγ. Moreover, W. cibaria-biotransformed whey inhibited the expression of adipokines, resistin, and leptin. Collectively, these results suggest that whey biotransformed by W. cibaria has the potential to exert anti-adipogenic effects by inhibiting intracellular signaling events of adipogenic-related transcription factors and target genes.

Design of fibronectin type III domains fused to an elastin-like polypeptide for the osteogenic differentiation of human mesenchymal stem cells.

Extracellular matrix (ECM) including fibronectin (FN) and elastin plays a pivotal role in providing a microenvironment to support tissue regeneration in stem cell therapy. To develop a novel biomimetic ECM for stem cell differentiation, we engineered FN type III 9 and 10 domains fused to elastin-like polypeptides (FN-ELPs). The recombinant FN-ELP fusion protein was expressed in Escherichia coli and purified by inverse transition cycling. Human mesenchymal stem cells (hMSCs) cultured on plates coated with FN-ELP had significantly greater adhesion activity and proliferation than cells grown on non-coated plates. FN-ELP induced the osteogenic differentiation by elevating alkaline phosphatase (ALP) and mineralization activity of hMSCs. Furthermore, the osteogenic marker gene expressions of ALP, collagen type I (Col I), osteopontin (OPN), and transcriptional coactivator with a PDZ-binding motif (TAZ) were increased in hMSCs cultured on plates coated with FN-ELP. We reported a novel biomimetic ECM with potential for bone regeneration that promotes the osteogenic differentiation of hMSCs.

The age-related characteristics of adults with asthma who visited emergency departments in Korea from 2007 to 2012.

BACKGROUND: Understanding the patterns of emergency department (ED) visits of patients with asthma is important for disease control and prevention of exacerbations. OBJECTIVE: This study aimed to investigate the characteristics of adult patients who visited EDs because of their asthma. METHODS: Patients with asthma, ages ≥19 years old, who visited 117 EDs throughout Korea between January 2007 and December 2012 were identified in the National Emergency Department Information System (NEDIS) data base using the International Classification of Disease, 10th revision, codes J45 (asthma) and J46 (status asthmaticus). RESULTS: A total of 97,835 adult patients with asthma visited 117 EDs throughout Korea during the study period. There was a slight female preponderance (male-to-female ratio, 1:1.09). The number of patients aged 70-79-years-old was 28,031 (28.7%), the highest among the patients with asthma. ED visits showed a seasonal distribution, with most occurring in winter and spring, followed by autumn. The seasonal distribution varied by age; most patients ages 19-49 years presented in autumn (September), whereas those patients ages ≥50 years presented to the ED most often in winter. Overall, 65.5% of patients were admitted to the hospital, including 12.6% admitted to an intensive care unit (ICU). Overall, 209 patients (0.2%) died. The rates of hospital admission to general wards and ICUs were highest in those patients ≥70 years old; this group also had the highest mortality rate. CONCLUSION: In this nationwide study, which spanned 6 years, of adult patients with asthma, we observed an age-specific seasonal pattern of ED visits. Identifying the causes of age-related deterioration and seasonal visits to the ED will help prevent asthma symptoms and reduce medical costs.

Long-range enhancers modulate Foxf1 transcription in blood vessels of pulmonary vascular network.

Intimate crosstalk occurs between the pulmonary epithelium and the vascular network during lung development. The transcription factor forkhead box f1 (Foxf1) is expressed in the lung mesenchyme and plays an indispensable role in pulmonary angiogenesis. Sonic hedgehog (Shh), a signalling molecule, is expressed in lung epithelium and is required to establish proper angiogenesis. It has been suggested that Foxf1, a downstream target of the Shh signalling pathway, mediates interaction between angiogenesis and the epithelium in lung. However, there has been no clear evidence showing the mechanism how Foxf1 is regulated by Shh signalling pathway during lung development. In this study, we investigated the lung-specific enhancers of Foxf1 and the Gli binding on the enhancers. At first, we found three evolutionarily conserved Foxf1 enhancers, two of which were long-range enhancers. Of the long-range enhancers, one demonstrated tissue-specific activity in the proximal and distal pulmonary blood vessels, while the other one demonstrated activity only in distal blood vessels. At analogous positions in human, these long-range enhancers were included in a regulatory region that was reportedly repeatedly deleted in alveolar capillary dysplasia with misalignment of pulmonary vein patients, which indicates the importance of these enhancers in pulmonary blood vessel formation. We also determined that Gli increased the activity of one of these long-range enhancers, which was specific to distal blood vessel, suggesting that Shh regulates Foxf1 transcription in pulmonary distal blood vessel formation.

Obesity and Its Potential Effects on Antidepressant Treatment Outcomes in Patients with Depressive Disorders: A Literature Review.

Accumulating evidence regarding clinical, neurobiological, genetic, and environmental factors suggests a bidirectional link between obesity and depressive disorders. Although a few studies have investigated the link between obesity/excess body weight and the response to antidepressants in depressive disorders, the effect of weight on treatment response remains poorly understood. In this review, we summarized recent data regarding the relationship between the response to antidepressants and obesity/excess body weight in clinical studies of patients with depressive disorders. Although several studies indicated an association between obesity/excess body weight and poor antidepressant responses, it is difficult to draw definitive conclusions due to the variability of subject composition and methodological differences among studies. Especially, differences in sex, age and menopausal status, depressive symptom subtypes, and antidepressants administered may have caused inconsistencies in the results among studies. The relationship between obesity/excess body weight and antidepressant responses should be investigated further in high-powered studies addressing the differential effects on subject characteristics and treatment. Moreover, future research should focus on the roles of mediating factors, such as inflammatory markers and neurocognitive performance, which may alter the antidepressant treatment outcome in patients with comorbid obesity and depressive disorder.

Head position and intraocular pressure in the lateral decubitus position.

PURPOSE: To investigate the effects of different head positions in the lateral decubitus posture on intraocular pressure (IOP). METHODS: Seventeen healthy Korean subjects were included in this prospective observational study. Intraocular pressure measurements were taken with the subjects in the sitting position and the recumbent positions including supine, right lateral decubitus, and left lateral decubitus positions. In right and left lateral decubitus positions, IOP measurements were taken with three different head positions (30 degrees higher, 30 degrees lower, and parallel to the center of the thoracic vertebra) in a randomized sequence. Intraocular pressure was measured using the ICare Pro tonometer in both eyes 5 minutes after assuming each posture. The eye on the lower side in the lateral decubitus position was termed as the dependent eye. We assessed differences in the IOP of the dependent and nondependent eyes in the lateral decubitus positions with different head positions. RESULTS: Regardless of the head position, the dependent eyes showed higher IOP than the nondependent eyes in the lateral decubitus positions except in the left lateral decubitus with high head position (p < 0.001 for all positions except left lateral decubitus, p = 0.083). Low head position significantly increased the IOP of dependent eyes, compared with the neutral or high head positions in lateral decubitus posture. CONCLUSIONS: Low head position elevates the IOP of the dependent eyes compared with neutral head position in the lateral decubitus posture. Proper adjustment of the height of a pillow may help mitigate IOP elevations resulting from lying on the side with a low pillow or with no pillow.

Effects of Polybutylene Succinate Content on the Rheological Properties of Polylactic Acid/Polybutylene Succinate Blends and the Characteristics of Their Fibers.

Polylactic acid (PLA) and polybutylene succinate (PBS) are gaining prominence as environmentally friendly alternatives to petroleum-based polymers due to their inherent biodegradability. For their textile applications, this research is focused on exploring the effects of PBS content on the rheological properties of PLA/PBS blends and the characteristics of PLA/PBS blend fibers. PLA/PBS blends and fibers with varying PBS contents (0 to 10 wt.%) were prepared using melt-blending and spinning methods. Uniform morphologies of the PLA/PBS blends indicated that PBS was compatible with PLA, except at 10% PBS content, where phase separation occurred. The introduction of PBS reduced the complex viscosity of the blends, influencing fiber properties. Notably, PLA/PBS fibers with 7% PBS exhibited improved crystallinity, orientation factor, and elasticity (~16.58%), with a similar tensile strength to PLA fiber (~3.58 MPa). The results suggest that an optimal amount of PBS enhances alignment along the drawing direction and improves the molecular motion in PLA/PBS blend fiber. This study highlights the potential of strategically blending PBS to improve PLA fiber characteristics, promising advancement in textile applications.

Development of examination objectives for the Korean paramedic and emergency medical technician examination: a survey study.

PURPOSE: The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation goals for P&EMTs by analyzing their work, especially the tasks that new P&EMTs (with less than 3 years' experience) find difficult, to foster the training of P&EMTs who could adapt to emergency situations after graduation. METHODS: A questionnaire was created based on prior job analyses of P&EMTs. The survey questions were reviewed through focus group interviews, from which 253 task elements were derived. A survey was conducted from July 10, 2023 to October 13, 2023 on the frequency, importance, and difficulty of the 6 occupations in which P&EMTs were employed. RESULTS: The P&EMTs' most common tasks involved obtaining patients' medical histories and measuring vital signs, whereas the most important task was cardiopulmonary resuscitation (CPR). The task elements that the P&EMTs found most difficult were newborn delivery and infant CPR. New paramedics reported that treating patients with fractures, poisoning, and childhood fever was difficult, while new EMTs reported that they had difficulty keeping diaries, managing ambulances, and controlling infection. CONCLUSION: Communication was the most important item for P&EMTs, whereas CPR was the most important skill. It is important for P&EMTs to have knowledge of all tasks; however, they also need to master frequently performed tasks and those that pose difficulties in the field. By deriving goals for evaluating P&EMTs, changes could be made to their education, thereby making it possible to train more capable P&EMTs.

Cpne7 deficiency induces cellular senescence and premature aging of dental pulp.

Once tooth development is complete, odontoblasts and their progenitor cells in the dental pulp play a major role in protecting tooth vitality from external stresses. Hence, understanding the homeostasis of the mature pulp populations is just as crucial as understanding that of the young, developing ones for managing age-related dentinal damage. Here, it is shown that loss of Cpne7 accelerates cellular senescence in odontoblasts due to oxidative stress and DNA damage accumulation. Thus, in Cpne7-null dental pulp, odontoblast survival is impaired, and aberrant dentin is extensively formed. Intraperitoneal or topical application of CPNE7-derived functional peptide, however, alleviates the DNA damage accumulation and rescues the pathologic dentin phenotype. Notably, a healthy dentin-pulp complex lined with metabolically active odontoblasts is observed in 23-month-old Cpne7-overexpressing transgenic mice. Furthermore, physiologic dentin was regenerated in artificial dentinal defects of Cpne7-overexpressing transgenic mice. Taken together, Cpne7 is indispensable for the maintenance and homeostasis of odontoblasts, while promoting odontoblastic differentiation of the progenitor cells. This research thereby introduces its potential in oral disease-targeted applications, especially age-related dental diseases involving dentinal loss.

Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study.

BACKGROUND: Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. METHODS: A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. FINDINGS: 27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility. INTERPRETATION: High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices. FUNDING: The Bill & Melinda Gates Foundation.

Copine7 deficiency leads to hepatic fat accumulation via mitochondrial dysfunction.

Objective: Mitochondrial dysfunction affects hepatic lipid homeostasis and promotes ROS generation. Copine7 (CPNE7) belongs to the ubiquitous copine family of calcium-dependent phospholipid binding proteins. CPNE7 has a high calcium ion binding affinity and the capacity to scavenge reactive oxygen species (ROS). A recent study reported that abnormalities in fatty acid and lipid metabolism were linked to the gene variant of CPNE7. Therefore, the purpose of this study is to examine the role of Cpne7 in hepatic lipid metabolism based on mitochondrial function. Methods: Lipid metabolism, mitochondrial function, and ROS production were investigated in high-fat diet (HFD)-fed Cpne7-/- mice and H2O2-damaged HepG2 hepatocytes following CPNE7 silencing or overexpression. Results: Cpne7 deficiency promoted severe hepatic steatosis in the HFD-induced NAFLD model. More importantly, mitochondrial dysfunction was observed along with an imbalance of mitochondrial dynamics in the livers of HFD-fed Cpne7-/-mice, resulting in high ROS levels. Similarly, CPNE7-silenced HepG2 hepatocytes showed high ROS levels, mitochondrial dysfunction, and increased lipid contents. On the contrary, CPNE7-overexpressed HepG2 cells showed low ROS levels, enhanced mitochondrial function and decreased lipid contents under H2O2-induced oxidative stress. Conclusions: In the liver, Cpne7 deficiency causes excessive ROS formation and mitochondrial dysfunction, which aggravates lipid metabolism abnormalities. These findings provide evidence that Cpne7 deficiency contributes to the pathogenesis of NAFLD, suggesting Cpne7 as a novel therapeutic target for NAFLD.

Lactobacillus paracasei ATG-E1 improves particulate matter 10 plus diesel exhaust particles (PM10D)-induced airway inflammation by regulating immune responses.

Particulate matter (PM) exposure can adversely affect respiratory function. Probiotics can alleviate the inflammatory responses in respiratory diseases. We examined the protective effects of Lactobacillus paracasei ATG-E1 isolated from the feces of a newborn baby against airway inflammation in a PM10 plus diesel exhaust particle (DEP) (PM10D)-induced airway inflammation model. BALB/c mice were exposed to PM10D by intranasal injection three times at 3-day intervals for 12 days, and L. paracasei ATG-E1 was administered orally for 12 days. Analysis of immune cell population and expression of various inflammatory mediators and gut barrier-related genes were determined in bronchoalveolar lavage fluid (BALF), lung, peyer's patch, and small intestine. A histological analysis of the lungs was performed. In addition, the in vitro safety and their safety in genomic analyses were examined. L. paracasei ATG-E1 was found to be safe in vitro and by genomic analysis. L. paracasei ATG-E1 suppressed neutrophil infiltration and the number of CD4+, CD4+CD69+, CD62L-CD44+high, CD21/35+B220+, and Gr-1+CD11b+ cells, as well as the expression of inflammatory mediators, including chemokine (C-X-C motif) ligand (CXCL)-1, macrophage inflammatory protein (MIP)-2, interleukin (IL)-17a, tumor necrosis factor (TNF)-α, and IL-6 in BALF and lungs in PM10D-induced airway inflammation. It protected against histopathological damage in the lungs of mice with PM10D-induced airway inflammation. L. paracasei ATG-E1 concomitantly increased the expression levels of the gut barrier function-related genes occludin, claudin-1, and IL-10 in the small intestine, with an increased number of CD4+ and CD4+CD25+ immune cells in the peyer's patch. L. paracasei ATG-E1 suppressed immune activation and airway inflammatory responses in the airways and lungs by restoring the lung damage by PM10D. It also regulated intestinal immunity and ameliorated the gut barrier function in the ileum. These results indicate the potential of L. paracasei ATG-E1 as an protective and therapeutic agent against airway inflammation and respiratory diseases.

Are ex vivo mesothelial cells representative of the in vivo transition from epithelial-to-mesenchymal cells in peritoneal membrane?

BACKGROUND: We investigated whether ex vivo mesothelial cells found in peritoneal dialysis (PD) effluents were representative of the in vivo epithelial-to-mesenchymal transition (EMT) in peritoneal membrane. METHODS: Thirty-six male Sprague-Dawley rats were equally divided into three groups: Group C (control), no PD; Group D, infused with 4.25% Dianeal and Group P, infused with 4.25% Physioneal. PD infusions (25 mL) were given twice daily for 8 weeks. The in vivo study included morphometric analyses performed on the peritoneal membranes of tissue specimens obtained at the end of the study. The ex vivo study included peritoneal mesothelial cells collected from PD effluent and cultured to confluence. Cells were scored with light microscopy. RESULTS: PD for 8 weeks induced significant EMT. The in vivo expression of EMT markers (α-smooth muscle actin:E-cadherin ratio, matrix metalloproteinase-2 and Snail) was higher in Group D than in Group P. However, ex vivo EMT marker expression was similar in cells derived from Groups D and P. A significant correlation was observed among in vivo EMT markers. Moreover, the ex vivo cell score increased with time on PD. However, changes in the ex vivo cell score did not correlated with changes in the in vivo EMT marker expression. Furthermore, we found no correlation between ex vivo and in vivo cells in the expression of EMT markers. CONCLUSIONS: In this animal study, ex vivo findings did not reflect the in vivo EMT changes in the peritoneum. It may be necessary to improve the current methodology for ex vivo studies.

Economic impact of cholera in households in rural southern Malawi: a prospective study.

INTRODUCTION: Cholera remains a significant contributor to diarrhoeal illness, especially in sub-Saharan Africa. Few studies have estimated the cost of illness (COI) of cholera in Malawi, a cholera-endemic country. The present study estimated the COI of cholera in Nsanje, southern Malawi, as part of the Cholera Surveillance in Malawi (CSIMA) programme following a mass cholera vaccination campaign in 2015. METHODS: Patients ≥12 months of age who were recruited as part of CSIMA were invited to participate in the COI survey. The COI tool captured household components of economic burden, including direct medical and non-medical costs, and indirect lost productivity costs. RESULTS: Between April 2016 and March 2020, 40 cholera cases were enrolled in the study, all of whom participated in the COI survey. Only two patients had any direct medical costs and five patients reported lost wages due to illness. The COI per patient was US$14.34 (in 2020), more than half of which was from direct non-medical costs from food, water, and transportation to the health centre. CONCLUSION: For the majority of Malawians who struggle to subsist on less than US$2 a day, the COI of cholera represents a significant cost burden to families. While cholera treatment is provided for free in government-run health centres, additional investments in cholera control and prevention at the community level and financial support beyond direct medical costs may be necessary to alleviate the economic burden of cholera on households in southern Malawi.

Bioconversion Products of Whey by Lactic Acid Bacteria Exert Anti-Adipogenic Effect.

Microbial bioconversion using lactic acid bacteria (LAB) provides several human health benefits. Although whey and whey-derived bioactive compounds can contribute to an improvement in human health, the potential anti-obesity effect of whey bioconversion by LAB has not been well studied. This study aimed to investigate whether bioconversion of whey by Pediococcus pentosaceus KI31 and Lactobacillus sakei KI36 (KI31-W and KI36-W, respectively) inhibits 3T3-L1 preadipocyte differentiation. Both KI31-W and KI36-W reduced intracellular lipid accumulation significantly, without decreasing 3T3-L1 preadipocyte proliferation. In addition, obesity-related transcription factor (peroxisome proliferator-activated receptor γ) and genes (adipocyte fatty acid-binding protein and lipoprotein lipase) were down-regulated significantly in 3T3-L1 cells in the presence of KI31-W and KI36-W. Collectively, these results suggest that bioconversion of whey by LAB exhibits anti-adipogenic activity and may be applied as a therapeutic agent for obesity.

The Enhanced Hydrogen Storage Capacity of Carbon Fibers: The Effect of Hollow Porous Structure and Surface Modification.

In this study, highly porous carbon fiber was prepared for hydrogen storage. Porous carbon fiber (PCF) and activated porous carbon fiber (APCF) were derived by carbonization and chemical activation after selectively removing polyvinyl alcohol from a bi-component fiber composed of polyvinyl alcohol and polyacrylonitrile (PAN). The chemical activation created more pores on the surface of the PCF, and consequently, highly porous APCF was obtained with an improved BET surface area (3058 m2 g-1) and micropore volume (1.18 cm3 g-1) compare to those of the carbon fiber, which was prepared by calcination of monocomponent PAN. APCF was revealed to be very efficient for hydrogen storage, its hydrogen capacity of 5.14 wt% at 77 K and 10 MPa. Such hydrogen storage capacity is much higher than that of activated carbon fibers reported previously. To further enhance hydrogen storage capacity, catalytic Pd nanoparticles were deposited on the surface of the APCF. The Pd-deposited APCF exhibits a high hydrogen storage capacity of 5.45 wt% at 77 K and 10 MPa. The results demonstrate the potential of Pd-deposited APCF for efficient hydrogen storage.

Behavior of Human Umbilical Vein Endothelial Cells on Titanium Surfaces Functionalized with VE-Cadherin Extracellular 1-4 Domains.

BACKGROUND: Angiogenesis is essential for the optimal functioning of orthopedic medical implants. Protein functionalization of implant surfaces can improve tissue integration through proper vascularization and prevent implant failure in patients lacking sufficient angiogenesis. OBJECTIVE: The aim of this study was to evaluate the angiogenic activity of titanium surfaces functionalized with recombinant VE-cadherin extracelluar1-4 (VE-CADEC1-4) protein in human umbilical vein endothelial cells (HUVECs). METHODS: After titanium discs were coated with recombinant VE-CADEC1-4 protein at appropriate concentrations, the behavior of HUVECs on the VE-CADEC1-4-functionalized titanium discs were evaluated by cell adhesion assay, proliferation assay, and real-time RT-PCR. RESULTS: Recombinant VE-CADEC1-4-functionalized titanium surfaces improved the adhesion of HUVECs by 1.8-fold at the optimal concentration, and the proliferative activity was 1.3-fold higher than the control at 14 days. In addition, when angiogenesis markers were confirmed by real-time RT-PCR, PECAM-1 increased approximately 1.2-fold, TEK approximately 1.4-fold, KDR approximately 1.6-fold, and Tie-1 approximately 2.1-fold compared to the control. CONCLUSION: Recombinant VE-CADEC1-4-functionalized titanium surfaces improved cell adhesion, proliferation, and angiogenic differentiation of HUVECs, suggesting that the VE-CADEC1-4-functionalization of titanium surfaces can offer angiogenic surfaces with the potential to improve bone healing in orthopedic applications.

Electroacupuncture May Improve Burning and Electric Shock-Like Neuropathic Pain: A Prospective Exploratory Pilot Study.

Objective: To test the effectiveness of electroacupuncture (EA) for managing intractable neuropathic pain (NeP) and assess the protocol for a larger confirmatory trial. Design: A prospective, multicenter, single-armed, add-on, pilot study. Settings/location: At two tertiary university-based hospitals in Seoul, Republic of Korea. Subjects: Patients with chronic peripheral NeP, who have received conventional oral medications but complained of moderate to severe pain. Interventions: Two Korean medicine doctors conducted 12 sessions of EA (2 sessions per week for 4 weeks, followed by 1 session per week for the second month) in addition to conventional treatment. Outcome measures: During the 8-week treatment period, pain intensity, pain natures such as burning, electric shock-like, temperature or mechanical hyperalgesia, and numbness, Short Form of the McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI-SF), the EuroQol five dimensions questionnaire, patients' satisfaction, and adverse events were evaluated. The primary endpoint was a change in pain intensity (%) at 4 weeks from the baseline. Results: Among 22 patients, 19 finished the protocol. The eight EA sessions over a month reduced pain intensity from 6.0 ± 1.6 at baseline to 3.2 ± 0.9 at 4 weeks, which was a 46.7% reduction (p < 0.001). The incidences of severe burning, electric shock-like pain, and mechanical hyperalgesia reduced at 8 weeks [36%-16% (p = 0.04), 53%-21% (p = 0.009), and 53%-26% (p = 0.03), respectively]. The affective dimensions in the SF-MPQ (p = 0.007) and the pain interference parameters, including mood (p = 0.02), relations with other people (p = 0.03), and enjoyment of life (p = 0.002) in the BPI-SF, were improved at 4 and 8 weeks. The majority of patients (68%) responded that their pain was "much or somewhat improved." Overall, 84.2% expressed "satisfaction" with their multidisciplinary management. Conclusions: EA might decrease the intensity of NeP, in particular, such as burning, electric shock-like pain, and mechanical hyperalgesia, which was accompanied by psychosocial and functional improvement. A larger study is warranted to prove the effectiveness of EA for managing refractory NeP. Trial registration: ClinicalTrials.gov: NCT03315598. Retrospectively registered on October 20, 2017.

Healthcare utilisation and costs for temporomandibular disorders: a descriptive, cross-sectional study.

OBJECTIVE: Temporomandibular joint disorder (TMD) requires long-term management and can be a financial burden for patients. Here, we investigated the treatment received by people diagnosed with TMD and its relevant costs. DESIGN: A descriptive, cross-sectional study. SETTING AND PARTICIPANTS: We performed secondary data analysis of health insurance claims data provided by the Health Insurance Assessment and Review (HIRA) of the Republic of Korea. We reviewed the records of 10 041 patients who were diagnosed with TMD and who utilised outpatient healthcare service at least once between January and December 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on use of medical services, hospitalisations, sociodemographic factors, treatment and medication were retrieved and analysed. Cost was defined as the cost of care incurred by a health insurance beneficiary at a care facility. RESULTS: We reported the characteristics as medians, frequencies and percentages and found that most TMD patients were outpatients, women (58.9%) and in their 20s (46.4%). For visit type, 85.9% of all patients had an outpatient dental medical visit, with most visiting dental clinics and dental hospitals. Western medicine (WM; 9.8%) was prescribed more often, followed by Korean medicine (KM; 8.2%). The median expense per patient was highest among those in their 20s (58.00, 23.90, 53.40, 65.90 US$ for overall, WM, dental medicine (DM) and KM, respectively). Consultation fees accounted for the greatest percentage (42.8%) of DM and WM care expenses, while injection/non-surgical intervention fees accounted for the greatest percentage of KM care expenses. The most commonly used treatments for TMD were temporomandibular joint stimulation therapy (51.1%) and acupuncture (19.9%), considered as the most basic care for TMD. Psychosomatic agents (86.4%) were the most commonly used medications in outpatients. CONCLUSIONS: While people with TMD most commonly received temporomandibular stimulation therapy, the costs and duration of treatment varied significantly for these patients.

Air-Perfused 23-Gauge Sutureless Diabetic Vitrectomy for Control of Intraoperative Bleeding during Removal of Fibrovascular Membrane.

PURPOSE: To demonstrate the advantages and efficacy of an air-perfused membrane dissection to control intraoperative bleeding in 23-gauge sutureless vitrectomy for proliferative diabetic retinopathy with severe fibrovascular membranes. Meterials and Methods: A prospective, consecutive, interventional case series of 15 eyes that underwent air-perfused diabetic vitrectomy (air vitrectomy group) for removal of the membranes was compared with a retrospective, membrane-matched case series of 10 eyes that underwent conventional diabetic vitrectomy (conventional vitrectomy group). The main outcome measures were real vitrectomy time, intraoperative and postoperative complications, and anatomic and functional successes at the final examination. RESULTS: The incidence of intraoperative retinal tears was 30% (3/10 eyes) in the conventional vitrectomy group and 20% (3/15 eyes) in the air vitrectomy group (p > 0.05). The postoperative complications such as vitreous hemorrhage or tractional retinal detachment were not common in both groups during the 6-month follow-up (p > 0.05). In addition, the final anatomic and functional success rates did not differ significantly between the groups (p > 0.05). However, the vitrectomy time was significantly shorter in the air vitrectomy group (67.0 ± 21.8 min) than in the conventional group (84.6 ± 21.1 min) (p = 0.04). CONCLUSION: Air-perfused vitrectomy showed comparable anatomic and functional success rates and shorter surgical time, compared with conventional vitrectomy in diabetic eyes with severe fibrovascular membranes. We suppose that the shortened surgical time in the air vitrectomy group is related to less intraoperative bleeding and more efficient hemostasis.