Statin exposure and the risk of dementia in individuals with hypercholesterolaemia.

OBJECTIVES: This study aimed to examine the association between statin exposure and dementia risk in individuals with hypercholesterolaemia using data from the NHIS-HEALS database between 2002 and 2015. METHODS: Subjects were classified into statin exposure and statin nonexposure groups according to medication possession ratio. Dementia was defined as those with primary diagnostic dementia codes such as F00-F03, G30, G31.1, G31.9 or G31.82. Cox proportional hazards regression models were adopted after stepwise adjustment for confounders to investigate the prospective association between statin exposure and dementia risk. RESULTS: During the follow-up period (median follow-up 11.7 years), 711 cases of dementia occurred, accounting for 11.5% of the total study population (statin exposure group, 8.2%; statin nonexposure group, 12.9%). Compared to the statin nonexposure group, fully adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) for overall dementia in the statin exposure group were 0.63 (0.43-0.91) and 0.62 (0.50-0.78) in men and women, respectively. Compared to the statin nonexposure group, the HRs (95% CIs) for Alzheimer's disease and related dementia, vascular dementia and other types of dementia in the statin exposure group were 0.54 (0.32-0.91), 2.45 (0.69-8.68) and 0.59 (0.32-1.07), respectively, in men and 0.53 (0.38-0.73), 1.29 (0.42-3.96) and 0.70 (0.51-0.96), respectively, in women. CONCLUSIONS: Hypercholesterolaemic individuals exposed to statin had a lower risk of overall dementia and Alzheimer's disease and related dementia in both sexes, and a lower risk of other types of dementia in women, than subjects who were not exposed to statins.

Alitretinoin can be a good treatment option for idiopathic recalcitrant trachyonychia in adults: an open-label study.

BACKGROUND: Trachyonychia can be refractory to conventional treatments including topical, intralesional or systemic corticosteroids, as well as cyclosporine and retinoids. Therefore, new treatment options are needed for recalcitrant trachyonychia. OBJECTIVE: To evaluate the efficacy and safety of oral alitretinoin for idiopathic recalcitrant trachyonychia. METHODS: A total of 21 adult patients with 210 nails affected by idiopathic recalcitrant trachyonychia were evaluated in this open-label prospective study. All patients took 30 mg of alitretinoin daily for at least 3 months. Clinical outcomes were assessed using the Physician Global Assessment (PGA) scale proposed by Park et al. (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at baseline and 1, 3 and 6 months after treatment. RESULTS: After 1, 3 and 6 months of treatment, 74.3% (123/210), 98.1% (206/210) and 99.2% (119/120) of nails showed clinical improvement, respectively; 0% (0/210), 22.9% (48/210) and 69.2% (83/120) were completely free from nail abnormalities. The mean PGA score at baseline was 3.4, decreasing significantly to 2.7, 1.3 and 0.7 at 1, 3 and 6 months following treatment, respectively. LIMITATIONS: A small number of participants and lack of a control group were limitations. CONCLUSIONS: For the first time, this study evaluated the efficacy and safety of oral alitretinoin for idiopathic recalcitrant trachyonychia in adults. The results suggest that oral alitretinoin can be a good treatment option for adult patients with recalcitrant trachyonychia.

The importance of dermoscopy for the diagnosis of acquired bilateral telangiectatic macules: the angioid streak pattern reveals underlying chronic liver disease.

BACKGROUND: Acquired bilateral telangiectatic macules (ABTM) are a newly recognized disease entity, which manifest as multiple telangiectatic pigmented macules confined mostly to the upper arms. OBJECTIVES: To evaluate clinical and dermoscopic features in a group of 50 patients with ABTM and to determine the diagnostic usefulness of dermoscopy in ABTM. METHODS: Patients were selected from two tertiary teaching hospitals in Korea [Pusan National University Hospitals (Busan and Yangsan)]. Fifty patients (41 males and 9 females; mean age 48.1 years; range 26-78 years) with ABTM were included in the study. The dermoscopic findings were graded using a 4-point scale: none (0), mild (1), moderate (2) and severe (3). In addition, the results of 23 patients with and 27 patients without chronic liver disease (CLD) were compared to determine whether the presence of CLD affects dermoscopic findings. RESULTS: Three distinct dermoscopic patterns were observed; brown pigmentations, telangiectasia (linear-irregular vessels) and an angioid streak pattern. Brown pigmentation in the group without CLD had higher severity score than those in CLD group (mean score: 2.00 vs. 1.48, P = 0.033). However, mean telangiectasia severity score was higher in the CLD group (2.14 vs. 1.39, P < 0.001). The angioid streak pattern was more severe and more common in patients with CLD than in those without [1.37 vs. 0.35 (P < 0.001) and 63.0% vs. 26.1%, respectively]. CONCLUSIONS: Detailed observations with dermoscopy can provide first clues of the presence of ABTM and underlying chronic liver disease.

Association between methylenetetrahydrofolate reductase polymorphisms and the relapse of acute lymphoblastic leukemia: a meta-analysis.

Relapse is a threat in patients treated for acute lymphoblastic leukemia (ALL). Methylenetetrahydrofolate reductase (MTHFR) activity may affect the sensitivity of patients to folate-based chemotherapeutic drugs, thus influencing the relapse risk. Two polymorphisms of the gene encoding MTHFR, C677T and A1298C, alter MTHFR enzyme activity and may be associated with ALL relapse. The aim of this meta-analysis was to clarify the correlation between the C677T and A1298C polymorphisms and ALL relapse. To this end, data were collected from studies of the association between these two polymorphisms and ALL relapse. Analysis of the data revealed a serious contradiction among the results. A recessive model demonstrated that the ALL relapse risk was significantly increased in carriers of the 677 TT genotype, especially for pediatric ALL, but was unaffected by the A1298C polymorphism. These findings confirm that the MTHFR C677T polymorphism could be considered as a good marker of the pediatric ALL relapse risk.

An assessment of teicoplanin use and monitoring serum levels in a Chinese teaching hospital.

OBJECTIVE: To validate a high performance liquid chromatography (HPLC) method for serum teicoplanin measurement and use the method for clinical monitoring of teicoplanin levels to analyze the clinical application of teicoplanin. METHODS: 55 patient profiles were collected and analyzed for the clinical teicoplanin application. 10 critically ill patients of the 55 cases were monitored for teicoplanin trough concentration using the HPLC method. RESULTS: The modified HPLC method exhibited excellent linearity, with correlation coefficient r = 0.9995. The intra-day and inter-day coefficients of variation were less than 10%. The lower limit of detection of teicoplanin was 5.63 mg/l. The recovery of teicoplanin was above 90%. Of the 55 patients in this study, there were 42 patients without load-dosing. There were only 29 patients treated with teicoplanin documented Gram-positive infections by etiological diagnoses. In the 10 patients with teicoplanin serum trough concentration monitoring, all cases received a loading dose of 400 mg every 12 h for 3 doses, and the mean trough concentration of teicoplanin was 10.82 ± 4.51 mg/l. The mean trough levels were 13.04 ± 6.23 mg/l in 4 patients with microbiological eradication and improvement of symptoms of diseases and 9.34 ± 2.61 mg/l in 6 patients with persistence of previous clinical infectious symptoms, respectively. CONCLUSION: The modified HPLC method is robust, highly reproducible and suited to monitor the concentration of teicoplanin. In critically ill Chinese patients, we should consider more appropriate loading doses and evaluate the relationship between teicoplanin trough concentration and the efficacy using microbiological and clinical parameters.

Tacrolimus-induced apoptotic signal transduction pathway.

Tacrolimus (FK506) has been widely used as an immunosuppressant. We examined the effects of FK506 on expression of apoptotic signal transduction pathway proteins of Jurkat human T lymphocytes. We investigated the effects of FK506 on apoptosis, cell viability, caspase family protein activity, Western blotts of Bcl-2, Bak, Fas, Fas-L, CDK4, and cyclin D1, as well as reactive oxygen species (ROS) generation and mitochondrial membrane potential transition. Cells were cultured in the presence or absence of FK506. Flow cytometric analysis was performed after staining with propidium iodide. Viability of Jurkat cells was decreased by the addition of FK506 in dose- and time- dependent manner. FK506-induced cytotoxicity was characterized by G0/G1 phase cell cycle arrest. FK506-induced cell death was confirmed by apoptosis characterized by nuclear fragmentation and caspase-3 protease activation. FK506 induced no change in catalytic activity of caspase-6, -8, and -9 proteases. No change in expression of Bcl-2 protein was noted but we confirmed increased expression of Bak protein. No changes of expressions of Fas and Fas-L were seen. Increased expressions of CDK4 and cyclin D1 were identified. In addition, pharmacological scavenging study of ROS, including H2O2, revealed that cytotoxicity was achieved by generation of ROS, which might modulate Bak protein expression and mitochondrial dysfunction. In conclusion, FK506-induced cell death was apoptotic, characterized by nuclear fragmentation and caspase-3 activation. FK506 induced G0/G1 phase cell cycle arrest via expression of CDK4 and cyclin D1. Apoptosis was also achieved by generation of H2O2, which modulated Bak protein expression and mitochondrial dysfunction.

Rapamycin-induced cytotoxic signal transduction pathway.

We examined the effects of rapamycin on activation, proliferation, and expression of cytotoxic effector molecules in Molt-4 human T lymphocytes. We investigated the effects of rapamycin on cell viability, caspase family protein activities. Western blots of Bcl-2, Bak, p53, p21, p27, Rb, CDK2, and cyclin B1, as well as measurement of reactive oxygen species (ROS) generation and mitochondrial membrane potential transition. Cells were cultured in the presence or absence of rapamycin. Flow cytometric analysis was performed using propidium iodide stain. Viability of Molt-4 cells was decreased by the addition of rapamycin in dose- and time-dependent manners. Rapamycin induced no nuclear fragmentation in Molt-4 cells. Generation of H2O2 in rapamycin-treated Molt-4 cells increased in a time-dependent manner. There were no changes among catalytic activities of caspase proteases. And there was no evidence of expression of Bcl-2, p53, p21, p27, or Rb proteins. G2/M phase cell cycle arrest was identified by flow cytometry. We noted decreased expressions of CDK2 and cyclin B1. We also noted increased Bak protein expression and change in mitochondrial membrane potential transition. In conclusion, rapamycin-induced cytotoxicity was characterized by generation of ROS, which modulated Bak protein expression and mitochondrial dysfunction. G2/M phase cell cycle arrest was achieved by decreased expressions of CDK2 and cyclin B1.

Effect of a DanJeon Breathing Exercise Program on the quality of life in patients with kidney transplants.

This quasi-experimental study attempted to show that nursing intervention using the DanJeon Breathing Exercise Program (DJBEP) improved the quality of life of recipients after kidney transplantation. DJBEP progressed in three steps. We prospectively included 29 outpatient volunteers: experimental group: n = 15; control group: n = 14. DJBEP derived from the Roy's adaptation model decreased both the stress and the uncertainty of kidney transplantation recipients. It has also been shown to restore serum cholesterol and serum creatinine levels and enhance strength and flexibility. Simultaneously, self-esteem was enhanced, and eventually adaptation was promoted both physiologically and psychologically. The quality of life of kidney transplantation recipients was enhanced. DJBEP played an effective role as a nursing intervention to promote the quality of life of kidney transplant patients by increasing their physiological and psychological status.

A novel application of an anaerobic membrane process in wastewater treatment.

The applications of membrane processes in anaerobic biological wastewater treatment still have some limitations due to severe membrane scaling and fouling, although they have been proven to achieve superior COD removal and biomass retention. An innovative anaerobic membrane process for wastewater treatment was conducted to control the membrane scaling problems. The process comprises an anaerobic reactor, an aerobic reactor, and a membrane separation tank. Anaerobic sludge from a full-scale UASB reactor treating food wastewater was inoculated to anaerobic and aerobic reactor to purify synthetic wastewater consisting of glucose and sodium acetate. The anaerobic reactor was operated in a sludge bed type without three-phase separator. The aerobic reactor can eliminate residual organics from the anaerobic reactor effluent using facultative microorganisms. To provide solid-liquid separation, hollow fiber ultrafiltration module was submerged in the separation tank. The results clearly show that the anaerobic membrane process combined methanogenic and aerobic COD reduction is a stable system. No fatal scaling was found after two months of operation even without chemical cleaning for the membrane. It was also found that inorganic precipitates formed in the aerobic reactor were reduced due to CO2 stripping in aerobic reactor. Another important finding was that the inorganic precipitates were entrapped into facultative aerobes floc. The ash/SS ratio of aerobes floc increased from 0.17 to 0.55 after 50 days of operation, which confirms this phenomenon. Based on our investigation, the new process can control scaling effectively to extend the membrane application in anaerobic treatment.

Broadcasting health programmes among audience and professionals in Korea: perceptions and needs.

Mass media has become an essential part of modern society, and it should be noted that mass media plays an important role in delivering information even in the area of health. This study was intended to investigate the perceptions of and needs for broadcasting health programmes among audience and related professionals in Korea, which will serve to help in the development of valuable health programmes. Data were collected through a series of self-administered questionnaire surveys conducted on two types of subjects sampled from residents in the areas around Seoul, Korea, and health or broadcasting professionals working on health programmes. There were some discrepancies in the perceptions of and needs for health programmes between audience and professionals, especially the main audience age group and image, needs for topics and mode of health programme. In conclusion, in order to enhance current health programmes which focus on aspects of diagnosis and treatment of diseases, the range of health programmes should be expanded to fulfill various needs.

Young adult attachment styles and perceptions of elder abuse: a cross-cultural study.

In this cross-cultural study of young adults' judgments of the abusiveness and typicality of caregivers abusive behaviors toward an elderly person, data were collected from 100 Caucasian-American and 115 Korean college students. All participants completed Bartholomew's four-category measure of attachment styles as well as Mills' Elderly Caregiving Questionnaire. The Korean college students judged material and physical maltreatment of an elderly person as significantly less abusive and psychological maltreatment as significantly more abusive than the Caucasian American students did. There were no gender differences in judgments of either the abusiveness or the typicality of the various forms of elder maltreatment. Multiple regression analyses revealed that both culture and insecure attachment contributed significantly to judgments of the abusiveness and typicality of aggressive and neglectful behaviors committed by a caretaker against an elderly person.