Intracellular Dynamics-Resolved Label-Free Scattering Reveals Real-Time Metabolism of Single Bacteria.

Nanoscopic investigation of bacterial cells is essential to reveal their physiological status, impacting all cellular functions. Currently, this requires labeled probes or targeted staining procedures. Herein, we report a new bacterial feature, intracellular dynamics-resolved Rayleigh scattering (IDRS), that visualizes spatiotemporal cytoplasmic transitions in unlabeled bacteria and characterizes their real-time physiological status in 10 s. From single-bacterium IDRS signals, we discovered unique spatial patterns and their multiple transitions in Gram-negative and Gram-positive bacteria. The magnitude of IDRS signal variation highly correlated with the metabolic status of bacteria, differentiating persistent subpopulations. This is also the first report demonstrating distinct real-time metabolic conditions of unlabeled drug-resistant bacteria that are exposed to different doses of antibiotics. Our strategy opens up a way to simultaneously trace in situ metabolic and antibiotic resistance statuses, which can be applied in single-cell level control of bacterial metabolism and efficacy with a heterogeneous nature.

The presence and prediction of lateralized inattention 7 years post-stroke.

OBJECTIVE: Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long-term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke. METHODS: From a cohort of acute ischemic stroke patients, aged 18-69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow-up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star- and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7-year follow-up was investigated with the Star- and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale. RESULTS: At the follow-up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P < .001) and inferior baseline performance on visual processing speed (P = .008). CONCLUSION: About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research.

Diagnostic accuracy of functional imaging modalities for chondrosarcoma: A systematic review and meta-analysis.

INTRODUCTION: The distinction between low-grade (grade 1) chondrosarcoma and its benign counterparts can be challenging. This systematic review aims to quantify the diagnostic accuracies of all functional imaging modalities used in the diagnosis of chondrosarcoma. METHODS: Medline and Embase were searched in February 2019. We included studies of either retrospective or prospective design if the results of functional scans were compared with pre-determined reference standards. Studies had to be primary diagnostic reports on patients with chondral tumours at first diagnosis. Two review authors independently performed study selection, extracted data and assessed the methodological quality. We calculated diagnostic accuracy measures for each included study. RESULTS: Four functional imaging modalities were identified across thirteen studies that met the inclusion criteria. 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) was a sensitive and specific test. Technetium-99 m with methylene diphosphonate (Tc-99 m MDP) had an overall low specificity of 4%. Thallium-201 scintigraphy demonstrated high positive predictive values across the studies. The negative predictive values of Technetium-99 m pentavalent dimercaptosuccinic acid (Tc-99 m DMSA (V)) were consistently 100%. CONCLUSIONS: Low-grade chondrosarcomas continue to pose a diagnostic dilemma. FDG-PET demonstrated superior diagnostic accuracy compared to Tc-99 m MDP, Thallium-201 and Tc-99 m DMSA (V). Characteristic uptake patterns of Thallium-201 and Tc-99 m DMSA (V) may provide additional metabolic information to guide the diagnosis in this challenging group of tumours.

Tropical tree cover in a heterogeneous environment: A reaction-diffusion model.

Observed bimodal tree cover distributions at particular environmental conditions and theoretical models indicate that some areas in the tropics can be in either of the alternative stable vegetation states forest or savanna. However, when including spatial interaction in nonspatial differential equation models of a bistable quantity, only the state with the lowest potential energy remains stable. Our recent reaction-diffusion model of Amazonian tree cover confirmed this and was able to reproduce the observed spatial distribution of forest versus savanna satisfactorily when forced by heterogeneous environmental and anthropogenic variables, even though bistability was underestimated. These conclusions were solely based on simulation results for one set of parameters. Here, we perform an analytical and numerical analysis of the model. We derive the Maxwell point (MP) of the homogeneous reaction-diffusion equation without savanna trees as a function of rainfall and human impact and show that the front between forest and nonforest settles at this point as long as savanna tree cover near the front remains sufficiently low. For parameters resulting in higher savanna tree cover near the front, we also find irregular forest-savanna cycles and woodland-savanna bistability, which can both explain the remaining observed bimodality.

Realization of a Valley Superlattice.

In a number of widely studied materials, such as Si, AlAs, Bi, graphene, MoS_{2}, and many transition metal dichalcogenide monolayers, electrons acquire an additional, spinlike degree of freedom at the degenerate conduction band minima, also known as "valleys." External symmetry-breaking fields such as mechanical strain, or electric or magnetic fields, can tune the valley polarization of these materials, making them suitable candidates for "valleytronics." Here we study a quantum well of AlAs, where the two-dimensional electrons reside in two energetically degenerate valleys. By fabricating a strain-inducing grating on the sample surface, we engineer a spatial modulation of the electron population in different valleys, i.e., a "valley superlattice" in the quantum well plane. Our results establish a novel manipulation technique of the valley degree of freedom, paving the way to realizing a valley-selective layered structure in multivalley materials, with potential application in valleytronics.

Hemosuccus Pancreaticus in the Simple Mucinous Cyst of the Pancreas.

Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a suspected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms.

Suggested new breakpoints of anti-MERS-CoV antibody ELISA titers: performance analysis of serologic tests.

To provide optimal cut-off values of anti-Middle East respiratory syndrome coronavirus (MERS-CoV) serologic tests, we evaluated performance of ELISA IgG, ELISA IgA, IFA IgM, and IFA IgG using 138 serum samples of 49 MERS-CoV-infected patients and 219 serum samples of 219 rRT-PCR-negative MERS-CoV-exposed healthcare personnel and patients. The performance analysis was conducted for two different purposes: (1) prediction of neutralization activity in MERS-CoV-infected patients, and (2) epidemiologic surveillance of MERS-CoV infections among MERS-CoV-exposed individuals. To evaluate performance according to serum collection time, we used 'days post onset of illness (dpoi)' and 'days post exposure (dpex)' assessing neutralization activity and infection diagnosis, respectively. Performance of serologic tests improved with delayed sampling time, being maximized after a seroconversion period. In predicting neutralization activity, ELISA IgG tests showed optimal performance using sera collected after 21 dpoi at cut-off values of OD ratio 0.4 (sensitivity 100% and specificity 100%), and ELISA IgA showed optimal performance using sera collected after 14 dpoi at cut-off value of OD ratio 0.2 (sensitivity 85.2% and specificity 100%). In diagnosis of MERS-CoV infection, ELISA IgG exhibited optimal performance using sera collected after 28 dpex, at a cut-off value of OD ratio 0.2 (sensitivity 97.3% and specificity 92.9%). These new breakpoints are markedly lower than previously suggested values (ELISA IgG OD ratio 1.1, sensitivity 34.8% and specificity 100% in the present data set), and the performance data help serologic tests to be practically used in the field of MERS management.

Commensurability Oscillations of Composite Fermions Induced by the Periodic Potential of a Wigner Crystal.

When the kinetic energy of a collection of interacting two-dimensional (2D) electrons is quenched at very high magnetic fields so that the Coulomb repulsion dominates, the electrons are expected to condense into an ordered array, forming a quantum Wigner crystal (WC). Although this exotic state has long been suspected in high-mobility 2D electron systems at very low Landau level fillings (ν≪1), its direct observation has been elusive. Here we present a new technique and experimental results directly probing the magnetic-field-induced WC. We measure the magnetoresistance of a bilayer electron system where one layer has a very low density and is in the WC regime (ν≪1), while the other ("probe") layer is near ν=1/2 and hosts a sea of composite fermions (CFs). The data exhibit commensurability oscillations in the magnetoresistance of the CF layer, induced by the periodic potential of WC electrons in the other layer, and provide a unique, direct glimpse at the symmetry of the WC, its lattice constant, and melting. They also demonstrate a striking example of how one can probe an exotic many-body state of 2D electrons using equally exotic quasiparticles of another many-body state.

Innovating healthcare delivery to address noncommunicable diseases in low-income settings: the example of hypertension.

London Dialogue event, The Hospital Club, 24 Endell St, London, WC2H 9HQ, London, UK, 1 December 2015 Hypertension is a global health issue causing almost 10 million deaths annually, with a disproportionate number occurring in low- and middle-income countries. The condition can be managed effectively, but there is a need for innovation in healthcare delivery to alleviate its burden. This paper presents a number of innovative delivery models from a number of different countries, including Kenya, Ghana, Barbados and India. These models were presented at the London Dialogue event, which was cohosted by the Novartis Foundation and the London School of Hygiene & Tropical Medicine Centre for Global Noncommunicable Diseases on 1 December 2015. It is argued that these models are applicable not only to hypertension, but provide valuable lessons to address other noncommunicable diseases.

Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey.

BACKGROUND: Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. METHODS: Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. RESULTS: Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). CONCLUSIONS: BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

Correlation of Primary Tumor FDG Uptake with Clinicopathologic Prognostic Factors in Invasive Ductal Carcinoma of the Breast.

PURPOSE: The purpose of this study was to investigate the correlation of primary tumor FDG uptake to clinicopathological prognostic factors in invasive ductal carcinoma of the breast. METHODS: We retrospectively reviewed 136 of 215 female patients with pathologically proven invasive ductal breast cancer from January 2008 to December 2011 who underwent F-18 FDG PET/CT for initial staging and follow-up after curative treatment with analysis of estrogen receptor (ER), progesterone receptor (PR) and human epithelial growth factor receptor 2 (HER2). The maximum standardized uptake value (SUVmax) of the primary breast tumor was measured and compared with hormonal receptor and HER2 overexpression status. RESULTS: The high SUVmax of primary breast tumors is significantly correlated with the clinicopathological factors: tumor size, histologic grade, TNM stage, negativity of ER, negativity of PR, HER2 overexpression and triple negativity. The recurrent group with non-triple negative cancer had a higher SUVmax compared with the non-recurrent group, though no significant difference in FDG uptake was noted between the recurrence and non-recurrent groups in subjects with triple-negative cancer. Lymph node involvement was the independent risk factor for cancer recurrence in the multivariate analysis. CONCLUSIONS: In conclusion, high FDG uptake in primary breast tumors is significantly correlated with clinicopathological factors, such as tumor size, histologic grade, TNM stage, negativity of the hormonal receptor, HER2 overexpression and triple negativity. Therefore, FDG PET/CT is a helpful prognostic tool to direct the further management of patients with breast cancer.

Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey

BACKGROUND: Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. METHODS: Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. RESULTS: Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). CONCLUSIONS: BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

Ipsilesional bias and processing speed are important predictors of functional dependency in the neglect phenomenon after a right hemisphere stroke.

Visuospatial neglect (VSN) predicts unfavorable functional outcome in stroke patients. This study examined the relative importance of different core symptoms of VSN as predictors of functional dependency. A consecutive series of 105 right hemisphere stroke patients were tested early after stroke on three basic symptoms of VSN (omissions, asymmetry of omissions and ipsilesional bias of attention) and on two symptoms related to VSN (processing speed and repetitive target detections in visual search). Neurological deficits were also assessed. Functional outcome was measured 3 months and 2 years after stroke with the modified Rankin Scale. Univariate analyses revealed significant relationships with functional outcome for both core and related symptoms of VSN and for neurological deficits. Area under the curve statistics and stepwise logistic regressions showed that the most important predictors assessed early after stroke were presence of ipsilesional bias for dependency at 3 months and visual processing speed for dependency at 2 years after stroke. These results show that valuable prognostic information regarding dependency after right hemisphere stroke can be obtained by assessing fundamental sub-components of VSN early after stroke. The development of standardized clinical methods for investigation of sub-components, such as a right capture of attention and processing speed, is essential.

High uric acid level associated with increased arterial stiffness in apparently healthy women.

OBJECTIVES: Increased serum uric acid level is regarded as a risk factor for cardiovascular disease, and found to be associated with increased arterial stiffness. While previous studies investigated the relationship between serum uric acid and arterial stiffness, most did not exclude the confounding factors, such as history or medications of hypertension, diabetes, dyslipidemia and hyperuricemia. The aim of this study was to explore the association of uric acid with arterial stiffness in an apparently healthy population. METHODS: This cross-sectional study enrolled 7025 participants during health examinations from October 2006 to August 2009. A total of 5150 apparently healthy subjects were enrolled in the final analysis. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). Uric acid was divided into quartiles in men (Q1: 59.5-333.1, Q2: 333.2-380.7, Q3: 380.8-428.3, Q4: 428.4-701.9 µmol/L) and women (Q1: 113.0-236.4, Q2: 236.5-273.6, Q3:273.7-315.2, Q4:315.3-585.0 µmol/L). RESULTS: Uric acid level was significantly different between women with and without increased arterial stiffness, but not in men. ANCOVA showed that women with Q3 and Q4 of serum uric acid had greater baPWV level. In multiple logistic regression analysis, Q4 (OR = 1.53, 95% CI = 1.04-2.26) of uric acid was positively associated with increased baPWV in women, but not in men. In addition, age and high blood pressure were also independently associated factors of increased arterial stiffness for both genders. CONCLUSION: In apparently healthy women, high-normal serum uric acid or greater was associated with greater risk of arterial stiffness. However, the relationship between hyperuricemia and increased arterial stiffness was not significant in men.

Mini-Mental Status Examination as predictors of mortality in the elderly.

OBJECTIVE: Because the number of elderly is increasing worldwide, cognitive dysfunction becomes important health care issue. This study investigated the association between cognitive dysfunction and mortality in the elderly. METHOD: Data were analyzed from a longitudinal mortality follow-up study of 2712 Korean elderly aged 60 and over, examined in 2002 with complete data followed an average 6.03 years. Measurements included socio-demographic and clinical factors and Mini-Mental State Examination (MMSE). MMSE was categorized into groups with no, mild, or moderate cognitive dysfunction, and the subscores of MMSE domains were categorized into no dysfunction or dysfunction. The Cox proportional hazards models were conducted to examine the association between MMSE score and mortality, after adjusting for age, gender, education and other socio-demographic factors. RESULTS: Death during follow-up occurred in 318 subjects. The mortality risk was significantly associated with the elderly with mild cognitive dysfunction [hazard ratio (HR) = 1.93] and with moderate cognitive dysfunction (HR = 2.66). 'Orientation-to-time' (HR = 1.39) and 'Attention' (HR = 1.48) domains of MMSE were independently associated with mortality. CONCLUSION: This study showed that cognitive dysfunction independently predicted mortality in the elderly. Cognitive dysfunction should be considered part of identifying the elderly at high risk for mortality.

Identification of chaperones in freeze tolerance in Saccharomyces cerevisiae.

Exposure to low temperatures reduces protein folding rates and induces the cold denaturation of proteins. Considering the roles played by chaperones in facilitating protein folding and preventing protein aggregation, chaperones must exist that confer tolerance to cold stress. Here, yeast strains lacking individual chaperones were screened for reduced freezing tolerance. In total, 19 of 82 chaperone-deleted strains tested were more sensitive to freeze-thaw treatment than wild-type cells. The reintroduction of the respective chaperone genes into the deletion mutants recovered the freeze tolerance. The freeze sensitivity of the chaperone-knockout strains was also retained in the presence of 20% glycerol.

Association of human adenovirus-36 in overweight Korean adults.

BACKGROUND: Although human adenovirus-36 (Ad-36) has been reported to be associated with obesity in US adults and children, Korean children and the Italian population, the association has not been found in Dutch or Belgian populations or in US military subjects. Therefore, we examined whether Ad-36 infection is associated with obesity in Korean adults. METHODS: A total of 540 age- and sex-matched individuals, who were normal weight, overweight or obese, were selected from participants in routine health examinations at the Ewha Womans University Medical Center. Overweight participants were defined as those with a body mass index (BMI) of 23 ≤ BMI<25 kg m(-2) and obese subjects were those with BMI ≥ 25 kg m(-2), according to the International Obesity Task Force definition. Ad-36 antibody was measured using a serum neutralization assay. RESULTS: Although more overweight participants than normal or obese subjects tested positive for the Ad-36 antibody (40%, 32.8% and 30%, respectively), the differences were not significant. The participants who tested positive for Ad-36 antibody had lower levels of triglycerides (TG) in each of the three groups, higher total cholesterol (TC) in the obese group and higher high-density lipoprotein-cholesterol (HDL-C) in both the normal and obese groups. The odds ratio (OR) for Ad-36 antibody positivity was greater in overweight than in normal subjects (OR=2.03; 95% confidence interval (CI), 1.16-3.55) after adjusting for age, sex and waist circumference. However, this OR was non-significant in the obese group (OR=1.56; 95% CI, 0.67-3.67). CONCLUSION: Ad-36 seems to be strongly associated with overweight, but not obese, Korean adults.

Overexpression of cold shock protein A of Psychromonas arctica KOPRI 22215 confers cold-resistance.

A polar bacterium was isolated from Arctic sea sediments and identified as Psychromonas artica, based on 16S rDNA sequence. Psychromonas artica KOPRI 22215 has an optimal growth temperature of 10 degrees C and a maximum growth temperature of 25 degrees C, suggesting this bacterium is a psychrophile. Cold shock proteins (Csps) are induced upon temperature downshift by more than 10 degrees C. Functional studies have researched mostly Csps of a mesophilic bacterium Escherichia coli, but not on those of psychrophilic bacteria. In an effort to understand the molecular mechanisms of psychrophilic bacteria that allow it withstand freezing environments, we cloned a gene encoding a cold shock protein from P. artica KOPRI 22215 (CspA(Pa)) using the conserved sequences in csp genes. The 204 bp-long ORF encoded a protein of 68 amino acids, sharing 56% homology to previously reported E. coli CspA protein. When CspA(Pa) was overexpressed in E. coli, it caused cell growth-retardation and morphological elongation. Interestingly, overexpression of CspA(Pa) drastically increased the host's cold-resistance by more than ten times, suggesting the protein aids survival in polar environments.

Association between human adenovirus-36 and lipid disorders in Korean schoolchildren.

BACKGROUND: Although the human adenovirus-36 (Ad-36) has been associated with obesity and related lipid disorders in the United States, this association has yet to be identified in other countries. Therefore, we tried to determine whether Ad-36 is associated with obesity or lipid disorders in Korean schoolchildren. METHOD: A total of 318 Korean schoolchildren aged 6-15 years, who participated in the Ewha Womans University Obesity Research Study, were selected for a community-based cohort study. Non-obese and obese were defined as body mass index (BMI) <85th and > or = 95th percentiles of the Korean reference BMI-for-age curves, respectively, according to International Obesity Task Force definitions. The cutoff points for lipid disorders were modified from the age-modified standards of the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP) III metabolic syndrome criteria. The Ad-36 antibody was measured using a serum neutralization assay. RESULTS: More obese participants than non-obese participants tested positive for the Ad-36 antibody (28.57 vs 13.56%, respectively; P = 0.0174). Within the obese group, the participants who tested positive for the Ad-36 antibody had higher levels of triglycerides (TG) and total cholesterol than those who tested negative for the Ad-36 antibody (P<0.001). However, these associations were not present in the non-obese group. The unadjusted odds ratio (OR) for Ad-36 antibody positivity was greater in obese participants than non-obese participants (OR = 2.550, 95% confidence interval (CI): 1.154-5.633). However, this OR seemed to be nonsignificant when age, sex and lipid variables were included in the analysis (OR = 1.752, 95% CI: 0.763-4.020). The unadjusted OR for the elevated TG was significantly higher in participants who were Ad-36 antibody-positive than those who were Ad-36 antibody-negative (OR = 2.511, 95% CI: 1.448-4.353). This trend remained constant even after adjustment for age, sex and obesity (OR = 2.328, 95% CI: 1.296-4.181). CONCLUSION: Ad-36 seems to be strongly associated with lipid disorders in Korean schoolchildren regardless of obesity.

Relationship between body mass index and alanine aminotransferase concentration in non-diabetic Korean adults.

BACKGROUND/OBJECTIVES: Obesity has been identified as an important factor of elevated alanine aminotransferase (ALT), a surrogate of non-alcoholic fatty liver disease. We investigated the relationship between obesity and elevated ALT in the general Korean population. SUBJECTS/METHODS: The study sample was comprised of 3098 Korean adults who had participated in the 2005 Korean National Health and Nutrition Examination Survey. Obesity was assessed using body mass index (BMI). Overweight (23< or =BMI<25) and obese (BMI> or =25) were defined by the International Obesity Task Force for Asian adults. ALT was measured by enzymatic methods. Elevated ALT was defined as an enzyme activity >40 IU/l for men and >31 IU/l for women. RESULTS: Among participants, 246 (12.7%) men and 86 (7.4%) women displayed elevated ALT. BMI was significantly higher in men and women with elevated ALT than those with normal ALT (P<0.0001). The unadjusted odds ratio (OR) for elevated ALT increased according to the degree of BMI in men (OR: 1.9, 95% confidence interval (CI): 1.25-2.93 in overweight vs OR: 5.01, 95% CI: 3.49-7.21 in obese; P<0.0001) and women (OR: 2.44, 95% CI: 1.24-4.82 vs OR: 3.94, 95% CI: 2.18-7.13; P<0.0001). This trend did not differ after adjustment for putative risk factors including alcohol intake in men (OR: 1.56 vs OR: 3.47, P<0.0001) and women (OR: 1.55 vs OR: 3.10, P=0.0015). CONCLUSION: BMI is implicated as a strong risk factor of elevated ALT in non-diabetic Korean adults.