Effects of Tumor Necrosis Factor-alpha Inhibitors on the Incidence of Tuberculosis

OBJECTIVE: Tumor necrosis factor-alpha (TNF-alpha) inhibitors are used as a treatment in various immune-mediated inflammatory diseases (IMIDs). Tuberculosis (TB) risk is reported in several meta-analyses in patients treated with TNF-alpha inhibitors. The purpose of this study is to collect, review, and evaluate the TB risk in TNF-alpha inhibitors according to IMIDs indications and between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors. METHODS: A systematic literature search on systematic reviews and meta-analyses was performed in PubMed, MEDLINE, Cochrane library, and EMBASE. We identified meta-analyses that evaluated TB infection risk of TNF-alpha inhibitors in IMIDs patients. RESULTS: Thirteen meta-analyses including 41 study results were included in this umbrella review. IMIDs patients treated with TNF-alpha inhibitors had an increased risk of TB than control group (placebo with or without standard therapy patients) (relative risk ratio (RR) 2.057, 95% confidence interval (CI) 1.697 to 2.495). Among them, RA patients with TNF-alpha inhibitors had a higher risk of TB than control group (RR 1.847, 95% CI 1.385 to 2.464), and non-RA patients with TNF-alpha inhibitors had an increased risk of TB (RR 2.236, 95% CI 1.284 to 3.894). In subgroup analysis on TB risk between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors in RA patients, the analysis indicated that monoclonal-antibody TNF-alpha inhibitors had higher risk of TB than solublereceptor TNF-alpha inhibitor (RR 2.880, 95% CI 1.730 to 4.792). CONCLUSION: This umbrella review confirms that the risk of TB is significantly increased in TNF-alpha inhibitor treated patients compared to control group.

Do Patients Want to Listen to a Diagnosis of Dementia in Korea? Preferences on Disclosing a Diagnosis of Dementia and Discussing Advance Care Planning in Elderly Patients with Memory Concerns and Their Families

OBJECTIVE: In this study, we aimed to investigate preferences regarding the disclosure of a dementia diagnosis and advance care planning (ACP) in patients with memory complaints and their families. METHODS: A total of 98 patients who visited the department of psychiatry at a tertiary hospital with memory complaints and 62 family members completed a structured questionnaire. The questionnaire included preferences on disclosure of dementia and cancer diagnosis, awareness and preferences on ACP. RESULTS: In total, 96.9% of patients were willing to know their dementia diagnosis. There were no significant differences in preferences between the diagnosis of cancer and dementia. Only 24.7% of patients and 45.8% of family members have heard of ACP. However, 82.8% of patients agreed on the necessity of ACP under the current condition. Multivariate analysis revealed that younger patients were more likely to agree with necessity for ACP under the current condition. CONCLUSION: In Korea, patients with memory complaints and their family members strongly favored a disclosure of dementia diagnosis. The majority of participants also agreed on the necessity of ACP. More active involvement of patients is needed in treatment decisions and care planning in cases of dementia as well as other life-threatening illnesses.

Distinct Clinical Characteristics Depending on Cerebral Amyloid Positivity in Patients with Alzheimer Disease Dementia

OBJECTIVE: The present study investigated the clinical characteristics of Alzheimer's disease (AD) dementia with low brain amyloid-beta (Aβ-AD) burden comparing with AD dementia with high amyloid-beta burden (Aβ+AD). We also developed a prediction model for the amyloid positivity on ¹¹C-labelled Pittsburgh Compound B (PiB) positron emission tomography (PET) with distinct clinical variables in AD dementia patients. METHODS: Fifty-nine clinically defined AD dementia individuals, who participated in the Korean Brain Aging Study for Early diagnosis and prediction of AD (KBASE) study, were included. All the subjects received comprehensive clinical evaluations and PiB-PET. Based on cerebral PiB retention, all subjects were divided into Aβ+AD (n=47) and Aβ-AD (n=12) subgroups. To develop a prediction model for amyloid positivity, stepwise multiple logistic regression analysis was conducted. RESULTS: When compared to Aβ+AD, Aβ-AD showed older age, later age-at-onset, and lower education. In regard of risk factors for dementia, Aβ-AD had higher frequency of hypertension and diabetes mellitus as well as lower frequency of apolipoprotein E (APOE) ε4 allele. Although there was no between group difference in Clinical Dementia Rating (CDR) or CDR sum-of-boxes scores, mini-mental state examination and constructional recall scores were higher for Aβ-AD than Aβ+AD. The final amyloid positivity prediction model included APOE4 genotype, hypertension, and diabetes mellitus. CONCLUSION: The findings from this study indicated that clinically diagnosed AD dementia may have high possibility of not being pathological AD if they have older age and higher vascular risks, and did not have APOE4 genotype.

Predictors of PTSD among North Korean Defectors Visited Psychiatric Department of North Korean Defectors Treatment Center / 신경정신의학

OBJECTIVES: This study was conducted to evaluate post-traumatic stress disorder (PTSD), the quality of life and social adjustment of North Korean refugees who consulted psychiatric clinics. METHODS: A total of 66 North Korean refugees who consulted a psychiatric clinic were included in the analysis. A psychiatrist conducted interviews with the subjects, and PTSD was diagnosed using the clinician-administered PTSD Scale. The quality of life of the subjects was evaluated using the World Health Organization Quality of Life Scale. RESULTS: Thirty five (53%) were diagnosed with PTSD. Quality of life was found to show association with understanding the language in South Korea, difficulty interacting with South Koreans, and experience or feeling of neglect. Quality of life of the PTSD group was lower than in the Non-PTSD group. Difficulty adapting to South Korean society was also higher in the PTSD group. Experience or feeling of neglect was negatively correlated with the quality of life in the PTSD group. CONCLUSION: The results of this study may be helpful in providing a specific direction for psychiatric intervention strategies to improve overall quality of life and adaptation to life in South Korea.

Molecular Imaging for Theranostics in Gastroenterology: One Stone to Kill Two Birds

Molecular imaging in gastroenterology has become more feasible with recent advances in imaging technology, molecular genetics, and next-generation biochemistry, in addition to advances in endoscopic imaging techniques including magnified high-resolution endoscopy, narrow band imaging or autofluorescence imaging, flexible spectral imaging color enhancement, and confocal laser endomicroscopy. These developments have the potential to serve as "red flag" techniques enabling the earlier and accurate detection of mucosal abnormalities (such as precancerous lesions) beyond biomarkers, virtual histology of detected lesions, and molecular targeted therapy-the strategy of "one stone to kill two or three birds"; however, more effort should be done to be "blue ocean" benefit. This review deals with the introduction of Raman spectroscopy endoscopy, imaging mass spectroscopy, and nanomolecule development for theranostics. Imaging of molecular pathological changes in cells/tissues/organs might open the "royal road" to either convincing diagnosis of diseases that otherwise would only be detected in the advanced stages or novel therapeutic methods targeted to personalized medicine.

Recent Advances in Molecular Imaging of Premalignant Gastrointestinal Lesions and Future Application for Early Detection of Barrett Esophagus

Recent advances in optical molecular imaging allow identification of morphologic and biochemical changes in tissues associated with gastrointestinal (GI) premalignant lesions earlier and in real-time. This focused review series introduces high-resolution imaging modalities that are being evaluated preclinically and clinically for the detection of early GI cancers, especially Barrett esophagus and esophageal adenocarcinoma. Although narrow band imaging, autofluorescence imaging, and chromoendoscopy are currently applied for this purpose in the clinic, further adoptions of probe-based confocal laser endomicroscopy, high-resolution microendoscopy, optical coherence tomography, and metabolomic imaging, as well as imaging mass spectrometry, will lead to detection at the earliest and will guide predictions of the clinical course in the near future in a manner that is beyond current advancements in optical imaging. In this review article, the readers will be introduced to sufficient information regarding this matter with which to enjoy this new era of high technology and to confront science in the field of molecular medical imaging.

Application of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Imaging Mass Spectrometry (MALDI-TOF IMS) for Premalignant Gastrointestinal Lesions

Imaging mass spectrometry (IMS) is currently receiving large attention from the mass spectrometric community, although its use is not yet well known in the clinic. As matrix-assisted laser desorption/ionization time-of-flight (MALDI)-IMS can show the biomolecular changes in cells as well as tissues, it can be an ideal tool for biomedical diagnostics as well as the molecular diagnosis of clinical specimens, especially aimed at the prompt detection of premalignant lesions much earlier before overt mass formation, or for obtaining histologic clues from endoscopic biopsy. Besides its use for pathologic diagnosis, MALDI-IMS is also a powerful tool for the detection and localization of drugs, proteins, and lipids in tissue. Measurement of parameters that define and control the implications, challenges, and opportunities associated with the application of IMS to biomedical tissue studies might be feasible through a deep understanding of mass spectrometry. In this focused review series, new insights into the molecular processes relevant to IMS as well as other field applications are introduced.

Pharmacokinetics of tacrolimus according to body composition in recipients of kidney transplants

BACKGROUND: Currently, the dosage of tacrolimus used after transplantation is based on the patient's body weight. However, there is a low correlation between body weight and body composition in kidney transplant recipients. In this study, we evaluate the pharmacokinetics of tacrolimus according to body composition in 18 Korean kidney transplant recipients with stable graft function. METHODS: Body composition parameters were calculated using bioelectrical impedance analysis. Pharmacokinetic profiles were determined 0, 1, 2, 3, and 4 hours after treatment with tacrolimus and were compared between high- and low-level median body composition groups. The values of C0, C1, C2, C3, and C4 were used in determining an abbreviated area under the curve (AUC) for tacrolimus. RESULTS: The mean body mass index (BMI) and body composition values were as follows: BMI, 24.3 kg/m2; lean mass, 49.8 kg; and fat mass, 17.4 kg. There were no statistical differences in pharmacokinetic profiles between groups with different BMIs. However, the C0 and C4 in the high-fat group were significantly elevated compared with those of the low-fat group (P=0.024 and 0.031, respectively). Furthermore, the C0, C2, C3, and C4 and the AUC were significantly different between the two lean mass groups (P=0.007, 0.038, 0.047, 0.015, and 0.015, respectively). Other variables, such as waist circumference and arm muscle circumference, did not differentiate between the pharmacokinetic profiles of tacrolimus. CONCLUSION: Taken together, these data suggest that tacrolimus dose monitoring based on body composition may provide adequate dosage leading to favorable long-term outcomes.

Perception of a Good Death in the Elderly

BACKGROUND: Family doctors are usually point of contact when the elderly think their death is imminent. To properly treat their disease and to provide good care of them and their families, family doctors must know the elderly's perception of a good death and dying. The purpose of this study was to investigate the components of a good death from the elderly. METHODS: We composed 9 questions focusing on good death and dying. A family medicine resident interviewed 35 people ages sixty five or over in Cheonan Welfare Center. The contents were recorded into audiotapes, and then translated and analyzed by quantitative method and coding technique. RESULTS: Among the total 35 respondents, many elders answered that they had thought about death and that the meaning of a death was the end of life, or transition from one world to another in religious belief. In their dying, they hoped that they would be with their offspring or spouse and that they would be in their home or hospital. Old people identified 8 major components of a good death: proper age, death without disease, death before death of their offspring and spouse, dying when whole family get together, death after seeing their family happy, death during sleep, and death without pain. They pointed out that the most meaningful event in their lives were related to their family, occupation and society. CONCLUSION: The elderly identified a good death in view of family as well as personal conditions such as proper age, a death without pain or disease. And most elderly pointed out that meaningful events in their lives were related to their family, occupation and society.

Factors associated with success of smoking cessation at smoking-cessation clinic

BACKGROUND: In spite of harmfulness of smoking, the rate of adult man's smoking is high in Korea and that of young people and women has risen recently. Although the number of hospitals operating smoking-cessation clinic has risen year by year, there is little research on smoking cessation. In this study, we tried to find the factors associated with successful smoking cessation and have attempted to contribute to developing effective smoking cessation strategy and help to continue cessation state. METHOD: Three hundred smokers, who had visited the Dankook Univ. Hospital from May 1999 to December 1999, were consulted. After doing a survey with a basic questionnaire and smoking cessation consultation, we asked them to revisit on the date of appointment with continued use of nicotine patch as much possible. Six months later, we selected 272 people and analyzed the factors of difference between the two groups ; one is the successful group and the other is the failure group. RESULT: The success group included 77 people (28.3%), and the failure group 195 people (71.7%). In view of demographic profiles such as age, sex, marital status, education, and job, there was no significant difference between the two groups. In view of smoking pattern and factors that can influence them such as age of starting to smoke, duration of smoking, motive of smoking, reason of failure to stop smoking, reason of trying to stop smoking, the presence of smoking family number, confidence in smoking cessation, dependence on nicotine and the number of alcohol drinking, there was no significant difference between the two groups. In the results of univariate analysis, daily mean smoking amount, the presence of smoking-associated disease, expiratory CO level at initial visit to hospital, period of using nicotine patch and total times of visiting clinic were significant difference between the two groups. Therefore, the total number of visits to the clinic was the only significant factor according to multivariate analysis. CONCLUSION: The results of multivariate analysis has shown that the factor that is most associated with success of smoking cessation is the total number of visits to smoking-cessation clinic. This means that the more people who smoke consult with doctor and the longer the period of utilizing the smoking-cessation clinic is, the more successful they in smoking cessation.