RESUMO
BACKGROUND: This study investigated the association of prenatal and early childhood exposure to air pollution with epigenetic age acceleration (EAA) at six years of age using the Environment and Development of Children Cohort (EDC Cohort) MATERIALS & METHODS: Air pollution, including particulate matter [< 2.5⯵m (PM2.5) and < 10⯵m (PM10) in an aerodynamic diameter], nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) were estimated based on the residential address for two periods: 1) during the whole pregnancy, and 2) for one year before the follow-up in children at six years of age. The methylation levels in whole blood at six years of age were measured, and the methylation clocks, including Horvath's clock, Horvath's skin and blood clock, PedBE, and Wu's clock, were estimated. Multivariate linear regression models were constructed to analyze the association between EAA and air pollutants. RESULTS: A total of 76 children in EDC cohort were enrolled in this study. During the whole pregnancy, interquartile range (IQR) increases in exposure to PM2.5 (4.56⯵g/m3) and CO (0.156â¯ppm) were associated with 0.406 years and 0.799 years of EAA (Horvath's clock), respectively. An IQR increase in PM2.5 (4.76⯵g/m3) for one year before the child was six years of age was associated with 0.509 years of EAA (Horvath's clock) and 0.289 years of EAA (Wu's clock). PM10 (4.30⯵g/m3) and O3 (0.003â¯ppm) exposure in the period were also associated with EAA in Horvath's clock (0.280 years) and EAA in Horvath's skin and blood clock (0.163 years), respectively. CONCLUSION: We found that prenatal and childhood exposure to ambient air pollutants is associated with EAA among children. The results suggest that air pollution could induce excess biological aging even in prenatal and early life.
RESUMO
Carbapenem-resistant Escherichia coli (CREC) is a global threat to public health; therefore, alternative treatment options are urgently needed. Bacteriophages have emerged as promising candidates for combating CREC infections. This study aimed to investigate the genetic basis of phage sensitivity in CREC by evaluating carbapenem resistance among multidrug-resistant (MDR) E. coli isolated in Daegu, South Korea and analyzing their sequence types (STs) with phage susceptibility spectra. Among the 60 MDR E. coli isolates, 80.4% were identified as CREC, with 77.0% demonstrating resistance to imipenem and 66.6% to meropenem. Moreover, 70 lytic E. coli bacteriophages were isolated from hospital sewage water and evaluated against those 60 E. coli isolates. The phages exhibited lytic activity of 33%-60%, with average titers ranging from 5.6 × 1012 to 2.4 × 1013 PFU/mL (Plaque-Forming Unit). Furthermore, multilocus sequence typing (MLST) analysis of the bacterial isolates revealed 14 distinct STs, mostly belonging to ST131, ST410, and ST648. Notably, the phage susceptibility spectra of ST73, ST13003, ST648, ST2311, ST167, ST405, ST607, ST7962, and ST131 were significantly different. Thus, the isolated phages can effectively lyse CREC isolates, particularly those with clinically dominant STs. Conversely, ST410 exhibited a 14.2%-87.14% susceptibility spectrum, whereas ST1139, ST1487, ST10, and ST206 did not lyse, suggesting the presence of more resistant STs. Future studies are warranted to identify the reasons behind this resistance and address it. Ultimately, this study will aid in developing focused treatments to address these pressing global health issues.
RESUMO
High mobility group box 1 (HMGB1), a protein with important functions, has been recognized as a potential therapeutic target for the treatment of sepsis. One possible mechanism for this is that inhibiting HMGB1 secretion can exert antiseptic effects, which can restore the integrity of the vascular barrier. (7S)-(+)-cyclopentyl carbamic acid 8,8-dimethyl-2-oxo-6,7-dihydro-2H,8H-pyrano[3,2-g]chromen-7-yl-ester (CGK012) is a newly synthesized pyranocoumarin compound that could function as a novel small-molecule inhibitor of the Wnt/ß-catenin signaling pathway. However, no studies have yet determined the effects of CGK012 on sepsis. We investigated the potential of CGK012 to attenuate the excessive permeability induced by HMGB1 and enhance survival rates in a mouse model of sepsis with reduced HMGB1 levels following lipopolysaccharide (LPS) treatment. In both LPS-stimulated human endothelial cells and a mouse model exhibiting septic symptoms due to cecal ligation and puncture (CLP), we assessed proinflammatory protein levels and tissue damage biomarkers as indicators of reduced vascular permeability. CGK012 was applied after induction in human endothelial cells exposed to LPS and the CLP-induced mouse model of sepsis. CGK012 effectively mitigated excessive permeability and suppressed HMGB1 release, resulting in improved vascular stability, decreased mortality, and enhanced histological conditions in the mouse model of CLP-induced sepsis. In conclusion, our findings indicate that CGK012 treatment in mice with CLP-induced sepsis diminished HMGB1 release and increased the survival rate, suggesting its potential as a pharmaceutical intervention for sepsis.
Assuntos
Anti-Infecciosos Locais , Carbamatos , Cumarínicos , Proteína HMGB1 , Sepse , Animais , Humanos , Camundongos , Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos Locais/uso terapêutico , Modelos Animais de Doenças , Proteína HMGB1/metabolismo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Lipopolissacarídeos/farmacologia , Camundongos Endogâmicos C57BL , Sepse/metabolismoRESUMO
BACKGROUND: Mohs micrographic surgery, involving pathology of the surgical margin, has the lowest recurrence rate for skin cancer. Moreover, because of technological advances, digital pathology systems are gradually being adopted in hospitals. Yongin Severance Hospital was the first hospital to construct a fully digitalized pathology system in Korea. OBJECTIVE: To evaluate the efficiency and characteristics of the digital pathology system for Mohs micrographic surgery. METHODS: The medical records of 80 patients with skin cancer who underwent Mohs micrographic surgery from March 2020 to August 2022 were analyzed for the number of frozen margins, number of stages, operation time, and recurrence rate to compare cases based on the pathology system. RESULTS: Overall, 23 and 57 patients were examined using the conventional and digital pathology systems, respectively. The mean number of final stages was 0.494 lower ( p -value = .008), the time from the previous to the next stage was 0.687-fold shorter ( p = .002), and the rate of switching from positive to negative margins was 1.990 times higher ( p = .044) in the digital than the conventional group. LIMITATIONS: Retrospective single-center experience; short follow-up time. CONCLUSION: Digital pathology reduces operative time and increases accuracy in Mohs micrographic surgery.
Assuntos
Cirurgia de Mohs , Neoplasias Cutâneas , Humanos , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Margens de ExcisãoRESUMO
BACKGROUND: The association between size of ganglia or type of ganglia (intra-articular or extra-articular) and meniscal tears or severity of the osteoarthritis (OA) is not evaluated. PURPOSE: To evaluate the prevalence, size, and location of intra- and extra-capsular ganglia at the gastrocnemius origin and to assess their associations with meniscal injury and grades of OA. MATERIAL AND METHODS: This study included 301 consecutive patients who had knee pain and had undergone magnetic resonance imaging (MRI) of the knee. We evaluated presence of ganglia at the gastrocnemius muscle origin site and diagnosed whether it was an intra-capsular located or mixed-capsular located (intra-capsular and extra-capsular) and then measured the diameter of each ganglion. After two weeks, we evaluated whether articular cartilage injury existed. The presence of a meniscal tear was also recorded. RESULTS: A total of 186 patients (93%) had intra- and extra-capsular ganglia. Intra-capsular ganglia were found in 183 cases (91%) and mixed-capsular ganglia were found in 16 cases (8%). In cases with intra- and extra-capsular ganglia, more meniscal tears were found (P = 0.029). Intra-capsular ganglia showed more meniscal tears (P = 0.021). Intra-capsular ganglia were more likely to have high-grade OA (P = 0.043). Patients who had a meniscal tear displayed larger-sized ganglia, especially of the intra-capsular type (P = 0.044). CONCLUSION: Patients with intra- and extra-capsular ganglia, especially of the intra-capsular type, are more likely to have meniscal injury and more severe OA. Patients with a meniscal tear or OA are more likely to have larger intra- and extra-capsular ganglia, especially of the intra-capsular type.
Assuntos
Doenças das Cartilagens , Traumatismos do Joelho , Osteoartrite do Joelho , Humanos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/complicações , Meniscos Tibiais , Articulação do Joelho , Gânglios , Músculo Esquelético/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodosRESUMO
PURPOSE: We quantified the familial risk of renal cell cancer (RCC) among first-degree relatives (FDRs) on a population level, and examined interactions between family history and body mass index or blood glucose. MATERIALS AND METHODS: Using the National Health Insurance database, which covers the entire Korean population, and the National Health Screening Program, we constructed a cohort of 5,524,403 individuals with blood-related FDRs and their lifestyle factors from 2002 to 2018. We calculated familial risk using incidence risk ratios (IRRs) with 95% confidence intervals, which compares the risk of individuals with and without FDR. The combined effect and interaction of a given risk factor and family history of RCC were measured by the relative excess risk due to interaction. RESULTS: Individuals with affected FDRs showed a 2.29-fold (95% CI 1.68-3.13) increased risk of disease. Familial risk adjusted for lifestyle factors showed minimal attenuation (IRR 2.25; 95% CI: 1.65-3.08), suggesting that genetic predisposition is the main contributor in the familial aggregation of RCC. Individuals with both a positive family history and overweight/obesity (IRR 3.71, 95% CI 2.50-4.92) or hyperglycemia (IRR 4.52, 95% CI 2.59-6.45) had a significantly higher risk that exceeded the sum of their individual risks, suggesting an interaction that was statistically significant (relative excess risk due to interaction 95% CI: 0.91, -0.21-2.12; 2.21, 0.28-4.14). CONCLUSIONS: Our findings suggest an interaction between genetic and environmental factors, namely obesity and hyperglycemia. Individuals with both factors should be considered a high-risk group and advised to undergo genetic counseling.
Assuntos
Carcinoma de Células Renais , Hiperglicemia , Neoplasias Renais , Carcinoma de Células Renais/etiologia , Carcinoma de Células Renais/genética , Família , Predisposição Genética para Doença , Humanos , Hiperglicemia/epidemiologia , Neoplasias Renais/etiologia , Neoplasias Renais/genética , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/genética , Fatores de RiscoRESUMO
OBJECTIVES: Attention-deficit hyperactivity disorder (ADHD) is a prevalent neurobehavioral disorder in children. There are limited studies for diet or dietary supplement effects on ADHD in preschool children in Asia. This study aimed to determine the association between dietary patterns in 4-year-old children and ADHD symptoms in 6-year-old children. METHODS: We estimated dietary intake in 4-year-old children using a food frequency questionnaire. Using 33 food groups, major dietary patterns were identified in relation to the consumption of sweets, vegetables, meats, and carbohydrates. Parents of 6-year-old children used the Korean version of the ADHD Rating Scale for ADHD symptom assessment. RESULTS: A sweet dietary pattern was associated with a higher risk of attention deficit (AD) (relative risk [RR], 1.34; confidence interval [CI], 1.17-1.55), hyperactivity (RR, 1.40; CI, 1.19-1.64), and ADHD symptoms (RR, 1.37; CI, 1.23-1.52). A vegetable dietary pattern was associated with a lower risk of ADHD symptoms (RR, 0.81; CI, 0.72-0.90). Food item analysis of the sweet dietary pattern showed that intake scores for chocolate, chips, and fruit jams positively correlated with AD, hyperactivity, and ADHD symptoms. DISCUSSION: These findings can be useful to further understand the roles of dietary factors in ADHD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Pré-Escolar , Dieta , Humanos , Estudos Prospectivos , República da Coreia/epidemiologia , VerdurasRESUMO
BACKGROUND: Sufficient sleep during childhood is important for cognitive functions such as learning and successful school performance. This study aimed to investigate the effects of sleep duration on the intelligence quotient (IQ) of 6-year-old children and aimed to analyze whether these effects differed by sex. METHODS: The IQ of 538 6-year-old Korean participants from the cohort study, "The Environment and Development of Children," was measured during follow-up using the Korean Educational Developmental Institute's Wechsler Intelligence Scale for Children. The total, verbal, and performance IQ scores were evaluated. The relationship between sleep duration and IQ scores after adjusting for maternal age, maternal educational level, maternal occupation, maternal IQ, exposure to secondhand smoking, gestational age, and monthly age and birth season was also assessed. RESULTS: Longer sleep duration was significantly associated with improved verbal IQ measures (ß 0.55; p value 0.030). After stratifying participants by sex, a significant association was observed between sleep duration and total, verbal, and performance IQ scores in boys (total IQ 2.49, p value 0.012; verbal IQ 0.75, p value: 0.037; performance IQ 0.73, p value 0.048), but not in girls. CONCLUSIONS: The results indicated that only boys show a significant association between IQ scores and sleep duration. These findings support the hypothesis that sleep duration is associated with IQ, in a sex dependent manner. Future studies are needed for a thorough evaluation of the connection between sleep duration and health outcome in young children.
Assuntos
Inteligência , Sono , Criança , Pré-Escolar , Estudos de Coortes , Escolaridade , Feminino , Humanos , Testes de Inteligência , MasculinoRESUMO
BACKGROUND: There have been no reports on the relationship between wedging of vertebral bodies at the thoracolumbar spine and disc herniation in healthy individuals on magnetic resonance imaging (MRI). PURPOSE: To investigate the degree of wedging of vertebral bodies at the thoracolumbar spine in healthy individuals who underwent whole-body (WB) MRI. We also assessed the correlation between wedging and adjacent disc pathology. MATERIAL AND METHODS: This retrospective study comprised 200 healthy patients who underwent WB MRI as part of a regular health check from January 2019 to February 2019. We measured anterior and posterior vertical heights of each vertebral body between T10 and L2. The ratio of anterior height to posterior height (APR) was calculated, and we evaluated disc degeneration or disc herniation using WB MRI. RESULTS: The APR of T10 was significantly higher than at the other levels (P < 0.05), and the APR of L1 was significantly lower (P < 0.05). Men had a significantly smaller APR than women at T12 to L2 (P < 0.05). Regarding the relationship between APR and disc degeneration, the group without disc degeneration had a higher APR, with statistical significance at T12, L1, and L2. Regarding the relationship between APR and disc herniation, the group without disc herniation had a higher APR, with statistical significance at T11, T12, L1, and L2. CONCLUSION: Wedging of vertebral bodies is most prominent at L1. Although the values were statistically significant only at some levels, the patients with disc degeneration or herniation had more prominent wedge deformity of thoracolumbar spine.
Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Corpo VertebralRESUMO
BACKGROUND: Increased body mass index (BMI) has been associated with a higher risk of severe coronavirus disease 2019 (COVID-19) infections. However, whether obesity is a risk factor for contracting COVID-19 has hardly been investigated so far. METHODS: We examined the association between BMI level and the risk of COVID-19 infection in a nationwide case-control study comprised of 3788 case patients confirmed to have COVID-19 between 24 January and 9 April 2020 and 15 152 controls matched by age and sex, who were aged 20 years or more and underwent National Health Insurance Service (NHIS) health examinations between 2015-2017, using data from the Korean NHIS with linkage to the Korea Centers for Disease Control and Prevention data. Our primary exposure of interest was BMI level, categorized into 4 groups: <18.5 (underweight), 18.5-22.9 (normal weight), 23-24.9 (overweight), and ≥25 kg/m2 (obese). RESULTS: Of the entire 18 940 study participants, 11 755 (62.1%) were women, and the mean age of the study participants was 53.7 years (standard deviation, 13.8). In multivariable logistic regression models adjusted for sociodemographic, comorbidity, laboratory, and medication data, there was a graded association between higher BMI levels and higher risk of COVID-19 infection. Compared to normal-weight individuals, the adjusted odds ratios in the overweight and obese individuals were 1.13 (95% confidence interval [CI], 1.03-1.25) and 1.26 (95% CI, 1.15-1.39), respectively. This association was robust across age and sex subgroups. CONCLUSIONS: Higher BMI levels were associated with a higher risk of contracting COVID-19.
Assuntos
COVID-19 , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco , SARS-CoV-2 , Adulto JovemRESUMO
INTRODUCTION: It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection. METHODS: A matched case-control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status. RESULTS: A total of 4167 patients with SARS-CoV-2 infection and 20 937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50-0.62). When ex-smokers and current smokers were analyzed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28-0.38; ex-smoker OR = 0.81, CI = 0.72-0.91). CONCLUSIONS: This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution. IMPLICATIONS: It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.
Assuntos
COVID-19 , SARS-CoV-2 , Fumar , COVID-19/epidemiologia , Estudos de Casos e Controles , Humanos , Coreia (Geográfico)/epidemiologia , Modelos Logísticos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologiaRESUMO
MEF2D (myocyte enhancer factor 2D)-rearranged acute lymphoblastic leukemia (ALL) has recently been documented by transcriptome sequencing in B-cell precursor ALL. It is associated with older age of onset (median: 14 y), and characterized by very early relapse and poorer outcomes than other B-cell precursor ALL groups. According to report by Suzuki and colleagues, all 4 cases of MEF2D-BCL9-fusion ALL among 59 children with relapsed or primary refractory ALL had leukemic blasts morphologically mimicking mature B-cell leukemia cells. However, we display morphologically different blast populations in 2 patients with MEF2D-BCL9-rearranged ALL. Mature B-cell leukemia-like morphology would aid the detection of MEF2D-BCL9 fusion, but not all cases might have typical morphology.
Assuntos
Proteínas de Fusão Oncogênica/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Fatores de Transcrição/genética , Linfócitos B/patologia , Medula Óssea/patologia , Criança , Feminino , Rearranjo Gênico , Humanos , Fatores de Transcrição MEF2/genética , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologiaRESUMO
BACKGROUND: The prevalence of congenital anomalies in newborns in South Korea was 272.9 per 100,000 in 2005, and 314.7 per 100,000 in 2006. In other studies, the prevalence of congenital anomalies in South Korea was equivalent to 286.9 per 10,000 livebirths in 2006, while it was estimated 446.3 per 10,000 births during the period from 2008 to 2014. Several systematic reviews and meta-analyses analyzing the factors contributing to congenital anomalies have been reported, but comprehensive umbrella reviews are lacking. METHODS: We searched PubMed, Google Scholar, Cochrane, and EMBASE databases up to July 1, 2019, for systematic reviews and meta-analyses that investigated the effects of environmental and genetic factors on any type of congenital anomalies. We categorized 8 subgroups of congenital anomalies classified according to the 10th revision of the International Statistical Classification of Diseases (ICD-10). Two researchers independently searched the literature, retrieved the data, and evaluated the quality of each study. RESULTS: We reviewed 66 systematic reviews and meta-analyses that investigated the association between non-genetic or genetic risk factors and congenital anomalies. Overall, 269 associations and 128 associations were considered for environmental and genetic risk factors, respectively. Congenital anomalies based on congenital heart diseases, cleft lip and palate, and others were associated with environmental risk factors based on maternal exposure to environmental exposures (air pollution, toxic chemicals), parental smoking, maternal history (infectious diseases during pregnancy, pregestational and gestational diabetes mellitus, and gestational diabetes mellitus), maternal obesity, maternal drug intake, pregnancy through artificial reproductive technologies, and socioeconomic factors. The association of maternal alcohol or coffee consumption with congenital anomalies was not significant, and maternal folic acid supplementation had a preventive effect on congenital heart defects. Genes or genetic loci associated with congenital anomalies included MTHFR, MTRR and MTR, GATA4, NKX2-5, SRD5A2, CFTR, and 1p22 and 20q12 anomalies. CONCLUSION: This study provides a wide perspective on the distribution of environmental and genetic risk factors of congenital anomalies, thus suggesting future studies and providing health policy implications.
Assuntos
Anormalidades Congênitas/epidemiologia , Exposição Ambiental/efeitos adversos , Cardiopatias Congênitas/epidemiologia , Exposição Materna/efeitos adversos , Metanálise como Assunto , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Revisões Sistemáticas como Assunto , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: Staphylococcus aureus bacteremia (SAB) presents heterogeneously, owing to the differences in underlying host conditions and immune responses. Although Toll-like receptor 2 (TLR2) is important in recognizing S. aureus, its function during S. aureus infection remains controversial. We aimed to examine the association of TLR2 expression and associated cytokine responses with clinical SAB outcomes. METHODS: Patients from a prospective SAB cohort at two tertiary-care medical centers were enrolled. Blood was sampled at several timepoints (≤5 d, 6-9 d, 10-13 d, 14-19 d, and ≥ 20 d) after SAB onset. TLR2 mRNA levels were determined via real-time PCR and serum tumor necrosis factor [TNF]-α, interleukin [IL]-6, and IL-10 levels were analyzed with multiplex-high-sensitivity electrochemiluminescent ELISA. RESULTS: TLR2 levels varied among 59 SAB patients. On days 2-5, TLR2 levels were significantly higher in SAB survivors than in healthy controls (p = 0.040) and slightly but not significantly higher than non-survivors (p = 0.120), and SAB patients dying within 7 d had lower TLR2 levels than survivors (P = 0.077) although statistically insignificant. IL-6 and IL-10 levels were significantly higher in non-survivors than in survivors on days 2-5 post-bacteremia (P = 0.010 and P = 0.021, respectively), and those dying within 7 d of SAB (n = 3) displayed significantly higher IL-10/TNF-α ratios than the survivors did (P = 0.007). CONCLUSION: TLR2 downregulation and IL-6 and IL-10 concentrations suggestive of immune dysregulation during early bacteremia may be associated with mortality from SAB. TLR2 expression levels and associated cytokine reactions during early-phase SAB may be potential prognostic factors in SAB, although larger studies are warranted.
Assuntos
Bacteriemia/metabolismo , Bacteriemia/mortalidade , Citocinas/metabolismo , Regulação para Baixo/genética , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/isolamento & purificação , Receptor 2 Toll-Like/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Citocinas/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , RNA Mensageiro/genética , Reação em Cadeia da Polimerase em Tempo Real , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/metabolismo , Sobreviventes , Centros de Atenção TerciáriaRESUMO
BACKGROUND: Previous studies have suggested links between exposure to ambient air pollutants and increased risk of congenital heart defects. However, few studies have investigated the association between other congenital diseases and traffic-related air pollution. In this study, we assessed the relationship between prenatal exposure to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) with congenital diseases in South Korea. METHODS: Patients with one or more congenital diseases and a control group of patients with non-infective gastroenteritis and colitis with a case:control ratio of 1:3 were obtained from the National Health Insurance Service data for 2008-2013 in South Korea. We estimated the associations of PM2.5 and NO2 exposures with congenital diseases using generalized estimation equations after controlling for covariates. RESULTS: Maternal PM2.5 exposure during the first and second trimester showed positive associations with overall congenital diseases, with changes of 14.7% (95% confidence intervals (CI), 9.3%, 20.3%) and 16.2% (95% CI, 11.0%, 21.7%), respectively, per 11.1 µg/m3 and 10.2 µg/m3 increase of PM2.5 interquartile range (IQR). Similarly, NO2 exposure during the first and second trimester was associated with increased numbers of overall congenital anomalies, with 8.2% (95% CI, 4.2%, 12.3%) and 15.6% (95% CI, 9.3%, 22.2%) more cases, respectively, per 10.6 ppb increase of NO2. We found that maternal PM2.5 exposure during the first and second trimesters of pregnancy was significantly associated with increased risk of specific congenital diseases, including subtypes affecting the circulatory, genitourinary, and musculoskeletal system. However, no significant associations were observed during the third trimester. Maternal NO2 exposure across the entire pregnancy was associated with malformations of the musculoskeletal system. CONCLUSIONS: Our study identified significant links between in utero exposure to PM2.5 and NO2 and certain congenital diseases, and suggests that stricter controls on PM2.5 and NO2 concentrations are required.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Efeitos Tardios da Exposição Pré-Natal , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Feminino , Humanos , Exposição Materna/efeitos adversos , Dióxido de Nitrogênio/análise , Dióxido de Nitrogênio/toxicidade , Material Particulado/análise , Material Particulado/toxicidade , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , República da Coreia/epidemiologiaRESUMO
Dermoid cyst is a rare benign tumor and about 7% of occurrences are found in the head and neck region. Its location is almost always in the midline of the body such as the orbit, oral cavity, and nose, but it is rarer in and around the auricle. The authors present a 31-year-old woman with dermoid cyst in the postauricular area which is a rare site for this lesion. In surgery under local anesthesia, the mass was limited to the subcutaneous area and excised completely. Surgical excision should be considered for cosmetic reasons and the mass should be excised completely to prevent recurrence and infection. Histopathologic confirmation is important and mandatory after excision to confirm the pathologic diagnosis and rule out the possibility of malignancy.
Assuntos
Cisto Dermoide/cirurgia , Neoplasias da Orelha/cirurgia , Adulto , Cisto Dermoide/diagnóstico por imagem , Pavilhão Auricular/patologia , Neoplasias da Orelha/diagnóstico por imagem , Neoplasias da Orelha/patologia , Feminino , HumanosRESUMO
BACKGROUND: Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 µm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors. METHODS: This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002-2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications. RESULTS: Each 10-µg/m increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95% confidence interval [CI]: 1.09-1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95% CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m; HR = 1.91; 95% CI = 1.28, 2.84). CONCLUSIONS: Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.
Assuntos
Material Particulado/efeitos adversos , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Adulto JovemRESUMO
BACKGROUND: It is unknown whether a selective-bundle tear of the anterior cruciate ligament (ACL) shows a different prevalence of posterolateral corner (PLC) injury than a both-bundle tear. PURPOSE: The prevalence of injury of PLC stabilizer in relation to the type of combined ACL tear (both-bundle and selective-bundle tears) has been investigated. MATERIAL AND METHODS: This retrospective study included 94 patients who were diagnosed with an ACL tear after knee joint magnetic resonance imaging and underwent arthroscopic surgery. We compared the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. We used Fischer exact tests to compare the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. RESULTS: Both-bundle tears occurred in 55 cases (56%) and selective-bundle tears in 39 cases (44%). The most common PLC injury with an ACL tear was inferior popliteomeniscal fascicle (PMF) injury, followed by superior PMF injury. The prevalence of each PLC injury was higher for both-bundle tears than selective-bundle tears, with the exception of popliteus tendon injury diagnosed by reader 1 (P.H.J). However, these differences were statistically significant for superior PMF injury only ( p < 0.05). The prevalence of PLC injury was unrelated to the type of selective-bundle tear (anteromedial vs posterolateral). CONCLUSION: Superior PMF injury is more common in both-bundle tears than selective-bundle tears. There is no statistically significant difference in the prevalence of PLC injury between both-bundle tears and selective-bundle tears.
RESUMO
BACKGROUND: The aim of this study was to determine the feasibility of image-guided marker-clip placement in axillary lymph nodes (ALNs) for breast cancer upon initial presentation and to assess the reliability of this method with sentinel lymph node biopsy (SLNB) for axillary restaging after neoadjuvant chemotherapy (NAC). METHODS: Between June 2015 and August 2016, a marker clip was placed at a clinically positive ALN under ultrasonography (US) guidance before initiation of NAC in 20 patients. Preoperative localization of marker-clipped LNs was performed, and the localized LNs were removed by SLNB. We compared the postoperative results of the marker-clipped LNs, SLNs and ALNs. RESULTS: Image-guided marker-clip placements and localization of marker-clipped LNs were performed successfully in 20 patients. A total of 24 marker clips were inserted, and 23 marker-clipped LNs were successfully retrieved during surgery (identification rate, 23/24, 95.8%). In the 11 patients with pathologically confirmed metastatic marker-clipped LNs, four became negative after NAC, and seven maintained metastatic residues on the marker-clipped LNs. Three of the seven patients had metastatic residues on the ALNs, and two of the three patients also had negative SLNs. Marker-clipped nodes accurately predicted the axillary nodal status in these two patients compared with SLNs alone. CONCLUSION: Image-guided marker-clip placement on positive ALNs before NAC and removal with SLNB is technically feasible. This technique can improve the accuracy of the residual disease evaluation on the axilla, especially in patients with negative SLNB results, and can identify candidates for limited axillary surgery after NAC.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Terapia Neoadjuvante , Cuidados Pré-Operatórios/métodos , Adulto , Axila , Neoplasias da Mama/patologia , Estudos de Viabilidade , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/patologia , Microcirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Neoplasia Residual , Reprodutibilidade dos Testes , Biópsia de Linfonodo Sentinela , Instrumentos Cirúrgicos , UltrassonografiaRESUMO
OBJECTIVE: The optimal follow-up interval for postoperative ultrasonography (US) surveillance after hemithyroidectomy in patients with papillary thyroid microcarcinoma (PTMC) is unclear. The purpose of this study was to evaluate the prevalence of tumor recurrence/persistence and to investigate the appropriateness of postoperative US surveillance in PTMC patients who underwent hemithyroidectomy. METHODS: Our institutional review board approved this retrospective study. From 2000 to 2011, 800 patients underwent hemithyroidectomy as treatment for PTMC, as well as at least one session of postoperative follow-up US, at four different institutions. The images and data of postoperative US surveillance were retrospectively investigated by experienced radiologists at each institution. Based on the follow-up US and histopathologic results, locoregional tumor recurrence/persistence was determined. RESULTS: Of the 800 patients, 82.2% had T1a, 17.8% had T3, and none had T1b, T2, T4a, or T4b disease; 6.9% had unknown N stage, 80.1% had N0, 13% had N1a, and none had N1b, based on histopathology. There were also no cases of distant metastasis after hemithyroidectomy. Among the patients, 784 (98%) showed no tumor recurrence/persistence, and 16 (2%) showed locoregional tumor recurrence/persistence during the follow-up period. The patients differed in the number of sessions and the intervals of postoperative follow-up US. In the 16 patients with tumor recurrence/persistence, the mean interval of postoperative follow-up US since the first US detection of tumor recurrence/persistence was 42.9 ± 25.9 months. All recurrence/persistence cases were subcentimeter. CONCLUSION: Postoperative US surveillance at 1-or 2-year intervals may be unnecessary because of the very low recurrence rate in PTMC. ABBREVIATIONS: EMR = electronic medical record; PTMC = papillary thyroid microcarcinoma; TNM = tumor, node, metastasis; US = ultrasonography; US-FNA = ultrasonography-guided fine-needle aspiration.