Publications by authors named "Seon Cho"

40 Publications

Comparison of diagnostic performance between FIB-4 and NFS in metabolic-associated fatty liver disease era.

Hepatol Res 2021 Nov 29. Epub 2021 Nov 29.

Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, Korea.

Aims: Fibrosis-4 index (FIB-4) and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) are the two most widely used non-invasive tools for screening of advanced fibrosis in subjects with NAFLD. Since metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new category of fatty liver disease, we aimed to compare the diagnostic performance of FIB-4 and NFS in subjects with MAFLD and in various subgroups.

Methods: This study was designed as cross-sectional study. Data from 6,775 subjects who underwent magnetic resonance elastography (MRE) and abdominal ultrasonography at the same time during a health check-up at 13 various health check-up centers were retrospectively reviewed. Advanced fibrosis was defined as an MRE value of ≥3.6 kPa.

Results: The area under the receiver operating characteristic curves (AUROCs) of FIB-4 and NFS for diagnosing advanced fibrosis were similar in subjects with MAFLD. However, the AUROC of NFS was lower than that of FIB-4 in the diabetic subgroup of MAFLD (0.809 in FIB-4 vs. 0.717 in NFS, P = 0.002). The performances of both FIB-4 and NFS were poor in the subgroup of MAFLD with significant alcohol intake.

Conclusions: The overall diagnostic performance of FIB-4 and NFS for diagnosing advanced fibrosis did not differ among subjects with MAFLD. However, the performance of NFS was lower in the diabetes subgroup of MAFLD. The diagnostic performance of FIB-4 was better for fibrosis in various subgroups of MAFLD. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/hepr.13737DOI Listing
November 2021

Subclinical steatohepatitis and advanced liver fibrosis in health examinees with nonalcoholic fatty liver disease (NAFLD) in 10 South Korean cities: A retrospective cross-sectional study.

PLoS One 2021 24;16(11):e0260477. Epub 2021 Nov 24.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Korea.

Background: Nonalcoholic steatohepatitis (NASH) has a risk of progressing to cirrhosis. The prevalence of NASH and its associated risk factors in community populations are relatively unknown. This study aimed to determine the prevalence of NASH and advanced liver fibrosis using magnetic resonance elastography (MRE), and determine those risk factors in health examinees with asymptomatic fatty liver.

Methods: This study consecutively selected subjects who underwent health checkups at 13 health-promotion centers in 10 Korean cities between 2018 and 2020. Hepatic steatosis and stiffness were assessed using ultrasonography and MRE, respectively. Stages of liver stiffness were estimated using MRE with cutoff values for NASH and advanced liver fibrosis of 2.91 and 3.60 kPa, respectively.

Results: The overall prevalence of NASH and advanced liver fibrosis in the subjects with fatty liver were 8.35% and 2.04%, respectively. Multivariate logistic regression analysis indicated that central obesity (OR = 5.12, 95% CI = 2.70-9.71), increased triglyceride (OR = 3.29, 95% CI = 1.72-6.29), abnormal liver function test (OR = 3.09, 95% CI = 1.66-5.76) (all P<0.001), and decreased high-density lipoprotein cholesterol (OR = 5.18, 95% CI = 1.78-15.05) (P = 0.003) were associated with NASH. The main risk factor for advanced liver fibrosis was diabetes (OR = 4.46, 95% CI = 1.14-17.48) (P = 0.032).

Conclusion: NASH or advanced liver fibrosis is found in one-tenth of health examinees with asymptomatic fatty liver. This suggests that early detection of NASH should be considered to allow early interventions such as lifestyle changes to prevent the adverse effects of NASH and its progression in health examinees with asymptomatic fatty liver.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260477PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612540PMC
November 2021

Fibrosis Burden of Missed and Added Populations According to the New Definition of Metabolic Dysfunction-Associated Fatty Liver.

J Clin Med 2021 Oct 8;10(19). Epub 2021 Oct 8.

Department of Laboratory Medicine, Health Promotion Research Institute, Seoul 07572, Korea.

Recently, the classification of fatty liver and the definition for non-alcoholic fatty liver disease (NAFLD) have been challenged. Herein, we aim to evaluate the burden of hepatic fibrosis in the missed and added populations following the proposal of the new definition of metabolic dysfunction-associated fatty liver (MAFLD) in a health check-up cohort. A total of 6775 subjects underwent both magnetic resonance elastography (MRE) and an abdominal ultrasound at 13 nationwide health check-up centers in Korea. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of sonographic fatty liver (FL) was 47.4%. Among the subjects with sonographic FL, 77.3% and 94% are compatible with NAFLD and with the new MAFLD definitions, respectively. Moreover, 72% of FL cases belong to both the NAFLD and MAFLD definitions, whereas 1.4% is compatible with neither. The population compatible with the MAFLD definition has the following coexisting liver diseases: alcohol-related (71.9%), hepatitis B (23.9%), hepatitis C (0.4%), and both alcohol and viral hepatitis (2.8%). The prevalence of significant and advanced hepatic fibrosis is considerable in the MAFLD-only group. However, the prevalence of significant and advanced hepatic fibrosis is similar in the NAFLD-only group, and neither the NAFLD nor MAFLD group compared to healthy controls. The added population (MAFLD-only group), according to the new MAFLD definition, has a higher metabolic and fibrosis burden when compared to those in the missed population (NAFLD-only group).
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http://dx.doi.org/10.3390/jcm10194625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509136PMC
October 2021

Reliability and Validity of an Ultrasonic Device for Measuring Height in Adults.

Korean J Fam Med 2021 Sep 20;42(5):376-381. Epub 2021 Sep 20.

Department of Family Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Background: The ultrasonic stadiometer was originally developed as a device to measure and monitor children's height. However, an ultrasonic stadiometer (InLab S50; InBody Co., Seoul, Korea) was used to measure adults' height in the 2018 Korea Community Health Survey (KCHS). This study was conducted to assess the reliability and validity of the InLab S50 in adults.

Methods: The study subjects were 120 adults (reliability test, n=20; validity test, n=100) who had visited a health screening center. The intra- and inter-rater reliabilities of InLab S50 were assessed using the intraclass correlation coefficient (ICC). The agreement between InLab S50 and an automatic stadiometer (HM-201; Fanics, Busan, Korea) was assessed using Pearson's correlation coefficient and Bland-Altman analysis.

Results: The intra- and inter-rater reliabilities of the InLab S50 were excellent (ICC=0.9999 and 0.9998, respectively). The correlation coefficient of the height measured by the two measurement devices was very high (r=0.996). The difference (Δheight [HM-201-InLab S50]) was -0.15±0.78 cm (95% limit of agreement [LOA], -1.69 to 1.38). After excluding the values outside 95% LOA, the difference was further reduced to -0.05±0.59 cm (95% LOA, -1.20 to 1.10).

Conclusion: This study showed that the InLab S50 is a reliable and valid device for the measurement of adults' height. Therefore, we think that InLab S50 could be used to measure adults' height in household health surveys such as the KCHS.
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http://dx.doi.org/10.4082/kjfm.20.0202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8490171PMC
September 2021

Hot Spot Analysis of YAP-TEAD Protein-Protein Interaction Using the Fragment Molecular Orbital Method and Its Application for Inhibitor Discovery.

Cancers (Basel) 2021 Aug 23;13(16). Epub 2021 Aug 23.

Bioinformatics and Molecular Design Research Center (BMDRC), Incheon 21983, Korea.

The Hippo pathway is an important signaling pathway modulating growth control and cancer cell proliferation. Dysregulation of the Hippo pathway is a common feature of several types of cancer cells. The modulation of the interaction between yes-associated protein (YAP) and transcriptional enhancer associated domain (TEAD) in the Hippo pathway is considered an attractive target for cancer therapeutic development, although the inhibition of PPI is a challenging task. In order to investigate the hot spots of the YAP and TEAD1 interacting complex, an ab initio Fragment Molecular Orbital (FMO) method was introduced. With the hot spots, pharmacophores for the inhibitor design were constructed, then virtual screening was performed to an in-house library. Next, we performed molecular docking simulations and FMO calculations for screening results to study the binding modes and affinities between PPI inhibitors and TEAD1. As a result of the virtual screening, three compounds were selected as virtual hit compounds. In order to confirm their biological activities, cellular (luciferase activity, proximity ligation assay and wound healing assay in A375 cells, qRT-PCR in HEK 293T cells) and biophysical assays (surface plasmon resonance assays) were performed. Based on the findings of the study, we propose a novel PPI inhibitor BY03 and demonstrate a profitable strategy to analyze YAP-TEAD PPI and discover novel PPI inhibitors.
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http://dx.doi.org/10.3390/cancers13164246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391968PMC
August 2021

The effect of a flexible thoracolumbar brace on neuromuscular scoliosis: A prospective observational study.

Medicine (Baltimore) 2021 Aug;100(32):e26822

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam.

Abstract: Neuromuscular scoliosis is a common deformity seen in patients with neuromuscular diseases. Although rigid thoracolumbosacral orthosis is the most frequently used brace, it has low compliance rates and can lead to complications including skin ulcers. Thus, alternative methods for treating neuromuscular scoliosis are needed. The purpose of this study is to evaluate the clinical effects of a novel flexible brace to prevent the progression of neuromuscular scoliosis.This study is a prospective observational study. Twenty-three patients with neuromuscular scoliosis were enrolled in the study. Among patients diagnosed with neuromuscular disease, spine radiographs were checked for a neuromuscular scoliosis diagnosis. The participants were treated with a novel flexible brace for 6 months. The control group (n = 46) was selected using propensity score matching method from a clinical data warehouse. The Cobb angle was measured and compared between the study and control groups.In the study group, the average Cobb's angle significantly decreased from 47.22 ± 18.9° to 31.8 ± 20.0 when wearing the flexible brace (P < .001). Thus, the correction rate was 36.9%. The annual progression rate was significantly lower in the study group than in the control group (P  < .05).The flexible brace showed a significant correction rate of scoliosis in patients with severe neuromuscular diseases. The flexible brace is an alternative treatment modality for patients with neuromuscular scoliosis. Daily application of the flexible brace during the growing period can reduce the degree of fixed deformity in the long term.
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http://dx.doi.org/10.1097/MD.0000000000026822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360469PMC
August 2021

Reference interval and the role of plasma oligomeric beta amyloid in screening of risk groups for cognitive dysfunction at health checkups.

J Clin Lab Anal 2021 Sep 3;35(9):e23933. Epub 2021 Aug 3.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Korea.

Background: Alzheimer's disease (AD) has a prolonged preclinical stage characterized by cognitive dysfunction. Simple, reliable, and noninvasive biomarkers reflecting the pathogenesis of AD are needed for screening cognitive dysfunction in primary health care. The aims of this study were to determine (1) the potential utility of the Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) value in cognitive assessments and (2) the reference interval (RI) of plasma MDS-OAβ values in the general population.

Methods: This prospective study consecutively recruited 1,594 participants who underwent health checkups including cognitive function examination at 16 health-promotion centers in Korea between December 2020 and January 2021. The inBlood OAβ test (PeopleBio, Gyeonggi-do, Republic of Korea) was utilized to quantify MDS-OAβ values in plasma. The reference subjects were obtained among those with normal general cognition on cognitive screening tools. RIs were established according to the CLSI C28-A3 guidelines.

Results: The median MDS-OAβ value was higher in subjects with Korean Dementia Screening Questionnaire-Cognition (KDSQ-C) scores ≥8 than in those with KDSQ-C scores of 6-7 (P = 0.013). The median MDS-OAβ value was higher in subjects with Mini-Mental State Examination for Dementia Screening (MMSE-DS) scores of 21-26 than in those with MMSE-DS scores ≥27 (P = 0.011). The RI (one-side upper 95th percentile) of the MDS-OAβ value was 0.80 ng/mL (95% confidence interval = 0.78-0.82) in those aged ≥50 years.

Conclusions: The plasma MDS-OAβ value reflects cognitive function as assessed using the KDSQ-C and MMSE-DS. RIs obtained from a large and cognitively healthy community-based sample are presented.
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http://dx.doi.org/10.1002/jcla.23933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418474PMC
September 2021

Compensatory Effects of Sequential 4-Channel Neuromuscular Electrical Stimulation for the Treatment of Acute, Subacute, and Chronic Dysphagia in a Prospective, Double-Blinded Randomized Clinical Trial.

Neurorehabil Neural Repair 2021 Sep 4;35(9):801-811. Epub 2021 Jul 4.

Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

The precise mechanism of 2-channel neuromuscular electrical stimulation (NMES) treatment is unknown, and controversy remains over its efficacy. The sequential 4-channel NMES was newly developed based on normal contractile sequences of swallowing-related muscles. To assess the clinical efficacy of sequential 4-channel NMES during swallowing. In this prospective RCT, 52 inpatients with dysphagia (acute, subacute, and chronic state) after stroke, brain tumor, or encephalitis were enrolled. Participants who underwent a videofluoroscopic swallowing study (VFSS) and clinical evaluation were enrolled and were randomly assigned to the 4-channel NMES or sham group. The 4-channel NMES and sham groups swallowed thin and honey-like fluids under NMES (sequential stimulation on suprahyoid and infrahyoid) and sham stimulation, respectively. The procedures were evaluated with the VFSS. Pre- and post-treatment evaluations were performed with the videofluoroscopic dysphagia scale (VDS), penetration-aspiration scale (PAS), Likert scale, and kinematic analysis. The 4-channel NMES group showed significantly greater improvements than the sham group with respect to oral VDS, pharyngeal VDS, total VDS, and PAS ( < .05). Furthermore, the Likert scale for satisfaction, easiness, and discomfort for swallowing showed favorable results for the 4-channel NMES group ( < .05). In the kinematic analysis, the peak speed point, distance, and velocity of hyoid movement were significantly greater in the 4-channel NMES group ( < .05). Sequential 4-channel NMES activating the suprahyoid, thyrohyoid, and other infrahyoid muscles during swallowing showed significant clinical improvement with respect to VDS, PAS, and kinematic analysis. Therefore, sequential 4-channel NMES is a potential new functional electrical stimulation system for the treatment of dysphagia.
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http://dx.doi.org/10.1177/15459683211029891DOI Listing
September 2021

Diabetes is the strongest risk factor of hepatic fibrosis in lean patients with non-alcoholic fatty liver disease.

Gut 2021 Jun 14. Epub 2021 Jun 14.

Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, Korea (the Republic of)

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http://dx.doi.org/10.1136/gutjnl-2021-325102DOI Listing
June 2021

Do we need a new cut-off for FIB-4 in the metabolic dysfunction-associated fatty liver disease era?

J Hepatol 2021 09 9;75(3):725-726. Epub 2021 Jun 9.

Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Republic of Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jhep.2021.05.035DOI Listing
September 2021

Nationwide seroprevalence of antibodies to SARS-CoV-2 in asymptomatic population in South Korea: a cross-sectional study.

BMJ Open 2021 04 24;11(4):e049837. Epub 2021 Apr 24.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Republic of Korea.

Objective: Asymptomatic active infection might be an important contributor to the COVID-19 outbreak. Serological tests can assess the extent of exposure and herd immunity to COVID-19 in general populations. This study aimed to estimate the nationwide seroprevalence of SARS-CoV-2 antibodies according to age, sex and clinical status in South Korea.

Design, Setting And Participants: This cross-sectional study randomly selected health examinees who underwent health check-up at 16 health promotion centres in 13 Korean cities across the country between late September and early December 2020. Residual serum samples were obtained from 4085 subjects (2014 men and 2071 women). Antibodies to SARS-CoV-2 were measured by electrochemiluminescence immunoassay using Elecsys Anti-SARS-CoV-2 (Roche Elecsys, Mannheim, Germany).

Primary And Secondary Outcome Measures: Fisher's exact test was used to compare the seroprevalence according to sex, age group and region. The relative risks of being seropositive according to the characteristics of the study subjects were analysed using logistic regression analysis.

Results: The overall seroprevalence of anti-SARS-CoV-2 was 0.39% (95% CI=0.20% to 0.58%): 0.30% (95% CI=0.06% to 0.54%) for men and 0.48% (95% CI=0.18% to 0.78%) for women. The rate of anti-SARS-CoV-2 positivity varied significantly between different regions of Korea (p=0.003), but not with age group, sex, or the statuses of obesity, diabetes, hypertension or smoking.

Conclusions: Most of the Korean population is still immunologically vulnerable to SARS-CoV-2, but the seroprevalence has increased relative to that found in studies performed prior to September 2020 in Korea.
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http://dx.doi.org/10.1136/bmjopen-2021-049837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076630PMC
April 2021

Prevalence of liver fibrosis and associated risk factors in the Korean general population: a retrospective cross-sectional study.

BMJ Open 2021 03 24;11(3):e046529. Epub 2021 Mar 24.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, South Korea.

Objectives: The health burden of chronic liver disease is increasing worldwide. Its main histological consequence is liver fibrosis, and eventually cirrhosis. This process is rarely diagnosed at the pre-cirrhotic stage due to it being asymptomatic. Little is known about the prevalence of liver fibrosis and associated risk factors in the general population. The aims of this study were to determine the prevalence and distribution of liver fibrosis using magnetic resonance elastography (MRE), as well as the risk factors associated with liver fibrosis in the asymptomatic general population.

Design, Setting And Participants: This cross-sectional retrospective study consecutively selected subjects who underwent health check-ups including MRE at 13 health promotion centres in Korea between 2018 and 2020. Liver fibrosis was estimated using MRE with cut-off values for significant and advanced liver fibrosis of 2.90 and 3.60 kPa, respectively.

Primary And Secondary Outcome Measures: The Χ test was used to compare the prevalence of liver fibrosis according to sex and age groups. Multivariable logistic regression analyses were performed to identify the factors for significant and advanced liver fibrosis.

Results: Among the 8183 subjects, 778 (9.5%) had ≥significant fibrosis (≥2.9 kPa), which included 214 (2.6%) subjects with ≥advanced fibrosis (≥3.6 kPa). Multivariable analysis revealed that liver fibrosis was associated with age (OR=1.34, 95% CI=1.18 to 1.51), male sex (OR=3.18, 95% CI=1.97 to 5.13), diabetes (OR=2.43, 95% CI=1.8 to 3.28), HBsAg positivity (OR=3.49, 95% CI=2.55 to 4.79), abnormal liver function test (OR=1.9, 95% CI=1.49 to 2.42) and obesity (OR=1.77, 95% CI=1.35 to 2.32) (all p<0.001), as well as metabolic syndrome (OR=1.4, 95% CI=1.05 to 1.87) (p=0.024).

Conclusions: The prevalence of significant or more liver fibrosis was high in the Korean general population and much higher among individuals with risk factors. This suggests that screening of liver fibrosis should be considered in general population, especially among high-risk groups.
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http://dx.doi.org/10.1136/bmjopen-2020-046529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993338PMC
March 2021

Farnesol induces mitochondrial/peroxisomal biogenesis and thermogenesis by enhancing the AMPK signaling pathway in vivo and in vitro.

Pharmacol Res 2021 01 24;163:105312. Epub 2020 Nov 24.

Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea. Electronic address:

Thermogenic activation of brown adipose tissue has been considered as an obesity treatment strategy that consumes energy. In this study, we investigated whether farnesol in vivoandin vitro models induces thermogenesis and affect the activation of the mitochondria and peroxisomes, which are key organelles in activated brown adipocytes. Farnesol induced the expression of thermogenic factors such as uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor γ coactivator 1 alpha (PGC1α), and PR domain zinc-finger protein 16 (PRDM16) together with the phosphorylation of AMP-activated protein kinase alpha (AMPKα) in brown adipose tissue and primary cultured brown adipocytes. Farnesol promoted lipolytic enzymes: hormone sensitive lipase (HSL) and adipose triglyceride lipase (ATGL). We confirmed that these inductions of lipolysis by farnesol were the underlying causes of β-oxidation activation. Farnesol also increased the expression of oxidative phosphorylation (OXPHOS) complexes and the oxygen consumption rate (OCR) and the expansion of peroxisomes. Moreover, we proved that the thermogenic activity of farnesol was dependent on AMPKα activation using Compound C inhibitor or siRNA-AMPKα knockdown. These results suggest that farnesol may be a potential agent for the treatment of obesity by inducing energy consumption through heat generation.
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http://dx.doi.org/10.1016/j.phrs.2020.105312DOI Listing
January 2021

The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis.

Epidemiol Health 2020 31;42:e2020061. Epub 2020 Aug 31.

Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.

Objectives: This study aimed to identify latent classes in hypertensive patients based on the clustering of factors including lifestyle risk factors, metabolic risk factors, and obesity in each sex.

Methods: This cross-sectional study included 102,780 male and 103,710 female hypertensive patients who underwent health check-ups at 16 centers in Korea, in 2018. A latent class analysis approach was used to identify subgroups of hypertensive patients. Multinomial logistic regression was performed to examine the association between latent classes and comorbidities of hypertension.

Results: A four-class model provided the best fit for each sex. The following latent classes were identified: Class I (male: 16.9%, female: 1.7%; high risk of lifestyle behaviors [HB] with metabolic disorders and obesity [MO]), Class II (male: 32.4%, female: 47.1%; low risk of lifestyle behaviors [LB] with MO), Class III (male: 15.3%, female: 1.8%; HB with metabolic disorders and normal weight [MNW]), Class IV (male: 35.5%, female: 49.4%; LB with MNW). Lifestyle patterns in the latent classes were classified as high-risk or low-risk according to smoking and high-risk drinking among male, and presented complex patterns including physical inactivity alone or in combination with other factors, among female. Stage 2 hypertensive or diabetic individuals were likely to belong to classes including obesity (HB-MO, LB-MO) in both sexes, and additionally belonged to the HB-MNW class in male.

Conclusions: Metabolic disorders were included in all latent classes, with or without lifestyle risk factors and obesity. Hypertensive females need to manage obesity, and hypertensive males need to manage lifestyle risk factors and obesity. Sex-specific lifestyle behaviors are important for controlling hypertension.
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http://dx.doi.org/10.4178/epih.e2020061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871153PMC
January 2021

Vanillic Acid Improves Comorbidity of Cancer and Obesity through STAT3 Regulation in High-Fat-Diet-Induced Obese and B16BL6 Melanoma-Injected Mice.

Biomolecules 2020 07 24;10(8). Epub 2020 Jul 24.

Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea.

Obesity is known to be associated with risk and aggressiveness of cancer. Melanoma, the most lethal type of skin cancer, is also closely related to the prevalence of obesity. In this study, we established a cancer-obesity comorbidity (COC) model to investigate the effects of vanillic acid (VA). After a five-week administration with a high-fat diet (HFD) to induce obesity, subcutaneous allograft of B16BL6 cells were followed, and VA was orally administrated for an additional two weeks. VA-fed mice showed significantly decreased body weight and white adipose tissue (WAT) weight, which were due to increased thermogenesis and AMPK activation in WATs. Growth of cancer was also suppressed. Mechanistic studies revealed increased apoptosis and autophagy markers by VA; however, caspase 3 was not involved. Since signal transducer and activator of transcription 3 (STAT3) is suggested as an important pathway linking obesity and cancer, we further investigated to find out if STAT3 phosphorylation was repressed by VA treatment, and this was again confirmed in a COC cell model of adipocyte conditioned medium-treated B16BL6 melanoma cells. Overall, our results show VA induces STAT3-mediated autophagy to inhibit cancer growth and thermogenesis to ameliorate obesity in COC. Based on these findings, we suggest VA as a candidate therapeutic agent for COC treatment.
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http://dx.doi.org/10.3390/biom10081098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464557PMC
July 2020

Reference interval and the role of soluble suppression of tumorigenicity 2 (sST2) in subclinical cardiac dysfunction at health checkups.

J Clin Lab Anal 2020 Nov 7;34(11):e23461. Epub 2020 Jul 7.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Soluble ST2 (sST2) is known to predict adverse outcomes and death in individuals with established heart failure. However, the role of sST2 testing in the general population has not been established. The aims of this study were to determine the reference interval (RI) and the clinical utility of sST2 in subclinical cardiac dysfunction in general population.

Methods: This cross-sectional study consecutively selected 41,806 general subjects at health checkups who underwent echocardiography and sST2 testing at 16 health promotion centers in 13 Korean cities. The reference subjects were obtained among those with normal findings in echocardiography. Sex-specific RIs were established according to the CLSI C28-A3 guidelines. sST2 was measured using immunoassay with the Presage ST2 assay (Critical Diagnostics).

Results: In the general subjects, age, sex, BMI, systolic blood pressure, blood glucose, creatinine, liver function, and triglycerides were associated with the sST2 levels. The RI for sST2 was higher in males (≤49.6 ng/mL, 95% CI = 48.5-51.5) than in females (≤44.5 ng/mL, 95% CI = 43.5-45.6) and higher in subjects aged < 40 years than ≥ 40 years in both sexes. The sST2 levels were 29.1 ± 10.7 (mean ± SD) and 29.1 ± 14.4 ng/mL in the groups with normal cardiac function and subclinical cardiac dysfunction, respectively. The sST2 level was not associated with subclinical cardiac dysfunction (odd ratio = 1.002, P = .13).

Conclusions: RIs obtained from a large and echocardiography-proven healthy community-based sample are presented. Subclinical cardiac dysfunction was associated with older age, male sex, and metabolic factors but not with the sST2 level.
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http://dx.doi.org/10.1002/jcla.23461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676181PMC
November 2020

A phytoestrogen secoisolariciresinol diglucoside induces browning of white adipose tissue and activates non-shivering thermogenesis through AMPK pathway.

Pharmacol Res 2020 08 11;158:104852. Epub 2020 May 11.

Department of Pharmacology, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-Gu, Seoul, 02447, Republic of Korea; Basic Research Laboratory for Comorbidity Regulation, Comorbidity Research Institute, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-Gu, Seoul, 02447, Republic of Korea. Electronic address:

Secoisolariciresinol diglucoside (SDG) is the main phytoestrogen component of flaxseed known as an antioxidant. Current study focused on the effect of SDG in white adipose tissue (WAT) browning. Browning of WAT is considered as a promising treatment strategy for metabolic diseases. To demonstrate the effect of SDG as an inducer of browning, brown adipocyte markers were investigated in inguinal WAT (iWAT) of high fat diet-fed obese mice and genetically obese db/db mice after SDG administration. SDG increased thermogenic factors such as uncoupling protein 1, peroxisome proliferator-activated receptor gamma coactivator 1 alpha and PR domain containing 16 in iWAT and brown adipose tissue (BAT) of mice. Similar results were shown in beige-induced 3T3-L1 adipocytes and primary cultured brown adipocytes. Furthermore, SDG increased factors of mitochondrial biogenesis and activation. We also observed SDG-induced alteration of AMP-activated protein kinase α (AMPKα). As AMPKα is closely related in the regulation of adipogenesis and thermogenesis, we then evaluated the effect of SDG in AMPKα-inhibited conditions. Genetic or chemical inhibition of AMPKα demonstrated that the role of SDG on browning and thermogenesis was dependent on AMPKα signaling. In conclusion, our data suggest SDG as a potential candidate for improvement of obesity and other metabolic disorders.
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http://dx.doi.org/10.1016/j.phrs.2020.104852DOI Listing
August 2020

Effect of Mass Drug Administration with a Single Dose of Albendazole on Ascaris lumbricoides and Trichuris trichiura Infection among Schoolchildren in Yangon Region, Myanmar.

Korean J Parasitol 2020 Apr 30;58(2):195-200. Epub 2020 Apr 30.

Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649, Korea.

Soil-transmitted helminths, including Ascaris lumbricoides and Trichuris trichiura, are important intestinal parasites mostly affecting younger people in developing countries. In 2014-2015, we performed mass fecal examinations targeting a total of 2,227 schoolchildren in 3 districts (South Dagon, North Dagon, and Hlaing-thar-yar) of Yangon Region, Myanmar, using the Kato-Katz thick smear technique. The egg positive children were subjected to a mass drug administration (MDA) using a single oral dose of 400 mg albendazole. The pre-treatment egg positive rate (EPG/person) of A. lumbricoides averaged 17.2% (15,532); it was 25.2% (21,796), 14.2% (11,816), and 12.8% (12,983) in 3 districts, respectively, and that of T. trichiura averaged 19.4% (1,074), and was 24.1% (1,040), 12.3% (852), and 21.2% (1,330) in 3 districts, respectively. Follow-up fecal examinations performed 4 months post-MDA revealed considerable decreases of A. lumbricoides prevalence (EPG/person) to av. 8.3% (12,429), and 13.7% (17,640), 8.0% (7,797), and 4.5% (11,849) in 3 districts, respectively. However, T. trichiura did not show any recognizable decrease in the prevalence (EPG/person) remaining at av. 18.2% (862), and 18.5% (888), 11.5% (812), and 23.3% (887) in 3 districts, respectively. The results demonstrated difficulty in short-term control of T. trichiura by MDA using albendazole and suggested necessity of either a long-term MDA (>10 years) or changing the albendazole regimen into 2~3-day course (total 800 or 1,200 mg), or using an alternative drug/drug combination.
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http://dx.doi.org/10.3347/kjp.2020.58.2.195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231822PMC
April 2020

Diagnostic performance of Mac-2 binding protein glycosylation isomer (M2BPGi) in screening liver fibrosis in health checkups.

J Clin Lab Anal 2020 Aug 29;34(8):e23316. Epub 2020 Mar 29.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Mild-to-moderate fibrosis is rarely diagnosed because the disease is asymptomatic in the early stage. The serum level of Mac-2 binding protein glycosylation isomer (M2BPGi) has been found to increase with the severity of liver fibrosis. The aim of this study was to determine the diagnostic performance of M2BPGi in screening liver fibrosis using magnetic resonance elastography (MRE) as a reference standard and to compare it with using the aspartate aminotransferase-to-platelet ratio (APRI) and the Fibrosis-4 index (FIB-4) in health checkups.

Methods: This cross-sectional study consecutively selected subjects at health examinations who underwent MRE and M2BPGi testing at eight health promotion centers in Korea between January and September 2019. The serum M2BPGi level was measured using the chemiluminescence enzyme immunoassay method. The measured levels were indexed using the cutoff index (COI). COI values of M2BPGi were compared with the MRE results.

Results: The median (interquartile) values of COI for fibrosis stages F0 (normal liver stiffness), F1 (mild fibrosis), F2 (significant fibrosis), and ≥F3 (advanced fibrosis) were 0.49 (0.34-0.61), 0.48 (0.38-0.68), 0.64 (0.43-1.03), and 1.01 (0.75-1.77), respectively (P < .0001). The AUCs of the COI for the screening of fibrosis stage ≥F1, ≥F2, and ≥F3 were 0.591, 0.698, and 0.853, respectively. Using a threshold of 0.75 for COI to exclude advanced fibrosis had a sensitivity, specificity, and negative predictive value of 80.0%, 77.9%, and 98.9%, respectively. The AUC for excluding advanced fibrosis was better for M2BPGi than for FIB-4 and APRI.

Conclusion: Serum M2BPGi was useful for screening significant and advanced fibrosis in health checkups.
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http://dx.doi.org/10.1002/jcla.23316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439422PMC
August 2020

Distribution of hemoglobin levels and prevalence of anemia according to sex, age group, and region in 13 Korean cities.

Int J Lab Hematol 2020 Apr 12;42(2):223-229. Epub 2020 Feb 12.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Introduction: The distribution of hemoglobin (Hb) levels and the prevalence of anemia are significant public health indicators. The aims of this study were to determine the distribution of Hb levels and the prevalence of anemia according to sex, age group, and region throughout Korea.

Methods: The study analyzed data on 1 159 298 subjects who received health checkups at 16 health-promotion centers in 13 Korean cities during 2018. Anemia and its severity were defined according to the World Health Organization classification for Hb levels as follows: mild anemia (11-12.9 g/dL in males and 11-11.9 g/dL in females), moderate anemia (10-10.9 g/dL in both sexes), and severe anemia (<10.0 g/dL in both sexes).

Results: The Hb level in the general sample was lower in females (13.25 ± 1.13 g/dL, mean ± SD) than in males (15.29 ± 1.22 g/dL). The overall prevalence of anemia was 6.0% (2.98% in males and 8.56% in females), and the prevalence of severe anemia was 0.92% (0.23% in males and 1.51% in females). While the prevalence of anemia increased monotonically with age in males, it was bimodal in females with two peaks at 40-49 years and ≥80 years. The highest prevalence of anemia in females aged 40-49 years was attributed to microcytic anemia, while increases in anemia prevalence in males aged ≥50 years and females aged ≥70 years were attributed to macrocytic anemia.

Conclusion: The distribution of Hb levels and the prevalence of anemia overall and by severity differ according to sex, age group, and region throughout Korea.
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http://dx.doi.org/10.1111/ijlh.13160DOI Listing
April 2020

Subclinical Iron Deficiency in Non-Anemic Individuals: A Retrospective Analysis of Korean Health Examinees.

Acta Haematol 2020 12;143(1):26-32. Epub 2019 Jul 12.

Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Republic of Korea.

Objectives: Non-anemic individuals may have undetected subclinical iron deficiency (SID). The aims of this study were to determine the prevalence of SID and identify the associated factors for SID. In addition, the screening performance of red blood cell (RBC) indices for SID in health check-ups was assessed.

Methods: This study was conducted with 16,485 non-anemic health examinees (3,567 males and 12,918 females) who underwent tests for iron variables (serum iron, total iron-binding capacity, ferritin, and iron saturation) at 16 health-promotion centers in 13 cities in Korea between January 2017 and June 2018. SID was defined as a decreased ferritin level (<24 µg/L in males and <15 µg/L in females) and either a decreased serum iron level (<44 µg/dL in males and <29 µg/dL in females) or a transferrin saturation of <20%.

Results: The prevalence rates of SID were 0.6 and 3.3% in males and females, respectively. In terms of age and sex, SID was most prevalent in males aged ≥70 years (7.8%) and females aged 15-49 years (7.6%). There were significant differences in the hemoglobin (Hb) level, white blood cell count, platelet count, mean corpuscular volume, mean corpuscular Hb (MCH), and RBC distribution width (RDW) between the SID and non-SID groups (p < 0.001). The factors associated with SID in males were older age (odds ratio, OR, 1.069, 95% confidence interval, CI, 1.03-1.109, p = 0.004), lower Hb (OR 0.58, 95% CI 0.345-0.976, p = 0.04), lower MCH (OR 0.433, 95% CI 0.298-0.629, p < 0.001), and higher RDW (OR 1.374, 95% CI 1.001-1.887, p = 0.049), while in females they were lower body mass index (BMI; OR 0.929, 95% CI 0.895-0.963, p < 0.001) and younger age (OR 0.954, 95% CI 0.945-0.963, p < 0.001), as well as lower Hb, lower MCH, and higher RDW. The AUC for the MCH (0.877, 95% CI 0.793-0.960 in males; 0.872, 95% CI 0.853-0.890 in females) indicates that the MCH at cut-offs of 29.2 and 29.3 pg are the best discriminators of SID in males and females, respectively (p < 0.001).

Conclusions: Reproductive-age females with a lower BMI and elderly males are high-risk groups for SID. MCH is a reliable RBC index for the screening of SID. For the population with defined risk factors, including females with lower BMI and elderly males, screening for SID is needed to prevent the development of anemia.
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http://dx.doi.org/10.1159/000500630DOI Listing
April 2020

Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar.

Emerg Infect Dis 2019 07;25(7):1435-1437

We performed an epidemiologic survey of opisthorchiasis in Yangon, Myanmar. The fecal egg-positive rate of residents was 0.7%, and we recovered an adult fluke after chemotherapy and purging of an egg-positive resident. We detected Opisthorchis viverrini metacercariae in freshwater fish. We found the Yangon area to have low-grade endemicity of opisthorchiasis.
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http://dx.doi.org/10.3201/eid2507.190495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590760PMC
July 2019

Plasma NT-proBNP levels associated with cardiac structural abnormalities in asymptomatic health examinees with preserved ejection fraction: a retrospective cross-sectional study.

BMJ Open 2019 04 20;9(4):e026030. Epub 2019 Apr 20.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, South Korea.

Objectives: Stage B heart failure (HF) is defined as an asymptomatic abnormality of the heart structure or function. The circulating level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in symptomatic patients with left ventricular (LV) dysfunction caused by a structural or functional abnormality. This study investigated the association of the NT-proBNP level with echocardiography-detected cardiac structural or diastolic abnormalities in asymptomatic subjects with preserved LV systolic function (ejection fraction >50%).

Methods: We retrospectively studied 652 health examinees who underwent echocardiography and an NT-proBNP test at a health-promotion centre in Seoul, between January 2016 and September 2018. The left ventricular mass index (LVMI) and the left atrial dimension (LAD) were used as markers for structural abnormalities, and the mean e' velocity and mitral early flow velocity/early diastolic tissue velocity (E/e') ratio were used as markers for diastolic dysfunction. The plasma NT-proBNP level was measured using electrochemiluminescence immunoassay (DPC Immulite 2000 XPi, Siemens Healthcare Diagnostics, Tarrytown, New York, USA).

Results: Subjects with preclinical structural abnormalities were older and had a higher body mass index (BMI), higher blood pressure, lower high-density lipoprotein cholesterol level, higher NT-proBNP level, and higher E/e' (p<0.05). Multivariate regression analysis indicated that the factors associated with a higher NT-proBNP level were older age, female sex, lower BMI, higher creatinine level, higher LVMI and higher LAD (p<0.01).

Conclusion: Diastolic dysfunction is not associated with higher NT-proBNP levels, whereas preclinical cardiac structural abnormalities, as well as older age, female sex, lower BMI, and higher creatinine level, are associated with higher NT-proBNP levels.
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http://dx.doi.org/10.1136/bmjopen-2018-026030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500281PMC
April 2019

In-Situ/Operando X-ray Characterization of Metal Hydrides.

Chemphyschem 2019 05 21;20(10):1261-1271. Epub 2019 Mar 21.

Advanced Light Source, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA.

In this article, the capabilities of soft and hard X-ray techniques, including X-ray absorption (XAS), soft X-ray emission spectroscopy (XES), resonant inelastic soft X-ray scattering (RIXS), X-ray photoelectron spectroscopy (XPS), and X-ray diffraction (XRD), and their application to solid-state hydrogen storage materials are presented. These characterization tools are indispensable for interrogating hydrogen storage materials at the relevant length scales of fundamental interest, which range from the micron scale to nanometer dimensions. Since nanostructuring is now well established as an avenue to improve the thermodynamics and kinetics of hydrogen release and uptake, due to properties such as reduced mean free paths of transport and increased surface-to-volume ratio, it becomes of critical importance to explicitly identify structure-property relationships on the nanometer scale. X-ray diffraction and spectroscopy are effective tools for probing size-, shape-, and structure-dependent material properties at the nanoscale. This article also discusses the recent development of in-situ soft X-ray spectroscopy cells, which enable investigation of critical solid/liquid or solid/gas interfaces under more practical conditions. These unique tools are providing a window into the thermodynamics and kinetics of hydrogenation and dehydrogenation reactions and informing a quantitative understanding of the fundamental energetics of hydrogen storage processes at the microscopic level. In particular, in-situ soft X-ray spectroscopies can be utilized to probe the formation of intermediate species, byproducts, as well as the changes in morphology and effect of additives, which all can greatly affect the hydrogen storage capacity, kinetics, thermodynamics, and reversibility. A few examples using soft X-ray spectroscopies to study these materials are discussed to demonstrate how these powerful characterization tools could be helpful to further understand the hydrogen storage systems.
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http://dx.doi.org/10.1002/cphc.201801185DOI Listing
May 2019

Efficacy of lifestyle interventions in the reversion to normoglycemia in Korean prediabetics: One-year results from a randomised controlled trial.

Prim Care Diabetes 2019 06 21;13(3):212-220. Epub 2018 Dec 21.

Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.

Aim: This study aimed to determine the efficacy of personalized lifestyle interventions on the reversion of a prediabetic state to normoglycemia compared with regular blood glucose testing alone in prediabetes.

Methods: A randomized, multicenter trial was conducted in prediabetes aged 30-70 with fasting blood glucose level of 5.6-6.9mmol/L (100-125mg/dL) and/or HbA1c level of 39-46mmol/mol (5.7-6.4%) recruited from health checkups at 16 health-promotion centers in Korea. The 799 recruited individuals were randomized to either the personalized lifestyle intervention group (LIG) or the control group (CG) by a computer generated random number list prepared by an independent statistician. The CG was provided with fasting blood glucose and HbA1c tests alone every 3months during the first year. The LIG was provided not only blood glucose test but five sessions of personalized lifestyle counseling by nutritionists every 3months during the first year aimed at improving the diet, alcohol and exercise behaviors. Data from lifestyle assesments and laboratory measurements were analyzed at 1-year after baseline. The primary outcome was the reversion rate from prediabetes to normoglycemia. Additional outcome include the effect of the lifestyle intervention program on lifestyle changes in the LIG to support primary outcome.

Results: The 799 participants randomly allocated to the LIG (n=398) or the CG (n=401). For the analyses of outcomes, 629 participants (313 men and 316 women; mean age, 53.7±9.4years; mean body mass index (BMI), 24.7kg/m) were included: 325 in the LIG; 304 in the CG. Diet (7.03, 95% CI=4.56-10.86, P<0.001), alcohol (2.24, 95% CI=1.48-3.41, P<0.001), and exercise behaviors (1.85, 95% CI=1.31-2.63, P<0.001) were improved relative to baseline by the personalized lifestyle intervention in the LIG after adjusting age, sex, and family history of diabetes. In terms of main outcome, the cumulative incidence of reversion from prediabetes to normoglycemia at the first year was 37.9% (123/325) [95% CI=32.6-43.1%] in the LIG and 29.6% (90/304) (95% CI=24.5-34.7%) in the CG. After adjustment for age, sex, family history of diabetes, BMI, blood pressure, and lipids, the hazard ratio for reverting to normoglycemia remained significantly higher in the LIG (1.40, 95% CI=1.06-1.83, P=0.017) than in the CG.

Conclusion: Personalized lifestyle intervention could be more effective compared with regular blood glucose testing alone in the reversion of a prediabetic state to normoglycemia in Korean prediabetics. This finding suggests that diabetes prevention care would be benefited by incorporating personalized lifestyle counseling. This study was registered at cris.nih.go.kr (KCT0001580).
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http://dx.doi.org/10.1016/j.pcd.2018.11.017DOI Listing
June 2019

Complete Blood Count Reference Intervals and Patterns of Changes Across Pediatric, Adult, and Geriatric Ages in Korea.

Ann Lab Med 2018 Nov;38(6):503-511

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Sampling a healthy reference population to generate reference intervals (RIs) for complete blood count (CBC) parameters is not common for pediatric and geriatric ages. We established age- and sex-specific RIs for CBC parameters across pediatric, adult, and geriatric ages using secondary data, evaluating patterns of changes in CBC parameters.

Methods: The reference population comprised 804,623 health examinees (66,611 aged 3-17 years; 564,280 aged 18-59 years; 173,732 aged 60-99 years), and, we excluded 22,766 examinees after outlier testing. The CBC parameters (red blood cell [RBC], white blood cell [WBC], and platelet parameters) from 781,857 examinees were studied. We determined statistically significant partitions of age and sex, and calculated RIs according to the CLSI C28-A3 guidelines.

Results: RBC parameters increased with age until adulthood and decreased with age in males, but increased before puberty and then decreased with age in females. WBC and platelet counts were the highest in early childhood and decreased with age. Sex differences in each age group were noted: WBC count was higher in males than in females during adulthood, but platelet count was higher in females than in males from puberty onwards (P<0.001). Neutrophil count was the lowest in early childhood and increased with age. Lymphocyte count decreased with age after peaking in early childhood. Eosinophil count was the highest in childhood and higher in males than in females. Monocyte count was higher in males than in females (P<0.001).

Conclusions: We provide comprehensive age- and sex-specific RIs for CBC parameters, which show dynamic changes with both age and sex.
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http://dx.doi.org/10.3343/alm.2018.38.6.503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056383PMC
November 2018

Patient Safety Culture Associated With Patient Safety Competencies Among Registered Nurses.

J Nurs Scholarsh 2018 09 15;50(5):549-557. Epub 2018 Jul 15.

Assistant Professor, College of Nursing Science, Kyung Hee University, Seoul, Korea.

Purpose: To investigate the relationships between registered nurses' (RNs') perceptions of the culture of patient safety in their workplace and their patient safety competency-attitudes, skills, and knowledge.

Design: A cross-sectional study design was used. Data were collected by using a self-reported survey from 343 RNs working in a university hospital in Seoul, South Korea.

Methods: Patient safety culture was measured using the Korean version of the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture (Hospital SOPSTM). Patient safety competency was measured using the Patient Safety Competency Self-Evaluation tool. Multiple regression analysis was performed using Stata version 14 to examine the relationships between patient safety culture and RNs' patient safety competency, while adjusting for the RNs nested in their units.

Findings: Of the 10 specific aspects of patient safety culture, only teamwork within units was significantly related to overall safety competency. In relation to each of the three patient safety competencies, teamwork within and across units and supervisor or manager expectations were significantly related to attitudes, while teamwork within units and learning were significantly related to skills. Only organizational learning was significantly related to knowledge.

Conclusions: Although teamwork, leadership, and continuous learning in the nursing unit were major factors influencing RNs' safety competency, the relationships of these factors to patient safety attitudes, skills, and knowledge among RNs were varied.

Clinical Relevance: Creating a unit-specific patient safety culture that is tailored to the competencies of the unit's RNs in patient safety practice would be essential to enhance and maintain high levels of patient safety attitudes, skills, and knowledge among the unit's RNs, which would ultimately affect patient safety.
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http://dx.doi.org/10.1111/jnu.12413DOI Listing
September 2018

Evaluation of the LC-1000 Flow Cytometry Screening System for Cervical Cancer Screening in Routine Health Checkups.

Acta Cytol 2018 29;62(4):279-287. Epub 2018 May 29.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Republic of Korea.

Objective: This study evaluated the performance of a flow cytometry system (LC-1000) in screening cervical precancerous lesions at routine health checkups.

Study Design: In total, 928 health examinees were enrolled at 16 health promotion centers in 13 Korean cities between 2016 and 2017. All participants underwent liquid-based cervical cytology and flow cytometry testing to determine the cell proliferation index (CPIx).

Results: The positivity rate of the LC-1000 system increased with the severity of the cervical cytology findings (p for trend < 0.001). When low-grade squamous intraepithelial lesion (LSIL) or higher (including LSIL, high-grade squamous intraepithelial lesion [HSIL], and atypical squamous cells without excluding HSIL [ASC-H]) was defined as gold-standard positivity, the sensitivity, specificity, PPV, and NPV of LC-1000 were 75.3% (95% confidence interval [CI], 66.8-83.7), 58.5% (95% CI, 55.2-61.9), 18.1% (95% CI, 14.5-21.8), and 95.1% [95% CI, 93.2-97.0], respectively. The median CPIx increased significantly from normal cytology to HSIL (p < 0.001). The median CPIx was higher in high-risk human papillomavirus (HR-HPV)-positive cases than in HR-HPV-negative cases (0.23 vs. 0.17, p < 0.001), while it did not differ between HR-HPV-positive and HR-HPV-negative cases with normal cytology findings (0.16 vs. 0.16, p = 0.700).

Conclusion: The LC-1000 system is potentially useful for screening cervical precancer and cancer, especially when excluding normal or ASC of undetermined significance cases in routinely screened populations.
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http://dx.doi.org/10.1159/000489079DOI Listing
August 2018

Comparison of Traditional and Reverse Syphilis Screening Algorithms in Medical Health Checkups.

Ann Lab Med 2017 Nov;37(6):511-515

Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul, Korea.

Background: The syphilis diagnostic algorithms applied in different countries vary significantly depending on the local syphilis epidemiology and other considerations, including the expected workload, the need for automation in the laboratory and budget factors. This study was performed to investigate the efficacy of traditional and reverse syphilis diagnostic algorithms during general health checkups.

Methods: In total, 1,000 blood specimens were obtained from 908 men and 92 women during their regular health checkups. Traditional screening and reverse screening were applied to the same specimens using automatic rapid plasma regain (RPR) and Treponema pallidum latex agglutination (TPLA) tests, respectively. Specimens that were reverse algorithm (TPLA) reactive, were subjected to a second treponemal test performed by using the chemiluminescent microparticle immunoassay (CMIA).

Results: Of the 1,000 specimens tested, 68 (6.8%) were reactive by reverse screening (TPLA) compared with 11 (1.1%) by traditional screening (RPR). The traditional algorithm failed to detect 48 specimens [TPLA(+)/RPR(-)/CMIA(+)]. The median TPLA cutoff index (COI) was higher in CMIA-reactive cases than in CMIA-nonreactive cases (90.5 vs 12.5 U).

Conclusions: The reverse screening algorithm could detect the subjects with possible latent syphilis who were not detected by the traditional algorithm. Those individuals could be provided with opportunities for evaluating syphilis during their health checkups. The COI values of the initial TPLA test may be helpful in excluding false-positive TPLA test results in the reverse algorithm.
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http://dx.doi.org/10.3343/alm.2017.37.6.511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587824PMC
November 2017

Human Papillomavirus Genotype Distribution Among 18,815 Women in 13 Korean Cities and Relationship With Cervical Cytology Findings.

Ann Lab Med 2017 Sep;37(5):426-433

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: The prevalence and genotype distribution of Human papillomavirus (HPV) infection vary depending on geographical region and the immunity provided by vaccines. This study aimed to clarify the recent prevalence and genotype distribution of HPV according to age and cervical cytology findings in Korea.

Methods: This study included 18,815 health examinees that underwent cervical cytology and HPV genotyping tests at 16 centers of Korean Association of Health Promotion in 13 cities in Korea, between January 2014 and October 2015. HPV was genotyped by using multiplex PCR (Anyplex II HPV 28, Seegene, Korea), which detects 19 high-risk HPVs (HR-HPV) and nine low-risk HPVs (LR-HPV).

Results: Overall HPV prevalence was 27.8%, with 22.2% HR-HPV and 11.4% LR-HPV. The five most common carcinogens were HPV 52 (3.2%), 58 (2.7%), 16 (2.0%), 56 (1.9%), and 51 (1.8%). The five most common HR-HPVs in normal cytology samples were HPV 53, 68, 70, 52, and 58, while HPV 16, 52, 58, 33, and 31 were prevalent in high grade squamous intraepithelial lesions (HSIL). In atypical squamous cells of undetermined significance (ASCUS), the prevalence of HR-HPV varied with age; it was highest in those aged <30 yr, declining to a minimum at age 50-59 yr, and then increasing in older women (P<0.05).

Conclusions: The prevalence and distribution of HR-HPV varied with age and cervical cytology findings. This information would be helpful in the development of cervical cancer prevention policies.
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http://dx.doi.org/10.3343/alm.2017.37.5.426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500742PMC
September 2017
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