So-Young Lee

Disease progression and the risk factor analysis for chronic hepatitis C

Background/Aims: The present study aimed to assess the incidence of advanced cirrhotic complications and to identify the risk factors associated with such complications in chronic hepatitis C.

Roles of Cognitive Characteristics in Tinnitus Patients

To investigate the cognitive characteristics that affect the emotional and functional distress caused by tinnitus and to decide and test the model to explain their relations, 167 patients with tinnitus, who visited Samsung Medical Center, Seoul, Korea between March 2001 and May 2002 were recruited. To examine their features related to tinnitus, the following scales were administered; Tinnitus-related basic questionnaire including dysfunctional beliefs, Tinnitus Handicap Inventory, State-Trait Anxiety Inventory, Anxious Thought and Tendencies, Self-Consciousness Scale, and modified catastrophic thought from Coping Strategies Questionnaire. The results showed that the duration of experiencing tinnitus was 4.7±7.1 yr, those who com-plained of hearing one sound were the most common (45.5%), and hearing sounds similarly described to whistling were the most common (22.5%). Also, there were significant correlations among tinnitus features, cognitive characteristics, and distresses from tinnitus. As a result of testing the model, Normed fit index, Incremental fit index, Tucker-Lewis index, and Comparative fit index were over .90, indicating that it is a good model, and Root mean square error of approximation showed a reasonable fit. Also, the direct effects of the trait or severity of tinnitus on distress did not appear to be significant, thus it appeared to be affecting indirectly through the cognitive characteristics. This result shows that cognitive interventions can be important for the psychological adaptations of tinnitus patients.

25-Hydroxyvitamin D Levels and Vascular Calcification in Predialysis and Dialysis Patients with Chronic Kidney Disease

Background/Aims: The role of vitamin D in the process of vascular calcification is unclear in patients with chronic kidney disease. We investigated whether serum 25-hydroxyvitamin D [25(OH)D] is associated with vascular calcification in predialysis and dialysis patients. Methods: We included 86 predialysis and 139 dialysis patients. The simple vascular calcification score (SVCS) was evaluated by examining plain X-rays of the pelvis and hands as described previously. The carotid-to-femoral pulse wave velocity (CF-PWV) was assessed with a commercially available device. Results: We found a high prevalence of vitamin D deficiency in our population (78.2%). Vascular calcification was present in 46.2% of all patients. Higher calcification (SVCS >3) was significantly associated with lower 25(OH)D levels in predialysis and dialysis patients. Multiple logistic regression analysis for SVCS >3 showed that 25(OH)D levels were negative independent predictors in predialysis (OR: 0.781; 95% CI: 0.623–0.908, p = 0.019) and dialysis patients (OR: 0.805; 95% CI: 0.749–0.853, p = 0.009). Lower 25(OH)D levels were associated with higher CF-PWV in predialysis patients, but this inverse relationship was no longer present in multivariate analysis. Conclusion: We showed an independent relationship between low serum 25(OH)D levels and vascular calcification in both predialysis and dialysis patients.

A preceding airway reaction to one allergen may lead to priming of the airway responses to another allergen.

This study aimed to determine whether a preceding airway response to one allergen leads to priming of the airway responses to another allergen. Twelve asthmatic children who had positive prick tests to two allergens, Dermatophagoides pteronyssinus (D.p.) and German cockroach (CR), participated in a randomized, placebo‐controlled crossover study. We performed two consecutive inhalation challenges, D.p. challenge being followed 48 h later by CR challenge. The effect of initial (D.p.) challenge on the early and late airway responses to the subsequent (CR) challenge (CR2) was examined by comparing the responses with those to CR challenge preceded by sham challenge (CR1). The geometric mean PD20 of CR allergen in the CR2 was 2.8 BU (breath unit) (range of 1 SD; 0.77‐10.4), which was 12.0‐fold less than that (33.7 BU, 10.8‐105.2) in the CR1. The administration of a 6.1–fold less dose (8.9 BU, 2.7‐28.8) in the CR2 than hi the CR1 (54.5 BU, 44.1‐69.3) provoked a similar degree of late‐phase reactions (18.7±7.3% vs 15.8 ± 9.6%). Our data indicated that the early‐ and late‐phase reactions to CR challenge were augmented by the preceding reaction to D.p. This suggests that a preceding airway response to one allergen may lead to priming, with enhancement of the early and late airway responses to the subsequent challenge with another allergen.

Winged Scapula Caused by Rhomboideus and Trapezius Muscles Rupture Associated with Repetitive Minor Trauma: A Case Report

We experienced a rare case of winged scapula that was caused by the rupture of the rhomboideus major and the lower trapezius muscles without any nerve injury in a 12 yr old female after she had carried a heavy backpack. Electrodiagnostic study revealed that the onset latencies, amplitudes and conduction velocities were normal in the long thoracic nerve, the spinal accessory nerve and the dorsal scapular nerve. The needle EMG findings were normal as well. An explorative operation was performed and the rupture of the rhomboideus major and lower trapezius muscles was detected. Direct surgical repair of the ruptured muscle was carried out and the deformity was corrected. The anatomical and functional restoration was satisfactorily accomplished.

Successful Pregnancy in a Patient with Autosomal Dominant Polycystic Kidney Disease on Long-Term Hemodialysis

Recent advances in dialysis and a multidisciplinary approach to pregnant patients with advanced chronic kidney disease provide a better outcome. A 38-yr-old female with autosomal dominant polycystic kidney disease (ADPKD) became pregnant. She was undergoing hemodialysis (HD) and her kidneys were massively enlarged, posing a risk of intrauterine fetal growth restriction. By means of intensive HD and optimal management of anemia, pregnancy was successfully maintained until vaginal delivery at 34.5 weeks of gestation. We discuss the special considerations involved in managing our patient with regard to the underlying ADPKD and its influence on pregnancy. Graphical Abstract

LOSS OF RESIDUAL RENAL FUNCTION WAS NOT ASSOCIATED WITH GLYCEMIC CONTROL IN PATIENTS ON PERITONEAL DIALYSIS

♦ Background: Better glycemic control has been reported to slow the progression of nephropathy in predialysis diabetic patients. However, the relationship between glycemic control and residual renal function (RRF) in patients on peritoneal dialysis (PD) is uncertain. ♦ Methods: 89 incident diabetic patients on PD were recruited from 5 centers. We measured glomerular filtration rate (GFR) and hemoglobin A1c (HbA1c) within 2 months (baseline) after the start of PD and at 6 and 12 months. GFR was calculated as the average of renal creatinine and urea clearances. We analyzed whether mean HbA1c was associated with change in GFR (ΔGFR) over 1 year. ♦ Results: During the first year of PD, ΔGFR was –1.7 ± 3.4 mL/min/1.73 m2 and was not affected by mean HbA1c. Acute hemodialysis before starting PD and mean arterial diastolic pressure were related to the decline of GFR in a multivariate analysis. ♦ Conclusion: Glycemic control was not associated with change in RRF in diabetic patients during the first year after starting PD.

PGC1α Activators Mitigate Diabetic Tubulopathy by Improving Mitochondrial Dynamics and Quality Control

Purpose. In this study, we investigated the effect of PGC1α activators on mitochondrial fusion, fission, and autophagic quality control in renal tubular cells in a diabetic environment in vivo and in vitro. We also examined whether the upregulation of PGC1α attenuates diabetic tubulopathy by normalizing mitochondrial homeostasis. Methods. HKC8 cells were subjected to high-glucose conditions (30u2009mM D-glucose). Diabetes was induced with streptozotocin (STZ, 50u2009mg/kg i.p. for 5 days) in male C57/BL6J mice. AICAR or metformin was used as a PGC1α activator. Results. Treatment with the PGC1α activators AICAR and metformin improved functional mitochondrial mass in HKC8 cells in high-glucose conditions. Moreover, in renal proximal tubular cells, increased PGC1α activity correlated with the reversal of changes in Drp1, Mfn1, and LC3-II protein expression in a high-glucose environment. Normalized mitochondrial life cycles resulted in low ROS production and reduced apoptosis. AICAR and metformin treatment effectively mitigated albuminuria and renal histopathology and decreased the expression of TGFβ1 and αSMA in the kidneys of diabetic mice. Conclusions. Our results demonstrate that increases in PGC1α activity improve diabetic tubulopathy by modulating mitochondrial dynamics and autophagy.

MTHFR C677T Polymorphism as a Risk Factor for Vascular Calcification in Chronic Hemodialysis Patients

Polymorphism of 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T is one of the suggested risk factors for atherosclerosis. However, few studies have reported on the relationship between MTHFR C677T polymorphism and vascular calcification (VC) in chronic hemodialysis patients. We investigated the relationship between the MTHFR C677T polymorphism and VC in 152 chronic hemodialysis patients. Patients with a TT genotype exhibited significantly higher VC scores than patients expressing CC and CT (P = 0.002). The prevalence of peripheral vascular disease increased with the incidence of MTHFR C677T mutations for all patients, and the incidence of cerebrovascular accidents also increased with the presence of mutations for young patients (≤ 60 yr) (P < 0.05). Patients with CT and TT genotypes had adjusted odds ratios for VC of 1.39 and 1.58, respectively (P < 0.05). In summary, these data suggest that the MTHFR C677T polymorphism affects the degree of VC in chronic hemodialysis patients.

The vitamin D analogue paricalcitol attenuates hepatic ischemia/reperfusion injury through down-regulation of Toll-like receptor 4 signaling in rats

Introduction Recent studies have revealed that vitamin D and its synthetic analogues have a protective effect on experimental ischemia/reperfusion (I/R) models in several organs, but little is known about its effect on the liver. The aim of this study was to evaluate the beneficial effects of vitamin D in a model of liver I/R in rats, focusing on Toll-like receptor (TLR) 4 signaling, which has been shown to be involved in I/R injury. Material and methods Twenty-four male Wistar rats were randomized into four groups: Saline + Sham, Saline + I/R, Paricalcitol + Sham, and Paricalcitol + I/R. A synthetic vitamin D2 analogue, paricalcitol, was intraperitoneally injected 24 h prior to surgery. The animals were subjected to 60 min of partial warm ischemia (70%), followed by reperfusion for 6 h on the same day. The ischemic lobe of the liver and blood were collected for molecular biochemical analyses. Results Liver damage following I/R was diminished by pretreatment with paricalcitol. Pretreatment with paricalcitol decreased the levels of pro-inflammatory mediators, such as interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and macrophage migration inhibitory factor (MIF), in both plasma and liver tissue. In addition, pretreatment with paricalcitol markedly down-regulated the expression of TLR4, HMGB1, TNF-α and NF-κB. Conclusions The vitamin D analogue paricalcitol attenuates hepatic I/R injury through down-regulation of the TLR4 signaling pathway and might be considered to be a potential nutritional therapeutic agent against I/R injury in the liver.