PURPOSE: With growing number of obese children, the prevalence of nonalcoholic fatty liver disease (NAFLD) in pediatric population is increasing. Nonalcoholic steatohepatitis (NASH) is a severe form of NAFLD, and can cause morbid complications. It is important to identify patients in order to grade pathologic severities and treat those children who possibly have NASH. This study was performed to evaluate whether the pharmacological therapy is also effective as well as the body weight reduction in pediatric NAFLD. METHODS: Among the 52 children presenting with obesity and hepatopathy, NAFLD was diagnosed through liver biopsy in 29 children, who were 7 to 14 years of age, from January 2006 to December 2011. The patients were advised to reduce their body weight through diverse methods. Medication with Ursodeoxycholic acid (UDCA) and vitamin E was performed in children whose liver functions did not improve or their weight reductions were not successful. The therapeutic effects were monitored and assessed via the biochemical profiles and the physical measurements. RESULTS: The therapy of vitamin E and UDCA combined with body mass index (BMI) reduction showed significantly higher rate of improvement in clinical profiles, which could be seen in data of aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT ratio, alkaline phosphatase, total bilirubin and gamma-glutamyl transpeptidase. Children whose BMI were successfully reduced showed favorable clinical improvements without any medication, but those without BMI reduction did not show any improvement despite medications. CONCLUSION: This study showed that the first line of therapy should be the BMI reduction in NAFLD and drug therapy combined with BMI reduction could have additive therapeutic effect in children with NAFLD.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bilirubin ; Biopsy ; Body Mass Index ; Body Weight ; Child ; Fatty Liver ; gamma-Glutamyltransferase ; Humans ; Liver ; Obesity ; Prevalence ; Ursodeoxycholic Acid ; Vitamin E ; Vitamins ; Weight Loss

BACKGROUND: According to US-EPA report, the use of pyrethrins and pyrethroids has increased during the past decade, and their area of use included not only in agricultural settings, but in commerce, and individual household. It is known that urinary 3-PBA, major metabolite of pyrethroid, have some associations with health effect in nervous and endocrine system, however, there’s no known evidence that urinary 3-PBA have associations with obesity. METHOD: We used data of 3671 participants aged above 19 from the Korean National Environmental Health Survey in 2009–2011. In our analysis, multivariate piece-wise regression and logistic regression analysis were used to investigate the association between urinary 3-PBA (3-Phenoxybenzoic Acid) and BMI. RESULT: Log-transformed level of urinary 3-PBA had significantly positive association with BMI at the low-level range of exposure (p < 0.0001), and opposite associations were observed at the high level exposure (p = 0.04) after adjusting covariates. In piece-wise regression analysis, the flexion point that changes direction of the associations was at around 4 ug/g creatinine of urinary 3-PBA. As quintiles based on concentration of urinary 3-PBA increased to Q4, the ORs for prevalence of overweight (BMI ≥ 23 kg/m2) were increased, and the OR of Q5 was lower than that of Q4 (OR = 1.810 for Q4; OR = 1.483 for Q5). In the analysis using obesity (BMI ≥ 25 kg/m2) as outcome variable, significant associations were observed between obesity and quintiles of 3-PBA, however, there were no differences between the OR of Q5 and that of Q4 (OR = 1.659 for Q4; OR = 1.666 for Q5). CONCLUSION: Our analysis suggested that low-level of pyrethroid exposure has positive association with BMI, however, there is an inverse relationship above the urinary 3-PBA level at 4 ug/g creatinine. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40557-015-0079-7) contains supplementary material, which is available to authorized users.
Adult* ; Body Mass Index* ; Commerce ; Creatinine ; Endocrine System ; Environmental Health* ; Family Characteristics ; Humans ; Logistic Models ; Methods ; Multivariate Analysis ; Obesity ; Overweight ; Prevalence ; Pyrethrins

BACKGROUND: Gelsolin and matrix metalloproteinase 12 (MMP12) expression has been reported in Langerhans cell histiocytosis (LCH), but the clinical significance of this expression is unknown. We investigated the associations of these proteins with clinical manifestations in patients diagnosed with LCH. METHODS: We performed a retrospective analysis of clinical data from patients diagnosed with LCH and followed up between 1998 and 2008. Available formalin-fixed, paraffin-embedded specimens were used for gelsolin and MMP12 immunohistochemical staining. We analyzed the expression levels of these proteins and their associations with LCH clinical features. RESULTS: Specimens from 36 patients (20 males, 16 females) with a diagnosis of LCH based on CD1a positivity with clinical manifestations were available for immunohistochemical staining. Median patient age was 62 months (range, 5 to 207). The expression of gelsolin varied; it was high in 17 patients (47.2%), low in 11 patients (30.6%), and absent in 8 patients (22.2%). The high gelsolin expression group had a higher tendency for multi-organ and risk organ involvement, although the trend was not statistically significant. MMP12 was detected only in 7 patients (19.4%) who showed multi-system involvement (P=0.018) and lower event-free survival (P=0.002) in comparison to patients with negative MMP12 staining. CONCLUSION: Gelsolin and MMP12 expression may be associated with the clinical course of LCH, and MMP12 expression may be particularly associated with severe LCH. Further studies of larger populations are needed to define the precise role and significance of gelsolin and MMP12 in the pathogenesis of LCH.
Disease-Free Survival ; Gelsolin ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Immunohistochemistry ; Langerhans Cells ; Male ; Matrix Metalloproteinase 12 ; Proteins ; Retrospective Studies

BACKGROUND: Numerous studies have shown that healthcare professionals are exposed to psychological distress. However, since most of these studies assessed psychological distress using self-reporting questionnaires, the magnitude of the problem is largely unknown. We evaluated the risks of mood disorders, anxiety disorders, sleep disorders, and any psychiatric disorders in workers in healthcare industry using Korea National Health Insurance (NHI) claims data from 2014, which are based on actual diagnoses instead of self-evaluation. METHODS: We used Korea 2014 NHI claims data and classified employees as workers in the healthcare industry, based on companies in the NHI database that were registered with hospitals, clinics, public healthcare, and other medical services. To estimate the standardized prevalence of the selected mental health disorders, we calculated the prevalence of diseases in each age group and sex using the age distribution of the Korea population. To compare the risk of selected mental disorders among workers in the healthcare industry with those in other industries, we considered age, sex, and income quartile characteristics and conducted propensity scored matching. RESULTS: In the matching study, workers in healthcare industry had higher odds ratios for mood disorders (1.13, 95% CI: 1.11–1.15), anxiety disorders (1.15, 95% CI: 1.13–1.17), sleep disorders (2.21, 95% CI: 2.18–2.24), and any psychiatric disorders (1.44, 95% CI: 1.43–1.46) than the reference group did. Among workers in healthcare industry, females had higher prevalence of psychiatric disorders than males, but the odds ratios for psychiatric disorders, compared to the reference group, were higher in male workers in healthcare industry than in females. CONCLUSIONS: The prevalence of mood disorders, anxiety disorders, sleep disorders, and all psychiatric disorders for workers in the healthcare industry was higher than that of other Korean workers. The strikingly high prevalence of sleep disorders could be related to the frequent night-shifts in these professions. The high prevalence of mental health problems among workers in healthcare industry is alarming and requires prompt action to protect the health of the “protectors.”
Age Distribution ; Anxiety Disorders ; Delivery of Health Care ; Diagnosis ; Diagnostic Self Evaluation ; Female ; Health Care Sector ; Humans ; Korea ; Male ; Mental Disorders ; Mental Health ; Mood Disorders ; National Health Programs ; Odds Ratio ; Prevalence ; Sleep Wake Disorders

BACKGROUND: With the development of technology, extensive use of computers in the workplace is prevalent and increases efficiency. However, computer users are facing new harmful working conditions with high workloads and longer hours. This study aimed to investigate the association between computer use at work and self-reported depressive and anxiety disorder (DAD) in a nationally representative sample of South Korean workers. METHODS: This cross-sectional study was based on the third Korean Working Conditions Survey (2011), and 48,850 workers were analyzed. Information about computer use and DAD was obtained from a self-administered questionnaire. We investigated the relation between computer use at work and DAD using logistic regression. RESULTS: The 12-month prevalence of DAD in computer-using workers was 1.46 %. After adjustment for socio-demographic factors, the odds ratio for DAD was higher in workers using computers more than 75 % of their workday (OR 1.69, 95 % CI 1.30−2.20) than in workers using computers less than 50 % of their shift. After stratifying by working hours, computer use for over 75 % of the work time was significantly associated with increased odds of DAD in 20–39, 41–50, 51–60, and over 60 working hours per week. After stratifying by occupation, education, and job status, computer use for more than 75 % of the work time was related with higher odds of DAD in sales and service workers, those with high school and college education, and those who were self-employed and employers. CONCLUSIONS: A high proportion of computer use at work may be associated with depressive and anxiety disorder. This finding suggests the necessity of a work guideline to help the workers suffering from high computer use at work. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40557-016-0146-8) contains supplementary material, which is available to authorized users.
Anxiety Disorders* ; Anxiety* ; Commerce ; Cross-Sectional Studies ; Depressive Disorder ; Education ; Humans ; Logistic Models ; Occupations ; Odds Ratio ; Prevalence

PURPOSE: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. MATERIALS AND METHODS: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 µg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. RESULTS: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. CONCLUSION: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.
Acetylcholine ; Aged ; Angina Pectoris/diagnosis ; Calcium Channel Blockers/therapeutic use ; Cardiovascular Agents/*therapeutic use ; Coronary Angiography/adverse effects ; Coronary Artery Disease/prevention & control ; Coronary Vasospasm/diagnosis/*drug therapy ; Diltiazem/*therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/prevention & control ; Nitrates/*therapeutic use ; Propensity Score ; Time Factors ; Vasodilator Agents/therapeutic use

BACKGROUND AND OBJECTIVES: Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. SUBJECTS AND METHODS: A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. RESULTS: There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). CONCLUSION: Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.
Acetylcholine ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Smoke ; Smoking* ; Spasm ; Stroke ; Tobacco Products*