The prevalence of dementia is 2- to 7-fold higher among patients with end-stage kidney disease (ESKD) than among the general population; however, its clinical implications in this population remain unclear. Therefore, this study aimed to determine whether comorbid dementia increases mortality among older patients with ESKD undergoing newly initiated hemodialysis. Methods: We analyzed data from the Korean Society of Geriatric Nephrology retrospective cohort, which included 2,736 older ESKD patients (≥70 years old) who started hemodialysis between 2010 and 2017. Kaplan-Meier survival and Cox regression analyses were used to examine all-cause mortality between the patients with and without dementia in this cohort. Results: Of the 2,406 included patients, 8.3% had dementia at the initiation of dialysis; these patients were older (79.6 ± 6.0 years) than patients without dementia (77.7 ± 5.5 years) and included more women (male:female, 89:111). Pre-ESKD diagnosis of dementia was associated with an increased risk of overall mortality (hazard ratio, 1.503; p < 0.001), and this association remained consistent after multivariate adjustment (hazard ratio, 1.268; p = 0.009). In subgroup analysis, prevalent dementia was associated with mortality following dialysis initiation in female patients, those aged <85 years, those with no history of cerebrovascular accidents or severe behavioral disorders, those not residing in nursing facilities, and those with no or short-term hospitalization. Conclusion: A pre-ESKD diagnosis of dementia is associated with mortality following dialysis initiation in older Korean population. In older patients with ESKD, cognitive assessment at dialysis initiation is necessary.

Purpose: This study aimed to develop a four-hour food additive education program for elementary school students to provide them with accurate information on food additives. Methods: A survey was conducted among 133 elementary school students living in Gyeonggi Province to identify the level of food additive awareness. A four-hour food additive education program and educational materials (PPT, activity sheets, and teacher guidelines) were developed based on the results of the food additive awareness survey. The developed educational programs were based on the Theoretical Model of Stages of Behavior Change.An elementary school nutrition teacher conducted a pilot education for 83 elementary school students to evaluate the feasibility of the developed education program. A survey was conducted to evaluate the effectiveness and satisfaction of the pilot education program. Results: The results of the Food Additive Awareness Survey showed that only 42.1% of people were aware of food additives; 46.3% wanted to know more about food additives, and 54.3% required food additive education. Food coloring (44.7%) and artificial sweeteners (18.7%) were the most common food additives of interest. What they wanted to know about food additives was the safety of food additives (36.8%) and the role and function of food additives (20.3%). After the pilot training on food additives, the level of awareness of food additives was improved significantly, and the percentage of participants who recognized the need for food additive education and promotion increased. According to the satisfaction survey of the food additives education, the interest, understanding, real-life application, learning method, and content amount were approximately 90%. Conclusion The educational program developed through this study will change the negative perceptions of food additives in elementary school students to a positive one. It will do so by helping nutrition educators educate students on this important subject.

Tumor necrosis factor alpha (TNFalpha) is a multifunctional inflammatory cytokine that regulates various cellular and biological processes. Increased levels of TNFalpha have been implicated in a number of human diseases including diabetes and arthritis. Sympathetic nervous system stimulation via the beta2-adrenergic receptor (beta2AR) in osteoblasts suppresses osteogenic activity. We previously reported that TNFalpha up-regulates beta2AR expression in murine osteoblastic cells and that this modulation is associated with TNFalpha inhibition of osteoblast differentiation. In our present study, we explored whether TNFalpha induces beta2AR expression in human osteoblasts and then identified the downstream signaling pathway. Our results indicated that beta2AR expression was increased in Saos-2 and C2C12 cells by TNFalpha treatment, and that this increase was blocked by the inhibition of NF-kappaB activation. Chromatin immunoprecipitation and luciferase reporter assay results indicated that NF-kappaB directly binds to its cognate elements on the beta2AR promoter and thereby stimulates beta2AR expression. These findings suggest that the activation of TNFalpha signaling in osteoblastic cells leads to an upregulation of beta2AR and also that TNFalpha induces beta2AR expression in an NF-kappaB-dependent manner.
Arthritis ; Biological Processes ; Chromatin Immunoprecipitation ; Durapatite ; Humans ; Luciferases ; NF-kappa B ; Osteoblasts ; Receptors, Adrenergic ; Sympathetic Nervous System ; Tumor Necrosis Factor-alpha ; Up-Regulation

Tumor necrosis factor alpha (TNFalpha) is a multifunctional cytokine that is elevated in inflammatory diseases such as atherosclerosis, diabetes and rheumatoid arthritis. Recent evidence has suggested that beta2 adrenergic receptor (beta2AR) activation in osteoblasts suppresses osteogenic activity. In the present study, we explored whether TNFalpha modulates betaAR expression in osteoblastic cells and whether this regulation is associated with the inhibition of osteoblast differentiation by TNFalpha. In the experiments, we used C2C12 cells, MC3T3-E1 cells and primary cultured mouse bone marrow stromal cells. Among the three subtypes of betaAR, beta2 and beta3AR were found in our analysis to be upregulated by TNFalpha. Moreover, isoproterenol-induced cAMP production was observed to be significantly enhanced in TNFalpha-primed C2C12 cells, indicating that TNFalpha enhances beta2AR signaling in osteoblasts. TNFalpha was further found in C2C12 cells to suppress bone morphogenetic protein 2-induced alkaline phosphatase (ALP) activity and the expression of osteogenic marker genes including Runx2, ALP and osteocalcin. Propranolol, a beta2AR antagonist, attenuated this TNFalpha suppression of osteogenic differentiation. TNFalpha increased the expression of receptor activator of NF-kappaB ligand (RANKL), an essential osteoclastogenic factor, in C2C12 cells which was again blocked by propranolol. In summary, our data show that TNFalpha increases beta2AR expression in osteoblasts and that a blockade of beta2AR attenuates the suppression of osteogenic differentiation and stimulation of RANKL expression by TNFalpha. These findings imply that a crosstalk between TNFalpha and beta2AR signaling pathways might occur in osteoblasts to modulate their function.
Alkaline Phosphatase ; Animals ; Arthritis, Rheumatoid ; Atherosclerosis ; Bone Morphogenetic Proteins ; Durapatite ; Mesenchymal Stromal Cells ; Mice ; Osteoblasts ; Osteocalcin ; Propranolol ; Receptor Activator of Nuclear Factor-kappa B ; Receptors, Adrenergic ; Tumor Necrosis Factor-alpha

BACKGROUNDS/AIMS: In patients with obstructive jaundice due to malignant biliary tract stricture, a tissue diagnosis is essential because the various treatment options are available. The tissue biopsy from the biliary tree is difficult because of the focal, sclerotic, small annular nature and lower celluarity. Brush cytology is an effective method for obtaining a tissue from bile duct stricture, and the diagnostic sensitivity of endoscopic brush cytology is reported as between 40% and 70% from malignant bile duct strictures. In this study, we analyzed the diagnostic value of endoscopic brush cytology in patient with extrahepatic bile duct strictures. METHODS: The eight patients with extrahepatic bile duct strictures diagnosed with endoscopic retrograde cholangiopancreatography underwent endoscopic brush cytology and aspiration bile cytology. Brushing were taken using a Greenen cytology brush passed with a guide wire through the stricture. RESULTS: The final diagnoses were made by surgical pathology and clinical follow-up. The sensitivity of brush cytology (62.5%, 5/8) was significantly higher than the sensitivity of bile cytology (0%; 0/8). No procedure related complication occured. CONCLUSIONS: Endoscopic brush cytology would be an effective and a relatively safe method for tissue diagnosis in patients with malignant biliary obstruction.
Bile ; Bile Ducts ; Bile Ducts, Extrahepatic ; Biliary Tract ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Humans ; Jaundice, Obstructive ; Pathology, Surgical

Acute gastric anisakiasis is caused by gastric mucosal penetration from an Anisakis larvae. It occurs with those who ingest raw or inadequately cooked saltwater fish or squid containing anisakis. The clinical symptoms are severe abdominal pain, nausea, vomiting, diarrhea, and so on. A case of acute gastric Anisakiasis with massive hematemesis was presented. Initial endoscopic examination revealed an edematous or raised erosive lesion with a small blood clot-covered vessel in the fundus which was thought to be a stigmata of recent bleeding. The lesion was treated with an epinephrine-hypertonic saline injection, electrocoagulation, and an ethanol injection. A follow-up gastroscopy revealed an artificial coagulation-induced ulcer at the previous bleeding site. At the ulcer margin, a whitish linear worm was found with half of its body penetrating the gastric mucosa. The worm was removed using biopsy forceps and the patient was subsequently placed on a soft diet. The next day however, hematemesis recurred. Gastroscopic band ligation of the vessel was performed with a cessation of bleeding. Three weeks later, a gastroscopy determined that the ulcer had completely healed.
Abdominal Pain ; Anisakiasis* ; Anisakis ; Biopsy ; Christianity ; Decapodiformes ; Diarrhea ; Diet ; Electrocoagulation ; Endoscopy ; Ethanol ; Follow-Up Studies ; Gastric Mucosa ; Gastroscopy ; Hematemesis* ; Hemorrhage ; Humans ; Larva ; Ligation ; Nausea ; Surgical Instruments ; Ulcer ; Vomiting

Although intestinal bleeding is known to occur in amyloidosis, it is rare as a presenting symptom or sole manifestation of the disease. We experienced a case of intestinal hemor-rhage in a 64-year old female patient with primary amyloidosis, kappa type. Antral muco-sal erosions were discovered and one shallow healing ulcer at the angle. Colonoscopy revealed multiple purplish nodules in the sigmoid colon and descending colon, as well as a large shallow ulcer with blood clots in the sigmoid colon which was suspected to be the intestinal hemorrhage site. Endoscopic biopsy established amyloidosis. Polarizing microscopy after Congo red staining and immunohistochemical staining identified primary amyloid, kappa type. A case of intestinal hemorrhage in patients with primary amyloidosis is presented and the literature is reviewed.
Amyloid ; Amyloidosis* ; Biopsy ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congo Red ; Female ; Hemorrhage* ; Humans ; Microscopy ; Middle Aged ; Ulcer

Carcinosarcoma of the stomach is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous components in a given tumor. Few cases have been reported since 1904. This is a case of carcinosarcoma of the stomach in a 61-year-old man. He suffered from indigestion, vomiting, and epigastric pain. Endoscopic finding showed a huge protruding mass with intact mucosa on the posterior wall of the antrum up to the pylorus. Surgery was performed and carcinosarcoma with pancreatic invasion was confirmed by pathology.
Carcinosarcoma* ; Dyspepsia ; Humans ; Middle Aged ; Mucous Membrane ; Pathology ; Pylorus ; Stomach ; Vomiting

Multiple primary malignancy is called when two cancers occur independently in one individual. Multiple primary malignancy may be divided into two groups, synchronous or metachronous depending on the interval between their diagnosis. Synchronous cancer is diagnosed simultaneously or within an interval of 6 months and metachronous cancer at interval of more than 6 months. Since Billroth reported the first case of multiple primary malignancy, many cases have been reported partly owing to the advancement of diagnostic procedures and treatment modalities. The incidence of multiple primary malignancy tends to increase and it is fundamental that patients who have been treated for cancer receive a careful follow-up study. Here we report on a case of stage-IV advanced gastric cancer with stage-I renal cell carcinoma which was discovered during the staging procedure of gastric cancer. Both cancers were confirmed histologically and classified as gastric adeno-carcinoma and renal cell carcinoma.
Carcinoma, Renal Cell ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Stomach ; Stomach Neoplasms*

Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis.
Adult ; Back Pain ; Diagnosis ; Drainage ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Hematemesis ; Humans ; Hyperkalemia ; Incidence ; Kidney Failure, Chronic ; Male ; Pleural Cavity* ; Rupture ; Sepsis ; Survival Rate