A Meta-Analysis of the Efficacy and Safety of the 0.19 mg Fluocinolone Acetonide Implant in Non-Infectious Uveitis

Background/Objectives: The fluocinolone acetonide implant (FAI) is an intravitreal corticosteroid implant designed to have a therapeutic effect lasting up to 3 years. We performed a meta-analysis to investigate the efficacy and safety of the FAI (0.19 mg, releasing at 0.2 mug/day) in patients with non-infectious uveitis. Methods: The PubMed, EMBASE, and Cochrane Library databases were last searched on 6 September 2024. Studies comparing FAI with sham injections were investigated. The primary outcome was the recurrence of uveitis. Secondary outcomes included visual acuity, intraocular pressure (IOP), and occurrence of cataracts. Results: Significantly more patients in the FAI group experienced no uveitis recurrence for up to 36 months compared to the sham group, with a relatively lower number of recurrences. Systemic adjuvant therapy was similar between groups, while fewer patients required local rescue injections in the FAI group (95% confidence interval (CI): -2.91 to -1.70). Visual acuity changes and the proportion of eyes with >/=15 letters gain were not significantly different between the groups. More patients needed cataract surgery in the FAI group (95% CI: 0.68-1.96). No differences were observed in IOP change, final IOP, or treatment-requiring events related to an increased IOP. However, more subjects experienced events of IOP > 25 mmHg with the FAI (95% CI: 0.73 to 2.14). Conclusions: The 0.19 mg FAI was effective in preventing uveitis recurrence, and reduced the need for local injections. No significant impacts were noted in terms of systemic therapy, visual improvement, or most IOP-related complications

Tumor Regulatory Effect of 15-Hydroxyprostaglandin Dehydrogenase (HPGD) in Triple-Negative Breast Cancer

Prostaglandin regulation is known to play a pivotal role in tumorigenesis; however, the contributions of the prostaglandin-metabolizing enzyme 15-hydroxyprostaglandin dehydrogenase (HPGD) to cancer development remain poorly understood. In this study, we investigate the effects of HPGD on cell viability, proliferation, anchorage-independent growth, and migration in triple-negative breast cancer (TNBC), an aggressive subtype of breast cancer. Overexpression of HPGD in human TNBC cells resulted in both positive and negative regulation of cell proliferation and colony formation, with these effects occurring independent of prostaglandin E2 (PGE(2)). In contrast, overexpression of the mouse homolog, Hpgd, in murine TNBC cells led to a consistent but modest reduction in cell viability and colony formation, indicating that HPGD activity varies depending on species and cell line context. Notably, TNBC cells expressing a mutant form of Hpgd (Hpgd(mut)), which lacks the ability to bind PGE(2), exhibited similar functional outcomes in cell viability and colony formation as those expressing wild-type Hpgd (Hpgd(WT)). These findings suggest that HPGD may exert its tumorigenic effects through non-enzymatic mechanisms, potentially by involving modulation of KRAS signaling in human TNBC cells. Our results highlight the diverse roles of HPGD in cancer biology, particularly in the context of TNBC, and point to non-enzymatic pathways as a significant aspect of its tumorigenic activity

Exposure-crossover observations of air pollution after large-scale fireworks in two Korean megacities, Seoul and Busan: Empirical evidence toward sustainable festivals

Firework burning can significantly contribute to emissions of ambient air pollutants such as particulate matters (PM), which might pose serious public health concerns. Nevertheless, environmental research and public health attention to this matter are limited in many countries, particularly in Korea where firework festivals remain popular in megacities. This study aimed to examine temporal and spatial patterns of ambient air pollution during large-scale firework festivals in two megacities of Korea, focusing on each event held in Seoul (the second highest population in the world, as a metropolitan area) and Busan (the second highest population in Korea) in 2023. We used self-matched exposure-crossover design to compare ambient air pollution trends on exposure-event days (firework festival dates) with those on reference days (one week before and after festival dates) to evaluate a sole contribution of firework display. We analyzed data from air quality monitoring stations and visualized spatiotemporal changes in concentrations of air pollutants (i.e., PM(2.5), PM(10), and SO(2)) during the festival period. Analysis of the Seoul festival revealed significant increases in PM(2.5) and PM(10) concentrations following fireworks, with peaks reaching 320 and 371 mug/m(3). Similar patterns were observed after the Busan festival, with peak concentrations of 241 and 253 mug/m(3) for PM(2.5) and PM(10). These concentrations were 7.4-12.2 times higher than those observed on reference days. Spatiotemporal analysis demonstrated that PM(2.5) and PM(10) emitted from fireworks dispersed in the direction of wind. In contrast to high increases in PM(2.5) and PM(10), SO(2) levels showed light increases after both festivals, with a peak concentration of 4.9 ppb in Seoul and 5.7 ppb in Busan. Considering the estimated attendance of about a million at each festival and the high-density population area around two firework locations, the potential health risk posed by firework-related air pollution is a significant public health concern

Effectiveness of adding glucagon-like peptide-1 receptor agonist on diabetes complications and mortality among basal insulin-treated people with type 2 diabetes: A real-world Korean study

AIMS: To compare the effectiveness of adding a glucagon-like peptide-1 receptor agonist (GLP-1RA) on composite of diabetes-related complications and mortality with that of adding short-acting insulin (SAI) or shifting to premixed insulin among basal insulin (BI)-treated individuals with type 2 diabetes mellitus (T2DM) in South Korea. METHODS: From the Health Insurance Review and Assessment Service database, individuals with T2DM who initiated BI treatment and had advanced their treatment regimen from July 1, 2012, to December 31, 2018. RESULTS: A total of 38,634 individuals with T2DM were included in this study. Compared to adding SAI to BI, adding GLP-1RA was associated with decreased risks of cardiovascular complications (hazard ratio 0.56; 95 % confidence interval 0.43-0.72), severe microvascular complications (0.30; 0.19-0.48), diabetes-related hospitalization (0.62; 0.53-0.73), and all-cause mortality (0.27; 0.13-0.57). Compared to switching to premixed insulin, adding GLP-1RA was also associated with lower risk of cardiovascular complications (0.65; 0.51-0.84), severe microvascular complications (0.36; 0.22-0.58), diabetes-related hospitalization (0.62; 0.53-0.73), and all-cause mortality (0.32; 0.15-0.67). CONCLUSIONS: In this real-world Korean study, adding GLP-1RA to BI reduced risks of diabetes complications and all-cause mortality than adding SAI or shifting to premixed insulin

Talar Allografts in Tibiotalocalcaneal Arthrodesis: A Salvage Approach for Complex Hindfoot Pathologies

Background: Tibiotalocalcaneal (TTC) arthrodesis using talar allografts has emerged as a viable surgical option for managing complex hindfoot pathologies, including post-traumatic avascular necrosis (AVN), infection-related complications, and failed total ankle replacement (TAR). These conditions present significant therapeutic challenges due to extensive bone loss and joint instability. Previous reports have focused on TTC arthrodesis using talar allografts, highlighting its potential to provide enhanced structural support. This study aims to further evaluate the efficacy and safety of this surgical approach by assessing union, clinical outcomes, and complications in a diverse patient population. Methods: This retrospective study reviewed 11 patients who underwent TTC arthrodesis with talar allograft between January 2020 and November 2022. The study cohort included patients with post-traumatic AVN, infection-related complications, and failed TAR. Preoperative and postoperative evaluations included X-rays, computed tomography scans, and functional outcome scores such as the Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS). Results: This study included 11 patients who underwent surgical treatment between January 2020 and November 2022, with a minimum follow-up of 24 months and a mean follow-up of 33.45 months (range, 24-50 months). Successful arthrodesis was observed in nine patients, yielding a success rate of 82%. Significant improvements in functional outcomes were noted, including marked reductions in pain and enhanced activity levels, as evaluated by VAS and FAOS scores. Two patients demonstrated radiographic nonunion (one tibiotalar, one subtalar), but both remained asymptomatic and did not require revision surgery. No other complications such as infection, wound issues, or thromboembolism were observed. Immediate postoperative radiographs confirmed appropriate allograft alignment and placement. Conclusions: TTC arthrodesis using structural talar allografts may be a viable and safe option for managing severe hindfoot pathology, potentially resulting in satisfactory fusion rates and clinical outcomes

Therapeutic Potential of Arginine-Loaded Red Blood Cell Nanovesicles Targeting Obese Asthma

Purpose: The role of the gut microbiomes has been emphasized in the pathogenesis of obese asthma (OA). However, the molecular mechanism of airway dysfunction underlying OA has not yet been fully elucidated. The effects of microbiomes on arginine metabolism in relation to lung functions and a novel method for delivering arginine to lung tissue based on arginine-loaded red blood cell (RBC)-derived nanovesicles (NVs) (NV(Arg)) will be investigated. Materials and Methods: Inflammatory status, amino acid profiles, and microbial diversity were evaluated in 20 adult patients with OA compared to 30 adult patients with non-OA (NOA) and 10 healthy control (HC) groups. Changes in gut or lung microbial composition that altered arginine metabolism in relation to airway inflammation were investigated in an OA mouse model in vivo. Additionally, this study evaluated the delivery of arginine to lung tissue utilizing NV(Arg) in vivo and in vitro. Results: Significantly increased Bacteroides abundance but decreased serum arginine concentration with lower forced exhaled volume at 1 s (FEV(1)) (%) was noted in the OA group compared to the NOA and HC groups. In mouse experiments, when OA mice were given living bacteria from normal control (NC) mice, lung arginine concentration and airway resistance were restored. However, the administration of arginine or its metabolite (citrulline) did not increase the arginine levels in the lung tissues. We therefore created NV(Arg), which successfully delivered arginine into the cytoplasm of the airway epithelial cell line in vitro. Oral administration of NV(Arg) for OA mice significantly induced the AMP-activated protein kinase (AMPK) and endothelial nitric oxide synthase (eNOS) pathways in airway epithelial cells, which reduced airway resistance and inflammation. Conclusion: These findings suggest that microbiomes contribute to airway dysfunction by regulating arginine metabolism, whereas NV(Arg) treatment may be a potential option for managing OA

Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Connective Tissue Disease Associated Interstitial Lung Disease

Connective tissue disease (CTD), comprising a range of autoimmune disorders, is often accompanied by lung involvement, which can lead to life-threatening complications. The primary types of CTDs that manifest as interstitial lung disease (ILD) include rheumatoid arthritis, systemic sclerosis, Sjogren's syndrome, mixed CTD, idiopathic inflammatory myopathies, and systemic lupus erythematosus. CTD-ILD presents a significant challenge in clinical diagnosis and management due to its heterogeneous nature and variable prognosis. Early diagnosis through clinical, serological, and radiographic assessments is crucial for distinguishing CTD-ILD from idiopathic forms and for implementing appropriate therapeutic strategies. Hence, we have reviewed the multiple clinical manifestations and diagnostic approaches for each type of CTD-ILD, acknowledging the diversity and complexity of the disease. The importance of a multidisciplinary approach in optimizing the management of CTD-ILD is emphasized by recent therapeutic advancements, which include immunosuppressive agents, antifibrotic therapies, and newer biological agents targeting specific pathways involved in the pathogenesis. Therapeutic strategies should be customized according to the type of CTD, the extent of lung involvement, and the presence of extrapulmonary manifestations. Additionally, we aimed to provide clinical guidance, including therapeutic recommendations, for the effective management of CTD-ILD, based on patient, intervention, comparison, outcome (PICO) analysis

Clinical Course and Prognosis of Long-Term Survivors of Hepatocellular Carcinoma

BACKGROUND AND AIMS: This study investigated the long-term prognosis and clinical course of patients who survived for more than 5 years after hepatocellular carcinoma (HCC) diagnosis. METHODS: This retrospective cohort study used data from the Korean National Health Insurance Service database. A total of 35,348 subjects newly diagnosed with HCC between January 2008 and December 2010 were followed up until December 2018. RESULTS: A total of 11,514 (32.6%) survived for 5 years after diagnosis of HCC among 35,348 patients diagnosed with HCC. Long-term survivors (>/= 5 years) had a higher proportion of females, younger age, more frequent aetiology of hepatitis B virus, less frequent liver cirrhosis, diabetes mellitus and hypertension, and received curative treatment more frequently than nonsurvivors (< 5 years). The additional 1-, 3- and 5-year cumulative survival probabilities were 90.7%, 77.6% and 68.4% respectively. Patients who underwent curative treatment as the first treatment for HCC showed a higher additional 5-year cumulative survival probabilities than those treated with noncurative therapy (74.5% vs. 64.2%). Among the long-term survivors, 44.4% underwent HCC retreatment 5 years after HCC diagnosis. The additional 5-year cumulative survival probability was 54.9% in the HCC retreatment group. The overall 5- and 10-year cumulative probabilities of second primary malignancies in long-term survivors were 15.36% and 27.54% respectively. The most frequent second primary malignancy was prostate cancer, followed by colorectal and pancreatic cancers. CONCLUSION: Our study highlights that a significant proportion of patients with HCC achieve long-term survival beyond 5 years, with favourable outcomes associated with curative treatments

Educational Needs and Priorities of People with Diabetes and Healthcare Providers in South Korea: A Mixed-Methods Study

Introduction: Effective self-care for managing diabetes requires culturally sensitive and patient-centered education. This study explored the educational needs and priorities of people with diabetes (PWD) and healthcare providers (HCPs). Method: A mixed-methods approach was employed with participants from a university-affiliated hospital in South Korea. Descriptive and content analyses were used for the questionnaire and interview data. Results: Both PWD (n=33) and HCPs (n=42) ranked diabetes-related side-effect management and medication purpose as the most important aspects of diabetes education. PWD had higher educational needs regarding diagnosed diseases and lifestyle modifications than HCPs. Three themes were revealed: incorporating lifestyle changes and medication taking, collaborating with HCPs and caregivers and providing care to meet person-centered mental health needs, and enhancing education on disease and complications. Discussion: Culturally sensitive and patient-centered education programs that recognize communal values, reflect individual preferences and needs, and promote lifestyle changes by leveraging technologies for Korean PWD are crucial