High triglyceride-glucose index is associated with subclinical cerebral small vessel disease in a healthy population: a cross-sectional study

The triglyceride-glucose (TyG) index is a marker of insulin resistance (IR) and has been associated with various metabolic syndromes, cardiovascular diseases, and cerebrovascular diseases. However, limited information is available regarding its association with subclinical cerebral small vessel disease (cSVD). In this study, we evaluated the relationship between the TyG index and cSVD, including silent brain infarcts (SBIs) and white matter hyperintensity (WMH). We assessed health check-up participants aged 40–79years from 2006 to 2013. The TyG index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. The Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was also calculated. This was compared with two insulin surrogates and cSVD as another IR indicator and compared the association between two insulin surrogates and cSVD. SBI was measured for both prevalence and burden. The WMH volume was quantitatively rated using a computer-assisted semi-automated technique. Results A total of 2615 participants were evaluated (median age: 56years, male sex: 53%). In the multivariable logistic regression analysis, the TyG index was seen to be associated with SBI prevalence (adjusted odds ratio: 1.39; 95% confidence interval [CI] = 1.06–1.81). Further quantitative analyses showed a positive dose–response relationship between the TyG index and SBI burden (P for trend = 0.006). In multivariable linear regression analysis, the TyG index was also found to be related to the volume of WMH (β = 0.084; 95% CI = 0.013 to 0.154). Additionally, the TyG index showed a similar or slightly stronger association with the prevalence of SBI and the volume of WMH than did HOMA-IR. A high TyG index was associated with a higher prevalence and burden of cSVD in a neurologically healthy population. This marker of IR could be a convenient and useful predictor of cSVD

High triglyceride/HDL cholesterol ratio is associated with silent brain infarcts in a healthy population

Background Triglycerides (TG)/high-density lipoprotein (HDL) cholesterol ratio is a marker of small/dense low-density lipoprotein particles, which are closely associated with various metabolic and vascular diseases. However, the role of TG/HDL cholesterol ratio in cerebrovascular diseases has not been well studied. In this study, we evaluated the relationship between TG/HDL cholesterol ratio and the presence of silent brain infarct (SBI) in a neurologically healthy population. Methods We retrospectively evaluated consecutive participants in health check-ups between January 2006 and December 2013. SBI was defined as an asymptomatic, well-defined lesion with a diameter of ≥3 mm on T1- or T2-weighted images. TG/HDL cholesterol ratio was calculated after dividing absolute TG levels by absolute HDL cholesterol levels. Results Of 3172 healthy participants, 263 (8.3%) had SBI lesions. In multivariate analysis, TG/HDL cholesterol ratio was independently associated with SBI (adjusted odds ratio [aOR] = 1.16, 95% confidence interval [CI] = 1.00 to 1.34, P = 0.047). This association was prominent in males (aOR = 1.23, 95% CI = 1.03 to 1.48, P = 0.021), but not in females. In the analyses of the relationships between lipid parameters and SBI lesion burden, TG/HDL cholesterol ratio was positively correlated, and total cholesterol/TG ratio was negatively correlated with SBI lesion burden, in dose-response manners (P for trend = 0.015 and 0.002, respectively). Conclusions The TG/HDL cholesterol ratio was positively associated with the prevalence of SBI in a neurologically healthy population

Exploring the Category and Use Cases on Digital Therapeutic Methodologies

Objectives As the Fourth Industrial Revolution advances, there is a growing interest in digital technology. In particular, the use of digital therapeutics (DTx) in healthcare is anticipated to reduce medical expenses. However, analytical research on DTx is still insufficient to fuel momentum for future DTx development. The purpose of this article is to analyze representative cases of different types of DTx from around the world and to propose a classification system. Methods In this exploratory study examining DTx interaction types and representative cases, we conducted a literature review and selected seven interaction types that were utilized in a large number of cases. Then, we evaluated the specific characteristics of each DTx mechanism by reviewing the relevant literature, analyzing their indications and treatment components. A representative case for each mechanism was provided. Results Cognitive behavioral therapy, distraction therapy, graded exposure therapy, reminiscence therapy, art therapy, therapeutic exercise, and gamification are the seven categories of DTx interaction types. Illustrative examples of each variety are provided. Conclusions Efforts from both the government and private sector are crucial for success, as standardization can decrease both the expense and the time required for government-led DTx development. The private sector should partner with medical facilities to stimulate potential demand, carry out clinical research, and produce scholarly evidence

Developing a biological age assessment equation using principal component analysis and clinical biomarkers of aging in Korean men

The purpose of the present study is to find clinically useful candidate biomarkers of aging,and using these to develop an equation measuring biological age(BA) in Korean men, then to validate the clinical usefulness of it. Among 4288 men who received medical health examinations, we selected 1588 men who met the normality criteria of each variable. We assumed that chronological ages (CA) of healthy persons represent the BA of them. Variables showing significant correlations with CA were selected. Redundant variables were excluded. We selected 11 variables: VO(2)max, percent body fat (%BF), waist circumference (WC), forced expiratory volume in 1s (FEV1), systolic blood pressure (SBP), low density cholesterol (LDLCH), blood urea nitrogen (BUN), serum albumin (SA), erythrocyte sedimentation rate(ESR) hearing threshold (HT), and glycosylated hemoglobin (HBA1C). These 11 variables were then submitted into principal component analysis (PCA) and standardized BA scores were obtained. Using them and T-scale idea, the following equation to assess BA was developed: BA= -28.7+0.83(%BF)+0.48(WC)+0.13(SBP)- 0.27(VO(2)max)+ 0.19(HT)-3.1(FEV1)+0.32(BUN)+0.06(LDLCH)-3.0(SA)+0.34(ESR)+ 4.6(HBA1C). We compared the BA of 3122 men by their fasting glucose and age level. The BA of the higher glucose level group was significantly higher than that of others at all CA levels. the selected 11 biomarkers encompassed known clinically important factors of adult diseases and functional disabilities. This BA assessment equation can be used in the general Korean male Population and it proved to be clinically useful. (C) 2008 Elsevier Ireland Ltd. All rights reserved.NAKAMURA E, 1994, EXP GERONTOL, V29, P151COOK NR, 1991, AM J EPIDEMIOL, V133, P784GATES GA, 1990, EAR HEARING, V11, P247LIGTHART GJ, 1990, MECH AGEING DEV, V55, P89FOZARD JL, 1990, J GERONTOL, V45, P116HOCHSCHILD R, 1990, J GERONTOL, V45, P187HOCHSCHILD R, 1989, EXP GERONTOL, V24, P289NAKAMURA E, 1988, MECH AGEING DEV, V46, P1FLEG JL, 1988, J APPL PHYSIOL, V65, P1147BURT VL, 1995, HYPERTENSION, V25, P305McClearn GE, 1997, EXP GERONTOL, V32, P87Nakamura E, 1998, EXP GERONTOL, V33, P421KRUTKO VN, 2001, FIZIOL CHELOVEKA, V27, P88KRUTKO VN, 2002, FIZIOL CHELOVEKA, V28, P95ERLICHMAN J, 2002, OBES REV, V3, P257UENO LM, 2003, J PHYSL ANTHR APPL H, V22, P37Andresdottir MB, 2003, AM J EPIDEMIOL, V158, P844, DOI 10.1093/aje/kwg222Shaper AG, 2004, J CLIN EPIDEMIOL, V57, P195, DOI 10.1016/j.jclinepi.2003.07.001Stone NJ, 2005, AM J CARDIOL, V96, p53E, DOI 10.1016/j.amjcard.2005.06.006*ADA, 2007, DIABETES CARE S, V1, pS4Zhang XL, 2007, ARCH INTERN MED, V167, P886, DOI 10.1001/archinte.167.9.886BAKER GT, 1988, EXP GERONTOL, V23, P223DUBINA TL, 1984, EXP GERONTOL, V19, P133VOITENKO VP, 1983, EXP AGING RES, V9, P239DUBINA TL, 1983, EXP GERONTOL, V18, P5INGRAM DK, 1983, EXP AGING RES, V9, P225HOFECKER G, 1980, MECH AGEING DEV, V14, P345LUDWIG FC, 1980, EXP AGING RES, V6, P497WEBSTER IW, 1976, J GERONTOL, V31, P546FURUKAWA T, 1975, J GERONTOL, V30, P422HEIKKINE.E, 1974, GERONTOLOGY, V20, P33FRIEDEWA.WT, 1972, CLIN CHEM, V18, P499

Development of a pain assessment tool for the older adults in Korea: The validity and reliability of a Korean version of the geriatric pain measure (GPM-K)

The purpose of this study is to develop the GPM-K and test the validity and reliability of it. GPM-K is a multidimensional pain assessment instrument for older adults. One hundred twenty-one community-dwelling old adults aged 65 and older who expressed chronic pain were included. They completed GPM-K. The Korean version of the Brief Pain Inventory (BPI-K), Korean Mini-Mental State Examination (K-MMSE), Geriatric Depression Scale Short Form Korean version (GDSSF-K), Pain Management Index (PMI), and Elderly Life Stress Index (ELSI) were used to further validate the GPM-K. A standardized Cronbach`s alpha was 0.92, and average inter-item correlation was 0.32. Of those, who repeated the GPM-K within 2-4 weeks (n = 32), Pearson`s r correlation of test-retest reliability was statistically significant (r = 0.640). Correlation coefficient was highly significant between the GPM-K and mean pain severity of the BPI-K (r = 0.726, p < 0.001), and between the GPM-K and mean pain interference of the BPI-K (r = 0.698, p < 0.001), as well. The GPM-K was correlated with the GDSSF-K (r = 0.256), the ELSI (r = 0.312) and the PMI (r = -0.509). The GPM-K is a valid and useful instrument to assess pain and its related factors for the Korean older adults. (C) 2008 Elsevier Ireland Ltd. All rights reserved.*AGS PAN PERS PAIN, 1998, J AM GERIATR SOC, V56, P635KANG Y, 1997, J KOREAN NEUROL ASS, V15, P300Helme RD, 1996, CLIN GERIATR MED, V12, P563KEE BS, 1996, J KOREAN NEUROPSYCHI, V35, P298Gold DT, 2000, GERIATR NURS, V21, P270Ferrell BA, 2000, J AM GERIATR SOC, V48, P1669GERSTLE DS, 2001, PAIN MANAGEMENT NURS, V2, P98Blyth FM, 2001, PAIN, V89, P127Bergman S, 2001, J RHEUMATOL, V28, P1369Helme RD, 2001, CLIN GERIATR MED, V17, P417*AGS PAN PERS PAIN, 2002, J AM GERIATR SOC, V50, pS205Guitera V, 2002, NEUROLOGY, V58, P1062Ng KFJ, 2002, CLIN J PAIN, V18, P275Buskila D, 2000, J RHEUMATOL, V27, P1521CYNTHIA AY, 2003, REHABILIT PSYCHOL, V48, P4*JOINT COMM ACCR H, 2004, COMPR ACCR MAN AMB CYun YH, 2004, ONCOLOGY-BASEL, V66, P439, DOI 10.1159/000079497Meydani A, 2005, NUTR REV, V63, P233, DOI 10.1301/nr.2005.jul.223-246Panda M, 2006, AM J MED SCI, V332, P18*KOR NAT STAT OFF, 2007, LIF TABL KOR*KOR NAT STAT OFF, 2007, ELD PEOPL STATSmith BH, 2007, CLIN J PAIN, V23, P143CLEELAND CS, 1994, NEW ENGL J MED, V330, P592TURK DC, 1992, HDB PAIN ASSESSMENT, P1DAUT RL, 1983, PAIN, V17, P197MELZACK R, 1975, PAIN, V1, P277Skevington SM, 1998, PAIN, V76, P395Abbott FV, 1998, J PSYCHIATR NEUROSCI, V23, P13

Systemic immune-inflammation index is associated with white matter hyperintensity volume

Systemic immune-inflammation index (SII) is a novel inflammatory marker based on the composition ratio of blood cell counts. In this study, we evaluated the association between the SII and cerebral small vessel disease (cSVD) in health check-up participants. We evaluated participants from our health check-up registry between 2006 and 2013. The SII was calculated using the following formula: SII = (platelet count x neutrophil count)/lymphocyte count. cSVD was assessed by considering white matter hyperintensity (WMH) volume, lacunes, and cerebral microbleeds (CMBs). A total of 3187 participants were assessed. In multivariable linear regression analysis, the SII was significantly related to WMH volume [beta = 0.120, 95% confidence interval (CI) 0.050-0.189]. However, lacunes and CMBs showed no statistical significance with the SII. In the subgroup analysis by age, the SII was significantly associated with WMH volume only in participants aged &gt;= 60 years (beta = 0.225, 95% CI 0.068-0.381). In conclusion, a high SII was associated with cSVD. Since this association was more pronounced in WMH than in lacunes or CMBs, WMH might be closer to the inflammation-related pathological mechanisms.N

Association of Body Shape Index with Cerebral Small Vessel Disease

Introduction: A body shape index (ABSI) is an anthropometric index designed to reflect the influence of visceral fat. ABSI has been previously associated with various atherosclerosis, metabolic diseases, and cardiovascular diseases; however, relatively few studies have been conducted on cerebrovascular disease. In this study, we evaluated the association between ABSI and cerebral small vessel disease (cSVD) in health check-up participants. Methods: We evaluated consecutive health check-up participants between January 2006 and December 2013. As subtypes of cSVD, we quantitatively measured the volume of white matter hyperintensity (WMH) and qualitatively measured the presence of silent brain infarct (SBI) and cerebral microbleed (CMB). ABSI was calculated according to the following formula: ABSI (m11/6/kg-2/3) = waist circumference (m) / [body mass index (kg/m2)2/3 × height (m)1/2]. Results: A total of 3,219 health check-up participants were assessed (median age, 56 years; male sex, 54.0%). In the multivariable analysis, ABSI was significantly associated with WMH volume (β = 0.107, 95% confidence interval [CI] = 0.013 to 0.200), SBI (adjusted odds ratio [aOR] = 1.62, 95% CI = 1.14-2.31) and CMB (aOR = 1.64, 95% CI = 1.16-2.33) after adjusting for confounders (per 100 m11/6/kg-2/3). Furthermore, ABSI showed a dose-response relationship with the burden of each cSVD pathology. Conclusions: High ABSI was associated with a higher burden of cSVD in health check-up participants. As ABSI showed close associations with all subtypes of cSVD, visceral fat may be a common risk factor penetrating cSVD pathologies

Data from: Serum homocysteine level is related to cerebral small vessel disease in a healthy population

Objective: To evaluate the relationship between serum total homocysteine (tHcy) levels and cerebral small vessel disease (cSVD) in a healthy population. Methods: We included consecutive participants who visited our department for health check-ups between 2006 and 2013. We rated white matter hyperintensity (WMH) volumes using both the Fazekas score and semi-automated quantitative methods. We also evaluated lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs) which are involved in cSVD. To assess the dose-dependent relationship between tHcy and cSVD parameters, we scored the burdens of each radiological marker of cSVD. Results: A total of 1,578 participants were included (age: 55 ± 8 years, male sex: 57%). In the multivariable analysis, tHcy remained an independent predictor of the WMH volume (B = 0.209; 95% confidence interval [CI] = 0.033 to 0.385, P = 0.020), presence of CMBs (adjusted odds ratio [aOR] = 2.800; 95% CI = 1.104 to 7.105, P = 0.030), and moderate-to-severe EPVSs (aOR = 5.906; 95% CI = 3.523 to 9.901, P < 0.001) after adjusting for confounders. Furthermore, tHcy had positive associations with periventricular Fazekas score (P = 0.001, P for trend < 0.001), subcortical Fazekas score (P = 0.003, P for trend = 0.005), and moderate-to-severe EPVS lesion burden (P < 0.001, P for trend < 0.001) in a dose-dependent manner. Conclusions: Serum tHcy level is correlated with cSVD development in a dose-dependent manner. These findings provide us with clues for further studies of the pathophysiology of cSVD