A case of hemophagocytic lymphohistiocytosis caused by an Epstein-Barr virus infection, presenting with unremitting fever and rash

Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome caused by excessive activation of lymphocytes and macrophages, leading to cytokine storm. Infection-associated HLH is most common, and Epstein-Barr virus is the leading triggers. Quick diagnosis is essential for starting the treatment before irreversible damage. We report a case of 16-year-old boy who presented with unremitted fever, jaundice, and erythematous maculopapular rash all over the body. Investigations showed thrombocytopenia, hyperferritinemia, hypertriglycemia, and the bone marrow biopsy showed hemophagocytosis. Epstein-Barr virus antibody was positive. He responded to chemotherapy as per the HLH-2004 protocol and supportive treatment, and was discharged without complication on day 17

Toll-Like Receptor 4 Decoy, TOY, Attenuates Gram-Negative Bacterial Sepsis

Lipopolysaccharide (LPS), the Gram-negative bacterial outer membrane glycolipid, induces sepsis through its interaction with myeloid differentiation protein-2 (MD-2) and Toll-like receptor 4 (TLR4). To block interaction between LPS/MD-2 complex and TLR4, we designed and generated soluble fusion proteins capable of binding MD-2, dubbed TLR4 decoy receptor (TOY) using ‘the Hybrid leucine-rich repeats (LRR) technique’. TOY contains the MD-2 binding ectodomain of TLR4, the LRR motif of hagfish variable lymphocyte receptor (VLR), and the Fc domain of IgG1 to make it soluble, productive, and functional. TOY exhibited strong binding to MD-2, but not to the extracellular matrix (ECM), resulting in a favorable pharmacokinetic profile in vivo. TOY significantly extended the lifespan, when administered in either preventive or therapeutic manners, in both the LPS- and cecal ligation/puncture-induced sepsis models in mice. TOY markedly attenuated LPS-triggered NF-κB activation, secretion of proinflammatory cytokines, and thrombus formation in multiple organs. Taken together, the targeting strategy for sequestration of LPS/MD-2 complex using the decoy receptor TOY is effective in treating LPS- and bacteria-induced sepsis; furthermore, the strategy used in TOY development can be applied to the generation of other novel decoy receptor proteins

Comparative Analysis Of Energy Expenditure Assessments From The Graded Exercise Test Vs. Galaxy Watch And Apple Watch In Korean College Students During A 30-minute Workout: A Pilot Study

OBJECTIVES In the modern era, there is heightened interest in understanding energy expenditure during exercise. Consequently, wearable devices such as the Galaxy Watch and Apple Watch have emerged as pivotal tools for daily health monitoring, given their convenience and increasing popularity. This study aimed to compare the calculated energy expenditure derived from the graded exercise test with readings from Galaxy and Apple Watches during a 30-min exercise session among Korean university students. Through this, we anticipate offering both motivation and clear insights into energy expenditure, thereby potentially aiding in weight management strategies for contemporary individuals. METHODS This study involved 27 college students from Korea National University of Transportation in Chungcheongbuk-do, Korea. We utilized COSMED's exercise load respiratory gas analysis system (Quark-CPET, COSMED, Rome, Italy), along with the Galaxy Watch (Galaxy Watch 5, Samsung, Seoul, Korea) and the Apple Watch (Apple watch series 5, Apple, Cupertino, USA) for measurements. Energy expenditure was monitored in real-time every 5 min throughout the 30-min exercise session. For statistical evaluations, we employed a one-way analysis of variance. Subsequent post-tests utilized the Tukey post-hoc test and Pearson correlation, with a significance level set at p0.05). Conversely, a notable difference was observed when comparing energy expenditure data from the graded exercise test to that of the Apple Watch for time intervals of 10, 15, 20, 25, and 30 min (p>0.05), although the 5-min interval did not exhibit a significant difference (p>0.05). Furthermore, a robust positive correlation was evident between the energy expenditure values derived from the graded exercise test and those from both the Galaxy Watch (r=0.952, p<0.001) and the Apple Watch (r=0.917, p<0.001). CONCLUSIONS Both devices demonstrated high reliability in calculating energy expenditure. Notably, the Galaxy Watch exhibited a more precise calculation compared to the Apple Watch, with a relative reliability margin of 3.5% higher. For individuals, especially those struggling with obesity, precise wearable devices that accurately reflect energy consumption can significantly boost motivation for exercise. Consequently, this study lays a foundation for future advancements in energy expenditure measurement tools, emphasizing enhanced convenience, reliability, and mobility

Fasting glucose variability and risk of dementia in Parkinson’s disease: a 9-year longitudinal follow-up study of a nationwide cohort

BackgroundDiabetes is associated with an increased risk of Parkinson’s disease dementia (PDD); however, it is unknown whether this association is dependent on continuous hyperglycemia, hypoglycemic events, or glycemic variability. We aimed to investigate the relationship between visit-to-visit fasting glucose variability and PDD development in patients with Parkinson’s disease (PD).MethodsUsing data from the Korean National Health Insurance Service, we examined 9,264 patients aged ≥40 years with de novo Parkinson’s disease (PD) who underwent ≥3 health examinations and were followed up until December 2019. Glucose variability was measured using the coefficient of variation, variability independent of the mean, and average real variability. Fine and Gray competing regression analysis was performed to determine the effect of glucose variability on incident PDD.ResultsDuring the 9.5-year follow-up period, 1,757 of 9,264 (19.0%) patients developed PDD. Patients with a higher visit-to-visit glucose variability had a higher risk of future PDD. In the multivariable adjusted model, patients with PD in the highest quartile (subdistribution hazard ratio [SHR] = 1.50, 95% CI 1.19 to 1.88), quartile 3 (SHR = 1.29, 95% CI 1.02 to 1.62), and quartile 2 (SHR = 1.30, 95% CI 1.04 to 1.63) were independently associated with a higher risk of PDD than those in the lowest quartile.ConclusionWe highlighted the effect of long-term glucose variability on the development of PDD in patients with PD. Furthermore, our findings suggest that preventive measures for constant glucose control may be necessary to prevent PDD

Ethanol Extract of Alismatis rhizome

The rhizome of Alisma orientale (Alismatis rhizome) has been used in Asia for promoting diuresis to eliminate dampness from the lower-jiao and to expel heat. In this study, an ethanol extract of the rhizome of Alisma orientale (AOE) was prepared and its effects on adipocyte differentiation of OP9 cells were investigated. Treatment with AOE in a differentiation medium for 5 days resulted in dose-dependent inhibition of lipid droplet formation in OP9 cells. Furthermore, AOE significantly inhibited adipocyte differentiation by downregulating the expression of the master transcription factor of adipogenesis, peroxisome proliferation-activity receptor γ (PPARγ), and related genes, including CCAAT/enhancer binding protein β (C/EBPβ), fatty acid-binding protein (aP2), and fatty acid synthase (FAS). AOE exerted its inhibitory effects primarily during the early adipogenesis stage (days 1-2), at which time it also exerted dose-dependent inhibition of the expression of C/EBPβ, a protein related to the inhibition of mitotic clonal expansion. Additionally, AOE decreased the expression of autophagy-related proteins, including beclin 1, and the autophagy-related genes, (Atg) 7 and Atg12. Our results indicate that AOE’s inhibitory effects on adipocyte differentiation of OP9 cells are mediated by reduced C/EBPβ expression, causing inhibition of mitotic clonal expansion and autophagy