Association of body mass index with incident tuberculosis in Korea

<div><p>Introduction</p><p>Overweight or obesity might be protective factors of tuberculosis (TB), but the evidence is inconclusive. The objective of study was to evaluate association between BMI and incident TB.</p><p>Methods</p><p>The National Health Insurance database was used. Eligible participants were individuals aged 20–89 years without history of TB before 2007, and who underwent national health examinations between January 2002 and December 2006. The latest record of BMI was used as the exposure and categorized as follows: <18.5, 18.5–23, 23–25, 25–30, and ≥30 kg/m². TB was defined as the first recorded diagnosis of TB, using ICD-10 between January 2007 and December 2013.</p><p>Results</p><p>Among 301,081 individuals, 3,772 (1.26%) incident TB cases were detected. The incidence rate of the event was 19.65 per 10,000 person-years. After adjusting age, sex, household income, smoking status, alcohol use, and diabetes, incident TB was decreased as BMI was increased in an inverse dose-response relationship. However, when stratified by age and sex, BMI >30 kg/m² did not show protective effect of TB in female under 50 years. Additionally, BMI >30 kg/m² did not decrease incident TB in diabetics.</p><p>Conclusion</p><p>Our study suggests that high BMI might be associated with decreased risk of TB. However, very high BMI did not reduce the risk of TB in young females or diabetics participants with in Korean population.</p></div

Baseline characteristics of the cohort.

<p>Baseline characteristics of the cohort.</p

Effect of BMI on development of tuberculosis and subgroup analysis.

<p>Effect of BMI on development of tuberculosis and subgroup analysis.</p

Effect of BMI: Subgroup analysis by sex and smoking status.

<p>Effect of BMI: Subgroup analysis by sex and smoking status.</p

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis

<div><p>Background</p><p>Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis.</p><p>We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs.</p><p>Methods</p><p>A systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter.</p><p>Results</p><p>From 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) using the BR approach and 93% (95% CI, 90–96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88–95) was superior to the BR approach (66%, 95% CI: 55–76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach.</p><p>Conclusions</p><p>CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.</p></div

Beneficial Effect of Betulinic Acid on Hyperglycemia via Suppression of Hepatic Glucose Production

The inhibitory effect of betulinic acid (BA) on hepatic glucose production was examined in HepG2 cells and high fat diet (HFD)-fed ICR mice. BA significantly inhibited the hepatic glucose production (HGP) and gene expression levels of PGC-1α, PEPCK, and G6Pase. BA activated AMPK and suppressed the expression level of phosphorylated CREB. These effects were all abolished in the presence of compound C (an AMPK inhibitor). Moreover, inhibition of AMPK by overexpression of dominant negative AMPK prevented BA from suppression of HGP, indicating that the inhibitory effect of BA on HGP is AMPK-dependent. In addition, BA markedly phosphorylated CAMKK, and phosphorylation of AMPK and ACC, and suppression of HGP were all reversed in the presence of STO-609 (a CAMKK inhibitor), suggesting that CAMKK is an upstream kinase for AMPK. In an animal study, HFD-fed ICR mice were orally administered with 5 or 10 mg of BA per kg (B5 and B10) for three weeks. Plasma glucose, triglyceride, and the insulin resistance index of the B10 group were decreased by 34%, 59%, and 38%, respectively. In a pyruvate tolerance test, pyruvate-induced glucose excursion was decreased by 27% when mice were pretreated with 10 mg/kg of BA. In summary, BA effectively ameliorates hyperglycemia through inhibition of hepatic gluconeogenesis via modulating the CAMKK-AMPK-CREB signaling pathway

Characteristics of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.

<p>Characteristics of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.</p

Relationship between vancomycin trough level group and each factor.

<p>Relationship between vancomycin trough level group and each factor.</p

Complication rates of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.

<p>Complication rates of the included studies in the TBLB-rEBUS&VBN and CT-TNB groups.</p

Flow chart of the study population TDM, therapeutic drug monitoring; CVVHDF, continuous venovenous hemodiafiltration; PICU, pediatric intensive care unit; ECMO, extracorporeal membrane oxygenation.

<p>Flow chart of the study population TDM, therapeutic drug monitoring; CVVHDF, continuous venovenous hemodiafiltration; PICU, pediatric intensive care unit; ECMO, extracorporeal membrane oxygenation.</p