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The transfusion rate in staged bilateral total knee arthroplasty (TKA) remains high despite the application of blood management techniques. The potential of robotic arm-assisted TKA (R-TKA) in reducing the transfusion rate in staged bilateral surgery has not yet been investigated. Therefore, we aimed to evaluate the effectiveness of R-TKA on transfusion reduction compared with conventional TKA (C-TKA) in staged bilateral surgery. This retrospective study involved two groups of patients who underwent 1-week interval staged bilateral TKA—the C-TKA group and the R-TKA group—using MAKO SmartRobotics (Stryker, Kalamazoo, MI, USA). Each group comprised 53 patients after propensity score matching and was compared in terms of nadir hemoglobin (Hb) level and transfusion rate after each stage of surgery. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb level. The R-TKA group showed a significantly higher nadir Hb level than the C-TKA group after the second TKA (p = 0.002). The transfusion rate was not significantly different between the two groups after the first TKA (p = 0.558). However, the R-TKA group showed a significantly lower transfusion rate in the TKA (p = 0.030) and overall period (p = 0.023) than the C-TKA group. Patients who undergo staged bilateral R-TKA have lower transfusion rate than those who undergo C-TKA. R-TKA may be effective in minimizing unnecessary allogeneic transfusions in staged bilateral surgery.

Cadmium (Cd) is a ubiquitous environmental pollutant with an exceptionally long biological half-life. The liver is a major organ for Cd metabolism, but the toxicity of Cd is unclear. This study sought to determine whether blood Cd (BCd) level (representing recent exposure [months] to Cd) was associated with liver function in Korean adults, both cross-sectionally and longitudinally. The baseline cross-sectional study involved 2,086 adults (male: 908, female: 1,178) in 2010−2011, and 503 of them (male: 207, female: 296) were followed up in 2014−2015. BCd was measured by graphite-furnace atomic absorption spectrometry, and liver function indices (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and γ-glutamyltransferase [GGT]) were determined. Liver damage was defined as an abnormal elevation of more than one liver function index. The geometric mean of BCd (1.07 µg/L) was higher in females than in males (1.16 vs. 0.96 µg/L). Liver function indices increased significantly in a dose-dependent manner according to the BCd levels, except for ALT in males, and were higher in males than in females. BCd level was also associated with the risk of liver damage in both sexes. No significant changes in BCd were observed between baseline and follow-up. The liver function indices in 2014−2015 were comparable to those in 2010−2011 in males, while ALT and GGT were significantly increased in 2014−2015 compared to 2010−2011 in females with relatively high BCd. These findings suggest that even a low level of environmental Cd exposure, short- and long-term, may affect liver function, and females appear more susceptible than males.

Nonalcoholic fatty liver disease (NAFLD) is a condition of excess accumulation of fats in the liver. Thyroid dysfunction is commonly observed in adult populations with NAFLD. In subjects with thyroid dysfunction, phthalates, which are chemical compounds widely used to increase the flexibility of various plastic products, may increase the risk of NAFLD prevalence. Therefore, our study aimed to evaluate the relationship between the levels of urinary phthalate metabolites and the risk of NAFLD stratified by the levels of thyroid-stimulating hormone (TSH). Data (n = 2308) were obtained from the Korean National Environmental Health Survey II (2012–2014). Using the hepatic steatosis index, participants were classified into non-NAFLD (36) groups. Participants with euthyroidism were defined as 0.45–4.5 mIU/L for serum TSH and normal thyroxine (T4) levels (n = 2125). Subclinical hypothyroidism (SCH) was defined as a higher TSH level (4.5–10 mIU/L) with normal total T4 levels in the serum (n = 183). A multivariate analysis was performed to assess the association of the urinary phthalate concentration with the risk of NAFLD after stratification based on the thyroid hormone levels. The levels of phthalate metabolites in urine were not significantly associated with NAFLD in adults with euthyroidism. However, a significant increased risk of NAFLD in those with SCH was observed in the fourth quartile of mono (2-ethyl-5-hydroxyhexyl) phthalate (odds ratio (OR) 13.59, 95% confidence interval (CI) 12.13–86.44), mono (2-ethyl-5-oxohexyl) phthalate (OR 8.55, 95% CI 1.20–60.53), mono-(2-ethyl-5-carboxypentyl) phthalate (OR 9.06, 95% CI 1.78–45.96), and mono-benzyl phthalate (OR 6.05, 95% CI 1.62–22.54) compared to those of the lowest quartile after being adjusted with covariates. In conclusion, the levels of phthalate metabolites in urine are positively associated with NAFLD in adults with SCH. More experimental studies are needed to clarify the risk of NAFLD caused by phthalate exposure in cases with poor thyroid function.

Background Abdominal aortic calcification (AAC) may overestimate lumbar bone mineral density (BMD) examined by dual-energy X-ray absorptiometry (DXA); however, the degree of effect of AAC on lumbar BMD has not been quantified. In particular, no study has quantitatively compared and analysed segmental BMD and AAC using computed tomography (CT) scan. Thus, this study aimed to quantify the effect of AAC on BMD measurements using DXA via multiple linear regression analysis. Methods This study retrospectively reviewed participants >30 years of age who underwent DXA and spinal CT scans between 2014 and 2016. Variables that significantly affected the BMD of each lumbar segment were identified. Additionally, segmental facet joint arthritis (FJA) and AAC volume were evaluated using CT. Results A total of 620 subjects (153 males and 467 females) were included. The mean age was 71.6 ± 9.1 years (range, 31–89 years). AAC had the highest prevalence in L3 (45.2%), followed by L4 (41.1%). The average volume of AAC was the highest in L4 at 213.67 ± 443.82 mm3, followed by L3 at 161.95 ± 338.09 mm3. Our regression model found that Ln (L4BMD) was significantly correlated with age, BMI, FJA, and AAC volume in female subjects. Additionally, L4 BMD might be overestimated by approximately 0.90% for every 100 mm3 increase in AAC volume. The results for Ln (L3BMD) were almost identical. However, these relationships were not observed in males. Conclusion According to this model, AAC may overestimate lumbar BMD examined by DXA in a dose-dependent manner in females.

Background Critical bone defects remain challenges for clinicians, which cannot heal spontaneously and require medical intervention. Following the development of three-dimensional (3D) printing technology is widely used in bone tissue engineering for its outstanding customizability. The 3D printed scaffolds were usually accompanied with growth factors, such as bone morphometric protein 2 (BMP-2), whose effects have been widely investigated on bone regeneration. We previously fabricated and investigated the effect of a polylactic acid (PLA) cage/Biogel scaffold as a carrier of BMP-2. In this study, we furtherly investigated the effect of another shape of PLA cage/Biogel scaffold as a carrier of BMP-2 in a rat calvaria defect model and an ectopic ossification (EO) model. Method The PLA scaffold was printed with a basic commercial 3D printer, and the PLA scaffold was combined with gelatin and alginate-based Biogel and BMP-2 to induce bone regeneration. The experimental groups were divided into PLA scaffold, PLA scaffold with Biogel, PLA scaffold filled with BMP-2, and PLA scaffold with Biogel and BMP-2 and were tested both in vitro and in vivo. One-way ANOVA with Bonferroni post-hoc analysis was used to determine whether statistically significant difference exists between groups. Result The in vitro results showed the cage/Biogel scaffold released BMP-2 with an initial burst release and followed by a sustained slow-release pattern. The released BMP-2 maintained its osteoinductivity for at least 14 days. The in vivo results showed the cage/Biogel/BMP-2 group had the highest bone regeneration in the rat calvarial defect model and EO model. Especially, the bone regenerated more regularly in the EO model at the implanted sites, which indicated the cage/Biogel had an outstanding ability to control the shape of regenerated bone. Conclusion In conclusion, the 3D printed PLA cage/Biogel scaffold system was proved to be a proper carrier for BMP-2 that induced significant bone regeneration and induced bone formation following the designed shape.

Arsenic is a human carcinogen. Data on urinary arsenic species analyses of Koreans is limited. This study evaluated the arsenic exposure level, contributing factors, and health effects in Korean adults. Dietary intake information and urine samples were obtained from 2,044 participants. Arsenic exposure was assessed based on urinary concentrations of arsenic species, such as inorganic arsenic, As(III) and As(V), monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and arsenobetaine (AsB), using high-performance liquid chromatography with inductively coupled plasma mass spectrometry, followed by determination of biomarkers, malondialdehyde and c-peptide. The geometric mean concentrations were 30.9 ㎍/L for the sum of inorganic arsenic and their metabolites, and 84.7 ㎍/L for the total sum of arsenic measured. Urinary concentrations of arsenic species were influenced by age, inhabitant area (inland or coastal), and seafood intake, which was positively correlated with inorganic arsenic, DMA, and AsB. Rice intake was positively correlated with inorganic arsenic and its metabolites but not with AsB. Additionally, malondialdehyde and c-peptide levels were significantly associated with urinary concentrations of various arsenic species. Seafood and rice are major sources of organic/inorganic arsenic exposure in Korean adults; however, it is necessary to evaluate whether their overconsumption could have a potentially detrimental effect on human health.

Purpose This cross-sectional study aimed to assess the effect of environmental cadmium (Cd) exposure and essential metal imbalance on renal tubular damage and oxidative stress in 979 adults living in a Cd-polluted area near an abandoned copper (Cu) refinery. Methods We analyzed urinary Cd concentrations, renal tubular damage and oxidative stress markers, such as beta-2 microglobulin (β2-MG) and N-acetyl-β-d-glucosaminidase (NAG) activity and urine malondialdehyde (MDA) levels. The serum copper-to-zinc ratio (CZR) was used as an essential metal imbalance indicator. We divided the subjects into two Cd exposure groups based on the reference level of urinary Cd for renal dysfunction (2 μg/g creatinine). Results The geometric mean concentration of urinary Cd in all subjects was 2.25 μg/g creatinine. In both low and high Cd exposure groups, urinary Cd levels were positively correlated with urinary NAG activity, but not with serum CZR. After multivariate adjustment, serum CZR was strongly associated with urinary β2-MG levels in the low Cd exposure group (β = 1.360, P = 0.019) and was significantly associated with urinary MDA levels, regardless of Cd exposure level. In addition, the risk of renal tubular damage was significantly associated with urinary Cd level, particularly in the lowest or highest CZR tertile groups. Conclusions Essential metal imbalance may be a determinant of oxidative stress and renal tubular damage in a chronically Cd-exposed population, and proper zinc supplementation will be effective in preventing adverse health effects due to Cd exposure.

Background After the global epidemic of coronavirus disease 2019 (COVID-19), lifestyle changes to curb the spread of COVID-19 (e.g., wearing a mask, hand washing, and social distancing) have also affected the outbreak of other infectious diseases. However, few studies have been conducted on whether the incidence of gastrointestinal infections has changed over the past year with COVID-19. In this study, we examined how the incidence of gastrointestinal infections has changed since COVID-19 outbreak through open data. Methods We summarized the data on the several viruses and bacteria that cause gastrointestinal infections from the open data of the Korea Disease Control and Prevention Agency for 3 years from March 2018 to February 2021 (from Spring 2018 to Winter 2020). Moreover, we confirmed three most common legal gastrointestinal infectious pathogens from March 2016. Results From March 2020, when the COVID-19 epidemic was in full swing and social distancing and personal hygiene management were heavily emphasized, the incidence of infection from each virus was drastically decreased. The reduction rates compared to the averages of the last 2 years were as follows: total viruses 31.9%, norovirus 40.2%, group A rotavirus 31.8%, enteric adenovirus 13.4%, astrovirus 7.0%, and sapovirus 12.2%. Among bacterial pathogens, the infection rates of Campylobacter and Clostridium perfringens did not decrease but rather increased in some periods when compared to the average of the last two years. The incidence of nontyphoidal Salmonella, Staphylococcus aureus, or enteropathogenic Escherichia coli somewhat decreased but not significantly compared to the previous two years. Conclusion The incidence of infection from gastrointestinal viruses, which are mainly caused by the fecal-to-oral route and require direct contact among people, was significantly reduced, whereas the incidence of bacterial pathogens, which have food-mediated transmission as the main cause of infection, did not decrease significantly., Graphical Abstract

Backgroud Open reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx. Methods We conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients' clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up. Results Nine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44-98.42). No patients required removal of the hardware. Conclusions Fixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.

Background: Although a few studies have reported the incidence of deep vein thrombosis (DVT) after opening-wedge high tibial osteotomy (OWHTO), previous studies focused only on symptomatic DVT. Information is lacking regarding the overall incidence of DVT after OWHTO, thrombus location, and the relationship between DVT and clinical outcome. Purpose: To determine the overall incidence of DVT and classify the location of DVT after OWHTO. We also determined whether significant differences in clinical improvement exist in patients with and without DVT at 6 months and at 2 years after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 46 patients (47 knees) who underwent OWHTO. All patients were instructed to perform knee range of motion exercises and partial weightbearing after drain removal. None of the patients received a chemoprophylaxis for DVT except intermittent pneumatic compression. DVT was diagnosed using 128-row multidetector computed tomography performed before discharge on the fourth postoperative day. The location was classified into 6 segments in the distal portion (muscular and axial veins) and proximal portion (popliteal, femoral, and common femoral veins and veins located above the iliac vein). International Knee Documentation Committee (IKDC) score was assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years using a linear mixed model. Results: Although the incidence of symptomatic DVT was 8.5% (n = 4), the overall incidence of early DVT was 44.7% (n = 21). All DVTs were located in the distal portion of the lower extremity vein, and 76.2% of the DVTs were located in an axial vein. The IKDC scores were 33.6 ± 7.2 and 35.3 ± 9.1 ( P = .910) preoperatively, 38.1 ± 5.6 and 40.6 ± 8.4 ( P = .531) at 6 months after surgery, and 44.8 ± 6.9 and 45.9 ± 11.4 ( P = .786) at 2 years after surgery in patients without and those with DVT, respectively. Conclusion: The overall incidence of early DVT after OWHTO was 44.7%. DVT after OWHTO was found particularly around the osteotomy site (76.2%). Patients with DVT did not have inferior short-term clinical outcomes after surgery.

Purpose Cerebral small vessel disease (SVD) is known to be associated with ischemic stroke, intracerebral hemorrhage (ICH), and cognitive impairment. In this retrospective observational study, we explored SVD markers on MRI relevant to spontaneous ICH. Materials and methods The ICH group consisted of 150 consecutive patients with a first primary parenchymal ICH, and the control group consisted of 271 age- and sex-matched individuals who underwent brain MRI in a health care center. We compared cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular space (EPVS), and lacunae in the ICH and control groups. Results A total of 1278 CMB lesions were identified in 121 of the 150 patients in the ICH group (80.6%), while 77 CMB lesions were found in 32 of the 271 individuals in the control group (11.8%). WMH and EPVS were more severe and lacunae were more frequent in the ICH patients than in the control group. When receiver operating characteristic (ROC) curves were plotted, number of CMBs most significantly predicted ICH. All imaging markers were significantly associated with ICH in every age group. The location of CMBs coincided with the location of ICH, and ICH volume correlated with CMB count. Conclusion All MRI markers for SVD were worse in ICH patients than in healthy controls, and these markers were prominent even in young ICH patients. Lacunae, WMH, EPVS, and CMB should be considered as factors related with spontaneous ICH.

In this study, we aimed to provide the recommended occupational exposure limits (OELs) for multi-walled carbon nanotubes (MWCNTs) and graphene nanomaterials based on data from a subchronic inhalation toxicity study using a lung dosimetry model. We used a no observed adverse effect level (NOAEL) of 0.98 mg m(–3) and 3.02 mg m(–3) in rats for MWCNTs and graphene, respectively. The NOAELs were obtained from a 13-week inhalation study in rats. The deposition fractions of MWCNTs and graphene in the respiratory tract of rats and humans were calculated by using the multi-path particle dosimetry model (MPPD model, v3.04). The deposition fraction in the alveolar region was 0.0527 and 0.0984 for MWCNTs and 0.0569 and 0.1043 for graphene in rats and human lungs, respectively. Then, the human equivalent exposure concentrations (HECs) of MWCNTs and graphene were calculated according to the method by the National Institute for Occupational Safety and Health (NIOSH). The HEC was estimated to be 0.17 mg m(–3) for MWCNTs and to be 0.54 mg m(–3) for graphene, which was relevant to the rat NOAEL of 0.98 mg m(–3) and 3.02 mg m(–3) for MWCNTs and graphene, respectively. Finally, we estimated the recommended OELs by applying uncertainty factors (UFs) to the HEC as follows: an UF of 3 for species differences (rats to humans), 2 for an experimental duration (subchronic to chronic), and 5 for inter-individual variations among workers. Thus, the OEL was estimated to be 6 μg m(–3) for MWCNTs and 18 μg m(–3) for graphene. These values could be useful in preventing the adverse health effects of nanoparticles in workers.

Table S1. The distribution of modified Rankin Scale scores according to the development of acute kidney injury in patients with good neurological outcomes at discharge. Table S2. The distribution of modified Rankin Scale scores according to the recovery from acute kidney injury in patients with good neurological outcomes at discharge. Table S3. The distribution of modified Rankin Scale scores according to renal replacement therapy in patients with good neurological outcomes at discharge. Table S4. Baseline characteristics of the study population according to the recovery of acute kidney injury after excluding patients who died within 48â h since return of spontaneous circulation. Table S5. Factors associated with survival discharge in multivariate analysis after excluding patients who died within 48â h since return of spontaneous circulation. Table S6. Factors associated with good neurological outcome in multivariate analysis after excluding patients who died within 48â h since return of spontaneous circulation. (DOCX 22 kb)

This study was performed to select single nucleotide polymorphisms (SNPs) related to the body burden of heavy metals in Koreans, to provide Korean allele frequencies of selected SNPs, and to assess the difference in allele frequencies with other ethnicities. The candidate-gene approach method and genome-wide association screening were used to select SNPs related to the body burden of heavy metals. Genotyping analysis of the final 192 SNPs selected was performed on 1,483 subjects using the VeraCode Goldengate assay. Allele frequencies differences and genetic differentiations between the Korean population and Chinese (CHB), Japanese (JPT), Caucasian (CEU), and African (YIR) populations were tested by Fisher’s exact test and fixation index (FST), respectively. The Korean population was genetically similar to the CHB and JPT populations (FST < 0.05, for all SNPs in both populations). However, a significant difference in the allele frequencies between the Korean and CEU and YIR populations were observed in 99 SNPs (60.7%) and 120 SNPs (73.6%), respectively. Ten (6.1%) and 26 (16.0%) SNPs had genetic differentiation (FST > 0.05) among the Korean-CEU and Korean-YIR comparisons, respectively. The SNP with the largest FST value between the Korean and African populations was cystathionine-β-synthase rs234709 (FST: KOR-YIR, 0.309; KOR-CEU, 0.064). Our study suggests that interethnic differences exist in SNPs associated with heavy metals of Koreans, and it should be considered in future studies that address ethnic differences in heavy-metal concentrations in the body and genetic susceptibility to the body burden of heavy metals.

The purpose of this study is to classify main risk factors on a construction phase of a plant project and analyze importance by the risk factors. Plant Industry is continuing boom and the increase in overseas plant orders in 2014 has showed a performance increase of 61% of the total orders, as the plant industry are risk factors for the construction phase, safety management target recognition and variety of accident prevention and safety factors by importance, etc. a situation that requires the development and introduction of management. So, it is performed that collected disaster conditions data on a construction phase of a plant project, is questioned by plant construction professional and is classified by 4M. Then, it is performed that is questioned by plant construction and safety professional in order to apply AHP method, and is presented from analyzing the risk factors, which are results of the survey, by importance and priority. This study will recognize from identifying the main risk factors in advance and will be utilized as a basic data is to prevent the risk factors.

This study was aimed to examine the association the blood/urinary concentration of toxic metal (Hg, Pb, and Cd) with children’s dietary patterns. This cross-sectional study included 1026 school children aged 8–17 years. Dietary patterns were defined using factor loading scores for 108 foods from a Semi-Quantitative Food Frequency Questionnaire. A high blood Hg level was found in boys with a high score in the ‘fish’ pattern (p = 0.02), and in girls with a high score in ‘fruit’ pattern (p = 0.04). The concentration of Pb was related to the ‘imprudent’ pattern in high school boys (p = 0.02). The effect of the ‘vegetable’ pattern on high excretion of urinary Cd was observed in low grade elementary (p = 0.04) and middle school students (p

Highly degraded human DNA is commonly encountered in the forensic studies. Despite many efforts, the poor quality and quantity of the DNA often result in unsuccessful DNA analysis. There has been no extensive evaluation of DNA polymerase performance for the successful PCR of highly degraded DNA samples. We evaluated the most efficient DNA polymerases, based on real-time PCR and agarose gel electrophoresis analyses for a single copy gene amplification, with 200 ancient DNA (aDNA) samples of various origins. Nine commercially available DNA polymerases were tested, which included enzymes that are reportedly effective for PCR-inhibitory samples. The first screening test for the polymerases with 20 aDNA samples showed that Pico Maxx HF, FastStart Taq, and Ex Taq HS DNA polymerases were the most effective. Further tests with 180 aDNA samples showed that AmpliTaq Gold (control) amplified PCR products from 52 aDNA samples, PicoMaxx HF from 62, FastStart Taq from 64, and Ex Taq HS from 65. The use of two or more of Ex Taq HS, FastStart Taq, and PicoMaxx HF resulted in a significantly higher success rate than that of AmpliTaq Gold alone. With 37 positive samples tested in duplicate, Ex Taq HS showed the highest reproducibility (13 samples) and AmpliTaq Gold, the lowest (four samples); this difference was significant. The data also showed preferential amplification by the enzymes; Ex Taq HS exclusively produced amplification from two samples, FastStart Taq from one, and PicoMaxx HF from one. We suggest that the initial use of these three DNA polymerases will increase the probability of successfully amplifying DNA from highly degraded human DNA samples.

Cadmium (Cd) is a metal that is toxic to renal tubules. If renal tubules are damaged by Cd, urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and beta 2-microglobulin (β2-MG) increases. The aim of this study was to describe the changing patterns of urinary Cd, NAG, and β2-MG levels over a 3-year period in individuals living in a Cd-contaminated area. This follow-up study included 191 residents (65.6±9.3 years) who were living in the vicinity of a copper refinery. Urinary levels of Cd, NAG activity, and β2-MG levels were measured, and their determinants and changing patterns were analyzed statistically. The natural logarithm of urinary Cd levels decreased significantly over time. Sex and intake of locally cultivated rice were significant determinants of urinary Cd concentration. Urinary NAG activity decreased over time. Age and urinary Cd concentration were significant determinants of urinary NAG activity in subjects with urinary Cd concentrations5μg/g creatinine. In subjects whose urinary Cd concentrations were2μg/g creatinine, diabetes was found to be a significant risk factor for high urinary NAG activity. The slope for temporal changes in urinary β2-MG levels was negative in subjects whose urinary Cd levels were2μg/g creatinine but was positive in those whose urinary Cd levels were 2-5μg/g creatinine or5μg/g creatinine. The urinary β2-MG levels found in individuals whose urinary Cd levels were2μg/g creatinine suggest that previous Cd-induced renal tubular damage had occurred.

Background Lead (Pb), mercury (Hg), and cadmium (Cd) are well-known environmental pollutants. They are unnecessary in the biological processes of humans. This study was performed to estimate the representative background exposure levels to the metals by measuring concentrations in whole blood of the Korean general population. Methods This population-based cross-sectional study included 4,000 subjects (1,886 males and 2,114 females) 0–83 years of age in 2010 and 2011. Adult subjects (≥ 19 years of age) were collected by sex- and age-stratified probability method, and preschool- and school-aged subjects were recruited by a cluster sampling method. Written consent was provided prior to blood sampling. Pb and Cd blood concentrations were determined by a flameless atomic absorption spectrophotometry, and blood Hg was analyzed by a direct Hg analyzer. Results The geometric mean, median and 95th percentile of blood Pb was 1.82 µg/dL, 1.83 µg/dL, and 3.78 µg/dL, respectively. The respective values were 2.92 µg/L, 2.87 µg/L, 9.12 µg/L for Hg, and 0.56 µg/L, 0.59 µg/L, 2.20 µg/L for Cd. Blood Pb and Hg were higher in males than in females, but no sex difference was observed, respectively, in subjects 0–4 years of age for Pb and in subjects less than 20 years for Hg. However, blood Cd was higher in females than in males and no sex difference was observed in subjects < 30 years of age. Conclusion This study provides representative data of human exposure to Pb, Hg, and Cd covering whole age groups of the general population in Korea., Graphical Abstract

Results of exome-wide association study for screening of genetic variability for blood lead levels; Table S1. Top 100 single nucleotide polymorphisms most significantly associated with blood lead levels, as identified by the exome-wide association study; Figure S1. Regional association plot of single nucleotide polymorphisms near C12orf51 and ALDH2 genes on chromosome 12q24. (DOCX 139Â kb)

This study aimed to estimate the risks for renal tubular damage and osteoporosis in individuals with long-term environmental Cd exposure. This cross-sectional study comprised 1086 residents living in the vicinity of a copper refinery plant. As the urinary Cd levels increased, the proportion of female subjects with β 2 -MG ≥300 μg/g creatinine also increased significantly, but this was not observed in the male subjects. The prevalence of osteoporosis was significantly higher in men with urinary Cd >5 μg/g creatinine than in those with urinary Cd ≤5 μg/g creatinine. This difference was not observed in the corresponding female groups. The association between increased urinary excretion of β 2 -MG and decreased BMD was statistically significant only in the female subjects. We suggest that an increased Cd body burden directly decreases the BMD in male subjects; however, in female subjects, it first induces renal microtubular damage, which can lead to osteoporosis.

OBJECTIVES Little is yet known about the determinants of bone mineral density (BMD) in young adults. Thus, in this study, we aimed to determine the factors that have an impact on BMD in young men. METHODS Questionnaires were sent out to 111 male medical students. Information on age, socio-economic status, medical history, lifestyle, physical activity during adolescence, school club participation, current physical activity, and dietary intake were collected by the survey. Height, weight, percent body fat and muscle mass were estimated by bioelectrical impedance, and BMD was obtained using calcaneal quantitative ultrasound. Using the Poisson regression model, prevalence ratios (PRs) were used to estimate the degree of association between risk factors and osteopenia. RESULTS The height and current physical activity showed a correlation to the Osteoporosis Index. Among the categorized variables, past physical activity during adolescence (p=0.002) showed a positive effect on the bone mineral content. In the multivariate model, past physical activity (≥1 time/wk) had a protective effect on osteopenia (PR, 0.37; 95% confidence interval [CI], 0.18 to 0.75) and present physical activity (1000 metabolic equivalent of task-min/wk) decreased the risk of osteopenia (PR, 0.64; 95% CI, 0.44 to 0.91). CONCLUSIONS Past physical activity during adolescence is as important as physical activity in the present for BMD in young men.

Competitive ELISA methods was used to measure the level of aflatoxin M1 (AFM1) from urine in 1008 of Korean adults. Subjects were selected by random sampling in all area of Korea except Cheju-do. The recovery rate of AFM1 in this method was 105% (73-124%). The geometric mean of urinary AFM1 in all subjects was 3.43 pg/mL (3.67 ng/ g creatinine). The level of AFM1 in male showed statistically higher than one in female subjects. However, the levels of AFM1 were not different according to their age. The subjects in Chungbuk-do showed the highest urinary AFM1 concentration, whereas the subjects in Kyeongnamdo showed the lowest one. Assuming an excretion rate of 5%, this AFM1 excretion corresponds to about a 0.1 microgram/day in Korean adults.

Henoch-Schönlein purpura (HSP) is one of the most common vasculitis in children. This study was aimed at identifying seasonal trends and epidemiologic features of pediatric HSP patients through public data to analyze the correlation of HSP and prevalence of a specific respiratory or enteric virus.We extracted information on pediatric HSP patients categorized into 4 age groups and data on 8 respiratory and 4 enteric viruses were extracted from national data. We used the decomposition of time series analysis and correlation analysis to identify the incidence of HSP and the prevalence of each virus.From 2013 to 2016, 16,940 patients under the age of 18 were diagnosed with HSP in Korea, 6203 (36.6%) were diagnosed with HSP in middle childhood. Spring had the largest number of patients (5252, 31.0%), and summer had the smallest number of patients (3224, 19.0%). The largest and smallest number of cases occurred in March (1949, 11.5%) and August (959, 5.7%), respectively. However, among the adolescents, more patients were diagnosed in the summer (985, 24.8%) than in the fall (760, 19.1%). The positive detection counts of most viruses showed apparent seasonal variations. Depending on the age group, the epidemic patterns of influenza and rotaviruses were temporally and statistically similar to that of HSP.We have confirmed that the occurrence of pediatric HSP in Korea shows a seasonal tendency, which is age-dependent and related to exposure to infectious agents and suggest some respiratory or enteric viruses may play an important role in pathophysiology.

The mechanism of copper (Cu) transport into the brain is unclear. This study evaluated the main species and route of Cu transport into the brain using in situ brain perfusion technique, and assessed the levels of mRNA encoding Cu transporters using real time RT-PCR. Free (64)Cu uptake in rat choroid plexus (CP), where the blood-cerebrospinal fluid barrier (BCB) is primarily located, is about 50 and 1000 times higher than (64)Cu-albumin and (64)Cu-ceruloplasmin uptake, respectively. The unidirectional transport rate constants (K(in)) for Cu in the CP and brain capillaries of the blood-brain barrier (BBB) were 1034 and 319 microl/s/g, respectively, while K(in) in CSF and capillary-depleted parenchyma were much reduced, 0.8 and 112 microl/s/g, respectively. The K(in) in cerebellum was significantly lower than that in hippocampus. The mRNAs encoding Cu transporter-1 (Ctr1) and ATP7A were higher in the CP than those in brain capillaries and parenchyma, whereas ATP7B mRNA was higher in brain capillaries than those in the CP and brain parenchyma. Taken together, these data suggest that the expression of Cu transporters is higher in brain barriers than in brain parenchyma; the Cu transport into the brain is mainly achieved through the BBB as a free Cu ion and the BCB may serve as a main regulatory site of Cu in the CSF.

Copper (Cu) is an essential trace element indispensable for brain development and function; either excess or deficiency in Cu can cause brain malfunction. While it is known that Cu and Fe homeostasis are strictly regulated in the brain, the question as to how systemic Fe status may influence brain Cu distribution was poorly understood. This study was designed to test the hypothesis that dietary Fe condition affects Cu transport into the brain, leading to an altered brain distribution of Cu. Rats were divided into 3 groups; an Fe-deficient (Fe-D) group which received an Fe-D diet (3~5 ㎎ Fe/㎏), a control group that was fed with normal diet (35 ㎎ Fe/㎏), and an Fe-overload group whose diet contained an Fe-O diet (20 g carbonyl Fe/㎏). Following a 4-week treatment, the concentration of Cu/Fe in serum, CSF (cerebrospinal fluid) and brain were determined by AAS, and the uptake rates of Cu into choroids plexus (CP), CSF, brain capillary and parenchyma were determined by an in situ brain perfusion, followed by capillary depletion. In Fe-D and Fe-O, serum Fe level decreased by 91% (p ＜ 0.01) and increased by 131% (p ＜ 0.01), respectively, in comparison to controls. Fe concentrations in all brain regions tested (frontal cortex, striatum, hippocampus, mid brain, and cerebellum) were lower than those of controls in Fe-D rats (p ＜ 0.05), but not changed in Fe-O rats. In Fe-D animals, serum and CSF Cu were not affected, while brain Cu levels in all tested regions (frontal cortex, striatum, hippocampus, mid brain, and cerebellum) were significantly increased (p ＜ 0.05). Likewise, the unidirectional transport rate constants (K in ) of Cu in CP, CSF, brain capillary and parenchyma were significantly increased (p ＜ 0.05) in the Fe-D rats. In contrast, with Fe-O, serum, CSF and brain Cu concentrations were significantly decreased as compared to controls (p ＜ 0.05). Cu transport was no significant change of Cu transport of serum in Fe-O rats. The mRNA levels of five Cu-related transporters were not affected by Fe status except DMT1 in the CP, which was increased in Fe-D and decreased in Fe-O. Our data suggest that Cu transport into brain and ensuing brain Cu levels are regulated by systemic Fe status. Fe deficiency appears to augment Cu transport by brain barriers, leading to an accumulation of Cu in brain parenchyma.

Drinking water is a main source of human exposure to arsenic. Hence, the determination of arsenic in groundwater is essential to assess its impact on public health. Here, we report arsenic levels in the groundwater of 722 sites covering all six major provinces of Korea. Water was sampled in two occasions (summer, 722 sites and winter, 636 sites) and the arsenic levels were measured with highly sensitive inductively coupled plasma-mass spectrometry method (limit of detection, 0.1 μg/l) to encompass the current drinking water standard (10 μg/l). Seasonal variation was negligible, but the geographical difference was prominent. Total arsenic in groundwater ranged from 0.1 to 48.4 μg/l. A 88.0-89.0% of sites were2.0 μg/l and the remaining ones generally did not exceed 10 μg/l (6.4-7.0%, 2.0-4.9 μg/l; 2.4-3.0%, 5.0-9.9 μg/l). However, some areas (1.0-9.2%) exhibited10 μg/l. Notably, urinary arsenic excretion of people around these regions was markedly higher compared with non-contaminated areas (5 μg/l) (79.7±5.2 μg/g (N=122) vs 68.4±5.4 μg/g (N=65) creatinine, P=0.052). All stratified analysis also revealed higher urinary excretion, where a statistically significant difference was noted for non-smokers (85.9±12.7 vs 54.0±6.3, P=0.030), suggesting that arsenic-contaminated groundwater may contribute to its systemic exposure.

Previous studies in this laboratory indicated that manganese (Mn) exposure in vitro increases the expression of transferrin receptor (TfR) by enhancing the binding of iron regulatory proteins (IRPs) to iron responsive element-containing RNA. The current study further tested the hypothesis that in vivo exposure to Mn increased TfR expression at both blood-brain barrier (BBB) and blood-cerebrospinal fluid (CSF) barrier (BCB), which contributes to altered iron (Fe) homeostasis in the CSF. Groups of rats (10-11 each) received oral gavages at doses of 5 mg Mn/kg or 15 mg Mn/kg as MnCl(2) once daily for 30 days. Blood, CSF, and choroid plexus were collected and brain capillary fractions were separated from the regional parenchyma. Metal analyses showed that oral Mn exposure decreased concentrations of Fe in serum (-66%) but increased Fe in the CSF (+167%). Gel shift assay showed that Mn caused a dose-dependent increase of binding of IRP1 to iron responsive element-containing RNA in BCB in the choroid plexus (+70%), in regional BBB of capillaries of striatum (+39%), hippocampus (+56%), frontal cortex (+49%), and in brain parenchyma of striatum (+67%), hippocampus (+39%) and cerebellum (+28%). Real-time RT-PCR demonstrated that Mn exposure significantly increased the expression of TfR mRNA in choroid plexus and striatum with concomitant reduction in the expression of ferritin (Ft) mRNA. Collectively, these data indicate that in vivo Mn exposure results in Fe redistribution in body fluids through regulating the expression of TfR and ferritin at BCB and selected regional BBB. The disrupted Fe transport by brain barriers may underlie the distorted Fe homeostasis in the CSF.

It is a non sequitur to attempt to combat political and bureaucratic corruption while leaving intact the existing regulatory structure and practices-the single-most important source of incentives to engage in corrupt activities for bothe private and public actors. Anti-corruption efforts will be self-defeating if they are made without keeping this fact clearly in mind. Unfortunately, however, this obvious fact is not well recognized. The lack of recognition can be found in the sidespread erroneous belief that all the government regulations exist to protect and enhance the public interest. This is emphatically not so. As abundant literature on rent-seeking or economic theory of regulation amply attests, a large chunkk of regulations has come into being as a result of self-interested attempts to appropriate economic rents, which must be created in the exercise of government's power over allocation of resources. Nevertheless, the efforts to put existing regulations under scrutiny from this perspective have been conspicuously lacking in the anti-corruption movement. Most importantly, we have to examine them whether they are of s uch a nature as to come into existence to promote particular actors' interest in disguise of public and general interest. In addition, we have to see whether they are simply mal-designed to encourage corruption at the stage of implementation. In this paper I will try to give pertinent examples of each with a particular reference to Korea, and strongly contend that anti-corruption should go hand in hand with regulatory reform, the emphasis of which should be placed on making regulations more market-conforming, transparent, and self-enforcing.

Both high-definition television (HDTV) and, standard-definition television (SDTV) use the MPEG-2 video coding standard, but they have different spatial resolutions. In order to support the interlaced video coding, MPEG-2 incorporates various macroblock prediction modes. Thus, the HDTV-to-SDTV transcoding needs to handle spatial resolution downscaling and various MEPG-2 macroblock prediction modes. We investigate schemes to exploit the correlations between the input and output video in the design of an HDTV-to-SDTV transcoder so that the computation can be greatly saved while the quality of video is preserved as much as possible. First, by utilizing the motion vectors and macroblock coding modes of the input video, efficient motion reestimation and macroblock mode decision algorithms are proposed. Then a novel picture target bit allocation algorithm taking advantage of the coding statistics of the input video is presented. Simulation results showing the effectiveness of the proposed approaches are also presented.

Iron (Fe) is an essential element in biological processes; however excessive Fe is harmful to human health. Some air pollutants contain a high level of Fe, and the human lung could therefore be over-exposed to Fe through inhaled air pollutants. This study was performed to investigate the role of metal transporters (divalent metal transporter 1, DMT1, and metal transporter protein 1, MTP1) in the lung under the environments of Fe deficiency in the body and Fe over-exposure in the lung.Rats were fed Fe deficient (FeD, 2-6 mg Fe/kg) or Fe supplemented (FeS, 120 mg Fe/kg) diet for 4 weeks, followed by a single intratracheal instillation of ferrous sulfate at low (10 mg/kg) or high (20 mg/kg) dose. Fe concentration was analyzed in the serum, lung and liver, and histopathological findings were observed in the lung at 24 hours after Fe administration. The level of DMT1 and MTP1 expression in the lung was analyzed by RT-PCR. Also, the effect of Fe deficiency in the body was evaluated on the level of Fe concentration and metal transporters compared to FeS-diet fed rats at the end of 4-week FeD or FeS diet.The 4-week FeD diet in rats induced an Fe deficiency anemia with decreased serum total Fe, increased unsaturated Fe binding capacity and hypochromic microcytic red blood cells. The concentration of Fe in the lung and liver was lower in the FeD-diet fed rats than in the FeS-diet fed rats. The level of metal transporters mRNA expression was higher in the FeD-diet fed rats than in the FeS-diet. The concentration of Fe in the lung was increased in a dose-dependent pattern after intratracheal instillation of Fe into the rats, while the level of Fe in the serum and liver was not increased in the low-dose Fe administered rats. Therefore, DMT1 and MTP1 mRNA was highly expressed in both FeD-diet and FeS-diet fed rats, after intratracheal instillation of Fe.DMT1 and MTP1 mRNA were more highly expressed in FeD-diet fed rats than in FeS-diet fed rats. The over-exposure of Fe intratracheally induced high expression of metal transporters and increased Fe deposition in the lung in both FeD-diet and FeS-diet fed rats, but did not increase the Fe level of the serum and liver in low-dose Fe administered rats. These results suggest that the role of metal transporters in the lung might be different in a part from the duodenum under the environment of over-exposure to Fe.

According to a recent study, mercury (Hg) exposure contributes to Alzheimer's disease (AD). However, the underlying mechanisms are not understood. This study investigated the effect of methylmercury (MeHg) treatment on the generation, degradation, and transport of amyloid β-protein (Aβ) in the brain. Wistar rats were administered MeHg by gavage (0, 20, 200, and 2,000 μg Hg/kg/day) for 4 weeks. The total Hg in the blood and brain regions was measured, and the levels of Aβ42 in plasma, cerebrospinal fluid (CSF), and brain regions were estimated. The expression of amyloid precursor protein (APP), beta-site APP-cleaving enzyme 1 (BACE1), and neprilysin (NEP) in the brain regions was determined, in addition to the expression of low-density lipoprotein receptor-related protein 1 (LRP1) and the receptor for advanced glycation end products (RAGE) in the brain capillary endothelium (BCE). Finally, the amount of soluble low-density lipoprotein receptor-related protein (sLRP) in the plasma was determined. Aβ42 levels were decreased in the CSF of the 2,000 μg Hg/kg/day group compared with controls, and Aβ42 levels increased in the hippocampus (HC) in a dose-dependent manner. MeHg decreased LRP1 expression but increased RAGE levels in BCE. sLRP levels were decreased in the plasma of the MeHg-treated rats. They were positively correlated with CSF Aβ42 and negatively correlated with Aβ42 and Hg levels in HC. These results imply that MeHg reduces the transportation of Aβ, thereby resulting in the accumulation of the protein in the HC. Plasma sLRP levels may be an early biomarker of Hg-induced Aβ accumulation in the brain.