The association of disease activity, pro-inflammatory cytokines, and neurotrophic factors with depression in patients with rheumatoid arthritis

Cheon, Yun-Hong,Lee, Seung-Geun,Kim, Mingyo,Kim, Hyun-Ok,Sun Suh, Young,Park, Ki-Soo,Kim, Rock Bum,Yang, Hyun-Su,Kim, Ji-Min,Son, Chang-Nam,Kyoung Park, Eun,Kim, Sang-Hyon,Lee, Sang-Il Elsevier 2018 Brain, behavior, and immunity Vol.73 No.-

<P><B>Abstract</B></P> <P>Inflammation and trophic factors (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor, glial cell line-derived neurotrophic factor, and insulin-like growth factor-1) are associated with depression in the general population. Rheumatoid arthritis (RA) is a chronic representative inflammatory autoimmune disease; however, the association of disease activity, pro-inflammatory cytokines, and neurotrophic factors with depression has not been sufficiently investigated. Therefore, we determined the prevalence of depression and risk factors for depression and deterioration of depressive symptoms in RA patients. In addition, we analyzed the association between disease activity, pro-inflammatory cytokines, trophic factors, and depression in RA (N = 474). Demographic and laboratory data were examined, and routine assessment of patient index data 3 (RAPID 3) and disease activity score 28-joint count C-reactive protein (DAS 28-CRP) was performed to assess disease activity of RA. Depression was measured using the Korean version of the Beck Depression Inventory-second edition (K-BDI II). A K-BDI score ≥18 was considered the cut-off for depression in accordance with a previous validation study. The serum level of pro-inflammatory cytokines and neurotrophic factors was assessed by enzyme-linked immune sorbent assay. The prevalence of depression was 32.4% in patients with RA. The severity of disease activity of RA (RAPID 3 score [OR 2.34; 95% confidence interval, CI 1.22–4.51], DAS 28-CRP [≥3.2] [OR 1.60, 95% CI 1.01–2.53]) and severity of fatigue (OR 1.26 95% CI 1.15–1.38) were associated with depression and deterioration of depressive symptoms in the multivariate analysis. Among the components of RAPID 3 and DAS 28-CRP, patient assessment for global health and abilities for daily performance were more related to depression. The level of pro-inflammatory cytokines (IL-1β, IL-6, TNF-alpha) was not related to depression. The level of BDNF was significantly lower in RA patients with depression and was negatively correlated with K-BDI II score. Depression was related with the level of fatigue, low expression of BDNF, and high RA disease activity, which was associated with impaired ability to perform activities of daily life. Strict control of fatigue and disease activity to improve one’s capacity to perform daily life activities would be important to regulate depression. The level of BDNF might be one of the possible biomarkers to predict or monitor depression in patients with RA.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Prevalence of depression in patients with rheumatoid arthritis (RA) was analyzed. </LI> <LI> Risk factors for depression and deterioration of depressive symptoms and were analyzed. </LI> <LI> Depression was related with disease activity in RA. </LI> <LI> Depression in RA was associated with impaired ability to perform activities of daily life. </LI> <LI> Among neurotrophic factors, the level of BDNF was related with depression in RA patients. </LI> <LI> The level of pro-inflammatory cytokines were not related with depression in RA patients. </LI> </UL> </P>

S-691 Metabolic and inflammatory links to rotator cuff tear in hand osteoarthritis

( Ji Sung Bok ),( Minyoung Kim ),( Yun-hong Cheon ),( Sang-il Lee ),( Rock-bum Kim ),( Ki Soo Park ),( Hyung Bin Park ),( Jae-bum Na ),( Hyun-ok Kim ),( Young Sun Suh ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Background: Rotator cuff tear (RCT) and hand osteroarthritis (HOA) are commonly accompanied because they share a similar pathogenesis. However, there was no previous study investigating the relationship between RCT and HOA. Objectives: To estimate the prevalence and associated factors of RCT in patients with HOA. Methods: In this study, we enrolled 1150 individuals who lived in Gyeongnam province in Korea from June 2013 to December 2015. Physical examinations were performed by rheumatologists and orthopedists. Plain radiography of hands and magnetic resonance imaging (MRI) of shoulders were performed in all participants. Serum levels of high sensitive C reactive protein (hsCRP) and high density lipoprotein (HDL) were checked. RCT was diagnosed by clinical examination and MRI findings. Diagnosis of HOA was made by the 1990 American College of Rheumatology classification criteria. Severity of radiographic HOA was assessed by sum of Kellgren-Lawrence (KL) grades of total involved joints on plain radiographs. Results: The prevalence of RCT was higher in patients with HOA group (192/307, 62.5%) than those without HOA (410/827, 49.5%, p<0.001). Among 307 with HOA, patients with RCT were older (62.69±7.04 vs. 59.11±7.69, p<0.001) and showed higher hsCRP (1.51±3.78 vs. 0.67±0.70, p=0.004) and lower HDL levels (55.66±15.46 vs. 60.48±12.45, p=0.003) compared to those without RCT. Multiple logistic regression analysis showed significant associations of age (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.016 - 1.099), serum levels of hsCRP (OR 1.37, CI 1.043 - 1.794), and low HDL (male <50mg/dL, female <40mg/dL) (OR 2.16, CI 1.160 - 4.005) with RCT in HOA patients. Conclusions: The prevalence of RCT is high and age and serum levels of hsCRP and HDL have predictive roles in the development of RCT in HOA patients.

Unmet Psychosocial Needs of Patients Newly Diagnosed with Ulcerative Colitis: Results from the Nationwide Prospective Cohort Study in Korea

Jung Rock Moon,Chang Kyun Lee,Sung Noh Hong,Jong Pil Im,Byong Duk Ye,Jae Myung Cha,Sung-Ae Jung,Kang-Moon Lee,Dong Il Park,Yoon Tae Jeen,Young Sook Park,Jae Hee Cheon,Hyesung Kim,BoJeong Seo,Youngdoe 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.4

Background/Aims: Limited data are available regarding psychosocial distress at the time of diagnosis of ulcerative colitis (UC). We investigated the psychosocial burden and factors related to poor health-related quality of life (HRQL) among patients newly diagnosed with moderate-to-severe UC who were affiliated with the nationwide prospective cohort study. Methods: Within the first 4 weeks of UC diagnosis, all patients were assessed using the Hospital Anxiety and Depression Scale (HADS), Work Productivity and Activity Impairment questionnaire, Inflammatory Bowel Disease Questionnaire (IBDQ), and 12-Item Short Form (SF-12) health survey. A multiple linear regression model was used to identify factors associated with HRQL. Results: Between August 2014 and February 2017, 355 patients completed questionnaires. Significant mood disorders requiring psychological interventions, defined by a HADS score ≥11, were identified in 16.7% (anxiety) and 20.6% (depression) of patients. Patients with severe disease were more likely to have presenteeism, loss of work productivity, and activity loss than those with moderate disease (all p<0.05). Significant mood disorders had the strongest negative relationship with total IBDQ score, which indicates disease-specific HRQL (β coefficient: –22.1 for depression and –40.0 for anxiety, p<0.001). The scores of all SF-12 dimensions, which indicate general HRQL, were remarkably decreased in the study population compared indirectly with previously reported scores in the general population. The Mayo score, C-reactive protein level, and white blood cell count showed significant negative associations with the IBDQ score (p<0.05). Conclusions: Psychosocial screening and timely interventions should be incorporated into the initial care of patients newly diagnosed with UC.

경남 지역 농업인의 상지 근골격계 질환 유병률과 위험인자

서영선 ( Young Sun Suh ),천윤홍 ( Yun Hong Cheon ),김현옥 ( Hyun Ok Kim ),김록범 ( Rock Bum Kim ),박기수 ( Ki Soo Park ),양현수 ( Hyun Su Yang ),박형빈 ( Hyung Bin Park ),나재범 ( Jae Bum Na ),윤철호 ( Chul Ho Yoon ),이상일 ( Sang 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.6

Objective. To evaluate the prevalence and risk factors of upper extremity musculoskeletal diseases (MSDs) among Korean farmers. Methods. The study was carried out from June 2013 to August 2015 on 850 farmers and 203 non-farmers (controls) in Gyeongnam Province. Physical examinations were performed by rheumatologists, orthopedists, and rehabilitation specialists. Plain radiography, a nerve conduction examination, and magnetic resonance imaging were performed, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess upper extremity function. Results. Thirty-four different types of upper extremity MSDs were detected in the 1,053 study subjects. The prevalence of any MSD in farmers was 8.96-fold higher than in control (p<0.001). The most obvious difference in prevalence between farmers and non-farmers was hand osteoarthritis (48.2% vs. 4.9%). Mean total DASH score was higher for farmers than non-farmers (14.29±13.66 vs. 10.03±10.85, p<0.001). Among farmers, myofascial pain syndrome, rotator cuff tear, and epicondylitis were more prevalent among overhead workers (growing persimmons, pears, and grapes) than in non-overhead workers (growing rice and upland crops). The following factors were associated with a rotator cuff tear; older age, overhead work, high waist circumference, and lower level of education. Hand osteoarthritis was found to be associated with older age, a female gender, high waist circumference, and longer total work time. Conclusion. The prevalence of upper extremity MSDs is much higher in farmers than non-farmers and greater still for farmers doing overhead work. Various factors contribute to the occurrence of upper extremity MSDs, and thus, the authors suggest an efficient preventive strategy, which involves consideration of type of work and risk factors, be established for farmers to reduce upper extremity MSDs. (J Rheum Dis 2015;22:366-373)

Medication nonadherence in Korean patients with rheumatoid arthritis: the importance of belief about medication and illness perception

( Young Sun Suh ),( Yun-hong Cheon ),( Hyun-ok Kim ),( Rock-bum Kim ),( Ki Soo Park ),( Sang-hyon Kim ),( Seung-geun Lee ),( Eun-kyoung Park ),( Jian Hur ),( Sang-il Lee ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.1

Background/Aims: To investigate medication nonadherence in Korean patients with rheumatoid arthritis (RA) and analyze related factors. Methods: A total of 292 patients with RA participated in this study. Medication nonadherence, intentional or unintentional, was gauged via self-reported questionnaire. Patient perceptions of illness, treatment beliefs, and moods were measured via Brief Illness Perception Questionnaire, Beliefs about Medicines Questionnaire, and Patient Health Questionnaire-2, respectively. Demographic and clinical data were also collected. Multinomial regression analysis was used to assess the impact of demographic, clinical, and psychological factors on medication nonadherence. Results: The medication nonadherence rate was 54.1% (intentional, 21.6%; unintentional, 32.5%). Intentional nonadherence was reported most often in patients treated daily drugs (nonsteroidal anti-inflammatory drugs and/or disease-modifying antirheumatic drugs) (24.2%), and unintentional nonadherence was highest in patients receiving methotrexate (33.3%) (p = 0.872). In univariate analysis, beliefs in necessity and concerns of medication differed significantly in adherent and nonadherent patients (intentional or unintentional). When controlling for other factors that may impact medication nonadherence, less belief in necessity of medication (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.68 to 0.95) and greater emotional response to disease (OR, 1.19; 95% CI, 1.01 to 1.40) were important predictors of intentional nonadherence. Conclusions: Medication nonadherence is common in Korean patients with RA. Less belief in necessity of medication and greater emotional response to disease were identified as key factors prompting intentional nonadherence. These factors may be strategically targeted to improve medication adherence rates and subsequent clinical outcomes.

Digital Implementation of PWM Techniques for Two-phase Eight-switch Inverter fed Brushless DC Motor Drives

Lin, Hai,You, Yong-Min,Cheon, Sung-Rock,Kwon, Byung-Il The Korean Institute of Electrical Engineers 2013 Journal of Electrical Engineering & Technology Vol.8 No.2

This paper reports an investigation of pulse width modulation (PWM) techniques for two-phase brushless DC (BLDC) motors fed by a two-phase eight-switch inverter in a fan application. The three-phase BLDC motor is widely applied in industry; however, a lower-cost two-phase BLDC motor and drive circuit has been greatly in demand in recent years. In this paper, we introduce a mathematical model of the two-phase BLDC motor with sinusoidal back electromotive forces (EMFs) based on traditional three-phase BLDC motors. To simplify the drive algorithm and speed up its application, we analyze the principle of block commutation for a two-phase BLDC motor drive in the 180-electrical-degree conduction mode, and we further propose five PWM schemes to improve the commutation performance of the two-phase BLDC drive. The effectiveness of the proposed PWM methods is verified through experiments.

Response to comment on “Medication nonadher-ence in Korean patients with rheumatoid arthri-tis: the importance of belief about medication and illness perception”

( Young Sun Suh ),( Yun-hong Cheon ),( Hyun-ok Kim ),( Rock-bum Kim ),( Ki Soo Park ),( Sang-hyon Kim ),( Seung-geun Lee ),( Eun-kyoung Park ),( Jian Hur ),( Sang-il Lee ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.6

Digital Implementation of PWM Techniques for Two-phase Eight-switch Inverter fed Brushless DC Motor Drives

Hai Lin,Yong-Min You,Sung-Rock Cheon,Byung-Il Kwon 대한전기학회 2013 Journal of Electrical Engineering & Technology Vol.8 No.2

This paper reports an investigation of pulse width modulation (PWM) techniques for two-phase brushless DC (BLDC) motors fed by a two-phase eight-switch inverter in a fan application. The three-phase BLDC motor is widely applied in industry; however, a lower-cost two-phase BLDC motor and drive circuit has been greatly in demand in recent years. In this paper, we introduce a mathematical model of the two-phase BLDC motor with sinusoidal back electromotive forces (EMFs) based on traditional three-phase BLDC motors. To simplify the drive algorithm and speed up its application, we analyze the principle of block commutation for a two-phase BLDC motor drive in the 180-electrical-degree conduction mode, and we further propose five PWM schemes to improve the commutation performance of the two-phase BLDC drive. The effectiveness of the proposed PWM methods is verified through experiments.

지모(知母)에탄올추출물의 HT-29대장암세포 Apoptosis 유도효과

김태현,김범호,전병국,윤정록,우원홍,문연자,이장천,이부균,박영규,임규상,Kim, Tae-Hyun,Kim, Pom-Ho,Jeon, Byoung-Kook,Yoon, Jeong-Rock,Woo, Won-Hong,Mun, Yeun-Ja,Lee, Jang-Cheon,Lee, Boo-Kyun,Park, oung-Gue,Lim, Kyu-Sang 대한한방안이비인후피부과학회 2011 한방안이비인후피부과학회지 Vol.24 No.1

Objective : In this study, we investigated the effects of ethanol extract of Anemarrhenae Rhizoma (EAR) on the proliferation and apoptosis induction of HT-29 human colon cancer cells. Methods : Cell viability of HT-29 cells were measured by MTT assay and apoptisis-related proteins were assessed using western blotting. Chromatin condensation of HT-29 cells stained with Hoechst 33258. Results : In the present study, we demonstrated that EAR exhibited significant cytotoxicity in HT-29 cells. The induction of apoptosis in HT-29 cells by EAR treatment was characterized by chromatin condensation and the activation of caspase-3. EAR-induced apoptosis is accompanied by the release of cytochrome c and the specific proteolytic cleavage of PARP. EAR was appeared cytotoxic effect to HT-29 cells in a dose-dependent manner. Concomitantly, EAR treatment led to increase in the caspase-9. The reduction of Bcl-2 and truncation of Bid were induced by EAR. Conclusion : We studied that the EAR induced apoptosis in human colon adenocarcinoma HT-29 cells. These results indicated that EAR can cause apoptosis through mitochondria/caspase pathway in human HT-29 cells.

유전성 대사질환에서의 동종조혈모세포이식 : 단일 기관에서의 경험 A single center experience

유건희,김흥렬,이지은,이호영,천정미,성기웅,구홍회,이문향,진동규,김종원,김대원,김형록 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

배경: 유전성 대사질환의 치료로서 효소 요법 및 유전자 치료가 제한적인 현실에서 동종 조혈모세포이식이 현재로선 가장 중요한 치료가 될 수 있다. 본 연구에서는 단일 기관에서 유전성 대사질환에 대해 동종 조혈모세포이식을 시행한 경험을 보고하고자 하였다. 방법: 삼성서울병원 유전성 대사질환 조혈모세포이식팀에서는 1999년 12월부터 2001년 3월까지 총 6례의 유전성 대사질환을 대상으로 동종 조혈모세포이식을 시행하였다. 대상 질환은 Hunter 증후군 3례, galactosialidosis 1례, 이염성 백질이영양증 1례, 부신백질이영양증 1례였으며 성별 분포는 남아가 5명, 여아가 1명이었으며 연령 분포는 2년 9개월에서 15년 9개월이었다. 5례는 HLA 일치 혈연간 골수이식이었으며 1례는 HLA 불일치 T 림프구 제거 말초혈액 조혈모세포이식이었다. 전처치는 모두 BuCy를 사용하였으며 이식편대숙주반응의 예방에는 cyclosporine을 사용하였다. 이식된 세포는 유핵세포가 4.81×10^(8)(2.40~7.01×10^(8))/kg이었으며 CD34+ 세포는 3.65×10^(6)(0.88~10.72×10^(6))/kg이었다. 결과: 이식 후 조혈기능의 회복은 모두 조기에 달성되었으며(ANC>500: 정중 9.5일, 범위 9~14일; PLT>50K: 정중 32일, 범위 23~34일) 이식과 관련된 합병증은 Gr I의 aGVHD 3례, 국한성의 cGVHD 1례, 경증의 간정맥 폐쇄성 질환이 1례이었다. 모든 환자에서 직간접적으로 이식 후 효소의 생산이 증가함이 확인되었으며 임상적인 호전을 보인 경우가 4례, 질병 진행이 중단된 경우가 1례, 질병이 진행된 경우가 1례이었다. 질병 진행이 중단되었던 1례는 면역억제제 투여 중 수두 감염에 의한 폐출혈로 사망하였다. 결론: 유전성 대사질환에서 동종 조혈모세포이식이 가장 중요한 치료법으로 사용될 수 있고 중추신경계 증상이 나타나기 전, 가능한 조기에 조혈모세포이식을 시행하는 것이 바람직할 것이며 적극적인 지지 요법이 필요하다. 향후 더 많은 임상 경험이 필요하리라 사료된다. Background: Allogeneic hematopoietic stem cell transplantation (HSCT) may be the most important treatment modality to cure a number of genetic metabolic disorders because of the limitation of enzyme replacement or gene therapy. In this study, we report our single center experience about HSCT in several genetic metabolic disorders. Methods: We performed 6 cases of HSCT for genetic metabolic disorders from December 1999 to March 2001. Patients' diagnoses were Hunter syndrome (3), galactosialidosis (1), metachromatic leukodystrophy (1), and adrenoleukodystrophy (1). Stem cell sources were bone marrow from HLA matched sibling donors in 5 patients and mother's peripheral blood stem cells in one patient who did not have HLA matched donors. Busulfan and cyclophosphamide for conditioning, and cyclosporine for the prevention of graft versus host disease were used in all patients. Transplanted total nucleated cell counts were median 4.81×10^(8)(2.40~7.01×10^(8))/kg , and CD34+ cells 3.65×10^(6)(0.88~10.72×10^(6))/kg. Results: All patients achieved early hematologic recovery (median 9.5 days, range 9~14 days for ANC>500/μL; median 32 days, range 23~34 days for PLT>50,000/μL). Transplant-related complications were 3 cases of grade 1 acute GVHD, a case of limited chronic GVHD, and a case of mild hepatic veno-occlusive disease. Enzyme levels were normalized in 4 patients evaluated and there were indirect evidences of enzyme production in the other 2 patients after HSCT. Four of the 6 patients showed symptomatic improvement, 1 patient (galactosialidosis) experienced disease stabilization without progression before he eventually died due to pulmonary hemorrhage, and the other 1 patient deteriorated progressively even after HSCT. Conclusions: Allogeneic HSCT can be done as the only curative treatment in a number of genetic metabolic disorders. It seems desirable to perform HSCT as early as possible before the onset of central nervous system symptoms. More experience and long term follow up is needed to evaluate the efficacy and to monitor the long term transplant-related complications.