These results demonstrate for the first time that TiO NPs induce MUC5B expression via TLR4-dependent ERK1/2 and p38 MAPK signaling pathways in respiratory epithelium.

This study aimed to evaluate the difference in patient survival according to the type of erythropoiesis-stimulating agent (ESA) treatment used in the Korean hemodialysis (HD) population. This retrospective study analyzed the laboratory data from a national HD quality assessment program and the claims of Korea. Included participants were divided into three groups according to the type of ESA used during the 6 months of each assessment period as follows: the EP group (n = 38,043, epoetin-α or epoetin-β), the DP group (n = 10,054, darbepoetin-α), and the MR group (2253, continuous erythropoietin receptor activator). The ESA doses in the EP, DP, and MR groups were 6451 ± 3586, 5959 ± 3857, and 3877 ± 2275 unit/week, respectively. The erythropoiesis resistance indexes (ERIs) in the three groups were 10.7 ± 6.7, 9.9 ± 7.6, and 6.3 ± 4.1 IU/kg/g/dL, respectively. Kaplan–Meier curves revealed similar rates of patient survival among the three groups (p = 0.530). A multivariate Cox regression analysis showed that the hazard ratios in the DP group and MR group were 1.00 (p = 0.853) and 0.87 (p < 0.001), respectively, compared to that of the EP group. The hazard ratio in the MR group was 0.87 (p = 0.001) compared to that of the DP group. Our study shows that the MR group had comparable or better patient survival than the EP and DP groups in the multivariate analysis. However, the ESA doses and ERI were considerably different among the three groups. It was difficult to determine whether the better patient survival in the MR group originated from the ESA type, ESA dose, ERI, or other hidden factors.

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IntroductionAdvances in the diagnosis and management of acute ischemic stroke (AIS) and the increased use of mechanical thrombectomy (MT) have improved the quality of care and prognosis of patients with AIS since 2015. We investigated the changing trends in mortality of patients with AIS in Korea before and after 2015.Materials and methodsA retrospective cohort study was conducted using combined anonymized data from the Acute Stroke Assessment Registry of Korea and the Health Insurance Review &amp; Assessment Service database. Patients with ischemic stroke with precise onset time and initial National Institute of Health Stroke Scale records were included.ResultsPatients receiving MT treatment increased from 256 (2.7%) pre-2015 to 1,037 (3.9%) post-2015 (p &lt; 0.001). Overall mortality significantly decreased from pre-2015 to post-2015. In pre-2015, intravenous thrombolysis (IVT) administered within 2 h significantly reduced 3-month mortality when compared with non-IVT. While, in post-2015, IVT administered within 2 h significantly reduced the 3-month, 1-year, 2-year, and 4-year mortality (p &lt; 0.05). MT only reduced 1-year mortality pre-2015; however, MT significantly reduced the 3-month, 1-year, and 2-year mortality post-2015 (p &lt; 0.05). Post-stroke antiplatelet and anticoagulant drugs significantly reduced the 3-month, 1-year, 2-year, and 4-year mortality post-2015.DiscussionSince 2015, faster IVT has significantly reduced the short- and long-term mortality in patients with AIS; MT reduced the 3-month, 1-year, and 2-year mortality. Post-stroke antithrombotic medication has significantly lowered the 2- and 4-year mortality since 2015.ConclusionsChanging trends in AIS management since 2015 have improved the prognosis of patients with AIS.

Background and Aims Atrial fibrillation (AF) can lead to stroke, heart failure, and mortality, and has a greater prevalence in dialysis patients than in the general population. Several studies have proposed that uremic toxins might promote AF development. However, the association between dialysis adequacy and incident AF has not been well established. Method In this retrospective study, we analyzed 27,475 patients receiving maintenance hemodialysis, included in the Periodic Hemodialysis Quality Assessment by Health Insurance Review & Assessment Service (HIRA). The main exposure was single pooled Kt/V and the primary outcome was the development of AF. Results During a median follow-up of 4.8 years, incident AF occurred in a total of 4,229 (15.4%) patients. Participants with higher single pooled Kt/V tended to have lower AF incidence. In survival analysis, there was a graded association between the risk of incident AF and single-pool Kt/V quartiles: subdistribution hazard ratios and 95% confidence intervals (CI) for the second, third, and the highest quartile compared with the lowest quartile were 0.90 (95% CI, 0.83-0.98), 0.85 (95% CI, 0.78-0.93), and 0.80 (95% CI, 0.73-0.89), respectively. When treating single-pool Kt/V as a continuous variable, a similar association was found. In addition, the risk of incident AF in the highest quartile of urea reduction ratio was 0.83-fold (95% CI, 0.76-0.91) lower than in the lowest quartile. Sensitivity analyses showed consistent results. This association was more pronounced in men. Conclusion As the part of the Joint Project on Quality Assessment Research by HIRA, this nationwide cohort study showed that lowering uremic toxin burden through increased dialysis clearance could be associated with a lower AF development risk in patients receiving maintenance hemodialysis.