Association between recent acetaminophen use and asthma: modification by polymorphism at TLR4

The risk of asthma has been increasing in parallel with use of acetaminophen, which is a potential source of oxidative stress. Toll-like receptor 4 (TLR4) plays a critical role not only in innate immunity, but also in mediating reactive oxygen species induced inflammation. Therefore, we investigated associations between acetaminophen usage and TLR4 polymorphism on asthma and bronchial hyperresponsiveness (BHR). The number of 2,428 elementary school children in Seoul and Jeongeup cities was recruited. Subjects who used acetaminophen with a family history of asthma had an increased risk of both asthma diagnosis ever and current asthma. Individuals with CT+TT genotypes at the TLR4 polymorphism, in combination with acetaminophen usage, also demonstrated an increased risk of asthma diagnosis ever (aOR, 2.08; 95% confidence interval [CI], 1.10-3.92). Family history of asthma and acetaminophen usage were risk factors for BHR. Although TLR4 was not an independent risk factor for BHR, individuals with CT+TT genotypes at the TLR4 polymorphism had an increased risk of BHR when combined with acetaminophen usage (aOR, 1.74; 95% CI, 1.03-2.94). In conclusion, acetaminophen usage may be associated with asthma and BHR in genetically susceptible subjects. This effect may be modified by polymorphism at TLR4.

Outbreak among healthy newborns due to a new variant of USA300-related meticillin-resistant Staphylococcus aureus

BACKGROUND

The prevalence of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is increasing throughout the world and is an important cause of skin and soft tissue infection (SSTI) in children and neonates.

AIM

To describe the successful control of an outbreak caused by a new strain of CA-MRSA in a newborn nursery.

METHODS

The investigation of the outbreak in July 2012 is reported with the control measures taken. Molecular typing of the MRSA isolates was performed.

FINDINGS

An outbreak of SSTI caused by CA-MRSA occurred in a newborn nursery. Six neonates were infected in a one-month period [infection rate: 8.5% (6/71)]. A new variant of CA-MRSA was responsible, which was characterized as USA300-related, Panton-Valentine Leucocidin (PVL) positive, arginine catabolic mobile element (ACME) negative, sequence type 8 (ST8), staphylococcal cassette chromosome mec (SCCmec) type IVa, agr type I and spa type t008. The outbreak among term neonates followed a rapid transmission pattern and was successfully controlled by implementing various outbreak control measures, including universal chlorhexidine bathing.

CONCLUSION

This is the first report of a hospital outbreak caused by a USA300-related CA-MRSA clone in Korea. Early recognition and reinforcement of infection control measures are important in decreasing transmission of CA-MRSA in a hospital setting.

Partial esophageal transplantation is possible as part of a multivisceral graft

We report a case of a 9-year-old female with inflammatory myofibroblastic tumor (IMT), which involved the upper retroperitoneum, visceral vessels, stomach and distal esophagus. Complete resection of the tumor required a multivisceral (MV) transplant. Due to tumor involvement, resection of the distal third of recipient esophagus was necessary. Gastrointestinal continuity was subsequently established via esophagoesophagostomy to donor esophagus en bloc with a standard MV graft. After 1.9 years of follow-up, the patient has no symptoms of dysphagia or reflux. This case illustrates the feasibility of including the distal donor esophagus as part of an MV graft.

A macrophage-specific synthetic promoter for therapeutic application of adiponectin

Foam cell formation from macrophage is a major cause of atherosclerosis. An efficient macrophage-specific promoter is required for the targeting to macrophages. In this study, we develop a macrophage-specific synthetic promoter for the therapeutic application of adiponectin (APN), an antiatherogenic gene. Synthetic promoter-146 (SP146), registered on the NCBI website (http://www.ncbi.nlm.nih.gov/nuccore/DQ107383), was tested for promoter activities in two non-macrophage cell lines (293 T, HeLa) and a macrophage cell line (RAW264.7, bone marrow-derived macrophages). To enforce macrophage specificity, partial elements of p47(phox) including the PU.1 site with various lengths (-C1, -C2 and -C3) were inserted next to the synthetic promoters. SP146-C1 showed the highest specificity and efficacy in RAW264.7 cells and was selected for development of an APN-carrying macrophage-specific promoter. Green fluorescent protein (GFP)- or APN-expressing lentivirus under SP146-C1 (Lenti-SP-GFP or Lenti-SP-APN, respectively) showed the highest expression efficacy in RAW264.7 cells compared with the non-macrophage cell lines. APN overexpression in RAW264.7 cells successfully inhibited intracellular lipid accumulation, and atherosclerotic lesions and lipid accumulation were significantly reduced by Lenti-SP-APN in ApoE-/- atherosclerosis mice. In conclusion, the synthetic promoter SP146-C1, combined with a p47(phox) promoter element, was successfully developed to target macrophage, and macrophage-specific introduction of APN under SP146-C1 was shown to ameliorate the atherosclerotic pathology.

Allergic diseases in preschoolers are associated with psychological and behavioural problems

Purpose

The aim of the present study was to investigate the relationship between three major allergic diseases, asthma, allergic rhinitis (AR), and atopic dermatitis (AD), and psychological and behavioural problems in preschoolers based on a community survey.

Methods

A cross-sectional survey was conducted using a modified International Study of Asthma and Allergies in Childhood questionnaire to determine the prevalence of symptoms and diagnosed allergic diseases, and a Korean version of the Child Behaviour Checklist to assess internalizing, externalizing, and sleep problems among 780 preschoolers. Five-hundred and seventy-five preschoolers with valid data were included in this study.

Results

The prevalence of lifetime diagnosis and treatment in the past 12 months was 8.7% and 4.4% for asthma, 24.4% and 19.2% for AR, and 35.1% and 16.6% for AD, respectively. Scores for internalizing and sleep problems were significantly higher in those diagnosed with AR. Preschoolers who had been treated for AD in the past 12 months had higher attention problem and attention-deficit/hyperactivity disorder scores. Sleep problems were more severe in moderate to severe AD compared to control and mild AD groups, categorised according to SCOring index of AD. The severity of sleep problems correlated positively with the percentage of eosinophils in peripheral blood.

Conclusions

Psychological and behavioural problems differed among the three major allergic diseases, weaker association for asthma and stronger association for AR and AD. The results of this study may lead to the identification of potential underlying shared mechanisms common to allergic diseases and psychological and behavioural problems.

Effect of paracetamol use on the modification of the development of asthma by reactive oxygen species genes

BACKGROUND

Recent studies have identified an increase in the prevalence of asthma associated with paracetamol use.

OBJECTIVE

To identify the relationship among asthma, biomarkers, genes, and paracetamol use in preschool children.

METHODS

We undertook a population-based, cross-sectional survey of 933 preschool children. Asthma status was classified according to medical history and asthmatic symptoms. History of paracetamol use in infancy was recorded. Impulse oscillometry, blood tests for eosinophils and total IgE, and genotyping of NAT2, Nrf2, and GSTP1 polymorphisms by TaqMan assay were conducted.

RESULT

Paracetamol use in infancy was associated with an increased risk of treatment for asthma within the previous 12 months. Paracetamol use together with a family history of asthma increased the risk of asthma diagnosis ever, current asthma, and treatment for asthma within the previous 12 months. Gene polymorphisms in NAT2 (rs4271002), Nrf2 (rd6726395), and GSTP1 (rd1695) increased the risk of treatment for asthma within the last 12 months. Eosinophils were significantly elevated in the group with paracetamol use and a family history of asthma; however, the serum total IgE level and IOS did not show any significant difference.

CONCLUSION

Paracetamol use in infancy was significantly associated with increased risk of asthma. The association is more significant in genetically susceptible children, related to antioxidant genes, and the effect may be mediated by eosinophilic inflammation.

Fraction of exhaled nitric oxide and wheezing phenotypes in preschool children

BACKGROUND

Asthma is a chronic lower airway inflammatory disease. Nitric oxide is an inflammatory mediator produced endogenously in the airway. Previous studies have demonstrated that the fractional concentration of exhaled nitric oxide (FeNO) is increased in asthma.

OBJECTIVES

To investigate if FeNO concentrations were correlated with wheezing phenotypes in preschool children and to compare the FeNO results with airway hyperresponsiveness (AHR) and pulmonary function test (PFT) results.

METHODS

We performed skin prick tests, methacholine provocation tests, PFT, impulse oscillometry bronchodilator response (IOS BDR) tests, and FeNO measurements in 372 preschool children between the ages of 4 and 6 years. Wheezing phenotypes were defined according to the age of onset and persistency.

RESULTS

Persistent wheezers had higher FeNO levels than transient wheezers and non-wheezers. Among persistent wheezers, those with atopy and AHR had significantly higher FeNO levels than those without atopy or AHR. FeNO levels were significantly higher in late-onset wheezers than early-onset wheezers and non-wheezers. Among late-onset wheezers, those with atopy and AHR had a significantly higher FeNO concentration than those without atopy or AHR as well as those with either atopy or AHR. However, there were no significant differences in AHR, PFT, or IOS BDR between persistent and transient wheezers or between late-onset wheezers and early-onset wheezers.

CONCLUSION

FeNO may be a better marker for asthma phenotypes in preschool children than AHR and PFT results.

Reno-portal anastomosis as an approach to pediatric kidney transplantation in the setting of inferior vena cava thrombosis

In pediatric renal transplantation in the setting of IVC thrombosis, the retrohepatic IVC or gonadal veins are often used for outflow. However, if use of systemic venous outflow is unsuccessful, options become limited. We report the use of the portal vein for venous outflow in kidney retransplantation in the setting of IVC thrombosis. The patient is a 19-month-old male who developed end-stage renal failure at seven months of age secondary to hypotension after spontaneous rupture of an accessory renal vein. The IVC was occluded during emergent laparotomy, and the patient developed extensive IVC thrombosis. The first two transplant attempts used the retrohepatic IVC for venous outflow. Despite good initial flow, in both instances the renal vein thrombosed on post-operative day 1. In an unsuccessful salvage attempt of the second transplant, a reno-portal anastomosis was performed. With few options for vascular access, a third transplant was attempted. The reno-portal stump from the second transplant was used for outflow. The patient recovered well from his third transplant (creatinine 0.6 mg/dL 35 months post-surgery), demonstrating that the portal vein can be used for outflow in cases of extensive IVC thrombosis.

Aorto-mesenteric and renal allograft transplant: a novel treatment for midaortic syndrome

Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the aorta and often involving renal and visceral arteries. Current therapies include medical management of associated hypertension, and interventional procedures such as angioplasty or surgical bypass. We report a 2-year-old female with severe MAS who was initially treated with angioplasty and stents in both her aorta and superior mesenteric artery (SMA). Due to the presence of long segment stenoses, her renal arteries were not amenable to surgical reconstruction and she rapidly progressed to Stage V chronic kidney disease. The patient underwent bilateral nephrectomy and renal transplantation using a donor thoracoabdominal aorta allograft to provide inflow for the kidney as well as to bypass the nearly occluded aorta. The donor SMA was used to bypass the native SMA stenosis. Postoperatively, the patient had normalization of four limb blood pressures. She weaned from five anti-hypertensive agents to monotherapy with excellent renal function. This is the first reported case of thoracoabdominal aortic bypass using allograft aorta to address MAS. This approach allowed for successful kidney transplantation with revascularization of the mesenteric, and distal aortic circulation using allograft conduit that will grow with the child, obviating the need for repeated interventional or surgical procedures.

Multivisceral transplantation using a 2.9 kg neonatal donor

Prematurity and very low birthweight have often been considered relative contraindications to neonatal organ donation. Organ procurement from neonatal donors is further complicated by unclear guidelines regarding neonatal brain death. We report a successful case of multivisceral transplantation using a graft from a 10-day-old, 2.9 kg, neonatal donor born at 36 6/7 wk in a 3.2 kg, three month old with intestinal and liver failure secondary to midgut volvulus. There was immediate liver graft function with correction of recipient coagulopathy, but delayed normalization of laboratory values and delayed return of bowel function. At six-yr post-transplant follow-up, the patient has normal intestine and liver function. Her last histologically confirmed rejection episode was 30 months prior to last follow-up. This case suggests that multivisceral grafts from very young or small neonatal donors may be transplanted successfully in selected cases. We propose a re-examination of the brain death guidelines for premature and young infants to potentially increase the availability of organs for infant recipients.

Effects of 12 weeks of aerobic exercise on body composition and vascular compliance in obese boys

AIM

This study tested the hypothesis that 12 weeks of air board exercise would enhance cardiorespiratory fitness and vascular compliance and reduce % body fat in obese Korean boys.

METHODS

Twenty-two obese boys (>30% body fat) were studied. They were divided into 2 groups- an aerobic exercise group (N.=12), which trained 3 days/week, 50 min/day for 12 weeks, and a control group (N.=10). Control subjects only performed activities involved in their physical education classes. Body composition, cardiovascular fitness (20 m multistage endurance test performance) and vascular compliance were assessed before and after the completion of exercise training.

RESULTS

The % changes in body fat (-4.6±0.9 vs. -1.5±1.0%), fat mass (-5.4±1.5 vs. -0.1±1.6%) and performance on the cardiovascular fitness test (14.3±2.5 vs. 3.7±1.6%) were greater in the exercise group than in the controls Compared to controls, % increases in vascular compliance were greater in the arms and legs of the exercise group (left arm: 2.8±0.5 vs. 2.0±2.9%; left leg: 2.6±1.2 vs. -0.5±2.0%; right arm: 2.9±0.9 vs. 0.3±2.9%; right leg: 4.8±1.8 vs. 1.5±2.0%).

CONCLUSION

Results suggest that exercise training can reduce % body fat and enhance vascular compliance in obese male adolescents; changes that may reduce the risk for later development of cardiovascular disease.

Reference values of impulse oscillometry and its utility in the diagnosis of asthma in young Korean children

AIMS

The aims of this study were (1) to determine the reference values for impulse oscillometry (IOS) and (2) to apply them to the evaluation of asthma in the general population of young Korean children.

METHODS

We performed a questionnaire survey and IOS measurements in 390 children aged 3-7 years in Seoul and Gyeonggi province, Korea, from July to August 2010. IOS measurements included respiratory resistance (Rrs) and respiratory reactance (Xrs) at 5, 10, 15, 20, 25, and 35 Hz, respiratory impedance (Zrs), and resonance frequency (RF) before and 15 min after inhalation of 200 μg salbutamol. To determine the reference values for IOS, 161 children defined as healthy controls were assessed.

RESULTS

The IOS measurements were presented as means and standard deviations. The reference equations for IOS variables were determined by multiple linear regression analysis taking into account their height, weight, and age (R5 = 2.242 - 0.008 × height (cm) - 0.005 × age (months), coefficients of determination (R(2)) = 0.213). Height had the greatest correlation with IOS variables, similar to previous studies. Positive airway obstruction was defined as R5 greater than the 95th percentile of predicted R5 from the reference equation. There was a higher percentage of children with positive airway obstruction in children with asthma than in healthy controls (27.3% vs. 6.2%). Multivariate logistic regression analysis indicated that positive airway obstruction was a significant risk factor for the diagnosis of asthma (adjusted odds ratio (aOR), 6.245; 95% confidence interval (CI), 2.270-17.175).

CONCLUSION

This study provided reference values for IOS in young Korean children and applied the reference values to evaluate children with asthma. We suggest the 95th percentile of predicted R5 as a cut-off value for positive airway obstruction, which may increase the risk for diagnosis of asthma.

Comparative faecal microbiota of dogs with and without calcium oxalate stones

AIMS

The absence of enteric oxalate-metabolizing bacterial species (OMBS) increases the likelihood of calcium oxalate (CaOx) urolithiasis in humans and dogs. The goal of this study was to compare the gut microbiota of healthy dogs and CaOx stone formed dogs (CaOx-dogs), especially with respect to OMBS.

METHODS AND RESULTS

Faecal samples from healthy and CaOx-dogs were obtained to analyse the hindgut microbiota by sequencing the V3 region of bacterial 16S rDNA. In total, 1223 operational taxonomic units (OTUs) were identified at 97% identity. Only 38% of these OTUs were shared by both groups. Significant differences in the relative abundance of 152 OTUs and 36 genera were observed between the two groups of dogs.

CONCLUSIONS

The faecal microbiota of healthy dogs is distinct from that of CaOx-dogs, indicating that the microbiota is altered in CaOx-dogs.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study that has compared the gut microbial diversity in healthy and CaOx-dogs. Results of this study indicate the future need for functional and comparative analyses of the total array of oxalate-metabolizing genes between healthy and CaOx stone formers, rather than focusing on specific bacterial species, to understand the critical role of OMBS in CaOx urolithiasis.

Parent-reported ISAAC written questionnaire may underestimate the prevalence of asthma in children aged 10-12 years

OBJECTIVES

The aim of the present study was to compare the validity of the International Study of Asthma and Allergies in Childhood (ISAAC) written (WQ) and audiovisual questionnaires (AVQ 3.0) in two age-groups (10-12 and 13-15 years, respectively).

METHODS

The 13-15 year olds performed the self-completed the WQ and AVQ on the same day. The 10-12 year olds performed the self-completed the AVQ and the parent-completed WQ was completed by their parents. The methacholine challenge test was conducted in 10-12 year olds from one elementary school.

RESULTS

In 10-12 year olds, the AVQ detected a generally higher prevalence of asthma symptoms than WQ. In 13-15 year olds, this was reversed. In 10-12 year olds, poor agreement was found between the parent-completed WQ and the self-reported AVQ. In 13-15 year olds, moderate agreement was found between the self-reported WQ and AVQ. Low sensitivity was found, in predicting bronchial hyper-responsiveness (BHR) for all questions of both WQ and AVQ in 10-12 year olds. However, the AVQ had slightly higher sensitivity than WQ, with the exception of wheeze ever, although it was not statistically significant.

CONCLUSION

The ISAAC AVQ may be another effective instrument for assessing the prevalence of asthma symptoms in children aged 10-12 years, whereas the parent-reported-WQ may underestimate the prevalence of asthma symptoms in this age-group.

Changes in the prevalence of childhood asthma in seoul from 1995 to 2008 and its risk factors

Purpose

To investigate the prevalence of asthma and determine its risk factors in elementary school students in Seoul.

Methods

A modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to survey 4,731 elementary school students from five areas in Seoul between April and October, 2008.

Results

In elementary school children, the lifetime and recent 12-month prevalence of wheezing were 11.7% and 5.6%, respectively. The lifetime prevalence of asthma diagnosis was 7.9%, and the recent 12-month prevalence of asthma treatment was 2.7%. Male sex (adjusted odds ratio [aOR], 1.90; 95% confidence interval [CI], 1.36-2.66), history of atopic dermatitis (AD) (aOR, 2.76; 95% CI, 1.98-3.84), history of allergic rhinitis (AR) (aOR, 3.71; 95% CI, 2.61-5.26), history of bronchiolitis before 2 years of age (aOR, 2.06; 95% CI, 1.39-3.07), use of antibiotics during infancy for >3 days (aOR, 1.88; 95% CI, 1.35-2.62), parental history of asthma (aOR, 2.83; 95% CI, 1.52-5.27), exposure to household molds during infancy (aOR, 1.84; 95% CI, 1.18-2.89), and the development or aggravation of asthma symptoms within 6 months after moving to a new house (aOR, 11.76; 95% CI, 5.35-25.86) were the independent risk factors for wheezing within 12 months.

Conclusions

The prevalence of wheezing and asthma in elementary school students in 2008 was similar to that in the past decade. Male sex, history of AD, history of AR, history of bronchiolitis before 2 years of age, parental asthma, use of antibiotics during infancy, exposure to molds in the house during infancy, and development or aggravation of asthma symptoms within 6 months after moving to a new house, could be risk factors for wheezing within 12 months.

Effects of early measles on later rhinitis and bronchial hyperresponsiveness

BACKGROUND

The hygiene hypothesis suggests that infectious diseases in early life reduce the risk of allergic diseases.

OBJECTIVE

To investigate the association between measles infection during early childhood and the prevalence of allergic diseases, lung function, bronchial hyperresponsiveness (BHR), and sensitization in later childhood.

METHODS

A survey was conducted 5 years after a nationwide measles outbreak in Korea. From September 1 through November 30, 2006, we obtained information on history of measles and allergic diseases but not of measles vaccination through a questionnaire completed by 1004 schoolchildren aged 6 to 7 years. Furthermore, we measured measles antibody titers and performed skin prick tests, pulmonary function tests, and methacholine challenge tests. Children were divided into groups based on their history of measles infection and antibody titers.

RESULTS

Prevalence of measles infection was 8.2%. Children with both a positive measles history and a positive antimeasles antibody had significantly higher antimeasles antibody levels than those without a measles history. The prevalence of current rhinitis (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.02-3.40), rhinitis ever (aOR, 2.17; 95% CI, 1.19-3.94), and current BHR (aOR, 1.98; 95% CI, 1.04-3.78) was significantly higher in the group with a positive measles history compared with the group with a negative measles antibody. No differences were found among groups in the prevalence of asthma, lung function, provocation concentration that caused a decrease in forced expiratory volume of 1 second of 20%, or sensitization.

CONCLUSION

Early measles infection was associated with increased prevalence of rhinitis and BHR at the age of 7 years but has no effect on the development of asthma and allergy at the age of 7 years. This study indicates that common childhood infections such as measles in early age do not protect against later development of allergic diseases.

A randomized intervention of montelukast for post-bronchiolitis: effect on eosinophil degranulation

OBJECTIVE

To investigate the effect of montelukast on eosinophil degranulation and recurrent wheezing episodes in post-respiratory syncytial virus (RSV) bronchiolitis.

STUDY DESIGN

Two hundred infants (age, 6-24 months) who were hospitalized with their first episode of acute RSV bronchiolitis were randomized in a double-blind, placebo-controlled, parallel comparison of 4-mg montelukast granules (RSV-MONT group) or matching placebo (RSV-PLC group) administered for 3 months. Serum eosinophil-derived neurotoxin (EDN) levels were measured (primary outcome), and recurrent wheezing was documented (secondary outcome) for 12 months. Comparisons were made with control subjects (control group, n = 50).

RESULTS

At the end of the 3-month treatment period, the RSV-PLC group (n = 71) exhibited significantly elevated EDN levels (P < .0001), and the RSV-MONT group (n = 79) showed significantly decreased EDN levels (P < .01) when compared with the initial levels. As a result, EDN levels in the 2 RSV groups significantly differed at this point (P < .0001) and remained different for the entire 12-month follow-up period. Cumulative recurrent wheezing episodes at 12 months were significantly lower in the RSV-MONT group (P = .039).

CONCLUSION

Montelukast treatment reduces eosinophil degranulation and is associated with a decrease in recurrent wheezing episodes in post-RSV bronchiolitis.

Clinical and epidemiological comparison of human metapneumovirus and respiratory syncytial virus in seoul, Korea, 2003-2008

Human metapneumovirus (HMPV) shares clinical and epidemiological characteristics with well-known respiratory syncytial virus (RSV). The aim of this study was to investigate the clinical and epidemiological differences between HMPV- and RSV-induced wheezing illnesses. A total of 1,008 nasopharyngeal aspirate specimens was collected from 1,008 pediatric patients hospitalized with acute respiratory tract infection at Inje University Sanggye Paik Hospital from December 2003 to April 2008, and tested for seven common respiratory viruses. Conditions classified as wheezing illness were bronchiolitis, reactive airways disease, and bronchial asthma. HMPV caused a significantly lower proportion of wheezing illness when compared to RSV (48.1% vs. 82.2%, P<0.05). HMPV-induced wheezing illness occurred predominantly in older patients when compared to RSV patients (P<0.001). RSV infections peaked in the fall and winter followed by peaks of HMPV infection in winter and spring. Eosinophil counts were significantly higher (P<0.01) in RSV patients when compared to HMPV patients. These results show that human metapneumovirus patients exhibit several different clinical and epidemiological characteristics, such as higher proportion of wheezing illness, age and seasonal incidence, and eosinophil counts, when compared to RSV patients.

Reduced size liver transplantation from a donor supported by a Berlin Heart

Patients on cardiac assist devices are often considered to be high-risk solid organ donors. We report the first case of a reduced size liver transplant performed using the left lateral segment of a pediatric donor whose cardiac function was supported by a Berlin Heart. The recipient was a 22-day-old boy with neonatal hemochromatosis who developed fulminant liver failure shortly after birth. The transplant was complicated by mild delayed graft function, which required delayed biliary reconstruction and abdominal wall closure, as well as a bile leak. However, the graft function improved quickly over the first week and the patient was discharged home with normal liver function 8 weeks after transplant. The presence of a cardiac assist device should not be considered an absolute contraindication for abdominal organ donation. Normal organ procurement procedures may require alteration due to the unusual technical obstacles that are encountered when the donor has a cardiac assist device.

Effect of active smoking on asthma symptoms, pulmonary function, and BHR in adolescents

BACKGROUND

Active smoking is known to increase asthma symptoms and bronchial hyper-responsiveness (BHR) while decreasing pulmonary function in adults, but few studies have addressed these issues in adolescents.

METHODS

We conducted a cross-sectional survey involving questionnaires and assessment of urinary cotinine levels among 1,492 adolescents from three urban areas of South Korea. Current smoking was defined as having smoked more than 1 day in the prior 30 days or having urine cotinine levels >or=100 ng/ml. Spirometry, skin tests, and methacholine challenge tests were performed on adolescents in Seoul (n = 724).

RESULTS

The prevalence of current smoking was 8.2% in boys and 2.4% in girls. Reports of wheeze and exercise-induced wheeze in the previous 12 months were more frequent in smokers than nonsmokers (15.2% vs. 8.5%, P = 0.024, and 20.4% vs. 10.7%, P = 0.004, respectively). In multiple logistic regression analysis, current smoking was found to be a significant risk factor for having wheezed in previous 12 months (OR = 4.5, 95% CI 1.5-13.2) and having exercise-induced wheezing in previous 12 months (OR = 8.7, 95% CI, 3.7-20.9). The subgroup analysis revealed that the FEV(1)/FVC was lower in smokers than nonsmokers (mean +/- SD, 105.1 +/- 8.6% vs. 107.8 +/- 7.8%, P = 0.019). In contrast, there was no significant difference in BHR. The effect of smoking on asthma symptoms were more pronounced in non-atopic compared with atopic adolescents.

CONCLUSION

Current smoking was significantly associated with symptoms of asthma, such as having recent wheezing and recent exercise-induced wheezing, especially for non-atopics, in Korean adolescent population. Current smoking was further associated with lower pulmonary function, but not BHR.

Ribonucleotide reductase small subunit p53R2 suppresses MEK-ERK activity by binding to ERK kinase 2

The p53-dependent RR small subunit (p53R2) protein, a newly identified member of the ribonucleotide reductase family, plays a key role in the p53-dependent cellular response to DNA. Several recent studies have suggested that p53R2 also plays an important role in suppressing the invasive potential of human cancer cells. However, the cellular mechanism that regulates invasiveness remains largely unknown. In this study, we show that p53R2 interacts with MEK2 (extracellular signal-regulated kinase (ERK) kinase 2-mitogen-activated protein kinase (MAPK) kinase 2), the molecule immediately upstream of ERK in the Ras-Raf-MAPK signaling cascade. In co-immunoprecipitation and immunofluorescence analyses, we found that p53R2 and MEK2 interact physically in cultured mammalian cells, and that the p53R2 segment comprising amino acids 161-206 is critical for this interaction. Moreover, serum-induced phosphorylation of MEK1/2 and ERK1/2 was greatly augmented in human cancer cells expressing small-interfering RNA against p53R2. On the other hand, phosphorylation of MEK1/2 and ERK1/2 in human cancer cells was markedly attenuated by overexpression of p53R2. Furthermore, MEK2 was required for p53R2 knockdown-induced enhancement of the invasive ability and anchorage-independent growth of human lung cancer H1299 cells. Taken together, these findings show that p53R2 negatively modulates serum-induced MEK-ERK activity and inhibits the MEK-ERK-mediated malignancy potential of human cancer cells.

Retrobulbar optic neuritis and meningoencephalitis following progressive outer retinal necrosis due to CMV in a patient with AIDS

We report on a 34-year-old male patient with AIDS who developed retrobulbar optic neuritis and meningoencephalitis following bilateral progressive outer retinal necrosis (PORN) caused by cytomegalovirus (CMV). This case documents the presumed association of PORN with retrobulbar optic neuritis, and CMV meningoencephalitis in an AIDS patient.

A familial case of pleuropulmonary blastoma

PURPOSE

Pleuropulmonary blastoma (PPB) is a rare intrathoracic neoplasm of early childhood arising in the lung or visceral pleura. Approximately 150 cases have been reported in the literature, with only one previously documented case of PPB in siblings.

PATIENTS AND METHODS

We present the case of two brothers diagnosed with PPB.

RESULTS

A two month-old boy with an abnormal breathing pattern was referred for evaluation of a cystic mass discovered on chest radiograph. Computed tomography (CT) of the chest was performed at our institution which revealed findings compatible with congenital cystic adenomatoid malformation (CCAM) of the right middle and lower lobes. The patient underwent urgent thoracic exploration one week later after developing severe respiratory distress. Histological examination revealed PPB type I (cystic). The patient's 15-month-old brother was presumed to have a CCAM noted radiographically months earlier during an asthma exacerbation. He underwent elective cyst resection and was also found to have type I PPB. The index patient was treated with adjuvant chemotherapy due to the large size of the PPB and intraoperative spillage of cystic fluid during the emergent surgery. In contrast, the brother is being followed without adjuvant chemotherapy, given the much smaller size of the PPB, wide margins of resection, and lack of spillage. Family history included an uncle diagnosed at age 11 with an unusual form of T cell acute lymphoblastic leukemia.

CONCLUSION

Although PPB is known to have a familial association with other neoplasms, this case represents only the second report of PPB occurring in siblings. The importance of thoroughly investigating and resecting pulmonary cystic masses in the pediatric population is highlighted by these cases.

Increased laryngeal lavage lipid-laden macrophage index during acute bronchiolitis

AIM

To investigate aspiration risks associated with bronchiolitis in infants using the lipid-laden macrophage index (LLMI) from laryngeal lavages.

METHODS

Laryngeal lavages from 29 infants with acute bronchiolitis caused by respiratory syncytial virus were evaluated (acute stage). Repeated studies were then performed at 3-4 weeks after the initial study (remission stage). Lavage cell counts and differentials were determined. The amount of lipid per single macrophage was evaluated and the LLMI was determined by evaluating 100 cells. In addition, 24-h pH monitoring (pHm) was performed in 16 patients.

RESULTS

The LLMIs in the acute stage were significantly higher than those in the remission stage (p < 0.05). The neutrophil percentage of the laryngeal lavage correlated significantly with the LLMI (r = 0.707, p < 0.0001) during the acute stage of bronchiolitis. When patients were divided into pHm-positive (n = 5) and pHm-negative (n = 11) subgroups, a significant decrease in LLMI between acute and remission stages was noted among the pHm-positive (p < 0.01) subgroup, but not in the pHm-negative subgroup.

CONCLUSION

These findings suggest that there is a transient increased LLMI in patients with bronchiolitis, which could be caused by gastroesophageal reflux.

The IL-10 (-627 A/C) promoter polymorphism may be associated with coronary aneurysms and low serum albumin in Korean children with Kawasaki disease

Kawasaki disease (KD) is an acute febrile vasculitic syndrome of unknown etiology that preferentially affects the coronary artery. Interleukin-10 (IL-10) is a key proinflammatory cytokine, and a polymorphism near the major transcriptional start site of the IL-10 gene was shown to influence IL-10 production in vitro. This study investigated the association of the IL-10 promoter polymorphism with KD and its clinical parameters in Korean children. A total of 194 children with congenital heart disease (CHD) and 95 children with KD were included in this study. IL-10 (-627 A/C) polymorphism genotypes were determined using the single-base extension method. There was no difference in the allele frequencies of IL-10 (-627 A/C) polymorphism between CHD children and KD children. KD children with one or two copies of the IL-10 (-627C) allele showed significantly lower albumin levels (p = 0.020) and higher frequencies of early coronary artery aneurysm [62.22% versus 37.78%, adjusted odds ratio (aOR) = 3.50, 95% confidence interval (CI): 1.50-8.16] compared with KD children with the common IL-10 (-627A) allele. These findings suggest that the IL-10 (-627 A/C) promoter polymorphism might be a genetic marker for the risk of early coronary artery complication in KD.

One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients

OBJECTIVE

To determine whether adherence to clinic visits early after initiation of highly active antiretroviral therapy (HAART) is predictive of long-term clinical outcome.

DESIGN

Observational cohort study.

SETTING

A tertiary referral hospital.

SUBJECTS

A total of 387 adult HIV patients who were followed for at least 1 year after initiation of HAART between January 1998 and December 2004.

MAIN OUTCOME MEASUREMENTS

The effect of 1-year adherence to clinic visits on the occurrence of new AIDS-defining illness or death was assessed using Kaplan-Meier survival estimates, and hazard ratios were estimated using Cox proportional hazards regression model.

RESULTS

Multivariate analysis revealed that advanced clinical stage, fewer new drugs in HAART, and longer total elapsed time without clinical visits for 1 year after HAART were all significant risk factors for the occurrence of new AIDS-defining illnesses or death. Compared with no missed visits, the hazard ratio adjusted by clinical stage and number of new drugs in HAART was 2.87 (95% confidence interval [CI], 1.34-6.16, P = 0.007) for one missed appointment, 4.37 (95% CI: 1.74-10.98, P = 0.002) for two, and 8.19 (95% CI: 2.95-22.78, P < 0.001) for three or more.

CONCLUSION

Adherence to clinic visits early after initiation of HAART is an independent predictor for long-term clinical progression in HIV patients.

Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea

OBJECTIVES

The high incidence of invasive liver abscess caused by Klebsiella pneumoniae in Taiwan, contrasted with the rareness of this disease in Western countries, has aroused special interest. There have been few detailed reports from other Asian countries. To investigate a current epidemiology of K. pneumoniae liver abscess in Korea and to determine K serotype distribution in K. pneumoniae strains causing liver abscess, we performed a nationwide prospective study.

METHODS

Community-acquired, culture-proven liver abscess cases were enrolled between 2004 and 2005. Etiologies and clinical features were analyzed. K. pneumoniae isolates were serotyped according to K antigen. Meta-analysis was done to determine the time trend of the etiologies of liver abscess in Korea.

RESULTS

Out of 371 cases collected prospectively, 290 (78.2%) were caused by K. pneumoniae. Most K. pneumoniae liver abscesses were monomicrobial. Diabetes mellitus was the most common underlying disease (39.9%). Distant metastatic infections were frequently observed (8.7%). magA PCR revealed that 95 (59.4%) out of 160 K. pneumoniae isolates belonged to the K1 serotype.

CONCLUSIONS

Our study indicates that K. pneumoniae has emerged as a major etiologic agent of liver abscess in Korea, and these emerging infections seem to be attributable to invasive K. pneumoniae strains with capsular K1 serotype.

Pulmonary tuberculosis in young Korean soldiers: incidence, drug resistance and treatment outcomes

OBJECTIVE

To determine the incidence and treatment outcomes of pulmonary tuberculosis (PTB) in young soldiers of South Korea.

DESIGN

From 2000 to 2004, all soldiers with a new diagnosis of tuberculosis (TB) were enrolled in the study, based on the official records of the Armed Forces Medical Command. The demographic and clinical data of the cases were evaluated retrospectively.

RESULTS

A total of 3115 TB cases were reported during the study period, of whom 2071 (66.5%) were reported as PTB. The annual incidence rates of PTB were 96.4 per 100,000 population in 2000, 89.3 in 2001, 67.6 in 2002, 60.2 in 2003, and 63.1 in 2004. A total of 270 patients diagnosed and treated at the Armed Forces Capital Hospital were analysed. Of the Mycobacterium tuberculosis isolates, 87.4% were susceptible to all available anti-tuberculosis drugs; 253 (93.7%) patients eventually completed initial anti-tuberculosis treatment. Among the patients with smear-positive PTB, the cure rate was 89.3% (100/112).

CONCLUSION

Our results demonstrate that the incidence of PTB in Korean soldiers, although still high, was declining steadily. With good case management, the overall success rate of initial treatment was approximately 90%.

Transverse myelitis after measles and rubella vaccination

The incidence of severe neurological complications associated with measles or rubella vaccination is low. A 9-year-old girl developed urinary retention and lower limb paralysis 16 days after measles and rubella vaccination. Her illness was diagnosed as transverse myelitis. Clinical, laboratory and magnetic resonance image findings were consistent with her diagnosis. She was treated with steroids and discharged with only mild lower limb weakness.

Systemic-to-pulmonary venous shunt in superior vena cava obstruction: depiction on computed tomography venography

PURPOSE

To describe computed tomography (CT) venographic appearances of systemic-to-pulmonary venous shunts with CT venography and three-dimensional reconstruction images from patients with superior vena cava obstruction.

MATERIAL AND METHODS

From January 1994 to April 2002, CT venography was performed in 45 patients with superior vena cava obstruction using a single-detector helical CT scanner (n=38) and four-detector row CT scanner (n=7). Analysis of CT scan data included the cause and degree of venous obstruction, the presence of pleural thickening and enhancement, and the attenuation of pulmonary veins. The causative factor for systemic-to-pulmonary venous shunt was evaluated using the Fisher exact test.

RESULTS

Systemic-to-pulmonary venous shunts were observed in four patients (9%) who had high-attenuated pulmonary veins and pleural enhancement on CT venography. Pleural thickening (P=0.01) and a history of pulmonary tuberculosis (P=0.034) are statistically significant risk factors.

CONCLUSION

CT venography showed strong pleural enhancement and high-attenuated pulmonary veins indicating systemic-to-pulmonary venous shunts. Radiologists should study the earlier enhancement of pulmonary veins in patients with superior vena cava obstruction.

Modulation of immune responses by treadmill exercise in Sprague-Dawley rats

AIM

The duration-dependence of the effect of forced treadmill exercise on the immune system is a subject of ongoing research. In this study, the effect of forced treadmill exercise on immune responses was investigated by evaluating the lymphocyte subset fractions in the peripheral blood and spleen of Sprague-Dawley rats.

METHODS

EXPERIMENTAL DESIGN

Comparative investigation over 8 weeks.

SETTING

Experimental animal laboratory.

PARTICIPANTS

Male Sprague-Dawley rats 5 weeks of age, weighing 150+/-10 g.

INTERVENTIONS

Animals were randomly assigned to one of the 4 following groups: the control group, the 1-week-exercise group, the 4-week-exercise group, and the 8-week-exercise group.

MEASURES

Lymphocyte subset fractions, including those for T, B, CD4+, and CD8+ cells and the T/B and CD4+/CD8+ ratios in the peripheral blood and spleen were measured via flow cytometric analysis after treadmill exercise.

RESULTS

The T cell and CD4+ cell fractions in both the peripheral blood and spleen were increased significantly after 8 weeks of treadmill exercise, but the B cell and CD8+ cell fractions did not change significantly.

CONCLUSION

From the results of the present study, it is suggested that a period of one week is insufficient to eliminate the effects of exercise-induced stress, that 4 weeks are needed to return to the control state, and that at least 8 weeks are needed in order for exercise of moderate intensity to have a positive effect on the immune system.

Life threatening tension pneumoperitoneum from intestinal perforation during air reduction of intussusception

We present a case report of a child with intussusception who underwent air reduction which was complicated by bowel perforation. Life threatening tension pneumoperitoneum developed rapidly and immediate needle decompression was life saving in this case. The pathophysiology of hyperacute abdominal compartment syndrome is discussed.

Acute hepatic vein occlusion: spiral CT findings in an experimental study

BACKGROUND

We investigated spiral computed tomographic (CT) findings and underlying hemodynamic alterations in acute hepatic vein occlusion.

METHODS

In nine dogs, immediately after balloon occlusion of the right ( n = 4) or left ( n = 5) hepatic vein through the transjugular or transfemoral route, we performed single-level dynamic CT with intravenous administration of contrast medium. We created time attenuation curves of individual hepatic segments showing attenuation differences. To investigate underlying hemodynamic alterations, hepatic arteriograms were obtained in two dogs.

RESULTS

In all cases, there were three compartments with different time attenuation curves: normal, occluded, and adjacent. The normal compartment, which comprised segments far from the occluded hepatic compartment, showed the normal pattern of hepatic enhancement. The occluded compartment, which was the drainage territory of the occluded hepatic vein, showed high attenuation in the early arterial phase and low attenuation in the portal phase. The adjacent compartment, which shared the same portal vein with the occluded compartment and was drained by the patent hepatic vein adjacent to the occluded one, showed strong contrast enhancement in the late arterial and early portal phase. Spiral CT and hepatic arteriography demonstrated the arterioportal shunt and reversed portal venous flow in the occluded compartment, which drained into the adjacent compartment.

CONCLUSION

Acute hepatic vein occlusion on spiral CT appears as mild, early arterial, high attenuation and portal low attenuation of the occluded compartment and strong enhancement in the late arterial and early portal phases of the adjacent compartment due to arterioportal shunt and reversed portal flow.

Pleckstrin homology domain interacts with Rkp1/Cpc2, a RACK1 homolog, to modulate Pck2-mediated signaling process in Schizosaccharomyces pombe

Rkp1/Cpc2, a fission yeast RACK1 homolog, interacts with Pck2, a PKC homolog, and is involved in the regulation of pck2-mediated signaling process. The N-terminal region of split pleckstrin homology domain (nPH) in human PLC-gamma1 bound to Rkp1/Cpc2 concomitantly with Pck2. nPH inhibited kinase activity of GST-Pck2 purified from Schizosaccharomyces pombe in vitro. The lethality induced by pck2(+) overexpression was suppressed by coexpression of either rkp1(+) or nPH domain. This result suggests that Rkp1/Cpc2 interacts with PH domain-containing protein and regulates the Pck2-mediated signaling process in S. pombe.

Octa(mu3-selenido)hexarhenium(III) complexes containing axial monodentate diphosphine or diphosphine-monoxide ligands

A series of the octahedral hexarhenium(III) complexes containing a variable number of diphosphine (diphos) or diphosphine-monoxide (diphosO) ligands have been prepared by the substitution of the diphosphine Ph2P(CH2)nPPh2 (n = 1 to 5) for the iodide ions in the parent octahedral hexarhenium cluster compound [Re6Se8I6]3-. The diphosphine Ph2P-(CH2)nPPh2 ligands adopt an eta1-bonding mode with the Re6(mu3-Se)8 core, and the P donor atom in the pendant arm is noncoordinated and oxygenated in most cases. The series of new hexarhenium(III) complexes have been well-defined by 1H, 13C, and 31P NMR spectroscopic and FAB-MS data. Four compounds among the series were characterized by X-ray structural determination. Geometrical isomers were identified by NMR spectroscopy as well as by the structural determinations. The apical ligand substitution induces significant change in the redox potentials and the photophysical properties of the Re6(mu3-Se), core. The E1/2 value of the reversible process ReIII6/ReIII5ReIV becomes more positive with the increasing number of the coordinated P donors. The phosphine-substituted hexarhenium(III) derivatives are highly luminescent, with microsecond scale emissive lifetime at ambient temperature, and the fully substituted derivatives with the formula [Re6Se8-(eta1-diphosO)6]2+ display the strongest luminescence with the longest emission lifetimes.

Molecular cloning and functional expression of bovine brain GABA transaminase

We isolated a cDNA that encodes the bovine brain gamma-aminobutyrate transaminase (GABA-T; EC 2.6.1.19) from the lambda gt 11 cDNA library, which showed a high degree of sequence similarity to the corresponding enzymes from various sources. Northern blot analysis revealed two differentially expressed GABA-T transcripts of approximately 2.0 and 6.0 kb in the bovine tissues. Southern blot analysis indicates that the two GABA-T transcripts are encoded in a greater-than 10-kb, single-copy gene. Bovine GABA-T cDNA was expressed in E. coli using the pGEX bacterial- expression vector system. The overexpressed GABA-T was enzymatically active after purification, and it had very similar kinetic parameters when compared with those of other mammalian GABA-Ts.