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Park YA, Plehwe WE, Varatharajah K, Hale S, Christie M, Yates CJ. Skeletal fluorosis secondary to methoxyflurane use for chronic pain. JBMR Plus 2024; 8:ziae032. [PMID: 38577522 PMCID: PMC10994646 DOI: 10.1093/jbmrpl/ziae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Skeletal fluorosis is rare and occurs secondary to chronic high amounts of fluoride consumption, manifesting as diffuse osteosclerosis, skeletal pain, connective tissue calcification, and increased fracture risk. Methoxyflurane is a volatile, fluorinated hydrocarbon-inhaled analgesic, and the maximum recommended dose is 15 mL (99.9 % w/w) per wk. A rodent study found increased skeletal fluoride after methoxyflurane exposure. However, skeletal fluorosis secondary to methoxyflurane use in humans has rarely been reported. We present the case of a 47-yr-old female with diffuse osteosclerosis secondary to fluorosis from methoxyflurane use for chronic pain, presenting with 3 yr of generalized bony pain and multiple fragility fractures. Lumbar spine BMD was elevated. CT and radiographs demonstrated new-onset marked diffuse osteosclerosis, with calcification of interosseous membranes and ligaments, and a bone scan demonstrated a grossly increased uptake throughout the skeleton. Biochemistry revealed an elevated alkaline phosphatase and bone turnover markers, mild secondary hyperparathyroidism with vitamin D deficiency, and mild renal impairment. Zoledronic acid, prescribed for presumed Paget's disease, severely exacerbated bony pain. Urinary fluoride was elevated (7.3 mg/L; reference range < 3.0 mg/L) and the patient revealed using methoxyflurane 9 mL per wk for 8 yr for chronic pain. A decalcified bone biopsy revealed haphazardly arranged cement lines and osteocytes lacunae and canaliculi, which was consistent with an osteosclerotic process. Focal subtle basophilic stippling around osteocyte lacunae was suggestive of fluorosis. Although fluorosis is not a histological diagnosis, the presence of compatible histology features was supportive of the diagnosis in this case with clinical-radiological-pathological correlation. Skeletal fluorosis should be considered as a cause of acquired diffuse osteosclerosis. Methoxyflurane should not be recommended for chronic pain. The risk of repeated low-dose exposure to fluoride from methoxyflurane use as analgesia may be greater than expected, and the maximum recommended dose for methoxyflurane may require re-evaluation to minimize skeletal complications. Abbreviated abstract Skeletal fluorosis is rare and occurs secondary to chronic high amounts of fluoride consumption, manifesting as diffuse osteosclerosis, skeletal pain, connective tissue calcification, and increased fracture risk. We present the case of a 47-yr-old female with skeletal fluorosis secondary to long-term methoxyflurane for chronic pain. The risk of repeated low-dose exposure to fluoride from methoxyflurane use for analgesia may be greater than expected, and the maximum recommended dose for methoxyflurane may require re-evaluation to minimize skeletal complications.
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Affiliation(s)
- Yeung-Ae Park
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria 3052, Australia
| | | | - Kapilan Varatharajah
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria 3052, Australia
| | - Sophie Hale
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Victoria 3052, Australia
| | - Michael Christie
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Victoria 3052, Australia
| | - Christopher J Yates
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria 3052, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville 3052, Australia
- Department of Diabetes & Endocrinology, Western Health, Melbourne, Victoria 3021, Australia
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Trinh A, Tjandra D, Park YA, Sood S, Thomson B, Speer T, Buchanan D, Boussioutas A, Metz AJ. Searching for low phospholipid associated cholelithiasis among patients with post-cholecystectomy biliary pain. ANZ J Surg 2024. [PMID: 38361311 DOI: 10.1111/ans.18904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/28/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Low phospholipid associated cholelithiasis (LPAC) is associated with variants of the adenosine triphosphate-binding cassette subfamily B, member 4 (ABCB4) gene and is characterized by reduced phosphatidylcholine secretion into bile, impairing the formation of micelles and thus exposing bile ducts to toxic bile acids and increasing cholesterol saturation. LPAC is present in 1% of patients with gallstones and post-cholecystectomy pain is common in this group. LPAC is an under-appreciated cause of post-cholecystectomy pain. The aim of this study is to assess a cohort of patients with post-cholecystectomy pain to identify those with clinical features suggesting that further investigations for LPAC would be beneficial. METHODS A retrospective chart review was performed of the first 2 years of post-operative follow-up for all patients under 40 years of age undergoing cholecystectomy for symptomatic gallstones at a tertiary centre between January 2016 and December 2017. RESULTS 258 patients under the age of 40 underwent a cholecystectomy. 50 patients (19.4%) reported abdominal pain post-cholecystectomy. Five patients (1.9%) fulfilled the criteria for suspected LPAC. Family history of gallstones was documented in 33 of 258 (12.8%) of cases. Obstetric history was obtained in 69 of 197 (35%) female patients. None of the five patients identified above who satisfied the criteria of LPAC had the diagnosis of LPAC considered by their treating clinicians. CONCLUSION LPAC is an under-recognized cause of post-cholecystectomy pain. Treatment can avoid long-term symptoms and complications. Clinicians should take a family history and obstetric history to alert them to the diagnosis of LPAC.
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Affiliation(s)
- Andrew Trinh
- Department of Medicine, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Doug Tjandra
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Yeung-Ae Park
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Benjamin Thomson
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Tony Speer
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Daniel Buchanan
- Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Alex Boussioutas
- Department of Medicine, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Andrew J Metz
- Department of Medicine, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia
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3
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Park YA, Gao F, Sim IW, Gilfillan C. Pseudo-Cushing Syndrome With an Atypically High Cortisol Burden and Clinical Improvement With Adrenal Enzyme Inhibitor. JCEM Case Rep 2023; 1:luad075. [PMID: 37909002 PMCID: PMC10580412 DOI: 10.1210/jcemcr/luad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Indexed: 11/02/2023]
Abstract
Distinguishing between Cushing syndrome (CS) and pseudo Cushing syndrome (PCS), also known as physiological hypercortisolism, can be difficult. PCS is caused by nonneoplastic overactivity of the hypothalamic-pituitary-adrenal axis and may be secondary to a range of conditions, including obesity, physical stress, malnutrition, and chronic alcoholism, and typically results in a lesser degree of hypercortisolism and fewer clinical features than CS. Management of PCS includes treatment of the underlying cause and reassessment of hypercortisolemia following improvement in the underlying etiology, as this may result in normalization of cortisol levels. The role of adrenal enzyme inhibitors in lowering cortisol levels in those with PCS is poorly understood. We report a case of a man presenting with weight loss who was found to have severe hypercortisolemia and elevated adrenocorticotropin (ACTH) complicated by infection, neuropsychiatric disturbance, and hypokalemia. Despite high cortisol levels, he was phenotypically not cushingoid, and the circadian rhythm of cortisol was preserved. Extensive investigations did not demonstrate a cause of symptoms or source of ACTH. Medical management with ketoconazole improved neuropsychiatric symptoms, and weight gain with nasogastric feeds resulted in the normalization of cortisol levels and resolution of symptoms following ketoconazole cessation.
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Affiliation(s)
- Yeung-Ae Park
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria 3128, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Frank Gao
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria 3128, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria 3084, Australia
| | - Ie-Wen Sim
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria 3128, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria 3010, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Chris Gilfillan
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, Victoria 3128, Australia
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Stephen S, Park YA, Chrysostomou A. Clinical benefits of Tocilizumab in COVID-19-related cytokine release syndrome in a patient with end-stage kidney disease on haemodialysis in Australia. Nephrology (Carlton) 2020; 25:845-849. [PMID: 32776624 PMCID: PMC7436382 DOI: 10.1111/nep.13767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/26/2020] [Accepted: 07/31/2020] [Indexed: 01/22/2023]
Abstract
COVID‐19 remains a global pandemic with more than 10 million cases and half a million deaths worldwide. The disease manifestations in patients with chronic kidney disease and especially those on haemodialysis are still being understood, with only a few overseas case series, and small observational trials thus far. It appears that the disease is more severe in this patient cohort. Part of the pathophysiology of severe COVID‐19 is related to accompanying cytokine release syndrome (CRS). Tocilizumab, an interleukin‐6 inhibitor, has been trialled for treatment of CRS in COVID‐19, but not yet approved. We present a case of an Australian patient on long‐term haemodialysis with severe COVID‐19 who was successfully treated with Tocilizumab. The peak of her illness was on day 7, with a C‐reactive protein of 624 mg/L (reference < 5 mg/L), ferritin of 5293 ng/mL (reference 30‐500 ng/mL), and interleukin‐6 level 1959.7 pg/mL, consistent with CRS. She was severely hypoxic on a ventilator, with rising inotropic requirements. With the use of Tocilizumab, there was a significant and immediate response in her inflammatory markers, and she made a steady recovery. The patient was discharged home 6 weeks after presentation. A report of an elderly long‐term haemodialysis patient who successfully recovered from a cytokine release syndrome due to severe COVID‐19 using an IL‐6 inhibitor, tocilizumab.
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Affiliation(s)
- Shiny Stephen
- Department of General Medicine, Epworth Richmond Hospital, Richmond, Victoria, Australia.,Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yeung-Ae Park
- Department of General Medicine, Epworth Richmond Hospital, Richmond, Victoria, Australia.,Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anastasia Chrysostomou
- Department of General Medicine, Epworth Richmond Hospital, Richmond, Victoria, Australia.,Department of Renal Medicine, Epworth Richmond Hospital, Richmond, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
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Park YA, Subasinghe AK, Ahmad BS, Gorelik A, Garland SM, Clifford V, Chiang C, Robinson H, Wark JD. Associations Between Serum Sodium Concentration and Bone Health Measures in Individuals Who Use Antiepileptic Drugs: A Pilot Study. J Clin Densitom 2020; 23:364-372. [PMID: 31036448 DOI: 10.1016/j.jocd.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Yeung-Ae Park
- University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia.
| | - Asvini K Subasinghe
- Royal Women's Hospital, Department of Microbiology and Infectious Diseases, Parkville, Australia; Murdoch Children's Research Institute, Infection and Immunity Theme, Parkville, Australia
| | - Baemisla Shiek Ahmad
- University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Alexandra Gorelik
- University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia; School of Psychology, Australian Catholic University, Fitzroy, Australia
| | - Suzanne M Garland
- Royal Women's Hospital, Department of Microbiology and Infectious Diseases, Parkville, Australia; Murdoch Children's Research Institute, Infection and Immunity Theme, Parkville, Australia; University of Melbourne, Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Vanessa Clifford
- Royal Women's Hospital, Department of Microbiology and Infectious Diseases, Parkville, Australia; Murdoch Children's Research Institute, Infection and Immunity Theme, Parkville, Australia; Department of Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Cherie Chiang
- Department of Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Heather Robinson
- Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - John D Wark
- University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Australia
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6
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Park YA, Harris G, Degen DA. Renal recovery in a dialysis-dependent patient with end-stage kidney disease secondary to analgesic nephropathy. Nephrology (Carlton) 2018; 23:705-706. [DOI: 10.1111/nep.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 10/28/2022]
Affiliation(s)
- Yeung-Ae Park
- University of Melbourne Department of Medicine; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Greg Harris
- Department of Renal Medicine; Bendigo Health; Bendigo Victoria Australia
| | - Dov A. Degen
- Department of Renal Medicine; Alfred Health; Melbourne Victoria Australia
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7
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Sol IS, Kim YH, Park YA, Lee KE, Hong JY, Kim MN, Kim YS, Oh MS, Yoon SH, Kim MJ, Kim KW, Sohn MH, Kim KE. Relationship between sputum clusterin levels and childhood asthma. Clin Exp Allergy 2017; 46:688-95. [PMID: 26661728 DOI: 10.1111/cea.12686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammation-associated diseases. Clusterin levels in childhood asthma have not been evaluated. OBJECTIVES (1) To evaluate sputum clusterin levels in children with asthma compared to a control group. (2) To assess the relationships between sputum clusterin levels and airway inflammation, pulmonary function, and bronchial hyperresponsiveness. METHODS This study included 170 children aged 5-18 years with stable asthma (n = 91), asthma exacerbation (n = 29), or no asthma (healthy controls; n = 50). Induced sputum, pulmonary function, and methacholine challenge tests were performed. Stable asthma was classified into two groups according to the severity. Clusterin levels in sputum were measured using an enzyme-linked immunosorbent assay. RESULTS Children with stable asthma had a higher clusterin level than healthy controls [4540 (3872-5651) pg/mL vs. 3857 (1054-4369) pg/mL, P < 0.001]. The clusterin level was also more elevated in eosinophil-dominant sputum than in non-eosinophilic sputum in stable asthma [5094 (4243-6257) pg/mL vs. 4110 (1871-4839) pg/mL, P = 0.0017]. Clusterin levels were associated with asthma severity. Paradoxically, clusterin levels were lower during asthma exacerbation than in stable asthma [1838 (350-4790] pg/mL vs. 4540 (3872-5651) pg/mL, P < 0.001]. Clusterin levels were strongly correlated with the methacholine concentration that caused a 20% decrease in the forced expiratory volume in 1 s (r = -0.617, P < 0.001); there was no significant correlation between clusterin levels and other pulmonary function parameters. CONCLUSIONS AND CLINICAL RELEVANCE Clusterin levels were altered in children with stable asthma and asthma exacerbation because of its antioxidant and anti-inflammatory effects. Clusterin may be a marker that reflects airway inflammation and severity of symptoms, and it can be used in the assessment and management of childhood asthma.
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Affiliation(s)
- I S Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y A Park
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K E Lee
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - J Y Hong
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M N Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M S Oh
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - S H Yoon
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M J Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K W Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M H Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K E Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Shim DH, Park YA, Kim MJ, Hong JY, Baek JY, Kim KW, Byun YH, Seong BL, Ryu S, Song MK, Hong KJ, Na W, Song D, Park JH, Sohn MH, Lee JM. Pandemic influenza virus, pH1N1, induces asthmatic symptoms via activation of innate lymphoid cells. Pediatr Allergy Immunol 2015; 26:780-8. [PMID: 26287507 DOI: 10.1111/pai.12462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The pandemic strain of the influenza A virus (pH1N1) in 2009 caused many complications in patients. In this study, we introduce asthmatic symptoms as a complication of pH1N1 infection in children, not having a relationship with asthma history. The aim of this study was to quantify asthmatic symptoms in pH1N1-infected children and elucidate the underlying mechanisms of airway hyper-responsiveness (AHR) induced in a murine model of pH1N1 infection. METHODS As a retrospective study, pH1N1-infected children who were hospitalized with moderate to severe acute asthmatic symptoms were enrolled and administered a methacholine challenge test (MCT) at 3 months post-discharge. Additionally, the induction of AHR by pH1N1 infection was measured by MCT in wild-type and Rag1(-/-) mice. The effect of the innate immune response on the development of AHR following pH1N1 infection was investigated. RESULTS More than 70% of the pH1N1-infected children without a pre-infection diagnosis of asthma had a negative response on the MCT. None of these children had recurrent wheezing or asthma during the 3 years following pH1N1 infection. The development of AHR in pH1N1-infected mice was associated with an elevation in IL-33 and innate lymphoid cells 2 (ILC2). CONCLUSIONS This study demonstrates that pH1N1 infection directly induces transient asthmatic symptoms in patients regardless of their medical history. pH1N1 infection was shown to stimulate the rapid development of AHR and Th2-type cytokine secretion in mice via the activation of ILC2; it may be activated independently of adaptive immunity.
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Affiliation(s)
- D H Shim
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Departments of Food and Animal Biotechnology, School of Agricultural Biotechnology and Center for Agricultural Biomaterials, Seoul National University, Seoul, Republic of Korea
| | - Y A Park
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics and Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics and Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Y Hong
- Department of Pediatrics and Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Y Baek
- Department of Pediatrics and Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K W Kim
- Department of Pediatrics and Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y-H Byun
- Laboratory of Molecular Medicine, Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - B-L Seong
- Laboratory of Molecular Medicine, Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - S Ryu
- Departments of Food and Animal Biotechnology, School of Agricultural Biotechnology and Center for Agricultural Biomaterials, Seoul National University, Seoul, Republic of Korea
| | - M K Song
- Laboratory Science Division, International Vaccine Institute, Seoul, Republic of Korea
| | - K-J Hong
- ATgen Co. Ltd., Sungnam, 463-400, Republic of Korea
| | - W Na
- Viral Infectious Disease Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea.,University of Science and Technology, Daejeon, Republic of Korea
| | - D Song
- Viral Infectious Disease Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea.,University of Science and Technology, Daejeon, Republic of Korea
| | - J H Park
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - M H Sohn
- Department of Pediatrics and Institute of Allergy, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J M Lee
- Department of Microbiology and Immunology, Yonsei University College of Medicine, Seoul, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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Raval JS, Mazepa MA, Russell SL, Immel CC, Whinna HC, Park YA. Passive reporting greatly underestimates the rate of transfusion-associated circulatory overload after platelet transfusion. Vox Sang 2015; 108:387-92. [PMID: 25753261 DOI: 10.1111/vox.12234] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Transfusion-associated circulatory overload (TACO) is the second leading cause of reported transfusion-related fatalities in the United States. While its occurrence has been previously investigated after red cell and plasma transfusion, no data are available regarding its association with platelet transfusion. Our goal was to determine the rate of platelet-associated TACO at our university medical centre. STUDY DESIGN AND METHODS This study had retrospective and prospective analyses. The 13-year retrospective analysis served to determine the historical rate of platelet-associated TACO by passive reporting. The 30-day prospective analysis included active surveillance of all non-emergently issued and non-operative platelet recipients ≥16 years old with no transfusions in the previous 6 h determined by analysis of blood bank product issue records. Data collected included demographics, vital signs pre- and posttransfusion, fluid balances, supplemental oxygen use, reports of dyspnoea, and infusion rates. For the prospective analysis, all variables were collected within 24 h of transfusion from the medical record and, when necessary, interviews with care providers and/or patients. RESULTS In the retrospective analysis, 366 reactions were reported, of which 6 (1·6%) were TACO. The historical rate of TACO was 1:5997 transfused platelet units. During the prospective analysis, 225 eligible patients received a total of 334 units of platelets. The average platelet transfusion volume was 261 ± 26 ml, and the average infusion rate was 391 ± 198 ml/h. Two unreported TACO reactions were discovered and characterized by new-onset hypertension, crackles on lung auscultation, dyspnoea, hypoxia and supplemental oxygen requirements which resolved completely with diuresis. The rate of TACO during this prospective analysis was 1:167 transfused platelet units. CONCLUSION Platelet-associated TACO is greatly underestimated by passive reporting in the adult patient population.
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Affiliation(s)
- J S Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA
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10
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Lee JS, Kim HJ, Woo ER, Park YA, Lee YS, Park H. 7-feruloylloganin: an iridoid glucoside from stems of Lonicera insularis. Planta Med 2001; 67:99-102. [PMID: 11270737 DOI: 10.1055/s-2001-10623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A new iridoid glucoside, 7-feruloylloganin (1), was isolated from stems of Lonicera insularis, along with six known lignans including (-)-pinoresinol, 9alpha-hydroxypinoresinol, balanophonin, erythro-1-(4-hydroxy-3-methoxyphenyl)-2-[4-[2-formyl-(E)-vinyl]-2-methoxyphenoxy]-propane-1,3-diol, threo-1-(4-hydroxy-3-methoxyphenyl)-2-[4-[2-formyl-(E)-vinyl]-2-methoxyphenoxy]-propane-1,3-diol and buddlenol A. The structure of 1 was determined by analyses of 2D NMR (1H-1H COSY, HMQC and HMBC) and HRFABMS.
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Abstract
We studied the effect of Rosa davurica Pall. (Rosaceae) fruits (RdF) on immediate-type allergic reactions. RdF completely inhibited compound 48/80-induced systemic anaphylactic shock at the dose of 1 g/kg. When RdF was given as pretreatment, at concentrations ranging from 0.0001 to 1 g/kg, the serum histamine levels induced by compound 48/80 were reduced in a dose-dependent manner. RdF inhibited the passive cutaneous anaphylaxis activated by anti-dinitrophenyl (DNP) IgE antibody dose dependently. RdF also inhibited the histamine release induced by compound 48/80 or anti-DNP IgE from the rat peritoneal mast cells (RPMC). Moreover, RdF had a significant inhibitory effect on anti-DNP IgE-induced tumor necrosis factor-alpha production from RPMC. These results indicate that RdF may contain compounds with actions that inhibit mast cell degranulation in the rat.
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Affiliation(s)
- H M Kim
- Department of Oriental Pharmacy, College of Pharmacy, Wonkwang University, Iksan, Chonbuk, South Korea.
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