BACKGROUND: Bronchial asthma is an inflammatory disease of the airways that is associated with airway remodeling. The vascular endothelial growth factor (VEGF) is a potent, multifunctional cytokine that contributes to angiogenesis and inflammation. Matrix metalloproteinase-9 (MMP-9) is a major proteolytic enzyme that induces bronchial remodeling in asthma. However, there is no data available on the possible role of the VEGF or on the potential relationship between the VEGF and MMP-9 in acute asthma. Therefore, the VEGF was studied to determine whether or not it participates in airway inflammation during acute asthma. An additional aim of this study was to determine whether or not the VEGF levels correlated with the MMP-9 levels in the sputum of acute asthma patients. METHODS: Both the VEGF and MMP-9 levels were measured by an enzyme immunoassay and zymographic analysis in the sputum of patients with either stable asthma or with acute asthma. The VEGF and MMP-9 levels were also evaluated during a spontaneous asthma attack. RESULTS: The VEGF levels were significantly higher in the sputum of acute asthmatic patients than in either the stable patients the control subjects. The VEGF levels in the sputum during asthma exacerbation were significantly higher than those on the remission days, and those levels decreased after decreased after asthma therapy. In acute asthmatic patients, the VEGF levels in the sputum correlated with the number of neutrophils and eosinophils. In addition, a significant correlation was established between the VEGF and MMP-9 levels in the sputum. CONCLUSION: These results suggest that VEGF overproduction is associated with airway inflammation during acute asthma and is related to the MMP-9 function.
Airway Remodeling ; Asthma* ; Eosinophils ; Extracellular Matrix ; Humans ; Immunoenzyme Techniques ; Inflammation ; Matrix Metalloproteinase 9* ; Neutrophils ; Sputum ; Vascular Endothelial Growth Factor A*

A 67-year-old man developed intermittent headaches, ophthalmoplegia, loss of consciousness, and hyporeflexic quadriparesis. An examination disclosed bilateral papilledema, constricted visual fields, and elevated intracranial pressure. All these symptoms were well correlated with intermittent high intracranial pressure which represented Lundberg A wave. Repeated lumbar punctures finally revealed metastatic malignant cells from lung cancer. Leptomeningeal metastasis may manifest with various constellations of symptoms.
Aged ; Headache* ; Humans ; Intracranial Hypertension* ; Intracranial Pressure ; Lung Neoplasms ; Neoplasm Metastasis ; Ophthalmoplegia* ; Papilledema ; Quadriplegia* ; Radiculopathy ; Spinal Puncture ; Unconsciousness ; Visual Fields

PURPOSE: The study was performed to investigate the association and autumnal exacerbation of asthma and house dust mites which has been suggested as one of the factors contributing to the seasonal epidemics of asthma. We measured Dermatophagoides pteronyssinus (Der p) specific IgE levels of patients who had experienced severe exacerbation during the autumn season and compared with the patients who had not. METHODS: The medical records of patients with asthma, aged from 3 to 15 years, were reviewed and classified into two groups; (1) those with acute severe exacerbation (cases hospitalized or treated at emergency room, ER), (2) those without severe exacerbation (cases treated in outpatient clinic). Each groups were divided into two subgroups according to season of their visit for treatment as autumn and other seasons except for autumn. The Der p specific IgE level was determined by using the UniCAP system. RESULTS: Both mean Der p specific IgE (43.5+/-39.2 kU/L) and total IgE (643.1+/-815.3 kU/L) levels of patients hospitalized or treated at the ER during the autumn were significantly higher than those from the following two groups; outpatients during the autumn (26.6+/-32.5 kU/L, 402.2+/-411.6 kU/L) and patients hospitalized or treated at ER during seasons other than the autumn (26.4+/-36.0 kU/L, 349.5+/-325.4 kU/L). CONCLUSION: Higher Der p specific IgE level in children with asthma was associated with autumnal exacerbation of asthma, which suggests those patients may be put at higher risk of exacerbation during the autumn.
Asthma* ; Child ; Dermatophagoides pteronyssinus* ; Emergency Service, Hospital ; Humans ; Immunoglobulin E* ; Medical Records ; Outpatients ; Pyroglyphidae* ; Seasons

PURPOSE: This study was performed to evaluate the distribution of homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance, and its association with metabolic risk factors among Korean adolescents. METHODS: This study was based on data from Korean National Health and Nutrition Examination Survey (KNHANES) 2008~2009. Data from 2,035 adolescents (1,053 boys, 982 girls; aged 10~19 years) were analyzed. We classified all subjects into four groups, based on the quartiles of HOMA-IR, and the highest quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis to determine the independent risk factors for insulin resistance. RESULTS: The highest quartile values of HOMA-IR representing insulin resistance were 3.4 for boys and 3.6 for girls. Mean body mass index, waist circumference, systolic blood pressure, serum triglyceride, alanine aminotransferase (ALT), fasting glucose and insulin increased, whereas HDL cholesterol decreased with increased HOMA-IR. We found HOMA-IR has significant positive correlation with waist circumference, triglyceride, ALT level and systolic/diastolic blood pressure, while it has negative correlation with HDL-cholesterol level (p<0.005). Independent predictors (odds ratio) for insulin resistance were elevated ALT (3.53 for boys; 4.04 for girls), central obesity (3.01 for boys; 3.20 for girls), and hypertriglyceridemia (3.03 for boys; 1.94 for girls). CONCLUSION: Metabolic risk factors were strongly associated with insulin resistance, defined as highest quartile values of HOMA-IR (> or =3.4 for boys and > or =3.6 for girls). These values could be useful as a marker of insulin resistance and metabolic risk in Korean adolescents.
Adolescent ; Aged ; Alanine Transaminase ; Biomarkers ; Blood Pressure ; Body Mass Index ; Cholesterol, HDL ; Fasting ; Glucose ; Homeostasis ; Humans ; Hypertriglyceridemia ; Insulin ; Insulin Resistance ; Logistic Models ; Metabolome ; Nutrition Surveys ; Obesity, Abdominal ; Risk Factors ; Waist Circumference

Cognitive impairment is a result of dementia of diverse causes, such as cholinergic dysfunction and Alzheimer's disease (AD). Houttuynia cordata Thunb. (Saururaceae) has long been used as a traditional herbal medicine. It has biological activities including protective effects against amyloid beta (Abeta) toxicity, via regulation of calcium homeostasis, in rat hippocampal cells. To extend previous reports, we investigated the effects of water extracts of H. cordata herb (HCW) on tauopathies, also involving calcium influx. We then confirmed the effects of HCW in improving memory impairment and neuronal damage in mice with Abeta-induced neurotoxicity. We also investigated the effects of HCW against scopolamine-induced cholinergic dysfunction in mice. In primary neuronal cells, HCW inhibited the phosphorylation of tau by regulating p25/p35 expression in Abeta-induced neurotoxicity. In mice with Abeta-induced neurotoxicity, HCW improved cognitive impairment, as assessed with behavioral tasks, such as novel object recognition, Y-maze, and passive avoidance tasks. HCW also inhibited the degeneration of neurons in the CA3 region of the hippocampus in Abeta-induced neurotoxicity. Moreover, HCW, which had an IC50 value of 79.7 microg/ml for acetylcholinesterase inhibition, ameliorated scopolamine-induced cognitive impairment significantly in Y-maze and passive avoidance tasks. These results indicate that HCW improved cognitive impairment, due to cholinergic dysfunction, with inhibitory effects against tauopathies and cholinergic antagonists, suggesting that HCW may be an interesting candidate to investigate for the treatment of AD.
Acetylcholinesterase ; Alzheimer Disease ; Amyloid ; Animals ; Calcium ; Cholinergic Antagonists ; Dementia ; Herbal Medicine ; Hippocampus ; Homeostasis ; Houttuynia* ; Inhibitory Concentration 50 ; Memory ; Mice ; Neurons ; Phosphorylation ; Rats ; Tauopathies ; Water

PURPOSE: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. MATERIALS AND METHODS: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. RESULTS: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. CONCLUSION: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.
Aged ; Animals ; Ankle ; Bandages ; Foot ; Humans ; Incidence ; Patient Satisfaction ; Postoperative Complications ; Retrospective Studies ; Wound Healing

PURPOSE: Our objective was to investigate the role of CD8+T cells in pathogenesis of wheezing in children with atopic nature. METHODS: Twelve atopic wheezers, 8 nonatopic wheezers, 8 disease controls and 8 healthy controls were enrolled in the study. We isolated CD8+ T cells from peripheral blood samples, incubated them for 72 hours either in the absence or presence of phytohemagglutinin (PHA) and compared the concentrations of interleukin (IL)-5, IL-13, and interferon (IFN)-gamma in the cell culture supernatants. RESULTS: In the atopic wheezer group, the IL-5 concentration was significantly higher after PHA stimulation than after non-stimulated incubation. This difference was not observed in the nonatopic wheezer, disease control and healthy control groups. IL-13 was undetectable in all of the cell culture supernatants. There was no significant difference in the IFN-gamma concentration between the PHA-stimulated and non-stimulated conditions in all 4 groups. CONCLUSION: The results of this study suggest that CD8+ T cells may play a role in the pathogenesis of wheezing in children with atopic nature through the production of IL-5.
Cell Culture Techniques ; Child ; Humans ; Interferon-gamma ; Interferons ; Interleukin-13 ; Interleukin-5 ; Interleukins ; Respiratory Sounds ; T-Lymphocytes

PURPOSE:This study was performed to investigate clinical characteristics and the etiology of cervical lymphadenopathy in children. METHODS:A clinical review of 240 cases of children under the age of 18 who were admitted with cervical lymphadenopathy from January 2002 to December 2007. RESULTS:Cervical lymphadenopathy was diagnosed as follows:clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4 %), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%). Abscess was presented as an acute lesion (94.1%) with less than 2 weeks of fever (69.4 %) and tuberculous lymphadenitis was presented as a chronic lesion (62.5%) without fever (90 %). Malignant disease (100%) and necrotizing lymphadenitis (62.5%) were found in chronic lesion of older children with systemic symptoms (40% and 37.5%, respectively). Leukopenia (57.9%) with various duration of fever occured in case of necrotizing lymphadenitis. CONCLUSION:Clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4%), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%) were found in cervical lymphadenopathy. Although cervical lymphadenopathy was commonly caused by a benign infectious process, a more serious disease was not rare, which may have different clinical characteristics including age, duration of fever and disease, previous or accompanying symptoms, or white cell counts. Meticulous combination of clinical characteristics, history, physical examination and workup as well as follow-up may be the most important for the proper approach on cervical lymphadenopathy in children.
Abscess ; Cell Count ; Child ; Fever ; Humans ; Hyperplasia ; Leukopenia ; Lymphadenitis ; Lymphatic Diseases ; Mucocutaneous Lymph Node Syndrome ; Physical Examination ; Tuberculosis, Lymph Node

BACKGROUND/OBJECTIVES: Citrus and its peels have been used in Asian folk medicine due to abundant flavonoids and usage of citrus peels, which are byproducts from juice and/or jam processing, may be a good strategy. Therefore, the aim of this study was to examine antioxidant and anti-inflammatory effects of bioconversion of Jeju Hallabong tangor (Citrus kiyomi × ponkan; CKP) peels with cytolase (CKP-C) in RAW 264.7 cells. MATERIALS/METHODS: Glycosides of CKP were converted into aglycosides with cytolase treatment. RAW 264.7 cells were pre-treated with 0, 100, or 200 µg/ml of citrus peel extracts for 4 h, followed by stimulation with 1 µg/ml lipopolysaccharide (LPS) for 8 h. Cell viability, DPPH radical scavenging activity, nitric oxide (NO), and prostagladin E2 (PGE2) production were examined. Real time-PCR and western immunoblotting assay were performed for detection of mRNA and/or protein expression of pro-inflammatory mediators and cytokines, respectively. RESULTS: HPLC analysis showed that treatment of CKP with cytolase resulted in decreased flavanone rutinoside forms (narirutin and hesperidin) and increased flavanone aglycoside forms (naringenin and hesperetin). DPPH scavenging activities were observed in a dose-dependent manner for all of the citrus peel extracts and CKP-C was more potent than intact CKP. All of the citrus peel extracts decreased NO production by inducible nitric oxide synthase (iNOS) activity and PGE2 production by COX-2. Higher dose of CKP and all CKP-C groups significantly decreased mRNA and protein expression of LPS-stimulated iNOS. Only 200 µg/ml of CKP-C markedly decreased mRNA and protein expression of cyclooxygenase-2 in LPS-stimulated RAW 264.7 cells. Both 100 and 200 µg/ml of CKP-C notably inhibited mRNA levels of interleukin-1β (IL-1β) and IL-6, whereas 200 µg/ml CKP-C significantly inhibited mRNA levels of TNF-α. CONCLUSIONS: This result suggests that bioconversion of citrus peels with cytolase may enrich aglycoside flavanones of citrus peels and provide more potent functional food materials for prevention of chronic diseases attributable to oxidation and inflammation by increasing radical scavenging activity and suppressing pro-inflammatory mediators and cytokines.
Asian Continental Ancestry Group ; Blotting, Western ; Cell Survival ; Chromatography, High Pressure Liquid ; Chronic Disease ; Citrus ; Cyclooxygenase 2 ; Cytokines ; Dinoprostone ; Flavanones ; Flavonoids ; Functional Food ; Glycosides ; Humans ; Inflammation ; Interleukin-6 ; Medicine, Traditional ; Nitric Oxide ; Nitric Oxide Synthase Type II ; RNA, Messenger

STUDY DESIGN: Retrospective study. OBJECTIVES: The aim of this study was to report the usefulness of lumbar posterior foraminotomy and central decompression using tubular retractor with minimally invasive technique. SUMMARY OF LITERATURE REVIEW: Posterior decompression and arthrodesis for the treatment of lumbar spinal stenosis with foraminal stenosis is a classical surgical method. It is inappropriate for patients who have rejection to arthrodesis or medical problems, because it may have several complications. MATERIALS AND METHODS: Clinical results were obtained from 12 patients who underwent posterior foraminotomy and central decompression from January 2009 to April 2011 and were assessed using a Visual analogue scale, Oswestry disability index and the Prolo outcome scale. RESULTS: Six Of 12 patients showed immediate relief of radiculopathy. Postoperative posterior lumbar pain and spasm were negligible, and no surgically related complication was noted. During the follow-up period, the Oswestry disability index decreased from 24.25+/-2.89(pre-op) to 19.33+/-3.02(Last F/U)(p=0.28, paired t-test) in 8 of 12 patients. CONCLUSIONS: A minimally invasive posterior foraminotomy and central decompression could be an alternative surgical option for the treatment of lumbar spinal stenosis with foraminal stenosis, especially in subjects with old age, having medical problems and refusal of arthrodesis.
Arthrodesis ; Constriction, Pathologic* ; Decompression ; Disulfiram ; Follow-Up Studies ; Foraminotomy* ; Humans ; Radiculopathy ; Retrospective Studies ; Spasm ; Spinal Stenosis* ; Surgical Procedures, Minimally Invasive