OBJECTIVE: Henoch-Schonlein purpura (HSP) is a systemic vasculitis, characterized by small-vessel leukocytoclastic vasculitis with the deposition of immune complexes containing IgA. It is the most common acute vasculitic disorder affecting children but is relatively uncommon in adults. We investigated the clinical features and factors affecting the prognosis of adult HSP in Korea. METHODS: From 1996 to 2011 seventy patients over 15 years of age with HSP were retrospectively analyzed. RESULTS: Thirty eight patients (54.3%) were female and the age at disease onset ranged from 15 to 75 years (35.0+/-15.8 years). Purpuric skin rash was observed in all patients and arthralgia was present in 34 patients (48.6%). GI symptoms and kidney involvements were observed in 28 patients (40.0%) and 34 patients (48.6%), respectively. Complete remission was achieved in 46 patients (65.7%). The remission group showed a lower incidence of hematochezia (p=0.044), hematuria (p=0.008), and proteinuria (p=0.011) at diagnosis than the no remission group. About 10% of adult HSP patient progressed to chronic kidney disease (CKD), which showed higher a incidence of nephrotic range proteinuria. Only nephrotic range proteinuria at diagnosis was a significant risk factor for CKD (OR=16.7, p=0.008, 95% CI=2.1~133.1). CONCLUSION: Hematochezia, hematuria and proteinuria at the diagnosis of HSP are important prognostic factors in predicting remission. In addition, HSP patients with nephrotic range proteinuria at diagnosis have an increased risk of renal failure.
Adult ; Antigen-Antibody Complex ; Arthralgia ; Child ; Exanthema ; Female ; Gastrointestinal Hemorrhage ; Hematuria ; Humans ; Immunoglobulin A ; Incidence ; Kidney ; Korea ; Prognosis ; Proteinuria ; Purpura, Schoenlein-Henoch ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Systemic Vasculitis ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.
Achievement ; Bottle Feeding ; Bronchopulmonary Dysplasia ; Enteral Nutrition ; Gastroesophageal Reflux ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Length of Stay ; Parturition ; Retrospective Studies

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.
Achievement ; Bottle Feeding ; Bronchopulmonary Dysplasia ; Enteral Nutrition ; Gastroesophageal Reflux ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Length of Stay ; Parturition ; Retrospective Studies

PURPOSE: Theophylline has recently been reported to have concurrent anti-inflammatory effects at low therapeutic plasma concentrations which are below the doses at which significants, clinically useful bronchodilatation is evident. Sustained-release formulation in capsule and dry syrup forms were developed to reduce its adverse effects and improve its clinical effects. We compared the therapeutic effects of theophylline dry syrup and capsules in children with mild asthma. METHODS: Ninety children with mild asthma were randomized to receive either theophylline dry syrup (n=44) or theophylline capsules (n=46); 4 mg per kilogram of body weight, twice a day, for 12 weeks. Baseline and serial measurements of daytime and nighttime asthma symptom score were performed. Compliance scores, drug swallowing scores, and drug usability scores were measured every 4 weeks. Each scoring was rated on a scale of 0-4. Serum theophylline concentration were measured at 4 and at 12 weeks. To examine the anti-inflammatory effect of theophylline on asthma, Serum eosinophilic cationic protein as a marker of airway inflammation caused by eosinophil was measured 12 weeks pre- and post-administration. RESULTS: The daytime and nighttime asthma symptom scores of the two groups after 4 weeks significantly improved over the baseline score. Daytime and nighttime asthma symptom scores in the dry syrup group were statistically lower at all time points except for the nighttime symptom scores at 4 weeks. Compliance scores, drug swallowing scores, and drug usability scores in the dry syrup group were significantly higher at the end time point. Only in the dry syrup group was the serum ECP at the end time point statistically lower than baseline. CONCLUSION: Low-dose sustained-release theophylline may be safe and effective in bronchial asthma and this effect may be mediated by its anti-inflammatory action mechanisms. Especially, when used in children with asthma, dry syrup formulation is recommended because of its higher compliance than capsule formulation.
Asthma* ; Body Weight ; Capsules ; Child* ; Compliance ; Deglutition ; Eosinophils ; Humans ; Inflammation ; Plasma ; Staphylococcal Protein A ; Theophylline*

Bleomycin, the generic name for a group of sulfur- containing polypeptide antibiotics derived from Streptomyces verticillus, has been used as a single agent and in combination for treatment of various neoplasms and viral diseases. Recently, intradermal bleomycin injections have been shown to bring about significant improvements in keloid and hypertrophic scar. However, the mechanism by which this drug acts on keloid is not entirely clear. In this study, the effects of bleomycin on growth rate, apoptosis, production of transforming growth factor(TGF-beta) and expression of its receptor, secretion of fibronectin were evaluated in keloid and normal human dermal fibroblasts. Human keloid and normal fibroblasts were primarily cultured from earlobe keloids of three female patients and treated with various concentration of bleomycin. Cell toxicity was assessed by MTT assay, growth rate and apoptosis was assessed by FACS, production of fibronectin by immunoprecipitation and western blot, TGF-beta secretion by ELISA, and expression of TGF-beta receptor by western blot, respectively. The obtained results are follows : Bleomycin induced cell toxicity dose-dependently in keloid fibroblasts in the range of 0.0012-0.075mg/ml, and the MTT90 and MTT50 values of bleomycin were 0.0081mg/ml and 0.0352mg/ml, respectively. Even in lower concentration (MTT90) of bleomycin, the cell growth was significantly suppressed in both normal and keloid fibroblasts, with the latter more suppressed than the former. Keloid fibroblasts secreted more TGF-beta than normal fibroblasts, but there was no significant difference of TGF-beta secretion between the group with bleomycin treatment and the untreated control group. There was no significant effect of bleomycin on the suppression of the expression of TGF-beta receptor and the production of fibronection in fibroblast. Keloid fibroblasts responded to bleomycin more sensitively than normal fibroblasts, and the percentage of apoptosis was higher in keloid fibroblasts than in normal fibroblast at the MTT50 concentration of bleomycin. Bleomycin had growth-inhibitory effect with inducing the apoptosis directly in lower concentration(MTT90). Therefore, clinical application with lower concentration than 1.0 mg/ml is adviced. Further studies, including clinical demonstration, will be required to better elucidate the anti-keloid effect of bleomycin depending on the dosage and the additive effect of different anti-keloid action by other agents. In summary, bleomycin may be a drug of promise in the treatment of keloid and hypertrophic scar.
Anti-Bacterial Agents ; Apoptosis* ; Bleomycin* ; Blotting, Western ; Cicatrix, Hypertrophic ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibroblasts* ; Fibronectins ; Humans ; Immunoprecipitation ; Keloid* ; Receptors, Transforming Growth Factor beta ; Streptomyces ; Transforming Growth Factor beta ; Virus Diseases

Keloids represent a dysregulated response to cutaneous wounding that results in an excessive deposition of extracellular matrix. However, the molecular mechanisms underlying this pathologic deposition of extracellular matrix still remain to be elucidated. In this study, the effects of anti-keloid drugs (triamcinolone(R), 5-FU(R), bleomycin(R), verapamil(R)) on the expression of fibronectin and TGF-beta and its receptor in keloid fibroblasts were evaluated in vitro. Human keloid fibroblasts(KFs) and normal human dermal fibroblasts(NHDFs) were isolated from earlobe keloids. Immunoprecipitation and Western blot of fibronectin, ELISA of TGF-beta secretion and Western blot of TGF-beta receptor were performed using the primary cultured fibroblasts treated with various drugs. TGF-beta secretion was increased in keloid fibroblasts compared to NHDFs. TGF-beta promoted fibronectin synthesis in keloid fibroblasts. These results substantiate the hypothesis that the elevated levels of TGF-beta play a potential role in keloid pathogenesis. 5-FU suppressed profoundly TGF-beta secretion. Triamcinolone and verapamil inhibited significantly fibronectin synthesis and secretion, and also suppressed TGF-beta receptor expression in keloid fibroblasts. In conclusion, it is postulated that the combination of low dose of 5-FU and triamcinolone or verapamil may be useful in keloid treatment by the additive effect of different anti-keloid action.
Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fibroblasts* ; Fibronectins* ; Fluorouracil ; Humans ; Immunoprecipitation ; Keloid* ; Receptors, Transforming Growth Factor beta ; Transforming Growth Factor beta ; Triamcinolone ; Verapamil ; Wounds and Injuries

OBJECTIVES: This study was carried out to identify seasonal variations of urinary concentrations of N-methylformamide (NMF) among workers employed at a synthetic leather factory. METHODS: Study subjects consisted of 16 male and 6 female workers who were involved in the direct treatment of dimethylformamide (DMF) in a synthetic leather factory. By using health examination data and the results of air measurements and biologic monitoring conducted in February and July, 2001, we identified seasonal variations of the DMF concentrations in the air and NMF concentrations in urine. RESULTS: 1) In winter and summer, average temperatures at the working sites were 3.2 degrees C and 26.5 degrees C, respectively and average humidities were 35.4 % and 84.5 %, respectively. 2) Airborne DMF concentrations were not significantly different between summer (13.78 ppm) and winter (11.55 ppm). 3) NMF concentrations in urine were found to be significantly higher in summer (96.09 mg/g creatinine) than in winter (31.23 mg/g creatinine) (p<0.001). CONCLUSIONS: The seasonal difference in the urinary excretion values of NMF may be due to increased dermal absorption of DMF with the higher ambient temperature and humidity in summer and the increased area of exposed skin.
Absorption ; Dimethylformamide ; Environmental Monitoring ; Female ; Humans ; Humidity ; Male ; Seasons* ; Skin

OBJECTIVES: The purpose of this study was to investigate the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the relationship between AUDIT score and liver function test. METHODS: AUDIT questionnaires were distributed to 440 blue-collar workers. We compared liver function test with firstly, normal and hazardous drinking as defined by WHO, and secondly, with normal, hazardous and harmful drinking as measured by Kim et al.(1999). We also compared influencing factors on abnormal liver function. RESULTS: By simple analysis in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 2.81) based on the guideline of WHO. By chi-square test for linear trend in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 1.23) and harmful drinking (odds ratio 2.14) based on the guideline of Kim et al.By multiple logistic regression analysis, abnormal liver function was significantly affected by AUDIT questionnaires No. 1-3 (odds ratio- high risk 2.39), age (odds ratio- thirties 1.95, forties 2.40, fifties 3.85), BMI (odds ratio- overweight 1.66, obesity 4.53), guideline by WHO (odds ratio- hazardous drinking 2.10), and guideline by Kim et al (odds ratio- harmful drinking 2.20) CONCLUSIONS: We found that the problem of alcohol drinking as measured by AUDIT was significantly associated with abnormal liver function. Therefore we suggest that AUDIT will be useful for the predictive test of abnormal liver function and screening test of hazardous and harmful drinking.
Alcohol Drinking ; Drinking ; Liver Function Tests* ; Liver* ; Logistic Models ; Mass Screening ; Obesity ; Overweight ; Questionnaires

OBJECTIVES: We examined the effects of INM 176 (K-1107) compared with placebo on the cognitive functions of 92 old aged subjects with cognitive impairment. METHODS: This was a prospective, 12 week, double-blind, placebo-controlled clinical trial. The elderly who achieved a score of less than 25 points on the K-MMSE or showed a high risk of Alzheimer's disease from the 7-Minute Neurocognitive Screening Battery were considered to have objective impairment and were selected as subjects for this study. The subjects were randomized to placebo or INM 176 group. The outcome measures were from the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Instrumental Activities of Daily Living (IADL) and the Korean Geriatric Depression Scale (KGDS) and two kinds of computerized priming tests. After setting the total error score in the Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-cog) as the repeated measurement factor, an analysis of variance of the combined factor design was done between the placebo and INM 176 group. RESULTS: The interaction effect of time (pre- and post- trial) and group (placebo and INM 176 group) was significant in the analysis of the ADAS-cog's total error score. The INM 176 group's total error score in the ADAS-cog decreased significantly (p<0.01), whereas the placebo group showed a slight increase. The mean changes in IADL and GDS from baseline scores favored in the INM 176 group than in the placebo group. Outcome changes of ADAS-cog, IADL, KGDS scores during the 12 week clinical trail of INM 176 and placebo demonstrated favorable responses in the INM176 administered group. CONCLUSIONS: This is a preliminary clinical trial result of INM176 as a memory pill. Based on these results, INM176 may be a candidate molecule for the improvement of cognitive functions, including memory. Further clinical trial should demonstrate its efficacy.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Depression ; Humans ; Mass Screening ; Memory* ; Outcome Assessment (Health Care) ; Prospective Studies

Interleukin (IL)-8 and vascular endothelial growth factor (VEGF) are important factors that induce the migration and proliferation of endothelial cells, increase the vascular permeability, and the modulate chemotaxis of monocytes. These molecules have been found in human atherosclerotic plaques. However, it is not clear whether the circulating levels of IL-8 and VEGF correlate with the extents of carotid stenosis. In this study, we investigated the relationship between circulating levels of IL-8 as well as VEGF and the extents of carotid stenosis. Sera from 41 patients with carotid stenosis were assessed for concentrations of IL-8 and VEGF by enzyme-linked immunosorbent assay. The degree of stenosis of extracranial carotid artery was calibrated by carotid B- mode ultrasonography. The serum concentration of IL-8 (r=-0.04733, p>0.05) was not correlated with the degree of stenosis. However, the serum concentration of VEGF (r=0.4974, p<0.01) was significantly correlated with the degree of carotid stenosis. These findings suggest that increased serum level of VEGF might be a marker for higher degree of stenosis of extracranial carotid artery.
Adult ; Aged ; Carotid Artery Diseases/blood ; Carotid Stenosis/*blood ; Disease Progression ; Endothelial Growth Factors/*blood ; Female ; Human ; Interleukin-8/*blood ; Lymphokines/*blood ; Male ; Middle Age