PURPOSE: Allergic rhinitis (AR) is common among children with asthma and exacerbates asthma symptoms. To assess the incremental utilization and cost of asthma-related health services due to concomitant AR among asthmatic children. MATERIALS and METHODS: Asthma-related claims were extracted from the Korean National Health Insurance (NHI) claims database, which covers 97% of the population. Per-capita utilization and costs of asthma-related services were determined from the societal perspective. RESULTS: Of 319,714 children (1-14 years old) with chronic asthma in 2003, 195,026 had concomitant AR (prevalence 610 per 1,000 asthmatic children). Children with AR had 1.14 times more outpatient visits, 1.30 times more emergency department (ED) visits, and 1.49 times more hospitalizations than children without AR. More children with AR used general hospitals (7.17%) than children without AR (3.23%). The ratios of unit pharmaceutical costs per outpatient visit, ED visit, and admission between children with and without AR were 1.27, 1.20, and 1.14. Total annual expenditure combining direct health care, transportation, and caregivers' costs, were dollar 273 and dollar 217 for children with and without AR, respectively. CONCLUSION: Health service utilization and costs for asthma were greater for asthmatic children with AR. More frequent ED visits and admissions among asthmatic children with AR suggest poorer control and more frequent exacerbations. Higher unit cost of pharmaceuticals during visits, tendency to receive asthma care from a higher-level facility, and greater risk of ED visit or admission all contributed to the additional economic burden of AR.
Adolescent ; Asthma/*economics/*epidemiology ; Child ; Child, Preschool ; Female ; Health Services/economics/statistics & numerical data ; Humans ; Hypersensitivity/economics/epidemiology ; Infant ; Male ; Rhinitis/*economics/*epidemiology

PURPOSE: IV-lipid emulsion can be a nutritional supplement to provide essential fatty acids and energy for patients who need total parenteral nutrition support. The recommended administration dose of lipid emulsion is less than 2.5 g/kg/d and the rate should not exceed 0.15 g/kg/h for adult patients. The purpose of this study is to evaluate the adequacy of the currently prescribed administration rate of IV-lipid emulsion in a single center. METHODS: We analyzed 1,739 lipid emulsion administration prescriptions in 1,095 patients over 18 years old at Ajou University Hospital from January 1, 2014 to March 31. RESULTS: The median prescription rate of total lipid emulsion was 0.134 (0.012~1.125) g/kg/h, and the exceeding portion of maximum recommended infusion rate was 36.9%. The median administration prescription rate of lipid emulsion was faster in 500 mL emulsions, compared to 250 mL emulsion (0.146 g/kg/h vs. 0.075 g/kg/h; P<0.001) and at emergency room (ER), compared to general ward (0.154 g/kg/h vs. 0.123; P<0.001). The exceeding portion of maximum recommended infusion rate of lipid emulsion was also higher in 500 mL emulsion, compared to 250 mL emulsion (52.2% vs. 30.4%; P<0.001) and at ER, compared to general ward (52.1% vs. 30.4%; P<0.001). Triglyceride level was higher in exceeding recommended infusion rate compared to less, but not statistically significant (119 mg/dL vs. 261 mg/dL; P=0.202). CONCLUSION: Administration prescription rate of lipid emulsion exceeded the recommended rate and this feature was dominant in 500 mL emulsion and at ER. Education and monitoring of lipid emulsion prescription is needed for appropriate lipid administration and prevention of fat overload syndrome.
Adult ; Education ; Emergency Service, Hospital ; Emulsions ; Fatty Acids, Essential ; Humans ; Parenteral Nutrition, Total ; Patients' Rooms ; Prescriptions* ; Triglycerides

Mesenchymal stem cells (MSCs) are attractive alternatives to conventional anti-asthmatic drugs for severe asthma. Mechanisms underlying the anti-asthmatic effects of MSCs have not yet been elucidated. This study evaluated the anti-asthmatic effects of intravenously administered MSCs, focusing on macrophages and monocytes. Seven-week-old transgenic (Tg) mice with lung-specific overexpression of IL-13 were used to simulate chronic asthma.MSCs were intravenously administered four days before sampling. We examined changes in immune cell subpopulations, gene expression, and histological phenotypes. IL-13 Tg mice exhibited diverse features of chronic asthma, including severe type 2 inflammation, airway fibrosis, and mucus metaplasia. Intravenous administration of MSCs attenuated these asthmatic features just four days after a single treatment. MSC treatment significantly reduced SiglecF - CD11c - CD11b + monocyte-derived macrophages (MoMs) and inhibited the polarization of MoMs into M2 macrophages, especially M2a and M2c. Furthermore, MSCs downregulated the excessive accumulation of Ly6c - monocytes in the lungs. While an intravenous adoptive transfer of Ly6c - monocytes promoted the infiltration of MoM and Th2 inflammation, that of MSC-exposed Ly6c - monocytes did not. Ex vivo Ly6c - MoMs upregulated M2-related genes, which were reduced by MSC treatment. Molecules secreted by Ly6c - MoMs from IL-13 Tg mice lungs upregulated the expression of fibrosis-related genes in fibroblasts, which were also suppressed by MSC treatment. In conclusion, intravenously administered MSCs attenuate asthma phenotypes of chronic asthma by modulating macrophages. Identifying M2 macrophage subtypes revealed that exposure to MSCs transforms the phenotype and function of macrophages. We suggest that Ly6c - monocytes could be a therapeutic target for asthma management.

PURPOSE: This study was designed to determine the relationship of cigarette smoking to the frequency and qualitative differences among KRAS mutations in lung adenocarcinomas from Korean patients. MATERIALS AND METHODS: Detailed smoking histories were obtained from 200 consecutively enrolled patients with lung adenocarcinoma according to a standard protocol. EGFR (exons 18 to 21) and KRAS (codons 12/13) mutations were determined via direct-sequencing. RESULTS: The incidence of KRAS mutations was 8% (16 of 200) in patients with lung adenocarcinoma. KRAS mutations were found in 5.8% (7 of 120) of tumors from never-smokers, 15% (6 of 40) from former-smokers, and 7.5% (3 of 40) from current-smokers. The frequency of KRAS mutations did not differ significantly according to smoking history (p=0.435). Never-smokers were significantly more likely than former or current smokers to have a transition mutation (G-->A or C-->T) rather than a transversion mutation (G-->T or G-->C) that is known to be smoking-related (p=0.011). In a Cox regression model, the adjusted hazard ratios for the risk of progression with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) were 0.24 (95% CI, 0.14-0.42; p<0.001) for the EGFR mutation and 1.27 (95% CI, 0.58-2.79; p=0.537) for the KRAS mutation. CONCLUSION: Cigarette smoking did not influence the frequency of KRAS mutations in lung adenocarcinomas in Korean patients, but influenced qualitative differences in the KRAS mutations.
Adenocarcinoma/drug therapy/etiology/*genetics/pathology ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group/genetics ; Female ; Humans ; Incidence ; Lung Neoplasms/drug therapy/etiology/*genetics/pathology ; Male ; Middle Aged ; *Mutation ; Mutation Rate ; Proportional Hazards Models ; Proto-Oncogene Proteins/*genetics ; Receptor, Epidermal Growth Factor/antagonists & inhibitors/genetics ; Smoking/adverse effects/*genetics ; Treatment Outcome ; ras Proteins/*genetics