Purpose: In retinal endothelial cells, homocysteine (Hcy) activates matrix metalloproteinase (MMP)-9, which results in apoptosis. This study investigated these effects of Hcy in human trabecular meshwork cells (HTMC). Methods: HTMC cultures using 5 mM low or 20 mM high glucose (HG)-containing media were exposed to 100 μM Hcy for 3 days. Cell viability was assessed with the MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide) assay. The MMP-9 and tissue inhibitor of MMP (TIMP)-1 levels were measured by western blotting and the degree of apoptosis was analyzed with flow cytometry using Annexin-propidium iodide double staining. Results: Exposure to Hcy in HG decreased cell viability compared to HG alone (p = 0.036). Compared to HG alone, co-exposure to Hcy with HG decreased the TIMP-1 levels, albeit not significantly (p = 0.094), and did not affect the MMP-9 levels (p = 0.413). In addition, co-exposure to Hcy with HG produced no difference in the degree of apoptosis compared to HG alone (p = 0.437). Conclusions Unlike in retinal endothelial cells, Hcy did not affect the activities of TIMP-1, MMP-9, or the degrees of apoptosis significantly in HTMC. Thus, the effects Hcy may be limited in HTMC.

Purpose: To investigate the effect of a prostaglandin (PG) analogue with or without preservative benzalkonium chloride (BAK) on corneal sensitivity. Methods: Central corneal sensitivity was measured prospectively with a Cochet–Bonnet esthesiometer in patients with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG) before and 1 and 3 months after treatment. All patients began treatment with PG monotherapy with or without BAK preservative. Results: The study enrolled 84 patients: 52 NTG and 32 POAG. The treatment was PG with BAK preservative in 45 eyes and without BAK preservative in 39 eyes. Without BAK, the mean corneal sensitivity was 58.22 ± 3.56, 57.77 ± 4.59, and 56.33 ± 5.47 mm before and after 1 and 3 months, respectively; with BAK the mean corneal sensitivity was 58.20 ± 4.51, 56.31 ± 6.22, and 55.52 ± 6.23 mm. Corneal sensitivity was reduced significantly in patients using PG with the preservative BAK after 3 months (p = 0.033). Co-administration of artificial tears did not affect this reduction in corneal sensitivity. Conclusions PG with the preservative BAK reduced corneal sensitivity and artificial tears did not improve this reduction. Reduced corneal sensitivity and accompanying side effects should be considered in the long-term use of PG with the preservative BAK.

Purpose: To investigate the effects of prostaglandin E2 agonist omidenepag (OMD) on the expression of matrix metalloproteinase (MMP) in human trabecular meshwork (TM) cells. Methods: Primarily cultured human TM cells were exposed to 0, 1, 10, or 40 µmol/L OMD for 3 days. The permeability through the TM cell monolayer was assessed using carboxyfluorescein. Expressions of messenger ribonucleic acid and protein levels of MMP-1, MMP-3, and MMP-9 were measured by reverse transcription polymerase chain reaction and Western blotting, respectively. Also, the permeability, expression of messenger ribonucleic acid, and protein levels of MMPs were measured after exposure to 1 µmol/L latanoprost free acid (LAT). Results: OMD and LAT did not affect the cellular survival (all p > 0.05). Each concentration of OMD and LAT did not affect the permeability of carboxyfluorescein significantly (all p > 0.05). LAT increased the level of MMP-1 protein but did not increase the levels of MMP-3 and MMP-9 proteins. Each concentration of OMD did not affect the levels of MMP-1, MMP-3, and MMP9 proteins (all p > 0.05) Conclusions In TM cells, prostaglandin E2 agonist OMD did not increase the permeability through the TM cell monolayer, and the protein levels of MMPs. These suggest that the direct effect on the trabecular outflow by OMD may be limited.

Purpose: We report a patient with bilateral dural arteriovenous fistulae (DAVF) who initially presented with unilateral, isolated trochlear nerve palsy; and later with contralateral, oculomotor nerve palsy.Case summary: A 72-year-old male without any underlying disease or a trauma history visited with sudden vertical diplopia in both eyes that had developed 5 days prior. Brain magnetic resonance imaging (MRI) performed before his first visit was unremarkable. The eye movement test revealed hyperdeviation and limitation of downgaze in the left eye; we thus suspected unilateral, ischemic trochlear nerve palsy and this was indeed observed. However, the diplopia did not improve and limitations of the upper, medial gaze of the right eye developed after 3 months. Follow-up examinations (orbital computed tomography, brain MRI, and cerebral angiography) revealed bilateral DAVF running from the left to the right. He underwent gamma-knife radiosurgery; then the eye movement limitations and diplopia improved. Conclusions Diplopia manifesting as paralysis in an elderly patient may be caused by DAVF; the diplopia may not always be the common ischemic paralytic strabismus. DAVF should be considered during differential diagnosis and further radiological examinations may be needed.

We evaluated whether thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces adverse clinical outcomes within 30-days and 1-year periods. There is no well-designed, Korean data about the clinical impact of intracoronary TA during primary PCI in patients with ST-segment elevation myocardial infarction (STEMI). From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) with pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and December 2015. The patients were divided into two groups: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac event (MACE), defined as the composite of cardiovascular death (CVD), recurrent MI and stroke for 30-days and 1-year. TA did not diminish the risk of MACE, all-cause mortality and CVD in all patients during 30-days or 1-year. After performing the propensity score matching, TA also did not reduce the risk of MACE (Hazard ratio (HR) with 95% Confidence Interval (CI):1.187 [0.863-1.633], p value=0.291), all-cause mortality (HR with 95% CI: 1.130 [0.776-1.647], p value=0.523) and CVD (HR with 95% CI: 1.222 [0.778-1.920], p value=0.384) during the 1-year period. In subgroup analysis, there was no benefit of clinical outcomes favoring PCI with TA. In conclusion, primary PCI with TA did not reduce MACE, all-cause mortality or CVD among the Korean patients with STEMI and pre-procedural TIMI flow 0, 1 during the 30-day and 1-year follow ups.

Primary lung cancer frequently metastasizes to distant organs. But breast is a very rare site of metastasis. So, accurate diagnosis is essential to rule out primary breast cancer. A 62-year old woman who had complained of cough was diagnosed as small cell lung carcinoma of the right lower lobe. She had a 2.5cm sized lobular mass in left upper mid portion of breast. Sonoguided breast biopsy revealed small cell carcinoma consistent with metastatis from primary lung cancer. She also had bone metastses to the scapula and the vertebrae. We report the case of metastatic breast cancer from small cell lung carcinoma.
Biopsy ; Breast Neoplasms ; Breast* ; Carcinoma, Small Cell ; Cough ; Diagnosis ; Female ; Humans ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis ; Scapula ; Small Cell Lung Carcinoma* ; Spine

Chemical pneumonitis usually occurs after occupational exposure and inhalation of various noxious gases, fumes and chemical compounds. There have been reports of different clinical cases after inhalation of many organic acids, but chemical pneumonitis after nitric acid inhalation has rarely been reported, especially in Korea. Nitric acid is a strong acid that's commonly used in the industrial field and its respiratory exposure can cause diverse reactions, including pulmonary edema. We experienced a 34 year-old patient who had an excessive cough and dyspnea after an acute massive exposure to nitric acid fumes at his workplace, where they refined and polished the metals. He was tachypneic and the arterial blood gas analysis showed hypoxemia on hospital admission. The chest radiograph showed patchy consolidation and diffuse interstitial opacities on whole lung fields. Five days later after conservative management that included an oxygen supply in the intensive care unit, his symptoms were improved and the hypoxemia was corrected. At the 8th day, the chest radiograph became normal.
Adult ; Anoxia ; Blood Gas Analysis ; Cough ; Dyspnea ; Gases ; Humans ; Inhalation Exposure ; Inhalation* ; Intensive Care Units ; Korea ; Lung ; Metals ; Nitric Acid* ; Occupational Exposure ; Oxygen ; Pneumonia* ; Pulmonary Edema ; Radiography, Thoracic

The prognosis of lung cancer is very poor. Patients with lung cancer have usually no symptom in early stage or some mild cough, sputum. When patient feel weight loss or dyspnea, majority of patients with lung cancer are advanced stage and inoperable. The growth rate of lung cancer is different according to cell type of tumor and related to prognosis. Generally, tumor. doubling time (TDT) of lung cancer has been known that small cell lung cancer is about 65 days, squamous cell carcinoma is about 90 days, and adenocarcinoma is about 185 days. There has been rarely reported of lung cancer with very fast or very slow growth. The prognosis of a slow growing lung cancer is relatively good but rapidly growing cancer is not. We report a very rare case that surgicallytreated early stage non-small cell lung cancer (adenocarcinoma) with 4-year- TDT without invasion or distant metastasis
Adenocarcinoma* ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cough ; Dyspnea ; Humans ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis ; Prognosis ; Small Cell Lung Carcinoma ; Sputum ; Weight Loss

BACKGROUND: Chronic cough, defined as a cough persisting for three weeks or longer, Is a common symptom for which outpatient care is sought. The most common etiologies of chronic cough are postnasal drip, asthma, arid gastroesophageal reflux. Methacholine challenge is a useful diagnostic study in the evaulation of chronic cough, particularly useful in chronic cough patients with asthmatic symptom. Patients with chronic cough may have dysfunction of bronchial and extrathoracic airways. To evaluate if dysfunction of the bronchial and extrathoracic airways causes chronic cough, we assessed bronchial (BHR) and extrathoracic airway (EAHR) responsiveness to inhaled methacholine in patients with chronic cough. METHODS: 111patients with chronic cough were enrolled in our study. Enrolled patients had no recorded diagnosis of asthma bronchopulmonary disease, hypertension, heart disease or systemic disease and no current treatment with bronchodilator or corticosteroid. Enrolled patients consisted of 46 patients with cough alone, 24 patieots with wheeze 22 patients with dyspnea; 19 patients with wheeze and dyspnea. The inhaled methacholine concentrations causing a 20% fall in forced expiratory volume in 1 s (PC20FEV1,) and 25% fall in n axiital midinspiratory flow (PC25MIF50) were used as bronchial and extrathoracic hyperrespornsiveness. RESULTS: There were four response patterns to methacholine challenge study HEIR in 27 patients, EAHR in 16 patients, combined BHR and EAHR in S patients, and no hyperresponsiveness in 60 patients. In patients with cough alone, there were BHR in 3 patients, EAHR in 9 patients, and combined BI-IR and EAHR in 2 patients. In patients with wheeze and/or dyspnea, there were BHR in 24 patients, EAHR in 7 patients, and BHR and EAHR in 6 patients. Compared with patients with wheeze and/or dyspnea, patients with cough alone had more common EAHR than BHR. In patients with wheeze mad/or dyspnea, BHR was more common than EAHR. CONCLUSION: These results show tint among patients with hyperresponsiveness to methacholine, those with dyspnea and/or wheezing had mainly bronchial hyperresponsiveness, whereas those with chronic cough alone had mainly extrathoracic airway hyperresponsiveness.
Ambulatory Care ; Asthma ; Cough* ; Diagnosis ; Dyspnea ; Forced Expiratory Volume ; Gastroesophageal Reflux ; Heart Diseases ; Humans ; Hypertension ; Methacholine Chloride* ; Respiratory Sounds

BACKGROUND: Goblet cell hyperplasia is a critical pathological feature in hypersecretory diseases of the airways. A bacterial infection of the lung is also known to induce inflammatory responses, which can lead to the overproduction of mucus. Recently, mucin synthesis in the airways has been reported to be regulated by neutrophilic inflammation-induced epidermal growth factor receptor (EGFR) expression and activation. In addition, it was reported that migration of the activated neutrophils is dependent on the matrix metalloproteinases (MMPs), especially MMP-9. In this study, bacterial lipopolysaccharide (LPS)-induced goblet cell hyperplasia and mucus hypersecretion by EGFR cascade, resulting from the MMPs-dependent neutrophilic inflammation were investigated in the rat airways. METHODS: Pathogen-free Sprague-Dawley rats were studied in vivo. Various concentrations of LPS were instilled into the trachea in 300microliter PBS (LPS group). Sterile PBS (300microliter) was instilled into the trachea of the control animals (control group). The airways were examined on different days after instilling LPS. For an examination of the relationship between the LPS-induced goblet cell hyperplasia and MMPs, the animals were pretreated 3 days prior to the LPS instillation and daily thereafter with the matrix metalloproteinase inhibitor (MMPI; 20 mg/Kg/day of CMT-3; Collagenex Pharmaceuticals, USA). The neutrophilic infiltration was quantified as a number in five high power fields (HPF). The alcian blue/periodic acid-Schiff (AB/PAS) stain were performed for the mucus glycoconjugates and the immunohistochemical stains were performed for MUC5AC, EGFR and MMP-9. Their expressions were quantified by an image analysis program and were expressed by the percentage of the total bronchial epithelial area. RESULTS: The instillation of LPS induced AB/PAS and MUC5AC staining in the airway epithelium in a time- and dose-dependent manner. Treatment with the MMPI prevented the LPS-induced goblet cell hyperplasia significantly. The instillation of LPS into the trachea induced also EGFR expression in the airway epithelium. The control airway epithelium contained few leukocytes, but the intratracheal instillation of LPS resulted in a neutrophilic recruitment. A pretreatment with MMPI prevented neutrophilic recruitment, EGFR expression, and goblet cell hyperplasia in the LPS-instilled airway epithelium. CONCLUSION: Matrix metalloproteinase is involved in LPS-induced mucus hypersecretion, resulting from a neutrophilic inflammation and EGFR cascade. These results suggest a potential therapeutic role of MMPI in the treatment of mucus hypersecretion that were associated with a bacterial infection of the airways.
Animals ; Bacterial Infections ; Coloring Agents ; Epidermal Growth Factor* ; Epithelium ; Glycoconjugates ; Goblet Cells ; Hyperplasia ; Inflammation ; Leukocytes ; Lung ; Matrix Metalloproteinases ; MMPI ; Mucins ; Mucus* ; Neutrophils* ; Rats ; Rats, Sprague-Dawley ; Receptor, Epidermal Growth Factor* ; Trachea