PURPOSE: The role of vitamin D in traditional atopic disorders (i.e., asthma, allergic rhinitis, and atopic dermatitis) is still uncertain. We have analyzed the association between serum 25-hydroxyvitamin D3 (25(OH)-D3) levels and asthma in children. METHODS: A total of 133 children were enrolled between April 2008 and December of 2008. Children were divided into 3 groups: the asthma group (n=80), bronchiolitis group (n=50), and normal group (n=35). Serum samples were collected and checked for 25(OH)-D3 levels. From the blood samples, we measured eosinophil counts, total IgE, specific IgE (Dermatophagoides pteronyssinus, Dermatophagoides farinae, milk, egg, cat, dog, cockroach) (Uni-CAP FEIA system). RESULTS: The mean age of the patients was 4.6 years. The mean 25(OH)-D3 levels of the asthma, bronchiolitis, and normal groups were 17.2+/-8.9, 22.5+/-9.3, and 27.8+/-10.2 ng/mL, respectively (P<0.01). There was no association between allergens and vitamin D levels. Mean 25(OH)-D3 levels were lower at acute state of asthma than at stable state. CONCLUSION: The mean level of 25(OH)-D3 was associated with asthma and acute state of asthma. Further experimental and clinical studies are needed to establish a definite link between vitamin D levels and asthma.
Allergens ; Animals ; Asthma* ; Bronchiolitis ; Calcifediol ; Cats ; Child* ; Dermatophagoides pteronyssinus ; Dogs ; Eosinophils ; Humans ; Immunoglobulin E ; Milk ; Ovum ; Rhinitis ; Vitamin D* ; Vitamins*

The internal transcribed spacer (ITS) regions including the 3'-end of 18S rRNA gene, 5.8S rRNA gene and the 5'-end of the 28S rRNA gene of Rhizopus spp. were amplified by PCR and analyzed by DNASIS program. Length polymorphism of these region ranged from 564 bp in R. oryzae to 789bp in R. stolonifer. The length and sequence of 5.8S was very conserved with 154~155 bp. The sequence of ITS2 was more variable than that of ITS1. The base substitution rates were ranged from 0 to 0.6069 per site, and higher rate was found in R. stolonifer. In general, transition was usually more frequent than transversion. On the basis of sequencing results, four groups were clustered with value of 61.9% similarity; R. oryzae, R. microspores, R. homothallicus, and R. stolonifer groups.
DNA, Ribosomal* ; Genes, rRNA ; Oryza ; Polymerase Chain Reaction ; Rhizopus* ; Sequence Analysis*

PURPOSE: To describe a case of exercise-induced anaphylaxis presenting with lower lid angioedema. CASE SUMMARY: A 35-year-old female patient for the past 3 years experienced lower lid edema in her left eye after exercising. In the treadmill exercise test, sneezing, coughing, and lower lid edema in her left eye appeared 13 minutes after initiating exercise. Additionally, contrast-enhanced computed tomography scan revealed minimal soft tissue thickening of the left inferior periorbital subcutaneous area with subtle enhancement after exercise. The serum immunoglobulin E (IgE) test showed elevated total IgE levels. The patient was diagnosed with exercise-induced anaphylaxis based on the above results. We informed the patient on her trigger factors and possible symptoms and prescribed an oral antihistamine and steroid. CONCLUSIONS: In patients presenting with facial edema or eyelid edema after exercise, the possibility of exercise-induced anaphylaxis should be considered. In addition, we have to aware of possibility of complication such as airway obstruction or a life-threatening condition, and it is needed to prevent a recurrence of anaphylaxis by cooperating with other department.
Adult ; Airway Obstruction ; Anaphylaxis* ; Angioedema* ; Cough ; Edema ; Exercise Test ; Eyelids ; Female ; Humans ; Immunoglobulin E ; Immunoglobulins ; Recurrence ; Sneezing

No abstract available.
Clostridium difficile* ; Clostridium* ; Critical Illness* ; Humans ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons*

BACKGROUND: Procalcitonin (PCT) is a new marker of severe systemic bacterial infection. PCT consists of fragments katacalcin and calcitonin, which are precursors of calcitonin in thyroid. The source and role of PCT in pathogenesis of sepsis remains clarified. This study was focused on which subsets of peripheral blood mononuclear cells (PBMC) can induce PCT when they are stimulated with endotoxin or phorbol myristate acetate (PMA), and how the PCT production is controlled. MATERIALS AND METHODS: PBMC were isolated and incubated overnight in each media containing 1 ug/mL lipopolysaccharide (LPS), or 5 ng/mL PMA. Intracellular PCT was detected using fluorescein isothiocyanate (FITC) labeled anti-katacalcin antibody (Ab). Monocytes and lymphocytes were identified by phycoerythrin-conjugated CD14 Ab and CyChrome-conjugated CD3 Ab, respectively. Ten micrograms of soluble TNF receptor (sTNFR) were pretreated in PBMC 1 hr prior to adding the stimuli. Then, PBMC were analyzed using a flow cytometer. RESULTS: LPS increased intracellular PCT from 10.0 % to 27.2% in CD14-positive monocytes from healthy donors, but PMA induced more PCT production from 10.0% to 40.8%. (one representative, n=8). For CD3-p ositive lymphocytes, LPS did not stimulate PCT, but PMA increased PCT production by 2.35 fold (P<0.05, n=8). In the PBMC from the same donor, sTNFR highly decreased LPS-stimulated PCT (control 10.0%, LPS 27.2%, sTNFR 12.3%), but it did not significantly affect PMA-stimulated PCT. For sepsis patients, PMA stimulated more PCT than LPS did and PCT was more expressed compared with healthy donors. CONCLUSION: The PCT was produced in both monocytes and lymphocytes. PMA stimulated more PCT production than LPS did. The LPS-induced PCT production is partly mediated through TNF-alpha production.
Bacterial Infections ; Calcitonin ; Fluorescein ; Humans* ; Lymphocytes ; Monocytes ; Receptors, Tumor Necrosis Factor ; Sepsis ; Tetradecanoylphorbol Acetate ; Thyroid Gland ; Tissue Donors ; Tumor Necrosis Factor-alpha

BACKGROUND: Procalcitonin (PCT) is a new marker of severe systemic bacterial infection. PCT consists of fragments katacalcin and calcitonin, which are precursors of calcitonin in thyroid. The source and role of PCT in pathogenesis of sepsis remains clarified. This study was focused on which subsets of peripheral blood mononuclear cells (PBMC) can induce PCT when they are stimulated with endotoxin or phorbol myristate acetate (PMA), and how the PCT production is controlled. MATERIALS AND METHODS: PBMC were isolated and incubated overnight in each media containing 1 ug/mL lipopolysaccharide (LPS), or 5 ng/mL PMA. Intracellular PCT was detected using fluorescein isothiocyanate (FITC) labeled anti-katacalcin antibody (Ab). Monocytes and lymphocytes were identified by phycoerythrin-conjugated CD14 Ab and CyChrome-conjugated CD3 Ab, respectively. Ten micrograms of soluble TNF receptor (sTNFR) were pretreated in PBMC 1 hr prior to adding the stimuli. Then, PBMC were analyzed using a flow cytometer. RESULTS: LPS increased intracellular PCT from 10.0 % to 27.2% in CD14-positive monocytes from healthy donors, but PMA induced more PCT production from 10.0% to 40.8%. (one representative, n=8). For CD3-p ositive lymphocytes, LPS did not stimulate PCT, but PMA increased PCT production by 2.35 fold (P<0.05, n=8). In the PBMC from the same donor, sTNFR highly decreased LPS-stimulated PCT (control 10.0%, LPS 27.2%, sTNFR 12.3%), but it did not significantly affect PMA-stimulated PCT. For sepsis patients, PMA stimulated more PCT than LPS did and PCT was more expressed compared with healthy donors. CONCLUSION: The PCT was produced in both monocytes and lymphocytes. PMA stimulated more PCT production than LPS did. The LPS-induced PCT production is partly mediated through TNF-alpha production.
Bacterial Infections ; Calcitonin ; Fluorescein ; Humans* ; Lymphocytes ; Monocytes ; Receptors, Tumor Necrosis Factor ; Sepsis ; Tetradecanoylphorbol Acetate ; Thyroid Gland ; Tissue Donors ; Tumor Necrosis Factor-alpha

Hypoparathyoidism is rarely reported during pregnancy or the puerperium. Since hypocalcemia during pregnancy increases the mortality and morbidity of fetus, neonate, and mother, the early diagnosis and treatment of hypocalcemia, especially hypocalcemic crisis, might be very important to reduce severe complications. We experienced a case of hypocalcemic crisis induced by hypoparathyroidism developed after Cesarean section. This case represents symptoms and signs of hypocalcemia such as dyspnea, tingling sensation of upper and lower limbs, chest pain during hypocalcemic crisis. Physicians should be aware of the symptoms and signs, and treatment of hypocalcemic crisis.
Cesarean Section* ; Chest Pain ; Dyspnea ; Early Diagnosis ; Female ; Fetus ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Infant, Newborn ; Lower Extremity ; Mortality ; Mothers ; Postpartum Period ; Pregnancy ; Sensation

Background: Although discharge summaries in patient-friendly language can enhance patient comprehension and satisfaction, they can also increase medical staff workload. Using a large language model, we developed and validated software that generates a patient-friendly discharge summary. Methods: We developed and tested the software using 100 discharge summary documents, 50 for patients with myocardial infarction and 50 for patients treated in the Department of General Surgery. For each document, three new summaries were generated using three different prompting methods (Zero-shot, One-shot, and Few-shot) and graded using a 5-point Likert Scale regarding factuality, comprehensiveness, usability, ease, and fluency. We compared the effects of different prompting methods and assessed the relationship between input length and output quality. Results: The mean overall scores differed across prompting methods (4.19 ± 0.36 in Few-shot, 4.11 ± 0.36 in One-shot, and 3.73 ± 0.44 in Zero-shot; P < 0.001). Post-hoc analysis indicated that the scores were higher with Few-shot and One-shot prompts than in zero-shot prompts, whereas there was no significant difference between Few-shot and One-shot prompts. The overall proportion of outputs that scored ≥ 4 was 77.0% (95% confidence interval: 68.8–85.3%), 70.0% (95% confidence interval [CI], 61.0–79.0%), and 32.0% (95% CI, 22.9–41.1%) with Few-shot, One-shot, and Zero-shot prompts, respectively. The mean factuality score was 4.19 ± 0.60 with Few-shot, 4.20 ± 0.55 with One-shot, and 3.82 ± 0.57 with Zero-shot prompts. Input length and the overall score showed negative correlations in the Zero-shot (r = −0.437, P < 0.001) and One-shot (r = −0.327, P < 0.001) tests but not in the Few-shot (r = −0.050, P = 0.625) tests. Conclusion Large-language models utilizing Few-shot prompts generally produce acceptable discharge summaries without significant misinformation. Our research highlights the potential of such models in creating patient-friendly discharge summaries for Korean patients to support patient-centered care.

Purpose: This report presents a case of repeated toxic conjunctival necrosis caused by amikacin eye drops in a patient with a corneal ulcer induced by Mycobacterium abscessus (M. abscessus).Case summary: During treatment for herpetic keratitis with complaints of conjunctival hyperemia and eye pain in the right eye for 1 month. Slit-lamp microscopy revealed a circular corneal epithelial defect and stromal infiltration of her right eye. Gram staining and culture were performed, and eye drops were prescribed for empirical treatment. The bacterial culture grew M. abscessus. Antibiotic susceptibility tests showed resistance to quinolone. The patient was prescribed amikacin eye drops and the corneal epithelial defects improved. Two weeks later, circular conjunctival epithelial defects and hyperemia were observed on the inferior conjunctiva. Conjunctival necrosis caused by amikacin was suspected. The amikacin eye drops were discontinued and the conjunctival lesion improved. However, the patient’s corneal ulcer recurred. The amikacin eye drops were restarted, but conjunctival toxicity recurred, so she was treated with topical clarithromycin and moxifloxacin. The eye drops were gradually reduced and the lesion healed leaving mild corneal opacity. Conclusions M. abscessus-induced keratitis resistant to quinolone antibiotics requires long-term combined therapy with multiple drugs. Amikacin eye drops should be used carefully as conjunctival toxicity may occur.

Acute gastric dilatation leading to gastric necrosis is rare but potentially fatal condition that can occur in patients with bulimia. It usually develops after a bulimic episode and it is not diagnosed with sufficient rapidity it may lead to gastric perforation followed by peritonitis, sepsis, shock, and death. Because of the rarity of this condition and the patients in whom it occurs, the clinician must maintain a high degree of suspicion when treating patients with eating disorders who present with abdominal pain after a binge. This case report describes a 24-year old woman with acute gastric dilatation due to binge eating, who had the gastrotomy and died of complications such as gastric necrosis and disseminated intravascular coagulation.
Abdominal Pain ; Bulimia ; Disseminated Intravascular Coagulation ; Feeding and Eating Disorders ; Female ; Gastric Dilatation ; Humans ; Necrosis ; Peritonitis ; Sepsis ; Shock