To evaluate the effect of low lactose special formula (MF-1) for the treatment of acute diarrhea, we studied thirty nine infants who were admitted with acute diarrhea to the Department of Pediatics, Yeungnam University Hospital. 39 infants of under 6 months of age who had been fed on formula feeds were randomly allocated to receive either a diluted regular formula milk or a low lactose special formula. Each infant received intravenous rehydration during fasting for 6-12 hou s. Group 1 (n=15) was fed half strength of regular. formula (80-100cc/kg/day) for the first 24 hours, three quarters strength formula (100-120cc/ kg/day) for the next 24 hours, and continued feeding with the full strength regular formula milk. Group 2 (n= 24), who fed the same amount of milk as Group 1, continued feeding with the full strength low lactose special formula from the start of feeding. Male to female sex ratio was 1.6 to 1. The characteristics of infants on admission were comparable in the age, the duration of diarrhea and the stool frequency before admission, the degree of dehydration. There were no significant differences in the duration of hospitalization, changes in stool weight and stool frequency after admission between two groups.(p>0.05) The Body weight and skin fold thickness were increased in group 2 who fed low lactose formula, but those who fed diluted regular formula showed reduction of body weight and skin fold thickness (64.251.48 vs -11.452.2g, 0.60.8mm vs -0.10.3mm
Body Weight ; Dehydration ; Diarrhea* ; Fasting ; Female ; Fluid Therapy ; Hospitalization ; Humans ; Infant* ; Lactose* ; Male ; Milk ; Sex Ratio ; Skin

BACKGROUND: Immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients. This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens. METHODS: We assigned 299 renal-transplant recipients to receive group A (standard-dose cyclosporine, mycophenolate mofetil, and corticosteroids), group B (low-dose cyclosporine, basiliximab induction, mycophenolate mofetil, and corticosteroids), group C (standard-dose tacrolimus, mycophenolate mofetil, and corticosteroids), or group D (low-dose tacrolimus, basiliximab induction, mycophenolate mofetil, and corticosteroids) regimens. We compared the groups according to graft function through estimated glomerular filtration rate (GFR), acute rejection, and allograft survival. RESULTS: The mean calculated GFR in patients receiving low-dose tacrolimus (76.4 mL per minute) was higher than in the other three groups (range, 66.3 to 73.8 mL per minute). The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus (14.3%) than in those receiving standard-dose cyclosporine (29.6%), low-dose cyclosporine (19.8%), or standard-dose tacrolimus (23.8%). Allograft survival rates differed significantly among the four groups (P=0.006) and were highest in the low-dose tacrolimus group (99.9%). Serious adverse events were more common in the standard-dose tacrolimus group than in the other groups (51.2% vs a range of 41.4 to 42.3%), although a similar proportion of patients in each group had at least one adverse event during treatment (81.1 to 90.5%). CONCLUSIONS: A regimen of basiliximab, mycophenolate mofetil, and corticosteroids in combination with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates, compared with regimens containing basiliximab induction plus either low-dose cyclosporine or standard-dose tacrolimus or with standard-dose cyclosporine without induction.
Adrenal Cortex Hormones ; Antibodies, Monoclonal ; Cyclosporine ; Glomerular Filtration Rate ; Graft Survival ; Humans ; Kidney Transplantation ; Mycophenolic Acid ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Survival Rate ; Tacrolimus ; Transplantation, Homologous ; Transplants

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are the most severe cutaneous drug hypersensitivity reactions, which are unpredictable adverse drug reactions. SJS/TEN is associated with significant mortality and morbidity; however, effective treatment is difficult. Mesenchymal stem cells (MSCs) are well-known for their anti-inflammatory and tissue regeneration properties. The purpose of the present study was to verify whether MSCs could be applied for the treatment of SJS/TEN. We developed an SJS/TEN mouse model using peripheral blood mononuclear cells from a lamotrigine-induced SJS patient. MSCs were injected into the model to verify the treatment effect. In SJS model mice treated with MSCs, ocular damage rarely occurred, and apoptosis rate was significantly lower. We demonstrated a therapeutic effect of MSCs on SJS/TEN, with these cells presenting a potential novel therapy for the management of this disorder.

Immediate-type hypersensitivity responses to systemic corticosteroids are rare despite their widespread use. It is still controversial whether the responses rarely occur or are underdiagnosed in clinical settings. Many cases probably remain underdiagnosed because the symptoms often mimic symptoms of underlying diseases. This case report describes a 73-year-old man who had immediate hypersensitivity reactions after intravenous administration of hydrocortisone, which was primarily intended to prevent hypersensitivity reactions to contrast media. Whole body rash with pruritus developed shortly after the steroid injection. Since the patient already experienced rash and itching sense after contrast media and antihistamine injection, we conducted skin testing to figure out which drug triggered the hypersensitivity reactions. Intradermal skin tests revealed a positive response to hydrocortisone sodium succinate, which suggested his hypersensitivity reactions were developed by hydrocortisone. Being a common therapy for allergic reaction, corticosteroids themselves are rarely suspected of causing hypersensitivity reactions. Considering there is no typical symptom or standard diagnostic test, awareness of corticosteroid hypersensitivity reactions is of importance to make the diagnosis.
Administration, Intravenous ; Adrenal Cortex Hormones ; Aged ; Contrast Media ; Diagnosis ; Diagnostic Tests, Routine ; Drug Hypersensitivity ; Exanthema ; Humans ; Hydrocortisone* ; Hypersensitivity* ; Hypersensitivity, Immediate ; Intradermal Tests ; Pruritus ; Skin Tests ; Sodium* ; Succinic Acid*

PURPOSE: The prevalence and burden of asthma is increasing worldwide. In this study, we analyzed 3 different Korean national health survey datasets to determine the general features of adult asthma in Korea and to obtain basic information that would support future strategies for better management of adult asthma. METHODS: The surveys used in this study included the Korea National Health and Nutrition Examination Survey (KNHANES), Korea Community Health Survey (KCHS) and National Health Insurance Service-National Sample Cohort (NHIS-NSC). We investigated annual asthma prevalence, evaluating the rate and risk factors of asthma exacerbation by age and sex, and clinical data of 1,832 patients with asthma who were registered in the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) were analyzed to elucidate risk factors for asthma exacerbation. We also analyzed another asthma cohort and added it as replication data. RESULTS: In the KNHANES database, annual asthma prevalence rates varied from 1.2% to 3.1%. In the KCHS database, overall prevalence increased, with significant regional differences (1.6%–2.1%). The NHIS-NSC indicated a gradual increase in annual asthma prevalence from 4.5% to 6.2%. Interestingly, all 3 surveys indicated the highest prevalence of asthma among elderly women. In addition, elderly women with asthma had a significantly higher risk of asthma exacerbation (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.19–2.93; P=0.006). Approximately 11% of patients were classified as having severe asthma. An asthma cohort analysis identified female sex, low baseline pulmonary function, longer treatment duration, high variability in pulmonary function and significant changes in Asthma Control Test scores as risk factors for asthma exacerbation. CONCLUSIONS: The prevalence of asthma in Korea is consistently high among elderly and female populations. These results should lay the foundation for strategies for effective asthma prevention and management; elderly female patients with asthma should receive particular attention.
Adult* ; Aged* ; Asthma* ; Cohort Studies* ; Dataset ; Female ; Health Surveys ; Humans ; Incidence ; Korea ; National Health Programs ; Nutrition Surveys ; Prevalence* ; Risk Factors

Although chronic eosinophilic inflammation is a common feature in patients with asthma, some patients have neutrophil-dominant inflammation, which is known to be associated with severe asthma.Human mesenchymal stem cells (hMSCs) have shown promise in treating various refractory immunological diseases. Thus, hMSCs may represent an alternative therapeutic option for asthma patients with neutrophil-dominant inflammation, in whom current treatments are ineffective. BALB/c mice exposed to ovalbumin and polyinosinic:polycytidylic acid (Poly I:C) to induce neutrophilic airway inflammation were systemically treated with hMSCs to examine whether the hMSCs can modulate neutrophilic airway inflammation. In addition, cytokine production was evaluated in co-cultures of hMSCs with either anti-CD3/CD28-stimulated peripheral blood mononuclear cells (PBMCs) obtained from asthmatic patients or cells of the human bronchial epithelial cell line BEAS-2B to assess the response to hMSC treatment. The total number of immune cells in bronchoalveolar lavage fluid (BALF) showed a dramatic decrease in hMSC-treated asthmatic mice, and, in particular, neutrophilic infiltration was significantly attenuated. This phenomenon was accompanied by reduced CXCL15 production in the BALF. BEAS-2B cells co-cultured with hMSCs showed reduced secretion of IL-8. Moreover, decreased secretion of IL-4, IL-13 and IFN-γ was observed when human PBMCs were cultured with hMSCs, whereas IL-10 production was greatly enhanced. Our data imply that hMSCs may have a role in reducing neutrophilic airway inflammation by downregulating neutrophil chemokine production and modulating T-cell responses.
Animals ; Asthma* ; Bronchoalveolar Lavage Fluid ; Coculture Techniques ; Eosinophils ; Epithelial Cells ; Humans ; Immune System Diseases ; Inflammation* ; Interleukin-10 ; Interleukin-13 ; Interleukin-4 ; Interleukin-8 ; Mesenchymal Stromal Cells ; Mice ; Neutrophils ; Ovalbumin ; T-Lymphocytes

Palonosetron is a 5-hydroxytryptamine-3 (5-HT-3) receptor antagonist used for preventing postoperative nausea and vomiting. Compared with ondansetron and granisetron, it is a better drug because of prolonged action and minimal side effects. Some adverse effects of palonosetron have been reported. In this report, we describe a 37-year-old male who developed severe hypersensitivity reactions to palonosetron during surgery for kidney donation. His medical history was unremarkable, except for inguinal hernia with herniorrhaphy 8 years ago. The surgery was uneventful until 2 hours 20 minutes. After palonosetron injection, his blood pressure dropped to 80/50 mm Hg, and facial edema, rash, conjunctival swelling, and wheezing developed. The patient was resuscitated by administration of ephedrine, hydrocortisone, and peniramine. Following the surgery, the patient was monitored for 3 days, and there were no subsequent anaphylactic reactions or other complications. The skin test on postoperative day 54 was positive for hypersensitivity to palonosetron. Although palonosetron is known for its safety, other hypersensitivity events have been reported. Ondansetron is another widely used 5-HT-3 antagonist, which has been reported to cause anaphylaxis. Therefore, clinicians should be aware of the possibility of patients experiencing severe adverse reactions to palonosetron.
Adult ; Anaphylaxis* ; Anesthesia, General* ; Blood Pressure ; Drug Hypersensitivity ; Edema ; Ephedrine ; Exanthema ; Granisetron ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Hydrocortisone ; Hypersensitivity ; Kidney ; Male ; Ondansetron ; Postoperative Nausea and Vomiting ; Respiratory Sounds ; Skin Tests

PURPOSE: Although mild to moderate asthma is much more common, the morbidity and mortality of severe asthma are much higher. This study was performed to identify and analyze the clinical characteristics of severe asthma in Korea. METHODS: We registered patients with severe refractory asthma into the Severe Asthma Registry supported by the Severe Asthma Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology. Patients were enrolled since 2010 from the 15 university hospitals nationwide in Korea. Severe asthma was defined according to modified European Respiratory Society/American Thoracic Society criteria. Information on demographics, medical history, pulmonary function tests and skin prick tests was collected; the clinical characteristics of severe asthmatics were analyzed from the collected data. RESULTS: A total of 489 patients were enrolled with a mean age of 62.3; 45% are male. Sixty percent of patients received Global Initiative for Asthma step 4 treatment, and 30% received step 5 treatment. The most common comorbidities were allergic rhinitis (58.7%). Aspirin hypersensitivity was observed in 14.0%. Approximately half (53.9%) are non-smokers. Atopy was proven in 38.5% of the patients. Regarding asthma medications, inhaled corticosteroids and long-acting β-agonist combination inhalers were most commonly prescribed (96.5%), followed by leukotriene antagonists (71.0%). A recombinant anti-immunoglobulin E monoclonal antibody (omalizumab) has been used in 1.8% of the patients. The mean forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC were 78.7%, 67.5% and 67.9% of predicted values, respectively. The mean Asthma Control Test and quality of life questionnaire scores were 16.5 out of 25 and 59.5 out of 85, respectively. CONCLUSIONS: The baseline characteristics of severe asthma patients in the Korea Severe Asthma Registry were analyzed and reported for the first time. With this cohort, further prospective studies should be performed to search for ways to improve management of severe refractory asthma.
Adrenal Cortex Hormones ; Adult* ; Allergy and Immunology ; Aspirin ; Asthma* ; Cohort Studies ; Comorbidity ; Demography ; Forced Expiratory Volume ; Hospitals, University ; Humans ; Hypersensitivity ; Korea* ; Leukotriene Antagonists ; Male ; Mortality ; Nebulizers and Vaporizers ; Prospective Studies ; Quality of Life ; Respiratory Function Tests ; Rhinitis, Allergic ; Skin ; Vital Capacity

PURPOSE: Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey. METHODS: Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online. RESULTS: The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS. CONCLUSIONS: Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.
Allergy and Immunology ; Asthma* ; Diagnosis ; Electronic Mail ; Forced Expiratory Volume ; Humans ; Hypersensitivity ; Lung Diseases, Obstructive ; Population Characteristics ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Smoking ; Specialization* ; Tuberculosis