OBJECTIVES: Asia sand dust (ASD) is known to cause various human diseases including respiratory infection. The aim of this study was to examine the effect of ASD on inflammatory response in human middle ear epithelial cells (HMEECs) in vitro and in vivo. METHODS: Cell viability was assessed using the cell counting kit-8 assay. The mRNA levels of various genes including COX-2, TNF-a, MUC 5AC, MUC 5B, TP53, BAX, BCL-2, NOX4, and SOD1 were analyzed using semiquantitative realtime polymerase chain reaction. COX-2 protein levels were determined by western blot analysis. Sprague Dawley rats were used for in vivo investigations of inflammatory reactions in the middle ear epithelium as a result of ASD injection. RESULTS: We observed dose-dependent decrease in HMEEC viability. ASD exposure significantly increased COX-2, TNF-a, MUC5AC, and MUC5B mRNA expression. Also, ASD affected the mRNA levels of apoptosis- and oxidative stress-related genes. Western blot analysis revealed a dose-dependent increase in COX-2 production. Animal studies also demonstrated an ASD-induced inflammatory response in the middle ear epithelium. CONCLUSION: Environmental ASD exposure can result in the development of otitis media.
Animals ; Asia ; Asian Continental Ancestry Group* ; Blotting, Western ; Cell Count ; Cell Survival ; Cyclooxygenase 2 ; Dust* ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Gene Expression* ; Humans ; In Vitro Techniques ; Mucins* ; Otitis Media ; Polymerase Chain Reaction ; Rats, Sprague-Dawley ; RNA, Messenger

To accurately assess the potential hazard of exposure to ionizing radiation from portable radiographs taken in the emergency department,.a study was performed to measure such radiation at different distances from the edge of an irradiated field during portable cervical spine, portable chest radiographs, and portable anteroposterior pelvis radiographs. For all three types of portable radiographs, radiation exposure is high at the edge from the beam. However, radiation exposure is deceased at 20, 40, 80, 160cm away from the beam. This study confirms and supports the evidence that although radiation exposure is dependent on distance from the primary radiograph beam, exposure in the ED is minimal. Medical personnel should not have to leave a patient care area for fear of undue acute and chronic radiation exposure while portable radiographs are performed in the ED. By using protective garments and standing appropriate distance away from the patient, continuous patient care can be maintained while portable radiographs are taken in the ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Patient Care ; Pelvis ; Radiation, Ionizing ; Radiography, Thoracic ; Spine

PURPOSE: Recently, the emergency departments of most general hospitals have been overcrowded, and one of the major causes is the increased number of pediatric patients. Therefore, our hospital separated the pediatric emergency room from the emergency department, and we assessed the effect of that separation. METHODS: Pediatric patients below 15 years of age who visited the emergency department from March 1998 to February 1999, which was before the separation, and from March 1999 to February 2000, which was after the separation, were included in this study. RESULTS: The average lengths of stay of pediatric and nonpediatric patients at emergency department before separation were 1.9+/-3.5 and 2.6+/-5 hours, respectively, and declined to 1.6+/-2.4 and 2.3+/-4.7 after separation (p<0.05). The waiting time until admission declined notably from 3.6+/-2.5 hours to 3.3+/-5.6 hours for pediatric patients, in spite of the fact that the number of pediatric admissions increased (p<0.05). In non-pediatric patients, it declined from 3.1+/-3.3 to 2.6+/-3.5 hours (p<0.05). CONCLUSION: The separation of the emergency department into pediatric and non-pediatric departments reduced emergency-department crowding, the length of stay at the emergency department, and, the waiting time until admission. A fundamental solution to the problem of emergency-department crowding requires an independent pediatric emergency department, an increased number of emergency physicians, increased paramedic coverage, and more efficient hospital policies regarding laboratory, radiology, and admission procedures.
Allied Health Personnel ; Crowding ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, General ; Humans ; Length of Stay ; Patient Admission

PURPOSE: To report the distribution of emergency department costs by category of expense and level of patient urgency. METHODS: We retrospectively analyzed the cases of 36,329 patients who visited the emergency department of Pundang CHA hospital during the recent 1year. the patients were divided into two groups : urgent group and non urgent group. Physician, facility, supply, pharmacy, laboratory, and radiology costs were considered. RESULTS: The average costs were urgent visits, 96,124 won; nonurgent visits, 87,028 won. For all patients, the average costs were radiology, 29%; facility, 26%; laboratory, 21%; physician, 12%; pharmacy, 8%; supply, 4%. CONCLUSION: The distribution of ED costs were similiar to regardless of the urgency of the medical condition. Overall improved cost efficiency can be achieved through reductions in the Variable costs of ED.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Pharmacy ; Retrospective Studies

PURPOSE: To determine whether initial corrected anion gap (C(o)AG), base excess caused by unmeasured anions (BEua), and strong ion gap (SIG) can predict the morbidity of critically ill patients admitted to emergency department (ED). METHODS: 138 patients who visited the critical section of the ED and were admitted to intensive care unit (ICU) were enrolled. We calculated the C(o)AG, BEua, and SIG from the initial blood samples of the patients and initial logistic organ dysfunction score (LODS) also. Then we measured the LODS at the last day of ICU stay again. Comparing with the initial LODS, we divided the patients into two groups based on the changes of the values: favorable group and poor group. RESULTS: There was a significant difference in the mean AGcorr (p=0.007), BEua (p=0.008), SIG (p=0.037) between favorable and poor group. The area under the receiver operating characteristic (AUROC) curves for morbidity prediction were relatively small: 0.66 (95% CI, 0.56-0.77) for C(o)AG, 0.65 (95% CI, 0.54-0.76) for BEua, and 0.59 (95% CI, 0.49-0.70) for SIG. CONCLUSION: We found the initial unmeasured anions at the ED of the patients who eventually showed improved LODS during ICU period are significantly different to those of the other patients. But they failed to show enough capability of discriminating the morbidities between two groups.
Acid-Base Equilibrium ; Anions* ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Organ Dysfunction Scores ; Organization and Administration ; ROC Curve

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of 138,000/mm3, activated partial thromboplastin time (aPTT) of 10?s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.
Acute Kidney Injury* ; Aged ; Atrial Fibrillation ; Cerebral Infarction ; Colonoscopy ; Creatinine ; Dabigatran ; Dialysis ; Disseminated Intravascular Coagulation ; Embolism ; Erythrocytes ; Fissure in Ano ; Gastrointestinal Hemorrhage ; Hematuria ; Hemorrhage ; Hemostasis ; Humans ; International Normalized Ratio ; Kidney ; Partial Thromboplastin Time ; Plasma ; Prothrombin Time ; Recurrence ; Renal Dialysis ; Renal Insufficiency ; Stroke ; Thrombin ; United States Food and Drug Administration

Granulomatous Mastitis (GM) is a rare chronic inflammatory lesion of the breast that clinically simulate carcinoma. The purpose of this report is to review the clinicopathological features of this clinical entity in a series of 5 cases that were diagnosed at our institute. Mammography, ultrasonography, and fine needle aspiration were performed in all cases. The treatment of choice for granulomatous mastitis is unclear. Of the 5 cases, one case underwent steroid therapy, two cases underwent anti-tuberculosis medication, and the others underwent only excision. There were no complications for the 5 cases during the follow-up periods. Therefore, the diagnosis and treatment of granulomatous mastitis should be determined on a case by case basis, by the clinician considering the various case results that have been reported on.
Biopsy, Fine-Needle ; Breast ; Diagnosis ; Follow-Up Studies ; Granulomatous Mastitis* ; Mammography ; Ultrasonography

PURPOSE: Fatty acid synthase (FAS) is a multi-enzyme molecule that plays a role in the de novo biosynthesis of fatty acids. FAS is expressed at low levels in most normal human tissues because, cells preferentially utilize circulating lipids for the synthesis of new structural lipids. Recent studies have demonstrated that high levels of FAS occur in a subset of human cancers (such as breast, ovary, and prostate cancer etc) and these high FAS levels are associated with a poor prognosis. The aim of this study was to investigate the expression of FAS in breast cancer and to examine the relationship between FAS and the clinicopathological data. METHODS: We reviewed clinical profiles [clinical data and short term outcome (recurrence)] of 67 breast cancer patients by reviewing their medical records. The average followed-up period was 22.6 month. FAS expressions were evaluated by immunohistochemistry on the formalin-fixed paraffin-embedded tissues. RESULTS: FAS expression of breast cancer was nonspecifically high, but there was no statistical importance between the FAS expression, the clinicopathological data and the short term recurrence (p > 0.05). CONCLUSION: The overexpression of FAS in breast cancer patients may not be a reliable marker for a poor prognosis. However, further studies are required in order to define the biological significance and the specific role of FAS in breast cancer development, growth, and invasion. Also, inhibition of FAS may be a target treatment for breast cancer.
Breast Neoplasms* ; Breast* ; Fatty Acids ; Female ; Humans ; Immunohistochemistry ; Medical Records ; Ovary ; Prognosis ; Prostatic Neoplasms ; Recurrence

PURPOSE: Fatty acid synthase (FAS) is a multi-enzyme molecule that plays a role in the de novo biosynthesis of fatty acids. FAS is expressed at low levels in most normal human tissues because, cells preferentially utilize circulating lipids for the synthesis of new structural lipids. Recent studies have demonstrated that high levels of FAS occur in a subset of human cancers (such as breast, ovary, and prostate cancer etc) and these high FAS levels are associated with a poor prognosis. The aim of this study was to investigate the expression of FAS in breast cancer and to examine the relationship between FAS and the clinicopathological data. METHODS: We reviewed clinical profiles [clinical data and short term outcome (recurrence)] of 67 breast cancer patients by reviewing their medical records. The average followed-up period was 22.6 month. FAS expressions were evaluated by immunohistochemistry on the formalin-fixed paraffin-embedded tissues. RESULTS: FAS expression of breast cancer was nonspecifically high, but there was no statistical importance between the FAS expression, the clinicopathological data and the short term recurrence (p > 0.05). CONCLUSION: The overexpression of FAS in breast cancer patients may not be a reliable marker for a poor prognosis. However, further studies are required in order to define the biological significance and the specific role of FAS in breast cancer development, growth, and invasion. Also, inhibition of FAS may be a target treatment for breast cancer.
Breast Neoplasms* ; Breast* ; Fatty Acids ; Female ; Humans ; Immunohistochemistry ; Medical Records ; Ovary ; Prognosis ; Prostatic Neoplasms ; Recurrence

OBJECTIVES: The primary aim of this study is to evaluate the gene expression profile of Asian sand dust (ASD)-treated human middle ear epithelial cell (HMEEC) using microarray analysis. METHODS: The HMEEC was treated with ASD (400 microg/mL) and total RNA was extracted for microarray analysis. Molecular pathways among differentially expressed genes were further analyzed. For selected genes, the changes in gene expression were confirmed by real-time polymerase chain reaction. RESULTS: A total of 1,274 genes were differentially expressed by ASD. Among them, 1,138 genes were 2 folds up-regulated, whereas 136 genes were 2 folds down-regulated. Up-regulated genes were mainly involved in cellular processes, including apoptosis, cell differentiation, and cell proliferation. Down-regulated genes affected cellular processes, including apoptosis, cell cycle, cell differentiation, and cell proliferation. The 10 genes including ADM, CCL5, EDN1, EGR1, FOS, GHRL, JUN, SOCS3, TNF, and TNFSF10 were identified as main modulators in up-regulated genes. A total of 11 genes including CSF3, DKK1, FOSL1, FST, TERT, MMP13, PTHLH, SPRY2, TGFBR2, THBS1, and TIMP1 acted as main components of pathway associated with 2-fold down regulated genes. CONCLUSION: We identified the differentially expressed genes in ASD-treated HMEEC. Our work indicates that air pollutant like ASD, may play an important role in the pathogenesis of otitis media.
Air Pollution ; Apoptosis ; Asian Continental Ancestry Group* ; Cell Cycle ; Cell Differentiation ; Cell Proliferation ; Dust* ; Ear, Middle* ; Epithelial Cells* ; Gene Expression* ; Humans* ; Microarray Analysis* ; Otitis Media ; Particulate Matter ; Real-Time Polymerase Chain Reaction ; RNA ; Silicon Dioxide* ; Transcriptome