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: 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: 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 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

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

BACKGROUND: The proper use of sedation and analgesia in the intensive care unit (ICU) minimizes its physical and psychological impact. Otherwise, patients can suffer from recall, nightmares, and depression after discharge. We investigated the sedatives, analgesics, and muscle relaxants used in the ICU. METHODS: We visited 79 ICUs in 52 training hospitals and noted the use of sedatives, analgesics, and muscle relaxants from July, 2007, to December, 2007, using a 5-item questionnaire with 57 sub-questions. The survey evaluated the ICU system administration of analgesics and muscle relaxants. RESULTS: Most ICU management is done by the anesthesiology department (55%). Most have resident doctors (63.3%) and an ICU committee (60.8%) in charge of the ICU, as well as a special ICU chart (88.6%) and scoring system (65.8%). Most hospitals have a consulting system (94.9%). The standard ICU analgesics are fentanyl (65.8%), NSAIDs (53.2%), and morphine (48.1%). CONCLUSIONS: Adequate sedation is difficult to achieve in the ICU, but is important for patient comfort and to reduce ICU stay duration. Awareness of patient status and appropriate drug/protocol use are therefore important.
Analgesia ; Analgesics ; Anesthesiology ; Anti-Inflammatory Agents, Non-Steroidal ; Depression ; Dreams ; Fees and Charges ; Fentanyl ; Humans ; Hypnotics and Sedatives ; Critical Care ; Intensive Care Units ; Morphine ; Muscles

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

Wegener`s granulomatosis(WG) is uncommon disease characterized by necrotizing granulomatous lesions in the both upper and lower respiratory tracts, generalized focal necrotizing vasculitis, and focal necrotizing glomerulonephritis. Other organs are also involved frequently. Ocular complications may occur secondary to contiguous granulomatous sinusitis or as a result of focal vasculitis and are encountered in 40-50% of cases of generalized form. We experienced a case of WG developed progressive paranasal sinusitis and rhinitis combined with orbital and ocular involvement. The diagnosis was confirmed by clinical findings and histopathologic features of tissue biopsy. The histopathology from periorbital area had typical findings of WG with necrotizing vasculitis and granuloma formation.
Biopsy ; Diagnosis ; Glomerulonephritis ; Granuloma ; Orbit* ; Respiratory System ; Rhinitis ; Sinusitis ; Vasculitis ; Wegener Granulomatosis*

Undifferentiated squamous cell carcinoma, lymphoepithelioma-like carcinoma of salivary glands is rare disease, the incidence of which is highest among the Inunit of Greenland and North America. By the way, the relation of Epstein-Barr virus(EBV) with this tumor has not been studied to any great extent here in Korean because of rare number of cases. Correlations between lymphoepithelioma and EBV have been investigated with morphologic and pathologic evaluation. Recently, nonnasopharyngeal neoplasms, which have morphologic features identical to those lymphoepithelioma, called lymphoepithelioma- like carcinoma(LEC). We experienced the treatment of lymphoepithelioma-like carcinoma arising from the parotid gland and a case is presented with the review of literatures.
Carcinoma, Squamous Cell ; Greenland ; Herpesvirus 4, Human ; Incidence ; North America ; Parotid Gland* ; Rare Diseases ; Salivary Glands