OBJECTIVES: To estimate the value of statistical life (VSL) and health damage cost on theoretical mortality estimates due to environmental pollution. METHODS: We assessed the health risk on three environmental problems and eight sub-problems. Willingness to pay (WTP) was elucidated from a questionnaire survey with dichotomous contingent valuation method and VSL (which is the division of WTP by the change of risk reduction) calculated from WTP. Damage costs were estimated by multiplying VSL by the theoretical mortality estimates. RESULTS: VSLs from death caused by air pollution, indoor air pollution and drinking water contamination were about 0.3, 0.5 and 0.3 billion won, respectively. Damage costs of particulate matters (PM10) and radon were higher in the sub-problems and were above 100 billion won. Because damage cost depends on theoretical mortality estimate and WTP, its uncertainty is reduced in the estimating process. CONCLUSION: Health damage cost or risk benefit should be considered as one scientific criterion for decision making in environmental policy.
Air Pollution ; Air Pollution, Indoor ; Cost-Benefit Analysis ; Decision Making ; Drinking Water ; Environmental Policy ; Environmental Pollution ; Methods ; Mortality* ; Radon ; Risk Assessment ; Uncertainty

Background: Onychomycosis is a common nail disease that accounts for 50% of abnormal nails. Accurate diagnosis of onychomycosis is essential before long-term antifungal treatment. Reflectance confocal microscopy (RCM) is a rapid real-time imaging technique that is widely used for the diagnosis of skin diseases. Objective: The purpose of this study was to compare the effectiveness of RCM and standard diagnostic methods in the diagnosis of onychomycosis and to determine their sensitivity and specificity. Methods: We evaluated 60 Korean patients with suspected onychomycosis using three diagnostic methods: KOH smear, culture, and RCM. RCM diagnosis was based on the presence of specific structures and filamentous and/or spore-like spherical structures. To compare the usefulness of the diagnostic methods, the sensitivity, specificity, positive predictive value, and negative predictive value for each method were calculated. Results: Of the patients, 57 had at least one positive value for these diagnostic methods. RCM was the most sensitive test for the diagnosis of onychomycosis, with a sensitivity of 84.21%, specificity of 100%, positive predictive value of 100%, negative predictive value of 25%, and accuracy of 85%. Among the 48 patients who showed positive results on RCM, RCM images presented hyphae structures in 35 cases (72.9%), conidia structures in 39 cases (81.3%), and coexistence of both structures in 26 cases (54.2%). Conclusion In this study, RCM was the most sensitive method for the diagnosis of onychomycosis. The fungal morphology and load can be identified in vivo by RCM and can be used in clinical situations.

No abstract available.
Athletes* ; Forearm* ; Humans ; Magnetic Resonance Spectroscopy* ; Metabolism* ; Phosphorus*

Steroid sulfatase (STS) is an enzyme responsible for the hydrolysis of aryl and alkyl sulfates. STS plays a pivotal role in the regulation of estrogens and androgens that promote the growth of hormone-dependent tumors, such as those of breast or prostate cancer. However, the molecular function of STS in tumor growth is still not clear. To elucidate the role of STS in cancer cell proliferation, we investigated whether STS is able to regulate the integrin signaling pathway. We found that overexpression of STS in HeLa cells increases the protein and mRNA levels of integrin β1 and fibronectin, a ligand of integrin α5β1. Dehydroepiandrosterone (DHEA), one of the main metabolites of STS, also increases mRNA and protein expression of integrin β1 and fibronectin. Further, STS expression and DHEA treatment enhanced phosphorylation of focal adhesion kinase (FAK) at the Tyr 925 residue. Moreover, increased phosphorylation of ERK at Thr 202 and Tyr 204 residues by STS indicates that STS activates the MAPK/ERK pathway. In conclusion, these results suggest that STS expression and DHEA treatment may enhance MAPK/ERK signaling through up-regulation of integrin β1 and activation of FAK.
Androgens ; Breast ; Cell Proliferation ; Dehydroepiandrosterone ; Estrogens ; Fibronectins ; Focal Adhesion Protein-Tyrosine Kinases ; HeLa Cells ; Humans* ; Hydrolysis ; Phosphorylation ; Prostatic Neoplasms ; RNA, Messenger ; Steryl-Sulfatase* ; Sulfates ; Up-Regulation ; Uterine Cervical Neoplasms*

Passive surveillance (PS) is a traditional approach to communicable disease surveillance. To complement the approach, several countries have adopted active surveillance (AS) systems that involve the voluntary participation of physicians. This study compares AS versus PS systems in Korea based on the systems' reporting propensity of chickenpox. A mail questionnaire survey was conducted with a random sample of physicians involved in the PS system (N=1,955) and all sentinel physicians of the AS system (N=193). Multiple regression analysis was conducted to identify factors associated with reporting propensity. The reporting propensity of physicians in the AS system was significantly higher than that in the PS surveillance system, 2.7 versus 1.9 on a 5-point Likert scale (p<0.05). Multiple regression analysis showed that, in addition to the type of the surveillance system, physician knowledge of chickenpox as a notifiable disease and the type of institution with which a physician was affiliated were significant factors for a physician's reporting propensity. For both systems, the common barriers for reporting were 'lack of confidence in diagnosis,' 'burden from interference by the public health department following reporting,' and 'complexity of the reporting system.' In conclusion, AS of communicable diseases appeared to have a significantly better performance compared to PS in Korea in the case of chickenpox reporting. These findings would be useful for countries concerned with developing more effective strategies for improving the reporting rate of notifiable diseases.
Chickenpox ; Communicable Diseases ; Complement System Proteins ; Korea ; Mandatory Reporting ; Postal Service ; Public Health ; Surveys and Questionnaires ; Republic of Korea* ; Sentinel Surveillance

Airway stenting has become a common treatment for malignant central airway obstruction. Most airway stents are well tolerated, and life-threatening complications are very rare. Here we describe the case of a life-threatening obstruction due to accumulated respiratory secretions. A 33-year-old man had a massive large cell neuroendocrine carcinoma in the anterior mediastinum, which caused extensive extrinsic compression of the whole trachea. Airway stents were successfully inserted into the whole trachea but 1 week after the procedure, the patient complained of worsening dyspnea due to sticky respiratory secretions accumulated inside the stents. Because the patient could not expectorate a large amount of sticky secretions, frequent bronchoscopic toiletings were performed for 2 months. The stent was well maintained for 7 months till the enlarged tumor causes extrinsic compression because stent revision was performed. About 1 year after the first stent insertion, the patient was admitted to the intensive care unit and intubated because of obstruction of the stent by organized secretions. Fortunately, these secretions were successfully removed and the patient was discharged without any sequelae. Thus, respiratory secretions can cause life-threatening complications after airway stent insertion. Clinicians should be aware of this, and careful examination and close follow-up of such patients are needed.
Adult ; Airway Obstruction ; Carcinoma, Neuroendocrine ; Dyspnea ; Follow-Up Studies ; Humans ; Intensive Care Units ; Mediastinum ; Self Expandable Metallic Stents ; Sputum ; Stents* ; Trachea

Objective: The endothelial inflammatory response plays an important role in atherogenesis by inducing nuclear factor (NF)κB-dependent cell adhesion molecule expression and monocyte recruitment. Here, we screened for natural ligands and investigated the ability of shinjulactone A to inhibit interleukin-1β (IL-1β)-induced endothelial inflammatory signaling. Methods: The natural compound library included 880 single compounds isolated from medicinal plants by the Korean Medicinal Material Bank. Primary endothelial cells were pretreated with single compounds before stimulation with IL-1β to induce endothelial inflammation. Endothelial inflammation was measured by assaying NFκB activation and monocyte adhesion. The endothelial-mesenchymal transition (EndMT) was evaluated using cell type-specific marker protein expression and morphology. Results: Shinjulactone A was identified as an efficient blocker of IL-1β -induced NFκB activation, with a half-maximal inhibitory concentration of approximately 1 µM, and monocyte recruitment in endothelial cells. However, it did not affect lipopolysaccharideinduced NFκB activation in macrophages. Compared to Bay 11-782, a well-known NFκB inhibitor that shows considerable cytotoxicity during long-term treatment, shinjulactone A did not affect endothelial cell viability. Furthermore, it also significantly inhibited the EndMT, which is known to promote atherosclerosis and plaque instability. Conclusion We suggest that shinjulactone A may be an effective and safe drug candidate for atherosclerosis because it targets and inhibits both endothelial inflammation and the EndMT, without impairing NFκB-dependent innate immunity in macrophages.

Disseminated superficial actinic porokeratosis (DSAP) is a type of porokeratosis that is characterized by multiple small lesions on the sun-exposed areas of the body. The presence of dermal amyloid deposition associated with disseminated superficial porokeratosis has rarely been reported in the literature. A 69-year-old female presented to our department with multiple pruritic brownish macules. Physical examination revealed scattered 2∼3-mm-sized, brownish-colored, round to annular macules limited to the sun-exposed areas, such as the forearms, lower legs, and upper trunk. Dermoscopy revealed a peripheral rim and central white hub surrounded by brown pigmentation. Skin biopsy of the leg showed not only the typical finding of DSAP, including the cornoid lamella, but also deposits of eosinophilic amorphous materials in the dermis. After Congo red staining, the dermal deposits were confirmed to be amyloid. Herein, we report a rare case of DSAP with dermal amyloid deposition and dermoscopic presentation.

Buschke-Ollendorff syndrome (BOS) is a rare autosomal dominant inherited genetic cutaneous disorder characterized by connective tissue nevi that may or may not be accompanied by sclerotic bone lesions (osteopoikilosis). BOS is caused by loss-of-function mutations in LEMD3. Skin lesions appear in childhood and may increase in size and number with age and primarily manifest as yellow or skin-colored plaques or papules. A 21-year-old male presented with brownish, firm plaques on his back and buttocks since childhood. He revealed a history of similar skin lesions in his mother and brother. He was incidentally diagnosed with osteopoikilosis, 2 years prior to presentation. Histopathological examination of a skin biopsy specimen revealed increased collagenous stroma. We report a rare case of Buschke-Ollendorff syndrome that presented with brownish plaques.

Buschke-Ollendorff syndrome (BOS) is a rare autosomal dominant inherited genetic cutaneous disorder characterized by connective tissue nevi that may or may not be accompanied by sclerotic bone lesions (osteopoikilosis). BOS is caused by loss-of-function mutations in LEMD3. Skin lesions appear in childhood and may increase in size and number with age and primarily manifest as yellow or skin-colored plaques or papules. A 21-year-old male presented with brownish, firm plaques on his back and buttocks since childhood. He revealed a history of similar skin lesions in his mother and brother. He was incidentally diagnosed with osteopoikilosis, 2 years prior to presentation. Histopathological examination of a skin biopsy specimen revealed increased collagenous stroma. We report a rare case of Buschke-Ollendorff syndrome that presented with brownish plaques.