PURPOSE: Although the role of eosinophils in eosinophilic gastroenteritis (EGE) is not fully understood, they are believed to be a principal effector cell. Previous studies have demonstrated that eotaxin and its specific receptor, cysteine-cysteine chemokine receptor-3 (CCR3), play a central role in eosinophil trafficking into the gastrointestinal (GI) tract. Thus, we examined the targeting of CCR3 as a potential therapeutic intervention for EGE in a mouse model. METHODS: Eight- to 10-week-old BALB/c mice were intraperitoneally sensitized and intragastrically challenged with ovalbumin (OVA). Different groups of mice were administered either an anti-CCR3 antibody or a control IgG by intraperitoneal injection 1 hour before each OVA challenge. Eosinophilic inflammation in the intestinal mucosa, mucosal injury, and severity of diarrhea were compared between different groups at 1 hour after final OVA challenge. RESULTS: Anti-CCR3 antibody reduced the number of eosinophils in peripheral blood and intestinal mucosa, but not in bone marrow. This reduction was associated with restoration of reduced villous crypt ratio, increased intestinal epithelial cell proliferation, and weight loss induced by OVA challenge. However, Anti-CCR3 antibody had no effect on the level of OVA specific immunoglobulin E (IgE) and the expression of critical chemokines or cytokines in eosinophil trafficking into the GI tract, such as eotaxin-1, interleukin (IL)-5, and IL-13. CONCLUSIONS: Anti-CCR3 antibody significantly reduced the severity of eosinophilic inflammation, mucosal injury, and diarrhea in a mouse model of food allergen-induced GI eosinophilic inflammation. CCR3 may be a novel therapeutic target for treatment of EGE and other GI eosinophil-mediated diseases.
Animals ; Bone Marrow ; Chemokine CCL11 ; Chemokines ; Cytokines ; Diarrhea ; Eosinophils* ; Epithelial Cells ; Gastroenteritis* ; Gastrointestinal Tract ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Inflammation* ; Injections, Intraperitoneal ; Interleukin-13 ; Interleukins ; Intestinal Mucosa ; Mice* ; Ovalbumin ; Ovum ; Weight Loss

PURPOSE: Nebulizers are commonly used to treat children with asthma. Some pulmonary infections associated with contaminated nebulizer units have been reported. The aims of this study were to determine whether home nebulizers are repositories of bacteria and to ascertain how asthmatic patients use and maintain their nebulizers at home. METHODS: Fifty-five children with asthma aged 2 to 6 years were enrolled in this study. The parents were asked to bring their child's nebulizer units to regular follow-up visits. Bacterial samples which were obtained from the masks(or mouthpieces), nebulizer chambers and throat swabs were inoculated to blood agar, chocolate agar, and McConkey agar. Cultures were incubated at 5 percent CO2 incubator and observed after 24 hours. Parents completed a questionnaire regarding nebulizer usage and care in their child. RESULTS: Bacterial contamination was found in samples from 27(49.1%) of the 55 masks(or mouthpieces) and 24(43.6%) of the 55 chambers. The predominant microorganisms isolated were Acinetobacter baumannii, Bacillus subtilis, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans. The questionnaire revealed that 40 parents cleaned the nebulizer units with tap water(and soap) and dried then, as they had received cleaning and drying instructions from a medical staff member. Seven organisms from nebulizer units were indistinguishable from the patient's throat isolates. CONCLUSION: We have demonstrated that home nebulizers in these asthmatic children were frequently contaminated with aerobic bacteria. Aerosolization might transmit these bacteria to their upper respiratory tracts. The education and training of home caregivers should include the principles of cleaning and maintenance of their child's nebulizer units.
Acinetobacter baumannii ; Agar ; Asthma ; Bacillus subtilis ; Bacteria ; Bacteria, Aerobic ; Cacao ; Candida albicans ; Caregivers ; Child* ; Education ; Follow-Up Studies ; Humans ; Incubators ; Inhalation ; Klebsiella pneumoniae ; Medical Staff ; Nebulizers and Vaporizers* ; Parents ; Pharynx ; Surveys and Questionnaires ; Respiratory System ; Staphylococcus aureus

BACKGROUND: The genicular arteries (GAs) can be utilized for genicular nerve block. We aimed to evaluate the ability to localize GAs under ultrasound in patients with chronic knee pain. METHODS: Twenty-four knees from 14 osteoarthritic patients were enrolled. The target GAs included the superomedial GA (SMGA), superolateral GA (SLGA), and inferomedial GA (IMGA). GAs were observed at the relevant adductor tubercle and epicondyle-shaft transition under ultrasound. Distribution of the SMGA at the adductor tubercle was evaluated using defined zones in transverse and longitudinal ultrasound images. SLGA and IMGA were also categorized using defined zones in longitudinal images. Distance from bony cortex to the relevant GA was then estimated. RESULTS: Among 24 knees, 91.7% of SMGAs were located at the upper part of the adductor tubercle. The distances between the SMGA and bony cortex on transverse view (dSMGAt) and on longitudinal view (dSMGAl) were directly correlated (rs = 0.6539, P = 0.0005). CONCLUSIONS: Under ultrasound guidance, the SMGA was found to be mainly localized to the upper part of the adductor tubercle. Likewise, the SLGA and IMGA were mainly localized at the distal and proximal parts of the epicondyle-shaft transition, respectively. Our results support the feasibility of ultrasound guidance for GA localization in patients with knee osteoarthritis.
Arteries* ; Humans ; Knee ; Nerve Block ; Osteoarthritis, Knee ; Ultrasonography*

PURPOSE: The aim of this study was to investigate the change in macrolide resistance rate in pediatric Mycoplasma pneumoniae pneumonia and to evaluate the influence of macrolide-resistant M. pneumoniae (MRMP) on the clinical course of disease, by comparing 2 recent, consecutive epidemics in Korea. METHODS: A total of 250 patients with M. pneumoniae pneumonia admitted to a single tertiary hospital were enrolled in this study. Detection of MRMP was based on specific point mutations in domain V of the 23S rRNA gene. The medical records of enrolled patients were reviewed retrospectively, and the clinical courses and laboratory data were compared. RESULTS: The macrolide resistance rate of M. pneumoniae was 51.1% (48/94) in the 2011 epidemic, and 87.2% (136/156) in the 2015 epidemic. All MRMP isolates had the A2063G point mutation. In comparison of 2 epidemics, the mean age of patients with M. pneumoniae pneumonia was increased, and the total febrile days and febrile days after initiation of macrolides were prolonged in the 2015 epidemic. Overall severity of MRMP or macrolide-susceptible M. pneumoniae (MSMP) pneumonia over 2 epidemics was not significantly changed. However, the proportion of patients who had a fever lasting more than 72 hours after initiation of macrolides and who received corticosteroid treatment were higher in MRMP pneumonia during 2 epidemics. CONCLUSIONS: The macrolide resistance rate of M. pneumoniae has risen rapidly over 2 recent, consecutive epidemics, and this has been associated with a prolonged clinical course and increased use of corticosteroids to treat pediatric M. pneumoniae pneumonia.
Adrenal Cortex Hormones ; Child* ; Drug Resistance ; Fever ; Genes, rRNA ; Humans ; Korea* ; Macrolides ; Medical Records ; Mycoplasma pneumoniae ; Pneumonia* ; Pneumonia, Mycoplasma ; Point Mutation ; Retrospective Studies ; Tertiary Care Centers

PURPOSE: The aim of this study was to investigate changes in bronchial hyperresponsiveness, total IgE, blood total eosinophil counts and serum eosinophil cationic protein (ECP), after treatment with inhaled corticosteroids or leukotriene modifiers in children with asthma. METHODS: Methacholine bronchoprovocation tests were repeated at 12 months of follow-up in 37 children with atopic asthma and eight children with non-atopic asthma, who regularly attended the Allergy Clinic of Korea University Anam Hospital and Seoul National University Hospital over one year from their initial visit. A serum total IgE, peripheral blood eosinophil counts, and serum ECP levels were measured on their initial visits and at 12 months of follow-up. RESULTS: Following six to 12 months of inhaled corticosteroids or leukotriene modifiers treatment, the geometric mean (range of 1 SD) of methacholine PC20 was significantly changed in the atopic asthma group [2.20 mg/mL (0.41-11.82) vs. 6.69 mg/mL (1.25-35.87), P=0.000] but not in non-atopic asthma group [2.41 mg/mL (0.90-6.42) vs. 2.46 mg/mL (0.62-9.78), P=0.065]. Blood total eosinophil counts and serum ECP levels decreased significantly over one year in atopic asthma, while these changes were not observed in non-atopic asthma. Significantly higher FEV1 %predicted values (98.3+/-6.6%) were noted at 12 month follow-up compareed to the initial values (92.9+/-11.4%, P=0.023) in the non-atopic asthma group. CONCLUSION: Inhaled corticosteroids or leukotriene modifiers treatment resulted in a significantly decreased bronchial hyperresponsiveness in children with atopic asthma. This effect was reflected primarily by reduced blood eosinophilic inflammation. The persistence of bronchial hyperresponsiveness in children with non-atopic asthma might be related with genetic factors or airway remodeling other than eosinophilic inflammation.
Adrenal Cortex Hormones ; Airway Remodeling ; Asthma* ; Child* ; Eosinophil Cationic Protein ; Eosinophils ; Follow-Up Studies ; Humans ; Hypersensitivity ; Immunoglobulin E ; Inflammation ; Korea ; Methacholine Chloride ; Seoul

PURPOSE: The aim of this study was to investigate bronchodilator responsiveness (BDR) following methacholine-induced bronchoconstriction and to determine differences in BDR according to clinical parameters in children with asthma. METHODS: The methacholine challenge test was performed in 145 children with mild to moderate asthma, and the provocative concentration causing a 20% decline in FEV1 (PC20) was determined. Immediately after the challenge test, patients were asked to inhale short-acting beta2-agonists (SABAs) to achieve BDR, which was assessed as the change in FEV1% predictedx100/post-methacholine FEV1% predicted. For each subject, the asthma medication, blood eosinophil count, serum total IgE, serum eosinophil cationic protein level, and skin prick test result were assessed. RESULTS: The FEV1 (mean+/-SD) values of the 145 patients were 90.5+/-10.9% predicted, 64.2+/-11.5% predicted, and 86.2+/-11.2% predicted before and after methacholine inhalation, and following the administration of a SABA, respectively. The BDR did not differ significantly according to asthma medication, age, or gender. However, BDR in the atopy group (37.4+/-17.7%) was significantly higher than that in the non-atopy group (30.5+/-10.7%; P=0.037). Patients with blood eosinophilia (38.6+/-18.1%) displayed increased BDR compared with patients without eosinophilia (32.0+/-13.8%; P=0.037). CONCLUSIONS: In children with mild to moderate asthma, the responsiveness to short-acting bronchodilators after methacholine-induced bronchoconstriction was not related to asthma medication, but was higher in children with atopy and/or peripheral blood eosinophilia.
Adrenergic beta-Agonists ; Asthma ; Azides ; Bronchoconstriction ; Bronchodilator Agents ; Child ; Eosinophil Cationic Protein ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin E ; Inhalation ; Methacholine Chloride ; Serotonin ; Skin

Dendritic cells (DCs) are potent antigen-presenting cells. OK432 (Picibanil(R)) was introduced as a potent stimulator of DC maturation in combination with prostaglandin-E2 and interferon-alpha. We compared the efficacy of a DC-prostate cancer vaccine using early-mature DCs stimulated with OK432, PGE2 and INF-alpha (OPA) with that of vaccines using other methods. On days 3 or 7 of DC culture, TNF-alpha (T), TNF-alpha and LPS (TL) or OPA were employed as maturation stimulators. DU145 cells subjected to heat stress were hybridized with mature DCs using polyethyleneglycol. T cells were sensitized by the hybrids, and their proliferative and cytokine secretion activities and cytotoxicity were measured. The yields of early-mature DCs were higher, compared to yields at the conventional maturation time (P<0.05). In the early maturation setting, the mean fusion ratios, calculated from the fraction of dual-positive cells, were 13.3%, 18.6%, and 39.9%, respectively (P=0.051) in the T only, TL, and OPA-treated groups. The function of cytotoxic T cells, which were sensitized with the hybrids containing DCs matured early with OPA, was superior to that using other methods. The antitumor effects of DC-DU145 hybrids generated with DCs subjected to early maturation with the OPA may be superior to that of the hybrids using conventional maturation methods.
Cancer Vaccines/*immunology ; Cell Line, Tumor ; Dendritic Cells/cytology/drug effects/*immunology ; Dinoprostone/*pharmacology ; Humans ; Immunologic Factors/*pharmacology ; Interferon-alpha/*pharmacology ; Lipopolysaccharides/toxicity ; Male ; Neoplasms, Hormone-Dependent/*immunology ; Phenotype ; Picibanil/*pharmacology ; Prostatic Neoplasms/*immunology ; T-Lymphocytes, Cytotoxic/immunology

Since the tuberculosis (TB) in adolescents has unique clinical characteristics, special attention should be paid to this age group. Adolescents are more susceptible to developing TB disease and more likely to have cavitary pulmonary disease. Also, adolescent patients with TB more frequently present with extrapulmonary disease. We report three adolescents with active pulmonary and/or intestinal TB: one had pulmonary and intestinal TB, another had a pulmonary TB, and the third exclusively had an intestinal TB. Diagnosis was confirmed by pathologic examination of the lung and/or intestines. All three patients were treated successfully without complication. A brief review of the literature has been included.
Adolescent* ; Diagnosis ; Humans ; Intestines ; Lung ; Lung Diseases ; Tuberculosis* ; Tuberculosis, Pulmonary

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects premature babies and contributes to their increased morbidity and mortality. The classic progressive stage with prominent fibroproliferation that first characterized BPD is generally less striking and the disease is currently predominantly defined by a disruption of distal lung growth, thus it has been termed "new BPD." We present here in a case of 5-month-old girl dying from BPD and pulmonary hypertension. Autopsy findings of the lung showed fewer and larger alveoli with less fibrosis, which is consistent with those of "new BPD."
Autopsy ; Bronchopulmonary Dysplasia ; Fibrosis ; Humans ; Hypertension, Pulmonary ; Infant ; Infant, Newborn ; Lung ; Lung Diseases ; Premature Birth ; Strikes, Employee

PURPOSE: The education for self-management of asthma is considered as an essential component to control asthma and improve outcomes. This study aimed to develope an educational game for increasing knowledge of asthma management among children and their caregivers. METHODS: Three subspecialists of pediatric allergy and respirology, 1 pediatrician, 3 pediatric residents and 15 medical students conducted this study. An instructional systemic design using analysis, design, development, implementation and evaluation (ADDIE) model was applied in the entire process of game production. We surveyed the demands of asthma education in 19 caregivers of children who were in the treatment of asthma in Korea University Anam Hospital and reflected its results on the construction of game. For the evaluation of the objective effects of developed game, the comparison study was performed between the patients who had experienced the game (n=20) and those who had not (n=22) by using questionnaire about the knowledge of asthma. RESULTS: The game was developed as a form of board game and had contents including precipitating factors, symptoms and treatment of asthma. The patients older than elementary student easily understood the mode and substances of game, and participated with their concentrations throughout approximately 2 hours' operating time. In analysis of the knowledge level of asthma, the patients who had experienced board game showed significantly higher knowledge level than those who had not (74.0+/-17.6 vs. 55.0+/-17.1, P=0.006). CONCLUSION: We developed a family board game for the asthma education through the systematic production process. The board game may increase the knowledge level in asthmatic children, which would improve the ability of self-management.
Asthma ; Caregivers ; Child ; Humans ; Hypersensitivity ; Korea ; Precipitating Factors ; Surveys and Questionnaires ; Self Care ; Students, Medical