PURPOSE: Inhaled corticosteroids (ICSs) are often considered an empirical therapy in the management of patients with cough. However, ICS responsiveness is difficult to interpret in daily clinical practice, as the improvements may include placebo effects or self-remission. We aimed to evaluate ICS and placebo treatment effects in adult patients with cough. METHODS: Electronic databases were searched for studies published until June 2018, without language restriction. Randomized controlled trials reporting the effects of ICSs compared with placebo in adult patients with cough were included. Random effects meta-analyses were conducted to estimate the treatment effects. Therapeutic gain was calculated by subtracting the percentage change from baseline in the cough score in the ICS treatment group from that in the placebo treatment group. RESULTS: A total of 9 studies were identified and 8 studies measuring cough severity outcomes were included for meta-analyses. Therapeutic gain from ICSs ranged from −5.0% to +94.6% across the studies included; however, it did not exceed +22%, except for an outlier reporting very high therapeutic gains (+45.6% to +94.6%, depending on outcomes). Overall ICS treatment effects in cough severity outcomes were small-to-moderate (standardized mean difference [SMD], −0.38; 95% confidence interval [CI], −0.54, −0.23), which were comparable between subacute and chronic coughs. However, pooled placebo treatment effects were very large in subacute cough (SMD, −2.58; 95% CI, −3.03, −2.1), and modest but significant in chronic cough (SMD, −0.46; 95% CI, −0.72, −0.21). CONCLUSIONS: Overall therapeutic gain from ICSs is small-to-moderate. However, placebo treatment effects of ICS are large in subacute cough, and modest but still significant in chronic cough. These findings indicate the need for careful interpretation of ICS responsiveness in the management of cough patients in the clinic, and also for rigorous patient selection to identify ICS-responders.
Adrenal Cortex Hormones ; Adult ; Cough ; Humans ; Overall ; Patient Selection ; Placebo Effect ; Steroids

BACKGROUND AND PURPOSE: Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. METHODS: We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies. Midline shift was measured preoperatively and postoperatively using computed tomography (CT). Consciousness level was evaluated using the Glasgow Coma Scale on postoperative day 1. Patient survival was assessed six months after stroke onset. RESULTS: The median time interval between preoperative and postoperative CT was 8.3 hours (interquartile range, 6.1–10.2 hours). Reduction in midline shift was associated with higher postoperative Glasgow Coma Scale scores (P<0.05). Forty-three patients (61.4%) were alive at six months after the stroke. Patients with reductions in midline shifts following hemicraniectomy were more likely to be alive at six months post-stroke than those without (P<0.001). Reduction of midline shift was associated with lower mortality at six months after stroke, after adjusting for age, sex, National Institutes of Health Stroke Scale score, and preoperative midline shift (adjusted hazard ratio, 0.71; 95% confidence interval, 0.62–0.81; P<0.001). CONCLUSIONS: Reduction in midline shift following hemicraniectomy was associated with improved consciousness and six-month survival in patients with MMI. Hence, it may be an early indicator of effective decompression following hemicraniectomy.
Brain ; Consciousness ; Decompression ; Decompressive Craniectomy ; Glasgow Coma Scale ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Mortality ; National Institutes of Health (U.S.) ; Stroke

OBJECTIVE: Cerebral vessels, such as intracerebral perforating arterioles isolated from rat brain, have been widely used as an ex vivo model to study the cerebrovascular function associated with cerebrovascular disorders and the therapeutic effects of various pharmacological agents. These perforating arterioles, however, have demonstrated differences in the vascular architecture and reactivity compared with a larger leptomeningeal artery which has been commonly implicated in cerebrovascular disease. In this study, therefore, we developed the method for studying cerebrovascular function utilizing the olfactory artery isolated from the mouse brain. METHODS: The olfactory artery (OA) was isolated from the C57/BL6 wild-type mouse brain. After removing connective tissues, one side of the isolated vessel segment (approximately -500 microm in length) was cannulated and the opposite end of the vessel was completely sealed while being viewed with an inverted microscope. After verifying the absence of pressure leakage, we examined the vascular reactivity to various vasoactive agents under the fixed intravascular pressure (60 mm Hg). RESULTS: We found that the isolated mouse OAs were able to constrict in response to vasoconstrictors, including KCl, phenylephrine, endothelin-1, and prostaglandin PGH2. Moreover, this isolated vessel demonstrated vasodilation in a dose-dependent manner when vasodilatory agents, acetylcholine and bradykinin, were applied. CONCLUSION: Our findings suggest that the isolated olfactory artery would provide as a useful ex vivo model to study the molecular and cellular mechanisms of vascular function underlying cerebrovascular disorders and the direct effects of such disease-modifying pathways on cerebrovascular function utilizing pharmacological agents and genetically modified mouse models.
Animals ; Arteries* ; Arterioles ; Bradykinin ; Brain ; Cerebral Arteries ; Cerebrovascular Disorders ; Cholinergic Agents ; Connective Tissue ; Endothelin-1 ; Mice* ; Phenylephrine ; Prostaglandin H2 ; Rats ; Vasoconstriction ; Vasoconstrictor Agents ; Vasodilation

The antiarrhythmic clofilium is an efficient blocker of hERG1 potassium channels that are strongly expressed in the heart. Therefore, derivatives of clofilium that emit positrons might be useful tools for monitoring hERG1 channels in vivo. Fluoroclofilium (F-clofilium) was synthesized and its channel-blocking properties were determined for hERG1 and hEAG1 channels expressed in HEK 293 cells and in Xenopus oocytes. When applied extracellularly in the whole-cell patch-clamp configuration, F-cloflium exhibited a slower onset of block when compared with clofilium, presumably owing to its lower membrane permeability. When applied in the inside-out configuration at the intracellular membrane side, it blocked hEAG1 channels almost as efficiently as clofilium (IC50 1.37 nM and 0.83 nM, respectively). Similar results were obtained for hERG1, showing Fclofilium is a potent hERG1 and hEAG1 channel blocker once it has reached the intracellularly accessible target site at the channel. Using the 18Flabeled analog we studied the in vivo binding and distribution of F-clofilium in mice and a dog. Greatest activity was found in kidneys and bones. A small but significant enrichment of activity in the dog myocardium known for its expression of cERG1 channels allowed to depict the myocardium of a living dog by PET. Thus, F-clofilium is a useful tool for imaging hERG channels in living organisms.
Animals ; Anti-Arrhythmia Agents/pharmacokinetics/*pharmacology ; Cell Line ; Dogs ; Electrons ; Ether-A-Go-Go Potassium Channels/*antagonists & inhibitors ; Female ; Inhibitory Concentration 50 ; Kidney/metabolism ; Mice ; Mice, Inbred BALB C ; Myocardium/metabolism ; *Positron-Emission Tomography ; Potassium Channel Blockers/pharmacokinetics/*pharmacology ; Quaternary Ammonium Compounds/pharmacokinetics/pharmacology ; Research Support, Non-U.S. Gov't ; Tissue Distribution ; Xenopus

The trial of external quality assessment for inborn error of metabolism was performed in 2003. A total 10 specimens for neonatal screening tests were distributed to 43 laboratories with a response rate of 83%. All the control materials were sent as a filter paper form. Each laboratory replied the test result as the screening items they were doing as a rountine test at the reception of the specimen among PKU screening, neonatal TSH, neonatal T4(total/free), galactosemia screen, homocytinuria screen and histidinemia screen. The mean, SD, and CV were analyzed.
Galactosemias ; Infant, Newborn ; Korea* ; Mass Screening ; Metabolism* ; Neonatal Screening

BACKGROUND: Neglect dyslexia is a type of neglect syndrome, in which patients with unilateral hemisphere injury omit or misread the contralateral side of a text or the initial letters of a word. Hangul can be arrayed vertically (vertical reading, VR) as well as horizontally (horizontal reading, HR). Thus, HR and VR can be differentially affected in neglect dyslexia. We conducted an experiment in a 66 year-old woman who suffered from neglect dyslexia after a right cerebral infarction. We compared HR with VR in terms of error frequencies and patterns. METHODS: Stimuli for neglect dyslexia consisted of 227 words. The 227 words were written horizontally or vertically (total 554 words) and were pre-sented in random order. The patient was asked to read the words and the examiner recorded the patient's responses and reaction times. RESULTS: The differences in HR and VR were as follows: 1) the error frequency in HR (59.0%) was higher than the error frequency in VR (20.3%), 2) the most frequent error in HR was syllabic deletion (79.1%) whereas phonemic substitution (89.1%) predominated in VR, 3) the error rate was highest at the first syllabic position in HR whereas no position effect was noted in VR. CONCLUSIONS: Patients with neglect dyslexia make less error in VR than in HR. The neural processing of HR may be different from that of VR. VR may be an alternative reading strategy that may be useful during the recovery stage of neglect dyslexia.
Aged ; Cerebral Infarction ; Dyslexia* ; Female ; Humans ; Reaction Time

BACKGROUND: The measurement of functional disabilities in patients with dementia is one of the essential parts of evaluation for dementia from the viewpoint of diagnosis and therapeutic intervention. Nevertheless, few standardized scales for the instrumental activities of daily living (IADL) are available in Korea. The purpose of this study was to test the reliability and validity of the Korean IADL (K-IADL). METHODS: K-IADL is comprised of 11 items that were selected by the Representative Committee of the Korean Dementia Research Group. These include: (1) shopping, (2) mode of transportation, (3) ability to handle finances, (4) house keeping, (5) preparing food, (6) ability to use a tele-phone, (7) responsibility for own medication, (8) recent memory, (9) hobbies, (10) watching television, and (11) fixing around the house. K-IADL was administered to informants of 114 dementia patients and age and sex matched 106 con-trols. The informants rated each item as follows: 0=normal, 1=with some assistance, 2=with much assistance, 3=unable to do, NA=not applicable. RESULTS: Internal consistency (Cronbach's alpha=0.96) and the test-retest reliability(r=0.94) of K-IADL were significant. A principle component factor analysis extracted a single factor that accounted for 70.3% of the total variance (Eigenvalue: 7.74), and K-IADL was correlated significantly with other general cognitive indices, demonstrating good validity. With a cut-off point of 0.43, the K-IADL had a sensitivity of 83% and a specificity of 82% in the diagnosis of dementia. CONCLUSIONS: Our results showed that K-IADL could be a reliable and valid tool for the quantification of functional disabilities of Korean dementia patients.
Activities of Daily Living* ; Dementia ; Diagnosis ; Factor Analysis, Statistical ; Hobbies ; Humans ; Korea ; Memory ; Reproducibility of Results* ; Sensitivity and Specificity ; Television ; Transportation ; Weights and Measures

BACKGROUND: GenediaTM H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of GenediaTM H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. METHODS: GenediaTM H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with GenediaTM H. pylori ELISA. H. pylori infection was determined by rapid urease test, histology, culture or 13C-urea breath test in adults. In children, the subject was considered to be H. pylori positive if 13C-urea breath test was positive. RESULTS: In adults, the sensitivity and specificity of GenediaTM H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of GenediaTM H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of GenediaTM H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%; plt;0.005 and 92.5% vs 71.4%; p<0.005, respectively). CONCLUSION: GenediaTM H. pylori ELISA is a relatively accurate method for the serodiagnosis of H. pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of GenediaTM H. pylori ELISA for epidemiological studies of H. pylori infection in Korea.
Adult ; Breath Tests ; Child ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Korea ; Sensitivity and Specificity ; Serologic Tests ; Urease

BACKGROUND: Helicobacter pylori infection occurs throughout the world and causes various gastroduodenal diseases in all age groups. The prevalence of H. pylori infection varies among countries and races. The aim of this study was to evaluate the seroprevalence of H. pylori infection in healthy people in Korea. METHODS: From March 1998 to October 1998, 5,732 asymptomatic subjects responded to the self-assessment questionnaires from 54 hospitals were enrolled. Serum level of anti-H. pylori IgG was measured by ELISA test. RESULTS: The overall prevalence of H. pylori infection was 46.6% and showed no significant difference between male (47.2%) and female (45.9%). According to the geographic areas, the highly prevalent provinces were Kangwon (53.4%), Cheju (52.9%) and Jeonra provinces (50.6%), while Seoul (41.9%) was the lowest prevalent area. The seroprevalence increased with age and was the highest at 40's (78.5%). The characteristic feature of this study was that the infection rate increased steeply in three age groups (10-12, 16-19 years old and 30's). In Seoul, there was no different prevalence rate among the districts studied. CONCLUSION: The nation-wide seroprevalence of H. pylori infection in Korea is higher than that of the developed countries. We hope that this study provides the landmark for the study of H. pylori infection in Korea.
Continental Population Groups ; Developed Countries ; Enzyme-Linked Immunosorbent Assay ; Female ; Gangwon-do ; Helicobacter pylori* ; Helicobacter* ; Hope ; Humans ; Immunoglobulin G ; Jeju-do ; Korea* ; Male ; Prevalence ; Self-Assessment ; Seoul ; Seroepidemiologic Studies* ; Surveys and Questionnaires

BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection varies between countries and between social classes. The aim of this study was to identify risk factors for with Helicobacter pylori infection in asymptomatic Korean population. METHODS: Sera were collected from 2,687 females and 3,049 males (mean age, 29.1 y; range, 1 m-79 y) in Korea from Mar 1998 through Oct 1998. All asymptomatic subjects completed assessment questionnaires. An enzyme-linked immunosorbent assay was performed to detect IgG antibody to H. pylori. RESULTS: The overall seroprevalence observed was 46.6% and showed nostatistical diffrerence between female (45.9%) and male (47.2%). The seroprevalences in children (neonate-15 y) and adult (16-79 y) were 17.2% and 66.9%, respectively. According to multivariate analysis, variables such as sex, age, geographic area, crowding (number of person per room) in childhood, economic status in childhood, and types of housing in childhood were significantly and independently associated with H. pylori seroprevalence of adults. In children, age, geographic area, income, mother's education, and drinking water source were significant risk factors of H. pylori infection. CONCLUSION: Socioeconomic condition and close person to person contact in childhood are the significant determinants for H. pylori infection in adult. Drinking water source is an another important risk factor for H. pylori infection in children, suggesting the fecal to oral transmission in Korea.
Adult ; Child ; Crowding ; Drinking Water ; Education ; Enzyme-Linked Immunosorbent Assay ; Epidemiology ; Female ; Helicobacter pylori* ; Helicobacter* ; Housing ; Humans ; Immunoglobulin G ; Korea ; Male ; Multivariate Analysis ; Prevalence ; Risk Factors* ; Seroepidemiologic Studies ; Social Class ; Surveys and Questionnaires