Background: Observational studies of the ongoing coronavirus disease 2019 (COVID-19) outbreak suggest that a ‘cytokine storm’ is involved in the pathogenesis of severe illness.However, the molecular mechanisms underlying the altered pathological inflammation in COVID-19 are largely unknown. We report here that toll-like receptor (TLR) 4-mediated inflammatory signaling molecules are upregulated in peripheral blood mononuclear cells (PBMCs) from COVID-19 patients, compared with healthy controls (HC). Methods: A total of 48 subjects including 28 COVID-19 patients (8 severe/critical vs. 20 mild/ moderate cases) admitted to Chungnam National University Hospital, and age/sex-matched 20 HC were enrolled in this study. PBMCs from the subjects were processed for nCounter Human Immunology gene expression assay to analyze the immune related transcriptome profiles. Recombinant proteins of severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) were used to stimulate the PBMCs and monocyte-derived macrophages, and real-time polymerase chain reaction was performed to quantify the mRNA expressions of the proinflammatory cytokines/chemokines. Results: Among the most highly increased inflammatory mediators in severe/critically ill patients, S100A9, an alarmin and TLR4 ligand, was found as a noteworthy biomarker, because it inversely correlated with the serum albumin levels. We also observed that recombinant S2 and nucleocapsid proteins of SARS-CoV2 significantly increased proinflammatory cytokines/chemokines and S100A9 in human primary PBMCs. Conclusion These data support a link between TLR4 signaling and pathological inflammation during COVID-19 and contribute to develop therapeutic approaches through targeting TLR4-mediated inflammation.

PURPOSE: This study was aimed to investigate the effect of early phosphorus intake on respiratory distress in extremely low-birth-weight infants (ELBWIs) with a high incidence of hypophosphatemia. METHODS: We performed a retrospective study to target 164 ELBWIs admitted to the neonatal intensive care unit in Seoul National University Children's Hospital. Birth characteristics, nutritional intake, and electrolyte levels during the first week were investigated as predictors that would affect the clinical outcomes. The correlations among invasive ventilation at postnatal age of 2 weeks, moderate-to-severe bronchopulmonary dysplasia (BPD), and phosphorous intake were analyzed. RESULTS: Hypophosphatemia (phosphorus level <4 mg/dL) was observed in 72.0% of the subjects. The rates of invasive ventilation (P=0.001) and moderate-to-severe BPD (P=0.005) were significantly lower in the high phosphorus intake group (≥0.7 mM/kg/day) than in the low phosphorus intake group (<0.7 mM/kg/day). Phosphorus intake during the first week was a significant factor affecting invasive ventilation at 2 weeks of age (adjusted odds ratio [OR], 8.212; 95% confidence interval [CI], 2.256 to 28.896; P=0.001) and moderate-to-severe BPD (adjusted OR, 3.402; 95% CI, 1.274 to 9.084; P=0.015). CONCLUSION: Early insufficient phosphorus intake confers a significantly higher risk with invasive ventilation at 2 weeks of age and moderate-to-severe BPD. Therefore, early sufficient phosphorus supply may improve respiratory outcomes in ELBWIs.
Bronchopulmonary Dysplasia ; Humans ; Hypophosphatemia ; Incidence ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Odds Ratio ; Parturition ; Phosphorus ; Retrospective Studies ; Seoul ; Ventilation

OBJECTIVE: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. METHODS: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. RESULTS: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). CONCLUSION: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.
Angiotensins ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Heart ; Hospitals, Teaching ; Humans ; Hypertension ; Incidence ; Logistic Models ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prescriptions*

The National Evidence-based Collaborating Agency (NECA) holds the NECA Round-table Conference that not only disseminates objective and systematic information on topics of social concern in public health care but also organizes discussions on core issues under dispute in the literature through panels composed of multidisciplinary experts. Accordingly, the Round-table Conference was composed of multidisciplinary experts including medical specialists in the areas of psychiatry and preventive medicine, psychiatric and mental health nursing, psychologists, social welfare experts, consultation experts, religious leaders, and government officials from the Ministry of Education, Science and Technology, and Ministry of Health and Welfare. The Round-table Conference, tasked with analysis of the actual status and causes of, and search for solutions for suicide in adolescents, has reached consensus on the current status, trend, risk factors and prevention factors, problems and issues in prevention and coping strategies, effective prevention and coping strategies and areas of research needed for the future. The Round-table Conference commented on the actual status and gravity of suicides in adolescents, and came to the agreement that mental health issues including stress from interpersonal relationships and depression are the key risk factors of suicide. It was further agreed that problems in the measures being implemented for each of the areas include lack of manpower and funding, and inadequate organic association and cooperation among relevant institutions. They also agreed that development of a government-initiated suicide prevention program for adolescents, association among relevant experts, and development, and management of practical guidelines that are of broad and practical use are important. Furthermore, the panels were in agreement that the mass media must comply with the recommended level of coverage in reporting of suicide as adolescents are greatly influenced by provocative mass media reports due to their strong impulsive dispositions.
Adenosine-5'-(N-ethylcarboxamide) ; Adolescent ; Cause of Death ; Consensus ; Depression ; Dissent and Disputes ; Financial Management ; Gravitation ; Humans ; Mass Media ; Mental Health ; Occupational Groups ; Porphyrins ; Preventive Medicine ; Public Health ; Risk Factors ; Social Welfare ; Specialization ; Suicide

OBJECTIVE: The study was conducted to investigate the association between economic status and depressive symptoms by comparing the prevalence rates of depressive symptoms at community level and analyzing the possibility of depressive symptoms at individual level. METHODS: A survey was conducted from November, 2006 to November, 2007 on 966 and 992 representative subjects recruited by stratified clustered sampling in two regions located in Seoul. We used a standardized questionnaire including the Center for Epidemiologic Studies-Depression and questions on the socioeconomic characteristics. The adjusted prevalence rates of depressive symptoms were compared at community level, and multiple logistic regression analysis was performed to determine the association between depressive symptoms and economic statuses at individual level among each region. RESULTS: The adjusted prevalence of depressive symptoms was higher in the region with a high socioeconomic status (23.1%) than in the region with a lower economic status (16.6%)(p<0.001). However, logistic regression analysis of individual level revealed that a higher economic status was significantly associated with a lower possibility of depressive symptoms among the females in the low economic status region. This tendency was not observed among the males in both of the regions. CONCLUSION: The association between economic status and depressive symptoms was found to be different when it was approached at community level or individual level. In addition, the association of two variables was different by gender at individual level. Further studies that consider the third mediators are needed to determine the association between the two variables.
Depression ; Female ; Humans ; Logistic Models ; Male ; Prevalence ; Surveys and Questionnaires ; Social Class

PURPOSE: This study was conducted to investigate how nurses who take care of terminal patients perceive fluid therapy and how this therapy is currently being used in hospitals. METHODS: This survey included 200 nurses, 87 of whom were working in the oncology units of 3 university hospitals in Seoul, Korea, and 113 were working in 18 hospice centers. The data for this study were collected by means of structured questionnaires and analyzed by using the Statistical Analysis System software. The differences in perception towards fluid therapy between nurses working in oncology units and those working in hospice centers were examined using the chi-square test and analysis of covariance. RESULTS: Fluid therapy was perceived more negatively by the nurses from hospice centers than by those from oncology units. Continuous subcutaneous infusion was used in hospice centers, but not in oncology units. In addition, the average amount of fluid infused daily differed significantly between the oncology units and hospice centers. CONCLUSION: Our results show that there were differences in the perception towards fluid therapy between nurses in different clinical settings. Nurses caring for terminal and palliative care patients should not simply provide or withhold fluid therapy, but rather develop a wider range of views on fluid therapy, focusing on effective alternative interventions.
Fluid Therapy ; Hospices ; Hospitals, University ; Humans ; Infusions, Subcutaneous ; Korea ; Palliative Care ; Terminally Ill ; Surveys and Questionnaires

OBJECTIVES: Subway drivers experience various types of work-related problems during their driving, and those experiences can act as risk factors for depressive symptoms. This study was conducted to investigate the association between work-related problems and subway driver's depressive symptoms. METHODS: We recruited all of the 961 current subway drivers of a subway company located in Seoul, South Korea and conducted a survey of their socio-demographic and vocational characteristics, hospital visits as an outpatient or inpatient, and work-related problem experiences during the last year. Work-related problems included an accident resulting in death or injury, a conflict with a customer, a sudden stop from an emergency bell, or a near accident. Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) instrument. The survey was performed using a self-report questionnaire from April 16 to July 13, 2007. The data of 827 drivers (86.2%) were analyzed. RESULTS: Experience of a conflict with a passenger (p=0.011), a sudden stop from an emergency bell (p=0.001), or a near accident (p=0.001) increased the prevalence of depressive symptoms among subway drivers. A multiple logistic regression analysis revealed that a sudden stop from an emergency bell increased the risk of depressive symptoms significantly (OR=2.59, p=0.026). Near accidents were marginally associated with a higher risk for depressive symptoms (OR=1.62, p=0.062). CONCLUSION: The experience of a sudden stop from an emergency bell increased subway driver's depressive symptoms, and near accidents may increase the risk of depressive symptoms. Therefore, interventions for the drivers who had experienced these work-related problems are needed.
Depression ; Emergencies ; Humans ; Inpatients ; Logistic Models ; Outpatients ; Prevalence ; Railroads ; Republic of Korea ; Risk Factors ; Surveys and Questionnaires

Sialadenosis is a unique form of non-inflammatory, non-neoplastic bilateral salivary gland disorder characterized by recurrent painless swelling which usually occurs in parotid glands. Alcoholism is one of the main causes of sialadenosis along with diabetes, bulimia, and other idiopathic causes. The prognosis is verified according to the degree of liver function. We present a case of a 46 year-old man who had alcoholic fatty liver disease diagnosed as alcoholic sialadenosis based on clinical points of recurrent bilateral parotid swelling after heavy alcohol drinking, computed tomography, and fine-needle aspiration biopsy. After stopping alcohol drinking and treated with conservative treatment, he got improved without specific sequela.
Adult ; *Alcohol Drinking ; Fatty Liver, Alcoholic/*diagnosis/etiology/radiography ; Humans ; Male ; Parotid Gland/*radiography/secretion ; Positron-Emission Tomography ; Sialadenitis/*diagnosis/etiology ; Tomography, X-Ray Computed

OBJECTIVES: Nurses' turnover has a negative influence on the nursing staff, as well as on the hospital organization as a whole. In an effort to reduce the turnover of nurses, the conditions causing turnover intentions can be identified and managed. The research is conducted to identify the association among verbal abuse, social support, and turnover intentions for special unit nurses. METHODS: A survey was conducted in 105 registered nurses who worked in the following areas at Kyonggi province hospital: operating room, intensive care unit, and anesthesia department. The questionnaires included questions in the following areas: verbal abuse by doctors, supervisors, and colleagues social supports by supervisors and colleagues and turnover intention. The survey was distributed and analyzed based on nurses' responses. RESULTS: Operating room nurses had the highest turn over intentions. The verbal abuse by doctors and supervisors were highest in the operating room. Verbal abuse by supervisors had a significantly positive association with turnover intentions. Verbal abuse by doctors and by colleagues was not associated with the intention to leave. Finally, the social support by supervisors had a significant negative association with turnover intentions. Social supports by colleagues did not affect turnover intentions. CONCLUSIONS: For nurses working at special units, verbal abuse and social support by supervisors had a significant association with turnover intentions. It is important for supervisors to make an effort to reduce nurses' turnover intentions by reducing verbal abuse and by increasing social support.
Anesthesia Department, Hospital ; Humans ; Intensive Care Units ; Intention ; Nursing Staff ; Operating Rooms ; Questionnaires

BACKGROUND/AIMS: Midazolam is widely used as a form of conscious sedation during endoscopy because of its rapid onset and safety. However, its relatively long half-life and paradoxical reactions are still a concern for doctors and patients. Flumazenil is a competitive benzodiazepine antagonist that acts to reverse the sedative and hypnotic effects of midazolam but its role and adequate dose have not been fully documented. This study evaluated the effect of a fixed dose of flumazenil on the recovery from sedative endoscopy by midazolam. METHODS: First study: 100 patients who received 0.05 mg/kg midazolam for conscious sedation were randomized into two groups: intravenous 0.25 mg flumazenil and a placebo. All patients were assessed using OAA/S (Observers Assessment of Alertness/Sedation Scale) scale (responsiveness, speech, facial expression and ptosis of eyelid) before the endoscopy, immediately after the procedure and every 5 minutes thereafter. The recovery time was defined as the time at which the OAA/S scale reached the pre-endoscopy level. Second study: In 40 patients, the OAA/S scale was assessed only after full recovery without any exogenous stimuli. The total dose of midazolam and the procedure time were assessed. RESULTS: The flumazenil group demonstrated a significantly shorter recovery time than the placebo group (p<0.0001). These results were not affected by age, gender, total midazolam dose and procedure time. There was a larger difference in the recovery time between the two groups in the second study than in the first. CONCLUSIONS: A fixed low dose flumazenil significantly reduced the recovery time after sedative endoscopy by midazolam. Flumazenil will be helpful for the early return to daily activities and for preventing post sedative complication.
Benzodiazepines ; Conscious Sedation ; Endoscopy* ; Facial Expression ; Flumazenil* ; Half-Life ; Humans ; Hypnotics and Sedatives ; Midazolam*