BACKGROUND: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients. METHODS: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified. RESULTS: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40–6.29) and 4.24 (95% CI, 1.37–13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level. CONCLUSION Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

BACKGROUND: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients. METHODS: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified. RESULTS: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40–6.29) and 4.24 (95% CI, 1.37–13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level. CONCLUSION Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

Adrenal Cortex Hormones ; Asthma ; Eosinophils ; Humans ; Inflammation ; Nebulizers and Vaporizers ; Nitric Oxide ; Odds Ratio ; Prescriptions ; Pulmonary Disease, Chronic Obstructive ; Respiratory Sounds

PURPOSE: The high mobility group box 1 (HMGB1) protein has roles in apoptosis and immune responses by acting as a ligand for receptor for advanced glycation end products (RAGE), Toll-like receptors (TLRs), and triggering receptor expressed on myeloid cells 1. In particular, HMGB1/RAGE is involved in tumor metastasis by inducing matrix metalloproteinase 2 (MMP2) and MMP9 expression. We investigated the associations between genetic variations in HMGB1-related genes and disease-free survival (DFS) and overall survival (OS) in Korean female breast cancer patients. METHODS: A total of 2,027 patients in the Seoul Breast Cancer Study were included in the analysis. One hundred sixteen single nucleotide polymorphisms (SNPs) were extracted from eight genes. A multivariate Cox proportional hazards model was used to estimate the hazard ratio and 95% confidence interval (CI) of each SNP. The effects of the SNPs on breast cancer prognosis were assessed at cumulative levels with polygenic risk scores. RESULTS: The SNPs significantly associated with DFS were rs243867 (hazard ratio, 1.26; 95% CI, 1.05–1.50) and rs243842 (hazard ratio, 1.24; 95% CI, 1.03–1.50); both SNPs were in MMP2. The SNPs significantly associated with OS were rs243842 in MMP2 (hazard ratio, 1.33; 95% CI 1.03–1.71), rs4145277 in HMGB1 (hazard ratio, 1.29; 95% CI, 1.00–1.66), rs7656411 in TLR2 (hazard ratio, 0.76; 95% CI, 0.60–0.98), and rs7045953 in TLR4 (hazard ratio, 0.50; 95% CI, 0.29–0.84). The polygenic risk score results for the DFS and OS patients showed third tertile hazard ratios of 1.72 (95% CI, 1.27–2.34) and 2.75 (95% CI, 1.79–4.23), respectively, over their first tertile references. CONCLUSION: The results of the present study indicate that genetic polymorphisms in HMGB1-related genes are related to breast cancer prognosis in Korean women.
Advanced Glycosylation End Product-Specific Receptor ; Apoptosis ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Female ; Genetic Predisposition to Disease* ; Genetic Variation ; HMGB1 Protein ; Humans ; Matrix Metalloproteinase 2 ; Myeloid Cells ; Neoplasm Metastasis ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prognosis* ; Proportional Hazards Models ; Seoul ; Toll-Like Receptors

An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8degrees C), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.
Aged, 80 and over ; Allopurinol/adverse effects ; Biliary Tract/pathology ; Biliary Tract Diseases/diagnosis ; Bilirubin/blood ; Creatine/blood ; Drug Hypersensitivity Syndrome/*diagnosis/etiology ; Endosonography ; Eosinophils/cytology ; Humans ; Magnetic Resonance Angiography ; Male ; Tomography, X-Ray Computed

OBJECTIVES: This study aimed to find the prevalence and occupational risk factors for major psychiatric disorders among subway drivers in South Korea. METHODS: Of all 998 current subway drivers, 995 participated in this study. The Korean version of the Composite International Diagnostic Interview (K-CIDI 2.1) was administered by trained interviewers to diagnose psychiatric disorders in all participants. The questions on socio-demographic characteristics and working conditions included some questions related to a person under train (PUT) experience and work-related problems. One-year prevalence and lifetime prevalence of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and panic disorder were diagnosed through the interview. The standardized prevalence ratios (SPRs) of these three disorders were calculated in the sample of subway drivers using the 2011 Korean National Epidemiologic Survey data as a basis. Multiple logistic regressions were performed to determine the association between work-related factors and the prevalence of the psychiatric disorders. RESULTS: The standardized prevalence ratios (SPRs) for a 1-year prevalence of MDD and PTSD among subway drivers were 1.1 (95% CI 0.7-1.7) and 5.6 (95% CI 3.1-8.8), respectively. Conflict with passengers was significantly associated with an increased risk for both MDD and PTSD in 1-year and in lifetime prevalence. Experiencing a sudden stop due to an emergency bell increased the risk of the lifetime prevalence of MDD (OR 2.61, 95% CI 1.14-6.97) and PTSD (OR 7.53, 95% CI 1.77-32.02). The risk of PTSD significantly increased among drivers who once experienced a near accident in terms of both the 1-year prevalence (OR 8.81, 95% CI 1.96-39.3) and the lifetime prevalence (OR 6.36, 95% CI 2.40-16.90). CONCLUSIONS: PTSD and panic disorder were more prevalent among subway drivers than in the general population. We found that having a conflict with passengers, a near accident, and a breakdown while driving can be risk factors for psychiatric disorders among subway drivers. Therefore, a prompt and sensitive approach should be introduced for these high risk groups within the subway company.
Depressive Disorder, Major ; Emergencies ; Humans ; Korea* ; Logistic Models ; Panic Disorder ; Prevalence ; Railroads* ; Risk Factors ; Stress Disorders, Post-Traumatic

PURPOSE: The bedside lung ultrasound in emergency (BLUE) protocol is an excellent diagnostic tool for acute respiratory failures requiring admission to the intensive care unit. We incorporated cardiac ultrasound in the BLUE algorithm because cardiac origin is also necessary to examine in an emergency setting. We studied the usefulness of the emergency department (ED)-BLUE protocol for patients complaining of dyspnea in an emergency department. METHODS: At first, we assessed lung sliding, artifacts (Alines and B-lines), alveolar consolidation and pleural effusion on stage I and II evaluation. Then, we checked heart to detect 3Es (Effusion, Equality, and Ejection fractions). We divided all the possible conditions into 10 categories. We compared it with final diagnosis and examined the agreements using kappa statistics. We compared the physician's level of confidence for the first impression. The 10 categories were: 1) normal or inconclusive, 2) pulmonary embolism, 3) airway disease (chronic obstructive pulmonary disease or asthma), 4) pneumothorax, 5) large pleural effusion, 6) alveolar consolidation, 7) acute pulmonary edema due to systolic congestive heart failure, 8) acute respiratory distress syndrome, 9) chronic interstitial lung disease with exacerbation, and 10) pericardial effusion with/without tamponade. RESULTS: This prospective study was performed for 172 patients over 18-years-of-age with dyspnea during a 25-month period. Kappa value between the diagnosis after ED-BLUE and final diagnosis was 0.812(p<0.001). The mean of physician's full term for LOC for the first impression before and after ED-BLUE was 3.09+/-0.83 and 4.36+/-0.70 (paired t-test, p<0.001). CONCLUSION: ED-BLUE protocol could help the emergency physician make an accurate diagnosis in patients with dyspnea in the emergent setting.
Artifacts ; Dyspnea ; Emergencies ; Heart ; Heart Failure ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Interstitial ; Lung Diseases, Obstructive ; Pericardial Effusion ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult

BACKGROUND: Although surgical excision is the standard method for the treatment of venous malformations, this procedure often leads to massive bleeding and cosmetic problems. Sclerotherapy for venous malformations has recently been reported, whereas sclerotherapy for varicose veins, leg telangiectasias and hemorrhoids has well been established. PBJECTIVE: To assess the usefulness of sclerotherapy for venous malformations. METHOD: Fourteen patients who had venous malformation were treated with sclerotherapy using sodium tetradecyl sulfate (Thromboject(R), Omega Laboratories, Ltd., Montreal, Canada). Clinical efficacy was evaluated by physical examination and comparison of photographs. RESULTS: In patients with venous malformations, 71.4% of the eases showed moderate to marked improvement. Side effects were noted in 6 patients, however, they were trivial and transient and no treatment was needed. CONCLUSION: Sclerotherapy can be recommended as an effective method for the treatment of venous malformations. It has milder and fewer side effects than other treatment modalities, and it also yields superior cosmetic results.
Hemorrhage ; Hemorrhoids ; Humans ; Leg ; Physical Examination ; Sclerotherapy* ; Sodium Tetradecyl Sulfate ; Telangiectasis ; Varicose Veins

Acrokeratoelastoidosis (AKE) is a rare skin disorder initially described by Costa, which is inherited by autosomal dominant, but also may be sporadic. Clinically, it consists of small, firm papules with occasional keratosis or umbilication, characteristically along the margins of hands and feet. Histopathologically, it shows hyperkeratosis, acanthosis in the epidermis and fragmentation and rarefaction of elastic fibers-elastorrhexis-in the dermis. A 32-year-old man presented with multiple papules along the border of the hands and feet, and from histopathology, AKE was diagnosed. Herein we report a case of acrokeratoelastoidosis and review the clinical and histopathologic features, etiology, differential diagnosis and treatment.
Adult ; Dermis ; Diagnosis, Differential ; Epidermis ; Foot ; Hand ; Humans ; Keratosis ; Skin

Cutanenous lupus mucinosis is a rare variant of lupus erythematosus eruptions. A 36-year-old female presented with a 1-year history of 1-2cm sized, skin colored, multiple nodules on the back. She had previously been diagnosed as having systemic lupus erythematosus 10 years ago. A complete blood count showed lymphopenia. Antinuclear antibodies (ANA) were positive at a titer of 1: 640. Anti-Sm and ds-DNA were also positive. Histopathological findings showed that the collagen fibers in the upper dermis were loosely arranged and separated by amorphous materials. These materials were all positive for alcian blue staining. This case is compatible with cutaneous lupus mucinosis.
Adult ; Alcian Blue ; Antibodies, Antinuclear ; Blood Cell Count ; Collagen ; Dermis ; DNA ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Lymphopenia ; Mucinoses* ; Skin