• IMMUNE NETWORK
• /
• 제22권2호
• /
• pp.19.1-19.20
• /
• 2022

Coxsackievirus B3 (CVB3) infection causes acute pancreatitis and myocarditis. However, its pathophysiological mechanism is unclear. Here, we investigated how lipid metabolism is associated with exacerbation of CVB3 pathology using high-fat diet (HFD)-induced obese mice. Mice were intraperitoneally inoculated with 1×10⁶ pfu/mouse of CVB3 after being fed a control or HFD to induce obesity. Mice were treated with mitoquinone (MitoQ) to reduce the level of mitochondrial ROS (mtROS). In obese mice, lipotoxicity of white adipose tissue-induced inflammation caused increased replication of CVB3 and mortality. The coxsackievirus adenovirus receptor increased under obese conditions, facilitating CVB3 replication in vitro. However, lipid-treated cells with receptor-specific inhibitors did not reduce CVB3 replication. In addition, lipid treatment increased mitochondria-derived vesicle formation and the number of multivesicular bodies. Alternatively, we found that inhibition of lipid-induced mtROS decreased viral replication. Notably, HFD-fed mice were more susceptible to CVB3-induced mortality in association with increased levels of CVB3 replication in adipose tissue, which was ameliorated by administration of the mtROS inhibitor, MitoQ. These results suggest that mtROS inhibitors can be used as potential treatments for CVB3 infection.

• Parasites, Hosts and Diseases
• /
• 제62권1호
• /
• pp.131-138
• /
• 2024

Halicephalobus gingivalis is a free-living nematode that occasionally causes infections in horses. We report a rare case of limb fracture of horse caused by infection with H. gingivalis. An 8-year-old mare was referred to the Veterinary Hospital of the Federal University of Lavras with claudication grade 5 of the right hind limb, that had been started 3 months ago. The patient had aseptic arthritis in the tarsal joint and edema that extended to the quartile. The radiographic examination showed punctate osteolysis with exacerbation of bone trabeculation along the calcaneus, talus, proximal epiphysis of the third metatarsal and distal epiphysis of the tibia. Treatment for arthritis was initiated, and the animal showed a slight improvement in limb function. However, 21 days after hospitalization, due to a comminuted fracture of the tibia, it was euthanized. At necropsy, yellowish masses were found from the metatarsal to the tibia, and around the tarsal bones and joint. Similar masses were also found in the left kidney. Numerous nematodes compatible with H. gingivalis were identified. This is the first description of a pathological fracture caused by H. gingivalis infection in an equine limb.

• Tuberculosis and Respiratory Diseases
• /
• 제87권3호
• /
• pp.261-281
• /
• 2024

Cardiovascular comorbidity is common in individuals with chronic obstructive pulmonary disease (COPD). This factor interferes with pharmacological treatment. The use of β-blockers has been proposed for their known cardioprotective effects. However, due to their adverse reactions, and the risk of causing bronchospasm, there is reluctance to use them. To summarize existing evidence on the effects of β-blocker use in COPD associated with cardiovascular comorbidities in relation to disease severity, exacerbation, and mortality outcomes. EMBASE, Medline, Lilacs, Cochrane Library, and Science Direct databases were used. Observational studies that evaluated the effects of β-blockers on individuals with COPD and cardiovascular comorbidities, and related disease severity, exacerbations, or mortality outcomes were included. Studies that did not present important information about the sample and pharmacological treatment were excluded. Twenty studies were included. Relevance to patient care and clinical practice: The use of β-blockers in individuals with COPD and cardiovascular disease caused positive effects on mortality and exacerbations outcomes, compared with the results of individuals who did not use them. The severity of the disease caused a slight change in forced expiratory volume in 1 second. The odds ratio for mortality was 0.50 (95% confidence interval [CI], 0.39 to 0.63; p<0.00001), and for exacerbations, 0.76 (95% CI, 0.62 to 0.92; p=0.005), being favorable to the group that used β-blockers. Further studies are needed to study the effect of using a specific β-blocker in COPD associated with a specific cardiovascular comorbidity.

• 농촌의학ㆍ지역보건
• /
• 제49권3호
• /
• pp.235-256
• /
• 2024

Background: The adequate provision of medical care relies on the availability of a suitable number of healthcare professionals. To ensure stability in healthcare delivery, it is crucial for a country to accurately estimate and address the supply of doctors. This study aims to contribute to the formulation of effective policies for securing and distributing doctor manpower, with a focus on medically underserved areas at both the national and local government levels. Methods: Employing the system dynamics methodology, this research utilizes stock and flow diagrams, including level and rate diagrams, to quantitatively analyze the cumulative structure of the doctor supply and demand system. Results: The analysis reveals a substantial shortage of clinical doctors in Gyeongsangnam-do, amounting to 15,477 as of 2021. Projections indicate a need for an additional 7,570 doctors by the year 2050 to maintain the current healthcare service level. Examination of medical treatment rights and distribution across cities and counties indicates an insufficiency in doctor supply relative to demand in the majority of regions. Alternative scenarios, such as increasing medical school enrollments and adjusting retirement ages, were explored, yet none provided a sufficient resolution to the shortage. Conclusion: The findings underscore an impending exacerbation of the doctor shortage in Gyeongsangnam-do if the existing system is perpetuated. Addressing this issue necessitates not only augmenting the number of medical school students and adapting retirement age policies but also implementing diverse strategies employed successfully in other countries. This study serves as a foundational step in informing evidence-based policies aimed at securing an ample and appropriately distributed doctor workforce for sustainable healthcare delivery.

• The Korean journal of internal medicine
• /
• 제39권1호
• /
• pp.123-136
• /
• 2024

Background/Aims: Despite short-acting β₂-agonist (SABA) overuse being associated with poor asthma outcomes, data on SABA use in South Korea is scarce. Herein, we describe prescription patterns of SABA and other asthma medications in patients from the South Korean cohort of the SABA use IN Asthma (SABINA) III study. Methods: This study included patients with asthma aged ≥ 12 years, who had ≥ 3 consultations with the same healthcare provider, and medical records containing data for ≥ 12 months prior to the study visit. Patients were classified by investigator-defined asthma severity (per 2017 Global Initiative for Asthma recommendations) and practice type (primary or specialist care). Data on disease characteristics, asthma treatments, and clinical outcomes in the 12 months before the study visit were collected using electronic case report forms. Results: Data from 476 patients (mean age, 55.4 years; female, 63.0%) were analyzed. Most patients were treated by specialists (83.7%) and had moderate-to-severe asthma (91.0%). Overall, 7.6% of patients were prescribed ≥ 3 SABA canisters (defined as over-prescription). In patients prescribed SABA in addition to maintenance therapy, 47.4% were over-prescribed SABA. Most patients (95.4%) were prescribed a fixed-dose combination of an inhaled corticosteroid and a long-acting β₂-agonist as maintenance therapy. Although asthma was well-controlled/partly-controlled in 91.6% of patients, 29.6% experienced ≥ 1 severe asthma exacerbation. Conclusions: SABA over-prescription was reported in nearly 50% of patients prescribed SABA in addition to maintenance therapy, underscoring the need to align clinical practices with the latest evidence-based recommendations and educate physicians and patients on appropriate SABA use.

• Tuberculosis and Respiratory Diseases
• /
• 제64권2호
• /
• pp.125-132
• /
• 2008

연구배경: COPD 환자에서 혈청 C-반응단백은 증가하는 것으로 알려져 있으며 이러한 변화는 급성 악화 시 보다 두드러진다. 폐동맥 고혈압은 COPD의 흔한 합병증 중 하나이며, C-반응단백은 전신적 심혈관계 질환 발생 위험과 밀접한 관련이 있다고 알려져 왔다. 하지만, COPD에서 이차적으로 발생하는 폐동맥 고혈압에 대한 C-반응단백의 영향에 대해서는 연구가 미비한 상태이다. 방법: 본 연구는 AECOPD에 대해 입원 치료를 시작한 72명의 환자를 대상으로 전향적으로 연구하였다. 환자들은 AECOPD에 대한 즉각적인 치료를 받았고 입원 2일 또는 3일째 실내 환기 하에서 혈청 C-반응단백, 동맥혈 산소 분압, 폐동맥 고혈압에 대한 이환 여부 등에 대한 검사를 시행 받았다. 결과: 폐동맥 고혈압에 이환된 환자는 47명으로 전체 환자 중 65.3%에 달하였다. COPD의 중증도가 심할수록 폐동맥 고혈압의 이환율과 C-반응단백 평균치가 증가하였고, C-반응단백 평균치가 증가할수록 평균 우심실 수축압 역시 증가하는 것을 관찰할 수 있었다. 폐동맥 고혈압 환자군과 비환자군에서 C-반응단백은 각각 $37.6{\pm}7.4mg/L$ 와 $19.9{\pm}6.6mg/L$ 통계적으로 의미 있게 폐동맥고혈압 환자군에서 높았지만, 동맥혈 산소분압은 양 군간 의미 있는 차이를 보이지 않았다($77.8{\pm}3.6mmHg$ vs. $87.2{\pm}6.0mmHg$). 결론: 본 연구는 COPD의 급성 악화 시 증가된 C-반응 단백은 폐동맥 고혈압의 이환 여부와 밀접한 관련이 있는 것을 보여 주고 있으며, 이는 COPD의 예후에 심혈관계 질환의 이환 여부가 중요하다는 점을 감안할 때 C-반응단백의 COPD에 대한 독립적 예후인자로서의 가능성을 시사해 준다.

• Clinical and Experimental Pediatrics
• /
• 제53권3호
• /
• pp.373-379
• /
• 2010

목 적 : 급성 하기도 감염으로 입원하는 소아에서 최근 알려진 hRV C 및 hBoV를 포함하여 13종 호흡기 바이러스의 임상 양상 및 역학을 알아보고자 하였다. 방 법 : 2008년 5월부터 2009년 4월까지 충북대학교병원 소아과에 급성 하기도 감염으로 입원한 소아 중 325명을 대상으로 비인두 흡인물에서 multiplex RT-PCR법을 이용하여 총 13종의 바이러스를 검출하였으며, 대상 소아의 의무기록을 검토하였다. 결 과 : 대상 소아 중 270례(83.1%)에서 호흡기 바이러스가 검출되었으며, 혼합 감염은 71례(26.3%)에서 관찰되었다. 바이러스 검출 빈도는 RSV 108례(33.2%), hRV 62례(19.1%), Flu A 55례(16.9%), hMPV 50례(15.4%), PIV 27례(8.3%), hBoV 26례(8.0%), ADV 19례(5.8%), hCoV 7례(2.2%)였다. 임상진단은 세기관지염 37.5%, 폐렴 34.5%, 급성 천식 악화 20.9%, 크룹 7.1%이었으며, 세기관지염과 폐렴으로 진단된 소아에서 가장 높은 빈도로 검출된 호흡기 바이러스는 RSV, hRV, hMPV, Flu A였다. Flu A와 hRV는 3세 이상의 천식 악화로 진단된 소아에서 가장 높은 빈도로 검출되었다. hRV A와 hRV C는 각각 48명(14.8%)와 14명(4.3%)에서 검출되었으며, hRV C가 검출된 소아의 평균 연령은 $4.1{\pm}3.5$세로 hRV A가 검출된 소아에서의 $1.7{\pm}2.3$세에 비해 유의하게 높았다(P =0.009). hBoV는 세기관지염 또는 폐렴으로 진단된 소아에서 주로 검출되었고, 이들의 평균 연령은 $2.3{\pm}3.4$세였다. 결 론 : 본 연구에서는 한국 소아에서 13종의 바이러스에 의한 하기도 감염의 양상을 관찰하였다. 소아 하기도 감염에서 새로 알려진 바이러스들의 역할을 명확히 알기 위해서는 향후 지속적인 연구가 필요하다.

• Tuberculosis and Respiratory Diseases
• /
• 제85권1호
• /
• pp.37-46
• /
• 2022

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma-COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion: Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

• Tuberculosis and Respiratory Diseases
• /
• 제85권2호
• /
• pp.185-194
• /
• 2022

Background: The Korea Interstitial Lung Disease Study Group has made a new nationwide idiopathic pulmonary fibrosis (IPF) registry because the routine clinical practice has changed due to new guidelines and newly developed antifibrotic agents in the recent decade. The aim of this study was to describe recent clinical characteristics of Korean IPF patients. Methods: Both newly diagnosed and following IPF patients diagnosed after the previous registry in 2008 were enrolled. Survival analysis was only conducted for patients diagnosed with IPF after 2016 because antifibrotic agents started to be covered by medical insurance of Korea in October 2015. Results: A total of 2,139 patients were analyzed. Their mean age at diagnosis was 67.4±9.3 years. Of these patients, 76.1% were males, 71.0% were ever-smokers, 14.4% were asymptomatic at the time of diagnosis, and 56.9% were at gender-age-physiology stage I. Occupational toxic material exposure was reported in 534 patients. The mean forced vital capacity was 74.6% and the diffusing capacity for carbon monoxide was 63.6%. Treatment with pirfenidone was increased over time: 62.4% of IPF patients were treated with pirfenidone initially. And 79.2% of patients were treated with antifiboritics for more than three months during the course of the disease since 2016. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality. Conclusion: In the recent Korean IPF registry, the percentage of IPF patients treated with antifibrotics was increased compared to that in the previous IPF registry. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.

• 대한영상의학회지
• /
• 제81권3호
• /
• pp.688-700
• /
• 2020

목적 폐암이 동반된 특발성 폐섬유증 환자와 폐암 비동반 특발성 폐섬유증 환자에서 폐섬유증 급성 악화의 발병률, 생존율 및 전산화단층촬영 소견을 비교하고자 하였다. 대상과 방법 2004년 6월부터 2018년 7월까지, 특발성 폐섬유증으로 진단받은 89명의 환자를 대상으로 하였으며 26명의 폐암 동반 특별 폐섬유증 환자군과 63명의 폐암 비동반 특발 폐섬유증 환자군으로 구성되었다. 이들의 폐섬유증, 폐암, 급성 악화와 관련된 임상 검사 소견과 CT 소견을 검토하였다. 폐암 환자들은 1차 또는 2차 치료로 수술(n = 6), 항암치료(n = 23) 등을 받았다. 두 군 간에 생존율, 급성 악화의 CT 소견, 무병 기간과 급성 악화 발병 이후 사망까지의 시간을 비교하였다. 결과 급성 악화의 발병률은 폐암 동반군에서는 61.5%, 비동반군에서는 58.7%였다(p = 0.806). 폐암 동반군과 비동반군의 평균 생존 기간은 각각 16.8개월과 83.0개월이었다(p < 0.001). 치료 시작부터 급성 악화까지의 기간은 수술과 항암치료에서 각각 16.0개월과 4.6개월이었다. 급성 악화에 의한 사망을 비교하였을 때, 생존율은 폐암 동반군이 비동반군보다 유의하게 낮았다(p = 0.008). 급성 악화의 CT 소견은 폐암 동반군에서 기관지 주위 분포(p < 0.001)와 비대칭 분포(p = 0.016)를 보이는 경우가 많았다. 결론 폐암을 동반한 특발성 폐섬유증 환자에서, 급성 악화에 의한 사망률이 폐암 비동반 특발 폐섬유증 환자들보다 높았다. 또한, 기관지 주위 또는 비대칭 분포의 CT 소견을 보이는 경향이 있다.