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Clinical Validation of Nebulized Budesonide and Effect of Nebulized Budesonide on the Hypothalamic-Pituitary-Adrenal Axis in Adult Patients Admitted with Acute Asthmatic Attack (급성 발작으로 내원한 성인 천식 환자에서 Nebulized Budesonide의 임상적인 효과와 시상하부-뇌하수체-부신 축에 대한 작용)

  • Seo, Ki-Hyun;Moon, Seung-Hyug;Kim, Yong-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.5
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    • pp.529-538
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    • 2002
  • Background : Many clinicians are reluctant to prescribe systemic corticosteroids to manage an asthmatic attack because of many complications such as osteoporosis, cushing's syndrome, diabetes, hypertension and bleeding tendency. The use of nebulized budesonide may be of value in some infants, old men, and in particular adult asthmatic patients who complain of severe dyspnea. A clinical validation and steroid-sparing effect of nebulized budesonide in asthmatic adults and COPD were evaluated, and the short-term effects of budesonide use on the HPA axis were assessed. Materials and Methods : Study A was prospectively done with 41 patients diagnosed with pure asthma and 30 patients diagnosed with COPD (including asthmatic component) in Soonchunhyang Hospital, Chunan from June. 2000 to Sep. 2001. They were treated with nebulized budesonide including systemic steroids (Group 1), a budesonide tubuhaler including a systemic steroid (Group 2), or only the systemic steroid(Group 3). The peak flow rate, arterial blood gas in room air, pulmonary function test, symptom scoring, steroid amount and hospital stay were analyzed. Study B was conducted with 19 patients to evaluate the short-term effects on the HPA axis of treatment with nebulized budesonide 1mg twice daily and a budesonide turbuhaler 5 puffs twice daily. The adrenal function was assessed prior to budesonide inhalation and after 7 days of budesonide inhalation. Results : In the pure asthmatic patients, the mean value of the symptoms (dyspnea, wheezing, cough, night asthma) or the arterial BGAs, total amounts of steroid or hospital stay and the difference in the results of the pulmonary function tests or peak expiratory flow rate were similar in the three groups. In COPD with an asthmatic component, there were no significant differences among the three groups. Although nebulized budesonide suppressed HPA function,(p=0.006) the HPA responses from the nebulized budesonide and turbuhaler budesonide were similar (p=0.288) Conclusion : This result suggests that systemic steroid should only be made available for acute asthmatic patients irrespective of the inhaled budesonides. Nebulized budesonide at the therapeutic dose has similar effects on the HPA axis compared to that of turbuhaler budesonide.

Effect of Paecilomyes japonica on Lipid Metabolism In Rats Fed High Fat Diet (눈꽃동충하초가 고지방 식이를 섭취한 흰쥐의 지질대사에 미치는 영향)

  • 고진복;최미애
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.32 no.2
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    • pp.238-243
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    • 2003
  • The effects of Paecilomyes japonica on weight gains, food intakes, food efficiency ratios, serum and hepatic lipid concentrations, serum protein levels and serum enzyme activities, were studied in adult male rats. Sprague-Dawley rats,35 weeks old, were given four different types of diets for a succeeding period of five weeks: either a normal diet (5% corn oil), a control diet (high fat; 5% corn oil + 15% lard), a PF diet (control diet + 3% fruiting body of Paecilomyes japonica), or a PM diet (control diet+.3% mycelium of Paecilomyes japonica). The body weight gains, hepatic weights and food efficiency ratios of rats fed the PF or PM diets were significantly lower than those fed the control diet, but were similar to those fed the normal diet. The concentrations of hepatic total lipids, cholesterol and triglyceric, and serum triglyceride, of rats given the PF or PM diets were significantly lower than those given the control diet. Hut the concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol and phospholipid in the serum of rats fed the control, PF or PM diets were significantly higher than those fed the normal diet. In the serum of rats fed the PF diet, the HDL-cholesterol/total cholesterol ratio was significantly higher and the atherogenic index was significantly lower than those fed the control diet, while such effect was not observed in rats fed the PM diet. The alkaline phosphatase activity in the serum of rats fed the control and PM diets was more significantly decreased compared to rats fed the PF and normal diet. No differences were noted in the weights of the pancreas, kidney and heart, the serum concentrations of glucose, hemoglobin and albumin, and the activities of GOT, GPT and ${\gamma}$-GTP, among the rats on all the experimental diets. In conclusion, the rats fed the PF or PM diets maintained normal body and hepatic weights. Despite of the high intake of fats in the PF and PM diets, the concentrations of hepatic total lipids, cholesterol and triglyceride, and serum triglyceride were decreased.

The Prevalence of Metabolic Syndrome and Related Risk Factors Based on the KNHANES V 2010 (제 5기 국민건강영양조사로 추정한 한국 성인의 대사증후군 유병률과 관련 요인)

  • Park, Eunok;Choi, Su Jung;Lee, Hyo Young
    • Journal of agricultural medicine and community health
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    • v.38 no.1
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    • pp.1-13
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    • 2013
  • Objectives: This study is to investigate the prevalence and related factors of metabolic syndrome among Korean adults aged 20 years and above. Methods: From the database of the $5^{th}$ Korea National Health and Nutrition Examination Survey (KNHANES V) conducted in 2010, data of 5,670 adults who responded to all the questionnaires of health interview and had metabolic syndrome in the health examination were included in this analysis. SAS 9.2 was used for statistical analysis with complex sample survey modules and commands. Results: The prevalence rate of metabolic syndrome based on the criteria proposed by International Diabetes Federation (IDF) was 18.8%. The prevalence of metabolic syndrome in each group was: 20.7% of women, 43.1% among elderly over 70 years old, 40.6% of the divorced or the separated, 27.6% of recipients of economic support from the government, 23.6% of people who had alcohol dependency problem, and 43.7% of overweight or obese adults. Independent risk factors based on the multiple logistic regression analysis revealed that prevalence of metabolic syndrome was associated with female (odds ratio 1.59 [95% confidence interval 1.20-2.11]), age (50s 3.95 [2.11-7.37], 60s 5.62 [2.98-10.61], 70s 10.56 [5.25-21.25]), high school education (0.52 [0.37-0.74]), clerk occupation (2.14 [1.27-3.60]), divorced marital status (1.72 [1.15-2.59]), alcohol dependency (1.86 [1.16-2.98]), higher BMI (14.08 [10.60-18.70]). Conclusions: The metabolic syndrome is prevalent among Korean adult population according to IDF criteria. Several demographic characteristics and potentially modifiable factors are associated with metabolic syndrome. Identification of this high-risk group and management of these modifiable factors are warranted to reduce the prevalence of metabolic syndrome.

Effect of Liquid Cultures of Cordyceps militaris on Lipid Metabolism and Enzyme activities in hyperlipidemic Female Rats (동충하초 균사체 액체배양액이 고지혈증 흰쥐의 지질대사 및 효소활성에 미치는 영향)

  • 고진복
    • Journal of Life Science
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    • v.13 no.3
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    • pp.265-272
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    • 2003
  • The effect of liquid cultures of Cordyceps militaris (LCM) on weight gain, food intakes, food efficiency ratios, serum and hepatic lipids, fecal lipids excretion, serum protein and enzyme activities, were investigated in adult female rats (30 weeks old). Sprague-Dawley rats were assigned to one normal and four hyperlipidemic diet groups, Hyperlipidemic diet groups (20% fat, 1% cholesterol) were divided into high fat diet (LCM free water), 10%, 20% or 30% LCM diet groups (10%, 20% or 30% LCM in water) according to the levels of LCM supplementation. After 35 days of experimental diet consumption, the body weight gains, hepatic weights, and food efficiency ratios of the rats fed hyperlipidemic diets were significantly increased compared with those of the rats fed normal diet. The concentrations of serum and hepatic triglycerides, hepatic total lipid, and atherogenic index of the rats fed 20% or 30% LCM diets were significantly lower than those of the rats fed the high fat diet. The concentration of serum HDL-cholesterol of the rats fed all LCM diets was significantly higher than those of the rats fed the high fat diet. The fecal excretion of triglyceride in the rats fed 20% or 30% LCM diets was significantly higher than those of the rats fed high fat diet. The concentrations of serum and hepatic total cholesterol, serum LDL-cholesterol, and HDL-cholesterol/total cholesterol ratio, fecal excretion of cholesterol, and the activities of serum glutamic pyruvic transaminase and alkaline phosphatase of the rats fed all LCM diets were similar to those of the rats fed high fat diet. No differences were noted in the weights of kidney and femur, the serum concentration of glucose, total protein and albumin, and the activities of glutamic oxaloacetic transaminase and ${\gamma}$ -glutamyltranspeptidase, among the rats on all the experimental diets. These results showed that the 20% or 30% LCM diets feeding decreased the serum and hepatic triglycerides, and the atherogenic index, and increased the serum HDL-cholesterol of the adult female rats.

Survey on Period Prevalence Rate and Therapeutic Practice For Low Back Pain in Adult Population of Rural Area (농촌지역 성인의 요통 유병률과 치료방법 조사)

  • Lee Seung-Ju;Park Jung-Han
    • The Journal of Korean Physical Therapy
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    • v.3 no.1
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    • pp.109-121
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    • 1991
  • To investigate the period prevalence rate and therapeutic practic for low back pain (LBP) in the adult population of rural area, a personal interview was conducted for 2.024 persons or 20-59 years old in Seohu Myon, Andong County, Kyungpook Province between 1st and 20th of April, 1991. The period prevalence rate (l February 1990-31 January 1991) of LBP for 1,106 adults who were interviewed was $47.9\%$. The age adjusted period prevalence rate for males was $43.7\%$ and that for females was $52.3\%$ and the difference was statistically significant (p<0.005). Clinical course of th LBP was acute in $14.1\%$ of males and $9.0\%$ of females, recurrent in $57.0\%$ and $55.2\%$, and chronic in $28.9\%$ and $35.8\%$, respectively. Common causes of the LBP were insidious on set with aging without known cause$(48.1\%)$, heavy work $(15.1\%)$, and trauma $(11.3\%)$. Due to LBP $12.5\%$ of the patients were not able to stand or walk for more than an hour and $2.5\%$ were bed-ridden or unable to carry out daily routine. To have the LBP diagnosed $10.2\%$ of the patients utilized a oriental medical clinic or hospital, $31.3\%$ visited a clinic or hospital, and $56.6\%$ hat not utilized any medical facility. Main reason for not having the LBP diagnosed was that the LBP was tolerable. The most popular therapeutic method that the LBP patients chose at the first was drug and physical therapy. Herb medicine was most commonly used when the first therapeutic method was not effective and the acupuncture was the most popular choice of therapy when the second therapeutic method failed. Folk medicine was utilized in $15.5\%$ of the LBP patients and it included 36 regimens such as tincture of motherwort (Leonurus sibiricus), boiled chicken with liquor, etc. It was revealed by this survey that the LBP is a serious health problem in the rural area and many of the LBP patients do not utilize a clinic or hospital but take non-scientific folk remedy. To prevent the economic waste and side effects of the folk remedy, public health education is needed for tile rational therapy of LBP.

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Expression of Nerve Growth Factor during Urinary Bladder Development (방광 발달과정에서 Nerve Growth Factor의 발현)

  • Lee, Kyoung Eun;Hong, Chang Hee;Kang, Hee Jung;Kim, Dug Ha
    • Clinical and Experimental Pediatrics
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    • v.48 no.4
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    • pp.411-415
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    • 2005
  • Purpose : This study was performed to determine the developmental expression pattern of nerve growth factor(NGF) in the urine of healthy children. It was hypothesized that NGF may contribute to the development of the spinobulbospinal micturition reflex that represents the adult micturition pattern. Methods : Voided urine was collected in 60 healthy children during the first 5 years of life(0-1 month, n=10; 1 month-1 year, n=10; 2 years, n=10; 3 years, n=10; 4 years, n=10). The urinary NGF was analyzed by using an enzyme linked immunosorbent assay. Results were normalized based on creatinine or total protein in urine. Results : NGF was significantly greater among neonates compared to other age groups(P<0.05). NGF levels declined during 1 month to 1 year and increased by age 2 years. NGF levels at age 3 years were less than in neonates examined. When comparing the NGF levels according to continence in children over 1 year old, NGF levels were significantly lower in children with continence than in children with incontinence(P<0.05). Conclusion : These data suggest that NGF is involved in the achievement of continence and in mechanisms of bladder nerve growth and in the reorganization of bladder reflex pathway.

Mitral Valve Replacement : A Report of 238 cases (승모판막 대치이식술 238예 보고)

  • Lee, Yung-Kyoon;Yang, Gi-Min
    • Journal of Chest Surgery
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    • v.13 no.4
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    • pp.422-434
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    • 1980
  • Since 1968 up to the end of October 1980, 448 valves were replaced in 354 patients in Seoul National University Hospital. There were 238 mitral, 38 aortic, 7 tricuspid, 45 aortic with mitral, 23 tricuspid with mitral, and 3 triple valve replacement aortic mitral and tricuspid cases. Annual increase of mitral valve replacement cases and decrease of operative maortality were remarkable. Recently operative mortality of mitral valve replacement is about 5%. Sex ratio of mitral valve replacement is almost equal and there were 12 cases of pediatric patients (5%) among 238 cases, and patients under the age of 20 years were 34 (14.3%). Mitral valve replacement was done for 199 single mitral, 38 double valve and one triple valve lesions. Among 238 mitral valve replacement paients left atrial thrombus in 23(9.7%), atrial fibrillation in 132 (55.5%), and reoperation after blind mitral commissurotomy in 12(5%) cases were noted. In recent cases bioprosthetic valves, mainly lonescu-shiley valve were utilized to overcome the difficulties of postoperative late complications in anticoagnuation, especially for the rural patients and pediatric cases, in addition to the hemodynamic advantages of lonesocu valve. Among 354 patients 16 cases were congenital heart anomaly related, 5 ventricular septal defect related aortic and 4 Ebstein related tribuspid valve replacement cases. There were 2 congenital anomaly related mitral valve replacements, one for congenital mitral insufficiency of 7 years old boy and one for corrected transposition of the great vessels associated with mitral insufficiency. Among total 354 valve replacements 49 operative deaths (13.3%) were noted and in 238 mitral valve replacement 24 operative deaths occurred (10.1%). In 39 patients among 354 total valve replacements late complications were found. In 238 mitral valve replacement cases late complications were noted in 26 patients, among whom 16 cases expired. Main late complications were thrombe-embolism, subacute becteerial endocarditis, arrythmia cerebral hemorrhage due to unsatisfactory anticoagulation, and congestive heart failure in the incipient period of valve replacement were also noted. In mitral valve replacement cases long-term survival rate was 83.2% who showed marked clinical improvement. Ther were no evidences of calcification during the 2 years follow-up period for the lonescu-valve replacement cases among 19 pediatric patients. In conclusion 238 cases of mitral valve replacement were done with 24 operative deaths and 26 late complication cases among whom 16 expired. The long term survival was 83.2% of the cases. In pediatric cases in place of coumadin anticoagulation Persantin **** 75 and aspirin were administered after valve replacement. In adult cases who have difficulaties with coumadin anticoagulation and for those even with bioprosthetic heart valve replacement who needs long-term or permanent anticoagulation persantin 75 and aspirin combination regimen were administered with antisfactory results.

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BONE REGENERATION WITH ADIPOSE TISSUE-DERIVED MESENCHYMAL STEM CELL AND HA/TCP (HA/TCP 골이식재상에 이식된 지방유래 줄기세포의 골모세포로의 분화 및 골형성에 대한 연구)

  • Rim, Jae-Suk;Gwon, Jong-Jin;Jang, Hyon-Seok;Lee, Eui-Seok;Jeong, You-Min;Lee, Tai-Hyung;Park, Jeong-Kyun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.2
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    • pp.97-106
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    • 2010
  • Aim of the study: An alternative source of adult stem cells that could be obtained in large quantities, under local anesthesia, with minimal discomfort would be advantageous. Adipose tissue could be processed to obtain a fibroblast-like population of cells or adipose tissue-derived stromal cells (ATSCs). This study was performed to confirm the availability of ATSCs in bone tissue engineering. Materials amp; Methods: In this study, adipose tissue-derived mesenchymal stem cell was extracted from the liposuctioned abdominal fat of 24-old human and cultivated, and the stem cell surface markers of CD 105 and SCF-R were confirmed by immunofluorescent staining. The proliferation of bone marrow mesenchymal stem cell and ATSCs were compared, and evaluated the osteogenic differentiation of ATSCs in a specific osteogenic induction medium. Osteogenic differentiation was assessed by von Kossa and alkaline phosphatase staining. Expression of osteocyte specific BMP-2, ALP, Cbfa-1, Osteopontin and osteocalcin were confirmed by RT-PCR. With differentiation of ATSCs, calcium concentration was assayed, and osteocalcin was evaluated by ELISA (Enzyme-linked immunosorbant assay). The bone formation by 5-week implantation of HA/TCP block loaded with bone marrow mesenchymal stem cells and ATSCs in the subcutaneous pocket of nude mouse was evaluated by histologic analysis. Results: ATSCs incubated in the osteogenic medium were stained positively for von Kossa and alkaline phosphatase staining. Expression of osteocyte specific genes was also detected. ATSCs could be easily identified through fluorescence microscopy, and bone formation in vivo was confirmed by using ATSC-loaded HA/TCP scaffold. Conclusions: The present results show that ATSCs have an ability to differentiate into osteoblasts and formed bone in vitro and in vivo. So ATSCs may be an ideal source for further experiments on stem cell biology and bone tissue engineering.

A Case of Citrin Deficiency Presenting with Recurrent Hypoglycemia: Diagnosed by Targeted Exome Sequencing (반복적인 저혈당으로 엑솜 시퀀싱을 통해 31개월에 진단된 Citrin 결핍증 1례)

  • Kim, Chiwoo;Hwang, Jeongyun;Yang, Aram;Kim, Jinsup;Lee, Taeheon;Jang, Ja-Hyun;Cho, Sung Yoon;Jin, Dong-Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.17 no.2
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    • pp.69-76
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    • 2017
  • Citrin deficiency is an autosomal recessive disorder caused by mutations in the SLC25A13 gene on chromosome 7q21.3, and a type of urea cycle disorder that causes hyperammonemia. Although neonatal intrahepatic cholestasis and adult-onset type II citrullinemia, a type of citrin deficiency, have been described well in many articles for several decades, failure to thrive and dyslipidemia caused by citrin deficiency (FTTDCD), the other type of citrin deficiency, has been only identified recently. There was previously no case report about FTTDCD in Korea. Patients with FTTDCD could present with loss of appetite, fatigue, failure to thrive, hypoglycemia, hypercitrullinemia, dyslipidemia, and an increased lactate/pyruvate ratio. Routine evaluation may not reveal the cause of hypoglycemia caused by citrin deficiency. We recently had a case that presented with recurrent hypoglycemia in a 30-month-old boy. Chemistry profiling, urine organic acid analysis, plasma acylcarnitine analysis, and hormone studies indicated values within the normal range or non-specific findings. Mutation analysis to identify the cause of hypoglycemia identified the subject as a compound heterozygote carrying each of the c.852_855del ($p.Met285Profs^*2$), and c.1177+1G>A mutant alleles. We report here on this unusual case of citrin deficiency presenting with FTTDCD for the first time in Korea.

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Hypoxia Induced Expression of Vascular Endothelial Growth Factor in Rat Pulmonary Artery Smooth Muscle Cells (쥐의 폐동맥 평활근 세포에서 저산소에 의한 Vascular Endothelial Growth Factor의 발현)

  • Nho, Un Seok;Kim, Yeo Hyang;Hyun, Myung Chul;Lee, Sang Bum
    • Clinical and Experimental Pediatrics
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    • v.46 no.2
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    • pp.167-172
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    • 2003
  • Purpose : Pulmonary vascular hypertension is a common problem in congenital heart disease, the most common cardiac condition in childhood. However, the mechanisms responsible for this pathologic change, treatment, and prevention are poorly understood. Therefore, we studied the gene expression of vascular endothelial growth factor(VEGF) by using a hypoxic model of the pulmonary artery smooth muscle cells. Methods : The main pulmonary artery and its proximal branches of a 6 wk old Fischer rat were excised. They were cut into multiple small pieces and suspended in DMEM medium supplemented with 20% fetal bovine serum and incubated in 5% $CO_2$-95% air atmosphere. The smooth muscle cells were confirmed by immunostaining with smooth muscle myosin and ${\alpha}$-smooth muscle actin antibodies. The VEGF gene expression in the hypoxic group was compared with the one in control the group as well as the one in the starved group by RT-PCR and Northern blot hybridization. Results : There was no statistically significant difference among the control, hypoxic and starved groups. Conclusion : There are few studies of pulmonary vascular hypertension at the molecular level in Korea. Therefore, we studied the expression of VEGF gene in hypoxic pulmonary vascular smooth muscle cells. Further studies will be needed to find the difference between newly born and adult rats, or human and rat pulmonary vascular smooth muscle cells in gene expression. We hope that the study will lead to a better understanding of pulmonary vascular hypertension.