Retrospective validation of the Step-by-Step approach for febrile infants younger than 90 days in the emergency department

Purpose To retrospectively validate the Step-by-Step approach, a sequential algorithm for prediction of serious bacterial infections (SBI) using the appearance, age, and inflammatory markers, in febrile infants younger than 90 days. Methods The presence of SBI was reviewed in febrile infants younger than 90 days undergoing blood and urine cultures (using perineal adhesive bags), assays for procalcitonin, C-reactive protein and absolute neutrophil count, and urinalysis at the emergency department from September 2015 through August 2017. The low-risk infants were classified according to the Step-by-Step approach. SBI was defined as urinary tract infection (UTI), bacteremia or meningitis. We measured the sensitivity and negative predictive value (NPV) of the approach in predicting SBI, and compared the values to those of the Rochester criteria and the Lab-score. Results Of 488 febrile infants (44.7% underwent lumbar puncture), 71 (14.5%) had SBI, including 67 UTI, 5 bacteremia, and 3 meningitis (mutually inclusive). Of 208 low-risk infants (42.6%), no SBI was found. The Step-by-Step approach showed a 100% sensitivity (95% confidence interval [CI]: 94.9-100.0) and NPV (95% CI: not applicable). The Rochester criteria showed a 98.6% sensitivity (95% CI: 92.4-100.0) and 99.6% NPV (95% CI: 97.1-99.9), and missed 1 meningitis. The Lab-score showed a 59.2% sensitivity (95% CI: 46.8-70.7) and 93.2% NPV (95% CI: 91.2-94.8), and missed 2 meningitis and 27 UTI. Conclusion The Step-by-Step approach showed a 100% sensitivity and NPV in predicting SBI. This approach may help predict SBI without lumbar puncture in febrile infants younger than 90 days

Application of Recycled Zero-Valent Iron Nanoparticle to the Treatment of Wastewater Containing Nitrobenzene

Zero-valent iron (ZVI) was synthesized using iron oxide, a byproduct of pickling line at a steel work. ZVI with a mean particle size of 500 nm was synthesized. The reaction activity of the synthesized ZVI was much higher than commercial ZVI. When applied to the decomposition of nitrobenzene (NB), the ZVI particles underwent corrosion and passivation oxide film formation, resulting in particle size decrease. The NB decomposition rate increased with increasing ZVI dosage level and with decreasing pH. The solution pH increased monotonously with increasing reaction duration, whereas the aniline concentration showed a maximum at 50 min. Based on the GC/MS analysis, NB is presumed to be reduced into aniline via reductive intermediates such as azobenzene and azoxybenzene. When combined with a subsequent biological process, the synthesized ZVI will be able to decompose NB in wastewater effectively

Point prevalence and epidemiological characteristics of chronic cough in the general adult population: The Korean National Health and Nutrition Examination Survey 2010-2012

© 2017 the Author(s). Cough is frequently self-limiting, but may persist longer in certain individuals. Most of previous studies on the epidemiology of chronic cough have only measured period prevalence, and thus have afforded limited information on the burden and natural course. We aimed to investigate the epidemiology of chronic cough by using a point prevalence measure in a large-scale general population. We analyzed cross-sectional data collected from 18,071 adults who participated in the Korean National Health and Nutrition Examination Survey 2010-2012. Presence and duration of current cough was ascertained by structured questionnaires, and cough was classified into acute

Inhibitory effect of a tyrosine-fructose Maillard reaction product, 2,4-bis(p-hydroxyphenyl)-2-butenal on amyloid-β generation and inflammatory reactions via inhibition of NF-κB and STAT3 activation in cultured astrocytes and microglial BV-2 cells

<p>Abstract</p> <p>Background</p> <p>Amyloidogenesis is linked to neuroinflammation. The tyrosine-fructose Maillard reaction product, 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal, possesses anti-inflammatory properties in cultured macrophages, and in an arthritis animal model. Because astrocytes and microglia are responsible for amyloidogenesis and inflammatory reactions in the brain, we investigated the anti-inflammatory and anti-amyloidogenic effects of 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal in lipopolysaccharide (LPS)-stimulated astrocytes and microglial BV-2 cells.</p> <p>Methods</p> <p>Cultured astrocytes and microglial BV-2 cells were treated with LPS (1 μg/ml) for 24 h, in the presence (1, 2, 5 μM) or absence of 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal, and harvested. We performed molecular biological analyses to determine the levels of inflammatory and amyloid-related proteins and molecules, cytokines, Aβ, and secretases activity. Nuclear factor-kappa B (NF-κB) DNA binding activity was determined using gel mobility shift assays.</p> <p>Results</p> <p>We found that 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal (1, 2, 5 μM) suppresses the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) as well as the production of nitric oxide (NO), reactive oxygen species (ROS), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) in LPS (1 μg/ml)-stimulated astrocytes and microglial BV-2 cells. Further, 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal inhibited the transcriptional and DNA binding activity of NF-κB--a transcription factor that regulates genes involved in neuroinflammation and amyloidogenesis via inhibition of IκB degradation as well as nuclear translocation of p50 and p65. Consistent with the inhibitory effect on inflammatory reactions, 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal inhibited LPS-elevated Aβ₄₂levels through attenuation of β- and γ-secretase activities. Moreover, studies using signal transducer and activator of transcription 3 (STAT3) siRNA and a pharmacological inhibitor showed that 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal inhibits LPS-induced activation of STAT3.</p> <p>Conclusions</p> <p>These results indicate that 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal inhibits neuroinflammatory reactions and amyloidogenesis through inhibition of NF-κB and STAT3 activation, and suggest that 2,4-bis(<it>p</it>-hydroxyphenyl)-2-butenal may be useful for the treatment of neuroinflammatory diseases like Alzheimer's disease.</p

Inhaled Corticosteroids and Placebo Treatment Effects in Adult Patients With Cough : A Systematic Review and Meta-analysis

Copyright © 2019 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.Peer reviewedPublisher PD

Staphylococcal enterotoxin sensitization in a community-based population : a potential role in adult-onset asthma

Background: Recent studies suggest that Staphylococcus aureus enterotoxin sensitization is a risk factor for asthma. However, there is a paucity of epidemiologic evidence on adult-onset asthma in community-based populations. Objective: We sought to evaluate the epidemiology and the clinical significance of staphylococcal enterotoxin sensitization in community-based adult populations. Methods: The present analyses were performed using the baseline data set of Korean adult population surveys, consisting of 1080 adults (mean age=60.2years) recruited from an urban and a rural community. Questionnaires, methacholine challenge tests, and allergen skin tests were performed for defining clinical phenotypes. Sera were analysed for total IgE and enterotoxin-specific IgE using ImmunoCAP. Results: Staphylococcal enterotoxin sensitization (0.35kU/L) had a prevalence of 27.0%. Risk factors were identified as male sex, current smoking, advanced age (61years), and inhalant allergen sensitization. Current asthma was mostly adult onset (18years old) and showed independent associations with high enterotoxin-specific IgE levels in multivariate logistic regression tests. In multivariate linear regressions, staphylococcal enterotoxin-specific IgE level was identified as the major determinant factor for total IgE level. Conclusions and Clinical Relevance: Staphylococcal enterotoxin sensitization was independently associated with adult-onset asthma in adult community populations. Strong correlations between the enterotoxin-specific IgE and total IgE levels support the clinical significance. The present findings warrant further studies for the precise roles of staphylococcal enterotoxin sensitization in the asthma pathogenesis

Enhanced cardiac expression of two isoforms of matrix metalloproteinase-2 in experimental diabetes mellitus.

BackgroundDiabetic cardiomyopathy (DM CMP) is defined as cardiomyocyte damage and ventricular dysfunction directly associated with diabetes independent of concomitant coronary artery disease or hypertension. Matrix metalloproteinases (MMPs), especially MMP-2, have been reported to underlie the pathogenesis of DM CMP by increasing extracellular collagen content.PurposeWe hypothesized that two discrete MMP-2 isoforms (full length MMP-2, FL-MMP-2; N-terminal truncated MMP-2, NTT-MMP-2) are induced by high glucose stimulation in vitro and in an experimental diabetic heart model.MethodsRat cardiomyoblasts (H9C2 cells) were examined to determine whether high glucose can induce the expression of the two isoforms of MMP-2. For the in vivo study, we used the streptozotocin-induced DM mouse heart model and age-matched controls. The changes of each MMP-2 isoform expression in the diabetic mice hearts were determined using quantitative real-time polymerase chain reaction (qRT-PCR). Immunohistochemical stains were conducted to identify the location and patterns of MMP-2 isoform expression. Echocardiography was performed to compare and analyze the changes in cardiac function induced by diabetes.ResultsQuantitative RT-PCR and immunofluorescence staining showed that the two MMP-2 isoforms were strongly induced by high glucose stimulation in H9C2 cells. Although no definite histologic features of diabetic cardiomyopathy were observed in diabetic mice hearts, left ventricular systolic dysfunction was determined by echocardiography. Quantitative RT-PCR and IHC staining showed this abnormal cardiac function was accompanied with the increases in the mRNA levels of the two isoforms of MMP-2 and related to intracellular localization.ConclusionTwo isoforms of MMP-2 were induced by high glucose stimulation in vitro and in a Type 1 DM mouse heart model. Further study is required to examine the role of these isoforms in DM CMP

Cough persistence in adults with chronic cough: a 4-year retrospective cohort study

BackgroundThere is very limited evidence regarding long-term prognosis of chronic cough. We examined longitudinal outcomes among patients with chronic cough, and explored predictors of cough persistence.MethodsA retrospective cohort was constructed of adults who had newly visited a specialist cough clinic in 2012–2013. All had undergone systematic investigation for chronic cough. The Hull Airway Reflux Questionnaire (HARQ) was administered to assess reflux cough symptoms. A follow-up survey was conducted in 2016–2017 to assess cough persistence.ResultsFrom 418 candidates, 323 participated in the follow-up study; main analyses focused on patients with chronic persistent cough (n=64; 19.8%) and remitted cough (n=193; 59.8%). Compared with remitted cough, chronic persistent cough group had more family history of chronic cough (17.2% vs. 4.7%, p=0.001) and cold air-sensitive cough (62.5% vs. 44.6%, p=0.013). The total HARQ score did not differ; however, two items (cough with eating and cough with certain foods) scored significantly higher in chronic persistent cough. In multivariate analyses, a family history of chronic cough (adjusted odds ratio 4.27 [95% confidence interval 1.35-9.89]), cold air-sensitive cough (2.01 [1.09-3.73]), and cough with eating (1.22 [1.02–1.45]) were associated with chronic persistent cough at 4 years.Conclusions Cough persists in about 20% of patients after 4 years following systematic assessment and treatments. Several cough characteristics, such as family history, cold air-sensitivity, or reflux cough, may be associated with cough persistence. Larger cohort studies are warranted to further understand long-term prognosis and confirm predictors of persistence in patients with chronic cough