Search

Young Bae Choi,1,&ast; Hyun Joo Jung,1,&ast; Hae-Rim Kim,2 Soo In Jeong1 1Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea; 2College of Natural Science, School of Statistics, University of Seoul, Seoul, Korea&ast;These authors contributed equally to this workCorrespondence: Soo In Jeong, Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Korea, Tel +82-31-219-5160, Fax +82-31-219-5169, Email sooinjeong@aumc.or.krPurpose: We investigated whether nonpharmaceutical interventions (NPI) to reduce the spread of coronavirus disease 2019 (COVID-19) was associated with a change in the incidence of immune thrombocytopenia (ITP).Patients and Methods: Using the Korean Health Insurance Review and Assessment Services (HIRA) database, individuals newly diagnosed with ITP between January 2015 and December 2020 were identified. The NPI period was defined as February 2020 to December 2020. The ITP incidence in the NPI period was compared with the mean annual incidence during the same months in the pre-NPI period and the incidence predicted by the autoregressive integrated moving average model.Results: In total, 25,723 patients were identified, and the overall annual incidence of ITP was 8.28 per 100,000 persons ([95% confidence interval (CI): 8.18– 8.39]. The ITP incidence in the NPI period was 6.60 per 100,000 person-years (95% CI: 6.37– 6.85), 0.77 times (95% CI: 0.74– 0.80) lower than that during the pre-NPI period [8.62/100,000 (95% CI: 8.50− 8.74)]. With the exception for patients aged ≥ 70 years, the ITP incidence was significantly lower in the NPI period than in the pre-NPI period. The most significant decline in the ITP incidence during the NPI period was observed in the 0– 9 years age group [25.76/100,000 vs 14.01/100,000, P < 0.001; incidence rate ratio (IRR): 0.54 (95% CI: 0.51– 0.58)]. The intravenous immunoglobulin-treated ITP incidence in the NPI period was 1.69/100,000 (95% CI: 1.58– 1.81), 0.79 times (95% CI: 0.73– 0.85) lower than that in the pre-NPI period 2.15/100,000 (95% CI: 2.09− 2.21)]. The incidence of steroid-treated ITP was lower in the NPI period than in the pre-NPI period (2.73/100,000 vs 2.2/100,000, P < 0.001), with an IRR of 0.80 (95% CI: 0.76– 0.83).Conclusion: This nationwide study revealed a significant decrease in ITP incidence, particularly among children, after the implementation of NPI.Keywords: purpura, thrombocytopenic, idiopathic, COVID-19, incidence, pandemic

Gopal Lamichhane,1,2,&ast; Grinsun Sharma,1,3,&ast; Biswash Sapkota,1,4,&ast; Mahendra Adhikari,1,5,&ast; Sandhaya Ghimire,1,&ast; Prakash Poudel,1,6 Hyun-Ju Jung2 1School of Health and Allied Sciences, Faculty of Health Sciences, Pokhara University, Pokhara, 33700, Nepal; 2Department of Oriental Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan, Jeollabuk-do, 570-749, South Korea; 3Institute of Pharmaceutical Research and Development, College of Pharmacy, Wonkwang University, Iksan, 570-749, South Korea; 4Department of Pharmacy and Clinical Pharmacology, Madan Bhandari Academy of Health Sciences, Hetauda, 44107, Nepal; 5Department of Pharmacy, Institute of Pharmaceutics and Biopharmaceutics, Heinrich Heine University Düsseldorf, Düsseldorf, 40225, Germany; 6Pharmacy Program, Gandaki University, Pokhara, 33700, Nepal&ast;These authors contributed equally to this workCorrespondence: Prakash Poudel; Hyun Ju Jung, Email poudelprakesh@gmail.com; hyun104@wku.ac.krIntroduction: Herbal products have been widely used for the treatment of diseases throughout the ages. In this research, we investigated antioxidant, antibacterial, anti-adipogenic, and anti-inflammatory activities of methanolic extracts of five ethnomedicinally important plants; namely, Alnus nepalensis, Dryopteris sparsa, Artocarpus lacucha, Litsea monopetala, and Lyonia ovalifolia.Methods: We investigated the DPPH free radical scavenging potential, sensitivity of selected bacterial strains towards the extracts using a disc diffusion assay, anti-inflammatory activity in RAW-264.7 cells, and anti-adipogenic activity by the ORO assay in 3T3-L1 preadipocytes.Results and discussion: The extract of A. nepalensis showed significant antioxidant activity (IC50=4.838 μg/mL), followed by A. lacucha, L. monopetala, and L. ovalifolia, exhibiting comparable IC50 values to that of ascorbic acid (IC50=5.063 μg/mL). Alnus nepalensis also showed good antibacterial activity in disc diffusion methods, with remarkable zones of inhibition in A. baumannii (14.66 mm) and P. mirabilis (15.50 mm) bacterial species. In addition, A. nepalensis was found to increase adipogenesis in 3T3-L1 cells, evidenced by increased lipid deposition in differentiated 3T3-L1 cells. A similar pattern of increased adipogenesis was observed on treatment with L. ovalifolia extracts. On the other hand, A. lacucha effectively reduced lipid deposition in 3T3-L1 cells at 100 μg/mL (75.18± 6.42%) by inhibiting adipogenesis, showing its potential use in the management of obesity. Furthermore, A. lacucha 100 μg/mL (15.91± 0.277 μM) and L. monopetala 75 μg/mL (12.52± 0.05 μM) and 100 μg/mL (11.77± 0.33 μM) significantly inhibited LPS-induced nitric oxide production in RAW 264.7 cells. Also, A. nepalensis and L. ovalifolia inhibited NO production significantly, endorsing their anti-inflammatory potential.Conclusion: The findings from these in-vitro studies suggest that the selected five plants possess remarkable antioxidant, antibacterial, anti-adipogenic, and anti-inflammatory activities. This study opens the door to conduct further advanced in-vivo experiments to find possible lead compounds for the development of valuable therapeutic agents for common health problems.Keywords: Alnus nepalensis, Dryopteris sparsa, Artocarpus lacucha, Litsea monopetala, Lyonia ovalifolia

Soo In Jeong, Hyun Joo Jung Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of KoreaCorrespondence: Hyun Joo Jung, Department of Pediatrics, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Korea, Tel +81 31 219 5160, Fax +81 31 219 5169, Email free1109@ajou.ac.krPurpose: The association between coronavirus disease 2019 (COVID-19) and Kawasaki disease (KD) remains controversial. Prior to the nationwide epidemic of COVID-19, there was a unique, large-scale, regional outbreak in Daegu and Gyeonsangbuk-do (DG) in Korea in the spring of 2020. We evaluated the impact of COVID-19 on KD by comparing the characteristics of KD incidence between epidemic and non-epidemic regions in Korea.Patients and Methods: We analyzed nationwide Health Insurance Review and Assessment (HIRA) data to estimate KD incidence from February 2019 to July 2020. Patients below 18 years who were admitted with KD and administered both intravenous immunoglobulin and aspirin (ICD-10 code M303 for KD) were included in the study. We compared the incidence of KD in DG and other regions by analyzing the period-specific incidence from February to May before and after the COVID-19 era.Results: A total of 4461 patients were identified to have KD nationwide from February 2019 to July 2020. The nationwide incidence of KD was significantly reduced during this period compared with the period from February 2018 to July 2019 (p < 0.001). In the DG region, within the 0– 4-years age group, there was no significant difference in the incidence of KD between periods (p = 0.714). In the 5– 9 years age group, a significant decrease in KD incidence was observed in the DG region and all other regions from February 2019 to July 2020.Conclusion: There was a significant decrease in nationwide KD incidence during and until 2 months after the local epidemic in Korea. However, no significant decrease in KD incidence was observed in the 0– 4 years age group in the DG region where the local COVID-19 outbreak occurred. A larger study is necessary to determine the correlation between KD in this age group and the COVID-19 outbreak.Keywords: mucocutaneous lymph node syndrome, seasonal incidence, SARS-COV-2, social distancing, Republic of Korea

Hyun Joo Jung,1 Il Jae Lee,2 Seung-Hyun Yoon3 1Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea; 2Department of Plastic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South Korea; 3Department of Physical Medicine and Rehabilitation, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, South KoreaCorrespondence: Seung-Hyun Yoon Tel +82 31 219 5279Fax +82 31 219 5209Email yoonsh.md@gmail.comPurpose: Kikuchi disease (KD) is typically a benign disease. Recent studies reporting recurrence or serious cases suggest a possible association of KD with systemic autoimmune disorders. We performed a long-term analysis of the characteristics of KD in patients of all ages and assessed KD recurrence or progress to systemic autoimmune disorders.Patients and Methods: Electronic medical records of patients diagnosed with KD between April 1995 and May 2017 were reviewed for clinical and laboratory manifestations.Results: In total, 480 patients were confirmed to have KD based on histopathology findings. The mean age at KD diagnosis was 24.4 years. Recurrence occurred in 11.3% of patients; 2.7% developed autoimmune diseases after KD diagnosis. Patients who experienced recurrence had more extranodal symptoms, lymphopenia, and a longer lymphopenia-recovery duration. Patients who developed autoimmune diseases after KD were more likely to have extranodal symptoms, KD recurrence, and anti-nuclear antibody positivity.Conclusion: KD patients with risk factors need to be followed-up for KD recurrence and the development of systemic autoimmune diseases.Keywords: Kikuchi disease, histiocytic necrotizing lymphadenitis, recurrence, autoimmune disorders

Sooyoung Shin,1,2 Hyun Joo Jung,3 Sang-Min Jeon,1 Young-Joon Park,1 Jung-Woo Chae,2 Hwi-Yeol Yun2 1College of Pharmacy, Ajou University, Suwon, Gyeonggi-do 16499, Republic of Korea; 2College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea; 3Department of Pediatrics, Ajou University Hospital, Suwon, Gyeonggi-do 16499, Republic of KoreaCorrespondence: Hwi-Yeol Yun; Jung-Woo Chae Tel +82 42 821 5941; +82 42 821 5929Fax +82 42 823 6566Email hyyun@cnu.ac.kr; jwchae@cnu.ac.krAim: The aim of this study was to evaluate whether vancomycin trough concentrations at initial steady state are associated with clinical and microbiological outcomes along with vancomycin-related nephrotoxicity in pediatric patients with Gram-positive bacterial (GPB) infections.Methods: A retrospective cohort study of pediatric patients who received vancomycin for ≥ 72 hours during 2008– 2016 was conducted. Study patients were divided into three cohorts in accordance with their first trough levels at steady state: < 5 mg/L (lower-trough), 5– 10 mg/L (low-trough), and > 10 mg/L (high-trough; reference) cohorts.Results: Of the 201 patients eligible for study inclusion, 60 patients in the lower- and low-trough cohorts, respectively, were idect 3ntified via propensity score matching and analyzed against 30 high-trough patients in each comparison pair (neonates were excluded due to small sample size). Lower-trough patients were at a greater risk for prolonged therapy, retreatment, and dose adjustment than high-trough patients. Final steady-state troughs remained substantially lower in both the lower- and low-trough cohorts (p< 0.001 and p=0.005, respectively), despite greater dose up-titration in the lower-trough cohort and percent change in daily dose in both the lower- and low-trough cohorts than in the high-trough cohort (p< 0.001 for all). Clinical cure and death risk, along with the risks of isolation of resistant strains and renal events, were not significantly different between cohorts in both comparison pairs.Conclusion: Vancomycin troughs of < 5 mg/L at initial steady state were associated with significantly compromised clinical outcomes in terms of risk of therapy prolongation, retreatment, and aggressive dose up-titration, compared to > 10 mg/L troughs in pediatric patients with GPB infections.Keywords: pediatrics, vancomycin, drug monitoring, Gram-positive bacterial infection

Hyo-Jung Kim,1 Joo-Young Lee,1 Eun-Song Lee,1 Hyo-Jung Jung,2 Hyung-Joon Ahn,2 Baek-Il Kim11Department of Preventive Dentistry & Public Oral Health, Brain Korea 21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea; 2Department of Orofacial pain & Oral medicine, Yonsei University College of Dentistry, Seoul, Republic of KoreaPurpose: Conventional oral exercises in previous studies are considered impractical for continuous use in the elderly because of the extended duration needed for effective outcomes. Therefore, in the present study, a simple oral exercise (SOE) was developed to reduce performance time, focusing on improvements in mastication, salivation, and swallowing functions. The aim of this study was to determine the short-term effects of the SOE with respect to improving mastication, salivation, and swallowing function in elderly subjects ≥65 years of age.Patients and methods: The study included 84 subjects, all of whom performed the SOE 2 times per day for 1 week. Masticatory performance was assessed using the mixing ability index (MAI). Unstimulated saliva and the degree of moisture of the tongue/buccal mucosa were evaluated, and the repetitive saliva swallowing test was performed. On the basis of each of these four measurements, subjects were dichotomized into two groups with high (good) and low (poor) conditions. The same evaluations were conducted before and immediately after intervention, as well as after 1 week of intervention. A subjective evaluation with questionnaires was performed after 1 week of intervention. The changes were analyzed using repeated-measures ANOVA, Cochran’s Q test, and McNemar’s test.Results: The mean MAI increased by 6% immediately after the intervention, and by 16% in the poor-chewing group. Similarly, the amount of unstimulated saliva increased by 0.1 ml/min immediately after the SOE, and by 29% in the poor-salivation group. The degree of tongue moisture increased by 3% and was maintained. In the poor-swallowing group, 25% and 40% of the subjects were upgraded to the good-swallowing group immediately after intervention, as well as after 1 week of intervention, respectively. The subjects experienced less discomfort as their oral function improved.Conclusion: The SOE was effective in immediately improving oral functions, and improvement was maintained for 1 week.Keywords: deglutition disorders, elderly, mastication, oral exercise, salivation, xerostomia

Dae Ro Lee,1 Myoung Jin Ho,1 Hyuck Jun Jung,1 Ha Ra Cho,1 Jun Seo Park,1 Suk-Hyun Yoon,2 Yong Seok Choi,1 Young Wook Choi,3 Chung-Hun Oh,2,4,5 Myung Joo Kang1 1College of Pharmacy, 2Department of Medical Laser, Graduate School, Dankook University, Dongnam-gu, Choenan, Chungnam, 3College of Pharmacy, Chung-Ang University, Dongjak-gu, Seoul, 4Department of Oral Physiology, College of Dentistry, Dankook University, 5Abel Medi-Tech Inc., Dongnam-gu, Cheonan, Chungnam, Korea Abstract: A new Soluplus (polyvinyl caprolactam–polyvinyl acetate–polyethylene glycol graft copolymer)-based supersaturable self-emulsifying drug delivery system (S-SEDDS) was formulated to enhance oral absorption of tacrolimus (FK506) with minimal use of oil, surfactant, and cosurfactant. A high payload supersaturable system (S-SEDDS) was prepared by incorporating Soluplus, as a precipitation inhibitor, to SEDDS consisting of Capmul MCM, Cremophor EL, and Transcutol (FK506:vehicle:Soluplus =1:15:1). In vitro dissolution profile and in vitro pharmacokinetic aspect of S-SEDDS in rats were comparatively evaluated with those of conventional SEDDS formulas containing four times greater content of vehicle components (FK506:vehicle =1:60). Both formulations formed spherical drug-loaded microemulsion 80% of accumulated dissolution rate for 24 hours, analogous to that from conventional SEDDS. Moreover, pharmacokinetic parameters of the maximum blood concentration and area under the curve from S-SEDDS formula in rats were not statistically different (P>0.05) than those of conventional SEDDS. The results suggest that the Soluplus-based supersaturable system can be an alternative to achieve a comparable in vitro dissolution profile and in vivo oral absorption with conventional SEDDS, with minimal use of vehicle ingredients. Keywords: tacrolimus, supersaturation, precipitation inhibitor, Soluplus, microemulsion, oral bioavailability

Resveratrol is a polyphenol compound and prominent anti-inflammatory agent found in plants, including the fruits of Morus alba. However, the therapeutic mechanisms of resveratrol remain largely unclear. To gain insight into the biological effects of resveratrol, we examined its influence on LPS-induced IL-8 production in the human monocytic cell line, THP-1. In inflammatory diseases, IL-8 plays a central role in the initiation and maintenance of inflammatory response. In the present study, IL-8 production was measured by ELISA and RT-PCR, while MAPK activation, IkappaBalpha degradation, nuclear factor (NF)-kappaB activation and cyclooxygenase (COX)-2 expression were determined by Western blot analysis. Resveratrol inhibited LPS-induced IL-8 production in a dose-dependent manner. Furthermore, resveratrol inhibited extracellular signal-regulated kinase (ERK) and p38 MAPK phosphorylation, IkappaBalpha degradation, NF-kappaB activation and cyclooxygenase (COX)-2 expression, which suggest that resveratrol inhibits IL-8 secretion by blocking MAPK phosphorylation and NF-kappaB activation. Taken together, these findings may help elucidate the mechanism by which resveratrol modulates THP-1 cell activation under inflammatory conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Endoscopic sphincterotomy (EST) to remove bile-duct stones is the most frequently used endoscopic technique. Few reports exist regarding application of large-balloon dilation (LBD) after EST for treatment of patients with bile-duct stones. OBJECTIVE: To compare the effect of EST plus LBD with that of EST alone. DESIGN: A prospective randomized controlled trial. SETTING: A large tertiary-referral center. PATIENTS AND INTERVENTIONS: Two hundred consecutive patients with bile-duct stones were randomized in equal numbers to EST plus LBD (12- to 20-mm balloon diameter) or EST alone. MAIN OUTCOME MEASUREMENTS: Successful stone removal and complications such as pancreatitis and bleeding. RESULTS: EST plus LBD compared with EST alone resulted in similar outcomes in terms of overall successful stone removal (97.0% vs 98.0%), large size (>15 mm) stone removal (94.4% vs 96.7%), and the use of mechanical lithotripsy (8.0% vs 9.0%). Complications were similar between the 2 groups (5.0% vs 7.0%, P = .767). Complications were as follows for the EST plus LBD group and the EST group: pancreatitis, 4.0% and 4.0%; cholecystitis, 1.0% and 1.0%; and bleeding (delayed), 0% and 2.0%, respectively. CONCLUSIONS: Based on the similar rates of successful stone removal and complications, EST plus LBD should be an effective alternative to EST. EST plus LBD is a safe and effective treatment for endoscopic removal of common bile duct stones. [ABSTRACT FROM AUTHOR]