Characteristics and effects of high-flow nasal cannula oxygen therapy in patients with heart failure admitted to the emergency department

Objective@#This study aimed to compare the effects of high-flow nasal cannula (HFNC) treatment and conventional oxygen therapy (COT) in patients with heart failure (HF) admitted to the emergency department (ED). @*Methods@#This study was a single-center, retrospective, observational study. The subjects were divided into HFNC and COT groups. The characteristics were compared, and vital signs and arterial blood gas (ABG) results were analyzed. In addition, mortality, intubation rate, intensive care unit (ICU) admission, and length of stay (LOS) were analyzed for clinical outcome. @*Results@#Among 252 patients, 91 and 161 were treated with HFNC and COT. Two groups showed differences in vital signs, ABG results, and pulmonary edema. The HFNC group showed no difference in mortality and LOS, but more intubation and ICU admission were observed (P=0.005, P<0.001). Due to the changes in vital signs and ABG results, the HFNC group reduced blood pressure, heart rate and respiratory rate, improved SpO2, increased pH, and decreased PaCO2. @*Conclusion@#HFNC therapy effectively improved vital signs and ventilation when administered to relatively unstable patients with HF admitted to the ED.

Cholesterol Depletion in Cell Membranes of Human Airway Epithelial Cells Suppresses MUC5AC Gene Expression

PURPOSE: If cholesterol in the cell membrane is depleted by treating cells with methyl-beta-cyclodextrin (MbetaCD), the activities of transmembrane receptors are altered in a cell-specific and/or receptor-specific manner. The proinflammatory cytokines, IL-1beta is potent inducers of MUC5AC mRNA and protein synthesis in human airway epithelial cells. Cells activated by IL-1beta showed increased phosphorylation of extracellular signal regulated kinase (ERK) and p38 mitogen-activated protein kinase (MAPK). Thus, we investigated the effects of cholesterol depletion on the expression of MUC5AC in human airway epithelial cells and whether these alterations to MUC5AC expression were related to MAPK activity. MATERIALS AND METHODS: After NCI-H292 cells were pretreated with 1% MbetaCD before adding IL-1beta for 24 hours, MUC5AC mRNA expression was determined by reverse transcription-polymerase chain reaction (RT-PCR) and real time-PCR. Cholesterol depletion by MbetaCD was measured by modified microenzymatic fluorescence assay and filipin staining. The phosphorylation of IL-1 receptor, ERK and p38 MAPK, was analyzed by western blot. RESULTS: Cholesterol in the cell membrane was significantly depleted by treatment with MbetaCD on cells. IL-1beta-induced MUC5AC mRNA expression was decreased by MbetaCD and this decrease occurred IL-1-receptor-specifically. Moreover, we have shown that MbetaCD suppressed the activation of ERK1/2 and p38 MAPK in cells activated with IL-1beta. This result suggests that MbetaCD-mediated suppression of IL-1beta-induced MUC5AC mRNA operated via the ERK- and p38 MAPK-dependent pathway. CONCLUSION: Cholesterol depletion in NCI-H292 cell membrane may be considered an anti-hypersecretory method since it effectively inhibits mucus secretion of respiratory epithelial cells.

Nasal Colonization of Methicillin-Resistant Staphylococcus aureus in Patients with Chronic Suppurative Otitis Media

BACKGROUND AND OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) is one of major pathogens in patients with chronic suppurative otitis media (CSOM). In addition to intrinsic MRSA infection of the mastoid air cell system, nasal colonization of MRSA, a known predictor of postoperative surgical site infection, may pose increased risk of postoperative complications. The purpose of this study is to describe microbiology of preoperative nasal swab screening and localized middle ear specimens in patients undergoing otologic surgeries. SUBJECTS AND METHODS: Forty-nine consecutive patients with CSOM who underwent middle ear surgery were included. Preoperative nasal swabs for MRSA, and preoperative and intraoperative middle ear swabs were collected and compared for pathogens. RESULTS: Preoperative nasal swab screening confirmed MRSA colonization in 3/49 patients (6.1%) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 9/49 patients (18.4%). Correlation with preoperative culture results and nasal swab screening results were compatible in 2/4 patients with positive nasal swab for MRSA and 1/9 patients with positive nasal swab for MRCNS. Postoperative conversion to MRSA was observed in 3 patients. CONCLUSIONS: The rate of nasal MRSA colonization among patients with CSOM was higher than among the general community. Preoperative MRSA colonization was associated with MRSA from middle ear specimens. Further studies are warranted to investigate the possible benefit of preoperative treatment of MRSA colonized patients undergoing middle ear surgeries.

A FGF23-Positive Maxillary Sinus Tumor Associated with Oncogenic Osteomalacia

Oncogenic osteomalacia is a rare acquired paraneoplastic syndrome caused by excessive renal phosphate wasting that causes hypophosphatemia and osteomalacia. Fibroblast growth factor 23 (FGF23) has been identified as the causative factor of oncogenic osteomalacia and is also known as its diagnostic marker in immunohistochemistry studies. Recently, the authors of the present study experienced a female patient with a prolonged history of osteomalacia; a rare maxillary sinus tumor was confirmed by anti-FGF23 immunohistochemical staining as the causative tumor. The present case is the first reported case in Korea to have been diagnosed as a head and neck tumor associated with oncogenic osteomalacia according to anti-FGF23 immunohistochemical staining.