Trial of New Protocol (Modified Luteal Long; MLL) for Improvement of Outcomes in In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of new protocol (Modified luteal long; MLL protocol) to improve the clinical outcomes in IVF-ET. METHODS: New protocol was applied to repeated ART failure group for 7 months (GroupI, n=106) after informed consent. Outcomes of new protocol group were evaluated and compared to conventional long protocol group (Group II, n=315) prospectively and compared to same indication group with GroupI (Group III, n=144) historical prospectively. RESULTS: There were no differences in the clinical characteristics except patient's age between GroupI and II (35.16+/-4.35 vs. 33.22+/-4.14, p<0.05). Outcomes of IVF-ET, such as numbers of retrieved oocytes, numbers of transferred embryos, numbers of 2 PN, rates of ICSI, rates of blastocyst ET, rates of fertilization, ampules of gonadotropin between GroupI & II, and GroupI & III, respectively. But the embryo quality score of GroupII was significantly higher than GroupI. There was significant increase of implantation rate (25.2 vs. 17.1%, p=0.02) in GroupII compared to GroupI, especially in 31-35 years old group. Implantation rate of less than 35 years old group and clinical pregnancy rate of 31-35 years old group in GroupII tubal factor patients were significantly higher than GroupI tubal factor patients. Clinical pregnancy rate (47.2 vs. 12.8%, p=0.001) and implantation rate (15.2 vs. 5.5%, p=0.009) of GroupI was significantly higher than GroupIII, especially in 36-40 years old group. Implantation rates of ES factor patients (especially in 36-40 years old) and unknown factor patients (especially less than 35 years old), and clinical pregnancy rate of ES factor patients (especially in 36-40 years old) were significantly higher in GroupI than III. CONCLUSION: These results suggest that new protocol may play some role in the increase of endometrial receptivity. Further investigation, including molecular research work will be needed to clarify the factors concerned in the increase of implantation rate.

Prevalence of aspirin sensitivity among asthmatic patients with mild to moderate severity and its clinical characteristics / 천식및알레르기

BACKGROUND: While aspirin sensitivity has been known to be common among patients with severe asthma, its frequency among asthmatics with mild to moderate severity remains to be learned. OBJECTIVES: To elucidate the frequency of aspirin sensitivity and its clinical characteristics among asthma patients with mild to moderate severity. MATERIAL AND METHODS: A total of 96 asthmatics with mild to moderate severity were enrolled. They underwent lysine-aspirin and methacholine bronchial provocation tests, and gave their induced sputum after the lysine-aspirin challenge. RESULTS: FEV1 declined greater than 20% compared with baseline FEV1 in 11 of 96 patients on the lysine-aspirin challenge. The frequency of aspirin sensitivity was higher among patients with enhanced bronchial hyperresponsiveness to methacholine (PC20 < 1 mg/ml) than among those without it (27.3% vs. 6.8%). The frequency was also higher in those with induced sputum eosinophil count higher than 3% than among those without it (38.9% vs. 0%). However, it was not associated with other risk factors such as age, sex, atopy, nasal polyps, and rhinosinusitis. CONCLUSION: More than 10% of mild to moderate asthmatics have aspirin sensitivity even though they have experienced no history of aspirin sensitivity which may be related with bronchial hyperresponsiveness to methacholine and eosinophil activation.

Prevalence of adult asthma based on questionnaires and methacholine bronchial provocation test in Seoul / 천식및알레르기

BACKGROUND: There have been no reports concerning asthma prevalence in the Korean adult population using objective parameters such as methacholine bronchial provocation tests. OBJECTIVE: The purpose of this study was to evaluate the prevalence of asthma using an objective parameter, and the atopy rate in an adult population living in Seoul. METHOD: A total of 718 subjects (aged from 16 to 70 years) were enrolled in this study. They responded to a modified ATS respiratory questionnaire and underwent methacholine bronchial challenge and skin prick testing to common aeroallergens. RESULTS: The prevalence of current asthma, based on the questionnaire and bronchial challenge, was 3.4%. The prevalences of current asthma and bronchial hyperresponsiveness were higher in subjects over 50 years of age than in those under 50 years of age. The atopy rate, based on the skin prick testing, was 26.9%, and common sensitizing allergens in decreasing frequency were Dermatophagoides farinae (15.5%), D. pteronyssinus (14.2%), Tyrophagus putrescentiae (5.9%), cockroach (5.0%) and Tetranychus urticae (4.9%). CONCLUSION: The prevalence of current asthma and the rate of atopy in an urban adult population were 3.4% and 26.9%, respectively.

Two cases of alcohol-induced asthma / 천식및알레르기

Alcohol-induced asthma is defined as exacerbation of asthmatic symptoms after drinking alcoholic beverages. This phenomenon is rare in Caucasians and is more specific to Asians. It has been observed among 50% of Japanese asthmatic patients and genetic predisposition in acetal-dehyde metabolism is thought to be a main factor in alcohol-induced asthma. Although the genetic predisposition of acetaldehyde metabolism in Koreans may be similar to the Japanese, alcohol-induced asthma has not been reported in Korea. We experienced two cases of alcohol-induced asthma which were confirmed by oral ethanol provocation test. In the first case, a 60-year-old male asthma patient presenting a recurrent episode of wheezing and dyspnea after alcohol consumption visited our clinic. After an oral challenge with 300ml of 10% ethanol solution dissolved in 5% glucose solution, dyspnea and wheezing episode were reproduced and 23% decrease in FEV1 compared to basal level was also shown at 20 minutes after ingestion. In the second case, a 32-year-old female asthma patient was presented with the same symptoms. After oral challenge, dyspnea and wheezing episode were reproduced and 30% decrease in FEV1 compared to basal level was shown at 60 minutes after ingestion. Short acting bronchodilator was applied and 21% increase in FEV1 resulted. They were instructed to avoid alcohol consumption with good results.

Are Churg-Strauss syndrome and idiopathic hypereosinophilic syndrome in the same spectrum?: A case with overlapping features / 천식및알레르기

Sometimes, it is difficult to distinguish Churg-Strauss syndrome from idiopathic hypereosinophilic syndrome and there may be overlap syndrome in the differential diagnosis of systemic vasculitis with hypereosinophilia. Recently, we experienced a 42-year-old female patient who presented signs and symptoms of cardiac failure and neuropathy with peripheral hypereosinophilia. She had no history of asthma. She had erythematous skin lesions and distal digit necrosis. The cause of hypereosinophilia could not be identified. Skin and nerve biopsy revealed vasculitis with eosinophilic infiltration. Cardiac failure improved dramatically with steroid, inotropics and diuretics. Other symptoms including digital necrosis also improved. During steroid, tapering peripheral eosinophilia recurred. For maintenance therapy, we added daily cyclophosphamide to every-other-day prednisolone therapy. We report the case with a review of the literature.

Antigenic distribution of HLA - DRB1 locus in citrus red mite ( Panonychus citri ) - sensitive asthma / 천식및알레르기

BACKGROUND: Specific IgE responses to allergens provide useful models for evaluating the genetic factors that control human immune responses. HLA class II gene products are involved in the antigen presentation of exogenous antigens. OBJECTIVE: The aim of this study was to evaluate whether susceptibility or resistance to asthma induced by the citrus red mite (Panonychus citri, CRM) was associated with HLA class II gene-encoded antigens. METHODS: Peripheral venous blood samples were collected from two groups of unrelated Korean adults. Ninety-one patients with citrus red mite-induced asthma and 98 exposed, healthy control subjects. The second exon of the HLA-DRB1 genes was selectively amplified by the polymerase chain reaction method. HLA typing was carried out using PCR-sequence specific oligonucleotide probes(PCR-SSOP). RESULTS: The frequency of HLA-DR7 was significantly higher among the CRM-sensitive asthmatics than among the controls (17.6% vs 4.1%, RR=3.92, p=0.01). Conversely, the frequency of HLA-DR4 was significantly lower among the CRM-sensitive asthmatics than among the controls(19.8% vs 40.8%, RR=0.36, p=0.01). No significant difference was found in the distributions of the other HLA-DRB1 gene-encoded antigens between the two groups. CONCLUSION: HLA-DRB1 genes may be involved in the development of citrus red mite-induced asthma. In addition, HLA-DR7 may increase, and DR4 decrease, the risk of developing asthma in exposed individuals.

Sensitization rate to citrus red mite (Panonychus citri) allergen in primary school children living in rural areas on Cheju Island and envlronmental influence on the risk of specific sensitization / 천식및알레르기

BACKGROUND: We have demonstrated recently that citrus red mite(Panonychus citri) is the most important allergen in citrus-cultivating farmers with asthma and/or rhinitis. OBJECTIVE: A cross-sectional survey was performed to evaluate the sensitizat,ion to the citrus red mite and the effect of environmental exposure on the specific sensitization among primary school children living in rural areas of Cheju Island. Material and METHODS: A total of 4,490 children (from ages 7 to 12 years) living in rural are- as were enrolled in this study. Each subject was evaluated by a questionnaire developed by International Study of Allergy and Asthma in Childhood (ISAAC), and a skin prick test with 11 common inhalant allergens including citrus red mite. RESULTS: On skin prick tests, the most common sensitizing allergen was Dermatophagoides pteronyssinus(7-9 years : 22.7%, 10-12 years : 25.5%), followed by D. farinae(20.4%, 21.8%), cockroach(9.6%, 12.8%), and citrus red mite(8.8%, 12.6%). The sensitization rate to citrus

The comparison of ovalbumin sensitization by intraperitoneal injection and by inhalation in the development of guinea pig asthma model / 천식및알레르기

BACKGROUND AND OBJECTIVE: The induction of allergic sensitization is the key process of guinea pig asthma model, but few studies has been done on allergen sensitization per se. We performed to investigate the effect of initial sensitization route on asthmatic reactions in response to subsequent repeated allergen challenges. Subjects and METHODS: Thirteen guinea pigs were sensitized with ovalbumin by intraperitoneal injection(group A) and 14 by exposure to aerosolized ovalbumin(group B) on two occasions separated by 1 week. Animals were challenged by inhalation of stepwise increasing concentration of 0.1, 0.5, 1, and 2% ovalbumin every 2 weeks 5 times. We used Penh (enhanced pause) as an index of airway constriction. Allergen inhalation discontinued when an increase of Penh more than 200%, and provocative concentration of ovalbumin causing a 200% increase in Penh was defined as PC200 Bronchoalveolar lavage and histopathological examination of lung tissue was done 24 after last challenge. RESULTS: On first challenge, 11 (85%) of group A had asthmatic reactions, but only 5 (36%) of group B did. Geographic mean of PC200 was significantly lower in group A than that of group B(0.26% vs. 1.26 %, p<0.01). On repeated allergen challenge, PC200 of group A was relatively unchanged, but that of group B was much variable. Sensitized guinea pig had increased eosinophil infiltration in BAL and there are no differences between group A and B in lang pathology. CONCLUSION: Ovalbumin sensitization by intraperitoneal injection of guinea pig is better than inhalation method in first allergen challenge and unvaried asthmatic reactions on repeated challenges.